Artykuły

Introduction. Around 57% of Hungarian hypertensive patients did not reach the goal blood pressure. According to an ESH Newsletter published in 2011, the prevalence of resistant hypertension is 2.9–43%.

Objective. Analysing only the therapy of hypertensive patients of the Hypertension Outpatient Clinic of the University of Szeged, the authors wanted to answer following main questions: How many patients were therapeutically resistant according to the definition of resistant hypertension? How many patients were taking 3 or more antihypertensive drugs? How many of these patients reached target SBP values? How many drugs were usually used in combination therapy?

Material and methods. Data were retrospectively collected from 01/01/2011 to 31/08/2011 from the electronic files of the hypertensive patients. Altogether 310 patients’ data were analysed, of all cases only one visit was taken into account. For those patients who visited the Clinic more than once during this period, only the first visit was considered. Means of two measurements were calculated. The goal SBP was 140 mmHg.

Results. In this population, 234/310 (76%) patients had resistant hypertension according to the definition (158 ± 17/97 ± 8 mmHg). Three or more antihypertensive drugs were taken by 257/310 (83%) patients (136 ± 20 mmHg) and 134 of them (52% of 257 patients) reached the therapeutic goal. A fourfold combination of antihypertensive agents was the most frequent in this population.

Conclusion. It is advised to use multiple drug combinations and it is recommended to spend enough time but not longer than necessary to find the most effective combination in every case.

Arterial Hypertens. 2017, vol. 21, no. 2, pages: 69–72 DOI: 10.5603/AH.2017.0009

Nadciśnienie tętnicze jest istotnym czynnikiem ryzyka sercowo-naczyniowego. Skuteczność leczenia hipotensyjnego ciągle jednak pozostaje niewystarczająca. Terapia skojarzona nadciśnienia tętniczego co najmniej dwoma lekami umożliwia osiągnięcie docelowych wartości ciśnienia. Połączenie peryndoprylu z amlodypiną to dobrze przebadana kombinacja leków, w odniesieniu do której wykazano redukcję śmiertelności całkowitej, incydentów sercowo-naczyniowych oraz udarów mózgu.

W artykule przedstawiono analizę badań molekularnych i klinicznych wyjaśniających związek między układem renina-angiotensyna, nadciśnieniem tętniczym i otępieniem oraz czy leczenie inhibitorem ACE (peryndoprylem) i CCB (amlodypiną) ma pewien wpływ na postępowanie w tych chorobach.

Introduction. Arterial hypertension (HT) affects 10.4 million adult Poles, and the blood pressure (BP) control rate is only 26%. Beyond any doubt, high blood pressure results in cardiovascular (CV) target organ damage, which markedly influences national healthcare programs. Childhood introduced cardiovascular prophylaxis offers opportunities to decrease incident HT and delay or even eliminate its consequences. Therefore we have decided to study the level of knowledge on HT and CV disease (CVD) among random 1st and 2nd grade high school students in Tricity, Poland.

Material and methods. Questionnaire-based study was conducted voluntarily in two selected high schools of the Tricity agglomeration, Poland, in 2000 and repeated in 2016. All participants were presented with a 38-item questionnaire on cardiovascular risk factors knowledge as well as students’ health habits.

Results. Studied group consisted of 615 students (57.6% females) at the age of 16, mean BMI 20.89 ± 2.95 kg/m2 (78% BMI norm). The evaluation of the several habits in two time-points was as follows: additional salt intake was reported by 38.3% vs. 35.1% adolescents in 2000 and 2016, respectively; p = 0.43, dining in fast food restaurants at least once a week: 13.9% vs. 44.8%; 2000/2016; p < 0.01; hours per week spent on physical activity: 5.6 ± 4.4 vs. 5.5 } 4.5; p = 0.85; students who never drank alcohol: 19.7% vs. 31.1%; p < 0.01; cigarettes ever smoking: 39.6% vs. 21.2%; p < 0.01; regular smokers: 10.2% vs. 4.1%; p < 0.05. The awareness of CV-preventive measures such as body weight reduction was presented by 88.1% vs. 93.9% students in 2000 vs. 2016; p = 0.01; regular physical activity 92.6% vs. 97.1%; P = 0.01, limiting smoking and alcohol consumption 84.2% vs. 91.2%; p = 0.01; salt reduction: 62.6% vs. 82.3%; p < 0.001. Interestingly, in 2016 the majority of students identified myocardial infarction as a consequence of AH 92.4%, which was markedly less evident in case of stroke and kidney disease (46.2%, and 28%, respectively).

Conclusion. Although the awareness of negative consequences of HT and other CV-risk factors has grown over the past 15 years, the implementation of this knowledge is insufficient among high-school adolescents.

Arterial Hypertens. 2017, vol. 21, no. 1, pages: 51–59 DOI: 10.5603/AH.2017.0007

Introduction. Pressure measurements obtained before and after hemodialysis (HD) are marked by their high variability and poor reliability, which undermine their ability to estimate cardiovascular events (CVs).

Objective. This study sought to determine whether more measurements performed over a longer period of time enable a more accurate evaluation of the CVs associated with arterial hypertension.

Material and methods. This study included 40 patients (23 men and 17 women) aged between 27 and 82 years with a mean age of 58.8 ± 13.6 years who underwent chronic HD for 4 to 338 months. On days without HD, blood pressure home measurements (HMs) were recorded in the morning, afternoon and evening, and the results were obtained each day for 8 days. Furthermore, pressure measurements were recorded five times during 7 subsequent planned HD procedures: before HD, after HD and three times during HD. After 12 months, the number of CVs was determined with respect to the pressure measurement method.

Results. The correlation coefficients between the HMs and HD with regard to systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were 0.85, 0.80, and 0.84, respectively (P < 0.001). The receiver operating curve (ROC) values for SBP were 137.8 mmHg for HM and 140.4 mmHg for HD. The sensitivity and specificity of the HMs for SBP were 0.667 and 0.727, respectively. CVs occurred in 66.7% of the patients with SBPs ≥ 137.8 mmHg. The sensitivity and specificity of the HD measurements of SBP were 0.611 and 0.818, respectively. CVs occurred in 73.3% of patients with SBPs ≥ 140.4 mmHg.

Conclusions. Increasing the number of pressure measurements over a longer period of time in patients with HD likely improves the reliability of CV risk estimates.

Arterial Hypertens. 2017, vol. 21, no. 1, pages: 42–50 DOI: 10.5603/AH.2017.0006

Introduction. Arterial hypertension is a well-known risk factor of both cardiovascular complications and faster progression of chronic kidney disease (CKD). There is growing evidence that central blood pressure (BP) and nighttime BP may have an advantage in predicting the risk of cardiovascular complications and the progression of CKD in comparison with the traditional office BP measurements. The aim of this study was to evaluate the central BP and nighttime BP in non-diabetic CKD patients with no, or only mild proteinuria i.e. autosomal dominant polycystic kidney disease (ADPKD) or IgA nephropathy (IgAN).

Material and methods. Forty patients with CKD stage 3 or 4 were enrolled into the study. In each patient the measurement of peripheral and central BP was conducted, as well as the assessment of pulse wave velocity (PWV) and the 24-hour blood pressure monitoring (ABPM).

Results. Despite the lower office and central BP values in patients with IgAN in comparison to patients with ADPKD, both studied groups did not differ in the mean BP in the 24-hour ABPM. In the entire studied group a significant positive correlation was found between the augmentation pressure and age, as well as between the augmentation index — AIx% and age. Moreover, a significant positive correlation between the decrease of nighttime BP and eGFR was observed. Additionally, a significant positive correlation between PWV and age was found.

Conclusions. 1. Patients with ADPKD and IgAN, despite the differences in office and central BP do not differ in respect of the mean BP in the 24-hour ABPM. 2. In both groups of patients vascular stiffness increases with age and deteriorating kidney function. 3. Lower decrease of nighttime blood pressure is related to the worse kidney function in patients with non-diabetic CKD.

Arterial Hypertens. 2017, vol. 21, no. 1, pages: 34–41 DOI: 10.5603/AH.2017.0005

Introduction. Orthopaedic surgeries are major procedures, often associated with perioperative risk. They are especially challenging for elderly patients afflicted with several comorbidities and cardiovascular risk factors. Currently, one of the most frequent types of orthopaedic surgeries is joint alloplasties of hip or knee. The aim of this study was to establish the clinical characteristics of hypertensive patients undergoing total hip or knee replacement and to describe the frequency of the early complication of the surgery, which is a need for blood transfusion.

Material and methods. The study enrolled 199 consecutive patients who underwent hip or knee alloplasty. From this group patients with previous diagnosis of hypertension were selected for further assessment. All patients were screened for presence of cardiovascular risk factors and cardiovascular disease, according to the current guidelines. All patients were also followed for the necessity of blood transfusion during the hospitalisation.

Results. From the screened population 135 patients had previous diagnosis of hypertension and met inclusion criteria (mean age 69.0 ± 9.3 years, 30.4% male). From those patients, 70 (48.1%) underwent knee replacement, and 65 (51.9%) had hip replacement. As for the prevalence of cardiovascular disease, 16 (11.9%) had coronary artery disease, 5 (3.7%) had a history of previous myocardial infarction and 2 (1.5%) had diagnosed heart failure. Cardiovascular risk factors were also highly prevalent in the study population, 26 (19.3%) patients had diagnosed dyslipidemia, 27 (20.0%) had diabetes and 58 (43.0%) were obese. There were no statistical differences in the prevalence of those factors between patients with hip and knee replacement. 33 (24.4%) had blood loss during the operation, which led to a need for blood transfusion (19 (29.2%) patients in hip replacement group, and 14 (20%) in knee replacement group, p = 0.05). We found no differences in the prevalence of cardiovascular disease and cardiovascular risk factors between patients who required and did not require blood transfusion (p > 0.05).

Conclusions. Hypertensive patients who undergo hip or knee replacement have high prevalence of cardiovascular risk factors and other cardiovascular disease, therefore are at high perioperative risk. No differences are seen between patients with hip and knee replacement. There is also a high frequency of blood transfusions in this group.

Arterial Hypertens. 2017, vol. 21, no. 1, pages: 29–33 DOI: 10.5603/AH.2017.0004

Choroby sercowo-naczyniowe (CVD, cardiovascular diseases ) są główną przyczyną zgonów w całej Europie, co potwierdzają wyniki najnowszych badań epidemiologicznych. Choroby układu krążenia powodują ponad 4 miliony zgonów rocznie, co stanowi 45% całkowitej liczby zgonów w Europie. W 2015 roku choroba niedokrwienna serca i choroby naczyń mózgowych były najczęstszymi powodami śmierci z przyczyn sercowo-naczyniowych, odpowiadając odpowiednio za 1,8 miliona i 1,0 mln zgonów...

Hyperuricemia is defined as a serum uric acid level exceeding 6.8 mg/dL (404 μmol/L). At that level we can observe a crystallization of a monosodium urate in the water solution at the physiological pH and body temperature. The solubility of the uric acid in water and physiologic fluids is limited and depends mostly on the pH and temperature...

Hiperurykemia definiowana jest jako stężenie kwasu moczowego w surowicy krwi przekraczające 6,8 mg/dl (404 μmol/l), czyli stężenie, w którym dochodzi do krystalizacji moczanu jednosodowego in vitro w roztworze wodnym w warunkach fizjologicznego pH i prawidłowej ciepłoty ciała. Rozpuszczalność kwasu moczowego w wodzie i płynach ustrojowych jest mała i zależy przede wszystkim od pH i temperatury...

Wstęp: Witamina D ma duży wpływ na kontrolę biologicznych funkcji organizmu pod wieloma względami. Znaczenie witaminy D w patogenezie i leczeniu różnych chorób zostało wielokrotnie opisane. Jednym z najszerzej omawianych w literaturze problemów jest znaczenie niedoborów witaminy D w patogenezie nadciśnienia. Związek ten jest szczególnie ważny u pacjentów obciążonych zwiększonym ryzykiem choroby sercowo-naczyniowej, co bez wątpienia obejmuje osoby ze zdiagnozowaną chorobą układu sercowo-naczyniowego. Celem tej pracy jest określenie związku pomiędzy występowaniem niedoboru witaminy D a pojawianiem się nadciśnienia u kobiet przed menopauzą o bardzo wysokim ryzyku sercowo-naczyniowym.

Materiały i metody: Badaniem objęto 49 kobiet, u których wcześniej zdiagnozowano chorobę sercowo-naczyniową. U wszystkich pacjentów włączonych do badania wykonano pomiar witaminy D, wykrywając prawidłowy poziom witaminy D lub jej niedobór w oparciu o istniejące kryteria. Pacjentów zbadano również w kierunku nadciśnienia. Autorzy dokonali przeglądu dokumentacji medycznej pod kątem występowania nadciśnienia. Pomiary ciśnienia krwi były wykonywane przy przyjęciu do szpitala, przed wykonaniem operacji przez wykwalifikowanego lekarza według obowiązujących wytycznych.

Wyniki: Średni wiek badanej populacji wynosił 47,7 lat ± 13,4 roku. Średnia wartość BMI wynosiła 25,2 kg/m 2 . Niedobór witaminy D zdiagnozowano u 25 pacjentek (51%), a nadciśnienie u 30 (61,2%). W grupie pacjentek z niedoborem witaminy D nadciśnienie wystąpiło u 18 (72%), podczas gdy w grupie bez niedoboru witaminy D nadciśnienie zdiagnozowano u 50% kobiet (12). Obserwowana różnica między grupami była znacząca statystycznie (p = 0,049). Nie zaobserwowano różnicy w częstości występowania innych czynników ryzyka sercowo-naczyniowego pomiędzy grupami, łącznie z częstością występowania dyslipidemii i uzależnienia od nikotyny.

Wniosek: Związek nadciśnienia z niedoborem witaminy D był wielokrotnie podkreślany w wielu opracowaniach naukowych. W badanej grupie pacjentów o bardzo wysokim ryzyku sercowo naczyniowym potwierdziliśmy istnienie związku pomiędzy niedoborem witaminy D i występowaniem nadciśnienia. Dokładne potwierdzenie tego zagadnienia wymaga dalszych, szeroko zakrojonych badań, ale już to badanie wskazuje na znaczenie suplementacji witaminy D w tej grupie pacjentów.

Nadciśnienie Tętnicze w Praktyce 2016, tom 2 nr 1–2, strony: 64 –69