Independent association of FTO rs9939609 polymorphism with overweight and obesity in Polish adults. Results from the representative population-based WOBASZ study.

Genetic factors play an important role in the origin of obesity. We investigated the association between the FTO rs9939609 genotype and overweight and obesity, along with additional anthropometric variables in the representative sample of adult Polish population. We genotyped a random sample of 3369 adult individuals examined in a cross-sectional population survey (WOBASZ 2003-2005). More than 40% of men and women had at least one A allele. The AA genotype was found in approximately one fifth of both men and women. The frequency of the AA genotype increased with higher BMI in both sexes and was associated with higher anthropometric obesity indicators in both men and women. The FTO rs9939609 AA genotype was significantly related to abnormal BMI [OR=1.55 (1.14-2.11)] and overweight [OR=1.55 (1.11-2.16)] or obesity [OR=1.56 (1.04-235)] in men regardless of age, tobacco smoking, physical activity, diet and diabetes, while in women it was related to abnormal BMI [OR=1.45 (1.05-2.01)] and overweight [OR=1.59 (1.11-2.29)] after adjustment in addition for menopause. The frequency of the A allele in the Polish population was the same as in other European countries. About one fifth of both men and women have the FTO rs9939609 AA variant. A significant relationship was found between the FTO genotype and anthropometric obesity indicators. The AA genotype was significantly associated with abnormal BMI and overweight in both sexes, but the relation to the obesity phenotype was observed only in men.

Tetrazole derivatives bearing benzodiazepine moiety-synthesis and action mode against virulence of Candida albicans.

Tetrazole and benzodiazepine derivatives attract widespread attention due to their remarkable pharmaceutical potential. 5-(2-bromophenyl)-7-fluoro-1-[3-(5-(4-chlorophenyl)-2H-tetrazol-2-yl)propyl]-1,3-dihydro-2H-1,4-benzodiazepin-2-one (6c) and 5-(2-bromophenyl)-7-fluoro-1-[3-(5-(2-chlorophenyl)-2H-tetrazol-2-yl)propyl]-1,3-dihydro-2H-1,4-benzodiazepin-2-one (6d) were selected using the microdilution approach and because of their preferential fungicidal activity toward C. albicans. 6c or 6d altered the hyphal morphology, chitin deposition and membrane permeation in planktonic and sessile cells. The tetrazoles caused PS translocation and the accidental dependent permeabilization (ADP) of sessile cells; 6d showed CNB1-dependent action in candidiasis. The exosome Rh123-rich vesicles extruded out of the membrane as an element of the self-defense detoxification strategy when the treatment, especially with 6d, was conducted. The tetrazoles affected the C. albicans biofilm's viability, and Rh123 sequestrates led to a heterogenous sub-cellular localization. While 6c-dependent sequestration into membranes or sub-cellular organelles was noted, Rh123 cellular loading in control cells and distributed within cells was observed (partitioning into subcellular membranes and organelles in apoptotic cells). In conclusion, we propose new agents aimed at Candida virulence factors triggering ACD without toxicity against eukaryotic cells.

Prevalence of diabetes and impaired fasting glucose in Poland in 2005-2014: results of the WOBASZ surveys.

AIMS: To evaluate the prevalence of diabetes and impaired fasting glucose in Poland in 2013-2014 and to determine the temporal trends between 2003-2005 and 2013-2014. METHODS: A questionnaire survey was conducted in a representative sample of Polish adults, complemented by anthropometric and fasting plasma glucose measurements. The research was part of the national cross-sectional WOBASZ study. Diabetes was assessed as self-reported or screened (fasting plasma glucose level ≥ 7 mmol/l, based on one blood sample). RESULTS: In the years 2013-2014 among 5694 participants aged 20-74 years, 6.0% (95% CI 5.4-6.6) reported a previous diagnosis of diabetes (5.8% in women and 6.2% in men). In addition, 2.4% of the participants (95% CI 2.0-2.8) without a previous diagnosis of diabetes (1.8% of women and 3.1% of men) had a fasting blood glucose level ≥7.0 mmol/l in a single measurement. In a single measurement, 18.4% of the participants (95% CI 17.4-19.4; 13.2% of women and 23.8% of men) had impaired fasting glucose. The prevalence of dysglycaemia in the WOBASZ II study was significantly higher compared to the WOBASZ I study findings from 2003-2005, increased from 6.6% to 8.4% for diabetes and from 9.3% to 18.4% for impaired fasting glucose (after age and sex standardization to the 2013 Polish population). CONCLUSIONS: The prevalence of diabetes in Poland is similar to that observed in other European populations and has increased significantly over the last decade.

Influence of Sociodemographic, Behavioral and Other Health-Related Factors on Healthy Ageing Based on Three Operative Definitions.

OBJECTIVES: Healthy ageing (HA) is a key concept and highly desirable phenomenon in every ageing and already old societies. The aim of our study was to evaluate the influence of socio-economic conditions as well as life-style and other health-related factors on the WHO definition of HA. DESIGN, SETTING, PARTICIPANTS: The study used cross-sectional data of the PolSenior Project - nationwide research evaluating different aspects of ageing in Poland - which included 4'653 respondents aged 65 years and over. MEASUREMENTS: Data were collected by trained interviewers in respondents' homes. Three definitions of HA including or not the participants' chronic conditions were analyzed. RESULTS: The prevalence of HA appeared as high as 17.6% if none or 1 chronic disease was present and 42.8% if no information about chronic diseases was taken into account. The association between known health predictors (age, marital status, education, income) and HA was observed. Moreover, HA appeared in relation with indicators of physical functioning and lifestyle. There was a strong concordance between HA and the fair self-rated health (OR = 1.87; 1.99, and 2.74 for the 1st, 2nd and 3rd definitions, respectively) and opposite relation with self-reported need for help (OR = 0.15; 0.15; and 0.13, respectively). CONCLUSIONS: The HA definition based on no functional activity limitations, no cognitive impairment, no depressive symptoms, no more than one disease and being socially active seems to be a useful approach of HA.

Prevalence of diabetes in Poland: a combined analysis of national databases.

AIMS: To assess the number of people with diabetes in Poland using combined national sources and to evaluate the usefulness of data from an insurance system for epidemiological purposes. METHODS: The data were collected from four sources: 1) 2013 all-billing records of the national insurance system comprising people of all age groups undergoing procedures or receiving services in primary healthcare, specialist practices and hospitals and also those receiving drugs; 2) an epidemiological study, NATPOL, that involved the assessment of people with undiagnosed diabetes; 3) the RECEPTOmetr Sequence study on prescriptions; and 4) regional child diabetes registries. RESULTS: In 2013, 1.76 million people (0.98 million women and 0.79 million men) had medical consultations (coded E10-E14) and 2.13 million people (1.19 million women and 0.94 million men) purchased drugs or strip tests for diabetes. A total of 0.04 million people who used medical services did not buy drugs. In total, the number of people with diabetes in the insurance system was 2.16 million (1.21 million women and 0.95 million men), which corresponds to 6.1% (95% CI 6.11-6.14) of women and 5.1% (95% CI 5.12-5.14) of men. Including undiagnosed cases, the total number of people with diabetes in Poland was 2.68 million in 2013. CONCLUSION: The estimated prevalence of diabetes (diagnosed and undiagnosed cases) in Poland is 6.97%. Data from the national insurance system with full coverage of the population can be treated as a reliable source of information on diseases with well-defined diagnosis and treatment methods, combined with an assessment of the number of undiagnosed individuals.

Atrial fibrillation independently linked with depression in community-dwelling older population. Results from the nationwide PolSenior project.

BACKGROUND: Depression is a frequently observed comorbid condition in patients with cardiovascular diseases. In contrast to coronary heart disease and heart failure there is a limited amount of published data concerning the increased prevalence of depression among patients with atrial fibrillation (AF). Therefore, we decided to assess the prevalence of depression in Polish community-dwelling older patients with a history of AF. METHODS: The data were collected as part of the nationwide PolSenior project (2007-2012). Out of 4979 individuals (age range 65-104 years), data on self-reported history of AF were available for 4677 (93.9%). Finally, 4049 participants without suspected moderate or severe dementia in Mini Mental State Examination test were assessed with the 15-item Geriatric Depression Scale (GDS), and a score of 6 points and more was regarded as suspected depression. RESULTS: Mean age (±SD) of the study population was 78.1 (±8.3) years; 52% were males. The history of AF was reported by 788 (19.5%) subjects. In the univariate analysis a self-reported AF history was associated with 42% increase of suspected depression (41% vs 29%; P < 0.001). In multivariate logistic regression AF remained an independent predictor of depression (OR = 1.69; 95%CI: 1.43-2.00), stronger than heart failure, diabetes or coronary heart disease. CONCLUSIONS: In community-dwelling geriatric Polish population AF is associated with higher prevalence of depression. This association is independent from the demographic factors, disabilities and comorbidities (including history of stroke).

Long-term mortality after stroke is higher than after myocardial infarction.

Mortality caused by coronary heart disease and ischemic stroke (IS) in Poland is still among the highest in Europe. Because acute myocardial infarction (AMI) and IS share major common risk factors, it would be expected that trends in long-term mortality (LTM) and incidence of these two diseases would be similar. Nevertheless, better AMI acute phase therapy and older age of IS patients make post-IS and post-AMI prognosis difficult to compare. The aim of the study was to verify the thesis that, regardless of age and sex, the long-term prognosis is worse for post-IS than for post-AMI subjects. The study was conducted in Polish city-Gdynia (250,000 of inhabitants) among 997 subjects (464 post-IS, 533 post-AMI) randomly selected from all post-IS and post-AMI patients, witch survived hospitalization period in years 2000-2005. The observation period varied from 1 month to 11 years. LTM was shown as standardized mortality ratios. Kaplan-Meyer survival curves and Cox proportional hazard regression model were used to compare LTM in post-IS and post-AMI subjects. Post-IS and post-AMI groups did not differ by sex or age of event. Fewer deaths were recorded in post-AMI group (38.8 vs. 51.5 %, OR 0.60, 95 % CI 0.46-0.77). This difference was most evident in males (39.7 vs. 57.8 %, OR 0.48, 95 % CI 0.34-0.66). Kaplan-Meyer estimates showed faster reduction of survival probability in the post-IS males. In Cox regression model presence of IS increased long-term mortality in males. Long-term prognosis was worse for post-IS males in comparison with post-AMI population from Gdynia.

Exploring potential mortality reductions in 9 European countries by improving diet and lifestyle: A modelling approach.

BACKGROUND: Coronary heart disease (CHD) death rates have fallen across most of Europe in recent decades. However, substantial risk factor reductions have not been achieved across all Europe. Our aim was to quantify the potential impact of future policy scenarios on diet and lifestyle on CHD mortality in 9 European countries. METHODS: We updated the previously validated IMPACT CHD models in 9 European countries and extended them to 2010-11 (the baseline year) to predict reductions in CHD mortality to 2020(ages 25-74years). We compared three scenarios: conservative, intermediate and optimistic on smoking prevalence (absolute decreases of 5%, 10% and 15%); saturated fat intake (1%, 2% and 3% absolute decreases in % energy intake, replaced by unsaturated fats); salt (relative decreases of 10%, 20% and 30%), and physical inactivity (absolute decreases of 5%, 10% and 15%). Probabilistic sensitivity analyses were conducted. RESULTS: Under the conservative, intermediate and optimistic scenarios, we estimated 10.8% (95% CI: 7.3-14.0), 20.7% (95% CI: 15.6-25.2) and 29.1% (95% CI: 22.6-35.0) fewer CHD deaths in 2020. For the optimistic scenario, 15% absolute reductions in smoking could decrease CHD deaths by 8.9%-11.6%, Salt intake relative reductions of 30% by approximately 5.9-8.9%; 3% reductions in saturated fat intake by 6.3-7.5%, and 15% absolute increases in physical activity by 3.7-5.3%. CONCLUSIONS: Modest and feasible policy-based reductions in cardiovascular risk factors (already been achieved in some other countries) could translate into substantial reductions in future CHD deaths across Europe. However, this would require the European Union to more effectively implement powerful evidence-based prevention policies.

Smoking among pregnant women in small towns in Poland.

OBJECTIVES: The aim of the work was to assess among pregnant women from small towns and villages in Poland: the prevalence of smoking, credibility of smoking, and influence of socioeconomic factors on smoking status. METHODS: The data came from 4512 interviews with women in different trimesters of pregnancy. The interviews were collected in 2007 and 2008 year in towns up to 8000 citizens in 12 voivodeships. RESULTS: Prevalence of smoking in the beginning of pregnancy was confirmed by 34.6 % of women. During the pregnancy 14.7 % of women declared quitting smoking and 19.9 % continued smoking. Cigarette smoking was most frequent in those with a primary education, unemployed, very low incomes in household, and having both smoking parents. In multifactorial analysis, risk of smoking was highest (95 % CI 1.74-6.06) for women that were divorced or not living with a partner compared with married. CONCLUSIONS: Rates of active smoking among a population of pregnant women living in small towns in Poland are very high. Since the correlates of smoking during pregnancy are a low education level and a low economic status of the pregnant woman, these socioeconomic groups should be first priority targets.

Prevalence of diabetes and impaired fasting glucose in Poland--the NATPOL 2011 Study.

AIMS: The aim of the analysis was to assess the prevalence of diabetes and impaired fasting glucose in Poland. METHODS: A questionnaire survey on a representative sample of 2411 Polish adults, complemented by blood pressure, anthropometric and fasting plasma glucose measurements. The research was part of the national cross-sectional NATPOL 2011 Study. Diabetes was assessed as self-reported (diagnosed) or screened (fasting plasma glucose level ≥ 7 mmol/l, based on one blood draw). RESULTS: Total prevalence of diabetes in 2011 was 6.7% (95% CI 5.6-7.9); 6.4% (95% CI 5.0-8.0) in women and 7.0% (95% CI 5.4-8.8) in men and did not change from 2002 (6.8%, 95% CI 95% CI 5.8-7.9). Over one quarter of individuals with diabetes were not aware of having the condition. Obesity, arterial hypertension and male gender were strong predictors of screened diabetes. Total prevalence of impaired fasting glucose in the surveyed population was 15.6% (95% CI 14.0-17.2). CONCLUSIONS: The prevalence of diabetes in Poland is similar to that observed in other European populations and has not changed over the last decade. The fact that every fourth person with diabetes is unaware of the disease creates important opportunities for screening and detection of the disease.

Plasma level of N-terminal pro brain natriuretic peptide (NT-proBNP) in elderly population in Poland--the PolSenior Study.

BACKGROUND: The brain natriuretic peptides (BNP, NT-proBNP) are useful diagnostic markers of heart failure (HF), as exemplified by the ESC Heart Failure guidelines. The PolSenior project was an epidemiological study carried out to examine medical, psychological and socioeconomic aspects of aging in Poland. The aim of this study is an epidemiological description of HF based on elderly population from the PolSenior Study, stratified by NT-pro-BNP concentration values. MATERIAL AND METHODS: The research sample included 4979 respondents (2567 males and 2412 females) split into six equally sized age groups of elderly individuals. The study consisted of three visits performed by trained nurses and included a questionnaire survey, comprehensive geriatric assessment and blood and urine sampling with more than 50 biochemical parameters measured. Serum NT-pro-BNP was measured by electrochemiluminescence method (ECLIA). RESULTS: The prevalence of chronic kidney disease (CKD) (77.8%) and atrial fibrillation (39.5%), number of hospitalizations (23.7%) and number of patients treated with HF drugs were highest in NT-proBNP > 2000 pg/ml group and least frequent in NT-proBNP < 400 pg/ml group. Obese patients had significantly more frequently NT-proBNP values < 400 pg/ml (73.0%) and less frequently NT-proBNP values >2000 pg/ml (2.8%). Age over 70 years and male gender were associated with the increased NT-pro-BNP (> 400 pg/ml) (OR 1.41; CI 1.20-1.65 for male gender). CONCLUSIONS: We conclude that CKD and atrial fibrillation are associated with the occurrence of increased NT-pro-BNP, the surrogate for HF in elderly population. On the contrary, overweight or obesity is associated with lower prevalence of HF in elderly.

[Population-level changes to promote cardiovascular health]. / Zmeny na úrovni populace zamerené na podporu kardiovaskulárního zdraví

BACKGROUND: Cardiovascular diseases (CVD) cause 1.8 million premature (<75 years) death annually in Europe. The majority of these deaths are preventable with the most efficient and cost-effective approach being on the population level. The aim of this position paper is to assist authorities in selecting the most adequate management strategies to prevent CVD. DESIGN AND METHODS: Experts reviewed and summarized the published evidence on the major modifiable CVD risk factors: food, physical inactivity, smoking, and alcohol. Population-based preventive strategies focus on fiscal measures (e.g. taxation), national and regional policies (e.g. smoke-free legislation), and environmental changes (e.g. availability of alcohol). RESULTS: Food is a complex area, but several strategies can be effective in increasing fruit and vegetables and lowering intake of salt, saturated fat, trans-fats, and free sugars. Tobacco and alcohol can be regulated mainly by fiscal measures and national policies, but local availability also plays a role. Changes in national policies and the built environment will integrate physical activity into daily life. CONCLUSION: Societal changes and commercial influences have led to the present unhealthy environment, in which default option in life style increases CVD risk. A challenge for both central and local authorities is, therefore, to ensure healthier defaults. This position paper summarizes the evidence and recommends a number of structural strategies at international, national, and regional levels that in combination can substantially reduce CVD.

Assessment of the quality of secondary ischemic stroke prevention in selected urban areas of Poland and Ukraine: the ASCEP study results.

UNLABELLED: The aim of this study was to assess the quality of secondary ischemic stroke (IS) prevention among subjects after IS from selected urban areas of Poland (Gdynia, G) and Ukraine (Lutsk, L). METHODS: The study was conducted on representative samples of post-IS patients from G and L who suffered from IS in the years 2000-2005. A questionnaire, anthropometric and blood pressure (BP) measurements and laboratory tests were performed. RESULTS: The data of 440 patients were collected. Only 47% in G and 58% in L (p < 0.05) had visited a neurologist within 6 months before the interview. Results of the prevalence and control of consecutive IS risk factors were estimated: (1) arterial hypertension (prevalence: 88% G, 92% L, p = 0.1; BP <140/90 mm Hg: 23% G, 16% L, p = 0.02); (2) hypercholesterolemia (prevalence: 90% G, 76% L, p < 0.05; total cholesterol <175 mg/dl: 11% G, 6% L, p = 0.05); (3) self-reported diabetes or glycemia >125 mg/dl: 22% G, 17% L, p = 0.08; (4) smoking: 26% men versus 16% women in G, 33% men versus 2% women in L, p < 0.05, and (5) self-reported atrial fibrillation: 28% G, 7% L, p < 0.05. Antiplatelet drugs or oral anticoagulants were taken by 51% G versus 45.5% L (not significant). CONCLUSIONS: The quality of secondary IS prevention is insufficient, and there is a need for complex educational interventions in patients, their families and medical staff. Our data also call for organizational changes in the health service both in Poland and Ukraine.

Socio-demographic and lifestyle correlates of commuting activity in Poland.

OBJECTIVES: The aim of this study is to analyse the epidemiology of active transportation and to investigate the relationship between commuting physical activity (PA) and socio-demographic and lifestyle characteristics in Poland. METHODS: A cross sectional analysis was conducted among 7280 randomly selected individuals (3747 men and 3533 women) aged 20-74 years participating in the National Multicentre Health Survey WOBASZ (2002-2005). Socio-demographic, smoking and physical activity details were assessed by an interviewer-administered questionnaire. RESULTS: Only 36% of the participants (30% men and 42% of women) are active commuters. Moreover, 55.4% of them spend less than 15 min/day on walking or cycling. The highest risk of commuting inactivity was noticed among residents of large urban settings, with university education, the highest income and low occupational PA in both genders. Smoking and leisure-time PA were not significantly associated with commuting activity. CONCLUSIONS: Active commuting is not common in Poland. There are several differences in commuting patterns as compared with the US or Western European populations. Due to important differences between various socio-demographic groups, future interventions should be specific for the targeted subpopulations.

Epidemiology of physical inactivity in Poland: prevalence and determinants in a former communist country in socioeconomic transition.

OBJECTIVES: The aim of this study was to identify physical activity patterns and determinants of physical inactivity in a representative sample of Polish adults. STUDY DESIGN: A cross-sectional analysis of 14 769 randomly selected individuals (52.7% women and 47.3% men) aged 20-74 years participating in the National Polish Health Survey, WOBASZ (2002-2005). METHODS: Sociodemographic and lifestyle details were collected. Assessment of physical activity was based on selected questions from the CINDI Health Monitor Questionnaire. RESULTS: Approximately 35% of Polish adults are not physically active in leisure time, whilst 39.5% declare sufficient level of leisure-time physical activity. Leisure-time inactivity is significantly less likely in persons aged <35 years, those with university education and those living in rural areas. Almost 48% of men and 28.4% of women employed full- or part-time report highly active work, whilst sedentary work is reported by 42.7% of women and 30.2% of men. Low occupational activity is more prevalent in young adults, persons with university education and those living in large urban areas. Nearly 67% of the entire working population report no active commuting. CONCLUSIONS: There is a need to promote various forms of physical activity, with special attention on active commuting and leisure-time activities across both genders and all age groups. Public health policies and programmes should focus on substantial differences between various sociodemographic groups.

Arterial hypertension in Poland in 2002.

Arterial hypertension represents a serious medical, social and economic problem in Poland. Owing to a small number of studies concerning HT epidemiology in Poland and large differences in methodology, it is difficult to make an objective verification of the changes regarding principal parameters in our country within the last decade. Important programme for the assessment of the situation in our country is NATPOL PLUS, carried out in the year 2002 on a representative sample of 3051 adult Polish residents aged between 18 and 93 years, using the current diagnostic criteria for arterial hypertension (blood pressure readings obtained at three separate visits in cases of newly detected HT, different cuff sizes for different arm circumference, age range 18-93 years, rejection of first measurement during initial screening visit). Prevalence of HT in Poland is 29%, awareness-67%, and effectiveness of treatment-12%. This means that while HT affects about 8.4 million adult Poles, only 1 million of them get effective treatment. Moreover, as much as 8.7 million Poles have high normal blood pressure and they should apply active prevention. The awareness, detection and control of hypertension is much worse in men than in women. A series of NATPOL studies indicated over the period 1994-2002 a significant and rapid decrease in the awareness of one's own blood pressure among the adult Polish population, especially in small towns and villages, among less educated people, and in males.

Have rapid socioeconomic changes influenced awareness of blood pressure in Poland?

The aim of our study was to evaluate changes in awareness of blood pressure during transition into a market economy in Poland. Thus, in 1994, we conducted a cross-sectional survey based on a questionnaire interview on a sample of 2080 men (M) and women (F) aged 18 years and over. The subjects were selected from a Polish population by stratified and cluster random sampling with quotas by the Center for Social Research in Sopot. They were asked if they were aware of blood pressure. The results were analysed according to age, sex, education level, income and place of living. In September 1997 we carried out the same investigation on a new group of 1664 adults. In addition to the questionnaire, the blood pressure (three recordings at home) measurements were completed. The interviewers were well-trained medical students. Awareness of blood pressure has declined (P < 0.001) from 71% in 1994 to 65.5% in 1997. The highest decrease in awareness of blood pressure was observed among less educated people, as well as among people living in smaller cities and villages. The overall prevalence of hypertension was 25.9% by 'older' WHO criteria (BP > or =160/95 mm Hg or taking antihypertensive medication) and 44.5% by JNC VI criteria (BP > or =140/90 mm Hg or taking antihypertensive medication). Forty-six percent of hypertensive subjects classified by JNC VI criteria were previously known to be hypertensives and 54% were newly detected (F: 39%, M: 69%). Low awareness of blood pressure in Poland is the crucial factor of insufficient detectability of hypertension. Decline of awareness of blood pressure being the most significant among people representing lower social status, emphasises the need for urgent preventive measures.

[Pharmacotherapy of arterial hypertension and pharmacoeconomic aspects of hypotensive therapy in elderly patients in Poland]. / Leczenie farmakologiczne nadcisnienia tetniczego oraz wybrane aspekty farmakoekonomiczne terapii hipotensyjnej u chorych w starszym wieku w Polsce.

The aim of our study was to examine the use of pharmacological therapy and to evaluate the economical aspects of treating hypertension (HT) in elderly patients in Poland. Two hundred and sixty eight elderly persons (147 females, 121 males; mean age: 72.2 +/- 6.0 years) were selected from Polish population by stratified and cluster random sampling with quotas. BP measurement was performed 3 times every 2 minutes at respondents home. In the questionnaire, awareness of HT was assessed. Prevalence of hypertension among subjects aged 65 years and over by JNC VI criteria (SAP > or = 140 mm Hg, DAP > or = 90 mm Hg or hypotensive therapy) was 74%. Awareness of HT was equal to 61%. Eleven percent of all hypertensives were well controlled. Among hypertensives, 71% took prescribed antihypertensive drugs on a regular basis. Patients with HT were taking the following antihypertensive drugs: diuretics 16%, diuretics and reserpine 20%, beta-blockers 19%, ACE inhibitors 53%, calcium antagonists 30%, and other 3%. Newer drugs were prescribed in 7%, and multi-source (generic) products in 93%. The average cost of treatment with one drug was 147 PLN (37.5 USD) per year (newer drugs: 413 PLN; multi-source product 126 PLN). Assuming those data and number of elderly people in Poland (4.335 mln), we estimated that 3.208 mln of subjects have had hypertension according to JNC VI criteria. Only 1.957 mln of patients with HT have been detected and only 0.353 mln of hypertensives have been well controlled. The approximate global cost of antihypertensive drugs per year in elderly patients in Poland has been equal to 285 mln PLN (72.8 mln USD). In hypothetical situation with optimal (100%) detection and control of HT the global cost by the actual rate of regularity in taking drugs would increase to 569 mln PLN (145.3 mln USD). The prevalence of HT in elderly people in Poland is very high. In elderly hypertensives ACE inhibitors are used most often. More than 90% of prescribed drugs are multi-source products. An optimal improvement of HT detection and control would cause a two-fold augmentation of the costs of pharmacological therapy.

Renin-aldosterone regulation during upright posture in young men with mitral valve prolapse syndrome.

Previous studies have shown that symptom complex in patients with mitral valve prolapse syndrome (MVPS) may result from various forms of autonomic dysfunction. However, the interaction between adrenergic activity and renin release has not been studied. The purpose of this investigation was to assess changes in plasma renin activity (PRA) and plasma aldosterone in response to prolonged orthostatic stimulation in 19 young men with MVPS when compared to age- and sex-matched 20 control subjects. Heart rate was measured, and blood samples for PRA and aldosterone were obtained in the supine position and 90 min after assuming an upright position and slow walk. With posture the heart rate increase was greater in patients with MVPS in comparison with control subjects (19 +/- 9 vs. 12 +/- 8 beats per min, p < 0.05). Also an increase of PRA during upright activity was significantly greater in patients with MVPS (control 1.0 +/- 0.5 ng angiotensin I/mlxh, MVPS 1.8 +/- 1.7 ng angiotensin I/mlxh; p < 0.05). A significant correlation (r = 0.52, p < 0.05) was found between a rise of heart rate and PRA in patients with MVPS, but not in the control subjects. During prolonged upright activity aldosterone increased significantly in control subjects (at rest 74 +/- 41 pg/ml, with posture 98 +/- 68 pg/ml, p < 0.05) but did not change in patients with MVPS (at rest 64 +/- 29 pg/ml, with posture 67 +/- 26 pg/ml, NS).(ABSTRACT TRUNCATED AT 250 WORDS)