Chinese expert consensus on the management of hypertension in the very elderly

Population aging has become a major challenge for the healthcare in China. More than 23 million Chinese are cur- rently ≥ 80 years, with an annual increase of 5%. The Chi- nese population of 80 years or older is expected to reach 30.67 million by 2020 and 74 million by 2040.

BLOOD PRESSURE CHANGES OF ELDERLY HYPERTENSIVE PATIENTS DURING DENTAL EXTRACTION UNDER SEDATION WITH CONTINUOUS INTRAVENOUS INFUSION OF MIDAZOLAM

Objective To evaluate the changes in blood pressure (BP) of elderly hypertensive patients having dental extraction under sedation with continuous intravenous infusion of midazolam. Methods One hundred elderly hypertensive patients undergoing dental extraction were recruited for this single-blind, randomized, controlled study. Patients in intervention group (n=50) were given midazolam dissolved in glucose solution and patients in control group (n=50) were given glucose solution only with communication technique. Systolic BP (SBP) and diastolic BP (DBP) were recorded in five time points. Results Under basal conditions, intervention group did not show significant difference in BP compared with control group. Before sedation, mean values of SBP and DBP (especially SBP) significantly increased compared with basal conditions in both groups (P<0.05). During dental extraction sessions, mean values of BP in intervention group significantly decreased than control group (P<0.05), but coefficient of variation did show significant difference in both groups. Conclusion Continuous intravenous infusion of midazolam has been proved to be very successful in controlling BP of elderly patients having dental extraction.

Effects of atorvastatin on vascular remodeling in spontaneously hypertensive rats

Objective: To investigate the structural changes of aorta, and evaluate the effects of atorvastatinon the remodeling of thoracic aorta in spontaneously hypertensive rats(SHR) . Methods : Twelve eight-week-old SHR were randomized into atorvastatin treated group( ATV group, n = 6) and distilled water group( DW group, n = 6) ; Wistar-Kyoto rats(WKY) were used as normal controls. Atorvastatin was administered to ATV group for 10 weeks by gavage in mixture with distilled water( 1ml) ; the latter two groups were given the same amount of distilled water by gavage for 10 weeks. Systolic blood pressure of caudal artery was examined before and after treatment, and serum concentrations of total cholesterol, triglycerides and HDL-C were measured.Wall thickness, media thickness, medial cross-sectional area and lumen diameter of thoracic aorta were assessed with computed video processing. Results: Systolic blood pressure in ATV group was markedly lower than that in DW group( P < 0.01). Compared with DW group and WKY group, serum concentrations of total cholesterol, triglycerides and HDL-C in ATV group were significantly lower( P < 0.01, P < 0.05). Wall thickness, media thickness, and medial cross-sectional area to lumen ratio in DW group were significantly higher than those in WKY group and ATV group( P < 0.01, P < 0.05), but no such difference was found between WKY group and ATV group( P > 0.05 ). Conclusion : Vascular structural changes of aorta are due to the alteration of the vessel wall in early stage of SHR. Atorvastatin can markedly improve vascular remodeling.

The association between orthostatic hypertension and all-cause mortality in hospitalized elderly persons

Background Little is known about the prevalence oforthostatic hypertension （OHT） and its effect on long-term mortality in the eld- erly. We evaluated the prevalence of OHT and its effect on mortality in hospitalized elderly patients. Methods Out of 1852 patients admit- ted between 31/12/1999 and 31/12/2000 to an acute geriatric ward, 474 patients （48% males） with a mean age of 81.5 ±6.8 years were en- rolled in this study. Blood pressure （BP） was measured three times during the day in a supine and standing position. Patients with at least one increase in systolic or diastolic BP levels upon standing were diagnosed with OHT. Medical history, physical examination and laboratory parameters were retrieved from the medical records. Mortality data until 18th June 2014 were retrieved from the computerized system of the Ministry of the Interior. Results Four hundred and seven patients （86%） were diagnosed with OHT. Those without OHT had a lowerbody mass index and were more likely males, smokers, had a higher rate of Parkinson＇s disease and less congestive heart failure compared with those with OHT. Patients with OHT had a better survival rate than those without OHT （P = 0.024）. Hazard ratios （HRs） for mortality in those with OHT adjusted to age and multiple risk factors were： 0.67 [95% confidence interval （CI）： 0.51-0.87] and 0.73 （95% CI： 0.55-0.97）, respectively; a similar tendency was noticed in a sensitivity analysis by gender. Conclusion Hospitalized elderly patients with OHT had a better survival rate than those without OHT.

Role of PGI_2 in the formation and maintenance of hyperdynamic circulatory state of portal hypertensive rats

AIM: To investigate the role of prostacyclin (PGI2) and nitric oxide (NO) in the development and maintenance of hyperdynamic circulatory state of chronic portal hypertensive rats. METHODS: Ninety male Sprague-Dawley rats were divided into three groups: intrahepatic portal hypertension (IHPH) group by injection of CCI4, prehepatic portal hypertension (PHPH) group by partial stenosis of the portal vein and sham-operation control (SO) group. One week after the models were made, animals in each group were subdivided into 4 groups: saline controlled group (n = 23), Nω-nitro-L-arginine (L-NNA)group (n = 21) group, indomethacin (INDO) group (n = 22) and high-dose heparin group (n = 24). The rats were administrated 1mL of saline, L-NNA (3.3 mg/kg-d) and INDO (5 mg/kg·d) respectively through gastric tubes for one week/then heparin (200 IU/Kg/min) was given to rats by intravenous injection for an hour. Splanchnic and systemic hemodynamics were measured using radioactive microsphere techniques. The serum nitrate/nitrite(NO2-/NO3-) levels as a marker of production of NO were assessed by a colorimetric method, and concentration of 6-keto-PGF1α, a stable hydrolytic product of PGI2, was determined by radioimmunoassay. RESULTS: The concentrations of plasma 6-keto-PGFla (pg/mL) and serum NO2-/NO3- (μmol/L) in IHPH rats (1123.85±153.64, 73.34±4.31) and PHPH rats (891.88±83.11, 75.21±6.89) were significantly higher than those in SO rats (725.53±105.54, 58.79±8.47) (P<0.05). Compared with SO rats, total peripheral vascular resistance (TPR) and spanchnic vascular resistance (SVR) decreased but cardiac index (CI) and portal venous inflow (PVI) increased obviously in IHPH and PHPH rats (P<0.05). L-NNA and indomethacin could decrease the concentrations of plasma 6-keto-PGFla and serum NO2/7NO3-in IHPH and PHPH rats (P<0.05) .Meanwhile, CI, FPP and PVI lowered but MAP, TPR and SVR increased(P<0.05). After deduction of the action of NO, there was no significant correlation between plasma PGI2 level and hemodynamic parameters such as CI, TPR, PVI and SVR. However, after deduction of the action of PGI2, NO still correlated highly with the hemodynamic parameters, indicating that there was a close correlation between NO and the hemodynamic parameters. After administration of high-dose heparin, plasma 6-keto- concentrations in IHPH, PHPH and SO rats were significantly higher than those in rats administrated vehicle (P<0.05). On the contrary, levels of serum NO2-/NO3- in IHPH, PHPH and SO rats were significantly lower than those in rats administrated Vehicle (P<0.05). Compared with those rats administrated vehicle, the hemodynamic parameters of portal hypertensive rats, such as CI and PVI, declined significantly after administration of high-dose heparin (P<0.05), while TPR and SVR increased significantly (P<0.05). CONCLUSION: It is NO rather than PGI2 that is a mediator in the formation and maintenance of hyperdynamic circulatory state of chronic portal hypertensive rats.

Which prognostic factors should be used in pulmonary arterial hypertension in elderly patients？

In recent times, the prevalence of pulmonary arterial hypertension creased prevalence of hypertension, diabetes, obesity, arterial stiffness, （PAH） is more commonly seen among elderly populations. The inas well as diastolic dysfunction, may cause endothelial dysfunction and affect pulmonary vasculature. Furthermore, older patients have certain differences in clinical characteristics and outcomes. In this article the special characteristics of aging in PAH patients have been reviewed, while the risk predictors of elderly patients are also discussed.

Dynamics of phase transformation of Cu-Ni-Si alloy with super-high strength and high conductivity during aging

The precipitation behaviors of the Cu-Ni-Si alloys during aging were studied by analyzing the variations of electric conductivity.The Avrami-equation of phase transformation kinetics and the Avrami-equation of electric conductivity during aging were established for Cu-Ni-Si alloys,on the basis of linear relationship between the electric conductivity and the volume fraction of precipitates,and the calculation results coincide well with the experiment ones.The transformation kinetics curves were established to characterize the aging process.The characteristics of precipitates in the supersaturated solid solution alloy aged at 723 K were established,and the results show that the precipitates areβ-Ni3Si andδ-Ni2Si phases.

Effect of different intensities of physical activity on cardiometabolic markers and vascular and cardiac function in adult rats fed with a high-fat high-carbohydrate diet

Background: Physical activity(PA) and diet are 2 lifestyle factors that affect cardiometabolic risk. However, data on how a high-fat highcarbohydrate(HFHC) diet influences the effect of different intensities of PA on cardiometabolic health and cardiovascular function in a controlled setting are yet to be fully established. This study investigated the effect of sedentary behavior, light-intensity training(LIT), and high-intensity interval training(HIIT) on cardiometabolic markers and vascular and cardiac function in HFHC-fed adult rats.Methods: Twelve-week-old Wistar rats were randomly allocated to 4 groups(12 rats/group): control(CTL), sedentary(SED), LIT, and HIIT.Biometric indices, glucose and lipid control, inflammatory and oxidative stress markers, vascular reactivity, and cardiac electrophysiology of the experimental groups were examined after 12 weeks of HFHC-diet feeding and PA interventions.Results: The SED group had slower cardiac conduction(p = 0.0426) and greater thoracic aortic contractile responses(p < 0.05) compared with the CTL group. The LIT group showed improved cardiac conduction compared with the SED group(p = 0.0003), and the HIIT group showed decreased mesenteric artery contractile responses compared with all other groups and improved endothelium-dependent mesenteric artery relaxation compared with the LIT group(both p < 0.05). The LIT and HIIT groups had lower visceral(p = 0.0057 for LIT, p = 0.0120 for HIIT)and epididymal fat(p < 0.0001 for LIT, p = 0.0002 for HIIT) compared with the CTL group.Conclusion: LIT induced positive adaptations on fat accumulation and cardiac conduction, and HIIT induced a positive effect on fat accumulation,mesenteric artery contraction, and endothelium-dependent relaxation. No other differences were observed between groups. These findings suggest that few positive health effects can be achieved through LIT and HIIT when consuming a chronic and sustained HFHC diet.

Sex-specific effects of social networks on the prevalence, awareness, and control of hypertension among older Korean adults

Background Hypertension is a common chronic disease among older adults, and is associated with medical complications and mor- tality. This study aimed to examine the effects of social network characteristics on the prevalence, awareness, and control of hypertension among older adults. Methods The Korean Social Life, Health, and Aging Project （KSHAP） interviewed 814 〉 60-year-old residents and their spouses from a rural township between December 2011 and March 2012 （response rate： 95%）. We evaluated the data from 595 partici- pants. Multivariate logistic regression models were used to assess the effects of network characteristics on hypertension. Results We ob- served strong sex-specific network effects on the prevalence, awareness, and control of hypertension. Among older women, network density was associated with hypertension awareness [odds ratio （OR）： 2.63, 95% confidence interval （CI）： 1.03 5.37J and control （OR： 1.72; 95% CI 0.94-3.13）. Among older men, large networks were associated with a lower prevalence of hypertension （OR： 0.75; 95% CI： 0.58-0.96）. Compared to older women, older men with coarse networks exhibited better hypertension awareness （OR： 0.37; 95% CI： 0.14-0.95） and control （OR： 0.42; 95% CI： 0.19-0.91 ）. Network size interacted with density for hypertension control （P = 0.051）, with controlled hyperten- sion being associated with large and course networks. Conclusions A large network was associated with a lower risk for hypertension, and a coarse network was associated with hypertension awareness and control among older men. Older women with dense networks were most likely to exhibit hypertension awareness and control.

Cardiovascular care for older adults： hypertension and stroke in the older adult

1 Introduction Hypertension and cerebrovascular disease incidence and prevalence rise dramatically with age, owing to longer exposure time to age-associated alterations in vascular function and structure and cardiovascular risk factors. This chapter is aimed at connecting age-related alterations in vascular function and structure to the resultant target organ damage, and to raise awareness of unique presentations and treatment strategies for hypertension and stroke in older adults.

Change in expression of apoptosis genes after hyperthermia,chemotherapy and radiotherapy in human colon cancer transplanted into nude mice

AIM:To investigate the change in expression of p53 ,Bcl-2 ,and Bax genes in human colon cancer cells transplanted into nude mice after hyperthermia,chemotherapy,radiotherapy,thermochemotherapy,thermoradiotherapy and thermochemoradiotherapy. METHODS:Human colon cancer cell line (HT29) was transplanted into the hind limbs of nude mice. Under laboratory simulated conditions of hyperthermia (43℃,60 min),the actual radiation doses and doses of mitomycin C (MMC) were calculated in reference to the clinical radiotherapy for human rectal cancer and chemotherapy prescription for colon cancer. The mice were divided into 6 groups according to the treatment approaches:hyperthermia,chemotherapy,radiotherapy,thermochemotherapy,thermoradiotherapy,and thermochemoradiotherapy. The mice were sacrificed at different time points and the tumor tissue was taken for further procedures. The morphologic changes in membrane,cytoplasm and nuclei of tumor cells of p53,Bcl-2,and Bax after treatment,were observed by immunohistochemistry staining. RESULTS:All of the six treatment modalities down-regulated the expression of p53,Bcl-2 and up-regulated the expression of Bax at different levels. The combined therapy of hyperthermia,with chemotherapy,and/or irradiation showed a greater effect on down-regulating the expression of p53 (0.208 ± 0.009 vs 0.155 ± 0.0115,P < 0.01) and Bcl-2 (0.086 ± 0.010 vs 0.026 ± 0.0170,P < 0.01) and up-regulating Bax expression (0.091 ± 0.0013 vs 0.207 ± 0.027,P < 0.01) compared with any single therapy.CONCLUSION:Hyperthermia enhances the effect of radio-and chemotherapy on tumors by changing the expression of apoptosis genes,such as p53,Bcl-2 and Bax.

Number of medications is associated with outcomes in the elderly patient with metabolic syndrome

Background The diagnosis of metabolic syndrome indicates a clustering of metabolic imbalances which in sum have been recognized as a major predictor of cardiovascular and all-cause mortality. The aim of this study was to assess the level of under-pharmacy and poly-pbarmacy and its prognostic impact in elderly patients with metabolic syndrome. Methods Retrospective chart-review at a tertiary medical center, of 324 patients greater than 65 years of age who met the International Diabetes Foundation criteria for metabolic syndrome diagnosis [Body Mass Index （BMI） 〉 30 kg/m2, diagnosis of type 2 diabetes, hypertension, and dyslipidemia]. Results There were 60 （18.5%） patients in the low （〈 5） medication burden group, 159 （49.1%） in the medium （〉 5 and 〈 10） medication burden group, and 105 （32.4%） in the high （〉 10） medication burden group. At baseline, the groups differed only by systolic blood pressure. At two years follow-up, the medium group had significantly better improvement in high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C）, HbAlc, and systolic blood pressure compared to the low medication burden group and significantly better improvement in triglycerides, Haemoglobin Alc （HbAlc） and systolic blood pressure compared to the high medication group. Decrease in HDL-C was the only variable associated with strokes. High medication burden predicted hospitalization burden. The number of anti-hypertensives, history of tobacco use, low and high medication burdens and decrease in HDL-C were all associated with death. Conclusions Both poly-pharmacy and under-pharmacy are associated with a decreased therapeutic benefit among patients with metabolic syndrome in terms of important laboratory measurements as well as clinical outcomes such as myocardial infarctions, hospitalization, and death.

Serum level of MMP-2,MMP-9 and Ox-LDL in Alzheimer's disease with hyperlipoidemia

Objective：To investigate serum levels of MMP-2,MMP-9, oxidized low-density lipoprotein （ox-LDL） in Alzheimer＇s disease （AD） patients and study the possible pathway and mechanism of AD with abnormal lipid metabolism. Methods： Subjects in this study were divided into 4 groups ： normal lipid group without AD （N）, hyperlipoidemia group without AD （H）, normal group with AD （A）, hyper- lipoidemia group with AD （AH）. There were 15 individuals in each group. MMP-2, MMP-9, ox-LDL was measured by enzyme linked immunosorbent assay （EL1SA）. Serum lipids levels were measured by biochemical methods. Results： The serum levels of MMP-2, MMP-9, ox-LDL were significantly higher in H, A and AH groups than those in N group. Those of ox-LDL in H, AH groups was higher than that of in A group. The serum level of MMP-2, MMP-9 in AH groups were higher than that of in H group. The score of mini-mental state examination （MMSE） in A and AD groups was negatively correlated with the serum level of ox-LDL. Relationship between the score of MMSE and the serum level of ox-LDL in AD groups and non-AD groups had statistical significance. Conclusion： MMP-2, MMP-9, ox-LDL and abnor- mal lipid metabolism may participate in pathogenesis of AD, in which abnormal lipid metabolism induces expressions of MMP-2,MMP-9 and ox-LDL. Oxidative stress and blood-brain barrier disruption might ac- celerate the process of AD.

Modeling of whole process of ageing precipitation and strengthening in Al-Cu-Mg-Ag alloys with high Cu-to-Mg mass ratio

A physically based numerical model to predict the microstructure evolution and yield strength of high Cu-to-Mg mass ratio Al-Cu-Mg-Ag alloys during the whole ageing process was developed.A thermodynamically-based precipitation model,employing the classical nucleation and growth theories,was adapted to deal with the precipitation kinetics (evolution of radius and volume fraction of precipitates for Ω phase) of aged Al-Cu-Mg-Ag alloys.The model gives an estimation of the precipitation kinetics (evolution of radius and density of precipitates for both θ' and Ω phases) of the alloy.The strengthening model based on Orowan mechanism was deduced.The microstructural development and strength predictions of the model are generally in good agreement with the experimental data.

Effects of salvia miltiorrhiza bge on myocardial fibrosis in hypertensive rats

Objective: To study the effects of Salvia Miltiorrhiza Bge (SMB) on myocardial fibrosis in hypertension in rats. Methods: Normal Wistar kyoto rats served as negative control (group A) . The rats with hypertension were divided into 2 groups: the hypertension group (group B) which served as the positive control and the SMB-treated hypertension group (group C). The effects of SMB on the systolic pressure, the myocardial content of aldosterone (ALD) and nitric oxide (NO) and the activity of superoxide dismutase (SOD) in the myocardium were detected. Results: The systolic pressure of the rats of group C showed no marked change after the administration of SMB and showed no difference from that of the rats of group B. The content of collagen Ⅰ and Ⅲ of the left ventricle, the collagen Ⅰ /collagen Ⅲ ratio and the content-of ALD were lower in group C than in group B and higher in group C than in group A. The content of NO and the activity of SOD in the myocardium were higher in group C than in group B and lower in group C than in group A. Conclusion: It was concluded that SMB was able to prevent or reverse the progress of myocardial fibrosis resulting from hypertension. The mechanism of this effect of SMB might be due to the fact that SMB can decrease the collagen synthesis and ALD content and increase collagen decomposition, NO content and SOD activity in the myocardium.

Study on Influence of Gasoline Sulfur Content on Performance of Vehicle Exhaust Catalytic Converter

This paper has investigated the influence of gasoline sulfur content on durability of catalytic converter for vehicle exhaust gas. Two gasoline samples with different sulfur contents (equating to 150 μg/g and 50 μg/g of sulfur, respectively) were used to examine the durability and performance of catalytic converter on the bench test. The test results have revealed that in comparison to the influence of sulfur on ageing of catalytic converter the thermal ageing had a more remarkable impact on the performance of catalytic converter, and the performance of catalytic converter could be restored by high-temperature desulfurization process after ageing by the high-sulfur gasoline sample (containing 150 μg/g of sulfur) .

Thai Elderly Population： Lifestyle Enhancement Amongst the Overweight and Hypertensive

Hypertension and obesity are two prevalent conditions that often simultaneously affect the same individual and can increase one＇s chances of cardiovascular morbidity. In Thailand, older people often seek medical attention at times when they are extremely ill. Healthy lifestyle behaviors are essential in order for one to maintain their health. Certain regimens can be initiated to manage and control health problems. However, very few know about how the elderly maintain their subjective physical well-being, while living with obesity and hypertension. This qualitative study focuses on describing health care practices and behaviors of overweight and hypertensive older people in everyday Thai society. Ten elderly people have participated in this study through purposive sampling. Qualitative data was gathered via in-depth interviews and was analyzed by using a content analysis method. The findings illustrate that health care seeking behaviors emerged from an understanding to seek health care; acting behaviors based on knowledge, and seeking health care support. Most overweight and hypertensive elderly people in Thai cultures have the desire to maintain their everyday lives by continuing their routines or traditions that were in place before seeking professional attention. This knowledge is useful in developing health care practices with wider implications such as holistic care to elderly people for alleviating their suffering by promoting healthy lifestyles and maintaining healthy blood pressure.

Relationship of serum vitamin D level on geriatric syndromes and physical performance impairment in elderly hypertensive patients

Objective To investigate the relationship among serum vitamin D levels, physical performance impairment, and geriatric syndromes in elders with hypertension. Methods According to the concentration of vitamin D levels, a total of 143 elderly patients with hypertension were classified into vitamin D deficient group （vitamin D 〈 20 ng/mL, n = 94） and vitamin D appropriate group （vitamin D 〉 20 ng/rnL, n = 49）. Geriatric syndromes and physical performance were assessed by using comprehensive geriatric assessment （CGA）. Correlation among vitamin D levels, geriatric syndromes and physical performance was analyzed. Results No statistical differences were found in various aspects of geriatric syndromes between the two groups （P 〉 0.05）. While correlation analysis indicated that vitamin D levels had a positive association with ADL score （r = 0.235, P 〈 0.01） and a negative association with Morse fall scale score （r = 0.238, P 〈 0.01）. Patients with deficient vitamin D level had longer time both in the Five Time Sit to Stand Test （5tSTS）, （15.765 ± 5.593） and the four-meter walk test [7.440 （5.620, 9.200）], a weaker hand-grip in the grip strength test （28.049 ± 9.522）, and a lower Tinetti performance-oriented mobility assessment （Tinetti POMA） [26 （22, 27）] and Balance subscale of the Tinetti performance-oriented mobility assessment （B-POMA） score [ 14 （12, 16）], compared with appropriate vitamin D level [（13.275 ± 3.692）; 5.810 （4.728, 7.325）]; （31.989 ± 10.217）; [26.5 （25, 28）]; [15 （14, 16）, respectively, all P 〈 0.05]. Furthermore, results of logistic regression indicated that vitamin D was significantly associated with 5tSTS （OR = 1.2, 95% CI = 1.050-1.331, P 〈 0.01）, Tinetti POMA （OR = 3.7, 95% CI：1.284-10.830, P 〈 0.05） and B-POMA （OR = 0.8, 95% CI：0.643-0.973, P 〈 0.05）. Conclusions In elderly hypertensive patients, serum vitamin D deficient level is associated with physical performance impairment. However, no statistical significance was found between vitamin D and geriatric syndromes. Further study is required to investigate possible mechanisms for the association between vitamin D and physical performance.

POLYMORPHISM OF ANGIOTENSIN I TYPE 1 RECEPTOR GENE IN ELDERLY PATIENTS WITH ESSENTIAL HYPERTENSION

Objective To detect the A/C1165 polymorphism of angiotensin Ⅱ type Ⅰ receptor (AT1-R)gene in essential hypertensive elderly. Methods The A/C1166 polymorphism of AT1-R gene was assessed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in a case-control study of 87 essential hypertensive elders (EH) and 55 normolensive elders (NT). Results The genotype frequencies of AA, AC, CC were 0 .805 , 0.161, 0 .034 in EH group and 0 .927 ,0 .073 ,0 .000 in NT group respectively. The frequency of C61166 allele was higher in EH group (0.115) than in NT group (0 .036 )(P<0 .05 ). Conclusion The resultsindicate that A/C1166 polymorphism of AT1-R gene may be associated with essential hypertension in elderly.