RESUMEN
The authors analyse current practice of management of elderly patients with arterial hypertension in medical institutions of the Ivanovo region to find out factors impeding introduction of modern approaches to treatment of the hypertensive elderly. Medical documents were analysed for aged 291 outpatients and 178 inpatients with arterial hypertension (AH). 100 physicians filled in questionnaires. The following data were obtained: 91% physicians are sure about age-specific standards of arterial pressure; 85% physicians make their decision on elderly hypertensive patients' treatment basing on diastolic pressure; the necessity of AH treatment in the elderly is supported by only 6% physicians; nonpharmacological treatment of AH in practiced in 9% elderly patients; 40, 39, 28 and 16% patients receive ACE inhibitors, calcium antagonists, beta-blockers, diuretics, respectively; the percentage of unjustified hospitalizations is high; target arterial pressure was reached only in 0.9% hypertensive aged patients. It is concluded that the impeding factors for updating AH treatment in the region studied are the following: lack of information, stereotypes in medical practice, uneffective organization of medical aid for aged patients with hypertension.
Asunto(s)
Antihipertensivos/uso terapéutico , Servicios de Salud/normas , Hipertensión/tratamiento farmacológico , Pautas de la Práctica en Medicina , Anciano , Antihipertensivos/clasificación , Áreas de Influencia de Salud , Humanos , Hipertensión/epidemiología , Persona de Mediana Edad , Federación de Rusia/epidemiologíaRESUMEN
The dynamics of cross-sectional, isochronic, and integral maps of electric potential distribution during the dipyridamole test was examined in 35 patients with verified coronary heart disease and 12 control patients. Basic differences were found in changes of excitation propagation velocities and positive potential amplitude in the groups examined. A local increase in R wave areas on the maps of positive potential differences was found to be the most significant mapping sign of transient myocardial ischemia (the sensitivity, specificity, and diagnostic accuracy being more than 97%). The diagnostic accuracy of an absolute or relative increase in the integral time and amplitude parameters of the mapping was 77% and 70%, respectively.
Asunto(s)
Enfermedad Coronaria/diagnóstico , Dipiridamol , Electrocardiografía , Adulto , Estudios de Evaluación como Asunto , Humanos , Persona de Mediana EdadRESUMEN
Quantitative indices of instantaneous maps of the distribution of electric potential on the chest surface were compared to a left ventricular myocardial mass value, calculated on the basis of echocardiographic results and echocardiographic signs of left ventricular hypertrophy, in 77 patients with essential hypertension or neurocirculatory dystonia of hypertensive type and in 25 healthy controls. Four quantitative cartographic indices were shown to be very important for diagnosis: 1) tMaxk; 2) tapic; 3) + sigma QRS; 4) NQ15. The sensitivity, specificity and accuracy of diagnosis of left ventricular hypertrophy was over 80%. Cartographic quantitative indices were shown to correlate with a high degree of significance (p less than 0.01) (r much greater than 0.75) with a left ventricular myocardial mass value calculated on the basis of echocardiography results.