Katarzyna Piotrowicz

Abdominal obesity and hypertension: a double burden to the heart

Abdominal obesity (AO) is strongly associated with increased cardiovascular risk in hypertensives. Visceral adipose tissue has an important part in water retention, the sympathetic nervous system and renin–angiotensin–aldosterone system activation, which may influence central and systemic hemodynamics. The aim of this study was to estimate the relationship between AO and the hemodynamic profile of patients with arterial hypertension (AH). The clinical evaluation of 144 hypertensives included the following: (1) echocardiographic assessment of the left ventricular ejection fraction (LVEF), the global longitudinal systolic strain (GLSS) and diastolic function (E/A—phase ratio of mitral flow early (E) and late (A) and E/e′—ratio of early mitral flow and mitral septal annulus early diastolic velocity (e′)); (2) the applanation tonometry including the central pulse pressure (CPP) and augmentation index (AI); and (3) the impedance cardiography, acceleration index (ACI), velocity index (VI), systemic vascular resistance index (SVRI) and total artery compliance (TAC). Obese hypertensives in comparison with non-obese ones were characterized with the following values: (1) lower echocardiographic (GLSS: −17.2±2.5% vs. −19.0±2.8%, P=0.0002) and impedance indices of left ventricular performance (VI: 44.8±12.4 vs. 51.6±14.2 × 1000*Ω* s−1, P=0.006; ACI: 66.7±27.8 vs. 79.1±31.2 100*Ω* s−2, P=0.003) and (2) worse diastolic function (e′: 9.08±2.69 vs. 10.39±2.34 cm*s−1, P=0.003; E/e′: 7.54±1.81 vs. 6.74±1.40, P=0.007; E/A: 1.02±0.34 vs. 1.15±0.33, P=0.008). No relevant differences for gender, age, blood pressure, heart rate, LVEF, SVRI, TAC, CPP and AI were identified. AH and AO have overlapping effects on cardiovascular hemodynamics. At the early asymptomatic stage, this overlap is exhibited in the impaired cardiac function.

Who benefits more from hemodynamically guided hypotensive therapy? The experience from two randomized, prospective and controlled trials.

Objectives: Arterial hypertension (AH) may be related to fluid retention, increased vascular resistance or hyperdynamic heart function. Impedance cardiography (ICG) is shown to be useful in the individualization of antihypertensive therapy but little is known about who most benefits from this therapeutic approach. The aim of this analysis was to estimate the effectiveness of ICG-guided antihypertensive therapy with respect to baseline blood pressure (BP) from the perspective of 12 weeks’ observation in randomized, prospective and controlled trials. Methods: This analysis involved 272 patients (average age: 44.1 ± 10.8 years) with AH. After baseline evaluation, including: office BP measurement (systolic, SBP; diastolic, DBP; mean, MBP) and ambulatory BP monitoring (mean 24-h SBP, mean 24-h DBP) the subjects were randomly assigned to groups of empiric [GE] and ICG-guided antihypertensive therapy [HD]. The results were evaluated separately in subgroups derived from median of MBP (110 mmHg): with slightly increased (‘SI_BP’) and more increased BP (‘MI_BP’). The comparative analysis included absolute change in BP (d_OSBP, d_ODBP, d_24-h SBP, d_24-h DBP) and the percentage of patients with reduction of BP ⩾ 10 mmHg (d10_OSBP, d10_ODBP, d10_24-h SBP, d10_24-h DBP). Results: ICG-guided therapy was shown to be superior to the empiric approach, especially in MI_BP. In this subgroup, the BP reduction in HD was higher than in GE: d_OSBP (23.3 ± 10.8 versus 18.5 ± 13.9 mmHg; p = 0.035), d_ODBP (16.0 ± 6.3 versus 11.6 ± 9.6 mmHg; p = 0.003), d_24-h SBP (17.7 ± 10.8 versus 13.1 ± 13.1 mmHg; p = 0.035). This benefit was also confirmed by a higher percentage of patients with significant BP reduction: d10_OSBP (87.7% versus 69.1%; p = 0.012), d10_ODBP (69.2% versus 47.3%; p = 0.012) and d10_24-h SBP (72.3% versus 52.7%; p = 0.012). The comparison in the SI_BP subgroup did not reveal such significant differences. Conclusions: The hemodynamically guided pharmacotherapy results in greater BP reduction. This effect is more pronounced in patients with higher baseline BP, while in those with slightly increased BP the empiric approach seems comparable to ICG.

The effect of hemodynamically-guided hypotensive therapy in one-year observation: Randomized, prospective and controlled trial (FINEPATH study).

BACKGROUND The use of impedance cardiography (ICG) revealed to provide beneficial blood pressure (BP) lowering effect. However, the follow-up in previous trials was short and brachial BP was the only evaluated hemodynamic variable. Thus, we aimed to estimate the influence of ICG-guided therapy on brachial and central BP, impedance-derived hemodynamic profile and echocardiographic features after 12 months in a randomized, prospective and controlled trial (NCT01996085). METHODS One hundred and forty-four hypertensives were randomly assigned to groups of empiric (GE) and ICG-guided therapy (HD). Office BP, ambulatory BP monitoring, central BP and echocardiography (left ventricular hypertrophy and diastolic function assessment) were performed before and after 12 months of treatment. RESULTS Blood pressure reduction was higher in HD (office BP: 21.8/14.1 vs. 19.9/11.8 mm Hg; mean 24-h BP: 19.0/10.9 vs. 14.4/9.2 mm Hg). However, the only statistically significant differences were: percentage of patients achieving BP reduction of minimum 20 mm Hg for of-fice diastolic BP (27.3% vs. 12.1%; p = 0.034) and mean 24-h systolic BP (49.1% vs. 27.3%; p = 0.013). More pronounced improvement in the left ventricular diastolic dysfunction (delta E/A 0.34 vs. 0.12, p = 0.017) was the only other beneficial hemodynamic effect. CONCLUSIONS Beneficial BP lowering effect of hemodynamically-guided pharmacotherapy, observed previously in short-term observation, persists over time. Hemodynamic effects of such a treatment approach, especially those of prognostic value (central BP, myocardial hypertrophy), should be evaluated in further studies including patients with resistant hypertension, heart failure, diabetes mellitus and chronic kidney disease.

Self-reported health-related behaviors and dietary habits in patients with metabolic syndrome.

BACKGROUND There is an ongoing debate about factors affecting the maintenance of a healthy lifestyle especially in the population without coronary artery disease (CAD) symptoms and with one or several risk factors. The study was aimed at describing self-reported health-related behaviors and dietary habits in patients with metabolic syndrome (MetS). METHODS Consecutive patients with an outpatient diagnosis of MetS admitted to our cardiology department underwent clinical examination and cardiovascular risk assessment based on the SCORE scale. Self-reported intensity of pro-healthy behaviors was described using the Health Behavior Inventory (HBI) developed by Juczynski. Diet quality was assessed using the 24-h dietary recall method, diet history questionnaire and the Healthy Eating Index-2010 (HEI). RESULTS A total of 113 patients were recruited (90 males, mean age 48 ± 9 years) including 85% of patients with at least moderate cardiovascular risk (SCORE ≥ 1%). Central obesity was confirmed in 100%, family history of CAD in 75%, LDL exceeding 115 mg/dL in 68% of the patients. A total of 66% of the patients had already been on antihypertensive and 30% on lipid-lowering treatment without previous counselling on lifestyle modification. Most patients reported high or medium level health-related behaviors (23% and 45%, respectively). However, 91% led sedentary lifestyle and none of the patients followed cardioprotective diet recommendations. According to the HEI, 73% required partial and 27% complete diet modification. CONCLUSIONS There is a significant discrepancy between health perception and medical recommendations in patients with MetS. Effective patient education, taking into account a revision of the patients knowledge on the principles of prophylaxis, may form the fundament for the changes in patient behavior, and cardiovascular risk reduction.

The diagnostic value of supine blood pressure in hypertension.

Introduction Correct blood pressure (BP) measurement is crucial in the diagnosis of arterial hypertension (AH), and controversy exists whether supine BP should be treated as equal to sitting BP. The aim of this study was to evaluate the relation of supine BP to sitting BP and ambulatory BP with regard to identification of diagnostic cut-offs for hypertension. Material and methods This study included 280 patients with AH (mean age: 44.3 ±10.6 years). The following measurements of BP were performed and analyzed: 1) sitting office blood pressure measurement (OSBP and ODBP); 2) supine BP (supSBP and supDBP), measured automatically (5 times with a 2-minute interval) during evaluation by the Niccomo device (Medis, Germany); 3) 24-hour ambulatory blood pressure (ABP) monitoring. Results The mean supSBP and supDBP were found to be lower than OSBP and ODBP (130.9 ±14.2 vs. 136.6 ±15.5 mm Hg and 84.8 ±9.4 vs. 87.8 ±10.2 mm Hg, respectively; p < 0.000001). The correlations between ABP and supBP/OBP were moderate and strong (correlation coefficients in range 0.55–0.76). The ROC analysis revealed that mean supBP ≥ 130/80 mm Hg was more precise than OBP ≥ 140/90 mm Hg in diagnosing hypertension (AUC: 0.820 vs. 0.550; sensitivity 80.7% vs. 57.4%; specificity 83.2% vs. 52.7%; p < 0.0001) and the additive value derived mostly from its higher predictive power of identifying patients with increased night-time BP. Conclusions In young and middle-aged hypertensive patients the blood pressure during a 10-minute supine rest was lower than in the sitting position. The supine blood pressure ≥ 130/80 mm Hg was found to be a specific and sensitive threshold for hypertension.

Unstable angina in a young woman with Hodgkin's lymphoma.

We present the case of a 30 year-old woman - 16 months after successful treatment of Hodgkins lymphoma (chest location) with chemotherapy (including doxorubicin) and radiotherapy - with recurrent chest pain and dyspnea. In ambulatory event telemetry, she reported nocturnal chest pain with transient ST elevation characteristic for acute cardiac ischemia. Urgent coronary angiography with intravascular ultrasound and virtual histology visualization revealed 70% fibrotic stenosis in the proximal segment of the left anterior descending artery successfully treated with a drug-eluting stent implantation. This case is especially noteworthy because of the short period from initial therapy to the symptomatic coronary artery disease that is entirely unlike the reported mean latency period of several years.

Uric acid in hypertension – a marker of cardiovascular risk related to body composition

Introduction. Elevated uric acid (UA) is associated with arterial hypertension (AH), obesity, dyslipidemia and insulin resistance. However, its association with body components has not been previously investigated. Objective. The aim of this study was to evaluate the relationship between UA and cardiovascular risk factors, anthropometric parameters and body composition in patients with AH. Materials and method. In 138 patients with AH the following parameters were evaluated: UA, low and high density lipoproteins (LDL-C, HDL-C), triglycerides (TG), fasting glucose (FG), creatinine; body mass index (BMI), waist circumference (WC), fat mass (FM), fat free mass (FFM) and total body water (TBW). Results. Positive correlations were shown between UA and LDL-C (p=0.041), TG (p<0.001), FG (p=0.025) and creatinine (p<0.001) and negative between UA and HDL-C (p<0.001). Significant associations between UA and anthropometric parameters and body components, such as WC (p<0.001), BMI (p<0.001), FFM (p<0.001) and TBW (p<0.001), were also observed. In the multiple regression model, independent predictors of UA concentration were serum creatinine and TBW (R2=0.45; p<0.001). Conclusions. In patients with AH, uric acid was significantly related to cardiovascular risk factors, including obesity. However, the main anthropometric determinant of plasma UA concentration is FFM. The consideration of body composition in the interpretation of UA concentration appears to be justified, but the verification of this hypothesis requires further studies.

Złożona natura sztywności naczyniowej u chorych z nadciśnieniem tętniczym

Wstep. Sztywnośc naczyniowa jest obecnie celem interwencji terapeutycznych u pacjentow z chorobami ukladu sercowo-naczyniowego. Dlatego mozliwośc oceny wlaściwości ukladu naczyniowego okazuje sie szczegolnie istotna. Celem pracy byla ocena charakteru powiązan predkośc fali tetna (PWV) z parametrami klinicznymi oraz hemodynamicznymi u chorych z nadciśnieniem tetniczym. Material i metody. Analizą objeto grupe 150 pacjentow (w tym 111 mezczyzn; średni wiek 43,5 roku) z nadciśnieniem tetniczym, bez istotnych schorzen wspolistniejących. U wszystkich badanych po wstepnej ocenie klinicznej wykonano 10-minutową rejestracje parametrow hemodynamicznych metodami kardiografii (ICG) i pletyzmografii impedancyjnej z oceną miedzy innymi PWV, średniego ciśnienia tetniczego (MAP), czestości rytmu serca (HR), wskaźnika wyrzutowego (SI), calkowitej podatności naczyniowej (TAC), wskaźnika systemowego oporu naczyniowego (SVRI), okresu przedwyrzutowego (PEP) i czasu wyrzutu z lewej komory (LVET). Wyniki. Wartośc PWV okazala sie istotnie wieksza u kobiet niz u mezczyzn (6,18 ± 0,77 v. 5,91 ± 0,99 m/s; p = 0,035). W ocenie wzajemnych relacji wartośc PWV najistotniej korelowala z wiekiem (R = 0,41), MAP (R = 0,32), HR (R = 0,32), SI (R = –0,47), TAC (R = –0,31), SVRI (R = 0,38) oraz podokresami skurczu serca: PEP (R = 0,59) i LVET (R = 0,28). W modelu wieloczynnikowym (R2 = 0,61) niezaleznymi zmiennymi związanymi z PWV okazaly sie: wiek, MAP, PEP i LVET. Wnioski. Metody bioimpedancyjne okazują sie przydatne w ocenie zlozonej natury sztywności naczyniowej. Predkośc fali tetna wykazuje powiązania z innymi parametrami hemodynamicznymi charakteryzującymi interakcje lewej komory mieśnia sercowego z ukladem naczyniowym, w tym najsilniejsze z ciśnieniem tetniczym (BP), SVRI, TAC oraz wskaźnikami funkcji mieśnia sercowego jako pompy (HR, SI, PEP, LVET). Otrzymane wyniki wskazują, ze wartośc rokownicza PWV powinna byc interpretowana z uwzglednieniem biezącego stanu hemodynamicznego badanej osoby.

Association of N-terminal pro-brain natriuretic peptide and hemodynamic parameters measured by impedance cardiography in patients with essential hypertension

Abstract The aim of this study was to evaluate the association of NT-proBNP with clinical and hemodynamic assessment in 156 patients with arterial hypertension. NT-proBNP correlated positively with, i.e. age (r = 0.310, p = 0.00008), mean blood pressure (MBP; r = 0.199, p = 0.0136), Heather index (HI; r = 0.375, p < 0.00001) and negatively with thoracic fluid content (TFC; r = −0.300, p = 0.0002). The patients with higher NT-proBNP were older (46.1 versus 40.6 years, p = 0.001), with higher MBP (102.6 versus 98.5 mm Hg, p = 0.0043), HI (14.54 versus 11.93 Ohm s2, p = 0.009) and lower TFC (27.5 versus 29.4 1/kOhm, p = 0.0032). The independent predictors of higher NT-proBNP were: age, MBP and HI.