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The effect of oral glucose tolerance testing on changes in arterial stiffness and blood pressure in elderly women with hypertension and relationships between the stage of diabetes and physical fitness levels

  • Lee, Jaesong (Department of Physical Education, Korea University) ;
  • Park, Wonil (Department of Physical Education, Korea University) ;
  • Sung, Eunsook (Department of Physical Education, Korea University) ;
  • Kim, Bokbeom (Department of Physical Education, Korea University) ;
  • Kim, Nahyun (Department of Physical Education, Korea University) ;
  • Park, Saejong (Department of Sports Science, Korea Institute of Sport Science) ;
  • Shin, Chulho (Department of Health Care, Namseoul University) ;
  • Park, Jonghoon (Department of Physical Education, Korea University)
  • Received : 2020.12.22
  • Accepted : 2020.12.30
  • Published : 2020.12.31

Abstract

[Purpose] The purpose of this study was to assess changes in blood glucose level, blood pressure, and arterial stiffness after a 75 g oral glucose tolerance test (OGTT) in elderly women aged over 65 years with hypertension and either normal glycemic control, impaired fasting glucose tolerance, or diabetes mellitus. We also wished to investigate the relationship between stages of diabetes and physical fitness. [Methods] A total of 24 elderly women with hypertension were assigned to a control group (CON; n=7), impaired fasting glucose group (IFG; n=9), and diabetes mellitus group (DM; n=8). In each group, blood glucose level, brachial ankle pulse wave velocity (PWV), and blood pressure were measured at baseline as well as 60 and 120 minutes after a 75 g OGTT. Physical fitness factors such as hand grip strength, balance test, 4 m gait speed test, chair stand test, short physical performance battery, and 6-minute walking test were subsequently assessed. [Results] In all three groups, blood glucose levels were significantly increased at 60 and 120 minutes after a 75 g OGTT. In the DM group, blood glucose levels were significantly higher before and after a 75 g OGTT than in the CON group. In the CON group, PWV was significantly increased at 60 minutes after a 75 g OGTT; however, there were no changes in other groups after glucose ingestion. In the CON group, systolic and diastolic blood pressures were significantly decreased at 60 and 120 minutes after a 75 g OGTT compared to baseline. However, there was no change in blood pressure after ingestion in the DM group. The IFG group had greater grip strength than the CON group; however, there were no differences in other variables between the groups. [Conclusion] After a 75 g OGTT, elderly women with hypertension and diabetes maintain higher blood glucose levels compared to those with hypertension alone. Unlike elderly women with hypertension alone, those with hypertension and diabetes did not show changes in arterial stiffness and blood pressure after a 75 g OGTT. Therefore, elderly women with hypertension and diabetes may not be able to control their blood vessels following a 75 g OGTT due to impaired vascular endothelial function. Moreover, there was no association between diabetes stage and physical fitness in elderly women with hypertension.

Keywords

Acknowledgement

This research was supported by the College of Education, Korea University Grant in 2020.

References

  1. Nikolaos L, Dimitrios M, Elias S, Georgios F, Maria G. Hypertension in the elderly. World J Cardiol. 2012;4:135-47. https://doi.org/10.4330/wjc.v4.i5.135
  2. Statistics korea. Korean social trends 2018.
  3. National health insurance Service. 2018.
  4. Stewart KJ, Bacher AJ, Turner K. Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med. 2005;165:756-62. https://doi.org/10.1001/archinte.165.7.756
  5. Park HJ, Kim SM, Yu HS. The effects of regular physical activities on female senior adults aging related hormone levels and a risk factor in cardiovascular disease. Korea Convergence Society. 2020;11:323-30.
  6. Lloyd-Jones DM, Evans JC, Levy D. Hypertension in adults across the age spectrum: current outcomes and control in the community. JAMA. 2005;294:466-72. https://doi.org/10.1001/jama.294.4.466
  7. Oliveros E, Patel H, Kyung S, Fugar S, Goldberg A, Madan N, Williams KA. Hypertension in older adults: assessment, management and challenges. Clin Cardiol. 2019;43:99-107. https://doi.org/10.1002/clc.23303
  8. Mattace-Raso FUS, Cammen T, Hofman A, Popele NM, Bos ML, Schalekamp M, Asmar R, Reneman R, Hoeks A, Breteler M, Witteman J. Arterial stiffness and risk of coronary heart disease and stroke: the rotterdam study. Circulation. 2006; 113:657-63. https://doi.org/10.1161/CIRCULATIONAHA.105.555235
  9. Yoon ES, Choo JA, Kim JY, Jae SY. Effects of isometric handgrip exercise versus aerobic exercise on arterial stiffness and brachial artery flow-mediated dilation in older hypertensive patients. Korean J Sports Med. 2019;37:162-70. https://doi.org/10.5763/kjsm.2019.37.4.162
  10. Cecelja M, Chowienczyk P. Role of arterial stiffness in cardiovascular disease. JRSM Cardiovasc Dis. 2012;31;1:cvd.2012.012016.
  11. Franklin SS, GustinIV W, Wong ND, Larson MG, Weber MA, Kannel WB, Levy D. Hemodynamic patterns of age-related changes in blood pressure. the framingham heart study. Circulation. 1997;96:308-15. https://doi.org/10.1161/01.CIR.96.1.308
  12. Watanabe H, Ohtsuka S, Kakihana M, Sugishita Y. Coronary circulation in dogs with an experimental decrease in aortic compliance. J Am Coll Cardiol. 1993;21:1497-506. https://doi.org/10.1016/0735-1097(93)90330-4
  13. Avolio AP, Chen SG, Wang RP, Zhang CL, Li MF, O'Rourke MF. Effects of aging on changing arterial compliance and left ventricular load in a northern chinese urban community. Circulation. 1983;68:50-8. https://doi.org/10.1161/01.CIR.68.1.50
  14. van Popele NM, Grobbee DE, Bots ML, Asmar R, Topouchian J, Reneman RS, Hoeks AP, van der Kuip DA, Hofman A, Witteman JC. Association between arterial stiffness and atherosclerosis: the rotterdam study. Stroke. 2001;32:454-60. https://doi.org/10.1161/01.STR.32.2.454
  15. sutton-Tyrrell K, Najjar SS, Boudreau RM, Venkitachalam L, Kupelian V, Simonsick EM, Havlik R, Lakatta EG, Spurgeon H, Kritchevsky S, Pahor M, Bauer D, Newman A. Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults. Circulation. 2004;111:3384-90. https://doi.org/10.1161/CIRCULATIONAHA.104.483628
  16. Kjeldsen SE, Aksnes TA, Wachtell K, Okin PM. Arterial stiffness predicts incident atrial fibrillation in the framingham heart study: a mechanistic contribution in people with high blood pressure or history of hypertension. Hypertension. 2016;68:555-7. https://doi.org/10.1161/HYPERTENSIONAHA.116.07671
  17. AlGhatrif M, Strait JB, Morrell C, Canepa M, Wright J, Elango P, Scuteri A, Najjar SS, Ferrucci L, Lakatta EG. Longitudinal trajectories of arterial stiffness and the role of blood pressure: the baltimore longitudinal study of aging. Hypertension. 2013;62:934-41. https://doi.org/10.1161/HYPERTENSIONAHA.113.01445
  18. Lee JG, Joo SJ. Arterial stiffness and cardiovascular risk. Korean J Intern Med. 2019;34:504-6. https://doi.org/10.3904/kjim.2019.110
  19. Sun Z. Aging, arterial stiffness and hypertension. Hypertension. 2015;65:252-6. https://doi.org/10.1161/HYPERTENSIONAHA.114.03617
  20. Schram MT, Henry RM, van Dijk RA, Kostense PJ, Dekker JM, Nijpels G, Heine RJ, Bouter LM, Westerhof N, Stehouwer CD, Health ABC study. Increased central artery stiffness in impaired glucose metabolism and type 2 diabetes, the hoorn study. Hypertension. 2004;43:176-81. https://doi.org/10.1161/01.hyp.0000111829.46090.92
  21. Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, Huang ES, Korytkowski MT, Munshi MN, Odegard PS, Pratley RE, Swift CS. Diabetes in older adults. Diabetes Care. 2012;35:2650-64. https://doi.org/10.2337/dc12-1801
  22. Preis SR, Hwang SJ, Coady S, Pencina MJ, D'Agostino RB, Savage PJ, Levy D, Fox CS. Trends in all-cause and cardiovascular disease mortality among women and men with and without diabetes mellitus in the framingham heart study, 1950 to 2005. Circulation. 2009;119:1728-35. https://doi.org/10.1161/CIRCULATIONAHA.108.829176
  23. Schram MT, Henry R, van Dijk, R, Kostense P, Dekker J, Nijpels G, Heine R, Bouter L, Westerhof N, Stehouwer C. Increased central artery stiffness in impaired glucose metabolism and type 2 diabetes: the hoorn study. Hypertension. 2004;43:176-81. https://doi.org/10.1161/01.hyp.0000111829.46090.92
  24. Chang S, Kim JH, Sohn TS, Son HS, Lee JM. Effects of glucose control on arterial stiffness in patients with type 2 diabetes mellitus and hypertension: an observational study. J Int Med Res. 2018;46:284-92. https://doi.org/10.1177/0300060517722697
  25. Ohnishi H, Saitoh S, Takagi S, Ohata JI, Isobe T, Kikuchi Y, Takeuchi H, Shimamoto K. Pulse wave velocity as an indicator of atherosclerosis in impaired fasting glucose: the tanno and sobetsu study. Diabetes Care. 2003;26:437-40. https://doi.org/10.2337/diacare.26.2.437
  26. Kobayashi R, Sato K, Sakazaki M, Nagai Y, Iwanuma S, Ohashi N, Hashiguchi T. Acute effects of difference in glucose intake on arterial stiffness in healthy subjects. Cardiol J. 2019;8.
  27. van Popele NM, Elizabeth Hak A, Mattace-Raso FU, Bots ML, van Der Kuip DA, Reneman RS, Hoeks PG, Hofman A, Grobbee DE, Witteman JC. Impaired fasting glucose is associated with increased arterial stiffness in elderly people without diabetes mellitus: the rotterdam study. J Am Geriatr Soc. 2006;54:397-404. https://doi.org/10.1111/j.1532-5415.2005.00614.x
  28. Vasu S, Morgan TM, Kitzman DW, Bertoni A, Stacey RB, Hamilton C, Chiles C, Thohan V, Hundley WG. Abnormal stress-related measures of arterial stiffness in middle-aged and elderly men and women with impaired fasting glucose at risk for a first episode of symptomatic heart failure. J Am Heart Assoc. 2015;4:e000991. https://doi.org/10.1161/JAHA.114.000991
  29. Loehr LR, Meyer ML, Poon AK, Selvin E, Palta P, Tanaka H, Pankow JS, Wright JD, Griswold ME, Wagenknecht LE, Heiss G. Prediabetes and diabetes are associated with arterial stiffness in older adults: the ARIC study. Am J Hypertens. 2016;29:1038-45. https://doi.org/10.1093/ajh/hpw036
  30. Yan Q, Sun D, Li X, Chen G, Zheng Q, Li L, Gu C, Feng B. Association of blood glucose level and hypertension in elderly chinese subjects: a community based study. BMC Endocr Disord. 2016;16:40. https://doi.org/10.1186/s12902-016-0119-5
  31. Henry RM, Kostense PJ, Spijkerman AM, Dekker JM, Nijpels G, Heine RJ, Kamp O, Westerhof N, Bouter LM, Stehouwer CD. Arterial stiffness increases with deteriorating glucose tolerance status: the hoorn study. Circulation. 2003;107:2089-95. https://doi.org/10.1161/01.CIR.0000065222.34933.FC
  32. Jahn LA, Hartline L, Rao N, Logan B, Kim JJ, Aylor K, Gan LM, Westergren HU, Barrett EJ. Insulin enhances endothelial function throughout the arterial tree in healthy but not metabolic syndrome subjects. J Clin Endocrinol Metab. 2016;101:1198-206. https://doi.org/10.1210/jc.2015-3293
  33. Nakagomi A, Sunami Y, Okada S, Ohno Y, Shoji T, Fujisawa T, Kobayashi Y. Association between 1-h post-load plasma glucose levels and arterial stiffness in normotensive subjects with normal glucose tolerance. Diab Vasc Dis Res. 2018;15:39-45. https://doi.org/10.1177/1479164117736509
  34. Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, Skinner JS. American college of sports medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41:1510-30. https://doi.org/10.1249/MSS.0b013e3181a0c95c
  35. Stewart KJ, Bacher AC, Turner KL, Fleg JL, Hees PS, Shapiro EP, Tayback M, Ouyang P. Effect of exercise on blood pressure in older persons: a randomized controlled trial. Arch Intern Med. 2005;165:756-62. https://doi.org/10.1001/archinte.165.7.756
  36. Baan CA, Stolk RP, Grobbee DE, Witteman JC, Feskens EJ. Physical activity in elderly subjects with impaired glucose tolerance and newly diagnosed diabetes mellitus. Am J Epidemiol. 1999;149:219-27. https://doi.org/10.1093/oxfordjournals.aje.a009795
  37. van Dam RM, Schuit AJ, Feskens EJ, Seidell JC, Kromhout D. Physical activity and glucose tolerance in elderly men: the zutphen elderly study. Med Sci Sports Exerc. 2002;34:1132-6. https://doi.org/10.1097/00005768-200207000-00013
  38. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, Macera CA, Castaneda-Sceppa C. Physical activity and public health in older adults: recommendation from the american college of sports medicine and the american heart association. Med Sci Sports Exerc. 2007;39:1435-45. https://doi.org/10.1249/mss.0b013e3180616aa2
  39. Metsamarttila E, Rodilla E, Jokelainen J, Herrala S, Leppaluoto J, Keinanen-Kiukaann Iemi S, Herzig KH. Effect of physical activity on pulse wave velocity in elderly subjects with normal glucose, prediabetes or type 2 diabetes. Sci Rep. 2018;8:8045. https://doi.org/10.1038/s41598-018-25755-4
  40. Kobayashi R, Sato K, Takahashi T, Asaki K, Iwanuma S, Ohashi N, Hashiguchi T. Arterial stiffness during hyperglycemia in older adults with high physical activity vs low physical activity. J Clin Biochem Nutr. 2019;65:146-52. https://doi.org/10.3164/jcbn.19-32
  41. Kobayashi R, Sato K, Takahashi T, Asaki K, Iwanuma S, Ohashi N, Hashiguchi T. Effects of a shortterm increase in physical activity on arterial stiffness during hyperglycemia. J Clin Biochem Nutr. 2020;66:238-44. https://doi.org/10.3164/jcbn.19-69
  42. Peterson MD, Zhang P, Choksi P, Markides KS, Snih SA. Muscle weakness thresholds for prediction of diabetes in adults. Sports Med. 2016;46:619-28. https://doi.org/10.1007/s40279-015-0463-z
  43. Peterson MD, McGrath R, Zhang P, Markides KS, Al Snih S, Wong R. Muscle weakness is associated with diabetes in older mexicans: the mexican health and aging study. J Am Med Dir Assoc. 2016;17:933-8. https://doi.org/10.1016/j.jamda.2016.06.007
  44. Umam FJ, Setiati S. Association between type II diabetes mellitus and hand grip strength in the elderly. Journal of Physics: Conference Series. 2018;1073:35-42.
  45. Rosano C, Longstreth Jr WT, Boudreau R, Taylor CA, Du Y, Kuller LH, Newman AB. High blood pressure accelerates gait Slowing in well-functioning older adults over 18-years of follow-up. J Am Geriatr Soc. 2013;59:390-7. https://doi.org/10.1111/j.1532-5415.2010.03282.x
  46. Gutierrez-Misis A, Sanchez-Santos MT, Banegas JR, Castell MV, VGonzalez-Montalvo JI, Otero A. Walking speed and high blood pressure mortality risk in a spanish elderly population. J Hum Hypertens. 2015;29:566-72. https://doi.org/10.1038/jhh.2015.32
  47. Baek SH, Kim EJ, Shin JE. Analysis of the relationship between chronic diseases and grip strength of the korean senior citizens: focusing on hypertension and diabetes. Journal of the Korean Data Analysis Society. 2019;21:2645-56. https://doi.org/10.37727/jkdas.2019.21.5.2645
  48. van Lummel RC, Walgaard S, Pijnappels M, Elders PJ, Garcia-Aymerich J, van dieen JH, Beek PJ. Physical performance and physical activity in older adults: associated but separate domains of physical function in old age. PLoS One. 2015;10:e0144048. https://doi.org/10.1371/journal.pone.0144048
  49. Brown RT, Diaz-Ramirez LG, Boscardin WJ, Lee SJ, Steinman MA. Functional impairment and decline in middle age: a cohort study. Ann Intern Med. 2017;167:761-8. https://doi.org/10.7326/m17-0496
  50. Isobe T, Saitoh S, Takagi S, Ohnishi H, Ohhata J, Takeuchi H, Fujiwara T, Akasaka H, Shimamoto K. Relation of hypertension and glucose tolerance impairment in elderly people to the development of arteriosclerosis: Investigation using pulse wave velocity. Nihon Ronen Igakkai Zasshi. 2005;40:610-4.
  51. Garcia-Puig J, Ruilope LM, Luque M, Fernandez J, Ortega R, Dal-Re R. Glucose metabolism in patients with essential hypertension. Am J Med. 2006;119:318-26. https://doi.org/10.1016/j.amjmed.2005.09.010
  52. Li CH, Wu JS, Yang YC, Shih CC, Lu FH, Chang CJ. Increased arterial stiffness in subjects with impaired glucose tolerance and newly diagnosed diabetes but not isolated impaired fasting glucose. J Clin Endocrinol Metab. 2012;97:E658-62. https://doi.org/10.1210/jc.2011-2595
  53. Safar ME, Asmar R, Benetos A, Blacher J, Boutouyrie P, Lacolley P, Laurent S, London G, Bruno P, Protogerou A, Regnault V. Interaction between hypertension and arterial stiffness. Hypertension. 2018;72:796-805. https://doi.org/10.1161/hypertensionaha.118.11212
  54. Cohen J. Statistical power analysis for the behavioral sciences (2nd ed). Hillsdale, NJ: Lawrence ealbaum associates. 1998.
  55. Henry P, Thomas F, Benetos A, Guize L. Impaired fasting glucose, blood pressure and cardiovascular disease mortality. Hypertension. 2002:40;458-63. https://doi.org/10.1161/01.hyp.0000032853.95690.26
  56. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412-9. https://doi.org/10.1007/BF00280883
  57. Yiming G, Zhou X, Lv W, Peng Y, Zhang W, Cheng X, Li Y, Xing Q, Zhang J, Zhou Q, Zhang L, Lu Y, Wang H, Tang B. Reference values of brachial-ankle pulse wave velocity according to age and blood pressure in a central Asia population. PLoS One. 2017;12:e0171737. https://doi.org/10.1371/journal.pone.0171737
  58. Miyai N, Shiozaki M, Yabu M, Utsumi M, Morioka I, Miyashita K, Arita M. Increased mean arterial pressure response to dynamic exercise in normotensive subjects with multiple metabolic risk factors. Hypertens Res. 2013;36;534-9. https://doi.org/10.1038/hr.2012.215
  59. Sesso HD, Stampfer MJ, Rosner B, Hennekens CH, Gaziano JM, Manson JE, Glynn RJ. Systolic and diastolic blood pressure, pulse pressure, and mean arterial pressure as predictors of cardiovascular disease risk in men. Hypertension. 2000;36:801-7. https://doi.org/10.1161/01.hyp.36.5.801
  60. Lee YL, Lee BH, Lee SY. Handgrip Strength in the korean population: normative data and cutoff values. Ann Geriatr Med Res. 2019;23:183-9. https://doi.org/10.4235/agmr.19.0042
  61. Rodriguez-Manas L, Bayer AJ, Kelly M, Zeyfang A, Izquierdo M, Laosa O, Hardman TC, Sinclair AJ, Moreira S, Cook J. An evaluation of the effectiveness of a multi-modal intervention in frail and pre-frail older people with type 2 diabetes--the MID-frail study: study protocol for a randomised controlled trial. Trials. 2014;15:34. https://doi.org/10.1186/1745-6215-15-34
  62. Veloso-Guedes CA, Rosalen ST, Thobias CM, Andreotti RM, Galhardo FD, Oliveira da Silva AM, Araujo O, Boin IFSF. Validation of 20-Meter corridor for the 6-minute walk test in men on liver transplantation waiting list. Transplant Proc. 2011;43:1322-4. https://doi.org/10.1016/j.transproceed.2011.03.057
  63. Nathan DM, Davidson MB, Defronzo RA, Heine RJ, Henry RR, Pratley R, Zinman B. Impaired fasting glucose and impaired glucose tolerance. Diabetes Care. 2007;30:753-9. https://doi.org/10.2337/dc07-9920
  64. Kim DL, Kim SD, Kim SK, Park SY, Song KH. Is an oral glucose tolerance test still valid for diagnosing diabetes mellitus?. Diabetes Metab J. 2016;40:118-28. https://doi.org/10.4093/dmj.2016.40.2.118
  65. Cefalu WT. Insulin resistance: cellular and clinical concepts. Exp Biol Med (Maywood). 2001;226:13-26. https://doi.org/10.1177/153537020122600103
  66. Roder PV, Wu B, Liu Y, Han W. Pancreatic regulation of glucose homeostasis. Exp Mol Med. 2016;48:e219. https://doi.org/10.1038/emm.2016.6
  67. Kobayashi R, Sato K, Sakazaki M, Nagai Y, Takahashi T, Asaki K, Iwanuma S, Ohashi N, Hashiguchi T. Acute changes in arterial stiffness with palatinose versus glucose Intake in elderly. Cardiology Cardiovascular Med. 2020;4: 144-57.
  68. Kalyani RR, Varadhan R, Weiss CO, Fried LP, Cappola AR. Frailty status and altered glucose-insulin dynamics. J Gerontol A Biol Sci Med Sci. 2012;67:1300-6. https://doi.org/10.1093/gerona/glr141
  69. Choi ES, Rhee EJ, Choi JH, Bae JC, Yoo SH, Kim WJ, Park SE, Park CY, Lee WY, Cho YK, Oh KW, Park SW, Kim SW. The association of brachial-ankle pulse wave velocity with 30-minute post-challenge plasma glucose levels in korean adults with no history of type 2 diabetes. Korean Diabetes J. 2010;34:287-93. https://doi.org/10.4093/kdj.2010.34.5.287
  70. Foreman YD, Brouwers MCGJ, Berendschot TTJM, van Dongen MCJM, Eussen SJPM, van Greevenbroek MMJ, Henry RMA, Houben AJHM, van der Kallen CJH, Kroon AA, Reesink KD, Schram MT, Schaper NC, Stehouwer CDA. The oral glucose tolerance test-derived incremental glucose peak is associated with greater arterial stiffness and maladaptive arterial remodeling: the maastricht study. Cardiovasc Diabetol. 2019;18:152. https://doi.org/10.1186/s12933-019-0950-x
  71. Maruhashi T, Kajikawa M, Kishimoto S, Hashimoto H, Takaeko Y, Yamaji T, Harada T, Hashimoto Y, Han Y, Aibara Y, Yusoff FM, Hidaka T, Chayama K, Nakashima A, Goto C, Kihara Y, Higashi Y. Vascular function is further impaired in subjects aged 80 years or older. Hypertens Res. 2020;43:914-21. https://doi.org/10.1038/s41440-020-0435-z
  72. van Sloten TT, Henry RM, Dekker JM, Nijpels G, Unger T, Schram MT, Stehouwer CD. Endothelial dysfunction plays a key role in increasing cardiovascular risk in type 2 diabetes: the hoorn study. Hypertension. 2014;64:1299-305. https://doi.org/10.1161/HYPERTENSIONAHA.114.04221
  73. de Oliveira Alvim R, Santos PCJL, Musso MM, de Sa Cunha R, Krieger JE, Mill JG, Pereira AC. Impact of diabetes mellitus on arterial stiffness in a representative sample of an urban brazilian population. Diabetol Metab Syndr. 2013;5:45. https://doi.org/10.1186/1758-5996-5-45
  74. Falkner B, Sherif K, Sumner AE, Kushner H. Blood pressure increase with impaired glucose tolerance in young adult american blacks. Hypertension. 1999;34:1086-90. https://doi.org/10.1161/01.HYP.34.5.1086
  75. Vloet LC, Smits R, Jansen RW. The effect of meals at different mealtimes on blood pressure and symptoms in geriatric patients with postprandial hypotension. J Gerontol A Biol Sci Med Sci. 2003;58:1031-5.
  76. Taylor JL, Curry TB, Matzek LJ, Joyner MJ, Casey DP. Acute effects of a mixed meal on arterial stiffness and central hemodynamics in healthy adults. Am J Hypertens. 2014;27:331-7. https://doi.org/10.1093/ajh/hpt211
  77. Li D, Guo G, Xia L, Yang X, Zhang B, Liu F, Ma J, Hu Z, Li Y, Li W, Jiang J, Gaisano H, Shan G, He Y. Relative handgrip strength is inversely associated with metabolic profile and metabolic disease in the general population in china. Front Physiol. 2018;9:59. https://doi.org/10.3389/fphys.2018.00059
  78. Jang MS, Kim HK, Oh BJ. Comparison of hand-grip strength between normal korean adults and those with type 2 diabetes: 2014-2015 korea national health and nutrition examination survey. Korean J Fam Pract. 2018;8:654-61. https://doi.org/10.21215/kjfp.2018.8.5.654
  79. Liang X, Jiang CQ, Zhang WS, Zhu F, Jin YL, Cheng KK, Lam TH, Xu L. Glycaemia and hand grip strength in aging people: guangzhou biobank cohort study. BMC Geriatr. 2020;20:399. https://doi.org/10.1186/s12877-020-01808-0
  80. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-56. https://doi.org/10.1093/gerona/56.3.M146
  81. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitsk A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489-95. https://doi.org/10.1503/cmaj.050051
  82. Morley JE, von Haehling S, Anker SD, Vellas B. From sarcopenia to frailty: a road less traveled. J Cachexia Sarcopenia Muscle. 2014;5:5-8. https://doi.org/10.1007/s13539-014-0132-3
  83. Samper-Ternen R, Reyes-Ortiz C, Ottenbacher KJ, Cano CA. Frailty and sarcopenia in bogota: results from the SABE bogota study. Aging Clin Exp Res. 2017;29:265-72. https://doi.org/10.1007/s40520-016-0561-2