Pulse wave velocity testing in the Baltimore longitudinal study of aging.

Carotid-femoral pulse wave velocity is considered the gold standard for measurements of central arterial stiffness obtained through noninvasive methods(1). Subjects are placed in the supine position and allowed to rest quietly for at least 10 min prior to the start of the exam. The proper cuff size is selected and a blood pressure is obtained using an oscillometric device. Once a resting blood pressure has been obtained, pressure waveforms are acquired from the right femoral and right common carotid arteries. The system then automatically calculates the pulse transit time between these two sites (using the carotid artery as a surrogate for the descending aorta). Body surface measurements are used to determine the distance traveled by the pulse wave between the two sampling sites. This distance is then divided by the pulse transit time resulting in the pulse wave velocity. The measurements are performed in triplicate and the average is used for analysis.

Trends in hypertension prevalence, awareness, treatment and control in older Mexican Americans, 1993-2005.

PURPOSE: To describe trends in hypertension prevalence, awareness, treatment, and control among older Mexican Americans living in the Southwestern United States from 1993-1994 to 2004-2005. METHODS: This study is a comparison between two separate cross-sectional cohorts of non-institutionalized Mexican Americans 75 years of age or older from the Hispanic Established Population for the Epidemiological Study of the Elderly (919 subjects from the 1993-1994 cohort and 738 from the 2004-2005 cohort). Data were collected on self-reported hypertension, measured blood pressure, medications, as well as sociodemographic and other health-related factors. RESULTS: Hypertension prevalence increased from 73.0% in the period 1993-1994 to 78.4% in 2004-2005. Cross-cohort multivariate analyses showed that the higher odds of hypertension in the 2004-2005 cohort was attenuated by adding diabetes and obesity to the model. There was a significant increase in hypertension awareness among hypertensives (63.0% to 82.6%) and in control among treated hypertensives (42.5% to 55.4%). Cross-cohort multivariate analyses showed that the higher odds of control in 2004-2005 cohorts were accentuated by adding diabetes to the model. There were no significant changes in treatment rates (62.2% to 65.6%) CONCLUSION: Hypertension prevalence in very old Mexican Americans residing in the Southwestern United States was higher in 2004-2005 than in 1993-1994 and was accompanied by a significant increase in awareness and control rates.

Trends in diabetes medication use and prevalence of geriatric syndromes in older Mexican Americans from 1993/1994 to 2004/2005.

BACKGROUND: New diabetes medications introduced over the last decade have led to changes in diabetes treatment recommendations for the increasing number of elderly patients with diabetes. It is, however, not clear whether these changes are accompanied by changes in prevalence of comorbid geriatric syndromes. OBJECTIVE: To determine whether changes in diabetes treatment between 1993/1994 and 2004/2005 were accompanied by changes in prevalence of geriatric syndromes in Mexican Americans aged 75 years and older. METHODS: Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly were used. Participants aged 75 years and older with diabetes in 1993/1994 (n = 284) and in 2004/2005 (n = 324; new cohort added in 2004/2005) were included in the analyses. Medication use and geriatric syndromes prevalence rates were estimated and compared using descriptive and univariate statistics for continuous variables and contingency tables (chi(2)) for categorical variables. RESULTS: Older Mexican Americans with diabetes in 2004/2005 were more likely to be taking 2 or more oral diabetes medications than were those in the 1993/1994 cohort; most of the drugs taken by the 2004/2005 cohort were the newly introduced oral diabetes medications. Use of insulin as sole diabetes therapy decreased from 20.3% in the 1993/1994 cohort to 7.5% in the 2004/2005 cohort. The 2004/2005 cohort reported longer diabetes duration and higher prevalence of obesity and hypertension; they were also more likely than the 1993/1994 cohort to have more geriatric syndromes: pain, arthritis, incontinence, and self-reported activities of daily living disability. No significant differences exist between the 2 cohorts in objective measures of cognitive and physical function. CONCLUSIONS: Older Mexican Americans with diabetes in 2004/2005 used more of the newer diabetes medications and less insulin compared to the 1993/1994 cohort. The prevalence rates of geriatric syndromes were higher in the 2004/2005 cohort. Our findings suggest that screening for and treating comorbid geriatric syndromes is increasingly important for optimal geriatric diabetes care.

High depressive symptomatology among older community-dwelling Mexican Americans: the impact of immigration.

OBJECTIVES: This analysis explores nativity differences in depressive symptoms among very old (75+) community-dwelling Mexican Americans. DESIGN: Cross-sectional analysis using the fifth wave (2004-2005) of the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE). PARTICIPANTS: The sample consisted of 1699 non-institutionalized Mexican American men and women aged 75 years and above. Depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Logistic regression was used to predict high depressive symptoms (CES-D score 16 or higher) and multinomial logistic regression was used to predict sub-threshold, moderate, and high depressive symptoms. RESULTS: Results showed that elders born in Mexico had higher odds of more depressive symptoms compared to otherwise similar Mexican Americans born in the US. Age of arrival, gender, and other covariates did not modify that risk. CONCLUSION: The findings suggest that older Mexican American immigrants are at higher risk of depressive symptomatology compared to persons born in the US, which has significant implications for research, policy, and clinical practice.

Trends in diabetes prevalence and diabetes-related complications in older Mexican Americans from 1993-1994 to 2004-2005.

OBJECTIVE: Evidence has shown that Mexican Americans have a higher prevalence of diabetes and a greater risk for diabetes-related complications than non-Hispanic whites. However, no studies have described the changes in prevalence among older Mexican Americans. The purpose of this study was to expand on the current literature by examining the trends in diabetes prevalence and diabetes-related complications in Mexican Americans aged >or=75 years from 1993-1994 to 2004-2005. RESEARCH DESIGN AND METHODS: The prevalences of self-reported diabetes and diabetes-related complications were estimated in the original cohort (1993-1994) and the new cohort (2004-2005) of the Hispanic Established Population for the Epidemiologic Study of the Elderly (Hispanic EPESE) and were compared across the two surveys. RESULTS: The prevalence of diabetes among Mexican Americans aged >or=75 years has nearly doubled between 1993-1994 and 2004-2005 from 20.3 to 37.2%, respectively (P < 0.001). The increase in the prevalence of diabetes was similar across all sociodemographic factors. Diabetes complications did not change significantly between the two cohorts. However, the prevalence of having any lower-extremity function disability did increase between the two cohorts. CONCLUSIONS: The prevalence of diabetes in older Mexican Americans has increased dramatically. At the same time, there has been no improvement in diabetes-related complications as has been found in the general older population. These findings heighten the urgency for more effective public health interventions targeted to this population. As diabetes and obesity become more prevalent in older adults, physicians should encourage appropriate management in older patients, including early detection and glycemic control.