Matej Bendzala

Prognostic significance of dipping in older hypertensive patients

Abstract Background and aims. Arterial hypertension doubles the risk of coronary heart disease, heart and kidney failure, and peripheral arterial disease. Less variation in diurnal ambulatory blood pressure monitoring (ABPM) patterns may affect mortality outcome. Therefore, as hypertension occurs in over 95% of older subjects, the prognostic value of dipping status in older hypertensive patients will be assessed. Method. The retrospective study group consisted of 170 hypertensive patients, aged 75–84 years, enrolled in the years 2005 to 2007. Baseline measures included 24-h ABPM. Diurnal index and dipping status was calculated and stratified the group into dippers (40 patients, 23.5%), non-dippers (65 patients, 38.2%) and reverse-dippers (65 patients, 38.2%). Results. During a 5-year observation, after baseline we have observed 69 deaths (40.9%) from the whole group of 170 patients with 23 (35.4%) being non-dippers and 36 (55.4%) reverse-dippers. There were significant differences between the groups divided according to diurnal dipping status in survival time, number of recorded deaths and night mean blood pressure. We have identified and confirmed risk factors for the all-cause mortality: age, mean systolic and diastolic blood pressure, diurnal index and dipping status (dipping, non-dipping or reverse-dipping). Conclusion. Reverse-dippers and non-dippers revealed worse prognosis compared with dippers.

Effect of short term aerobic exercise on fasting and postprandial lipoprotein subfractions in healthy sedentary men

BackgroundOur goal was to investigate the effect of short term exercise on fasting and postprandial lipoprotein profile.MethodsHealthy sedentary men exercised 20 min for four days. The intensity of exercise was modulated to maintain 75–80 % of a calculated HRmax. Before and after the exercise program, fasting and postprandial (4 h after standard meal) concentrations of lipoprotein subfractions were measured by an electrophoresis in polyacrylamide gel and total concentrations of TAG, LDL and HDL by enzymatic colorimetric method. After 2 days of rest, fasting and postprandial concentrations of lipoprotein fractions and subfractions were measured to determine a persistency of a changes in the lipoprotein profile.Results4 days of physical exercise led to statistically significant decrease of concentration of triacylglycerol in fasting (76.29 ± 20.07, 53.92 ± 10.90, p < 0.05) and postprandial state (139.06 ± 23.72, 96.55 ± 25.21, p < 0.05) VLDL in fasting (21.88 ± 3.87, 18.00 ± 3.93, p < 0.05) and postprandial state (23.88 ± 3.52, 19.25 ± 3.62, p < 0.05), total cholesterol in fasting (162.26 ± 23.38, 148.91 ± 17.72, p < 0.05) and postprandial state (163.73 ± 23.02, 150.08 ± 18.11, p < 0.05). Atherogenic medium LDL decreased also in fasting (9.89 ± 3.27, 6.22 ± 2.55, p < 0.001) and postprandial state (8.88 ± 6.51, 6.88 ± 5.57, p < 0.001). However decrease of large IDL (25.38 ± 3.54, 23.88 ± 3.91, p < 0.05) and large LDL particles (42.89 ± 11.40, 38.67 ± 9.30) was observed only in postprandial state. Total HDL concentration remained unchanged but we observed statistically significant decrease of small HDL particles in fasting (6.11 ± 2.89, 4.22, p < 0.05) and postprandial state (6.44 ± 3.21, 4.56 ± 1.33, p < 0.05). Concentration of these particles are associated with progression of atherosclerosis. All changes of fasting and postprandial lipoprotein profile disappeared after 2 days of rest.ConclusionJust 4 daily settings of 20 min of physical exercise can lead to significant positive changes of fasting and postprandial lipoprotein profile.

THE NEED OF BETTER ARTERIAL HYPERTENSION AND ATRIAL FIBRILLATION MANAGEMENT IN REDUCING STROKE INCIDENCE

Objective: Strokes are among the most common causes of morbidity and mortality, and in individuals who suffered stroke, subsequent long-term neurological deficit in a larger or smaller range is also an important factor. Arterial hypertension and atrial fibrillation are the most common influencing factors of strokes. Numerous clinical and epidemiological studies have confirmed that elevated systemic blood pressure values are among the major risk factors for both ischemic and hemorrhagic stroke, and the effect of arterial hypertension is complex. Aim of the study was to point out the need to improve the early identification, elimination and treatment of risk factors for stroke, according to the valid recommendations of the European Society of Hypertension and European Society of Cardiology. Design and method: Retrospectively, we analyzed a cohort of patients hospitalized for stroke during a three month period (July - September 2016) at the Ist Department of Neurology in Bratislava. The group consisted of 104 patients, from which ischemic stroke was diagnosed in 88 subjects (84.6 %) and hemorrhagic stroke in 16 subjects (15.4 %). The average age was 70.7 years. A history of previous stroke was in 18 (17.3 %) patients. Results: Among the most important risk factors in addition to age, we found that arterial hypertension as the most common risk factor occured in 96 subjects (92.3 %). Atrial fibrillation occured in 34 patients (32.7 %), but only 14 patients (41.2 %) were treated with anticoagulant therapy before hospitalization. Hemorrhagic stroke during anticoagulant therapy was only in 1 patient, but ischemic stroke in 13 patients. In this group of patients with anticoagulant therapy who have evolved ischemic stroke in spite of this treatment, we found that in 7 patients (53.8 %) the treatment was underdosed and therefore inneffective. Conclusions: Our results from real clinical practice points to the need to improve the effective management of arterial hypertension and atrial fibrillation, the most common influencing factors of stroke. It is necessary to improve the inadequate indication of anticoagulant treatment with consideration of the stroke risk calculation for atrial fibrillation (CHA2DS2-VASc Score) and bleeding risk calculator (HAS-BLED).

Components of Metabolic Syndrome and Their Relation to Tinnitus

Tinnitus is defined as a non-specific symptom characterized as buzzing, whistling, fizzing, ringing or sensing of wide frequency range and different intensity sounds in one or both ears. Tinnitus is a sensation of sound perceived by an individual in the absence of an external sound source. It affects approximately 15% of the population worldwide. Tinnitus is usually connected with many kinds of hearing disturbances, but it could be also a symptom of different other health problems. Metabolic syndrome and its components as arterial hypertension, diabetes mellitus, obesity and dyslipoproteinaemia with arteriosclerosis are important and frequent causes of tinnitus. Due to the high number of heterogeneous etiologic factors in subjective and objective tinnitus a complex approach in differential diagnosis is crucial. Tinnitus can be a concomitant symptom to many disorders of peripheral statoacoustic apparatus. It is necessary to distinguish whether tinnitus is an acute symptom in onset, e.g. in Meniere’s disease, acute trauma, inflammation of the inner ear, or it is a part of chronic disease otological in origin. Various cardiovascular diseases can be the cause of newly arisen or persistent tinnitus. Among the most important causes there is a reduced perfusion with ischemic changes. Vascular changes can be localized either extraor intracranially. Among them are stenosis of arteries, haemangioma and glomus caroticum tumours. Changes in the rheology of blood in anaemia or polycythemia can be the cause of tinnitus, as well. It is important to think also about vasculitis as a cause of tinnitus especially among younger patients. Diagnosis of hypertension requires serious and careful approach. The use of a 24-hour ABPM should be considered and carried out as soon as possible in patients with presence of tinnitus. Despite our results are from the limited number of patients with tinnitus, the diagnostic of arterial hypertension is very important, as several prospective studies have reported that ABPM give better prediction of clinical outcomes compared with conventional clinic or office blood pressure measurements. The inner ear, like the brain, is totally lacking in energy reserves. Its metabolism depends directly on the supply of oxygen and glucose from the blood supply. Alterations in glucose metabolism therefore have great potential for disturbing the workings of the inner ear.