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  1. Article ; Online: Blood Pressure Control in Older Adults: Toward a More Personalized Medicine Approach.

    Williamson, Jeff D

    Journal of the American Geriatrics Society

    2020  Volume 68, Issue 11, Page(s) 2489–2491

    MeSH term(s) Aged ; Blood Pressure ; Cross-Sectional Studies ; Humans ; Hypertension/drug therapy ; Precision Medicine
    Language English
    Publishing date 2020-09-18
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 80363-7
    ISSN 1532-5415 ; 0002-8614
    ISSN (online) 1532-5415
    ISSN 0002-8614
    DOI 10.1111/jgs.16750
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  2. Article ; Online: The Effects of Lower BP Goals on Cognitive Function in the Elderly.

    Zamora, Zeke / Williamson, Jeff D

    Current cardiology reports

    2020  Volume 22, Issue 8, Page(s) 63

    Abstract: Purpose of review: To review the research on the impact of blood pressure control on prevention of cognitive impairment and dementia.: Recent findings: Observational evidence has shown an association between hypertension and cognitive impairment. ... ...

    Abstract Purpose of review: To review the research on the impact of blood pressure control on prevention of cognitive impairment and dementia.
    Recent findings: Observational evidence has shown an association between hypertension and cognitive impairment. However, clinical trial results of blood pressure lowering have been inconclusive, likely due to inadequate cognitive assessment, blood pressure difference between groups, and follow-up duration. SPRINT-MIND showed a 19% reduction in mild cognitive impairment (14.6 vs 18.3 per 1000 person-years; HR, 0.81; 95% CI, 0.67-0.95), the earliest manifestation of dementia, with intensive blood pressure control. There was a statistically non-significant 17% reduction in the risk of probable dementia (HR 0.83, 95% CI 0.67-1.04). The progress of clinical trials testing the impact of blood pressure reduction on cardiovascular disease incidence has helped inform large trial testing of this intervention's impact on cognitive decline and dementia. SPRINT MIND demonstrated a positive effect of intensive blood pressure control on risk for mild cognitive impairment (MCI), and though the effect size was similar to MCI, the result was statistically non-significant possibly due to early termination of the intervention. Extension of follow-up may increase the number of new cases of dementia, producing a more conclusive result for dementia.
    MeSH term(s) Aged ; Blood Pressure ; Cognition ; Cognitive Dysfunction ; Goals ; Humans ; Hypertension
    Language English
    Publishing date 2020-06-19
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2055373-0
    ISSN 1534-3170 ; 1523-3782
    ISSN (online) 1534-3170
    ISSN 1523-3782
    DOI 10.1007/s11886-020-01312-2
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  3. Article ; Online: New Guidelines and SPRINT Results: Implications for Geriatric Hypertension.

    Supiano, Mark A / Williamson, Jeff D

    Circulation

    2019  Volume 140, Issue 12, Page(s) 976–978

    MeSH term(s) Aged ; American Heart Association ; Blood Pressure ; Clinical Trials as Topic ; Dementia/epidemiology ; Health Services for the Aged ; Humans ; Hypertension/diagnosis ; Hypertension/epidemiology ; Hypertension/therapy ; Hypolipidemic Agents/therapeutic use ; Practice Guidelines as Topic ; United States/epidemiology
    Chemical Substances Hypolipidemic Agents
    Language English
    Publishing date 2019-09-16
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 80099-5
    ISSN 1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
    ISSN (online) 1524-4539
    ISSN 0009-7322 ; 0069-4193 ; 0065-8499
    DOI 10.1161/CIRCULATIONAHA.119.037872
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  4. Article ; Online: Blood Pressure and Statin Effects on Cognition: a Review.

    Yang, Mia / Williamson, Jeff

    Current hypertension reports

    2019  Volume 21, Issue 9, Page(s) 70

    Abstract: Purpose of review: This is a review of available data on the effects of blood pressure and statins on cognition.: Recent findings: Recent randomized clinical trials have shown that intensive control of systolic blood pressure in older adults ... ...

    Abstract Purpose of review: This is a review of available data on the effects of blood pressure and statins on cognition.
    Recent findings: Recent randomized clinical trials have shown that intensive control of systolic blood pressure in older adults prevented the development of mild cognitive impairment (MCI) and the combined effects of MCI and probable dementia. Previous randomized clinical trials have suggested that statin use may prevent a decline in cognition; however, no randomized clinical trials have clearly shown evidence of statin's either positive or negative effect on cognition. Continued follow-up of SPRINT-MIND participants is crucial to evaluate the long-term effects of intensive systolic blood pressure control on the prevention of cognitive decline. A well-conducted and adequately powered randomized control trial is needed to evaluate the effect of statins on cognition, especially for primary prevention of the cognitive decline in aging.
    MeSH term(s) Aged ; Blood Pressure/drug effects ; Cardiovascular Diseases/drug therapy ; Cardiovascular Diseases/etiology ; Cognition/drug effects ; Cognitive Dysfunction/etiology ; Cognitive Dysfunction/prevention & control ; Dementia/etiology ; Dementia/prevention & control ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Hypertension/complications ; Hypertension/drug therapy ; Randomized Controlled Trials as Topic
    Chemical Substances Hydroxymethylglutaryl-CoA Reductase Inhibitors
    Language English
    Publishing date 2019-07-26
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2057367-4
    ISSN 1534-3111 ; 1522-6417
    ISSN (online) 1534-3111
    ISSN 1522-6417
    DOI 10.1007/s11906-019-0973-4
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  5. Article ; Online: Blood Pressure Control Among Older Adults With Hypertension: Narrative Review and Introduction of a Framework for Improving Care.

    Bowling, C Barrett / Lee, Alexandra / Williamson, Jeff D

    American journal of hypertension

    2021  Volume 34, Issue 3, Page(s) 258–266

    Abstract: Although antihypertensive medications are effective, inexpensive, and recommended by clinical practice guidelines, a large percentage of older adults with hypertension have uncontrolled blood pressure (BP). Improving BP control in this population may ... ...

    Abstract Although antihypertensive medications are effective, inexpensive, and recommended by clinical practice guidelines, a large percentage of older adults with hypertension have uncontrolled blood pressure (BP). Improving BP control in this population may require a better understanding of the specific challenges to BP control at older age. In this narrative review, we propose a framework for considering how key steps in BP management occur in the context of aging characterized by heterogeneity in function, multiple co-occurring health conditions, and complex personal and environmental factors. We review existing literature related to 4 necessary steps in hypertension control. These steps include the BP measure which can be affected by the technique, device, and setting in which BP is measured. Ensuring proper technique can be challenging in routine care. The plan includes setting BP treatment goals. Lower BP goals may be appropriate for many older adults. However, plans must take into account the generalizability of existing evidence, as well as patient and family's health goals. Treatment includes the management strategy, the expected benefits, and potential risks of treatment. Treatment intensification is commonly needed and can contribute to polypharmacy in older adults. Lastly, monitor refers to the need for ongoing follow-up to support a patient's ability to sustain BP control over time. Sustained BP control has been shown to be associated with a lower rate of cardiovascular disease and multimorbidity progression. Implementation of current guidelines in populations of older adults may be improved when specific challenges to BP measurement, planning, treating, and monitoring are addressed.
    MeSH term(s) Aged ; Antihypertensive Agents/therapeutic use ; Blood Pressure Determination/standards ; Humans ; Hypertension/epidemiology ; Hypertension/prevention & control ; Multimorbidity ; Quality Improvement/organization & administration
    Chemical Substances Antihypertensive Agents
    Language English
    Publishing date 2021-04-02
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
    ZDB-ID 639383-4
    ISSN 1941-7225 ; 1879-1905 ; 0895-7061
    ISSN (online) 1941-7225 ; 1879-1905
    ISSN 0895-7061
    DOI 10.1093/ajh/hpab002
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    Zs.A 2329: Show issues Location:
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  6. Article ; Online: Intensive Blood Pressure Treatment and Subclinical Brain Infarcts: A Secondary Analysis of SPRINT (Systolic Pressure Intervention Trial).

    Kern, Kyle C / Nasrallah, Ilya M / Bryan, R Nick / Williamson, Jeff / Reboussin, David M / Pajewski, Nicholas M / Wright, Clinton B

    Annals of neurology

    2024  Volume 95, Issue 5, Page(s) 866–875

    Abstract: Objective: Subclinical brain infarcts (SBI) increase the risk for stroke and dementia, but whether they should be considered equivalent to symptomatic stroke when determining blood pressure targets remains unclear. We tested whether intensive systolic ... ...

    Abstract Objective: Subclinical brain infarcts (SBI) increase the risk for stroke and dementia, but whether they should be considered equivalent to symptomatic stroke when determining blood pressure targets remains unclear. We tested whether intensive systolic blood pressure (SBP) treatment reduced the risk of new SBI or stroke and determined the association between SBI and cognitive impairment.
    Methods: In this secondary analysis of SPRINT (Systolic Pressure Intervention Trial), participants ≥50 years old, with SBP 130-180mmHg and elevated cardiovascular risk but without known clinical stroke, dementia, or diabetes, were randomized to intensive (<120mmHg) or standard (<140mmHg) SBP treatment. Brain magnetic resonance images collected at baseline and follow-up were read for SBI. The occurrence of mild cognitive impairment (MCI) or probable dementia (PD) was evaluated.
    Results: For 667 participants at baseline, SBI were identified in 75 (11%). At median 3.9 years follow-up, 12 of 457 had new SBI on magnetic resonance imaging (5 intensive, 7 standard), whereas 8 had clinical stroke (4 per group). Baseline SBI (subhazard ratio [sHR] = 3.90; 95% CI 1.49 to 10.24; p = 0.006), but not treatment group, was associated with new SBI or stroke. For participants with baseline SBI, intensive treatment reduced their risk for recurrent SBI or stroke (sHR = 0.050; 95% CI 0.0031 to 0.79; p = 0.033). Baseline SBI also increased risk for MCI or PD during follow-up (sHR = 2.38; 95% CI 1.23 to 4.61; p = 0.010).
    Interpretation: New cerebral ischemic events were infrequent, but intensive treatment mitigated the increased risk for participants with baseline SBI, indicating primary prevention SBP goals are still appropriate when SBI are present. ANN NEUROL 2024;95:866-875.
    MeSH term(s) Humans ; Male ; Female ; Aged ; Middle Aged ; Antihypertensive Agents/therapeutic use ; Brain Infarction/diagnostic imaging ; Cognitive Dysfunction/diagnostic imaging ; Magnetic Resonance Imaging ; Hypertension/complications ; Blood Pressure/physiology ; Stroke/diagnostic imaging ; Dementia
    Chemical Substances Antihypertensive Agents
    Language English
    Publishing date 2024-02-16
    Publishing country United States
    Document type Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 80362-5
    ISSN 1531-8249 ; 0364-5134
    ISSN (online) 1531-8249
    ISSN 0364-5134
    DOI 10.1002/ana.26892
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  7. Article ; Online: Deprescribing Antihypertensive Medication in Elderly Adults.

    Applegate, William B / Williamson, Jeff D / Berlowitz, Dan

    JAMA

    2020  Volume 324, Issue 16, Page(s) 1682

    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Antihypertensive Agents/therapeutic use ; Blood Pressure ; Deprescriptions ; Humans ; Hypertension/drug therapy ; Polypharmacy
    Chemical Substances Antihypertensive Agents
    Language English
    Publishing date 2020-10-27
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2020.16438
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  8. Article ; Online: Relationship of Self-reported and Performance-based Visual Function With Performance-based Measures of Physical Function: The Health ABC Study.

    Thompson, Atalie C / Miller, Michael E / Webb, Christopher C / Williamson, Jeff D / Kritchevsky, Stephen B

    The journals of gerontology. Series A, Biological sciences and medical sciences

    2022  Volume 78, Issue 11, Page(s) 2060–2069

    Abstract: Background: To assess the relationship between self-reported and performance-based visual impairment (VI) and lower extremity physical function.: Methods: Cross-sectional analysis of 2 219 Health ABC participants who completed vision testing and the ... ...

    Abstract Background: To assess the relationship between self-reported and performance-based visual impairment (VI) and lower extremity physical function.
    Methods: Cross-sectional analysis of 2 219 Health ABC participants who completed vision testing and the Short Physical Performance Battery (SPPB). Linear regression models used either self-reported (weighted visual function question [VFQ] score) or performance-based (visual acuity [VA], log contrast sensitivity [LCS], Frisby stereoacuity [SA]) to predict SPPB or its components-gait speed, chair stands, or standing balance-with and without covariate adjustment.
    Results: Mean age was 73.5 years (range 69-80); 52.4% were female and 37.4% African American. All VI measures were strongly associated with SPPB in unadjusted and adjusted models (p < .001). A self-reported VFQ score 1 standard deviation lower than the mean (mean 87.8 out of 100) demonstrated a -0.241 (95% confidence interval [CI]: -0.325, -0.156) adjusted difference in SPPB. After controlling for covariates, VA of <20/40 (41%) demonstrated a -0.496 (-0.660, -0.331) lower SPPB score while SA score>85 arcsec (30%) had a -0.449 (-0.627, -0.271) adjusted SPPB score versus those with better visual function. LCS < 1.55 (28.6%) was associated with a -0.759 (-0.938, -0.579) lower and LCS ≤ 1.30 (8%) with a -1.216 (-1.515, -0.918) lower adjusted SPPB score relative to better LCS. In a final multivariable model containing multiple vision measures, LCS remained independently associated with SPPB and all components, while SA remained associated with balance (all p < .05).
    Conclusions: Both self-reported and performance-based VI are strongly associated with poor lower extremity physical function. These findings may identify a subgroup of older adults with co-existing visual and physical dysfunction who may benefit from targeted screening and intervention to prevent disability.
    MeSH term(s) Humans ; Female ; Aged ; Aged, 80 and over ; Male ; Self Report ; Cross-Sectional Studies ; Walking Speed ; Disabled Persons
    Language English
    Publishing date 2022-11-08
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 1223643-3
    ISSN 1758-535X ; 1079-5006
    ISSN (online) 1758-535X
    ISSN 1079-5006
    DOI 10.1093/gerona/glac225
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  9. Article ; Online: Can Preferentially Prescribing Angiotensin II Receptor Blockers (ARBs) over Angiotensin-Converting Enzyme Inhibitors (ACEIs) Decrease Dementia Risk and Improve Brain Health Equity?

    Marcum, Zachary A / Cohen, Jordana B / Larson, Eric B / Williamson, Jeff / Bress, Adam P

    NAM perspectives

    2022  Volume 2022

    Language English
    Publishing date 2022-05-09
    Publishing country United States
    Document type Journal Article ; Review
    ISSN 2578-6865
    ISSN (online) 2578-6865
    DOI 10.31478/202205c
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  10. Article ; Online: Older Adults' Perspectives on Screening for Cognitive Impairment Following Critical Illness: Pre-Implementation Qualitative Study.

    Keegan, Alek / Strahley, Ashley / Taylor, Stephanie P / Wilson, Taniya M / Shah, Meehir D / Williamson, Jeff / Palakshappa, Jessica A

    Critical care explorations

    2023  Volume 5, Issue 5, Page(s) e0920

    Abstract: Screening for cognitive impairment following ICU discharge is recommended but not part of routine care. We sought to understand older adults' perspectives on screening for cognitive impairment following an ICU admission to inform the design and delivery ... ...

    Abstract Screening for cognitive impairment following ICU discharge is recommended but not part of routine care. We sought to understand older adults' perspectives on screening for cognitive impairment following an ICU admission to inform the design and delivery of a cognitive screening intervention.
    Design: Qualitative study using semi-structured interviews.
    Subjects: Adults 60 years and older within 3 months of discharge from an ICU in an academic health system.
    Interventions: Interviews were conducted via telephone, audio recorded and transcribed verbatim. All transcripts were coded in duplicate. Discrepancies were resolved by consensus. Codes were organized into themes and subthemes inductively.
    Measurements and main results: We completed 22 interviews. The mean age of participants was 71 ± 6 years, 14 (63.6%) were men, 16 (72.7%) were White, and 6 (27.3%) were Black. Thematic analysis was organized around four themes: 1) receptivity to screening, 2) communication preferences, 3) information needs, and 4) provider involvement. Most participants were receptive to cognitive screening; this was influenced by trust in their providers and prior experience with cognitive screening and impairment. Participants preferred simple, direct, compassionate communication. They wanted to understand the screening procedure, the rationale for screening, and expectations for recovery. Participants desired input from their primary care provider to have their cognitive screening results placed in the context of their overall health, because they had a trusted relationship, and for convenience.
    Conclusions: Participants demonstrated limited understanding of and exposure to cognitive screening but see it as potentially beneficial following an ICU stay. Providers should use simple, straightforward language and place emphasis on expectations. Resources may be needed to assist primary care providers with capacity to provide cognitive screening and interpret results for ICU survivors. Implementation strategies can include educational materials for clinicians and patients on rationale for screening and recovery expectations.
    Language English
    Publishing date 2023-05-12
    Publishing country United States
    Document type Journal Article
    ISSN 2639-8028
    ISSN (online) 2639-8028
    DOI 10.1097/CCE.0000000000000920
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