Arterial hypertension and cerebrovascular disease

Артериалната хипертония е най-важният рисков фактор за развитието на мозъчно-съдова болест (МСБ) и най-вече на нейната най-тежка изява - мозъчния инсулт. Ето защо най-точният критерий за нивото на контрол на хипертонията в дадена популация е понижаването на болестността и смъртността от мозъчни инсултиArterial hypertension is the most important risk factor for development of cerebrovascular disease and stroke in particular. That is why the most accurate marker for the level of control of hypertension is stroke mortality and morbidity

Practical significance of individual blood pressure trajectories

Individual blood pressure values tend to be close to a certain population pattern (because of environmental and socioeconomic factors), without fully following it (because of specifi c individual genetic predisposition). These population "patterns" or "trajectories' can be followed back to prenatal period and across the whole lifespan. Some of them are correlated with higher risk for development of arterial hypertension. There are also several "cornerstones" in these patterns, where the individual may be at an increased risk for movement to a higher-risk group. They can explain why certain individuals are more prone to target organ damage than others and why we, as clinicians, should have an individualized approach when we translate population-based guidelines to the single patient. Proper defi nition and practical knowledge of the signifi cance of these blood pressure trajectories could be important for everyday prophylaxis and practice

Case Report: Transthyretin Glu54Leu—a rare mutation with predominant cardiac phenotype

We report two unrelated Bulgarian families with hereditary transthyretin (ATTR) amyloidosis due to a rare p.Glu74Leu (Glu54Leu) pathogenic variant found in seven individuals—three of them symptomatic. Only one family with the same variant and with a Swedish origin has been clinically described so far. Our patients are characterized by predominant cardiac involvement, very much similar to the Swedish patients. Although the initial complaint was bilateral carpal tunnel syndrome, advanced amyloid cardiomyopathy was found in two symptomatic carriers at diagnosis with heart failure manifestations. The neurological involvement was considered as mild, with mainly sensory signs and symptoms being present. We followed a non-biopsy algorithm to confirm the diagnosis. Tafamidis 61 mg has been initiated as the only approved disease modifying treatment for ATTR cardiomyopathy. Clinical stability in the absence of adverse events has been observed at follow up

Therapeutic strategies for reduction of the cardiovascular risk in patients with inflammatory joint diseases

Възпалителните ставни заболявания /ВСЗ/ протичат с хронично възпаление и са свързани с висoк процент на сърдечно-съдова заболеваемост и смъртност, главно в резултат на акцелерирана атеросклероза. Целта на настоящия обзор е да посочи съвременните терапевтични стратегии за намаляване на сърдечно-съдовия риск при тези пациенти и за повишаване на качеството им на живот, свързано със здравето.Inflammatory joint diseases are associated with high cardiovascular morbidity and mortality, due to accelerated atherosclerosis. The aim of the current review is to discuss the modern therapeutic strategies for reduction of the cardiovascular risk in patients with inflammatory joint diseases and for improvement of their health-related quality of life

The use of single-pill combinations as first-line treatment for hypertension: translating guidelines into clinical practice

The 2008 European Society of Cardiology/European Society of Hypertension guidelines recommend the first-line prescription of two antihypertensive drugs in single-pill combinations (SPCs), also known as fixed-dose combinations, for the treatment of most patients with hypertension. This recommendation is based on a large amount of data, which shows that first-line treatment with SPCs supports reaching blood pressure targets rapidly and reducing cardiovascular outcome risk while keeping the therapeutic strategies as simple as possible and fostering adherence and persistence. As this approach constitutes a big shift from the stepped-care approaches that have been dominant for many years, practicing physicians have expressed concerns about using SPCs as first-line agents. In this review, we will discuss the barriers to the uptake of this recommendation. We will also offer suggestions to reduce the impact of these barriers and address specific concerns that have been raised

2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD.

Guideline

Heart failure in Europe: Guideline-directed medical therapy use and decision making in chronic and acute, pre-existing and de novo, heart failure with reduced, mildly reduced, and preserved ejection fraction – the ESC EORP Heart Failure III Registry

Aims We analysed baseline characteristics and guideline-directed medical therapy (GDMT) use and decisions in theEuropean Society of Cardiology (ESC) Heart Failure (HF) III Registry. Methods and results Between1November 2018and31December 2020,10162 patients with acute HF (AHF, 39%, age 70 [62-79],36% women) or outpatient visit for HF (61%, age 66 [58-75], 33% women), with HF with reduced (HFrEF, 57%),mildly reduced (HFmrEF,17%) or preserved (HFpEF, 26%) ejection fraction were enrolled from 220 centres in 41European or ESC-affiliated countries. With AHF, 97% were hospitalized, 2.2% received intravenous treatment in theemergency department, and 0.9% received intravenous treatment in an outpatient clinic. AHF was seen by most bya general cardiologist (51%) and outpatient HF most by a HF specialist (48%). A majority had been hospitalized forHF before, but 26% of AHF and 6.1% of outpatient HF had de novo HF. Baseline use, initiation and discontinuation ofGDMT varied according to AHF versus outpatient HF, de novo versus pre-existing HF, and by ejection fraction. Afterthe AHF event or outpatient HF visit, use of any renin-angiotensin system inhibitor, angiotensin receptor-neprilysininhibitor, beta-blocker, mineralocorticoid receptor antagonist and loop diuretics was 89%, 29%, 92%, 78%, and 85%in HFrEF; 89%, 9.7%, 90%, 64%, and 81% in HFmrEF; and 77%, 3.1%, 80%, 48%, and 80% in HFpEF. ConclusionUse and initiation of GDMT was high in cardiology centres in Europe, compared to previous reports from cohortsand registries including more primary care and general medicine and regions more local or outside of Europe andESC-affiliated countries....................................