Background. Heart rate variability (HRV) response to an exercise bout may provide useful insight into autonomic stress reactivity. Considering that cardiovascular responses to a stressor may be predictive of certain diseases, it becomes critical to understand if high blood pressure can influence the autonomic nervous system response to acute exercise. We, therefore, undertook a study to investigate the effect of a single bout of aerobic exercise on autonomic responses in hypertensives. Material and methods. Twenty hypertensives were randomly assigned to one of the two experimental groups [control (CG) or exercise (EG)]. The exercise session was conducted on a treadmill and consisted of 40 min of running/walking at 60–70% HRreserve. In the control session, the participants remained seated in a quiet room for 40 min. After the exercise/control sessions, the HRV was recorded continuously for 60 min. Results. The EG presented an increase with a large effect size for LF [1.0 (post-30) and 1.0 (post-60)] and LF/HF [0.8 (post-30) and 1.1 (post-60)]. Additionally, a reduction with a large effect was observed for HF [–1.0 (post-30) and –1.0 (post-60)]. Conclusion. There is a considerable reduction in post-aerobic-exercise parasympathetic activity and an increase in sympathetic activity. Therefore, a single bout of aerobic exercise is not able to quickly improve the cardiac autonomic regulation.
{"title":"Post-aerobic-exercise autonomic responses in hypertensives — a randomized controlled trial","authors":"Juliano Casonatto, L. S. Oliveira, K. Grandolfi","doi":"10.5603/AH.A2020.0009","DOIUrl":"https://doi.org/10.5603/AH.A2020.0009","url":null,"abstract":"Background. Heart rate variability (HRV) response to an exercise bout may provide useful insight into autonomic stress reactivity. Considering that cardiovascular responses to a stressor may be predictive of certain diseases, it becomes critical to understand if high blood pressure can influence the autonomic nervous system response to acute exercise. We, therefore, undertook a study to investigate the effect of a single bout of aerobic exercise on autonomic responses in hypertensives. Material and methods. Twenty hypertensives were randomly assigned to one of the two experimental groups [control (CG) or exercise (EG)]. The exercise session was conducted on a treadmill and consisted of 40 min of running/walking at 60–70% HRreserve. In the control session, the participants remained seated in a quiet room for 40 min. After the exercise/control sessions, the HRV was recorded continuously for 60 min. Results. The EG presented an increase with a large effect size for LF [1.0 (post-30) and 1.0 (post-60)] and LF/HF [0.8 (post-30) and 1.1 (post-60)]. Additionally, a reduction with a large effect was observed for HF [–1.0 (post-30) and –1.0 (post-60)]. Conclusion. There is a considerable reduction in post-aerobic-exercise parasympathetic activity and an increase in sympathetic activity. Therefore, a single bout of aerobic exercise is not able to quickly improve the cardiac autonomic regulation.","PeriodicalId":42110,"journal":{"name":"Arterial Hypertension","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83442478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Varga, Teodor Zah, C. Suciu, D. Petra, C. Buicu
Background. Increased arterial stiffness assessed by pulse wave velocity (PWV) measurement is a marker of arterial wall dysfunction and has an independent predictive value for adverse cardiovascular outcomes. A positive correlation between the neutrophil-to-lymphocyte ratio (NLR) and PWV has been reported in chronic inflammatory conditions and the general population as well. Furthermore, an association between NLR and PWV has been assumed in hypertensive patients. However, the available data are scarce. The objective of the study was to validate the association between NLR and PWV in a homogenous group of controlled-hypertensive patients without chronic inflammatory conditions. Material and methods. A retrospective observational study was conducted in outpatient cardiology and a general practice. A total number of 25 already on-target treated essential hypertensive, non-diabetic and non-chronic kidney disease (non-CKD) patients were selected. PWV was automatically calculated for each patient using the ABPM BPLab® device. The following laboratory data were collected: complete blood count, fibrinogen, alkaline phosphatase, lactate dehydrogenase, uric acid, serum glucose, total cholesterol, triglycerides, iron, calcium, and creatinine. Neutrophil-to-lymphocyte ratio was calculated. Antihypertensive treatment classes were also assessed. Results. A correlation between increased NLR and PWV in a homogenous group of controlled-hypertensive patients was identified. Conclusions. There is an evident relation between increased NLR and increased PWV in controlled hypertensive patients without evidence of chronic inflammatory conditions.
{"title":"Neutrophil-to-lymphocyte ratio and pulse wave velocity in patients with controlled systemic hypertension — a preliminary report","authors":"A. Varga, Teodor Zah, C. Suciu, D. Petra, C. Buicu","doi":"10.5603/AH.A2020.0008","DOIUrl":"https://doi.org/10.5603/AH.A2020.0008","url":null,"abstract":"Background. Increased arterial stiffness assessed by pulse wave velocity (PWV) measurement is a marker of arterial wall dysfunction and has an independent predictive value for adverse cardiovascular outcomes. A positive correlation between the neutrophil-to-lymphocyte ratio (NLR) and PWV has been reported in chronic inflammatory conditions and the general population as well. Furthermore, an association between NLR and PWV has been assumed in hypertensive patients. However, the available data are scarce. The objective of the study was to validate the association between NLR and PWV in a homogenous group of controlled-hypertensive patients without chronic inflammatory conditions. Material and methods. A retrospective observational study was conducted in outpatient cardiology and a general practice. A total number of 25 already on-target treated essential hypertensive, non-diabetic and non-chronic kidney disease (non-CKD) patients were selected. PWV was automatically calculated for each patient using the ABPM BPLab® device. The following laboratory data were collected: complete blood count, fibrinogen, alkaline phosphatase, lactate dehydrogenase, uric acid, serum glucose, total cholesterol, triglycerides, iron, calcium, and creatinine. Neutrophil-to-lymphocyte ratio was calculated. Antihypertensive treatment classes were also assessed. Results. A correlation between increased NLR and PWV in a homogenous group of controlled-hypertensive patients was identified. Conclusions. There is an evident relation between increased NLR and increased PWV in controlled hypertensive patients without evidence of chronic inflammatory conditions.","PeriodicalId":42110,"journal":{"name":"Arterial Hypertension","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77767837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Dąbrowska, J. Harazny, J. Wolf, Urszula Szulc, K. Narkiewicz
Microvascular alterations can parallel and even precede development of cardiovascular disease. Ocular bulb, due to transparent anatomical elements provides a unique opportunity to examine microcirculation non-invasively and in vivo by means of scanning laser Doppler flowmetry. This device enables to obtain both structural and functional parameters of retinal microvasculature. Alterations observed in retinal arterioles, i.e. lumen narrowing, increased wall-to-lumen ratio, rarefaction or reduced retinal capillary flow, have been independently associated with cardiometabolic diseases: hypertension, heart failure, coronary artery disease, stroke, chronic kidney disease and diabetes. Therefore, examination of easily accessible retinal microcirculation may provide novel insights into the mechanisms underlying various diseases, serve as a marker of target organ damage and add valuable information to cardiovascular risk stratification.
{"title":"The eye — a window to cardiovascular diseases","authors":"E. Dąbrowska, J. Harazny, J. Wolf, Urszula Szulc, K. Narkiewicz","doi":"10.5603/AH.A2020.0006","DOIUrl":"https://doi.org/10.5603/AH.A2020.0006","url":null,"abstract":"Microvascular alterations can parallel and even precede development of cardiovascular disease. Ocular bulb, due to transparent anatomical elements provides a unique opportunity to examine microcirculation non-invasively and in vivo by means of scanning laser Doppler flowmetry. This device enables to obtain both structural and functional parameters of retinal microvasculature. Alterations observed in retinal arterioles, i.e. lumen narrowing, increased wall-to-lumen ratio, rarefaction or reduced retinal capillary flow, have been independently associated with cardiometabolic diseases: hypertension, heart failure, coronary artery disease, stroke, chronic kidney disease and diabetes. Therefore, examination of easily accessible retinal microcirculation may provide novel insights into the mechanisms underlying various diseases, serve as a marker of target organ damage and add valuable information to cardiovascular risk stratification.","PeriodicalId":42110,"journal":{"name":"Arterial Hypertension","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83239285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background. Obesity is frequently referred to as an independent risk factor for high blood pressure and hypertension is very prevalent among obese people. The aims of this study were: to compare office-based and 24 h blood pressure (BP) and its circadian pattern between lean and obese women; to study correlations between BP, insulin resistance (IR) and markers of subclinical inflammation/early atherosclerosis. Material and methods. Eighty-eight lean and 107 otherwise healthy obese women were characterized for anthropometrics, BP (office-based determinations and 24 h ABPM) and for glucose, insulin, triglycerides, inteleukin 6 (IL-6), tumor necrosis factor alpha (TNF-a), high-sensitivity C reactive protein (hs-CRP), retinol-binding protein 4 (RBP-4), leptin, adiponectin, resistin, monocyte chemoattractant protein 1 (MCP-1), intercellular adhesion molecule 1 (ICAM-1), and vascular-cellular adhesion molecule 1 (VCAM-1). Insulin resistance was determined by homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and McAuley indexes (also Matsuda in obese). Results. Obese group presented higher office-based systolic/diastolic BP, systolic ambulatory blood pressure monitoring (ABPM), and more non-dippers. HOMA-IR and body fat was correlated to systolic (r2 = 0.176) and glucose to diastolic (p = 0.008; r = 0.256) ABPM. Age, QUICKI, and TNF-a was correlated with dipping (r2 = 0.172); adiponectin, age, BMI, and glucose to systolic (r2 = 0.226) and diastolic (r2 = 0.215) office-based BP. Concerning lean women, MCP-1 was associated with diastolic ABPM (p = 0.013; r = 0.267). Systolic office-based BP was associated with waist-to-hip ratio (p = 0.01; r = 0.273); this and RBP-4 was correlated with office-based diastolic BP (r2 = 0.12). Conclusion. Although relatively healthy, obese women present higher BP than lean. Anthropometrics, IR, and fasting glucose all influence BP in obesity; additionally, IR is involved in non-dipping. No strong correlation exists between BP/dipping and subclinical inflammation in either group of women.
{"title":"Blood pressure and its circadian pattern in obese and lean premenopausal women","authors":"J. Silva-Nunes, M. Brito, L. Veiga","doi":"10.5603/AH.A2020.0005","DOIUrl":"https://doi.org/10.5603/AH.A2020.0005","url":null,"abstract":"Background. Obesity is frequently referred to as an independent risk factor for high blood pressure and hypertension is very prevalent among obese people. The aims of this study were: to compare office-based and 24 h blood pressure (BP) and its circadian pattern between lean and obese women; to study correlations between BP, insulin resistance (IR) and markers of subclinical inflammation/early atherosclerosis. Material and methods. Eighty-eight lean and 107 otherwise healthy obese women were characterized for anthropometrics, BP (office-based determinations and 24 h ABPM) and for glucose, insulin, triglycerides, inteleukin 6 (IL-6), tumor necrosis factor alpha (TNF-a), high-sensitivity C reactive protein (hs-CRP), retinol-binding protein 4 (RBP-4), leptin, adiponectin, resistin, monocyte chemoattractant protein 1 (MCP-1), intercellular adhesion molecule 1 (ICAM-1), and vascular-cellular adhesion molecule 1 (VCAM-1). Insulin resistance was determined by homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and McAuley indexes (also Matsuda in obese). Results. Obese group presented higher office-based systolic/diastolic BP, systolic ambulatory blood pressure monitoring (ABPM), and more non-dippers. HOMA-IR and body fat was correlated to systolic (r2 = 0.176) and glucose to diastolic (p = 0.008; r = 0.256) ABPM. Age, QUICKI, and TNF-a was correlated with dipping (r2 = 0.172); adiponectin, age, BMI, and glucose to systolic (r2 = 0.226) and diastolic (r2 = 0.215) office-based BP. Concerning lean women, MCP-1 was associated with diastolic ABPM (p = 0.013; r = 0.267). Systolic office-based BP was associated with waist-to-hip ratio (p = 0.01; r = 0.273); this and RBP-4 was correlated with office-based diastolic BP (r2 = 0.12). Conclusion. Although relatively healthy, obese women present higher BP than lean. Anthropometrics, IR, and fasting glucose all influence BP in obesity; additionally, IR is involved in non-dipping. No strong correlation exists between BP/dipping and subclinical inflammation in either group of women.","PeriodicalId":42110,"journal":{"name":"Arterial Hypertension","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88139051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paiboon Chattakul, P. Napinkul, Sittichai Khamsai, P. Limpawattana, J. Chindaprasirt, V. Chotmongkol, S. Silaruks, V. Senthong, Laddawan Yuenyaow, Supasson Wansutha, Akkaranee Timinkul, Chalongchai Phitsanuwong, K. Sawanyawisuth
Background. Hydrochlorothiazide is a cheap and effective antihypertensive agent but may cause hyponatremia. Even though several risk factors for hydrochlorothiazide-induced hyponatremia have been reported, this study aimed to evaluate additional risk factors for hydrochlorothiazide-induced hyponatremia in hypertensive patients. Material and methods. The inclusion criteria were: adult patients, diagnosed with hypertension and receiving hydrochlorothiazide treatment. Eligible patients were divided into two groups: with and without hyponatremia. Those with hyponatremia were identified by using the ICD-10 code E871, while those without hyponatremia were patients who did not have any reported hyponatremia until the last visit. The ratio between hyponatremia and non-hyponatremia group was 1:2. Predictors for hyponatremia were analyzed by using logistic regression analysis. Results. During the study period, there were 68 patients admitted due to symptomatic hyponatremia from hydrochlorothiazide. There were four independent factors in the model predictive of occurrence of symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients: sex, body mass index, plasma glucose, and serum albumin. Male sex, body mass index, and serum albumin were negatively associated with occurrence of symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients with adjusted OR of 0.099, 0.683, and 0.122, respectively. The plasma glucose had adjusted OR of 1.030 [95% CI of (1.009, 1.051)]. Conclusions. Factors associated with hydrochlorothiazide-induced symptomatic hyponatremia in hypertensive patients were sex, body mass index, plasma glucose level, and serum albumin level. The latter two risk factors have never been reported as risk factors for hydrochlorothiazide-induced symptomatic hyponatremia in hypertensive patients.
{"title":"Additional risk factors associated with symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients","authors":"Paiboon Chattakul, P. Napinkul, Sittichai Khamsai, P. Limpawattana, J. Chindaprasirt, V. Chotmongkol, S. Silaruks, V. Senthong, Laddawan Yuenyaow, Supasson Wansutha, Akkaranee Timinkul, Chalongchai Phitsanuwong, K. Sawanyawisuth","doi":"10.5603/AH.A2020.0003","DOIUrl":"https://doi.org/10.5603/AH.A2020.0003","url":null,"abstract":"Background. Hydrochlorothiazide is a cheap and effective antihypertensive agent but may cause hyponatremia. Even though several risk factors for hydrochlorothiazide-induced hyponatremia have been reported, this study aimed to evaluate additional risk factors for hydrochlorothiazide-induced hyponatremia in hypertensive patients. Material and methods. The inclusion criteria were: adult patients, diagnosed with hypertension and receiving hydrochlorothiazide treatment. Eligible patients were divided into two groups: with and without hyponatremia. Those with hyponatremia were identified by using the ICD-10 code E871, while those without hyponatremia were patients who did not have any reported hyponatremia until the last visit. The ratio between hyponatremia and non-hyponatremia group was 1:2. Predictors for hyponatremia were analyzed by using logistic regression analysis. Results. During the study period, there were 68 patients admitted due to symptomatic hyponatremia from hydrochlorothiazide. There were four independent factors in the model predictive of occurrence of symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients: sex, body mass index, plasma glucose, and serum albumin. Male sex, body mass index, and serum albumin were negatively associated with occurrence of symptomatic hydrochlorothiazide-induced hyponatremia in hypertensive patients with adjusted OR of 0.099, 0.683, and 0.122, respectively. The plasma glucose had adjusted OR of 1.030 [95% CI of (1.009, 1.051)]. Conclusions. Factors associated with hydrochlorothiazide-induced symptomatic hyponatremia in hypertensive patients were sex, body mass index, plasma glucose level, and serum albumin level. The latter two risk factors have never been reported as risk factors for hydrochlorothiazide-induced symptomatic hyponatremia in hypertensive patients.","PeriodicalId":42110,"journal":{"name":"Arterial Hypertension","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81851357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. Zych, A. Jaruszewska, Ł. Obołończyk, P. Wiśniewski, K. Sworczak, K. Chełmińska, J. Cwikła
The rarity of malignant pheochromocytoma coupled with the lack of definitive predictors of malignancy and the variability of clinical course, poses a significant diagnostic and therapeutic challenge. Since data on treatment is so scarce, case reports are a valuable source of knowledge for clinicians. This case report describes the medical history of a woman, aged 51 at the time of initial diagnosis and adrenalectomy. Within over 5 years she presented with recurrent relapse of tumour in adrenal gland bed and multiple distant metastases to descending colon, abdominal wall, postoperative scars, and the peritoneum. Neither before diagnosis nor during the whole follow-up were symptoms associated with pheochromocytoma present. The treatment administered to our patient consisted of numerous debulking surgeries along with administration of both hot and cold somatostatin analogues. We believe that debulking surgeries played a substantial role in enabling the patient to survive nearly 6 years despite aggressive clinical course of pheochromocytoma. She passed away in 2012 as a result of postlaparotomy complications. We stress the role of debulking surgery in the treatment of malignant pheochromocytoma and summarise current literature.
{"title":"Epic battles in endocrinology — malignant pheochromocytoma: a case report","authors":"E. Zych, A. Jaruszewska, Ł. Obołończyk, P. Wiśniewski, K. Sworczak, K. Chełmińska, J. Cwikła","doi":"10.5603/AH.A2020.0001","DOIUrl":"https://doi.org/10.5603/AH.A2020.0001","url":null,"abstract":"The rarity of malignant pheochromocytoma coupled with the lack of definitive predictors of malignancy and the variability of clinical course, poses a significant diagnostic and therapeutic challenge. Since data on treatment is so scarce, case reports are a valuable source of knowledge for clinicians. This case report describes the medical history of a woman, aged 51 at the time of initial diagnosis and adrenalectomy. Within over 5 years she presented with recurrent relapse of tumour in adrenal gland bed and multiple distant metastases to descending colon, abdominal wall, postoperative scars, and the peritoneum. Neither before diagnosis nor during the whole follow-up were symptoms associated with pheochromocytoma present. The treatment administered to our patient consisted of numerous debulking surgeries along with administration of both hot and cold somatostatin analogues. We believe that debulking surgeries played a substantial role in enabling the patient to survive nearly 6 years despite aggressive clinical course of pheochromocytoma. She passed away in 2012 as a result of postlaparotomy complications. We stress the role of debulking surgery in the treatment of malignant pheochromocytoma and summarise current literature.","PeriodicalId":42110,"journal":{"name":"Arterial Hypertension","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86422545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
According to the World Health Organization (WHO) arterial hypertension remains the most important cause of death in the world. Due to ageing of the population and the proven importance of high blood pressure in older age, various expert groups dealing with hypertension worldwide have dedicated more and more separate recommendations to elderly (65–79 years of age) and very elderly patients ( > 80 years of age). The subject of this work is to present and compare current guidelines for the diagnosis and treatment of hypertension developed for this demographic segment. Due to the global significance in shaping the views on hypertension, the following Englishlanguage guidelines have been used for comparative analyses in this work: 2017 ACC/AHA Guideline, 2018 ESC//ESH Guidelines, Hypertension Canada’s 2018 Guidelines, 2019 Hypertension in adults: diagnosis and management by National Institute for Health and Care Excellence (NICE), 2016 Guideline for the diagnosis and management of hypertension in adults by National Heart Foundation of Australia. The comparisons have been made based on of blood pressure criteria, the threshold values for drug treatment initiation and the blood pressure target values. In summary, hypertension guidelines for the elderly and very elderly differ significantly, although similar trends in their recommendations are evident.
{"title":"Current guidelines and controversies in the diagnosis and therapy of hypertension in the elderly and very elderly — a review of international recommendations","authors":"Piotr Zieleniewicz, T. Zdrojewski","doi":"10.5603/AH.A2020.0004","DOIUrl":"https://doi.org/10.5603/AH.A2020.0004","url":null,"abstract":"According to the World Health Organization (WHO) arterial hypertension remains the most important cause of death in the world. Due to ageing of the population and the proven importance of high blood pressure in older age, various expert groups dealing with hypertension worldwide have dedicated more and more separate recommendations to elderly (65–79 years of age) and very elderly patients ( > 80 years of age). The subject of this work is to present and compare current guidelines for the diagnosis and treatment of hypertension developed for this demographic segment. Due to the global significance in shaping the views on hypertension, the following Englishlanguage guidelines have been used for comparative analyses in this work: 2017 ACC/AHA Guideline, 2018 ESC//ESH Guidelines, Hypertension Canada’s 2018 Guidelines, 2019 Hypertension in adults: diagnosis and management by National Institute for Health and Care Excellence (NICE), 2016 Guideline for the diagnosis and management of hypertension in adults by National Heart Foundation of Australia. The comparisons have been made based on of blood pressure criteria, the threshold values for drug treatment initiation and the blood pressure target values. In summary, hypertension guidelines for the elderly and very elderly differ significantly, although similar trends in their recommendations are evident.","PeriodicalId":42110,"journal":{"name":"Arterial Hypertension","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74754604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Drugs that act by inhibiting the renin–angiotensin–aldosterone system (RAAS), such as angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor type 1 (AT1) blockers (ARBs), have been recognized as a basic canon of nephroprotection for years. They are commonly used in monotherapy for glomerulonephritis with proteinuria. At present, they are rarely used in combination therapy in a form of dual blockade of RAAS due to concern about possible side effects. On the other hand, both ACE-Is and ARBs are also wrongly referred to as nephrotoxic drugs. The significance of therapy with these drugs is seen in evoking acute kidney injury (AKI) or acceleration of CKD. The aim of this article was to clarify the opinion on the relationship between ACE-Is or ARBs treatment and AKI occurrence, and to attempt to reassess the role of dual RAAS blockade in the treatment of kidney diseases. The principles of heart failure (HF) therapy with ACE-Is or ARBs and current data on the importance of RAAS dual blockade in hypertension are also discussed.
{"title":"Controversy over renin–angiotensin–aldosterone system (RAAS) inhibitors treatment in nephrology and cardiovascular diseases","authors":"Rafał Donderski, R. Bednarski, J. Manitius","doi":"10.5603/AH.A2020.0007","DOIUrl":"https://doi.org/10.5603/AH.A2020.0007","url":null,"abstract":"Drugs that act by inhibiting the renin–angiotensin–aldosterone system (RAAS), such as angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor type 1 (AT1) blockers (ARBs), have been recognized as a basic canon of nephroprotection for years. They are commonly used in monotherapy for glomerulonephritis with proteinuria. At present, they are rarely used in combination therapy in a form of dual blockade of RAAS due to concern about possible side effects. On the other hand, both ACE-Is and ARBs are also wrongly referred to as nephrotoxic drugs. The significance of therapy with these drugs is seen in evoking acute kidney injury (AKI) or acceleration of CKD. The aim of this article was to clarify the opinion on the relationship between ACE-Is or ARBs treatment and AKI occurrence, and to attempt to reassess the role of dual RAAS blockade in the treatment of kidney diseases. The principles of heart failure (HF) therapy with ACE-Is or ARBs and current data on the importance of RAAS dual blockade in hypertension are also discussed.","PeriodicalId":42110,"journal":{"name":"Arterial Hypertension","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83665173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Shalimova, V. Psarova, M. Kochuieva, O. Kolesnikova, A. Isayeva, V. Zlatkina, V. Nemtsova
Background. The aim was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH). Material and methods. The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally prescribed a third antihypertensive drug. Of the 98 patients who were assigned to triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy. Results. After 6 months of therapy, unlike patients without resistance, individuals with resistant AH had more pronounced cardiovascular remodeling and metabolic disorders, disbalance of oxidative stress-antioxidant protection, proinflammatory activity and higher activity of the renin-angiotensin-aldosterone system. Patients with true resistance differed from pseudo-resistant patients by having significantly lower body mass index (BMI); in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone, higher activity of oxidative stress system, lower levels of general antioxidant protection, higher adiponectin levels, and lower leptin level. Conclusions. Obese patients with true resistance differed from pseudo-resistant patients by having significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress-antioxidant protection and less pronounced adipokine imbalance.
{"title":"Features of hemodynamic and metabolic disorders in obese patients with resistant hypertension","authors":"A. Shalimova, V. Psarova, M. Kochuieva, O. Kolesnikova, A. Isayeva, V. Zlatkina, V. Nemtsova","doi":"10.5603/AH.A2020.0002","DOIUrl":"https://doi.org/10.5603/AH.A2020.0002","url":null,"abstract":"Background. The aim was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH). Material and methods. The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally prescribed a third antihypertensive drug. Of the 98 patients who were assigned to triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy. Results. After 6 months of therapy, unlike patients without resistance, individuals with resistant AH had more pronounced cardiovascular remodeling and metabolic disorders, disbalance of oxidative stress-antioxidant protection, proinflammatory activity and higher activity of the renin-angiotensin-aldosterone system. Patients with true resistance differed from pseudo-resistant patients by having significantly lower body mass index (BMI); in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone, higher activity of oxidative stress system, lower levels of general antioxidant protection, higher adiponectin levels, and lower leptin level. Conclusions. Obese patients with true resistance differed from pseudo-resistant patients by having significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress-antioxidant protection and less pronounced adipokine imbalance.","PeriodicalId":42110,"journal":{"name":"Arterial Hypertension","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73367861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It has been known for a number of years that air pollution significantly increases the morbidity and mortality of people exposed. More and more research and the last two meta-analyses also showed that even a short-time increase in air pollution can raise blood pressure and long-term air pollution leads to an increase in the incidence and prevalence of arterial hypertension. The elevation of blood pressure caused by air pollution may contribute to the increase in cardiovascular diseases observed in areas affected by air pollution. This increase in blood pressure caused by air pollution can be particularly dangerous for women, the elderly, obese people and those already burdened with cardiovascular diseases.
{"title":"Effect of short- and long-time exposure to ambient air pollution on blood pressure","authors":"J. Głuszek, T. Kosicka","doi":"10.5603/AH.A2019.0009","DOIUrl":"https://doi.org/10.5603/AH.A2019.0009","url":null,"abstract":"It has been known for a number of years that air pollution significantly increases the morbidity and mortality of people exposed. More and more research and the last two meta-analyses also showed that even a short-time increase in air pollution can raise blood pressure and long-term air pollution leads to an increase in the incidence and prevalence of arterial hypertension. The elevation of blood pressure caused by air pollution may contribute to the increase in cardiovascular diseases observed in areas affected by air pollution. This increase in blood pressure caused by air pollution can be particularly dangerous for women, the elderly, obese people and those already burdened with cardiovascular diseases.","PeriodicalId":42110,"journal":{"name":"Arterial Hypertension","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78574822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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