351 research outputs found
Arterial compliance may be reduced by ingestion of red wine
No full textThe aim of this study was to assess the effect of alcohol on blood pressure and arterial compliance over 24 h in a group of volunteers, comparing the same group of subjects on two consecutive but separate days, one with alcohol intake (alcohol day) and one free of alcohol (control day). We studied 18 healthy subjects (mean age 34.2 years, range 25-53). The subjects received the two days in random order. On the alcohol day, the subjects were asked to drink two glasses of red wine (12% ethanol) between 1830 hours and 0430 hours. Measurements of heart rate, blood pressure and QKD interval (Q wave to Korotkoff (K) sound, diastolic phase (D) using Diasys Integra (Novacor, France)) were recorded (usually 1500 hours to 1500 hours). Three 'ingestion' periods were defined, from 1500 hours to 1830 hours ('before'), 1900 hours to 0430 hours ('during') and from 0430 hours to the following afternoon ('after') on both the alcohol day and on the control day. Red wine increased heart rate during alcohol ingestion and reduced arterial compliance after ingestion. The significant effect of interaction between day and ingestion period on heart rate, diastolic blood pressure and QKD were found, suggesting that the differences in response among the ingestion periods depended on whether alcohol has been consumed that day. For the first time our study indicates the effect of alcohol on 24 h arterial stiffness in a healthy group of volunteers
Irbesartan improves arterial compliance more than lisinopril.
No full textBACKGROUND:
Antihypertensive agents can reduce arterial stiffness. We hypothesized that an angiotensin receptor blocker (ARB) irbesartan and an angiotensin converting enzyme inhibitor (ACEI) lisinopril improved arterial compliance.
METHODS:
A randomized, double-blind, double-dummy, controlled crossover trial. Fifteen hypertensive patients, mean age 65.5 +/- 8.9 years (mean +/- SD) were given irbesartan (150 to 300 mg/day) or lisinopril (10 to 20 mg/day) for 12 weeks and then crossed over for 12 weeks. Pulse wave velocity (PWV) in the carotid-femoral (CF), carotid-radial (CR), and femoral dorsalis-pedis (FD) were measured using a Complior((R)) PWV system.
RESULTS:
After 12 weeks, systolic blood pressure (SBP) decreased from 162.4 +/- 12.9 to 134.5 +/- 14.8 with irbesartan and to 145.2 +/- 25 mmHg with lisinopril. Irbesartan and lisinopril reduced PWV (CF) in the elastic arterial system from 15.1 +/- 5 to 13.3 +/- 2.6 (p < 0.005) and to 14 +/- 4.7 (p < 0.05) m/s respectively (p = 0.345). Irbesartan reduced PWV (CR) and PWV (FD), whereas lisinopril did not. The difference between treatments was significant after SBP adjustment (p = 0.037 for PWV (CR) and p < 0.001 for PWV (FD)).
CONCLUSIONS:
Irbesartan improved arterial compliance in elastic and muscular arteries, whereas lisinopril improved it only in elastic arteries
is augmentation index a good measure of vascular stiffness in the elderly?
No full textObjectives: we investigated the exact relationship between age and gender on augmentation pressure (AG) and augmentation
index (AI) measured over the radial (muscular) and carotid (elastic) arteries.
Design and Methods: AG is the contribution that wave reflection makes to systolic arterial pressure. AI is an indirect measure of arterial stiffness and is calculated as AG divided by pulse pressure (PP) ×100. AG and AI both increase with age.
AG and AI were measured in 458 subjects using SphygmoCor. A total of 755 readings were obtained (302 carotid, 453 radial).
The mean age was 57.5 ± 13.7 years. Diabetic subjects were excluded. Among the subjects, 13.5% were hypertensive.
Results: statistically, women had mean values of AI significantly higher than men in both radial and carotid arteries. These
differences were less marked with AG.
Quadratic equations better described the relationship between AI and age but not AG and age. Thus, AI increased with age up to our median age of 55 years but plateaued thereafter, whereas the AG continued to increase steadily with age. A multiple regression analysis demonstrated that both AI and AG were negatively related to height and positively related to
diastolic blood pressure (DBP).
Conclusions: AG continues to increase in the elderly over the age of 55, but not AI. AI is higher in women and higher when
measured over the carotid than the radial. AI is positively related to DBP and negatively to height. AG is proposed as a more
suitable measure of arterial stiffness than AI
Self management and patient understanding of diabetes in the older person.
No full textAIM: To examine knowledge and management of diabetes by older people. METHODS: A representative sample of 1047 people with Type 2 diabetes, aged 75 years and over, were asked a series of questions relating to their diabetes management and their understanding of self management. The impact of cognitive impairment and socio-economic status were assessed. RESULTS: The majority of people, 1015 (96.9%), were under the care of a health professional and 1018 (97.2%) were taking insulin, tablets, controlling their diet or a combination. Cognitive impairment (Mini-Mental State Examination ≤ 23) was found in 235 (22.5%) people. Recent eye, foot and dietician assessment was reported by 813 (77.7%), 836 (79.7%) and 326 (31.1%) people, respectively. A quarter overall and 70% of those taking insulin tested their blood glucose. In the insulin group, 78 (54.2%) reported hypoglycaemia and those with cognitive impairment gave more incorrect responses when asked about diabetes management. Socio-economic status made very little difference to any of these outcomes. CONCLUSIONS: Most older people with diabetes, regardless of their socio-economic status, are under the care of a healthcare professional and use medication or diet to manage their disease. Large numbers also attend foot and eye examinations. However, over one fifth of older people with diabetes have cognitive impairment. Older people had a reasonable understanding of their diabetes management but this was worse in those people with cognitive impairment
SARCOPENIA AND VASCULAR RISK IN A HEALTHY ELDERLY UK POPULATION (BRAVES STUDY)
No full text[not available
The prevalence of Type 2 diabetes and its associated health problems in a community-dwelling elderly population.
No full textAIMS: Prevalence estimates of Type 2 diabetes and its associated health problems in elderly populations are rare, especially in the very elderly. METHODS: A sample of 15 095 community-dwelling older people aged > or = 75 years were assessed. Type 2 diabetes and associated health problems were identified using self-reporting, general practitioner records, drug histories, and blood and urine measurements. RESULTS: There were 1177 people identified as having Type 2 diabetes mellitus, giving an overall prevalence of 7.8% (95% confidence interval 7.1, 8.5), 9.4% (8.4, 10.5) for men and 6.8% (6.1, 7.6) for women. The age, sex and smoking adjusted odds ratios for various health problems, comparing people with and without diabetes were: low vision 1.6 (1.3, 1.9), proteinuria 1.7 (1.4, 2.1), chronic kidney disease stage 4 or 5 1.5 (1.0, 2.1), angina 1.3 (1.1, 1.6), myocardial infarction 1.5 (1.2, 1.8), cerebrovascular event 2.0 (1.8, 2.1) and foot ulceration 1.7 (1.2, 2.4). CONCLUSIONS: The prevalence of Type 2 diabetes is not high in community-dwelling older people, but diabetes was a contributory factor to a number of health problems
CKD and hospitalization in the elderly: a community-based cohort study in the United Kingdom
No full textBackground: we previously have shown that chronic kidney disease (CKD) is associated with cardiovascularand all-cause mortality in community-dwelling people 75 years and older. The present study addresses thehypothesis that CKD is associated with a higher rate of hospital admission at an older age.Study Design: cohort study.Setting & Participants: 15,336 participants from 53 UK general practices underwent comprehensive healthassessment between 1994 and 1999.Predictor: data for estimated glomerular filtration rate (eGFR, derived from creatinine levels using the CKDEpidemiology Collaboration [CKD-EPI] study equation) and dipstick proteinuria were available for 12,371participants.Outcomes: hospital admissions collected from hospital discharge letters for 2 years after assessment.Measurements: Age, sex, cardiovascular risk factors, possible biochemical and health consequences ofkidney disease (hemoglobin, phosphate, and albumin levels; physical and mental health problems).Results: 2,310 (17%) participants had 1 hospital admission, and 981 (7%) had 2 or more. After adjusting forage, sex, and cardiovascular risk factors, HRs were 1.66 (95% CI, 1.21-2.27), 1.17 (95% CI, 0.95-1.43), 1.08(95% CI, 0.90-1.30), and 1.11 (95% CI, 0.91-1.35) for eGFRs ?30, 30-44, 45-59, and ?75 mL/min/1.73 m2,respectively, compared with eGFRs of 60-74 mL/min/1.73 m2 for hospitalizations during ?6 months offollow-up. HRs were weaker for follow-up of 6-18 months. Dipstick-positive proteinuria was associated with anincreased HR throughout follow-up (HR, 1.29 [95% CI, 1.11-1.49], adjusting for cardiovascular risk factors).Dipstick-positive proteinuria and eGFR ?30 mL/min/1.73 m2 were independently associated with 2 or morehospital admissions during the 2-year follow-up. Adjustment for other health factors and laboratory measurementsattenuated the effect of eGFR, but not the effect of proteinuria.Limitations: follow-up limited to 2 years, selection bias due to nonparticipation in study, missing data forpotential covariates, and single noncalibrated measurements from multiple laboratories.Conclusions: the study indicates that community-dwelling older people who have dipstick-positive proteinuriaand/or eGFR ?30 mL/min/1.73 m2 are at increased risk of hospitalization
Respiratory symptoms in older people and their association with mortality.
No full textBACKGROUND: A study was undertaken to assess the prevalence of reported respiratory symptoms in a population aged over 75 years and their association with mortality. METHODS: A total of 14 458 people aged 75 years and over participating in a trial of health screening of older people in general practice answered questions on three respiratory symptoms: cough, sputum production, and wheeze. The association of symptoms with mortality was examined for all cause and respiratory causes of death taking account of potential confounders. RESULTS: Coughing up phlegm in winter mornings had a prevalence of 27.0% (95% confidence interval (CI) 26.8 to 27.2). Those with this symptom had an adjusted hazard ratio for all cause mortality of 1.35 (95% CI 1.21 to 1.50), p<0.001 and for respiratory specific mortality of 2.01 (95% CI 1.66 to 2.41), p<0.001. Phlegm at any time of the day in winter had a prevalence of 16.5% (95% CI 16.3 to 16.7) with hazard ratios for all cause and respiratory specific mortality of 1.28 (95% CI 1.15 to 1.42) and 2.28 (95% CI 1.92 to 2.70), p<0.001. Wheeze or whistling from the chest had a prevalence of 14.3% (95% CI 14.1 to 14.5) with hazard ratios of 1.45 (95% CI 1.31 to 1.61) and 2.86 (95% CI 2.45 to 3.35), p<0.001. CONCLUSIONS: The prevalence of respiratory symptoms is widespread among elderly people and their presence is a strong predictor of mortality
Antihypertensive drugs in very old people: a subgroup meta-analysis of randomised controlled trials. INDANA Group.
No full textBeneficial clinical effects of treatment with antihypertensive drugs have been shown in middle-aged patients and in those hypertensive patients over 60 years old, but whether treatment is beneficial in patients over 80 years old is not known.
METHODS:
We collected data from all participants aged 80 years and over in randomised controlled trials of antihypertensive drugs through direct contact with study investigators. Our primary outcome was fatal and non-fatal stroke. Secondary outcomes were death from all causes, cardiovascular death, fatal and non-fatal major coronary and cardiovascular events, and heart failure.
FINDINGS:
There were 57 strokes and 34 deaths among 874 actively treated patients, compared with 77 strokes and 28 stroke deaths among 796 controls, representing 1 non-fatal stroke prevented for about 100 patients treated each year. The meta-analysis of data from 1670 participants aged 80 years or older suggested that treatment prevented 34% (95% CI 8-52) of strokes. Rates of major cardiovascular events and heart failure were significantly decreased, by 22% and 39%, respectively. However, there was no treatment benefit for cardiovascular death, and a non-significant 6% (-5 to 18) relative excess of death from all causes.
INTERPRETATIONS:
The inconclusive findings for mortality contrast with the benefit of treatment for non-fatal events. Results of a large-scale specific trial are needed for definite conclusion that antihypertensive treatment is beneficial in very elderly hypertensive patients. Meanwhile, an age threshold beyond which hypertension should not be treated cannot be justified
The MRC trial of assessment and management of older people in the community: objectives, design and interventions [ISRCTN23494848].
No full textBACKGROUND: The benefit of regular multidimensional assessment of older people remains controversial. The majority of trials have been too small to produce adequate evidence to inform policy. Despite the lack of a firm evidence base, UK primary care practitioners (general practitioners) are required to offer an annual health check to patients aged 75 years and over. DESIGN: Cluster-randomised factorial trial in primary care comparing a package of assessments (i) universal versus targeted assessment and (ii) management by the primary care team (PC) or a multidisciplinary geriatric assessment team (GM). The unit of randomization is the general practice. METHODS: Older people aged 75 and over eligible for the over 75s health check and excluding those in nursing homes or terminally ill were invited to participate. All participants receive a brief assessment covering all areas of the over 75s check. In the universal arm all participants also receive a detailed health and social assessment by a study nurse while in the targeted arm only participants with a pre-determined number and range of problems at the brief assessment go on to have the detailed assessment. The study nurse follows a standard protocol based on results and responses in the detailed assessment to make referrals to (i) the randomised management team (PC or GM) (ii) other medical services, health care workers or agencies (iii) emergency referrals to the GP. The main outcomes are mortality, hospital and institutional admissions and quality of life. 106 practices and 33,000 older people have been recruited to the trial
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