Age-related changes in blood pressure.

This report is based on three different representative population samples of a total of 1304 men (50-79 years old) and 1246 women (38-79 years old) observed for up to 12 years. Subjects' consumption of antihypertensive drugs and blood pressure levels in subjects with and without such treatment are presented. The prevalence of treatment with antihypertensive drugs (including beta-blockers and diuretics for other indications) increased from 2% at age 50 years to 37% at 79 years of age among the men and from 1% at 38 years to 61% at 79 years of age among the women. The mean systolic/diastolic blood pressure in untreated subjects increased from 138/91 mm Hg at age 50 years to 159/91 mm Hg at age 70 years in the men and from 123/79 mm Hg at age 38 years to 168/93 mm Hg at age 70 years in the women. At age 79 years the mean systolic/diastolic blood pressure was 155/83 mm Hg in the men and 161/85 mm Hg in the women. In a longitudinal follow-up of reexamined subjects, there was an increase in systolic blood pressure levels up to age 75 years and a reduction in diastolic blood pressure after age 75 years in both sexes.

Seven-year survival rate after age 85 years: relation to Alzheimer disease and vascular dementia.

OBJECTIVE: To investigate the survival rate in very elderly individuals in relation to Alzheimer disease, vascular dementia, and other mental and physical disorders. DESIGN: A 7-year longitudinal survey. SETTING: Community and institutions in Gothenburg, Sweden. PARTICIPANTS: A representative sample of 494 people aged 85 years. MAIN OUTCOME MEASURES: Results of neuropsychiatric and physical examinations, key informant interview, and computed tomographic scan of the head. Information on mortality was obtained from the parish office. RESULTS: The 7-year survival rate was higher in women (34.5%) than in men (20.3%). Alzheimer disease and vascular dementia predicted 30.7% of deaths in men and 49.7% of deaths in women according to a calculation of population attributable risk (PAR). A regression analysis showed that mortality in men was predicted by the presence of chronic obstructive lung disease (PAR, 18.8), Alzheimer disease (PAR, 16.0), vascular dementia (PAR, 14.7), cancer of the gastrointestinal tract (PAR, 10.2), and skin cancer (PAR, 6.2), and in women by vascular dementia (PAR, 29.4), Alzheimer disease (PAR, 20.3), cerebrovascular disorder (PAR, 12.1), congestive heart failure (PAR, 8.5), hypertension (PAR, 8.0), myocardial infarction (PAR, 6.5), and cancer of the gastrointestinal tract (PAR, 4.3). Life expectancy decreased with severity of dementia, although survival time in individuals with mild Alzheimer disease was not different from that in individuals without dementia. CONCLUSIONS: In extreme old age, Alzheimer disease and vascular dementia influence the mortality rate considerably. However, mild Alzheimer disease does not influence longevity, at least not during the first 7 years. These findings have important public health implications.

Overtreatment of hypertension in the elderly?

In a representative population sample of 619 70-year-old people, 26% were taking antihypertensive treatment. Twenty per cent (n = 32) of them showed no signs of cardiovascular disease and had a blood pressure of less than 175/95 mmHg. Treatment was withdrawn in 25 of the 32 patients. Casual blood pressure, blood pressure during isometric exercise and left ventricular morphology and function were studied repeatedly over 2 years, using non-invasive methods. A significant increase in mean systolic and diastolic blood pressures was observed in the 14 patients who completed the study. No change was observed with respect to left ventricular morphology and left ventricular diastolic function. A statistically significant decrease in left ventricular fractional shortening, but no clinical signs of congestive heart failure were observed. Withdrawal of antihypertensive treatment in elderly patients free from signs of cardiovascular disease may thus be attempted without harmful effects on cardiovascular function.

Marital coital activity in men at the age of 75: relation to somatic, psychiatric, and social factors at the age of 70.

OBJECTIVE: To find somatic, psychiatric, and social variables that predicted cessation of coital activity in elderly married men. DESIGN: Prospective, longitudinal, observational study SETTING: General survey of a representative sample of 70-year-old urban men (born in 1901-02) in Göteborg, Sweden. PARTICIPANTS: Forty-one men who were married and had coital activity at age 70 and who, at the age of 75, were still married when the sample was reinterviewed. MAIN OUTCOME MEASURES: Presence (c) or absence (nc) of coital activity at age 75. RESULTS: Cessation of coital activity was associated with vasculogenic factors. At least one of the following disorders--systemic hypertension, ischemic heart disease, congestive heart failure, diabetes mellitus, or hypertriglyceridemia--was found in three of the C men and 14 of the NC men, P less than 0.005. Systemic hypertension was the most common disorder and was found in one C man and 10 NC men, P less than 0.01. Cessation of coital activity was associated with specified types of stress between 65 and 70 years of age in the subgroup of men who had stopped due to inability; six out of eight reported stress against five out of 20 in the C group, P less than 0.05. There was no association with any of the psychiatric or social factors studied. CONCLUSIONS: Cessation of coital activity is predicted by somatic disorders which are associated with vascular damage and especially by hypertension. This observation does not allow the conclusion that antihypertensive treatment would be effective in postponing the cessation of coital activity.

The influence of gonadal steroids and the pituitary on the levels and composition of plasma phospholipids in the rat.

Gonadal steroids have been shown to influence plasma phospholipids. In the present study, the possible interaction between gonadal steroids and the pituitary in the regulation of plasma phospholipids was studied in rats. The total phospholipid concentration (higher in females) and the fatty acid composition of plasma lecithin was different in male compared to female rats. Gonadectomy resulted in a "feminization" of plasma phospholipids (total concentration and fatty acids in lecithin) in male rats but had no effect in females. Testosterone treatment of gonadectomized males or intact females resulted in a "masculinization" of plasma phospholipids, whereas estrogen treatment of intact males resulted in a "feminization." Hypophysectomy resulted in a marked decrease in plasma phospholipid concentration and the fatty acid composition of lecithin showed a "masculine" pattern in both males and females. Neither testosterone nor estrogen treatment had any effects on plasma phospholipids in hypophysectomized male and female rats, respectively. It is concluded that gonadal steroids and the hypothalamic-pituitary axis interact in the regulation of the synthetic and perhaps also degradative pathways controlling plasma phospholipids.

Determination of plasma cholesterol: comparison of gas-liquid chromatographic, colorimetric and enzymatic analyses.

The efficacy of methods for plasma cholesterol analyses based on gas-liquid chromatographic (GLC) or enzymatic cholesterol determinations was tested on commercially available standard serum, plasma obtained in a study of an age stratum of the population and on plasma from a number of patients from an out-patient department. These results were compared with colorimetric cholesterol determinations on chloroform/methanol extracts from plasma using the ferric chloride/sulphuric acid reagent. The GLC-based procedure gave values 12% lower than the colorimetric determinations. This discrepancy seemed to be explained, to a marked extent, by the fact that cholesterol metabolites interfere with the colorimetric determinations. The GLC-based method was apparently accurate since it has the advantage of specificity and is easy to standardize with the internal standard technique. Enzymatic total cholesterol analyses gave slightly (2%) lower values than the GLC-based analyses, apparently because of an incomplete hydrolysis of cholesterol esters. Enzymatic analyses of free cholesterol gave similar results to those of the GLC-based method.

Blood components in a 70-year-old population.

The concentrations of many blood components change with age, and the aim of the present study was to determine, at the age of 70, the concentrations of blood components commonly used in clinical routine, and to examine how the exclusion of probands with disease influenced their distribution. In connection with a longitudinal population study "70-year-old people in Göteborg" 30 blood components have been analyzed in a representative sample of 973 70-year-old men and women. 29% of the probands were found to be without definable disease or treatment for presumed disease. Concentrations of 13 components were found to have a gaussian distribution which was not altered after the exclusion of probands with definable disease. Three components were asymmetrically distributed in the total material and showed a normal distribution with decreased concentrations at the 97.8% level after the exclusion of probands with definable disease. The remaining 14 components had asymmetrically distributed concentrations both in the total material and in the subjects without definable diseases. For blood components with normally distributed concentrations in the probands without definable disease, acceptable reference values could be obtained without exclusion of sick probands. For asymmetrically distributed blood components the concentration at the 97.8% level usually decreased more, after exclusion of probands with definable disease, the more asymmetric the distribution was. Examples of reference intervals are (men and women) B-Hb: 130--171 and 119--159 g/l, S-iron: 6--29 and 5--28 mumol/l, S-creatinine: 52--110 and 44--100 mumol/l, P-cholesterol: 3.6--9.2 and 4.6--9.7 mmol/l, P-B12: 50--350 and 65--390 pmol/l, B-ESR: 1--30 and 2--34 mm/h and B-glucose: 4.0--7.2 and 4.0--6.8 mmol/l.

Plasma lipid changes in the female in aging and the menopause. Results from three population studies.

Postabsorbtive plasma lipid levels have been analyzed in studies of the female population in the Swedish city of Gothenburg. The population samples cover the ages 15, 23, 30, 38, 40, 45, 46, 50, 54, 60 and 70. In some groups data are available from both cross-sectional and prospective longitudinal studies. Cross-sectional studies showed a successive increase in total plasma cholesterol from 15 to 54 years of age. Longitudinal studies showed a further increase at least up to 60 years of age. The triglyceride level remained rather constant between 15 and 30 years of age, then increased but was again rather similar in the 40--50-year olds and reached the highest level in the 60- and 70-year samples. The total phospholipid curve was approximately parallel with the cholesterol curve at younger ages but nearer the cholesterol curve at higher ages. The composition of the plasma phospholipid fraction apparently changed at the ages around the menopause, mainly due to an increase in the proportions of lecithin and lysolecithin. Data available allowed considerations concerning possible influences on plasma lipids by age, by changes in dietary habits and body composition, as well as by gonadal steroid hormones.

Age-related changes in cardiac physiology. Can they be postponed or treated by drugs?

The basic mechanisms that cause aging are still poorly understood. Longitudinal prospective population studies using noninvasive examination techniques have improved our ability to differentiate between aging and disease. This review describes some general morphological and functional aging-related changes of the heart that have clinical relevance, and considers the possibility of drug treatment for the manifestations of aging per se. Digitalis has not been shown to improve the aging-related decline in myocardial strength and contractility. During aging, heart tissue stiffens and the speed and extent of diastolic filling decline. The latter is a limiting functional factor, particularly during increases in heart rate. Lowering peripheral vascular resistance, which is often increased in older people, might indirectly improve heart function. However, no drug has been shown to improve myocardial strength or lower tissue stiffness via a direct effect on the heart. It has been claimed, however, that calcium antagonists might improve diastolic filling. Morphological changes during aging are dominated by some left ventricular wall and septal hypertrophy, and left atrial and ventricular widening. Recent findings have suggested that angiotensin II might act as a growth stimulating factor, promoting cardiac hypertrophy. This has led to speculation that ACE inhibitors might contribute to the restructuring of the heart, not only in hypertension but also in patients with the common combination of slightly elevated blood pressure and aging-related myocardial hypertrophy. At present, it appears that improving exogenous factors (e.g. lifestyle, living circumstances and access to adequate medical care) offers greater opportunities for postponing cardiac aging than drugs that directly interfere with the physiological aging of the heart.

Personality and sexuality in relation to an index of gonadal steroid hormone balance in a 70-year old population.

Relationships between an index of gonadal steroid hormone function and personality as well as sexual activity were studied in a sample representative for 70-year-olds in Gotenburg, Sweden. Personality was described by means of inventories, sexual activity through a systematic interview and the balance between androgen and oestrogen activity by the quotient between lecithin and lysolecithin in plasma. Men with a relative dominance of oestrogen activity reported a lower frequency of sexual intercourse than other men. Women with a relative dominance of oestrogen activity described themselves as more resourceful, active, confident, unconcerned with the opinion of others, and able to take care of themselves than other women. There were no associations in women between the hormonal balance and the frequency of sexual intercourse.

Lipid metabolic studies in oophorectomised women: effects on serum lipids and lipoproteins of three synthetic progestogens.

Norethisterone acetate, medroxyprogesterone acetate and levonorgestrel were administered to oophorectomised women to evaluate the effects they have on lipid metabolism. Blood samples were drawn after a 3 wk period without hormone therapy and after 3 wk on each progestogen. Serum and lipoprotein lipids were followed and an oral glucose tolerance test with blood glucose and plasma insulin determinations were performed. The nortestosterone derivatives, norethisterone acetate and levonorgestrel, decreased high density lipoprotein cholesterol as well as alpha-lipoproteincholesterol, while the 17-hydroxyprogesterone derivative medroxyprogesterone acetate did not. Norethisterone acetate and medroxyprogesterone acetate impaired glucose tolerance. A difference between nortestosterone derivatives and 17-hydroxyprogesterone derivatives having an effect on high density lipoproteins is suggested.

Occurrence, nature and treatment of urinary incontinence in a 70-year-old female population.

An intervention trial using oral oestriol to treat urinary incontinence was performed in a number of patients taken from a representative sample of 562 women aged 75 yr. The clinical series consisted of 34 patients who took part in a double-blind crossover study of the possible effects of oestriol, given in a single daily dose of 3 mg, and of a placebo over a period of 3 mth. The clinical examinations included bacteriological cultures and an assessment of the degree of atrophy of the surface membranes in the vagina. In most patients, oestriol was effective in reversing the atrophy. The clinical effect was excellent in urgency and mixed incontinence, but not in stress incontinence.

Radiographic osteoarthritis in the elderly. A cohort comparison and a longitudinal study of the "70-year old people in Göteborg".

The prevalence of radiographic osteoarthritis in hand and knee joints was studied in representative subsamples of the 75 and 79 year old population of Göteborg, Sweden. A comparison between two cohorts of 79-year-olds, revealed no significant difference between them. A longitudinal study within one of these cohorts including those aged between 75 and 79 showed a modest but not statistically significant progression of osteoarthritis in hand and knee joints. The results suggest a reduced progression of osteoarthritis after 75 years of age.

Activities of daily living studied longitudinally between 70 and 76 years of age.

Functional performance, i.e. personal and instrumental activities of daily living (P-ADL, I-ADL), was studied in a population of 70-year-old persons followed to the age of 76, and with an intervention period included between the ages of 70 and 73. At age 70 (n = 617), 83% were independent, 13% were dependent in I-ADL and 4% dependent in I+P-ADL. Among the independent subjects, the 6-year outcome in mortality was 13%. Dependence at 70 predicted mortality as well as institutionalization, and the risk was higher for those dependent in P+I-ADL than for persons dependent in I-ADL only. Of participant survivors the incidence of disability was 30% (8% between 70 and 73, 26% between 73 and 76 years of age) and was dominated by dependence in I-ADLs. The intervention did not lead to less dependence in ADL at age 76. Gender differences were found at age 76 in cooking, bathing and dressing, males being more dependent in such activities. At 70, 73 and 76 years of age, assistance given by relatives dominated.