Isolated systolic hypertension, an elevation in systolic but not diastolic pressure, is the most prevalent type of hypertension in those aged 50 or over, occurring either de novo or as a development after a long period of systolic-diastolic hypertension with or without treatment. The increase in blood pressure with age is mostly associated with structural changes in the arteries and especially with large artery stiffness. It is known from various studies that rising blood pressure is associated with increased cardiovascular risk. In the elderly, the most powerful predictor of risk is increased pulse pressure due to decreased diastolic and increased systolic blood pressure. All evidence indicates that treating the elderly hypertensive patient will reduce the risk of cardiovascular events. However, there is no evidence yet for the very elderly. This population is particularly susceptible to side effects of treatments and the reduction of blood pressure, although reducing the risk of cardiovascular events such as stroke, may result in increased mortality.

Background/Aims: The Clock Drawing Test (CDT) is used in clinical practice for the screening of cognitive disorders. This systematic review aims to present and discuss the CDT scoring methods available in the literature, in order to find differences in administration and utility of the CDT. Methods: A literature search was carried out in Medline (1966 to June 2008), Psychinfo (1967 to June 2008) and EMBASE (1980 to June 2008). Results: All studies showed good interrater and test-retest reliabilities. The correlation with other standard screening tests was statistically significant in most studies, but the results were influenced by age, education and language. In studies that included patients with mild or questionable dementia, the CDT had a low sensitivity and variable specificity. Conclusion: The CDT has the characteristics of a good screening method for moderate and severe dementia. However, the scoring method used and potential confounders need to be taken into consideration.

OBJECTIVE -To compare age-related changes in the mechanical properties of different arterial segments in normal volunteers and subjects with type 2 diabetes.RESEARCH DESIGN AND METHODS -In 169 subjects (diabetic n ϭ 57 and nondiabetic n ϭ 112), we assessed the mechanical properties of three arterial segments of differing wall composition. Pulse wave velocity (PWV) was measured noninvasively in a thoracoabdominal segment (carotid femoral PWV [PWV cf ]), in an upper limb muscular artery (carotid radial PWV [PWV cr ]), and from the aorta to the finger (PWV from the aorta to the finger [PWV fin ]). Central aortic compliance (CAC) was also measured.RESULTS -Average CAC was lower (0.662 vs. 0.850, P Ͻ 0.05) and all measures of PWV tended to be faster in diabetic subjects despite the fact that they were, on average, 10 years younger. However, these measures were not related to age in diabetic subjects. After correcting for blood pressure, only PWV cf was associated with age in nondiabetic subjects (P Ͻ 0.001). Expressing results as ratios of nonelastic to elastic arterial segments (i.e., PWV cr -to-PWV cf and PWV fin -to-PWV cf ) improved the relationship with age. Both PWV cr -to-PWV cf and PWV fin -to-PWV cf were significantly associated with age in nondiabetic subjects (r ϭ Ϫ0.59, P Ͻ 0.001; r ϭ Ϫ0.57, P Ͻ 0.001) but not in diabetic subjects (r ϭ Ϫ0.15, P ϭ 0.302; r ϭ Ϫ0.24, P ϭ 0.129). Multivariate analysis showed that the ratios were not associated with systolic blood pressure.CONCLUSIONS -There are significant differences in the rate of age-related decline in vascular stiffness in elastic arteries of nondiabetic compared with diabetic arteries. Diabetic arteries appear to age at an accelerated rate at an earlier age and then reach a functional plateau. Diabetes Care 26:2133-2138, 2003T he mechanical properties of the large conduit arteries are now recognized as an important component of cardiovascular pathophysiology. Less compliant arteries are associated with suboptimal cardiac energy supplydemand balance with reduced subendocardial blood flow and increased left ventricular afterload (1). There are also adverse effects of poor compliance on wave reflection and systolic blood pressure (SBP) (2). It is usually accepted that the age-related increase in SBP and decrease in diastolic blood pressure (DBP) are largely due to decreased proximal aortic compliance, causing more rapid diastolic run-off of a lower-contained volume (hence decreasing DBP) along with an early return of the reflected pressure wave in systole, causing increased pressure augmentation (increased SBP). Thus, increased aortic stiffness is the predominant cause of increased pulse pressure (3).Pulse pressure is a marker of cardiovascular risk in a general population (4) and, independent of SBP and DBP, has been shown to be a predictor of cardiovascular events (5), particularly in older individuals (6). It has also been shown that aortic stiffness (measured as pulse wave velocity [PWV]) is an independent predictor of cardiovascular risk (7) and all-ca...

there was a strong association between baseline depression scores and later fatal and non-fatal cardiovascular endpoints over a mean follow-up of 2 years in a hypertensive very elderly group. The mechanism of this association warrants further study.