Социально-демографические и поведенческие факторы и их влияние на 5-летнюю выживаемость у лиц старше 75 лет

Objective: to study the impact of social, demographic and behavioral factors on 5-year survival rate in persons older than 75 years living in Moscow and the Moscow region. Materials and methods. We included in this prospective observational study 283 patients (25% men, age 75-98, mean 86.8±4.3 years) after stay at the Russian gerontological clinical research center. To study social and behavioral factors we recorded anthropometric parameters and used questionnaires. Duration of follow-up was 5 years. Endpoint was death from any cause. Results. One hundred five patients (37.1%) died during the follow-up (median 3.8 years). Survival analysis using the Kaplan-Meier method revealed a number of parameters that affected 5-year survival: age, deficient and excessive body weight, consumption of less than 1 liter of water per day, start of the night sleep after midnight, nighttime sleep duration >10 h, level of physical activity and history of blood donation. At multivariate analysis adjusted for age and sex the following factors were independently associated with death during follow-up: weight deficiency (hazard ratio [HR] 7.36, 95% confidence interval [CI] 2.15-25.26, p=0.001), second degree obesity (HR 0.47, 95% CI 0.25-0.87, p=0.016), start of night sleep after midnight (HR 2.53, 95% CI 1.32-4.85, p=0.005), nighttime sleep duration ≥10 h (HR 3.89, 95% CI 1.77-8.59, p=0.001), and history of blood donation (HR 0.24, 95% CI 0.09-0.62, p=0.003). Conclusion. In people older than 75 years late sleep initiation and long duration of night sleep, and weight loss increase the risk of death in the next 5 by years, 2.5, 3.9 and 7.4 times, respectively, while overweight and history of blood donation are associated with 53% and 76% reduction of the risk of death.Цель исследования. Оценка влияния социально-демографических и поведенческих факторов на 5-летнюю выживаемость у лиц старше 75 лет, проживающих в Москве и Московской области. Материалы и методы. В проспективное наблюдательное исследование включили 283 пациента (25% мужчин) в возрасте 75-98 лет (средний возраст 86,8±4,3 года), получавших плановое стационарное лечение в Российском геронтологическом научно-клиническом центре. При госпитализации регистрировали антропометрические показатели и проводили анкетирование с целью изучения социальных и поведенческих факторов, таких как образ жизни, привычки, характер питания и физическая активность. Период наблюдения составил 5 лет. Конечная точка -смерть от любых причин. Результаты. За время наблюдения (медиана 3,8 года) умерли 105 (37,1%) пациентов. Анализ выживаемости по методу Каплана-Мейера выявил ряд параметров, влияющих на 5-летнюю выживаемость лиц старше 75 лет: возраст, дефицит и избыток массы тела, употребление менее 1 л жидкости в сутки, отход ко сну после 24 ч, ночной сон продолжительностью >10 ч, физическая активность и донорство крови в анамнезе. Последующий многофакторный анализ с поправкой на возраст и пол идентифицировал дефицит (относительный риск - ОР 7,36 при 95 % доверительном интервале - ДИ от 2,15 до 25,26; р=0,001) и избыток (ОР 0,47 при 95% ДИ от 0,25 до 0,87; р=0,016) массы тела, отход ко сну после 24 ч (ОР 2,53 при 95% ДИ от 1,32 до 4,85; р=0,005), ночной сон продолжительностью >10 ч (ОР 3,89 при 95% ДИ от 1,77 до 8,59; р=0,001) и донорство крови в анамнезе (ОР 0,24 при 95% ДИ от 0,09 до 0,62; р=0,003) в качестве независимых предикторов 5-летней выживаемости у лиц старше 75 лет. Заключение. У лиц старше 75 лет поздний отход ко сну, длительная продолжительность ночного сна и дефицит массы тела увеличивают риск смерти в ближайшие 5 лет в 2,5, 3,9 и 7,4 раза соответственно, а избыточная масса тела и донорство крови в анамнезе ассоциируются со снижением риска смерти на 53 и 76%

INDAPAMIDE SR/AMLODIPINE FIXED DOSE COMBINATION: NOVEL APPROACH TO EFFECTIVE CONTROL OF SYSTOLIC ARTERIAL PRESSURE

Effective control of arterial pressure (AP) is achieved only in 1/3 of patients with arterial hypertension. It is especially difficult to achieve control of systolic (S) AP in elderly patients in whom SAP is the strongest prognostic factor of cardiovascular complications. Thiazide and thiazide-like diuretics and calcium antagonists are effective for lowering of elevated SAP and pulse (P) AP including aortic PAP elevation of which is associated with high stiffness of arterial wall and is typical for elderly people. Combination of a thiazide diuretic and a calcium antagonist has been recommended by modern guidelines on arterial hypertension (AH) management but until recently it has not found wide application because of absence of a fixed preparation. Evidence base of indapamide-retard and amlodipine use in AH, their profiles of efficacy and safety are such that their combination can become an alternative variant for treatment of patients with AH. Appearance of a fixed indapamide-retard/amlodipine combination opens new perspectives of effective therapy of AH with high SAP and PAP in elderly and other patients with high stiffness of arterial wall

Социально-демографические и поведенческие факторы и их влияние на 5-летнюю выживаемость у лиц старше 75 лет

Objective: to study the impact of social, demographic and behavioral factors on 5-year survival rate in persons older than 75 years living in Moscow and the Moscow region. Materials and methods. We included in this prospective observational study 283 patients (25% men, age 75-98, mean 86.8±4.3 years) after stay at the Russian gerontological clinical research center. To study social and behavioral factors we recorded anthropometric parameters and used questionnaires. Duration of follow-up was 5 years. Endpoint was death from any cause. Results. One hundred five patients (37.1%) died during the follow-up (median 3.8 years). Survival analysis using the Kaplan-Meier method revealed a number of parameters that affected 5-year survival: age, deficient and excessive body weight, consumption of less than 1 liter of water per day, start of the night sleep after midnight, nighttime sleep duration >10 h, level of physical activity and history of blood donation. At multivariate analysis adjusted for age and sex the following factors were independently associated with death during follow-up: weight deficiency (hazard ratio [HR] 7.36, 95% confidence interval [CI] 2.15-25.26, p=0.001), second degree obesity (HR 0.47, 95% CI 0.25-0.87, p=0.016), start of night sleep after midnight (HR 2.53, 95% CI 1.32-4.85, p=0.005), nighttime sleep duration ≥10 h (HR 3.89, 95% CI 1.77-8.59, p=0.001), and history of blood donation (HR 0.24, 95% CI 0.09-0.62, p=0.003). Conclusion. In people older than 75 years late sleep initiation and long duration of night sleep, and weight loss increase the risk of death in the next 5 by years, 2.5, 3.9 and 7.4 times, respectively, while overweight and history of blood donation are associated with 53% and 76% reduction of the risk of death.Цель исследования. Оценка влияния социально-демографических и поведенческих факторов на 5-летнюю выживаемость у лиц старше 75 лет, проживающих в Москве и Московской области. Материалы и методы. В проспективное наблюдательное исследование включили 283 пациента (25% мужчин) в возрасте 75-98 лет (средний возраст 86,8±4,3 года), получавших плановое стационарное лечение в Российском геронтологическом научно-клиническом центре. При госпитализации регистрировали антропометрические показатели и проводили анкетирование с целью изучения социальных и поведенческих факторов, таких как образ жизни, привычки, характер питания и физическая активность. Период наблюдения составил 5 лет. Конечная точка -смерть от любых причин. Результаты. За время наблюдения (медиана 3,8 года) умерли 105 (37,1%) пациентов. Анализ выживаемости по методу Каплана-Мейера выявил ряд параметров, влияющих на 5-летнюю выживаемость лиц старше 75 лет: возраст, дефицит и избыток массы тела, употребление менее 1 л жидкости в сутки, отход ко сну после 24 ч, ночной сон продолжительностью >10 ч, физическая активность и донорство крови в анамнезе. Последующий многофакторный анализ с поправкой на возраст и пол идентифицировал дефицит (относительный риск - ОР 7,36 при 95 % доверительном интервале - ДИ от 2,15 до 25,26; р=0,001) и избыток (ОР 0,47 при 95% ДИ от 0,25 до 0,87; р=0,016) массы тела, отход ко сну после 24 ч (ОР 2,53 при 95% ДИ от 1,32 до 4,85; р=0,005), ночной сон продолжительностью >10 ч (ОР 3,89 при 95% ДИ от 1,77 до 8,59; р=0,001) и донорство крови в анамнезе (ОР 0,24 при 95% ДИ от 0,09 до 0,62; р=0,003) в качестве независимых предикторов 5-летней выживаемости у лиц старше 75 лет. Заключение. У лиц старше 75 лет поздний отход ко сну, длительная продолжительность ночного сна и дефицит массы тела увеличивают риск смерти в ближайшие 5 лет в 2,5, 3,9 и 7,4 раза соответственно, а избыточная масса тела и донорство крови в анамнезе ассоциируются со снижением риска смерти на 53 и 76%

INDAPAMIDE SR/AMLODIPINE FIXED DOSE COMBINATION: NOVEL APPROACH TO EFFECTIVE CONTROL OF SYSTOLIC ARTERIAL PRESSURE

Effective control of arterial pressure (AP) is achieved only in 1/3 of patients with arterial hypertension. It is especially difficult to achieve control of systolic (S) AP in elderly patients in whom SAP is the strongest prognostic factor of cardiovascular complications. Thiazide and thiazide-like diuretics and calcium antagonists are effective for lowering of elevated SAP and pulse (P) AP including aortic PAP elevation of which is associated with high stiffness of arterial wall and is typical for elderly people. Combination of a thiazide diuretic and a calcium antagonist has been recommended by modern guidelines on arterial hypertension (AH) management but until recently it has not found wide application because of absence of a fixed preparation. Evidence base of indapamide-retard and amlodipine use in AH, their profiles of efficacy and safety are such that their combination can become an alternative variant for treatment of patients with AH. Appearance of a fixed indapamide-retard/amlodipine combination opens new perspectives of effective therapy of AH with high SAP and PAP in elderly and other patients with high stiffness of arterial wall

Antihypertensive Therapy and its efficacy in outpatient elderly and very elderly subjects

Purpose of the study. The study of the characteristics and effectiveness of antihypertensive therapy (AHT) in patients aged 65 years and older. Material and methods. The study included 356 patients, mean age 74,916,1 years, 80.4% women. The prevalence of arterial hypertension (AH) and the current intake of antihypertensive drugs were evaluated by self-reported patient. Results. The prevalence of hypertension was 88.5%. The predominant variant was isolated systolic hypertension. 51.1% of patients have systolic blood pressure as measured at the reception turned > 140 mm Hg in 34.7% of patients >150 mm Hg AHT received 91.6% of patients with hypertension in 65.6% of cases it was combined. Of the various combinations of bicomponent most patients took angiotensin converting enzyme inhibitor in combination with a Adrenoblocker or a diuretic. Conclusions. The study showed the high prevalence of hypertension and the lack of efficacy in patients AHT elderly seeking outpatient care

Arterial hypertension in a very old: Significance of the biological age

Elderly population is heterogenic, and persons with the same chronological age differ greatly by their physical and cognitive functioning. Regardless the convincing witness on the adverse influence of raised blood pressure (BP) in a middle age persons, its influence on the prognosis of a very old is still debatable, as the question, whether to treat arterial hypertension (AH) in elderly, and if so, how intensively. The article focuses on the results of observational and randomized clinical studies that make it to decide that not the chronological, but biological age is an important criteria for decision on AH management in elderly. The article presents in details mechanisms interacting in BP regulation, and influence of BP on the risk of morbidity and mortality in elderly. Also, the current guidelines are cited, on antihypertension treatment, as the issues dicussed on AH treatment in elderly, that require further investigation

ФИЗИЧЕСКИЕ НАГРУЗКИ - "ПОЛИПИЛЮЛЯ" ДЛЯ ПРОФИЛАКТИКИ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ И ЗАМЕДЛЕНИЯ СТАРЕНИЯ

The concept of polypill in the prevention of cardiovascular diseases has received growing attention. However, the same, if not greater, therapeutic effect can be achieved through constant physical activity. Compared with pharmacotherapy, physical activity is more accessible, more economical and has no side effects. The epidemiological data on the preventive and curative properties of regular physical exercises and their influence on the main biological mediators are considered.Концепция «полипилюли» в профилактике сердечно-сосудистых заболеваний привлекает все больше внимания. Однако такой же, если не больший, терапевтический эффект может быть достигнут благодаря постоянной физической активности. По сравнению с фармакотерапией, физическая нагрузка более доступна, более экономична и не дает побочных эффектов. Рассмотрены эпидемиологические данные о профилактических и лечебных свойствах регулярных физических упражнений и влияние их на основные биологические медиаторы

Prevention of cardiovascular events: Are all recommendations applicable to elderly patients with senile Asthenia?

Primary prevention of cardiovascular events is based on achievement of optimal control of risk factors - arterial hypertension, dyslipidemia, glycemia - in accordance with current recommendations of scientific societies. But most rapidly growing segment of population - elderly and old individuals - have been underrepresented in randomized clinical trials underlying recommendations on primary and secondary prevention. That is why it is problematic to directly apply recommendations to patients from this group of population. In addition, old patients are characterized by accumulation of functional deficits, development of syndrome of senile asthenia («frailty»), and multimorbidity. Effect of these characteristics on prognosis often exceeds that of risk factors. Other important factor is high susceptibility of old patients to risk of development of unfavorable effects because of both changes of pharmacokinetics and pharmacodynamics of drugs and the need for multiple medicines (polypragmasy). While applying existing recommendations to old people one should recognize limitations of current knowledge on best ways of realization of approaches to prevention of cardiovascular prevention which effectiveness has been proved in younger individuals. Improvement of awareness and development of special skills of physicians involved in management of old patients is required for timely detection of the syndrome of senile asthenia. Special geriatric approaches should be implemented in cooperation with specialists in geriatric medicine

ОСОБЕННОСТИ ВЕДЕНИЯ "ХРУПКИХ" ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТОНИЕЙ

The aspects of arterial hypertension in patients of elderly and senile age are listed. These are comorbidity and polypharmacyintrinsic to them, as well as such syndromes as orthostatic hypotension, falls, cognitive impairments, senile asthenia syndrome. Recommendations for the treatment of hypertension in this category of patients are proposed.Перечислены особенности течения артериальной гипертонии у пациентов в пожилом и старческом возрасте. Это в первую очередь характерные для них коморбидность и полипрагмазия, а также наличие таких синдромов, как ортостатическая гипотония, падения, когнитивные нарушения, синдром старческой астении. Предложены рекомендации лечения АГ у данной категории пациентов

Проблемы гериатрии в кардиологической практике

Increase in life expectancy during the second part of the 20th century is accompanied by increase in proportion of elderly and senile age population. However, despite the increase in life expectancy, the prevalence of most chronic diseases and functional impairments rises with age. Elderly and senile age is associated with the risk of cardiovascular diseases (CVD), therefore the problem of managing elderly patients with CVD becomes especially urgent.Еще во второй половине XX века вместе с ростом продолжительности жизни было отмечено увеличение доли населения пожилого и старческого возраста. Однако, несмотря на увеличение ожидаемой продолжительности жизни, со старением возрастает распространенность большинства хронических заболеваний и функциональных нарушений. Пожилой и старческий возраст ассоциируется с риском развития сердечно-сосудистых заболеваний (ССЗ), в связи с чем проблема ведения пожилых пациентов с ССЗ становится особенно актуальной