Hypertension and kidney protection in the elderly: what is the evidence in 2007?

Hypertension and diabetes mellitus are the two most widely recognized risk factors for cardiovascular disease (CVD), chronic kidney disease (CKD), and end-stage renal disease (ESRD) requiring dialysis/transplantation; both become increasingly important as one ages. Common pathways and mechanisms are involved in the development of renal vascular lesions in both conditions, and effective treatments for each are now available to reduce morbidity, mortality and progression of organ damage. Although this review will focus primarily on the ability to protect the kidney and vasculature elsewhere by lowering blood pressure in the elderly, other approaches, specifically dietary restriction of protein, strict control of diabetes mellitus, and the management of the different dyslipidemias, must be used in conjunction with the antihypertensive agents to obtain optimum protection.

Prevalence of depressive symptoms in new Mexico Hispanic and non-Hispanic white elderly.

OBJECTIVE: To evaluate the prevalence rates, risk factors, and pattern of depressive symptoms in elderly Hispanic and non-Hispanic Whites (NHWs). METHODS: This survey was a community-based, cross-sectional survey of randomly selected Medicare recipients living in Bernalillo County (Albuquerque, New Mexico). The survey's objective was to examine the health and health-related issues of Hispanic and NHW elderly persons (> or =65 years of age). As part of the survey, participants were administered the Geriatric Depression Scale-short form (GDS). RESULTS: Complete data were available on 798 subjects with a mean age of 73.7 years, age range 65-96. The prevalence of a GDS score > or =6 was: Hispanic males, 9.5%; Hispanic females, 19.2%; NHW males, 5.4%; and NHW females, 8.7%. Hispanics (P=.001) and women (P=.003) had higher prevalence rates. Sociodemographic variables, health, social support, and the activities of daily living (ADLs) were significantly related to symptoms. English skills (P<.0001) and birthplace (P=.011) were associated with symptoms in Hispanics. Significant differences were found in the response patterns between Hispanics and NHWs. Logistic regression analyses showed that ethnic differences were largely explained by differences in the level of education and income among Hispanics and NHWs. CONCLUSION: A difference was seen in the prevalence rates of depressive symptoms between Hispanic and NHW elderly persons and between men and women. In addition to the traditional risk factors for depressive symptoms, we found that ethnic differences in prevalence rates can be largely explained by education and income differences in the two groups.

Cognitive function in drinkers compared to abstainers in the New Mexico elder health survey.

BACKGROUND: Recent epidemiological studies have shown that individuals who ingest alcohol regularly have a higher level of cognitive function and are less likely to develop dementia than those who abstain. The purpose of this study was to compare nine measures of cognitive function in drinkers compared to abstainers. METHODS: A cross-sectional community survey was conducted of 883 randomly selected Hispanic and non-Hispanic white men and women, age >or=65 years of age, undergoing a paid home interview and 4-hour interview/examination in a senior health clinic (The New Mexico Elder Health Survey). The interviews included questions on frequency and quantity of alcohol ingested. RESULTS: Participants who consumed alcohol had significantly better mean scores on 7 of 9 cognitive function tests and less frequently had scores below selected "cut points" compared to those who abstained from all alcohol intake. Scoring used multivariate linear and logistic regression models adjusted for sex, ethnicity, age, level of education, and evidence of depression. CONCLUSIONS: Participants in the New Mexico Elder Health Survey (nearly equal numbers of Hispanic and non-Hispanic white men and women) who consumed alcohol had better scores on their cognitive tests than did those participants who abstained.

Serum insulin concentrations in daily drinkers compared with abstainers in the New Mexico elder health survey.

BACKGROUND: Recent epidemiological studies have shown that individuals who ingest alcohol regularly have a lower prevalence of diabetes mellitus than those who abstain. The purpose of this study was to compare serum glucose and insulin concentrations between daily drinkers and abstainers stratified by diabetic status (participants with diabetes, impaired glucose tolerance, and normal glucose tolerance) to determine if there was a difference in glucose sensitivity (resistance) that might explain the lower prevalence of diabetes in drinkers. METHODS: A cross-sectional community survey was conducted of 883 randomly selected Hispanic and non-Hispanic white men and women, aged >or=65 years, undergoing a home interview and 4-hour interview/examination in a senior health clinic (The New Mexico Elder Health Survey). The interviews included a history of frequency, type, and quantity of alcohol ingested. Serum samples were obtained after an overnight fast and 2 hours after ingestion of 75 grams of glucose for determination of glucose and insulin levels. Height and weight was measured for determination of body mass index. RESULTS: Participants who consumed alcohol daily had significantly lower fasting and 2-hour postglucose serum insulin concentrations compared with those who abstained from alcohol intake, when adjusted using linear logistic regression models for serum glucose concentration, gender, ethnicity, age, and body mass index. CONCLUSIONS: Abstainers with their relative hyperinsulinemia appear to be more insulin resistant than daily moderate drinkers. This difference in insulin sensitivity may explain the lower prevalence of diabetes in drinkers compared with abstainers observed in various epidemiological studies.

Impact of subclinical hypothyroidism on serum total homocysteine concentrations, the prevalence of coronary heart disease (CHD), and CHD risk factors in the New Mexico Elder Health Survey.

The serum/plasma total homocysteine (tHcy) concentration, now recognized as an independent risk factor for accelerated atherosclerotic disease, is increased in overtly hypothyroid patients, and it decreases with thyroid replacement therapy. Whether or not individuals with subclinical hypothyroidism also increase their tHcy concentrations, and whether this elevation might help to explain the increased prevalence of the atherosclerotic diseases observed in this condition, remains unclear. If individuals with subclinical hypothyroidism have higher tHcy concentrations than euthyroid subjects, there would be added incentive to treat this condition earlier. In this cross-sectional study (New Mexico Elder Health Survey) of a randomly selected sample of Medicare recipients (age > or =65 years), no significant difference in serum tHcy concentrations could be detected between the 112 participants with subclinical hypothyroidism (Groups 2 and 3) and the 643 participants with thyrotropin (TSH) values < or =4.6 microU/mL (Group 1) after adjusting for differences in gender, ethnicity, age, and serum concentrations of folate, vitamin B(12), and creatinine. Only those participants with the highest TSH levels (>10 microU/mL) (Group 3) had a significantly higher prevalence of coronary heart disease (CHD) when compared against Group 1 participants (p = 0.007). No consistent significant differences in the prevalences of CHD or in the CHD risk factors examined were observed when all participants with subclinical hypothyroidism (Groups 2 and 3 combined) were compared against Group 1 participants.

Serum homocysteine concentrations and their relation to serum folate and vitamin B12 concentrations and coronary artery disease prevalence in an urban, bi-ethnic community.

OBJECTIVE: To compare fasting serum total homocysteine (tHcy) concentrations in a randomly selected sample of elderly (> or = 65 years of age) Hispanic and non-Hispanic White (NHW) men and women, to examine associations of tHcy with folate and vitamin B12, and then to correlate these with the prevalence of coronary heart disease (CHD) in these 4 ethnic/ gender groups. DESIGN AND PARTICIPANTS: Equal numbers of Hispanic and NHW men and women were randomly selected from the Healthcare Financing Administration (Medicare) registrant list for Bernalillo County (Albuquerque), New Mexico, and asked to volunteer for a paid home interview, to be followed by a paid, comprehensive interview/examination covering health and health-related issues. INTERVENTIONS AND MAIN OUTCOME MEASURES: Serum concentrations of tHcy, folate, and vitamin B12 were determined and correlated with the prevalence of CHD, after adjusting for other CHD risk factors (age, diabetes, hypertension, smoking, dyslipidemia, adiposity). RESULTS: Men and Hispanics had higher serum tHcy concentrations compared to women and non-Hispanic Whites (NHWs), respectively. After adjusting for lower concentrations of serum folate and vitamin B12 in Hispanics, the differences between Hispanics and NHWs were no longer significant. There was a direct association between serum tHcy concentrations and the prevalence of CHD after adjusting for other known risk factors that was most significant in Hispanic women. CONCLUSIONS: The higher serum tHcy concentrations observed in Hispanics compared to NHWs can be explained by lower levels of serum folate and vitamin B12. A direct association between serum tHcy concentrations and prevalence of CHD was observed primarily in women, and was most significant in Hispanic women.