Biomedical subjects

S M Hakala

Publications and source records attributed to S M Hakala.

4 recordsLinked to original sources

PubMed1998

Determinants and significance of declining blood pressure in old age. A prospective birth cohort study.

AIMS: To investigate the changes in blood pressure and their causes in an elderly population. METHODS: Orthostatic blood pressure measurements were performed in randomly in four birth cohorts (years 65-, 75-, 80- and 85, n=773) at 5-year intervals. RESULTS: Both systolic and diastolic blood pressures decreased in both genders and all age groups. The falls in blood pressure related closely to initial blood pressure values and to the thickness of the left ventricular posterior wall of the heart. The changes in supine (r=0.118, P=0.007) and standing systolic blood pressure (r=0.123, P=0.005), as well as supine (r=0.148, P<0.001) and standing diastolic blood pressure (r=0.186, P<0.001) correlated with changes in body weight. Changes in supine diastolic blood pressure also related to changes in serum cholesterol (r=0.207, P=0.002) and triglycerides (r=0.160, P=0.016). Changes in supine and standing systolic and standing diastolic blood pressures also related to changes in dehydroepiandrosterone sulphate (r=0.161, P<0.05; r=0.205, P<0.01; r=0.140, P<0.05, respectively). Changes in blood pressure also correlated with self-estimated poor health after 5 years (r for supine systolic blood pressure= -0.133, P<0.001, for standing systolic blood pressure= -0.135, P<0.001, for supine diastolic blood pressure= -0.111, P<0.002). PATIENTS: who were institutionalized during the follow-up or who had severely impaired performance capacity after 5 years, displayed the most marked decline in blood pressure. Declining systolic blood pressure was also related to impaired survival prognosis. According to the logistic regression analyses the baseline blood pressure, antihypertensive drugs and changes in dehydroepiandrosterone sulphate and cholesterol explained over 30% of the changes in blood pressure. In the logistic models, declining blood pressure was associated with baseline blood pressure, antihypertensive treatment, poor health after 5 years, and decreasing cholesterol and triglycerides. CONCLUSION: Decline in blood pressure in old age is associated with deteriorating health and is only partly explained by the use of antihypertensive drugs.

Aged↗

PubMed1997

Blood pressure and mortality in an older population. A 5-year follow-up of the Helsinki Ageing Study.

OBJECTIVE: Hypertension is an established risk factor of cardiovascular diseases, and in clinical studies its treatment has reduced cardiovascular complications in subjects up to 80 years of age. In the older age groups, prognostic data on blood pressure is sparse. We evaluated the prognostic significance of different blood pressure levels and the history of elevated blood pressure in an older population. DESIGN: In the Helsinki Ageing Study random individuals 75, 80, and 85 years of age (n = 521) were evaluated at baseline using postal questionnaires, structured interviews, clinical examinations, laboratory investigations, and blood pressure measurements (supine, seated, standing). Date of death during a 5-year follow-up was verified using computerized registers, and thus the follow-up was 100% complete. The data were analysed using life-table analyses and Cox proportional hazards models. RESULTS: At 5 years, 240 subjects (40%) had died, 50% of them of cardiovascular disease. In crude analyses, an inverse relationship between both systolic and diastolic blood pressure and mortality was observed in all groups combined (P < 0.01), and separately in the 80 and 85-year-old groups. However, a J-shaped link between diastolic blood pressure and mortality was found in the 75-year-old group. After controlling for age, gender and the presence of clinically significant diseases (in 72% of subjects) baseline blood pressure was associated with favourable 5-year survival. The risk ratios of systolic (per 10 mmHg) and diastolic blood pressure (per 5 mmHg) were 0.90 (95% CI 0.85-0.96) and 0.92 (95% CI 0.86-0.99), respectively. Neither isolated systolic hypertension nor a history of hypertension treatment were associated with 5-year survival. CONCLUSION: At the population level, among subjects aged 75 years and over, favourable 5-year survival is indicated by a high, but not a low, blood pressure.

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PubMed1996

Postural hypotension and dizziness in a general aged population: a four-year follow-up of the Helsinki Aging Study.

OBJECTIVE: To evaluate the frequency, risk factors, and prognostic significances of postural hypotension (PH) and dizziness on postural testing (DPT). DESIGN: A prospective cohort study. SETTING: General community, The Helsinki (Finland) Aging Study. SUBJECTS: Persons of three age cohorts (75, 80, and 85 years, n = 569) were chosen randomly and followed for 4 years. MEASURES: Postal questionnaires, structured interview, extensive clinical and laboratory examinations, blood pressure (BP) changes in a postural test using different definitions for PH, history of dizziness, dizziness on testing postural blood pressure reactions (DPT), and date of death during a 4-year follow-up. RESULTS: The frequency of a fall in systolic blood pressure greater than 20 mm Hg or a fall in diastolic pressure greater than 10 mm Hg (PH-I) was 30.3%. Both criteria occurred simultaneously (PH-II) in 7.5%, and if dizziness on postural testing (DPT) was an additional symptom (PH-III), the prevalence was 2.6%. The overall prevalence of DPT was 19.7%. PH-I, PH-II, and DPT were also frequent among the healthy aged (26.6%, 6.6%, and 17.3%, respectively). The postural change in BP correlated inversely with the initial supine BP levels (systolic r = -.149, P < .001 and diastolic r = -.218, P < .001), but in persons with isolated systolic hypertension PH was rather less frequent (21.9% and 2.3%). DPT was more common in the subjects with heart failure (26.3%, P < .05), impaired exercise tolerance (NYHA III-IV) (33.7%, P < .05), and PH-II (37.2%, P < .05) compared with the healthy controls (17.3%). The 1-year mortality was higher in subjects with than without DPT (7.1% vs 4.8%, P < .05), but the difference was not significant after controlling for age and gender. PH-I, PH-II, and PH-III were not significantly related to 4-year mortality. CONCLUSIONS: In this study of older people in Helsinki, Finland, asymptomatic hypotensive postural BP reactions and DPT were found frequently among healthy older people, and they tended to be increased in people with some diseases. Neither PH nor DPT were of prognostic significance for mortality in this population.

Aged↗

PubMedDate not supplied

Sertraline-induced panic attacks.

Sertraline is a selective serotonin reuptake inhibitor that is approved by the U.S. Food and Drug Administration for the treatment of major depression, obsessive-compulsive disorder (in adults and children), and panic disorder. Although numerous studies have found sertraline to be very effective in the treatment of anxiety, there have been few case reports of panic attacks actually being induced by treatment with sertraline. In this article, we present the cases of two patients without any personal or family history of anxiety disorders who developed panic attacks shortly after the initiation of sertraline therapy. We will also review the literature in regard to the development of anxiety symptoms during treatment with the newer antidepressants and discuss the neurochemical basis of these antidepressant-induced panic attacks.

Adult↗