Adina Carmen Ilie

Techniques of determining arterial stiffness in clinical practice

With the aging of population, assessment of total vascular risk is very important, because old age is associated with multiple risks. More specifically, arterial stiffness has been recognized as a measure of biological ageing. Pulse wave velocity (PWV) is not a direct measure of stiffness, it is a measurement of the velocity of the pressure pulse, and is related with stiffness and is influenced by pressure. Brachial-ankle PWV (ba PWV) has been confirmed to increase in conditions with cardiovascular factors such as ageing, hypertension, diabetes, chronic kidney disease. Measurement of this parameter is easy and has a good reproducibility. As an alternative, to measure direct the stiffness, was developed Cardio-Ankle Vascular Index (CAVI). CAVI reflects stiffness of the artery from the origin of aorta to ankle region. Several clinical and experimental studies have shown that CAVI is not correlated with blood pressure from the moment of determination, unlike PWV. CAVI evolves with age and reflects the severity of coronary disease, also is increased in early atherosclerotic disease than does ba PWV. Assessment of arterial stiffness could allow further risk stratification of high-risk individuals and can assist in the early detection of arteriosclerosis.

Sarcopenia and the importance of biochemical determinations in the hospitalised older adults

Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength. It is the major pathway leading to physical frailty, an important geriatric syndrome and an important problem in the elderly population. There are multiple factors leading to sarcopenia and frailty and for preventing them is important to determine the biochemical factors involved. We conducted a study on 143 elderly patients hospitalized during a nine months period. Demographic data were collected and biochemical parameters were determined. Sarcopenia was determined through muscle mass and muscle strength. The average age of the persons included in the study was 77.13 ± 6.30 years, without differences between gender distributions. To assess the relationship between the biochemical parameters and the presence of sarcopenia, the patients were divided into two groups: the group with sarcopenia and the group without sarcopenia. The analysis of the relationships between the presence of sarcopenia and the biochemical parameters determined within the study group, revealed that sarcopenia is correlated with blood glucose (p = 0.002, r = − 0.266), creatinine (p=0.010, r= −0.221) and also creatinine clearance (p=0.017, r=0.207). Biochemical determinations are important in determining sarcopenia and frailty and are of high importance before establishing any measure of treatment or prevention.

Home blood pressure monitoring — One step towards reducing defensive medicine

Hypertension is one of the major risk factors for developing cardiovascular diseases such as heart failure, stroke, coronary heart disease, and renal failure, and one of the most frequent reasons for access to medical care. In elderly patients, hypertension is usually associated with several concomitant diseases, which leads to polypharmacy, iatrogeny, repeated hospitalizations and un-necessary consultations. Defensive medicine is defined as the ordering of treatments, tests, and procedures for the purpose of protecting the doctor from criticism rather than diagnosing or treating the patient. Our case presentation illustrates defensive medicine applied to an elderly female patient with high blood pressure. What should have been the methods to prevent the delaying of treatment for the main problems (high blood pressure and atrial fibrillation)? A better medical surveillance and monitoring should have been the answer. Use of blood pressure telemonitoring technique might help in improving blood pressure control and adherence, helping the quantification and definition of the psychological trait of the hypertensive patient and preventing defensive medicine expressed by un-necessary hospitalization and interdisciplinary consults.