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The article presents information on chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA). Topics include risk of sleep desaturation, poor sleep efficiency and COPD exacerbation is shown in case of COPD–OSA; devices used to identify phenotypes in research studies is multi detector computed tomography (MDCT); and COPD–OSA overlap have increased thickness of airways compared to COPD alone as shown in a study.

Systolic blood pressure (SBP) and pulse pressure (PP) have been identified in western industrialized countries as major predictors of cardiovascular events in the elderly on the basis of measurements taken at a single visit. Considering the wide variability of blood pressure (BP) in older people, this study set out to assess the prognostic significance of measurements of SBP and PP taken over several months according to a monitoring scheme mimicking routine care. A total of 444 Italian general practitioners enrolled a cohort of 3858 unselected elderly outpatients and followed them up for 10 years. BP was recorded at recruitment, 1 week later and at quarterly visits during the first year. The average BP of these six visits was used to define the patient's BP status. During the 10-year follow-up, 1561 participants died, 709 from cardiovascular diseases. Proportional hazard regression analysis, adjusted for all main prognostic factors including antihypertensive treatment, showed that for each 10-mmHg increment in SBP and PP there were, respectively, 5 and 9%increases in risk for total mortality (TM) and 9 and 13%increases in risk for cardiovascular mortality (CVM) (all P<0.01). However, including both SBP and PP in the model, only PP showed an independent, significant relationship with TM and CVM. In conclusion, prognostic information based on repeated measurements of PP is stronger than that given by SBP and consequently should be recommended in the definition of cardiovascular risk in the elderly.Journal of Human Hypertension (2005) 19, 355-363. doi:10.1038/sj.jhh.1001827 Published online 17 March 2005 [ABSTRACT FROM AUTHOR]

Objective: To determine whether general practitioners (GP) who are readers of independent drug bulletins can be used as an international epidemiological observatory of the criteria adopted by 'well informed' doctors in various countries in the management of mild hypertension. Design: Questionnaire study of GPs' diagnostic criteria for mild hypertension, routine investigation and management of patients with this diagnosis. Participants: 206 GPs readers of independent drug bulletins in 7 countries, comprising 95 known systematic readers of a local bulletin and 111 randomly selected regular subscribers. Main outcome measures: Response rate to the questionaire. Diagnostic criteria, routine investigations, and treatment used for patients with mild hypertension. Results: The study required two months for planning and implementation. Four countries out of eleven had a response rate ≤50% and were excluded; the frequency of responses from other countries was 69%. The average diastolic blood pressure (DBP) considered diagnostic of mild hypertension range from 94 mm Hg (lower threshold) to 106 (upper threshold). A minority (17%) of GPs routinely request the minimum recommended laboratory tests to assess patients. GPs routinely advise non-drug measures before starting a drug. Most would not start drug treatment in patients without other risk factors and a DBP below 100 mmHg. The top first choice drugs were diuretics and β-adrenoceptor blockers. Half of the doctors were able to quote some published guide to the management of mild hypertension, and 18% cited a relevant trial. Attitudes in diagnosing and treating mild hypertension differed widely between GPs and countries. Conclusions: GP readers of drug bulletins can be used quickly and inexpensively to assess the extent to which recommended diagnostic and therapeutic practices are accepted by 'well informed' doctors. The results suggest that attitudes in managing mild hypertension vary widely among GPs and countries and differ remarkably from the recommendations of published guidelines. [ABSTRACT FROM AUTHOR]

The pharmacological treatment, mainly based on diuretics, of isolated systolic hypertension (ISH) has recently been shown to reduce the risk of stroke and coronary heart disease in the elderly. The purpose of this study was to compare the antithypertensive effect and tolerability of different drug regimens in elderly subjects with ISH (systolic blood pressure—SBP —≥160 mmHg and diastolic blood pressure — DBP — <90 mmHg). A multicentre, randomized, controlled open trial was planned in the general practice setting. Four widely used treatment schedules were tested: hydrochlorothiazide 25 mg plus amiloride 2·5 mg (H+Am), nifedipine slow release 20 mg (N), atenolol 50 mg (At) and atenolol 25mg plus chlorthalidone 6·25 mg (At+C). After a baseline evaluation, 308 patients (76·3% female, mean age 75·3 ± 7·1 years) were randomized and followed up for 6 months. After 3 months the drug dosage was doubled if the systolic blood pressure goal (SBP<160 mmHg and SBP reduction of at least 20 mmHg) had not been reached Ninety-four subjects (30·5%) presented contraindications to β-blockers. At the 3rd- and 6th-month visits all treatment groups, except At, showed a significant reduction in SBP compared to the control group; DBP showed no significant reduction in any group at any time. At the end of the follow-up the percentage of hypertensives who had reached the BP goal was 14·6% in the control group, 52·9% in H+Am, 54·8% in N, 28·6% in At and 52·2% in At+C. Over two-thirds of the patients on H+Am or N, and about 50% of those on At or At+ C at 6 months were taking the medication at low dose. The rate of therapy discontinuation due to side effects during follow-up was significantly different among the drug regimens tested: 1·9% in the H+Am group compared to 12·5%, 19·2% and 14·8% respectively in N, At and At+C groups (<0·05 for H+Am vs At). The proportion of subjects who spontaneously reported, mild adverse effects after 3 and 6 months of therapy was not signficantly different in the study groups, even if an excess was observed in the N group at 3 months. In conclusion, these data suggest that. diuretics are a first choice in the treatment of ISH, because of their hypotensive efficacy and acceptability; nifedipine, if well tolerated, is an effective alternative to diuretics; a high proportion of elderly patient with ISH present contraindications to β-blockers, and atenolol has a poor antihypertensive effect. [ABSTRACT FROM PUBLISHER]

The prevalence of orthostatic hypotension (OH) in an elderly outpatient population was assessed according to the most common criteria given in the literature. Short-term OH variability and relationships between OH and its known risk factors were also analysed. A sample of 3858 elderly outpatients aged 65 years or more was randomly recruited by 444 italian general practitioners. The patients' blood pressure (BP) and heart rate were recorded in both lying and standing positions at two visits 7 days apart. Three definitions were used for the identification of OH: (1) a decrease in systolic BP>20mmHg (SOH): (2) a decrease in both systolic (>20 mmHg) and diastolic (>10 mmHg) BP (SDOH): (3) any decrease in systolic BP associated with symptoms (SyOH). Prevalence figures for SOH were l3.8% at the first and 12.6% at the second visit, and respectively 5.3 and 4.8% for SDOH, 14.1 and 11.8% for SyOH. All the criteria were met by less than 2% of subjects at each visit. The diagnosis of OH was confirmed at both visits in 36.3% of cases for SOH, in 25.7% for SDOH, and in 43.9% for SyOH. Each different OH definition identifies a population subgroup characterized by different sets of risk-factors. The presence and prevalence of OH is dfficult to define because dfferent people may be identfied by the currently accepted criteria or by the same criterion over a short time. [ABSTRACT FROM PUBLISHER]

To assess the value of exercise stress testing and of mental stress as predictors of hypertension, we studied 130 normotensive males 14–18 years of age. Sixty-five had at least one hypertensive parent (SHT), while 65 had normotensive parents (SNT). Systolic (SBP) and diastolic (DBP) blood pressure, rate-pressure product (RPP) and 12-lead ECG were recorded at rest, throughout the tests and during the recovery phase. The two groups were not significantly different at rest for the examined variables. However, the SHT group showed a greater average SBP than the SNT group (198.4±18.7 vs 189.5±14.9 mmHg; P<0.05) at the peak of exercise. A significantly higher proportion of SHT subjects (40.0% vs 18.5%: P<0.01) had SBP >200 mmHg. No difference in the ECG pattern between the two groups was observed. During mental stress, no significant differences in the examined variables between the two groups were noted, although SBP, DBP, HR and RPP were slightly higher in SHT than in SNT subjects. These data suggest that the SBP response to dynamic exercise may be a good predictor of hypertension in subjects at risk. [ABSTRACT FROM PUBLISHER]

Examines the clinical trials on hypertension in the context of general practice. Assessment of the treatment of isolated systolic hypertension in elderly people; Reasons behind the non-participation of the practitioners; Suggestions in increasing the compliance of the practitioners.