Vesna Stojanov

Nighttime Road-Traffic Noise and Arterial Hypertension in an Urban Population

Commonly used daytime measurements in previous investigations on community noise and arterial hypertension (AH) may be a source of exposure bias, as urban residents spend most of their daytime hours out of the home on workdays. For this reason, we focused on the relation of nighttime noise and AH. A cross-sectional study was performed on a sample of 2,503 (995 men and 1,508 women) adult residents of a downtown Belgrade municipality. The inclusion criteria were a period of residence longer than 10 years and a bedroom oriented toward the street. The exclusion criteria were a high level of noise annoyance at work and diseases related to AH. Noise measurements were performed in all 70 streets of the municipality. The streets were grouped into noisy areas (equivalent noise level [Leq;[gt;45 dB(A)) and quiet areas (Leq≤45 dB(A)). The residents were interviewed in regard to antihypertensive therapy. Subjects who responded that they had not received such therapy were contacted for blood pressure measurements with mercury sphygmomanometer. Possible confounding factors: family history of AH, age, body mass index, smoking habits, physical activity and alcohol consumption were controlled for. The proportions of men with AH in the noisy and quiet areas were 23.6% and 17.5%, respectively. The adjusted odds ratio (OR) for AH was 1.58; the 95% confidence interval (CI) ranged from 1.03–2.42; and the probability value was 0.038, when men living in quiet streets were taken as a reference category. This relation was statistically insignificant for women: adjusted OR: 0.90; 95% CI: 0.59–1.38; p: 0.644. This cross-sectional study showed that nighttime urban road-traffic noise might be related to occurrence of AH in men.

Cardiovascular effects of environmental noise: Research in Serbia

Research on the cardiovascular effects of noise in Serbia started in the year 2002, including experimental studies on humans and epidemiological studies on the adult and children population of Belgrade and Pancevo. Experimental exposure to noise [L eq = 89 dB (A)] had a hypodynamic effect, significantly lowering the cardiac index, cardiac work, and pump performance (P < 0.01). The vasoconstrictive effect of noise was shown through the significant elevation of after-load (P < 0.01). In a cross-sectional population study that was carried out on 2874 residents [1243 males and 1631 females] in Pancevo City, a significant odds ratio (adjusted for age, body mass index (BMI), and smoking habits) was found for self-reported hypertension (OR = 1.8, 95% CI = 1.0 - 2.4, P < 0.01) in men with a high level of noise annoyance compared to those with a low level of noise annoyance. In another study on 2503 residents (995 men and 1508 women) residents of Belgrade, the proportions of men with hypertension in the noisy [(L night , 8h > 45 dB (A)] and quiet areas [(L night , 8h ≤ 45 dB (A)] were 23.6% and 17.5%, respectively. The adjusted odds ratio (OR) for hypertension of the exposed group was 1.58 (95% CI = 1.03 - 2.42, P = 0.038), where men living in quiet streets were taken as a reference category. Associations between road traffic noise and blood pressure were also investigated in 328 preschool children in Belgrade. The systolic blood pressure was significantly higher among children from noisy residences and kindergartens, compared to children from both quiet environments (97.30 ± 8.15 and 92.33 ± 8.64 mmHg, respectively, P < 0.01). As a continuation of the study on preschool children, investigations were also carried out on 856 school children, aged between seven and eleven years, in Belgrade. It was found that systolic pressure was significantly higher among children from noisy schools and quiet residences, compared to children from both quiet environments (102.1 ± 9,3 and 100.4 ± 10.4 mmHg, respectively, P < 0.01).

Obesity and fat distribution as predictors of aortoiliac peripheral arterial disease in middle-aged men

BACKGROUND Peripheral arterial disease (PAD) in the aortoiliac segment is found in nearly a half of patients with PAD. The aim of this study was to estimate the influence of obesity and fat distribution on the occurrence of aortoiliac PAD in middle-aged men. METHODS This case-control study included 204 middle-aged men (mean 58±7 years; range 45-70 years): 102 patients with aortoiliac PAD and 102 healthy controls without PAD. Aortoiliac PAD was diagnosed by ankle-brachial index (ABI) and angiography. Body mass index (BMI) was categorized as: normal weight, overweight, and obese. Percents of body fat were grouped according to quartile distribution. The relationship between anthropometrics and aortoiliac PAD was estimated by multivariate logistic regression. RESULTS Patients with aortoiliac PAD had higher body mass index, waist circumference, waist-hip ratio and percent of body fat. A strong correlation between all anthropometric parameters and ABI index and mean angiographic score was shown among patients with PAD. Multivariate regression, adjusted for blood pressure and cholesterol level, identified being overweight, body fat over 26.5% and WHR over 1.02 as predictors for aortoiliac PAD. Body fat over 26.5% and WHR over 1.02 remained significant after further adjustment for blood pressure, cholesterol and body mass index. CONCLUSION This study has identified the quantity of fat tissue (body fat over 26.5%) and its visceral distribution (waist-hip ratio over 1.02) as predictors of aortoiliac PAD in middle-aged men. Body mass index, a crude indicator of obesity, should be combined with these parameters when assessing the risk for aortoiliac PAD.

Thoracic bioelectrical impedance assessment of the hemodynamic reactions to recorded road-traffic noise in young adults

Noise exposure increases blood pressure in both experimental and field studies. The underlying mechanisms may be evaluated by thoracic bioelectrical impedance. The aim of this experimental study was to assess changes in blood pressure, cardiac and hemodynamic parameters provoked by recorded traffic noise in young adults. The study included 130 participants (42 men and 88 women), aged 24.88±2.67 years. Thoracic electrical bioimpedance device was applied to monitor cardiac parameters, hemodynamic parameters, heart rate variability, blood pressure and heart rate. The testing procedure consisted of three phases. Participants were exposed to recorded road-traffic noise (Leq=89dBA) for 10min and relaxed in quiet conditions (Leq=40dBA) before and after noise exposure. Listening to recorded noise resulted in significant decrease of stroke volume and cardiac output, and an increase of vascular resistance. Heart rate variability and the overall sympathovagal balance remained similar through all experimental conditions. During noise exposure, systolic pressure increased by 2mmHg among women (95% confidence interval=0.97-2.73mmHg), and by 4mmHg among men (95% confidence interval=2.16-5.00mmHg). Similarly, diastolic pressure increased by 2mmHg among women (95% confidence interval=0.95-2.47mmHg), and by 4mmHg among men (95% confidence interval=2.46-5.28mmHg). Once noise ceased, both pressures returned to pre-exposure levels. Experimental exposure to recorded road-traffic noise of 89dBA for 10min provoked significant hemodynamic changes in young adults, including vasoconstriction (increase of vascular resistance), and hypodynamics (decrease of global heart flow). The interaction of these effects resulted in the elevation of blood pressure during noise exposure.

Left ventricular hypertrophy in hypertensive obese women

Objective — Left ventricular hypertrophy (LVH) is an independent predictor of cardiovascular and general mortality. Both arterial hypertension and obesity cause changes in structure and function of the left ventricle. Given the rising global epidemic of obesity, it is likely that adverse health consequences of excess adiposity will escalate in the future. The aim of this investigation was to assess the relation and predictive value of obesity on the occurrence of left ventricular hypertrophy in hypertensive middle-aged women. Methods and results — Investigation was conducted on a sample of 64middle-aged women, diagnosed with arterial hypertension and treated longer than 10years in the absence of other chronic diseases or heart failure. Based on anthropometric parameters, 14 women (21.9%) had a body mass index (BMI) within the normal range, 17 (26.6%) were overweight, and 33 (52.5%) were obese. Left ventricular hypertrophy was assessed by electrocardiographic and echocardiographic criteria.The influence of anthropometric parameters on left ventricular hypertrophy and patterns in left ventricular geometry was assessed using multivariate regression analyses. The prevalence of LV hypertrophy was 7.1% among normal-weight hypertensive women, 41.2% among overweight and 66.7% among obese women. Compared to normal-weight women, overweight and obese hypertensive subjects had higher mean values of all ECG and echo parameters. The strong correlation between anthropometric and left ventricular parameters was observed. Multivariate analysis showed that percent of body fat (OR=1.226; 95% CI 1.011-1.486) was the only independent predictor of left ventricular hypertrophy. Being overweight was identified as predictor for the development of eccentric LV hypertrophy (OR=31.824; 95%CI 1.225-826.850), and for concentric left ventricular remodelling (OR=20.755; 95%CI 1.119-385.029). Conclusions — Heart abnormalities occurring in arterial hypertension in conjunction with overweight/obesity include left ventricular hypertrophy and structural changes in the left ventricle.These findings support weight control and the regulation of blood pressure for the prevention of left heart abnormalities.

The pathophysiological basis of carotid baroreceptor stimulation for the treatment of resistant hypertension.

The prevalence of resistant hypertension and existing limitations in antihypertensive drug therapy renders the interventional management of hypertension an attractive alternative. Carotid baroreceptors have been traditionally thought to be implicated only in short-term blood pressure regulation; however recent evidence suggests that the baroreceptors might play an important role even in the long-term blood pressure regulation. Electrical baroreflex stimulation appears safe and effective and might represent a useful adjunct to medical therapy in patients with resistant hypertension. This review endeavors to summarize the complex pathophysiology of blood pressure regulation, to describe the baroreflex circuit, its anatomy and physiology, to present previous data refuting a role for the baroreceptors in the long-term control of blood pressure and recent animal and human data suggesting an effective role of carotid baroreceptor activation in long-lasting blood pressure reduction. In this paper we attempt to critically evaluate existing information in this area and provide the scientific basis for carotid baroreceptor stimulation in the management of resistant hypertension.

Assessment of the left ventricular chamber stiffness in athletes.

Since diastolic dysfunction is an early sign of the heart disease, detecting diastolic disturbances is predicted to be the way for early recognizing underlying heart disease in athletes. So‐called chamber stiffness index (E/e′)/LVDd was predicted to be useful in distinguishing physiological from pathological left ventricular hypertrophy, because it was shown to be reduced in athletes. It remains unknown whether it is reduced in all athletic population. Standard and tissue Doppler were used to assess cardiac parameters at rest in 16 elite male wrestlers, 21 water polo player, and 20 sedentary subjects of similar age. In addition to (E/e′)/LVDd index, a novel (E/e′)/LVV, (E/e′)/RVe′lat indices were determined. Progressive continuous maximal test on treadmill was used to assess the functional capacity. VO2 max was the highest in water polo players, and higher in wrestlers than in controls. LVDd, LVV, LVM/BH2.7 were higher in athletes. Left ventricular early diastolic filling velocity, deceleration and isovolumetric relaxation time did not differ. End‐systolic wall stress was significantly higher in water polo players. RV e′ was lower in water polo athletes. Right atrial pressure (RVE/e′) was the highest in water polo athletes. (E/e′lat)/LVDd was not reduced in athletes comparing to controls (water polo players 0.83 ± 0.39, wrestlers 0.73 ± 0.29, controls 0.70 ± 0.28; P = 0.52), but (E/e′s)/RVe′lat better distinguished examined groups (water polo players 0.48 ± 0.37, wrestlers 0.28 ± 0.15, controls 0.25 ± 0.16, P = 0.015) and it was the only index which predicted VO2 max. In conclusion, intensive training does not necessarily reduce (E/e′lat)/LVDd index. A novel index (E/e′s)/RVe′lat should be investigated furthermore in detecting diastolic adaptive changes. (Echocardiography 2011;28:276‐287)

Blood pressure categories and mortality during a thirty-six-year follow-up

BackgroundThe aim of this study was to assess the mortality rate and risk of death in relation to the blood pressure (BP) categories during 36 years of follow-up period.Methods265 healthy middle-aged participants were included in the follow up for 36 years; 136 deaths occurred during this time. Causes of death (myocardial infarction (MI), stroke and other causes) were obtained from the death certificates. Participants were divided into four groups according to their blood pressure measurements (normal blood pressure, prehypertension, stage I and stage II hypertension). Hazard ratios (HR) for mortality from all investigated causes of death were calculated using measurements of normal BP as a reference. Kaplan-Meier method was used to calculate probability of survival for each BP category.ResultsParticipants with prehypertension and stage I hypertension have shared similar all-cause mortality rates (15 deaths per 1000 person-years), and MI mortality rates (7 per 1000 person-years). Participants with stage II hypertension had the highest risk of all-cause mortality (HR 2.78, 95% confidence interval 1.16 to 6.66).ConclusionPrehypertension and stage I hypertension induced similar rates of mortality due to myocardial infarction or all-causes. The survival probabilities were lower for participants with hypertension and prehypertension in comparison with those who had normal blood pressure. Participants with stage II hypertension had the highest mortality rates and the lowest probability of survival during a 36-year follow-up period.

Relationship between blood pressure and retrobulbar blood flow in dipper and nondipper primary open-angle glaucoma patients

Purpose To evaluate the relationship between retrobulbar hemodynamic parameters in the ophthalmic artery (OA), central retinal artery, and short posterior ciliary artery and 24-hour blood pressure (BP) measurements in dipper and nondipper patients with primary open-angle glaucoma (POAG). Methods A prospective, cross-sectional, and observational study was conducted on consecutive patients, referred or recruited, attending the outpatient service of our ophthalmology department. Ambulatory BP monitoring, Doppler imaging, and ocular pulse amplitude measurements were performed on the same day. Patients with nocturnal BP decrease up to 10% of the diurnal BP were defined as dippers and those with BP decrease less than 10% were defined as nondippers. Results A total of 114 patients (36 nondippers and 78 dippers) were included in the study. The end-diastolic velocity was significantly lower and the resistivity index (RI) was significantly higher in the dippers than in the nondippers (p<0.0001 and p<0.0001, respectively). The RI in the OA was significantly correlated with daytime and nighttime systolic BP and with the daytime mean arterial pressure in the dippers. Conclusions The RI in the OA significantly correlates with BP in patients with POAG with nocturnal BP dips. Additionally, retrobulbar blood flow parameters are reduced in dippers as compared with nondippers with POAG.

Dual Roles of the Mineral Metabolism Disorders Biomarkers in Prevalent Hemodilysis Patients: In Renal Bone Disease and in Vascular Calcification

Summary Background Vascular calcification (VC) is highly prevalent in dialysis (HD) patients, and its mechanism is multifactorial. Most likely that systemic or local inhibitory factor is overwhelmed by promoters of VC in these patients. VC increased arterial stiffness, and left ventricular hypertrophy. Thus, the present study aimed to investigate the association of VC and myocardial remodeling and to analyze their relationship with VC promoters (fibroblast growth factor 23-FGF23, Klotho, intact parathormon-iPTH, vitamin D) in 56 prevalent HD patients (median values: age 54 yrs, HD vintage 82 months). Methods Besides routine laboratory analyzes, serum levels of FGF 23, soluble Klotho, iPTH, 1,25-dihydroxyvitamin D3; pulse wave velocity (PWV); left ventricular (LV) mass by ultrasound; and VCs score by Adragao method were measured. Results VC was found in 60% and LV concentric or eccentric hypertrophy in 50% patients. Dialysis vintage (OR 1.025, 95%CI 1.007–1.044, p=0.006) FGF23 (OR 1.006, 95% CI 0.992–1.012, p=0.029) and serum magnesium (OR 0.000, 95%CI 0.000–0.214, p=0.04) were associated with VC. Changes in myocardial geometry was associated with male sex (beta=-0.273, 95% CI -23.967 1.513, p=0.027), iPTH (beta 0.029, 95%CI -0.059–0.001, p=0.027) and vitamin D treatment (beta 25.49, 95%CI 11.325–39.667, p=0.001). Also, patients with the more widespread VC had the highest LV remodeling categories. PWV was associated patient’s age, cholesterol, diastolic blood pressure, LV mass (positively) and serum calcium (negatively), indicating potential link with atherosclerotic risk. Conclusions Despite to different risk factors for VC and myocardial remodeling, obtained results could indicate that risk factors intertwine in long-term treatment of HD patients and therefore careful and continuous correction of mineral metabolism disorders is undoubtedly of the utmost importance.