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People between 18 and 49 years of age with isolated systolic hypertension (ISH) have increased risk of death from cardiovascular causes or ischemic heart disease (IHD) according to the results of a study published in the Journal of the American College of Cardiology.

The authors used a database of patients from 1967 to 2003 and evaluated the risk of developing cardiovascular disease (CVD) in the presence of ISH, defined as systolic blood pressure (SBP)> / = 140 mmHg and diastolic blood pressure (DBP) <90 mmHg in men and women under the age of 50.

27,081 participants were classified into five categoriesm, based on the values of BP: optimal BP (SBP <130 DBP <85 mmHg); high normal BP (130-139 / 85-89 mmHg); ISH (SBP> / = 140 mmHg and DBP <90 mmHg); isolated diastolic hypertension (IDH; SBP <140 and DBP> / = 90 mmHg) and systolic – diastolic hypertension (SDH; SBP> / = 140 mmHg and DBP> / = 90 mmHg).

According to this distribution, 53% of the women had optimal baseline BP and 13% – ISH, while among men – around 25% of the participants fell into each category: optimal blood pressure, high normal BP and ISH. Patients with known coronary artery disease and those taking antihypertensive medications were excluded.

The results showed that after 31 years of follow up the participants with baseline ISH were at increased risk for CVD and CHD mortality as compared to those who had optimal or normal blood pressure or high IDH. The relationship described was more pronounced in women. The risk in patients with ISH, however, was lower than that in patients with SDH.

Up to that point ISH at a young age had not attracted particular attention as a risk factor, but the data from this study showed that ISH was associated with an increased risk of CVD and mortality.

Since the frequency of hypertension, obesity and lipid profile disorders among young people have been increasing substantially, early intervention in the course of the disease and the promotion of a healthy lifestyle could significantly influence the future incidence of adverse cardiovascular events.

According to the Guidelines for the Management of Arterial Hypertension of the European Society of Cardiology and the European Society of Hypertension (ESC / ESH), the preferred antihypertensive drugs for adults with ISH are calcium channel blockers (CCBs) and diuretics with class indication ΙA.

Some meta-analyzes suggest that CCBs may be more effective than other antihypertensive classes for stroke prevention (perhaps precisely because of the favorable influence of SBP, whose values are closely associated with stroke risk).
In addition, this class of drugs has been shown to lower the central aortic pressure, improving the endothelial function, and it also has antiatherosclerotic effects.

Ireland, the United Kingdom and Albania are the first three countries in Europe in child obesity. Bulgaria is fifth, according to a study published at a Congress on the problem in Prague. The study has been conducted with the participation of the World Health Organization (WHO) based on data for children aged up to 5 years in 32 countries of the Old Continent.

In Ireland, 27.5% of the children under the age of 5 are fat or obese, while in the UK they are 23.1%. Albania follows with 22%, and Georgia – with 20%.

In Bulgaria 19.8% of the children aged up to 5 years are obese. Spain follows with 18.4%. At the opposite pole are the Czech Republic – with 5.5 percent, Belgium – with 7% and 8% – in Sweden. Italy and France are in the middle of the table, respectively by having 10.2% and 11.4%.

Another study, presented at the colloquium in the Czech capital, concluded it was more likely that obese children leave school early compared to the ones with normal weight. 56% of overweight children under the age of 12 regularly attend school. This applies to 76 percent of their other peers.
According to the WHO estimates presented in Prague, by 2030 Europe will be facing a large scale obesity epidemic among its working-age population.

One of the most prominent Italian neurologists and acknowledged European experts in the field of Parkinson’s disease Prof. Angelo Antonini was an official guest speaker at the 14th National Congress of Neurology, held over the weekend in the resort “Golden Sands”, announced the organizers of the forum. Prof. Antonini is Director of the Department of Parkinsonism at the Institute of Neurology, “San Camillo” in Venice. The topic of his lecture focused on the possibilities for modern treatment of the late stages of Parkinson’s disease. The neurologist presented his clinical experience with the leading contemporary therapy that is currently applied for this indication – treatment with levodopa / carbidopa intestinal gel.

The method has been among the preferred ones by professionals in the recent years, and very good therapy results and usability have been reported. This method is also known in Bulgaria and has been used for several years in a few university clinics. The treatment is entirely reimbursed by the NHIF and so far our neurologists have successful experience with 40 patients. Prof. Antonini arrived in Bulgaria from Romania, where he was a speaker at the Romanian Neurological Congress and participated in a discussion with Romanian neurologists, who were presented the treatment results of using this method and the follow up results of 200 Romanian patients.

Tchaikapharma High Quality Medicines AD has been offering on the Bulgarian market a drug designed to treat the symptoms of Parkinson’s disease since 2009. Sinepar is a medicine which combines the aromatic amino acid carbidopa monohydrate (a decarboxylase inhibitor) with levodopa (a metabolic precursor of dopamine) in an extended release tablet formulation of the active substance.

The Parliamentary Health Committee could not decide whether GPs should hand out universal access codes (UAC) to the NHIF electronic system to patients. This proposal was made by the MP from GERB Semir Abumelih and was passed among the amendments to the Health Insurance Act, which the Commission considered during its second presentation.

The idea of the MP provoked the sharp reaction of the National Association of General Practitioners in Bulgaria some days ago, who said that that they were not postal services to provide this type of service. The GPs announced that in order to perform this, they would have to be paid additionally for the work.

Meanwhile, during the discussion in the Health Committee last week, Abumelih noted that family physicians could play precisely the role of couriers between citizens and the NHIF. According to his proposal, they would be obliged to hand out to patients the UAC in question, in a sealed envelope, and the keep the receipts in a special form. Currently, to receive the code, citizens have to go to the RHIF, where it is handed out to them.

The President of the Bulgarian Dental Association Dr. Borislav Milanov took the floor on behalf of the professional organizations. He urged lawmakers to take into account the opinions of doctors and not to burden them with additional clerical work.

The MP from GERB Kiril Dobrev said that when the proposed text was to be voted, the MPs should take into account the opinion of the General Practitioners. According to him, they should not be obliged to perform the service in question. The Chair of the Health Committee Dr. Daniela Daritkova went on to ask who would pay for the organization of the proposed service.

In response, the Manager of the NHIF Dr. Glinka Komitov said the Fund could not prepare 7 million envelopes with UACs. The Deputy Minister of Health Dr. Boyko Penkov said that neither the Fund, nor the Ministry had extra money this year. According to him, if lawmakers adopted the proposal, an amendment to the budget would have to be made.

As a result, the MPs postponed their decision until the next meeting.

The NHIF does not fund hospitals, but the services provided to the patients who visited the hospitals, stated Dr. Glinka Komitov, Manager of the NHIF, in front of the media. He noted that this was the reason for having to make adjustments to some hospitals’ budgets. According to him, most patients go to those hospitals where there are highly specialized personnel and high-tech equipment.

“If a reputable doctor from a certain hospital last year, went to work in another hospital on the same or a different territory – in another location, patients would follow the doctor. They would not visit the medical establishment they had gone to up to that point any more, since they had not visited the hospital, but the reputable doctor – the good, highly qualified specialist. Not surprisingly, in some hospitals, such as the specialized ones, part of the patients from the Oncology Hospital in Sofia for example, have already been visiting a private hospital, as the good, the very good doctors from the Oncology Hospital in Sofia are now working in the private hospital. Therefore, this resource is not simply redistributed to a given hospital, but because more patients visit this hospital, because of the presence of its employed highly skilled professionals,” he explained.

Commenting the case of the additional funds for hospitals, Dr. Komitov said: “I will propose to the Supervisory Board to increase the hospital resources of 146 of all 364 hospitals in the country. This proposal will not be based on which hospital should get how much, but on the justified requests of the medical institutions. Some hospitals want BGN 16 thousand, others – 2 or 5 million. All this will be presented to the Supervisory Board. Our funds for hospital care were 1.3 billion, but the Law on the NHIF Budget has the opportunity to advance funds from the Health Insurance Fund Reserve in the amount of 10% of the total revenue, or BGN 301 million. Up to BGN 5 million could be spent on primary care, up to BGN 10 million – on specialized care, and up to 5 million – on medical diagnostic aid, while  hospital care is allowed to be given up to BGN 180 million from the reserve in advance ” .

Dr. Komitov said his greatest desire was for hospitals not to have determined budgets, but to got paid for all activities performed. He, however, noted that for this to happen there should be greater control. “We will pay for the respective amounts of activities, as long as they are done according to the respective prices we have agreed upon,” said the Manager of the NHIF. According to his words, the medical institutions should concentrate solely on the quality of their medical care for patients.

The NHIF can perform inspections only after the events, said Dr. Komitov. He noted that if a breach was caught in a hospital now, it could not be sanctioned immediately, but would have to wait for the activity to be reported. According to him, under these circumstances, no employee would account for that activity and would report double for another clinical path. This requires changes to the existing legislation. Dr. Komitov added that both types of control should merge – the financial and medical control. According to him, the control authorities should conduct inspections suddenly and impose sanctions immediately, without reporting the activity. “To have transparency, we need the NHIF to publish the inspection information every month on the site, with the names of the hospitals and the violations found,” said he.