Systolic Hypertension in the Elderly Program (SHEP). Part 4: Baseline medical history findings.
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Health Services for the Aged↗
Biomedical subjects
J D Curb
Publications and source records attributed to J D Curb.
Cardiovascular risk factor levels in ethnic Hawaiians.
We report a cardiovascular risk factor survey of "native" Hawaiians 20-59 years old (70 percent, or 257), living on the Hawaiian Homestead lands on the island of Molokai, Hawaii. More than 60 percent of both sexes were overweight. Among males, 42 percent were smokers. The percent of the population with systolic blood pressure greater than 140 mm Hg or a diastolic pressure greater than 90 mm Hg or taking hypertensive medications was 14 percent of those ages 20-39 and 36 percent of those ages 40-59. The percent with serum cholesterol greater than or equal to 6.2 mmol/L ranged from 8 percent of those 20-29 years old to 46 percent in those 50-59 years old. Two percent of those ages 20-29 had a history of diabetes, or 2 + or greater glycosuria by dipstick, as did 23 percent of those ages 50-59. The majority of the known diabetics exhibited glycosuria and elevated glycohemoglobin levels, indicating poor control. Hypertension, although usually known to the participant, was frequently uncontrolled. From these data, it appears that among this group of Hawaiians major risk factors for cardiovascular disease were frequent, while at the same time the levels of awareness and/or control for most of these factors were low.
Adult↗
Effect of thiazide-based therapy on serum alkaline phosphatase. Hypertension Detection and Follow-up Group.
This study reports a correlation of alkaline phosphatase (AP) with diastolic blood pressure (DBP), and a reduction of alkaline phosphatase after chlorthalidone therapy that reached a nadir at three years of therapy, then gradually returned toward, but not reaching, baseline values. The data is from the baseline examination and follow-up of 3928 initially untreated stepped-care patients in the Hypertension Detection and Follow-up Program. In multiple regression analysis, both age and DBP were significantly correlated with increased AP in males and females. After initiation of therapy with chlorthalidone, AP levels fell progressively until the third year, when they were reduced by 11 +/- 15 IU in the males and 14 +/- 15 IU in the females. The data are compatible with the interpretation that thiazide-induced reduction in urinary calcium excretion has led to a more positive calcium balance and reduction of bone turnover, and suggests that a beneficial effect of thiazide-based antihypertensive therapy could be decreased osteoporosis.
Adult↗
Smoking, pulmonary function, and mortality.
The association of pulmonary function (as percent of predicted forced expiratory volume in 1 second [FEV1]) with total and cause-specific mortality over 15 to 18 years was investigated in a large cohort (5924) of prospectively followed Japanese-American men. Among those who never smoked, pulmonary function was found not to be significantly predictive of total mortality in a multivariate model in which adjustment for variables that might confound the results was made. Among past and current smokers, highly significant associations were found (P < 0.0001). The positive relationship of pulmonary function to mortality in smokers was so strong that it overshadowed these differences in nonsmokers in a model including all smoking groups combined, even after adjusting for smoking. A smoking-pulmonary function interaction term added to this model was statistically significant (P < 0.003). This illustrates the need for attention to the potential for complex interactions between biologic variables when carrying out multivariate statistical analysis. Findings for cardiovascular and noncardiovascular mortality were similar. This analysis indicates that while pulmonary function is associated with subsequent mortality, the relationship is significantly associated with smoking history.
Asian↗
Health status and life style in elderly Japanese men with a long life expectancy.
The Japanese population in Hawaii has one of the longest life expectancies of any large population subgroup in the U.S. and the world. Cross-sectional data on 1,379 elderly, noninstitutionalized, male Japanese American survivors of a population-based cohort study indicated the most common health problems were hypertension (43%), arthritis (33%), diabetes (13%), and gout (9%). For cancer and hypertension there is a trend toward higher prevalence in older age groups. For coronary heart disease, stroke, and angina the oldest age group (75-81 years) has a higher prevalence than that seen in younger age groups. Other relatively common diseases such as diabetes, gout, peptic ulcer, and arthritis do not have higher prevalence in older age groups. Drugs reported to be used frequently by study participants were for hypertension, gout, CHD, and diabetes. The prevalence rates of major limitations of mobility and of living alone appear to be relatively low in this population. Less than one percent of the current population rate their health status as poor. The prevalence of normal serum cholesterol and smoking are similar to those seen in U.S. White males, while the rates of hypertension appear lower. Prevalence rates for stroke and heart attack also appear to be somewhat lower in these long-lived individuals than those seen in U.S. Whites.
Activities of Daily Living↗
Effective aging. Meeting the challenge of growing older.
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Adaptation, Psychological↗
Designing and executing randomized clinical trials involving elderly persons.
Although randomized clinical trials are the most scientifically rigorous design for evaluating a clinical intervention, the methodology involved is intricate, particularly when elderly subjects are involved. Special attention must be paid to framing precise primary and secondary study hypotheses, adjusting for the potential confounding effects of comorbidity and disability, and analyzing multiple outcomes. When the sample or study cohort is chosen, there will be an inevitable trade-off between internal and external validity. Because elderly study cohorts are more prognostically heterogeneous, consideration should be given to enrolling an "at-risk" cohort and possibly to stratified randomization.
Aged↗
Chest pain and coronary heart disease mortality among older men and women in three communities.
Angina pectoris is a manifestation of coronary heart disease, yet little is known from clinical or epidemiologic studies about its prognosis in older populations. We investigated the relation of uncomplicated angina symptoms to risk of coronary heart disease mortality within 3 years in a prospective study of 8,359 people aged 65 and older residing in three communities. From baseline (1981-1983) to the third year of follow-up (1984-1986), there were 245 deaths from coronary heart disease. Three classifications of chest pain were defined using the Rose Questionnaire: nonexertional chest pain, chest pain on exertion (including angina), and angina. Exertional chest pain was a strong, independent predictor of coronary heart disease death for older men and women. There were no differences in the prognostic implications of this symptom between the sexes; the relative risks being 2.4 (95% confidence interval, 1.4-4.4) in men and 2.7 (1.7-4.2) in women. The risk of coronary heart disease mortality for those reporting chest pain on exertion was at least as high as that for participants whose symptoms met the Rose Questionnaire criteria for angina. The association between exertional chest pain and coronary heart disease mortality was independent of other coronary risk factors. The relation was specific for deaths from coronary heart disease, as there was no association between exertional chest pain and noncoronary causes of death. Chest pain on exertion conveys important prognostic information about risk of coronary death in older populations, regardless of gender.
Aged↗
Physical performance measures in aging research.
Evaluation of physical functioning plays a valuable role in clinical geriatrics as well as in aging research. Physical functioning has generally been assessed through self- or proxy-report. An important addition to this form of assessment is the use of performance measures of physical function, in which individuals are asked to actually perform specific tasks and are evaluated using standardized criteria. Although there has been limited methodological work on physical performance instruments, this approach offers a number of potential advantages. Several performance assessments have been developed that correlate highly with other measures of health status and predict need for long-term care and mortality. It is suggested that more widespread use be made of physical performance assessments and that they be evaluated as measures of functioning in cross-national studies, as indicators of change in functioning over time, as endpoints in intervention studies, as tools for identifying persons functioning at high levels, and as sources of relevant information for the clinician.
Activities of Daily Living↗
Pulmonary function as a predictor of coronary heart disease.
The role of pulmonary function as an independent predictor of coronary heart disease was examined in 1965-1983 in a cohort of Japanese-American men. As part of the Honolulu Heart Program, the authors measured pulmonary function in 5,924 men aged 45-68 years who were free of coronary heart disease at baseline examination and followed them for 15-18 years for the development of nonfatal myocardial infarction and fatal coronary heart disease. Per cent predicted forced expiratory volume in one second (%PFEV1) was significantly inversely related to coronary heart disease incidence in the total cohort after adjusting for age (p less than 0.0001) and then for all known coronary heart disease risk factors (p = 0.0004). However, when examined by smoking status, %PFEV1 was a predictor of coronary heart disease only among past and current smokers, and not for men who had never smoked cigarettes (p = 0.36). The association between pulmonary function and coronary heart disease can be explained by cigarette smoking, which leads to both lung impairment and coronary heart disease incidence.
Aged↗
The Systolic Hypertension in the Elderly Program (SHEP): an intervention trial on isolated systolic hypertension. SHEP Cooperative Research Group.
The Systolic Hypertension in the Elderly Program (SHEP) is a randomized double-blind placebo-controlled trial to determine if antihypertensive treatment of isolated systolic hypertension (ISH) [systolic blood pressure (SBP) greater than or equal to 160 mmHg, diastolic blood pressure (DBP) less than 90 mmHg] reduces the 5 year incidence of fatal and nonfatal stroke. Between March 1, 1985 and January 15, 1988, 4736 persons (target 4800) with ISH, age 60 years and over, were enrolled. Potential participants met blood pressure (BP) and age criteria. Those on antihypertensive medication prior to enrollment without documented diastolic hypertension had their medication tapered and discontinued, and then met BP criteria (33% of cohort). Stepped-care therapy with chlorthalidone and atenolol (alternative, reserpine) or matching placebos was initiated as first and second steps. At baseline the trial population was 43.1% male, 56.9% female; 13.9% black, 86.1% non-black. Also, the mean age was 71.6 years; the mean SBP was 170.3 mmHg and the mean DBP was 76.6 mmHg; 59.8% had codeable resting electrocardiographic abnormalities. The trial is now in follow-up phase with scheduled termination in 1991.
Aged↗
Mortality patterns among hypertensives by reported level of caffeine consumption.
The effect of caffeine consumption on mortality was evaluated in a historical cohort study of 10,064 diagnosed hypertensive individuals participating in the Hypertension Detection and Follow-up Program from 1973 to 1979. Total caffeine intake level from beverages (coffee and tea) and certain medications, was estimated at the 1-year visit. No evidence was found supporting an association between increased level of caffeine consumption and increased all-cause mortality or cardiovascular disease mortality during the following 4 years. Cigarette smoking was significantly associated with mortality; the association being more pronounced among non- and low-caffeine consumers for all-cause mortality and among non-caffeine consumers for all cardiovascular mortality except cerebrovascular mortality.
Adult↗
The predictive value of resting electrocardiograms for 12-year incidence of coronary heart disease in the Honolulu Heart Program.
The predictive value of electrocardiographic (ECG) abnormalities at baseline for subsequent risk of fatal and total coronary heart disease (CHD) was analyzed in a 12-year follow-up of 7682 men in the Honolulu Heart Program aged 45-68 who were free of CHD at baseline. Univariate analysis showed that men with major or minor ECG abnormalities, ST depression, high R wave, T-wave inversion, left ventricular hypertrophy or strain and premature ventricular contractions had considerably higher (2-10 fold) CHD incidence rates than those with normal ECG. When blood pressure, cigarette smoking, body mass index, alcohol use, physical activity, serum glucose, serum cholesterol, serum uric acid, age and years lived in Japan were taken into consideration through multivariate analysis, the ECG abnormalities retained significant associations with fatal and total CHD. This study demonstrated that resting ECG abnormalities were independent predictors of both total and fatal CHD.
Aged↗
Coffee consumption and serum cholesterol in the hypertension detection and follow-up program.
The relation between coffee consumption and serum cholesterol level was investigated in a group of 9,043 hypertensive adults who were in the Hypertension Detection and Follow-up Program. In this study, men and women aged 30-69 years at baseline (1973-1974) had their serum cholesterol level measured at the two-year examination (1975-1976). Information about coffee, tea, and cola consumption was also obtained at that time from a food frequency questionnaire. The relation of coffee consumption and serum cholesterol level with potentially confounding variables including age, race, sex, diuretic status, diastolic blood pressure, cigarette smoking, relative weight, physical activity, stress, and education level was examined. When these variables were entered into a multiple regression equation, a positive association with coffee consumption and serum cholesterol level (p less than 0.05) was present. There was no significant relation between serum cholesterol level and consumption of tea, cola, or decaffeinated coffee--the other major contributors of caffeine to the diet--or total caffeine intake. This study indicates a significant positive relation between coffee consumption and serum cholesterol level.
Adult↗
Antihypertensive drug side effects in the Hypertension Detection and Follow-up Program.
The 5485 participants in the Hypertension Detection and Follow-up Program, Stepped-Care group form one of the largest groups to date on which detailed surveillance of long-term antihypertensive therapy and drug side effects has been reported. During a 5-year period, among all hypertensive persons (mild, moderate, and severe combined) who were not taking antihypertensive medications at the beginning of the study and who attended the clinic at least once during the 5-year trial, a total of 9.3% had definite or probable side effects severe enough to cause discontinuation of the drug treatment in question. Less than 1% of active participants required hospitalization for side effects. No death that could be attributed to side effects was detected. Thus, the Hypertension Detection and Follow-up Program data, which have previously demonstrated the beneficial effects of antihypertensive therapy, confirm the relative safety of such therapy.
Adult↗
Predictive value of resting electrocardiograms for 12-year incidence of stroke in the Honolulu Heart Program.
The importance of electrocardiographic (ECG) abnormalities at baseline examination for subsequent risk of stroke was analyzed in a 12-year follow-up of 7,560 men in the Honolulu Heart Program, aged 45-68 years, who were free of coronary heart disease and stroke at baseline. Age-adjusted univariate analysis showed that men with major ST depression, left ventricular strain, left ventricular hypertrophy, major T wave inversion, and overall major ECG abnormalities had considerably higher (2.5-5.4 times) incidence rates of both thromboembolic and hemorrhagic stroke than those with normal baseline ECG. When blood pressure, age, cigarette smoking, alcohol consumption, fat intake, serum glucose concentration, serum uric acid concentration, years of education, and years lived in Japan were taken into consideration through multivariate analysis, the ECG abnormalities retained a significant relation with stroke. Our study demonstrates that resting ECG abnormalities are independent predictors of both thromboembolic and hemorrhagic stroke.
Aged↗
Reference values for FEV1 in Japanese-American men from 45 to 68 years of age.
Pulmonary function is known to vary by racial group, yet no standards have been published for Asian-Americans. The Honolulu Heart Program, a prospective epidemiologic study of cardiovascular disease, provided an opportunity to examine pulmonary function, specifically, forced expiratory volume in one second (FEV1), in Japanese-American men 45 to 68 yr of age. Of a cohort of 6,346 men, 1,490 were identified as healthy asymptomatic nonsmokers. Prediction equations and reference values were derived from this subgroup. When the prediction equation was compared with those derived from Caucasian and black populations, mean predicted FEV1 for Japanese-Americans was intermediate to higher values for Caucasians and lower values for blacks. In addition to age and height, skinfolds, dynamometry, and biacromial diameter were found to be independent predictors of FEV1. In summary, standards derived from Japanese-American populations should be used when measuring pulmonary function in this group and additional physical measurements make a small contribution to the accuracy of prediction equations.
Aged↗
Correlates of FEV1 and prevalence of pulmonary conditions in Japanese-American men.
Correlates of forced expiratory volume in one second (FEV1) and the prevalence of pulmonary disease and symptoms were examined in 6,346 Japanese-American men 45 to 68 yr of age. There was a significant inverse dose-response relationship between FEV1 and cigarette smoking measured as pack-years, number of cigarettes, or number of years smoked. Ex-smokers had FEV1 values that were intermediate to the higher values for nonsmokers and the lower values for current smokers. Among current smokers, inhaling and starting to smoke at a younger age were associated with lower values of FEV1, independent of pack-years. FEV1 was also correlated with a variety of other biologic and sociobehavioral variables, even after removing the effects of smoking. These variables included skinfold thickness, dynamometry, hematocrit, triglycerides, and systolic blood pressure. When compared with Caucasian populations, these Japanese-American men had low prevalence rates of airflow obstruction and pulmonary disease symptoms.
Aged↗