Background: Hypertension in the elderly is commonly characterized by an elevation of pulse pressure. With regard to advanced arteriosclerosis and limited physical fitness, doubt was casted whether elderly patients still achieve relevant cardiovascular benefits by physical exercise. The present work examines the impact of pulse pressure as a footprint of vascular ageing on cardiovascular benefits of endurance training in elderly hypertensives. Methods: 54 patients ≧60 years with systolic 24-hour ambulatory blood pressure (ABP) >140 mm Hg and/or antihypertensive treatment and diastolic ABP ≤90 mm Hg were randomly assigned to sedentary activity or a 12-week treadmill exercise program (target lactate 2.5 ± 0.5 mmol/l). Results: Exercise significantly decreased systolic and diastolic ABP by 8.5 ± 8.2 and 5.1 ± 3.7 mm Hg (p < 0.001 each) and increased physical performance. Arterial compliance remained unchanged, whereas endothelium-dependent vasodilation – measured by flow-mediated dilation – significantly increased from 5.6 ± 1.7 to 7.9 ± 3.0% (p < 0.007). After adjustment for initial systolic ABP, pulse pressure did not affect the change of BP. Conclusion: The exercise-induced reduction of BP, which is mediated by improved endothelial function, is independent of pulse pressure. Thus, physical exercise is a helpful adjunct to control BP even in old hypertensives with markedly increased arterial stiffness.

Our findings show that static measurement of vascular parameters by an automated pulse-wave analysis procedure cannot be used to assess endothelial function. Further studies are needed to examine whether a dynamic measurement of arterial compliance before and after stimulation of the endothelium (e.g. by ischemia) might quantify endothelial dilatory capacity in a better way.

Methods: The noise level was measured continuously for five days and eight hours a day at 11 measurement points in the waiting areas of the outpatient clinics. The device was set to give an hourly average. This was a descriptive study and there was no sample selection. SPSS statistical package was used and Kruskal Wallis, Mann-Whitney U, Friedman and Wilcoxon tests were performed for data analysis. A value of p <0.05 was considered significant. Results: The average noise level was 62.1 dBA (min 48.5dBA and max 70.8dBA). This value and even the minimum measured value were above the threshold values specified in the EPA, WHO and Environmental Noise Assessment and Management Regulations. Although their noise levels were also above the thresholds, only the radiology outpatient clinics have significantly lower values than the others (p <0.05). The noise levels had no significant differences among days or hours. Conclusions: The measured noise levels were above the threshold values in the waiting areas of the outpatient clinics. Noise prevention measures should be considered.