Combination antihypertension therapy: The “underresearched” combinations

Decrease of blood pressure (BP) and its maintenance on target level is the main factor for cardiovascular mortality and morbidity reduction in hypertensive patients. For effective BP decrease most patients need combination therapy. The article is focused on benefits and adverse events of some combinations. In details an issue considered, on the combination of beta-blocker and renin-angiotensine-aldosteron system blocker, which, by the data from Russian observational programs, is the leader among two-component combinations. © 2017, Silicea-Poligraf, All right reserved

Combination antihypertension therapy: The “underresearched” combinations

Decrease of blood pressure (BP) and its maintenance on target level is the main factor for cardiovascular mortality and morbidity reduction in hypertensive patients. For effective BP decrease most patients need combination therapy. The article is focused on benefits and adverse events of some combinations. In details an issue considered, on the combination of beta-blocker and renin-angiotensine-aldosteron system blocker, which, by the data from Russian observational programs, is the leader among two-component combinations. © 2017, Silicea-Poligraf, All right reserved

Arterial hypertension in a very old: Significance of the biological age

Elderly population is heterogenic, and persons with the same chronological age differ greatly by their physical and cognitive functioning. Regardless the convincing witness on the adverse influence of raised blood pressure (BP) in a middle age persons, its influence on the prognosis of a very old is still debatable, as the question, whether to treat arterial hypertension (AH) in elderly, and if so, how intensively. The article focuses on the results of observational and randomized clinical studies that make it to decide that not the chronological, but biological age is an important criteria for decision on AH management in elderly. The article presents in details mechanisms interacting in BP regulation, and influence of BP on the risk of morbidity and mortality in elderly. Also, the current guidelines are cited, on antihypertension treatment, as the issues dicussed on AH treatment in elderly, that require further investigation

Antihypertensive Therapy and its efficacy in outpatient elderly and very elderly subjects

Purpose of the study. The study of the characteristics and effectiveness of antihypertensive therapy (AHT) in patients aged 65 years and older. Material and methods. The study included 356 patients, mean age 74,916,1 years, 80.4% women. The prevalence of arterial hypertension (AH) and the current intake of antihypertensive drugs were evaluated by self-reported patient. Results. The prevalence of hypertension was 88.5%. The predominant variant was isolated systolic hypertension. 51.1% of patients have systolic blood pressure as measured at the reception turned > 140 mm Hg in 34.7% of patients >150 mm Hg AHT received 91.6% of patients with hypertension in 65.6% of cases it was combined. Of the various combinations of bicomponent most patients took angiotensin converting enzyme inhibitor in combination with a Adrenoblocker or a diuretic. Conclusions. The study showed the high prevalence of hypertension and the lack of efficacy in patients AHT elderly seeking outpatient care

Prevention of cardiovascular events: Are all recommendations applicable to elderly patients with senile Asthenia?

Primary prevention of cardiovascular events is based on achievement of optimal control of risk factors - arterial hypertension, dyslipidemia, glycemia - in accordance with current recommendations of scientific societies. But most rapidly growing segment of population - elderly and old individuals - have been underrepresented in randomized clinical trials underlying recommendations on primary and secondary prevention. That is why it is problematic to directly apply recommendations to patients from this group of population. In addition, old patients are characterized by accumulation of functional deficits, development of syndrome of senile asthenia («frailty»), and multimorbidity. Effect of these characteristics on prognosis often exceeds that of risk factors. Other important factor is high susceptibility of old patients to risk of development of unfavorable effects because of both changes of pharmacokinetics and pharmacodynamics of drugs and the need for multiple medicines (polypragmasy). While applying existing recommendations to old people one should recognize limitations of current knowledge on best ways of realization of approaches to prevention of cardiovascular prevention which effectiveness has been proved in younger individuals. Improvement of awareness and development of special skills of physicians involved in management of old patients is required for timely detection of the syndrome of senile asthenia. Special geriatric approaches should be implemented in cooperation with specialists in geriatric medicine

Prevention of cardiovascular events: Are all recommendations applicable to elderly patients with senile Asthenia?

Primary prevention of cardiovascular events is based on achievement of optimal control of risk factors - arterial hypertension, dyslipidemia, glycemia - in accordance with current recommendations of scientific societies. But most rapidly growing segment of population - elderly and old individuals - have been underrepresented in randomized clinical trials underlying recommendations on primary and secondary prevention. That is why it is problematic to directly apply recommendations to patients from this group of population. In addition, old patients are characterized by accumulation of functional deficits, development of syndrome of senile asthenia («frailty»), and multimorbidity. Effect of these characteristics on prognosis often exceeds that of risk factors. Other important factor is high susceptibility of old patients to risk of development of unfavorable effects because of both changes of pharmacokinetics and pharmacodynamics of drugs and the need for multiple medicines (polypragmasy). While applying existing recommendations to old people one should recognize limitations of current knowledge on best ways of realization of approaches to prevention of cardiovascular prevention which effectiveness has been proved in younger individuals. Improvement of awareness and development of special skills of physicians involved in management of old patients is required for timely detection of the syndrome of senile asthenia. Special geriatric approaches should be implemented in cooperation with specialists in geriatric medicine

Arterial hypertension in a very old: Significance of the biological age

Elderly population is heterogenic, and persons with the same chronological age differ greatly by their physical and cognitive functioning. Regardless the convincing witness on the adverse influence of raised blood pressure (BP) in a middle age persons, its influence on the prognosis of a very old is still debatable, as the question, whether to treat arterial hypertension (AH) in elderly, and if so, how intensively. The article focuses on the results of observational and randomized clinical studies that make it to decide that not the chronological, but biological age is an important criteria for decision on AH management in elderly. The article presents in details mechanisms interacting in BP regulation, and influence of BP on the risk of morbidity and mortality in elderly. Also, the current guidelines are cited, on antihypertension treatment, as the issues dicussed on AH treatment in elderly, that require further investigation

Antihypertensive Therapy and its efficacy in outpatient elderly and very elderly subjects

Purpose of the study. The study of the characteristics and effectiveness of antihypertensive therapy (AHT) in patients aged 65 years and older. Material and methods. The study included 356 patients, mean age 74,916,1 years, 80.4% women. The prevalence of arterial hypertension (AH) and the current intake of antihypertensive drugs were evaluated by self-reported patient. Results. The prevalence of hypertension was 88.5%. The predominant variant was isolated systolic hypertension. 51.1% of patients have systolic blood pressure as measured at the reception turned > 140 mm Hg in 34.7% of patients >150 mm Hg AHT received 91.6% of patients with hypertension in 65.6% of cases it was combined. Of the various combinations of bicomponent most patients took angiotensin converting enzyme inhibitor in combination with a Adrenoblocker or a diuretic. Conclusions. The study showed the high prevalence of hypertension and the lack of efficacy in patients AHT elderly seeking outpatient care

Cognition disorders in hypertensive patients of older age and senile

Aim. To assess cognitive status of the older age patients with arterial hypertension, in outpatient setting. Material and methods. Totally, 356 patients included, age 74,9±6,1 y., 80,4% females. For cognition assessment before and after the treatment, neuropsychological test was done, with MMSE - short scale of psychic status assessment, drawing test; literal and categoric associations test. Results. In the group <80 y. o. The prominence of MMSE disorders correlated with blood pressure values (BP): for systolic BP (r=-0,22, p=0,0003), for diastolic BP (r=-0,13, p=0,03), i. e. in higher BP patients there were lower points in cognition scale by Spearman correlation. In the group ≥80 y. both correlations were non-significant, for systolic BP (r=-0,05, p=0,64), and for diastolic BP (r=-0,13, p=0,25). Conclusion. In older age and senile patients with arterial hypertension there should be differential approach to BP management according to the age and cognition disorders, complex approach to treatment in these patients might prevent further worsening of cognitive decline