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Mazurek E.,Poradnia Kardiologiczna NZOZ Jantar w Ostrowie Wielkopolskim | Rutz-Danielczak A.,Katedra i Klinika Hipertensjologii | Tarchalski J.,Poradnia Kardiologiczna NZOZ Jantar w Ostrowie Wielkopolskim | Tykarski A.,Katedra i Klinika Hipertensjologii
Nadcisnienie Tetnicze | Year: 2012

An integral part of therapy in arterial hypertension, an important cardiovascular risk factor, is nonpharmacological treatment which includes appropriate physical activity. Response of the cardiovascular system to physical effort depends on its type (static, dynamic), time of endurance, intensity and amount of involved muscle tissue. In patients with arterial hypertension blood pressure rise is higher than in normotensive subjects. With the progression of the disease there is a rise in values of peripheral vascular resistance, while left ventricle ejection fraction and heart rate gradually decrease. Regular physical effort reduces SBP per 4-8 mm Hg and DBP per 2-6 mm Hg. Through reaching new balance between elements of the autonomic nervous system heart rate in physical effort and while resting is being reduced. In physical effort ejection fraction is rising and left ventricle load is decreased. Increase in coronary flow and regression of left ventricle hypertrophy is observed. This effect is comparable with achieved with antihypertensive treatment. Following changes mentioned above, physical effort economizes work of the cardiovascular system and allows for more effective oxygen usage with significantly lower load. Regular physical activity has positive influence also on many other factors of cardiovascular risk such as coagulation system parameters, serum lipids profile or insulin resistance. Patients with arterial hypertension should be advised to perform regular physical effort of moderate intensity for around 30-45 minutes per day. Endurance exercises (walking, jogging, swimming) are preferred, while resistance exercises should be only an addition. Intensity of advised aerobic training should depend on necessary baseline and repeated thereafter assessment of the state of cardiovascular system and control of the values of blood pressure. If hypertension is not properly controlled the physical effort should be limited until sufficient hypotensive pharmacotherapy is used. Strenuous isometric exercises (i.e. weight lifting) are not recommended. The hypotensive effect achieved with regular physical effort may require appropriate modification of pharmacotherapy. Copyright © 2012 Via Medica.

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.

Obesity and overweight are one of the fundamental health problems of the contemporary world. The prevalence of obesity and overweight in developed countries has reached 50% and is constandy increasing. Visceral adipose tissue in obese subject releases many biologically active substances which may play a potential role in the pathogenesis of hypertension. These active substances include: angiotensin II, tumour necrosis factor, C-reactive protein, interleukin 6, resistin. Insulin resistance, typical for obese people, increases sympathetic nervous system activation and renal tubular sodium reabsorption. Epidemiological and clinical studies clearly show the relationship between obesity, overweight and prevalence of hypertension. At the same time current studies show that reduction of body mass leads to decrease or even normalization of blood pressure. Unfortunately, in most of them the duration of observation period was only 1 year or 2 years. There were only a few studies in which patients had been observed for several years, but the results were ambiguous. No data from long-term trials are available. Thus, a great interest arouse by the reports concerning long-term effect of bariatric surgery on blood pressure. Obesity reduction by bariatric surgery decreases or normalizes blood pressure values in majority of cases, but many years after the operation blood pressure often increases again. Copyright © 2011 Via Medica.

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.

Gluszek J.,Katedra I Klinika Hipertensjologii | Kosicka T.,Katedra I Klinika Hipertensjologii
Nadcisnienie Tetnicze | Year: 2011

Pathogenesis of essential hypertension is complex and, up to now, not well explained. Results of the increasing number of experimental and clinical studies point to the essential role of inflammation in pathogenesis of this disease. In patients with hypertension the levels of CRP, Il-6, tumor necrosis factor and, fibrinogen in blood are usually increased. The increase of CRP is also considered to be the cause of hypertension. In the secondary forms of hypertension, there is also evidence that not only the high values of blood pressure but also the increased CRP level are the significant risk factors of cardio-vascular complications. The methods of non-pharmacological and pharmacological therapy, for ameliorating of the inflammation which accompanies the hypertension are discussed. Copyright © 2011 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.

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.

Niklas A.,Katedra I Klinika Hipertensjologii | Piekarska A.M.,Katedra I Klinika Hipertensjologii | Tykarski A.,Katedra I Klinika Hipertensjologii
Nadcisnienie Tetnicze | Year: 2013

Hypertension is the major cause of death worldwide. In Poland about a third of people have high blood pressure, while more than two thirds population have abnormal level of lipids. Low efficacy of the treatment may be due to the long duration of treatment and number of dose. The use of fixed-dose drugs, once a day, promotes better compliance. This article reviews studies using the one-pill combination of amlodipine and atorvastatin. This paper discusses the place of statins, particularly atorvastatin in lipid-lowering therapy and amlodipine - calcium antagonists in antihypertensive therapy. The article summarizes the efficacy and safety of combination of amlodipine and atorvastatin in studies: ASCOT, AVALON, RESPOND, CUSP, DUAAL, GEMINI, JEWEL. The results show the effectiveness of this combination, reduction of blood pressure and LDL-cholesterol. The effects of treatment resulted in a reduction of total cardiovascular risk and mortality. Copyright © 2013 Via Medica.

Kostka-Jeziorny K.,Katedra I Klinika Hipertensjologii | Uruski P.,Katedra I Klinika Hipertensjologii | Tykarski A.,Katedra I Klinika Hipertensjologii
Nadcisnienie Tetnicze | Year: 2010

Background: Some studies show that allopurinol reduces blood pressure in adolescents with newly diagnosed hypertension, decreases aortic pulse wave velocity (PWV) and improves endothelial function in hypertensives. It was not the case with uricosuric agents. It is possible that there may be vasoprotective mechanism of allopurinol which is independent from its hypouricemic effect. To determine effects of allopurinol on arterial blood pressure and PWV depending on hypouricemic effect in treated hypertension. Material and methods: The study was performed between 2006 and 2008 in the Department of Hypertension, Angiology and Internal Medicine of Poznan University of Medical Sciences. Whenever there was any doubt about a possible secondary cause of arterial hypertension the patients were hospitalized in the Department, where further diagnostic procedures were performed. 66 patients with treated arterial hypertension aged 30 to 70 (mean age 46.17 ± 10.89) have been studied. After 8 weeks of antihypertensive therapy, allopurinol 150 mg daily was added for 2 months. Clinic blood pressure, ABPM and PWV measurements were done before and after alloprurinol treatment. Patients are diveded in two groups depending on hypouricemic effect. Group A presents stronger hypouricemic effect (median over > 0.835), group B presents poor hypouricemic effect (median ≤ 0.835). Results: After allopurinol treatment changes in the office blood pressure in groups A and B were following: ΔSBP +0.01, ΔSBP +0.78 (p = 0.65), ΔDBP +0.43 and ΔDBP +0.83 (p = 0.78), ΔPP -0.43 and ΔPP -0.04 (p = 0.79). After allopurinol treatment PWV in group A decreased from 11.26 ± 1.9 m/s (ΔPWV -1.06) to 10.21 ± 1.7 m/s and group B from 11.01 ± 1.33 m/s to 10.24 ± 1.04 m/s (ΔPWV -0.77). The degree of improvement in pulse wave velocity was not correlated with hypouricemic effect of allopurinol (p = 0.24). Although, there was observed the tendency to greater PWV improvement in case of greater changes in urate levels. Conclusion: 1. There were no significant changes in blood pressure after allopurinol treatment regardless of the extent of lowering uric acid level. 2. The degree of improvement in PWV was not correlated with hypouricemic effect of allopurinol. Although, there was observed the tendency to greater PWV improvement in case of greater changes in urate levels. Copyright © 2010 Via Medica.

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.

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