Alexander Reshetnik

Arteriosclerosis and vascular calcification: causes, clinical assessment and therapy.

Arteriosclerosis is a pathological, structural (media vascular calcification) and physiological (modified vascular smooth vessel cells; increased arterial stiffness) alteration of the vessel wall. Through improved assessment methods (functional and imaging), it has become a well‐known phenomenon in recent decades. However, its clinical importance was underestimated until recently.

Oscillometric assessment of arterial stiffness in everyday clinical practice.

Measurement of carotid-femoral pulse wave velocity (cfPWV) is considered the gold standard for assessing arterial stiffness. Although widely used in clinical and observational studies, the detection of cfPWV has not yet been applied in everyday clinical practice due to technical and procedural difficulties. We, therefore, evaluated the applicability of oscillometric cfPWV assessment for everyday clinical practice. Eighty-nine patients were prospectively included in the study. Oscillometric calculations of cfPWV were performed with Tel-O-GRAPH and tonometric calculations with Sphygmocor. The accuracy, reproducibility, reliability and robustness of Tel-O-GRAPH calculations in different clinical situations were evalu??ated. The mean study population age was 48.8±19.1 years. More than half (59.6%) of the patients were male, and 15.1% were smokers. The mean difference of PWV between devices was 0.49±1.26 m s−1 (P<0.0001), and the Pearson correlation index was 0.86 (P<0.0001). The coefficient of variation and intraclass correlation coefficients between three single measured PWV values with the Tel-O-GRAPH and Sphygmocor were 2.38±6.13% vs. 6.3±4.33% (P<0.05) and 0.99; 0.99; and 0.99 vs. 0.78; 0.84; and 0.71, respectively. For Tel-O-GRAPH, there was no statistically significant difference between PWV in seated vs. supine positions or by experienced or inexperienced users. High reproducibility and reliability of the calculated single PWV values with Tel-O-GRAPH and considerable performance accuracy compared with Sphygmocor were observed. The reported evidence suggests that oscillometry might evolve as a favored method for the assessment of the PWV in everyday clinical practice and in clinical studies due to its ease of use, accuracy and robustness.

High-flux hemodialysis after administering high-dose methotrexate in a patient with posttransplant lymphoproliferative disease and impaired renal function.

A young patient develops cerebral posttransplant lymphoproliferative disorder. Despite concurrent significantly impaired transplant kidney function use of add‐on high‐flux hemodialysis for additional clearance made the administration of high‐dose methotrexate feasible in this patient without occurence of acute chronic kidney failure and significant hematological toxicity.

Noninvasive oscillometric cardiac output determination in the intensive care unit – comparison with invasive transpulmonary thermodilution

Assessment of the cardiac output (CO) is usually performed with invasive techniques requiring specialized equipment in the intensive care unit (ICU). With TEL-O-GRAPH (TG), CO can be derived from the oscillometrically obtained brachial pulse wave during the measurement of brachial blood pressure. CO and stroke volume (SV) determinations with TG were compared with transpulmonary thermodilution measurements with the PICCO system (PICCO) in 38 haemodynamically unstable ICU patients with a total of 84 comparison measurements performed. SV (33.3 ± 9.0 ml/m2 vs. 44.3 ± 14.4 ml/m2, p < 0.001) and CO (2.7 ± 0.5 l/min/m2 vs. 3.8 ± 1.2 l/min/m2, p < 0.001) were underestimated significantly with TG and oscillometric brachial systolic blood pressure (BP) was significantly lower and diastolic BP significantly higher than invasive femoral artery pressure. A linear correlation was found between CO dimension and CO underestimation with TG. Correct tracking of CO changes with a fluid challenge was possible in 69.5% of measurements. Oscillometric noninvasive CO is possible in the ICU, but accuracy and precision of this new method are lacking. Implementation of a correction factor accounting for the linear increase in CO underestimation observed with increasing CO could improve CO assessment with TG in haemodynamically unstable patients.

Polypille in der Therapie der arteriellen Hypertonie

Die Therapie der arteriellen Hypertone erfordert meist den Einsatz mehrerer antihypertensiver Wirkstoffe, um die Zielwerte zu erreichen. Die damit verbundene Tablettenanzahl führt häufig zu einer schlechten Compliance, welche durch die Reduktion der Tablettenzahl mittels Polypille erhöht werden kann.

Arterielle Hypertonie 2016

In 2016 hat die SPRINT-Studie die Diskussion um Blutdruckziele und geeignete Blutdruckmessung entfacht. Eine nähere Betrachtung dieser und der HOPE-3-Studie zeigt Besonderheiten und Problematiken dieser Studien. In den vergangen Jahren gab es wenig Innovatives in der medikamentösen antihypertensiven Therapie. In der interventionellen antihypertensiven Therapie hingegen gab es neue interessante Ansätze, die aktuell in klinischen Studien getestet werden.

SGLT2-Antagonisten – ein Medikament gegen Diabetes und Bluthochdruck?

SGLT2-Inhibitoren sind wirksam in der Behandlung von Diabetes mellitus und haben gleichzeitig eine geringfügig blutdrucksenkende Wirkung. Welche Mechanismen diesem Zusammenhang zugrundeliegen und weshalb diese Substanzen gerade für hypertone Diabetiker interessant sein könnten, wird in der folgenden Übersicht herausgestellt.