02695nas a2200349 4500008004100000022001400041245018200055210006900237260001300306300001100319490000700330520167100337653000902008653002202017653003002039653002102069653002002090653002102110653001102131653001102142653000902153653002402162653001702186653001802203100001502221700001102236700001702247700001602264700001702280700001302297856003502310 1992 eng d a0895-435600aAssessing the use of medications in the elderly: methods and initial experience in the Cardiovascular Health Study. The Cardiovascular Health Study Collaborative Research Group.0 aAssessing the use of medications in the elderly methods and init c1992 Jun a683-920 v453 a

The Cardiovascular Health Study (CHS), a cohort study of risk factors for coronary heart disease and stroke, recruited 5201 community-dwelling adults aged 65 years or older. To assess the prevalence of medication use at baseline, we used the method of medication inventory and transcribed information about drug names and doses from prescription bottles. Using a specially-written computer program, persons without a knowledge of drug nomenclature coded 10,511 (89%) of the 11,846 medicines entered. We compared the results of the medication inventory and answers to questions on specific medications for reliability and validity. The use of beta-blockers and beta-agonists assessed by the method of medication inventory, but not by the method of directed recall, was associated with a significant effect on mean heart rate. Among 5197 participants with medication data, 76.1% were taking at least one medicine, and the mean number of drugs per person was 2.28. Among those with a reported history of high blood pressure, participants with cardiovascular disease (CVD) were more likely to be treated, and they were more likely to be taking beta-blockers and calcium-channel blockers than those without CVD. Daily aspirin use was also more common among those with CVD (30.5% of women and 43.2% of men) than among those without CVD (14.0% of women and 14.0% of men). The prevalence of post-menopausal estrogen use differed significantly among the four clinical centers (range = 5.5%-22.5% of women). We conclude that this method of assessing medications was easy to use and provided estimates of exposure to drugs that may affect risk of cardiovascular disease.

10aAged10aAged, 80 and over10aCerebrovascular Disorders10aCoronary Disease10aData Collection10aDrug Utilization10aFemale10aHumans10aMale10aProspective Studies10aRisk Factors10aUnited States1 aPsaty, B M1 aLee, M1 aSavage, P, J1 aRutan, G, H1 aGerman, P, S1 aLyles, M uhttps://chs-nhlbi.org/node/84803340nas a2200361 4500008004100000022001400041245011200055210006900167260001300236300001100249490000700260520237100267653000902638653001002647653001302657653001502670653001102685653001802696653001102714653002902725653000902754653002602763653002802789653001502817653001702832100001602849700001702865700001502882700001802897700001302915700001502928856003502943 1992 eng d a0194-911X00aOrthostatic hypotension in older adults. The Cardiovascular Health Study. CHS Collaborative Research Group.0 aOrthostatic hypotension in older adults The Cardiovascular Healt c1992 Jun a508-190 v193 a

The purpose of the present study was to assess the prevalence of orthostatic hypotension and its associations with demographic characteristics, cardiovascular risk factors and symptomatology, prevalent cardiovascular disease, and selected clinical measurements in the Cardiovascular Health Study, a multicenter, observational, longitudinal study enrolling 5,201 men and women aged 65 years and older at initial examination. Blood pressure measurements were obtained with the subjects in a supine position and after they had been standing for 3 minutes. The prevalence of asymptomatic orthostatic hypotension, defined as 20 mm Hg or greater decrease in systolic or 10 mm Hg or greater decrease in diastolic blood pressure, was 16.2%. This prevalence increased to 18.2% when the definition also included those in whom the procedure was aborted due to dizziness upon standing. The prevalence was higher at successive ages. Orthostatic hypotension was associated significantly with difficulty walking (odds ratio, 1.23; 95% confidence interval, 1.02, 1.46), frequent falls (odds ratio, 1.52; confidence interval, 1.04, 2.22), and histories of myocardial infarction (odds ratio, 1.24; confidence interval, 1.02, 1.50) and transient ischemic attacks (odds ratio, 1.68; confidence interval, 1.12, 2.51). History of stroke, angina pectoris, and diabetes mellitus were not associated significantly with orthostatic hypotension. In addition, orthostatic hypotension was associated with isolated systolic hypertension (odds ratio, 1.35; confidence interval, 1.09, 1.68), major electrocardiographic abnormalities (odds ratio, 1.21; confidence interval, 1.03, 1.42), and the presence of carotid artery stenosis based on ultrasonography (odds ratio, 1.67; confidence interval, 1.23, 2.26). Orthostatic hypotension was negatively associated with weight. We conclude that orthostatic hypotension is common in the elderly and increases with advancing age. It is associated with cardiovascular disease, particularly those manifestations measured objectively, such as carotid stenosis. It is associated also with general neurological symptoms, but this link may not be causal. Differences in prevalence of and associations with orthostatic hypotension in the present study compared with others are largely attributed to differences in population characteristics and methodology.

10aAged10aAging10aDementia10aDemography10aFemale10aHealth Status10aHumans10aHypotension, Orthostatic10aMale10aMultivariate Analysis10aNervous System Diseases10aPrevalence10aRisk Factors1 aRutan, G, H1 aHermanson, B1 aBild, D, E1 aKittner, S, J1 aLaBaw, F1 aTell, G, S uhttps://chs-nhlbi.org/node/84102348nas a2200277 4500008004100000022001400041245005200055210005100107260001300158300001000171490000700181520163800188653000901826653001901835653003301854653001901887653001301906653001101919653002401930653001201954100001801966700001601984700001702000700001702017856003602034 1993 eng d a0194-911X00aProperties of the random zero sphygmomanometer.0 aProperties of the random zero sphygmomanometer c1993 May a632-70 v213 a

The random zero sphygmomanometer is widely used in studies involving blood pressure measurement because it is believed to eliminate digit preference and reduce measurement error. We performed blood pressure measurements sequentially using random zero and standard sphygmomanometers in random order in 1,356 participants in the Cardiovascular Health Study. Despite adherence to the manufacturer's instructions, we observed a substantially nonuniform distribution of zero levels generated by the random zero sphygmomanometer and a disturbing correlation between the zero level and blood pressures taken with the standard sphygmomanometer. With the random zero device, the pooled estimated slopes for the regression of standard systolic and diastolic pressures on the zero level were -0.71 and -0.17, respectively (both p < 0.0001). The only plausible explanation for this relation between the random zero device and the standard device is that by some unknown mechanism the subject's blood pressure is influencing the zero level. Systolic and diastolic blood pressures measured with the random zero device were, respectively, 1.65 and 1.84 mm Hg lower (both p < 0.0001) than standard blood pressures. Digit preference was detectable in the uncorrected blood pressure and zero level measured with the random zero device but was eliminated after calculation of the corrected blood pressure. For most epidemiological studies, the random zero sphygmomanometer offers no significant advantage over the standard sphygmomanometer. It may still be useful in those epidemiological studies and clinical trials where blinding is important.

10aAged10aBlood Pressure10aBlood Pressure Determination10aCohort Studies10aDiastole10aHumans10aRegression Analysis10aSystole1 aKronmal, R, A1 aRutan, G, H1 aManolio, T A1 aBorhani, N O uhttps://chs-nhlbi.org/node/144702942nas a2200373 4500008004100000022001400041245016600055210006900221260001300290300001000303490000700313520187400320653000902194653002202203653001002225653001902235653001902254653002102273653001102294653001902305653001102324653003402335653000902369653002402378653001802402100001502420700001602435700001802451700001502469700001602484700001502500700001702515856003602532 1994 eng d a0194-911X00aCorrelates of blood pressure in community-dwelling older adults. The Cardiovascular Health Study. Cardiovascular Health Study (CHS) Collaborative Research Group.0 aCorrelates of blood pressure in communitydwelling older adults T c1994 Jan a59-670 v233 a

Although elevated blood pressure is an important predictor of cardiovascular disease and stroke in the elderly, little information exists on the distribution and risk factor correlates of blood pressure in this group. As part of the Cardiovascular Health Study, a population-based cohort study of 5201 men and women aged 65 to 101 years, we investigated correlates of systolic and diastolic blood pressure. Multiple regression analyses were conducted for all participants and a subgroup of 2482 without coronary heart disease and not on antihypertensive therapy (the "healthier" subgroup). In the total group, independent predictors of diastolic blood pressure included heart rate, aortic root dimension, creatinine, hematocrit, alcohol use, and black race (positive associations) and internal carotid artery wall thickness, mitral early/late peak flow velocity, white blood cell count, cigarette smoking, and age (negative associations). Positive predictors of systolic blood pressure included mitral late peak flow velocity, left ventricular mass, common carotid artery wall thickness, serum albumin, factor VII, diabetes, alcohol use, and age; negative predictors were coronary heart disease, uric acid, height, and smoking. In the healthier subgroup, positive predictors of diastolic blood pressure included heart rate, hematocrit, serum albumin, creatinine, and body weight, whereas mitral early/late peak flow velocity, serum potassium, smoking, and age inversely related to diastolic pressure. For the same group, common carotid artery wall thickness, left ventricular mass, serum albumin, factor VII, high-density lipoprotein cholesterol, and age were directly related to systolic blood pressure, whereas serum potassium was inversely related. Both systolic and diastolic pressures varied considerably by geographic site.(ABSTRACT TRUNCATED AT 250 WORDS)

10aAged10aAged, 80 and over10aAging10aBlood Pressure10aCohort Studies10aCoronary Disease10aFemale10aHealth Surveys10aHumans10aHypertrophy, Left Ventricular10aMale10aRegression Analysis10aUnited States1 aTell, G, S1 aRutan, G, H1 aKronmal, R, A1 aBild, D, E1 aPolak, J, F1 aWong, N, D1 aBorhani, N O uhttps://chs-nhlbi.org/node/143703221nas a2200385 4500008004100000022001400041245015700055210006900212260001600281300001100297490000800308520208200316653000902398653002802407653002902435653003702464653002802501653001102529653001102540653001702551653000902568653003502577653001802612100001502630700001902645700001602664700001502680700001702695700001802712700001702730700001602747700002002763700001602783856003602799 1995 eng d a0098-748400aTemporal patterns of antihypertensive medication use among older adults, 1989 through 1992. An effect of the major clinical trials on clinical practice?0 aTemporal patterns of antihypertensive medication use among older c1995 May 10 a1436-80 v2733 a

OBJECTIVE: To describe the changing patterns of antihypertensive medication use in the years immediately before and after the publication of the results of three major clinical trials of the treatment of hypertension in older adults.

DESIGN: In this cohort study, adults 65 years or older were examined annually on four occasions between June 1989 and May 1992, and the use of antihypertensive medications was assessed by inventory at each visit. The four visits defined the boundaries of three study periods. For each study period, participants receiving antihypertensive therapy were either continuous users (n = 1667, 1643, and 1605, respectively) or starters (n = 157, 142, 120) of hypertensive therapy. The large clinical trials that convincingly proved the efficacy and safety of low-dose diuretic therapy in older adults were published during the latter parts of period 2 and the early parts of period 3.

RESULTS: Among starters, the proportion initiating therapy on diuretics increased from 35.9% in period 2 to 47.5% in period 3, significantly so among women (P = .04). The proportions initiating other drugs displayed no significant trends. Among continuous users, the use of diuretics, beta-blockers, and vasodilators generally decreased over the 3-year period, while the use of calcium channel blockers and angiotensin-converting enzyme inhibitors increased significantly in each of the three periods (P < .05). The decline of 2.7% in the prevalence of diuretic use in period 1 abated during period 2 (1.8% decline), and it slowed significantly (P = .03) to almost a complete halt during period 3 (0.2% decline). The rate of increase in the use of calcium channel blockers slowed significantly (P = .01) between period 1 (+6.7%) and period 3 (+2.8%).

CONCLUSIONS: Although other factors such as cost may have been important, the temporal trends in antihypertensive drug therapy coincided in time with and may have reflected in part the influence of the major clinical trials on the patterns of clinical practice.

10aAged10aAntihypertensive Agents10aClinical Trials as Topic10aData Interpretation, Statistical10aDrug Utilization Review10aFemale10aHumans10aHypertension10aMale10aPractice Patterns, Physicians'10aUnited States1 aPsaty, B M1 aKoepsell, T, D1 aYanez, N, D1 aSmith, N L1 aManolio, T A1 aHeckbert, S R1 aBorhani, N O1 aGardin, J M1 aGottdiener, J S1 aRutan, G, H uhttps://chs-nhlbi.org/node/141802751nas a2200373 4500008004100000022001400041245016800055210006900223260001300292300001100305490000700316520167800323653000902001653001902010653002702029653002802056653002102084653001102105653002102116653001102137653001702148653000902165653001802174653001702192100001602209700001802225700001502243700001702258700001702275700001602292700001602308700001702324856003602341 1996 eng d a0039-249900aCompensatory increase in common carotid artery diameter. Relation to blood pressure and artery intima-media thickness in older adults. Cardiovascular Health Study.0 aCompensatory increase in common carotid artery diameter Relation c1996 Nov a2012-50 v273 a

BACKGROUND AND PURPOSE: Common carotid artery (CCA) diameter is thought to increase as a consequence of hypertension and may increase as the thickness of the arterial wall increases. The purpose of this study was to determine CCA dimensions and correlate them with clinical features.

METHODS: We performed a cross-sectional, community-based study of adults 65 years of age and older, measuring inner and outer diameter of the CCA in vivo with carotid sonography. Findings were correlated against risk factors for atherosclerosis, CCA intima-media thickness (IMT), and echocardiographically determined left ventricular (LV) mass.

RESULTS: Independent variables showing strong positive associations with outer and inner CCA diameter included age, male sex, height, weight, and systolic blood pressure. As an independent variable, LV mass (r = .40 and r = .37, respectively; P < .00001) had a strong positive relation to inner and outer CCA diameters. The relationship between diameter and IMT was different. In a model that controlled for age, sex, and estimated LV mass, an increase of 1 mm in CCA IMT corresponded to a 1.9 mm increase in the outer diameter of the artery (P < .00001) but was not significantly related to the inner diameter (slope = +0.07 mm; P = .26).

CONCLUSIONS: Increase in the outer diameter of the CCA is associated with subject size, sex, age, echocardiographically estimated LV mass, and CCA IMT. Increases in internal diameter of the CCA have similar relationships but are not related to IMT. This supports the hypothesis that the human CCA dilates as the thickness of the artery wall increases.

10aAged10aBlood Pressure10aCarotid Artery, Common10aCross-Sectional Studies10aEchocardiography10aFemale10aHeart Ventricles10aHumans10aHypertension10aMale10aTunica Intima10aTunica Media1 aPolak, J, F1 aKronmal, R, A1 aTell, G, S1 aO'Leary, D H1 aSavage, P, J1 aGardin, J M1 aRutan, G, H1 aBorhani, N O uhttps://chs-nhlbi.org/node/146602719nas a2200301 4500008004100000022001400041245009800055210006900153260001300222300001200235490000700247520191200254653000902166653002802175653001902203653001502222653001102237653001102248653000902259100001502268700001502283700001802298700001902316700001602335700001602351700001402367856003602381 1997 eng d a0895-706100aThe association of antihypertensive medication with serum creatinine changes in older adults.0 aassociation of antihypertensive medication with serum creatinine c1997 Dec a1368-770 v103 a

Many of the potential effects of antihypertensive therapy, including renal function, have been inadequately investigated in clinical trials in older adults. In an observational study, we examined the association between treatment with various classes of antihypertensive agents and 3-year changes in serum creatinine in 1296 older adults with treated hypertension and without prior renal disease (mean age 72.2 years; 60% female; 30% diabetic; 42% with cardiovascular disease (CVD)) from the Cardiovascular Health Study. Baseline antihypertensive medications included thiazides (HCT), beta-adrenergic blockers, angiotensin converting enzyme inhibitors (ACE-I), calcium channel blockers (CCB), vasodilators (VAS), HCT + BB, HCT + ACE-I, HCT + CCB, HCT + VAS, loop diuretics (LOOP), and other combinations. Unadjusted results indicated that minimal changes in mean serum creatinine occurred over time for all therapies and only a few changes were statistically significant (HCT: +0.02 mg/dL, ACE-I: +0.04, CCB: +0.04; all P < .05; LOOP: +0.06 mg/dL; P < .001). In multivariate analyses with HCT users as the reference group and adjusting for baseline serum creatinine, age, sex, smoking, diabetes mellitus, CVD, height, weight, common carotid intima-media thickness, and use of allopurinol, phenytoin, cimetidine, and nonsteroidal antiinflammatory drugs, all of the relative changes were small and statistically nonsignificant except for HCT + VAS users (+0.07 mg/dL; P < .05). When users of the same therapy at baseline and follow-up were restricted, only LOOP users had significant albeit small changes in serum creatinine (+0.05 mg/dL; P < .05). Although results from clinical trials are needed to confirm these findings, these observational data suggest no major differences between specific antihypertensive therapies in 3-year serum creatinine changes in older adults without prior renal disease.

10aAged10aAntihypertensive Agents10aCohort Studies10aCreatinine10aFemale10aHumans10aMale1 aSmith, N L1 aPsaty, B M1 aHeckbert, S R1 aLemaitre, R, N1 aKates, D, M1 aRutan, G, H1 aBleyer, A uhttps://chs-nhlbi.org/node/1493