Mirtazapine versus Megestrol in the Treatment of Anorexia-Cachexia Syndrome in Patients with Advanced Cancer: A Randomized, Double-Blind, Controlled Phase II Clinical Trial.

This study compared mirtazapine with megestrol in the management of cancer-related anorexia-cachexia syndrome in patients with advanced cancer. A randomized, double-blind, controlled clinical trial involving patients with advanced cancer and anorexia-cachexia syndrome was performed. Participants received mirtazapine 30 mg/day or megestrol 320 mg/day for eight weeks. The primary endpoint was the effect of mirtazapine on weight gain and the secondary endpoints were its effect on appetite, muscle strength, physical performance, body composition, adverse events, and medication adherence. Linear regression model with mixed effects was applied and a significance level of 5% was adopted. Fifty-two patients were randomized. Mean age was 65.8 ± 8.4 years. There was weight gain in 52% of the participants in the megestrol group and in 38% in the mirtazapine group after four weeks (p = 0.040). Appetite improved in 92% of the participants in the megestrol group and in 56% in the mirtazapine group after eight weeks (p = 0.007). In the sub-analysis by sex, women showed improvement in appetite (p < 0.001) and weight gain (p < 0.005) in the mirtazapine group, which was not observed in men. Mirtazapine appears to be inferior to megestrol in weight and appetite improvement. However, there may be a difference in the therapeutic response between sexes.

Effect of chocolate on older patients with cancer in palliative care: a randomised controlled study.

BACKGROUND: Older advanced stage cancer patients, with changes in nutritional status, represent an important demand for palliative care. The aim was to determine the effects of 4 weeks of chocolate consumption on the nutritional status of older cancer patients in palliative care. METHODS: Older cancer patients in palliative care with ambulatory (n = 46) monitoring were randomized to control (CG, n = 15), intervention with 55% cocoa chocolate (IG1, n = 16) and intervention with white chocolate (IG2, n = 15) groups and evaluated before and after 4 weeks for nutritional status (primary outcome), evaluated by the Mini Nutritional Assessment tool (MNA). Food consumption, anthropometry, body composition, laboratory parameters and quality of life (QL) with the European Organization for the Research and Treatment of Cancer instrument were also evaluated. RESULTS: IG1 progressed with increased screening (estimated difference [95% CI]: - 1.3 [- 2.2;-0.4], p < 0.01), and nutritional (estimated difference [95% CI]: - 1.3 [- 2.5;-0.1], p = 0.04) scores on the MNA, with no change in anthropometry and body composition. Regarding antioxidant capacity, reduced glutathione levels increased (estimated difference [95% CI]: - 0.8 [- 1.6;-0.02], p = 0.04) and malondealdehyde levels decreased in IG2 (estimated difference [95% CI]:+ 4.9 [+ 0.7;+ 9.1], p = 0.02). Regarding QL, functionality improved in IG1, with higher score in the functional domain (estimated difference [95% CI]:-7.0 [- 13.3;-0.7], p = 0.03). CONCLUSIONS: The consumption of chocolate with a greater cocoa content may contribute to the improvement of the nutritional status and functionality among older cancer patients in palliative care. The consumption of white chocolate was associated with improved oxidative stress. TRIAL REGISTRATION: A randomized clinical trial (ClinicalTrials.gov NCT04367493 ).

Older Adult Cancer Patients Under Palliative Care With a Prognosis of 30 Days or More: Clinical and Nutritional Changes.

Objective: The aim of this study was to characterize nutritional status, body composition, oxidative stress, and inflammatory activity and to determine the possible associations between nutritional status and clinical variables in advanced cancer patients.Method: This was a cross-sectional study of 46 elderly cancer patients under palliative care with a prognosis of 30 days or more. Nutritional status, food intake, anthropometry, body composition (deuterium oxide method), metabolic profile, inflammation damage (C-reactive protein), oxidative damage (8-hydroxy-2'-deoxyguanosine), and symptom intensity were evaluated.Results: Among elderly cancer patients, 36.9% were malnourished or at risk of malnutrition. Systemic inflammation was detected, with a correlation between worse nutritional status and higher C-reactive protein levels (p < 0.01, r= -0.57), while lower lean mass (p < 0.01, r = 0.62) and higher fat mass percentages (p < 0.01, r = 0.62) correlated with higher levels of 8-hydroxy-2'-deoxyguanosine. Furthermore, daily energy (n = 25; 57.4%) and protein intake (n = 24; 52.2%) were lower than recommended in more than half the patients. The most prevalent symptoms were anxiety, impairment of well-being, drowsiness, tiredness, and lack of appetite.Conclusions: Despite preserved functionality, patients already had clinical and laboratory changes that, together with inadequate food intake, risk of malnutrition, systemic inflammation, and the presence of uncontrolled symptoms, alerted to the importance of an early and comprehensive palliative approach.

Salt Preference is Linked to Hypertension and not to Aging.

BACKGROUND: Seasoning is one of the recommended strategies to reduce salt in foods. However, only a few studies have studied salt preference changes using seasoning. OBJECTIVES: The aim of this study was to compare preference for salty bread, and if seasoning can change preference in hypertensive and normotensive, young and older outpatients. METHODS: Outpatients (n = 118) were classified in four groups: older hypertensive subjects (OH) (n = 32), young hypertensive (YH) (n = 25); older normotensive individuals (ON) (n = 28), and young normotensive (YN) (n = 33). First, volunteers random tasted bread samples with three different salt concentrations. After two weeks, they tasted the same types of breads, with seasoning added in all. Blood pressure (BP), 24-hour urinary sodium and potassium excretion (UNaV, UKV) were measured twice. Analysis: Fisher exact test, McNamer's test and ANCOVA. Statistical significance: p < 0.05. RESULTS: Systolic BP, UNaV, and UKV were greater in HO and HY and they had a higher preference for saltier samples than normotensive groups (HO: 71.9%, HY: 56% vs. NO: 25%, NY; 6%, p<0.01). With oregano, hypertensive individuals preferred smaller concentrations of salt, with reduced choice for saltier samples (HO: 71.9% to 21.9%, and HY: 56% to 16%, p = 0.02), NO preferred the lowest salt concentration sample (53.6% vs. 14.3%, p < 0.01), and NY further increased the preference for the lowest one (63.6% vs. 39.4%, p = 0.03). CONCLUSIONS: Older and younger hypertensive individuals prefer and consume more salt than normotensive ones, and the seasoned bread induced all groups to choose food with less salt. Salt preference is linked to hypertension and not to aging in outpatients.

Salt Preference is Linked to Hypertension and not to Aging / A Preferência ao Sal está Relacionada à Hipertensão e não ao Envelhecimento

Abstract Background: Seasoning is one of the recommended strategies to reduce salt in foods. However, only a few studies have studied salt preference changes using seasoning. Objectives: The aim of this study was to compare preference for salty bread, and if seasoning can change preference in hypertensive and normotensive, young and older outpatients. Methods: Outpatients (n = 118) were classified in four groups: older hypertensive subjects (OH) (n = 32), young hypertensive (YH) (n = 25); older normotensive individuals (ON) (n = 28), and young normotensive (YN) (n = 33). First, volunteers random tasted bread samples with three different salt concentrations. After two weeks, they tasted the same types of breads, with seasoning added in all. Blood pressure (BP), 24-hour urinary sodium and potassium excretion (UNaV, UKV) were measured twice. Analysis: Fisher exact test, McNamer's test and ANCOVA. Statistical significance: p < 0.05. Results: Systolic BP, UNaV, and UKV were greater in HO and HY and they had a higher preference for saltier samples than normotensive groups (HO: 71.9%, HY: 56% vs. NO: 25%, NY; 6%, p<0.01). With oregano, hypertensive individuals preferred smaller concentrations of salt, with reduced choice for saltier samples (HO: 71.9% to 21.9%, and HY: 56% to 16%, p = 0.02), NO preferred the lowest salt concentration sample (53.6% vs. 14.3%, p < 0.01), and NY further increased the preference for the lowest one (63.6% vs. 39.4%, p = 0.03). Conclusions: Older and younger hypertensive individuals prefer and consume more salt than normotensive ones, and the seasoned bread induced all groups to choose food with less salt. Salt preference is linked to hypertension and not to aging in outpatients.

Resumo Fundamento: Adicionar temperos aos alimentos é umas das estratégias recomendadas para diminuir a quantidade de sal nos alimentos. No entanto, poucos estudos investigaram alterações na preferência ao sal através do uso de temperos. Objetivos: O objetivo deste estudo foi comparar a preferência pelo pão salgado, e até que ponto o uso de temperos pode alterar as preferências dos indivíduos hipertensos e normotensos, pacientes ambulatoriais jovens e idosos. Métodos: Os pacientes ambulatoriais (n = 118) foram classificados em quatro grupos: idosos com hipertensão (IH) (n = 32), jovens hipertensos (JH) (n = 25); indivíduos idosos normotensos (IN) (n = 28), e jovens normotensos (JN) (n = 33). Primeiro, os voluntários provaram amostras aleatórias de pão com três diferentes concentrações de sal. Após duas semanas, eles provaram os mesmos tipos de pão, porém acrescidos de temperos. A pressão arterial (PA), e a excreção urinária de sódio e potássio de 24 horas (UNaV, UKV) foram medidas duas vezes. Análise: Teste exato de Fisher, teste de McNemar e teste ANCOVA. Significância estatística: p < 0,05. Resultados: A PA sistólica e a excreção urinária de sódio e potássio foram maiores nos grupos IH e JH, e eles tiveram maior preferência por amostras mais salgadas quando comparados com os grupos de normotensos (IH: 71,9%, JH: 56% vs. IN: 25%, JN; 6%, p < 0,01). Quando o orégano foi adicionado, a preferência dos indivíduos hipertensos foi pelas amostras com menores concentrações de sal, com uma diminuição da escolha por amostras mais salgadas (IH: 71,9% a 21,9%, e JH: 56% a 16%, p = 0,02); o grupo IN preferiu a amostra com a concentração de sal mais baixa (53,6% vs. 14,3%, p < 0,01) e no grupo JN aumentou ainda mais o número de indivíduos com preferência pela amostra com concentrações mais baixas de sal (63,6% vs. 39,4%, p = 0,03). Conclusões: Os idosos e jovens hipertensos preferem e consomem mais sal do que os normotensos, e o pão adicionado de tempero ajudou todos os grupos a escolher alimentos menos salgados. A preferência ao sal está ligada à hipertensão e não à idade nos pacientes ambulatoriais.

Mood, lifestyle and cardiovascular risk factors among older caregivers of patients with Alzheimer's disease dementia: a case-control study.

BACKGROUND: Caregivers may have a higher risk of cardiovascular diseases and have high rates of anxiety and depression. AIMS: The objective of this study was to evaluate mood, lifestyle and the presence of cardiovascular risk factors in older women caregivers of patients with Alzheimer´s disease (AD) dementia compared to non-caregivers living in the neighborhood. METHODS: Paired case-control (1:1). Volunteers responded to a questionnaire with information about physical and leisure activities, smoking, alcohol use, and daily hours of care. Blood pressure (BP) was measured on 5 days with the Home Blood Pressure Monitoring (HBPM) system, and mood was assessed with the Geriatric Depression Scale (GDS) and Mini International Neuropsychiatric Interview (MINI). Laboratory testing for cardiovascular risk factors was performed. RESULTS: Sixty-two volunteers were evaluated. Total cholesterol levels were higher among caregivers, with an odds ratio (OR) of 3.57 (95% CI 1.2-11, p = 0.03). There was no difference in BP. A positive screening for depression was obtained for 58% of caregivers and for 16% of control subjects (OR = 6.62, 95% CI 1.9-22.6, p < 0.01). The MINI revealed that 38.7% of caregivers had an actual depressive episode as compared to 9.7% of controls (9.7%) (OR = 5.42, 95% CI 1.3-22.7, p = 0.02); 35.5% of caregivers and 6% of controls had a diagnosis of anxiety disorder (OR = 4.79, 95% CI 1.2-19.1, p = 0.03). DISCUSSION: The cardiovascular risk markers and lifestyle were similar in caregivers and non-caregivers, but there was a higher prevalence of depression and anxiety among caregivers. CONCLUSIONS: Older women caregivers of patients with AD have more mental health symptoms and disorders and need to be treated.

Resistance Exercise Training Is More Effective than Interval Aerobic Training in Reducing Blood Pressure During Sleep in Hypertensive Elderly Patients.

Bertani, RF, Campos, GO, Perseguin, DM, Bonardi, JMT, Ferriolli, E, Moriguti, JC, and Lima, NKC. Resistance exercise training is more effective than interval aerobic training in reducing blood pressure during sleep in hypertensive elderly patients. J Strength Cond Res 32(7): 2085-2090, 2018-An appropriate fall in blood pressure (BP) during sleep is known to be related to a lower cardiovascular risk. The objective of this study was to compare the effect of different types of training on hypertensive elderly patients under treatment in terms of pressure variability assessed by the nocturnal decline in BP. Hypertensive elderly subjects under pharmacological treatment were randomly assigned to the following groups: 12 weeks of continuous aerobic training, interval aerobic training (IA), resistance training (R), or control (C). All subjects underwent ambulatory BP monitoring before and 24 hours after the last exercise session. The results were assessed using the mixed effects model. A greater nocturnal decline in diastolic BP compared with the wakefulness period was observed in R in comparison with C (11.0 ± 4.1 vs. 6.0 ± 5.7 mm Hg and p = 0.01) and with IA (11.0 ± 4. vs. 6.5 ± 5.1 mm Hg and p = 0.02). No fall in BP during a 24-hour period was observed in training groups compared with C, perhaps because the subjects were mostly nondippers, for whom the effect of training on BP is found to be lower. In conclusion, resistance training promoted a greater nocturnal fall in BP among hypertensive elderly subjects under treatment compared with IA subjects.

Combined aerobic and resistance training: are there additional benefits for older hypertensive adults?

OBJECTIVES:: The objective of this study was to compare the effects of a combination of aerobic and resistance training to those of isolated aerobic training on blood pressure, body composition, and insulin sensitivity in hypertensive older adults. METHOD:: Forty-four patients were randomly assigned to the aerobic group, resistance and aerobic group, and control group. Before and after 10 weeks, the following data were obtained: 24-hour ambulatory blood pressure data, abdominal circumference, waist circumference, body mass index, lean mass, fat mass, and insulin sensitivity. The study was conducted with 3 training sessions per week. RESULTS:: Comparison revealed significant reductions in the body mass index, abdominal and waist circumferences, and ambulatory blood pressure (24-hour, wakefulness and sleep systolic/diastolic blood pressures) in both the aerobic group and the resistance and aerobic (combined) group. The fat mass only changed in the combined group. There was no difference in the insulin sensitivity in any group. CONCLUSIONS:: The combined treatment and aerobic treatment alone were equally effective in reducing the blood pressure, body mass index, and abdominal and waist circumferences, although the addition of the resistance component also helped reduce the fat mass.

Assessment of the integration between oncology and palliative care in advanced stage cancer patients.

PURPOSE: Chemotherapy is indicated for patients with metastatic malignancy in order to improve quality of life and in some cases to increase survival. However, the greatest difficulty regarding the choice of treatment is to evaluate the clinical benefit and intrinsic toxicity of each procedure. The best strategy is the integration between oncology and palliative care, which is still mostly insufficient. The main objective of this study was to assess time to palliative care referral for cancer patients with advanced local or metastatic disease and to investigate the impact of covariates on this relationship. METHODS: A retrospective, cross-sectional, observational pilot study was conducted on 286 patients divided into two groups, one consisting of metastatic patients and the other of non-metastatic patients at diagnosis. Karnofsky Performance Scale (KPS), setting, and survival time were evaluated. RESULTS: One hundred eighteen patients (41.25%) were metastatic and 168 (58.74%) had locally advanced malignant disease. The median time of metastatic patient referral to the group of palliative care (GPC) was 5.3 months, with 39.8% referred earlier and 60.2% referred late (≥3 months). 60.2% of metastatic patients were referred to the GPC with a KPS <70% and 56% of non-metastatic patients were referred earlier and 44% after 3 months. There was improved survival only in metastatic patients referred to the GPC with a KPS ≥70% (p = 0.02). CONCLUSIONS: Many oncology patients were referred late to the GPC. A higher KPS was a risk factor for late referral because only severe patients were referred earlier. Metastatic patients referred with a KPS ≥70% had a longer survival.

Cardiovascular risk factors and inflammatory activity among centenarians with and without dementia.

A better knowledge of the differences existing between individuals who maintain cognition up to 100 years of age or more and those of the same age who present dementia syndrome may be of help in understanding the dementia of the very elderly people. The aim of this study was to assess cardiovascular risk factors and inflammatory markers among centenarians with and without dementia. A population-based cross-sectional study was conducted on centenarians residing in a middle-size city. Volunteers were evaluated by comprehensive geriatric assessment at home. General laboratory examinations were performed and cardiovascular risk and inflammatory activity markers were determined. Mean subject age was 101 ± 2 years, and 82 % were women. Assessment of dementia syndrome revealed that 36.4 % of the centenarians had preserved cognition. Centenarians with dementia had lower schooling (p < 0.01), lower body mass index (p = 0.02) and higher homocysteine levels (p < 0.01) and tended to have a lower systolic blood pressure (p = 0.05). Regarding the markers of inflammatory activity, demented subjects had high levels of interleukin-6 (p < 0.01), high-sensitivity C-reactive protein (p = 0.02), and erythrocyte sedimentation rate (p = 0.01) and lower albumin levels (p = 0.02) compared to centenarians without dementia. Concluding, centenarians with preserved cognition had better nutritional status, lower homocysteinemia, tendency to higher blood pressure and lower inflammatory activity compared to demented subjects.

Effect of different types of exercise on sleep quality of elderly subjects.

OBJECTIVE/BACKGROUND: There are still many gaps in research concerning the effect of different physical training modalities on sleep quality in the elderly population. Thus, the objective of the present study was to compare the quality of sleep of hypertensive elderly subjects submitted to two types of training (ie, aerobic exercise alone or combined aerobic and resistance training). PATIENTS/METHODS: Participants aged 60-75 years were randomized to three groups: aerobic group (AG), combined aerobic and resistance group (ARG), and control untrained group (CG). Training lasted ten consecutive weeks with 30 uninterrupted sessions. The actigraph (Actiwatch Minimitter Company, INC - Sunriver, OR, USA) was placed on the non-dominant wrist and activities were monitored continuously while being recorded at one minute intervals. The participants kept the device for a period of 96 hours before the first and last training sessions. RESULTS: There was a reduction in sleep fragmentation index of 18.9 for AG and 13 for ARG (p < 0.01) and the sleep efficacy was improved in the exercise groups, with a 5.6% increase for AG (p = 0.02) and a 6.1% increase for ARG (p = 0.01). After training, percentage of minutes motionless was increased by 8.2% for AG and by 6.9% for ARG (p < 0.01), indicating improved sleep quality. A reduction in total activity score during sleep was observed for AG and ARG (p < 0.01). CONCLUSIONS: The two types of exercise performed for ten weeks similarly improved sleep quality, thus reducing the fragmentation index, the percentage of minutes in motion and total activity score, and increasing sleep efficacy.

Effect of aerobic training and aerobic and resistance training on the inflammatory status of hypertensive older adults.

There is a relationship between high levels of inflammatory markers and low adhesion to the practice of physical activity in the older population. The objective of the present study was to compare the effect of two types of exercise programs, i.e., aerobic training and aerobic plus resistance training on the plasma levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) of elderly hypertensive subjects. Hypertensive older volunteers in use of antihypertensive drugs were randomized to three groups: aerobic group (AG), resistance and aerobic group (RAG) and control group (CG). Training lasted 10 weeks, with sessions held three times a week. Blood samples were collected before training and 24 h after completion of the 30 sessions for the determination of serum IL-6 and TNF-α levels. Body mass index was obtained before and after 10 weeks. After intervention, BMI values were lower in AG and RAG compared to CG (p < 0.001), IL-6 was reduced in AG compared to CG (p = 0.04), and TNF-α levels were lower only in RAG compared to CG (p = 0.01). Concluding, both types of training were effective in reducing BMI values in hypertensive older subjects. Aerobic exercise produced the reduction of plasma IL-6 levels. However, the combination of aerobic and resistance exercise, which would be more indicated for the prevention of loss of functionality with aging, showed lower TNF-α mediator after training than control group and a greater fall of TNF-α levels associated to higher BMI reduction.

Under-reporting of food intake and body fatness in independent older people: a doubly labelled water study.

BACKGROUND: there are no accurate methods for the assessment of food intake in older populations, under-reporting of intake being highly prevalent. There is controversy about which dietary assessment method and what person's characteristics are associated with greater under-reporting rates. OBJECTIVE: to assess the correlation between under-reporting of energy intake (EI) and different percentages of body fat in independent older people. DESIGN: cross-sectional study. SETTTING: area assisted by the Family Health Program of the Ribeirão Preto Medical School, University of São Paulo, Brazil. SUJECTS: one hundred volunteers aged 60-70 years. METHODS: all volunteers had their body composition assessed by dual-energy x-ray absorptiometry. In second phase, 41 volunteers were evaluated, representing the four quartiles of fat percentage. Total energy expenditure (TEE) was measured by the doubly labelled water method, and EI was assessed by 24-h recalls and a food frequency questionnaire (FFQ). TEE and EI values, EI-to-TEE ratios and EI-TEE values were compared. RESULTS: TEE was 2,220 ± 601 kcal, while the EI was 1,919 ± 602 kcal (24-h recall) and 2,119 ± 670 kcal (FFQ). The proportion of under-reporters was 31 and 40.5%, respectively. Under-reporting was more frequent in subjects with higher percentage of body fat and in females (P < 0.05). CONCLUSION: under-reporting was more frequent among older persons with higher percentage of body fat in both methods of assessment of food intake. Older persons follow the same profile of under-reporting as younger adults.

Body composition, muscle strength and quality of active elderly women according to the distance covered in the 6-minute walk test.

BACKGROUND: Changes arising from the aging process, particularly changes in body composition, contribute to the functional decline of the elderly. OBJECTIVE: To compare the body composition and muscle strength, mobility and quality in active elderly women according to the distance walked during the 6-minute walk test (6MWT). METHOD: The study included 77 active elderly women aged 65 to 80 years, who were divided into tertiles (A, B and C) according to the distance covered in the 6MWT. We performed anthropometric and clinical evaluations. Body composition was determined by dual energy X-ray absorptiometry (DXA). Handgrip strength (HGS) was measured with a portable dynamometer (Saehan), and knee extension strength (KES) was measured with the one repetition maximum test (1-RM). Functional mobility was assessed by the Timed Up and Go (TUG) test, and body balance was assessed by the Berg Balance Scale (BBS). Muscle quality was defined by the ratio between muscle strength (kgf) and muscle mass (kg). RESULTS: The group that walked the shortest distance in the 6MWT had a higher BMI (A=30.8±7.0, B=27.2±4.2 and C=25.9±3.5 kg/m2), greater amount of fat mass (A=31.3±10.7, B=25.9±6.7 and C=23.81±6.46 kg) lower HGS (A=21.8±5.1, B=22.1±3.5 and C=25.5±5.1 kgf), lower knee extension strength (A=30.6±10.9, B=40.4±12.5 and C=47.2±10.1 kgf), lower arm muscle quality (A=10.1±3.7, B=11.6±2 and C=12.7±2.2 kg) and lower leg muscle quality (A=1.78±1, B=2.84±0.98 and C=3.31±0.77 kg). There was no significant difference between muscle mass (p=0.25) and lean mass (p=0.26). CONCLUSION: Body fat has a negative influence on functional performance, even among active elderly women.

Body composition, muscle strength and quality of active elderly women according to the distance covered in the 6-minute walk test

BACKGROUND: Changes arising from the aging process, particularly changes in body composition, contribute to the functional decline of the elderly. OBJECTIVE: To compare the body composition and muscle strength, mobility and quality in active elderly women according to the distance walked during the 6-minute walk test (6MWT). METHOD: The study included 77 active elderly women aged 65 to 80 years, who were divided into tertiles (A, B and C) according to the distance covered in the 6MWT. We performed anthropometric and clinical evaluations. Body composition was determined by dual energy X-ray absorptiometry (DXA). Handgrip strength (HGS) was measured with a portable dynamometer (Saehan), and knee extension strength (KES) was measured with the one repetition maximum test (1-RM). Functional mobility was assessed by the Timed Up and Go (TUG) test, and body balance was assessed by the Berg Balance Scale (BBS). Muscle quality was defined by the ratio between muscle strength (kgf) and muscle mass (kg). RESULTS: The group that walked the shortest distance in the 6MWT had a higher BMI (A=30.8±7.0, B=27.2±4.2 and C=25.9±3.5 kg/m2), greater amount of fat mass (A=31.3±10.7, B=25.9±6.7 and C=23.81±6.46 kg) lower HGS (A=21.8±5.1, B=22.1±3.5 and C=25.5±5.1 kgf), lower knee extension strength (A=30.6±10.9, B=40.4±12.5 and C=47.2±10.1 kgf), lower arm muscle quality (A=10.1±3.7, B=11.6±2 and C=12.7±2.2 kg) and lower leg muscle quality (A=1.78±1, B=2.84±0.98 and C=3.31±0.77 kg). There was no significant difference between muscle mass (p=0.25) and lean mass (p=0.26). CONCLUSION: Body fat has a negative influence on functional performance, even among active elderly women. .

Association of frailty syndrome in the elderly with higher blood pressure and other cardiovascular risk factors.

BACKGROUND: Few studies have evaluated blood pressure (BP) and cardiovascular risk in older persons with frailty syndrome. The objective of the present study was to assess the cardiovascular risk factors of subjects with frailty syndrome with emphasis on BP, as compared with individuals without frailty or with prefrailty. METHODS: This was a cross-sectional study in which 77 frail, prefrail, and nonfrail older subjects were selected according to the criteria of Fried et al.: self-reported weight loss, low grip strength, low energy, slow gait speed, and low physical activity. Anthropometric and BP measurements were obtained in the office, and home blood pressure monitoring (HBPM) and ambulatory blood pressure monitoring (ABPM) were also performed. Fasting glucose and plasma lipids were collected. Data were analyzed by linear fixed effects model and ANOVA. RESULTS: Mean age was 74.5 ± 7.5 years. There was no difference in office BP or HBPM between groups, but ABPM of frail group demonstrated higher systolic and diastolic BP values over the 24 h (135/74 mm Hg, P = 0.02 and P = 0.04) and during sleep (135/74 mm Hg, P = 0.01 and P = 0.02) than nonfrail group (122/68 mm Hg and 120/67 mm Hg, respectively). Body mass index and fasting glucose were similar among groups, although abdominal circumference was greater (P = 0.04) and high-density lipoproteins (HDL) were lower (P = 0.03) in the frail group than nonfrail one (P = 0.04). CONCLUSIONS: Subjects with frailty syndrome had higher BP evaluated by ABPM and other cardiovascular risk factors such as lower HDL and more abdominal fat than nonfrailty group.

Adesão ao tratamento e controle da pressão arterial em idosos com hipertensão / Treatment adherence and blood pressure control in older individuals with hypertension

FUNDAMENTO: A não adesão ao tratamento tem sido identificada como a causa principal da Pressão Arterial (PA) não controlada, e pode representar um risco maior em idosos. OBJETIVO: O objetivo deste estudo foi avaliar e comparar a taxa de adesão ao tratamento da hipertensão arterial por diferentes métodos, para estimar a taxa de controle da PA, e observar se há uma associação entre controle da pressão arterial e adesão. MÉTODOS: A adesão ao tratamento foi avaliada em pacientes idosos com hipertensão, acompanhados pelo serviço público de saúde, por meio de quatro métodos, incluindo o teste de Morisky-Green (referência), o questionário sobre atitudes referentes à ingestão de medicação (AMI), uma avaliação da adesão por parte do enfermeiro em consultório (AEC), e avaliação domiciliar da adesão (ADA). A ingestão de sal foi estimada pela excreção urinária de sódio de 24 horas. O controle da pressão arterial foi avaliado pelo monitorização ambulatorial da pressão arterial na vigília. RESULTADOS: A concordância entre o teste de Morisky-Green e o AMI (Kappa = 0,27) ou a AEC (Kappa = 0,05) foi pobre. Houve uma concordância moderada entre o teste de Morisky-Green e a ADA. Oitenta por cento tinham a PA controlada, incluindo 42% com efeito do jaleco branco. O grupo com menor excreção de sal relatou evitar o consumo de sal mais vezes (p < 0,001) e também teve maior adesão ao medicamento (p < 0,001) do que o grupo com maior de excreção de sal. CONCLUSÃO: Os testes avaliados não apresentaram boa concordância com o teste de Morisky-Green. A adesão ao tratamento da hipertensão foi baixa; no entanto, houve uma elevada taxa de controle da pressão arterial, quando os sujeitos com o efeito do jaleco branco foram incluídos na análise.

BACKGROUND: Non-adherence to treatment has been identified as the main cause of uncontrolled blood pressure (BP), and may represent a greater risk in older individuals. OBJECTIVE: The aim of this study was to evaluate and compare the rate of adherence to hypertension treatment using different methods, to estimate the BP control rate, and to observe if there is an association between BP control and adherence. METHODS: Treatment adherence was evaluated in older patients with hypertension, followed by the public primary health care, through four methods, including the Morisky-Green test (reference), the Attitude regarding the Medication Intake questionnaire (AMI), an evaluation of adherence by the nurse in the office (Nurse Adherence Evaluation - NAE), and at home (Home Adherence Evaluation - HAE). Salt intake was estimated by 24-hour sodium urinary excretion. BP control was assessed by the awake ambulatory blood pressure monitoring. RESULTS: Concordance between the Morisky-Green test and AMI (Kappa=0.27) or NAE (Kappa=0.05) was poor. There was a moderate concordance between the Morisky-Green test and HAE. Eighty percent had controlled BP, including 42% with white-coat effect. The group with lower salt excretion informed to avoid salt intake more times (p<0.001) and had better medication adherence (p<0.001) than the higher salt excretion group. CONCLUSION: The evaluated tests did not show a good concordance to the Morisky-Green test. Adherence to hypertension treatment was low; however, there was a high rate of BP control when subjects with the white-coat effect were included in the analysis.

Treatment adherence and blood pressure control in older individuals with hypertension.

BACKGROUND: Non-adherence to treatment has been identified as the main cause of uncontrolled blood pressure (BP), and may represent a greater risk in older individuals. OBJECTIVE: The aim of this study was to evaluate and compare the rate of adherence to hypertension treatment using different methods, to estimate the BP control rate, and to observe if there is an association between BP control and adherence. METHODS: Treatment adherence was evaluated in older patients with hypertension, followed by the public primary health care, through four methods, including the Morisky-Green test (reference), the Attitude regarding the Medication Intake questionnaire (AMI), an evaluation of adherence by the nurse in the office (Nurse Adherence Evaluation - NAE), and at home (Home Adherence Evaluation - HAE). Salt intake was estimated by 24-hour sodium urinary excretion. BP control was assessed by the awake ambulatory blood pressure monitoring. RESULTS: Concordance between the Morisky-Green test and AMI (Kappa=0.27) or NAE (Kappa=0.05) was poor. There was a moderate concordance between the Morisky-Green test and HAE. Eighty percent had controlled BP, including 42% with white-coat effect. The group with lower salt excretion informed to avoid salt intake more times (p<0.001) and had better medication adherence (p<0.001) than the higher salt excretion group. CONCLUSION: The evaluated tests did not show a good concordance to the Morisky-Green test. Adherence to hypertension treatment was low; however, there was a high rate of BP control when subjects with the white-coat effect were included in the analysis.

Effect of a single session of aerobic walking exercise on arterial pressure in community-living elderly individuals.

Several studies have demonstrated that one exercise session (ES) on a cycloergometer or ergometric treadmill causes a reduction in blood pressure (BP). However, there are few similar studies on walking, which is the exercise modality most available to the elderly. We investigated the immediate and 24-h effects of walking on BP in independent, community-living elderly individuals. Volunteers participated in a single ES and resting control session (CS). Before and after each session, BP was measured by auscultatory and oscillometric methods. After each session, 24-h ambulatory blood pressure monitoring was conducted. An accelerometer was installed 48 h before the sessions and left in place for 5 days. The mean volunteer age was 67.7±3.5 years; 11 were hypertensive patients under treatment, and 12 were normotensive. In the total sample, there were immediate 14mm Hg and 12 mm Hg reductions in systolic BP (SBP) after the ES according to the auscultatory and oscillometric methods, respectively. Diastolic BP (DBP) was reduced by 4 mm Hg after the ES according to both methods. SBP during wakefulness and sleep and DBP during wakefulness were lower after the ES than after the CS (P<0.01), when wakefulness and sleep were determined individually (variable-time pattern) using data from the activity monitors and provided by the volunteers. The variable-time pattern was more effective in detecting reductions in BP than the fixed-time pattern.