Krystyna Widecka

The associations between cardiometabolic risk factors and visceral fat measured by a new dual-energy X-ray absorptiometry-derived method in lean healthy Caucasian women

Excess visceral adipose tissue (VAT) is associated with a cluster of metabolic abnormalities. A new dual-energy X-ray absorptiometry (DXA)-based VAT measurement approach, CoreScan™, computes VAT mass and volume within the android region of a total body DXA scan. However, there have been no reference values developed for this method. The objective of this study was to determine the normal reference ranges for DXA-derived VAT in young, healthy, premenopausal women. We also sought associations between VAT, blood lipids, glucose, insulin and insulin resistance. In 120 randomly selected, normal weight, Caucasian women aged 20–40xa0years, we measured body fat (BF), VAT and lean mass by DXA. We also assessed blood pressure, waist and hip circumference, waist-to-hip ratio, body mass index, fasting glucose, insulin, triglycerides (TG), and high- (HDL) and low-density lipoproteins. Insulin resistance was evaluated by the homeostasis model assessment (HOMA). VAT mass accounted for 0.37xa0±xa00.3xa0% of weight and 1.11xa0±xa00.72xa0% of BF. Mean VAT mass and volume were 235.9xa0±xa0183xa0g (95xa0% CI 202.7–269.1) and 250.3xa0±xa0194.5xa0cm3 (95xa0% CI 215.1–285.4), respectively. Anthropometric indices moderately correlated with VAT. VAT significantly correlated with HDL (Rxa0=xa0−0.193; Pxa0=xa00.03), glucose (Rxa0=xa00.252; Pxa0=xa00.005) and HOMA (Rxa0=xa00.184; Pxa0=xa00.049). In this study, we provide normal values of VAT mass and volume measured by DXA and determined for healthy, normal weight, Caucasian women aged 20–40xa0years. Even in such strictly selected population VAT correlated positively with insulin resistance and inversely with HDL.

Adiponectin, visfatin and regional fat depots in normal weight obese premenopausal women

Normal weight obesity (NWO) is defined as percentage body fat (%BF) above 30% or %BF in the upper tertile in normal weight subjects. Using these criteria, we assessed lipid profiles, glucose metabolism parameters, blood pressure and regional fat in 91 premenopausal women with NWO and 54 age‐matched healthy controls.

Changes in adiponectin level and fat distribution in patients with type 2 diabetes

The aim of this study was to assess the impact of standard hypoglycaemic treatment strategies on adiponectin levels and fat distribution in patients with newly diagnosed type 2 diabetes mellitus (T2DM).

SCORE model underestimates cardiovascular risk in hypertensive patients: results of the Polish Hypertension Registry.

Abstract Objective. The aim of the present study was to compare the effectiveness of Systemic COronary Risk Evaluation (SCORE) charts and European Society of Hypertension/European Society of Cardiology (ESH/ESC) hypertension guidelines for identifying high-risk hypertensive patients. Methods. The data on hypertensive patients was collected using the Polish Hypertension Registry. We enrolled 636 patients (357 females and 279 males, mean age 54.4 ± 7.9 years) from hypertension centres in Poland. Results. Only 3.5% of the subjects had no additional risk factors. Thirty-six per cent of the patients had three or more risk factors. Metabolic syndrome was found in 40.1% of the patients. According to the SCORE charts, 9.0% of females and 27.2% of males had high to very high cardiovascular risk (p < 0.001). Taking into account risk factors and the metabolic syndrome, 55.7% of females and 56.3% of males (p = NS) had high or very high additional cardiovascular risk according to the 2007 ESH/ESC guidelines. For both females and males, the prevalence of high to very high risk was greater (p < 0.001) from the calculation based on the 2007 ESH/ESC guidelines than from the SCORE charts. Fifty-two per cent of patients classified as low to moderate risk according to the SCORE system, had high or very high risk according to the 2007 ESH/ESC guidelines. Conclusions. The SCORE charts seem to underestimate the burden of the cardiovascular risk among hypertensive patients. The cardiovascular risk, especially in the hypertensive female population, seems to be much higher when estimated according to the 2007 ESH/ESC guidelines.

Impaired aldosterone response to the saline infusion test in patients with resistant hypertension and obstructive sleep apnea

Background In this cross-sectional study, we sought associations among severity of obstructive sleep apnea (OSA), renin-angiotensin-aldosterone system and blood pressure patterns in patients with resistant hypertension. Material and methods In 65 patients with resistant hypertension we measured the apnea-hypopnea index (AHI) by a portable sleep recorded system and aldosterone and plasma renin activity (PRA) in response to saline infusion test. We also collected data on cardiovascular events, dyslipidemia, chronic kidney disease, and diabetes and performed 24-hour blood pressure monitoring (ABPM). Results Baseline PRA, aldosterone and aldosterone-to-renin ratio were within normal range but aldosterone level in response to saline infusion was increased above normal upper limit. In ABPM, 68% of patients had an altered pattern of blood pressure (non-dipping or reverse dipping). AHI was inversely correlated with PRA and positively with weight, BMI, plasma aldosterone, aldosterone to renin ratio, and aldosterone after saline load but not with blood pressure. Patients with severe OSA (AHI > 30) in comparison to those with mild OSA (AHI 5–15) had significantly higher PRA and aldosterone (baseline and after saline load) but comparable values of blood pressure. We did not find significant impact of OSA severity on the frequency of abnormal blood pressure patterns. Frequencies of diabetes, abnormal lipid profiles, ischemic heart disease, myocardial infarction, and stroke increased with increases in severity of OSA. Conclusions Despite of normal basal PRA and aldosterone concentration, patients with resistant hypertension and OSA had impaired response to saline load and a rate of this impairment depended on the severity of OSA.

Associations of the –344T>C polymorphism of CYP11B2 gene with 24-hour blood pressure profiles in middle-aged women with essential hypertension

Background In this cross-sectional study, we assessed the impact of –344T>C polymorphism of the CYP11B2 gene which encodes aldosterone synthase on 24-hour blood pressure patterns. Material and methods The study was performed in 137 females with essential hypertension aged 42−60 years. We measured plasma aldosterone level and renin activity (PRA), fasting glucose, lipid profiles and 24-hour urinary sodium and potassium excretion. Based on 24-hour blood pressure monitoring we identified cases with dipping and non-dipping patterns of blood pressure. Results Mean PRA and aldosterone levels and aldosterone-to-renin ratio (ARR) were within normal range. Non-dipping hypertension was found in 54.3% of patients. Genotype frequencies of TT, CC and CT were 27%, 27% and 46%, respectively. Carriers of the C allele had significantly lower nocturnal blood pressure reduction (P = 0.004) and higher nocturnal systolic (P = 0.02) and diastolic blood pressure (P = 0.044), frequency of non-dipping profile (P = 0.001), and 24-hour urinary potassium excretion (P = 0.047). Urinary sodium excretion was positively correlated with a decrease in nocturnal blood pressure (R = 0.202; P = 0.037). In a multiple regression analysis, ARR and presence of the C allele adjusted for confounding variables were inversely associated with the nocturnal blood pressure decline (b = −0.348; P = 0.022 and b = −0.222; P = 0.018, respectively). Conclusions In conclusion, in middle-aged females with essential hypertension carrying the C allele we found higher nocturnal blood pressure, lower nocturnal blood pressure reduction, and higher prevalence of non-dipping hypertension than in TT carriers.

Single-pill combinations (SPCs) and treatment of arterial hypertension in Poland. Expert consensus statement of the Polish Society of Hypertension and Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy

The reasons for the publication of current expert consensus statement after 4 years from the previous one are: the growing number of evidence on the benefits of the use of single-pill combinations (SPCs) in hypertension (also with concomitant dyslipidaemia), the extension of indications for their use in the hypertension management algorithm and the emergence in recent years after the publication of Polish Society of Hypertension experts position statement in 2013 of new types of SPCs available to doctors in Poland, including triple-drug combinations of antihypertensives and the so-called hybrids SPCs containing not only antihypertensive drugs but also statins. The current position statement of experts summarizes the progress of knowledge and practical application of SPCs of antihy-pertensives in Poland. It seems that there will be a long gap in the introduction of new classes of antihypertensive drugs. The only noticeable progress in the pharmacotherapy of hypertension in the last 15 years, which may explain some increase in the effectiveness of blood pressure control in patients, is more common use of SPCs of antihypertensive drugs. Analysis of European Society of Hypertension (ESH) experts lectures during this years ESH 2017 Annual Meeting in Milan suggests that the next edition of the 2018 ESH Guidelines may include major changes in the antihypertensive therapy algorithm, suggesting the need for initiation of pharmacologic treatment with combination therapy, i.e. SPCs, in most patients with hypertension. Combination of an angiotensin converting enzyme (ACE) inhibitor + calcium antagonist should be considered optimal in patients with high and very high cardiovascular risk. Undoubtedly, the position of this combination is due to the ACCOM-PLISH trial in which such SPCs werefound to be more effective in reducing cardiovascular risk than SPCs composed of an ACE-inhibitor + thiazide diuretic. As a result of gradually increasing popularity of combined drugs, further SPCs that meet the criteria for optimal combination of antihypertensive drugs emerged in Poland between 2012 and 2017. Two of them provided the possibility of using SPCs in patients who do not need or should not use renin-angiotensin-aldosterone inhibitors. An interesting alternative is the SPC which contains antihypertensive agents along with other drugs used in cardiovascular prevention: statins and acetylsalicylic acid. This direction in the evolution of pharmacotherapy of hypertension is approaching the concept of polypill. In the opinion of the authors, the use of SPCs in antihypertensive therapy will increase in Poland, which may contribute to further improvement of pressure control in our country. At present, almost all useful anti-hypertensive agents are available in the form of two-drug SPCs. The combination of a sartan with beta-blocker for hypertensive patients with cardiac hypertrophy who do not tolerate ACE inhibitors and a hybrid SPCs of an ACE inhibitor + statin are still expected. Three-drug combinations: ACE inhibitor + beta-blocker + calcium antagonist, for patients with hypertension and coronary artery disease requiring intensive therapy, and ACE inhibitor + beta-blocker + statin, which will enable SPCs therapy for most patients, would also be useful.

The influence of varying dietary sodium content on circadian blood pressure profile in patients with salt-sensitive hypertension

The pathogenesis of essential hypertension is not fully understood. Literature indicates the complexity of blood pressure regulating mechanisms with a high impact of genetics and environmental factors. Previous experimental studies have shown the importance of salt intake in the development of hypertension. The aim of the study was to explore the influence of varying dietary sodium content on circadian blood pressure profile in patients with salt-sensitive hypertension. The study was carried out among 69 salt-sensitive hypertensive patients (19 females i 50 males) mean aged 36.1 ± 8.0 years. Study protocol provided low sodium diet firstly then high sodium diet containing 10–20 mmol and 220–240 mmol of sodium per day respectively. On each of the diet ABPM was performed. Our results suggest that in salt-sensitive patients the reduction of salt intake may decrease blood pressure and restore its circadian profile and thus lead to the reduction in the rate of complications of hypertension.

Nadciśnienie u młodych dorosłych mężczyzn — jak je optymalnie leczyć?

Nadciśnienie tetnicze jest chorobą cywilizacyjną, ktorej czestośc rośnie wraz z wiekiem. W ostatnich latach obserwuje sie coraz wieksze rozpowszechnienie nadciśnienia samoistnego wśrod mlodych doroslych. Nadciśnienie tetnicze u mlodych chorych jest zaburzeniem hemodynamicznym, ktore we wczesnej fazie charakteryzuje sie duzą pojemnością wyrzutową i prawidlowym oporem obwodowym, natomiast w bardziej utrwalonej fazie choroby obserwuje sie prawidlową lub zmniejszoną pojemnośc minutową oraz zwiekszony calkowity opor obwodowy. W postepowaniu diagnostycznym istotne znaczenie mają badania laboratoryjne, poniewaz umozliwiają ocene ryzyka sercowo-naczyniowego, powiklan narządowych oraz rozpoznanie wtornych postaci nadciśnienia tetniczego. Z uwagi na brak duzych wieloośrodkowych badan klinicznych decyzja o leczeniu farmakologicznym mlodych chorych podejmowana jest glownie na podstawie opinii ekspertow i doświadczen wlasnych. Nalezy miec świadomośc, ze celem krotkoterminowym u takich pacjentow nie jest zapobieganie incydentom sercowo-naczyniowym i zgonom z ich powodu, poniewaz są one malo prawdopodobne. Wlaściwym celem leczenia hipotensyjnego u mlodych chorych powinno byc zapobieganie postepowi nadciśnienia tetniczego i wystąpieniu lub progresji subklinicznych uszkodzen narządowych, ktore ostatecznie prowadzą do jawnej choroby sercowo-naczyniowej i śmierci. Przeprowadzone metaanalizy jednoznacznie wskazują, ze skuteczne obnizenie ciśnienia tetniczego nie moze byc jedynym celem terapii. Leczenie hipotensyjne powinno poprawic jakośc zycia, wywierac korzystny wplyw na zaburzenia hemodynamiczne, metaboliczne i prowadzic do regresji wtornych do nadciśnienia zmian narządowych, co w przyszlości spowoduje zmniejszenie chorobowości i śmiertelności w tej grupie chorych.

The importance of postoperative control: adrenal insufficiency after unilateral adrenalectomy for Conn’s syndrome. A case study

According to the current guidelines of the Polish Society of Hypertension on the management of primary aldosteronism (PA) associated with aldosterone-producing adenoma, the treatment of choice is unilateral laparoscopic adrenalectomy. Isolated deficiency of aldosterone after adrenalectomy for Conn’s syndrome is rare. The literature finds few reports on postoperative hypoaldosteronism requiring mineralocorticoid replacement. In this case study we present a patient who developed postoperative hypoaldosteronism.