Background: Sarcopenia, particularly low handgrip strength has been observed and correlated in association with hypertension among the older people. However, the results reported in different studies were inconsistent. In the current study, we conducted a systematic review and meta-analysis to reveal the significant association between sarcopenia, handgrip strength, and hypertension in older adults. Methods: PubMed, MEDLINE, Cochrane Library, and EMBASE databases were searched from inception to 15 November 2019 to retrieve the original research studies that addressed the association between sarcopenia, handgrip strength, and hypertension. All the relevant data were retrieved, analyzed, and summarized. Results: Twelve articles met the inclusion criteria and a total of 21,301 participants were included in the metaanalysis. Eight eligible studies have reported the odd ratios (ORs) of hypertension and sarcopenia, and the ORs ranged from 0.41 to 4.38. When pooled the ORs together, the summarized OR was 1.29 [95% confidence interval (CI) =1.00-1.67]. The summarized OR for the Asian group 1.50 (95% CI = 1.35-1.67) was significantly higher than that of Caucasian group 1.08 (95% CI = 0.39-2.97). Eleven studies have provided the data on association between handgrip strength and hypertension. The overall OR and 95% CI was 0.99 (95% CI = 0.80-1.23), showing no significant association. Conclusion: Sarcopenia was associated with hypertension, but no correlation was found between handgrip strength and hypertension in older adults.

Abstract-Patients with peripheral arterial disease may have elongated upstroke time in pulse waves in the lower extremities.We investigated upstroke time as a diagnostic tool of peripheral arterial disease and predictor of mortality in an elderly (≥60 years) Chinese population. We recorded pulse waves at the left and right ankles by pneumoplethysmography and calculated the percentage of upstroke time per cardiac cycle. Diagnostic accuracy was compared with the conventional ankle-brachial index method (n=4055) and computed tomographic angiography (34 lower extremities in 17 subjects). Upstroke time per cardiac cycle at baseline (mean±SD, 16.4%±3.1%) was significantly (P<0.0001) associated with ankle-brachial index in men (n=1803; r=−0.44) and women (n=2252; r=−0.32) and had an overall sensitivity and specificity of 86% and 80%, respectively, for the diagnosis of peripheral arterial disease (upstroke time per cardiac cycle, ≥21.7%) in comparison with computed tomographic angiography. During 5.9 years (median) of follow-up, all-cause and cardiovascular deaths occurred in 366 and 183 subjects, respectively. In adjusted Cox regression analyses, an upstroke time per cardiac cycle ≥21.7% (n=219; 5.4%) significantly (P<0.0001) predicted total and cardiovascular mortality. The corresponding hazard ratios were 1.98 (95% confidence interval, 1.48-2.65) and 2.29 (1.58-3.32), respectively, when compared with that of 2.10 (1.48-3.00) and 2.44 (1.57-3.79), respectively, associated with an ankle-brachial index of ≤0.90 (n=115; 2.8%). In conclusion, pulse waves in the lower extremities may behave as an accurate and ease of use diagnostic tool of peripheral arterial disease and predictor of mortality in the elderly. (Hypertension. 2016;67:527-534.

Abstract-No previous study has addressed the relative contributions of environmental and genetic cues to the diurnal blood pressure rhythmicity. From 24-hour ambulatory recordings of systolic blood pressure obtained in untreated patients (51% women; mean age, 51 years), we computed the night-to-day ratio in 897 and morning surge in 637. Environmental cues included season, mean daily outdoor temperature, atmospheric pressure, humidity and weekday, and the genetic cues 14 single nucleotide polymorphisms in 10 clock genes. Systolic blood pressure averaged (±SD) 126.7±11.9 mm Hg, night-to-day ratio 0.86±0.07, and morning surge 24.8±10.7 mm Hg. In adjusted analyses, night-to-day ratio was 2.4% higher in summer and 1.8% lower in winter (P<0.001) compared with the annual average with a small effect of temperature (P=0.079); morning surge was 1.7 mm Hg lower in summer and 1.1 mm Hg higher in winter (P<0.001). The other environmental cues did not add to the night-to-day ratio or morning surge variance (P≥0.37). Among the 14 genetic variations, only CLOCK rs180260 was significantly associated with morning surge after adjustment for season, temperature, and other host factors and after Bonferroni correction (P=0.044). In CLOCK rs1801260 C allele carriers (n=83), morning surge was 3.7 mm Hg higher than in TT homozygotes (n=554). Of the night-to-day ratio and morning surge variance, season and temperature explained ≈8% and ≈3%, while for genetic cues, these proportions were ≈1% or less. In conclusion, environmental compared with genetic cues are substantially stronger drivers of the diurnal blood pressure rhythmicity. Methods Study PopulationAs described elsewhere, 24,25 we recruited consecutive patients referred for ambulatory BP monitoring to the Hypertension Outpatient Clinic of Ruijin Hospital, Shanghai, China. We adhered to the principles of the Declaration of Helsinki. The Ethics Committee of Ruijin Hospital, Shanghai Jiaotong University School of Medicine, approved the study protocol. All patients gave informed written consent.Of patients referred from December 2008 until November 2012, 929 were eligible for inclusion in the present analysis because they were not on antihypertensive drug treatment or off antihypertensive medication for at least 2 weeks because they had both their clinic and 24-hour ambulatory BP measured and because they had been genotyped for the SNPs of interest. For analysis of the night-to-day BP ratio, we excluded 32 participants because their ambulatory BP recording was unsuccessful (n=24) or because of missing genotypes (n=8). For analysis of the morning surge, we discarded an additional 260 participants because they had not completed a diary, so that reliably differentiating between the awake and asleep periods of the day was impossible. Thus, the number of participants analyzed totaled 897 for the night-to-day BP ratio and 637 for the morning BP surge. BP MeasurementPhysicians measured the office BP after the patients had rested in the sitting position for at least 5 minutes. They obtained ...

To share our experience of establishing an acute outreach service to nursing homes and to evaluate the impact of such service on emergency department presentations, data were drawn from a pre‐existing database from 2013 to 2017. Of the 986 acute patients treated in 12 nursing homes over a 23‐month period, the acute geriatric outreach service was shown to be safe, with few adverse events (one allergic reaction) and 5.3% of patients required transfer to hospital. The acute service decreased emergency department presentation of nursing home patients by 10% compared to the subacute service (incidence rate ratio = 0.90; 95% confidence interval: 0.84–0.96; P = 0.001). Cost–benefit analysis showed for every $1 spent, a saving of $5 was realised.

Arterial stiffness, as assessed by PWV, independently increased both with BP and with PTH, but BP remains the main driver of arterial stiffening.

In a retrospective analysis, the authors investigated day‐by‐day blood pressure variability (BPV) and its association with clinical outcomes (critical vs. severe and discharged) in hospitalized patients with COVID‐19. The study participants were hospitalized in Tongji Hospital, Guanggu Branch, Wuhan, China, between February 1 and April 1, 2020. BPV was assessed as standard derivation (SD), coefficient of variation (CV), and variability independent of mean (VIM). The 79 participants included 60 (75.9%) severe patients discharged from the hospital after up to 47 days of hospitalization, and 19 (24.1%) critically ill patients transferred to other hospitals for further treatment ( n = 13), admitted to ICU ( n = 3) or died ( n =3). Despite similar use of antihypertensive medication (47.4% vs. 41.7%) and mean levels of systolic/diastolic blood pressure (131.3/75.2 vs. 125.4/77.3 mmHg), critically ill patients, compared with severe and discharged patients, had a significantly ( p ≤ .04) greater variability of systolic (SD 14.92 vs. 10.84 mmHg, CV 11.39% vs. 8.56%, and VIM 15.15 vs. 10.75 units) and diastolic blood pressure (SD 9.38 vs. 7.50 mmHg, CV 12.66% vs. 9.80%, and VIM 9.33 vs. 7.50 units). After adjustment for confounding factors, the odds ratios for critical versus severe and discharged patients for systolic BPV were 3.41 (95% confidence interval [CI] 1.20‐9.66, p = .02), 4.09 (95% CI 1.14‐14.67, p = .03), and 2.81 (95% CI 1.12‐7.05, p = .03) for each 5‐mmHg increment in SD, 5% increment in CV, and 5‐unit increment in VIM, respectively. Similar trends were observed for diastolic BPV indices ( p ≤ .08). In conclusion, in patients with COVID‐19, BPV was greater and associated with worse clinical outcomes.

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Malnutrition is a state of altered body composition and body cell mass due to inadequate intake or utilization of energy or nutrients, leading to physical and mental dysfunction and impaired clinical outcomes. As one of the most common geriatric syndromes, malnutrition in the elderly is a significant risk factor for poor clinical outcomes, causing a massive burden on medical resources and society. The risk factors for malnutrition in the elderly are diverse and include demographics, chronic diseases, and psychosocial factors. Presently, recommendations for the prevention and intervention of malnutrition in the elderly are not clear or consistent in China. This consensus is based on the latest global evidence and multiregional clinical experience in China, which aims to standardize the prevention and intervention of malnutrition in the elderly in China and improve the efficacy of clinical practice and the prognosis of elderly patients.