Deaths, disability-adjusted life years and years of life lost due to elevated systolic blood pressure in Poland: estimates for the Global Burden of Disease Study 2016

Introduction. High systolic blood pressure (SBP) is a well-known risk factor for major adverse cardiovascular outcomes; however, data regarding disease burden due to high SBP in the Polish population are scarce. Material and methods. We extracted and analyzed the latest country-, gender-, age- and year-specific estimates from the Global Burden of Disease (GBD) Study 2016 for SBP-related mortality, years of life lost (YLLs), disability-adjusted life years (DALYs), and attributable risk factors in Poland in 2016. In the GBD 2016, the term ‘high SBP’ refers to SBP of at least 110−115 mmHg. Results. High SBP was attributable to (per 100,000) 106,043.16 deaths (95% UI [Uncertainty Interval]: 88,207–121,849) that was 27.22% of all deaths in Poland in 2016; 1,751,844.69 DALYs (95% UI: 1,525,188–1,966,25) and 1,497,959.71 YLLs (95% UI: 1,287,279–1,497,959). In males, DALYs attributable to high SBP were higher by 34% and YLLs by 23%, while in females death rates were higher by 14%. SBP was highly attributable to ischemic heart disease, stroke, and chronic kidney disease (63.7%, 63,1%, and 59.1%, respectively). In the GBD hierarchy, high SBP was the most common risk factor, followed by smoking, high body mass index (BMI), high total cholesterol levels, alcohol use, and high fasting plasma glucose levels. Conclusions. In Poland, SBP of at least 110–115 mmHg remains one of the largest risks for loss of good health; greater than smoking, high cholesterol levels, or high BMI. With the population aging globally, the burden due to high SBP is expected to increase further

The prospective evaluation of the osteoporotic vertebral fractures incidence in a random population sample

Wstęp. Osteoporotyczne złamania trzonów kręgów najczęściej mają charakter incydentalny, ale u części chorych mogą wywoływać objawy kliniczne oraz charakterystyczne deformacje kręgosłupa, a także zwiększać śmiertelność ogólną. Celem pracy była ocena częstości występowania osteoporotycznych złamań kręgów i czynników ryzyka osteoporozy w losowo wybranej próbce populacyjnej mieszkańców Szczecina powyżej 50 rż. oraz odniesienie tych danych do wyników uzyskanych z całej populacji europejskiej w ramach badań EVOS (European Vertebral Osteoporosis Study) i jego części prospektywnej - EPOS (European Prospective Osteoporosis Study). Materiał i metody. W warunkach wyjściowych przebadano łącznie 607 osób, w tym 301 kobiet i 306 mężczyzn. U wszystkich osób wykonano badania ankietowe odnośnie czynników ryzyka osteoporozy oraz badania radiologiczne kręgosłupa oceniane za pomocą morfometrii. Wyniki. Częstość występowania osteoporotycznych deformacji kręgów w badanej populacji była podobna u obu płci (12,6% kobiet i 10,3% mężczyzn), ale u mężczyzn w wieku 50-64 lat istotnie częściej stwierdzano złamania niż u kobiet. Po 4 latach zapadalność na nowe złamania kręgów była wyższa u kobiet (9,1 vs 6,4/1000 osobolat). Spośród czynników ryzyka osteoporozy na występowanie deformacji kręgów istotnie wpływała mała aktywność fizyczna i długotrwałe unieruchomienie u kobiet. Wnioski 1) Badania wskazują na dużą częstość występowania czynników ryzyka osteoporozy oraz osteoporotycznych deformacji trzonów kręgów w populacji mieszkańców Szczecina powyżej 50 rż. 2) Ocena wizualna jedynie w połączeniu z morfometrią stanowi optymalne narzędzie do rozpoznawania złamań kręgów.Introduction Osteoporotic vertebral fractures are mosty incydent but in some patients may lead to clinical symptoms, characteristic deformations of the vertebral column and increase total mortality. The aim of the study was to evaluate the prevalence of osteoporotic vertebral fractures and risk factors for osteoporosis in a random sample of Szczecin inhabitants aged over 50 in the relation to the whole European population examined in the frame of EVOS (European Vertebral Osteoporosis Study) and its prospective phase - EPOS (European Prospective Osteoporosis Study). At the baseline, 607 persons were studied, including 301 women and 306 men. Material and methods The questionnaire on the risk factors for osteoporosis and the spine X-rays analysed by morphometry, were taken in all subjects. The incidence of osteoporotic vertebral deformity in the studied population was similar in both sexes (12.6% women and 10,3% men) but in men aged 50-64 fracture incidence was significantly higher in comparison with women. The prevalence of new vertebral fractures examined after 4 years was higher in women than in men (9.1 vs 6.4/1000 persons years). Among the risk factors for osteoporosis, low physical activity and prolonged immobilization in women significantly influenced the incidence of vertebral deformities. Conclusions: 1) The study shows the high incidence of risk factors and osteoporotic vertebral deformities in the population of Szczecin inhabitants aged over 50. 2) Visual assessment only with a combination with morphometry is an optimal tool for detection of incident vertebral fractures

Hypertension and beyond — does circulating irisin matter?

Irisin is a myokine secreted by skeletal muscles. It has been proposed to drive the brown-fat-like conversion of the white adipose tissue. By enhancing energy expenditure, irisin may affect systemic metabolism and be associated with insulin resistance; however, the mechanism(s) of action still remain largely unexplained. The discovery of irisin can contribute to the exploration of the novel and effective therapeutic targets or therapeutic strategies of metabolic diseases or metabolism-associated health issues. In this review, based on the recent literature (from 2013 to 2015 inclusive), we will systematically discuss the associations of irisin with obesity, type 2 diabetes, lipid disorders, and hypertension. We also introduce unanswered questions for future research.Irisin is a myokine secreted by skeletal muscles. It has been proposed to drive the brown-fat-like conversion of the white adipose tissue. By enhancing energy expenditure, irisin may affect systemic metabolism and be associated with insulin resistance; however, the mechanism(s) of action still remain largely unexplained. The discovery of irisin can contribute to the exploration of the novel and effective therapeutic targets or therapeutic strategies of metabolic diseases or metabolism-associated health issues. In this review, based on the recent literature (from 2013 to 2015 inclusive), we will systematically discuss the associations of irisin with obesity, type 2 diabetes, lipid disorders, and hypertension. We also introduce unanswered questions for future research

The civilization-related phenotypes of abnormal fatty tissue distribution: visceral obesity and sarcopoenic obesity

Obesity is a well-known risk factor of abnormal carbohydrate and lipid metabolism, arterial hypertension, and cardiovascular diseases. This risk increases with abnormal fat distribution with excessive fat accumulation in the abdominal cavity, liver, pancreas, heart, kidneys, blood vessels, and muscles. In this review we present pathogenesis, diagnostic challenges and metabolic consequences of visceral and sarcopoenic obesity — the new phenotypes of fat distribution in human evolution.Obesity is a well-known risk factor of abnormal carbohydrate and lipid metabolism, arterial hypertension, and cardiovascular diseases. This risk increases with abnormal fat distribution with excessive fat accumulation in the abdominal cavity, liver, pancreas, heart, kidneys, blood vessels, and muscles. In this review we present pathogenesis, diagnostic challenges and metabolic consequences of visceral and sarcopoenic obesity — the new phenotypes of fat distribution in human evolution

Plasma fibronectin in pregnancy complicated by diabetes mellitus and preeclampsia

Abstract Objectives: The aim of this study was to evaluate concentration of plasma fibronectin (FN) in course of pregnancy complicated by preeclampsia accompannied by diabetes mellitus and to assess whether the concentration of FN depends on the state of carbohydrate metabolism . Material and methods: The study was carried out in 2 groups: group K – consisting of 35 healthy pregnant women without complications, and group G – consisting of 12 pregnant women, 4 with gestational diabetes mellitus and 8 with pregestational diabetes mellitus, who developed preeclampsia, in course of reaserch, after 37th week of pregnancy. Concentration of FN and Fm – in order to the state of carbohydrate metabolism – was marked in the following: before 33rd week of pregnancy, between 33rd and 37th week of pregnancy and after 37th week of pregnancy. Results: No correlation between concentration of FN and duration of pregnancy in group K was found. Average concentration of FN in the subsequent periods of the pregnancy in group K were simillar and have not shown vital, statistical differences. In group G crucial statistical increase in FN concentration along with increase of pregnancy duration was found (r=0,3860,

Plasma adiponectin in hypertensive patients with and without metabolic syndrome

Introduction. The metabolic syndrome is defined on the basis of a cluster of coexisting metabolic deteriorations, which increase the risk of cardiovascular disease. Earlier studies suggested a role of adipokines and proinflammatory cytokines in the pathogenesis of metabolic syndrome-induced complications. Some clinical studies reported the association of hypoadiponectinemia with cardiovascular diseases, diabetes mellitus, hypertension and dyslipidemia. Decreased adiponectin has been proposed as a useful biomarker of the metabolic syndrome. The aim of the study was to compare serum adiponectin levels in patients with primary hypertension with and without coexisting metabolic syndrome. Material and methods. The study group comprised 145 patients aged 18–50 years with primary hypertension. On the basis of IDF diagnostic criteria, all patients were categorized in groups with (HTMS; n = 73) and without (HTC; n = 72) metabolic syndrome. Study protocol included anthropometric measurements including waist circumference, 24 hour blood pressure measurement, serum levels of adiponectin, uric acid, lipids, insulin and glucose, and assessment of insulin resistance using HOMA-IR index. Results. The plasma levels of adiponectin were significantly lower in the subjects with hypertension and metabolic syndrome as compared with those without the MS (4.2 ± 3.1 μg/dL vs. 6.7 ± 6.5 μg/dL, p = 0.0026). In all patients with hypertension, adiponectin negatively correlated with insulin (r = −0.20; p = 0.014), HOMA-IR (r = −0.24; p = 0.003), triglycerides (r = −0.19; p = 0.025), uric acid (r = −0.25; p = 0.003) and positively with HDL-cholesterol (r = 0.33; p = 0.0001). In the ROC curve analysis, the cut-off value predicting metabolic syndrome in patients with hypertension was 4.1 μg/mL for adiponectin. Conclusions. In conclusion, low adiponectin levels should be taken into account as a potential non-classical biomarker of metabolic complications in patients with primary hypertension, not only with concomitant metabolic syndrome.Introduction. The metabolic syndrome is defined on the basis of a cluster of coexisting metabolic deteriorations, which increase the risk of cardiovascular disease. Earlier studies suggested a role of adipokines and proinflammatory cytokines in the pathogenesis of metabolic syndrome-induced complications. Some clinical studies reported the association of hypoadiponectinemia with cardiovascular diseases, diabetes mellitus, hypertension and dyslipidemia. Decreased adiponectin has been proposed as a useful biomarker of the metabolic syndrome. The aim of the study was to compare serum adiponectin levels in patients with primary hypertension with and without coexisting metabolic syndrome. Material and methods. The study group comprised 145 patients aged 18–50 years with primary hypertension. On the basis of IDF diagnostic criteria, all patients were categorized in groups with (HTMS; n = 73) and without (HTC; n = 72) metabolic syndrome. Study protocol included anthropometric measurements including waist circumference, 24 hour blood pressure measurement, serum levels of adiponectin, uric acid, lipids, insulin and glucose, and assessment of insulin resistance using HOMA-IR index. Results. The plasma levels of adiponectin were significantly lower in the subjects with hypertension and metabolic syndrome as compared with those without the MS (4.2 ± 3.1 μg/dL vs. 6.7 ± 6.5 μg/dL, p = 0.0026). In all patients with hypertension, adiponectin negatively correlated with insulin (r = −0.20; p = 0.014), HOMA-IR (r = −0.24; p = 0.003), triglycerides (r = −0.19; p = 0.025), uric acid (r = −0.25; p = 0.003) and positively with HDL-cholesterol (r = 0.33; p = 0.0001). In the ROC curve analysis, the cut-off value predicting metabolic syndrome in patients with hypertension was 4.1 μg/mL for adiponectin. Conclusions. In conclusion, low adiponectin levels should be taken into account as a potential non-classical biomarker of metabolic complications in patients with primary hypertension, not only with concomitant metabolic syndrome

The influence of varying dietary sodium content on circadian blood pressure profile in patients with salt-sensitive hypertension

The pathogenesis of essential hypertension is not fully understood. Literature indicates the complexity of blood pressure regulating mechanisms with a high impact of genetics and environmental factors. Previous experimental studies have shown the importance of salt intake in the development of hypertension. The aim of the study was to explore the influence of varying dietary sodium content on circadian blood pressure profile in patients with salt-sensitive hypertension. The study was carried out among 69 salt-sensitive hypertensive patients (19 females i 50 males) mean aged 36.1 ± 8.0 years. Study protocol provided low sodium diet firstly then high sodium diet containing 10–20 mmol and 220–240 mmol of sodium per day respectively. On each of the diet ABPM was performed. Our results suggest that in salt-sensitive patients the reduction of salt intake may decrease blood pressure and restore its circadian profile and thus lead to the reduction in the rate of complications of hypertension

Impaired aldosterone response to the saline infusion test in patients with resistant hypertension and obstructive sleep apnea

Background In this cross-sectional study, we sought associations among severity of obstructive sleep apnea (OSA), renin-angiotensin-aldosterone system and blood pressure patterns in patients with resistant hypertension.Material and methods In 65 patients with resistant hypertension we measured the apnea-hypopnea index (AHI) by a portable sleep recorded system and aldosterone and plasma renin activity (PRA) in response to saline infusion test. We also collected data on cardiovascular events, dyslipidemia, chronic kidney disease, and diabetes and performed 24-hour blood pressure monitoring (ABPM).Results Baseline PRA, aldosterone and aldosterone-to-renin ratio were within normal range but aldosterone level in response to saline infusion was increased above normal upper limit. In ABPM, 68% of patients had an altered pattern of blood pressure (non-dipping or reverse dipping). AHI was inversely correlated with PRA and positively with weight, BMI, plasma aldosterone, aldosterone to renin ratio, and aldosterone after saline load but not with blood pressure. Patients with severe OSA (AHI > 30) in comparison to those with mild OSA (AHI 5–15) had significantly higher PRA and aldosterone (baseline and after saline load) but comparable values of blood pressure. We did not find significant impact of OSA severity on the frequency of abnormal blood pressure patterns. Frequencies of diabetes, abnormal lipid profiles, ischemic heart disease, myocardial infarction, and stroke increased with increases in severity of OSA.Conclusions Despite of normal basal PRA and aldosterone concentration, patients with resistant hypertension and OSA had impaired response to saline load and a rate of this impairment depended on the severity of OSA.Background In this cross-sectional study, we sought associations among severity of obstructive sleep apnea (OSA), renin-angiotensin-aldosterone system and blood pressure patterns in patients with resistant hypertension.Material and methods In 65 patients with resistant hypertension we measured the apnea-hypopnea index (AHI) by a portable sleep recorded system and aldosterone and plasma renin activity (PRA) in response to saline infusion test. We also collected data on cardiovascular events, dyslipidemia, chronic kidney disease, and diabetes and performed 24-hour blood pressure monitoring (ABPM).Results Baseline PRA, aldosterone and aldosterone-to-renin ratio were within normal range but aldosterone level in response to saline infusion was increased above normal upper limit. In ABPM, 68% of patients had an altered pattern of blood pressure (non-dipping or reverse dipping). AHI was inversely correlated with PRA and positively with weight, BMI, plasma aldosterone, aldosterone to renin ratio, and aldosterone after saline load but not with blood pressure. Patients with severe OSA (AHI > 30) in comparison to those with mild OSA (AHI 5–15) had significantly higher PRA and aldosterone (baseline and after saline load) but comparable values of blood pressure. We did not find significant impact of OSA severity on the frequency of abnormal blood pressure patterns. Frequencies of diabetes, abnormal lipid profiles, ischemic heart disease, myocardial infarction, and stroke increased with increases in severity of OSA.Conclusions Despite of normal basal PRA and aldosterone concentration, patients with resistant hypertension and OSA had impaired response to saline load and a rate of this impairment depended on the severity of OSA

Associations of the –344T>C polymorphism of CYP11B2 gene with 24-hour blood pressure profiles in middle-aged women with essential hypertension

Background In this cross-sectional study, we assessed the impact of –344T>C polymorphism of the CYP11B2 gene which encodes aldosterone synthase on 24-hour blood pressure patterns.Material and methods The study was performed in 137 females with essential hypertension aged 42−60 years. We measured plasma aldosterone level and renin activity (PRA), fasting glucose, lipid profiles and 24-hour urinary sodium and potassium excretion. Based on 24-hour blood pressure monitoring we identified cases with dipping and non-dipping patterns of blood pressure.Results Mean PRA and aldosterone levels and aldosterone-to-renin ratio (ARR) were within normal range. Non-dipping hypertension was found in 54.3% of patients. Genotype frequencies of TT, CC and CT were 27%, 27% and 46%, respectively. Carriers of the C allele had significantly lower nocturnal blood pressure reduction (P = 0.004) and higher nocturnal systolic (P = 0.02) and diastolic blood pressure (P = 0.044), frequency of non-dipping profile (P = 0.001), and 24-hour urinary potassium excretion (P = 0.047). Urinary sodium excretion was positively correlated with a decrease in nocturnal blood pressure (R = 0.202; P = 0.037). In a multiple regression analysis, ARR and presence of the C allele adjusted for confounding variables were inversely associated with the nocturnal blood pressure decline (b = −0.348; P = 0.022 and b = −0.222; P = 0.018, respectively).Conclusions In conclusion, in middle-aged females with essential hypertension carrying the C allele we found higher nocturnal blood pressure, lower nocturnal blood pressure reduction, and higher prevalence of non-dipping hypertension than in TT carriers.Background In this cross-sectional study, we assessed the impact of –344T>C polymorphism of the CYP11B2 gene which encodes aldosterone synthase on 24-hour blood pressure patterns.Material and methods The study was performed in 137 females with essential hypertension aged 42−60 years. We measured plasma aldosterone level and renin activity (PRA), fasting glucose, lipid profiles and 24-hour urinary sodium and potassium excretion. Based on 24-hour blood pressure monitoring we identified cases with dipping and non-dipping patterns of blood pressure.Results Mean PRA and aldosterone levels and aldosterone-to-renin ratio (ARR) were within normal range. Non-dipping hypertension was found in 54.3% of patients. Genotype frequencies of TT, CC and CT were 27%, 27% and 46%, respectively. Carriers of the C allele had significantly lower nocturnal blood pressure reduction (P = 0.004) and higher nocturnal systolic (P = 0.02) and diastolic blood pressure (P = 0.044), frequency of non-dipping profile (P = 0.001), and 24-hour urinary potassium excretion (P = 0.047). Urinary sodium excretion was positively correlated with a decrease in nocturnal blood pressure (R = 0.202; P = 0.037). In a multiple regression analysis, ARR and presence of the C allele adjusted for confounding variables were inversely associated with the nocturnal blood pressure decline (b = −0.348; P = 0.022 and b = −0.222; P = 0.018, respectively).Conclusions In conclusion, in middle-aged females with essential hypertension carrying the C allele we found higher nocturnal blood pressure, lower nocturnal blood pressure reduction, and higher prevalence of non-dipping hypertension than in TT carriers

Umbilical cord plasma endothelin 1 and cyclic guanosine concentrations monophosphate at delivery in pregnancy complicated by diabetes mellitus

Abstract Objectives: The aim of the study was to assess the relationship between maternal and umbilical cord plasma concentrations of endothelin 1 (ET-1) and cyclic guanosine monophosphate (cGMP) in women with diabetes mellitus (DM). Material and methods: The study was performed on 19 neonates of women with pregestational DM, 23 neonates of women with gestational diabetes (GDM), and 18 neonates of healthy, uncomplicated pregnancies. Results: We found that umbilical and maternal ET-1 and cGMP concentrations in pregestational DM or GDM women were not changed in comparison with the controls. In women without DM, positive correlations between maternal (r=0.64;