03340nas 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/84102903nas a2200421 4500008004100000022001400041245011100055210006900166260001300235300001100248490000800259520175200267653002502019653000902044653001902053653002402072653003002096653002802126653001102154653001102165653002002176653000902196653001502205653003302220653002402253653000902277653001702286653001302303100001602316700001902332700001502351700001702366700001602383700001802399700001402417700001502431856003502446 1999 eng d a0002-934300aOral anticoagulation in patients with atrial fibrillation: adherence with guidelines in an elderly cohort.0 aOral anticoagulation in patients with atrial fibrillation adhere c1999 Feb a165-710 v1063 a

PURPOSE: To determine adherence with practice guidelines in a population-based cohort of elderly persons aged 70 years or older with atrial fibrillation.

SUBJECTS AND METHODS: This was a cross-sectional analysis of a subgroup of participants in the Cardiovascular Health Study, a prospective observational study involving four communities in the United States. Subjects were participants with atrial fibrillation on electrocardiogram at one or more yearly examinations from 1993 to 1995. The outcome measure was self-reported use of warfarin in 1995.

RESULTS: In 1995, 172 (4.1%) participants had atrial fibrillation together with information regarding warfarin use and no preexisting indication for its use. Warfarin was used by 63 (37%) of these participants. Of the 109 participants not reporting warfarin use, 92 (84%) had at least one of the clinical risk factors (aside from age) associated with stroke in patients with atrial fibrillation. Among participants not taking warfarin, 47% were taking aspirin. Several characteristics were independently associated with warfarin use, including age [odds ratio (OR) = 0.6 per 5-year increment, 95% CI 0.5-0.9], a modified mini-mental examination score <85 points [OR = 0.3, 95% confidence interval (CI) 0.1-0.9], and among patients without prior stroke, female sex (OR = 0.5, 95% CI 0.2-1.0).

CONCLUSIONS: Despite widely publicized practice guidelines to treat patients who have atrial fibrillation with warfarin, most participants who had atrial fibrillation were at high risk for stroke but were not treated with warfarin. More studies are needed to determine why elderly patients with atrial fibrillation are not being treated with warfarin.

10aAdministration, Oral10aAged10aAnticoagulants10aAtrial Fibrillation10aCerebrovascular Disorders10aCross-Sectional Studies10aFemale10aHumans10aLogistic Models10aMale10aOdds Ratio10aPractice Guidelines as Topic10aProspective Studies10aRisk10aRisk Factors10aWarfarin1 aWhite, R, H1 aMcBurnie, M, A1 aManolio, T1 aFurberg, C D1 aGardin, J M1 aKittner, S, J1 aBovill, E1 aKnepper, L uhttps://chs-nhlbi.org/node/590