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BACKGROUND Despite readily available treatments, control of blood pressure (BP) with population aging remains suboptimal. Further, there are gaps in the understanding of the management of high BP in the aged. We explored antihypertensive treatment and control among elderly hypertensive participants free from overt cardiovascular disease (CVD), and identified factors related to both "untreated" and "treated but uncontrolled" high BP. METHODS We analyzed baseline data from 19,114 individuals aged ≥65 years enrolled from Australia and United States (US) in the ASPirin in Reducing Events in the Elderly study. Hypertension was defined as an average systolic/diastolic BP ≥140/90 mm Hg and/or the use of any BP lowering medication. "Controlled hypertension" was defined if participants were receiving antihypertensive medication and BP <140 and 90 mm Hg. Descriptive analyses were used to summarize hypertension control rates; logistic regression was used to investigate relationships with treatment and BP control. RESULTS Overall, 74% (14,213/19,114) of participants were hypertensive; and of these 29% (4,151/14,213) were untreated. Among those treated participants, 53% (5,330/10,062) had BP ≥140/90 mm Hg. Participants who were untreated were more likely to be men, have higher educational status, and be in good physical health, and less likely to have significant comorbidities. The factors related to "treated but uncontrolled" BP included older age, male, Black race (vs. White), using antihypertensive monotherapy (vs. multiple) and residing in Australia (vs. US). CONCLUSIONS High levels of "untreated" and "treated but uncontrolled" BP occur in healthy elderly people without CVD, suggesting there are opportunities for better BP control in the primary prevention of CVD in this population. CLINICAL TRIALS REGISTRATION NCT01038583. [ABSTRACT FROM AUTHOR]

Aims: Atrial fibrillation (AF) is a progressive disease. Obesity is associated with progression of AF. This study evaluates the impact of weight and risk factor management (RFM) on progression of the AF.Methods and results: As described in the Long-Term Effect of Goal-Directed Weight Management in an Atrial Fibrillation Cohort: A Long-Term Follow-Up (LEGACY) Study, of 1415 consecutive AF patients, 825 had body mass index ≥ 27 kg/m2 and were offered weight and RFM. After exclusion, 355 were included for analysis. Weight loss was categorized as: Group 1 (<3%), Group 2 (3-9%), and Group 3 (≥10%). Change in AF type was determined by clinical review and 7-day Holter yearly. Atrial fibrillation type was categorized as per the Heart Rhythm Society consensus. There were no differences in baseline characteristic or follow-up duration between groups (P = NS). In Group 1, 41% progressed from paroxysmal to persistent and 26% from persistent to paroxysmal or no AF. In Group 2, 32% progressed from paroxysmal to persistent and 49% reversed from persistent to paroxysmal or no AF. In Group 3, 3% progressed to persistent and 88% reversed from persistent to paroxysmal or no AF (P < 0.001). Increased weight loss was significantly associated with greater AF freedom: 45 (39%) in Group 1, 69 (67%) in Group 2, and 116 (86%) in Group 3 (P ≤ 0.001).Conclusion: Obesity is associated with progression of the AF disease. This study demonstrates the dynamic relationship between weight/risk factors and AF. Weight-loss management and RFM reverses the type and natural progression of AF. [ABSTRACT FROM AUTHOR]

Background: There are no primary prevention trials of aspirin with relevant geriatric outcomes in elderly people. ASPirin in Reducing Events in the Elderly (ASPREE) is a placebo-controlled trial of low-dose aspirin that will determine whether 5 years of daily 100-mg enteric-coated aspirin extends disability-free and dementia-free life in a healthy elderly population and whether these benefits outweigh the risks.Methods: Set in primary care, this randomized double-blind placebo-controlled trial has a composite primary endpoint of death, incident dementia or persistent physical disability. Participants aged 70+ years (non-minorities) or 65+ years (U.S. minorities) were free of cardiovascular disease, dementia, or physical disability and without a contraindication to, or indication for, aspirin. Baseline data include physical and lifestyle, personal and family medical history, hemoglobin, fasting glucose, creatinine, lipid panel, urinary albumin:creatinine ratio, cognition (3MS, HVLT-R, COWAT, SDMT), mood (CES-D-10), physical function (gait speed, grip strength), Katz activities of daily living and quality of life (SF-12).Results: Recruitment ended in December 2014 with 16,703 Australian and 2,411 U.S. participants, a median age of 74 (range 65-98) years and 56% women. Approximately 55% of the U.S. cohort were from minority groups; 9% of the total cohort. Proportions with hypertension, overweight, and chronic kidney disease were similar to age-matched populations from both countries although lower percentages had diabetes, dyslipidemia, and osteoarthritis.Discussion: Findings from ASPREE will be generalizable to a healthier older population in both countries and will assess whether the broad benefits of daily low-dose aspirin in prolonging independent life outweigh the risks. [ABSTRACT FROM AUTHOR]

BACKGROUND New techniques that measure central blood pressure (BP) using an upper arm cuff-based approach require performance assessment. The aim of this study was to compare a cuff-based device (CuffCBP) to estimate central BP indices (systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), augmentation pressure (AP), augmentation index (AIx)) with noninvasive radial tonometry (TonCBP). METHODS Consecutive CuffCBP (SphygmoCor Xcel) and TonCBP (SphygmoCor 8.1) duplicate recordings were measured in 182 people with treated hypertension (aged 61 ± 7 years, 48% male). Agreement between methods was assessed using standard calibration with brachial SBP and DBP (measured with the Xcel device), as well as with brachial mean arterial pressure (MAP; 40% form factor method) and DBP. RESULTS The mean difference ± SD for central SBP (cSBP), central DBP (cDBP), and central PP (cPP) between methods were -0.89 ± 3.48 mm Hg (intra-class correlation (ICC) 0.977; 95% confidence interval (CI) 0.973-0.982), -0.50 ± 1.54 mm Hg (ICC 0.992, 95% CI 0.987-0.993), and -0.42 ± 3.57 mm Hg (ICC 0.966, 95% CI 0.958-0.972), indicating good agreement. Wider limits of agreement were observed for central AP (cAP) and central AIx (cAIx) (-0.91 ± 5.31 mm Hg; ICC 0.802; 95% CI 0.756-0.839, -0.99 ± 10.91%; ICC 0.749; 95% CI 0.691-0.796). Re-calibration with brachial MAP and DBP resulted in an overestimation of cSBP with CuffCBP compared with TonCBP (8.58 ± 19.06 mm Hg, ICC 0.164, 95% CI -0.029 to 0.321). CONCLUSION cSBP, cDBP, and cPP derived from CuffCBP are substantially equivalent to TonCBP, although the level of agreement is dependent on calibration method. Further validity testing of CuffCBP by comparison with invasively measured central BP will be required. [ABSTRACT FROM AUTHOR]

BACKGROUND The average of multiple blood pressure (BP) readings (mean BP) independently predicts target organ damage (TOD). Observational studies have also shown an independent relationship between BP variability (BPV) and TOD, but there is limited longitudinal data. This study aimed to determine the effects of changes in mean BP levels compared with BPV on left ventricular mass index (LVMI) and aortic pulse wave velocity (aPWV). METHODS Mean BP levels (research-protocol clinic BP (clinic BP), 24-hour ambulatory BP, and 7-day home BP) and BPV were assessed in 286 patients with uncomplicated hypertension (mean age 64 ± 8 SD years, 53% women) over 12 months. Reading-to-reading BPV (from 24-hour ambulatory BP) and day-to-day BPV (from 7-day home BP) were assessed at baseline and 12 months, and visit-to-visit BPV (clinic BP) was assessed from 5 visits over 12 months. LVMI was measured by 3D echocardiography and aPWV with applanation tonometry. RESULTS The strongest predictors of the changes in LVMI (ΔLVMI) were the changes in mean 24-hour systolic BPs (SBPs) (P < 0.02). Similarly, the strongest predictors of the changes in aPWV (ΔaPWV) were the changes in mean 24-hour ambulatory SBPs (P < 0.01) and the changes in mean clinic SBP (P < 0.001). However, none of the changes in BPV were independently associated with ΔLVMI or ΔaPWV (P > 0.05 for all). CONCLUSIONS Changes in mean BP levels, but not BPV, were most relevant to changes in TOD in patients with uncomplicated hypertension. Thus, from this point of view, BPV appears to have limited clinical utility in this patient population. [ABSTRACT FROM AUTHOR]

BACKGROUND Central blood pressure (BP) is an acknowledged contributor to end-organ damage and independent determinant of prognosis. Primary analysis from the BPGUIDE study demonstrated no detriment on left ventricular (LV) structure from central BP-guided hypertension management, despite significant medication withdrawal. However, the effect of this on LV function has not been investigated. In this study, we sought to investigate the impact of central BP-guided hypertension management on LV systolic and diastolic performance. METHODS A total of 286 enrollees with uncomplicated hypertension were randomized to therapeutic decisions guided by best-practice usual care (UC) or, in addition, by central BP intervention (CBP) for 12 months. Each participant underwent baseline and follow-up 2-dimensional echocardiography, with assessment undertaken by an expert blinded to participant allocation. RESULTS Antihypertensive medication quantity remained unchanged for UC but significantly decreased with intervention. However, no significant between-group differences were noted for changes during follow-up in both brachial and central BP, as well as other central hemodynamic parameters: augmentation index and augmented pressure. Similarly, there were no differences between groups in parameters of LV diastolic function: tissue e' velocity (ΔUC vs. ΔCBP; P = 0.27) and Ele' ratio (ΔUC vs. ΔCBP; P = 0.60), and systolic parameters: LV longitudinal strain (ΔUC vs. ΔCBP; P = 0.55), circumferential strain (ΔUC vs. ΔCBP; P = 0.79), and ejection fraction (ΔUC vs. ΔCBP; CONCLUSIONS Hypertension management guided by central BP, resulting in significant withdrawal of medication to maintain appropriate BP control, had no adverse effect on LV systolic or diastolic function. CLINICAL trials registration Australia New Zealand Clinical Trial Registry Number ACTRN12608 000041358 [ABSTRACT FROM AUTHOR]

Background: Research on associations between blood pressure, brain structure, and cognitive function has produced somewhat inconsistent results. In part, this may be due to differences in age ranges studied and because of sex differences in physiology and/or exposure to risk factors, which may lead to different time course or patterns in cardiovascular disease progression. The aim of this study was to investigate the impact of sex on associations between blood pressure, regional cerebral volumes, and cognitive function in older individuals. Methods: In this cohort study, brachial blood pressure was measured twice at rest in 266 community-based individuals free of dementia aged 68-73 years who had also undergone a brain scan and a neuropsychological assessment. Associations between mean blood pressure (MAP), regional brain volumes, and cognition were investigated with voxel-wise regression analyses. Results: Positive associations between MAP and regional volumes were detected in men, whereas negative associations were found in women. Similarly, there were sex differences in the brain-volume cognition relationship, with a positive relationship between regional brain volumes associated with MAP in men and a negative relationship in women. Conclusions: In this cohort of older individuals, higher MAP was associated with larger regional volume and better cognition in men, whereas opposite findings were demonstrated in women. These effects may be due to different lifetime risk exposure or because of physiological differences between men and women. Future studies investigating the relationship between blood pressure and brain structure or cognitive function should evaluate the potential for differential sex effects. [ABSTRACT FROM AUTHOR]

BACKGROUND Mechanisms underlying the inverse relationship between height and cardiovascular mortality are unknown but could relate to central hemodynamics. We sought to determine the relation of height to central and peripheral hemodynamics, as well as clinical characteristics. METHODS The study population was comprised of 1,152 randomly selected community-dwelling adults (aged 67.7±12.3 years; 48% men). Brachial blood pressure (BP) was recorded by sphygmomanometry; central BP and aortic pulse wave velocity were estimated by applanation tonometry. Stepwise multiple regression analysis was used to determine associations between height and central and peripheral hemodynamics. RESULTS Height was not significantly associated with aortic pulse wave velocity in men or women. The relationship with height and brachial systolic BP was borderline in women (β = −0.115; P = 0.051) but not significant in men (β = −0.096; P = 0.09). Conversely, central systolic BP, estimated by transfer function (β = −0.139 for men [βM]; β = −0.172 for women [βW]) or radial second systolic peak (βM = −0.239; βW = −0.281), augmentation index at 75 bpm (βM = −0.189; βW = −0.224), and aortic pulse wave timing (βM = 0.224; βW = 0.262) were independently associated with height in both sexes (P < 0.003 for all). Both men and women of greater than median height were less likely to have coronary artery disease (P < 0.05), to have systemic hypertension (P < 0.01), or to be taking vasoactive medication (P < 0.001) compared with participants of less than median height. CONCLUSIONS Even after correcting for conventional cardiovascular risk factors, taller individuals have more favorable central hemodynamics and reduced evidence of coronary artery disease compared with shorter individuals. These findings may help explain the decreased cardiovascular risk associated with being taller and also have important clinical consequences regarding therapy. [ABSTRACT FROM PUBLISHER]

BACKGROUND Higher levels of baseline pulse wave velocity (PWV) have been associated with longitudinal decline in renal function in patients with kidney disease. We examined longitudinal decline in renal function in relation to levels of PWV. We hypothesized that longitudinal decline in renal function in a community-based, nonclinic sample would be associated with higher levels of PWV. METHODS We conducted a 4–5 year longitudinal study with 482 community-living individuals free from acute stroke, dementia, and end-stage renal disease (mean age = 60.9 years; 59% women; 93.2% white; 10% with diabetes mellitus; mean estimated glomerular filtration rate (eGFR) = 79.2ml/min/1.73 m2). Multiple linear regression analyses were used to examine the association between changes in renal function (eGFR and serum creatinine) from baseline to follow-up and PWV levels at follow-up, the outcome measure. Regression coefficients were adjusted for age, sex, education, race/ethnicity, weight, activity level, mean arterial pressure, treatment of hypertension, and cardiovascular risk factors. RESULTS With adjustment for covariables, decline in renal function was associated with higher levels of PWV over a mean follow-up of 4.68 years. CONCLUSIONS Decline in renal functioning from baseline levels measured 4–5 years before measurement of PWV is related to higher levels of PWV in a community sample. [ABSTRACT FROM PUBLISHER]

Background The J-curve relationship between brachial diastolic blood pressure (DBP) and mortality is believed to be mediated through reduced myocardial perfusion. This study aimed to determine the relationship between DBP and subendocardial perfusion in patients with and without coronary artery disease (CAD) and to examine central hemodynamic variables that may explain the risk associated with low DBP (aortic stiffness, central pulse pressure, and augmentation index). Methods Brachial DBP and radial tonometry were measured in 134 patients with CAD (aged 76±7years; 69% male), 134 individuals without a prior cardiovascular event (control subjects) (aged 77±2years; 69% male) and 47 patients (aged 63±10years) during dobutamine stress echocardiography. Central hemodynamics and subendocardial viability ratio (SEVR), a marker of subendocardial perfusion, were recorded by tonometry. Results There was no difference in DBP or SEVR between control subjects and CAD patients (P > 0.05), nor was there a difference in SEVR across quartiles of DBP in CAD patients (P = 0.07) or control subjects (P = 0.14). After adjustment for age and height, associations between DBP and SEVR in control subjects (r = 0.185; P = 0.03) and CAD patients (r = 0.204; P = 0.02) were attenuated (P = 0.07 and P = 0.11, respectively). There were no significant relationships between DBP and central hemodynamics (P > 0.05 for all). At peak dobutamine stress, SEVR was significantly reduced in patients with inducible ischemia vs. those with nonischemic response (84±17 vs. 101±22%; P = 0.01). However, DBP was not significantly different (65±14 vs. 67±15mm Hg; P = 0.32). Conclusions Brachial DBP is a poor marker of subendocardial perfusion. The J-curve relationship between DBP and mortality is unlikely attributable to reduced myocardial perfusion or adverse central hemodynamics. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Baseline Characteristics of Participants in the ASPREE (Aspirin in Reducing Events in the Elderly) Study", which appeared in an earlier issue.