Ocena zależności między ciśnieniem centralnym w aorcie a zesztywniającym zapaleniem stawów kręgosłupa

Introduction. Ankylosing spondylitis (AS) is a chronic inflammatory disease with an unknown etiology that belongs to the group of spondyloarthropathies. Patients with AS have an increased cardiovascular mortality but the reason is controversial. Central aortic pressure (CAP) is defined as the blood pressure in the aortic root and can be measured non-invasively via arteriography. Inflammation in the aortic root, which also causes aortic regurgitation in late sta ges of AS, possibly causes increased levels of central aortic pressure and this may explain the increased mortality rates from cardiovascular events in patients with AS. We investigated the CAP levels in patients with AS compared to healthy age- and sex-matched control group in this novel study. Material and methods. This is an observational case-control study composed of 30 patients with ankylosing spondylitis without conventional cardiovascular risk factors (such as known diabetes, hypertension, and smoking) or heart failure, peripheral or coronary artery disease. The peripheral blood pressures and CAP measurements were obtained with ‘arteriograph’ (TensioMed, Budapest, Hungary).Pulse wave velocity (PWV), peripheral and central augmentation index (pAIx and cAIx) and systolic central aortic pressure (sCAP) of both the AS and control group were compared. Results. There was no statistically significant difference between the groups for pAIx, cAIx, PWV or PP. Patient with AS had higher sCAP values but there wasn’t any statistically significant difference for sCAP. Conclusion. Our objective was to investigate the relationship between the AS and sCAP. There was an increase in sCAP in AS group compared to controls. But this was not statistically significant. This result can be due to the small population size and should be verified in larger population.Wstęp. Zesztywniające zapalenie stawów kręgosłupa (AS) to przewlekła choroba zapalna o nieznanej etiologii należąca do spondyloartropatii. U chorych z AS obserwuje się zwiększoną śmiertelność sercowo-naczyniową, jednak przyczyny tego zjawiska nie są znane. Ciśnienie centralne w aorcie (CAP) jest definiowane jako ciśnienie krwi w korzeniu aorty. Możliwy jest nieinwazyjny pomiar CAP metodą arteriografii. Zapalenie w obrębie korzenia aorty, będące również przyczyną niedomykalności w późnym stadium AS, może powodować wzrost ciśnienia centralnego w aorcie, co może tłumaczyć zwiększoną śmiertelność z powodu zdarzeń sercowo-naczyniowych w grupie chorych z AS. Autorzy zbadali wartości CAP u chorych z AS w porównaniu z wartościami uzyskanymi w grupie kontrolnej złożonej ze zdrowych osób dobranych pod względem wieku i płci. Materiał i metody. Tym obserwacyjnym badaniem kliniczno-kontrolnym objęto 30 chorych z AS, u których nie występowały tradycyjne czynniki ryzyka sercowo-naczyniowego (rozpoznana cukrzyca, nadciśnienie tętnicze, palenie tytoniu), niewydolność serca, choroba tętnic obwodowych ani choroba wieńcowa. Wartości obwodowego ciśnienia tętniczego i pomiary CAP uzyskano metodą arteriografii (TensioMed, Budapeszt, Węgry). Porównano wartości następujących parametrów w grupie AS i grupie kontrolnej: szybkość fali tętna (PWV), wskaźnik wzmocnienia ciśnienia obwodowego i centralnego (pAIx, cAIx) i skurczowe ciśnienie centralne w aorcie (sCAP). Wyniki. Nie stwierdzono statystycznie istotnych różnic między grupami pod względem wartości pAIx, cAIx, PWV ani PP. U chorych z AS zaobserwowano wyższe wartości sCAP, jednak różnice nie osiągnęły poziomu istotności statystycznej. Wnioski. Badanie przeprowadzono w celu zbadania zależności między AS a sCAP. W grupie chorych na AS wartości sCAP były wyższe niż w grupie kontrolnej. Jednak różnice nie były istotne statystycznie. Wyniki te mogą być spowodowane niewielką liczebnością badanej populacji i powinny zostać zweryfikowane w badaniu z większą liczbą uczestników

Would Anti-Hypertensive Treatment be a Risk Factor for National Health Budget of Turkey in 2023?

This study aims to predict the prevalence of hypertension and the cost of anti-hypertensive treatment in future by analyzing the adults diagnosed with hypertension and the drugs prescribed for their treatment in Turkey during a period of five years. This study reviews data related to the patients diagnosed with hypertension amongst the individuals registered within the Medula database of the Turkish Social Insurance Institution from 2009 to 2013. A significant and gradual increase was specified in the prevalence of hypertension during the study period. The number of female patients was significantly higher than the number of male patients over the passing years. The number of anti-hypertensive drug boxes consumed was significantly increased during the study period. Surprisingly, the number of anti-hypertensive boxes annually consumed by the hypertensive patients remained statistically similar between 2009 and 2013. A significant increase was noted in the prescription of angiotensin II receptor blockers, beta blockers, and angiotensin converting enzyme inhibitors during the study period. The cost of anti-hypertensive treatment was found to decrease by 36.7% during the study period. The economical measures currently adopted for drug pricing are successful but health policies developed for the prevention of hypertension are inadequate. [Med-Science 2015; 4(4.000): 2813-24

Endothelial dysfunction in patients with isolated coronary artery ectasia: Decreased flow-mediated dilatation in the brachial artery

© 2015, Biomed Res-India. All rights reserved.The underlying pathology of Isolated Coronary Artery Ectasia (ICAE) still remains unknown; however, endothelial dysfunction (ED) may be responsible for the disease process. The aim of this study was to assess the endothelial functions of patients with ICAE in comparison to patients with normal coronary arteries (NCA) by using flow-mediated dilatation (FMD) in the brachial artery. Thirty patients with ICAE, and 30 control subjects with angiographically NCA were included in this study. The FMD was measured in all patients using a high-resolution ultrasonographic system. The results showed that the baseline brachial artery diameters in patients with ICAE were not statistically different from those in patients with NCA (4.3 ± 0.3 vs.4.2 ± 0.3 mm, respectively, p = 0.265). However, the forearm FMD of the patients with ICAE was significantly lower than the values in the control group (8.5 ± 4.0 vs. 13.7 ± 3.0%, p <0.001). In addition, patients with ICAE have significantly higher levels of low-density lipoprotein (LDL) cholesterol compared to the control group (114.5 ± 28.8 vs. 97.9 ± 31.5 mg/dL, p = 0.03). Therefore, we conclude that patients with ICAE have more severe ED than patients with NCA, which supports the hypothesis that atherosclerosis may be involved in the pathogenesis of coronary ectasia. Hyperlipidemia may have a key role in the disease process

The effect of sleep apnea severity on cardiac autonomic activity during night time in obstructive sleep apnea patients

ABSTRACT CONTEXT AND OBJECTIVE: Impaired autonomic cardiac function is an important consequence of obstructive sleep apnea (OSA). This impairment is mainly due to intermittent hypoxia episodes following apneas. However, the impact of apnea severity on autonomic cardiac function remains unclear. The aim of this study was to evaluate the relationship between the severity of sleep apnea and heart rate turbulence (HRT) and heart rate variability (HRV) in OSA. DESIGN AND SETTING: Observational cross-sectional study conducted in the Departments of Cardiology and Pulmonary Diseases, Afyon Kocatepe University, Turkey. METHODS: 106 patients with OSA and 27 healthy volunteers were enrolled. Based on apnea hypopnea index (AHI) values, obstructive sleep apnea severity was classified as follows: mild OSA (AHI ≥ 5 and 30). HRV and HRT parameters were assessed via 24-hour digital Holter electrocardiogram recordings for all subjects. RESULTS: HRV and HRT results were significantly lower among OSA patients than among control subjects (P < 0.05). However, there were no significant differences in HRT and HRV between the three patient subgroups. Correlations did emerge between AHI and the NN-interval parameter RMSSD and between oxygen desaturation and turbulence slope (respectively: r = -0.22, P = 0.037; and r = -0.28, P = 0.025). CONCLUSION: HRT and HRV results deteriorate in OSA. Correlations between apnea severity and these parameters seem to be present