Paweł Salwa

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.

The relationship between admission heart rate and early prognosis in patients with ST-elevation myocardial infarction

BACKGROUND Heart rate (HR) is a basic cardiovascular parameter. The relationship between HR and cardiovascular mortality and morbidity has been indicated in clinical trials and epidemiological studies. AIM The evaluation of the relationship between HR upon hospital admission and the in-hospital prognosis in a group of patients with ST-elevation myocardial infarction (STEMI). METHODS The medical records of 927 patients were subject to retrospective analysis. The patients were classified on the basis of HR upon hospital admission: < 60 bpm (n = 75), 60-69 bpm (n = 169), 70-79 bpm (n = 245), 80-89 bpm (n = 172), 90-99 bpm (n = 134), and ≥ 100 bpm (n = 132). A group of patients with HR of 60-69 bpm on hospital admission (n = 169) constituted a reference group. Patients with atrioventricular blocks and arrhythmias were excluded from the analysis. Early mortality and co-existing diseases were evaluated in the study population. RESULTS Patients with HR ≥ 90 bpm demonstrated heart failure symptoms considerably more often than patients with HR of 60-69 bpm (p = 0.0010). In-hospital mortality was significantly higher in patients with a HR of more than 90 bpm and bradycardia. The relationship between HR and cardiovascular mortality is shown with a J-shaped curve. CONCLUSIONS HR is strictly correlated with early cardiovascular mortality in a population of patients with STEMI. The relationship between HR and early mortality is demonstrated by a J-shaped curve.

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.

Monakolina — pomost między prozdrowotną modyfikacją diety a farmakoterapią hipercholesterolemii

Choroby ukladu sercowo-naczyniowego (CVD) są glowną przyczyną przedwczesnych zgonow na świecie. Z kolei dyslipidemia to najcześciej wystepujący, modyfikowalny czynnik ryzyka CVD. Podstawe interwencji sluzącej normalizacji stezenia cholesterolu stanowi postepowanie niefarmakologiczne obejmujące modyfikacje stylu zycia, w tym przede wszystkim aktywnośc fizyczną i odpowiednią diete. Grupą lekow najcześciej stosowaną w leczeniu zaburzen gospodarki lipidowej są statyny. Pośrednim etapem miedzy postepowaniem niefarmakologicznym a leczeniem statynami moze byc zastosowanie zywności funkcjonalnej oraz suplementow diety, takich jak monakolina K. Skutecznośc monakoliny K zawartej w czerwonym ryzu drozdzowym w obnizaniu stezenia cholesterolu potwierdzono w wielu randomizowanych badaniach klinicznych. Zastosowanie suplementow diety oraz zywności funkcjonalnej jako alternatywy dla leczenia statyną jest uprawnione tylko u pacjentow z niskim bądź umiarkowanym ryzykiem sercowo-naczyniowym, ewentualnie w tej grupie chorych obciązonych wysokim ryzyka sercowo-naczyniowym, u ktorych wyjściowo stezenie cholesterolu frakcji LDL nie przekracza 100 mg/dl.

Jaki chory z nadciśnieniem tętniczym odnosi największe korzyści z zastosowania skojarzenia losartanu z amlodipiną

Combination of antihypertensive agents can better control blood pressure and reduce the number and severity of drugs side effects than a monotherapy. Calcium channel blockers and angiotensin II receptor type-1 blockers are effective antihypertensive drugs. Losartan and amlodipine are frequently used as first-line therapy in hypertensive patients, and combining these two drug has also been shown to be effective and safe in lowering blood pressure. Early initiation of amlodipine/losartan combination followed by subsequent dose escalation in patients who have not achieved recommended blood pressure levels may be particularly beneficial for patients with hypertension and metabolic syndrome, diabetes, pulmonary diseases and hyperuricaemia.