The relationship between fall-related activity restriction and functional fitness in elderly women]

The purpose of this study was to assess the relationship between experiences of falls or fear of falling and functional fitness in the elderly. A total of 41 women, aged 66-88, who visited Fall Prevention Clinic in Tokyo Metropolitan Geriatric Hospital, underwent an interview and functional assessment. We used a questionnaire about falls, fear of falling, activity restriction, and twelve variables were used to assess functional fitness. Data were collected from June 2000 to November 2001. The subjects were classified into four subgroups: the faller group (n = 29) were subjects who had at least one or more experiences of falling accidents in the past one year; the non-faller group (n = 12) were subjects who did not have any falling accidents in the past one year; the activity restricted group (n = 12) were subjects who were restricted from going out because of fear of falling; the activity non-restricted group (n = 23) consisted of subjects who did not have any restriction concerning going out because of fear of falling. The results were: 1) Among all subjects, 85.4% had fear of falling. Among the subjects who had fear of falling. 34.3% had restricted outdoor activities due to the fear of falling. 2) Where 86.2% of the faller group responded that they had fear of falling. 83.3% of the non-faller group also responded as having fear of falling. Of the faller group, 44.0% had some restriction concerning going out because of fear of falling. In the non-faller group, 10.0% of them showed some restriction concerning going out because of fear of falling. The rate of activity restriction in the faller group was significantly higher (p < 0.05) than in the non-faller group. 3) The faller group had significantly reduced LNG with eyes open and closed, one-leg balance with eyes open, tandem walking, grip strength, and leg extension than the non-faller group. 4) The activity-restricted group exhibited significantly reduced one-leg balance with eyes open, Up & Go test, grip strength, and leg extension than the activity non-restricted group. In conclusion, lower leg strength and walking ability as well as history of falls are significant predictors of activity restriction in elderly women related to fear of falling.     

Fall risk assessment and knee extensor muscle activity in elderly people

PURPOSE: The purpose of this study was to analyze relationships between the history of falls, tripping, sway, and knee extensor muscle strengths as a tool for fall risk assessment in elderly people. We examined effective fall prevention measures. METHODS: We investigated 102 elderly volunteers in the community. The subjects were classified according to history of falls, tripping, sway and 5 performance tests conducted to assess fall risk including Timed up-and-go test (TUG), Functional Reach test (FR), Hand grip and Reaction time (RT). In addition, the time serial data of the knee extensor muscle strength were acquired using a hand-held dynamometer. RESULTS: In comparison to the non-faller group, the faller group showed a significantly higher incident rate of tripping and sway. A frequency analysis using the Maximum Entropy Method revealed that the fallers group showed lower peak frequency (p=0.025). Also, the slope of the logarithmical spectrum was less steep in the fallers group (p=0.035). Also results from analysis of the peak force latency from the beginning of measurement to 50%, 80%, and 100% muscle strength, also showed that the faller group took more time for maximal voluntary contraction. CONCLUSIONS: The frequency analysis of the time series date of peak force latency of knee extensor muscle strength revealed that the muscle activity differs in faller compared to non-fallers. This study suggested that knee extensor muscle isometric performance could possibly be used as a new tool for fall risk assessment. We concluded that exercises to raise maximal muscle strength and muscle response speed are useful for the prevention of falls.     

增龄对老年高血压病患者动态血压的影响

目的：观察增龄对老年高血压病患动态血压（ABP）的影响。方法：比较478例高血压患（分为3个年龄组）和229例血压正常的ABP资料。结果：60－岁组高血压患的收缩压（SBP）和日／夜（N／D）血压比值低于70－岁和＞80岁组的；而舒张压（DBP）则前高于后两组（P＜0.05)，各组脉压（PP）值均呈现随年龄增大而增高之趋势（P＜0.05)；60－岁组的血压波动曲线类似于灼型，而后两组均为非杓型。结论：PP随年龄增大而增高可能与大动脉硬化加重有关，而血压昼夜节律的消失可能为增龄所致的自主神经功能紊乱及白天、夜间活动变化的表现。     

The clinical significance of abnormal diurnal blood pressure variation in healthy late middle-aged and older adults

Objective. A fall in nocturnal blood pressure (BP) is generally observed in normotensive subjects as well as in those with mild to moderate essential hypertension, regardless of the level of daytime BP. Among elderly hypertensive subjects, extreme-dippers with a marked nocturnal fall in BP as well as non-dippers with nocturnal fall absence are at increased risk for cardiovascular and cerebrovascular complications. However, the relationship between these abnormal diurnal BP variation patterns in normotensive elderly subjects has not been investigated. Methods. We classified 45 healthy late middle-aged and older adults into three groups according to the nocturnal systolic BP fall pattern examined by 24-h ambulatory BP monitoring (dipper, non-dipper and extreme-dipper), and compared the parameters of initial atherosclerosis, endothelial function and autonomic function. As a parameter of atherosclerotic factors, the intima-media thickness (IMT) of the carotid artery was examined, and as a parameter of endothelial function, brachial artery endothelium-dependent flow-mediated dilation (FMD) was ultrasonographyically measured. Autonomic function was assessed by power spectral analysis of heart rate variability (HRV). Results. No difference was observed in the severity of IMT between the three groups. The percent change of FMD in subjects in the extreme-dipper group was significantly lower than that of subjects in the dipper group, indicating that extreme-dippers in healthy elderly subjects may be associated with endothelial dysfunction. Also, HRV due to sympathetic modulation of subjects in the extreme-dipper group was significantly higher than that of subjects in the dipper and non-dipper groups, suggesting the activation of sympathetic tone. Conclusion. In healthy elderly subjects, the extreme-dipper type may reflect a decrease in endothelial function, i.e. initial stage atherosclerosis, rather than the dipper type.     

Thymus fat as an attractive source of angiogenic factors in elderly subjects with myocardial ischemia

Aging negatively affects angiogenesis which is found to be linked to declined vascular endothelial growth factor (VEGF) production. Adult human thymus degenerates into fat tissue (thymus adipose tissue (TAT)). Recently, we described that TAT from cardiomyopathy ischemic subjects has angiogenic properties. The goal of our study was to analyze whether aging could also impair angiogenic properties in TAT as in other adipose tissue such as subcutaneous (subcutaneous adipose tissue (SAT)). SAT and TAT specimens were obtained from 35 patients undergoing cardiac surgery, making these tissues readily available as a prime source of adipose tissue. Patients were separated into two age-dependent groups; middle-aged (n = 18) and elderly (n = 17). Angiogenic, endothelial, and adipogenic expression markers were analyzed in both tissues from each group and correlations were examined between these parameters and also with age. There were no significant differences in subjects from either group in clinical or biological variables. Angiogenic markers VEGF-A, B, C, and D and adipogenic parameters, peroxisome proliferator-activated receptors (PPARγ2), FABP4, and ADRP showed elevated expression levels in TAT from elderly patients compared to the middle-aged group, while in SAT, expression levels of these isoforms were significantly decreased in elderly patients. VEGF-R1, VEGF-R2, VEGF-R3, Thy1, CD31, CD29, and VLA1 showed increased levels in TAT from the elderly compared to the middle-aged, while in SAT these levels displayed a decline with aging. Also, in TAT, angiogenic and endothelial parameters exhibited strong positive correlations with age. TAT appears to be the most appropriate source of angiogenic and endothelial factors in elderly cardiomyopathy subjects compared to SAT.     

Age-Related Differences in the Mechanism of Nondipping Among Patients with Obstructive Sleep Apnea Syndrome

The frequency of nondipper (those lacking the normal drop in nocturnal blood pressure [BP]) is high in patients with obstructive sleep apnea syndrome (OSAS). The objective of this study is to investigate age-related differences in the nocturnal BP profile of patients with OSAS. The study subjects included 214 patients with polysomnography-diagnosed OSAS. The status of dipper or nondipper was determined by 24-hour ambulatory BP measurements. We divided the subjects into three groups by age (younger, middle-aged, and elderly) and compared the frequency and sleep profiles of nondippers in the different age groups. The prevalence of nondippers was significantly higher in the elderly OSAS group than in the younger and middle-aged OSAS groups (69% vs. 45%, 47%; P < .05). In the younger OSAS group, nondippers, when compared with dippers, were characterized by higher apnea–hypopnea index (AHI, 48.2 ± 27.1 vs. 37.4 ± 23.0 times/h, P < .05), whereas in the middle-aged and elderly OSAS groups, the AHI of nondippers was almost identical to that of dippers. On the other hand, in the elderly OSAS group, nondippers, when compared with dippers, had shorter periods of slow wave sleep as measured by nonrapid eye movement stage 3–4, whereas nondippers and dippers in the other two age groups were not different in terms of slow wave sleep. These results indicate age-related differences in major mechanisms leading to nondipping. Severe apnea causes nondipping only in young OSAS patients, whereas disturbance of sleep quality plays a more important role in elderly OSAS patients.     

Long-term effect of hypertension on neurobehavioral and cardiac function in the apparently healthy community-dwelling elderly: a 5-year follow-up study

Recently, it has been reported that hypertension causes not only cerebro-cardiovascular diseases, but also a decline of cognitive function in the elderly. However, it is not clear whether or not aging and hypertension have a latent effect on the cognitive-neurobehavioral and cardiac functions in healthy elderly whose scores of basic activities of daily living (ADL) are fully maintained. We evaluated the effect of aging and hypertension on cognitive-neurobehavioral and cardiac functions in 25 healthy community-dwelling elderly subjects (mean age: 69 y.o.) whose scores of basic ADL were fully maintained. Subjects were followed over a 5-year period, and the following examinations were performed before and after a 5-year follow-up: echocardiography, 24-hr ambulatory blood pressure monitoring (ABPM), and cognitive-neurobehavioral function test. Left ventricular mass index was significantly increased in the hypertensive (HT) subjects relative to the normotensive (NT) subjects over the 5 years (% change: 3% for HT vs. -0.8% for NT, p = 0.03). The number of non-dippers significantly increased over the 5 years in the HT group (initially: 20% [2/10] vs. follow-up: 58% [7/12], p = 0.04). Visuospatial cognitive performance scale scores for evaluation of higher cognitive-neurobehavioral functions significantly deteriorated in the HT subjects (initially; 2,344 +/- 110 vs. 2,380 +/- 102, ns, and follow-up: 2,149 +/- 181 vs. 2,356 +/- 159, p = 0.04). Hypertension contributes to the impairment of the cognitive-neurobehavioral function in the elderly by latently affecting the functions of multiple organs. This occurs even if basic ADL is maintained for 5 years. Therefore, it is important to control BP not only to prevent cardiovascular events, but also to preserve the neurobehavioral function.     

U-curve relationship between orthostatic blood pressure change and silent cerebrovascular disease in elderly hypertensives: orthostatic hypertension as a new cardiovascular risk factor

OBJECTIVES: The study investigated the clinical significance and mechanism of orthostatic blood pressure (BP) dysregulation in elderly hypertensive patients. BACKGROUND: Although orthostatic hypotension (OHYPO), often found in elderly hypertensive patients, has been recognized as a risk factor for syncope and cardiovascular disease, both the clinical significance and the mechanism of orthostatic hypertension (OHT) remain unclear. METHODS: We performed a head-up tilting test and brain magnetic resonance imaging (MRI) in 241 elderly subjects with sustained hypertension as indicated by ambulatory BP monitoring. We classified the patients into an OHT group with orthostatic increase of systolic blood pressure (SBP) of >or=20 mm Hg (n = 26), an OHYPO group with orthostatic SBP decrease of >or=20 mm Hg (n = 23), and a normal group with neither of these two patterns (n = 192). RESULTS: Silent cerebral infarcts were more common in the OHT (3.4/person, p < 0.0001) and OHYPO groups (2.7/person, p = 0.04) than in the normal group (1.4/person). Morning SBP was higher in the OHT group than in the normal group (159 vs. 149 mm Hg, p = 0.007), while there were no significant differences of these ambulatory BPs between the two groups during other periods. The OHT (21 mm Hg, p < 0.0001) and OHYPO (20 mm Hg, p = 0.01) groups had higher BP variability (standard deviation of awake SBP) than the normal group (17 mm Hg). The associations between orthostatic BP change and silent cerebrovascular disease remained significant after controlling for confounders, including ambulatory BP. The orthostatic BP increase was selectively abolished by alpha-adrenergic blocking, indicating that alpha-adrenergic activity is the predominant pathophysiologic mechanism of OHT. CONCLUSIONS: Silent cerebrovascular disease is advanced in elderly hypertensives having OHT. Elderly hypertensives with OHT or OHYPO may have an elevated risk of developing hypertensive cerebrovascular disease.     

Setting the criterion for fall risk screening for healthy community-dwelling elderly

This study aimed to develop a criterion for screening high risk elderly using Demura's fall risk assessment chart (DFRA), compared with the Tokyo Metropolitan Institute of gerontology (TMIG) fall risk assessment chart. Participants included 1122 healthy elderly individuals aged 60 years and over (380 males and 742 females) 15.8% of whom had experienced a fall. We assessed fall risk of the elderly by DFRA and TMIG. To develop a criterion for screening high fall risk subjects among community-dwelling elderly, receiver-operating-characteristic (ROC) analysis was conducted using fall experience (separated into the categories of faller and non-faller) and the following fall risk scale scores: (1) TMIG score, (2) DFRA score, and (3) potential for falling score according to the DFRA (summing the scores of three items). In ROC analyses, the area under the ROC curve (AUC) for evaluating the potential for falling gave a value of 0.797 (95% CI=0.759-0.834) which proved better than the evaluation of the overall TMIG (0.654, 95% CI=0.600-0.706) and DFRA scores (0.680, 95% CI=0.633-0.727). Assessment of the potential for falling and fall experience are of benefit in screening for elderly persons deemed to be at a high fall risk. Further examinations based on the prospective data setting will be required.     

80岁以上老年急性胰腺炎患者的临床特征分析

目的探讨≥80岁老年急性胰腺炎(AP)患者的临床特征。方法回顾性分析2013年1月—2019年12月西南医科大学附属医院消化内科收治的3642例AP患者,分为青年组(<65岁,n=2955)、中老年组(65~79岁,n=558)、老年组(≥80岁,n=129例)。收集并统计分析3组患者的资料信息,包括性别、年龄、病因、诱因、既往病史、病情严重程度、并发症和临床转归等。符合正态分布的计量资料3组间比较采用one-way ANOVA检验,进一步两两比较采用LSD-t检验;不符合正态分布的计量资料3组间比较采用Mann-Whitney U检验;计数资料3组间比较采用χ2检验或Fisher精确概率法,有序多分类变量比较采用Kruskal-Wallis H检验。结果中老年组和老年组女性比例均高于青年组(P值均<0.05);老年组并发高血压比例均高于中老年组和青年组(P值均<0.05);老年组并发高脂血症比例低于青年组(P<0.05)。3组AP患者均以高脂饮食为主要诱因,老年组因酒精、高脂饮食+酒精诱发AP比例均低于青年组(P值均<0.05);老年组以胆道疾病为病因的比例高于中老年、青年组(P值均<0.05),而高脂血症、酒精、胆道疾病+高脂血症比例均低于青年组(P值均<0.05)。老年组中发生轻症急性胰腺炎83例(64.3%),中度重症急性胰腺炎23例(17.8%),重症急性胰腺炎23例(17.8%),与中老年组及青年组相比,病情严重程度构成比例差异均有统计学意义(P值均<0.05);老年、中老年组复发比例均低于青年组(P值均<0.05)。在全身并发症方面,老年组发生肺炎、急性肾损伤、多器官功能障碍综合征的比例均高于青年组(P值均<0.05)。老年组治愈病例比例均低于中老年组和青年组(P值均<0.05),好转病例比例均高于中老年组和青年组(P值均<0.05)。老年组和中老年组放弃治疗比例均高于青年组(P值均<0.05)。老年组死亡1例(0.8%),中老年组死亡9例(1.6%)、青年组死亡16例(0.5%),3组间比较差异无统计学意义(P>0.05)。3组患者住院天数及住院费用比较差异均无统计学意义(P值均>0.05)。结论≥80岁AP患者以女性为主,多由胆源性因素引起,易并发肺炎、急性肾损伤、多器官功能障碍综合征。     

Ambulatory blood pressure monitoring in Uygur centenarians.

Cross-sectional surveillance was carried out in long-lived Uygur in China to investigate blood pressure (BP) and pulse rate (PR) variation in centenarians. The study group comprised 33 centenarians (age > or = 100 years), 103 longevous subjects (age 90-99 years) and 100 elderly (age 65-70 years) subjects. Office BP was measured, and 24-h noninvasive ambulatory blood pressure monitoring (ABPM) was performed. The office BP was higher and hypertension occurred more frequently in the centenarians than in either the longevous or elderly subjects. Mean 24-h systolic and diastolic BP was higher in the centenarians than in the other 2 groups. However, mean 24-h PR did not differ between them. Day-night differences in systolic BP decreased, and the non-dipper-type BP pattern was common in the centenarians (79.1% vs 68% and 63.6% in longevous and elderly subjects, respectively). Circadian BP was characterized by 3 peaks in longevous subjects and multiple peaks in centenarians. Morning rising and nocturnal dipping of BP were observed in both longevous and elderly subjects. In conclusion, BP in longevous and elderly Uygur was characterized by circadian rhythmicity, but the nocturnal fall in BP was not seen in centenarians. Differences in day-night BP and circadian rhythmicity may decrease with advancing age, especially in centenarians.     

Relationship between balance performance and musculoskeletal pain in lower body comparison healthy middle aged and older adults

The purpose of this study was to determine relationship between balance performance and pain in lower body among healthy adults. Two hundred and forty volunteer subjects (125 middle aged and 115 elderly people) aged 50 years and above participated. The average age was 61.52+/-8.22 years (range 50-75 years). The functional reach test (FRT) was used to measure balance ability. The visual analog scale (VAS) was used to measure pain intensity. Subjects were also asked to indicate sites they experienced pain in their lower body (e.g., low back, hip, knee, ankle, toes). Falls history was also recorded. The elderly people had a lower FRT score as compared to the middle-aged adults (p<0.001). Knee, low back, and hip pain were most common in both groups. The elderly people reported more frequency of falls than the middle-aged adults. The score of the FRT was higher among men (20.67+/-7.16cm) than among women (18.77+/-6.59cm). In both groups; the women had a higher VAS score than those of matched the men. Although the middle-aged adults had higher and better scores than the elderly people, the data showed that the middle-aged adults are also at risk and should be prepared properly for healthy aging.     

Effects of a long-term, community-based cardiac rehabilitation program on middle-aged and elderly cardiac patients

The purpose of this retrospective study was to compare the effects of a 2-year, community-based cardiac rehabilitation exercise program on cardiovascular fitness, body fatness, and blood lipids in middle-aged (65 years, n=40) male cardiac patients. Estimated maximal metabolic equivalents increased in both groups; however, the increase was greater for middle-aged patients (p=0.003). High-density lipoprotein cholesterol level increased significantly after 1 year in both groups, but the change was greater for the middle-aged subjects by Year 2 (p=0.02). The total cholesterol/high-density lipoprotein cholesterol ratio and serum triglyceride levels decreased in both groups, whereas total cholesterol and low-density lipoprotein cholesterol levels decreased only in the elderly group (p<0.01). Body fatness did not change in either group. These findings reinforce the importance of referring elderly as well as middle-aged patients to community-based cardiac rehabilitation exercise programs.     

Exaggerated ambulatory blood pressure variability is associated with cognitive dysfunction in the very elderly and quality of life in the younger elderly

BACKGROUND: It is reported that blood pressure (BP) variability increases with aging, and cognitive dysfunction may be related to BP variability; however, there are no data showing that exaggerated BP variability is associated with cognitive dysfunction or quality of life (QOL) in the older elderly. We investigated the relationships and the differences between ambulatory BP variability and cognitive function or QOL in younger elderly and very elderly. METHODS: We recruited both 101 very elderly (aged > or =80 years) and 101 younger elderly (aged 61 to 79 years). Twenty-four-hour ambulatory blood pressure monitoring, mini-mental state examinations (MMSE), and Medical Outcome Study Short-Form 36 Items Health Survey (SF-36) were performed for all subjects. RESULTS: The mean standard deviation (SD) of daytime systolic BP in young elderly was 17.2 +/- 4.6 mm Hg (mean SD +/- SD of mean SD), and that in very elderly was 21.2 +/- 4.3 mm Hg. The MMSE score significantly decreased with the tertile of SD of daytime systolic BP in very elderly (P = .004) and young elderly (P = .03). In very elderly, there was no significant association between the SD of daytime systolic BP and each of eight SF-36 categories. On the other hand, in younger elderly, two of eight SF-36 categories decreased with the tertile of SD of daytime systolic BP (P = .001 for Vitality and P = .003 for Role emotion). CONCLUSIONS: Very elderly had larger BP variability than younger elderly. Exaggerated ambulatory BP variability was related to cognitive dysfunction in the elderly, especially in the very elderly, and was related to lower QOL in the younger elderly.     

Effects of weight loss on clinic and ambulatory blood pressure in normotensive men

Obesity and physical inactivity are associated with both elevated cardiovascular risk and blood pressure (BP), but the interrelation of exercise, weight loss and BP is poorly understood. This study examines the independent effects of exercise and weight loss on both standard clinic and automated, ambulatory BP in 115 overweight, sedentary, normotensive men (aged 30 to 59 years) who were randomly assigned to control status or to lose weight over 1 year by moderate caloric restriction (dieting) or by increased caloric expenditure (exercise). Median daytime and evening BP were determined from measurements made every 20 minutes while the subjects were awake. After 1 year, the control group gained (mean +/- standard deviation) 0.5 +/- 3.8 kg while the diet group lost 6.9 +/- 4.4 kg and the exercise group lost 4.6 +/- 3.5 kg. Clinic BP decreased similarly in all 3 groups, but daytime and evening ambulatory BP decreased in both intervention groups and increased in the control group. Relative to the 1-year change in control subjects, net change in daytime ambulatory BP averaged -2 to -3 mm Hg in both dieters and exercisers, while net change in evening ambulatory BP averaged -3 to -4 mm Hg. These changes were all statistically significant (p less than 0.05) when compared with control subjects except for daytime systolic BP in both intervention groups and evening diastolic BP in dieters. Weight loss achieved through caloric restriction or expenditure may cause important decreases in BP in normotensive men; exercise appears to confer no unique benefit. If confirmed, these results have important public health implications for the prevention of cardiovascular disease.     

Guanidino compounds in the elderly]

To examine the metabolism of guanidino compounds in the elderly, we measured the serum concentrations of urea nitrogen, creatinine (Cr), guanidinoacetic acid (GAA) and creatine (CR) in middle-aged and elderly subjects. We also measured muscle mass in the elderly. The elderly subjects tended to have lower serum GAA concentrations than middle-aged subjects. On the contrary, CR concentrations of elderly subjects were higher than those of middle-aged subjects. Bedridden elderly subjects tended to have lower serum GAA concentrations and lighter muscle mass than ambulatory elderly subjects. On the contrary, serum CR concentrations of bedridden subjects were higher than those of ambulatory subjects. CR is an essential substance for muscle energy metabolism. These results indicate that high serum CR concentrations due to low CR metabolism in skeletal muscle might suppress glycine amidinotransferase (GAT) activity, resulting in decreased GAA production in the elderly.     

Identification of an Increased Short-Term Blood Pressure Variability on Ambulatory Blood Pressure Monitoring as a Coronary Risk Factor in Diabetic Hypertensives

We examined risk factors for coronary heart disease (CHD) by ambulatory blood pressure (BP) monitoring in 72 diabetic hypertensives who were hospitalized for the educational program. The patients were divided into two groups (CHD group, 19 subjects; and non-CHD group, 53 subjects) along with or without co-existing CHD. On ambulatory BP monitoring, no significant differences were found between the groups regarding BP values through the day. However, the CHD group had a significantly grater BP variability than non-CHD group. The result of logistic regression analysis demonstrated that nighttime systolic BP variability was an independent risk factor for CHD.     

Isolated clinic hypertension is not an innocent phenomenon: effect on the carotid artery structure

This study examines the common carotid intimal-medial wall thickness (CCA-IMT) in untreated patients with elevated clinic blood pressure (BP) but normal ambulatory BP (isolated clinic hypertension, n = 22), in comparison with a group with elevated clinic and ambulatory BP (hypertensives, n = 41) and a group with normal clinic and ambulatory BP (normotensives, n = 17) readings. The three groups did not differ in age, male/female ratio, lipid profile, glucose tolerance test, or smoking habits. No difference existed in CCA-IMT values between the groups with hypertension (0.67 +/- 0.18 mm) and isolated clinic hypertension (0.68 +/- 0.14 mm), but the values in these two groups were significantly higher (one-way ANOVA; F = 8.09, P < .001) than in the group of normotensives (0.50 +/- 0.09 mm). The CCA-IMT did not correlate with clinic systolic or diastolic BP readings or with BP derivatives of 24-h ambulatory monitoring. Mean 24-h BP in the isolated clinic hypertensives did not differ from that in the normotensives, whereas both were lower than in the hypertensives. We conclude that changes in the CCA-IMT occuring in subjects with isolated clinic hypertension are equal to the changes in sustained hypertension, indicating that isolated clinic hypertension may not be a benign condition.     

Is there a relationship between short FES-I test scores and objective assessment of balance in the older people with age-induced instability?

Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to evaluate whether there is a correlation between FOF, estimated via the short FES-I test, and objective evaluation of balance in a group of elderly patients with age-related instability. The balance of 139 subjects of more than 65 years of age is evaluated by the timed up and go test and the computerised dynamic posturography (CDP). Different groups of elderly patients were established according to the number of falls in the previous 12 months, and the correlation with short FES-I test scores was evaluated. Based on the results, ROC curves were calculated. The short FES-I test presents a good capacity to distinguish between subjects with ≤3 falls/year and subjects with ≥4 falls/year (AUC 0.719, 95%CI 0.627–0.810). A test score of 14.5 is the best cut-off point (74% sensitivity, 51% specificity). Using this cut-off point, the study sample comprises two groups: subjects with test scores of 7–14 vs 15–28, with the first group obtaining best results with statistical significance (Student’s t-test and the Mann–Whitney test) in most of the balance tests. The short FES-I is an excellent instrument that measures FOF in the elderly, and it is correlated with their number of falls both in real life and on the CDP. It is simple and fast, and so can be considered an extraordinary screening test relative to real risk of falls in the elderly.     

Nocturnal blood pressure predicts left ventricular mass index in normotensive elderly

Blood pressure (BP) predictors of left ventricular mass index (LVMI) were studied in 40 healthy normotensive (71.4 ±4.4 years) and 31 hypertensive (73.5 ±4.8 years) elderly community-dwelling subjects using short-axis cardiac cine magnetic resonance imaging and 24-h ambulatory BP monitoring. Mean night-time BPs were calculated from the average of readings during sleep and mean daytime BPs were calculated from the remaining recordings. The hypertensive subjects were all receiving anti-hypertensive therapy with angiotensin-converting enzyme (ACE) inhibitors, calcium-channel blockers, beta-blockers or diuretics. Nocturnal systolic BP was a strong predictor of LVMI in both normotensive ( β = 0.38, p = 0.02) and treated hypertensive ( β = 0.39, p = 0.03) subjects. By contrast, daytime systolic BP was a weaker predictor of LVMI in the treated hypertensives ( β = 0.36, p = 0.04) and did not predict LVMI in the normal subjects ( β = 0.27, NS). Nocturnal BP may partly explain the increase in LVMI with ageing in subjects thought to be normotensive on the basis of daytime clinic BP recordings.