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Background: Increasing evidence indicates that chronic obstructive pulmonary disease (COPD) is a complex disease involving more than airflow obstruction. Systemic inflammation can initiate or worsen comorbid diseases, such as ischemic heart disease, heart failure, arrhythmia, diabetes, osteoporosis, lung cancer and depression. Material and method: We explored the Medprax database, from an ambulatory care in order to obtain rates of comorbidities in COPD patients. Medprax electronic database is a locally developed system designed to fulfil the requirements of an integrated healthcare system. We identified a population of 9,659 patients (4472 men and 5187 women) aged = 30 years registered between 01.01.2000 and 01.02.2010. Results: The overall prevalence of COPD was 5.17% (384 men and 116 women). Compared to the non-COPD patients, COPD was found to be a significant risk factor in both sexes for cardiovascular events: ischemic heart disease (OR = 3.06, 95%CI 2.54-3.68), atrial fibrillation (OR = 2.70, 95%CI 2.12-3.43) and heart failure (OR = 4.49, 95%CI 3.74-5.40) regardless of age. Association with diabetes mellitus type 2 was extremely significant in COPD men (OR = 1.69, 95%CI 1.26-2.27), but not in COPD women. Significant correlation with osteoporosis (OR = 3.26, 95%CI 1.94-5.48) was found only in women over 60 years and men under 60. Pulmonary malignancy was found only in male COPD patient compared to non-COPD patients (OR = 5.04, 95%CI 2.02-12.44). The impact on depressive disorders was noted only in younger COPD men (OR = 5.71, 95%CI 1.94-16.82). Conclusions: Our results indicate that COPD is a risk factor for all these comorbid conditions and that in the management of COPD all these conditions need to be carefully evaluated. [ABSTRACT FROM AUTHOR]

Background: Twenty four hour ambulatory blood pressure monitoring (24-H ABPM) plays an important role in the management of hypertensive patients. The aim of our study was to determine the frequency of seven known adverse prognostic features in an ambulatory assisted hypertensive patient population. Methods: The study included all the 957 hypertensive patients with a performed 24-H ABPM, examined in the 2008-2011 period in a preventive ambulatory cardiology system. The studied adverse prognostic features were: daytime systolic blood pressure (BP) >140 mmHg, daytime diastolic BP >90 mmHg, nighttime systolic BP >125 mmHg, nighttime diastolic BP >75 mmHg, nocturnal dipping <10%, early morning hypertension >140/90 mm Hg, pulse pressure >53 mm Hg. Patient data were introduced in an integrated patient data management system as an electronic health record. The frequency of adverse prognostic features was compared in type 2 diabetic versus nondiabetic patients, and in patients with or without manifest cardiovascular complications (ischemic heart disease, stroke, lower extremity arterial disease). Results: The frequency of the studied adverse prognostic features was as follows: high daytime systolic BP 38.1%, high daytime diastolic BP 21.4%, high nighttime systolic BP 45.5%, high nighttime diastolic BP 31.3%, absent nocturnal dipping 59.9%, morning hypertension 33.6%, high pulse pressure 51.5%, morning surge 5.1%. A large proportion of subjects (86.2%) had one or more adverse features reported on the 24-H ABPM. Conclusions: In clinical practice there is a frequent association of multiple adverse prognostic features of ambulatory blood pressure monitoring. The presence of some prognostic features is associated with the presence of diabetes, stroke history, ischemic heart disease or lower extremity arterial disease. [ABSTRACT FROM AUTHOR]

Reducing the total cardiovascular risk of hypertensive patients is one of the basic targets in hypertension management. A good lipid control is a major contributor of the global risk reduction. Purpose: To simulate the impact of the ESC/EAS 2011 guidelines for the management of dyslipidaemias on the lipid management practice of a preventive profiled ambulatory cardiology system. Methods: The study included all the 7413 hypertensive patients examined between 2002-2011 in a preventive ambulatory system. As a part of the simulation patients were stratified to risk categories according to ESC 2011 guidelines. We compared the frequency of prescribed cholesterol lowering medication with that theoretically indicated based on the new guidelines. The study is based on a retrospective simulation of the theoretical effects of the implementation of the new guidelines in a real patient population. Results: Risk stratification could be performed in 78.74% of the population. Patients were stratified to very high risk 74.82%, high risk 1.96%, moderate risk 8.66%, and low risk 14.56%. Cholesterol lowering treatment was prescribed for 39.58% of the patients. Very high risk patients were treated more frequently (48.8%), than high (37.0%), moderate (26.5%), or low (16.4%) risk patients. According to the new ESC guidelines theoretical indication for cholesterol lowering treatment has been for 52.07% (3860) of patients. The analysis of the yearly trends in prescribing cholesterol lowering drugs showed an increase from 0% in 2002 to 52.7% in 2011. Conclusions: A yearly improving trend can be observed in the frequency of indicating cholesterol lowering drugs. The future implementation of the new guideline has the potential impact to assure cholesterol lowering medication indication for another 1980 patients in our sample. [ABSTRACT FROM AUTHOR]

Introduction: Increasing awareness, treatment and control rates of hypertensive patients is a worldwide problem especially in Central and East European countries. The objective of the study was to determine the yearly changes in the achievement of treatment targets according to ESC 2003-2007 guidelines for the management of arterial hypertension in a preventive profiled ambulatory cardiology setting. Patients and method: The study included 6591 hypertensive patients examined between 2002-2010 in the Procardia preventive ambulatory in Târgu Mureș, Romania. The sex distribution of the studied patients was 45.64% male average age 57.45 years, and 54.36% female average age 61.28 years. Patients received individually tailored self control education, lifestyle advice and drug treatment - the primary care providers were informed in detailed medical reports. We studied the yearly achievement of target blood pressure levels. We also analysed the frequency of investigations carried out for the global risk assessment screening for subclinical organ damage. We used "MedPrax" integrated patient data management system as an electronic health record. Statistical analysis was performed with the Open Office Calc programme. Results: Target blood pressure values (under 140/90 mmHg in non diabetic patients and 130/80 in diabetic patients) were reached in 27.51%. The percentage of patients treated to target increased progressively from 15.25% to 36.29%. Conclusions: The activity of the studied cardiology ambulatory setting provided a yearly increase in the level of blood pressure target achievement. Further improvement measures are needed to increase blood pressure control rates, with a specific attention to the diabetic patients. [ABSTRACT FROM AUTHOR]