Nutritional and Clinical Profiles of Elderly People with Diabetes and Hypertension at Conakry University Hospitals

Introduction: In Guinea, there is few data on dietary practices socio-economic and clinical characteristics of elderly diabetics and hypertensives. Methods: This was a descriptive cross-sectional study of people aged 60 years and over, seen in consultation or hospitalised in Conakry University hospitals during the period from 5 September to 15 December 2023 inclusively. Results: Among the 320 subjects included in the study, there were more men (50.6%). The average age was 67 ± 7.69 years;53.43% had hypertension and 46.57% had diabetes. Sex was significantly associated with diabetes (p = 0.035). Women in the study were more affected by diabetes (55.7%), 64.4% of diabetic subjects were married and more than 64% of them had dependent children. 26.2% of diabetics were not employed;85.9% had an income;34.9% had an income of less than one million Guinean francs per month and 74.5% of them had 3 meals a day. Physical activity, 24-hour recall for lunch (p Conclusion: Effective management of diabetes and hypertension in the elderly should necessarily involve nutrition education in hospitals.

Evaluation of the Effectiveness of Community Pharmacy Services on Rational Medication Use in Elderly Patients with Hypertension and Diabetes

Objective:To explore the effect of community pharmacy services on rational medication use in elderly patients with hypertension and diabetes.Methods:Between November 2022 and December 2023,80 elderly patients with hypertension and diabetes were selected and randomly divided into a control group(routine medication guidance)and an observation group(community pharmacy services),with 40 subjects each.The medication effect scores,blood pressure,blood sugar levels,and quality of life scores before and after intervention were compared between the two groups.Results:Comparison of pharmaceutical knowledge,medication compliance,and safe medication behavior scores showed that the observation group had higher scores as compared to the control group(P<0.05);blood pressure(systolic blood pressure,diastolic blood pressure,heart rate)and blood sugar(fasting blood glucose,2 h postprandial blood glucose,glycated hemoglobin)index levels were compared,and the observation group’s index levels were lower than those of the control group(P<0.05);the scores of physical health,mental health,social relationships,and environment in the observation group were higher than those in the control group(P<0.05).Conclusion:Community pharmacy services improved the rational medication effect of elderly patients with hypertension and diabetes,and improved their blood pressure,blood sugar control levels,and quality of life.

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.

How to select the appropriate candidate of pulmonary arterial hypertension： specific therapy in elderly patients with pulmonary hypertension

Recent reports from pulmonary arterial hypertension （PAH） registries suggest that the mean age at diagnosis is increasing in a growing proportion of elderly patients. The combination of several reasons such as aging popula- tion, increase in life expectancy, growing PAH awareness of physicians and patients, and availability of more treatment options could explain the changing picture of PAH. PAH should be considered as an emerging entity in the elderly.

Left atrial appendage occluder implantation for stroke prevention in elderly patients with atrial fibrillation： acute and long-term results

Atrial fibrillation （AF） is the most common cardiac ar-rhythmia in clinical practice with an increasing incidenceand prevalence. With ageing, the risk of thromboembolicand hemorrhagic events increases dramatically. As it hasbeen reported previously, 3-year survival rate among pa-tients with AF over 75 years of age after stroke is less than50%, and almost 90% of those patients will remain dis-abled.

Influence of psychosocial factors on treatment of elderly Chinese patients with hypertension

Objective The aim of the study is to investigate the effects of psychosocial factors on the treatment of elderly patients with hypertension. Methods Atotalof 260 elderly Chinese patients with hypertension were treated with benazepril alone or benazepril combined with amlodipine for 8 weeks. The target blood pressure (BP) (both <140 mmHg systolic, SBP, and <90 mmHg diastolic, DBP) was achieved in 180 patients, who were then assigned to the well-controlled BP group;the rest were placed in the modestly controlled BP group. The psychosocial factors present in both groups were assessed by the Hamilton depression scale, Hamilton anxiety scale, life event scale and social support evaluation list before and after anti-hypertensive treatment. Results There were no significant differences in gender, mean age, hist ory of hypertension, education and smoking habit, or in SBP and DBP between the groups before treatment. Significant differences were also not found in all psychosocial factors before and after treatment in the patients. However, significant differences were found between the groups with respect to post-treatment SBP and marital status. The patients with modestly controlled BP had significantly higher scores, as well as incidents, on the depressive, anxiety, and stressful life event scales than those with well-controlled BP. The patients with well-controlled BP had significantly higher scores in tangible support, subjective support, and social support compared to the patients with modestly controlled BP. Logistic regression analysis showed the independent contribution of psychosocial factors in reaching the goal of lowering BP at treatment endpoint in these hypertensive patients. Conclusions The results suggest that psychosocial factors stand as a main barrier to achieving the BP-lowering target in the management of elderly Chinese patients with hypertension.(J Geriatr Cardiol 2007;4:202-207.)

The Survey of Self-Regulation Behaviors and Related Factors in Elderly with Hypertension in South-East of Iran

Hypertension is one of the most important risk factors for heart diseases today. The effect of hypertension in the elderly is higher than other age groups and it may lead to changes in their quality of life. By the increase of age, the amount of self-care behaviors of patients with hypertension decreased. Therefore, control and self-care behaviors are so important. This study has been conducted to study self-regulation behaviors and Associated Factors in elderly patients with hypertension. This study was a cross sectional, descriptive analytic study, which was conducted using multistage sampling on the elderly 60 years and above with hypertension. The sample size was calculated 365 and the final sample size of 380 people was considered by possible losses. The instruments include of demographic and self-regulatory behaviors questionnaire. The results showed that self-regulation of behavior was 42.3% of the total score. In terms of quality, only 7.4% of the elderly had good behavior, 46.6% of poor performance, and the rest were mediocre performance. Age (p = 0.03), gender (p = 0.02), education (p = 0.001), income level (p = 0.03) and marital status (p = 0.001) significantly associated with behaviors of self-regulation. The results generally indicate unfavorable self-regulation of elderly patients with hypertension. Some variables such as gender, age, marital status, education and income levels were associated with these behaviors. So paying attention to the education of the elderly in care centers is essential.

Exploring the Effects of Health Education and Chronic Disease Management Nursing in the Management of Hypertension in Elderly Patients in the Community

Objective:To explore the effects of health education and chronic disease management nursing in elderly community patients with hypertension,in order to provide scientific evidence for improving the health management level of these patients.Methods:Sixty-four elderly hypertension patients treated at this hospital between March 2022 and March 2024 were selected and randomly divided into two groups,with 32 patients in each group.One group received conventional management,designated as the control group,while the other group received a combined management strategy involving health education and chronic disease management,designated as the experimental group.The study compared the management outcomes of the two groups to evaluate the value of the combined management approach in elderly hypertensive patients in the community.Results:The study found that the experimental group showed significantly lower systolic blood pressure(SBP),diastolic blood pressure(DBP),and scores on the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)compared to the control group,with statistically significant differences(P<0.05).Additionally,the experimental group demonstrated significantly higher scores in disease cognition levels regarding awareness of normal blood pressure ranges,prevention of complications,identification of high-risk factors,and healthy lifestyle practices,with statistically significant differences(P<0.05).Moreover,the experimental group showed significantly better rates of self-management behaviors,such as quitting smoking and alcohol,self-monitoring of blood pressure,dietary control,regular medication adherence,and consistent exercise,compared to the control group,with statistically significant differences(P<0.05).Conclusion:This study indicates that a combined management model integrating health education and chronic disease management effectively improves the emotional state of elderly hypertensive patients in the community,significantly enhances their disease cognition levels,and boosts their self-management abilities.Furthermore,this model can effectively lower patients’blood pressure,thereby achieving better health management outcomes for elderly hypertensive patients in the community.

Meta-Analysis the Quality of General Practitioners Management for Elderly Patients with Hypertension in China

Background: Among Chinese adults aged 35 - 75 years, nearly half have hypertension and the prevalence of hypertension is increased with age. But older patients with high systolic pressure and high pulse pressure could not be cured, and will have greater cardiovascular morbidity. This study aims to evaluate the effectiveness of general practitioners (GP) management for Chinese elderly hypertension, and explore reasonable and effective blood pressure management pattern. Methods: We searched the published literature for randomized controlled trials designed to improve blood pressure with community care management delivered by general practitioners or nurses, compared with usual care. Major outcome measures were systolic and diastolic blood pressure;the percentage of patients whose blood pressures are under control with community care management and Revman 5.3 was used in this study. Results: Pooled data from all 13 researches showed a lower outcome diastolic blood pressure (SMD = &minus;0.95, 95% CI (&minus;1.23, &minus;0.67)) and systolic blood pressure (SMD = &minus;1.17, 95% CI (&minus;1.52, &minus;0.81)) respectively in favor of community management. Pooled data from all 11 researches showed a higher percentage of patients with blood pressure under control in favor of community management (OR = 3.85, 95% CI (1.58, 9.37)) and the difference between treatment group and control group on blood pressure control ratio had statistical significance (Z = 2.97, P Conclusions: General practitioners’ management in Chinese elderly hypertension is effective, and complies with the advanced hypertension management guidelines. The multi-patterns are supposed to adopt community blood pressure monitoring and team-based general practitioners.

Effects of the self-management training program on self-management behavior and blood pressure levels among elderly people with hypertension

Objective:To determine the effects of the Self-Management Training Program on self-management behavior and blood pressure(BP)levels among elderly people with hypertension(HT).Methods:This study was based on a quasi-experimental design using sampling groups composed of elderly residents of Pathum Thani Province with HT.Simple random sampling was applied to two sampling groups,an experimental group and a control group.However,the experimental group had been on the Self-Management Training Program based on the Creer concept.The Program’s contents included small-group health-education sessions and the patients’manual,Self-Management Training Skills for Self-Management Behavior.Small group discussions were held for self-reflection,to stimulate follow-up for self-management behavior training during home visits.The Self-Management Training Program was compared with programs involving the more usual care.Data were collected using the Self-Management Behavior for Hypertension Control Questionnaire and BP assessment tests.Data were analyzed using a descriptive statistic,chi-square test,pair t-test,repeated-measures Analysis of Variance(ANOVA),and repeated-measures Analysis Covariance(ANCOVA).Results:It was found that at 13 weeks after entering the program,the experimental group demonstrated a significantly lower systolic and diastolic BP with a baseline statistical significance(P<0.005),and that at the 4th week and the 13th week,there was a decrease in BP in the experimental group.The experimental group also had above-baseline self-management behavior scores that were higher than in the control group(P<0.01).Conclusions:Results from this study show that the Self-Management Program was useful for BP control and promoted sustainable self-management behavior.

Simple Nutritional and Inflammatory Markers Associated with Bed Sores in Elderly Stroke People

Background: Bed sores are major burden to hospital care and usually associated with worse prognosis and longer hospital stay. Aims: To evaluate whether simple biochemical inflammatory and nutritional markers would differ between those with bedsores and those without in elderly stroke patients and if there is a distinction between recent bed sore stroke patients and old bed sore stroke patients as regard these biomarkers. Methods: 80 Stroke elderly patients were enrolled and divided into four groups: patients with recent stroke who developed bedsores, patients with recent stroke who did not develop bedsores, patients with old stroke who developed bedsores and patients with old stroke who did not develop bedsores. Nutritional markers (albumin, total protein, magnesium, iron, total iron binding capacity (TIBC), hemoglobin and cholesterol) and inflammatory markers (total leucocyte count, neutrophil to lymphocyte ratio and ferritin) were compared between the four groups. Results: Concerning nutritional markers, albumin (P =< 0.001), Alb/Pr ratio (P =< 0.001), TIBC (P =< 0.001) and cholesterol (P = 0.005) are lower in the acute stroke with bed sore patients versus acute stroke without bed sore. Lower albumin (P =< 0.001) is only found in comparison between chronic stroke with bed sore patients and chronic without bed sore patients. There is a difference between acute stroke with bed sore and chronic stroke with bed sore concerning albumin (P =< 0.001), TIBC (P =< 0.001) and TG (p =< 0.001). Albumin is lower while TG and TIBC are higher in those with acute stroke with bed sores. Regarding inflammatory markers, high neutrophil and ferritin (p =< 0.001) were found in acute stroke with bed sore patients versus acute stroke without bed sore. No difference was found between chronic stroke with bed sore patients and chronic stroke without bed sore patients. Acute stroke with bed sore group has higher TLC, neutrophil, neut/lymph ratio and ferritin (p =< 0.001) than chronic stroke with bed sore group. Conclusions: Acute stroke patients with bed sores are the highest group as regard inflammatory markers due to acute stroke and bed sores together. The presence of bed sore itself causes or is caused by decrease in nutritional markers especially albumin in both, acute and chronic strokes. Other markers are more evident in acute stroke patients who develop bed sore like higher ferritin and neutrophils and lower TIBC, alb/prot ratio and cholesterol. TG differs only in relation to acute stroke but not bed sore. MG was not different between the four groups.

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.

Effects of a Graded Brisk Walking Test with Different Intensity Levels on Elderly Patients with Essential Hypertension:A Prospective Study in Shanghai,China

Background:This study aimed to clarify the effects of a Graded Brisk Walking Test(GBWT)program on blood pressure(BP)control in elderly patients with essential hypertension and to determine its appropriate degree of intensity for elderly people.Methods:In total,421 out of 620 participants were randomly sampled from a community health center in Shanghai,China.Among them,200 and 221 patients were assigned to the intervened and control groups,respectively.They were all treated with the GBWT program for 8 weeks,16 weeks,and 24 weeks.Results:Based on ANOVA,there was no significant time main effect,condition main effect,or time by condition interaction both in heart rate and body mass index indicators(P>0.05).There were significant condition main effects,time by condition interaction,or time main effects in blood pressure(F=21.875,33.457,65.342,respectively;All P<0.05).After the intervention,significant differences in systolic blood pressure(SBP)and diastolic blood pressure(DBP)values were also observed in the two groups(P<0.05);the average values of the baseline and second phases of the intervention group were significantly lower than those of the control group(P<0.05).Significant differences in blood pressure values after the first two phases were also observed when compared with those before the intervention.Similarly,a significant difference in the first phase and second phase was also found between the BP group and intervention group.However,after the third phase(24 weeks,high-intensity exercise),no significant differences existed both in SBP and DBP groups compared with those before the intervention(P=0.07).Conclusion:GBWT is an effective exercise prescription to mitigate the essential hypertension in elderly Chinese patients,and the intensity,walking distance,and target number of steps can be adjusted according to the age of the patients.

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.

Catheter ablation for atrial fibrillation is associated with reduced risk of mortality in the elderly:a prospective cohort study and propensity score analysis

Background It is unclear whether catheter ablation(CA)for atrial fibrillation(AF)affects the long-term prognosis in the elderly.This study aims to evaluate the relationship between CA and long-term outcomes in elderly patients with AF.Methods Patients more than 75 years old with non-valvular AF were prospectively enrolled between August 2011 and December 2017 in the Chinese Atrial Fibrillation Registry Study.Participants who underwent CA at baseline were propensity score matched(1:1)with those who did not receive CA.The outcome events included all-cause mortality,cardiovascular mortality,stroke/transient ischemic attack(TIA),and cardiovascular hospitalization.Results Overall,this cohort included 571 ablated patients and 571 non-ablated patients with similar characteristics on 18 dimensions.During a mean follow-up of 39.75±19.98 months(minimum six months),24 patients died in the ablation group,compared with 60 deaths in the non-ablation group[hazard ratio(HR)=0.49,95%confidence interval(CI):0.30-0.79,P=0.0024].Besides,6 ablated and 29 non-ablated subjects died of cardiovascular disease(HR=0.25,95%CI:0.11-0.61,P=0.0022).A total of 27 ablated and 40 non-ablated patients suffered stroke/TIA(HR=0.79,95%CI:0.48-1.28,P=0.3431).In addition,140 ablated and 194 non-ablated participants suffered cardiovascular hospitalization(HR=0.84,95%CI:0.67-1.04,P=0.1084).Subgroup analyses according to gender,type of AF,time since onset of AF,and anticoagulants exposure in initiation did not show significant heterogeneity.Conclusions In elderly patients with AF,CA may be associated with a lower incidence of all-cause and cardiovascular mortality.

Which prognostic factors should be used in pulmonary arterial hypertension in elderly patients？

In recent times, the prevalence of pulmonary arterial hypertension creased prevalence of hypertension, diabetes, obesity, arterial stiffness, （PAH） is more commonly seen among elderly populations. The inas well as diastolic dysfunction, may cause endothelial dysfunction and affect pulmonary vasculature. Furthermore, older patients have certain differences in clinical characteristics and outcomes. In this article the special characteristics of aging in PAH patients have been reviewed, while the risk predictors of elderly patients are also discussed.

Evaluation of modified hemodilution combined therapy in the treatment of acute ischemic stroke in the elderly

BACKGROUND： Thrombolysis therapy is not suitable for the elderly patients with acute ischemic stroke who delayed to be diagnosed for more than 3 hours, but traditional medicine is also not very ideal. OBJECTIVE： To observe the clinical therapeutic effect of modified hemodilution combined therapy applied in elderly patients with acute cerebral thrombosis and analyze the mechanism of this therapeutic method. DESIGN： 1：1 paired grouping according to gender and controlled observation SETTING： Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University. PARTICIPANTS： Totally 90 elderly patients with acute ischemic stroke who received the treatment in the Cadre Ward and Mental Ward, Department of Internal Medicine, Chengzhanyuan District, First Hospital Affiliated to Zhejiang University from March 1996 to June 2004 were recruited. They all met the diagnosis criteria revised by the Fourth Academic Conference of National Cerebrovascular Diseases in 1995 and were diagnosed as acute ischemic stroke by skull CT. They were informed of therapeutic plan and detected items. According to 1：1 paired principle in gender, 90 enrolled patients were assigned into treated group （n=45） and control group （n=45）. There were 39 male and 6 female in the treatment group, and they were aged （76±6）years, ranging from 71 to 84 years, and hospitalized at the 14^th to 76^th hours after onset. There were 39 male and 6 female in the control group, and they were aged （76±6）years , ranging from 70 to 82 years, and hospitalized at the 16^th to 72^th hours after onset. METHODS： Therapeutic method： Patients of treated group received modified hemodilution combined therapy. 200 mL whole blood of patients was exchanged with 500 mL dextran-40 （including 20 mL danshen parenteral solution and 32 mg heparin） at the beginning of therapy; From the 2^nd day, compound huangqi tea bag （Huangqi mainly, including danshen, honghua, chuanxiong, shishao and a little acetyl salicylic acid） was made, twice a day, 1 bag once. At the same time, the above-mentioned dextran-40 liquid of 500 mL was intravenously injected, once a day, 14 days in total; On the 6^th day after therapy, the above-mentioned aseptic autoblood stored in refrigerator at 4℃ was transfused back into the patients following pre-treatment of high-concentration oxygenation and ultraviolet irradiation by light quantum instrument. Patients of control group were intravenously injected of 0.4 g venoruton（Traditional Chinese medicine compound parenteral solution for promoting blood circulation and removing blood stasis ） and 50 g/L glucose of 500 mL, 75 mg acetosal was taken orally, once a day, 14 days in total. ② Measurement and observation of index： Blood coagulation index, change of platelet aggregation rate and change of hemorrheology of patients in two groups were monitored before and after therapy. The level of blood lipid of patients in two groups was measured with American Beckman automatic biochemistry analyzer. Blood flow rate of middle cerebral artery of resting electrocardiogram were measured with American HP SONOS 2500 sonoscope. Neuro-dysfunction score revised in the national conference （1995） was used to evaluate the recovery of neurological function of the patients in two groups at the 3rd, 5^th, 7^th and 14^th days after therapy. ③Therapeutic effect and adverse effect were observed at the same time. MAIN OUTCOME MEASURES ： ① Changes of coagulation index, blood lipid level and hemorheology; ② Blood flow rate of middle cerebral artery and NDS of patients with acute ischemic stroke in two groups; ③Adverse effect of drug. RESULTS： Totally 90 patients were enrolled in the experiment. One patient from treated group died of hyperosmolar nonketotic diabetic coma of complicated diabetes mellitus. One patient from control group died of severe pulmonary infection. The rest 88 patients entered the stage of result analysis. ① Change of coagulation index and platelet aggregation rate： prothrombin time （PT）, activated partial thromboplastin time （APTT） and thrombin time （TT） of patients after therapy were significantly longer than those before therapy in the treated group and those after therapy in control group [After therapy in treated group： （18.4±1.9）, （41.8±2.1）, （19.7±1.7） s, Before therapy in treated group： （13.4±1.3）, （35.8±1.3）, （12.5±0.9） s, After therapy in control group： （16.9±1.5）, （39.1±1.1）, （11.9±2.1） s, P〈 0.05]：Concentration of fibrinogen （Fbg） after therapy was significantly lower than that before therapy in the treated group and that after therapy in control group[After therapy in treated group： （3.4±0.4） g/L; Before therapy in treated group： （4.3±0.7） g/L; After therapy in control group：（4.0±0.6） g/L; P 〈 0.05]. Platelet aggregation rate decreased from （37.92 ±0.85）% before therapy to （26.42±1.01）% after therapy （P 〈 0.01）. ②Change of blood lipid level： Levels of total cholesterol （TC）, triacylglycerol（TG） and low density lipoprotein cholesterol （LDL-C） of patients after therapy were significantly lower than those before therapy in treated group and those after therapy in control group [After therapy in treated group： （5.2±0.9）, （1.9±0.9）, （2.08±1.1） mmol/L, before therapy in treated group： （5.9±1.2）, （2.8±0.9）, （3.94±0.5） mmol/L, After therapy in control group： （6.0±1.1）, （2.6±0.8）, （3.84±0.9） mmol/L, P 〈 0.05]. ③Change of hemorheology index： Hematocrit of patients of treated group was significantly lower after therapy than before therapy [Before therapy： （43.84±4.55）% ;After therapy： （40.48±4.02）%;P 〈 0.05]. Blood flow rate of middle cerebral artery of patients of treated group was significantly lower before therapy than after therapy [（90±1.2）, （97±2.1） cm/s,P〈 0.01]. ⑤NDS of patients in treated group was significantly lower than of control group 14 days after therapy. The total effective rate after therapy was significantly higher in the treated group than in the control group （93%,78%, P 〈 0.05）. ⑥There was no obvious adverse effect. CONCLUSION： Modified hemodilution combined therapy can improve hemorheology, decrease hematocrit, increase blood flow rate of middle cerebral artery, so as to improve the impaired clinical neurological function of elderly patients with acute cerebral thrombosis through anticoagulation and antiplatelet aggregative activity as well as regulating blood lipid.

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）.

Hypertension in the elderly

The elderly are the most rapidly growing population group in the world.Data collected over a 30-year period have demonstrated the increasing prevalence of hypertension with age.The risk of coronary artery disease,stroke,congestive heart disease,chronic kidney insufficiency and dementia is also increased in this subgroup of hypertensives.Hypertension in the elderly patients represents a management dilemma to cardiovascular specialists and other practioners.During the last years and before the findings of the Systolic Hypertension in Europe Trial were published,the general medical opinion considered not to decrease blood pressure values similarly to other younger patients,in order to avoid possible ischemic events and poor oxygenation of the organs(brain,heart,kidney).The aim of this review article is to highlight the importance of treating hypertension in aged population in order to improve their quality of life and lower the incidence of the cardiovascular complications.

Transjugular intrahepatic porto-systemic shunt in the elderly:Palliation for complications of portal hypertension

AIM:To present a dedicated series of transjugular intrahepatic porto-systemic shunts(TIPS) in the elderly since data is sparse on this population group.METHODS:A retrospective review was performed of patients at least 65 years of age who underwent TIPS at our institutions between 1997 and 2010.Twentyfive patients were referred for TIPS.We deemed that 2 patients were not considered appropriate candidates due to their markedly advanced liver disease.Of the 23 patients suitable for TIPS,the indications for TIPS placement was portal hypertension complicated by refractory ascites alone(n = 9),hepatic hydrothorax alone(n = 2),refractory ascites and hydrothorax(n = 1),gastrointestinal bleeding alone(n = 8),gastrointestinal bleeding and ascites(n = 3).RESULTS:Of these 23 attempted TIPS procedure patients,21 patients had technically successful TIPS procedures.A total of 29 out of 32 TIPS procedures including revisions were successful in 21 patients with a mean age of 72.1 years(range 65-82 years).Three of the procedures were unsuccessful attempts at TIPS and 8 procedures were successful revisions of our existing TIPS.Sixteen of 21 patients who underwent successful TIPS(excluding 5 patients lost to follow-up) were followed for a mean of 14.7 mo.Ascites and/or hydrothorax was controlled following technically successful procedures in 12 of 13 patients.Bleeding was controlled following technically successful procedures in 10 out of 11 patients.CONCLUSION:We have demonstrated that TIPS is an effective procedure to control refractory complications of portal hypertension in elderly patients.