UNLABELLED: Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Wall-to-lumen ratio (WLR) may represent the earliest step in hypertension-mediated organ damage.Our objective was to compare functional and structural parameters of retinal microcirculation in a randomly selected urban population sample, in hypertensive and normotensive individuals. DESIGN AND METHOD: A total of 398 randomly selected individuals from an urban population aged 25-65 years, residing in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry, with data evaluable in 343 patients. Complete data were available for 342 individuals divided into four groups based on blood pressure and control status of hypertension: normotensive individuals ( n = 213), treated controlled hypertensive individuals ( n = 30), treated uncontrolled hypertensive individuals ( n = 26), and newly detected/untreated hypertensive individuals ( n = 73). RESULTS: There was a tendency to higher wall thickness in treated but uncontrolled hypertensive patients (compared to normotensive and treated controlled hypertensive individuals). WLR was significantly increased in treated but uncontrolled hypertensive patients as well as in individuals with newly detected thus untreated hypertension or in patients with known but untreated hypertension. There was no difference in WLR in treated, controlled hypertensive patients compared with normotensive individuals. CONCLUSION: Our results show that an increased WLR, reflecting early vascular damage, was found in newly detected individuals with hypertension and in untreated hypertensive patients, reflecting early hypertension-mediated vascular damage. Early initiation of hypertension treatment may be warranted.

• MeSH
• arterioly MeSH
• hypertenze * MeSH
• krevní tlak MeSH
• lidé MeSH
• mikrocirkulace MeSH
• retinální cévy diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: An inverse relationship between vitamin D supplementation and C-reactive protein (CRP) and hypertension has been reported, mostly through observational data. This inverse relationship, however, has not been confirmed in randomized controlled trials (RCTs). A meta-analysis of RCTs is needed to provide more robust evidence. OBJECTIVE: This systematic review of RCTs was conducted to assess the effect of vitamin D supplementation on CRP, systolic blood pressure (SBP), and diastolic blood pressure (DBP) in postmenopausal women. METHODS: Four databases (PubMed, Web of Science, Embase, and Scopus) were systemically searched to identify relevant RCTs published in international scientific journals up to January 2023. Changes from baseline and SDs of CRP, SBP, and DBP were compared between postmenopausal women who received vitamin D supplementation and those who did not (controls). These parameters were applied to compute the overall effect sizes using the random-effects model. Data were summarized as mean difference (MD) with 95% CI. Heterogeneity among arms was scrutinized using the Cochrane's Q test and I2 statistic. Publication bias was judged by means of funnel plots and Egger's test. RESULTS: Seven studies with 6 arms on CRP, 6 arms on SBP, and 6 arms on DBP were included in the meta-analysis. Combined effect sizes suggested a significant effect of vitamin D supplementation on CRP (MD = -0.65 mg/L; 95% CI -0.93 to -0.37 mg/L; P < .001). In addition, CRP concentrations were significantly reduced after vitamin D supplementation in studies with a duration of more than 3 months (MD = -0.91 mg/L; 95% CI -1.37 to -0.45 mg/L; P < .001) and studies involving doses of ≤1,000 IU/d (MD = -2.10 mg/L; 95% CI -2.51 to -1.68 mg/L; P < .001). Vitamin D supplementation did not reduce SBP significantly (MD = -1.06 mm Hg; 95% CI -2.43 to 0.30 mm Hg; P = .127) and DBP (MD = 0.003 mm Hg; 95% CI -0.86 to 0.86 mm Hg; P = .994) levels compared with control groups. CONCLUSIONS: This meta-analysis concluded that vitamin D supplementation is associated with reduced CRP concentrations among postmenopausal women.

• MeSH
• C-reaktivní protein * MeSH
• krevní tlak MeSH
• lidé MeSH
• postmenopauza * MeSH
• potravní doplňky MeSH
• randomizované kontrolované studie jako téma MeSH
• vitamin D MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• systematický přehled MeSH

OBJECTIVE: Prepregnancy optimization of cardiovascular function may reduce the risk of pre-eclampsia. We aimed to assess the feasibility and effect of preconception cardiovascular monitoring, exercise, and beetroot juice on cardiovascular parameters in women planning to conceive. DESIGN AND METHOD: Prospective single-site, open-label, randomized controlled trial. Thirty-two women, aged 18-45 years, were allocated into one of four arms (1 : 1 : 1 : 1): exercise, beetroot juice, exercise plus beetroot juice and no intervention for 12 weeks. Blood pressure (BP) was measured at home daily. Cardiac output ( CO ) and total peripheral resistance (TPR) were assessed via bio-impedance. RESULTS: Twenty-nine out of 32 (91%) participants completed the study. Adherence to daily BP and weight measurements were 81% and 78%, respectively ( n = 29). Eight out of 15 (53%) of participants did not drink all the provided beetroot juice because of forgetfulness and taste. After 12 weeks, exercise was associated with a reduction in standing TPR (-278 ± 0.272 dynes s cm -5 , P < 0.05), and an increase in standing CO (+0.88 ± 0.71 l/min, P < 0.05). Exercise and beetroot juice together was associated with a reduction in standing DBP ( 7 ± 6 mmHg, P < 0.05), and an increase in standing CO (+0.49 ± 0.66 l/min, P < 0.05). The control group showed a reduction in standing TPR ( 313 ± 387 dynes s cm -5 ) and standing DBP ( 8 ± 5mmHg). All groups gained weight. CONCLUSION: Exercise and beetroot juice in combination showed a signal towards improving cardiovascular parameters. The control group showed improvements, indicating that home measurement devices and regular recording of parameters are interventions in themselves. Nevertheless, interventions before pregnancy to improve cardiovascular parameters may alter the occurrence of hypertensive conditions during pregnancy and require further investigation in adequately powered studies.

• MeSH
• cvičení fyziologie   MeSH
• dusičnany * MeSH
• dvojitá slepá metoda MeSH
• hypertenze * MeSH
• krevní tlak MeSH
• lidé MeSH
• potravní doplňky MeSH
• prospektivní studie MeSH
• těhotenství MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Efektivita práce levé komory vyžaduje udržení srdečního výdeje, který je nárokován systémovým oběhem, a to bez vysokých metabolických nároků nebo nároků na kyslík ze strany myokardu levé komory. V tomto článku je levá komora uvažována jako pumpa a výkonnost je založena na hodnocení měření jejích tlaků, objemů a průtoku. Analýza funkce komory z hlediska vztahů mezi tlakem a objemem umožňuje plně analyzovat globální a regionální dynamiku komory, kterou lze poměrně snadno a přesně získat pomocí vodivostního katétru. Maximální změna tlaku za jednotku času v levé komoře je považována za ukazatel kontraktility levé komory, za jistých situací může být alternativou arteriální dP/dt max jakožto méně invazivní metoda. Při hodnocení nových kardiostimulačních technik a srdeční resynchronizační terapie se jako nejpraktičtější metoda jeví invazivní systolický krevní tlak s průměrováním více tepů a doplněním o několikrát opakované střídání stimulací

Effective performance of the left ventricle requires the maintenance of a cardiac output as demanded by the systemic circulation without a high hemodynamic cost or pressure and without a high metabolic cost or oxygen demand by the left ventricular myocardium. In this article the left ventricle is considered as a pump and performance is based on evaluation of measurements of its pressure, volumes, and flow. Analysis of ventricular function in terms of pressure-volume relationships allows global and regional ventricular dynamics to be fully analyzed and relatively easily and precisely obtained with conductance catheter. The maximum rate of left ventricular pressure is classically considered as a marker of left ventricular contractility and in specific situation arterial dP/dtmax, as minimally invasive method, can be an alternative. When assessing new pacing techniques and cardiac resynchronization therapy, invasive systolic blood pressure appears to be the most practical measure with multi-beat averaging and the addition of multiple spaced repeated alternations.

• Klíčová slova
• dP/dtmax, Srdeční funkce,
• MeSH
• diagnostické techniky kardiovaskulární klasifikace   MeSH
• funkce levé komory srdeční * MeSH
• hemodynamika MeSH
• kontrakce myokardu fyziologie   MeSH
• krevní tlak MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH
• přehledy MeSH

Kontext: Plicní hypertenze (PH) je u pacientů s chronickým onemocněním ledvin (chronic kidney disease, CKD) onemocněním s vysokou prevalencí; současně je spojeno s nepříznivějším výsledným stavem. Řada studií zkoumala u pacientů s CKD při již zavedené náhradě renálních funkcí (renal replacement therapy, RRT) prevalenci PH neinvazivními metodami. K dispozici je však málo údajů o hemodynamických poměrech pacientů s CKD před zahájením RRT. Účel: Cílem naší studie bylo popsat, s použitím invazivní katetrizace srdce, hemodynamické poměry v plicích u pacientů s CKD ještě před zahájením RRT. Metody: Před zahájením RRT bylo celkem 95 pacientů s CKD vyšetřeno na možnou přítomnost PH transtorakální echokardiografií; pacientům se středně vysokou až vysokou pravděpodobností PH bylo nabídnuto invazivní vyšetření hemodynamiky. Výsledky: Echokardiografické vyšetření zjistilo středně vysokou až vysokou pravděpodobnost přítomnosti PH u 37 (39 %) pacientů s CKD v predialýze. Z 21 pacientů, u nichž bylo invazivní vyšetření hemodynamiky provedeno, potvrdila invazivní katetrizace srdce u 19 (90,5 %) diagnózu PH. Medián věku studované populace byl 61 let (22–72); mezi pacienty bylo 57 % žen. U většiny studované populace byla pozorována symptomatická dyspnoe (85,7 %). Postkapilární PH byla přítomna v 16 případech (76,2 %), přičemž u tří pacientů (14,3 %) byla prokázána kombinace pre- a postkapilární PH. Průměrný tlak v plicnici koreloval s tloušťkou mezikomorového septa (p = 0,01), průměrem levé síně (p = 0,03) a s poměrem E/e’ (p < 0,001). Echokardiografické ukazatele napětí stěny pravé komory a diastolická dysfunkce byly – ve srovnání s pacienty s postkapilární PH v důsledku dilatace pravé komory (p = 0,001), středně těžké až těžké insuficience trojcípé chlopně (p = 0,01), tloušťky mezikomorové přepážky (p = 0,05) a poměru E/e’ (p = 0,03) – u pacientů s kombinovanou pre- a postkapilární PH ovlivněny statisticky významně. Závěr: V této monocentrické studii byla převládajícím fenotypem PH u pacientů s CKD v predialýze postkapilární PH. Echokardiografické markery diastolické dysfunkce korelovaly s invazivně naměřeným průměrným tlakem v plicnici. Pacienti s kombinací pre- a postkapilární PH vykazovali pokročilejší remodelaci pravé komory a vyšší hodnoty markerů diastolické dysfunkce, což ukazovalo na možnou úlohu terminálního selhání ledvin v remodelaci plicní vaskulatury.

Background: Pulmonary hypertension (PH) is a highly prevalent condition in patients with chronic kidney disease and is associated with worse outcomes. Many studies described the prevalence of PH in patients with chronic renal disease on established renal replacement therapy (RRT) by non-invasive methods. However, there is a paucity of data on the peculiar hemodynamic characterization of patients with CKD prior to estab-lished RRT. Purpose: Our study aimed to describe the pulmonary hemodynamics in chronic kidney disease patients before starting established renal replacement therapy by invasive cardiac catheterization. Methods: A total of ninety-five patients with CKD before starting established renal replacement therapy was assessed for probability of PH by transthoracic echocardiography, patients with an intermediate to high probability of PH by transthoracic echocardiography were offered invasive hemodynamic evaluation. Results: Thirty-seven (39%) pre-dialysis CKD patients had an intermediate to high echocardiographic probability of PH. Out of the twenty-one patients who proceeded to invasive hemodynamic study; nineteen (90.5%) patients had a confirmed diagnosis of pulmonary hypertension (PH) by invasive cardiac catheterization. The median age of the studied population was 61 years (22–72). Female gender represented 57% of patients. Most of the studied population had symptomatic dyspnea (85.7%). Post-capillary PH was present in 16 cases (76.2%); whereas 3 patients (14.3%) had a combined pre- and post-capillary PH. Mean pulmonary artery pressure was positively correlated with interventricular septal wall thickness (p-value = 0.01), left atrial diameter (p-value = 0.03) and E/e’ ratio (p-value <0.001). Echocardiographic indices of right ventricular strain and diastolic dysfunction were significantly affected in patients with combined pre- and post-capillary PH as compared to patients with post-capillary PH such as RV dilatation (p = 0.001), moderate to severe tricuspid incompetence (p = 0.01), septal wall thickness (p = 0.05), and E/e’ (p = 0.03). Conclusion: In this single-center study, post-capillary PH was the predominant phenotype of PH in pre-dialysis CKD patients. Echocardiographic markers of diastolic dysfunction were positively correlated with the invasively measured mean pulmonary artery pressure. Patients with combined pre- and post-capillary PH had a more progressive right ventricular remodeling and higher levels of markers of diastolic dysfunction suggesting the possible role of end stage renal disease on remodeling the pulmonary vasculature.

• MeSH
• chronická renální insuficience MeSH
• echokardiografie metody   MeSH
• hemodynamické monitorování metody   MeSH
• lidé MeSH
• plicní hypertenze * diagnóza   komplikace   patofyziologie   MeSH
• plicní tlak v zaklínění MeSH
• srdeční katetrizace metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• klinická studie MeSH

Zvýšení tlaku v levé síni v klidu a zejména při zátěži je hlavní příčinou symptomů a zvýšeného rizika hospitalizace a úmrtí u pacientů se srdečním selháním. Mechanistický přístup se zavedením zařízení s vytvořením mezisíňového zkratu (inter-atrial shunt device, IASD) s cílem snížit tlak v levé síni u pacientů s mírně sníženou a zachovanou ejekční frakcí levé komory se ukázal být v pilotní studii proveditelný a bezpečný. V nerandomizované studii REDUCE LAP-HF a v randomizované studii REDUCE LAP-HF I bylo zavedení IASD spojeno se zlepšením symptomů a hemodynamických parametrů. Dopad zavedení IASD na riziko kardiovaskulárních příhod včetně úmrtí a rizika hospitalizace pro srdeční selhání byl cílem multicentrické randomizované falešnou procedurou kontrolované studie REDUCE LAP-HF II. Přehledový článek se zaměřuje na zdůvodnění metody a výsledky zásadních studií s IASD.

An elevated left atrial pressure at rest and especially at stress is the main cause of symptoms and an increased risk of hospitalization and death in patients with heart failure. The mechanistic approach with implantation of inter-atrial shunt device (IASD) to reduce left atrial pressure in the patients with heart failure with mildly reduced and preserved ejection fraction was feasible and safe in a pilot study. In a non-randomized REDUCE LAP-HF and a randomized REDUCE LAP-HF I study the implantation of IASD was associated with improved symptoms and hemodynamic parameters. The effect of IASD on the risk of cardiovascular events including death and risk of heart failure hospitalizations was the objective of a multicentric randomized sham procedure controlled REDUCE LAP-HF II study. The review article is focused on the rationale of the method and the results of essential studies.

• Klíčová slova
• inter-atrial shunt device,
• MeSH
• echokardiografie MeSH
• hemodynamické monitorování MeSH
• klinická studie jako téma MeSH
• lidé MeSH
• plicní tlak v zaklínění MeSH
• síňová přepážka MeSH
• srdeční selhání * diagnóza   terapie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

High dietary sodium and low potassium intake is associated with high blood pressure (BP). The current study aimed to determine if the sodium-to-potassium ratio is more strongly associated with low (130-139/80-89 mm Hg) and high (≥140/90 mm Hg) BP thresholds among US adults than either sodium or potassium alone. A total of 30,776 patients aged ≥20 years with complete blood pressure participated in the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2018. Demographic information and health characteristics were compared between men and women using the chi-square test for categorical variables and independent samples t-test for continuous variables. Logistic regression was performed to investigate the association of the odds ratios (OR) of different levels of sodium, potassium, and sodium-to-potassium ratio. After multivariable adjustment (age, gender, Body mass index, Smoking, education, Race, Alcohol, total energy intake, and physical activity), no relationship has been observed between high versus low sodium-to-potassium ratio and BP threshold of 130-139/80-89 mm Hg (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 0.92-1.12). Higher sodium-to-potassium ratio (OR=1.24; CI: 1.11-1.38) and dietary intake of potassium (OR=0.66; CI: 0.55-0.80) showed significant association in reducing the BP threshold of ≥140/90 mm Hg. In dose-response analysis, higher BP ≥140/90 mm Hg was inversely associated with higher potassium intake. Furthermore, the sodium-to-potassium ratio showed higher odds in predicting the BP of patients aged ≤60 years, underweight, nonsmokers, and non-alcohol users. The study confirms an inverse association between higher potassium intake and higher BP threshold. The Doses-response analyses showed sodium-to-potassium ratio is a better predictor of BP thresholds than sodium or potassium alone.

• MeSH
• dospělí MeSH
• draslík dietní MeSH
• draslík MeSH
• hypertenze * epidemiologie   MeSH
• krevní tlak fyziologie   MeSH
• lidé MeSH
• rizikové faktory MeSH
• sodík * MeSH
• výživa - přehledy MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Inducible NO synthase (NOS II) was proposed to play an important role in salt resistance of Dahl salt-resistant (SR/Jr) rats. Its chronic inhibition by specific inhibitors was accompanied by blood pressure (BP) elevation in animals subjected to high salt intake. The aim of our study was to evaluate 1) whether such inhibitors affect BP and/or its particular components (sympathetic tone and NO-dependent vasodilation) only under the conditions of high salt intake, and 2) whether similar BP effects are elicited after systemic or intracerebroventricular (icv) application of these inhibitors. Wistar rats fed Altromin diet (0.45 % NaCl) and SR/Jr rats fed either a low-salt (LS, 0.3 % NaCl) or a high-salt (HS, 4 % NaCl) diet were studied. Aminoguanidine (AMG) and 2-amino-5,6-dihydro-6-methyl-4H-1,3-thiazine (AMT) were used as NOS II inhibitors. BP and its responses to acute blockade of renin-angiotensin system (captopril), sympathetic nervous system (pentolinium) and NO synthase (L-NAME) were measured in conscious cannulated rats. There were no significant changes of BP or its components in either Wistar rats or SR/Jr rats subjected to chronic inhibition of NOS II by peroral aminoguanidine administration (50 mg/kg/day for 4 weeks). This was true for SR/Jr rats fed either LS or HS diets. Furthermore, we have studied BP effects of chronic icv administration of both NOS II inhibitors in SR/Jr rats fed HS diet, but we failed to find any BP changes elicited by such treatment. In conclusion, inducible NO synthase does not participate in the resistance of SR/Jr rats to hypertensive effects of excess salt intake.

• MeSH
• chlorid sodný MeSH
• hypertenze * chemicky indukované   MeSH
• krevní tlak fyziologie   MeSH
• krysa rodu rattus MeSH
• kuchyňská sůl * MeSH
• oxid dusnatý MeSH
• potkani inbrední Dahl MeSH
• potkani Wistar MeSH
• synthasa oxidu dusnatého, typ II MeSH
• synthasa oxidu dusnatého MeSH
• zvířata MeSH
• Check Tag
• krysa rodu rattus MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

We recruited 5,970 hypertensive patients with obstructive sleep apnea (OSA) on current antihypertensive treatment from the European Sleep Apnea Database (ESADA) cohort. The group was subdivided into those receiving monotherapy (n = 3,594) and those receiving dual combined therapy (n = 2,376). We studied how major OSA confounders like age, gender, and body mass index as well as the degree of sleep apnea modified office systolic and diastolic blood pressure. Beta-blockers alone or in combination with a diuretic were compared with other antihypertensive drug classes. Monotherapy with beta-blocker was associated with lower systolic blood pressure, particularly in non-obese middle-aged males with hypertension. Conversely, the combination of a beta-blocker and a diuretic was associated with lower systolic and diastolic blood pressure in hypertensive patients with moderate-severe OSA. Systolic blood pressure was better controlled in female patients using this combined treatment. Our cross-sectional data suggest that specific clinical characteristics and type of antihypertensive medication influence the degree of blood pressure control in hypertensive OSA patients. Controlled trials are warranted.

• MeSH
• antihypertenziva terapeutické užití   farmakologie   MeSH
• diuretika farmakologie   terapeutické užití   MeSH
• hypertenze * komplikace   farmakoterapie   MeSH
• individualizovaná medicína MeSH
• krevní tlak MeSH
• lidé středního věku MeSH
• lidé MeSH
• obstrukční spánková apnoe * komplikace   terapie   MeSH
• polysomnografie MeSH
• průřezové studie MeSH
• syndromy spánkové apnoe * komplikace   terapie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

We performed longitudinal examinations of the arterial retinal microvasculature using Adaptive Optics Retinal Imaging in a 30-year-old healthy woman with twin pregnancy from the 23rd week of gestation (wog) to three days postpartum. Two blinded graders recorded the average wall-to-lumen ratio (WLR) of the examined retinal artery. There was a significant increase in the mean WLR over the course of pregnancy followed by a decreasing WLR from the 37th wog. The demonstrated changes in WLR may be an expression of vascular remodeling and adaptation to volume load which indicates that pregnancy can be viewed as a cardiovascular stress test.

• MeSH
• arteria centralis retinae * MeSH
• dospělí MeSH
• hypertenze * MeSH
• krevní tlak MeSH
• lidé MeSH
• preeklampsie * MeSH
• srdce MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH