Dynamics of fibrotic and vascular endothelial dysfunction markers in elderly hypertensive patients after ischemic stroke receiving beta-blockers

Aim. To compare the effect of beta-blocker therapy (bisoprolol and nebivolol) on the dynamics of fibrotic and vascular endothelial dysfunction markers in elderly hypertensive patients after ischemic stroke (IS).Material and methods. This prospective cohort study included 75 hypertensive patients who were admitted to the hospital due to IS. The mean age of patients was 67±6 years. The average National Institutes of Health Stroke Scale (NIHSS) score was 7±3. The followup period was 6 months. The control group consisted of 20 elderly people with hypertension without prior myocardial infarction. The patients were divided into groups based on received therapy: group 1 (n=38) — bisoprolol; group 2 (n=37) — nebivolol. The level of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) was determined by enzyme-linked immunosorbent assay (ELISAKit, USA). Vascular ultrasound was carried out using a LOGIQP9 (GE) system according to the Celermajer method.Results. After 6-month nebivolol, we revealed a decrease in the level of MMP-9 by 30,2% (p<0,01), TIMP-1 by 15,6% (p<0,05). After 6-month bisoprolol therapy, the level of MMP-9 decreased by 14,5% (p<0,05), while TIMP-1 did not change. Intergroup comparison found that when using nebivolol, there was a higher decrease in the level of MMP-9 by 15,7% (p<0,05), TIMP-1 by 9,7% (p<0,05), MMP-9/TIMP-1 by 7,8% (p<0,05) than with bisoprolol therapy. After 6-month bisoprolol therapy, there was a decrease in the proportion of patients with severe endothelial dysfunction (ED) by 7,9% (p<0,05). Two patients from the nebivolol group moved into mild ED category. The number of patients with moderate ED increased by 19% (p<0,01), while prevalence of severe ED decreased by 24,4% (p<0,01).Conclusion. The results obtained indicate that the beta-blocker nebivolol at an average dose of 8,55+1,75 mg/day significantly reduces the vascular fibrosis, normalizes the ratio of collagen synthesis and degradation markers, improves the vasodilation brachial artery properties in comparison with bisoprolol in elderly hypertensive patients after IS.

Community Health Management and Nursing Strategies for Elderly Hypertension

Objective: To explore the therapeutic effects of community health management and nursing strategies for elderly hypertensive patients. Methods: A total of 64 elderly hypertensive patients who were treated in our hospital from March 2020 to March 2021 were selected. The control group took conventional care and guidance. The research group carried out community health management and nursing strategy guidance on the basis of the control group. Then compare the blood pressure levels of the two groups of patients before and after nursing and the patients’ satisfaction with nursing. Results: Through comparison, it can be seen that the diastolic and systolic blood pressure levels of the study group and the control group are not significantly different before nursing. After nursing, the diastolic blood pressure of the patients in the study group was 81.22.1 mmHg and the systolic blood pressure was 126.58.7 mmHg. The diastolic blood pressure of the control group was 90.55.4 mmHg and the systolic blood pressure was 136.412.9 mmHg. There are obvious differences in the comparison of the two sets of data. By comparing the two groups of patients’ satisfactions with nursing care, it can be seen that among the 32 patients in the study group: 31 were very satisfied and basically satisfied, with a satisfaction rate of 96.87%. Among the 32 patients in the control group, 28 were very satisfied and basically satisfied, with a satisfaction rate of 87.5%. The data of the two groups of patients are clearly comparable. Conclusion: Through community health management and nursing strategies, the satisfaction and treatment effect of elderly hypertensive patients can be improved, thereby contributing to the recovery of patients.

AMBULATORY BLOOD PRESSURE MONITORING INDICATORS IN MIDDLE-AGED AND ELDERLY HYPERTENSIVE PATIENTS UNDER COMBINED ANTIHYPERTENSIVE THERAPY

It is known that arterial hypertension affects 30-35% of adult population of industrialized countries, and its prevalence reaches 40-50% among the elderly. In recent years, the issue of optimizing of treatment of hypertension in elderly people has been discussed such as choice of effective antihypertensive drugs with the least number of side effects, prevention of complications, reduced mortality, improvement of quality of life. The aim of the study was to substantiate the antihypertensive efficacy of the combination of enalapril and amlodipine in middle-aged and elderly hypertensive patients. Material and methods. Indices of ambulatory blood pressure monitoring were identified in 57 middle-aged patients (45-59 years) (group I) and 43 elderly patients (60-74 years) (group II), who underwent two-week in-patient treatment. All patients received the combined antihypertensive therapy (enalapril 10 mg twice daily and amlodipine 5 mg daily) for 2 weeks. And they were divided into 2 groups of 24 hours day's profile of blood pressure: dippers and non-dippers. Results. The combination of enalapril and amlodipine in elderly patients reduced the average daily diastolic blood pressure by 20,3% (p<0,05). Instead, in middle-aged patients there was the decrease in the average daily and the maximal daily systolic blood pressure by 17,3% (p<0,001) and 7,8% (p<0,05) and diastolic blood pressure respectively − by 23,2% (p<0,001) and 11,8% (p<0,05). Conclusions. Therefore, combined antihypertensive therapy in the elderly for 14 days was insufficient to improve significantly ambulatory blood pressure monitoring indicators. Obviously, positive changes require longer treatment.

Economic Burden of Depressive Symptoms Conditions among Middle-Aged and Elderly People with Hypertension in China

People with hypertension are more prone to incur depressive symptoms, while depressive symptoms have an obvious influence on the healthy functioning, treatment, and management of hypertensive patients. However, there have been limited studies on the association between depression and the economic burden of hypertension. We used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) to estimate the additional annual direct and indirect economic burden of depressive symptoms among middle-aged and elderly hypertensive patients with a multivariable regression model. The depressive symptoms were associated with substantial additional direct and indirect economic burden. Compared with non-co-MHDS (non-co-morbid hypertension and depressive symptoms) patients, the direct economic burden of lower co-MHDS (co-morbid hypertension and depressive symptoms) patients and higher co-MHDS patients increased 1887.4 CNY and 5508.4 CNY, respectively. For indirect economic burden, the lower co-MHDS patients increased 331.2 CNY and the higher co-MHDS patients increased 636.8 CNY. Both direct and indirect economic burden were incremental with the aggravation of depressive symptoms. The results showed depressive symptoms increased total healthcare costs by increasing the utilization and expenditure of primary healthcare services. Depressive symptoms also led to economic loss of productivity, especially for agricultural workers. This study highlights the importance of mental healthcare for hypertensive patients.