scholarly journals Current guidelines and controversies in the diagnosis and therapy of hypertension in the elderly and very elderly — a review of international recommendations

2020 ◽  
Vol 24 (1) ◽  
pp. 1-9
Author(s):  
Piotr Zieleniewicz ◽  
Tomasz Zdrojewski
Keyword(s):  
The Elderly ◽  
Very Elderly ◽  
Diagnosis And Therapy ◽  
Current Guidelines ◽  
Therapy Of Hypertension

scholarly journals Pacemaker therapy in the elderly and very elderly: comorbidity-burden vs age, as prognostic factors for excess of length of in-hospital stay, complications and mortality

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Marschall ◽  
H Del Castillo Carnevali ◽  
F Goncalves Sanchez ◽  
M Torres Lopez ◽  
F A Delgado Calva ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Elderly Patients ◽  
Hospital Stay ◽  
The Elderly ◽  
Very Elderly ◽  
Pacemaker Therapy ◽  
Clinical Scenarios ◽  
Comorbidity Burden ◽  
The Impact ◽  
Complications And Mortality

Abstract Background The number of elderly patients undergoing pacemaker (PM) implantation is constantly growing. However, information on survival and prognostic factors of this particular patient group is scarce. Recent studies suggest that comorbidity burden may have an equal, if not greater, effect on length of in-hospital stay (LOS), complications and mortality, as age in a variety of clinical scenarios. Objective The objective of this study was to determine the survival of elderly and very elderly patients undergoing PM implantation, as well as to investigate the impact of comorbidities, as compared to age, on excess of length of in-hospital stay and mortality. Methods This is a retrospective observational study of a single centre. Patients that underwent (both elective and non-elective) PM implantation between June 2016 and December 2018 in our centre, were included for chart review. Elderly patients were defined as those with age 80–89 years, whereas very elderly patients were defined as those with ≥90 years of age. Excess in LOS was defined as an in-hospital stay >3 days. Results A total of 507 patients were included in the study with a mean age of 80.6 (±8.5) years. 255 elderly and 60 very elderly patients were included. Median follow-up time was 24 months. Baseline clinical characteristics are presented in Table 1. The mortality rate for elderly patients was 18.8% for the elderly and 36.7% for the very elderly (p=0.002). The presence of ≥2 comorbidities (defined in Table 1) resulted to be a significant predictor for the excess of LOS, whereas age did not significantly predict excess of LOS (HR: 7.1 (4.4–11.4), p<0.001); HR: 1.01 (0.9–1.1), p=0.56, respectively). Neither age, nor comorbidity burden predicted the appearance of device related complications. Both comorbidites and age predicted mortality. However, the association was stronger for the presence of comorbidites, than for age (HR: 1.9 (1.1–3.1), p=0.002 vs HR: 1.1 (1.1–1.2), p<0.001, respectively). Elderly patients with low comorbidity burden (<2 comorbidities) showed no significant differences with regards to LOS and mortality when compared to younger patients (2 (2–4) vs 3 (2–5) days, p=0.529 and 18.3% vs 17.4%, p=0.702; respectively). Conclusions Our study shows a good life expectancy of elderly and very elderly patients, that underwent PM implantation, with a survival rate that is comparable to the general population. Comorbidity burden, rather than age, significantly predicts excess of LOS and should therefore be the driving factor in the approach of patients undergoing new PM implantation. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Hypertension in the elderly

2012 ◽  
Author(s):  
Giuliano Pinna ◽  
Claudio Pascale ◽  
Micaela La Regina ◽  
Francesco Orlandini
Keyword(s):  
Blood Pressure ◽  
Healthy Lifestyle ◽  
The Elderly ◽  
Consensus Conference ◽  
Lifestyle Changes ◽  
Isolated Systolic Hypertension ◽  
Very Elderly ◽  
Pharmaceutical Therapy ◽  
High Prevalence ◽  
Treatment Of Hypertension

IntroductionThere is a high prevalence of hypertension in the elderly, as evidenced by clinical and health behavioral policies. Still, there are uncertainties on the treatment of hypertension, especially treatment of the very elderly. These considerations have largely been ignored in clinical trials due to concern regarding contamination by other pathologies that are difficult to frame and manage.Methods We performed an effective and ample literature review and provided reflections on the Consensus Conference ACCF/AHA 2011 on the principle types of hypertension found in the elderly. We also considered the associated principle pathologies for various treatments and related organs.Discussion Even if the goal of treatment of elevated blood pressure in the elderly is same as in younger population, it is no longer certain that a target systolic blood pressure (SBP) <140 mmHg should be persistently reached in the very elderly. It is important to note that for all studies these values have never been reached. In the treatment of isolated systolic hypertension (ISH) the preferred target is a SBP >160 mmHg. Treating hypertension in the elderly and very elderly reduces the risk of stroke and heart failure, though the evidence is inconclusive for all-cause mortality.Conclusion Hypertension in the elderly is very common and needs to be treated with criteria that consider the patient's age, comorbidities, lifestyle and adherence. Above all, in the very elderly, therapeutic treatment should be personalized according to the above criteria. Where possible pharmaceutical therapy should be limited at the preference of healthy lifestyle changes (physical activity, diet, etc.).

Influence of Autologous Arteriovenous Fistula on the Blood Supply to the Hand in Very Elderly Hemodialyzed Patients

2005 ◽  
Vol 6 (2) ◽  
pp. 83-87 ◽  
Author(s):  
M. Kusztal ◽  
W. Weyde ◽  
W. Letachowicz ◽  
T. Porazko ◽  
M. Krajewska ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Blood Supply ◽  
The Elderly ◽  
Arterial Disease ◽  
Very Elderly ◽  
Non Invasive ◽  
Patients With Diabetes ◽  
Peripheral Arterial ◽  
Invasive Diagnostics ◽  
Steal Syndrome

Introduction Arteriovenous fistula (AVF) creation for hemodialysis (HD) could predispose to local arterial insufficiency of the hand (steal syndrome). Patients with diabetes mellitus, peripheral arterial disease and elderly patients tend to have a higher risk of hand ischemia. Purpose and methods To estimate the influence of AVF on the blood supply to the hands in the elderly population and to identify steal syndrome cases by non-invasive diagnostics (finger photoplethysmography (PPG), pulse volume recording (PVR), Doppler analysis and pulseoxymetry). The evaluation was carried out in 25 random patients (10 females, 15 males) >75 yrs of age (79.6 ± 3.87 yrs), whose functioning autologous AVFs had been placed at least 1 month previously. Results Mean PPG and PVR amplitudes did not differ in statistical analysis (p > 0.05) between hands with and without an AVF. One patient (4%) with end-to-side anastomosis was diagnosed with steal syndrome (typical manifestation confirmed in PPG, Doppler and pulseoxymetry). Two other patients with high brachiocephalic anastomosis presented subclinical steal syndrome (only low PPG and PVR). Conclusions Even in the very elderly, AVF creation should be considered due to a lesser influence on the blood supply to the hands. Non-invasive diagnostics used by us seemed to be useful in identifying steal syndrome after AVF creation.

scholarly journals Clinical evolution of adult, elderly and very elderly patients admitted in Intensive Care Units

2011 ◽  
Vol 19 (6) ◽  
pp. 1344-1351 ◽  
Author(s):  
Verônica Cunha Rodrigues de Oliveira ◽  
Lilia de Souza Nogueira ◽  
Rafaela Andolhe ◽  
Katia Grillo Padilha ◽  
Regina Marcia Cardoso de Sousa
Keyword(s):  
Intensive Care ◽  
Mortality Rate ◽  
Elderly Patients ◽  
Comparative Study ◽  
Clinical Outcomes ◽  
Intensive Care Units ◽  
The Elderly ◽  
Simplified Acute Physiology Score ◽  
Adult Patients ◽  
Very Elderly

This study compared clinical outcomes among adult, elderly and very elderly patients admitted to Intensive Care Units (ICUs) located in São Paulo, Brazil. This retrospective, longitudinal and comparative study included 279 adult (≥18 and <60 years), 216 elderly (≥60 and <80 years) and 105 very elderly (≥80 years) patients. Adult patients differed from other groups regarding the unit to which they were referred and severity, according to the Simplified Acute Physiology Score II. Adults were most frequently sent to hospitalization wards; elderly and very elderly patients who survived hospitalization in critical units showed sharper improvement before discharge. There were differences in relation to mortality between adult and elderly patients, with a higher rate in the elderly group; however, the mortality rate of very elderly and adult patients was similar. In general, the results indicated that older age was not associated with undesirable outcomes in ICUs.

scholarly journals Antihypertensive Treatment in the Elderly and Very Elderly: Always “the Lower, the Better?”

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Alberto Mazza ◽  
Emilio Ramazzina ◽  
Stefano Cuppini ◽  
Michela Armigliato ◽  
Laura Schiavon ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Clinical Trials ◽  
Antihypertensive Treatment ◽  
Antihypertensive Drugs ◽  
The Elderly ◽  
Organ Damage ◽  
Very Elderly ◽  
Age Dependent ◽  
Prolongation Of Life ◽  
Per Se

Arterial hypertension (HT) is age dependent and, with the prolongation of life expectancy, affects more and more elderly people. In the elderly, HT is a risk factor for organ damage and cardiovascular (CV) events. Both pharmacologic and nonpharmacologic reduction of blood pressure (BP) is associated with a corresponding decrease in systolic-diastolic or isolated systolic HT. Clinical trials have shown that BP lowering is associated with a decrease in stroke and other CV events. Therefore, BP reductionper seappears more important than a particular class of antihypertensive drugs. The benefit of antihypertensive treatment has been confirmed up to the age of 80 years, remaining unclear in the octogenarians. The benefit in lowering diastolic BP between 80 and 90 mmHg is well established, while that of lowering systolic BP below 140 mmHg requires further confirmations.

scholarly journals Combination therapy for hypertension in the elderly: a sub-analysis of the Combination Therapy of Hypertension to Prevent Cardiovascular Events (COPE) Trial

2012 ◽  
Vol 35 (4) ◽  
pp. 441-448 ◽  
Author(s):  
Toshio Ogihara ◽  
◽  
Masunori Matsuzaki ◽  
Seiji Umemoto ◽  
Hiromi Rakugi ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Cardiovascular Events ◽  
The Elderly ◽  
Therapy Of Hypertension
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