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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.

Despite a decline since 1991, cardiovascular diseases (CVD) are the major burden on public health in Poland.To assess the impact of the national Programme of Cardiovascular Disease Prevention (PCVDP) on the quality of primary CVD prevention in clinical practice.Sixty six primary care centres were invited to join the project (2-6 in each province). Half of these centres participated in the PCVDP (in other words, they were 'active' clinics) and the other half was included in the control group. A random sample of 300 patients aged 35-55, free of coronary heart disease, with no history of stroke or peripheral artery disease, and with medical documentation going back at least to 1 January 2005 was selected for the study in each centre. From the total of 3,940 patients in active clinics, 3,162 were judged to be eligible for the study and their medical records were reviewed. All were invited for examination. This was finally attended by 2,314 patients from active clinics and 2,101 from the control group.Before the introduction of the PCVDP, the percentage of patients with available information on risk factors in medical records was similar in the active and in the control clinics, and varied from more than 40% (hypertension) to less than 5% (weight and waist circumference). After the introduction of the PCVDP, the proportion of subjects with available information on risk factors greatly increased in the clinics which took part in the PCVDP. Knowledge of CVD risk factors was similar in the two studied groups. When asked, about 10% of patients in both groups could not list a single CVD risk factor. Smoking was the most frequently recognised risk factor (named by more than 60% of patients) and diabetes the least (less than 15%). No significant difference was found between the active and control clinics in the frequency of counselling as to smoking, diet, weight reduction or exercise. Only about 40% of smoking patients had received advice on smoking cessation. Counselling on diet had been received by about 40% of patients. Less than 20% of patients had been advised to reduce weight, with about 25% having received advice to increase their physical activity. Control of risk factors was poor and there was no significant difference between the active and control clinics in terms of the proportion of patients who reached prevention targets.1. The PCVDP appears to be effective in identifying high risk patients. 2. The effectiveness of the routine management of risk factors in primary care is very low. 3. Addressing via the PCVDP all decisions as to the extent and means of intervention on risk factors to primary care physicians appears to be ineffective. 4. There is a need to introduce an effective structured intervention on risk factors and add it to the PCVDP.

Polish heart failure surveys from 1999 and 2005 indicated that non-invasive and invasive diagnostic procedures in heart failure patients are underused, mostly due to limited availability.To assess the access to procedures used for the diagnosis and treatment of heart failure in randomly selected outpatient clinics and hospital wards in Poland.The study was undertaken in 2005, as a part of the National Project of Prevention and Treatment of Cardiovascular Diseases - POLKARD. The data on non-interventional and interventional procedures were collected from 400 primary care units, 396 secondary outpatient clinics and 259 hospitals, and included cardiology or internal medicine departments. Additionally, the last five patients with diagnosed heart failures were identified, who visited outpatient clinics or were discharged from the hospitals, and their medical records of diagnostic procedures were analysed.Echocardiography was not available in approximately 10% of hospital wards and 13-37% of outpatient clinics, both primary and secondary. Generally, the waiting time for echocardiography in Poland varied from region to region. A one-month waiting time was declared by more than 50% of secondary outpatient clinics and only 11-18% of primary care units, regardless of the community size. On the first day of hospital admission, echocardiography was performed in approximately 10% of patients of internal medicine wards and up to 36% of patients in cardiology departments. The assessment of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) was generally performed only in a few hospitals, usually in cardiology departments. In primary care units, it was practically not available. Percutaneous coronary interventions, pacemaker or cardioverter-defibrillator implantations were available in approximately 20% of city hospitals, 30-40% of province hospitals, and 60-70% of clinical wards of medical universities.These data show limited availability of echocardiography in primary care units. It is necessary to continue actions for better accessibility and frequency of performing interventional procedures in patients with heart failure in Poland.

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

Assessment of the influence of the guidelines on asthma for family physicians in reference to their knowledge in the field of patient's treatment.The assessed group consisted of 111 physicians before training in family medicine and guideline implemention of asthma for family physicians and four years later.The knowledge of the physicians accessment in the first part of the examination in the field of patient's treatment was low (compatibility with the guidelines was 42% in the part "General principles of treatment" and 65% in "Pharmacotherapy"). In the second part of the study, there was a statistically significant improvement (p0.05) of the level of knowledge in both fields (compatibility with the guidelines was 55% in "General principles of treatment" and 73% in "Pharmacotherapy"). The average improvement for the whole Questionnaire was 12.3% (13.3% for "General principles of treatment" and 8.4% for "Pharmacotherapy").Guideline Implementing for family physicians in the management of bronchial asthma had a significant influence on the improvement of knowledge about patients treatment. Provided that assessment of knowledge concerning treatment of patients with asthma in our study was declared better than real management, there is a need for modification of continuous medical education in order to change the behaviour of physicians.

The aim of this study was to assess actual management of heart failure (HF) in Poland, both in outpatient clinics and hospitals.The survey was undertaken between April 21 2005 and December 31 2005 in 796 outpatient departments and 258 internal medicine and cardiology hospital wards chosen at random. In total 3980 HF outpatients and 1294 inpatients were included. Trained nurses performed the questionnaire-based assessment of diagnostic procedures and pharmacotherapy. Heart failure was diagnosed among general practitioners' (GPs) outpatients most frequently, basing on symptoms (64.0%), ECG (47.0%) and chest X-ray (29.9%), while specialists based their diagnosis on symptoms (52.2%) and echocardiography (37.7%). Most HF outpatients and hospital patients were treated with ACE-I (88.3% and 81%, respectively), beta-blockers (68.3% vs. 84.7%) and diuretics (74.4% vs. 90.3%). Spironolactone accounted for 48.3% vs. 56.3% of the patients, while digitalis glycosides 39.2% and 27.4%, respectively. AT-1 blockers were used very rarely (3.5% vs. 2.5%).GPs in Poland tend to diagnose HF on clinical grounds while specialists use more diagnostic investigations. Specialists provide higher quality HF care than GPs, both in outpatient clinics and hospitals. Significant progress in HF management has occurred in Poland since previous studies. (Cardiol J 2007; 14: 552-560).

Aim of the study was to assess cardiovascular risk in the elderly patients during single visit to primary care (PC) offices.The study was performed in 256 units of PC in 2004 and 2005 year. Demographic data, history of diabetes and smoking habit were obtained from patients older than 60 years old, who visited general practitioners. Moreover, blood pressure, pulse, weight and height used to calculate body mass index (BMI), waist circumference and glucose strip tests were performed. Blood pressure levels were classified according to the guidelines, BMIor = 30 kg/m2 was considered as obesity, waistor = 88 cm for women andor = 102 cm for men were criterions of visceral obesity. Passing glucose125 mg/dl (6,9 mmol/l) was noted. Mean values and the performance of studied parameters were compared between three age groups: 61-70, 71-80, and80 years and reference to gender.26 801 patients aged between 61 and 102 years were examined, 59.5% were women, 81.9% were hypertensives, more often men. Isolated systolic hypertension (ISH) was diagnosed in 1/4 of subjects, more often in women. Along with age, the frequency of ISH and severe stages of hypertension increased. 39.8% subjects had visceral obesity, more often women (51.8% vs. 21.9%). Frequency of visceral obesity decreased along with age but constantly was significantly greater among women than men. Diabetes and glucose125 mg/dl was stated in 26.0% and 26.3%, respectively. Frequency of smokers was 19.3%, more frequent in men (30.9% vs. 11.5%), and decreased with age.Increased cardiovascular risk of primary care elderly patients was mainly connected with high frequency of hypertension, especially ISH in the oldest. Among elderly men additional risk resulted from widespread smoking habit, while among women from high frequency of obesity, especially visceral.

The mechanical properties of erythrocyte membrane have been studied using an atomic force microscope. Measurements were carried out on blood samples taken from 7 diabetes mellitus patients and 8 healthy individuals. For each blood sample a distribution of a Young's modulus was constructed. It has been found that both the mean value and the width of the distribution in diabetic patients exceed the corresponding results for healthy persons by a factor greater than 3. The high sensitivity of the atomic force microscopy and the ability to measure the full distribution of the erythrocyte membrane Young's modulus makes it a unique, powerful and promising tool in studies of the membrane stiffness of red blood cells.

The stiffness of erythrocytes in patients (N=45) suffering from certain disorders, such as coronary disease, hypertension, and diabetes mellitus has been assessed using the Atomic Force Microscopy (AFM) and compared with that in a group of healthy individuals (N=13). For each blood sample, around 20 erythrocytes were selected at random and the stiffness of each one was probed in 20-30 arbitrarily chosen points. From these results, distributions of the cell Young's modulus (YM) were determined. Average values and widths of YM distributions significantly increased in samples taken from diabetes mellitus patients and cigarette smokers, as compared to those taken from healthy donors. At the same time, the average values of YM were found to increase as a function of the patient's age. We demonstrated that the atomic force microscope is a very sensitive tool for determination of cell stiffness with every prospect of a routine application as a diagnostic tool in quantitative analysis of the physiological and pathological states of red blood cells.

The knowledge about hypertension--especially its diagnosis and therapy--among graduates of medical schools, is very important in view of hypertensive epidemics. The aim of this study was to assess the medical graduate's knowledge about recommended technique of blood pressure (BP) measurements, the factors affecting BP measurement value, the WHO/ISH--1999 hypertension diagnostic criteria, and its complications and basic therapy rules. The questionnaire investigating the respondent's knowledge was filled out by 132 medical students of the 6th year Medical College of the Jagiellonian University, in Cracow, from February till June 2000. Only 21.2% of students had good knowledge about BP measurement technique, 70% to 90% of subjects knew hypertension diagnostic criteria, about 30% gave the correct values defined as "high-normal". About 37.1% were aware of complications concerning heart, brain, kidney, eye and peripheral blood vessels. Only 11% knew all drugs recommended by WHO/ISH guidelines, as first-line medication; but 95% were only able to mention at least four of them (diuretics, beta-blockers, ACE-I, Ca-blockers). The students have unsatisfactory levels of knowledge about hypertension. This indicates poor preparation of future physicians in treatment of hypertensive problems.

The aim of the study was to evaluate risk factors of atherosclerosis and extra-cerebral target organ damage in patients with hypertension and vascular based mild memory disorders. A group of the study included 20 persons at age of 54-75 (8 males and 12 females) with mild vascular dementia (20-25 pts in MMSE, 22.8 +/- 1.73) with treated mild hypertension. A diagnosis of vascular dementia was confirmed in MRI by two independent experts. All examined patients presented multiinfarction changes in central nervous system as a cause of dementia. The study protocol contained present history, physical examination, 24-hour ambulatory blood pressure monitoring (ABPM), ECG, biochemical tests: total cholesterol, HDL-Ch, LDL-Ch, triglycerides, glucose, urea, creatinine plasma levels and urine test for microalbuminuria. In part of the study group (55%) echocardiography with posterior wall (PW) thickness and ejection fraction (EF) evaluation was performed. In the analysed group mean 24-hour blood pressure values were not elevated (SBP 130.8 +/- 15.8 mm Hg and DBP 77.6 +/- 9.2 mm Hg at day, respectively 121.6 +/- 17.1 mm Hg and 68.2 +/- 11.6 mm Hg at night). No significant (10%) nocturnal SBP decrease was observed, however DBP fall was noticed. Either total cholesterol (n5.2 mmol/l) or LDL-Ch (n3.5 mmol/l) plasma levels were increased in patients with vascular dementia and ranged respectively 5.8 +/- 0.9 and 3.7 +/- 0.9 mmol/l, HDL-Ch and triglycerides levels remained normal (respectively 1.7 +/- 0.5 and 1.5 +/- 1.1 mmol/l). Mean urea and creatinine levels were maintained in normal range (urea 5.8 +/- 1.7 mmol/l, creatinine 75.5 +/- 15.1 mumol/l). In a part of study group (35%) microalbuminuria was presented (urine albumine20 mg/l). In majority of patients with hypertension and vascular dementia a few risk factors co-existed. No systolic blood pressure decrease observed at night in 24-hour blood pressure monitoring, though normal mean values, can play an important role in vascular abnormalities progression.

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

We validated automated oscillometric measurement of the ankle-to-arm ratio of systolic blood pressure (ankle-brachial blood pressure index, ABI) against the manual approach, which requires trained observers and has an intra-observer variability of approximately 10%. A single observer measured ABI in 105 subjects (age range, 20-80 years; women, 51.9%). The manual approach involved the auscultatory measurement of systolic pressure at the brachial artery and Doppler measurements of systolic pressure at the anterior and posterior tibial arteries. The automated oscillometric VP-2000 (Omron Healthcare, Kyoto, Japan) was used to measure systolic pressure at the arm and ankle simultaneously. We applied Bland and Altman's methods to study reproducibility. Ankle-brachial blood pressure index averaged (+/-s.d.) 1.13+/-0.07 units and 1.12+/-0.10 units on automated and manual measurements, respectively. The absolute and percentage differences (P=0.64) between the two ABI measurements were 0.005 units (95% confidence interval, -0.015 to 0.024) and 0.60 (-0.69 to 1.04), respectively. The intra-observer variability of repeat ABI measurements was smaller on automated than on manual measurement (0.17 versus -0.84%; P=0.04). Automated ABI measurement by an oscillometric technique requires little observer training, and significantly increases the reproducibility of ABI estimates compared with the manual approach. ispartof: Hypertension Research vol:32 issue:10 pages:884-888 ispartof: location:England status: published

OBJECTIVE: Using 24-h ambulatory blood pressure monitoring, we studied the repeatability of the morning blood pressure in older (> or =60 years) patients with isolated systolic hypertension. METHODS: The sleep-through morning surge was the morning blood pressure minus the lowest nighttime blood pressure. The preawake morning surge was the morning blood pressure minus the preawake blood pressure. In addition, we determined the cusum plot height of blood pressure from 04:00 to 10:00 h from a plot of cumulative sums. RESULTS: In 173 patients with repeat recordings within 33 days (median), the short-term repeatability coefficients, expressed as percentages of maximal variation, ranged from 35 to 41% for the daytime and nighttime blood pressures and from 50 to 56% for the night-to-day blood pressure ratios. Short-term repeatability ranged from 52 to 75% for the sleep-through and the preawake morning surge, and from 51 to 62% for the cusum plot height. In 219 patients with repeat recordings within 10 months (median), the corresponding long-term estimates ranged from 45 to 64%, from 69 to 71%, from 76 to 83%, and from 50 to 78%, respectively. In categorical analyses of the short-term repeatability of the sleep-through morning surge and the preawake morning surge, using the 75th percentile as arbitrary cut-off, surging status changed in 28.0 and 26.8% of patients (kappa-statistic < or =0.33). In the long-term interval, these proportions were 32.0 and 32.0%, respectively (kappa-statistic < or =0.20). The kappa-statistic threshold for moderate reproducibility is 0.4. CONCLUSION: The morning surge of blood pressure is poorly reproducible, irrespective of whether it is analysed as continuous or categorical variable. ispartof: Journal of Hypertension vol:26 issue:7 pages:1328-1335 ispartof: location:Netherlands status: published

INTRODUCTION About 90% of Polish adults with hypercholesterolemia are not aware of their disease or are not treated. OBJECTIVES The aim of the study was to evaluate hypercholesterolemia control in general practice and to assess the implications of introducing the nationwide Program of Cardiovascular Disease Prevention (PCVDP). PATIENTS AND METHODS Sixty-six primary care clinics were scheduled to participate in the study. In half of them, PCVDP was implemented (active clinics), the remaining 33 constituted the control group. Study participants were selected from a group of persons aged 35-55 years with medical records established before January 1, 2005. Patients with coronary heart disease, stroke, or peripheral atherosclerosis were excluded. In a random sample of patients scheduled for the study, medical records were reviewed followed by an interview, physical examination, and blood lipid tests. RESULTS The availability of data on total cholesterol (TC) levels increased from 19.2% to 40.5% in patients from the active clinics and did not change in the control group. Hypercholesterolemia treatment was reported more often in the active clinics than in the control group (4.4% and 3.3%, respectively, P

IntroductIon Atrial fibrillation (AF) is the most common arrhythmia complicating heart failure (HF). The coexistence of these diseases may be partially explained by the presence of common risk factors. Although the effect of AF on the prognosis in HF is still debatable, it is associated with specific compli‑ cations and affects therapy. objEctIvEs The aim of this analysis was to evaluate epidemiology and management of coexisting HF and AF among Polish outpatients. PAtIEnts And mEthods The present study was performed within the framework of the Polish National Cardiovascular Disease Prevention and Treatment Program, POLKARD 2003–2005, and included patients with HF treated in a representative number of 400 outpatient clinics. Data was collected using question‑ naires and included demographic characteristics as well as information about coexisting diseases and treatment, provided by patients and physicians on the basis of the available medical records. rEsuL ts The study involved 3682 patients with HF (mean age 67.1 ±11.7 years; 58% of patients were men). AF was present in 38% of the patients. The prevalence of arrhythmia increased with the New York Heart Association class. We observed significant differences between the subgroups of patients with AF and those with sinus rhythm in terms of demographic para meters, risk factors, concomitant diseases, and therapy. Although the use of angiotensin‑converting enzyme inhibitors and β‑blockers was significantly lower in the subgroup with AF, a multivariable analysis showed that it was associated with specific demographic characteristics and comorbidities rather than with arrythmia itself. Specialty patient care was associated with increased use of therapy aimed to improve the prognosis of HF patients. concLusIons Patients with AF constitute a particular subgroup within the population of patients with HF. A specific distribution of risk factors with a significant effect of noncardiac diseases may confound HF therapy in this patient group. Specialty care may be able to optimize treatment in patients with coexisting HF and AF.