Factors determining compliance of hypertensive patients to physician advice on physical activity and other non-pharmacological treatment

Wstęp Postępowanie niefarmakologiczne stanowi nieodzowny element terapii nadciśnienia tętniczego, a regularna aktywność fizyczna, będąca jedną z jego form, redukuje ciśnienie tętnicze, wydłuża czas życia w zdrowiu i zmniejsza śmiertelność. Cel badania Ocena wiedzy pacjentów na temat niefarmakologicznych metod leczenia nadciśnienia tętniczego, ich stosowania się do zaleceń w tym zakresie oraz wpływu porady lekarskiej na zachowania prozdrowotne pacjenta. Materiał i metody 201 kolejnych pacjentów Poradni Nadciśnieniowej I Kliniki Kardiologii i Nadciśnienia Tętniczego Uniwersytetu Jagiellońskiego Collegium Medicum leczonych od co najmniej roku wypełniło anonimowe ankiety. Kryteria wykluczenia: wiek poniżej 18. roku życia, ciąża. Kwestionariusz zawierał pytania dotyczące przebiegu choroby nadciśnieniowej, znajomości i stosowania się do zaleceń lekarza, wiedzy na temat znaczenia aktywności fizycznej, podejmowania regularnego wysiłku fizycznego oraz jakości porady lekarskiej w tym zakresie. 34,8% badanych wyraziło pisemną zgodę na wgląd do swojej dokumentacji medycznej, co pozwoliło na włączenie do analizy danych antropometrycznych oraz informacji o przebiegu leczenia nadciśnienia tętniczego. Wyniki Średni wiek pacjentów wynosił 54,3 (± 13,7) lat; 92,2% badanych mierzyło ciśnienie tętnicze minimum raz w tygodniu; 91,5% leczonych farmakologicznie deklarowało regularne przyjmowanie wszystkich przepisanych leków; 54,9% ankietowanych podało, iż nigdy nie słyszało o niefarmakologicznych metodach leczenia nadciśnienia tętniczego. O postępowaniu niefarmakologicznym pacjenci informowani byli głównie przez lekarza; 30,5% pacjentów nie czuje się wystarczająco poinstruowanych w kwestii rodzaju i zakresu odpowiedniego dla nich wysiłku fizycznego; 80,7% badanych deklaruje aktywność fizyczną; 22,8% regularną. Zaobserwowano zależność między jakością udzielanej przez lekarza porady o korzyściach z regularnego wysiłku a podejmowaniem aktywności regularnej (p = 0,01) i/lub nieregularnej (p = 0,04). Stwierdzono istotną zależność między poradą lekarską na temat innych niefarmakologicznych metod leczenia a ich stosowaniem. Wnioski Wiedza pacjentów z nadciśnieniem tętniczym na temat niefarmakologicznych metod postępowania jest niewystarczająca, przez co w niedostatecznym stopniu stosują się oni do zaleceń lekarskich. Porada lekarska i jej jakość mają istotne znaczenie w niefarmakologicznej terapii nadciśnienia tętniczego.Background Non-pharmacological methods of treatment are crucial to high blood pressure therapy. In this respect physical activity seems worth particular attention, as it reduces blood pressure, prolongs life in good health and reduces mortality. Aims to assess patients’ knowledge about non-pharmacological methods of treatment in arterial hypertension, compliance to physician’s advice and the influence of physician’s advice on patients’ behaviour. Material and methods 201 consecutive patients of Outpatient Hypertensive Clinic of First Department of Cardiology and Hypertension, Jagiellonian University Medical College, treated for at least one year filled in a study form. Exclusion criteria: age under 18 years, pregnancy. The questionnaire enquired about the course of arterial hypertension, familiarity with methods and following with treatment, awareness of the importance of physical activity, taking regular exercise, and quality of physician’s advice in the matter. 34.8% of the examined consented to have their medical documentation studied, thus allowing the inclusion of anthropometric data and information about hypertension treatment course in the analysis. Results Mean age was 54.3 (± 13.7) years. 92.2% of the examined took their blood pressure at least once a week. 91.5% of those under pharmacological treatment declared regular medication intake. 54.9% of the surveyed claimed that they had never heard about non-pharmacological methods of arterial hypertension treatment. The physician was the main source of information on the problem. 30.5% of patients were insufficiently informed what kind of exercise they should take. Physical activity was declared by 80.7% of the questioned; regular activity by 22.8%. A correlation was observed between the quality of physician’s advice about benefits from regular physical activity and taking exercises regularly (p = 0.01) and/or irregularly (p = 0.04). Associations were also observed between physician’s advice about other non-pharmacological methods of treatment and complying with them. Conclusion There is insufficient patient’s knowledge on non-pharmacological treatment of hypertension, resulting in insufficient compliance with these recommendations. Physician’s advice and its quality are important in non-pharmacological treatment of arterial hypertension

The role of stress hyperglycemia and hyperlactatemia in non-diabetic patients with myocardial infarction treated with percutaneous coronary intervention

Background: Stress hyperglycemia and lactates have been used separately as markers of a severe clinical condition and poor outcomes in patients with myocardial infarction (MI). However, the interplay between glucose and lactate metabolism in patients with MI have not been sufficiently studied. The aim in the present study was to examine the relationship of glycemia on admission (AG) and lactate levels and their impact on the outcome in non-diabetic MI patients treated with percutaneous coronary intervention (PCI).  Methods: A total of 405 consecutive, non-diabetic, MI patients were enrolled in this retrospective, observational, single-center study. Clinical characteristic including glucose and lactate levels on admission and at 30-day mortality were assessed. Results: Patients with stress hyperglycemia (AG ≥ 7.8 mmol/L, n = 103) had higher GRACE score (median [interquartile range]: 143.4 (115.4–178.9) vs. 129.4 (105.7–154.5), p = 0.002) than normoglycemic patients (AG level < 7.8 mmol/L, n = 302). A positive correlation of AG with lactate level (R = 0.520, p < 0.001) was observed. The coexistence of both hyperglycemia and hyperlactatemia (lactate level ≥ 2.0 mmol/L) was associated with lower survival rate in the Kaplan-Meier estimates (p < 0.001). In multivariable analysis both hyperglycemia and hyperlactatemia were related to a higher risk of death at 30-day follow-up (hazard ratio [HR] 3.21, 95%, confidence interval [CI] 1.04–9.93; p = 0.043 and HR 7.08; 95% CI 1.44-34.93; p = 0.016, respectively) Conclusions: There is a relationship between hyperglycemia and hyperlactatemia in non-diabetic MI patients treated with PCI. The coexistence of both hyperglycemia and hyperlactatemia is associated with lower survival rate and are independent predictors of 30-day mortality in MI patients and these markers should be evaluated simultaneously

Model of the distribution of diastolic left ventricular posterior wall thickness in healthy adults and its impact on the behavior of a string of virtual cardiomyocytes

Correlation of the thickness of the left ventricular posterior wall (LVPWd) with various parameters, including age, gender, weight and height, was investigated in this study using regression models. Multicenter derived database comprised over 4,000 healthy individuals. The developed models were further utilized in the in vitro-in vivo (IVIV) translation of the drug cardiac safety data with use of the mathematical model of human cardiomyocytes operating at the virtual healthy population level. LVPWd was assumed to be equivalent to the length of one-dimensional string of virtual cardiomyocyte cells which was presented, as other physiological factors, to be a parameter influencing the simulated pseudo-ECG (pseudoelectrocardiogram), QTcF and $\Delta$QTcF, both native and modified by exemplar drug (disopyramide) after $I_{Kr}$ current disruption. Simulation results support positive correlation between the LVPWd and QTcF/$\Delta$QTc. Developed models allow more detailed description of the virtual population and thus inter-individual variability influence on the drug cardiac safet