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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The prevalence of hypertension is rising with age, and current evidence shows that the majority of elderly patients benefit from proper antihypertensive therapy. To support physicians in everyday care of elderly patients with hypertension, new guidelines were issued in Poland at the end of 2012. In 2013, the guidelines started to be implemented into practice. The aim of this article is to present an overview of the major recommendations included in these 2013 guidelines. Physicians should be aware of the key issues specific for the care of the elderly hypertensive population. Lowering blood pressure below 150/90 mmHg should be considered as the goal of therapy in hypertensive patients older than 80 years. Slight overweight (body mass index, 27-28 kg/m2) may be beneficial for patients older than 75 years and especially for octogenarians because it may prevent protein and calorie deficiency. Thiazide-like diuretics followed by angiotensin-converting-enzyme inhibitors, if needed, should be considered as a first-line therapy for hypertensive patients older than 80 years. Because of high risk of adverse effects, the pharmacological treatment of hypertension in the elderly should be started with lower doses of blood pressure-lowering agents, and treatment intensification should be careful. The guidelines on hypertension management were developed by 3 medical societies and specialists from different medical fields. The Delphi method was used to achieve consensus on controversial issues.
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PMID:Hypertension in the elderly: how to treat patients in 2013? The essential recommendations of the Polish guidelines. 2397 90

Birthweight is a marker for suboptimal fetal growth and development in utero. Offspring can be born large for gestational age (LGA), which is linked to maternal obesity or excessive gestational weight gain, as well as small for gestational age (SGA), arising from nutrient or calorie deficiency, placental dysfunction, or other maternal conditions (hypertension, infection). In humans, LGA and SGA babies are at an increased risk for certain neurodevelopmental disorders, including Attention Deficit/Hyperactivity Disorder, schizophrenia, and social and mood disorders. Using mouse models of LGA (maternal high fat (HF) diet) and SGA (maternal low protein (LP) diet) offspring, our lab has previously shown that these offspring display alterations in the expression of mesocorticolimbic genes that regulate dopamine and opioid function, thus indicating that these brain regions and neurotransmitter systems are vulnerable to gestational insults. Interestingly, these two maternal diets affected dopamine and opioid systems in somewhat opposing directions (e.g., LP offspring are generally hyperdopaminergic with reduced opioid expression, and the reverse is found for the HF offspring). These data largely involved evaluation at the transcriptional level, so the present experiment was designed to extend these analyses through an assessment of receptor binding. In this study, control, SGA and LGA offspring were generated from dams fed control, low protein or high fat diet, respectively, throughout pregnancy and lactation. At weaning, mice were placed on the control diet and sacrificed at 12 weeks of age. In vitro autoradiography was used to measure mu-opioid receptor (MOR), dopamine type 1 receptor (D1R), and dopamine transporter (DAT) binding level in mesolimbic brain regions. Results showed that the LP offspring (males and females) had significantly higher MOR and D1R binding than the control animals in the regions associated with reward. In HF offspring there were no differences in MOR binding, and limited increases in D1R binding, seen only in females in the nucleus accumbens core and the dorsomedial caudate/putamen. DAT binding revealed no differences in either models. In conclusion, LP but not HF offspring show significantly elevated MOR and D1R binding in the brain thus affecting DA and opioid signaling. These findings advance the current understanding of how suboptimal gestational diets can adversely impact neurodevelopment and increase the risk for disorders such as ADHD, obesity and addiction.
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PMID:Suboptimal maternal diets alter mu opioid receptor and dopamine type 1 receptor binding but exert no effect on dopamine transporters in the offspring brain. 2766 82