Luis Alcocer (Mexico), Christina Antza (Greece), Mustafa Arici (Turkey), Eduardo Barbosa (Brazil), Adel Berbari (Lebanon), Luís Bronze (Portugal), John Chalmers (Australia), Tine De Backer (Belgium), Alejandro de la Sierra (Spain), Kyriakos Dimitriadis (Greece), Dorota Drozdz (Poland), Béatrice Duly-Bouhanick (France), Brent M. Egan (USA), Serap Erdine (Turkey), Claudio Ferri (Italy), Slavomira Filipova (Slovak Republic), Anthony Heagerty (UK), Michael Hecht Olsen (Denmark), Dagmara Hering (Poland), Sang Hyun Ihm (South Korea), Uday Jadhav (India), Manolis Kallistratos (Greece), Kazuomi Kario (Japan), Vasilios Kotsis (Greece), Adi Leiba (Israel), Patricio López-Jaramillo (Colombia), Hans-Peter Marti (Norway), Terry McCormack (UK), Paolo Mulatero (Italy), Dike B. Ojji (Nigeria), Sungha Park (South Korea), Priit Pauklin (Estonia), Sabine Perl (Austria), Arman Postadzhian (Bulgaria), Aleksander Prejbisz (Poland), Venkata Ram (India), Ramiro Sanchez (Argentina), Markus Schlaich (Australia), Alta Schutte (Australia), Cristina Sierra (Spain), Sekib Sokolovic (Bosnia and Herzegovina), Jonas Spaak (Sweden), Dimitrios Terentes-Printzios (Greece), Bruno Trimarco (Italy), Thomas Unger (The Netherlands), Bert-Jan van den Born (The Netherlands), Anna Vachulova (Slovak Republic), Agostino Virdis (Italy), Jiguang Wang (China), Ulrich Wenzel (Germany), Paul Whelton (USA), Jiri Widimsky (Czech Republic), Jacek Wolf (Poland), Grégoire Wuerzner (Switzerland), Eugene Yang (USA), Yuqing Zhang (China).

• MeSH
• hypertenze * farmakoterapie   MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH
• Francie MeSH
• Itálie MeSH
• Nizozemsko MeSH
• Španělsko MeSH

BACKGROUND: Stroke is a leading cause of disability and one of the major causes of death worldwide. The short-term prognosis in individual patients is highly variable and cannot be explained solely by stroke severity. We investigated the association of left ventricular ejection fraction with early neurological outcome in acute ischemic stroke. METHODS: In total, 216 patients enrolled in a prospective study, underwent echocardiography and applanation tonometry performed within 1 week after stroke onset. At day 10, favorable outcome was defined as a 4 or more point improvement from baseline National Institutes of Health Stroke Scale or final National Institutes of Health Stroke Scale of 0-1. RESULTS: In patients with favorable outcome, the ejection fraction was significantly higher comparing with patients with poorer prognosis (54.3 ± 7.9 vs. 49.9 ± 9.8%, P = 0.005). Favorable neurological outcome at day 10 was also associated with lower heart rate and lower pulse wave velocity at baseline. Univariate analyses showed that left ventricle ejection fraction and arterial stiffness were the strongest predictors of the poststroke improvement. In multivariate analysis, ejection fraction at least 50% remained significantly associated with favorable outcome after full adjustment for potential confounders (odds ratio 3.81, [95% confidence interval, 1.18-12.35]; P = 0.02). CONCLUSION: These findings provide evidence that in ischemic stroke, preserved ejection fraction and lower pulse wave velocity are associated with early favorable outcome, independently of other known prognostic factors, including blood pressure.

• MeSH
• analýza pulzové vlny MeSH
• cévní mozková příhoda komplikace   patofyziologie   MeSH
• echokardiografie MeSH
• funkce levé komory srdeční * MeSH
• ischemie mozku komplikace   patofyziologie   MeSH
• krevní tlak fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nemoci nervového systému etiologie   MeSH
• odds ratio MeSH
• prognóza MeSH
• prospektivní studie MeSH
• senioři MeSH
• srdeční frekvence MeSH
• stupeň závažnosti nemoci MeSH
• tepový objem * MeSH
• tuhost cévní stěny * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Publikační typ
• úvodníky MeSH

While risk scores are invaluable tools for adapted preventive strategies, a significant gap exists between predicted and actual event rates. Additional tools to further stratify the risk of patients at an individual level are biomarkers. A surrogate endpoint is a biomarker that is intended as a substitute for a clinical endpoint. In order to be considered as a surrogate endpoint of cardiovascular events, a biomarker should satisfy several criteria, such as proof of concept, prospective validation, incremental value, clinical utility, clinical outcomes, cost-effectiveness, ease of use, methodological consensus, and reference values. We scrutinized the role of peripheral (i.e. not related to coronary circulation) noninvasive vascular biomarkers for primary and secondary cardiovascular disease prevention. Most of the biomarkers examined fit within the concept of early vascular aging. Biomarkers that fulfill most of the criteria and, therefore, are close to being considered a clinical surrogate endpoint are carotid ultrasonography, ankle-brachial index and carotid-femoral pulse wave velocity; biomarkers that fulfill some, but not all of the criteria are brachial ankle pulse wave velocity, central haemodynamics/wave reflections and C-reactive protein; biomarkers that do no not at present fulfill essential criteria are flow-mediated dilation, endothelial peripheral arterial tonometry, oxidized LDL and dysfunctional HDL. Nevertheless, it is still unclear whether a specific vascular biomarker is overly superior. A prospective study in which all vascular biomarkers are measured is still lacking. In selected cases, the combined assessment of more than one biomarker may be required.

• Klíčová slova
• Ankle-brachial index, Arterial stiffness, Carotid ultrasonography, Central haemodynamics, Circulating biomarkers, Endothelial function, Vascular biomarkers, Wave reflections,
• MeSH
• analýza nákladů a výnosů MeSH
• arteriae carotides diagnostické zobrazování   MeSH
• biologické markery krev   metabolismus   MeSH
• C-reaktivní protein metabolismus   MeSH
• hemodynamika MeSH
• intimomediální šíře tepenné stěny MeSH
• kardiologie normy   MeSH
• kardiovaskulární nemoci krev   diagnóza   MeSH
• lidé MeSH
• primární prevence MeSH
• riziko MeSH
• rozhodování MeSH
• sekundární prevence MeSH
• společnosti lékařské MeSH
• stárnutí MeSH
• tlakový index kotník-paže MeSH
• tuhost cévní stěny MeSH
• ultrasonografie MeSH
• výsledek terapie MeSH
• výzkumný projekt MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• biologické markery MeSH
• C-reaktivní protein MeSH

BACKGROUND AND OBJECTIVES: It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke. RESULTS: A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak. CONCLUSION: A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.

• MeSH
• cévní mozková příhoda prevence a kontrola   MeSH
• cholesterol MeSH
• hypercholesterolemie farmakoterapie   MeSH
• kognice MeSH
• kognitivní poruchy prevence a kontrola   MeSH
• krevní tlak účinky léků   MeSH
• LDL-cholesterol krev   MeSH
• lidé MeSH
• primární prevence MeSH
• randomizované kontrolované studie jako téma MeSH
• recidiva MeSH
• sekundární prevence MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• Názvy látek
• cholesterol MeSH
• LDL-cholesterol MeSH

BACKGROUND AND OBJECTIVES: The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design. PROTOCOL DESIGN: The European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment trial is a prospective multinational, randomized trial with a 3 × 2 factorial design comparing: three different SBP targets (1, <145-135; 2, <135-125; 3, <125 mmHg); two different LDL-C targets (target A, 2.8-1.8; target B, <1.8 mmol/l). The trial is to be conducted on 7500 patients aged at least 65 years (2500 in Europe, 5000 in China) with hypertension and a stroke or transient ischaemic attack 1-6 months before randomization. Antihypertensive and statin treatments will be initiated or modified using suitable registered agents chosen by the investigators, in order to maintain patients within the randomized SBP and LDL-C windows. All patients will be followed up every 3 months for BP and every 6 months for LDL-C. Ambulatory BP will be measured yearly. OUTCOMES: Primary outcome is time to stroke (fatal and non-fatal). Important secondary outcomes are: time to first major cardiovascular event; cognitive decline (Montreal Cognitive Assessment) and dementia. All major outcomes will be adjudicated by committees blind to randomized allocation. A Data and Safety Monitoring Board has open access to data and can recommend trial interruption for safety. SAMPLE SIZE CALCULATION: It has been calculated that 925 patients would reach the primary outcome after a mean 4-year follow-up, and this should provide at least 80% power to detect a 25% stroke difference between SBP targets and a 20% difference between LDL-C targets.

• MeSH
• antihypertenziva terapeutické užití   MeSH
• cévní mozková příhoda prevence a kontrola   MeSH
• demence etiologie   MeSH
• hypertenze komplikace   farmakoterapie   MeSH
• kognice MeSH
• kognitivní poruchy prevence a kontrola   MeSH
• krevní tlak účinky léků   MeSH
• LDL-cholesterol krev   MeSH
• lidé MeSH
• měření krevního tlaku MeSH
• prospektivní studie MeSH
• recidiva MeSH
• sekundární prevence metody   MeSH
• senioři MeSH
• statiny terapeutické užití   MeSH
• tranzitorní ischemická ataka farmakoterapie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Geografické názvy
• Čína MeSH
• Evropa MeSH
• Názvy látek
• antihypertenziva MeSH
• LDL-cholesterol MeSH
• statiny MeSH

OBJECTIVE: Aortic stiffness is increased in lacunar stroke. The precise mechanism linking aortic stiffness to symptomatic lacunar stroke is not well understood. The aim of this study was to compare the effects of aortic stiffness, carotid stiffness, central blood pressure, and cerebrovascular resistance on carotid flow pulsatility according to stroke subtype. METHODS: Two hundred and one consecutive patients were examined 13 months after hospitalization for their first-ever ischemic stroke. The stroke subtype was classified using the Causative Classification of Stroke System. Carotid-femoral pulse wave velocity (PWV) was used as a measure of aortic stiffness. Common carotid flow pulsatility was expressed as resistive index. Central blood pressure was measured using applanation tonometry. RESULTS: Complete data were available for 174 patients (mean age… 67 ± 10 years, 64% men). In patients with lacunar stroke, aortic PWV was higher (13.11 ± 2.74 m/s) than in individuals with large artery atherosclerosis (9.98 ± 1.87 m/s, P <0.001), cardioembolic (11.31 ± 3.18 m/s, P = 0.04) or cryptogenic stroke (11.13 ± 3.2 m/s, P = 0.01). Similarly, central SBP and resistive index were higher in patients with lacunar stroke (145 ± 23 mmHg and 0.80 ± 0.04, respectively) than those with large artery atherosclerosis (128 ± 18 mmHg, P <0.01 and 0.74 ± 0.07, P <0.01, respectively) or cryptogenic stroke (132 ± 18 mmHg, P <0.01 and 0.76 ± 0.07, P <0.05, respectively). In multivariate analysis, aortic stiffness and central pulse pressure were the main determinants of resistive index independent of stroke subtype. CONCLUSION: Our results suggest that aortic stiffening, by reducing the buffering function of the aorta and thereby increasing the transmission of pressure and flow pulsatility into the cerebral arterioles, may contribute to the pathogenesis of lacunar stroke.

• MeSH
• analýza pulzové vlny MeSH
• arteriae carotides patofyziologie   MeSH
• cévní mozková příhoda patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• přežívající * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tuhost cévní stěny * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Carotid-femoral pulse wave velocity (PWV), as a parameter of aortic stiffness, is an established marker of cardiovascular risk. There has been increasing use of arterial stiffness parameters combining aortic and muscular stiffness or a parameter derived from PWV - the stiffness index beta (BETA = ln(systolic/diastolic pressure) × 2 blood viscosity/pulse pressure × PWV(2)). The aim of this study was to compare different arterial stiffness parameters in a general population random sample. METHODS AND RESULTS: In 809 individuals from the Czech post-MONICA study (aged 54 ± 13.5 years, 47% men), we compared the association of carotid-femoral PWV (cfPWV), carotid-ankle PWV (caPWV), and BETA with cardiovascular risk factors, parameters of subclinical organ damage, and presence of manifest cardiovascular disease. Both cfPWV and caPWV were similarly associated with blood pressure and glucose level, while cfPWV was more strongly associated with age, cholesterol level and glomerular filtration rate whereas caPWV with Sokolow-Lyon index. BETA derived from cfPWV and caPWV was less dependent on blood pressure, while it showed a closer association with coronary heart disease presence, as compared to cfPWV and caPWV. CONCLUSIONS: Addition of lower extremity to aortic stiffness has an effect on the association with cardiovascular risk factors while having no effect on the association with manifest cardiovascular disease. Beta transformation of PWV decreases its dependence on blood pressure and may increase its power in cardiovascular risk prediction.

• Klíčová slova
• Arterial stiffness, Cardiovascular disease, Pulse wave velocity, Target organ damage,
• MeSH
• analýza pulzové vlny * MeSH
• aorta patologie   MeSH
• arteriae carotides patologie   MeSH
• cholesterol krev   MeSH
• dolní končetina patologie   MeSH
• dospělí MeSH
• hodnoty glomerulární filtrace MeSH
• kardiovaskulární nemoci krev   epidemiologie   MeSH
• krevní glukóza metabolismus   MeSH
• krevní tlak MeSH
• lidé středního věku MeSH
• lidé MeSH
• průřezové studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• srdeční frekvence MeSH
• srdeční komory patologie   MeSH
• tuhost cévní stěny * MeSH
• zdravotní stav MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• cholesterol MeSH
• krevní glukóza MeSH

OBJECTIVE: Scanty information is available on the clinical characteristics of resistant hypertension in Central and East European countries. The Blood Pressure (BP) control rate and CArdiovascular Risk profilE (BP-CARE) study allowed us to assess the prevalence and the main clinical features of resistant hypertension in this population. DESIGN AND METHOD: The study was carried out in 1312 treated hypertensive patients living in nine Central and East European countries. RESULTS: Four hundred and twenty-three patients had apparent resistant hypertension, of whom 168 had pseudo-resistant hypertension (noncompliant/white-coat) and 255 were true treatment-resistant hypertension patients (TRH). Clinical BP values in TRH amounted to 157.4±16.9/91.8±10.0 mmHg despite the daily use of 3.6±0.7 drugs. Their 24-h BP values were 149.5±16.5/97.5±9.8 mmHg. Compared to controlled hypertensive patients (n=368) and uncontrolled nonresistant hypertensive patients (n=521), TRH were older with a greater prevalence of women. They showed a higher rate of previous cardiovascular events and a very high cardiovascular risk profile. Estimated glomerular filtration rate was significantly lower in TRH as compared to controlled hypertensive patients and uncontrolled nonresistant hypertensive patients. Overall, target organ damage was more frequently detected in TRH than in controlled hypertensive patients and uncontrolled nonresistant hypertensive patients. The factor most frequently associated with TRH was severity of hypertension followed by age, total cholesterol, BMI and history of heart failure. CONCLUSIONS: The present study provides evidence that the prevalence of TRH in Central and East European countries is similar to that found in Western Europe and USA. It also shows the very high cardiovascular risk of TRH and the elevated association of this condition with obesity, renal failure, organ damage and history of cardiovascular events.

• MeSH
• antihypertenziva terapeutické užití   MeSH
• dospělí MeSH
• hodnoty glomerulární filtrace MeSH
• hypertenze farmakoterapie   epidemiologie   MeSH
• index tělesné hmotnosti MeSH
• kardiovaskulární nemoci komplikace   farmakoterapie   epidemiologie   MeSH
• krevní tlak MeSH
• léková rezistence * MeSH
• lidé středního věku MeSH
• lidé MeSH
• měření krevního tlaku MeSH
• obezita komplikace   MeSH
• prevalence MeSH
• průřezové studie MeSH
• renální insuficience komplikace   MeSH
• rizikové faktory MeSH
• senioři MeSH
• syndrom bílého pláště diagnóza   epidemiologie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• východní Evropa epidemiologie   MeSH
• Názvy látek
• antihypertenziva MeSH

While determinants of aortic pulse wave velocity (aPWV) are well known, much less is known about factors affecting lower-extremity pulse wave velocity (lePWV). Unlike aPWV, increased lePWV does not predict cardiovascular risk, but limits lower-extremity blood flow and is associated with increased left ventricular mass. The aim of this study was to compare the effect of cardiovascular risk factors on aPWV and lePWV. A total of 911 individuals from the Czech post-MONICA study (a randomly selected 1% representative population sample, mean age 54±13.5 years, 47% men) were examined. Pulse wave velocity was measured using the SphygmoCor device. Aging had a large effect on aPWV, but only a small effect on lePWV. After adjustment for covariates, we observed that hypertension, diabetes, chronic kidney disease and dyslipidemia were positively and significantly associated with aPWV. However, only hypertension had a significant effect on lePWV. Increased ankle systolic blood pressure was associated with increased aPWV independently of brachial blood pressure. Ankle systolic blood pressure was more closely related to aPWV than lePWV. Subjects with an ankle-brachial index <1.0 had higher aPWV and lower lePWV compared with individuals with a normal ankle-brachial index. Lower-extremity arterial stiffness is affected by age and cardiovascular risk factors to a lesser extent than aortic stiffness. Increased ankle systolic blood pressure is linked not only to increased lower-extremity arterial stiffness, but also increased aortic stiffness. In subjects with a low ankle-brachial index, lower-extremity arterial stiffness is spuriously decreased.

• MeSH
• analýza pulzové vlny MeSH
• aorta patofyziologie   MeSH
• cévní rezistence fyziologie   MeSH
• dospělí MeSH
• kardiovaskulární nemoci diagnóza   patofyziologie   MeSH
• krevní tlak fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pulzatilní průtok fyziologie   MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• sexuální faktory MeSH
• tlakový index kotník-paže MeSH
• tuhost cévní stěny fyziologie   MeSH
• věkové faktory MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH