Hypertension and Sleep Apnea

Diagnosis and treatment of comorbid conditions in hypertension are essential for efficient blood pressure control and for decreasing adverse clinical events and mortality. Sleep apnea, mainly its obstructive form, has a high prevalence both in the general population and in hypertensive patients, the main reason being the worldwide epidemic of obesity. This chapter summarizes the principal issues related to hypertension-sleep apnea relationship: definition of terms, epidemiological data and evidences, clinical manifestations of sleep apnea, pathophysiological background of the adverse effects of sleep apnea on the cardiovascular system, screening and definitive diagnosis, and the effects of specific and nonspecific sleep apnea interventions on hypertension

Elhízással összefüggő csökkent alvásminőség és nem megfelelő alvásidőtartam két erdélyi roma alcsoportban = Poor sleep quality and inadequate sleep duration related to obesity in two Roma subgroups in Transylvania

Absztrakt: Bevezetés: A rövid alvási idő, illetve a rossz alvásminőség összefüggésben állhat az elhízással, ezen összefüggést azonban még nem tanulmányozták roma populációkban. Célkitűzés: Alvási szokások tanulmányozása két felnőtt roma alcsoportban (a gazdag gábor és a szegény lovári romáknál), illetve a helyi nem roma lakosságnál, elhízással összefüggésben, tudva, hogy a roma népesség sajátos társadalmi és kulturális jellemzőkkel rendelkezik, gyorsan változó életmóddal. Módszer: Populációalapú keresztmetszeti felmérést végeztünk Erdélyben, Maros megyében, a Nyárád mentén, ahol nagyobb gábor roma, illetve lovári roma közösség él a magyar populáció mellett. A csoportok nemben és életkorban megfeleltek egymásnak. Eredmények: Az alvás időtartama 7,18 ± 1,6 óra volt a gábor romáknál, 7,67 ± 1,5 óra a lovári romáknál és 7,37 ± 1,5 óra a nem romáknál. Átlagosan a romák 70%-ánál volt elegendő az alvási idő (≥7 óra). A gábor romák 38,6%-ánál, a lovári romák 27,1%-ánál és a nem roma lakosság 23,5%-ánál volt rossz az alvás minősége (p = 0,05). A gábor romáknak szignifikánsan magasabb volt a testtömegindexük (31,1 ± 4,6 versus 27,4 ± 5,2 és 28,66 ± 5,7 kg/m2, p = 0,004), és ez szignifikáns fordított összefüggést mutatott az alvási idővel (F = 14,85, p<0,000). Következtetés: A gábor romáknál jóval magasabb arányban fordult elő rossz minőségű alvás. Az alvási időtartam és az alvás minősége összefüggésben volt az elhízással, főként a roma népesség körében. Orv Hetil. 2019; 160(32): 1279–1283. | Abstract: Introduction: Short sleep duration and poor sleep quality may be associated with weight gain; this association has not yet been studied in Roma (Gipsy) population. Aim: Our aim was to study sleep patterns in two adult Roma subgroups (the wealthy Gabor and the poor Lovari Roma), compared to the majority of Hungarian population, in relation to obesity, knowing that Roma population has specific socio-cultural characteristics, with a rapidly changing lifestyle. Method: A population-based cross-sectional survey was conducted in a rural region in Transylvania, where the above groups are cohabiting. The groups were age- and gender-matched. Results: Sleep duration was 7.18 ± 1.6 hours in the Gabor Roma, 7.67 ± 1.5 hours in the Lovari Roma and 7.37 ± 1.5 hours in the non-Roma group. In average, 70% of them had enough sleep (≥7 hours). 38.6% of Gabor Roma, 27.1% of Lovari Roma and 23.5% of non-Roma had poor-quality sleep (p = 0.05). Gabor Roma had significantly higher body mass index (31.1 ± 4.6 versus 27.4 ± 5.2 and 28.66 ± 5.7 kg/m2, p = 0.004), and this correlated inversely with sleep duration (F = 14.85, p<0.000). Conclusion: Gabor Roma had significantly higher percentage of poor-quality sleep. Sleep duration and sleep quality were linked with obesity, mainly in the Roma population. Orv Hetil. 2019; 160(32): 1279–1283

Bal oldali pneumothorax egy ritka EKG-megnyilvánulása: inferior STEMI és praecordialis Brugada-mintázat | A rare ECG manifestation of left sided pneumothorax: inferior STEMI with precordial Brugada pattern

Absztrakt A nem coronariás eredetű ST-eleváció felismerése, okának tisztázása fontos a mindennapi gyakorlatban, elsősorban a felesleges diagnosztikus és terápiás eljárások elkerülése végett. Betegünk esetében egy viszonylag ritka ok, spontán, bal oldali feszülő pneumothorax állt az akutan kialakuló, komplex EKG-elváltozások hátterében – alsó fali infarktust utánzó ST-eleváció társulása 1-es típusú Brugada-mintázattal (≥2 mm-es, „vitorlaszerű”, „coved” ST-eleváció) a praecordialis elvezetésekben. Bemutatjuk a klinikai képet és lefolyást, valamint ismertetjük a felmerülő differenciáldiagnosztikai problémákat és az EKG-elváltozások lehetséges okait. Orv. Hetil., 2016, 157(50), 2007–2010. | Abstract Recognition and identification of the cause of non-coronary ST elevation is important in daily practice, mainly for avoiding unnecessary diagnostic and therapeutic procedures. In this case, a rare cause, spontaneous, left sided tension pneumothorax was in the background of the suddenly appearing, complex ECG changes – ST elevation mimicking inferior wall myocardial infarction associated with type 1 Brugada pattern (“coved” ST-segment elevation ≥ 2 mm) in the precordial leads. The clinical picture and course, the differential diagnostic problems related to the case and the possible causes of the ECG changes will be presented. Orv. Hetil., 2016, 157(50), 2007–2010

Vércukorcsökkentő gyógyszerek biztonságossága szívelégtelenségben | The safety of anti-diabetic drugs in heart failure

Absztrakt: A diabetes és szívelégtelenség társulása igen gyakori, ugyanakkor a két kórkép patofiziológiája és kórlefolyása is számos ponton találkozik. Napjainkban a rendelkezésre álló antidiabetikus gyógyszerek spektruma rendkívül széles, a klasszikus szerektől (inzulin, biguanidok, szulfanilureák) a legmodernebbekig (gliptinek, gliflozinok) terjed. Ezeknek a gyógyszereknek a cardiovascularis hatásai sokrétűek, ismeretük fontos a mindennapi gyakorlatban, ugyanis előnyben részesül a szívelégtelenség szempontjából biztonságos szerek alkalmazása. Munkánk áttekintést nyújt az egyes gyógyszercsoportokról – a hatásmechanizmus, valamint a főbb képviselők bemutatása után ismertetjük a cardiovascularis rendszerre és ezen belül a szívelégtelenségre gyakorolt hatásokat, megemlítve a fontosabb klinikai vizsgálatok eredményeit is. Az adatok egyértelműen alátámasztják a metformin és a gliflozinok kedvező és a thiazolidindionok káros hatását szívelégtelenségben. A többi gyógyszercsoport alkalmazása megengedett szívelégtelenség esetén, de fontos a dekompenzáció jeleinek folyamatos monitorozása. Orv. Hetil., 2017, 158(5), 163–171. | Abstract: The association of diabetes and heart failure is very common, furthermore, the pathophysiology and clinical course of the two entities have many crossing-points. Today, the spectrum of available anti-diabetic drugs is extremely wide, ranging from the classical (insulin, biguanides, sulphonylureas) to the most recent agents (gliptins, gliflozins). The cardiovascular effects of these drugs are multiple, their knowledge is important in the everyday practice, as the use of safe drugs regarding of heart failure is preferred. Our work provides an overview of each class of drugs after the presentation of the mechanism of action and the main representatives, the effects on the cardiovascular system, including those on heart failure will be described, mentioning the results of the most important clinical trials. The available data confirm the beneficial effects of metformin and gliflozins and the harmful effect of thiazolidinediones in heart failure. The other classes of drugs are permitted in heart failure, but it is important to continuously monitor the signs of decompensation. Orv. Hetil., 2017. 158(5), 163–171

Increase of Short-Term Heart Rate Variability Induced by Blood Pressure Measurements during Ambulatory Blood Pressure Monitoring

Objective. The possible effect of blood pressure measurements per se on heart rate variability (HRV) was studied in the setting of concomitant ambulatory blood pressure monitoring (ABPM) and Holter ECG monitoring (HM). Methods. In 25 hypertensive patients (14 women and 11 men, mean age: 58.1 years), 24-hour combined ABPM and HM were performed. For every blood pressure measurement, 2-minute ECG segments (before, during, and after measurement) were analyzed to obtain time domain parameters of HRV: SDNN and rMSSD. Mean of normal RR intervals (MNN), SDNN/MNN, and rMSSD/MNN were calculated, too. Parameter variations related to blood pressure measurements were analyzed using one-way ANOVA with multiple comparisons. Results. 2281 measurements (1518 during the day and 763 during the night) were included in the analysis. Both SDNN and SDNN/MNN had a constant (the same for 24-hour, daytime, and nighttime values) and significant change related to blood pressure measurements: an increase during measurements and a decrease after them (p<0.01 for any variation). Conclusion. In the setting of combined ABPM and HM, the blood pressure measurement itself produces an increase in short-term heart rate variability. Clarifying the physiological basis and the possible clinical value of this phenomenon needs further studies

The Cardiomyopathy Registry of the EURObservational Research Programme of the European Society of Cardiology: Baseline data and contemporary management of adult patients with cardiomyopathies

Aims The Cardiomyopathy Registry of the EURObservational Research Programme is a prospective, observational, and multinational registry of consecutive patients with four cardiomyopathy subtypes: Hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmogenic right ventricular cardiomyopathy (ARVC), and restrictive cardiomyopathy (RCM). We report the baseline characteristics and management of adults enrolled in the registry. Methods and results A total of 3208 patients were enrolled by 69 centres in 18 countries [HCM (n = 1739); DCM (n = 1260); ARVC (n = 143); and RCM (n = 66)]. Differences between cardiomyopathy subtypes (P < 0.001) were observed for age at diagnosis, history of familial disease, history of sustained ventricular arrhythmia, use of magnetic resonance imaging or genetic testing, and implantation of defibrillators. When compared with probands, relatives had a lower age at diagnosis (P < 0.001), but a similar rate of symptoms and defibrillators. When compared with the Long-Term phase, patients of the Pilot phase (enrolled in more expert centres) had a more frequent rate of familial disease (P < 0.001), were more frequently diagnosed with a rare underlying disease (P < 0.001), and more frequently implanted with a defibrillator (P = 0.023). Comparing four geographical areas, patients from Southern Europe had a familial disease more frequently (P < 0.001), were more frequently diagnosed in the context of a family screening (P < 0.001), and more frequently diagnosed with a rare underlying disease (P < 0.001). Conclusion By providing contemporary observational data on characteristics and management of patients with cardiomyopathies, the registry provides a platform for the evaluation of guideline implementation. Potential gaps with existing recommendations are discussed as well as some suggestions for improvement of health care provision in Europe. © The Author 2017

Cardiac Morphofunctional Characteristics of Individuals with Early Repolarization Pattern: A Literature Review

The early repolarization pattern (ERP) is an electrocardiographic phenomenon characterized by the appearance of a distinct J-wave or J-point elevation at the terminal part of the QRS complex. ERP is associated with an increased risk of ventricular arrhythmias in susceptible individuals. The cardiac morphofunctional parameters in subjects with ERP have been characterized mainly by imaging techniques, which suggests that certain changes could be identified in the background of the electrical pathomechanism: however, in this regard, current data are often contradictory or insufficiently detailed. For clarification, a more comprehensive cardiac imaging evaluation of a large patient population is necessary. This review summarizes and analyses the data from the literature related to cardiac morphofunctional characteristics in individuals with ERP