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elderly diabetes trial

Faiçal Jarraya
Hypertension remains the most important risk factor for cardiovascular disease. If antihypertensive drugs choice is well guided today, blood pressure (BP) target still a subject of controversies. Residual risk is matter of debate and the lower- the better dogma is come back again regarding to data reported from recent trials. The J curve, reason for European Society of Hypertension Guidelines reappraisal in 2009, is criticized by recent data. The one goal (<140/90 mmHg) fit 90 mmg 90 mmHg) fit all should be adapted as a personalized goal guided by evidence generated by randomized controlled trials...
October 9, 2016: Advances in Experimental Medicine and Biology
Clive Rosendorff
Many guidelines for the management of hypertension have recommended that the goal of antihypertensive treatment in the elderly (usually specified as 80 years or above) should be less than 150/90 mmHg. SPRINT included subjects 50 years or above, and a substantial proportion of subjects 75 years and older. These are individuals at high risk for adverse cardiovascular events because of high prevalence of hypertension and atherosclerotic disease. The less stringent BP goals have been based on a percieved danger of lowering BP to levels that threaten vital organ pefusion (myocardium, brain, kidney)...
September 2016: Journal of Hypertension
Shokei Kim-Mitsuyama
There is accumulating evidence that RAS inhibitors not only reduce blood pressure, but also exert pleiotropic effects, including a renoprotective effect, amelioration of insulin resistance, reduction in onset of diabetes, and suppression of cardiovascular remodelling,. However, the definite benefit of RAS inhibition in treatment of hypertension with CKD or DM is not conclusive. We previously performed the OlmeSartan and Calcium Antagonists Randomized (OSCAR) study comparing the preventive effect of high-dose ARB therapy versus ARB plus CCB combination therapy on cardiovascular morbidity and mortality in 1164 Japanese elderly hypertensive patients with baseline type 2 diabetes and/or CVD (Am J Med (2012))...
September 2016: Journal of Hypertension
Suzanne Oparil
Heart disease, stroke, and kidney failure are leading causes of death worldwide, and hypertension is a significant risk factor for each. Hypertension is less common in women, compared to men, in those younger than 45 years of age. This trend is reversed in those 65 years and older. In the US between 2011-2014, the prevalence of hypertension in women and men by age group was 6% vs 8% (18-39 years), 30% vs 35% (40-59 years), and 67% vs 63% (60 years and over). Awareness, treatment, and control rates differ between genders with women being more aware of their diagnosis (85% vs 80%), more likely to take their medications (81% vs 71%) and more frequently having controlled hypertension (55% vs 49%)...
September 2016: Journal of Hypertension
Ernesto Schiffrin
Hypertension has been defined by the levels of BP above which lowering BP will reduce the cardiovascular risk associated with elevated BP. This level has been classically 140/90 mmHg on the basis of actuarial data from the insurance industry. However, we now know that cardiovascular risk rises progressively from levels as low as 115/75 mmHg upward with a doubling of the incidence of both coronary heart disease and stroke for every 20/10-mmHg increment of BP. In uncomplicated hypertension without cardiovascular risk factors or target organ damage, there is little randomized clinical trial evidence that lowering SBP of <160 mmHg reduces cardiovascular risk...
September 2016: Journal of Hypertension
Lawrence Appel
The identification of explicit blood pressure targets for clinical management remains controversial, particularly in older individuals with co-morbidities. Recommendations from the panel appointed to the Eighth Joint National Committee (JNC 8) and results of the SPRINT trial have rekindled interest in this issue. JNC8 recommended a higher (more relaxed) BP goal of < 150/90, instead of the traditional BP goal of <140/90, in persons aged 60+. In contrast, the recently completed SPRINT trial, which enrolled high risk patients without diabetes, documented that a lower (more stringent) SBP goal of <120 mmHg reduced total mortality and cardiovascular disease events compared to <140 mmHg...
September 2016: Journal of Hypertension
Hiromi Rakugi
European guidelines (ESH-ESC2013) for the elderly have discussed well about treatment blood pressure (BP) levels and targeting BP levels. In general, elderly patients with systolic BP (SBP) ≥160 mmHg including individuals older than 80 years in good physical and mental conditions are recommended reducing SBP to between 150 and 140 mmHg. Furthermore, fit elderly patients <80 years old are recommended to consider antihypertensive treatment at SBP values ≥140 mmHg with a target SBP <140 mmHg. On the other hand, frail elderly patients are recommended to leave decisions on antihypertensive therapy to the treating physician, and based on monitoring of the clinical effects of treatment...
September 2016: Journal of Hypertension
Michael Weber
UNLABELLED: Age is the most powerful cardiovascular risk factor. Based on a meta-analysis of a million control patients in hypertension trials, the Clinical Trialists Collaboration has estimated that doubling of major cardiac and stroke events occurs with age increments of < 10 years (1). Data from the ACCOMPLISH trial, which will be presented at this ISH meeting for the first time, show that patients aged > 70 (mean: 75.2), compared with those < 70 (mean: 63.7), had a 2...
September 2016: Journal of Hypertension
Hiroyuki Ito, Masahiro Shinozaki, Shinya Nishio, Mariko Abe
INTRODUCTION: Sodium glucose cotransporter 2 (SGLT2) inhibitors have been available for the treatment of type 2 diabetes (T2DM) in Japan since April 2014. The prescription rate in Japan is low in comparison to Western countries. We summarize the results obtained from the phase 3 clinical trials and clinical studies involving Japanese T2DM patients. We also discuss the current situation and the future prospects of SGLT2 inhibitors in Japan. AREAS COVERED: Unexpected adverse events, such as cerebral infarction and diabetic ketoacidosis have been reported from clinics shortly after the initiation of SGLT2 inhibitor treatment...
October 2016: Expert Opinion on Pharmacotherapy
Mark A Espeland, Kasia Lipska, Michael E Miller, Julia Rushing, Ronald A Cohen, Joseph Verghese, Mary M McDermott, Abby C King, Elsa S Strotmeyer, Steven N Blair, Marco Pahor, Kieran Reid, Jamehl Demons, Stephen B Kritchevsky
BACKGROUND: Type 2 diabetes mellitus may alter the effect of physical activity on physical and cognitive function. METHODS: The Lifestyle Interventions and Independence for Elders (LIFE) trial randomized controlled clinical trial of physical activity intervention (walking, resistance training, and flexibility exercises) enrolled adults aged 70-89 years who were sedentary and non-demented and who had functional limitations. Standardized measures of physical and cognitive function were collected an average of 2 years post-randomization...
September 2, 2016: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
Hemal Bhatt, Lama Ghazi, David Calhoun, Suzanne Oparil
Systolic blood pressure (SBP) is an important predictor of cardiovascular disease (CVD) outcomes. Lowering SBP has been shown to reduce CVD morbidity and mortality, but the optimal SBP target continues to be a topic of intense debate. The Systolic Blood Pressure Intervention Trial (SPRINT) reported a significantly lower risk for CVD outcomes and all-cause mortality by targeting SBP <120 mmHg compared with <140 mmHg in a population of hypertensive persons at high CV risk. In this review, we discuss the strengths, limitations, and generalizability of SPRINT findings to other hypertensive populations that were excluded from the trial, including those with diabetes or prior stroke, <50 years old, and at lower CVD risk...
October 2016: Current Cardiology Reports
Rohan Shah, Manesh R Patel
BACKGROUND: The safety and efficacy of the oral anticoagulant rivaroxaban were studied in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF trial). A number of subanalyses of the ROCKET AF trial have subsequently analyzed the use of rivaroxaban in special patient populations. METHODS: The outcomes of the ROCKET AF trial were reviewed. The use of rivaroxaban in higher risk populations, as determined by the presence of co-morbidities included in the CHADS2 criteria, was analyzed...
August 23, 2016: Therapeutic Advances in Cardiovascular Disease
Frank A Scannapieco, Albert Cantos
Oral diseases, such as caries and periodontitis, not only have local effects on the dentition and on tooth-supporting tissues but also may impact a number of systemic conditions. Emerging evidence suggests that poor oral health influences the initiation and/or progression of diseases such as atherosclerosis (with sequelae including myocardial infarction and stoke), diabetes mellitus and neurodegenerative diseases (such as Alzheimer's disease, rheumatoid arthritis and others). Aspiration of oropharyngeal (including periodontal) bacteria causes pneumonia, especially in hospitalized patients and the elderly, and may influence the course of chronic obstructive pulmonary disease...
October 2016: Periodontology 2000
Silvia Molino, Maurizia Dossena, Daniela Buonocore, Federica Ferrari, Letizia Venturini, Giovanni Ricevuti, Manuela Verri
Dementia is common in the elderly, but there are currently no effective therapies available to prevent or treat this syndrome. In the last decade, polyphenols (particularly curcumin, resveratrol and tea catechins) have been under very close scrutiny as potential therapeutic agents for neurodegenerative diseases, diabetes, inflammatory diseases and aging. Data were collected from Web of Science (ISI Web of Knowledge), Pubmed and Medline (from 2000 to 2015), by searching for the keywords "dementia" AND "curcumin", "resveratrol", "EGCG", "tea catechins"...
September 15, 2016: Life Sciences
Sarah Besse, Arun Besse, François R Jornayvaz
Over the last few years, we have noticed the arrival on the market of new antidiabetic treatments. These represent an potential advantage because of the increase in the prevalence of type 2 diabetes, particularly in the elderly population. Nevertheless, elderly patients have a number of frailties that should be considered in the treatment of this condition. There is a lack of literature in this population as elderly are frequently excluded from randomized controlled trials. Therefore, guidelines were developed based on the consensus of experts in geriatrics and diabetology for this specific population...
June 1, 2016: Revue Médicale Suisse
Frank Petrak, Martin Hautzinger, Matthias J Müller, Stephan Herpertz
Diabetes in the elderly is often associated with depressive symptoms. This comorbidity leads to a higher risk for diabetes related complications, disability and mortality and can be observed not only in major depression but also in subthreshold or minor depression. Specific psychological interventions for this high-risk patient group were not available yet. Therefore, we developed a diabetes specific cognitive behavioral group intervention for elderly outpatients with subthreshold or minor depression and type 2 diabetes within a randomized controlled trial...
August 2016: Psychotherapie, Psychosomatik, Medizinische Psychologie
Georg Wiltberger, Babett Muhl, Christian Benzing, Hans-Michael Hau, Michael Bartels, Felix Krenzien
BACKGROUND: Older patients are increasingly faced with pancreatic surgery because of shifting demographics. The differential effects of aging on surgical outcomes remain vague, while the elderly patient is often neglected in clinical trials. METHODS: Medical records of 370 patients who underwent pancreaticoduodenectomy were analyzed. Patients were then subdivided into 3 groups according to age and comorbidities. RESULTS: Overall mortality was 5% and did not significantly differ between age-matched groups...
July 20, 2016: Digestive Surgery
Atsushi Araki, Yukio Yoshimura, Takashi Sakurai, Hiroyuki Umegaki, Chiemi Kamada, Satoshi Iimuro, Yasuo Ohashi, Hideki Ito
AIM: The present study aimed to examine whether nutrient intakes predicted cognitive decline among elderly patients with diabetes mellitus. METHODS: This study evaluated data from a 6-year prospective follow up of 237 elderly patients (aged ≥65 years) with diabetes mellitus, and the associations of baseline nutrient intakes with cognitive decline. Cognitive decline was defined as a ≥2-point decrease in the Mini-Mental State Examination (MMSE) score. Intakes of food and nutrients were assessed using a validated food frequency questionnaire, and were compared between patients with cognitive decline and intact cognition...
July 18, 2016: Geriatrics & Gerontology International
Xue Long, Yongzhong Lou, Hongfei Gu, Xiaofei Guo, Tao Wang, Yanxia Zhu, Wenjuan Zhao, Xianjia Ning, Bin Li, Jinghua Wang, Zhongping An
Stroke has a greater effect on the elderly than on younger patients. However, the long-term outcomes associated with stroke among elderly patients with diabetes are unknown. We aimed to assess the differences in long-term outcomes between young and elderly stroke patients with diabetes. A total of 3,615 acute ischemic stroke patients with diabetes were recruited for this study between 2006 and 2014. Outcomes at 12 and 36 months after stroke (including mortality, recurrence, and dependency) were compared between younger (age <75 years) and elderly (age ≥75 years) patients...
2016: Frontiers in Aging Neuroscience
Matteo Monami, Sara Aleffi
Diabetes mellitus is one of the most important causes of cardiovascular morbidity and mortality; the incidence of chronic complications of diabetes appears to be closely related to the degree of hyperglycaemia. However, results of clinical trials showed that intensive treatment of hyperglycaemia prevents microvascular complications, but has little or no effect on the incidence of cardiovascular events. Different hypoglycaemic drugs show different effects on cardiovascular risk. However, those trials have shown a neutral effect on cardiovascular mortality...
2016: Monaldi Archives for Chest Disease, Archivio Monaldi Per le Malattie del Torace
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