Current guidelines and controversies in the diagnosis and therapy of hypertension in the elderly and very elderly — a review of international recommendations

According to the World Health Organization (WHO) arterial hypertension remains the most important cause of death in the world. Due to ageing of the population and the proven importance of high blood pressure in older age, various expert groups dealing with hypertension worldwide have dedicated more and more separate recommendations to elderly (65–79 years of age) and very elderly patients ( > 80 years of age). The subject of this work is to present and compare current guidelines for the diagnosis and treatment of hypertension developed for this demographic segment. Due to the global significance in shaping the views on hypertension, the following Englishlanguage guidelines have been used for comparative analyses in this work: 2017 ACC/AHA Guideline, 2018 ESC//ESH Guidelines, Hypertension Canada’s 2018 Guidelines, 2019 Hypertension in adults: diagnosis and management by National Institute for Health and Care Excellence (NICE), 2016 Guideline for the diagnosis and management of hypertension in adults by National Heart Foundation of Australia. The comparisons have been made based on of blood pressure criteria, the threshold values for drug treatment initiation and the blood pressure target values. In summary, hypertension guidelines for the elderly and very elderly differ significantly, although similar trends in their recommendations are evident

Chronic kidney disease in Polish elderly population aged 75+: results of the WOBASZ Senior Survey

PURPOSE: Kidney filtration decreases with age, which results in an increased frequency of chronic kidney disease (CKD) in the elderly population. The purpose of the study was to assess the prevalence and epidemiology of CKD in the Polish elderly population. METHODS: A representative sample of the Polish elderly population, composed of 918 people (F 452, M 466) in the age of ≥75 years, was chosen. All participants had their history, anthropometric measures and biochemical parameters (creatinine, fasting glucose, complete cholesterol) evaluated. CKD was diagnosed when eGFR was <60 ml/min/1.73 m(2). The comorbidities, anthropometric and social factors connected with the onset of CKD were also analyzed. RESULTS: The prevalence of CKD in the analyzed population was 26.9% (F 32.0%, M 15.8%), which gives an estimated number of 495,590 (95% CI 396,363–594,817) patients in the study subpopulation. The majority of these people were in the G3A category—70.1%, while the remaining fell under the G3B—25.7%, G4—3.1% and G5—1.1% categories. Disease awareness among the participants was found to be at 17%. Arterial hypertension (AH) was more frequent in people with CKD (91.0 vs. 80.3%, P < 0.001), whereas diabetes mellitus (DM) prevalence was comparable in both CKD and non-CKD groups (11.7 vs. 11.4%, ns). In the examined group, DM had no influence on the frequency of CKD. In contrast, the presence of cardiovascular diseases substantially increased the chances of developing CKD (OR 1.87, P < 0.05). CONCLUSION: 1. The prevalence of CKD in the Polish elderly population was 26.9%. 2. Awareness of CKD is low. 3. DM, increasing age and AH did not increase the risk of CKD. 4. Coexistence of cardiovascular diseases increased the risk of having CKD

Treatment of Arterial Hypertension during Rapid Economic and Political Transition in Poland

Leczenie nadciśnienia tętniczego, z uwagi na jego rozpowszechnienie i powikłania, stanowi w większości krajów poważny problem zdrowotny, społeczny i ekonomiczny. W Stanach Zjednoczonych narodowy program prewencji nadciśnienia wprowadzony w latach 70. spowodował po 25 latach zdecydowaną poprawę wykrywalności i skuteczności leczenia nadciśnienia z równoczesnym obniżeniem śmiertelności z powodu choroby wieńcowej i udarów mózgu. W związku z istotnie pogarszającą się sytuacją epidemiologiczną w krajach Europy Środkowo-Wschodniej istnieje potrzeba wprowadzenia w tych krajach zdecydowanych działań na rzecz lepszej kontroli nadciśnienia. W artykule omówiono potencjalne sposoby poprawy sytuacji w kontekście skomplikowanych zmian społecznych i ekonomicznych zachodzących od 1990 roku w Polsce i krajach sąsiednich.Hypertension, due to its prevalence and serious complications, constitutes a major public health problem and implies a great economical and social cost. In the U.S., "The National High Blood Pressure Education Program" was developed and implemented in early seventies. Subsequently, improved levels of awareness, treatment and control of hypertension were demonstrated, coincident with continued declines in coronary heart disease mortality and striking declines in stroke mortality. At present, in the eastern part of Europe where cardiovascular and cerebrovascular diseases are on the increase, there is a particulary urgent need for more vigorous public health action against hypertension. The potential activities that should be undertaken are discussed in this paper in the context of a rapid transformation into a market economy, which followed the collapse of the former economic and political system. This process, being in itself a unique psychological and social experience for our populations, presents a source of many difficulties to adjust to new economic conditions, progress in medical knowledge and new mechanisms at the pharmaceutical market

Blood pressure determinants. Part II. Application of some physical laws in the hemodynamics of cardiovascular system

Praca udowadnia użyteczność praw fizyki w zakresie charakterystyki układu krążenia i ciśnienia tętniczego. Autorzy skoncentrowali się na zagadnieniach związanych z dynamiką krążenia krwi, w tym na zjawiskach zachodzących przy tradycyjnym pomiarze ciśnienia tętniczego. Pojęcia impedancji naczyniowej, podatności naczyń oraz pulsacyjnego przepływu krwi przedstawiono w kontekście ich praktycznego zastosowania w diagnostyce i leczeniu nadciśnienia tętniczego oraz niewydolności serca, a także jako wykładniki o znaczeniu rokowniczym.This paper analyzes physical laws crucial for hemodynamics and arterial blood pressure. The major issue addressed is the dynamic aspects of circulation, including physical phenomena underlying the traditional way of the arterial pressure measurement. Terms: vascular impedance, vascular compliance, and pulsatile blood flow are exposed in context of their practical usage in diagnosis and treatment of hypertension and heart insufficiency, and also as indices of high prognostic value

Blood pressure determinants. Part I: Structure &#8212; function links in blood pressure regulation. Reliability of blood pressure measurement

W niniejszym opracowaniu podjęliśmy próbę systematycznego wyszczególnienia, podstawowych czynników determinujących ciśnienie tętnicze: uwarunkowań morfologicznych, czynników fizycznych oraz zależności regulacyjnych. Dynamiczny charakter ciśnienia tętniczego skonfrontowano z koncepcją o dominującym wpływie zaspokojenia potrzeb metabolicznych tkanek obwodowych na regulację ciśnienia tętniczego. Praca została podzielona na trzy części. W pierwszej, aktualnie prezentowanej, przypomniano metody pomiaru ciśnienia tętniczego i najczęstsze błędy pomiarowe oraz omówiono istotne w regulacji ciśnienia tętniczego związki strukturalno-czynnościowe.The major structural, physical, and regulatory determinants of blood pressure are systematically reviewed. A dynamic nature of blood pressure is coupled with the idea that the regulation of blood pressure is primarily to meet metabolic needs of peripheral tissues. The paper is divided into three parts. In the first one, the basic methods of blood pressure measurement and the most common mistakes in its assessment are recalled. Links between morphological structure and function of essential impact on blood pressure regulation are discussed

Analysis of the effect of inertial forces of the electrolyte flow on the ECM machining effects of curvilinear rotary surfaces

This paper presents an analysis of the impact of inertial forces of the electrolyte flow in an interelectrode gap on the effects of ECM process of curvilinear rotary surfaces. Considering a laminar flow in the interelectrode gap, the equations of the flow of the mixture of electrolyte and hydrogen in the curvilinear orthogonal coordinate system have been defined. Two classes of equations of motion have been formulated, which differ in the estimates referred to the components of velocity and pressure, and which were analytically solved using the method of perturbation. Using the machined surface shape evolution equation, the energy equation, and the analytical solutions for velocity and pressure, the ECM-characteristic distributions have been determined: of mean velocity, pressure, mean temperature, current density, gas phase concentration, the gap height after the set machining time for the case when there is no influence of inertial forces, the effect of centrifugal forces and, at the same time, centrifugal and longitudinal inertial forces

Age-related gap in the management of heart failure patients. The National Project of Prevention and Treatment of Cardiovascular Diseases &#8212; POLKARD

Background: Heart failure (HF) is strongly associated with aging. It affects 10&#8211;12% of patients older than 80 years, with five-year overall mortality after first hospitalization for HF being as high as 81%. The main objective of this study was to assess the diagnosis and treatment of HF in hospitalized octogenarians compared to younger subjects. Methods: The survey was performed among a random sample of all Polish hospitals and in all academic centers, as part of the National Project of Prevention and Treatment of Cardiovascular Diseases in Poland &#8212; POLKARD. Using a questionnaire-based method, hospital documentation of the last five patients with diagnosed HF was reviewed. Eventually, in 2005, HF patients of 259 internal medicine and cardiology hospital wards, including 260 very elderly patients, were selected to the study. Results: The mean age of the 1,289 studied patients was 69.8 &#177; 11.4 years (age range: 26&#8211;96 years), 57.8% were males, and 80.1% were in NYHA class III or IV. Echocardiography was performed in 41.7% of octogenarians in comparison with 58.7% of those categorized as younger elderly, i.e. 60&#8211;79 years, and 75.2% of patients aged below 60 years (p < 0.0001). The most prescribed drugs in very elderly patients were diuretics (86.9%, p = 0.005) and ACE-I (81.9%), while only 61.5% used beta-blockers (p < 0.0001). In stepwise logistic regression analysis, hypertension, history of myocardial infarction and admission to cardiology ward were positively associated with beta-blocker and ACE-I (or ARB) therapy, while older age and pulmonary diseases (COPD or asthma) were related to their non-prescription. Conclusions: Despite significant progress in HF management, there is still a need for an improvement in the medical care of very elderly patients. The major obstacles seem to be advanced age and the presence of coexistent pulmonary diseases. Therefore, the participation of geriatricians and pulmonologists should be recommended in caring for octogenarians with HF. (Cardiol J 2012; 19, 2: 146&#8211;152