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Chronic obstructive pulmonary disease (COPD) affects almost 10% of the adult population of our country; obstructive sleep apnoea is increasingly being recognized and concerns, according to accepted criteria, 2-9% of females and 4-24% of men. The greatest mortality in chronic obstructive pulmonary disease is not caused by respiratory failure, but cardiovascular complications, including ischaemic heart disease. Obstructive sleep apnoea in half the cases is complicated by hypertension, often refractory to antihypertensive therapy. The paper discusses the pathogenesis of ischaemic heart disease in patients with COPD with particular attention to the inflammation that occurs in these two diseases. The pathogenesis of hypertension in the course of obstructive sleep apnoea is also presented with particular emphasis on hypoxia and sympathetic stimulation. Prevention of coronary heart disease should be a priority of the procedure in chronic obstructive pulmonary disease. The paper also discusses the treatment of ischaemic heart disease, paying attention to the modification of treatment in patients with chronic obstructive pulmonary disease, and discussing the influence of drugs used in COPD on the progression of ischaemic heart disease. Hypertension in the course of obstructive sleep apnoea is often resistant to therapy despite the use of continuous positive airway pressure devices, and often decrease after the use of aldosterone antagonists. Attention is drawn to the anti-inflammatory action of statins and trials of their use in the prevention of exacerbations of chronic obstructive pulmonary disease. © 2013 PTChP.

Magnesium (Mg) is one of the most important intracellular cations in the human body. It catalyzes many reactions of carbohydrate, protein and fat metabolism. Researches show that many people do not have enough products rich in magnesium in their diets. Proper/reference magnesium blood plasma level is 0.65-1.25 mmol/l. Magnesium deficiencies may cause arrhythmia as well as mood disorders, depression and difficulties in concentrating. Magnesium deficiency in the human body is often recognized in the industrialized countries and is caused mainly by the increased consumption of the processed foods. Daily magnesium intake increases in stress, intense physical activity, pregnancy and lactation. Bioavailability of magnesium supplement depends on its chemical form, the presence of inorganic anion or organic ligand, water solubility, stability of the compound, presence of vitamin B6 and potassium ions, daily dosage and administration. In this review bioavailability of organic and inorganic magnesium compounds, supplement composition and magnesium ion content is presented. Magnesium ion complexes with organic ligands are more stable in acidic environment, and give better absorption, thus higher bioavailability due to easier passage through the intestinal wall. Greater intestinal absorption of magnesium organic complexes, mainly citrates, than inorganic salts is observed. Many clinical studies point to the importance of magnesium deficiencies in the development of hypertension and stroke. Magnesium has a direct, dilating influence on vascular endothelium through the influx of calcium into cells. In many studies it has been confirmed that there exists the dependence between the magnesium supplementation and the decrease in blood pressure. Antihypertensive efficacy of magnesium is small, therefore this cation can only be an additional element of a therapy. Magnesium decreases the risk of diabetes and metabolic syndrome development. Polish and European Society of Hypertension recommend the DASH diet, which contains 500 mg of Mg per 2100 kcal and which does not require additional Mg intake. Copyright © 2013 Via Medica.

Arterial hypertension concerns 7-10% of pregnancies and leads to an increased risk of complications for both, the mother and the child. This rate will probably rise in the years to come due to the notable tendency among women to delay the decision to become pregnant - values of blood pressure and occurrence of arterial hypertension increase with age, as well as due to the growing problem of obesity, resulting from inappropriate dietary habits and lack of regular everyday physical activity. Difficulties with management of that clinical condition are partly related with lack of unified and widely accepted guidelines. Different opinions in the subject of terminology and classification of pregnancy hypertension or indications for pharmacotherapy, as well as choice of the optimal antihypertensive drug, emerge from objective causes such as combination of various pathogenetic factors typical for arterial hypertension itself and those connected with pregnancy, elsewhere stressed priorities of therapy from the point of view of the health of the mother and of the fetus, as well as lack of randomized clinical trials due to obvious ethical purposes, but also from the fact that pregnancy hypertension is a focus of attention for different specialists - obstetricians, hypertensiologists and perinatologists. A good cooperation regarding experience and information among all of these specializations would be the most beneficial for pregnant women and their children. Lack of new modern antihypertensive agents, safe and effective in pregnancy, while the older ones are being withdrawn from the market as their production is no longer cost-effective for pharmacological companies, has become an increasing problem in many countries, and Poland among them. The aim of the following publication was to present the statement on management of pregnancy hypertension from the current guidelines of the Polish Society of Arterial Hypertension 2011 to gynecologists and obstetricians, with a commentary. According to the guidelines, methyldopa, labetalol (or metoprolol), long-acting nifedipine or verapamil should be used in the therapy of mild and moderate pregnancy hypertension, preferably in the given order. In case of severe and life-threatening arterial hypertension, labetalol intravenously should be administered and if it is still not sufficient, eventually sodium nitroprusside or hydralazine could be ordered, bearing in mind their possible adverse effects. Unfortunately, labetalol, nifedipine, hydralazine and sodium nitroprusside are no longer available in Poland, which significantly narrows the practical treatment possibilities in the pregnant population. Inhibitors of angiotensin converting enzyme and angiotensin II receptor blockers are contraindicated during pregnancy and breastfeeding, as well as aldosteron inhibitors, as suggest in the guidelines. In the paper the authors present the guidelines and also, based on the information available to date in medical journals, other hypertension pharmacotherapeutic options possible for consideration in pregnancy, which could be helpful in management of severe arterial hypertension in pregnancy. © Polskie Towarzystwo Ginekologiczne.

In observational studies the relationship between blood pressure and chronic kidney diseases is direct and progressive. Evidence from numerous clinical trials has demonstrated the benefit of blood pressure control. Till now however blood-pressure target for optimal renal protection is controversial. Previously European guidelines on the management of hypertension: the European Society of Hypertension position statement from 2007 and Polish guidelines from 2008 recommended reduction of blood pressure below 130/80 mm Hg and in patients with proteinuria below 125/75 mm Hg. The latest European and Polish guidelines recommended higher threshold of blood pressure below 140/90 mm Hg for these patients. In this paper we review current evidence concerning blood pressure goals in patients with chronic kidney diseases. Copyright © 2011 Via Medica.

Szczepaniak-Chichel L.,Katedra I Klinika Hipertensjologii | Tykarski A.,Katedra I Klinika Hipertensjologii
Nadcisnienie Tetnicze | Year: 2012

Candesartan, a selective angiotensin II AT1 receptor blocker is used in arterial hypertension in monotherapy or in combined treatment. On the contrary to ACE inhibitors candesartan does not influence the bradykinine levels hence incidence of dry cough and angioedema is much lower. Majority of the hypotensive effect of the drug is being observed after the first two weeks of chronic therapy and full influence after 4-6 weeks of regular pharmacotherapy and does not diminish in longitudinal annual observation. The publication aims at brief description, in the light of data from available large clinical trials, of the candesartan's hypotensive effectiveness in comparison with other hypotensive agents or in combination with them, its influence on left ventricle hypertrophy, heart failure, cerebrovascular risk and new-onset diabetes incidence. Copyright © 2012 Via Medica.

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