The relationship between baroreflex sensitivity (BRS) and inflammatory vascular biomarker Lipoprotein associated phospholipase A2 (Lp-PLA2) in subjects with high normal blood pressure (HNBP, prehypertensives) with a positive family history of hypertension (FHH+) and hypertension history free control subjects (FHH-) was evaluated. A total of 24 HNBP participants (age 39.5 ± 2.5 years, 18 male/ 6 female) were studied. 14 HNBP subjects FHH+ were compared to 10 HNBP participants FHH-, being of similar age and body mass index. BRS (ms/mmHg) was determined by the sequence and spectral methods (five-minute non-invasive beat-to-beat recording of blood pressure and RR interval, controlled breathing at a frequency of 0.33 Hz). Venous blood was analyzed for Lp-PLA2 biomarker of vascular inflammation and atherothrombotic activity. A significant negative correlation between spontaneous BRS obtained by both methods and systolic blood pressure (BP) was present (BRS spect r = -0.54, P<0.001, BRS seq r = -0.59, P<0.001). BRS obtained by sequence and spectral methods were reduced in HNBP FHH+ compared to the group of HNBP FHH- (P = 0.0317 BRS seq, P = 0.0395 BRS spect). Lp-PLA2 was significantly higher in HNBP FHH+ compared to FHH- controls (P<0.05). Lp-PLA2 was negatively correlated with BRS obtained by sequence method (r = -0.798, R2 = 0.636, P<0.001) in the HNBP FHH+ subjects. These findings demonstrate that reduced baroreflex sensitivity, as a marker of autonomic dysfunction, is associated with vascular inflammation, predominantly in otherwise healthy participants with a positive family history of hypertension who could predispose to increased risk of hypertension. We conclude that our transversal study suggests that a lowbaroreflex sensitivity could be an early sign of autonomic dysfunction even in the prehypertensive period, and to corroborate these findings, a longitudinal study is needed.
- MeSH
- 1-alkyl-2-acetylglycerofosfocholinesterasa krev MeSH
- anamnéza MeSH
- autonomní nervový systém patofyziologie MeSH
- baroreflex * MeSH
- biologické markery krev MeSH
- dospělí MeSH
- hypertenze krev diagnóza enzymologie patofyziologie MeSH
- krevní tlak * MeSH
- lidé středního věku MeSH
- lidé MeSH
- prediktivní hodnota testů MeSH
- rizikové faktory MeSH
- studie případů a kontrol MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Vitamín D má významný vplyv na naše zdravie. Zabezpečuje normálny vývoj a metabolizmus kostí, je nevyhnutný pre správnu diferenciáciu buniek, pre imunitný systém, sekréciu inzulínu, reguláciu krvného tlaku a iné, pre život nevyhnutné procesy. Je všeobecne známe ,že nedostatok vitamínu D má za následok mnohé zdravotné komplikácie a čoraz častejšie sa hovorí o jeho vzťahu ku riziku vzniku koronárnej choroby srdca. Kardiovaskulárne ochorenia sú vedúcou príčinou mortality nielen v Slovenskej republike, ale aj na celom svete. Uvedený prehľad poukazuje na možné vzťahy medzi deficitom vitamínu D a kardiovaskulárnym rizikom. Výpočtová tomografia môže prispieť k presnejšej indikácii selektívnej koronarografie najmä u pacientov s nejednoznačným klinickým nálezom. Jej vzťah k hladine vitamínu D (niekedy zrejme postačí len vyšetrenie kalciového skóre) môže byť príspevkom v klinickej aplikácii tzv. personalizovanej medicíny.
Vitamin D has a significant impact on our health. It is responsible for regular bone development and metabolism and is essential for proper cell differentiation, for the immune system, insulin secretion, blood pressure regulation, and other processes necessarily for life. There are many well-established health risks of vitamin D deficiency, even more probably exist relationship between levels of vitamin D and the risk of coronary artery disease. Cardiovascular disease are still the leading cause of mortality not only in Slovak Republic, but more or less, worldwide. Submitted review describes possible relationship between vitamin D deficiency and the level of cardiovascular risk. Computed tomography may be used for more precise indication of selective coronary angiography, preferentially in patients with ambiguous clinical findings. Its relationship to vitamin D level (sometimes is even sufficient only determination of calcium score) could be helpful in clinical application of so called personalized medicine.
- Klíčová slova
- kalciové skóre, kardiovaskulární riziko,
- MeSH
- CT angiografie metody MeSH
- kardiovaskulární nemoci etiologie prevence a kontrola MeSH
- koronární nemoc * etiologie MeSH
- lidé MeSH
- nedostatek vitaminu D * komplikace MeSH
- vitamin D metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
Clinical case reports play an invaluable role in education of medical students, especially in their preparation for bedside teaching. In general, it is because of the real background based on true stories and integration of professionals' experiences involved in strategies used to solve particular clinical case. In addition, the real clinical case reports are often the core and essential part of another teaching methods including problem-based learning, virtual patients etc. The inconsistency in such education materials offered to our students forced us to initiate activities leading to the development of clinical case reports database and to the motivation of our academic clinicians to participate on it and to utilize it in the education process.
- MeSH
- publikování * normy MeSH
- studium lékařství metody MeSH
- učební pomůcky * MeSH
- učebnice jako téma MeSH
- Publikační typ
- práce podpořená grantem MeSH
INTRODUCTION: Impaired baroreflex function is associated with a shift in autonomic balance towards sympathetic dominance, which may play important role in the development of arterial hypertension and consequent target organ damage. AIM: To determine the effect of treatment on the cardiovascular autonomic modulation expressed by baroreflex sensitivity (BRS) in hypertensives. METHODS: A total of one hundred fourteen hypertensive patients (58 male/56 female, 65 ± 13 years of age, BMI 30 ± 3.4 kg/m(2)) were enrolled. Control group of 20 subjects with normal blood pressure (BP) (ten male/ten female, 59 ± 8 years of age, body mass index 28.3 ± 2.5 kg/m(2)) without any treatment was also studied. BRS and BRSf were determined by the sequence and spectral method: a 5-min on-invasive beat-to-beat recording of blood pressure and R-R interval with use of Collin CBM-7000 monitor, controlled breathing at a frequency of 0.1 Hz. RESULTS: Significant negative correlation between spontaneous BRS and BP was present in hypertensives (r = -0.52, p < 0.001). All cohort of hypertensive patients had significantly lower BRS than subjects with normal blood pressure (p < 0.05). The greatest decline in BRS values was in hypertensive patients with metabolic syndrome, who had BRS values <5 ms/mmHg. Hypertensives with hypercholesterolaemia on low dose statin therapy (atrovastatin 20 mg) had higher BRS/BRSf values than statin free patients (p < 0.05). Only BRSf not BRS was significantly increased in hypertensives with beta-blockers. CONCLUSION: An inverse correlation between blood pressure and BRS is present in hypertensives. BRS and BRSf is higher in low dose statin-treated patients with essential hypertension.
- MeSH
- antihypertenziva aplikace a dávkování MeSH
- arteriální tlak účinky léků MeSH
- atorvastatin aplikace a dávkování MeSH
- autonomní nervový systém účinky léků patofyziologie MeSH
- baroreflex účinky léků MeSH
- časové faktory MeSH
- hyperlipidemie diagnóza farmakoterapie patofyziologie MeSH
- hypertenze diagnóza farmakoterapie patofyziologie MeSH
- kardiovaskulární systém inervace MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- statiny aplikace a dávkování MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Observačné prieskumy ukazujú nízke percento kontrolovaného krvného tlaku. Zlá kontrola tlaku krvi sa pripisuje trom hlavným dôvodom: 1. veľká časť pacientov nie je identifikovaná alebo liečená, najmä v nízko alebo stredne príjmových krajinách, 2. mnoho liečených pacientov nie je adekvátne alebo trvalo kontrolovaných svojimi lekármi alebo neužívajú predpísanú liečbu, 3. malá, ale podstatná časť hypertonikov sa ťažko lieči kvôli rezistentnej hypertenzii, ktorá zahŕňa aj liekmi indukovanú hypertenziu a sekundárnu hypertenziu. Kľúčové slová: baroreceptorová stimulácia, rezistentná hypertenzia, baroreflexná senzitivita
Observational surveys show low rates of blood pressure control. Poor control of blood pressure is attributed to three major reasons: 1. very large proportion of the patients is not identified or not treated, especially in low or low middle income countries, 2. many treated patients are not adequately or persistently managed by their physicians or the patients are not compliant with the prescribed treatment, 3. smaller but substantial proportion of hypertensive patients are difficult to be controlled due to resistant hypertension including drug induced hypertension and secondary hypertension. Key words: baroreceptor stimulation, resistant hypertension, baroreflex sensitivity
Redukovaná baroreflexná senzitivita (BRS) je neinvazívnym markerom dysfunkcie autonómneho nervového systému, ktorá z dlhodobého hľadiska môže prispievať ku vzniku artériovej hypertenzie, jej komplikácií a zvýšeniu globálneho kardiovaskulárneho rizika. Cieľom prezentovanej štúdie bolo stanoviť klinický význam baroreflexnej senzitivity (BRS) pre rizikovú stratifikáciu u hypertonikov bez/ s pridruženými kardiovaskulárnymi ochoreniami. Zistili sme, že esenciálna artériová hypertenzia je asociovaná s redukciou BRS, medzi hodnotami BRS a kategóriou artériovej hypertenzie existuje inverzný vzťah. Hodnota spontánnej BRS bola signifikantne nižšia u hypertonikov s pridruženým kardiovaskulárnym ochorením (CMP, IM) ako u hypertonikov bez tohto ochorenia (p < 0,05). Vyšetrenie spontánnej BRS je klinicky aplikovateľná, neinvazívna metóda s aditívnym významom pre adresnejší, individuálny stratifikačný proces u chorých s artériovou hypertenziou.
Impaired baroreflex sensitivity (BRS) is a marker of autonomous dysfunction, which may play an important role in the long‑term development of arterial hypertension, disease progression as well as complications related to global cardiovascular risk. The aim of the study was to evaluate the clinical significance of baroreflex sensitivity in hypertensives with/ without major cardiovascular events. We found out that essential hypertension is associated with decreased BRS, and that grade of hypertension is inversely related to BRS values. Spontaneous BRS values in hypertensives with major cardiovascular event (stroke, myocardial infarction) were significantly lower even 6 months and more after myocardial infarction and stroke onset compared to remaining patients (p < 0.05). BRS is a clinically applicable, noninvasive method for assessing early dysfunction of autonomic nervous system, which seems to be an additive emerging marker of cardiovascular risk stratification in hypertensive patients.
- MeSH
- autonomní nervový systém patofyziologie MeSH
- baroreflex MeSH
- dospělí MeSH
- hypertenze farmakoterapie komplikace patofyziologie MeSH
- kardiovaskulární nemoci etiologie MeSH
- konzervace krve MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
Baroreflexná senzitivita (BRS) je neinvazívnym markerom dysfunkcie autonómneho nervového systému. Redukovaná BRS je asociovaná s posunom autonómnej rovnováhy ku sympatikovej dominancii, ktorá z dlhodobého hľadiska môže prispievať ku vzniku artériovej hypertenzie, jej komplikácií a zvýšeniu globálneho kardio-vaskulárneho rizika. Cieľom prezentovanej štúdie bolo stanoviť klinický význam baroreflexnej senzitivity (BRS) pre rizikovú stratifikáciu u hypertonikov. Zistili sme, že esenciálna artériová hypertenzia je asociovaná s redukciou BRS, medzi hodnotami BRS a kategóriou artériovej hypertenzie existuje inverzný vzťah. Vyšetrenie spontánnej BRS je metódou s aditívnym významom pre adresnejší, individuálny stratifikačný proces u chorých s artériovou hypertenziou.
Examination of baroreflex sensitivity (BRS) is a non-invasive marker of autonomic dysfunction. Reduced BRS is associated with a shift in autonomic balance towards sympathetic dominance, which leads to initiation of arterial hypertension, disease progression as well as complications related to global cardio-vascular risk in the long term. The aim of the study was to evaluate the clinical significance of baroreflex sensitivity for risk stratification in hypertensive subjects. We found out that essential hypertension is associated with decreased BRS, and that grade of hypertension is inversely related to BRS values. BRS is a clinically applicable, non-invasive method for assessing early dysfunction of autonomic nervous system, which seems to be an additive emerging marker of cardiovascular risk stratification in hypertensive patients.
- MeSH
- autonomní nervový systém krevní zásobení patofyziologie MeSH
- baroreflex fyziologie MeSH
- biologické markery krev MeSH
- hodnocení rizik metody statistika a číselné údaje MeSH
- hypertenze krev patofyziologie MeSH
- kardiovaskulární nemoci etiologie krev MeSH
- krevní tlak MeSH
- lidé MeSH
- prognóza MeSH
- Check Tag
- lidé MeSH
The relationship between baroreflex sensitivity expressed in ms/mm Hg (BRS) or in Hz/mm Hg (BRSf) in hypertensives with stroke in comparison with a group of stroke-free patients was evaluated. Twenty-six patients (aged 66±10 years, 11 females/ 15 males) with a history of the first ever ischemic stroke (6 months and more after stroke onset), which was neuroradiologically confirmed, were studied. These were compared to 30 hypertensive patients without history of any cardiovascular event, being of similar age and sex. BRS and BRSf were determined by the sequence and spectral methods (fiveminute non-invasive beat-to-beat recording of blood pressure and inter-beat interval, controlled breathing at a frequency of 0.1 Hz). A significant negative correlation between spontaneous BRS and blood pressure (BP) represented by the grade of hypertension was present (r = -0.52, p<0.001). Differences between hypertensives with and without stroke were detected in BRS obtained by the spectral method (BRS spect p=0.0237, BRSf spect p=0.0285) or BRS obtained by sequence method (BRS seq p=0.0532, BRSf seq p=0.0273). The greatest decline in BRS values was in hypertensive stroke patients with metabolic syndrome, who had BRS values below 3 ms/mm Hg. We found out that BRS and BRSf were more impaired in stroke patients with essential hypertension even 6 months and more after stroke onset than in stroke-free hypertensive patients. This finding was independent of age-dependent decrease of BRS. Examination of baroreflex sensitivity as a marker of autonomic dysfunction along with global cardiovascular risk stratification of individuals seems to be a method for identifying patients at high residual cardiovascular risk.
- MeSH
- autonomní nervový systém patofyziologie MeSH
- baroreflex MeSH
- časové faktory MeSH
- cévní mozková příhoda diagnóza etiologie patofyziologie MeSH
- dospělí MeSH
- hodnocení rizik MeSH
- hypertenze diagnóza komplikace patofyziologie MeSH
- krevní tlak MeSH
- lidé středního věku MeSH
- lidé MeSH
- regresní analýza MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční frekvence MeSH
- studie případů a kontrol MeSH
- stupeň závažnosti nemoci MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Geografické názvy
- Slovenská republika MeSH
