Mortality in Elderly Patients Taking Furosemide: Prospective Cohorts Study

Objectives

Low blood pressure (BP) has been proposed as a risk factor of death in elderly patients. However, this association could be partially accounted for by the deleterious effects of BP-lowering drugs. We analyzed whether these drugs are associated to an increased risk of death in elderly patients taking multiple potential confounders into account.

Design

This is a prospective cohort study. Setting and Participants. Probabilistic sample of 772 community-dwelling patients aged >65 years living in Spain, who were appointed for an initial clinical visit and followed up through telephone calls 4, 6, 9, 12, and 60 months afterwards.

Methods

At baseline visit, BP was measured using standardized methods, and BP medications and risk factors of death in elderly patients (BMI, oxygen saturation, toxic habits, comorbidity, muscular strength, and functional and cognitive capacity) were collected. During the follow-up, the vital status of patients and the date of death were ascertained.

Results

During a median 5-year follow-up, 226 all-cause deaths occurred among the 686 participants included in the analysis. In a Cox regression model that included all the BP drug classes, diuretics and nitrites were significantly associated with mortality (p < 0.005). Within diuretics, furosemide was found to be responsible for the association of the group. In multivariable Cox regression models adjusted for BP and the rest of the mortality risk factors, furosemide remained as the only BP drug that was independently associated with mortality (hazard ratio 2.34; p < 0.01).

Conclusions

Furosemide was prospectively associated with increased mortality in older people. If confirmed, this drug should be taken into account by prescribers and considered a confounder in BP studies.

The Impact of Glucocorticoid Therapy on Guideline-Directed Medical Treatment Titration in Patients Hospitalized for Heart Failure with Low Blood Pressure: A Retrospective Study

Background

Positive inotropic and renal protective actions of glucocorticoids have been observed clinically. Therefore, glucocorticoids may be used in patients with heart failure and low blood pressure (HF-LBP).

Methods

The medical records of 144 consecutive patients with HF-LBP who received glucocorticoids as an adjunctive treatment to facilitate the up-titration of β-blocker and angiotensin-converting enzyme inhibitor were reviewed.

Results

After four weeks of treatment, the metoprolol and captopril (or equivalent) dosages were progressively and consistently increased from 25 (interquartile range [IQR] = 12.5-75 mg/day) to 100 mg/day (IQR = 50-178.8 mg/day) and from 0 (IQR = 0-25 mg/day) to 12.5 mg/day (IQR = 0-50 mg/day), respectively. There was a remarkable beneficial hemodynamic response to the glucocorticoid treatment signified by an increase in blood pressure and decrease in heart rate. The average heart rate decreased by 6 beat per minute (bpm) (0.5-16 bpm), and the mean arterial blood pressure increased from 74.06 ± 7.81 to 78.85 ± 7.91 mmHg. We also observed an improvement in renal function and an increased diuretic response following glucocorticoid treatment. As a result, the left ventricular ejection fraction increased from 28.92 ± 8.06% to 33.86 ± 8.76%, and the diuretic response increased from 776.7 mL/40 mg furosemide (IQR = 133.8-2000 mL) to 4000 mL/40 mg furosemide on day 28 (IQR = 2200-5925 mL).

Conclusion

The use of glucocorticoid treatment to maintain hemodynamic and renal functional targets when titrating guideline-directed medical treatment in patients with HF-LBP may be safe, effective, and feasible.

Frailty Syndrome among oldest old Individuals, aged ≥80 years: Prevalence & Correlates

OBJECTIVES

Objectives were to study prevalence of frailty among Indian oldest old population, and to detect its correlates.

METHODS

A cross sectional community based study was done including 200 healthy participants aged ≥80 years, randomly sampled from Hyderabad city in India. They completed an administered questionnaire and physical function tests including SPPB, grip strength. Cognitive function was assessed using MMSE and depression using GDS. Blood pressure, haemoglobin, and fasting blood sugar were measured for all participants. Frailty was defined using Fried phenotype criteria. Logistic regression was done to identify independently associated correlates.

RESULTS

The prevalence of frailty syndrome was 83.4% in our study population. Frailty among men was 80.3% and among women was 84.7%, and it increased with increasing age. The independent correlates which increased the odds of frailty were poor physical performance (SPPB) (OR: 4.21; 95% CI: 1.12-15.83), depression (OR: 3.35; 95% CI: 1.29-8.73), chronic joint pains (OR: 4.90; 95% CI: 1.97-12.18) and COPD (OR: 3.01; 95% CI: 1.03- 8.78), while hypertension showed inverse association (OR: 0.33;95% CI: 0.11-0.94).

CONCLUSION

The prevalence of frailty among the oldest old is very high. Geriatric medicine protocols must include routine screening for frailty, while also including early detection of poor physical performance, depression, COPD and osteoarthritis.

Biomarkers versus traditional risk factors to predict cardiovascular events in very old adults: cross-validated prospective cohort study

OBJECTIVES

To test new cardiovascular (CV) risk models in very old adults with and without a history of CV disease (CVD), based on traditional risk factors and biomarkers.

DESIGN

Cross-validated prospective cohort study. The models were tested in the BELFRAIL Study and externally validated in the Leiden 85-plus Study.

SETTING

General practice, Belgium and The Netherlands.

PARTICIPANTS

The BELFRAIL cohort consisted of 266 patients aged 80 years or older without a history of CVD and 260 with a history of CVD. The Leiden 85-plus Study consisted of 264 patients aged 85 years without a history of CVD and 282 with a history of CVD.

OUTCOME MEASURES

The model with traditional risk factors and biomarkers, as well as the model using only biomarkers, was compared with the model with only traditional risk factors to predict 3-year CV morbidity and mortality. A competing-risk analysis was performed, and the continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI) and net benefit were used to compare the predictive value of the different models.

RESULTS

Traditional risk factors poorly predicted CV mortality and morbidity. In participants without a history of CVD, adding N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) improved the prediction (NRI 0.56 (95% CI 0.16 to 0.99) and relative IDI 4.01 (95% CI 2.19 to 6.28)). In participants with a history of CVD, the NRI with the addition of NT-pro-BNP and high-sensitivity C reactive protein was 0.38 (95% CI 0.09 to 0.70), and the relative IDI was 0.53 (95% CI 0.23 to 0.90). Moreover, in participants without a history of CVD, NT-pro-BNP performed well as a stand-alone predictor (NRI 0.32 (95% CI -0.12 to 0.74) and relative IDI 3.44 (95% CI 1.56 to 6.09)).

CONCLUSIONS

This study tested new risk models to predict CV morbidity and mortality in very old adults. Especially, NT-pro-BNP showed a strong added predictive value. This opens perspectives for clinicians who are in need of an easily applicable strategy for CV risk prediction in very old adults.

Frailty in Chinese older adults with hypertension: Prevalence, associated factors, and prediction for long-term mortality

Hypertension and frailty are associated and often coexist in older adults. Few studies have examined the association between hypertension and frailty in Chinese population. We explored the prevalence of and the factors associated with frailty as well as whether frailty could identify patients at risk of adverse outcomes among older adults with hypertension. Data were from the Beijing Longitudinal Study of Aging. A total of 1111 hypertensive participants aged ≥60 years old who completed the comprehensive geriatrics assessment were included. All participants were followed up for 8 years. The total number of deaths was 604. Frailty was assessed by the 68-item frailty index. Stepwise forward logistic regression was used to explore the association between the associated factors and frailty in hypertensive participants. The prediction for mortality was assessed using the adjusted Cox proportional hazards model. Two hundred and eighteen older adults were determined as frail (prevalence rate: 19.6%). Frail older adults with hypertension had worse physical performance, worse psychological, and social function, as well as worse lifestyle habits, compared to nonfrail older adults with hypertension. Chair stand test failure, balance test failure, fracture, disability, depression, and physical frailty measured with modified frailty phenotype were independently associated with frailty. Frailty was associated with a higher 8-year mortality, hazard ratio (HR) = 3.40, adjusted for age and sex, HR = 2.61. Frailty is associated with poorer physical function and higher mortality in community-dwelling hypertensive older adults in China. These findings emphasize the importance and need for frailty intervention and prevention in older adults with hypertension.

Screening and treatment of hypertension in older adults: less is more?

Screening and treatment of hypertension is a cornerstone of cardiovascular disease (CVD) prevention. Hypertension causes a large proportion of cases of stroke, coronary heart disease, heart failure, and associated disability and is highly prevalent especially among older adults. On the one hand, there is robust evidence that screening and treatment of hypertension prevents CVD and decreases mortality in the middle-aged population. On the other hand, among older adults, observational studies have shown either positive, negative, or no correlation between blood pressure (BP) and cardiovascular outcomes. Furthermore, there is a lack of high quality evidence for a favorable harm-benefit balance of antihypertensive treatment among older adults, especially among the oldest-old (i.e., above the age of 80 years), because very few trials have been conducted in this population. The optimal target BP may be higher among older treated hypertensive patients than among middle-aged. In addition, among frail or multimorbid older individuals, a relatively low BP may be associated with worse outcomes, and antihypertensive treatment may cause more harm than benefit. To guide hypertension screening and treatment recommendations among older patients, additional studies are needed to determine the most efficient screening strategies, to evaluate the effect of lowering BP on CVD risk and on mortality, to determine the optimal target BP, and to better understand the relationship between BP, frailty, multimorbidity, and health outcomes.

Management of hypertension in older people

INTRODUCTION

As the population ages, the prevalence of hypertension is increasing. Treatment of hypertension is associated with a reduction in cardiovascular risk. However, the optimal blood pressure targets in older people are not clearly defined due to paucity of randomised clinical trials specific to this age group.

AREAS COVERED

We performed a Medline and Embase search from 1998 to present for articles on the management of hypertension in older people published in English language.

EXPERT COMMENTARY

The recent guidelines have suggested a lower blood pressure target of less than 130/80 mmHg. Due to the heterogeneity of older people, this universal low target may not be applicable to all of them. Targets based on functional level rather than chronological age are more appropriate. Special considerations in older people such as increased prevalence of frailty, falls, dementia, polypharmacy and the predominance of isolated systolic hypertension should also be taken into account. Tighter control, if well tolerated, is suitable for the fit person but relaxed targets are more reasonable in individuals with physical or cognitive decline. Therefore, in older people, targets should be individualised putting quality, rather than quantity, of life at the heart of their care plans.

Revisiting the association of blood pressure with mortality in oldest old people in China: community based, longitudinal prospective study

OBJECTIVE

To examine the associations of blood pressure with all cause mortality and cause specific mortality at three years among oldest old people in China.

DESIGN

Community based, longitudinal prospective study.

SETTING

2011 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey, conducted in 22 Chinese provinces.

PARTICIPANTS

4658 oldest old individuals (mean age 92.1 years).

MAIN OUTCOME MEASURES

All cause mortality and cause specific mortality assessed at three year follow-up.

RESULTS

1997 deaths were recorded at three year follow-up. U shaped associations of mortality with systolic blood pressure, mean arterial pressure, and pulse pressure were identified; values of 143.5 mm Hg, 101 mm Hg, and 66 mm Hg conferred the minimum mortality risk, respectively. After adjustment for covariates, the U shaped association remained only for systolic blood pressure (minimum mortality risk at 129 mm Hg). Compared with a systolic blood pressure value of 129 mm Hg, risk of all cause mortality decreased for values lower than 107 mm Hg (from 1.47 (95% confidence interval 1.01 to 2.17) to 1.08 (1.01 to 1.17)), and increased for values greater than 154 mm Hg (from 1.08 (1.01 to 1.17) to 1.27 (1.02 to 1.58)). In the cause specific analysis, compared with a middle range of systolic blood pressure (107-154 mm Hg), higher values (>154 mm Hg) were associated with a higher risk of cardiovascular mortality (adjusted hazard ratio 1.51 (95% confidence interval 1.12 to 2.02)); lower values (<107 mm Hg) were associated with a higher risk of non-cardiovascular mortality (1.58 (1.26 to 1.98)). The U shaped associations remained in sensitivity and subgroup analyses.

CONCLUSIONS

This study indicates a U shaped association between systolic blood pressure and all cause mortality at three years among oldest old people in China. This association could be explained by the finding that higher systolic blood pressure predicted a higher risk of death from cardiovascular disease, and that lower systolic blood pressure predicted a higher risk of death from non-cardiovascular causes. These results emphasise the importance of revisiting blood pressure management or establishing specific guidelines for management among oldest old individuals.

High Sensitivity Cardiac Troponin T and Cognitive Function in the Oldest Old: The Leiden 85-Plus Study

BACKGROUND

Impaired cardiac function has been related to accelerated cognitive decline in late-life.

OBJECTIVE

To investigate whether higher levels of high sensitivity cardiac troponin T (hs-cTnT), a sensitive marker for myocardial injury, are associated with worse cognitive function in the oldest old.

METHODS

In 455 participants of the population-based Leiden 85-plus Study, hs-cTnT was measured at 86 years. Cognitive function was measured annually during four years with the Mini-Mental State Examination (MMSE).

RESULTS

Participants in the highest gender-specific tertile of hs-cTnT had a 2.0-point lower baseline MMSE score than participants in the lowest tertile (95% confidence interval (CI) (95% CI 0.73-3.3), and had a 0.58-point steeper annual decline in MMSE during follow-up (95% CI 0.06-1.1). The associations remained after adjusting for sociodemographic and cardiovascular risk factors excluding those without a history of overt cardiac disease.

CONCLUSION

In a population-based sample of the oldest old, higher levels of hs-cTnT were associated with worse cognitive function and faster cognitive decline, independently from cardiovascular risk factors and a history of overt cardiac disease.

Association between Frailty and Hypertension Prevalence, Treatment, and Control in the Elderly Korean Population

Frailty is a common geriatric syndrome characterized by increased risk of disability, hospitalization, and mortality. Hypertension (HTN) is one of the most common chronic medical conditions in the elderly. However, there have been few studies regarding the association between frailty and HTN prevalence, treatment, and control rates. We analyzed data of 4,352 older adults (age ≥ 65 years) from the fifth Korea National Health and Nutrition Examination Survey. We constructed a frailty index based on 42 items and classified participants as robust, pre-frail, or frail. Of the subjects, 2,697 (62.0%) had HTN and 926 (21.3%) had pre-HTN. Regarding frailty status, 721 (16.6%), 1,707 (39.2%), and 1,924 (44.2%) individuals were classified as robust, pre-frail and frail, respectively. HTN prevalence was higher in frail elderly (67.8%) than pre-frail (60.8%) or robust elderly (49.2%) (P < 0.001). Among hypertensive patients, frail elderly were more likely to be treated than pre-frail or robust elderly (P < 0.001), but the proportion of patients whose blood pressure was under control ( < 150/90 mmHg) was lower in frail elderly (P = 0.005). Considering the adverse cardiovascular outcomes associated with frailty, more attention should be paid to the blood pressure control of the frail elderly.

Cardiovascular risk factors and inflammatory activity among centenarians with and without dementia

A better knowledge of the differences existing between individuals who maintain cognition up to 100 years of age or more and those of the same age who present dementia syndrome may be of help in understanding the dementia of the very elderly people. The aim of this study was to assess cardiovascular risk factors and inflammatory markers among centenarians with and without dementia. A population-based cross-sectional study was conducted on centenarians residing in a middle-size city. Volunteers were evaluated by comprehensive geriatric assessment at home. General laboratory examinations were performed and cardiovascular risk and inflammatory activity markers were determined. Mean subject age was 101 ± 2 years, and 82 % were women. Assessment of dementia syndrome revealed that 36.4 % of the centenarians had preserved cognition. Centenarians with dementia had lower schooling (p < 0.01), lower body mass index (p = 0.02) and higher homocysteine levels (p < 0.01) and tended to have a lower systolic blood pressure (p = 0.05). Regarding the markers of inflammatory activity, demented subjects had high levels of interleukin-6 (p < 0.01), high-sensitivity C-reactive protein (p = 0.02), and erythrocyte sedimentation rate (p = 0.01) and lower albumin levels (p = 0.02) compared to centenarians without dementia. Concluding, centenarians with preserved cognition had better nutritional status, lower homocysteinemia, tendency to higher blood pressure and lower inflammatory activity compared to demented subjects.

Temporal Relationship Between Cognitive and Physical Performance in Middle-Aged to Oldest Old People

Background

Cognitive and physical impairment frequently co-occur in older people. The aim of this study was to assess the temporal order of these age-related changes in cognitive and physical performance and to assess whether a relationship was different across specific cognitive and physical domains and age groups.

Methods

Cognitive domains included global, executive, and memory function; physical domains included gait speed and handgrip strength. These domains were assessed in two population-based longitudinal cohorts covering the age ranges of 55-64, 65-74, 75-85, and 85-90 years with a follow-up of 5-12 years. Cross-lagged panel models were applied to assess the temporal relationships between the different cognitive and physical domains adjusting for age, sex, education, comorbidity, depressive symptoms, and physical activity.

Results

Over all age groups, poorer executive function was associated with a steeper decline in gait speed (p < .05). From the age of 85 years, this relationship was found across all cognitive and physical domains (p < .02). From the age of 65 years, slower gait speed and/or weaker handgrip strength were associated with steeper declines in global cognitive function (p < .02), with statistically significant results across all cognitive domains in the age group of 75-85 years (p < .04).

Conclusions

The temporal relationship between cognitive and physical performance differs across domains and age, suggesting a specific rather than a general relationship. This emphasizes the importance of repeated measurements on different domains and encourages future research to the development of domain- and age-specific interventions.

New horizons: the management of hypertension in people with dementia

The optimal management of hypertension in people with dementia is uncertain. This review explores if people with dementia experience greater adverse effects from antihypertensive medications, if cognitive function is protected or worsened by controlling blood pressure (BP) and if there are subgroups of people with dementia for whom antihypertensive therapy is more likely to be harmful. Robust evidence is scant, trials of antihypertensive medications have generally excluded those with dementia. Observational data show changes in risk association over the life course, with high BP being a risk factor for cognitive decline in mid-life, while low BP is predictive in later life. It is therefore possible that excessive BP lowering in older people with dementia might harm cognition. From the existing literature, there is no direct evidence of benefit or harm from treating hypertension in people with dementia. So what practical steps can the clinician take? Assess capacity, establish patient preferences when making treatment decisions, use ambulatory monitoring to thoroughly assess BP, individualise and consider deprescribing where side effects (e.g. hypotension) outweigh the benefits. Future research might include pragmatic randomised trials of targeted deprescribing, which include patient-centred outcome measures to help support decision-making and studies to address mechanistic uncertainties.

Functional Status and Antihypertensive Therapy in Older Adults: A New Perspective on Old Data

BACKGROUND

Functional status may be useful for identifying older adults who benefit from lower blood pressure. We examined whether functional status modifies the effect of antihypertensive treatment among older adults.

METHODS

Post hoc analyses of the Systolic Hypertension in the Elderly Program (SHEP), a randomized trial of antihypertensive therapy vs. placebo (1985-1991) in 4,736 adults aged 60 years or older with isolated systolic hypertension. Outcomes were all-cause death, cardiovascular (CV) death, myocardial infarction (MI), stroke, falls, and symptoms of hypotension. The effect modifier of interest was functional status, assessed by self-reported physical ability limitation (PAL).

RESULTS

Among persons with no PAL, those receiving treatment had a lower rate of death, CV death, and MI compared with placebo (4.0, 2.9, and 4.2 per 1,000 person-years lower, respectively). In contrast, among persons with a PAL, those receiving treatment had a higher rate of death, CV death, and MI compared with placebo (8.6, 5.3, and 2.7 per 1,000 person-years higher, respectively). These patterns persisted in Cox models, although interaction terms did not reach statistical significance. Treatment remained protective for stroke regardless of functional status. The rate of falls associated with treatment differed by functional status; incidence-rate ratio = 0.81, 95% confidence interval (CI) = (0.66, 0.99), and 1.32, 95% CI = (0.87, 2.00) in participants without and with a PAL, respectively, in models adjusted for demographics and baseline blood pressure (P-value for interaction, 0.04).

CONCLUSIONS

Functional status may modify the effect of antihypertensive treatment on MI, mortality, and falls, but not stroke, in older adults. Functional status should be examined in other trial settings.

Age-Dependent Impact of Medication Underuse and Strategies for Improvement

Background: Medication underuse is common in aging populations and, because of the growing risk for competing deaths, the benefit of preventive medicines gradually vanishes with advancing age, thus limiting their success. Objective: To estimate the optimum time of initiation of the secondary prevention of cardiovascular events, we examined the impact of appropriate pharmacotherapy for different starting ages at which it is implemented. Methods: In the competing risk framework, we obtained the population's life course from life tables, combined it with effect estimates quantifying the real-world effectiveness of secondary prevention, and compared the outcome of patients not receiving appropriate treatment (underuse) with those receiving preventive medicines that have demonstrated a reduction in the transition to serious cardiovascular events (START criteria). Starting at the age of 55 years, the population proportions of the distinct states of the framework were calculated for each year of chronological age in subgroups of appropriate treatment and underuse. These proportions were used over a follow-up period to estimate measures of treatment effectiveness and risks of underuse. Results: Despite increasing relative effectiveness with advancing age, benefits measured by patient-relevant endpoints, such as life years gained (LYG) or gained quality-adjusted life years (QALYs), markedly dropped after the starting age of 75 years, but even at an initiation age of 85 years, QALYs gained exceeded 1 year. Conclusion: Interventions targeting medication underuse may achieve considerable benefits at any stage of later life, while the benefit is probably largest if appropriate treatment is started before 75 years.

Blood pressure and 10-year mortality risk in the Milan Geriatrics 75+ Cohort Study: role of functional and cognitive status

BACKGROUND

Optimal blood pressure targets in older adults are controversial.

OBJECTIVE

to investigate whether the relation of blood pressure with mortality in older adults varies by age, functional and cognitive status.

DESIGN

longitudinal geriatric outpatient cohort.

SETTING

Milan Geriatrics 75+ Cohort Study.

SUBJECTS

One thousand five hundred and eighty-seven outpatients aged 75 years and over.

METHODS

The relations of systolic (SBP) and diastolic blood pressure (DBP) with mortality risk were analysed using Cox proportional hazards models. Blood pressure, Mini-Mental State Examination (MMSE) and Basic Activities of Daily Living (ADL) were assessed at baseline. All analyses were adjusted for socio-demographic factors, co-morbidities and medications.

RESULTS

One thousand and forty-six patients died during 10-year follow-up. The relationships of SBP and DBP with mortality risk were U-shaped; SBP of 165 mmHg and DBP of 85 mmHg were associated with the lowest mortality. Patients with SBP < 120 mmHg and patients with SBP 120-139 mmHg had 1.64-fold (95% confidence intervals, CI 1.21-2.23) and 1.32-fold (95% CI 1.10-1.60) higher mortality risk than patients with SBP 160-179 mmHg (P values 0.001 and 0.004, respectively). In patients with SBP below 180 mmHg, higher SBP was associated with lower mortality in patients with impaired ADL and MMSE but not in those with preserved ADL and/or MMSE (P for interaction 0.033). Age did not modify the correlation of SBP with mortality.

CONCLUSIONS

The correlations of SBP and DBP with mortality were U-shaped. Higher SBP is related to lower mortality in subjects with impaired ADL and MMSE. ADL and MMSE may identify older subjects who benefit from higher blood pressure.

Hypertension in the geriatric population: a patient-centered approach

Hypertension contributes greatly to adverse cardiovascular outcomes; the magnitude of this contribution increases with age. The most recent guideline has proposed raising the goal systolic blood pressure to less than 150 mm Hg among those over age 60; however, this recommendation is not endorsed by other organizations. There are multiple contributors to hypertension in the older individual, including increased vascular stiffness, salt sensitivity, and decreased baroreceptor responsiveness. Therapy in the hypertensive patient over age 60 should be individualized and account for patient's health, functional and cognitive status, comorbidities, frailty, and prognosis.

Mildly elevated blood pressure is a marker for better health status in Polish centenarians

The number of centenarians is projected to rise rapidly. However, knowledge of evidence-based health care in this group is still poor. Hypertension is the most common condition that leads to multiple organ complications, disability, and premature death. No guidelines for the management of high blood pressure (BP) in centenarians are available. We have performed a cross-sectional study to characterize clinical and functional state of Polish centenarians, with a special focus on BP. The study comprised 86 consecutive 100.9 ± 1.2 years old (mean ± SD) subjects (70 women and 16 men). The assessment included structured interview, physical examination, geriatric functional assessment, resting electrocardiography, and blood and urine sampling. The subjects were followed-up on the phone. Subjects who survived 180 days (83 %) as compared to non-survivors had higher systolic BP (SBP), diastolic BP (DPB), mean arterial pressure (MAP), pulse pressure (PP), higher mini-mental state examination, Barthel Index of Activities of Daily Living and Lawton Instrumental Activities of Daily Living Scale scores, higher serum albumin and calcium levels, and total iron-binding capacity, while lower serum creatinine, cystatin C, folate, and C-reactive protein levels. SBP ≥140 mm Hg, DBP ≥90 mm Hg, MAP ≥100 mm Hg, and PP ≥40 mm Hg were associated with higher 180-day survival probability. Results suggest that mildly elevated blood pressure is a marker for better health status in Polish centenarians.

Thyroid status and renal function in older persons in the general population

BACKGROUND

Prevalence estimates of thyroid dysfunction and chronic kidney disease both increase with age. The aim of this study was to investigate the cross-sectional association between low thyroid function and renal function in subjects aged 85 years and to assess whether a low thyroid function at age 85 years is associated with an accelerated decline in renal function during follow-up.

METHODS

We included 558 participants from the Leiden 85-plus Study. At baseline (age 85 y), TSH, free T4 (fT4), and free T3 levels were measured. Thyroid function groups were created using clinical cutoff values of TSH and fT4. Serum creatinine concentrations were determined at baseline and annually during a 5-year follow-up period. Estimated glomerular filtration rates (eGFRs) were calculated by means of the Modification of Diet in Renal Disease Study equation.

RESULTS

At baseline, subjects with higher levels of TSH and lower levels of fT4 and free T3 had lower renal function. Participants with hypothyroidism [mean 53.7 (2.0) mL/min per 1.73 m(2))] and subclinical hypothyroidism [55.7 (2.1) mL/min per 1.73 m(2)] had lower mean eGFRs (SE) than participants with normal thyroid function [59.5 (0.7) mL/min per 1.73 m(2)]; the highest eGFR was observed in participants with hyperthyroidism [eGFR 61.5 (3.1) mL/min per 1.73 m(2)] (P for trend = .004). There was no association between thyroid hormone levels at baseline and the change in renal function during follow-up.

CONCLUSIONS

Although low thyroid function was associated with lower renal function at age 85 years, an association between a low thyroid function and change in renal function over time was absent. Our findings question the causal relevance of the thyroid status for the deterioration of renal function in the oldest old.

Biomarkers of healthy ageing: expectations and validation

The challenge of devising a set of biomarkers capable of measuring the ageing rate in human subjects was articulated long ago. In recent years, progress in the basic biology of ageing suggests the realistic possibility of preventive or restaurative interventions that may extend healthy lifespan in mammals including human subjects. Specifically, frailty is being increasingly recognised as a clinically relevant syndrome that may be therapeutically addressed. This greatly enhances the need for sensitive and specific biomarkers of healthy ageing that are validated in both experimental animals and, importantly, in human subjects over the whole age range. Here, we will discuss the present challenges and requirements for biomarker validation in human subjects. We propose the central requirements for a validated biomarker of healthy ageing as: (i) better predictive power than chronological age for multiple dimensions of ageing; (ii) identification of the age range in which the marker is informative; (iii) establishment of sensitivity/specificity as indicators of its predictive power at the level of the individual; (iv) minimisation of methodological variation between laboratories.