Hypertension in the Polish elderly: Insights into prevalence, awareness, treatment, and control from the NOMED-AF study.

BACKGROUND: Hypertension is a significant global health issue, disproportionately affecting the elderly population. In Poland, the rapid aging of the population underscores the need for updating data on the epidemiology of hypertension in the elderly. AIMS: This study aimed to investigate the prevalence, awareness, treatment, and control of hypertension among individuals aged 65 and older in Poland. METHODS: The NOMED-AF study, a cross-sectional survey conducted from March 2017 to March 2018, enrolled a representative sample of 3014 participants aged 65 and over, using a multistage, stratified, and clustered sampling method. Data collection included standardized questionnaires and physical measurements carried out by trained nurses. Hypertension was diagnosed per the 2018 European Society of Hypertension/European Society of Cardiology guidelines. RESULTS: The study showed a hypertension prevalence of 82.5% in females and 78.3% in males aged 65 and older. Awareness of hypertension was high across all age and sex groups, with 86.2% of women and 83.4% of men being aware of their condition. Treatment rates were 84.8% in women and 80.5% in men. Optimal control of blood pressure among those treated was achieved in 40.3% of women and 45.6% of men. Women over 80 achieved optimal blood pressure control less frequently than men. CONCLUSIONS: The results highlight the high prevalence and suboptimal control of hypertension in Poland's elderly population, pointing to a significant public health challenge. Despite high rates of treatment, management of hypertension remains inadequate, which emphasizes the need for enhanced strategies in hypertension care, particularly for elderly women.

Case report: Transected Hickman catheter and its thrombotic occlusion in a patient with idiopathic pulmonary arterial hypertension-can a catheter replacement be avoided?

A 25-year-old female with idiopathic pulmonary arterial hypertension (PAH), who had a Hickman catheter implanted for continuous intravenous epoprostenol infusion, was admitted to the clinic after inadvertently cutting the catheter with nail scissors during a routine dressing change. Approximately 7 cm of the external segment of the Hickman catheter remained intact, with the distal end knotted by paramedics. A decision was made to repair the damaged Hickman catheter. However, it was discovered that its lumen was completely occluded by thrombosis. Therefore, catheter patency was mechanically restored using a 0.035-inch stiff guidewire in a sterile operating theatre setting, under fluoroscopy guidance. Successful aspiration and catheter flushing were achieved. Continuity of the Hickman catheter was then restored using a repair kit (Bard Access Systems) as per the manufacturer's instructions, with no visible leakage thereafter. Epoprostenol infusion through the Hickman catheter was resumed 24 h later, and the patient was discharged in good general condition two days afterward.

Prevalence of atrial fibrillation in the 65 or over Polish population. Report of cross-sectional NOMED-AF study.

BACKGROUND: Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by an increased risk of thromboembolic complications that can be markedly reduced with anticoagulation. There is a paucity of studies assessing the total prevalence of AF in national populations. AIMS: To assess the nationwide prevalence of AF in a population of adults ≥65 old and to determine the impact of duration of electrocardiogram (ECG) monitoring on the number of newly detected AF episodes. METHODS: The NOMED-AF study (ClinicalTrials.gov; NCT: 0324347) was a cross-sectional study performed on a nationally representative random sample of 3014 Polish citizens 65 years or older. Final estimates were adjusted to the national population. All participants underwent up to 30 days of continuous ECG monitoring. Total AF prevalence was diagnosed based on the patient's medical records or the presence of AF in ECG monitoring. RESULTS: The prevalence of AF in the Polish population ≥65 years was estimated as 19.2% (95% confidence interval [CI], 17.9%-20.6%). This included 4.1% (95% CI, 3.5%-4.8%) newly diagnosed cases and 15.1% (95% CI, 13.9%-16.3%) previously diagnosed cases and consisted of 10.8% (95% CI, 9.8%-11.9%) paroxysmal AF and 8.4% (95% CI, 7.5%-9.4%) persistent/permanent AF. The incidence of all paroxysmal AF events as a function of ECG monitoring duration increased from 1.9% (95% CI, 1.4%-2.6%) at 24 hours to 6.2% (95% CI, 5.3%-7.2%) at 4 weeks. CONCLUSIONS: The prevalence of AF in elderly adults is higher than estimated based on medical records only. Four weeks of monitoring compared to 24-hour ECG Holter allow detection of 7-fold more cases of previously undiagnosed paroxysmal AF.