Ambulatory blood pressure monitoring (ABPM) is being used increasingly in both clinical practice and hypertension research. Although there are many guidelines that emphasize the indications for ABPM, there is no comprehensive guideline dealing with all aspects of the technique. It was agreed at a consensus meeting on ABPM in Milan in 2011 that the 34 attendees should prepare a comprehensive position paper on the scientific evidence for ABPM.This position paper considers the historical background, the advantages and limitations of ABPM, the threshold levels for practice, and the cost-effectiveness of the technique. It examines the need for selecting an appropriate device, the accuracy of devices, the additional information and indices that ABPM devices may provide, and the software requirements.At a practical level, the paper details the requirements for using ABPM in clinical practice, editing considerations, the number of measurements required, and the circumstances, such as obesity and arrhythmias, when particular care needs to be taken when using ABPM.The clinical indications for ABPM, among which white-coat phenomena, masked hypertension, and nocturnal hypertension appear to be prominent, are outlined in detail along with special considerations that apply in certain clinical circumstances, such as childhood, the elderly and pregnancy, and in cardiovascular illness, examples being stroke and chronic renal disease, and the place of home measurement of blood pressure in relation to ABPM is appraised.The role of ABPM in research circumstances, such as pharmacological trials and in the prediction of outcome in epidemiological studies is examined and finally the implementation of ABPM in practice is considered in relation to the issue of reimbursement in different countries, the provision of the technique by primary care practices, hospital clinics and pharmacies, and the growing role of registries of ABPM in many countries.

OBJECTIVES. The purpose of this study was to identify associations between specific medical conditions in the elderly and limitations in functional tasks; to compare risks of disability across medical conditions, controlling for age, sex, and comorbidity; and to determine the proportion of disability attributable to each condition. METHODS. The subjects were 709 noninstitutionalized men and 1060 women of the Framingham Study cohort (mean age 73.7 +/- 6.3 years). Ten medical conditions were identified for study: knee osteoarthritis, hip fracture, diabetes, stroke, heart disease, intermittent claudication, congestive heart failure, chronic obstructive pulmonary disease, depressive symptomatology, and cognitive impairment. Adjusted odds ratios were calculated for dependence on human assistance in seven functional activities. RESULTS. Stroke was significantly associated with functional limitations in all seven tasks; depressive symptomatology and hip fracture were associated with limitations in five tasks; and knee osteoarthritis, heart disease, congestive heart failure, and chronic obstructive pulmonary disease, were associated with limitations in four tasks each. CONCLUSIONS. In general, stroke, depressive symptomatology, hip fracture, knee osteoarthritis, and heart disease account for more physical disability in noninstitutionalized elderly men and women than other diseases.

Osteoarthritis (OA) is a disease with a truly formidable impact. As the most common form of arthritis, it accounts for more dependency in walking, stair climbing, and other lower extremity tasks than any other disease, especially in the elderly (1). Its economic costs are impressive. Yelin (2) summarized data from several studies and estimated the cost of OA in the US at $15.5 billion (in 1994 dollars), roughly 3 times the cost of rheumatoid arthritis. More than half of the OA costs are due to work loss.As a chronic disease with a multifactorial etiology that includes modifiable risk factors, OA could, in theory, be prevented. To weigh the prospects for preventing OA, investigators have turned to epidemiology, i.e., the study of disease in human populations and its association with individual and environmental characteristics. The foundation of our understanding of OA epidemiology emanatcd from cross-sectional population-based studies conducted by Kellgren and Lawrence in the 1950s in Britain. After a long hiatus, a large number of cohort-based epidemiologic studies, many also community-based, were initiated in the mid-1980s and later. These have begun to provide a wealth of new insights into the risk factors for disease. Some of these studies have now begun to produce longitudinal information that could facilitate valid inferences about causation. When risk factors are consistently identified among epidemiologic studies as preceding disease occurrence, these factors can reasonably be identified as causes of disease. The present review arises in the context of this burgeoning sct of high-quality studies, many of them longitudinal, that provide important new insights, particularly with regard to disease prevention. This review will focus on 2 separate, but related, issues. First, we will review the current state of knowledge about OA epidemiology based on cross-sectional and early longitudinal evidence, concentrating on selected recent advances such as studies of racial differences and reports on lifestyle and environmental risk factors tied to disease occurrence. Second, using these data, we will suggest approaches to disease prevention. Anticipating the prevention focus, our discussion of risk factors for disease will necessarily concentrate on modifiable risk factors for OA, although demographic risk profiling may facilitate the selection of high-risk populations at whom efforts at prevention should be targeted. Genetic studies promise to identify persons and groups at high risk of OA. For comprehensive reviews of OA epidemiology, the reader is referred to other sources (3,4). This review will focus on knee and hip OA, which together account for more lower extremity disability among the US elderly than any other disease. These are also the sites in which we have accumulated the most information regarding disease risk factors. Recent data from the Framingham Study suggest that symptomatic knee OA (defined as pain on most days plus positive findings on a radiograph of the symptomatic knee) occurs in 6.1% of adult...

In both active and inactive ambulatory persons aged > or =60 y, 25(OH)D concentrations between 40 and 94 nmol/L are associated with better musculoskeletal function in the lower extremities than are concentrations < 40 nmol/L.

Given the increasing use of ambulatory blood pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability, in year 2013 published a comprehensive position paper dealing with all aspects of the technique, based on the available scientific evidence for ABPM. The present work represents an updated schematic summary of the most important aspects related to the use of ABPM in daily practice, and is aimed at providing recommendations for proper use of this technique in a clinical setting by both specialists and practicing physicians. The present article details the requirements and the methodological issues to be addressed for using ABPM in clinical practice, The clinical indications for ABPM suggested by the available studies, among which white-coat phenomena, masked hypertension, and nocturnal hypertension, are outlined in detail, and the place of home measurement of blood pressure in relation to ABPM is discussed. The role of ABPM in pharmacological, epidemiological, and clinical research is also briefly mentioned. Finally, the implementation of ABPM in practice is considered in relation to the situation of different countries with regard to the reimbursement and the availability of ABPM in primary care practices, hospital clinics, and pharmacies.

Weight loss reduces the risk for symptomatic knee osteoarthritis in women.

National Basic Research Program of China (973 Program).

Background Recent surge in knee replacements has been assumed to be due to aging and increased obesity of the US population. Objectives We described the trend in prevalences of knee pain and symptomatic knee osteoarthritis and assessed whether age, obesity, and change in radiographic osteoarthritis explained this trend. Design We used data from six National Health and Nutrition Examination Surveys (NHANES) between 1971 and 2004 and from three examination periods in the Framingham Osteoarthritis (FOA) Study between 1983 through 2005 (Original cohort 1983–5 and 1992–5, Offspring 1992–5 and 2002–5, and a Community sample 2002–5). Setting NHANES included nationally representative samples of the non-institutionalized US population, and the Framingham Study was a population-based cohort. Participants We included data from NHANES participants 60 to 74 years of age, of White or Black race, and data from Framingham Study of mostly White participants, 70 years or older. Measurements Subjects in NHANES were asked about pain in or around the knee on most days. In the Framingham Study, subjects were asked about knee pain and had bilateral weight-bearing anteroposterior knee x-rays to define radiographic osteoarthritis. We used radiographic evidence and pain to define symptomatic osteoarthritis. We used marginal standardization with logistic regression first to calculate age-adjusted, and then age and BMI-adjusted prevalence by sex, and compared the adjusted prevalence of knee pain and osteoarthritis at later exams with earlier exams using the ratio of the prevalence estimates. Results The age-adjusted prevalence of knee pain and symptomatic osteoarthritis increased over time in all samples studied. With adjustment for both age and BMI the prevalence of knee pain increased by about 65% in NHANES from 1974 to 1994 among Non-Hispanic White and Mexican men and women and among African American women. In the Framingham Osteoarthritis (FOA) Study, the age and body mass index (BMI)-adjusted prevalences of knee pain and symptomatic knee osteoarthritis approximately doubled in women and tripled in men over a 20-year period. No such increasing trend was observed in radiographic osteoarthritis prevalence in Framingham subjects. After age adjustment, additionally adjusting for BMI resulted in a 10–25% decrease in the prevalence ratios for knee pain and symptomatic knee osteoarthritis. Limitations We cannot rule out differences in sampling of Framingham subjects over time or birth cohort effects (generational factors) as possible explanations of the increased reporting of knee pain. Increases in prevalence at the last time period in Framingham might be due to differences in cohort membership by time period. Conclusions Results suggest that independent of age and BMI prevalence of knee pain has increased substantially over a 20–year period. Obesity accounted for only part of this increase. In the FOA Study, there was an increase in symptomatic osteoarthritis but no increase in radiographic osteoarthritis. Primary Funding...