This paper overviewed theoretical basis, clinical evidence and clinical practice principles of antiplatelet therapy in patients with hypertension to draw attention to take appropriate risk stratification, rigorous screening for bleeding cases and to administer aspirin with appropriate dose in daily clinical practice.
Background and aims: PREDATORR is a national study designed to estimate the prevalence of diabetes mellitus, prediabetes, overweight, obesity, dyslipidemia, hyperuricemia and chronic kidney disease in Romanian adult population. The aim of present study was to estimate the prevalence, incidence, treatment and control in subjects from PREDATORR study.
Material and methods: This study included 2727 adults aged 20 – 79 years. Subjects were examined, and three measurements were performed at a time of at least one minute and the mean of blood pressure readings was recorded. Hypertension was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg and/or antihypertensive drug therapy.
Results: The prevalence of hypertension in Romanian adult population aged 20 – 79 years was 47.38% and was higher in men: 48.62% than women: 46.23%. The incidence of hypertension was: 10.7% in 20 – 39 years age group, 43.1% in 40 – 59 years age group and 75.1% in subjects aged ≥ 60 years. Among subjects with hypertension, 18.7% did not receive antihypertensive drug therapy, 27.7% received antihypertensive treatment in monotherapy, 34.7% were under double antihypertensive drugs and most of them (37.6%) received three or more antihypertensive drugs.
Conclusions: The prevalence of hypertension in Romania is high, possible explanations of this might be the unhealthy lifestyle and diet.
Şuteu Carmen, Blesneac Cristina, Togănel Rodica and Benedek Theodora
Introduction: Pulmonary arterial hypertension (PAH) is a rare disease associated with significant morbidity and mortality. Pediatric patients often present with mixted aetiologies.
Objectives: To characterize the epidemiology, management and outcome of pediatric PAH.
Methods: Children with PAH were included and followed prospectively for six months. WHO functional class, 6-minute walk test, biomarkers, electrocardiogram, spirometers and echocardiographic parameters were evaluated in progressive PAH group.
Results: Two hundred and four children were included in the study from July 2012 until July 2013, with a mean age of 6.13 years. Transient PAH patients (n=170, 83.33%) included newborns with persistent pulmonary hypertension (n=8, 3.92%) and children with congenital heart defects with systemic-to-pulmonary shuntflow PAH (n=162, 79.41%) in whom PAH resolved after successful surgery correction. Progressive PAH (n=34, 16.66%) included patients with idiopathic PAH (n=5, 2.45%), Eisenmenger syndrome (n=17, 8.33%) and post-operative PAH (n= 6, 2.94%). Patients with progressive PAH remained stable in regards to clinical status, WHO functional class, 6-minute walk distance, biomarkers, spirometers parameters and echocardiographic parameters with prognostic value.
Conclusions: Pediatric PAH is characterized by various age-specific diagnoses, the majority of which comprise transient forms of PAH. Pediatric PAH associated with congenital heart defects represents a heterogeneous group with highly variable clinical courses. PAH specific therapies may have contributed to disease stability and favorable outcomes.
Ingrid Prkacin, Petra Vrdoljak, Gordana Cavric, Damir Vazanic, Petra Pervan and Visnja-Nesek Adam
Studies have documented independent contribution of sympathetic activation to the cardiovascular disease continuum. Hypertension is one of the leading modifiable factors. Most if not all the benefit of antihypertensive treatment depends on blood pressure lowering, regardless how it is obtained. Resistant hypertension is defined as blood pressure that remains uncontrolled in spite of the concurrent use of three antihypertensive drugs of different classes. Ideally, one of the three drugs should be a diuretic, and all drugs should be prescribed at optimal dose amounts. Poor adherence to antihypertensive therapy, undiscovered secondary causes (e.g. obstructive sleep apnea, primary aldosteronism, renal artery stenosis), and lifestyle factors (e.g. obesity, excessive sodium intake, heavy alcohol intake, various drug interactions) are the most common causes of resistant hypertension. Cardio(reno)vascular morbidity and mortality are significantly higher in resistant hypertensive than in general hypertensive population, as such patients are typically presented with a long-standing history of poorly controlled hypertension. Early diagnosis and treatment is needed to avoid further end-organ damage to prevent cardiorenovascular remodeling. Treatment strategy includes lifestyle changes, adding a mineralocorticoid receptor antagonist, treatment adherence in cardiovascular prevention and, in case of failure to control blood pressure, renal sympathetic denervation or baroreceptor activation therapy. The comparative outcomes in resistant hypertension deserve better understanding. In this review, the most current approaches to resistant hypertension and cardiovascular risk based on the available literature evidence will be discussed.
Hypertension is a well-known risk factor for ischaemic heart disease and cerebrovascular events. Globally, there is a drive to try to reduce salt intake. In an older population, where hypertension is likely to have a high prevalence, are health care professionals aware of the sodium content in replacement factor?
Jairo Silva, Amandio Geraldes, Antônio Natali, João Pereira, Rodrigo Vale and Estélio Dantas
Acute Effects of Swimming on the Arterial Pressure of Hypertensive Adults
Aim. The purpose of this work was to verify the acute effects of a regular swimming programme on the arterial pressure of hypertensive adults.
Material and methods. The sample was composed of 26 individuals who presented mild to moderate hypertension. The subjects were divided into two groups: the Experimental Group (EG) comprising 13 subjects (four men and nine women) and the Control Group (CG) comprising 13 subjects (seven men and six women), with average ages of 38.40 ± 8.24 and 38.36 ± 8.96 years, respectively. GE individuals took part in a regular swimming programme consisting of three weekly fifty-minute sessions of training (ST) for 10 weeks, whereas GC individuals were instructed not to alter their physical activity and nutritional habits. The Kruskal-Wallis test was used to determine statistical significance (p < 0.05).
Results. At the end of the ten weeks, an increase of 4.8% in Systolic Blood Pressure at rest (from 133.67 ±2.26 to 138.56 ± 3.23) and an increase of 7.8% in Diastolic Blood Pressure (from 83.15 ± 1.50 to 89.67 ± 7.19) were observed.
Conclusion. The results allow us to conclude that a regular swimming programme, consisting of training sessions three times a week for 10 weeks, was not sufficient to significantly alter the acute pressure levels of hypertensive adults.
Andrei Georgian Florescu, Andrei Cristian Dan Gheorghe, Cristina Elena Georgescu, Alina Ștefania Luiceanu, Ioan Tiberiu Nanea and Gabriela Silvia Gheorghe
Porto-pulmonary hypertension (PPH) is the association between portal hypertension (PoH) due to liver disease or extra hepatic etiology and pulmonary hypertension (PH). It’s prevalence ranges between 2 and 16 % (1,2)and it’s diagnosis requires the exclusion of alternative causes of PH which can be sometimes challenging, especially in the context of a wide range of comorbidities that a patient with chronic liver disease can present with. We describe a 72 years-old man with a clinical presentation of right heart failure and signs of severe PH shown by the echocardiography. The blood tests were positive for anti-HCV antibodies and CT-imaging showed signs of cirrhosis and PoH. Complementary exams and review of the literature allowed use to rule out other potential causes constituting the differential diagnosis of the PH in this patient.
The problem of gestational hypertension (GH) remains to be of current concern in obstetric practice. The purpose of this study, therefore, was to determine the risk factors for GH development. We examined 53 pregnant women and allocated them to 2 groups: the main group - pregnant women with gestational hypertension (n = 30) and the control group - pregnant women without the pathology (n = 23). The selection of persons for the study was carried out on the basis of detailed history taking, examination and complaints, using standard clinical, laboratory and instrumental methods of investigation. The data was processed on a PC (standard statistical package Statistica 6.0). Our results show that the gestational hypertension development is closely linked with such risk factors as: age ≤ 18 years old and over 35 years old, unmarried status, living in a city/town, post-secondary education, unemployment, obesity, first labor in consecutively pregnant women, the threat of pregnancy termination, cardiovascular system diseases, urinary tract pathology, varicose veins, as well as ABO-sensibilization.
Joanna Rosiak, Beata Kubic-Filiks and Jolanta Szymanska
The authors discuss the factors coexistent with hypertension both in children and youth, as well as the treatment methods and possible symptoms that might appear in the oral cavity. In the work, the authors emphasize that there is a need for cooperation between the general practitioner, a cardiologist and a dentist, so as to provide an early diagnosis and effective treatment, as well as to prevent complications with regard to hypertension itself and the drugs used in treatment. The discussion is based on a review of the most recent works in the field.
Marija Andjelkovic, Marina Mitrovic, Ivana Nikolic, Danica Bacanin Jovanovic, Ivanka Zelen, Milan Zaric, Petar Canovic, Aleksandra Kovacevic and Slobodan Jankovic
Non-pharmacological treatment including diet, body weight reduction, smoking cessation and physical activity, is very important part of hypertension treatment. The objective of this study was to investigate the adherence to healthy lifestyle behavior in the representative sample of the older hypertensive patients, and to investigate factors associated with adherence in the studied older population. The study was conducted on random sample of 362 long term hypertensive (> five years) patients older than 65 years of age, at Health Care Center of Kragujevac. Adherence was assessed using the structured questionnaire for the analysis of the implementation of both hypertension and diabetes guidelines in the primary care. Both bivariate and multivariate analyses were conducted. Nearly 35% of examined patients were highly adherent; they exercised regularly, avoided smoking for at least five years and consumed special healthy diet prescribed for hypertension. Another 35.6% of the cases reported exercising regularly, 39.5% followed the recommended diet for the hypertension, while 23.4% of the patients have still consumed cigarettes. Multivariate logistic regression demonstrated that received counseling on healthy lifestyle behaviors by physicians and lack of education predicted high adherence to healthy lifestyle behavior. In order to improve adherence of elderly hypertensive patients to healthy lifestyle, strengthening patient-physician relationships through efforts to enhance communication may be a promising strategy to enhance patients’ engagement in healthy lifestyle behaviors for hypertension. Such an improvement could be achieved through the education of both the physicians and patients.