In vivo human brachial artery elastic mechanics: effects of smooth muscle relaxation.

BACKGROUND: The effects of smooth muscle relaxation on arterial wall mechanics are controversial. We used a new, in vivo, noninvasive technique to measure brachial artery wall mechanics under baseline conditions and following smooth muscle relaxation with nitroglycerin (NTG). METHODS AND RESULTS: Eight healthy, normal subjects (6 male, 2 female; age 30+/-3.1 years) participated in the study. The nondominant brachial artery was imaged through a water-filled blood pressure cuff using an external ultrasound wall-tracking system at baseline and following 0.4 mg sublingual NTG. Simultaneous radial artery pressure waveforms were recorded by tonometry. Transmural pressure (TP) was reduced by increasing water pressure in the cuff. Brachial artery area, unstressed area, compliance, stress, strain, incremental elastic modulus (Einc), and pulse wave velocity (PWV) were measured over a TP range from 0 to 100 mm Hg. Baseline area versus TP curves generated 30 minutes apart were not significantly different. NTG significantly shifted area versus TP (P<0.0001) and compliance versus TP (P<0.001) curves upward, whereas the Einc versus TP (P<0.05) and PWV versus TP (P<0. 01) curves were shifted downward. NTG also significantly shifted stress versus strain (P<0.01) and Einc versus strain (P<0.01) curves to the right. CONCLUSIONS: We conclude that brachial artery elastic mechanics can be reproducibly measured over a wide range of TP and smooth muscle tone using a new noninvasive ultrasound technique. Smooth muscle relaxation with NTG increases isobaric compliance and decreases isobaric Einc and PWV in the human brachial artery.

Effect of obesity on the response to insulin therapy in noninsulin-dependent diabetes mellitus.

An initial improvement in glycemic control is often followed by gradual deterioration of glycemia during insulin treatment of patients with noninsulin-dependent diabetes mellitus (NIDDM). We examined the causes of such worsening in a 12-month follow-up analysis of 100 insulin-treated NIDDM patients in the Finnish Multicenter Insulin Therapy Study who were treated with either combination therapy with insulin or insulin alone. In the entire study group, glycemic control averaged 9.7 +/- 0.2% at 0 months and 8.0 +/- 0.1%, 8.0 +/- 0.1%, 8.2 +/- 0.1%, and 8.5 +/- 0.2% at 3, 6, 9, and 12 months (P < 0.001 for each time point vs. 0 months). Glycemic control at 12 months was significantly worse than that at 3 (P < 0.001), 6 (P < 0.001), and 9 months (P < 0.02). Baseline body mass index was the most significant predictor of deterioration in glycemic control. During 1 yr, hemoglobin A1c decreased almost 3-fold more (by 1.7 +/- 0.2%; P < 0.001 vs. 0 months) in patients whose baseline weight was below the mean baseline body mass index of 28.1 kg/m2 (nonobese patients) than in those whose weight exceeded 28.1 kg/m2 (obese patients; 0.5 +/- 0.2%; P = NS vs. 0 months; P < 0.01 vs. obese patients). Glycemic control improved similarly over 1 yr in the nonobese subjects and deteriorated similarly in the obese patients regardless of their treatment regimen. Insulin doses, per body weight, were similar in the nonobese and obese patients. The nonobese patients consistently gained less weight during 12 months of combination therapy with insulin (3.5 +/- 0.6 kg at 12 months) than during insulin therapy alone (5.1 +/- 0.6 kg; P < 0.05). The treatment regimen did not influence weight gain in the obese group, who gained 4.4 +/- 1.0 kg during combination therapy with insulin and 4.5 +/- 1.1 kg during insulin therapy alone. We reached the following conclusions: 1) after an initial good response, glycemic control deteriorates more in obese than in nonobese patients with NIDDM; 2) in obese patients, weight gain per se cannot explain the poor glycemic response to combination or insulin therapy, but it may induce a disproportionately large increase in insulin requirements because of greater insulin resistance in the obese than in the nonobese; 3) in nonobese patients, glycemic control improves equally during 1 yr with combination therapy with insulin and insulin alone, but combination therapy with insulin is associated with less weight gain than treatment with insulin alone; 4) weight gain appears harmful, as it is associated with increases in blood pressure and low density lipoprotein cholesterol.

Blood pressure in the very old.

Seven hundred and twenty-four people (541 female, 183 male), aged 84-88 years and living at home in the city of Tampere, Finland, accepted our invitation to be examined in the outpatient department of the local geriatric hospital. These subjects were re-examined annually, and their fate was followed for 3 years. The blood pressure level was a prognostic sign for mortality during the first year after its measurement. The lowest mortality rate was found among those subjects with systolic blood pressure between 140 and 169 mmHg and diastolic blood pressure between 70 and 99 mmHg. Blood pressures outside of these ranges were associated with increased mortality rates, particularly cardiac and coronary mortality. The mortality rate was especially high among those whose systolic blood pressure had decreased to low levels in the year before, but was lower in those whose systolic blood pressure had decreased from high to middle levels (140-169 mmHg) than in those with consistently high systolic blood pressure. Eventual institutionalization was more common in those with low systolic blood pressure.

Electrocardiogram, clinical findings and chest x-ray in persons aged 85 years or older.

Persons aged 85 years or more (n = 674) living in Tampere, Finland, were surveyed in 1977 and 1978. Five hundred fifty-nine persons (83%) were examined. Electrocardiographic findings, classified according to the Minnesota code, were compared with reported cardiac symptoms, clinical congestive heart failure, clinical coronary heart disease and relative cardiac volume on chest radiograph. Electrocardiographic items had a poor association with cardiac symptoms. ST-segment depression, T-wave inversion, ventricular premature complexes and atrial fibrillation were related statistically highly significantly to clinical congestive heart failure, as were ST-segment depression and T-wave inversion to clinical coronary heart disease. High left R waves, ventricular premature complexes and atrial fibrillation showed a significant association with cardiac enlargement (over 500 ml/m2) and pulmonary congestion in chest radiographs.

Vitamin D treatment and bone mineral density in the aged.

The purpose of this study was to investigate whether long-term vitamin D treatment increased bone mineral density in the aged. The bone mineral density in the distal forearm and femoral neck did not differ between nine residents (mean age 81.0 years) of an old peoples' home who had received an annual injection of 150,000 IU ergocalciferol during the foregoing 2-7 years (mean 5.1 years) and nine age-, weight- and height-matched control subjects who had subnormal 25 hydroxyvitamin D level. The alkaline phosphatase and parathyroid hormone levels were clearly higher when the 25 hydroxyvitamin D level was below 10 nmol/1. The authors suggest that the ability of vitamin D treatment to diminish fracture incidence may derive from improved bone quality, not measurable by the standard dual energy X-ray absorptiometry, and/or improved nervous and muscular control of movements to counter the tendency to fall.

Blood glucose and diabetes mellitus in subjects aged 85 years or more.

Blood and urine glucose values and the prevalence of diabetes mellitus were determined in the course of a health survey covering inhabitants of Tampere, Finland, aged 85 or over. Out of the total cohort, 561 (83%) subjects, of whom 82% were women, were examined. A high blood glucose level (greater than or equal to 7.0 mmol/l) was recorded in 10% of the males and 7% of the females. The prevalence of diabetes mellitus in the series was 17%. Five per cent of the total series were on drug treatment for their diabetes; 5% of the diabetics were on insulin therapy and 25% took oral antidiabetic drugs, while 70% were either on diet or had no treatment. Diabetes seems to be common among the very aged, but it is generally mild and easy to treat.

Electrocardiographic findings and 5-year cardiovascular mortality in very old people.

The electrocardiograms (ECGs) of 558 individuals, 83% of the total population aged 85 years or over in the city of Tampere in 1977, were assessed according to the Minnesota code in a health survey. The underlying causes of death were identified from the death certificates during the following five years. The total mortality rate was 70%, while the cardiovascular mortality was 51%. The lowest 5-year mortality from cardiovascular and cardiac diseases was observed in subjects with no codable or only minor ECG abnormality in the initial examination. The highest cardiovascular mortality rate was found in individuals with atrial fibrillation, atrioventricular blocks and left or right bundle branch block. The cardiac mortality was related to left or right bundle branch block and atrial fibrillation. Mortality from stroke showed the highest association with clockwise rotation and left high R waves.

Blood pressure and five year survival in the very old.

During 1977-8 we measured blood pressure in 561 old people (83% of those aged 85 or more living in Tampere) and analysed their five year survival according to their blood pressure group. The subjects were divided into six groups on the basis of their blood pressures (from less than 120 to greater than 200 mm Hg systolic, from less than 70 to greater than 110 diastolic). The greatest mortality was observed in those in the lowest systolic and lowest diastolic groups. Mortality was least in subjects with systolic pressures of 160 mm Hg or more and diastolic pressures of 90 mm Hg or more. The most essential finding in this series of the very old was an increased mortality in the lowest blood pressure groups.

A health survey of the very aged in Tampere, Finland.

The population aged 85 years or over (n = 674) living in Tampere, Finland, was surveyed in 1977-78. Altogether, 561 persons (83%)--99 men and 462 women--were examined. The study comprised questionnaire, medical examination, laboratory tests, ECG and chest X-ray examination. Of the subjects, 24% were hospitalized, 22% were in old people's homes and 54% lived at home. The most common symptoms were aches and pains (24%), vertigo (22%), defective vision (15%) and defective hearing (12%). Congestive heart failure (49%), dementia or confusional state (28%) and urinary tract infection (22%) were the most common diseases.

Urinary characteristics and infection in the very aged.

In the course of a health survey covering 561 inhabitants of Tampere, Finland, aged 85 or over, morning urine specimens were studied. 82% of the participants were women. Significant bacteriuria was recorded in 27% of the subjects, 13% of the men and 30% of the women. Pyuria was recorded in 47% of the total material. Replying to the questionnaire, 5% of the subjects reported urinary symptoms and 7% reported to be suffering from urinary tract infection (UTI) diagnosed by a physician. The prevalence of drug-treated UTI was 9% of the subjects replying to the questionnaire. Although positive urinary 'abnormalities' are common in very old people, they do not cause significant distress and do not constitute a disease requiring drug treatment in asymptomatic old people.

Prevalence of ECG findings in very old people.

The electrocardiograms of 559 persons, 83% of the total population 85 years of age or over in the city of Tampere, were evaluated according to the classification of the modified Minnesota code. Electrocardiograms showed no codable item in only 3.6% of the subjects. The prevalence of the most frequent electrocardiographic findings was: T wave inversion 53.3%, counter-clockwise rotation 42.9%, ST junction depression 42.8%, premature beats 33.8%, Q-QS pattern 21.3% and atrial fibrillation 17.4%. The prevalence of left axis deviation, left anterior hemiblock and right bundle branch block was statistically significantly higher in men than in women. Electrocardiographic abnormalities suggestive of ischaemic heart disease were present in 45.3% with no statistically significant relation to sex or age. The results are discussed and compared with those of electrocardiographic studies concerning age groups over 80 and 90 years.

ECG findings and survival in very old people.

The electrocardiograms of 559 persons, 82% of the total population 85 years of age or over in the city of Tampere in 1977-1978, were evaluated according to the classification of the modified Minnesota code. The relative five-year survival rates matched by sex and age were calculated for subjects with various ECG findings. Of the series, 391 persons (70%) died during the five-year follow-up period. The lowest mortality rate was observed in those with no codable change or with minor abnormality in the ECG. Electrocardiographic abnormalities suggestive of ischaemic heart disease were associated with significantly increased mortality. In respect of single ECG changes the greatest mortality rate was found in subjects with atrial fibrillation or first-degree atrioventricular block revealed in the ECG. No increased risk of death was associated with left and right bundle branch block, supraventricular premature beats and ventricular premature beats.

Living conditions and health of a population aged 85 years or over: a five-year follow-up study.

The population aged 85 years or over (n = 674) living in Tampere, Finland was surveyed in 1977-78. Altogether 561 persons (83%), 99 men and 462 women, were examined. A re-examination of 170 persons, 23 men and 147 women, was carried out in 1982 by the same procedure as in 1977-78, The results were compared with those of the same people and with those of over-90s five years before. Of the group followed, in the initial survey 65% were living at home and 25% in old people's homes, 10% being hospitalized. The percentage of hospital in-patients had increased threefold during the five-year follow-up. The functional capacity of the subjects had deteriorated as regards mental function and ability to walk. The mean values of blood samples (apart from ESR) were still in normal ranges, although the levels of haemoglobin and haematocrit had fallen significantly. Dementia or confusion, anaemia, femoral-neck fracture and cataract were significantly increased.

Treatment of chronic constipation with lactitol sweetened yoghurt supplemented with guar gum and wheat bran in elderly hospital in-patients.

The faecal output of 33 elderly hospitalized patients was followed daily for 4 weeks. After an observation period of 1 week 18 patients received during the following 2 weeks a 150 ml portion of yoghurt containing lactitol, guar gum and wheat bran (fibre yoghurt group) twice daily. Fifteen control patients received the same volume of yoghurt without lactitol, guar gum or wheat bran (control yoghurt group). The study design was randomized double-blind. The mean faecal output increased 1.6-fold in patients receiving fibre yoghurt, while the corresponding value for control patients was 1.2 (p less than 0.05). About 50% of the fibre yoghurt group and 25% of the controls considered the treatment effective. Some in the fibre yoghurt group experienced meteorism and loose stools. No significant changes were observed in blood glucose, serum cholesterol or triglyceride values, body weights or faecal pH values in either group.