Blood pressure control and components of the metabolic syndrome: the GOOD survey

<p>Abstract</p> <p>Background</p> <p>The GOOD (Global Cardiometabolic Risk Profile in Patients with Hypertension Disease) survey showed that blood pressure control was significantly worse in hypertensive patients with metabolic syndrome and/or diabetes mellitus than in those with essential hypertension only. This analysis aimed to investigate which components of the metabolic syndrome are primarily associated with poor blood pressure control.</p> <p>Methods</p> <p>The GOOD survey was designed as an observational cross-sectional survey in 12 European countries to assess the cardiometabolic risk profile in patients with essential hypertension. Investigators were randomly selected from a list of general practitioners (70% of investigators) and a list of specialists such as internists, cardiologists and hypertension specialists (30% of investigators). Data from 3,280 outpatients with hypertension, aged at least 30 years who were receiving antihypertensive treatment or had newly diagnosed hypertension according to the European Society of Hypertension and the European Society of Cardiology criteria, were included in the analyses. Blood pressure control, body mass index (BMI), waist circumference, serum triglycerides, total and high density lipoprotein (HDL) cholesterol measurements were compared in patients with diabetes mellitus and metabolic syndrome, with diabetes mellitus only, with metabolic syndrome only, and with neither metabolic syndrome nor diabetes mellitus.</p> <p>Results</p> <p>The highest blood pressure values were found in patients with metabolic syndrome with or without diabetes mellitus. Blood pressure was significantly lower in patients with diabetes mellitus only. The highest BMI, waist circumference and serum triglycerides, and the lowest HDL cholesterol levels among the groups studied occurred in patients with metabolic syndrome, either with or without diabetes mellitus.</p> <p>Conclusion</p> <p>Among the components of the metabolic syndrome, it is not impaired glucose tolerance which is associated with the poor response to antihypertensive treatment. Instead, visceral obesity and dyslipidemia components of the metabolic syndrome, i.e. hypertriglyceridemia and low HDL cholesterol levels, are associated with resistance to antihypertensive treatment.</p

Comparison of particle-size analyzing laboratory methods

Patients with chronic renal failure are known to have renal osteodystrophy (bone disease) and increased calcification of vessels. A new marker of bone disease, sclerostin, the two pro-inflammatory cytokines tumour necrosis factor-alpha (TNF-alpha) and interleukin-18 (IL-18), and the fibroblast growth factor-23 (FGF-23) receptor-associated marker Klotho were tested in 84 haemodialysis (HD) patients and in healthy controls. The patients had significantly higher levels of the three former markers than of the controls while Klotho was significantly higher in the controls. Low level, but significant, correlations were observed in the patient group when the levels of these four markers were compared to each other and to those of 5 cytokines and growth factors tested earlier; high-sensitive CRP (hsCRP), interleukin-6 (IL-6), hepatocyte growth factor (HGF), fibroblast growth factor-23 (FGF-23) and soluble urokinase plasminogen activator (suPAR). Ln sclerostin correlated positively to Ln hsTNF-alpha, Ln HGF and Ln suPAR. Ln hsTNF-alpha correlated positively to Ln sclerostin, Ln hsCRP, Ln IL-6, Ln FGF-23, Ln suPAR and Ln IL-18. Ln IL-18 correlated positively to Ln suPAR and Ln TNF-alpha. Ln Klotho correlated negatively to Ln hsCRP but did not correlate to Ln FGF-23. The markers studied here may be involved in the calcification of vessels seen in HD patients due to a combination of inflammation and bone disease. The mechanisms are still not fully known but may be of importance for future therapeutic possibilities in this group of patients.Funding agencies: County Council of ostergotland; Research Council of South Eastern Sweden (FORSS)</p

A dohányzás-kiváltotta fokozott vazopresszin kiválasztás és a bőr vérátáramlás csökkenésének összefüggése az életkor előrehaladása, magas vérnyomás, cukorbetegség és vazospasztikus angina esetén: lehet-e vazopresszinnek etiológiai szerepe a hipertóniában = Association between cigarette smoking-provoked vasopressin release and skin blood flow reduction in relation to ageing, hypertension, diabetes mellitus and vasospastic angina: can vasopressin play an etiological role in the development of hypertensio

A kutatás folyamán azt tapasztaltuk, hogy a dohányzás-kiváltotta vazopresszin szekráció emberben fokozódik az életkor előrehaladtával, amely fokozott vérnyomás emelkedéssel és bőr vérátáramlás csökkenéssel jár. Anginás betegekben a vazopresszin kiválasztás nagyobb, mint hasonló korú nem anginásokban. Humán eredményeink arra utalnak, hogy a vazopresszin kiválasztásnak szerepe lehet az életkorral növekvő rizikójú szívérrendszeri események kialakulásában. A vazopresszin kiválasztást hipofízis hátsó lebeny szövettenyészekből számos stimulus befolyásolja. ilyen stimulusok a hisztamin, serotonin és galanin, amelyek hatásmechanizmusát tanulmányoztuk a támogatás segítségével. Megállapítottuk egyúttal, hogy a nemsoká piacra kerülő vazopresszin antagonista (OPC-31260) hogyan befolyásolja az endogén vazopresszin biológiai fél életidejét, illetve a szervekben történő eloszlását. | We found that cigarette smoking-provoked vasopressin release increases with age in humans. The enhanced vasopressin secretion correlates with an augmnted systolic blood pressure response and with a reduction in skin blood flow. It was shown that cigarette smoking leads an enhanced vasopressin secretion in smokers suffering from angina compared to an age-matched control group. Our results may support the role of endogenous vasopressin in the increased risk of myocardial infarction among aged people. In additional experiments, it was shown that the release of vasopressin from rat neurohypophyseal tissue cultures is regulated by histamine, serotonin and galanin. The pathways of actions of these agents on vasopressin release were also studied. Finally, we demonstrated the actions of OPC-31260, a novel non-peptide vasopressin antagonist, on the biological half-life and organ distribution of endogenous vasopressin

Effects of Verapamil SR and Atenolol on 24-Hour Blood Pressure and Heart Rate in Hypertension Patients with Coronary Artery Disease...

Elevated night-time blood pressure (BP) and heart rate (HR), increased BP and HR variability, and altered diurnal variations of BP and HR (nighttime dipping and morning surge) in patients with systemic hypertension are each associated with increased adverse cardiovascular events. However, there are no reports on the effect of hypertension treatment on these important hemodynamic parameters in the growing population of hypertensive patients with atherosclerotic coronary artery disease (CAD). This was a pre-specified subgroup analysis of the INternational VErapamil SR-Trandolapril STudy (INVEST), which involved 22,576 clinically stable patients aged ≥50 years with hypertension and CAD randomized to either verapamil SR- or atenolol-based hypertension treatment strategies. The subgroup consisted of 117 patients undergoing 24-hour ambulatory monitoring at baseline and after 1 year of treatment. Hourly systolic and diastolic BP (SBP and DBP) decreased after 1 year for both verapamil SR- and atenolol-based treatment strategies compared with baseline (P<0.0001). Atenolol also decreased hourly HR (P<0.0001). Both treatment strategies decreased SBP variability (weighted standard deviation: P = 0.012 and 0.021, respectively). Compared with verapamil SR, atenolol also increased the prevalence of BP and HR night-time dipping among prior non-dippers (BP: OR = 3.37; 95% CI: 1.26 – 8.97; P = 0.015; HR: OR = 4.06; 95% CI: 1.35-12.17;P = 0.012) and blunted HR morning surge (+2.8 vs. +4.5 beats/min/hr; P = 0.019). Both verapamil SR- and especially atenolol-based strategies resulted in favorable changes in ambulatory monitoring parameters that have been previously associated with increased adverse cardiovascular events

Effects of Verapamil SR and Atenolol on 24-Hour Blood Pressure and Heart Rate in Hypertension Patients with Coronary Artery Disease...

Elevated night-time blood pressure (BP) and heart rate (HR), increased BP and HR variability, and altered diurnal variations of BP and HR (nighttime dipping and morning surge) in patients with systemic hypertension are each associated with increased adverse cardiovascular events. However, there are no reports on the effect of hypertension treatment on these important hemodynamic parameters in the growing population of hypertensive patients with atherosclerotic coronary artery disease (CAD). This was a pre-specified subgroup analysis of the INternational VErapamil SR-Trandolapril STudy (INVEST), which involved 22,576 clinically stable patients aged ≥50 years with hypertension and CAD randomized to either verapamil SR- or atenolol-based hypertension treatment strategies. The subgroup consisted of 117 patients undergoing 24-hour ambulatory monitoring at baseline and after 1 year of treatment. Hourly systolic and diastolic BP (SBP and DBP) decreased after 1 year for both verapamil SR- and atenolol-based treatment strategies compared with baseline (P<0.0001). Atenolol also decreased hourly HR (P<0.0001). Both treatment strategies decreased SBP variability (weighted standard deviation: P = 0.012 and 0.021, respectively). Compared with verapamil SR, atenolol also increased the prevalence of BP and HR night-time dipping among prior non-dippers (BP: OR = 3.37; 95% CI: 1.26 – 8.97; P = 0.015; HR: OR = 4.06; 95% CI: 1.35-12.17;P = 0.012) and blunted HR morning surge (+2.8 vs. +4.5 beats/min/hr; P = 0.019). Both verapamil SR- and especially atenolol-based strategies resulted in favorable changes in ambulatory monitoring parameters that have been previously associated with increased adverse cardiovascular events

A boka-kar index oszcillometriás elven működő meghatározásának helye a klinikai gyakorlatban = The potential role of oscillometric devices for ankle-brachial index measurements in clinical practice

Absztrakt: Bevezetés: A boka-kar index meghatározása során az oszcillometriás eszközök a hagyományos Doppler-elven működő eszközökkel összevetve több ígéretes előnyt mutatnak. A speciális képzés szükségtelensége, a gyorsabb kivitelezés, valamint a mérés operátortól független volta sorolható ezek közé. Célkitűzés: A boka-kar index oszcillometriás és a Doppler-elven működő meghatározásának összehasonlító elemzése. Módszer: A vizsgálati egyének esetében folyamatos hullámú Doppler és automata oszcillometriás (BOSO ABI-system 100) módszerrel a boka-kar index egyidejű meghatározását végeztük. Az összehasonlító elemzés Bland−Altman- és ROC-analízis alkalmazásával történt. Eredmények: A két módszerrel végzett vizsgálat (734 mérés) jó egyezést mutatott a boka-kar index tartomány 0,9 értékéhez közel. Ezen érték alatt és felett az egyezés mértéke csökkent. Az oszcillometriás mérés során optimálisnak tekinthető diagnosztikus boka-kar index határérték 0,96 volt. Következtetések: A boka-kar index oszcillometriás meghatározása nem helyettesíti a Doppler-alapú mérést a teljes boka-kar index tartományban. Mindazonáltal a hatékony diszkriminációs tulajdonságának köszönhetően a tünetmentes egyének szűrésekor hathatós eszköz lehet. Orv Hetil. 2018; 159(5): 176–182. | Abstract: Introduction: Oscillometric devices in contrast to the traditional Doppler based method for ankle-brachial index measurements have promising advantages like no need for special training, faster performance, and operator independence. Aim: Comparative assessment of the oscillometric and Doppler-based ankle-brachial index measurement. Method: Ankle-brachial index measurements were performed by continuous wave Doppler and an automatic oscillometric device (BOSO ABI-system 100) in consecutive subjects. The comparative assessment was performed by Bland−Altman and ROC analysis. Results: The two kinds of measurements (734 measurements) showed a good agreement in the ankle-brachial index spectrum close to the cut-off value of 0.9. The agreement diminished below or above this value. The optimal oscillometric ankle-brachial index diagnostic cut-off value was 0.96. Conclusions: The oscillometric device is not interchangeable for Doppler devices in the whole ankle-brachial index spectrum. Nevertheless, owing to its discriminative power, the oscillometric measurement potentially has an efficient role in the screening of asymptomatic patients. Orv Hetil. 2018; 159(5): 176–182