Beata Krasińska

A marked fall in nocturnal blood pressure is associated with the stage of primary open-angle glaucoma in patients with arterial hypertension

Abstract Introduction. The aim of this study was to assess blood flow in the vessels of the eyeball and changes in the optic nerve in patients with arterial hypertension and primary open-angle glaucoma. Material and Methods. The patients were divided into groups: 1 (night blood pressure, BP, fall, NBPF, not more than 10%; non-dippers); 2 (NBPF 10–15%, dippers) and 3 (NBPF>15%; extreme dippers). Results. In the group of dippers and extreme dippers, perfusion pressure was significantly lower than that in the non-dippers group, there was reduced thickness of the nerve fibers and a greater decrease in the visual field. Significant relationships between peak systolic, end-diastolic flow in the ophthalmic and central retinal arteries and night perfusion pressure, thickness of nerve fibers, and a loss of visual field were observed. Conclusion. In patients with glaucoma and well-controlled hypertension, a nocturnal BP fall of more than 10% is associated with a greater visual field defect and greater degeneration of the optic nerve fibers. Low minimum diastolic pressure and the level of nocturnal BP fall, but not the absolute value of average arterial BP at night, should be included in the group of specific risk factors in patients with hypertension and open-angle glaucoma. These findings also suggest avoiding excessive lowering of BP at night in this group.

Effects of the time of antihypertensive drugs administration on the stage of primary open-angle glaucoma in patients with arterial hypertension

Many patients with glaucoma suffer from arterial hypertension (AH). It has been proved that both AH and low blood pressure (BP) at night are important vascular risk factors for primary open-angle glaucoma (POAG). The aims of this study were to assess the severity of pathological changes within the optic nerve and characteristics of blood flow in selected arteries of the eyeball and orbit in patients with POAG and controlled hypertension, in relation to the time of hypotensive drugs administration. Eighty-eight patients with POAG and treated, controlled hypertension were examined. The patients were divided into two subgroups, consisting of group A (n = 43), in whom hypotensive drugs were dosed only in the morning and group B (n = 45), in whom hypotensive drugs were also taken in the evening. In patients who were taking hypotensive drugs also in the evening (group B), there was a statistically significant lower mean perfusion pressure at night, a greater visual field loss and reduced amplitude of evoked potentials. Our analysis showed significantly worse changes in the parameters relating to the optic nerve in patients taking hypertensive medicines in the evening and also significantly lower perfusion pressures at night.

Observations on Degenerative Changes Within the Optic Nerve in Patients With Primary Open Glaucoma and Arterial Hypertension: 6-Month Follow-Up

J Clin Hypertens (Greenwich). 2012;14:701–710. ©2012 Wiley Periodicals, Inc.

Standardised tomato extract as an alternativeto acetylsalicylic acid in patients with primaryhypertension and high cardiovascular risk –a randomised, controlled trial

Introduction Cardiovascular (CV) diseases remain a leading global cause of death. It has been proven that the use of acetylsalicylic acid (ASA) in secondary prevention reduces the CV risk, while the benefits of ASA in primary prevention have recently been debated. The aim of the study was to compare the antiplatelet effect of standardised tomato extract (STE) and ASA in hypertensive patients with high CV risk. Material and methods The study involved high-risk patients with arterial hypertension (AH) randomly assigned to one of two groups: group 1 included 33 patients receiving ASA and group 2 included 32 patients receiving STE. The platelet aggregation was determined using the VerifyNow analyser. Results After 4 weeks of ASA treatment in group 1, a statistically significant reduction in aspirin reaction units (ARU) was observed (p < 0.001). However, the obese subgroup using ASA (n = 18) did not reveal a significant decrease in ARU (p > 0.05). After 4 weeks of STE treatment in the obese subgroup (n = 14), significant declines in ARU by 8.6% (95% CI: –19.5 to –1.7%; p < 0.05) and in P2Y12 reaction units (PRU) by 7.5% (95% CI: –17.6 to 1.8%; p < 0.05) were observed. Conclusions The antiplatelet effect of STE in hypertensive patients may be weight dependent. The group with AH and obesity might have potentially benefitted from STE treatment.

Do surgeries for varicose veins carry a risk of deep vein thrombosis? Endovenous laser ablation and conventional saphenectomy – a comparison

Zbigniew Krasiński1, Krzysztof Aniukiewicz2, Aleksandra Krasińska3, Beata Krasińska4, Łukasz Dzieciuchowicz1

Nadciśnienie oporne a zespół obturacyjnego bezdechu sennego

Obturacyjny bezdech senny (OSA) jest obecnie uwazany za jedną z najczestszych przyczyn nadciśnienia tetniczego opornego. Związek miedzy OSA i nadciśnieniem tetniczym opornym byl opisywany w wielu badaniach. W przebiegu OSA nadciśnienie tetnicze stwierdza sie u 37–56% chorych, a wśrod pacjentow z nadciśnieniem tetniczym opornym OSA wystepuje az u 70–85%. Do rozwoju nadciśnienia tetniczego opornego u osob z obturacyjnymi zaburzeniami oddychania podczas snu dochodzi prawdopodobnie przez wspoldzialanie kilku mechanizmow. Kluczową role odgrywa hipoksja, ktora doprowadza do aktywacji ukladu wspolczulnego, pobudzenia ukladu RAA, zwiekszonego stresu oksydacyjnego i wzrostu wydzielania endoteliny. Pobudzenie ukladu RAA i związane z tym podwyzszone stezenie angiotensyny II i aldosteronu generuje wzrost oporu naczyniowego, co w konsekwencji zwieksza obciązenie nastepcze serca. Wspolistnienie OSA zmniejsza skutecznośc terapii hipotensyjnej. W celu uzyskania kontroli ciśnienia tetniczego w tej grupie chorych konieczne jest rownoczesne stosowanie kilku lekow hipotensyjnych o zroznicowanym mechanizmie dzialania, w tym leku moczopednego.

Favourable hypotensive effect after standardised tomato extract treatment in hypertensive subjects at high cardiovascular risk: a randomised controlled trial

BACKGROUND Cardiovascular (CV) diseases remain a leading global cause of death. Lowering blood pressure (BP) reduces the risk of CV complications, especially stroke and acute coronary events, and it delays the progression of kidney disease. Adequate non-pharmacological treatment improves the effectiveness of the antihypertensive therapy. A Mediterranean diet with high content of vegetables (rich in tomatoes) is associated with a reduced CV risk. AIM The main objective of the present study was to assess whether the addition of standardised tomato extract (STE) or acetylsalicylic acid (ASA) to standard antihypertensive therapy can improve BP control in patients with arterial hypertension (HT). METHODS The study involved 82 high-risk hypertensive patients. Patients with primary HT at high to a very high total CV risk were randomised in a blinded fashion to one of two groups, i.e. the ASA and STE group. The patients had two visits, a baseline visit and one after four weeks of treatment. In all the patients, during each visit, clinical BP and ambulatory BP measurements (ABPM) were performed. Platelet aggregation was determined using the VerifyNow analyser. RESULTS After four weeks of treatment in the STE group, there was a statistically significant reduction in 24-h systolic BP, diastolic BP, and mean arterial pressure values measured in ABPM (p < 0.001). After four weeks of treatment in the STE group there was a statistically significant reduction in pulse pressure (PP) during the daytime and during 24 h (p < 0.05). Interestingly, it was found that the use of STE in obese patients significantly decreased the day PP (p < 0.05). After four weeks of treatment in the ASA group there was no statistically significant reduction in BP values measured in ABPM. CONCLUSIONS The results of this study show that the addition of STE to standard antihypertensive therapy improves BP control in hypertensive patients with high CV risk. This effect, together with the anti-aggregatory effect, may indicate the pleiotropic effect of tomato extract. This fact justifies further research into functional foods and gives new insights into STE as a food supplement that could have new therapeutic and prophylactic uses for the treatment of hypertensive patients with high CV risk and especially with obesity.