The incidence of hypertension increases with advancing age and represents a significant burden of disease. Lifestyle modification represents the first-line intervention in treatment algorithms; however, the majority of evidence for this comes from studies involving young participants using interventions that may not always be feasible in the elderly. This manuscript presents a systematic review of all randomized controlled trials involving participants with a mean age of 65 or over investigating nonpharmacological strategies to reduce blood pressure (BP). Fifty-three randomized controlled trials were included. The majority of interventions described aerobic exercise training, dynamic resistance exercise training, or combined aerobic and dynamic resistance exercise training (COM), with limited studies reporting isometric exercise training or alternative lifestyle strategies. Aerobic exercise training, dynamic resistance exercise training, COM, and isometric exercise training all elicited significant reductions in both systolic and diastolic BP, with no additional benefit of COM compared with single modality exercise training. Three months of traditional exercise-based lifestyle intervention may produce a reduction in BP of approximately 5 mmHg systolic and 3 mmHg diastolic in older individuals, similar to that expected in younger individuals.
Pulmonary disease is a significant factor determining long-term survival. Patients with severe COPD still have a relatively good long-term survival and should not be denied surgery. LIMA utilization in patients with COPD results in a significantly increased long-term survival, without an increased intensive care unit stay, re-intubation rate or in-hospital mortality rate.
Logistic EuroSCORE is a reasonable approximation for long-term survival after CABG, if the score is <5; however, its predictive capacity is limited due to the absence of LIMA usage, BMI, diabetes and CKMB in its calculation, all of which are significant factors affecting long-term survival.
Non-smokers under the age of 65 years of age have significantly worse long-term survival compared with ex-smokers after risk factor adjustment. We speculate that this is because ex-smokers have had the causative factor, smoking, removed, but non-smokers have not.
Background The incidence of hypertension increases with advancing age and represents a substantial burden of disease. Lifestyle modification is the first-line intervention in treatment algorithms; however, most evidence for this comes from studies involving young participants using interventions that may not be feasible in older adults.
The aim of this review was to assess the effect of non-pharmacological interventions on hypertension in older adults.Methods We did a systematic review of all randomised controlled trials involving participants with a mean age of 65 years or over investigating non-pharmacological strategies to reduce blood pressure. We searched Medline, EMBASE, CINAHL, AMED, and PubMed from inception to March 3, 2017, with no language restriction (appendix). Outcomes were aggregated with a random-effects model, and the I² statistic was used to quantify statistical heterogeneity. Risk of bias was judged with the Cochrane Collaboration's risk assessment tool. This systematic review is registered with PROSPERO, number CRD42017059443.
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