Blood pressure, frailty status, and all-cause mortality in elderly hypertensives; The Nambu Cohort Study

Antihypertensive therapy is pivotal for reducing cardiovascular events. The 2019 Guidelines for the Management of Hypertension set a target blood pressure (BP) of <140/90 mmHg for persons older than 75 years of age. Optimal BP levels for older persons with frailty, however, are controversial because evidence for the relationship between BP level and prognosis by frailty status is limited. Here, we evaluated the relationship between systolic BP and frailty status with all-cause mortality in ambulatory older hypertensive patients using data from the Nambu Cohort study. A total of 535 patients (age 78 [70–84] years, 51% men, 37% with frailty) were prospectively followed for a mean duration of 41 (34–43) months. During the follow-up period, 49 patients died. Mortality rates stratified by systolic BP and frailty status were lowest in patients with systolic BP < 140 mmHg and non-frailty, followed by those with systolic BP ≥ 140 mmHg and non-frailty. Patients with frailty had the highest mortality regardless of the BP level. The adjusted hazard ratios (95% confidence intervals) of each category for all-cause mortality were as follows: ≥140 mmHg/Non-frailty 3.19 (1.12–11.40), <140 mmHg/Frailty 4.72 (1.67–16.90), and ≥140 mmHg/Frailty 3.56 (1.16–13.40) compared with <140 mmHg/Non-frailty as a reference. These results indicated that frail patients have a poor prognosis regardless of their BP levels. Non-frail patients, however, with systolic BP levels <140 mmHg had a better prognosis. Frailty may be a marker to differentiate patients who are likely to gain benefit from antihypertensive medication among older hypertensives.

The Influence of Abdominal Obesity on Endothelial Function of the Tibial Artery in the Elderly Essential Hypertensives of Different Sex

Background To investigate the relationship between abdominal obesity and endothelial function of the tibial artery in the elderly essential hypertensives of different sex. Methods A total of 658 elderly patients (≥60 years old) with essential hypertension and 64 elderly subjects without clinical evidence of hypertension were recruited from the department of geriatrics from August 2000 to May 2016. The dilatation of anterior tibial artery induced by reactive hyperemia was examined by high-resolution vascular ultrasound and was defined as endothelium-dependent dilatation (EDD). All the participants were divided into 4 groups based on blood pressure (≥140/90 mm Hg) and waist circumference (male ≥90 cm, female ≥85 cm): normotensive without abdominal obesity (n = 34), normotensive with abdominal obesity (n = 30), hypertensive without abdominal obesity (n = 287), and hypertensive with abdominal obesity (n = 371). Results A gradual decline in EDD was observed from normotensive without abdominal obesity (9.37 ± 1.11%), normotensive with abdominal obesity (8.59 ± 0.99%), hypertensive without abdominal obesity (7.70 ± 0.30%) to hypertensive with abdominal obesity (6.75 ± 0.26%) (P &lt; 0.05). There was no significant difference in EDD between the male and female elderly hypertensives with or without abdominal obesity. In male elderly hypertensives, EDD in those with central obesity was more blunted compared with those without central obesity (6.31 ± 0.38% vs. 7.46 ± 0.38%, P &lt; 0.05). Whereas, in female elderly hypertensives, EDD in those with abdominal obesity was similar to those without abdominal obesity. In male elderly hypertensives, EDD was correlated with waist circumference (r = −0.194, P &lt; 0.05) while such association was not shown in females. Multivariate linear regression analysis revealed that waist circumference was associated with EDD (β = −0.161, P &lt; 0.05) in the male elderly hypertensives, but not in females. Conclusions Waist circumference is an influencing factor of EDD in male elderly essential hypertension patients. However, abdominal obesity has little effect on EDD of the tibial artery in female elderly hypertensives.

Orthostatic Hypotension among the Elderly Hypertensives in Anambra State, South Eastern Nigeria

Background: Orthostatic hypotension is a sustained reduction of systolic blood pressure of at least 20mmHg or diastolic blood pressure of at least 10mmHg within three minutes of standing from supine position. The burden of orthostatic hypotension on public health is substantial, with a prevalence of 7% to 55% in the elderly and is higher in those with risk factors especially hypertension, use of antihypertensive drugs and diabetes mellitus. The objective of this study was to determine the prevalence of orthostatic hypertension among the elderly hypertensives in Anambra State.Methods: This was a community based cross-sectional study among 400 elderly people aged 60 years and above who were recruited using a multistage sampling method. Data was collected using interviewer administered questionnaire. Mercury sphygmomanometer, weighing scale, stadiometer and glucometer were used to record blood pressure, body weight, height and random blood sugar respectively. Statistical analysis was done using Statistical Package for the Social Sciences version 21 and p value ≤ 0.05 was considered statistically significant.Results: Most of the participants had either systolic or diastolic hypertension (85.8%). The prevalence of orthostatic hypotension was 14.8% in the study population and 16.3% among those who were hypertensive. Those with supine diastolic hypertension [OR: 1.699 (95% CI: 0.401-7.209)] were more likely than those without supine diastolic hypertension to have orthostatic hypotension. Conclusion: The prevalence of orthostatic hypotension among elderly hypertensives aged 60 years and above in Anambra State was found to be relatively high, implying a higher risk of orthostatic hypotension in elderly hypertensives than in normotensives. This finding will aid clinicians in better management of elderly patients which will lead to prevention of the various complications due orthostatic hypotension.