Nocturnal hypertension represents an uncontrolled burden in patients with metabolic dysfunction-associated steatotic liver disease
Journal of Hypertension,
Год журнала:
2025,
Номер
unknown
Опубликована: Фев. 4, 2025
Background&Aims:
Metabolic
dysfunction-associated
steatotic
liver
disease
(MASLD)
is
an
independent
risk
factor
for
cardiovascular
morbidity
and
mortality.
Another
critical
in
these
patients
arterial
hypertension
(AH).
Although
it
estimated
that
50%
of
MASLD
are
suffering
from
AH,
24-h
ambulatory
blood
pressure
monitoring
(24-h-ABPM),
the
gold
standard
diagnosing
hypertension,
often
neglected.
However,
only
24-h-ABPM
can
identify
subtypes,
particularly
nocturnal
(NH),
which
a
stronger
predictor
mortality
than
daytime
or
pressure.
The
aim
this
study
was
to
investigate
prevalence
NH
associated
factors.
Methods:
To
end,
226
with
without
known
AH
were
prospectively
recruited
outpatient
department
underwent
together
repeated
office-blood-pressure
measurements.
Results:
datasets
218
included
final
analysis.
observed
112
(51.3%),
whom
54
(48.2%)
receiving
antihypertensive
treatment
(uncontrolled
hypertension).
Univariable
regression
analysis
showed
age,
increased
waist-to-hip
ratio,
waist-to-height
ratio
≥0.5,
type
2
diabetes
mellitus
(T2DM),
dyslipidemia,
lower
glomerular
filtration
rate
stiffness
significantly
higher
NH.
In
multivariable
analysis,
T2DM
[odds
(OR)
2.56;
95%
confidence
interval
(CI)
1.09–6.23;
P
=
0.033],
dyslipidemia
(OR
3.30;
CI,
1.67–6.73;
0.001)
1.09;
1.02–1.18;
0.021)
identified
as
Conclusions:
conclusion,
accompanying
T2DM,
should
undergo
detect
treat
NH,
they
at
highest
adverse
events.
Clinical
trial:
NCT-04543721
Язык: Английский
Perspectives on deprescribing in older people with type 2 diabetes and/or cardiovascular conditions: challenges from healthcare provider, patient and caregiver perspective and interventions to support a proactive approach
Expert Review of Clinical Pharmacology,
Год журнала:
2024,
Номер
17(8), С. 637 - 654
Опубликована: Авг. 2, 2024
For
people
with
type
2
diabetes
and/or
cardiovascular
conditions,
deprescribing
of
glucose-lowering,
blood
pressure-lowering
lipid-lowering
medication
is
recommended
when
they
age,
and
their
health
status
deteriorates.
So
far,
rates
these
so-called
cardiometabolic
medications
are
low.
A
review
challenges
interventions
addressing
in
this
population
pertinent.
Язык: Английский
Harm vs. benefit of antihypertensive treatment in very old and frail people – do not miss the forest for the trees
Journal of Hypertension,
Год журнала:
2023,
Номер
41(10), С. 1551 - 1553
Опубликована: Авг. 29, 2023
In
recent
years,
population
ageing
has
led
to
a
substantial
increase
in
the
number
of
older
hypertensive
persons
requiring
medical
attention
and
management
hypertension
adults
become
major
public
health
concern
[1].
Accumulating
evidence
encourages
more
intensive
blood
pressure
(BP)
lowering
patients,
showing
reduced
risk
cardiovascular
events
mortality
patients
receiving
strict
BP
control,
also
at
old
age
[2,3].
Yet,
benefits
treatment
may
come
expense
significant
hypotension-related
adverse
events,
particularly
older,
multimorbid
frail
patients.
Indeed,
aggressive
predispose
syncope
falls,
potentially
resulting
severe
injuries,
decline
functional
autonomy
disability
[4–6].
Symptoms
associated
with
low
BP,
for
example,
fatigue,
sensory
deficits
orthostatic
intolerance,
significantly
impair
individuals'
well
being
quality
life,
leading
anxiety
restriction
working
social
activities
[7].
Finally,
control
negatively
affect
renal
function
cognitive
performance
[8].
While
consequences
high
are
known,
there
is
limited
awareness
potential
complications
very
from
antihypertensive
therapy.
scarcely
investigated
clinical
trials
likely
underestimated
due
highly
selective
inclusion
criteria
precluding
frailty
multimorbidity
eligible
[9–11].
The
review
by
Shantsila
et
al.[12],
which
published
current
issue,
extensively
discusses
limitations
existing
as
regards
above
80
years
age.
authors
illustrate
discrepancy
between
interventional
study
samples
'real-world'
geriatric
population,
derives
underrepresentation
frailer
individuals
selected
research
settings
or
application
restrictive
enrolment
procedures.
Such
accounts
several
'gaps
evidence'
concerning
vulnerable
subgroups,
include
strategies,
targets
deprescribing
criteria.
al.
highlight
cardiovascular,
musculoskeletal,
endocrine
age-related
phenomena,
disturb
maintenance
homeostasis
adults,
thus
predisposing
them
hypotension
related
complications.
Autonomic
aging,
impaired
baroreflex
sensitivity
chronotropic
heart
rate
response,
hamper
postural
postprandial
responses,
while
arterial
stiffness
reduce
tissue
perfusion.
Numerous
conditions
increased
falls
frequently
combine
context
multimorbidity,
gait
balance
disorders,
muscle
loss,
autonomic
dysfunction,
deficits.
changes
glomerular
tubular
alter
drug
excretion,
electrolyte
volume,
increasing
accumulation,
dehydration,
disorders.
Over
last
decades,
prevention
clearly
emerged
healthcare
priority
role
factors
have
been
emphasized,
order
identify
highest
who
deserve
strategies.
On
other
hand,
given
overlooked
practice.
Hypotensive
consist
and/or
might
limit
benefits.
At
present,
hypotensive
identified
(Fig.
1).FIGURE
1:
Cardiovascular
factors.
How
assess
harm
vs.
benefit
treatment.
Traditional
hypertension,
diabetes,
dyslipidaemia,
hyperuricemia,
smoking,
disease.
susceptibility
includes
manifestations
such
past
history
syncope,
recurrent
symptoms,
detected
on
office/out-of-office
measurements,
during
active
stand
test,
episodes
24-h
ambulatory
monitoring.
Risk
vision
deficits,
mass.
Harm
assessment
should
all
appropriate
elements
listed
left
side.
Final
decision
be
reached
agreement
patient
his/her
family.
CV,
cardiovascular;
ECHO,
echocardiography;
cMRI,
cardiac
magnetic
resonance
imaging;
ABPM,
monitoring;
home
monitoring.Hypotensive
defined
tendency
hypotension,
predominant
mechanism
[13].
It
typically
manifests
that
can
office,
standing
assessment,
monitoring
[14,15].
consequent
responsible
symptoms
dizziness
life
hospital
admission
[16,17].
dysfunction
considered
this
context.
dysautonomia
characterized
loss
regulation
ability,
extreme
hemodynamic
variability
manifest
(i.e.
intolerance)
period
[18].
exacerbated
medications,
if
pursued
[19].
Previous
accidental
indicates
an
Accidental
result
mass,
imply
vulnerability
changes.
even
mild
fluctuations
induce
dizziness,
instability
tone,
substantially
presence
[16,20].
impairment
demonstrated
influence
lower
values
were
found
rapid
impairment,
discouraging
these
[16,21].
Abnormal
regulation,
physical
coexist
individuals,
making
hallmark
[22,23].
above-described
encourage
prudent
approach
help
deprescribing.
usually
prompt
intensification,
reduction,
probability
treatment-related
exceeding
A
paradigm
shift
attitudes
advocated
al.,
call
equal
emphasis
both
prescribing
optimization.
Drawing
first
step
towards
shift.
As
commonly
overlap
oppose
age,
so
carried
out
parallel,
aiming
minimize
not
excluding
prevention.
With
view
urgent
need
perspective
research.
Future
studies
representative
comorbidities
final
aim
clinicians'
patients'
negative
outcomes.
once
said
famous
French
writer,
Albert
Camus,
'Good
intentions
do
much
malevolence,
they
lack
understanding'.
We
better
understand
beware
octogenarians.
ACKNOWLEDGEMENTS
None.
Conflicts
interest
There
no
conflicts
interest.
Язык: Английский
Deprescribing Hypertension Medication in Older Adults
Clinics in Geriatric Medicine,
Год журнала:
2024,
Номер
40(4), С. 659 - 668
Опубликована: Июнь 5, 2024
Язык: Английский
Pharmacological treatment of arterial hypertensin in old and very old patient in current evidence-based guidelines
Vnitřní lékařství,
Год журнала:
2024,
Номер
70(7), С. 419 - 429
Опубликована: Ноя. 14, 2024
Přestože
arteriální
hypertenze
patří
mezi
nejčastější
onemocnění
vyššího
věku
a
je
nepochybně
odborná
shoda
o
přínosu
léčby
v
širokém
věkovém
rozmezí
na
snížení
kardiovaskulárních
příhod
celkové
mortality,
léčba
u
starých
pacientů
spojena
s
řadou
farmakologických
rizik.
Právě
ohledem
věk
uvádějí
současné
guidelines
pro
management
Evropské
společnosti
hypertenzi
dvě
seniorská
věková
pásma
(65-79
více
než
80
let),
která
jsou
individuálně
nastavena
kritéria
zahájení
i
cílové
hodnoty
krevního
tlaku.
Bohužel
seniory
ve
nad
také
90
let
není
dost
důkazů
efektivitě
bezpečnosti
antihypertenzivy.
Při
léčbě
vycházíme
z
klinických
studií
provedených
populaci
věkově
mladší
obvykle
bez
doprovodných
komorbidit
funkčních
omezení.
V
klinické
praxi
rozhodování
se
řídíme
nejen
EBM
doporučeními,
ale
seniorů
léčbu
individualizujeme
komorbidity,
fyzickou
zdatnost
soběstačnost,
kognitivní
schopnosti,
stupeň
seniorské
křehkosti
očekávanou
dobu
dožití.
článku
shrnujeme
poznatky
účinnosti
antihypertenziv,
měnícím
poměru
přínos/riziko
léčby,
možném
využití
kritérií
potenciálně
nevhodných
antihypertenziv
lékových
postupů
doporučení
vysazování
(depreskripci)
avšak
pouze
přísně
indikovaných
nemocných.