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Objective:To investigate the influencing factors for orthostatic hypotension(OH)in elderly patients with hypertension.Methods:This was a case-control study.A total of 224 patients with hypertension aged over 65 years were included.After resting for more than 5 minutes, subjects had their blood pressures measured in the supine and standing position at 0 min, 1 min, 2 min and 3 min.OH was defined as a fall in systolic BP of more 20 mmHg(1 mmHg=0.133 kPa)and/or diastolic BP below 10 mmHg of baseline within 3 min in the upright position.Subjects were divided into the OH group( n=34)and the non-OH group( n=190). Baseline data, comorbidities and differences in medications were compare between the OH group and the non-OH group, and the influencing factors for OH were analyzed. Results:The proportion of drinkers was higher in the OH group than in the non-OH group(29.4% or 10/34 vs.7.4% or 14/190, χ2=14.649, P<0.01). Both systolic pressure(139.0±22.1 mmHg vs.124.5±16.3 mmHg, t=-3.661, P<0.01)and diastolic pressure(77.6±6.3 mmHg vs.69.2±9.0 mmHg, t=-6.696, P<0.01)in the supine position were higher in the OH group than in the non-OH group.The proportions of patients with diabetes(47.1% or 16/34 vs.25.3% or 48/190, χ2=6.731, P<0.05)and stroke(41.2% or 14/34 vs.24.2% or 46/190, χ2=4.233, P<0.05)were higher in the OH group than in the non-OH group.The proportion of patients receiving α receptor blockers was higher in the OH group than in the non-OH group(23.5% or 8/34 vs.4.2% or 8/190, χ2=16.228, P<0.01). After adjusting for factors such as alcohol consumption, diabetes, stroke and other differences between the OH and non-OH group, logistic regression found patients with alcohol intake( OR=5.274, 95% CI: 1.990~13.982, P<0.01), diabetes( OR=2.744, 95% CI: 1.213~6.208, P<0.05)and using α receptor blockers( OR=8.812, 95% CI: 2.835~27.383, P<0.01)had a higher risk of OH. Conclusions:OH is very common in elderly patients with hypertension.Alcohol consumption, diabetes mellitus and the application of α receptor blockers can increase the risk of OH.
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Objective:The purpose of the study was to explore the association between red blood cell volume distribution width(RDW)and in-hospital mortality in elderly patients with acute ST segment elevation myocardial infarction(STEMI).Methods:A total of 429 elderly patients aged ≥65 years diagnosed with acute STEMI were recruited for this study.These patients were divided into 2 groups according to the median RDW: the low RDW group(RDW<13.33%, n=213)and the high RDW group(RDW≥13.33%, n=216). The in-hospital mortality was compared between the groups, and the relationship between RDW and in-hospital mortality in elderly STEMI patients was analyzed.Results:The in-hospital mortality of the high RDW group was significantly higher than that of the low RDW group(12.0% or 26 cases vs.3.3% or 7 cases, P<0.01). After adjusting for differences in age, sex, mean erythrocyte volume, RDW grouping and Killip grade between the two groups, the risk of in-hospital death for patients in the high RDW group was 3.258 times that in the low RDW group( OR=3.258, 95% CI: 1.291-8.222, P<0.05). In addition, aging( OR=1.079, 95% CI: 1.003-1.161, P<0.05)and Killip grade ≥Ⅲ( OR=13.987, 95% CI: 6.136-1.879, P<0.01)were also associated with increased risk of in-hospital death in elderly STEMI patients. Conclusions:RDW is associated with in-hospital mortality in elderly STEMI patients and can predict in-hospital mortality of STMEI in elderly patients.
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At present,the worldwide prevalence of cardiovascular diseases is very high,and shows an upward trend along with aging.In recent years,more and more evidence supported that cardiac rehabilitation could improve the subjective symptoms related to cardiovascular disease,including chest pain,dyspnea,fatigue and so on,and may reduce the long-term rehospitalization rate and mortality.Along with aging of the population and with the developing of medical technology in the cardiovascular field,the proportion of cardiovascular diseases in elderly population is rising.This article reviews the benefits of heart rehabilitation in the elderly,the current situation and the trend of heart rehabilitation in China.
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Frailty is common among elderly patients with coronary artery disease.It prolongs the length of hospitalization and can independently predict poor short-term and long-term prognosis in patients with acute coronary syndrome (ACS).The assessment of frailty can contribute to a more comprehensive risk stratification in ACS patients.For patients with coronary artery disease seeking reperfusion therapy,frailty can be an independent predictor for higher short-term and long-term mortality rates after PCI and can increase the mortality rate after coronary artery bypass grafting (CABG).Previous findings suggest that frailty should be included in the preoperative risk assessment model of reperfusion therapy for patients with coronary artery disease.In addition,frailty assessment is helpful in predicting the mortality after reperfusion therapy.
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Frailty is very common in heart failure patients and adversely affects the ability of self-care and quality of life.It is a strong and independent predictor of increased visits to outpatient and emergency departments,rates of hospitalization and in-hospital mortality.Furthermore,preoperative frailty is associated with increased risk of complications and death in patients with advanced heart failure referred for left ventricular assist devices or heart transplants.
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Objective To compare the clinical effect of unarmed cardiopulmonary resuscitationand cardiopulmonary resuscitationmachine in the emergency room.Methods One hundred cases patients with cardiopulmonary arrest in Hainan Agricultural Reclamation General Hospital from February 2014 to February 2016 were analyzed.The control group(n=50) were given unarmed cardiopulmonary resuscitation,while thetest group(n=50) were given ardiopulmonary resuscitation machine.Two groups' before and after cardiopulmonary resuscitation of arterial blood gas index(oxygen saturation (SaO2),C02 partial pressure (PaC02),oxygen partial pressure(Pa02)),cardiopulmonary resuscitation effectiveness and the success rate,and complications were compared.Results Before cardiopulmonary resuscitation,there were no significant differences on arterial blood gas index (SaO2,PaCO2,PaO2) between the two groups (t =0.069,0.097,0.121,P ＞ 0.05).After cardiopulmonary resuscitation,the SaO2,PaO2 of the test group were higher than that of the control group ((98.60± 8.51) ％ vs.(86.37 ± 7.84) ％,(13.84 ± 1.40) kPa vs.(8.69± 1.21) kPa),while PaCO2 of test group was lower than the control group ((3.24 ± 0.56) kPa vs.(6.41 ± 0.87) kPa),the differences were significant(t =7.474,21.665,19.679,P ＜ 0.05).The cardiopulmonary resuscitation of effective rate,success rate of test group were higher than the control group (84.00％ (42/50) vs.62.00％ (31/50),26.00％ (13/50)vs.10.00％(5/50),x2=6.139,4.336,P＜0.05).The total complication rate of the test group was lower than the control group(8.00％ (4/50) vs.28.00％ (14/50)),the difference was significant (x2 =6.775,P ＜0.05).Conclusion The clinical effect of cardiopulmonary resuscitation machine is significantly superior to unarmed cardiopulmonary resuscitation,which can effectively improve the patient's arterial blood gas state,improve the efficiency and success rate of cardiopulmonary resuscitation,and reduce the complications.
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Tolvaptan is a novel oral selective arginine vasopressin V2 receptor antagonist.Tolvaptan improves heart failure signs and symptoms without serious adverse events.Tolvaptan has no effect on all-cause mortality and cardiovascular death or admission rate for heart failure.But in heart failure patients with hyponatremia,tolvaptan can decrease cardiovascular death and admission rate for heart failure.
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Serum high sensitivity C-reactive protein(hs-CRP)and glycosylated hemoglobin(HbA1c )were detected in 89 type 2 diabetes patients with chronic periodontitis.The patients were divided into HbA1c≥ 7.0% and <7.0% groups according HbA1c levels.Serum hs-CRP,probing depth(PD),attachment loss(AL)in HbA1c ≥ 7.0% group were all significantly higher than those in <7.0% group (P <0.01 ),and serum hs-CRP was positively correlation with PD and AL in all patients.In patients with type 2 diabetes,high HbA1c and chron-ic periodontitis serum hs-CRP is positively correlation with periodontal disease.
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Fifty six elderly patients with acute coronary syndrome (ACS) were divided into nonsmoking group (n =30) and smoking group (n =26).All patients received aspirin 100 mg/d + Clopidogrel 75 mg/d for 14 d.The expression of glycoprotein Ⅱ b/Ⅲa and P-Selectin on the surface of platelets in both groups were assessed with flow cytometry (FCM).The positive expression rates of GP Ⅱ b/Ⅲ a and P-Selectin before treatment were (67.86 ± 12.14)％,(70.37 ± 10.15)％ in non-smoking group and (79.47 ± 11.62) ％,(81.26 ± 9.74) ％ in smoking group.The positive expression rates of GP Ⅱ b/Ⅲ a and P-Selectin after treatment were significantly decreased to (50.18 ± 8.72) ％,(49.36 ± 11.43) ％ in nonsmoking group and to (61.15±9.29)％,(57.52±10.81)％ in smoking group(P＜0.01).Also the degree of decreasing expression rates of GP Ⅱ b/Ⅲ a and P-Selectin was nore markedly in non-smoking group than that in smoking group (P ＜ 0.05).The results indicate that expressions of GP Ⅱ b/Ⅲ a and P-Selectin on the surface of platelets are increased in the elderly smoker patients with ACS,and smoking may decrease the effect of anti-platelet agents.
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Objective To investigate the effect of combined anti-platelets drugs on platelet activation in the elderly patients with acute coronary syndrome (ACS).Methods Totally 72 elderly patients with ACS were divided randomly into two groups according to age ≤ 80 years and ＞ 80 years.Aspirin 100 mg/d plus clopidogrel 75 mg/d were used in all the patients for 2 weeks.The positive glycoprotein Ⅱb/Ⅲa and P-selectin expressions on the surface of platelets were assessed with flow cytometry (FCM) after the platelets were activated by adenosine diphosphate (ADP) and arachidonic acid.Results The expressions of GP Ⅱb/Ⅲa and P-selectin were (73.5± 11.0,71.2±8.7) ％ at baseline and (51.3±9.1,57.3±12.4)％ after anti-platelets medicine more than 14 days in group of age≤80 years.than 14 days.The expression of GP Ⅱb/Ⅲa and P-selectin were (78.3 ±12.7,75.8±8.6)％ on the surface of platelet at baseline in group of age＞ 80 years,after anti-platelets medicine treatment were (41.2±8.5,47.3±10.3)％.The positive expressions of GP Ⅱb/Ⅲa and P-selectin in group of age＞ 80 years were decreased compared with those in group of age≤ 80 years after combination of medicines treatment (P＜0.05).Conclusions Combined aspirin and Clopidogrel treatment have a more strong effect in inhibiting the activation of platelets in the elderly patients more than 80-year with ACS.
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Objective To compare the safety and efficacy of varied treatments for cardioversion of paroxysmal atria] fibrillation (AF) in the aged patients and to explore choice of electrical cardioversion with direct current. Methods Clinical data of cardioversion with lanatoside (cedilandid) or propafenone, a sodium channel blocker prolongs refractoriness, for 57 aged patients with paroxysmal AF were summarized to observe their cardioversion and control of heart rate. And, synchronous electrical cardioversion will be offered to those with severe complications and ineffective with drug treatment within 24 h after the onset of AF. Results An emergency cardioversion ratio was 28.1 % with lanatoside within 24 h with a satisfactory control of ventricular rate, as compared with that of 62.2% with propafenone (P