Maximal athletic performance can be limited by various factors, including restricted respiratory function. These limitations can be mitigated through targeted respiratory muscle training, as supported by numerous studies. However, the full potential of respiratory training in competitive finswimming has not been fully investigated. This case study aims to evaluate the effects of eight-week respiratory muscle training (RMT) on performance variability during the underwater phases of a 200 m bi-fins race simulation in an elite finswimmer (current world record holder and multiple world championship medalist). Performance variability was assessed based on pre-test, inter-test, and post-test data. Each measurement included pulmonary function and swim performance evaluations. In this study, underwater performance parameters, such as distance, time, velocity, and number of kicks, were assessed using video analysis synchronized with race timing and evaluated using the Dartfish software. The swimmer followed a 28-day training program with an Airofit PROTM respiratory trainer between tests, with daily sessions targeting both inspiratory and expiratory muscles. The training involved 6-10 min of targeted exercises per day. Significant improvements were observed in Wilcoxon's paired-sample test between the pre-test and post-test results in terms of underwater distance (p = 0.012; d = 1.26), underwater time (p = 0.012; d = 1.26), and number of underwater kicks (p = 0.043; d = 1.01), resulting in a 14.23% longer underwater distance, 14.08% longer underwater time, and 14.94% increase in underwater kicks. Despite the increased distance and time, underwater velocity remained stable, indicating improved underwater performance efficiency. Despite some improvements, it is not possible to conclude that respiratory muscle training (RMT) can contribute to improved finswimming performance during the underwater phases of a 200 m bi-fins race simulation in this particular athlete's case. Further research with a larger sample size is necessary to fully understand the impact of RMT on finswimming performance.
- Publikační typ
- časopisecké články MeSH
Poškození funkce ledvin patří mezi podceňovaná rizika nekompenzované hypertenze. Dlouhodobé nepříznivé působení vysokého krevního tlaku je rizikové již od mladého věku. V prevenci hypertenzního poškození ledvin je potřebná časná diagnóza a důsledná léčba hypertenze. Podle nových doporučení je třeba vést léčbu k cílovým hodnotám TK < 130/80 mmHg, kterých by mělo být dosaženo optimálně do 3 měsíců od zahájení terapie. U každého hypertonika je navíc doporučeno vyšetřovat nejméně 1× ročně glomerulární filtraci a albuminurii (pomocí poměru albumin : kreatinin v moči). V terapii pacientů s hypertenzí a chronickou renální insuficiencí je zásadní kompenzace krevního tlaku, restrikce konzumace soli a výběr nefroprotektivních antihypertenziv, zejm. ACEI, které je třeba titrovat k nejvyšší tolerované dávce. Již ve druhém kroku léčby hypertenze je doporučena trojkombinace antihypertenziv, pokud ani ta není dostatečná, přidává se nejčastějii spironolakton. Z diuretik by měla být preferována thiazidová a thiazidům podobná diuretika, pouze při hypervolemii, pokročilé renální insuficienci nebo srdečním selhání je vhodný furosemid. Při výpočtu kardiovaskulárního rizika pacientů s hypertenzí je třeba zohlednit i přítomnost albuminurie a u pacientů s vysokým KV rizikem podávat statin.
Renal impairment is one of the underestimated risks of uncompensated hypertension. Long-term adverse effects of high blood pressure are risky from a young age. Early diagnosis and consistent treatment of hypertension are needed in the prevention of hypertensive kidney damage. According to the new recommendations, treatment should be guided to target BP values < 130/80 mmHg, which should be optimally achieved within 3 months of therapy. In addition, it is recommended that every hypertensive patient be examined glomerular filtration rate and albuminuria (using the albumin : creatinine ratio in the urine) at least once a year. In the management of patients with hypertension and chronic renal insufficiency, blood pressure compensation, salt restriction, and the selection of nephroprotectives, especially the use of non-fetal antihypertensives, where ACEIs should be titrated to the highest tolerated dose, are essential. In the second step of the treatment of hypertension, a triple combination of antihypertensive drugs is recommended. If it is insufficient, spironolactone is most often added. Of the diuretics, thiazide and thiazide-like diuretics should be preferred, only in hypervolemia, advanced renal insufficiency, or heart failure furosemide is suitable. When calculating the cardiovascular risk of hypertensive patients, the presence of albuminuria should be taken into account and a statin should be administered in patients at high CV risk.
Nocturnal hypertension is a significant risk factor for cardiovascular mortality and morbidity. Its determination requires the use of 24-hour blood pressure monitoring (ABPM). However, the examination results can be less reliable in patients with insomnia, habitual short sleep or other sleep disorders. In these patients, it is possible to detect falsely high values of blood pressure in the night interval. At the same time, the treatment of sleep disorders itself could adjust the nighttime values of blood pressure and thus prevent unreasonably intensive treatment of high blood pressure. The article summarizes current knowledge about the effect of sleep quality on the accuracy of diagnosis using ABMP. At the same time, we present the study "How to diagnose true nocturnal hypertension?", which will analyze this clinical problem.
Noční hypertenze je významným rizikovým faktorem pro mortalitu i morbiditu z kardiovaskulárních příčin. K její diagnostice je potřeba použít 24hodinové měření krevního tlaku (AMTK). Výsledky vyšetření však mohou být zkresleny u pacientů s nespavostí, habituálním krátkým spánkem či jinými poruchami spánku. U těchto pacientů je možné zachytit falešně vysoké hodnoty krevního tlaku v nočním intervalu. Přitom léčba samotných poruch spánku by mohla hodnoty nočního tlaku upravit, a tím zabránit nepřiměřeně intenzivní léčbě vysokého krevního tlaku. Článek shrnuje aktuální poznatky o vlivu kvality spánku na přesnost diagnostiky pomocí AMTK. Současně prezentujeme studii „Jak diagnostikovat pravou noční hypertenzi?“, která bude tento klinický problém analyzovat.
Objective Real-life management of patients with hypertension and chronic kidney disease (CKD) among European Society of Hypertension Excellence Centres (ESH-ECs) is unclear : we aimed to investigate it. Methods A survey was conducted in 2023. The questionnaire contained 64 questions asking ESH-ECs representatives to estimate how patients with CKD are managed. Results Overall, 88 ESH-ECS representatives from 27 countries participated. According to the responders, renin-angiotensin system (RAS) blockers, calcium-channel blockers and thiazides were often added when these medications were lacking in CKD patients, but physicians were more prone to initiate RAS blockers (90% [interquartile range: 70-95%]) than MRA (20% [10-30%]), SGLT2i (30% [20-50%]) or (GLP1-RA (10% [5-15%]). Despite treatment optimisation, 30% of responders indicated that hypertension remained uncontrolled (30% (15-40%) vs 18% [10%-25%]) in CKD and CKD patients, respectively). Hyperkalemia was the most frequent barrier to initiate RAS blockers, and dosage reduction was considered in 45% of responders when kalaemia was 5.5-5.9 mmol/L. Conclusions RAS blockers are initiated in most ESH-ECS in CKD patients, but MRA and SGLT2i initiations are less frequent. Hyperkalemia was the main barrier for initiation or adequate dosing of RAS blockade, and RAS blockers' dosage reduction was the usual management.
- MeSH
- antagonisté receptorů pro angiotenzin terapeutické užití MeSH
- antihypertenziva terapeutické užití MeSH
- blokátory kalciových kanálů terapeutické užití MeSH
- chronická renální insuficience * komplikace farmakoterapie MeSH
- hypertenze * farmakoterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- průzkumy a dotazníky MeSH
- společnosti lékařské MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
Objectives: Evidence suggests that renal function increasingly deteriorates in patients with apparently treatment-resistant hypertension (ATRH) in comparison with those who have non-resistant arterial hypertension (NAH). We aimed to assess the long-term decline in renal function between these patient groups and identify specific risk factors contributing to the progression of renal dysfunction. Methods: Data for 265 patients with ATRH and NAH in a hypertension excellence centre were retrospectively evaluated. Demographic characteristics, co-morbidities, laboratory findings, secondary causes of hypertension, medication and exposure to contrast agents were assessed. To address differences between groups, adjustment with linear mixed-effect models was used. Results: Data from the first 4 years of follow-up were evaluated. After adjustment for age and diabetes, which were identified as independent risk factors for renal dysfunction progression in the study cohort, the mean decrease in estimated glomerular filtration rate per year was steeper with ATRH than with NAH (-1.49 vs. -0.65 mL/min/1.73 m2 per year; difference in slope, 0.83 mL/min/1.73 m2 per year; 95% confidence interval [CI]: 0.25-1.41, p = 0.005). In subgroup analyses, without Holm-Bonferroni correction, the prescription of MRA indicated a faster decline in renal function in ATRH. Following correction, no specific therapeutic risk factor was associated with faster progression of renal dysfunction. Conclusions: Renal function declines twice as fast with ATRH compared with NAH, independently of age and diabetes. Larger studies are needed to reveal risk factors for renal dysfunction in patients with hypertension.
- MeSH
- antihypertenziva terapeutické užití MeSH
- hodnoty glomerulární filtrace * MeSH
- hypertenze * patofyziologie farmakoterapie komplikace MeSH
- ledviny patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- progrese nemoci MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
OBJECTIVE: Real-life management of hypertensive patients with chronic kidney disease (CKD) is unclear. METHODS: A survey was conducted in 2023 by the European Society of Hypertension (ESH) to assess management of CKD patients referred to ESH-Hypertension Excellence Centres (ESH-ECs) at first referral visit. The questionnaire contained 64 questions with which ESH-ECs representatives were asked to estimate preexisting CKD management quality. RESULTS: Overall, 88 ESH-ECs from 27 countries participated (fully completed surveys: 66/88 [75.0%]). ESH-ECs reported that 28% (median, interquartile range: 15-50%) had preexisting CKD, with 10% of them (5-30%) previously referred to a nephrologist, while 30% (15-40%) had resistant hypertension. The reported rate of previous recent (<6 months) estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (UACR) testing were 80% (50-95%) and 30% (15-50%), respectively. The reported use of renin-angiotensin system blockers was 80% (70-90%). When a nephrologist was part of the ESH-EC teams the reported rates SGLT2 inhibitors (27.5% [20-40%] vs. 15% [10-25], P = 0.003), GLP1-RA (10% [10-20%] vs. 5% [5-10%], P = 0.003) and mineralocorticoid receptor antagonists (20% [10-30%] vs. 15% [10-20%], P = 0.05) use were greater as compared to ESH-ECs without nephrologist participation. The rate of reported resistant hypertension, recent eGFR and UACR results and management of CKD patients prior to referral varied widely across countries. CONCLUSIONS: Our estimation indicates deficits regarding CKD screening, use of nephroprotective drugs and referral to nephrologists before referral to ESH-ECs but results varied widely across countries. This information can be used to build specific programs to improve care in hypertensives with CKD.
- MeSH
- antihypertenziva terapeutické užití MeSH
- chronická renální insuficience * komplikace patofyziologie MeSH
- hodnoty glomerulární filtrace MeSH
- hypertenze * farmakoterapie komplikace MeSH
- konziliární vyšetření a konzultace MeSH
- lidé středního věku MeSH
- lidé MeSH
- pilotní projekty MeSH
- plošný screening metody MeSH
- průzkumy a dotazníky MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
Non-adherence to antihypertensive treatment is frequent, complicates the care of hypertensive patients, represents one of the major causes of treatment failure and is linked with the increased risk of cardiovascular events. Identifying a non-adherent patient is one of the recent daily-practice tasks for which the ideal solution has not yet been found. Presence of certain clinical red flags should prompt the clinician to consider non-adherence. Chemical adherence testing using serum or urine antihypertensive levels is regarded as the best method so far and should be used if available. Alternatively, the check for prescription refills in the patient electronic medical records, or directly observed therapy with subsequent ambulatory blood pressure monitoring may be used. We suggest a simple algorithm to guide the clinicians to detect non-adherence in the practice.
BACKGROUND: Increased glucose uptake and utilization via aerobic glycolysis are among the most prominent hallmarks of tumor cell metabolism. Accumulating evidence suggests that similar metabolic changes are also triggered in many virus-infected cells. Viral propagation, like highly proliferative tumor cells, increases the demand for energy and macromolecular synthesis, leading to high bioenergetic and biosynthetic requirements. Although significant progress has been made in understanding the metabolic changes induced by viruses, the interaction between host cell metabolism and arenavirus infection remains unclear. Our study sheds light on these processes during lymphocytic choriomeningitis virus (LCMV) infection, a model representative of the Arenaviridae family. METHODS: The impact of LCMV on glucose metabolism in MRC-5 cells was studied using reverse transcription-quantitative PCR and biochemical assays. A focus-forming assay and western blot analysis were used to determine the effects of glucose deficiency and glycolysis inhibition on the production of infectious LCMV particles. RESULTS: Despite changes in the expression of glucose transporters and glycolytic enzymes, LCMV infection did not result in increased glucose uptake or lactate excretion. Accordingly, depriving LCMV-infected cells of extracellular glucose or inhibiting lactate production had no impact on viral propagation. However, treatment with the commonly used glycolytic inhibitor 2-deoxy-D-glucose (2-DG) profoundly reduced the production of infectious LCMV particles. This effect of 2-DG was further shown to be the result of suppressed N-linked glycosylation of the viral glycoprotein. CONCLUSIONS: Although our results showed that the LCMV life cycle is not dependent on glucose supply or utilization, they did confirm the importance of N-glycosylation of LCMV GP-C. 2-DG potently reduces LCMV propagation not by disrupting glycolytic flux but by inhibiting N-linked protein glycosylation. These findings highlight the potential for developing new, targeted antiviral therapies that could be relevant to a wider range of arenaviruses.
- Klíčová slova
- Triplixam, poškození cílových orgánů způsobené hypertenzí (HMOD),
- MeSH
- antihypertenziva terapeutické užití MeSH
- echokardiografie MeSH
- hypertenze * farmakoterapie komplikace prevence a kontrola MeSH
- ischemická cévní mozková příhoda diagnóza MeSH
- komorbidita MeSH
- krevní tlak účinky záření MeSH
- lidé středního věku MeSH
- lidé MeSH
- měření krevního tlaku MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
