HYPERTENSION IN ELDERLY:OUR CURRENT TRENDS

2021 ◽  
pp. 56-57
Author(s):  
Rohit Arora ◽  
D.K Sharma
Keyword(s):  
Blood Pressure ◽  
Elderly Patients ◽  
The Elderly ◽  
Common Disease ◽  
Old Patients ◽  
Current Trends ◽  
Increased Risk ◽  
Individualized Approach ◽  
Risk Of Falls ◽  
Optimal Target

Hypertension is a common disease in the elderly associated with signicant morbidity and mortality. Due to the complexity of this population, the optimal target of blood pressure (BP) control is still controversial. In this article, we conduct a literature review of trials published in English in the last 10 years which were specically designed to study the efcacy and safety of various BP targets in patients who are 70 years or older. Using these criteria, we found that the benets in the positive studies were demonstrated even with a minimal BPcontrol (systolic BP[SBP] <150 mmHg) and continued to be reported for a SBP<120 mmHg. On the other hand, keeping SBP<140 mmHg seemed to be safely achieved in elderly patients. Although the safety of lowering SBP to <120 mmHg is debated, Systolic Blood Pressure Intervention Trial study has shown no increased risk of falls, fractures, or kidney failure in elderly patients with SBP lower than this threshold. While the recent guidelines recommended to keep BP <130/80 mmHg in the elderly, more individualized approach should be considered to achieve this goal in order to avoid undesirable complications. Furthermore, further studies are required to evaluate BPtarget in very old patients or those with multiple comorbidities.

scholarly journals Целевой уровень артериального давления при лечении артериальной гипертензии у пациентов пожилого возраста с хронической сердечной недостаточностью

2019 ◽  
pp. 8-16
Author(s):  
M.S. CHERNIAEVA ◽  
O.D. OSTROUMOVA
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Cardiovascular Events ◽  
The Elderly ◽  
Target Blood Pressure ◽  
Lower Systolic Blood Pressure ◽  
Reduced Ejection Fraction ◽  
Increased Risk

Высокая распространенность хронической сердечной недостаточности (ХСН) в популяции пожилых пациентов наряду с устойчивым ро- стом численности пожилого населения как в России, так и в западных странах все больше привлекает внимание врачей к проблеме, связан- ной с ведением данного заболевания. Известно, что ведущим фактором риска развития ХСН является повышенное артериальное давление (АД) и большинство пациентов с ХСН имеют в анамнезе артериальную гипертонию (АГ), поэтому лечение пациентов пожилого возраста c АГ и ХСН является одним из важных направлений в профилактике прогрессирования ХСН, снижения количества госпитализаций и смерт- ности. Лечение АГ у пожилых имеет свои особенности, связанные с функциональным статусом пациентов и их способностью переносить лечение. В европейских рекомендациях (2018) пересмотрены целевые цифры АД при лечении АГ у пожилых, однако данные по целевым цифрам АД для лечения АГ у пациентов с ХСН опираются лишь на исследования, проводившиеся у больных без ХСН. Данные об оптималь- ном целевом уровне у пациентов с АГ и ХСН представлены в единичных исследованиях. В настоящей статье проанализирована взаимосвязь уровня АД и сердечно-сосудистых событий и смертности отдельно для пациентов с АГ и сердечной недостаточностью с низкой фракцией выброса левого желудочка и с сохраненной фракцией выброса левого желудочка. Результаты многих исследований показывают, что более низкий уровень систолического АД (120 мм рт. ст.) и диастолического АД (80 мм рт. ст.) ассоциирован с развитием неблагоприятных сердечно-сосудистых событий, особенно у пациентов с сердечной недостаточностью с низкой фракцией выброса левого желудочка.The high prevalence of chronic heart failure (CHF) in the elderly patients, along with the steady growth of the elderly population, both in Russia and in Western countries, is increasingly attracting the attention of doctors to the problem associated with the management of this disease. It is known that the leading risk factor for CHF is high blood pressure (BP) and most patients with CHF have a history of hypertension (H), so the treatment of elderly patients with H and CHF is the major focus in the slowing CHF progression, reducing the heart failure hospitalisation and mortality. Treatment of hypertension in the elderly has some specific features associated with the functional status of patients and their ability to tolerate treatment. The European recommendations (2018) revised target blood pressure levels in the elderly patients, however, data on target blood pressure levels in patients with CHF are based only on studies conducted in patients without CHF, data on the optimal target blood pressure levels in patients with hypertension and CHF are presented in single studies. In this article we analyze the relationship between blood pressure levels and cardiovascular events and mortality separately for patients with hypertension and heart failure with reduced ejection fraction and with preserved ejection fraction. Several studies show that lower systolic blood pressure (120 mm Hg) and diastolic blood pressure (80 mm Hg) is associated with the increased risk of cardiovascular events, especially in patients with heart failure with reduced ejection fraction.

scholarly journals Association of Frailty With the Risk of Mortality and Resource Utilization in Elderly Patients in Intensive Care Units: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Feiping Xia ◽  
Jing Zhang ◽  
Shanshan Meng ◽  
Haibo Qiu ◽  
Fengmei Guo
Keyword(s):  
Intensive Care ◽  
Elderly Patients ◽  
Resource Utilization ◽  
Meta Analysis ◽  
The Elderly ◽  
Cochrane Central Register ◽  
Old Patients ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
The Impact

Background: The associations of frailty with the risk of mortality and resource utilization in the elderly patients admitted to intensive care unit (ICU) remain unclear. To address these issues, we performed a meta-analysis to determine whether frailty is associated with adverse outcomes and increased resource utilization in elderly patients admitted to the ICU.Methods: We searched PubMed, EMBASE, ScienceDirect, and Cochrane Central Register of Controlled Trials through August 2021 to identify the relevant studies that investigated frailty in elderly (≥ 65 years old) patients admitted to an ICU and compared outcomes and resource utilization between frail and non-frail patients. The primary outcome was mortality. We also investigated the prevalence of frailty and the impact of frailty on the health resource utilization, such as hospital length of stay (LOS) and resource utilization of ICU.Results: A total of 13 observational studies enrolling 64,279 participants (28,951 frail and 35,328 non-frail) were finally included. Frailty was associated with an increased risk of short-term mortality (10 studies, relative risk [RR]: 1.70; 95% CI: 1.45–1.98), in-hospital mortality (five studies, RR: 1.73; 95% CI: 1.55–1.93), and long-term mortality (six studies, RR: 1.86; 95% CI: 1.44–2.42). Subgroup analysis showed that retrospective studies identified a stronger correlation between frailty and hospital LOS (three studies, MD 1.14 d; 95% CI: 0.92–1.36).Conclusions: Frailty is common in the elderly patients admitted to ICU, and is associated with increased mortality and prolonged hospital LOS.Trial registration: This study was registered in the PROSPERO database (CRD42020207242).

scholarly journals How to Treat Hepatocellular Carcinoma in Elderly Patients

2021 ◽  
Vol 14 (3) ◽  
pp. 233
Author(s):  
Piera Federico ◽  
Emilio Francesco Giunta ◽  
Annalisa Pappalardo ◽  
Andrea Tufo ◽  
Gianpaolo Marte ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Elderly Patients ◽  
Elderly Population ◽  
Primary Tumour ◽  
The Elderly ◽  
Chronic Liver Diseases ◽  
Old Patients ◽  
Choice Of Treatment ◽  
Definition Of ◽  
Optimal Treatment Strategy

Hepatocellular carcinoma (HCC) is the primary tumour of the liver with the greatest incidence, particularly in the elderly. Additionally, improvements in the treatments for chronic liver diseases have increased the number of elderly patients who might be affected by HCC. Little evidence exists regarding HCC in old patients, and the elderly are still underrepresented and undertreated in clinical trials. In fact, this population represents a complex subgroup of patients who are hard to manage, especially due to the presence of multiple comorbidities. Therefore, the choice of treatment is mainly decided by the physician in the clinical practice, who often tend not to treat elderly patients in order to avoid the possibility of adverse events, which may alter their unstable equilibrium. In this context, the clarification of the optimal treatment strategy for elderly patients affected by HCC has become an urgent necessity. The aim of this review is to provide an overview of the available data regarding the treatment of HCC in elderly patients, starting from the definition of “elderly” and the geriatric assessment and scales. We explain the possible treatment choices according to the Barcelona Clinic Liver Cancer (BCLC) scale and their feasibility in the elderly population.

Two Types of Anesthesia and Hemodynamic Changes in Patients Over 60 Years of Age Who Need Artificial Femoral Head Replacement: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Weiqi Ke ◽  
Yuting WANG ◽  
Xukeng GUO ◽  
Ronghua HUANG ◽  
Xiangdong ZHANG ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Femoral Head ◽  
Elderly Patients ◽  
The Elderly ◽  
Hemodynamic Changes ◽  
Medical College ◽  
Replacement Surgery ◽  
Elder Patients ◽  
Significant Difference ◽  
And Gender

Abstract Background:Artificial femoral head replacement is one of the most effective methods for treatment of severe diseases of femoral joint in the elderly. The ideal anesthetic effect is one of the key elements for the success of the operation because it brings fast recovery. However, the multiple comorbidities of the elder patients make them too weak to tolerate the hemodynamic changes after anesthesia. In this case, the most suitable anesthesia method for patients undergoing femoral head replacement surgery is of great significance.Objective:To compare the post-anesthetic hemodynamic changes between combined lumbar plexus and sciatic nerve block(CLPSB) and combined spinal and epidural anesthesia(CSEA) in elderly patients undergoing unilateral artificial femoral head replacement.Methods:We reviewed records of the patients who aged over 60 years old (age 62-103 years) and received unilateral artificial femoral head replacement between January 2015 and December 2020 in the first affiliated hospital of Shantou University Medical College. After adjustment according to the inclusion criteria, 477 patients were included and divided into CLPSB group (n=90) and CSEA group (n=387). The primary outcome was comparison of the hemodynamic changes after anesthesia, including the systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR). The second outcome was the comparison of the vasopressor used during the surgery.Results:We established three models to compare the two anesthesia methods on hemodynamic changes. Crude model included all variates for analysis, while model I adjusted age and gender. Model II adjusted other comorbidities in addition to model I. All three models exhibit that changes of MAP (∆MAP) after CSEA were higher than that after CLPSB(β= 6.88, 95% CI: 4.33 - 9.42, P < 0.0001), with significant difference, which indicated that CSEA causes higher fluctuation of MAP. Concurrently, the use of vasopressors increased by 137% (OR=2.37, 95%CI: 1.24-4.53, P=0.0091) in the CSEA group, which is statistically significant. However, the changes of HR (∆HR) between the CLPSB and CSEA was not significant(β= 0.50, 95% CI: 1.62 - 2.62, P = 0.6427). Conclusions:Both CLPSB and CSEA are ideal anesthesia methods for patients receiving femoral head eplacement, though CLPSB is more suitable for elderly patients with advanced hemodynamic stability.

PREVALENCE AND FEATURES OF GERIATRIC SYNDROMES TREATMENT IN OLD PATIENTS (CLINICAL AND EPIDEMIOLOGICAL STUDY)

2020 ◽  
pp. 331-338
Author(s):  
Е. Д. Голованова ◽  
Н. Е. Титова ◽  
Т. Е. Афанасенкова ◽  
И. А. Аргунова ◽  
Т. Н. Янковая ◽  
...  
Keyword(s):  
Geriatric Patients ◽  
Age Groups ◽  
Older Age ◽  
Age Dependence ◽  
Old Patients ◽  
Increased Risk ◽  
Planning Treatment ◽  
Risk Of Falls ◽  
Gender Characteristics ◽  
Outpatient Practice

Изучали распространенность хронических неинфекционных заболеваний (ХНИЗ) у пациентов пожилого и старческого возраста во взаимосвязи с синдромом старческой астении, распространенность саркопении в зависимости от гендерных особенностей и частоту встречаемости синдрома падений у пациентов старших возрастных групп с саркопенией. Анализировали особенности медикаментозной терапии в амбулаторной практике. Использовали метод комплексной гериатрической оценки у 528 пациентов, разделенных на три возрастные группы (65-74 года, 75-84 года, 85 лет и старше). Оказалось, что в структуре ХНИЗ у пациентов гериатрического профиля преобладают артериальная гипертензия, ИБС, а также их осложнения - ХСН и фибрилляция предсердий, частота встречаемости которых имеет выраженную возрастную зависимость и увеличивается у больных со старческой астенией. Для пациентов старших возрастных групп обоего пола характерно увеличение частоты встречаемости саркопении и связанного с ней повышенного риска синдрома падений, что необходимо учитывать при планировании лечебно-реабилитационных мер как в стационаре, так и при оказании первичной медикосоциальной помощи. We studied the prevalence of chronic non-communicable diseases (CND) in elderly and senile patients in conjunction with the syndrome of senile asthenia, the prevalence of sarcopenia depending on gender characteristics and the frequency of occurrence of the falls syndrome in patients with sarcopenia of older age groups. The features of drug therapy in outpatient practice were analyzed. The method of complex geriatric assessment was used in 528 patients divided into 3 age groups (65-74 years, 75-84 years, 85 years or more). It turned out that in the structure of CND in geriatric patients dominated: arterial hypertension, coronary heart disease, and their complications - chronic heart failure and atrial fi brillation their incidence has a pronounced age dependence and increases in patients with senile asthenia. Patients of older age groups of both sexes are characterized by an increase in the incidence of sarcopenia and the associated increased risk of falls syndrome, which must be taken into account when planning treatment and rehabilitation measures both in the hospital and when providing primary medical and social care.

Abstract P329: White Matter Score Does Not Predict Post-tPA Hemorrhage in Elderly Patients Evaluated Acutely via Telestroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Muhammad Bilal Tariq ◽  
Shekhar Khanpara ◽  
Eliana Bonfante Mejia ◽  
Liang Zhu ◽  
Christy T Ankrom ◽  
...  
Keyword(s):  
White Matter ◽  
Elderly Patients ◽  
The Elderly ◽  
Periventricular White Matter ◽  
Severe Stroke ◽  
Age Related ◽  
Increased Risk ◽  
Symptomatic Intracranial Hemorrhage ◽  
Relationship Of ◽  
Patient Presentation

Background: While tPA may be safe in the elderly, increasing age appears to augment risk of post-tPA symptomatic intracranial hemorrhage (sICH). Age-related white matter changes (ARWMC) are associated with increased sICH. Patients evaluated for acute ischemic stroke (AIS) via telestroke (TS) may not have access to MRI to allow incorporation of microbleeds in tPA decisions. We assessed if increased CT-based ARWMC was associated with increased sICH in elderly patients. Methods: Patients 80 years and older who received tPA for AIS at spoke hospitals were selected from our TS network registry from 9/2015 to 12/2018. TS spoke CT scans from patient presentation were reviewed by three of the authors for periventricular white matter (PWMC) and deep white matter (DWMC) changes. Total ARWMC score, based on the Fazekas score, was collected. Total ARWMC score was either mild (0-2), moderate (3-4), or severe (5-6). PWMC and DWMC were either mild (0-1) or moderate-severe (2-3). Logistic regression adjusted for age, sex, race, ethnicity, NIHSS and premorbid mRS was used to analyze relationship of ARWMC scores with sICH and patient-outcomes. Results: Of 241 patients, median age overall was 86 years (IQR 83-90), and 66% were female. The overall median ARWMC score was 3 (IQR 2-5). Regression analysis showed that more severe ARWMC scores did not lead to higher frequency of post-tPA ICH (moderate OR 0.57, CI 0.19-1.71; severe OR 1.32, CI 0.48-3.65) including sICH (moderate OR 0.78, CI 0.21-2.94; severe OR 2.09, CI 0.62-7.02). Similarly, severe PWMC and DWMC were not associated with increased risk of post-tPA ICH (PWMC OR 1.31, CI 0.51-3.38; DWMC OR 1.25, CI 0.52-3.01), including sICH (PWMC OR 1.61, CI 0.51-5.08; DWMC OR 1.81, CI 0.65-5.01). In our cohort, older patients had no difference in hemorrhage (ICH OR 0.93 CI 0.85-1.00: sICH OR 0.95 CI 0.86-1.04), and patients with less severe stroke were more likely to have hemorrhage (ICH OR 1.06 CI 1.02-1.10; sICH OR 1.08 CI 1.03-1.13). IRR among the CT scan readers was moderate (k=0.504). Conclusions: ARWMC scores were not associated with post-tPA ICH in the elderly. Our analysis lends support for the use of tPA despite severity of white matter disease. ARWMC should not be used to assist in tPA decision-making in elderly patients via telestroke.

scholarly journals Assessment of risk of falls and internal risk factors in elderly patients who need heart pacemarkers

2021 ◽  
Vol 2 (9 (297)) ◽  
pp. 1-8
Author(s):  
Guoda Burneikaitė ◽  
Lina Spirgienė
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Fall Risk ◽  
Pacemaker Implantation ◽  
Leg Pain ◽  
Old Patients ◽  
Fall Risk Factor ◽  
Fall Risk Factors ◽  
Experienced Fatigue ◽  
Risk Of Falls

Abstract. The aim is to assess the frequency of falls and intrinsic fall risk factors in patients requiring pacemakers. Methodology. The research was conducted from November 2020 to February 2021. Participated patients were hospitalized at the LUHS hospital Kauno Klinikos Department of Cardiology and required heart pacemaker implantation. Total 82 patients participated in the study. The questionnaire was composed by the authors of the research. The study was obtained by the Bioethics Permit of the Medical Academy of LUHS (No. BEC-SL (B) -42). Results. Almost half of the patients fell (45.1%) at least once a year. Elderly patients (65 years and older) are more likely to experience falls than patients under 65 years of age p=0,006. Elderly patients are more often exposed to various internal risk factors of falls: urination at night (82,9 %), weakness (82,9 %), dizziness (76,8 %). Perceived decreased leg muscle strength was found in both women and men (69.6% and 52.8%, respectively, p = 0.002). Patients older than 65 years and therefore <65 years experienced leg pain (54,9% and 7,2%, respectively, p = 0.002), urination at night (68,4% and 14,6%, respectively, p = 0.009), and experienced fatigue (63,0% and 13,6%, p = 0.028). Conclusions. Almost half of the patients who were in need of heart pacemaker implantation experienced falls. ≥ 65 years old patients experienced falls more than once a year. It has been found that these patients often experience weakness, fatigue, and dizziness. A common intrinsic fall risk factor is urination at night. ≥ 65 years old patients have more internal falls risk factors than patients under 65 years old.

scholarly journals Faktor Determinan yang Berhubungan dengan Upaya Pengendalian Hipertensi di PSTW Budi Luhur Kota Jambi

2020 ◽  
Vol 9 (2) ◽  
pp. 234
Author(s):  
Fithriyani Fithriyani ◽  
Miko Eka Putri
Keyword(s):  
Blood Pressure ◽  
Elderly People ◽  
The Elderly ◽  
Smoking History ◽  
Bivariate Analysis ◽  
Projection Data ◽  
Moderate Activity ◽  
Cross Sectional ◽  
Major Health Problem ◽  
Increased Risk

Aging is a natural process that can not be avoided, running continuously, and continuously. Based on population projection data the number of elderly people will increase where the most number is found at the age of 60-64 years 94,012 people. Increasing age decreases bodily functions, decreased organ function and changes in blood pressure, therefore the elderly are advised to check their blood pressure regularly. As they age, blood pressure in the elderly will increase so that there is a higher risk of developing hypertension. Hypertension is a major health problem throughout the world, causing a high prevalence and is associated with an increased risk of cardiovascular disease. Some things that need to be considered in an effort to control hypertension include regular exercise, adequate rest, medical, traditional, regulate diet and reduce salt consumption one teaspoon per day. The purpose of this study was to determine the determinants and factors associated with efforts to control hypertension in the elderly at PSTW Budi Luhur, Jambi City. The research method uses descriptive analysis design with cross sectional approach. Samples were conducted for the elderly with hypertension. The research instrument was in the form of questionnaire sheets by interview. The results obtained 40% of elderly people have a history of smoking, 45% are quite good in consuming food, 60% elderly with moderate activity and 60% elderly are good in controlling hypertension. The results of bivariate analysis showed that there was no correlation between determinant factors (smoking history, food consumption, physical activity) and hypertension control efforts in the elderly in PSTW Budi Luhur, Jambi City

Success ful Kyphoplasty in the Presence of Severe Retropulsion of Lumbar Spine without Neurological Deficits

2020 ◽  
pp. 127-130
Author(s):  
Ruben H. Schwartz
Keyword(s):  
Lumbar Spine ◽  
Compression Fracture ◽  
Disease Process ◽  
The Elderly ◽  
Fracture Pattern ◽  
Neurological Deficits ◽  
Vertebral Compression Fractures ◽  
Common Disease ◽  
Fracture Formation ◽  
Increased Risk

Background: Vertebral compression fractures are common causes of back pain in the aging patient population. Osteoporosis is an extremely common disease process within the elderly population, especially females, placing these patients at an increased risk of compression fracture formation. Besides pain, the fracture pattern can increase the risk of neurological compromise as well. Retropulsed fragments of the vertebral body cause impingement on the spinal canal and can be catastrophic. Case Report: We present the case of a 72-year-old man with 5 mm retropulsion of the lumbar spine at the L1 level without signs of neurological compromise. This extensive amount of retropulsion causing no signs of weakness is rare. He was subsequently successfully treated with kyphoplasty after failed conservative therapies. Conclusions: A case by case basis must be utilized when considering kyphoplasty for patients with retropulsion of the spine. If a patient’s pain persists after conservative therapy, then kyphoplasty can be utilized with full knowledge of the risks involved. Key words: Retropulsion, kyphoplasty, lumbago, spinal stenosis

scholarly journals Prevalence of Hypertension and Its Associated Risk Factors among 34,111 HAART Naïve HIV-Infected Adults in Dar es Salaam, Tanzania

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Marina Njelekela ◽  
Alfa Muhihi ◽  
Akum Aveika ◽  
Donna Spiegelman ◽  
Claudia Hawkins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Dar Es Salaam ◽  
Hiv Treatment ◽  
Overweight And Obesity ◽  
Disease Stage ◽  
Old Patients ◽  
Increased Risk ◽  
History Of ◽  
Associated Risk Factors

Background. Elevated blood pressure has been reported among treatment naïve HIV-infected patients. We investigated prevalence of hypertension and its associated risk factors in a HAART naïve HIV-infected population in Dar es Salaam, Tanzania.Methods. A cross-sectional analysis was conducted among HAART naïve HIV-infected patients. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg and/or diastolic blood pressure (DBP) ≥ 90 mmHg. Overweight and obesity were defined as body mass index (BMI) between 25.0–29.9 kg/m2and ≥30 kg/m2, respectively. We used relative risks to examine factors associated with hypertension.Results. Prevalence of hypertension was found to be 12.5%. After adjusting for possible confounders, risk of hypertension was 10% more in male than female patients. Patients aged ≥50 years had more than 2-fold increased risk for hypertension compared to 30–39-years-old patients. Overweight and obesity were associated with 51% and 94% increased risk for hypertension compared to normal weight patients. Low CD4+ T-cell count, advanced WHO clinical disease stage, and history of TB were associated with 10%, 42%, and 14% decreased risk for hypertension.Conclusions. Older age, male gender, and overweight/obesity were associated with hypertension. Immune suppression and history of TB were associated with lower risk for hypertension. HIV treatment programs should screen and manage hypertension even in HAART naïve individuals.

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