IntroductionThere are several prognostic scores for the assessment of risk of atrial fibrillation... more IntroductionThere are several prognostic scores for the assessment of risk of atrial fibrillation (AF) recurrence post ablation procedure. However, the use of these complex scores is difficult and the validation on different populations brought divergent results. Our goal was to compare the performance of these risk scores as the basis for the development of a new, simplified score based only on few universally predictive variables.MethodsAll cryoballoon‐based AF ablations performed in a single‐center over a 10‐year period were prospectively analyzed with regard to AF recurrence. This served to analyze the performance of APPLE, CAAP‐AF, SCALE‐CryoAF, MB‐LATER, CHADS2, and CHA2DS2‐VASc risk scores.ResultsA total of 597 patients, mostly (78.1%) with paroxysmal AF were studied. Analyzed risk scores performed poorer than in the original publications because some risk factors were not predictive of AF recurrence. A simplified score named 0‐1‐2 PL, composed of just two universally predict...
Background Several electrocardiographic (ECG) algorithms have been developed for predicting acces... more Background Several electrocardiographic (ECG) algorithms have been developed for predicting accessory pathway (AP) location in Wolff-Parkinson-White syndrome. However, their accuracy may be related to the manifested degree of preexcitation on ECG. aims Our goal was to assess the effect of the degree of preexcitation on the accuracy of 4 traditional AP localization algorithms and to compare them with the algorithm specifically designed for ECGs with maximal preexcitation (Pambrun). methods The study included 300 patients who underwent successful ablation of an overt atrioventricular AP. Resting and maximally preexcited ECGs obtained during incremental atrial pacing were assessed using 4 traditional AP localization algorithms: Xie, d'Avila, Iturralde, and Taguchi. Maximally preexcited ECGs were additionally assessed with the Pambrun algorithm. We compared the precision of the algorithms to predict accurate or anatomically adjacent AP location. results The overall accuracy of traditional AP localization algorithms using resting ECG ranged between 26% and 53.7% and improved to a range of 47.3% to 69.7% when adjacent locations were accepted. When used with maximal preexcitation, all algorithms had significantly higher accuracy, with a mean improvement of 14.3 and 15.6 percentage points for precise and adjacent sites, respectively. The Pambrun algorithm for maximally preexcited ECGs had the highest precision for both accurate and adjacent locations of the APs (89.7% and 97%, respectively). conclusions Greater preexcitation on ECG improved the accuracy of the traditional AP localization algorithms. The algorithm designed to use maximally preexcited ECGs has the best accuracy. Maximally preexcited ECG recordings should preferably be used in clinical practice to facilitate the ablation procedure.
Objective: To assess the validity of the estimation of 24-h urinary sodium (UNa) and potassium (U... more Objective: To assess the validity of the estimation of 24-h urinary sodium (UNa) and potassium (UK) excretion obtained through 4 formulae based on occasional urine samples.
BackgroundDuring permanent deep septal pacing, it is important to confirm left bundle branch (LBB... more BackgroundDuring permanent deep septal pacing, it is important to confirm left bundle branch (LBB) capture.ObjectiveThe effective refractory period (ERP) of the working myocardium is different than the ERP of the LBB; we hypothesized that it should be possible to differentiate LBB capture from septal myocardial capture using programmed extra-stimulus technique.MethodsIn consecutive patients undergoing pacemaker implantation who received pacing lead in a deep septal position programmed pacing was delivered from this lead. Responses to programmed pacing were categorized on the basis of QRS morphology of the extrastimuli as: myocardial (broader QRS, often slurred), selective (narrower QRS, preceded by an isoelectric interval) or non-diagnostic (unequivocal change).ResultsProgrammed deep septal pacing was performed 269 times in 143 patients; in every patient with the use of an 8-beat basic drive train of 600 ms and when possible also during supraventricular rhythm. Responses diagnostic ...
Aims: Permanent pacing of the His bundle (HB) is usually accompanied by simultaneous capture of t... more Aims: Permanent pacing of the His bundle (HB) is usually accompanied by simultaneous capture of the adjacent right ventricular (RV) myocardium - this is described as a non-selective (ns)-HB pacing. Our aim was to identify ECG criteria for loss of HB capture during ns-HB pacing. Methods: Consecutive patients with permanent HB pacing were recruited. 12-lead ECGs during ns-HB pacing and loss of HB capture (RV-only capture) were obtained. ECG criteria for loss / presence of HB capture were identified. In the validation phase these criteria and the HB ECG algorithm were tested by two blinded observers using a separate, sizable set of ECGs. Results: A total of 353 ECG (226 ns-HB and 128 RV-only) were obtained from 226 patients with permanent HB pacing devices. QRS notch/slur in left ventricular leads and R wave peak time in lead V6 were identified as the best features for differentiation. The 2-step HB ECG algorithm based on these features correctly classified 87.1% of cases with sensitiv...
Background: Heart failure affects patients with normal left ventricular systolic function (heart ... more Background: Heart failure affects patients with normal left ventricular systolic function (heart failure with preserved ejection fraction [HFPEF]) and those with reduced ejection fraction (HFREF). The treatment of HFPEF remains an unresolved issue. Aim: We sought to determinate the relationship between inflammatory markers and left ventricular diastolic dysfunction (LVDD) in a family-based population study. Methods: A total of 303 participants from the general population (55% women, median age 49 years and 45% men, median age 40 years) underwent echocardiography and measurement of serum inflammatory markers: C-reactive protein (CRP), myeloperoxidase (MPO), and interleukin 6 (IL-6). Results: Serum IL-6 concentration correlated with peak transmitral late diastolic velocity (A) and pulmonary vein systolic-to-diastolic velocity (S/D) ratio (p < 0.01). Moreover, a significant correlation between IL-6 concentration and E/A ratio and early diastolic peak velocities of the mitral annulus displacement (E') was observed. The association of IL-6 concentration and peak transmitral early diastolic velocities (E) and the E/E' ratio (p < 0.05) was noted in men. In addition, the CRP concentration was shown to have an effect on E/A ratio in women (p < 0.05). A significant correlation between the CRP concentration and S/D ratio was observed both in women (p < 0.01) and men (p < 0.05). No significant correlation was found between the level of MPO and LVDD parameters. Additionally, only one predictive model was identified; E' was found to be dependent on IL-6, age, and heart rate in men (p < 0.001, R 2 = 0.611). Conclusions: The above results suggest that inflammation may lead to the onset of LVDD, probably via vascular endothelial dysfunction.
Methods: A total of 78 hypertensive patients with coronary atherosclerotic heart disease from Oct... more Methods: A total of 78 hypertensive patients with coronary atherosclerotic heart disease from October 2016 to October 2017 were taken as observation group, and 49 hypertensive patients as the control group. Compared the differences of sex, age, occupation, diet and sleep, smoking history, drinking history, history of diabetes, history of hypertension, body mass index (BMI), total cholesterol (CHO), triacylglycerol (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and other related levels in two groups. The mini-mental state examination (MMSE) score were used to assessed cognitive function. For those patients with cognitive impairment, The Montreal cognitive assessment (MoCA) were used to assessed cognitive impairment domains. Results: The average score of MMSE in patients with coronary atherosclerotic heart disease was not signifi cantly different from those in control group (P > 0.05), but the incidence of mild cognitive impairment was higher in patients with coronary atherosclerotic heart disease (P < 0.05); With the increasing of blood pressure, the score of MMSE showed a decreasing trend. The average scores of MMSE of those patients whose blood pressure above Grade 3 were signifi cantly decreased than those whose blood pressure below Grade 2 (P < 0.05), but the incidence of mild cognitive impairment has no signifi cant difference (P > 0.05); Memory, attention and computational power, abstraction ability and delayed recall of the selected patients were signifi cantly decreased. Conclusion: Patients with hypertension,coronary atherosclerotic heart disease are prone to mild cognitive impairment; There is a close relation between hypertension and cognitive impairment.
Badanie częściowo zrealizowane z funduszów projektu "Znaczenie pozanerkowych mechanizmów homeosta... more Badanie częściowo zrealizowane z funduszów projektu "Znaczenie pozanerkowych mechanizmów homeostazy sodowej w regulacji ciśnienia tętniczego" realizowanego w ramach programu POMOST Fundacji na rzecz Nauki Polskiej, współfinansowanego przez Unię Europejską z Europejskiego Funduszu Rozwoju Regionalnego.
W farmakoterapii nadciśnienia tętniczego niezbędne jest zapewnienie optymalnej kontroli ciśnienia... more W farmakoterapii nadciśnienia tętniczego niezbędne jest zapewnienie optymalnej kontroli ciśnienia tętniczego oraz nieprzerywalnego kontynuowania terapii przez pacjentów z zastosowaniem skutecznych, łatwych w dawkowaniu i bezpiecznych leków. Preparaty złożone stanowią racjonalną odpowiedź na przedstawione powyżej cele, podpartą wytycznymi europejskich towarzystw nadciśnienia tętniczego i kardiologicznego. Jednym z najlepiej zbadanych w szeregu wieloośrodkowych, randomizowanych badaniach klinicznych jest połączenie inhibitora konwertazy angiotensyny-perindoprilu z diuretykiem tiazydopodobnym-indapamidem. Celem niniejszego artykułu jest przedstawienie dostępnych danych naukowych na temat skuteczności połączenia perindopril/indapamid w obniżaniu ciśnienia tętniczego, ze szczególnym uwzględnieniem jego wpływu na obniżenie ryzyka sercowo-naczyniowego w poszczególnych grupach pacjentów z nadciśnieniem tętniczym.
Introduction. Hypertension is one of the most common risk factors of cardiovascular disease, whic... more Introduction. Hypertension is one of the most common risk factors of cardiovascular disease, which remains the major cause of death in Poland. Number of patients with controlled hypertension remains low. The aim of the study was to evaluate strategies of hypotensive pharmacotherapy, to determine prevalence of poorly controlled hypertension and of cardiovascular risk factors and comorbidities in these patients. Material and methods. Non-interventional, observational study was conducted in patients treated in various outpatient care settings. The study had two stages: 1) screening, with collection of baseline medical data in 50 patients with hypertension attending one physician; 2) collection of additional medical data concerning 10 patients with poorly controlled hypertension. Results. The total of 42,338 patients was included in the screening stage, and of those 54.3% had poorly controlled hypertension. In the latter group, the most prevalent cardiovascular risk factor was dyslipidemia (77.8%) and abdominal obesity (68.3%). More than 25% respondents were smokers. Ischaemic heart disease and diabetes were the most common comorbidities (33.4% and 31%, respectively). As to pharmacotherapy, 73% of patients received more than one antihypertensive agent (angiotensin converting enzyme inhibitor 59.7%, beta-blocker 45%, and diuretic 38.7%), and 10.6% subjects were treated with fixed dose combinations. In 38 patients antihypertensive therapy was modified more than a year before. Conclusions. Of all hypertensive patients in outpatient care setting, still more than half do not reach the target blood pressure values. In this group, the most common risk factors and comorbidities are dyslipidemias, obesity, ischaemic heart disease and diabetes. Nearly three-quarters of patients receive more than one hypotensive agent (usually angiotensin-converting enzyme inhibitor, beta-blocker, and diuretic). Antihypertensive therapy was not modified for more than six months in over 60% of patients.
The data associating blood pressure to salt intake in humans comes from randomized clinical trial... more The data associating blood pressure to salt intake in humans comes from randomized clinical trials of interventions on dietary salt intake and population studies. Generally, estimates from meta-analyses are similar to those derived from prospective population studies (1.7 mm Hg change in systolic blood pressure per 100 mmol change in 24-hour urinary sodium). This observation, however, does not translate into a higher risk of incidence rate of hypertension in individuals consuming a highsalt diet. On the other hand, prospective studies relating cardiovascular outcomes to 24-h urinary sodium excretion produced inconsistent conclusions. Thus, available evidence does not support current recommendations of an indiscriminate and generalized reduction of salt intake in the general population.
Journal of the American Society of Hypertension, 2015
adolescents Also, the logistic regression analysis was used to estimate the most important risk f... more adolescents Also, the logistic regression analysis was used to estimate the most important risk factors for WCH. The WCH prevalence was 5.2% (n¼26) in all adolescents, 8.0% in males and 2.7% in females (p<0.007). Adolescents with WCH showed significant higher values than normotensives in all anthropometric parameters studied, these values were: 73AE18 vs. 47AE8 kg for weight (p<0.0001), 165AE9 vs. 158AE10 cm fir height (p<0.007), 85AE13 vs. 66AE5 mm for waist circumference (p<0.0001), 99AE12 vs. 84AE6 mm for hip circumference, 26.6AE5 vs. 18.5AE2 kg/mt2 for BMI (p<0.0001), 0.85AE0.1 vs. 0.78AE0.1 for WHR (p<0.0001) and 0.51AE0.1 vs. 0.41AE0.1 for WHtR (p<0.0001). Spearman Correlation shows a statistically significant correlation among WCH with weight (r¼0.297), waist circumference (r¼0.297), BMI (r¼0.290), WHtR (r¼0.290), hip circumference (r¼0.288), and WHR (r¼0.211). The BMI was the most important risk factor for WCH (OR¼ 2.411; 95% Cls¼1.803-3.225). In conclusion, there is a high WCH prevalence in Hispanic adolescent population. In this age group, all anthropometric parameters are associated with the presence of WCH, but only the BMI should be the most important factor to predict WCH in adolescents. These conditions, WCH and higher BMI, are extremely important because from the early age the subjects could be in cardiovascular risk.
Cardiovascular diseases remain the leading cause of death in Poland and in Europe. Children rarel... more Cardiovascular diseases remain the leading cause of death in Poland and in Europe. Children rarely suffer from them, although most of the risk factors which accelerate progression of atherosclerosis commence in childhood, including: dyslipidemias, hypertension, diabetes, and obesity. Moreover during last few years the incidence of some of risk factors in children, such as obesity, diabetes and dyslipidemia has increased significantly. It is known from the autopsy studies that atherosclerosis can be identified at very young age in healthy children. In adult population medications such as HMG-CoA reductase inhibitors (statins) and acetylsalicylic acid (ASA, aspirin) have strong position confirmed by many multicenter clinical trials. They significantly reduce cardiovascular risk and increase life expectancy. Latest recommendations on management of hyperlipidemias in children expand indications for screening of lipid level imbalances and indicate statins as main pharmacotherapy after fa...
The evidence relating blood pressure to salt intake in humans originates from population studies ... more The evidence relating blood pressure to salt intake in humans originates from population studies and randomized clinical trials of interventions on dietary salt intake. Estimates from meta-analyses of trials in normotensive subjects generally are similar to estimates derived from prospective population studies (+1.7-mm Hg increase in systolic blood pressure per 100 mmol increment in 24-hour urinary sodium). This estimate, however, does not translate into an increased risk of incident hypertension in subjects consuming a high-salt diet. The meta-analyses of intervention trials have consistently shown that potassium supplementation is associated with lowering of blood pressure. However, prospective studies relating health outcomes to 24-hour urinary sodium and/or potassium excretion produced inconsistent results. Taken together, available evidence does not support the current recommendations of a generalized and indiscriminate reduction of salt intake at the population level, although the blood-pressure lowering effect of dietary sodium restriction might be of value in hypertensive patients. Potassium supplementation in hypertensive patients or healthy persons is not recommended by the current guidelines, but importance of adhering to healthy diet rich in vegetables and fruits is emphasized.
IntroductionThere are several prognostic scores for the assessment of risk of atrial fibrillation... more IntroductionThere are several prognostic scores for the assessment of risk of atrial fibrillation (AF) recurrence post ablation procedure. However, the use of these complex scores is difficult and the validation on different populations brought divergent results. Our goal was to compare the performance of these risk scores as the basis for the development of a new, simplified score based only on few universally predictive variables.MethodsAll cryoballoon‐based AF ablations performed in a single‐center over a 10‐year period were prospectively analyzed with regard to AF recurrence. This served to analyze the performance of APPLE, CAAP‐AF, SCALE‐CryoAF, MB‐LATER, CHADS2, and CHA2DS2‐VASc risk scores.ResultsA total of 597 patients, mostly (78.1%) with paroxysmal AF were studied. Analyzed risk scores performed poorer than in the original publications because some risk factors were not predictive of AF recurrence. A simplified score named 0‐1‐2 PL, composed of just two universally predict...
Background Several electrocardiographic (ECG) algorithms have been developed for predicting acces... more Background Several electrocardiographic (ECG) algorithms have been developed for predicting accessory pathway (AP) location in Wolff-Parkinson-White syndrome. However, their accuracy may be related to the manifested degree of preexcitation on ECG. aims Our goal was to assess the effect of the degree of preexcitation on the accuracy of 4 traditional AP localization algorithms and to compare them with the algorithm specifically designed for ECGs with maximal preexcitation (Pambrun). methods The study included 300 patients who underwent successful ablation of an overt atrioventricular AP. Resting and maximally preexcited ECGs obtained during incremental atrial pacing were assessed using 4 traditional AP localization algorithms: Xie, d'Avila, Iturralde, and Taguchi. Maximally preexcited ECGs were additionally assessed with the Pambrun algorithm. We compared the precision of the algorithms to predict accurate or anatomically adjacent AP location. results The overall accuracy of traditional AP localization algorithms using resting ECG ranged between 26% and 53.7% and improved to a range of 47.3% to 69.7% when adjacent locations were accepted. When used with maximal preexcitation, all algorithms had significantly higher accuracy, with a mean improvement of 14.3 and 15.6 percentage points for precise and adjacent sites, respectively. The Pambrun algorithm for maximally preexcited ECGs had the highest precision for both accurate and adjacent locations of the APs (89.7% and 97%, respectively). conclusions Greater preexcitation on ECG improved the accuracy of the traditional AP localization algorithms. The algorithm designed to use maximally preexcited ECGs has the best accuracy. Maximally preexcited ECG recordings should preferably be used in clinical practice to facilitate the ablation procedure.
Objective: To assess the validity of the estimation of 24-h urinary sodium (UNa) and potassium (U... more Objective: To assess the validity of the estimation of 24-h urinary sodium (UNa) and potassium (UK) excretion obtained through 4 formulae based on occasional urine samples.
BackgroundDuring permanent deep septal pacing, it is important to confirm left bundle branch (LBB... more BackgroundDuring permanent deep septal pacing, it is important to confirm left bundle branch (LBB) capture.ObjectiveThe effective refractory period (ERP) of the working myocardium is different than the ERP of the LBB; we hypothesized that it should be possible to differentiate LBB capture from septal myocardial capture using programmed extra-stimulus technique.MethodsIn consecutive patients undergoing pacemaker implantation who received pacing lead in a deep septal position programmed pacing was delivered from this lead. Responses to programmed pacing were categorized on the basis of QRS morphology of the extrastimuli as: myocardial (broader QRS, often slurred), selective (narrower QRS, preceded by an isoelectric interval) or non-diagnostic (unequivocal change).ResultsProgrammed deep septal pacing was performed 269 times in 143 patients; in every patient with the use of an 8-beat basic drive train of 600 ms and when possible also during supraventricular rhythm. Responses diagnostic ...
Aims: Permanent pacing of the His bundle (HB) is usually accompanied by simultaneous capture of t... more Aims: Permanent pacing of the His bundle (HB) is usually accompanied by simultaneous capture of the adjacent right ventricular (RV) myocardium - this is described as a non-selective (ns)-HB pacing. Our aim was to identify ECG criteria for loss of HB capture during ns-HB pacing. Methods: Consecutive patients with permanent HB pacing were recruited. 12-lead ECGs during ns-HB pacing and loss of HB capture (RV-only capture) were obtained. ECG criteria for loss / presence of HB capture were identified. In the validation phase these criteria and the HB ECG algorithm were tested by two blinded observers using a separate, sizable set of ECGs. Results: A total of 353 ECG (226 ns-HB and 128 RV-only) were obtained from 226 patients with permanent HB pacing devices. QRS notch/slur in left ventricular leads and R wave peak time in lead V6 were identified as the best features for differentiation. The 2-step HB ECG algorithm based on these features correctly classified 87.1% of cases with sensitiv...
Background: Heart failure affects patients with normal left ventricular systolic function (heart ... more Background: Heart failure affects patients with normal left ventricular systolic function (heart failure with preserved ejection fraction [HFPEF]) and those with reduced ejection fraction (HFREF). The treatment of HFPEF remains an unresolved issue. Aim: We sought to determinate the relationship between inflammatory markers and left ventricular diastolic dysfunction (LVDD) in a family-based population study. Methods: A total of 303 participants from the general population (55% women, median age 49 years and 45% men, median age 40 years) underwent echocardiography and measurement of serum inflammatory markers: C-reactive protein (CRP), myeloperoxidase (MPO), and interleukin 6 (IL-6). Results: Serum IL-6 concentration correlated with peak transmitral late diastolic velocity (A) and pulmonary vein systolic-to-diastolic velocity (S/D) ratio (p < 0.01). Moreover, a significant correlation between IL-6 concentration and E/A ratio and early diastolic peak velocities of the mitral annulus displacement (E') was observed. The association of IL-6 concentration and peak transmitral early diastolic velocities (E) and the E/E' ratio (p < 0.05) was noted in men. In addition, the CRP concentration was shown to have an effect on E/A ratio in women (p < 0.05). A significant correlation between the CRP concentration and S/D ratio was observed both in women (p < 0.01) and men (p < 0.05). No significant correlation was found between the level of MPO and LVDD parameters. Additionally, only one predictive model was identified; E' was found to be dependent on IL-6, age, and heart rate in men (p < 0.001, R 2 = 0.611). Conclusions: The above results suggest that inflammation may lead to the onset of LVDD, probably via vascular endothelial dysfunction.
Methods: A total of 78 hypertensive patients with coronary atherosclerotic heart disease from Oct... more Methods: A total of 78 hypertensive patients with coronary atherosclerotic heart disease from October 2016 to October 2017 were taken as observation group, and 49 hypertensive patients as the control group. Compared the differences of sex, age, occupation, diet and sleep, smoking history, drinking history, history of diabetes, history of hypertension, body mass index (BMI), total cholesterol (CHO), triacylglycerol (TG), high density lipoprotein (HDL), low density lipoprotein (LDL) and other related levels in two groups. The mini-mental state examination (MMSE) score were used to assessed cognitive function. For those patients with cognitive impairment, The Montreal cognitive assessment (MoCA) were used to assessed cognitive impairment domains. Results: The average score of MMSE in patients with coronary atherosclerotic heart disease was not signifi cantly different from those in control group (P > 0.05), but the incidence of mild cognitive impairment was higher in patients with coronary atherosclerotic heart disease (P < 0.05); With the increasing of blood pressure, the score of MMSE showed a decreasing trend. The average scores of MMSE of those patients whose blood pressure above Grade 3 were signifi cantly decreased than those whose blood pressure below Grade 2 (P < 0.05), but the incidence of mild cognitive impairment has no signifi cant difference (P > 0.05); Memory, attention and computational power, abstraction ability and delayed recall of the selected patients were signifi cantly decreased. Conclusion: Patients with hypertension,coronary atherosclerotic heart disease are prone to mild cognitive impairment; There is a close relation between hypertension and cognitive impairment.
Badanie częściowo zrealizowane z funduszów projektu "Znaczenie pozanerkowych mechanizmów homeosta... more Badanie częściowo zrealizowane z funduszów projektu "Znaczenie pozanerkowych mechanizmów homeostazy sodowej w regulacji ciśnienia tętniczego" realizowanego w ramach programu POMOST Fundacji na rzecz Nauki Polskiej, współfinansowanego przez Unię Europejską z Europejskiego Funduszu Rozwoju Regionalnego.
W farmakoterapii nadciśnienia tętniczego niezbędne jest zapewnienie optymalnej kontroli ciśnienia... more W farmakoterapii nadciśnienia tętniczego niezbędne jest zapewnienie optymalnej kontroli ciśnienia tętniczego oraz nieprzerywalnego kontynuowania terapii przez pacjentów z zastosowaniem skutecznych, łatwych w dawkowaniu i bezpiecznych leków. Preparaty złożone stanowią racjonalną odpowiedź na przedstawione powyżej cele, podpartą wytycznymi europejskich towarzystw nadciśnienia tętniczego i kardiologicznego. Jednym z najlepiej zbadanych w szeregu wieloośrodkowych, randomizowanych badaniach klinicznych jest połączenie inhibitora konwertazy angiotensyny-perindoprilu z diuretykiem tiazydopodobnym-indapamidem. Celem niniejszego artykułu jest przedstawienie dostępnych danych naukowych na temat skuteczności połączenia perindopril/indapamid w obniżaniu ciśnienia tętniczego, ze szczególnym uwzględnieniem jego wpływu na obniżenie ryzyka sercowo-naczyniowego w poszczególnych grupach pacjentów z nadciśnieniem tętniczym.
Introduction. Hypertension is one of the most common risk factors of cardiovascular disease, whic... more Introduction. Hypertension is one of the most common risk factors of cardiovascular disease, which remains the major cause of death in Poland. Number of patients with controlled hypertension remains low. The aim of the study was to evaluate strategies of hypotensive pharmacotherapy, to determine prevalence of poorly controlled hypertension and of cardiovascular risk factors and comorbidities in these patients. Material and methods. Non-interventional, observational study was conducted in patients treated in various outpatient care settings. The study had two stages: 1) screening, with collection of baseline medical data in 50 patients with hypertension attending one physician; 2) collection of additional medical data concerning 10 patients with poorly controlled hypertension. Results. The total of 42,338 patients was included in the screening stage, and of those 54.3% had poorly controlled hypertension. In the latter group, the most prevalent cardiovascular risk factor was dyslipidemia (77.8%) and abdominal obesity (68.3%). More than 25% respondents were smokers. Ischaemic heart disease and diabetes were the most common comorbidities (33.4% and 31%, respectively). As to pharmacotherapy, 73% of patients received more than one antihypertensive agent (angiotensin converting enzyme inhibitor 59.7%, beta-blocker 45%, and diuretic 38.7%), and 10.6% subjects were treated with fixed dose combinations. In 38 patients antihypertensive therapy was modified more than a year before. Conclusions. Of all hypertensive patients in outpatient care setting, still more than half do not reach the target blood pressure values. In this group, the most common risk factors and comorbidities are dyslipidemias, obesity, ischaemic heart disease and diabetes. Nearly three-quarters of patients receive more than one hypotensive agent (usually angiotensin-converting enzyme inhibitor, beta-blocker, and diuretic). Antihypertensive therapy was not modified for more than six months in over 60% of patients.
The data associating blood pressure to salt intake in humans comes from randomized clinical trial... more The data associating blood pressure to salt intake in humans comes from randomized clinical trials of interventions on dietary salt intake and population studies. Generally, estimates from meta-analyses are similar to those derived from prospective population studies (1.7 mm Hg change in systolic blood pressure per 100 mmol change in 24-hour urinary sodium). This observation, however, does not translate into a higher risk of incidence rate of hypertension in individuals consuming a highsalt diet. On the other hand, prospective studies relating cardiovascular outcomes to 24-h urinary sodium excretion produced inconsistent conclusions. Thus, available evidence does not support current recommendations of an indiscriminate and generalized reduction of salt intake in the general population.
Journal of the American Society of Hypertension, 2015
adolescents Also, the logistic regression analysis was used to estimate the most important risk f... more adolescents Also, the logistic regression analysis was used to estimate the most important risk factors for WCH. The WCH prevalence was 5.2% (n¼26) in all adolescents, 8.0% in males and 2.7% in females (p<0.007). Adolescents with WCH showed significant higher values than normotensives in all anthropometric parameters studied, these values were: 73AE18 vs. 47AE8 kg for weight (p<0.0001), 165AE9 vs. 158AE10 cm fir height (p<0.007), 85AE13 vs. 66AE5 mm for waist circumference (p<0.0001), 99AE12 vs. 84AE6 mm for hip circumference, 26.6AE5 vs. 18.5AE2 kg/mt2 for BMI (p<0.0001), 0.85AE0.1 vs. 0.78AE0.1 for WHR (p<0.0001) and 0.51AE0.1 vs. 0.41AE0.1 for WHtR (p<0.0001). Spearman Correlation shows a statistically significant correlation among WCH with weight (r¼0.297), waist circumference (r¼0.297), BMI (r¼0.290), WHtR (r¼0.290), hip circumference (r¼0.288), and WHR (r¼0.211). The BMI was the most important risk factor for WCH (OR¼ 2.411; 95% Cls¼1.803-3.225). In conclusion, there is a high WCH prevalence in Hispanic adolescent population. In this age group, all anthropometric parameters are associated with the presence of WCH, but only the BMI should be the most important factor to predict WCH in adolescents. These conditions, WCH and higher BMI, are extremely important because from the early age the subjects could be in cardiovascular risk.
Cardiovascular diseases remain the leading cause of death in Poland and in Europe. Children rarel... more Cardiovascular diseases remain the leading cause of death in Poland and in Europe. Children rarely suffer from them, although most of the risk factors which accelerate progression of atherosclerosis commence in childhood, including: dyslipidemias, hypertension, diabetes, and obesity. Moreover during last few years the incidence of some of risk factors in children, such as obesity, diabetes and dyslipidemia has increased significantly. It is known from the autopsy studies that atherosclerosis can be identified at very young age in healthy children. In adult population medications such as HMG-CoA reductase inhibitors (statins) and acetylsalicylic acid (ASA, aspirin) have strong position confirmed by many multicenter clinical trials. They significantly reduce cardiovascular risk and increase life expectancy. Latest recommendations on management of hyperlipidemias in children expand indications for screening of lipid level imbalances and indicate statins as main pharmacotherapy after fa...
The evidence relating blood pressure to salt intake in humans originates from population studies ... more The evidence relating blood pressure to salt intake in humans originates from population studies and randomized clinical trials of interventions on dietary salt intake. Estimates from meta-analyses of trials in normotensive subjects generally are similar to estimates derived from prospective population studies (+1.7-mm Hg increase in systolic blood pressure per 100 mmol increment in 24-hour urinary sodium). This estimate, however, does not translate into an increased risk of incident hypertension in subjects consuming a high-salt diet. The meta-analyses of intervention trials have consistently shown that potassium supplementation is associated with lowering of blood pressure. However, prospective studies relating health outcomes to 24-hour urinary sodium and/or potassium excretion produced inconsistent results. Taken together, available evidence does not support the current recommendations of a generalized and indiscriminate reduction of salt intake at the population level, although the blood-pressure lowering effect of dietary sodium restriction might be of value in hypertensive patients. Potassium supplementation in hypertensive patients or healthy persons is not recommended by the current guidelines, but importance of adhering to healthy diet rich in vegetables and fruits is emphasized.
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