Fixed combination of felodipine and metoprolol in treatment of hypertension.

The therapy with combination of felodipine and metoprolol in treatment of hypertension results in satisfactory effect with hypertensive patients on lowering the values of systolic and diastolic blood pressure (BP). This effect is sustained during the period over two years, while lowering of systolic and diastolic BP results in reduction of total cardiovascular complications: reduction of incidence of stroke for one third of patients and myocardial infarction for one sixth of patients. This fixed combination is applicable with patients that did not manage to regulate BP by using some other specific antihypertensive drugs, achieving sustained lowering of BP in a 24-hour period. There are fewer side-effects associated with this therapy than with the fixed combinations of antihypertensive drugs used so far, since there are no negative metabolic effects and therefore it may be applied in high risk patients with metabolic syndrome and diabetes. The application of the fixed combination of felodipine and metoprolol may achieve the set targets related with lowering of BP and reducing cardiovascular risk efficiently in 70-89% patients. Both felodipine and metoprolol are individually applied in treatment of coronary heart disease whereas this combination may lead to coronary protection

TEN YEARS AFTER PUBLISHING RESULTSFROM THE HEART OUTCOMES PREVENTION EVALUATION STUDY – HOPE:IMPLICATIONS ON TREATMENT WITH ANGIOTENSIN CONVERTING ENZYME INHIBITORSIN CLINICAL PRACTICE

Rezultati HOPE ispitivanja (Heart Outcomes Prevention Evaluation Study) publicirani prije deset godina, utjecali su na mjesto ACE-inhibitora u kliničkoj praksi. Usporedba primjene ramiprila u dozi do 10 mg ili placeba na 9541 ispitaniku s povišenim kardiovaskularnim rizikom tijekom 4,5 godine pokazala je smanjenje relativnog rizika svih praćenih kardiovaskularnih komplikacija: kardiovaskularne smrtnosti, infarkta miokarda i moždanog udara za 22% u skupini koja je liječena ramiprilom, uz minimalni pad sistoličkoga krvnog tlaka od 3 mmHg. Učinak je bio povoljan neovisno o dobi, spolu i pridruženim bolestima te drugoj terapiji. Produljenje praćenja ispitanika dokazalo je da se povoljan učinak zadržava daljnjih 2,6 godina. Zabilježeno je i smanjenje relativnog rizika od novonastalog dijabetesa za 34%. Rezultati ispitivanja između ostalog su utjecali na uvrštavanje ACE-inhibitora u sve smjernice za liječenje kardiovaskularnih i dijabetičnih bolesnika. Prvo je to ispitivanje u primjeni ACE-inhibitora u primarnoj prevenciji kardiovaskularnih komplikacija kod visokorizičnih bolesnika.Ten years ago results from The Heart Outcomes Prevention Evaluation Study were published. Those results had a great impact on position of ACE inhibitors in clinical practice. In the study, comparsion of ramipril in daily dosage up to 10 mg and placebo in 9541 patients with high cardiovascular risk during 4.5 years of follow-up resulted in relative risk reduction for all primary end-points: cardiovascular mortality, myocardial infarction and stroke for 22% in patients treated with ramipril. Systolic blood pressure was reduced minimally for 3 mmHg. The effect was indipendent of age, gender, concomitant diseases or therapy. Extended follow-up of the patients for further 2.6 years showed prolonged beneficial effect of ramipril. Ramipril reduced relative risk for newly developed diabetes for 34%. Results of the study greatly influenced the guidelines for treatment of patients with cardiovascular diseases. This study proved benefits of ACE inhibitors in primary prevention in patients with high cardiovascular ris

TEN YEARS AFTER PUBLISHING RESULTSFROM THE HEART OUTCOMES PREVENTION EVALUATION STUDY – HOPE:IMPLICATIONS ON TREATMENT WITH ANGIOTENSIN CONVERTING ENZYME INHIBITORSIN CLINICAL PRACTICE

Rezultati HOPE ispitivanja (Heart Outcomes Prevention Evaluation Study) publicirani prije deset godina, utjecali su na mjesto ACE-inhibitora u kliničkoj praksi. Usporedba primjene ramiprila u dozi do 10 mg ili placeba na 9541 ispitaniku s povišenim kardiovaskularnim rizikom tijekom 4,5 godine pokazala je smanjenje relativnog rizika svih praćenih kardiovaskularnih komplikacija: kardiovaskularne smrtnosti, infarkta miokarda i moždanog udara za 22% u skupini koja je liječena ramiprilom, uz minimalni pad sistoličkoga krvnog tlaka od 3 mmHg. Učinak je bio povoljan neovisno o dobi, spolu i pridruženim bolestima te drugoj terapiji. Produljenje praćenja ispitanika dokazalo je da se povoljan učinak zadržava daljnjih 2,6 godina. Zabilježeno je i smanjenje relativnog rizika od novonastalog dijabetesa za 34%. Rezultati ispitivanja između ostalog su utjecali na uvrštavanje ACE-inhibitora u sve smjernice za liječenje kardiovaskularnih i dijabetičnih bolesnika. Prvo je to ispitivanje u primjeni ACE-inhibitora u primarnoj prevenciji kardiovaskularnih komplikacija kod visokorizičnih bolesnika.Ten years ago results from The Heart Outcomes Prevention Evaluation Study were published. Those results had a great impact on position of ACE inhibitors in clinical practice. In the study, comparsion of ramipril in daily dosage up to 10 mg and placebo in 9541 patients with high cardiovascular risk during 4.5 years of follow-up resulted in relative risk reduction for all primary end-points: cardiovascular mortality, myocardial infarction and stroke for 22% in patients treated with ramipril. Systolic blood pressure was reduced minimally for 3 mmHg. The effect was indipendent of age, gender, concomitant diseases or therapy. Extended follow-up of the patients for further 2.6 years showed prolonged beneficial effect of ramipril. Ramipril reduced relative risk for newly developed diabetes for 34%. Results of the study greatly influenced the guidelines for treatment of patients with cardiovascular diseases. This study proved benefits of ACE inhibitors in primary prevention in patients with high cardiovascular ris

Mortality and causes of death among Croatian male Olympic medalists

Aim To compare the overall and disease-specific mortality of Croatian male athletes who won one or more Olympic medals representing Yugoslavia from 1948 to 1988 or Croatia from 1992 to 2016, and the general Croatian male population standardized by age and time period. Methods All 233 Croatian male Olympic medalists were included in the study. Information on life duration and cause of death for the Olympic medalists who died before January 1, 2017, was acquired from their families and acquaintances. We asked the families and acquaintances to present medical documentation for the deceased. Data about the overall and disease-specific mortality of the Croatian male population standardized by age and time period were obtained from the Croatian Bureau of Statistics (CBS). Overall and disease-specific standard mortality ratios (SMR) with 95% confidence intervals (CI) were calculated to compare the mortality rates of athletes and general population. Results Among 233 Olympic medalists, 57 died before the study endpoint. The main causes of death were cardiovascular diseases (33.3%), neoplasms (26.3%), and external causes (17.6%). The overall mortality of the Olympic medalists was significantly lower than that of general population (SMR 0.73, 95% CI 0.56-0.94, P = 0.013). Regarding specific causes of death, athletes’ mortality from cardiovascular diseases was significantly reduced (SMR 0.61, 95% CI 0.38- 0.93, P = 0.021). Conclusions Croatian male Olympic medalists benefit from lower overall and cardiovascular mortality rates in comparison to the general Croatian male populatio

Total atrioventricular block in Lyme borreliosis

Introduction: Lyme disease is caused by the spirochete Borrelia Brugdorferi. It manifests as erythema migrans but can also cause central neuropathy, arthritis and carditis.1 Cardiac manifestations include conduction abnormalities with varying degrees of atrioventricular block and other rhythm disturbances. 2 The incidence of Lyme disease increases from west to east across Europe, with the highest incidence in Slovenia (155/100 000).3 Case report: We observed a 32-year-old male patient who presented to the Emergency Department with recurrent syncope. Electrocardiography recorded intermittent total atrioventricular block, with an average heart rate of 25/min. A temporary pacemaker (Oscor Pace 101H, Single Chamber External Pacemaker) was implanted emergently using right jugular access. He had been on Sovsko lake near Čaglin village in Požega-Slavonia county 7 days prior to admittance, after which he had fever and chills for 2 days followed by diarrhea for 1 day. We started empirical treatment with intravenous ceftriaxone due to suspected Lyme disease. No tick bites on skin were found. Results: Results of serological testing showed that IgM Lyme titer (ELISA) was positive >5.23, also CLIA IgM were positive (IgM >190, IgG >240), followed by positive IgM and IgG Western Blot. Considering these results, we continued ceftriaxone treatment according to guidelines for 6 weeks. Echocardiography demonstrated normal left and right ventricular systolic function with no valvular dysfunction. First 3 days continuous pacing was required, afterwards for 7 days only intermittent pacing in night hours was required. In the end, the patient maintained normal sinus rhythm at 65-75 bpm. Two days after, the external pacemaker and active fixation lead was removed. Conclusion: Lyme borreliosis infection can cause conduction abnormalities, including total atrioventricular block in structurally healthy heart. Conduction abnormalities are reversible with the use of proper antibiotic treatment

Association of chronic kidney disease with periprocedural myocardial injury after elective stent implantation: a single center prospective cohort study

Coronary artery disease (CAD) is the leading cause of mortality in patients with chronic kidney disease (CKD). Patients with CKD who undergo percutaneous coronary intervention (PCI) may have more ischemic events than patients without CKD. The aim of our study was to determine the incidence of periprocedural myocardial injury (PMI) after elective stent implantation in patients with CKD using the Third Joint ESC/ACCF/AHA/WHF PMI definition.In a single center prospective cohort study, we enrolled 344 consecutive patients who underwent elective PCI in a period of 39 months. Serum troponin I (cTnI) concentrations were measured at baseline and at 8 and 16 hours after PCI. Periprocedural increase of cTnI, according to the most recent PMI definition, was used to define both the presence and intensity of PMI. Patients were further stratified according to the estimated glomerular filtration rate (eGFR) using 4 variable Modification of Diet in Renal Disease (MDRD) equation: control group with eGFR >90 mL/min/1.73 m and the CKD group with eGFR 90 mL/min/1.73 m) and the CKD group (<90 mL/min/1.73 m) both 8 and 16 hours after PCI. When the CKD patients were further subdivided according to their CKD stage, there was again no difference in the intensity or incidence of PMI compared to the control group. Further analyses of our data showed angina pectoris CCS IV, bare metal stent (BMS) implantation, and treatment with angiotensin-converting enzyme inhibitors (ACEI) as independent predictors of PMI. Furthermore, the presence of hypertension was inversely related to the occurrence of PMI.Applying the new guidelines for PMI and using the eGFR equation most suitable for our patients, we found no association between PMI and CKD. Further analyses showed other factors that could potentially influence the occurrence of PMI

Total atrioventricular block in Lyme borreliosis

Introduction: Lyme disease is caused by the spirochete Borrelia Brugdorferi. It manifests as erythema migrans but can also cause central neuropathy, arthritis and carditis.1 Cardiac manifestations include conduction abnormalities with varying degrees of atrioventricular block and other rhythm disturbances. 2 The incidence of Lyme disease increases from west to east across Europe, with the highest incidence in Slovenia (155/100 000).3 Case report: We observed a 32-year-old male patient who presented to the Emergency Department with recurrent syncope. Electrocardiography recorded intermittent total atrioventricular block, with an average heart rate of 25/min. A temporary pacemaker (Oscor Pace 101H, Single Chamber External Pacemaker) was implanted emergently using right jugular access. He had been on Sovsko lake near Čaglin village in Požega-Slavonia county 7 days prior to admittance, after which he had fever and chills for 2 days followed by diarrhea for 1 day. We started empirical treatment with intravenous ceftriaxone due to suspected Lyme disease. No tick bites on skin were found. Results: Results of serological testing showed that IgM Lyme titer (ELISA) was positive >5.23, also CLIA IgM were positive (IgM >190, IgG >240), followed by positive IgM and IgG Western Blot. Considering these results, we continued ceftriaxone treatment according to guidelines for 6 weeks. Echocardiography demonstrated normal left and right ventricular systolic function with no valvular dysfunction. First 3 days continuous pacing was required, afterwards for 7 days only intermittent pacing in night hours was required. In the end, the patient maintained normal sinus rhythm at 65-75 bpm. Two days after, the external pacemaker and active fixation lead was removed. Conclusion: Lyme borreliosis infection can cause conduction abnormalities, including total atrioventricular block in structurally healthy heart. Conduction abnormalities are reversible with the use of proper antibiotic treatment