Lege Artis Medicinae

[Hypertension in the elderly - critical review of diagnostic-therapeutic guidelines and their background]


SEPTEMBER 20, 2012

Lege Artis Medicinae - 2012;22(08-09)

[In the majority of old and very old hypertensive patients, the reduction of abnormally high blood pressure has been proved to provide a strategic defense of target organs. In patients younger than 80 years, both initial and target blood pressure (BP) values are similar to those of younger age groups. In those older than 80 years, a a systolic blood pressure level >160 mmHg is the threshold of indication for antihypertensive treatment and the therapeutic target value is<150 mmHg. Both values are evidence- based (HYVET). The latest ACCF/AHA guidelines (USA 2011) advise to achieve a BP below 140 mmHg if the use of one or two antihypertensive agents result in sufficient BP reduction. However, this strategy is not yet supported by unequivocal evidence regarding complications in target organs. It is not recommended to aim for target levels lower than the above values (especially the value defined by the ESH guidelines) even in elderly hypertensive patients at high cardiovascular risk, as the results of several studies suggest a J-curve effect. In multimorbid elderly patients it is highly important to adapt antihypertensive treatment to individual needs, rather than to use schematic approaches. The number and progression of comorbid diseases can greatly influence, in certain cases attenuate the aimed BP reduction. A similar medical decision should be made if the target BP level could only be achieved by the combination of multiple antihypertensive medications, which can remarkably impair quality of life in elderly patients. Among non-comorbid elderly patients with hypertension, there seems to be no convincing difference in the efficiency of target organ protection between antihypertensive treatments that have different target sites but can achieve similar target levels. However, the majority of elderly hypertensive patients have comorbidities with variable rates of progression. In those at even low cardiometabolic risk the use of beta-receptor blockers (BRB) and especially a combination of BRB+diuretic (DIU) is not recommended. The adequate therapeutic tactic includes the use of only moderate drug-doses and their early combination. This approach has been convincingly proved mainly with early combinations of RAS inhibitors+CCB-s and RAS inhibitors+small doses of DIU-s. It is very important to monitor the treated patients, as the BP and circulatory response to the same antihypertensive treatment can markedly change in elderly patients when either the enviromental conditions change or a new pathologic process develops and/or is treated. Strict control is also necessary because it occurs quite often that the earlier optimal compliance of elderly patients in taking antihypertensive medicines rapidly deteriorates. The efficiency of statins and acetylsalicylic acid decreases over 80 years of age, but this does not indicate that the previously efficient approach should be suspended.]



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[Therapeutic potential and risks of ayahuasca]

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[Ayahuasca, which originates from the Amazon Basin, is a psychoactive brew of two components. Its active agents are betacarboline and tryptamine derivatives. Near the spring of the Amazon River this brew is still a central component of many healing and tribal rituals. During the past few decades, the substance has become known among both laymen and scientistss and nowadays its use is spreading all over in Europe. In the present paper we give an overview of the scientific research and describe ayahuasca's main features, the main questions raised over its use, the risk factors and potential benefits. A growing number of scientific results seem to support the psychotherapeutic potential of ayahuasca, which has a strong serotonergic effect, whereas studies on its effect on the immune system also raise the possibility that certain ethno-medical observations can be scientifically proved.]

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[Stress load and health risk behaviour among medical, dental and pharmacy school students]

SIMA Ágnes, KOVÁCS Eszter, CSEH Károly, BALÁZS Péter

[INTRODUCTION - This study aims to analyse interrelations of stress load, mental state and work related symptoms with health risk behaviour of medical, dental and pharmacy school students. SAMPLE AND METHODS - 473 fourthyear students participated, 73.4% of medical, 10.1% of dental and 16.5% of pharmacy school. Measuring stress, we used the validated version of Anderson's questionnaire for mental, physical and work related divisions. Those with high level of stress on the score system entered the risk groups in the relevant divisions. Among health risks, tobacco smoking, alcohol consume, illegal drugs and psychoactive pharmaceuticals were measured. RESULTS - 15.2% of students perceived mental and 7.8% physical complaints. Work related symptoms were in 26.0% indicated. The overall prevalence of health risks were found to be 12.1% for smoking, 36.2% for drinking, 30.9% for drug use and 9.1% for taking pharmaceuticals. There was a significant (p<0.001) association between taking pharmaceuticals and all the three risk divisions. CONCLUSIONS - The prevalence of smoking is low in all student groups, but three out of ten students are regularly consuming alcohol and some kind of illegal drugs, yet there is no significant association between these health risks and the stress phenomena. Using pharmaceuticals is relatively less frequent, but it must be concerned that these drugs are taken primarily to manage stress related problems.]

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