Correlations between indices of dynamic components of ambulatory blood pressure and renal damage in elderly Chinese male with essential hypertension.

OBJECTIVE: Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is an accurate method to document changes in blood pressure (BP) and is more predictive than office and home BP monitoring for cardiovascular outcomes in elderly people. We aimed to determine the relationship between ABPM indices and renal damage in elderly Chinese male patients with essential hypertension. METHODS: We investigated 998 Chinese men (mean age of 78.44 ± 12.02 years) with essential hypertension. Renal function, laboratory testing, and ABPM, including ABP, BP variability, and BP circadian rhythms were investigated. Data were shown according to BP controlling status. The relationships between ABPM indices and renal damage [expressed by urine protein, urine albumin/creatinine ratio (uACR), estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN)] were assessed using multiple regression analysis. RESULTS: After adjustments for age, common cardiovascular risk factors, and medications, uACR level was positively associated with 24-h mean systolic blood pressure (SBP), 24-h mean pulse pressure (PP), and 24-h SBP percent time of elevation. eGFR level was negatively associated with the 24-h mean SBP and 24-h mean PP. BUN level was positively correlated with the 24-h mean SBP, 24-h mean PP, and 24-h SBP percent time of elevation, whereas the BUN level was negatively associated with the 24-h DBP SD. CONCLUSION: The ABPM indices associated with renal damage may be regarded as an early predictive marker for renal function impairment in Chinese elderly male patients with hypertension.

Associations between plasma total homocysteine, blood pressure stages and pulse wave velocity in Chinese rural community population.

The aim of the study was to examine the associations among plasma total homocysteine (tHcy) and blood pressure (BP) stages and brachial-ankle pulse wave velocity (ba-PWV) in a Chinese rural community population. In this cross-sectional study, 2148 rural community subjects with normotension and mild hypertension (HTN) were classified into four groups according to ba-PWV level. Multivariate regression showed that ba-PWV was significantly and independently correlated with tHcy (ß = 5.32, p < 0.001) in the entire study population. Moreover, ba-PWV showed a significant increase with increasing plasma tHcy level in subjects with both high normal BP and grade 1 HTN (p < 0.05). Compared with optimal BP stage, ba-PWV was significantly associated with high normal BP stage (ß = 193, p < 0.001) and grade 1 HTN (ß = 413, p < 0.001).There was a statistical interaction effect between high normal BP stage and optimal BP stage (p = 0.045). The similar result was found between subjects with optimal BP and those with grade 1 HTN (p = 0.037). In conclusion, tHcy was independently correlated with ba-PWV in subjects with high normal BP and grade 1 HTN. High normal BP and grade 1 HTN may worsen the impact of tHcy on arterial stiffness in a Chinese rural community population.

[Incidence and risk factors of the causes of death among elderly hypertensive inpatients].

OBJECTIVE: To retrospectively analyze the causes of death in elderly patients with hypertension in a hospital-based population from 1993 to 2012. METHODS: During the study period of over 19 years, a total of 2866 cases of death in 25238 hospitalized hypertensive patients with the age of 60 years or older were documented. Age, gender, complications, cause of death and other relevant variables were collected. All patients were divided into different subgroups according to gender, age or hypertension stage and risk stratification. The mortality of elderly hypertensive patients was analyzed using chi-square test. RESULTS: (1) Target organ damage (TOD) associated with hypertension was present in a substantial proportion of elderly patients. The complications related to death were heart disease (45.15%), stroke (34.37%), renal failure (11.88%), infective disease (4.58%), and cancer (4.06%). (2) Mortality in male elderly hypertension was higher than in women (53.31% vs 46.69%). The percentage of deaths from heart disease and stroke were higher in men than those in women (heart disease: 46.73% vs 43.35%; stroke: 37.04% vs 31.32%). (3) Age-specific constituent ratio of cause of death showed that deaths from stroke were significantly lower in very old patients (> or = 90 years) than in patients with 60-79 years of age (P < 0.01). In addition, deaths from heart disease, renal failure and infection disease were significantly lower in patients with more than 90 years than other patients. Deaths from cancer were highest in patients with 70-79 years of age (P < 0.01). (4) When compared with patients at stage 1 and 2 hypertension, subjects at stage 3 were more likely to die from stroke (P < 0.01) and renal failure (P < 0.05), while less likely to die from heart disease and cancer (P < 0.01). Patients in high and very high risk stratification of hypertension, compared with subjects in low and medium risk were likely to die from renal failure (P < 0.01) whereas less likely to die from heart disease (P < 0.05) and stroke (P < 0.01). CONCLUSION: Prevalence of complication and TOD is high in elderly hypertensive inpatients, especially in deaths. The male patients and 60- 79-year-old patients have a higher percentage of causes of death. The stage and risk stratification of hypertension are associated with constituent ratios of the causes of death.

Impact of beta2-agonists, beta-blockers, and their combination on cardiac function in elderly male patients with chronic obstructive pulmonary disease.

PURPOSE: This study was undertaken to determine the association between cardiac function and therapy with beta2-adrenoceptor agonists (ß2-agonists), ß-blockers, or ß-blocker-ß-agonist combination therapy in elderly male patients with chronic obstructive pulmonary disease (COPD). PATIENTS AND METHODS: This was a retrospective cohort study of 220 elderly male COPD patients (mean age 84.1 ± 6.9 years). The patients were divided into four groups on the basis of the use of ß-blockers and ß2-agonists. N-terminal fragment pro-B-type natriuretic peptide (NT pro-BNP), left ventricular ejection fraction (LVEF), and other relevant parameters were measured and recorded. At follow-up, the primary end point was all-cause mortality. RESULTS: Multiple linear regression analysis revealed no significant associations between NT pro-BNP and the use of ß2-agonists (ß = 35.502, P = 0.905), ß-blockers (ß = 3.533, P = 0.989), or combination therapy (ß = 298.635, P = 0.325). LVEF was not significantly associated with the use of ß2-agonists (ß = -0.360, P = 0.475), ß-blockers (ß = -0.411, P = 0.284), or combination therapy (ß = -0.397, P = 0.435). Over the follow-up period, 52 patients died, but there was no significant difference in mortality among the four groups (P = 0.357). Kaplan-Meier analysis showed no significant difference among the study groups (log-rank test, P = 0.362). After further multivariate adjustment, use of ß2-agonists (hazard ratio [HR] 0.711, 95% confidence interval [CI] 0.287-1.759; P = 0.460), ß-blockers (HR 0.962, 95% CI 0.405-2.285; P = 0.930), or combination therapy (HR 0.638, 95% CI 0.241-1.689; P < 0.366) were likewise not correlated with mortality. CONCLUSION: There was no association between the use of ß2-agonists, ß-blockers, or ß-blocker-ß2-agonist combination therapy with cardiac function and all-cause mortality in elderly male COPD patients, which indicated that they may be used safely in this population.