Artykuły

Starzenie się ludności, wyrażające się we wzroście w społeczeństwie odsetka ludzi w wieku podeszłym, koncentruje uwagę naukowców, między innymi specjalistów medycyny. Na przestrzeni ostatnich stuleci kilkukrotnie wzrosła spodziewana długość życia w krajach rozwiniętych. Prognozy demograficzne przewidują jej dalszy przyrost. W Polsce proces ten postępuje bardzo szybko i według prognoz liczba osób w wieku emerytalnym (powyżej 65. roku życia) do 2035 roku wzrośnie 1,5–2 razy. Jest to skutek postępu cywilizacyjnego i poprawy jakości życia.

Background. The objective of the study was to evaluate the prevalence of metabolic syndrome (MS) in male population of the Warmia and Masuria region in Poland according to IDF 2005 recommendations.

Material and methods. 631 men, aged 19–82 years (mean 47 ± 14) were examined between Dec 2014 and Dec 2016. Standardized questionnaire was completed by the subjects. Anthropometric measurements were performed. Blood pressure was measured. Blood tests (serum fasting glucose, lipidogram) were performed in 398 men (age: 48 ± 13years). Following age groups were identified: < 30YOA, 30–47YOA, 48–64YOA, ≥ 65YOA. Two groups of 398 men were defined: MS+ who fulfilled MS criteria, MS- who did not fulfill MS criteria.

Results. MS was diagnosed in 45.7% of 398 men. There was a significant age-related increase in its prevalence: < 30years of age (YOA) 9.5%, 30–47YOA 38.1%, 48–64YOA 53.2%, ≥ 65YOA 65.8%. Prevalence of components of MS in study group (n = 398) was: waist circumference (≥ 94 cm) in 254 (63.8%); high triglycerides (≥ 150 mg/dl or hypertriglyceridemia treatment) in 146 (36.7%); low HDL (< 40 mg/dl or dyslipidemia treatment) in 83 (20.9%); fasting glucose (≥ 100 mg/dl or diabetes treatment) in 173 (43.5%); elevated blood pressure (SBP ≥ 130 mmHg or DBP ≥ 85 mmHg or treatment of hypertension) in 313 (78.6%).

Conclusions. The prevalence of MS in male population of Warmia and Masuria was 45.7% with significant increase in age. The study confirms the necessity of early prevention of MS in that region of Poland

Arterial Hypertens. 2017, vol. 21, no. 3, pages: 148–152 DOI: 10.5603/AH.2017.0020

Introduction. Regular physical activity is a recognized method of non-pharmacological prevention many chronic diseases. The aim of this study was to evaluate the prevalence of physical activity and abdominal obesity in 631 randomly selected men from Warmia and Masuria region in Poland.

Material and methods. 631 men from the Warmia and Mazury region in age of 19–82 years (47.2 } 13.7 years) were examined between Dec 2014 and Dec 2016. Participants completed standardized questionnaire. Anthropometric measurements were performed. BP was measured. In serum of 398 participants glucose and lipidogram were measured. Analyses were performed separately for three groups depending on time of physical activity in week: ACT+ (meet WHO physical activity recommendations ≥ 150 min/week), ACT+/- (do not meet WHO recommendations < 150 min/week and ≥ 50 min/week) and ACT — (do sport occasionally or never). Two groups were performed depending on the BP: AHT+ (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg or antihypertensive therapy) and AHT — (BP values < 140/90 mmHg and no antihypertensive therapy).

Results. ACT-, ACT+/- and ACT+ accounted respectively for 53%, 24% and 23%, AHT+ for 55.6% and men with waist circumference ≥ 94 cm for 63.9% of studied population. In ACT- increased BP was measured more frequently in comparison with ACT+. In ACT+ waist circumference, DBP and HR were lower and PP was higher in comparison to ACT-. Laboratory tests results did not differ between all three groups of respondents. It was observed that group of participants with waist circumference < 94 cm had lower values of blood pressure parameters in comparison to participants with waist circumference ≥ 94 cm.

Conclusions. Only 1 out of 4 men in Warmia and Masuria region in Poland meets the WHO physical activity recommendations, 64% of them have abdominal obesity and more than a half had measured increased values of arterial blood pressure. These findings reveal increased risk of CVD and mortality among men in Warmia and Masuria region comparing to population of Poland and Europe.

Arterial Hypertens. 2017, vol. 21, no. 3, pages: 140–147 DOI: 10.5603/AH.2017.0019

Introduction. Interest in isolated systolic hypertension (ISH) in young people has increased in recent years. The applanation tonometry technique provides new diagnostic opportunities in this group of patients. The aim of the study was to evaluate the incidence of ISH among young adults and factors contributing to its occurrence.

Material and methods. One hundred and two medical students aged 21 to 26 years were examined. The study was based on three peripheral blood pressure measurements and central blood pressure measurement. Information on health status and physical activity was collected using the author-developed questionnaire.

Results. Based on the mean of peripheral blood pressure measurements, hypertension (HT) was detected in 23 students (22.55%): 18 had ISH, 4 — combined systolic/diastolic HT and 1 — isolated diastolic HT. Pulse wave analysis showed that all individuals with ISH had central blood pressure within the normal range — higher than those without HT, but lower than in the combined systolic/diastolic HT group (p < 0.001). Subjects with ISH were characterized by higher pulse pressure amplitude and lower augmentation index (AIx) compared to those with normal blood pressure. Subjects with ISH were taller, had a higher body mass index (BMI) and were more likely to have a positive family history of HT compared to normotensives. They also reported more frequent coffee consumption; and 22% of them used creatine supplements (vs. 0% in non-HT group).

Conclusions. Measurement of central arterial blood pressure by applanation tonometry should be an integral part of the assessment of young patients with ISH. The study confirmed that ISH patients are characterized by higher growth, weight and physical activity. Further studies are needed to assess the clinical significance of ISH.

Arterial Hypertens. 2017, vol. 21, no. 3, pages: 132–139 DOI: 10.5603/AH.a2017.0018

Introduction. Resistant hypertension (RHT) is recognized when the blood pressure (BP) is equal to or greater than 140/90 mmHg, despite changes in lifestyle and using at least 3 antihypertensive drugs, including diuretics at optimal doses. Often, patients limit the proper control of BP by voluntary reduction and discontinuation of less tolerated drugs, failure to follow healthy lifestyle rules, and taking medications that increase BP. The reason for the lack of effects in treatment of hypertension (HT) is also unrecognized secondary HT. The aim of the study is to evaluate the occurrence of pseudo-RHT in patients with primary RHT diagnosis.

Material and methods. The study was conducted in 2012–14 among patients hospitalized in the Department of Cardiology of The Pope John Paul II Province Hospital in Zamość. 99 patients diagnosed with RHT were examined, (59 men) at age 54.5–67.0 on average 60.0 } 9.8 years. Statistical analysis was performed based on Statistica; Chi2 and U-Mann-Whitney tests were used. Results. The final group consisted of 93 people (55 men). In the course of hospitalization, studies were conducted for secondary causes of HT. Efficacy of treatment was evaluated, education on healthy lifestyle was conducted and in some cases pharmacotherapy was modified. As a result of the diagnostic procedure and increased control of applied therapy, 30 patients with true RHT and 63 patients with pseudo-RHT were identified from a group of 93 patients with initial RHT. Patients with true RHT (16 men) were proposed renal artery denervation.

Conclusions. A large group of patients with diagnosed RHT are patients with pseudo-RHT. The common cause of RHT is the presence of an undetected secondary HT.

Arterial Hypertens. 2017, vol. 21, no. 3, pages: 127–131 DOI: 10.5603/AH.a2017.0015

Hypertension is a major modifiable risk factor for cardiovascular diseases (ischaemic heart disease, stroke, heart failure and ischaemic artery disease of the lower limbs) and the most epidemiologically significant cause of death in the world. At the same time, the prevalence of hypertension in Poland is constantly increasing — according to the 2002 NATPOL study, it was 29% of adult Polish population. In the second NATPOL study, the proportion of hypertensive patients increased to 32% and in the WOBASZ II study in 2014 it reached 43%.

Nadciśnienie tętnicze jest podstawowym modyfikowalnym czynnikiem ryzyka chorób sercowo-naczyniowych: choroby niedokrwiennej serca, udaru mózgu, niewydolności serca i choroby niedokrwiennej tętnic kończyn dolnych, a także najistotniejszą epidemiologicznie przyczyną zgonów na świecie. Jednocześnie częstość występowania nadciśnienia tętniczego w Polsce stale rośnie — według badania NATPOL z 2002 roku — dotyczyła 29% populacji dorosłych Polaków, w powtórnym badaniu NATPOL 2011 wzrosła do 32%, a w badaniu WOBASZ II w 2014 roku wynosiła już 43%.

Arterial Hypertens. 2017, vol. 21, no. 3, pages: 105–115 DOI: 10.5603/AH.2017.0014

In recent years a new very promising drug was introduced for the treatment of chronic heart failure. This drug, sacubitril/valsartan, prevents the clinical progression of surviving patients with heart failure more effectively than enalapril and it reduces the need for hospitalization by more than 20%. At the same time it has been shown that it reduces blood pressure particularly in patients with essential hypertension. This drug is an inhibitor of neprilysin, an enzyme that degrades natriuretic factors. Natriuretic factors (ANP, BNP, CNP) increase diuresis and natriuresis, reduce the activity of the sympathetic system, relax the blood vessels and inhibit fibrosis. Several studies have shown that sacubitril/valsartan therapy more significantly reduces blood pressure in patients with salt-sensitive or refractory to treatment hypertension than is observed with valsartan or amlodipine. Furthermore, beneficial effects of this drug on central blood pressure and renal function have been demonstrated in patients with chronic renal failure. More rarely than enalapril it leads to hyperkalaemia in patients treated simultaneously with mineralocorticoid receptor inhibitors. Sacubitril/valsartan is the first representative of a new class of drugs that inhibit neprilysin, which probably in the future will be frequently used in hypertension.

Arterial Hypertens. 2017, vol. 21, no. 2, pages: 99–104 DOI: 10.5603/AH.2017.0013

Wstęp. Nadciśnienie tętnicze (AH) jest uznanym czynnikiem ryzyka schorzeń układu sercowo-naczyniowego. Obecnie 32% Polaków ma stwierdzone nadciśnienie tętnicze, z czego tylko 26% jest skutecznie leczonych. Celem pracy było określenie częstości występowania czynników ryzyka miażdżycy i ich wpływu na skuteczność leczenia hipotensyjnego w populacji pacjentów z AH i współistniejącą chorobą niedokrwienną serca (CAD) lub ekwiwalentem wieńcowym.

Materiał i metody. Kryterium włączenia do badania dla 204 osób stanowiło rozpoznanie HA (204 osoby), rozpoznanie CAD (138 osób) lub obecność ekwiwalentu wieńcowego rozumianego jako wysokie (≥ 5%) ryzyko zgonu z powodu miażdżycy w ciągu najbliższych 10 lat, szacowane według skali oceny ryzyka SCORE (66 osób). W czasie obserwacji modyfikowano postępowanie niefarmakologiczne i farmakologiczne zgodnie z obowiązującymi standardami leczenia AH, ponownie oceniając uzyskaną skuteczność kontroli AH po 6 miesiącach.

Wyniki. Analiza wieloczynnikowa wykazała, że niezależnymi czynnikami wpływającymi na brak prawidłowej kontroli wartości ciśnienia tętniczego po 6 miesiącach były: otyłość, wiek > 65 lat, stężenie cholesterolu frakcji LDL > 130 mg/dl. Wykazano również, że pacjenci z cukrzycą łatwiej osiągali wartości skurczowego ciśnienia tętniczego (SBP) < 140 mm Hg. Po 6 miesiącach terapii zadowalającą kontrolę SBP odnotowano u 42,7%, a rozkurczowego ciśnienia tętniczego u 65,2% pacjentów.

Wnioski. Niezależnymi czynnikami ryzyka braku prawidłowej kontroli wartości ciśnienia tętniczego były: podwyższone stężenia cholesterolu frakcji LDL, otyłość, wiek > 65 lat i płeć żeńska. Paradoksalnie, cukrzyca nie była czynnikiem zwiększającym ryzyko nieprawidłowej kontroli wartości ciśnienia tętniczego. Wprowadzenie skojarzonych preparatów hipotensyjno-hipolipemizujących powinno w szczególny sposób przyczynić się do lepszej kontroli nadciśnienia tętniczego w Polsce.

Arterial Hypertens. 2017, vol. 21, no. 2, pages: 94–98 DOI: 10.5603/AH.2017.0012

ntroduction. Hypertension (HT) is one of the most common causes of death in the adult population in the world. The lifestyle factors play a significant role in its pathogenesis. To be effective in preventing its development or slowing its progress the society needs to have proper knowledge.

Material and methods. The study was conducted in a population of 929 adults who had no known HT. Sociodemographic data were collected from each subject, anthropometric measurements were taken, blood pressure and heart rate were measured twice. The knowledge was assessed using the authorial questionnaire, and questions were related to knowledge about the effects of smoking, alcohol, coffee, salt, fat, irregular diet, low fibre and vegetables, and skimmed dairy products in diet, overweight and obesity, cholesterol, physical activity, stressful lifestyle on the development of HT.

Results. Incorrect knowledge of the influence on the development of HT in the case of alcohol drinking was found in 16.9% of the respondents, coffee — 58.8%, large amounts of salt — 10.3%, large amounts of fat — 82.7%, small amounts of fibre and vegetables and skimmed dairy products — 26.2%, irregular diet — 46.4%, cigarette smoking — 70.9%, overweight and obesity — 5.1%, high cholesterol — 87.6%, low physical activity — 10.9%, stressful lifestyle — 6.5%.

Conclusions. Incorrect knowledge of HT-related risk factors was associated particularly with higher level of cholesterol, excessive fat intake, smoking and coffee consumption. Most frequently incorrect answers were given by men, low-educated and non-smokers. In the above-mentioned groups emphasis on health promotion should be placed the most.

Arterial Hypertens. 2017, vol. 21, no. 2, pages: 73–82 DOI: 10.5603/AH.2017.0010