Karolina Semczuk

Prevalence of arterial hypertension in patients with atrial fibrillation undergoing ablation — a prospective, cohort study

Background Arterial hypertension is one of the major cofounders in the development of atrial fibrillation (AF) and hypertension is commonly found in AF patients. The aim of the study was to establish the prevalence of arterial hypertension in patients undergoing ablation, who are relatively young and healthy group of AF patients. Material and methods 266 consecutive patients admitted for AF ablation were screened for arterial hypertension. All patients had their blood pressure measured on admission by, prior to the ablation procedure by a qualified physician, according to the current guidelines. Also, medical records of patients were reviewed for the previous diagnosis of hypertension or taking hypotensive agents. Results The study group was predominantly male (65.0%; mean age 57.6 ± 10.1 years). Mean body mass index was 29.7 ± 5.0 kg/m 2 . Paroxysmal AF was present in 69.5% of patients. In 72.9% of patients hypertension was diagnosed previously. On admission, mean systolic and diastolic blood pressure values were 131.7 ± 16.7 and 80.7 ± 11.1 mm Hg. 123 (46.2%) patients had systolic and/or diastolic blood pressure values respectively > 140 and/or > 90 mm Hg. Patients with previously diagnosed hypertension were older (58.7 ± 8.7 vs 54.6 ± 12.7 years; p = 0.003), had higher BMI (30.3 ± 5.0 vs 28.1 ± 4.8 kg/m 2 ; p = 0.002), and more often history of diabetes (10.8% vs 1.4%; p = 0.03) compared to non-hypertensive group. There were no differences in terms of history of dyslipidaemia, stroke, myocardial infarction or family history of cardiovascular disease. Conclusions In patients with AF undergoing ablation procedure, prevalence of diagnosed arterial hypertension is very high, much higher than in the general population. Nevertheless, majority of patients meet the criteria for adequate blood pressure control.

Wpływ nieklasycznych czynników ryzyka sercowo-naczyniowego na wybór terapii hipolipemizującej i hipotensyjnej

Cardiovascular risk assessment in clinical practice isessential. It affects treatment methods of cardiovascular diseases in patients. Recommended tools such as POL-SCORE do not take into account the clinical picture of all the patients. The clinical case shows that the use of nonclassical elements of risk factors in clinical practice changes the scheme of action undertaken so far.

Assessment of cardiovascular risk in patients undergoing total joint alloplasty: the CRASH-JOINT study.

BACKGROUND Risk assessment is of particular importance for patients undergoing surgical interventions. Orthopaedic procedures, especially total joint alloplasty, are major procedures associated with high perioperative risk, as well as one of the highest rates of complications. AIM The aim of the present study was to establish the prevalence of classical and non-classical cardiovascular risk factors in patients undergoing total hip or knee alloplasty. METHODS The CRASH-JOINT (Cardiovascular Risk Assessment ScHeme in JOINT alloplasty) was a prospective, epidemiological study performed in consecutive patients scheduled for total joint (hip or knee) replacement surgery. Patients enrolled into the study were screened for cardiovascular risk factors and had ambulatory blood pressure performed for the diagnosis of hypertension. RESULTS The present study enrolled 98 patients. During initial screening eight patients were disqualified from the study and the surgery, in the majority due to the cardiac causes. Sixty-five patients had a hip joint replacement and 25 had knee joint replacement (mean age 63.7 ± 12.2 years, 62.2% female). Fifty (55.6%) patients were diagnosed with arterial hypertension in the past, ten (11.1%) patients had diabetes mellitus, two (2.2%) had a history of myocardial infarction, and family history of cardiovascular disease was present in 24 (26.7%) cases. Mean body mass index (BMI) was 28.0 ± 5.1 kg/m² and 39 (43.3%) patients were overweight, while 28 (31.1%) were obese. Patients undergoing hip replacement were significantly younger (61.8 ± 12.6 vs. 68.5 ± 10.0 years; p = 0.02), were more often current smokers (24.6% vs. 4.0%; p = 0.03), had significantly lower BMI (26.8 ± 4.5 vs. 31.2 ± 5.3 kg/m²; p < 0.0001), and were less often obese (18.5% vs. 64.0%; p < 0.0001). There were no significant differences between patients scheduled for primary surgery and reoperation. CONCLUSIONS The study showed that classical cardiovascular risk factors in patients undergoing total hip or knee alloplasty have a higher prevalent than in the general population, which can potentially contribute to the higher risk of development of perioperative complications.

Ocena skuteczności leczenia hipotensyjnego pacjentów z nadciśnieniem tętniczym i chorobą niedokrwienną serca lub ekwiwalentem wieńcowym

Introduction. Arterial hypertension (AH) is a well-known cardiovascular risk factor. Currently, in Poland, approximately 32% of adults suffer from AH, and only 26% of them are treated successfully. The study aims to determine the incidence of atherosclerosis risk factors and their influence on the effectiveness of hypotensive treatment in the population of patients with AH and coexisting coronary artery disease (CAD) or coronary equivalent. Material and methods. The study included 204 adults. The inclusion criteria were: diagnosis of AH with coexisting a diagnosis of CAD (138 people) or coronary equivalent defined as high (≥ 5%) atherosclerosis-related risk of death in 10-year prognosis, estimated using the EURO SCORE scale (66 people). During observation, pharmacological and nonpharmacological treatments were modified according to the current AH treating standards. After 6 months of observation, the effectiveness of AH control was assessed. Results. Multivariate logistic regression analysis revealed that main factors affecting poor blood pressure control after six months of observation were: obesity, age > 65 years, LDL cholesterol level > 130 mg/dL. Moreover, systolic blood pressure (SBP) < 140 mmHg was more frequent in patients with diabetes mellitus. After six months of therapy, good control of SBP was found in 42.7% of patients and normal values of diastolic blood pressure (DBP) — in 65.2 % of patients. Conclusion. Independent risk factors for poor control of blood pressure were: high level of LDL-cholesterol, age > 65 years and female sex. Paradoxically, diabetes was not a risk factor for poor control of hypertension. The introduction of combined hypotensive and lipid-lowering drugs should contribute to a better control of hypertension in Poland.

Epidemiology of arterial hypertension in patients scheduled for elective hip replacement

Background: Assessment of blood pressure values and early diagnosis of hypertension are especially important in high-risk group, including patients in preoperative and postoperative period. The aim of the current study was the assessment of blood pressure values and prevalence of hypertension in patients undergoing elective hip replacement surgery — an orthopedic procedure associated with one of the highest cardiovascular complication rate. Material and methods: Two hundred and eighty-four consecutive patients admitted for elective hip replacement surgery were screened for arterial hypertension. All patients had their medical records reviewed for prior diagnosis and had their blood pressure measured on admission by a qualified physician prior to the procedure, according to the current guidelines. Results: The mean age of the study population was 62.2 ± 13.9 years and 42.7% of the patients were male. The body mass index (BMI) in the study population was 27.0 ± 4.2 kg/m 2 . Fifty-eight point two percent of patients were diagnosed with arterial hypertension previously. Mean blood pressure values on admission for systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 134.5 ± 20.4 and 78.6 ± 13.1 mm Hg, respectively. In 43.2% of patients, the on admission blood pressure values exceeded the threshold of ≥ 140 and/or 90 mm Hg. Arterial hypertension was diagnosed de novo in 33 (15.0%) patients. Patients with the disease were older (67.5 ± 12.3 vs. 54.4 ± 13.9 years; p < 0.0001), and had higher BMI (27.6 ± 4.3 vs. 26.2 ± 3.8 kg/m 2 ; p = 0.05) than patients without the diagnosed disease. Diabetes mellitus was more often found in hypertensive patients (13.3% vs. 3.3%; p = 0.02), they also more often had history of myocardial infarction (p = 0.02), stable coronary artery disease (p = 0.001) and heart failure (p = 0.006) compared to patients without the diagnosis. Conclusions: The majority of patients scheduled for elective hip replacement surgery is diagnosed with arterial hypertension. The disease is also diagnosed de novo in 15% of these patients. Screening for arterial hypertension is important in this group of patients and can potentially reduce the complication rates of the hip replacement surgery.

Association between vitamin D levels and arterial hypertension in women at very high cardiovascular risk

Background Vitamin D is a compound of great importance in controlling the biological functions of the body in a variety of ways. Significance of vitamin D in the pathogenesis and treatment of various diseases has been described repeatedly. One of the most discussed issues in the literature is the importance of vitamin D deficiency in the pathogenesis of hypertension. This relationship is particularly important in patients burdened with elevated cardiovascular risk, which undoubtedly represent patients with diagnosed disease of the cardiovascular system. The aim of the study was to determine the association between the occurrence of vitamin D deficiency and the prevalence of hypertension in premenopausal women at very high cardiovascular risk. Materials and methods The study included 49 women who had previously been diagnosed with cardiovascular disease. In all patients enrolled in the study serum concentrations of vitamin D were measured and the patients were classified to have vitamin D deficiency or normal vitamin D level, based on the existing criteria. The patients were also tested for the occurrence of hypertension. Medical records of all patients were reviewed for early diagnosis of hypertension, and blood pressure measurements were performed on admission to the hospital before the surgery by a qualified physician, in a manner consistent with current guidelines Results The study population was aged 47.7 ± 13.4 years. The mean body mass index was 25.2 kg/m 2 . Vitamin D deficiency was diagnosed in 25 (51%) patients, and hypertension was diagnosed in 30 women (61.2%). In patients with vitamin D deficiency hypertension occurred in 18 (72%) women, while in the group without vitamin D deficiency hypertension was diagnosed in 50% of cases (12 women). The observed difference between the groups was statistically significant (p = 0.049). There was no difference in the incidence of other cardiovascular risk factors between the groups, including the prevalence of dyslipidaemia or nicotine addiction. Conclusion Association of hypertension with the vitamin D deficiency has been repeatedly underlined in many scientific studies. In the present group of patients at very high cardiovascular risk, we confirmed the relationship of vitamin D deficiency with the occurrence of hypertension. Exact confirmation of this issue requires further, largescale research, but this study may suggest the importance of vitamin D supplementation in these patients.

The relationship between the use of cement during total hip replacement and blood pressure values

Background Total hip replacement is a common orthopaedic procedure associated with an elevated cardiovascular risk. There are several methods for total hip replacement, including whether or not to use cement for the prosthesis fixation. The aim of the study was to compare clinical characteristics, including blood pressure, in patients undergoing total hip replacement with and without the use of cement. Material and methods The study included patients with elective total hip replacement surgery, who were divided into those in whom the procedure was performed with or without the use of medical cement. The criteria for using cement were assessed during operation by the operator, according to the current protocol. All patients were interviewed, screened, and had their medical records checked for the prior diagnosis of cardiovascular risk factors. Blood pressure values were measured before and after the procedure according to the current guidelines. Results The study population consisted of 65 patients in whom the total hip replacement was performed (mean age 61.5 ± 15.0 years; 50.8% male). 60% of patients had the hip replacement without cement and 40.0% had a procedure with the use of cement. Patients in whom the cement was used were significantly older (75.0 ± 8.5 vs. 53.0 ± 11.5 years; p < 0.0001) and more often diagnosed with arterial hypertension (61.5 vs. 33.3%; p = 0.04), than those in whom it was not used. Systolic blood pressure values were significantly higher before and after the procedure (138.8 ± 18.2 vs. 130.8 ± 21.5 mm Hg, p = 0.04; 122.6 ± 13.3 vs. 113.8 ± 14.1 mm Hg, p = 0.03; respectively) in the group which required cement. Conclusions Patients with hip replacement using cement have higher systolic values before, and after the surgery than in patients in whom cement wasn’t used. Therefore careful management and risk assessment is especially important in patients receiving the total hip replacement with the use of cement.

Does obstructive sleep apnoea influence BNP concentrations in atrial fibrillation patients

Background B-type natriuretic peptide (BNP) is a biomarker commonly used in diagnosing and assessing prognosis in heart failure patients. Its concentration can be elevated in various conditions associated with excessive heart wall stretch including atrial fibrillation and obstructive sleep apnoea (OSA). The aim of the study was to assess if BNP levels in atrial fibrillation patients are associated with the value of apnoea-hypopnea index (AHI). Material and methods Study population were consecutive patients with atrial fibrillation, who underwent overnight sleep study, and had blood taken for BNP concentration assessment. Subsequently, patients were divided into group according to AHI: Group I ( 15/h). Results Analysis covered 158 patients (males, 64.6%; mean age, 58.3 ± 9.2 years). 83 (52.5%) patients had AHI 15 (104.0 ± 150.8 pg/mL; p for trend = 0.03). Conclusions Majority of patients with atrial fibrillation have AHI < 5/h and these generally have lower BMI, and neck circumference. Patients who have AHI exceeding ≥ 5/h BNP levels tend to be elevated, and its values rise along with AHI.