Hypertension, the decline of activities of daily living (ADL) and frailty

Association between central obesity and ADL impairment among the middle-aged and elderly population in China based on CHARLS

To explore the associations of central obesity indicators including waist circumference (WC), waist-to-height ratio (WHtR), and weight-adjusted waist index (WWI) with the impairment of basic activities of daily living (BADL) and instrumental activities of daily living (IADL) among middle-aged and elderly population in China. This prospective study used baseline data from 2011 and follow-up data, involving 6440 and 9646 participants, respectively. Binary logistic regression analysis was used to assess the relationships. Restricted cubic spline (RCS) curve was also used to analyze the correlation trends. Stratified analyses were performed to identify potential differences. Receiver operating characteristic curves were plotted to evaluate the predictive value of each indicator. WC (OR = 1.01, 95% CI:1.01-1.02), WHtR (OR = 1.21, 95% CI = 1.09-1.33), and WWI (OR = 1.10, 95% CI:1.02-1.19) were significantly associated with BADL impairment. Only WWI (OR = 1.16, 95%CI:1.09-1.23) was associated with IADL impairment. WC, WHtR and WWI were linearly associated with BADL impairment while WWI was linearly associated with IADL impairment. The risk association between WWI and BADL was stronger in drinking individuals and males. In the participants with a BMI less than 24 kg/m² and who had received a high school education or above, the increase in WWI was accompanied by a more significant risk of IADL impairment. The predictive ability of WWI is higher than that of WC and WHtR, with AUC values of 0.597 and 0.615. WWI, as a comprehensive indicator of central obesity, may be useful in comprehensively identifying the risk of early daily living activity impairment among middle-aged and elderly population.

Current issues in frailty and hypertension management

The significance of hypertension management in older individuals is greatly influenced by factors other than chronological age, as they have diverse physical, mental, and social backgrounds. Differences in physical functions, between independence, frailty and dependence, have a great impact on antihypertensive therapy in the older population. While recent clinical trials support the significance of intensive antihypertensive therapy regardless of age, there is little evidence to positively support the significance of antihypertensive therapy for older patients with physical function requiring nursing care, and observational studies suggest that antihypertensive treatment may instead be harmful in these older patients. Therefore, frailty, the transitional state between independence and dependence with the need for nursing care, is conceivable to be the tipping point at which the balance of risks and benefits of antihypertensive treatment is converted. The increased risk of acute adverse outcome is another issue that complicates management in the practice of hypertension treatment in frail patients. Particularly, increased blood pressure variability manifested by orthostatic hypotension in frail patients can induce fall and fracture leading to disability shortly after initiation or modification of antihypertensive treatment. Future challenges to optimize the management of frail hypertensive patients include developing techniques to estimate treatment efficacy, identifying safe antihypertensive regimens that reduce the risk of falls, and establishing strategies to restore frail patients to robust health.

Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19

The coronavirus disease 2019 (COVID-19) affects infected patients even after the acute phase and impairs their health and quality of life by causing a wide variety of symptoms, referred to as long COVID. Although the evidence is still insufficient, hypertension is suspected to be a potential risk factor for long COVID, and the occurrence of cardiovascular diseases seems to be a key facet of multiple conditions observed in long COVID. Nonetheless, there are few reports that comprehensively review the impacts of long COVID on hypertension and related disorders. As a sequel to our previous report in 2020 which reviewed the association of COVID-19 and hypertension, we summarize the possible influences of long COVID on hypertension-related organs, including the cardiovascular system, kidney, and endocrine system, as well as the pathophysiological mechanisms associated with the disorders in this review. Given that the clinical course of COVID-19 is highly affected by age and sex, we also review the impacts of these factors on long COVID. Lastly, we discuss areas of uncertainty and future directions, which may lead to better understanding and improved prognosis of clinical problems associated with COVID-19.

The relationship between changes in exercise habits and psychosomatic activities in older hypertensive patients during the COVID-19 pandemic

We conducted a one-year follow-up study to determine the temporal change in exercise habits and the related factors during the COVID-19 pandemic in older hypertensive patients. A total of 190 patients were 76.1 ± 5.7 years, and 44.7% (n = 85) were male. One-hundred fifty-one and 138 patients had exercise habits at baseline and a year later, respectively (p = 0.053). We categorized patients based on the change in exercise habits (at baseline/a year later): Group A: +/+ (n = 122); Group B: +/- (n = 29); Group C: -/+ (n = 16); and Group D: -/- (n = 23). In women, the geriatric depression scale and the incidence of falls in a year were higher in group B (n = 18) than (n = 61) in group A. Such a trend was not observed in men. In conclusion, although exercise habit in older hypertensive patients was well-maintained in our survey, reduced physical activity was associated with depression and risk of fall only in women.