老年高血压患者围术期静脉使用乌拉地尔和硝普钠降压疗效对比研究

目的观察乌拉地尔(URA)在老年高血压患者腹部手术围手术期控制血压的效果和优点以及它对心血管系统效应的影响。方法将病例随机分成两组,乌拉地尔组(n=127)和硝普钠组(n=127)和对比观察两组在围术期心率、血压(MAP)的变化。结果乌拉地尔组降压开始后HR逐渐减慢,降压均维持在正常范围(P>0.05);硝普钠组降压开始后HR多有明显增快,与乌拉地尔组比较有显著性差异(P<0.05)。结论老年高血压患者行腹部外科手术治疗前应使血压控制在正常高值水平,术中发生血压波动应尽早处理,术后密切观察,防止心衰及心肌梗塞等并发症发生,静脉应用盐酸乌拉地尔降压疗效肯定,其控制血压较硝普钠平稳,效果明显优越,其特点为降压过程缓和,心率变化小,降压后不反跳;使用安全,副作用少,可作为高血压围术期的首选药物。

Cardiovascular care for older adults： hypertension and stroke in the older adult

1 Introduction Hypertension and cerebrovascular disease incidence and prevalence rise dramatically with age, owing to longer exposure time to age-associated alterations in vascular function and structure and cardiovascular risk factors. This chapter is aimed at connecting age-related alterations in vascular function and structure to the resultant target organ damage, and to raise awareness of unique presentations and treatment strategies for hypertension and stroke in older adults.

Sex-specific effects of social networks on the prevalence, awareness, and control of hypertension among older Korean adults

Background Hypertension is a common chronic disease among older adults, and is associated with medical complications and mor- tality. This study aimed to examine the effects of social network characteristics on the prevalence, awareness, and control of hypertension among older adults. Methods The Korean Social Life, Health, and Aging Project （KSHAP） interviewed 814 〉 60-year-old residents and their spouses from a rural township between December 2011 and March 2012 （response rate： 95%）. We evaluated the data from 595 partici- pants. Multivariate logistic regression models were used to assess the effects of network characteristics on hypertension. Results We ob- served strong sex-specific network effects on the prevalence, awareness, and control of hypertension. Among older women, network density was associated with hypertension awareness [odds ratio （OR）： 2.63, 95% confidence interval （CI）： 1.03 5.37J and control （OR： 1.72; 95% CI 0.94-3.13）. Among older men, large networks were associated with a lower prevalence of hypertension （OR： 0.75; 95% CI： 0.58-0.96）. Compared to older women, older men with coarse networks exhibited better hypertension awareness （OR： 0.37; 95% CI： 0.14-0.95） and control （OR： 0.42; 95% CI： 0.19-0.91 ）. Network size interacted with density for hypertension control （P = 0.051）, with controlled hyperten- sion being associated with large and course networks. Conclusions A large network was associated with a lower risk for hypertension, and a coarse network was associated with hypertension awareness and control among older men. Older women with dense networks were most likely to exhibit hypertension awareness and control.

BLOOD PRESSURE CHANGES OF ELDERLY HYPERTENSIVE PATIENTS DURING DENTAL EXTRACTION UNDER SEDATION WITH CONTINUOUS INTRAVENOUS INFUSION OF MIDAZOLAM

Objective To evaluate the changes in blood pressure (BP) of elderly hypertensive patients having dental extraction under sedation with continuous intravenous infusion of midazolam. Methods One hundred elderly hypertensive patients undergoing dental extraction were recruited for this single-blind, randomized, controlled study. Patients in intervention group (n=50) were given midazolam dissolved in glucose solution and patients in control group (n=50) were given glucose solution only with communication technique. Systolic BP (SBP) and diastolic BP (DBP) were recorded in five time points. Results Under basal conditions, intervention group did not show significant difference in BP compared with control group. Before sedation, mean values of SBP and DBP (especially SBP) significantly increased compared with basal conditions in both groups (P<0.05). During dental extraction sessions, mean values of BP in intervention group significantly decreased than control group (P<0.05), but coefficient of variation did show significant difference in both groups. Conclusion Continuous intravenous infusion of midazolam has been proved to be very successful in controlling BP of elderly patients having dental extraction.

The association between orthostatic hypertension and all-cause mortality in hospitalized elderly persons

Background Little is known about the prevalence oforthostatic hypertension （OHT） and its effect on long-term mortality in the eld- erly. We evaluated the prevalence of OHT and its effect on mortality in hospitalized elderly patients. Methods Out of 1852 patients admit- ted between 31/12/1999 and 31/12/2000 to an acute geriatric ward, 474 patients （48% males） with a mean age of 81.5 ±6.8 years were en- rolled in this study. Blood pressure （BP） was measured three times during the day in a supine and standing position. Patients with at least one increase in systolic or diastolic BP levels upon standing were diagnosed with OHT. Medical history, physical examination and laboratory parameters were retrieved from the medical records. Mortality data until 18th June 2014 were retrieved from the computerized system of the Ministry of the Interior. Results Four hundred and seven patients （86%） were diagnosed with OHT. Those without OHT had a lowerbody mass index and were more likely males, smokers, had a higher rate of Parkinson＇s disease and less congestive heart failure compared with those with OHT. Patients with OHT had a better survival rate than those without OHT （P = 0.024）. Hazard ratios （HRs） for mortality in those with OHT adjusted to age and multiple risk factors were： 0.67 [95% confidence interval （CI）： 0.51-0.87] and 0.73 （95% CI： 0.55-0.97）, respectively; a similar tendency was noticed in a sensitivity analysis by gender. Conclusion Hospitalized elderly patients with OHT had a better survival rate than those without OHT.

Clinical and hemodynamic profiles of elderly patients with pulmonary arterial hypertension： a single center, prospective study

Backgrounds Pulmonary arterial hypertension （PAH） was previously considered an illness that affects mostly the young, but now it is also increasingly recognized in the elderly. The aim of this study was to compare the features of elderly versus younger patients diagnosed with PAH, and to define the prognostic factors which affect their long-term survival. Methods In this prospective, single center study, the clinical, echocardiographic, hemodynamic characteristics, and the outcomes of younger （18-65 years） and elderly （〉 65 years） patients with definitive diagnosis of precapillary PAIl were compared. Results A total of 119 patients were analyzed in this study; 43 were elderly （mean age： 71.5 ± 5.5 years）, while 76 were non-elderly （mean age 44.5 ±15.2 years）. During the mean follow-up duration of 26.8 ±25.0 months, 43 deaths occurred, 17 of which were among the elderly group, with 28 among non-elderly group. Comparison of baseline parameters showed that 6 min walking distance, hemoglobin levels, pulmonary artery pressures and pulmonary vascular resistance were significantly lower; and estimated glomerular filtration rate, body mass index, E/e＇ and pulmonary capillary wedge pressure were significantly higher in the elderly group than in the younger group. Survival analysis demonstrated that the independent predictors of death were tricuspid plane annular systolic excursion （TAPSE; HR： 1.272, 95% CI： 1.079-1.499, P = 0.004） and uric acid （HR： 1.291, 95% CI： 1.042-1.600, P = 0.019） in the elderly group. In contrast, in the non-elderly group, higher brain natriuretic peptide （HR： 1.002, 95% CI： 1.001-1.004, P 〈 0.001） and higher right atrial pressure （HR： 1.128, 95% CI： 1.026-1.241, P = 0.013） values were the only parameters associated with mortality. Conclusions Our data suggest that elderly PAH patients have a unique clinical and hemodynamic profile, with totally different prognostic markers compared to younger PAH patients.

Hypertension in the elderly： insights from recent research

Hypertension is a leading cause of mortality and morbidity around the world and,prevalence of hypertension is increasing with aging.Hypertension in the elderly is associated with increased occurrence rates of sodium sensitivity,isolated systolic hypertension,and ＇white coat effect＇.Arterial stiffness and endothelial dysfunction also increase with age.These factors should be considered in selecting antihypertensive therapy.The prime objective of this therapy is to prevent stroke.The fmdings of controlled trials show that there should be no cut-off age for treatment.A holistic program for controlling cardiovascular risks should be fully discussed with the patient,including evaluation to exclude underlying causes of secondary hypertension,and implementation of lifestyle measures.The choice of antihypertensive drug therapy is influenced by concomitant disease and previous medication history,but will typically include a thiazide diuretic as the first-line agent;to this will be added an angiotensin inhibitor and/or a calcium channel blocker.Beta blockers are not generally recommended,in part because they do not combat the effects of increased arterial stiffness.The hypertension-hypoten-sion syndrome requires case-specific management.Drug-resistant hypertension is important to differentiate from faulty compliance with medication.Patients resistant to the third-line drug therapy may benefit from treatment with extended-release isosorbide mononitrate.A trial of spironolactone may also be worthwhile.

Thai Elderly Population： Lifestyle Enhancement Amongst the Overweight and Hypertensive

Hypertension and obesity are two prevalent conditions that often simultaneously affect the same individual and can increase one＇s chances of cardiovascular morbidity. In Thailand, older people often seek medical attention at times when they are extremely ill. Healthy lifestyle behaviors are essential in order for one to maintain their health. Certain regimens can be initiated to manage and control health problems. However, very few know about how the elderly maintain their subjective physical well-being, while living with obesity and hypertension. This qualitative study focuses on describing health care practices and behaviors of overweight and hypertensive older people in everyday Thai society. Ten elderly people have participated in this study through purposive sampling. Qualitative data was gathered via in-depth interviews and was analyzed by using a content analysis method. The findings illustrate that health care seeking behaviors emerged from an understanding to seek health care; acting behaviors based on knowledge, and seeking health care support. Most overweight and hypertensive elderly people in Thai cultures have the desire to maintain their everyday lives by continuing their routines or traditions that were in place before seeking professional attention. This knowledge is useful in developing health care practices with wider implications such as holistic care to elderly people for alleviating their suffering by promoting healthy lifestyles and maintaining healthy blood pressure.

Role of ghrelin in cognitive impairment of hypertensive elders with chronic psychological distress

Objective:To investigate ghrelin level change in combination with psychological stress in the hypertensive old people with cognitive impairment and to explore its effect as well as possible mechanism.Methods:The study population of 300 elders was divided into 2 groups,148 with hypertension and 152 non-hypertension,who were screened for psychological distress and cognition function,and had blood drawn to measure plasma levels of ghrelin and total cortisol on the same day.Results:The rates of anxiety and cognitive impairment were higher in the hypertension elders,which were negatively correlated with plasma ghrelin level,resulted from chronic cortisol response to anxiety.Conclusion:Chronic plasma cortisol increase to long-term anxiety leads a reduce in ghrelin level which then adversely affects blood pressure and cognitive function in old people.So measuring ghrelin of elders may be a diagnostic tool to predict cognitive development and ghrelin may be a selective antihypertensive medicine for cognitive impairment elders with or without chronic psychological stress.

Epidemiology of pulmonary hypertension in the elderly

1 Introduction Pulmonary hypertension （PH） is a haemodynamic and pathophysiological condition defined as increase in mean pulmonary arterial pressure≥ 25 mmHg at rest as assessed by right heart catheterization （RHC）.

Mental health is as important as physical health: The degree and influencing factors of self-perceived burden in elderly patients with essential hypertension

Objective: The purpose of the study is to investigate the degree and influencing factors of self-perceived burden in elderly patients with essential hypertension in China's Mainland. Methods:The study used the cross-sectional investigation method and the patients were recruited from six tertiary hospitals in Chengdu, China. A convenience sample of 451 elderly patients with essential hypertension was included in this study. Multiple linear regression analysis was performed as well. Results: Results showed that the score of elderly essential hypertension patients’self-perceived burden was 27.96 ± 6.04, which was at medium degree. According to Spearman's r test the anxiety, depression and medication compliance with Self-perceived burden (SPB) of elderly hypertension patients were statistically significant (r=0.372, 0.899,0.438,P=0.000,respectively). Single factor analysis showed that the difference of patients’ gender, place of residence, monthly per capita income, marital status, whether can afford medical expenses and number of complications in SPB scores was statistically significant (P<0.05). Multiple regression analysis also showed that anxiety, medication compliance, age and marital status were the main influencing factor of SPB of elderly hypertension patients (P<0.05). Conclusion: Our care workers should pay attention to the self-perceived burden of elderly patients with essential hypertension, and omnibearing, systematic nursing should be supplied to decrease the self-perceived burden of them.

Characteristics of coronary microvascular lesions in autopsied elderly with hypertensive left ventricular hypertrophy

OBJECTIVE: To observe the characteristics of coronary microvascular lesions (CML) in the autopsied elderly cases with hypertensive left ventricular hypertrophy (LVH) and the difference of CML among the groups of essential hypertension (EHT), coronary heart disease (CHD) and diabetes (NIDDM) also with LVH. METHODS: A retrospective study was performed in 206 cases > or = 60 years old of EHT, CHD and NIDDM with LVH and 30 normal cases as control, out of 3195 consecutive autopsied cases from 1954 to 1996 in our hospital. Arterioles with diameters of 10 - 60 microm and capillaries in the muscular layer were shown by the methods of HE, Elastic fiber + VG staining and immunohistochemistry of CD31. Quantitative measurements on the arteriole density (AD), the ratio of arteriolar wall and cavity (RWC), capillary density (CD) and the area of endothelial cell (AEC) were performed with light microscope observation and image analysis by computer. According to the thickness of the left ventricle free wall, the severity of LVH was divided into four degrees from 0 to III. LVH of degree 0-III was observed in EHT group, while only LVH of degree I was found in CHD, EHT + CHD, and NIDDM groups. SAS system was used for statistical analysis. RESULTS: AD and RWC increased while CD and AEC decreased significantly with the progression of LVH in EHT groups (P

Effect of direct moxibustion on blood pressure and clinical symptoms in elderly patients with essential hypertension

Objective： To assess the effects of direct moxibustion on 24-hour ambulatory blood pressure （ABP） and clinical symptoms of traditional Chinese medicine （TCM） in elderly patients with essential hypertension, and to explore the antihypertensive effect and influencing factors of moxibustion. Methods： A total of 101 elderly hypertension patients who met the inclusion criteria were randomly assigned to a direct moxibustion I group （n=33）, a direct moxibustion II group （n=34）, and a control group （n----34）. The treatment of calcium antagonist （CCB） or angiotensin II receptor antagonist （ARB） was adopted in the control group. The treatment of direct moxibustion I plus the same medicine as the control group were adopted in the direct moxibustion I group, five cones per acupoint and three times per week, for 5 weeks in total. The treatment of direct moxibustion II plus the same medicine as the control group were adopted in the direct moxibustion II group, five cones per acupoint and three times per week, for 5 weeks in total. The changes of 24-hour ABP and clinical symptoms of TCM after treatment were compared in the three groups. Results： The mean 24-hour ambulatory systolic blood pressure （mean 24 h ASBP）, night ASBP, percentage of mean 24-hour ambulatory diastolic blood pressure （mean 24 h ADBP）~90 mmHg, and percentage of day ADBP^90 mmHg in the control group were elevated after treatment （P^0.05）. The percentage of night ADBP^80 mmHg in the direct moxibustion I group was reduced by treatment （P〈0.01）. There were no significant differences in the other outcome measures of 24 h ABP, such as day ASBP, percentage of mean 24 h ASBP^140 mmHg, percentage of day ASBP^140 mmHg, percentage of night ASBP 〉120 mmHg, mean 24 h ADBP, day ADBP, night ADBP, 24 h ambulatory pulse pressure （APP）, after treatment in all groups （P^0.05）. The degree of improvement of the clinical symptoms of TCM showed significant differences among the three groups of patients （P^0.01）. The total effective rate in the direct moxibustion I group was 73.3%, which was superior to those in the direct moxibustion II group and control group （13.3% and 10.0%, respectively）. Conclusion： The direct moxibustion has benign regulative effect on blood pressure of elderly patients with essential hypertension, and improves their clinical symptoms. The direct moxibustion method I （burning the next moxa cone after the previous one had totally burnt out） was superior to method II （burning the next moxa cone when the previous one had not totally burnt out ） in lowering blood pressure and improving symptoms of elderly patients with essential hypertension.