Treatment of Hypertension: Favourable Effect of the Twice-Daily Compared to the Once-Daily (Evening) Administration of Perindopril and Losartan

Background/Aims: Little is known about the effect of twice daily administration of same dose of ACE inhibitor and ARB on the diurnal/nocturnal blood pressure (BP) ratio. We aimed to assess the effect of two widely used long-acting drugs: perindopril and losartan in the treatment of hypertension comparing the once-daily (evening) vs. twice-daily (morning and evening) administration with the same daily doses. Methods: Untreated primary hypertensive patients without complaints (a total of 164: 65 men, 99 women, 55.7±13.7 years of age, 41-41 patients per treated groups) were selected with non-dipper phenomenon, estimated by diurnal index (DI) Results: The mean BP, the percent time elevation index, and the hyperbaric impact decreased in both drug groups. Significant difference was observed in the DI in the case of twice-daily administration vs once-daily evening dosing. Conclusions: The twice-daily administration with the same daily dose of perindopril or losartan seems to be more effective compared to the once daily evening administration in eliminating the non-dipper phenomenon. According to some authors the non-dipping phenomenon increases cardiovascular risk, while others are of the opinion that the association of non-dipping with cardiovascular events does not necessarily mean that selective treatment of non-dipping improves cardiovascular outcomes

Increased Short-Term Variability of the QT Interval in Professional Soccer Players: Possible Implications for Arrhythmia Prediction

BACKGROUND: Sudden cardiac death in competitive athletes is rare but it is significantly more frequent than in the normal population. The exact cause is seldom established and is mostly attributed to ventricular fibrillation. Myocardial hypertrophy and slow heart rate, both characteristic changes in top athletes in response to physical conditioning, could be associated with increased propensity for ventricular arrhythmias. We investigated conventional ECG parameters and temporal short-term beat-to-beat variability of repolarization (STV(QT)), a presumptive novel parameter for arrhythmia prediction, in professional soccer players. METHODS: Five-minute 12-lead electrocardiograms were recorded from professional soccer players (n = 76, all males, age 22.0±0.61 years) and age-matched healthy volunteers who do not participate in competitive sports (n = 76, all males, age 22.0±0.54 years). The ECGs were digitized and evaluated off-line. The temporal instability of beat-to-beat heart rate and repolarization were characterized by the calculation of short-term variability of the RR and QT intervals. RESULTS: Heart rate was significantly lower in professional soccer players at rest (61±1.2 vs. 72±1.5/min in controls). The QT interval was prolonged in players at rest (419±3.1 vs. 390±3.6 in controls, p<0.001). QTc was significantly longer in players compared to controls calculated with Fridericia and Hodges correction formulas. Importantly, STV(QT) was significantly higher in players both at rest and immediately after the game compared to controls (4.8±0.14 and 4.3±0.14 vs. 3.5±0.10 ms, both p<0.001, respectively). CONCLUSIONS: STV(QT) is significantly higher in professional soccer players compared to age-matched controls, however, further studies are needed to relate this finding to increased arrhythmia propensity in this population

Versenysportolók hirtelen szívhalálának elemzése, az esetszámok csökkentésének lehetőségei = Analysis of sudden cardiac death in competitive athletes, possibilities for reducing cases

Bevezetés: A sportolói hirtelen szívhalál ritka (0,5–1/100 000 sportolói év), de az ismert sportolók hirtelen szívhalála általános megrázkódtatást okoz. Célkitűzés: Kutatási célunk volt összegyűjteni és tanulmányozni minél több hirtelenszívhalál-esetet, megítélni a stressz szerepét és keresni a tragédiák csökkentésének lehetőségeit. Módszer: Az interneten talált regiszterekből, újságcikkekből kigyűjtöttünk 360 (köztük 14 nő) olyan sportolói hirtelen szívhalált, amelynél a sportág, az életkor és a halál helye (edzésen/versenyen/ezeket követően) megállapítható volt. Ezekből a halál évszáma szerinti sorrendben egységes adatbázist készítettünk, amelyet készséggel bocsátunk az érdeklődők rendelkezésére. Az eseteket sportágak szerint csoportosítottuk, elemeztük. Eredményeink és irodalmi adatok alapján a tragédiák csökkentése céljából javaslatokat tettünk. Eredmények és következtetés: Versenyen több hirtelen szívhalál történt, mint edzésen (239 vs. 99), de fizikai terheléssel nem járó bemelegítés és sakkozás közben is történtek tragédiák, viszont a maraton/félmaraton/triatlon sportolók tét nélküli edzésein nem volt hirtelen szívhalál. Mindezek a stressz szerepét bizonyítják, ezért nagy tétű verseny előtt pszichológiai beszélgetést ajánlunk. A csapatsportok edzésein is sok (79/360) hirtelen szívhalál történt, ezért már ott is javaslunk reanimációs készenlétet. Edzés/verseny után hirtelen szívhalál elsősorban a nagy statikus erőkifejtést igénylő sportágakban történt, ott a versenyek utáni megfigyelés is ajánlott. Az edzéseken meghalt sportolók fiatalabbak voltak a verseny közben elhunytakhoz képest (p<0,01), ezért az edzéseken a fiatalokat fokozottan kell orvosi és (alul)edzettségi szempontból figyelni. A maratonfutók és a triatlonosok idősebbek voltak a csapatsportolóknál (p<0,005), és csak versenyen haltak meg, ezért náluk verseny előtt is ajánlott egy alapvizsgálat és 1 hónapon belüli EKG. Irodalmi adatokból levont következtetések: a sportorvosi vizsgálat egységesítése és hozzáférhető dokumentálása lenne szükséges; mivel a hamarabb és szakszerűen megkezdett újraélesztés eredményesebb, minden versenyző kapjon reanimációs oktatást. Orv Hetil. 2023; 164(29): 1155–1163. | Introduction: Sudden cardiac death in athletes is rare (0.5 to 1 per 100 000 athlete years), but sudden cardiac death in known athletes causes general shock. Objective: Our research aim was to collect and study as many sudden cardiac death cases as possible, judge the role of stress and look for ways to reduce fatal tragedies. Method: From registers and newspaper articles found on the Internet, we collected 360 (including 14 women) athletes’ sudden cardiac death cases where the sport, age and place of death (during training/competition/after) could be determined. From these, a single database has been prepared in order of the year of death. The cases were grouped and analyzed by sports. Based on our results and literature data, we made recommendations to reduce fatalities. Results and conclusion: There were more sudden cardiac deaths in competitions than in trainings (239 vs. 99), but tragedies also happened during warm-ups and chess without physical exertion, furthermore, there was no sudden cardiac death in the stakeless training of marathon/half marathon/triathlon athletes; all these prove the role of stress, so we recommend a psychological conversation before a high-stakes race. There were also a lot of sudden cardiac deaths (79/360) during team sports trainings, so we recommend reanimation readiness there as well. After training/ competition, sudden cardiac death happened mainly in sports requiring high static effort, where post-competition monitoring is also recommended. Those who died in training were younger than those who died during the race (p<0.01), so young people should be monitored more closely for medical and (under)fitness. Marathon runners and triathletes were older than team athletes (p<0.005) and only died in competition, so for them a basic examination and an ECG within 1 month before competition are recommended. Conclusions drawn from literature data: sports medicine examination should be standardized and documented in an accessible way; since resuscitation started earlier and professionally is more effective, all competitors should receive reanimation training