American Journal of Geriatric Cardiology最新文献

Unsatisfactory blood pressure (BP) control in the treated hypertensive patient is largely related to poor compliance with antihypertensive drug regimens. The aim of the present study was to prospectively evaluate the rate of persistence on treatment and the extent of BP control in 301 elderly, uncomplicated grade I or II hypertensive patients randomly allocated to monotherapy with angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), β-blockers, angiotensin II receptors (ARBs), or diuretics according to an open-label single-blind study design. After 24 months, the percentage of patients continuing their initial therapy was higher in those treated with ARBs (68.5%) and ACE inhibitors (64.5%) and lower in patients taking diuretics (34.4%; P<.01). The logistic regression model using ARBs as reference term showed that patients treated with ACE inhibitors (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.79–0.99) or CCBs (OR, 0.76; 95% CI, 0.54–0.85) were more likely to continue their initial antihypertensive therapy when compared with those treated with β-blockers (OR, 0.67; 95% CI, 0.57–0.79) or diuretics (OR, 0.56; 95% CI, 0.38–0.84). The average systolic and diastolic BP decrease was greater in patients treated with ARBs (−11.2±4/−5.8±2 mm Hg), ACE inhibitors (−10.5±4/−5.1±2 mm Hg), and CCBs (−8.5±3/−4.6±2 mm Hg) and lesser in those treated with diuretics (−2.3±4/−2.1±3 mm Hg, P<.05) and β-blockers (−4.0±2/−2.3±2 mm Hg; P<.05). The study confirms the importance of persistence with treatment for the effective management of hypertension in clinical practice.

Commencing with this issue, we introduce a new department devoted to the education of the elderly cardiac patient. The column has been formatted as a tear-out sheet and may be used by the clinician for patient education. Dr. Ahmed invites suggestions of topics of concern to your patients; topic suggestions may be forwarded to Elizabeth Ferretti, Editorial Director ([email protected]).—Nanette K. Wenger, MD, Editor in Chief

Aortic stiffness increases with age and may contribute to adverse remodeling after myocardial infarction (MI). The authors examined whether vascular stiffness affects left ventricular (LV) size after MI using contrast-enhanced cardiac magnetic resonance imaging. Despite similar infarct sizes, patients aged 60 years or older (n=30) had a lower ejection fraction (42±15 vs 53±11%, P<.01) and greater end-systolic volume index (75±47 vs 44±18 mL/m², P<.01) than younger patients (n=19). As infarct size increased, LV end-systolic volumes (P<.0001) and ejection fraction (P<.0001) in the older participants were progressively greater. Participants with greater aortic stiffness had greater end-systolic volume indices (P<.0001) and lower ejection fraction (P<.0001) with increasing infarct size. Using multivariate analysis, MI size (P<.001) and aortic distensibility (P=.02) were significant predictors of end-systolic volume index. Older patients have increased LV size after MI compared with younger patients, possibly related to age-related decreases in aortic distensibility affecting LV remodeling.

Dr Lipman invites your submissions of case reports for analysis and discussion in future columns and/or your submission of papers detailing ethics educational initiatives; submissions may be made at www.lejacq.com/submit—Nanette Wenger, MD, Editor in Chief.

While the incidence and prevalence of heart failure (HF) increase markedly with age, few studies have included data on a large series of patients aged 85 years and older. Clinical and echocardiographic data from 533 patients admitted to a tertiary care hospital for acute HF were obtained. Data from the oldest old (≥85 years; n=252; mean age, 91.9±3.6 years) were compared with data from those aged 65 to 74 years (n=123; mean age, 70.1±2.8 years) and 75 to 84 years (n=158; mean age, 79.4±2.9 years). Echocardiographic data were consistent with hypertensive remodeling. The proportion of patients with HF and a preserved left ventricular ejection fraction was greatest in the oldest patients (61%) in comparison to patients aged 65 to 74 years (48%) and 75 to 84 years (48%). Approximately three-fourths of the oldest patients were women, and two-thirds of women had a left ventricular ejection fraction ≥50%.

The objective of this study was to determine whether syncope of unknown etiology (SUE) influences mortality in the elderly. Patients with SUE at 65 years or older were identified retrospectively and their outcomes were compared with an age-, sex-, and comorbidity-matched group of patients drawn from the same population. All-cause 3-year mortality was analyzed using the Kaplan-Meier method and the log-rank test. SUE was identified in 150 of 304 patients (49%) with syncope. Patients with SUE and controls experienced mortality rates (1/1000 person-years [95% confidence interval]) of 147.8 (112.6–193.9) and 153.4 (117.5–200.3), P=.7, respectively. Of all the recorded characteristics of SUE, only the inpatient status was associated with higher all-cause mortality (Cox model adjusted hazard ratio [95% confidence interval] of inpatients vs outpatients with SUE: 2.2 [1.1–4.1], P=.017). New-onset SUE is not an independent predictor of mortality in elderly patients.