Kemalettin Büyüköztürk

Left ventricular geometric patterns and QT dispersion in untreated essential hypertension.

The spectrum of left ventricular adaptation to hypertension, different types of hypertrophy patterns, and QT dispersion in different types of hypertrophy was investigated in 107 patients with untreated essential hypertension and 30 age- and gender-matched normal adults studied by 12-derivation electrocardiogram (ECG), two-dimensional, and M-mode echocardiography. Left ventricular mass (LVM), body mass index, total peripheral resistance (TPR), relative wall thickness (RWT), and QT dispersion were found to be statistically significantly higher in the hypertension group (P < .001 for all). Among hypertensive patients, 41.1% had both normal LVM and RWT, here called normal left ventricle in hypertension; 10.3% had concentric hypertrophy with increased LVM and RWT; 14.95% had eccentric hypertrophy with increased LVM and normal RWT; and 32.7% had concentric remodeling with normal LVM and increased RWT. Echocardiographically derived cardiac index was higher in the concentric hypertrophy and eccentric hypertrophy patterns (P = .002 and P < .0001, respectively), whereas TPR was higher in the concentric hypertrophy and concentric remodeling patterns (P = .017 and .02, respectively). QT dispersion values were found to be increased in the hypertensive group (P = .001), whereas similar values were calculated for different types of hypertrophy patterns. We conclude that the more common types of ventricular adaptation to essential hypertension are eccentric hypertrophy and concentric remodeling. Concentric hypertrophy is found to be associated with both volume and pressure overload, whereas eccentric hypertrophy is associated with volume overload only and concentric remodeling is associated with pressure overload. But different left ventricular geometric patterns seem to have similar effects on QT dispersion.

Effect of irbesartan monotherapy compared with ACE inhibitors and calcium-channel blockers on patient compliance in essential hypertension patients: a multicenter, open-labeled, three-armed study.

Objectives. This multicenter, three‐armed, open‐labeled study investigated patient compliance of patients receiving irbesartan, angiotensin‐converting enzyme (ACE) inhibitors or calcium‐channel blockers (CCB) for essential hypertension for a 6‐month period. Patients were either newly diagnosed or switched from existing antihypertensive medication due to lack of efficacy or side‐effects. Methods. Patients were started monotherapy with irbesartan (n = 377), ACE inhibitors (n = 298) or CCB (n = 308) and were reevaluated on 1st, 3rd, and 6th months of the treatment. The primary endpoint was patient compliance, assessed by proportion of patients who had taken their study medication every day. Efficacy was recorded as mean reductions in blood pressure and the proportion of patients whose blood pressure normalized. Tolerability was assessed by reported adverse events. Results. Significantly more patients receiving irbesartan had complied with study medication after 3 and 6 months of treatment than ACE inhibitors or CCB. Significantly fewer patients receiving irbesartan needed to change their antihypertensive medication. All three study treatments exhibited similar efficacy profiles, but irbesartan had significantly less adverse events. Conclusions. This study demonstrated that patient compliance to irbesartan was significantly superior to other study treatments. Irbesartan is therefore a suitable first‐line therapy for essential hypertension in everyday clinical practice.

Comparison of the effects of trimetazidine and diltiazem on exercise performance in patients with coronary heart disease. The Turkish trimetazidine study (TTS).

Objective — A multicentre, double-blind comparative study was performed to compare the effects of trimetazidine with diltiazem on exercise performance in patients with stable angina pectoris. Methods and results — A total of 116 male patients with documented coronary artery disease at 11 centres were randomized into trimetazidine and diltiazem groups both including 58 men (mean age 55.1 ± 8.6 years and 54.9 ± 6.6 years, respectively) in a prospective, multicentre, double-blind active treatment trial.The study consisted of a two-week placebo washout period and a four-week active treatment phase. Clinical examinations and exercise tests were performed at the beginning (D0) and at the end (D28) of the active treatment. Laboratory investigations were also performed at the beginning of the washout period (D-14) and at D28. Holter recordings were done in the mid of the washout period (D-7) and D28. Both trimetazidine and diltiazem decreased the number of anginal attacks per week (p < 0.0001 for both drugs) and weekly nitrate consumption (p = 0.0008 and p < 0.0001, respectively). Both trimetazidine and diltiazem improved the recovery of anginal pain (p = 0.0188 and p = 0.0079, respectively) and maximal ST-segment depression (p = 0.0134 and p = 0.0214, respectively) but none of the drugs significantly changed the time to 1 mm ST-segment depression and ST recovery time on exercise test. Diltiazem caused a slight prolongation of PR and QRS durations (p = 0.039) on ambulatory ECG whereas trimetazidine did not change these parameters significantly. Conclusion — This study suggests that trimetazidine is an effective and safe alternative for diltiazem in the treatment of patients with stable angina pectoris. Although several other trials have shown that this drug can be used in combination with other antianginal drugs or instead of beta blockers or nifedipine in the symptomatic treatment of stable anginal syndromes, this study suggests that trimetazidine can be used instead of diltiazem, a well-known powerful antianginal drug.

Impact of dyslipidemia on cardiovascular risk stratification of hypertensive patients and association of lipid profile with other cardiovascular risk factors: results from the ICEBERG study

Background: Hypertension, dyslipidemia, and other cardiovascular risk factors are linked epidemiologically, clinically, and metabolically. Intensive/Initial Cardiovascular Examination regarding Blood Pressure levels, Evaluation of Risk Groups (ICEBERG) study focuses on the effect of dyslipidemia on cardiovascular risk evaluation and association of lipid profile with other risk factors. Patients and methods: The ICEBERG study consisted of two sub-protocols: ICEBERG-1, conducted at 20 university hospitals (Referral Group) and ICEBERG-2, conducted at 197 primary healthcare centers (Primary Care Group). Sub-protocol had two patient profiles: patients previously diagnosed with essential hypertension and under medical treatment (Treated Group) and patients with systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg, with no antihypertensive treatment for at least 3 months before inclusion (Untreated Group). Dyslipidemia was evaluated and cardiovascular risk stratification was performed according to ESC/ESH guidelines. Results: More than half of the treated and untreated subjects were classified into high or very high cardiovascular risk groups. In a total of 1817 patients, the percentage of patients in “high” plus “very high” added risk groups increased to 55.2% in Treated Referral Group (p < 0.001), to 62.6% in Untreated Referral Group (p = 0.25) and to 60.7% in Untreated Primary Care Group (p < 0.001), by re-evaluation of patients’ lipid values. Conclusions: Serum lipid levels are useful in stratifying hypertensive patients into cardiovascular risk groups more accurately, for appropriate antihypertensive treatment.

The Impact of Plasma High‐Sensitivity C‐Reactive Protein Levels on Cardiovascular Risk Stratification of Hypertensive Patients: Results of the ICEBERG Study

The Intensive/Initial Cardiovascular Examination Regarding Blood Pressure Levels: Evaluation of Risk Groups (ICEBERG) study focused on the impact of high‐sensitivity C‐reactive protein (hs‐CRP) measurement on cardiovascular risk evaluation. The ICEBERG study comprised 2 subprotocols. Each subprotocol had 2 patient profiles: patients previously diagnosed with essential hypertension and under medical treatment and patients with systolic blood pressure 130 mm Hg or higher, or diastolic blood pressure 85 mm Hg or higher, with no treatment for at least 3 months before inclusion. Measurement of hs‐CRP and cardiovascular risk stratification were performed according to European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines. A total of 1817 patients were analyzed. In 1 group, the percentage of patients in “high” plus “very high” added‐risk groups increased from 59.2% to 72.7% when hs‐CRP data were added to routine serum biochemistries. In another, the increase was from 66.9% to 77.9%, whereas in a third group, it changed from 65.1% to 77.2%. The use of plasma hs‐CRP levels might help in stratifying hypertensive patients into specific risk groups and modifying preventive approaches.

TRANDOLAPRIL IN OVERWEIGHT PATIENTS WITH MILD-TO-MODERATE ESSENTIAL HYPERTENSION: THE TURKISH MULTICENTER TRANDOLAPRIL STUDY

Abstract We studied the effect of trandolapril 2 mg once-daily on mild-to-moderate essential hypertension in 325 overweight patients in an open-label, prospective, multicenter study. The male patients had a body mass index >25.5 kg/m 2 , and the females >24 kg/m 2 . Mild-to-moderate hypertension was defined as a baseline diastolic blood pressure (DBP) of 90 to 110 mm Hg. After a washout period of 2 weeks, patients were treated for 4 weeks. Efficacy analysis was performed on 295 patients. Mean systolic blood pressure (SBP) and DBP fell significantly from 155.7 ± 16.7/95.8 ± 8.8 mm Hg to 136.3 ± 15.9/82.9 ± 8.0 mm Hg at the end of treatment. The mean reductions in SBP and DBP were 20 mm Hg and 13 mm Hg, respectively. The target blood pressure (DBP

Intensive Cardiovascular Examination regarding Blood pressure levels: Evaluation of Risk Groups. ICEBERG study

Objective. Assessment of total cardiovascular risk level is crucial for approaching hypertensive patients. Therefore, the aim of the Intensive/Initial Cardiovascular Examination regarding Blood pressure levels: Evaluation of Risk Groups (ICEBERG) study is to determine cardiovascular risk evaluation and stratification of subjects with high normal and high blood pressure (BP⩾130/85 mmHg), and to evaluate the impact of laboratory tests on this stratification. Methods. ICEBERG was an epidemiological study conducted at 20 university hospitals and 197 primary healthcare centers. A total of 10,313 patients, who were diagnosed with high BP and under antihypertensive treatment or not antihypertensive under treatment at least for the last 3 months were selected. Besides routine clinical evaluation, microalbuminuria (MAU) and high sensitive C‐reactive protein (hs‐CRP) tests, echocardiography (Echo) and carotid ultrasonography (USG) were performed in selected arms. The patients were stratified into low, moderate, high and very high added risk groups as described by the European Society of Hypertension/European Society of Cardiology Guidelines Committee (2003). Results. Upon routine evaluation, the percentage of “high and very high added cardiovascular risk” groups was between 51.2% and 60.7% in different study arms. This percentage increased to 62.9% by subsequent serum biochemistry assessment and to 76.2% by hs‐CRP test results. Switching upwards to “high and very high added risk” groups was around 6% when MAU results were used, with a 4.9% upwards switch to “high and very high added risk” groups when Echo was performed; this proportion increased by 6.8%, when carotid USG was taken into account. Conclusion. Cardiovascular risk evaluation by intensive cardiovascular examination including Echo and carotid USG provided more accurate risk stratification. Furthermore, a simple test to demonstrate presence of MAU usable at primary healthcare level will also help to evaluate the patients risk profile better than routine assessment methods alone.

P-384: The impact of echocardiography and carotid ultrasonography on risk evaluation in people with high-normal and high blood pressure: Results from ICEBERG study

THE IMPACT OF ECHOCARDIOGRAPHY AND CAROTID ULTRASONOGRAPHY ON RISK EVALUATION IN PEOPLE WITH HIGH-NORMAL AND HIGH BLOOD PRESSURE: RESULTS FROM ICEBERG STUDY Baris Ilerigelen, Giray Kabakci, Omer Kozan, Nevrez Koylan, Kemalettin Buyukozturk, Mehmet Kanbolat, Sarper Toker. Cardiology Dept, Istanbul Univ, Cerrahpasa, Istanbul, Turkey; Cardiology Dept, Hacettepe Univ, Ankara, Turkey; Cardiology Dept, Dokuz Eylul Univ, Izmir, Turkey; Cardiology Dept, Istanbul Univ, Capa, Istanbul, Turkey; Lamartin Cad, No 49/3 Taksim, Istanbul, Turkey; Medical Dept, Sanofi-Aventis, Istanbul, Turkey.

Techniques for Interventional Catheterization Guided by Transesophageal Echocardiography

Transesophageal echocardiography (TEE) was first used clinically by anesthesiologists for intraoperative monitoring of cardiac functions. Later, intraoperative TEE has been accepted by cardiologists, cardiac surgeons, and anesthesiologists as a basic tool to evaluate the immediate hemodynamic results of a surgical procedure.1,2

Percutaneous Mitral Balloon Valvuloplasty

Since it was first introduced in 1982 by Inoue et al.,1 percutaneous balloon mitral valvuloplasty (PMBV) has become established as an important nonsurgical alternative for the management of patients with mitral stenosis.2 Another technique using a single-balloon3 or double-balloon4 through transseptal left atrial catheterization quickly followed. Variations of this technique using transarterial balloon introduction5 and retrograde left atrial catheterization6 have also been reported. Today, the most commonly used technique is the antegrade approach with a single and double balloon, or a specially designed Inoue balloon. The mechanism of this procedure is similar to that of surgical commissurotomy for the splitting of the fused commissures.