Mental health problems and hypertension in the elderly: Review from the HOPE Asia Network.

The "triple burden" of aging population, hypertension, and mental health problems making elderly in Asia is more vulnerable. There is evidence of a bidirectional relationship between mental health and hypertension, which results in lower quality of life, lower rate of treatment adherence, and higher mortality among elderly individuals. It is essential to overcome known barriers and care for the elderly with high-risk factors in order to address these burdens. This review revealed that elderly with hypertension were more likely to suffer from depression and anxiety. Therefore, debunking myths, creating awareness regarding mental health, and increasing access to mental health resources through holistic community-based programs would greatly reduce such problems and optimize the chances of success in controlling hypertension-related problems.

Morning surge in blood pressure and blood pressure variability in Asia: Evidence and statement from the HOPE Asia Network.

Hypertension is a major risk factor for cardiovascular and cerebrovascular diseases. To effectively prevent end-organ damage, maintain vascular integrity and reduce morbidity and mortality, it is essential to decrease and adequately control blood pressure (BP) throughout each 24-hour period. Exaggerated early morning BP surge (EMBS) is one component of BP variability (BPV), and has been associated with an increased risk of stroke and cardiovascular events, independently of 24-hour average BP. BPV includes circadian, short-term and long-term components, and can best be documented using out-of-office techniques such as ambulatory and/or home BP monitoring. There is a large body of evidence linking both BPV and EMBS with increased rates of adverse cardio- and cerebrovascular events, and end-organ damage. Differences in hypertension and related cardiovascular disease rates have been reported between Western and Asian populations, including a higher rate of stroke, higher prevalence of metabolic syndrome, greater salt sensitivity and more common high morning and nocturnal BP readings in Asians. This highlights a need for BP management strategies that take into account ethnic differences. In general, long-acting antihypertensives that control BP throughout the 24-hour period are preferred; amlodipine and telmisartan have been shown to control EMBS more effectively than valsartan. Home and ambulatory BP monitoring should form an essential part of hypertension management, with individualized pharmacotherapy to achieve optimal 24-hour BP control particularly the EMBS and provide the best cardio- and cerebrovascular protection. Future research should facilitate better understanding of BPV, allowing optimization of strategies for the detection and treatment of hypertension to reduce adverse outcomes.

Outcome of blood pressure and renal function in patients with renal artery stenosis after stenting.

OBJECTIVE: To study the response of systolic and diastolic blood pressure (BP) and renal function after renal artery stenting at three months, six months, one year and last follow-up. METHODS: Patients with significant renal artery stenosis who underwent angioplasty with stenting from January 1999 to September 2006 were analyzed. The BP and serum creatinine levels were recorded at baseline, three months, six months, one year and at last follow-up. Generalized estimating equations were applied to analyze the changes in blood pressure and serum creatinine over time. RESULTS: There were 32 patients - 21 Chinese, six Malay and five Indian. The male to female ratio was 1.3:1. The mean age (± SD) was 69.4±8.8 years. The mean follow-up time was 1.8±1.6 years (range 0.5 to six years). When compared with the baseline BP, there was significant improvement at three months, six months, one year and at last follow-up. In the diabetes mellitus (DM) group, there was deterioration in serum creatinine. In the non-DM group, there was stabilization of serum creatinine with improvement at one year. CONCLUSION: Significant improvement in BP occurs in renal artery stenosis patients after stenting. In patients without DM, renal function remains stable or improves. However, in DM patients, especially those with proteinuria, there is deterioration in renal function.