Marta Sołtysiak

Visceral fat reference values derived from healthy European men and women aged 20-30 years using GE Healthcare dual-energy x-ray absorptiometry

Dual energy X-ray absorptiometry (DXA) is an established technique used in clinical and research settings to evaluate total and regional fat. Additionally, recently developed software allow to quantify visceral adipose tissue (VAT). Currently, there are no reference values available for GE Healthcare DXA systems for VAT. The aim of this study was to develop reference values for VAT in healthy European adults aged 20–30 years using a GE Healthcare Prodigy densitometer along with the dedicated CoreScan application. We also assessed the associations of VAT with traditional cardiometabolic risk factors. In 421 participants (207 men; 214 women), we performed DXA whole-body scans and calculated total body fat (BF) and VAT (in gender-specific percentiles). We also measured blood pressure and fasting glucose, insulin, and blood lipids. Males, in comparison with females, had 2-fold greater VAT both in units of mass (542 ± 451 g; 95% CI: 479.6‒605.1 g vs. 258 ± 226 g; 95% CI: 226.9‒288.6 g) and volume (570 ± 468 cm3; 95% CI: 505.1‒635.2 cm3 vs. 273 ± 237 cm3; 95% CI: 240.6‒305.3 cm3). They also had significantly higher the VAT/BF ratio. VAT showed a stronger positive correlation than BF with blood pressure, triglycerides, LDL-cholesterol, glucose, insulin, and homeostasis model assessment-insulin resistance index and a stronger negative correlation with HDL-cholesterol. Among these variables, VAT had the highest area under the curve for triglycerides ≥150 mg/dL (0.727 in males and 0.712 in females). In conclusion, we provide reference values for VAT obtained from healthy adults using the GE Healthcare DXA. These values may be useful in the diagnosis of visceral obesity, for identifying subjects with high obesity-related risks, in epidemiological studies, as a target for therapies, and in physically trained individuals. In both genders, VAT was associated with traditional cardiometabolic risk factors, particularly hypertriglyceridemia.

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.

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.

Testosterone assocition with blood pressure profile and left ventricular mass in a young hypertensive population

Sex hormones not only regulate the gonads function, but also may affect the cardiovascular system, although their role is still not clear. Testosterone influence on arterial pressure and left ventricular hypertrophy were widely reported. A number of factors have been implicated as the underlying cause of the relation between testosterone and blood pressure, including sex and age as most important ones. In present findings, a 24-hour ABPM revealed that 33.9% of patients had an altered pattern of blood pressure with no significant differences between sexes. In the whole studied sample, positive correlation has been found between testosterone and 24-hour systolic blood pressure, daytime BP, sodium and potassium levels in the 24-hour urine collection, and left ventricular mass index. In conclusion, testosterone association with blood pressure profile and left ventricular mass in a young hypertensive population seems to be probable, but further analysis is necessary.

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.

The civilization-related phenotypes of abnormal fatty tissue distribution: visceral obesity and sarcopoenic obesity

Obesity is a well-known risk factor of abnormal carbohydrate and lipid metabolism, arterial hypertension, and cardiovascular diseases. This risk increases with abnormal fat distribution with excessive fat accumulation in the abdominal cavity, liver, pancreas, heart, kidneys, blood vessels, and muscles. In this review we present pathogenesis, diagnostic challenges and metabolic consequences of visceral and sarcopoenic obesity — the new phenotypes of fat distribution in human evolution.

Effect of different classes of antihypertensive drugs on central and peripheral pressure in a young patient with hypertension — clinical case

In recent years, it has been shown that the central pressure correlated with cardiovascular risk and, better than peripheral pressure, provides the risk of serious cardiovascular events. It is known that blood pressure and pulse wave shape are different in different sections of the arterial tree. This difference is related to the age sex, incidence of heart disease, concomitant cardiovascular disease, diabetes, renal failure, used drugs. In young people, with flexible walls of the vessels, the difference between the circumferential pressure, measured at the upper limb and the central pressure can range from a few to over twenty mmHg. In this context, we present a case of a young patient with hypertension treated with antihypertensive fixed dose combination drug.

Postępowanie z nadciśnieniem tętniczym w ostrym uszkodzeniu nerek

Despite the fact that in recent years the concept of hypertension treatment has been verified and the management in special situations and groups of patients has been standardized , there are not many reports of antihypertensive therapy in patients with acute kidney injury. Acute renal failure, defined as a sudden decline of kidney function, is a clinical syndrome of various etiologies, often accompanies by hypertension, and specific pathological mechanism determines the therapeutic management. Diuretics are first-line drugs, particularly preferred in patients with volume overload. RAA blockers are not recommended for the hypertension treatment in acute kidney injury, but the broad definition of AKI forces individualization of therapy in various clinical situations - the results of large clinical trials show the benefits of ACE inhibitors in cases of HTA associated with acute glomerulopathies or vasculitis. Prevalence of drugs that affect potassium levels contribute to the rising incidence of hyperkalemia, which can be a consequence of both — acute and chronic kidney diseases. In case of a dynamically growing levels of potassium in AKI there is a need to decrease the dose or withdrawal of RAA blockers and mineralocorticoid antagonists.

Biochemically silent pheochromocytoma — rare, but not uncommon. Case study

Approximately 5–6.5% of adrenal incidentalomas are pheochromocytomas, and 8% of the patients with a pheochromocytoma are completely asymptomatic. Marker-negative pheochromocytomas represent a small group of rare tumours, yet rarely reported in the current medical literature. In the current study presents a case of 49-year old patient with hypertension, caused by biochemically silent pheochromocytoma and the potential medical complications, which can be particularly dangerous in cases of misdiagnosed, non-functional tumours.