Factors associated with intensification of antihypertensive drug therapy in patients with poorly controlled hypertension

Objective To assess antihypertensive management of older patients with poor blood pressure(BP)control.Methods Physicians,voluntary participating in the study,included six consecutive hypertensive patients during routine visits.Hypertension had to have been previously recognized and averaged office BP was>140 and/or>90 mmHg in spite of>6 weeks of antihypertensive therapy.The physicians completed a questionnaire on patients'history of cardiovascular(CV)risk factors,comorbidities,home BP monitoring,anthropometric data and the pharmacotherapy.Results Mean age of the 6462 patients was 61 years,7%were>80 years,51%were female.Mean士SD office BP values were 158士13/92土10 mmHg.The most commonly prescribed antihypertensive drugs were:diuretics(67%),ACE inhibitors(64%),calcium channel blockers(58%)and卩-blockers(54%),and their use increased with age.On monotherapy or dual therapy,43%of the patients and 40%had their latest treatment modification within six months.Home BP monitoring was a factor that accelerated the modification of the therapy.Older patients had to have less chance on faster modification of antihypertensive therapy in spite of presence of diabetes and higher systolic BP.Conclusions Our study suggests that a large number of outpatients with poor BP control receive suboptimal antihypertensive therapy,especially in primary care.In older patients,higher BP values in the office settings are more frequently accepted by physicians even in case of higher CV risk.Regular home BP monitoring hastens the decision to intensify of antihypertensive treatment.

Promoting whole person health:Exploring the role of traditional Chinese medicine in Polish healthcare

Poland has a unique history of traditional Chinese medicine(TCM)dating back to the 17th century when Polish missionary Michael(Michal)Boym was a pioneer in the field.In the 20th century,his successor,Professor Zbigniew Garnuszewski,reintroduced acupuncture to medical practice in Poland.However,other methods of TCM and its holistic approach to patient care have not found their place in modern medicine in Poland.At present,the legal status of TCM in Poland remains unregulated,with TCM included in the broad spectrum of complementary and alternative medicine(CAM)practices.Few reports are available on the use of TCM methods among the Polish population.Integrative medicine combines conventional medicine with evidence-based CAM interventions and considers all aspects of a patient's health,including physical,emotional,mental,social,and environmental factors.An integrative healthcare model that incorporates TCM modalities and lifestyle recommendations as well as a whole person approach may provide a more sustainable solution for the constantly underfinanced Polish healthcare system,which faces challenges of multimorbidity in an aging society and limited access to care.The coronavirus disease 2019 pandemic,war in Ukraine,and ongoing climate crisis have underscored the need to strengthen the resilience of the Polish healthcare system and search for new solutions.A model of care that blends the best of biomedicine and TCM healing approaches may be a better option for both patients and the healthcare system in Poland.