Ivan Rihacek

The Effect of Short-term Isometric Muscle Contraction and the Valsalva Maneuver on Systemic and Pulmonary Hemodynamics in Patients with Severe Heart Failure

Chronic heart failure is characterized by high mortality, frequent hospitalization, and reduced quality of life. Patients with severe heart failure are often in very poor physical condition, they are unable to take part in the usual exercise programs, and therefore need an individual approach.

24 hour ambulatory blood pressure values corresponding to office blood pressure value of 130/80 mm Hg

BACKGROUND 24 hour ambulatory blood pressure monitoring (ABPM) values for patients who have office BP of 130/80 mm Hg have not been clearly reported. AIM The determination of ABPM values in treated hypertensive subjects corresponding to a mean office BP of 130/80 mm Hg. METHODS BP measurement in subjects 40-70 years old, by ABPM and mercury sphygmomanometer. The inclusion criteria were: mean office BP systolic (SBP) 128-132 mm Hg and diastolic (DBP) 78-82 mm Hg. Seventy six subjects met all study inclusion criteria. RESULTS Mean office BP: SBP 129.5 ± 1.1 mm Hg, DBP 79.9 ± 1.3 mm Hg. Mean 24 hour BP: SBP 121.9 ± 2.0 mm Hg, DBP 73.1 ± 1.9 mm Hg. Mean awake BP: SBP 124.9 ± 2.4 mm Hg, DBP 75.5 ± 2.2 mm Hg. Mean asleep BP: SBP 109.1 ± 3.9 mm Hg, DBP 63.3 ± 4.0 mm Hg. CONCLUSIONS The target values of ABPM identified in this study can be used in clinical practice and will contribute to risk stratification and treatment of hypertension.

Ambulatory blood pressure monitoring and hypertension related cardiovascular risk in patients with rheumatoid arthritis

Background: To assess hypertension related cardiovascular risk parameters in patients with rheumatoid arthritis. To determine the effect of long-term treatment with corticosteroids, non-steroid antiinflammatory drugs, and methotrexate on diurnal BP variability. Material and methods: 60 patients with clinically stable rheumatoid arthritis and treated hypertension. Casual blood pressure measurement and 24-hour ambulatory blood pressure monitoring. Results: Mean casual systolic blood pressure 139.0 ± 14.6 mmHg, diastolic blood pressure 85.7 ± 6.5 mmHg, and heart rate 74.9 ± 7.2 beats.min-1. Mean 24-hour systolic blood pressure 129.0 ± 12.7 mmHg, diastolic blood pressure 77.6 ± 7.4 mmHg, and heart rate 73.9 ± 8.7 beats.min-1. Mean casual pulse pressure 54.7 ± 15.6 mmHg, and the mean 24-hour ambulatory pulse pressure 50.1 ± 11.0 mmHg. The mean morning surge of systolic blood pressure 35.3 ± 11.00 mmHg. The number of patients with increased short-term variability of their systolic blood pressure using the coefficient of variation 30 (50%). A number of systolic nondippers in the group were treated with corticosteroids and non-steroidal anti-inflammatory drugs 34% and 35%, respectively, and a number of excessive diastolic dippers in the group were treated with methotrexate 49%. Conclusions: Certain hypertension characteristics in patients with rheumatoid arthritis can increase cardiovascular risk: Higher pulse pressure, elevated levels of morning surge of systolic blood pressure, increased short-term 24-hour blood pressure variability, higher number of systolic nondippers treated with corticosteroids and non-steroidal anti-inflammatory drugs, and excessive diastolic dippers treated with methotrexate. In addition increased heart rate may contribute to higher cardiovascular risk.

EARLY AUTONOMIC CHANGES IN PATIENTS WITH NEWLY DIAGNOSED ARTERIAL HYPERTENSION: PP.25.05

Objective: The autonomic nervous system plays a key role in the regulation of blood circulation and its abnormal function is a major factor involved in the early phases of essential arterial hypertension. The objective of the study was to assess the differences between short-term variation in heart rate and blood pressure in healthy individuals and in a group of patients with newly diagnosed mild essential arterial hypertension. Design and Method: Three continuous 5-minute measurements of the ECG and blood pressure in supine position with different breathing patterns (spontaneous breathing, paced breathing 0.1 Hz and 0.33 Hz), were applied at 2 groups of subjects: young healthy (YH, 31 subjects, 13 female) and patients with newly diagnosed mild arterial hypertension (HT, 29 subjects, 12 female). Analyzed parameters: heart rate (HR), heart rate variability spectral power in low frequency (HRVlf) and high frequency (HRVhf) power bands, systolic pressure (SBP), diastolic pressure (DBP) and baroreflex sensitivity (BRS). Results: Mean HR [beat/min] over groups YH/HT at 0.1Hz breathing is 69.9/73.2 (p = NS), during spontaneous breathing 66.1/72.9 (p = NS), and 0.33Hz breathing 67.1/72.8 (p = NS); mean HRVlf [ms2/1000] at 0.1Hz is 17.9/8.5 (p < 0.01), during spontaneous breathing 3.8/2.0 (p = NS) and at 0.33Hz 2.2/0.8 (p < 0.05); mean HRVhf [ms2/1000] at 0.1 Hz is 2.4/1.3 (p = NS), during spontaneous breathing 2.6/1.3 (p = NS) and at 0.33 Hz 2.1/0.7 (p = NS); mean BRS [ms/mmHg] at 0.1 Hz is 17.3/11.2 (p < 0.01), during spontaneous breathing 10.6/8.3 (p = NS) and at 0.33 Hz 9.9/5.9 (p < 0.05). Conclusions: Increased risk of cardiac mortality is closely connected to decreased HRV and BRS as the markers of the short-term circulation control dysfunction. There are no significant differences between both groups in HRVlf, HRVhf and BRS during spontaneous breathing. Group differences in HRVlf and BRS are more significant (p < 0.01) at 0.1Hz breathing than during 0.33Hz breathing (p < 0.05). The 0.1Hz paced breathing is simple and convenient approach to amplify inter-groups differences of the cardiovascular control detected by the HRVlf and BRS in early stages of hypertension.

Comparison Evaluation of Trough/Peak Ratio BetaxololHydrochloride and Metoprolole in Patients with Newly DiagnosedHypertension.

One of the important characteristic features of the new antihypertensive drugs is its 24-hour effectiveness. If the drug reaches the mean trough/peak over 50% it can be dosed once daily. Betablockers are one of initial drug choice in young patients with hypertension. We evaluated 60 patients in two groups before and after the 3months of treatment with 20mg betaxolol hydrochloride once daily or 200mg metoprolole once daily. For the peak value we used the mean BP from the 3rd - 6th hour after the using of betaxolol hydrochloride or metoprolole, for the trough value the mean BP from the 22nd to 24th hour of the measurement was used, 30 minutes after getting up in the morning and excluding the influence of the hospital surroundings. Results: Trough/peak ratio betaxolol hydrochloride is 78% by the systolic BP, and it is 77% by the diastolic BP. Trough/peak ratio metoprolole is 75% by the systolic BP, and it is 71% by the diastolic BP. Conclusion: Both drugs, betaxolol hydrochloride and metoprolole have the trough/peak ratio over 70% and it can be dosed once daily. There is no statistically significant difference in trough/peak ratios between betaxolol hydrochloride and metoprolole.