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Objectives To evaluate factors influencing resistive index (RI) and intima-media thickness of common carotid artery (IMT-CCA) as indices of arterial atherosclerosis in hypertensive patients. Methods 56 treated hypertensive outpatients (mean age 68.9±9.7 years; 31 diabetics) were examined. Fasting blood glucose, cholesterol, and HbA 1c concentration and glomerular filtration rate were measured. Systolic (SBP), diastolic blood pressure (DBP) and pulse pressure were estimated during ambulatory blood pressure monitoring. Ultrasonography of the CCA was performed with determination of IMT-CCA and RI. Results With diabetes IMT-CCA was significantly (1.025±0.17 vs 0.928±0.18mm, p =0.04) and RI not significantly (0.71±0.06 vs 0.68±0.08, p =0.07) higher. A correlation between HbA 1c and RI, IMT-CCA and the age was found. After dividing the whole group into subgroups corresponding to the tertiles of HbA 1c levels, mean IMT-CCA values in I and II tertile were significantly lower than in III tertile ( p =0.008 and p =0.002 respectively), while RI was significantly higher in III tertile than in I tertile ( p =0.03). On multiple regression analysis IMT-CCA was significantly influenced by the age ( β =0.343, p =0.04), SBP ( β =0.430, p =0.03) and HbA 1c ( β =0.369, p =0.01), while RI was influenced by SBP ( β =0.696, p =0.0006), DBP ( β =−0.618, p =0.003) and HbA 1c ( β =0.279, p =0.04). Conclusion Patients with hypertension and diabetes mellitus had significantly increased IMT and not significantly higher RI. Concentration of HbA 1c , next to the age, SBP and DBP values was independently associated with IMT-CCA and RI – parameters determining indirectly the degree of atherosclerosis of common carotid artery.

Objective: The aim of the study was to asses the relationship between structural (IMT- intima-media thickness) and functional (PWV - pulse wave velocity, SBP - systolic blood pressure, PP - pulse pressure) parameters of the large arterial damage and the mean blood flow velocity (CBFV) in middle cerebral artery (MCA). Design and Methods: CBFV in (MCA) was measured bilaterally with transcranial Doppler (TCD). The early stage of vascular atherosclerosis was estimated with sonographic measurement of carotid IMT. We assessed large arterial stiffness using carotid-to-femoral PWV, brachial PP and SBP. Results: The mean (SD) age of 165 analyzed subjects was 56.1 (11.8), age range: 22–86 years. We assessed the CBFV in thirds of respective distributions of IMT, PWV, PP and SBP and found that CBFV was less with advancing thirds of PWV and IMT (all p0.37). The within-tertile mean values and standard deviations are shown in table. Mean±SD value of characteristic I II III SBP (mmHg) 116.3±5.9 134.3±4.8 159.2±13.1 PP (mmHg) 36.4±5.0 49.2±1.9 65.5±9.3 PWV (m/s) 9.8±1.2 12.2±0.57 16.2±3.0 IMT (mm) 0.6±0.08 0.9±0.06 1.2±0.2 Conclusion: Damage of large arteries expressed by increased IMT and PWV influences negatively the blood flow velocity in middle cerebral artery.

I n their thorough analysis of the treatment of hypertension in elderly nursing home residents, Gambassi and colleagues concluded that the current prescription pattern with a predominance of calcium antagonists and angiotensin-converting enzyme inhibitors at the expense of b-blockers did not follow recommended guidelines. As an explanation for this discrepancy, they suggest that “the present findings may reflect appropriate prescribing by an enlightened physician facing the difficult applicability of the guidelines to the frail, very old nursing home resident with multiple comorbid conditions and concomitant, complex pharmacological regimens.” We can only reemphasize these thoughts. As can be seen in the Table, there is a distinct difference between the “healthy” elderly patients with hypertension (such as those included in the SHEP [Systolic Hypertension in the Elderly Program], Syst-Eur [Systolic Hypertension in Europe], or Syst-China [Systolic Hypertension in the Elderly Chinese Trial] studies) and even the normotensive elderly population, not to speak of nursing home residents. It must be remembered that in the SHEP trial, of each 100 screened patients with isolated systolic hypertension, only 1 was randomized. Thus, most of the clinical trials in the elderly are not dealing with populations that are representative of the general elderly population with hypertension. In addition, the previous Joint National Committee (JNC), the JNC V, has erroneously promoted b-blockers as first-line therapy in the elderly, although since then it has become clear that, in the elderly, b-blockers are inappropriate and should no longer be used as initial antihypertensive therapy. This means that in the United States alone more than 7 million elderly patients with hypertension still are exposed to the cost, inconvenience, and adverse effects of b-blockers without having any benefits whatsoever. This also means, “mirabile dictu,” that we are currently unable to provide evidence-based therapy in the majority of elderly patients with hypertension. The evidence on which the JNC guidelines are based originates from a completely different patient subset and therefore cannot be extrapolated to the 99% of patients who were for one reason or another excluded from participating in the SHEP study. It is perhaps reassuring to note that in the study of Gambassi and colleagues, the percentage of patients (8%) receiving b-blockers was remarkably small. Perhaps physicians in that study are trying to teach physicians who write guidelines a lesson on how to more appropriately treat hypertension in the elderly.

Erratum to ‘‘Polish Centenarians Programme – Multidisciplinary studies of successful ageing: Aims, methods, and preliminary results [Exp. Gerontol. 43 (2008) 238–244]” Malgorzata Mossakowska *, Maria Barcikowska , Katarzyna Broczek , Tomasz Grodzicki , Alicja Klich-Raczka , Malgorzata Kupisz-Urbanska , Teresa Podsiadly-Marczykowska , Ewa Sikora , Aleksandra Szybinska , Katarzyna Wieczorowska-Tobis , Jolanta Zyczkowska , Jacek Kuznicki a

A case of bradycardia is reported developing after intramuscular injection of Serpasil. In the treatment temporary endocavitary pacing was used.

Measurement of blood pressure together with applanation tonometry at the radial artery allows the reproducible assessment of various indexes of arterial stiffness, including the peripheral (PPp) and central pulse pressures (PPc) and the peripheral (AIp) and central augmentation indexes (AIc). We defined preliminary diagnostic thresholds, using the distributional characteristics of these hemodynamic measurements in a reference population. We randomly recruited 870 subjects from 3 European populations. PPp was the average difference between systolic and diastolic blood pressure measured five times at one home visit. For measurement of PPc, AIp and AIc, we used the SphygmoCor device. We selected subjects without hypertension, diabetes, dyslipidemia in need of medical treatment or previous or concomitant cardiovascular disease. The study population included 228 men and 306 women (mean age 34.9 years). All hemodynamic measurements were curvilinearly related to age, and AIp and AIc were lower in men than in women. In men at age 40, the upper 95% prediction bands of the relations of the hemodynamic measurements with age approximated 60 mmHg for PPp, 40 mmHg for PPc, 90% for AIp, and 30% for AIc. For PPc, AIp and AIc, these thresholds must be adjusted for age, leading to lower and higher thresholds at younger and older age, respectively. In addition, in women of any age, the AIp and AIc thresholds must be increased by 10% and 7%, respectively. Pending validation in prospective outcome studies, distributional characteristics of arterial stiffness indexes in a reference population can be used to generate operational thresholds for use in clinical practice. (Hypertens Res 2006; 29: 475‐483)

An analysis of cardiac arrhythmias in relation to left ventricular morphology and function was performed in 68 hypertensive patients 60 to 83 years of age. The study comprised Holter monitoring and echocardiography. Our results suggest that in elderly patients with primary arterial hypertension a correlation exists between left ventricular mass and the incidence of ventricular arrhythmias but not between left ventricular mass and supraventricular arrhythmias.

To the Editor. —In their meta-analysis of the effect of antihypertensive therapies on preventing disease end points, such as stroke, coronary heart disease, congestive heart failure, and total and cardiovascular mortality, Dr Psaty and colleagues 1 concluded that the data provide strong support for the use of β-blockers and diuretics as first-line agents. However, after a closer look at their data, these conclusions are not supported by the data in the case of β-blockers. When calculating the relative risk associated with β-blocker therapy, the authors used 4 studies: (1) Medical Research Council trial of treatment of mild hypertension (MRC) 2 ; (2) Medical Research Council trial of treatment of hypertension in older adults (MRC-O) 3 ; (3) Swedish Trial in Old Patients With Hypertension (STOP-H) 4 ; and (4) Coope and Warrender. 5 By doing so, they glossed over the fact that in STOP-H, two thirds of the patients in the active treatment

In Reply. —Not unexpectedly, our article on short-acting nifedipine for hypertensive emergencies has stirred some strong reactions to the notion that nifedipine capsules no longer have a place in the treatment of hypertension, on an emergency basis or not. Additional case reports documenting morbidity and mortality from the use of nifedipine capsules would bring fatalities to a total of 11. As Dr Meggs points out, we do not know the denominator of our study, but the numerator almost certainly is underestimated because of the reluctance of physicians to report strokes, MI, and death—adverse effects for which they can be held responsible. More important, however, the benefits of abruptly (as opposed to gradually) lowering arterial pressure, especially in patients in whom blood pressure probably has been elevated for hours if not for days, has never been documented. Given the complete lack of data attesting to benefits, any data, however imperfect, attesting to serious

Over the past 2 decades, nifedipine in the form of capsules has become widely popular in the treatment of hypertensive emergencies. Unlike other agents, such as sodium nitroprusside, nicardipine hydrochloride, diazoxide, and nitroglycerin— which require intravenous administration and monitoring of blood pressure— nifedipine can be given orally, and close monitoring is said not to be necessary. Although administration of nifedipine capsules has been reported to be expedient and safe, it has not been approved by the Food and Drug Administration for labeling for treatment of hypertensive emergencies or of any other form of hypertension because of lack of outcome data. A review of the literature revealed reports of serious adverse effects such as cerebrovascular ischemia, stroke, numerous instances of severe hypotension, acute myocardial infarction, conduction disturbances, fetal distress, and death. Sublingual absorption of nifedipine has been found to be poor; most of the drug is absorbed by the intestinal mucosa. Given the seriousness of the reported adverse events and the lack of any clinical documentation attesting to a benefit, the use of nifedipine capsules for hypertensive emergencies and pseudoemergencies should be abandoned.

Background To evaluate the relationship between bone loss and new bone formation in ankylosing spondylitis (AS) using 10-year X-ray, dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography (QCT) follow-up. Methods Fifteen AS patients free from medical conditions and drugs affecting bone metabolism underwent X-ray, DXA and QCT in 1999 and 2009. Results In spine QCT a statistically significant (p = 0,001) decrease of trabecular bone mineral content (BMC) was observed (change ± SD: 18.0 ± 7.3 mg/cm3). In contrast, spine DXA revealed a significant increase of bone mineral density (change ± SD: -0.15 ± 0.14 g/cm2). The mean BMC, both at baseline and follow-up was significantly lower (p = 0.02 and p = 0.005, respectively) in advanced radiological group as compared to early radiological group. However, in multiple regression model after adjustment for baseline BMC, the baseline radiological scoring did not influence the progression of bone loss as assessed with QCT (p = 0.22, p for BMC*X-ray syndesmophyte scoring interaction = 0.65, p for ANOVA-based X-ray syndesmophyte scoring*time interaction = 0.39). Baseline BMC was the only significant determinant of 10-year BMC change, to date the longest QCT follow-up data in AS. Conclusions In AS patients who were not using antiosteoporotic therapy spine trabecular bone density evaluated by QCT decreased over 10-year follow-up and was not related to baseline radiological severity of spine involvement.

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

The present analysis was undertaken to evaluate postprandial (PP) changes in blood pressure (BP) assessed with ambulatory BP monitoring (ABPM) in elderly subjects with isolated systolic hypertension (ISH) on conventional measurement. A total of 530 patients (335 women and 195 men, aged 60–100 years, median 70 years) who performed an ABPM during the placebo run-in period of the Syst-Eur trial were included into the analysis. The PP changes in BP and heart rate (HR) were calculated by subtracting the mean systolic BP (SBP), diastolic BP (DBP) and HR in the 2 h preceding the main meal from the corresponding means covering the 2 h after the meal. The reproducibility of the postprandial fall in BP and heart rate (PPH) was assessed by contrasting the first and second ABPM in a subgroup of 147 patients who performed two ABPM’s during the placebo run-in period. The mean SBP and DBP decreased and reached the nadir 2 h after the main meal while HR did not change. When PPH was assessed by comparing BP in the 2 h before and after the meal, both SBP and DBP decreased significantly (respectively −6.6 mm Hg, −5.4 mm Hg; P

Background Clinical activity of ankylosing spondylitis (AS) predicts the natural course of the disease and the response to treatment. Several molecules are involved in new bone formation resulting in structural damage in patients with AS. However, the link between the clinical and molecular phenomena has not yet been fully established. The aim of the study was to investigate the relation between markers of bone remodeling and inflammation with clinical activity and structural damage in AS. Methods We assessed the serum levels of sclerostin, Dickkopf-1 protein, Wingless protein-3a, bone morphogenic protein-7, matrix metalloproteinase-3, osteoprotegerin, bone alkaline phosphatase and inflammatory markers in 50 AS patients with high disease activity (BASDAI ≥ 4), 28 with low disease activity (BASDAI

IntroductIon Recently, the relationship between vitamin D deficiency and various pathologies as well as functional decline has been reported. o bject Ives The aim of the study was to assess the relationship between 25‑hydroxyvitamin D, 25(OH)D, levels and functional status in elderly patients. PAtIents And methods Mean age of 140 participants (women, 67.1%) was 79.64 ±6.99 years. The study had a cross‑sectional design. Physical performance was measured using the handgrip strength, Timed Up and Go, single‑leg stance, and tandem stance tests, as well as a balance platform. Cognition was evaluated with the Abbreviated Mental Test Score (AMTS), while functional status with the Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scales. Plasma 25(OH)D levels were measured. results Less able patients (worse results in all tests) had significantly lower 25(OH)D levels. Subjects with 25(OH)D levels within the 3rd tertile had a higher AMTS score and handgrip strength; they swayed less on the balance platform and performed better in the IADL. In multivariate logistic regression analysis, 25(OH)D levels of 23.26–47.75 nmol/l were associated with increased odds of cognitive impairment (odds ratio [OR], 3.17; 95% confidence interval [CI], 1.04–9.68; P = 0.04), but also with less lateral sway (OR, 0.24; 95% CI, 0.09–0.64; P = 0.005). Plasma 25(OH)D levels above 47.75 nmol/l were associated with better performance in the tandem stance test (OR, 0.14; 95% CI, 0.04–0.52; P = 0.003) and further decreased lateral sway (OR, 0.27; 95% CI, 0.10–0.77; P = 0.01). conclusIons In elderly people with comorbid conditions, 25(OH)D levels were not associated with handgrip strength, but were associated with balance and cognitive function. These associations as well as high prevalence of vitamin D deficiency necessitate further research evaluating the effect of vitamin D supplementation on the functional status in elderly people.

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