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OBJECTIVE: The study aims at assessing the relationship between blood pressure, heart geometry parameters, and the erythrocyte content of sulfur, potassium, chlorine and phosphorus, in a group of patients with ambulatory systolic and diastolic blood pressure (SBP, DBP) below 140 or 90 mm Hg, respectively, who were otherwise healthy and untreated. METHODS: The study group consisted of 42 adults recruited in a primary care setting. The individuals were healthy, not undergoing any therapy and free from smoking. For each individual, data were obtained on: average 24-hour SBP and DBP, left ventricle geometry, complete blood count, lipids profile, fibrinogen, hs-CRP and the erythrocyte concentration of sulfur (S), potassium (K), chlorine (Cl) and phosphorus (P). RESULTS: Multivariate regression analysis showed statistically significant relationships of diastolic posterior wall thickness (PWTd) and relative wall thickness (RWT) with the concentration ratio of sulfur and potassium (S/K) in erythrocytes: PWTd and RWT increase as the S/K ratio increases. Also, SBP was found to be positively correlated with the S/K ratio. CONCLUSIONS: The increase in sulfur content in RBCs could be an indicator of the downregulation of nitric oxide (NO) erythrocyte bioavailability exerted by endogenously produced hydrogen sulfide (H2S), and, in consequence, a marker of the development of hypertension and/or adverse changes in heart geometry.

Polypharmacy is a challenging issue in geriatrics. The aim of the study was to characterize correlates of polypharmacy in the PolSenior project. The PolSenior project, was a comprehensive survey in a large and longitudinal representative sample of thePolish older population. The project was conducted by the International Institute of Molecular and Cell Biology in Warsaw between 2008 and 2011. All medications consumed during the week preceding the survey were evaluated for each participant (n = 4793, including 2314 females (48.3%)). Thereafter, the percentage of those with polypharmacy (at least 5 medications) and excessive polypharmacy (at least 10 medications) was calculated, and their correlates were determined. The average number of medications used by participants was 5.1 ± 3.6, and was higher in females than in males (5.5 ± 3.5 vs. 4.8 ± 3.5; p < 0.001). Polypharmacy characterized 2650 participants (55.3%) and excessive polypharmacy—532 of them (11.1%). The independent correlates associated withpolypharmacy were: age over 70 years, female sex, higher than primary education, living in an urban area, comorbidities, any hospitalization during past five years, and visiting general practicioners at least yearly. As for correlates with excessive polypharmacy, they were: age 80–84 years, female sex, living in an urban area, diagnosis of at least four chronic diseases, and at least two hospitalizations in the last five years. This study serves as a starting place to understand patient characteristics associated with polypharmacy, excessive polypharmacy, and identify targeted interventions.

Purpose: The parameters of cerebral blood flow are modulated by many factors. The aim of the study was to prospectively assess the relationship between the number of the established cardiovascular ...

INTRODUCTION: Long-term care facility (LTCF) residents are typically excluded from clinical trials due to multimorbidity, dementia, and frailty, so there are no clear evidence-based rules for treating arterial hypertension in this population. Moreover, the role of hypertension as mortality risk factor in LTCFs has not yet been clearly established. OBJECTIVES: The study aimed to investigate whether treated hypertension is associated with lower mortality among older LTCF residents with multimorbidity. PATIENTS AND METHODS: The study was performed in a group of 168 residents aged ≥ 65 years in three LTCFs. Initial assessment included blood pressure (BP) measurements and selected geriatric scales: MNA-SF, AMTS and ADL. Hypertension, comorbidities, pharmacotherapy, antihypertensive drugs and mortality during one-year follow-up were extracted from the medical records. The data was compared in groups: Survivors and Deceased. RESULTS: Survivors and Deceased revealed similar age, DBP, number of diseases, medications, and antihypertensive drugs. However, Deceased had significantly lower SBP (P

Background In hospital settings, delirium affects as many as 50% of older patients, aggravating their symptoms and worsening their condition, and therefore increasing the risk of in-hospital complications and death. The aim of this study is to assess the efficacy of structured, non-pharmacological care, delivered to older hospitalised patients by trained volunteers (students of medical fields), on the reduction of incidence of adverse health-related outcomes. Methods/design This trial will be a randomised, investigator-blind, controlled trial conducted in an internal medicine and geriatric ward in Poland. We aim to include 416 patients who are 70 years of age and have been hospitalised for medical reasons. Eligible patients will be randomised 1:1 to receive structured, non-pharmacological care delivered by students of medicine, psychology and nursing, together with standard medical treatment or standard medical care alone. The protocol of interventions has been designed to cover nine main risk factors for delirium, with the scope of multidisciplinary interventions being individualised and tailored. The protocol will be aimed at immobilisation, vision and hearing impairment, cognitive impairment and disorientation, stress and anxiety, sleep–wake cycle disturbances, dehydration and malnutrition, and pain. A structured evaluation of patients’ cognition, mood, anxiety and functional performance is planned to be carried out twice, on the day of group allocation and at discharge; structured screening assessment for delirium will be conducted daily using the Confusion Assessment Method. The primary outcome will be the incidence of delirium in hospital; secondary outcomes will be in-hospital changes in cognition, mood and anxiety, and functional status, occurrence of falls and death. Discussion Delirium prevention programmes are being introduced worldwide. A particular novelty of our project, however, is that invitations for voluntary work with older patients at risk for delirium will be addressed to medical students. With the use of the service learning method, the students will shape their attitudes, increase their knowledge and understanding of hospital care, and master competencies to work within interdisciplinary teams, which establishes the originality and practicality of the project. Trial registration Polish Science Database, 317484. Registered on 23 October 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2781-6) contains supplementary material, which is available to authorized users.

Background Numerous medications should be avoided, or require dose adjustment in subjects with impaired kidney function. We aimed to assess the prevalence of potentially inappropriate use of renal risk drugs in a nation-wide, community-dwelling Polish older adult population. Methods We analysed regular intake of 38 medications that should be avoided, requiring dose modification, increase the risk of pre-renal kidney injury, or may cause potassium retention in subjects with moderately to severely impaired renal function in the PolSenior data base (N = 4514, mean age 76 ± 11 yrs). Kidney function was assessed with short Modification of Diet in Renal Disease formula estimated glomerular filtration rate (sMDRD) and Cockcroft-Gault creatinine clearance (CC). Results There were 855 (19%) individuals with sMDRD

Depression is a frequently observed comorbid condition in patients with cardiovascular diseases. In contrast to coronary heart disease and heart failure there is a limited amount of published data concerning the increased prevalence of depression among patients with atrial fibrillation (AF). Therefore, we decided to assess the prevalence of depression in Polish community-dwelling older patients with a history of AF.The data were collected as part of the nationwide PolSenior project (2007-2012). Out of 4979 individuals (age range 65-104 years), data on self-reported history of AF were available for 4677 (93.9%). Finally, 4049 participants without suspected moderate or severe dementia in Mini Mental State Examination test were assessed with the 15-item Geriatric Depression Scale (GDS), and a score of 6 points and more was regarded as suspected depression.Mean age (±SD) of the study population was 78.1 (±8.3) years; 52% were males. The history of AF was reported by 788 (19.5%) subjects. In the univariate analysis a self-reported AF history was associated with 42% increase of suspected depression (41% vs 29%; P 0.001). In multivariate logistic regression AF remained an independent predictor of depression (OR = 1.69; 95%CI: 1.43-2.00), stronger than heart failure, diabetes or coronary heart disease.In community-dwelling geriatric Polish population AF is associated with higher prevalence of depression. This association is independent from the demographic factors, disabilities and comorbidities (including history of stroke).

Background: Organizational and educational activities in primary care in Poland have been introduced to improve the chronic heart failure (CHF) management. Objectives: To assess the use of diagnostic procedures, pharmacotherapy and referrals of CHF in primary care in Poland. Methods: The cross-sectional survey was conducted in 2013, involving 390 primary care centres randomly selected from a national database. Trained nurses contacted primary care physicians who retrospectively filled out the study questionnaires on the previous year’s CHF management in the last five patients who had recently visited their office. The data on diagnostic and treatment procedures were collected. Results: The mean age ± SD of the 2006 patients was 72 ± 11 years, 45% were female, and 56% had left ventricular ejection fraction Ρ P Conclusion: The use of echocardiography in CHF diagnostics has significantly improved in primary care in Poland but a noticeable inequality in the geriatric patients and women remains. Most CHF patients received drug classes in accordance with guidelines.

Thomas G. Pickering spent most of his scientific career in carrying out research on clinical hypertension and blood pressure (BP) measurement. In our review of Pickering's seminal work, we first focused on white-coat hypertension and masked hypertension, two terms that he had introduced. Next, we highlighted the early publications of Pickering on diurnal BP variability and on the clinical application of self-measured BP. Pickering's work inspired many investigators worldwide and constituted a solid basis for further research. Pickering's original ideas led to algorithms for risk stratification involving white-coat hypertension and masked hypertension, diurnal BP variability, and self-measured BP. Recent studies validated Pickering's observations in terms of cardiovascular outcome and bridged the path from concept to application in clinical practice. ispartof: Blood Pressure Monitoring vol:15 issue:2 pages:72-81 ispartof: location:England status: published

OBJECTIVE: No population study investigated whether 24-h ambulatory blood pressure (ABP) predicts distensibility of the elastic common carotid (DCar) and the muscular femoral (DFem) arteries over and beyond conventionally measured blood pressure (CBP). METHODS: At baseline, we measured CBP and 24-h ABP in 1063 randomly recruited participants (mean age, 44.3 years). CBP was the average of five consecutive readings obtained by trained observers at the participants' homes. We measured arterial distensibility by a wall-tracking ultrasound system, 21 months after CBP and ABP (5-95th percentile interval range, 13-33 months). RESULTS: Compared with men, women (49.2%) had higher (P

The relationship between systemic arterial stiffness and parameters of cerebral circulation is poorly understood. We aimed to assess the relation between pulsatility (PI) and resistance (RI) indexes of the middle cerebral artery (MCA) and aortic pulse wave velocity (PWV) and brachial pulse pressure (PP).Bilateral transcranial Doppler ultrasound (TCD) examination of the MCAs was performed using the GE Vivid 3 Ultrasound, equipped with a 2.5-MHz probe and PI and RI were calculated. Aortic PWV was obtained with the Complior device (Colson France). Conventional blood pressures were measured at the time of TCD. Data regarding risk-profile constituents, habits and medication use were recorded. Subjects with occlusion or significant stenosis of carotid arteries or MCA, previous or acute stroke, temporary ischaemic attack, bilaterally absent transtemporal sonographic windows, dysrhythmia, haematocrit value30% or48% were excluded.Of the 165 included subjects (mean age, 56.70+/-11.80 years, range 22-86 years), 50.3% were men, 20.9% smokers, 20.7% diabetic and 63.4% hypertensive. PWV correlated to both PI (r=0.45, p0.001) and RI (r=0.36, p0.001) of MCA. A similar relation was found for PP and PI (r=0.32, p0.001) or RI (r=0.30, p0.001). Age, diabetes and hypertension, but not chronic tobacco smoking, interfered with MCA flow parameters. In multivariate adjusted regression analysis, PP was related to both PI and RI of MCA (p0.001). In similar models, increased PWV was related to PI (p=0.007), but not RI (p=0.08) of MCA.Increased PI and RI of MCA are closely related to measures of increased aortic stiffness.

Rheological properties of erythrocytes from patients with high risk of cardiovascular disease (CVD) were analyzed in relation to individual patient risk factors as well as to the medication. Additionally, comparative statistical analysis was performed considering plasma concentration of the selected mediators of vascular endothelium: 6-keto-prostaglandin F(1alpha) (PGF(1alpha)), sVCAM-1 and E-selectin adhesion molecules and interleukin-6 (IL-6). It was found that antihypertensive therapy with angiotensin-converting enzyme inhibitor (ACEI) is accompanied by improvement of RBC rheology: the increase of deformability and the decrease of aggregability. This improvement is probably mediated by endothelial prostacyclin and nitric oxide which are generated by ACEI. A correlation was observed between RBC deformability/aggregability and the patient's hematocrit level, what implicates that the hematocrit level should be explicitly taken into consideration when investigating rheological properties of erythrocytes. A strong relationship was also found between the plasma concentration of sVCAM-1 and patient's age.

OBJECTIVE The aim of the study was to examine prevalence, awareness, and control of hypertension in elderly and very elderly in Poland. METHODS The random sample of 4950 study participants aged 65 or more (age range 65-104 years), equally distributed in six age subgroups, and participated in cross-sectional, nationally representative survey PolSenior. During two separate visits, standardized interviews on awareness of hypertension as well as anthropometric measurements, blood pressure (BP) and heart rate readings were obtained. Hypertension was defined according to 2013 European Society of Hypertension/European Society of Cardiology Guidelines. RESULTS Mean SBP was highest in men aged 75-79 years (148.3 mmHg) and in women aged 80-84 years (149.9 mmHg), and then steadily decreased, whereas DBP decreased steadily from age 65. Hypertension affected about 80% of septuagenarians. Its prevalence decreased with age to 67% in women and 60% in men aged 90 years or older. In nonagenarians, awareness of hypertension (72% in women and 61% in men) and percentage of treated study participants (64% of women and 54% of men) was the lowest. In contrast, among treated study participants proportion of well controlled (BP

The aim of the study was to evaluate of the association between renal function and the intima-media thickness of common carotid artery (CCA-IMT) in treated hypertensive patients. Eighty-seven hypertensives (51.7% diabetic), aged45 years, were examined. Renal function was evaluated by plasma concentration of creatinine, cystatin C (in 64 patients) and creatinine clearance, calculated according to the Cockcroft-Gault formula. HbA1c measurement and blood pressure monitoring were performed. CCA-IMT was measured at near and far wall of the CCA and of the bulb on both sides and averaged. In 63 hypertensives (72.4%) IMT was over 0.9 mm. These subjects were older (71.17+/-9.72 vs 57.75+/-7.76 years; p0.0001), had higher pulse pressure (57.45+/-11.73 vs 49.35+/-8.35, p = 0.004), cystatin C concentration (1.25+/-0.34 vs 0.99+/-0.17 mg/l; p = 0.002), higher HbA1c (7.24+/-1.59 vs 6.25+/-1.28, p = 0.01), and lower creatinine clearance (71.28+/-28.32 vs 93.86+/-25.04; p0.0001) in comparison to patients with IMT0.9 mm. Groups did not differ with respect to creatinine concentration. The logistic regression analysis showed that CCA-IMT was independently influenced only by age, and the effect of age was stronger in older patients. After exclusion of age, 0.1 mg/l higher concentrations of cystatin C or 10 ml/min lower estimated creatinine clearance were significantly associated with 56% and 34%, respectively, higher probability of CCA-IMT of more than 0.9 mm. Cystatin C concentration seems to be a useful indicator of renal function impairment associated with carotid intima-media thickening. Similar information is obtained when estimated creatinine clearance is used.

The aim of our study was to assess the relationship between blood pressure and arterial stiffness in Polish centenarians.We examined 59 centenarians with the mean age of 101.3 years. Peripheral blood pressure was estimated upon mean value of three measurements and arterial stiffness by pulse wave analysis (PWA). Pressure waveforms were recorded from the radial artery and the waveform data were then processed by SphygmoCor to produce the estimated aortic pressure waveform. All subjects were divided into the three subgroups: normotensives (140/ 90 mmHg), systolic hypertensives (ISH, SBPor = 140 and DBP90 mmHg) and systolo-diastolic hypertensives (or = 140/90 or treated).The mean values of peripheral BP for the entire group were: 149.5/76.8 mmHg for SBPP/DBPP and 136.1/ 77.8 mmHg for central SBPC/DBPC, respectively. The mean value of pulse pressures were: 72.7/58.4 mmHg for peripheral (PPP)/central (PPc). Arterial stiffness indices calculated from PWA were: 96.6%, 33.2% and 32.2% for peripheral (AIxP), central (AIxC) and central normalized for heart rate (AIxC75) augmentation indexes, respectively. The PPc was the lowest in the normotensive group (40.1 mmHg) when compared both with the ISH group (71.1 mmHg) and the systolo-diastolic group (58.1 mmHg). The lowest arterial stiffness indices (AIxp, AIxC75) calculated from PWA were found in the normotensive group: 85.4% and 28.5%, comparing with 96.1% and 33.7% in the ISH group and 104.8% and 32.9% for the systolo-diastolic group.In centenarians, similarly to younger subjects, those with hypertension present with arterial stiffness.

In spite of considerable progress, the control of hypertension in most countries is still insufficient. One of the reasons may be the poor awareness of the blood pressure (BP) cutoff values that define hypertension. The aim of this report is to verify the hypothesis that patients with hypertension accept higher BP levels as normal. The study was performed during a street-based BP screening project carried out across Poland, in summer 1997. In 444 persons who voluntarily participated in Cracow's part of the project, BP was taken on the left arm, in the sitting position, after a minimum of 5 min of rest, using a semiautomated device (Digital Blood Pressure UA-702). A questionnaire investigated participants' age, weight, height, level of education, history of hypertension and perception of normal values of BP. We compared measured BP values with those perceived as normal, and with the values recommended by WHO/ISH guidelines (

Objectives. To evaluate blood monocyte subsets and functional monocyte properties in patients with rheumatoid arthritis (RA) of short duration in the context of cardiovascular (CV) risk and disease activity.Methods. We studied conventional markers of CV risk, intima media thickness (IMT), and blood monocyte subsets in 27 patients aged 41 ± 10 years with RA of short duration (median 12 months) and 22 healthy controls. The RA subjects were divided into low (DAS28: 2.6–5.1) and high (DAS28 > 5.1) disease activity.Results. RA patients exhibited increased levels of intermediate (CD14++CD16+) monocytes with decreased CD45RA expression compared to controls, increased counts of classical (CD14++CD16−) monocytes, and decreased percentages of nonclassical (CD14+CD16++) monocytes. Patients with high disease activity had lower HLA DR expression on classical monocytes compared to low disease activity patients. There were no differences in monocyte subsets between subjects with DAS > 5.1 and DAS ≤ 5.1. There were no significant intergroup differences in IMT and the majority of classical CV risk factors.Conclusions. Patients with RA of short duration show alteration in peripheral blood monocyte subsets despite the fact that there is no evidence of subclinical atherosclerosis. Disease activity assessed with DAS28 was associated with impaired functional properties but not with a shift in monocyte subpopulations.

The presence of major cardiovascular risk factors was investigated in a group of centenarians.The following risk factors: sex, smoking, overweight, diabetes, hypertension and hypercholesterolemia were analysed in 93 centenarians and compared with data obtained from 90 individuals age 40-60 years.Smoking, overweight and hypercholesterolemia were found statistically more often in a younger population, whereas hypertension was diagnosed more frequently in centenarians. No or one risk factor were found in 55.4% of centenarians and in 14.2% of younger subjects.Centenarians are characterized by a much better cardiovascular risk profile than middle-aged individuals. This indicates that longevity is related to low cardiovascular risk.

Objectives Posttraumatic stress disorder (PTSD) develops after exposure to particularly traumatic events. Its severity depends on the nature and intensity of the stressor and the susceptibility of the exposed person. The aim of our study was to assess the relationship between PTSD resulting from deportation to Siberia in the patients' childhood and cognitive, emotional, and physical decline in advanced age. Methods Eighty patients with PTSD with a history of deportation to Siberia and 70 subjects without PTSD were diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; severity of the symptoms included in the criteria was also assessed. In all patients, a standardized interview (including demographic data and comprehensive geriatric assessment tools such as the Mini–Mental State Examination, Geriatric Depression Scale, activities of daily living, and instrumental activities of daily living) was performed. Results In analyses with the comparison group, patients with PTSD had a higher frequency of cognitive deficits (7.1% versus 22.5%), depression (31.4% versus 88.8%) and physical disability in activities of daily living (0% versus 21.3%), and instrumental activities of daily living (40.0% versus 88.8%). Moreover, increasing severity of PTSD was associated with significant deterioration in cognitive function, severity of depression, and the deterioration of basic and complex activities of daily living. Conclusions Higher frequency of cognitive function deficits, depression, and physical disability was found in the group of former deportees compared with the group of individuals without history of such a traumatic experience.

Aim To assess daily functioning and geriatric conditions of older subjects suffering from heart failure (HF) as compared to the general population. Methods and results The data were collected as part of the nationwide PolSenior project (2007–2011). Of 4979 individuals (age range 65–104years), data on self-reported HF hospitalization were available for 4795 subjects (96%). Geriatric assessment (GA) included functional status (ADL, Activities of Daily Living and IADL, Instrumental ADL scales), cognitive function, mood disorders, sensory organ impairment, falls and comorbidity. Mean age±SD of the study population was 73.8±6.5years; 62% were female. The proportion of subjects with HF hospitalizations increased from 8% in subjects aged 65–69years up to 13% in the age group of 85–89years, and decreased in nonagenarians (11%). Subjects with the HF hospitalization were older, used more drugs, and were characterized by a higher prevalence of comorbid conditions, mood disorders, hearing impairment and functional limitations. In logistic regression, HF hospitalization increased the age–sex adjusted risk of disability by 40%, both in ADL and IADL. After adjustment to other clinical and geriatric conditions, HF hospitalization remained an independent predictor of disability in both ADL (OR=1.36, 95%CI: 1.00–1.84) and IADL (OR=1.40, 95%CI: 1.01–1.93). Conclusions Older people who reported HF admissions had a higher number of comorbidities and geriatric conditions: mood disorders, hearing impairment and functional limitations. Besides, in our study, HF hospitalization independently and significantly increased the risk of limitations in IADL and ADL. Therefore, further studies are needed to evaluate the benefits of GA in patients with HF.

The growing incidence of dementia in ageing societies is a major concern of health care organizations. Because of its detrimental influence on the mental and functional statuses of elderly people, it leads to increased economic burdens caused by the social and financial needs of patients with dementia and their caregivers. There has been no data concerning the prevalence of dementia in the elderly in the general Polish community so far. The main aim of the study was to assess the prevalence of cognitive impairment suspected of dementia among the Polish elderly and the relationships between cognitive performance and age, gender, place of residence and educational status. The presented data was the result of nationwide, multicentre PolSenior Study conducted from 2007 to 2011 in the Polish elderly population. Cognitive functions were evaluated using Mini-Mental State Examination (MMSE) performed by pre-trained nurses. The result of MMSE lower than 24 points was classified as cognitive impairment suspected of dementia and divided according to its severity into three stages: mild, moderate and severe dementia. The results were analysed in two ways: raw MMSE and MMSE scores after Mungas adjustment (MMSEadj), that is, corrected for age and educational level, and these were compared. To verify the suspicion of dementia an assessment was complemented by an interview of carers for the occurrence and course of memory disorders, treatment of dementia and by functional status assessment. In order to assess the prevalence of suspicion of dementia in the general Polish population, statistical analyses based on weighting were done. The suspicion of dementia on the basis of raw MMSE was made in 20.4% of respondents aged 65 years and more, and after Mungas adjustment in 12.1% of older subjects. The prevalence of cognitive impairment grew with increasing age, as well as depending on the educational status of elderly respondents in both types of analyses; raw MMSE and MMSEadj. There was no significant difference in the prevalence of cognitive impairment according to gender in the general population (raw MMSE); however in analyses including MMSEadj results, the suspicion of dementia was made more often among men. Suspicion of dementia based on raw MMSE and MMSEadj results was made significantly more often among men than women at the age of 65–69 years, and significantly more often among the oldest women, aged 90 years and more. Suspicion of dementia was diagnosed more often in respondents living in rural communities (based on raw MMSE, but not on MMSEadj), which might be related to the differences in their educational status.

Objectives To assess the relationships of red blood cell distribution width (RDW), mean corpuscular hemoglobin concentration (MCHC) and erythrocyte deformability with pathological changes of selected target organs, and with inflammation markers interleukin-6 (IL-6) and fibrinogen, in a group of newly diagnosed, never-treated and otherwise healthy hypertensive patients. Methods The study group consisted of 101 adults divided into three sub-groups: 37 diagnosed arterial hypertension, 29 with hypercholesterolemia, and 35 healthy. The individuals with hypertension or hypercholesterolemia were otherwise healthy and were not on any therapy prior to entering the study. For each individual, data were obtained on: systolic and diastolic blood pressure (SBP, DBP), pulse wave velocity (PWV), carotid intima media thickness (IMT), left ventricle geometry, blood morphology, lipids profile, fibrinogen, CRP, IL-6 and red blood cell deformability index (DI). Results In the group of hypertensives, the multivariate regression analysis showed significant relationship of RDW with PWV, IL6 and fibrinogen. Also, RDW was found to be correlated with MCHC and DI, and MCHC was significantly related to IMT and IL-6. Conclusions A hypothesis has been formulated that the development of target organ damage in hypertension is accompanied by the increasing impairment of erythropoiesis. This process may be mediated by inflammation.

Background: Heart failure (HF) is a chronic disease of great clinical and economic significance for both the healthcare system and patients themselves. Aim: To determine the consumption of medical resources for treatment and care of HF patients and to estimate the related costs. Methods: The study involved 400 primary care practices and 396 specialist outpatient clinics, as well as 259 hospitals at all reference levels. The sample was representative and supplemented with patient interview data. Based on the consumption of particular resources and the unit costs of services in 2011, costs of care for HF patients in Poland were estimated. Separate analyses were conducted depending on the stage of the disease (according to NYHA classification I–IV). The public payer’s perspective and a one year time horizon were adopted. Results: Direct annual costs of an HF patient’s treatment in Poland may range between PLN 3,373.23 and 7,739.49 (2011), the main cost item being hospitalisation. The total costs for the healthcare system could be as high as PLN 1,703 million, which is 3.16% of the National Health Fund’s budget (Ex. rate from 05.03.2012: 1 EUR = 4.14 PLN). Conclusions: The costs of treating heart failure in Poland are high; proper allocation of resources to diagnostic procedures and treatment may contribute to rationalisation of the relevant expenditure.

Heart failure (HF) is a common complication of cardiovascular diseases, and patients with HF remain largely under the care of primary care physicians (GPs). Therefore, the goal of the study presented was to assess the GPs' knowledge of chronic HF guidelines in regards to their professional experience.In 2008, during a nationwide educational project on HF management, 15 courses for GPs were conducted. Before the training, physicians filled out a standardized questionnaire about the diagnosis and treatment of HF. The answers were assessed in a three age-group of respondents: 24-39 years (n = 142), 40-55 years (n = 316), 56 years and above (n = 156). Of 614 physicians, 97% indicated echocardiography as obligatory diagnostic procedure in HF diagnosis. The oldest GPs more frequently pointed to the role of chest X-ray (63%, p0.001) and electrocardiography (32%, p0.001) in exclusion of systolic HF. There was a significant reverse relationship between physicians' age and their declarations in prescription of angiotensin II receptor blockers (p = 0.007; contingency coefficient, Cc= 0.13) and b-blockers (p = 0.01; Cc = 0.12) in patients with advanced HF (NYHA III-IV), and positive relation between application of spironolactone (p = 0.007; Cc = 0.13) and digitalis (p0.001; Cc = 0.16) in patients of NYHA class I-II. The new generation b-blockers (bisoprolol, carvedilol, nebivolol) were more frequently prescribed by the youngest physicians (respectively: 98%, 96%, 58%) compared to the oldest group (respectively: 88%, 87%, 50%; p0.05).The study revealed age of GPs to be inversely related to their knowledge of HF guidelines and potential therapeutic decisions in management of HF patients and support of the need of continuing medical education.

Falls are a geriatric syndrome which affects the physical and psychological well-being of the aged. So far, in Poland there have not been any population-based data on the prevalence of falls among the elderly. The aim of this analysis was to assess the prevalence of falls, their circumstances and consequences in the Polish population aged 65 years and older in comparison to younger respondents aged 55-59 years, and the relation of falls to visual and hearing deficits. Mean age of the 4920 elderly subjects (51.6% men) was 79.4±8.7 years. Falls in the past year were reported by 10.4% of the younger and 19.1% of the older subjects. In both groups falls occurred more frequently in women (11.9% vs. 8.7%, p=0.03 in the younger and 22.7% vs. 13.2%, p

Heart failure (HF) is strongly associated with aging. It affects 10-12% 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.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 -- 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.The mean age of the 1,289 studied patients was 69.8 ± 11.4 years (age range: 26-96 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. 60-79 years, and 75.2% of patients aged below 60 years (p0.0001). 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 (p0.0001). 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.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.

Post-traumatic stress disorder (PTSD) develops after exposure to particularly traumatic events. Its severity depends on the nature and intensity of the stressor and susceptibility of the exposed person. The present study was carried out to find out whether PTSD and its severity, resulting from deportation to Siberia in the patients' childhood (from 1940 to 1946), have any association on the somatic health status and cardiovascular risk of these persons in advanced age.Eighty patients with PTSD and 70 subjects without PTSD followed up in primary care setting were enrolled in the study. Post-traumatic stress disorder was diagnosed according to the DSM-IV criteria; severity of the symptoms included in the criteria was also assessed. All patients were subject to a standardized interview including demographic data and current and past diseases, supplemented with physical examination, biochemical tests, and aortic pulse wave velocity (PWV). The group of patients with PTSD resulting from deportation to Siberia in their childhood had higher prevalence of coronary artery disease (71.3 vs. 44.3%, P0.001), diabetes (26.3 vs. 11.4%, P0.05), and hearing impairment (23.8 vs. 2.9%, P0.001) than controls. They also had higher incidence of blood pressure140/90 (86.0 vs. 65.7%, P = 0.003), fasting blood glucose5.6 mmol/L (65.0 vs. 45.7%, P = 0.018), HDL level1.0 mmol/L (31.3 vs. 8.6%, P = 0.0006), and triglyceride level2.3 mmol/L (62.5 vs. 321.4%, P = 0.001). Patients with PTSD had higher PWV (13.7 vs. 12.9 m/s, P= 0.042). The magnitude of PWV increased with the severity of PTSD (P = 0.001). Stepwise logistic regression has shown that PTSD was a strong factor promoting the appearance of coronary heart disease in the former deportees group (OR 3.80; 95% CI: 1.62-8.94; P = 0.002).Several-year long deportation in childhood and PTSD elevated overall cardiovascular risk in the group of former deportees compared with the group of persons without history of such a traumatic experience.

Demographic, social and economic trends will serve to increase the importance of women as healthcare consumers. Design. The aim of the study was to assess cardiovascular (CV) risk in the normotensive female patients during single visit to primary care (PC) offices.Demographic data, history of coronary heart disease (CHD), diabetes (DM), smoking habit and family history of CV diseases were obtained from women who visited general practitioners. Moreover, blood pressure (BP), pulse rate, weight and height used to calculation body mass index (BMI) and waist circumference (WC) were performed. Prehypertension was defined as a systolic BP (SBP) of 120-139 mmHg, and/or a diastolic BP (DBP) of 80-89mmHg.Prehypertension was observed in 21.5% of the whole group of female PC patients. SBP, DBP, BMI and WC revealed significant trends towards increase with age among both prehypertensives (p0.001) and normotensives (SBP, BMI, WC: p0.001; DBP: p0.05) and in the whole group (p0.001). Nevertheless, heart rate (HR) significantly increased with age only among prehypertensive women (p0.05). The CV risk of the studied adult women increased progressively with presence of overweight, obesity and visceral obesity. The CV risk of the youngest groups was associated mainly with high prevalence of smoking, and with high prevalence of CHD and DM among the oldest female patients.The prevalence of majority of CV risk factors increase with age among both prehypertensive and normotensive women, which should stimulate PC practitioners to identify and modify them.

OBJECTIVE: Studies directly comparing the associations of intima-media thickness with blood pressure (BP) on manual sphygmomanometric blood pressure measurement (SBPM) and 24-h ambulatory blood pressure measurement (ABPM) are scarce and have a cross-sectional design. METHODS: At baseline, we measured systolic and diastolic blood pressures, pulse pressure, and mean arterial pressure in 532 randomly recruited patients (women, 48.3%; mean age, 38.9 years) by SBPM and ABPM. SBPM was the average of five consecutive readings obtained by trained observers at the patients' homes. We measured carotid intima-media thickness (CIMT) and femoral intima-media thickness (FIMT) by a wall-tracking ultrasound system, 26 months (median) after BP measurement (interquartile range, 21-29 months). We adjusted all analyses for observer, sex, age, BMI, smoking, and total/high-density lipoprotein-cholesterol ratio. RESULTS: The multivariable-adjusted associations of CIMT and FIMT with all BP components on SBPM were not significant (P >or= 0.12). In multivariable-adjusted models, CIMT increased with 24-h systolic blood pressure (effect size per SD increase, +0.131 mm; P = 0.003) and 24-h pulse pressure (+0.139 mm; P = 0.001), whereas FIMT increased with 24-h diastolic blood pressure (+0.091 mm; P = 0.03) and 24-h mean arterial pressure (+0.090 mm; P = 0.04). Models including the ambulatory blood pressure components additionally adjusted for SBPM and more covariables than those listed above were confirmatory. CONCLUSION: In a general population, BP on ABPM predicts CIMT and FIMT over and beyond highly standardized SBPM. At the elastic carotid artery, CIMT increased predominantly with the pulsatile component of BP, whereas at the muscular femoral artery, FIMT increased with the steady component of BP. ispartof: Journal of Hypertension vol:27 issue:4 pages:813-821 ispartof: location:Netherlands status: published

The aim of this study was to evaluate vascular and echocardiographic markers of hypertension (HT) in subjects with newly diagnosed HT before treatment started. We studied 32 patients with newly diagnosed HT without pharmacological therapy (HT group) and 31 healthy ones (control group). ABPM were performed to exclude or confirm HT. Cardiovascular risk factors and pulse wave velocity (PWV) were assessed. Measurements of left ventricle, size of left atrium and parameters of diastolic function of left ventricle were measured using echocardiography. The student’s T-test, U Mann-Whitney and Chi2 tests were used to compare differences between groups. There were no significant differences in cardiovascular risk factors (sex, age, total cholesterol level, HbA1c) between groups with exception of BMI (p

Background Endothelial dysfunction is considered as a link between chronic, systemic inflammatory process in rheumatoid arthritis (RA) and initiation of atherosclerosis process. Microvascular dysfunction may precede the beginning of atherosclerosis and predispose RA patients to development of cardiovascular disease (CVD) (1). In patients with longstanding RA, microvascular function is impaired and associated with activity of disease (DAS28). Recently, it has been demonstrated that microvascular endothelium-dependent vasodilatation and capillary recruitment is preserved in early disease-modifying antirheumatic drugs (DMARD)-naive patients (2). However, there is no information about skin hyperaemic heat response which is an integrated index of neurovascular and nitric oxide-dependent cutaneous blood flow regulation (3). Objectives Present study was performed to investigate disorders in macro- and microcirculation in newly diagnosed, (DMARD)-naive patients with RA and healthy controls. Methods Twenty nine patients (22 women, 7 men) at the age of 40,96±9,45 years, with active early RA (DAS28: 4,41±1,79, with history of symptoms - mean 16,3 months) and twenty nine healthy controls (13 women, 16 men) at the age of 31,65±7,64 years were recruited. Blood pressure (BP), body mass index (BMI) and waist to hip ratio (WHR) were measured and blood samples were collected to estimate inflammation (ESR, CRP, hsTNFalfa and hsIL6), CV risk factors (lipids, glucose), biochemical marker of endothelial dysfunction (von Willenbrand factor - vWF) and RF, aCCP in RA group. Presence of atherosclerosis in macrovascular bed was assessed by measurements of intima-media thickness (IMT) using B-mode ultrasonography. Skin microcirculation reaction during local heat stress was assessed noninvasively using laser Doppler flowmetry (LDF, Periflux 5000). Results There were no significant differences between groups in values of BP, BMI, WHR and levels of lipids and glucose. As expected patients with RA had significantly higher CRP, ESR, hsTNFalfa and hsIL6 levels. VWF (%) was also higher in RA patients (109,75±48,6 vs 73,7±22,39, p=0,005). The study groups were similar in IMT, however differed in LDF parameters of flow during local heat stress. Time to maximal heat flow (sec) was increased [17,01±4,35 vs 11,14±5,36 (p=0,04)] and maximal heat flow velocity (U/min) was lower [10,43±5,49 vs 24,67±24,1 (p=0,03)] in patients with RA. All results were age and sex standardized. Conclusions Microvascular dysfunction preceding the onset of atherosclerosis in early active rheumatoid arthritis is represented by alteration in microcirculation response to thermal stress. References A. Sandoo, C. Douglas, GS. Metsios et al. The association between microvascular and macrovascular endothelial function in patients with rheumatoid arthritis: a cross–sectional study. Arthritis Res Ther 2011; 13:R99. van Eijk IC, Serne EH, Dijkmans BA, Smulders Y, Nurmohamed M. Microvascular function is preserved in newly diagnosed rheumatoid arthritis and low systemic inflammatory activity. Clin Rheumatol 2011;30(8):1113-8. Charkoudian N. Skin blood flow in adult human thermoregulation: How it works, when it does not, and why. Mayo Clin Proc 2003;78:603-612. Disclosure of Interest None Declared