Search

We aimed to identify trajectories of nutrition, cognitive function, and autonomy over time among very old adults and to assess their impact on mortality. A cohort of subjects aged ≥80 years (in 2007–2008) who were followed for 5 years in 72 Italian and French nursing homes was used for post hoc analyses. Body mass index (BMI; weight (kg)/height (m)2), Mini-Mental State Examination (MMSE) score, and Katz Index of Independence in Activities of Daily Living (ADL) score were assessed at 4 time points. Information on vital status was collected during follow-up. Latent trajectory and Cox models were used. In the 710 subjects included, the mean age at inclusion was 88.0 (standard deviation, 4.8) years, and 78.9% were female. We identified 7 composite trajectories based on BMI, MMSE, and ADL values. As compared with the reference group (trajectory 7—stable overweight; preserved cognitive function and autonomy), 2 trajectories presented increased hazards of dying: trajectory 1 (stable overweight; moderately impaired, then declining, cognitive function and autonomy (adjusted hazard ratio = 1.79, 95% confidence interval (CI): 1.26, 2.55)) and trajectory 6 (stable normal BMI; slight cognitive decline; and moderate, then degrading, loss of autonomy (adjusted hazard ratio = 1.67, 95% CI: 1.15, 2.44)). The C-index was 0.81 (95% CI: 0.72, 0.88). Repeated monitoring of BMI, MMSE score, and ADL in very old adults provides trajectories that produce better prognostic information than simple baseline assessment. [ABSTRACT FROM AUTHOR]

Objectives Several studies have highlighted a link between vascular alterations and cognitive decline. The PARTAGE study showed that arterial stiffness as evaluated by carotid-femoral pulse wave velocity (cfPWV) was associated with a more pronounced cognitive decline over a 1-year period in very old frail institutionalized individuals. The aim of the present analysis was to assess the role of hemodynamic parameters, such as blood pressure (BP), heart rate (HR), cfPWV, and central/peripheral pulse pressure amplification (PPA) on cognitive decline over 2 years in very old frail individuals. Methods A total of 682 individuals from the PARTAGE study cohort, aged older than 80 years (mean age at inclusion: 87.5 ± 5.0 years) and living in French and Italian nursing homes, were analyzed. Mini-Mental State Examination (MMSE) score was assessed at baseline (BL) and at the end of the first and second year of follow-up (2y-FU). Those with a decrease in MMSE of 3 or more points between BL and 2y-FU were considered as “decliners.” The cfPWV and PPA at baseline were assessed with an arterial tonometer. Results After adjustment for baseline MMSE, HR, body mass index, age, education level, and activities of daily living (ADLs), cfPWV was higher and PPA lower in “decliners” compared with “nondecliners,” whereas BP did not differ between the 2 groups. Logistic multivariate analysis also revealed that high cfPWV, low PPA, high HR, and low ADLs were all determinants of MMSE decline. Conclusion This 2-year longitudinal study in very old institutionalized individuals shows that arterial stiffness and high HR enabled us to identify subjects at higher risk of cognitive decline, whereas BP alone did not appear to have a significant predictive value. These findings highlight the contribution of vascular determinants in cognitive decline even in this very old population. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Studies have shown the importance of vascular risk factors in the pathogenesis and evolution of cognitive disorders and dementia especially among the very elderly. The aim of the present longitudinal 1-year cohort analysis was to evaluate the influence of arterial stiffness on cognitive decline in institutionalized subjects older than 80 years. Design: Longitudinal study. Setting: Nursing homes in France and Italy. Participants: A total of 873 subjects (79% women), aged 87 ± 5 years were included in this longitudinal analysis from the PARTAGE cohort. Measurements: All completed the Mini-Mental Status Examination (MMSE) on the 2 visits over 1 year and underwent a measurement of carotid-femoral pulse wave velocity (PWV), an indicator of aortic stiffness. Clinical and 3-day self-measurements of blood pressure (BP) and activities of daily living (ADL) were evaluated at baseline visit. Results: According to PWV tertiles and after adjustment for baseline MMSE, mean BP (MBP), age, education level, and ADL, Δ MMSE was –1.42 ± 3.60 in the first tertile, –1.78 ± 4.08 in the second tertile, and –2.20 ± 3.98 in the third tertile (P < .03). Similar analyses with self-measured MBP failed to show any association between BP on MMSE decline. Conclusion: This 1-year longitudinal study in institutionalized patients older than 80 years shows that the higher the aortic stiffness, the more pronounced the decline in cognitive function. These results point out the interest of measuring PWV, a simple noninvasive and validated method for arterial stiffness assessment, to detect high-risk patients for cognitive decline. [Copyright &y& Elsevier]

Background: Several clinical studies have shown that blood pressure (BP) measurements in very old frail individuals are of limited interest due to the fact that several age-related alterations and geriatric syndromes may modify BP. We studied in persons over 80-year old living in nursing homes the combined effects of 3 BP patterns on total mortality and major cardiovascular (CV) events: (i) low pulse pressure amplification (L-PPA) between carotid and brachial artery, (ii) systolic BP (SBP) <130 mm Hg (L-SBP), under >1 antihypertensive drugs, and (iii) changes in SBP between supine and upright position of >20 mm Hg in both directions (hypotension/hypertension, orthostatic SBP [O-SBP])., Methods: This analysis was performed in subjects of the PARTAGE study presenting all these 3 measurements (n = 883). The combined effects of L-PPA, L-SBP, and O-SBP were studied during the 2 years followed-up period., Results: After adjusting for age, sex, and history of CV events, all 3 BP patterns were independent determinants of major CV events (L-PPA, (P = 0.023); L-SBP, (P = 0.050); O-SBP, (P = 0.015)), whereas L-PPA (P = 0.012) and L-SBP (P = 0.006) were also independent determinants of total mortality. Compared with the subjects without any BP pattern, the presence of 2 or 3 BP patterns was associated with an increase in total mortality and major CV events greater than 2 and 2.5 times, respectively., Conclusions: In very old frail subjects, there is a particular interest for using different BP measurement approaches, than in younger populations, in order to evaluate the risks related to the BP levels., Clinical Trials Registration: Trial Number: NCT00901355 (Clinical Trials.gov).

Importance: Clinical evidence supports the beneficial effects of lowering blood pressure (BP) levels in community-living, robust, hypertensive individuals older than 80 years. However, observational studies in frail elderly patients have shown no or even an inverse relationship between BP and morbidity and mortality., Objective: To assess all-cause mortality in institutionalized individuals older than 80 years according to systolic BP (SBP) levels and number of antihypertensive drugs., Design, Setting, and Participants: This longitudinal study included elderly residents of nursing homes. The interaction between low (<130 mm Hg) SBP and the presence of combination antihypertensive treatment on 2-year all-cause mortality was analyzed. A total of 1127 women and men older than 80 years (mean, 87.6 years; 78.1% women) living in nursing homes in France and Italy were recruited, examined, and monitored for 2 years. Blood pressure was measured with assisted self-measurements in the nursing home during 3 consecutive days (mean, 18 measurements). Patients with an SBP less than 130 mm Hg who were receiving combination antihypertensive treatment were compared with all other participants., Main Outcomes and Measures: All-cause mortality over a 2-year follow-up period., Results: A significant interaction was found between low SBP and treatment with 2 or more BP-lowering agents, resulting in a higher risk of mortality (unadjusted hazard ratio [HR], 1.81; 95% CI, 1.36-2.41); adjusted HR, 1.78; 95% CI, 1.34-2.37; both P < .001) in patients with low SBP who were receiving multiple BP medicines compared with the other participants. Three sensitivity analyses confirmed the significant excess of risk: propensity score-matched subsets (unadjusted HR, 1.97; 95% CI, 1.32-2.93; P < .001; adjusted HR, 2.05; 95% CI, 1.37-3.06; P < .001), adjustment for cardiovascular comorbidities (HR, 1.73; 95% CI, 1.29-2.32; P < .001), and exclusion of patients without a history of hypertension who were receiving BP-lowering agents (unadjusted HR, 1.82; 95% CI, 1.33-2.48; P < .001; adjusted HR, 1.76; 95% CI, 1.28-2.41; P < .001)., Conclusions and Relevance: The findings of this study raise a cautionary note regarding the safety of using combination antihypertensive therapy in frail elderly patients with low SBP (<130 mm Hg). Dedicated, controlled interventional studies are warranted to assess the corresponding benefit to risk ratio in this growing population.

Objectives: The aim of the longitudinal PARTAGE study was to determine the predictive value of blood pressure (BP) and pulse pressure amplification, a marker of arterial function, for overall mortality (primary endpoint) and major cardiovascular (CV) events, in subjects older than 80 years of age living in a nursing home., Background: Assessment of pulse indexes may be important in the evaluation of the CV risk in very elderly frail subjects., Methods: A total of 1,126 subjects (874 women) who were living in French and Italian nursing homes were enrolled (mean age, 88 ± 5 years). Central (carotid) to peripheral (brachial) pulse pressure amplification (PPA) was calculated with the help of an arterial tonometer. Clinical and 3-day self-measurements of BP were conducted., Results: During the 2-year follow-up, 247 subjects died, and 228 experienced major CV events. The PPA was a predictor of total mortality and major CV events in this population. A 10% increase in PPA was associated with a 24% (p < 0.0003) decrease in total mortality and a 17% (p < 0.01) decrease in major CV events. Systolic BP, diastolic BP, or pulse pressure were either not associated or inversely correlated with total mortality and major CV events., Conclusions: In very elderly individuals living in nursing homes, low PPA from central to peripheral arteries strongly predicts mortality and adverse effects. Assessment of this parameter could help in risk estimation and improve diagnostic and therapeutic strategies in very old, polymedicated persons. In contrast, high BP is not associated with higher risk of mortality or major CV events in this population. (Predictive Values of Blood Pressure and Arterial Stiffness in Institutionalized Very Aged Population [PARTAGE]; NCT00901355)., (Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: Pulse wave velocity (PWV) and pulse pressure amplification (PPA) are independent predictors of cardiovascular risk, mainly in the elderly. The aim of the current research was to determine the influence of PPA and PWV, both manifestations of arterial stiffness, on heart disease in the elderly., Methods: The study population consisted of 1042 participants (814 women) aged 80 years and over who participated in the PARTAGE study. Carotid-femoral PWV was determined in order to assess aortic stiffness. Central aortic blood pressure values and central pulse wave analysis were obtained using the calibration method applied on the common carotid artery by a PulsePen tonometer. Amplification phenomenon was expressed as PPA, that is, the percentage of increase of pulse pressure in the brachial artery relative to central pulse pressure. Heart disease was defined as presence of heart failure, ischemic heart disease or atrial fibrillation., Results: PPA was significantly lower in patients with heart disease, independently of the presence of hypertension, diabetes or both. Heart disease was present in 61.8% of participants with PPA less than 10%, in 46.2% of participants with PPA between 10 and 20% (P < 0.01), in 42.6% of participants with PPA between 20 and 30% (P < 0.005) and in 32.5% of participants with PPA more than 30% (P < 0.001). PWV, on the contrary, was not influenced by the presence of heart disease (12.3 ± 4.0 vs. 13.5 ± 4.6 m/s) but significantly increased in presence of hypertension (14.4 ± 5.0 m/s, P < 0.001) or diabetes (16.1 ± 5.1 m/s, P < 0.001)., Conclusion: In the very elderly, low brachial/aortic PPA is associated with higher prevalence of heart disease.

Background: The Saharan adult population is characterized by a high prevalence of hypertension. The aim of the present study was to compare blood pressure (BP) levels in Saharan Arab-origin teenagers, in relationship with Europeans of the same age, and to assess the association with birth weight, body weight, and other anthropometric measurements., Methods: BP values, heart rate (HR), clinical parameters, and anthropometric measurements were determined in 2,057 teenagers ages 15-19, 1,122 Algerians (388 boys) and 935 Italians (407 boys). Birth weight was obtained from obstetrical records in 568 Algerians and 735 Italians., Results: The European teenagers were significantly taller and heavier than their Algerian counterparts. In the Algerian population, systolic BP (SBP) was higher in boys (P < 0.01) and lower in girls (P < 0.0001) compared to the Italians, whereas diastolic BP (DBP) was higher in Italians (P < 0.001). Both SBP and DBP were higher in boys than in girls independently of geographic origin (P < 0.001). In all four gender and ethnic groups, both SBP and DBP were strongly correlated with weight or body mass index (BMI). Influence of body weight was stronger on SBP than on DBP; in all four groups, those with the highest weight or BMI quartiles had higher SBP levels by 6-12 mm Hg as compared to those individuals in the lowest quartiles. No correlation was found between birth weight, and SBP or DBP., Conclusions: In Algerian and Italian teenagers, both male and female, current weight but not birth weight was found to be a strong determinant of BP levels.

Objective: The aim of the longitudinal study PARTAGE (predictive values of blood pressure and arterial stiffness in institutionalized very aged population) was to determine the predictive value of blood pressure (BP) and arterial stiffness for overall mortality, major cardiovascular events and cognitive decline in a large population of institutionalized patients aged 80 and over. In the study herein, we present the baseline data values of this study., Methods: A total of 1130 patients were recruited (878 women), living in French and Italian nursing homes. Clinical and 3-day self-measurements of BP were conducted. Aortic and upper limb pulse wave velocity were obtained using a PulsePen tonometer., Results: Of this population, 76% of women and 60% of men had a known hypertension and over 91% of the patients were under antihypertensive treatment; 51% of the treated hypertensive patients were well controlled (systolic BP <140 mmHg). No significant differences were found between clinical and self-measured BP. With age, there was an increase in pulse pressure (P < 0.001) due to a decrease in diastolic BP (P < 0.001), without any increase in systolic BP. Aortic but not peripheral pulse wave velocity significantly increased with age (P < 0.005)., Conclusion: Baseline values obtained herein demonstrate that elderly patients living in nursing homes present hemodynamic characteristics which are different to those described in community-living elderly populations, and indicate the interest of assessing, in longitudinal studies, the role of BP and arterial stiffness in morbidity and mortality in this population.