Maciej Krzysztof Kluk

Variability of circadian blood pressure profile during 24-hour ambulatory blood pressure monitoring in hypertensive patients

BACKGROUND Evaluation of circadian blood pressure (BP) profile is an important element of ambulatory BP monitoring (ABPM). Abnormal nocturnal fall in BP is more common in patients with secondary causes of hypertension and in the elderly. Cardiovascular risk is substantially increased in these patients. AIM Analysis of circadian BP profile in a population of treated hypertensives and identification of factors affecting variability of nocturnal fall in BP. METHODS 24-h ABPM was performed in hypertensive patients. Based on nocturnal fall pattern, four subgroups were identified:dippers, non-dippers, extreme dippers, and risers. Comorbidities were assessed, and data obtained in all groups were compared with the dipper profile group. RESULTS We analysed 161 patients (86 men, 53.4%). A dipper profile was noted in 44.7% of patients. Abnormal circadian BP profile was observed in 55.3% of patients, including a non-dipper profile in 21.1% of patients, an extreme dipper profilein 32.3% of patients, and a riser profile in 1.9% of patients. No significant differences in the rates of dyslipidaemia, previous myocardial infarction, previous stroke, and coronary artery disease were seen between the groups. The whole study population was also characterised by similar rates of excessive body weight and abdominal obesity. CONCLUSIONS An abnormal circadian BP profile was found in over 50% of hypertensive patients. A negative correlation was found between nocturnal BP fall and the patient age. No differences were found between groups with different circadian BP pattern regarding duration of hypertension and the presence of dyslipidaemia, obesity, diabetes, or coronary artery disease.

Blood pressure load in adults with treated hypertension

BACKGROUND AND AIM To assess blood pressure (BP) load in a population of treated hypertensive patients. METHODS The study group consisted of 137 hypertensive adults, including 75 (54.75%) men and 62 (45.25%) women, with either formerly or newly diagnosed hypertension based on office BP measurements. The median age in the whole study group was 52 years (47 and 56 years among men and women, respectively). The mean body mass index (BMI) was 27 ± 4 kg/m², and median duration of hypertension was 3 years. We divided the study group into subgroups depending on age, gender, BMI, and duration of hypertension. All patients underwent single 24-h ambulatory BP monitoring. We calculated 24-h, daytime and nighttime BP loads separately for systolic and diastolic BP. Statistical analysis was carried out using the SPSS 15.0 environment. RESULTS Men were significantly younger than women (48.17 vs. 55.48 years, p < 0.02). Mean BMI was higher in men than women (28 vs. 26 kg/m², p < 0.044). There were no differences in the mean values of BP load depending on gender, BMI and, duration of hypertension (p = NS). Twenty-four hour and daytime diastolic BP load was higher in patients aged 41-65 years than in patients above 65 years (32.4 vs. 20.8%, p < 0.04; and 29.6 vs. 17.5%, p < 0.03). A negative correlation was found between daytime diastolic BP load and age (r = -0.19, p < 0.026) and a positive correlation was found between night time systolic BP load and age (r = 0.24, p < 0.005). CONCLUSIONS There was no relationship between BP load and gender, BMI, and duration of hypertension. Diastolic BP load was age-related. Middle-aged patients were characterised by significantly higher values of 24-h and daytime diastolic BP load than the elderly patients.

Inhibitory konwertazy angiotensyny i antagoniści receptora angiotensyny II — metaanaliza 38 randomizowanych badań na temat wpływu leków hamujących układ renina–angiotensyna–aldosteron na ryzyko sercowo-naczyniowe u pacjentów z niewydolnością serca

Adres do korespondencji: dr n. med. Maciej Krzysztof Kluk, I Klinika Kardiologii i Elektroterapii, Świętokrzyskie Centrum Kardiologii, ul. Grunwaldzka 45, 25–736 Kielce, tel. 41 367 13 91/13 88, faks 41 367 13 96, e-mail: maciej.kluk@gmail.com Inhibitory konwertazy angiotensyny i antagoniści receptora angiotensyny II — metaanaliza 38 randomizowanych badań na temat wpływu leków hamujących układ renina–angiotensyna–aldosteron na ryzyko sercowo-naczyniowe u pacjentów z niewydolnością serca

Idarucizumab — nowy poziom terapii przeciwkrzepliwej. Opis leczenia powikłań krwotocznych u 93-letniej chorej

Idarucizumab to fragment przeciwciala monoklonalnego, ktore ma silne powinowactwo do eteksylanu dabigatranu i sie z nim lączy, powodując szybkie zahamowanie jego przeciwzakrzepowego dzialania. Iniekcja idarucizumabu u chorych stosujących eteksylan dabigatranu w krotkim czasie przywraca ogolnoustrojowe krzepniecie krwi i umozliwia powtorne tworzenie fibryny, ktora odgrywa kluczową role w mechanizmie krzepniecia krwi.

Trudne wybory u pacjentów z wysokim ryzykiem powikłań zakrzepowo-zatorowych i krwotocznych — przypadek 81-letniej pacjentki z wysokim ryzykiem udaru mózgu po przebytym epizodzie krwawienia z przewodu pokarmowego

The problem of serious bleeding complications, like gastrointestinal bleeding, generates the main risk associated with chronic anticoagulation, including non vitamin K oral anticoagulants (NOAC), in patients with atrial fibrillation. A presented case report of 81-year old woman demonstrates that recovering from the life-threatening gastrointestinal bleeding is not a contraindication to restart NOAC therapy, especially when the thromboembolic risk is high. NOAC give an opportunity to choose the optimal treatment considering age, renal function as well as CHA2DS2VASc and HAS-BLED scores. Apixaban is suggested to be favoured in patients with high risk of gastrointestinal bleeding recurrence and serious renal function impairment.

Skąpoobjawowa manifestacja ostrego zespołu wieńcowego u 51-letniego mężczyzny bez wywiadu kardiologicznego — indywidualizacja postępowania na podstawie analizy czynników ryzyka choroby wieńcowej

Ischaemic heart disease (IHD), including coronary artery disease, tends to manifest in younger population of cardiologic patients. This process is accelerated by presence of classic coronary artery heart disease risk factors as smoking or dyslipidaemia, as well as contemporary ones as chronic stress. In younger population IHD is often oligosymptomatic which makes it difficult to diagnose correctly.

Czy niedokrwistość może stanowić istotny czynnik predykcyjny incydentów sercowo- -naczyniowych u pacjentów z migotaniem przedsionków? Badanie prospektywne

In this current summary of scientific literature it has been presented two articles concentrated on risk factors associated with atrial fibrillation. Anemia increases the risk of adverse cardiovascular events in patients with arrythmia, whereas diastolic dysfunction, especially left atrium diameter, is a risk factor for occurence of arrythmia in the future.

Superior vena cava syndrome in a 37-year-old woman with a cardioverter-defibrillator

A 37-year-old woman was admitted to the cardiology department because of a clinical suspicion of superior vena cava (SVC) syndrome. This suspicion was based on anamnesis of decreased physical effort tolerance with recurrent facial and eyelid oedema, resistant to an antiallergic treatment. At the age of 16, the patient had been diagnosed as having hypertrophic obstructive cardiomyopathy. After one year, a dual-chamber pacemaker was implanted to decrease the maximum left ventricular outflow tract gradient. Sixteen years later, an implantable cardioverter-defibrillator (ICD) was implanted as primary sudden cardiac death (SCD) prevention due to the following risk factors: recurrent non-sustained ventricular tachycardia, persistent massive interventricular septum hypertrophy, and a family history of SCD. The former pacemaker unit was removed, but the two leads were left with distal tips localised in the right atrium and right ventricle and proximally cut off and secured in the area of the primary pacemaker cavity. The implantation of a dual-chamber ICD was complicated by pneumothorax. Next, in order to verify the diagnosis of SVC syndrome, phlebography of the intrathoracic venous system was performed. This confirmed the obstruction of both left and right subclavian vein, as well as of the SVC (Figs. 1, 2). This caused a collateral circulation through the thoracic wall venous system to develop. Additionally, all four leads of both the former and the current implantable devices were visualised, two of them being actively fixated in the right atrium and the right ventricle (Fig. 3). In transthoracic echocardiography, there was no thrombus visible in the right heart cavities and the echoes of hyperechogenic atrial and ventricular leads were visualised (Fig. 4). Due to the final diagnosis of SVC thrombosis, antithrombotic treatment was initiated — starting with a therapeutic dose of low molecular weight heparin followed by a vitamin K antagonist with target international normalised ratio ranged 2.5–3.0. In conclusion, redundant leads of electrotherapy devices left in the venous system can generate significant health complications. Careful consideration of indications for electrotherapy devices implantation may help prevent future complications, especially in young patients.