27 results on '"Stefanadis, Christodoulos I"'
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2. Novel antidepressant drugs, arterial hypertension and cardiovascular disease.
- Author
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Katsi VK, Marketou M, Vamvakou G, Makris T, Tousoulis D, Stefanadis CI, Vardas P, and Kallikazaros IE
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- Animals, Antidepressive Agents adverse effects, Bupropion adverse effects, Bupropion therapeutic use, Cardiovascular Diseases chemically induced, Cardiovascular System drug effects, Cyclohexanols adverse effects, Cyclohexanols therapeutic use, Humans, Hypertension chemically induced, Patents as Topic, Selective Serotonin Reuptake Inhibitors adverse effects, Selective Serotonin Reuptake Inhibitors therapeutic use, Venlafaxine Hydrochloride, Antidepressive Agents therapeutic use, Cardiovascular Diseases physiopathology, Hypertension physiopathology
- Abstract
Depression is a common mental health issue worldwide leading to disability, functional decline and increased mortality. Novel antidepressants have been developed during the last decades in order to treat depression syndromes. Some evidence suggests that major depression has been associated with the development of congestive heart failure and with adverse outcomes in patients with coronary heart disease. The purpose of the present article is to review the impact of novel antidepressant patent drugs on cardiovascular disease and arterial hypertension.
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- 2013
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3. Impaired glucose homeostasis in non-diabetic Greek hypertensives with diabetes family history. Effect of the obesity status.
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Vyssoulis GP, Liakos CI, Karpanou EA, Triantafyllou AI, Michaelides AP, Tzamou VE, Markou MI, and Stefanadis CI
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- Adult, Aged, Diabetes Mellitus, Type 2 epidemiology, Diabetes Mellitus, Type 2 metabolism, Family Health, Female, Glucose Intolerance metabolism, Glycemic Index physiology, Greece epidemiology, Homeostasis physiology, Humans, Hypertension metabolism, Male, Metabolic Syndrome epidemiology, Metabolic Syndrome metabolism, Middle Aged, Obesity metabolism, Prediabetic State metabolism, Prevalence, Risk Factors, Blood Glucose metabolism, Glucose Intolerance epidemiology, Hypertension epidemiology, Obesity epidemiology, Prediabetic State epidemiology
- Abstract
Arterial hypertension (AH) and diabetes mellitus (DM) are established cardiovascular risk factors. Impaired glucose homeostasis (IGH; impaired fasting glucose or/and impaired glucose tolerance) or pre-diabetes, obesity, and DM family history identify individuals at risk for type 2 DM in whom preventive interventions are necessary. The aim of this study was to determine the glycemic profile in non-diabetic Greek adult hypertensive men and women according to DM family history and the obesity status. Diabetes family history, obesity markers (waist-to-hip ratio, WHR; body mass index, BMI), glycemic parameters (fasting and 2-hour post-load plasma glucose, if necessary; glycated hemoglobin, HbA1c; fasting insulin), insulin resistance indices (homeostasis model assessment, HOMA; quantitative insulin sensitivity check index, QUICKI; Bennett; McAuley), and IGH prevalence were determined in a large cohort of 11,540 Greek hypertensives referred to our institutions. Positive DM family history was associated with elevated fasting glucose (98.6 ± 13.1 vs 96.5 ± 12.3 mg/dL), HbA1c (5.58% ± 0.49% vs 5.50% ± 0.46%), fasting insulin (9.74 ± 4.20 vs 9.21 ± 3.63 μU/mL) and HOMA (2.43 ± 1.19 vs 2.24 ± 1.01) values, lower QUICKI (0.342 ± 0.025 vs 0.345 ± 0.023), Bennett (0.285 ± 0.081 vs 0.292 ± 0.078) and McAuley (6.73 ± 3.43 vs 6.95 ± 3.44) values, and higher IGH prevalence (45.3% vs 38.7%); P < .01 for all comparisons. The difference in the prevalence of IGH according to DM family history was significant (P < .01) in both genders and every WHR and BMI subgroup (except for women with BMI <20 kg/m(2)). Non-diabetic hypertensives with positive DM family history present with higher IGH prevalence and worse glycemic indices levels compared with those with negative family history, especially in the higher WHR/BMI subgroups., (Copyright © 2013 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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4. The interplay of exercise heart rate and blood pressure as a predictor of coronary artery disease and arterial hypertension.
- Author
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Michaelides AP, Liakos CI, Vyssoulis GP, Chatzistamatiou EI, Markou MI, Tzamou V, and Stefanadis CI
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- Adult, Aged, Blood Pressure Determination, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Risk Assessment, Risk Factors, Blood Pressure physiology, Coronary Artery Disease diagnosis, Exercise physiology, Heart Rate physiology, Hypertension diagnosis
- Abstract
Delayed blood pressure (BP) and heart rate (HR) decline at recovery post-exercise are independent predictors of incident coronary artery disease (CAD). Delayed BP recovery and exaggerated BP response to exercise are independent predictors of future arterial hypertension (AH). This study sought to examine whether the combination of two exercise parameters provides additional prognostic value than each variable alone. A total of 830 non-CAD patients (374 normotensive) were followed for new-onset CAD and/or AH for 5 years after diagnostic exercise testing (ET). At the end of follow-up, patients without overt CAD underwent a second ET. Stress imaging modalities and coronary angiography, where appropriate, ruled out CAD. New-onset CAD was detected in 110 participants (13.3%) whereas AH was detected in 41 former normotensives (11.0%). The adjusted (for confounders) relative risk (RR) of CAD in abnormal BP and HR recovery patients was 1.95 (95% confidence interval [CI], 1.28-2.98; P=.011) compared with delayed BP and normal HR recovery patients and 1.71 (95% CI, 1.08-2.75; P=.014) compared with normal BP and delayed HR recovery patients. The adjusted RR of AH in normotensives with abnormal BP recovery and response was 2.18 (95% CI, 1.03-4.72; P=.047) compared with delayed BP recovery and normal BP response patients and 2.48 (95% CI, 1.14-4.97; P=.038) compared with normal BP recovery and exaggerated BP response individuals. In conclusion, the combination of two independent exercise predictors is an even stronger CAD/AH predictor than its components., (© 2012 Wiley Periodicals, Inc.)
- Published
- 2013
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5. The antihypertensive treatment effect on left ventricular diastolic function is reflected in exercise electrocardiogram.
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Liakos CI, Michaelides AP, Vyssoulis GP, Chatzistamatiou EI, Dilaveris PE, Markou MI, and Stefanadis CI
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- Adult, Aged, Diastole physiology, Echocardiography, Doppler, Exercise Test, False Positive Reactions, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, Ventricular Dysfunction, Left diagnostic imaging, Antihypertensive Agents therapeutic use, Diastole drug effects, Electrocardiography, Exercise physiology, Hypertension drug therapy, Hypertension physiopathology, Ventricular Dysfunction, Left drug therapy, Ventricular Dysfunction, Left physiopathology
- Abstract
Background/purpose: Exercise electrocardiographic hump sign is associated with uncontrolled arterial hypertension (AH), left ventricular (LV) diastolic dysfunction, and false-positive exercise testing (ET). The aim of this prospective study was to evaluate the antihypertensive treatment effect on hump and on pseudoischemic ST-segment depression and potential correlations to LV diastolic function and mass changes., Methods: The study comprised 59 non-coronary artery disease patients (45.9 years; 67.8% men) with never-treated arterial hypertension (143.2/95.1 mm Hg). Treadmill ET and echocardiography were performed at baseline and 6 months after pharmaceutical blood pressure normalization. Prevalence of hump and ST depression, transmitral (E/A) and tissue Doppler imaging (E'/A') early/late velocities ratios, E/E' ratio, and LV mass index (LVMI) were all defined., Results: Prevalence of hump was reduced from 69.5% to 23.7% and false-positive ETs from 35.6% to 18.6% (P < .05). Significant improvement (P < .05) was found in E'/A' ratio (0.68 vs 0.84), E/E' ratio (9.3 vs 7.9), and LVMI (109.2 vs 99.8 g/m(2)). Changes in hump were related to ST-depression changes (r = 0.632, P < .001) and to LV diastolic indices changes; patients with hump only at first ET (54.2%) improved E/A and E'/A' ratios, whereas patients with hump only at second ET (8.5%) worsened diastolic indices with similar changes in blood pressure and LVMI., Conclusions: Antihypertensive treatment reduces the prevalence of hump and exercise ischemic-appearing ST depression probably through LV diastolic function improvement., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
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6. New-onset diabetes and cardiovascular events in essential hypertensives: a 6-year follow-up study.
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Tsiachris D, Tsioufis C, Thomopoulos C, Syrseloudis D, Antonakis V, Lioni L, Kallikazaros I, Makris T, Papademetriou V, and Stefanadis CI
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- Age of Onset, Cardiovascular Diseases mortality, Cardiovascular Diseases physiopathology, Diabetes Mellitus mortality, Diabetes Mellitus physiopathology, Female, Follow-Up Studies, Humans, Hypertension mortality, Hypertension physiopathology, Male, Middle Aged, Predictive Value of Tests, Risk Factors, Cardiovascular Diseases epidemiology, Diabetes Mellitus epidemiology, Hypertension epidemiology
- Abstract
Background: Controversy still exists regarding the impact of new-onset diabetes (NOD) on CV outcomes among patients with hypertension. Our aim was to determine the incidence of NOD in essential hypertensives and to evaluate its association with major cardiovascular (CV) events., Methods: We followed-up for a mean period of 6 years 1572 essential hypertensives (mean age 54.3 years, 696 males) for the incidence of NOD, as well as of fatal and non-fatal coronary artery disease and stroke. Based on the development of NOD, the cohort was divided into patients with pre-existing diabetes (10%), patients with NOD (10%) and those who remained free from diabetes., Results: During the follow-up period, new or recurrent cases of coronary artery disease and stroke events occurred at a rate of 5.6% (n = 88) and 4.65% (n = 73). The independent predictors for NOD were age (OR = 1.026, p = 0.041), waist circumference (OR = 1.044, p < 0.001), family history of diabetes (OR = 2.173, p = 0.003) and systolic BP at follow-up (OR 1.022, p = 0.044). The presence of NOD was independently associated with greater incidence of stroke (HR 2.404, p = 0.046), along with age (HR 1.078, p < 0.001), duration of hypertension (HR 1.039, p = 0.017) and office systolic blood pressure at follow-up (HR 1.022, p = 0.026), whereas development of NOD had no relationship with the incidence of coronary artery disease., Conclusions: Our findings indicate the high incidence of NOD and its close association with stroke in essential hypertension. Poorer control of hypertension appears to be a common denominator of both NOD and stroke in this setting., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2011
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7. Arterial hypertension parental burden affects arterial stiffness and wave reflection to the aorta in young offsprings.
- Author
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Kyvelou SM, Vyssoulis GP, Karpanou EA, Adamopoulos DN, Gialernios TP, Spanos PG, Cokkinos DV, and Stefanadis CI
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- Adolescent, Adult, Female, Humans, Male, Prognosis, Severity of Illness Index, Young Adult, Arteries physiopathology, Blood Pressure physiology, Hypertension physiopathology, Parents, Vascular Resistance
- Published
- 2010
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8. A 31 year old woman with essential hypertension grade III and branch retinal vein occlusion with homozygous C677T MTHFR hyperhomocysteinemia and high Lp(a) levels.
- Author
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Katsi V, Tousoulis D, Chatzistamatiou E, Androulakis E, Moustakas G, Skiadas I, Tsioufis C, Antoniades C, Stefanadis CI, and Kallikazaros IE
- Subjects
- Adult, Antihypertensive Agents therapeutic use, Aspirin therapeutic use, Female, Humans, Hyperhomocysteinemia metabolism, Hypertension drug therapy, Lipoprotein(a) blood, Point Mutation, Retinal Vein Occlusion drug therapy, Vitamins therapeutic use, Hyperhomocysteinemia complications, Hyperhomocysteinemia genetics, Hypertension complications, Methylenetetrahydrofolate Reductase (NADPH2) genetics, Retinal Vein Occlusion etiology
- Abstract
We report a 31-year old woman with essential hypertension grade III and history of branch retinal vein occlusion in the setting of hyperhomocysteinemia due to homozygous MTHFR gene mutation and elevated Lp(a). The patient was treated successfully with antihypertensive treatment, acetylsalicylic acid and multivitamin complex supplementation., (Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2010
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9. Differential impact of metabolic syndrome on arterial stiffness and wave reflections: focus on distinct definitions.
- Author
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Vyssoulis GP, Pietri PG, Karpanou EA, Vlachopoulos CV, Kyvelou SM, Spanos P, Cokkinos DV, and Stefanadis CI
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- Adult, Aortic Diseases epidemiology, Aortic Diseases physiopathology, Blood Flow Velocity physiology, Blood Pressure physiology, Carotid Arteries physiopathology, Female, Femoral Artery physiopathology, Heart Rate physiology, Humans, Hypertension diagnosis, Male, Middle Aged, Predictive Value of Tests, Pulsatile Flow physiology, Regression Analysis, Risk Factors, Arteries physiopathology, Hypertension epidemiology, Hypertension physiopathology, Metabolic Syndrome epidemiology, Metabolic Syndrome physiopathology
- Abstract
Background: Arterial stiffness and wave reflections are independent predictors of cardiovascular disease. Metabolic syndrome (MS) is related to increased aortic stiffness in several populations. However, it is unclear whether the association of MS with aortic stiffness differs according to the considered definition. Moreover, data regarding the association of wave reflections with MS are limited. For this purpose, we examined the relationship of arterial stiffness and wave reflections with MS by using four current definitions and a score., Methods: We studied 732 never treated, non-diabetic hypertensive patients. Metabolic syndrome was defined by Adult Treatment Panel III, American Heart Association, World Health Organization (WHO), International Diabetes Federation criteria and MS (GISSI) score. Arterial stiffness was assessed by measuring carotid-femoral pulse wave velocity (PWVc-f). Heart rate-corrected augmentation index (AIx(75)) was estimated as a measure of wave reflections., Results: By all definitions, hypertensive patients with MS had higher PWVc-f compared to hypertensives without MS. On the contrary, no significant difference was observed in AIx(75) between patients with and those without MS except when MS was defined by WHO criteria. An independent association emerged between PWVc-f and GISSI score and MS components (p=0.038 and 0.033 respectively) in patients with MS, after adjustment for age, gender, LDL cholesterol and smoking. Nevertheless, after further adjustment for systolic blood pressure or body mass index, the strength of this association was reduced to a non-significant level., Conclusion: Arterial stiffness is increased in patients with metabolic syndrome irrespective of the definition criteria. On the contrary, metabolic syndrome has no effect on wave reflections, except when this is defined by WHO criteria. Regarding the high prognostic significance of both arterial stiffness and wave reflections, these findings might have important clinical implications., (Copyright (c) 2008 Elsevier Ireland Ltd. All rights reserved.)
- Published
- 2010
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10. Impact of waist circumference on cardiac phenotype in hypertensives according to gender.
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Tsioufis CP, Tsiachris DL, Selima MN, Dimitriadis KS, Thomopoulos CG, Tsiliggiris DC, Gennadi AS, Syrseloudis DC, Stefanadi ES, Toutouzas KP, Kallikazaros IE, and Stefanadis CI
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- Adult, Aged, Blood Pressure, Electrocardiography, Female, Greece epidemiology, Heart physiopathology, Heart Rate, Humans, Male, Middle Aged, Pulse, Sex Characteristics, Heart physiology, Hypertension epidemiology, Waist Circumference
- Abstract
Our aim was to assess the differential effect of waist circumference on left-ventricular (LV) structural and functional alterations, in hypertensive males and females. One thousand seven hundred and eighty nine consecutive, nondiabetic, essential hypertensives (aged 55.8 +/- 13.5 years, 966 females), included in the 3H Study, an ongoing registry of hypertension-related-target-organ damage, were classified to obese and nonobese groups according to Adult Treatment Panel III criteria. All participants underwent complete echocardiographic study including LV diastolic function evaluation by means of conventional and tissue Doppler imaging (TDI) methods, averaging early and late diastolic mitral annular peak velocities (Em, Am, Em/Am) from four separate sites of measurement. Hypertensive obese women compared with nonobese exhibited significantly greater LV mass index and prevalence of LV hypertrophy (by 5.5 g/m(2), P = 0.003, and 8.8%, P = 0.005, respectively), while such differences were not present among men. Obese women compared to nonobese ones were accompanied by lower transmitral E/A (by 0.08, P < 0.001), TDI-derived Em/Am (by 0.12, P < 0.001), and higher E/Em ratio (by 0.8, P = 0.016). In contrast, hypertensive obese men compared to nonobese ones exhibited lower E and Em (by 0.04 m/s and 0.6 cm/s, both P < 0.05). A significant interaction between sex and abdominal obesity was observed only regarding TDI-derived Am and Em/Am. Furthermore, waist circumference was a predictor of E/A (beta = -0.097, P = 0.002) and Em/Am (beta = -0.116, P = 0.001), independently of body size, in females but not in males. The adverse effect of abdominal obesity on LV alterations is more pronounced among female hypertensives, suggesting that routine measurement of waist circumference provides additional information on cardiac phenotype especially in women.
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- 2009
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11. Arterial stiffness in offspring of hypertensive parents: a pilot study.
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Kyvelou SM, Vyssoulis GP, Karpanou EA, Adamopoulos DN, Deligeorgis AD, Cokkinos DV, and Stefanadis CI
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- Adolescent, Adult, Blood Pressure physiology, Child of Impaired Parents, Female, Humans, Hypertension pathology, Male, Pilot Projects, Young Adult, Hypertension genetics, Vascular Resistance physiology
- Published
- 2008
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12. The future of antihypertensive treatment: from myth to imminent reality.
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Stefanadis CI
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- Blood Pressure drug effects, Blood Pressure physiology, Humans, Hypertension metabolism, Hypertension physiopathology, Renin-Angiotensin System drug effects, Treatment Outcome, Antihypertensive Agents therapeutic use, Hypertension drug therapy
- Published
- 2008
13. Microalbuminuria and global myocardial function in patients with essential hypertension [correction of hypertensive].
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Vyssoulis P, Karpanou EA, Michaelidis AP, Barbetseas JD, Kyvelou SM, Gialernios TP, Cokkinos DV, and Stefanadis CI
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- Adult, Aged, Albuminuria complications, Blood Pressure physiology, Female, Heart Rate physiology, Humans, Hypertension complications, Kidney Function Tests, Male, Middle Aged, Myocardial Contraction physiology, Albuminuria physiopathology, Atrial Function physiology, Hypertension physiopathology, Ventricular Function physiology
- Abstract
Introduction: The myocardial performance index, Tei index, is a relatively new echocardiography indice which is related to parameters which express both the systolic and diastolic myocardial function. The purpose of the present study was to investigate the possible correlation of Tei index to microalbuminuria, which is an indice of kidney target-organ damage in hypertensive patients., Materials and Methods: We evaluated 9680 consecutive patients (mean age 55.2 years, 5144 male and 4536 female) with chronic uncomplicated essential hypertension and the correlation between Tei index, defined as the sum of the isovolumetric relaxation and contraction time divided by the ejection time, and kidney target damage (microalbuminuria) was evaluated., Results: In univariate analysis we noticed a positive correlation of Tei index with microalbuminuria (r=0.353 p<0.001). Furthermore, a significant difference was found in each Tei quartile for microalbumin levels (p<0.001). In multivariate analysis with Tei index as a dependent variable (high versus low quartile) and independent variables gender, age, body mass index, plasma glucose, heart rate, blood pressure, kidney function indices and lipids, the independent prognostic correlation to microalbuminuria was noticed (OR: 1.002 p<0.001)., Conclusions: In the present study we found that Tei index correlates with microalbuminuria in essential hypertensive patients. Thus we can assume that this index could be used not only for the evaluation of the global myocardial performance of hypertensive patients but also for the assessment of the cardiovascular risk in arterial hypertension since it correlates with kidney damage.
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- 2008
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14. Beneficial effect of angiotensin II type 1 receptor blocker antihypertensive treatment on arterial stiffness: the role of smoking.
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Vyssoulis GP, Karpanou EA, Kyvelou SM, Adamopoulos DN, Antonakoudis GC, Deligeorgis AD, Cokkinos DV, and Stefanadis CI
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- Adult, Aged, Angiotensin II Type 1 Receptor Blockers adverse effects, Biphenyl Compounds adverse effects, Blood Flow Velocity drug effects, Blood Pressure drug effects, Cohort Studies, Elasticity, Female, Heart Rate drug effects, Humans, Irbesartan, Male, Middle Aged, Muscle, Smooth, Vascular drug effects, Renin blood, Single-Blind Method, Smoking adverse effects, Tetrazoles adverse effects, Angiotensin II Type 1 Receptor Blockers therapeutic use, Atherosclerosis drug therapy, Biphenyl Compounds therapeutic use, Hypertension drug therapy, Tetrazoles therapeutic use, Vascular Resistance drug effects
- Abstract
The purpose of the present study was to assess angiotensin receptor blocker (ARB) treatment on arterial stiffness in select hypertensive patients and define possible differences between smokers and nonsmokers. The authors evaluated 81 consecutive, nondiabetic patients (mean age, 52 years; 47 men) with uncomplicated essential hypertension with high plasma renin activity who were administered monotherapy with irbesartan, an ARB, at maximal dose. Patients were divided into smokers (n=24) and nonsmokers (n=57). Carotid-radial pulse wave velocity (PWVc-r), carotid-femoral pulse wave velocity (PWVc-f), and augmentation index (AIx) were measured before and 6 months after ARB antihypertensive treatment. All mean values of elastic effect indices were decreased after irbesartan monotherapy (AIx, from 26.3%to 21.2% [P<.01;] PWVc-f, from 7.7 m/s to 7.3 m/s [P<.05], and PWVc-r, from 8.9 m/s to 8.3 m/s [P<.001]). When comparing smokers vs nonsmokers, no difference was noted in AIx and PWVc-f change (P=not significant), while PWVc-r change was greater in smokers compared with nonsmokers (P<.05). Chronic ARB treatment may favorably affect arterial stiffness and wave reflections in hypertensive chronic smokers with elevated plasma renin levels.
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- 2008
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15. The effect of heart rate on wave reflections may be determined by the level of aortic stiffness: clinical and technical implications.
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Papaioannou TG, Vlachopoulos CV, Alexopoulos NA, Dima I, Pietri PG, Protogerou AD, Vyssoulis GG, and Stefanadis CI
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- Adult, Brachial Artery physiology, Brachial Artery physiopathology, Case-Control Studies, Elasticity, Female, Humans, Linear Models, Male, Middle Aged, Pulsatile Flow physiology, Regional Blood Flow physiology, Aorta physiology, Aorta physiopathology, Blood Pressure physiology, Heart Rate physiology, Hypertension physiopathology
- Abstract
Background: Augmentation Index (AIx) is related to cardiovascular diseases, risk, and mortality. AIx is associated with heart rate but the effect of aortic stiffness on this relationship has not been studied. The purpose of our study was to investigate the relationship between AIx and heart rate at different aortic stiffness levels., Methods: The study consisted of 425 normotensive and untreated hypertensive subjects. Wave reflections and pulse-wave velocity (PWV) were determined by the Sphygmocor and the Complior systems, respectively., Results: AIx was independently associated with heart rate, age, gender, height, mean blood pressure (BP) and the effective reflection site distance (ERD). The population was divided into three groups of those with different PWV levels (tertiles). The regression lines for AIx with heart rate differed significantly between the 3rd and the other two tertiles of PWV (P = 0.039 for slopes and P = 0.002 for intercepts). This difference remained significant even after adjustment for age, gender, height, mean BP, and distance of wave reflections., Conclusions: A significantly stronger correlation of AIx with heart rate was observed in subjects with higher levels of aortic stiffness as compared to those with lower levels; namely, the same increase in the heart rate between subjects, induced a greater decrease in the AIx at higher compared to lower PWV levels. The correction of AIx for heart rate should be reconsidered based on the aortic stiffness level. This finding has implications for interventional studies that aim to improve central hemodynamics but simultaneously affect heart rate. Further studies that show acute modifications of heart rate at different arterial stiffness levels are required to support these findings.
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- 2008
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16. Nocturnal blood pressure fall and metabolic syndrome score in hypertensive patients.
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Vyssoulis GP, Karpanou EA, Kyvelou SM, Adamopoulos DN, Deligeorgis AD, Spanos PG, Pietri PG, Cokkinos DF, and Stefanadis CI
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- Adult, Aged, Blood Pressure Monitoring, Ambulatory, Cohort Studies, Female, Humans, Hypertension complications, Male, Middle Aged, Circadian Rhythm, Hypertension physiopathology, Metabolic Syndrome complications, Sleep physiology
- Abstract
Background: Data relating dipping status to metabolic syndrome (MS) scores are not available. The purpose of this study is to investigate any possible association of different dipping patterns to MS scores in untreated patients with essential hypertension., Methods: The study included 6256 consecutive, treatment-naive patients with essential hypertension who attended our outpatient clinics. All underwent repeated office blood pressure measurements, 24-h ambulatory blood pressure monitoring, and full clinical and laboratory evaluation. The diagnosis of MS was made according to the Adult Treatment Panel III criteria and patients were classified into five groups: group I (hypertension), group II (hypertension+any one component), group III (hypertension+any two components), group IV (hypertension+any three components), and group V (all five components). Dipping pattern was defined as 'dippers' with nocturnal systolic blood pressure (NSBP) falling >or=10 but <20%, 'nondippers' with NSBP falling >or=0% but <10%, 'extreme dippers' with NSBP falling >or=20%, and 'reverse dippers' with NSBP increasing., Results: Hypertensive patients with MS (n=2573) had higher clinical and ambulatory blood pressure values (P<0.001), whereas the dominant dipping pattern in the non-MS group was nondippers (47.6%), and in the MS group, extreme dippers (37.8%). Furthermore, a considerable decrease in the prevalence of dippers was noticed with the increasing number of MS components (21.1 vs. 19.2 vs. 14.5 vs. 8.4 vs. 7.2%, P<0.001). In contrast, a significant rise in the prevalence of reverse dippers was observed with the increasing number of MS components (7.4 vs. 10.1 vs. 14.9 vs. 20.4 vs. 31.2%, P<0.001)., Conclusions: It seems that hypertensive patients have an increased prevalence of abnormal dipping patterns as the number of MS components rises.
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- 2007
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17. Hypertensive patients with false-positive thallium-201 scintigraphic results in the infero-posterior wall are in high risk for coronary artery disease development.
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Michaelides AP, Tousoulis D, Fourlas CA, Vyssoulis GP, Andrikopoulos GK, Aznaouridis KA, and Stefanadis CI
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- Adult, Chest Pain diagnostic imaging, Chest Pain epidemiology, Coronary Angiography, Coronary Artery Disease diagnostic imaging, Echocardiography, Exercise Test, False Positive Reactions, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Radionuclide Ventriculography, Risk Factors, Tomography, Emission-Computed, Single-Photon methods, Coronary Artery Disease epidemiology, Hypertension diagnostic imaging, Hypertension epidemiology, Thallium Radioisotopes, Tomography, Emission-Computed, Single-Photon standards
- Abstract
Background: It has been previously postulated that Thallium-201 (Tl201) scintigraphy is characterized by relatively low specificity in hypertensive patients. This study was undertaken to assess any possible influence of false-positive scintigraphic results on the prognosis of hypertensive patients., Methods: The study group comprised 179 consecutive hypertensive patients (128 men and 51 women), aged 50+/-7 years, who underwent exercise Tl(201) scintigraphy and coronary angiography (patients with normal scintigraphic results underwent coronary angiography due to persistent angina-like symptoms). All patients with normal coronary arteries underwent a second Tl201 scintigraphy within 36+/-6 months. Patients with reversible ischemia in the second scintigraphy underwent also a second coronary angiography., Results: Coronary artery disease (CAD) was detected in 78 (44%) patients, while the rest 101 (56%) patients had normal coronary arteries. Abnormal scintigraphic results were revealed in 66 (85%) patients with CAD and in 38 (38%) patients without CAD. Twenty-two (58%) of the 38 hypertensive patients with false-positive scintigraphic results presented reversible ischemia of the infero-posterior wall of the left ventricle. Coronary artery disease was detected in 7 (32%) of these patients during the follow-up period., Conclusions: Hypertensive patients with normal coronary arteries and false-positive scintigraphic results usually present with reversible ischemia of the infero-posterior wall of the left ventricle. This group of patients seems to be at increased risk of developing CAD in a long-term follow-up period.
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- 2007
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18. Left ventricular (LV) geometry and dipping state are determinants of LV mass reduction with angiotensin-converting enzyme inhibitor antihypertensive treatment.
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Aznaouridis KA, Vyssoulis GP, Karpanou EA, Marinakis AG, Barbetseas JD, Zervoudaki AI, Cokkinos DV, and Stefanadis CI
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- Adult, Blood Pressure drug effects, Blood Pressure Monitoring, Ambulatory, Drug Therapy, Combination, Female, Humans, Hypertension diagnosis, Hypertension epidemiology, Hypertrophy, Left Ventricular epidemiology, Hypertrophy, Left Ventricular pathology, Male, Middle Aged, Multivariate Analysis, Prognosis, Regression Analysis, Risk Factors, Angiotensin-Converting Enzyme Inhibitors administration & dosage, Hypertension drug therapy, Hypertrophy, Left Ventricular drug therapy, Sodium Chloride Symporter Inhibitors administration & dosage
- Abstract
Objectives: Left ventricular hypertrophy is a major risk predictor in hypertensive patients and its regression is beneficial in terms of prognosis. The aim of this observational, open-labeled study was to investigate the effect of left ventricular geometry and dipping pattern on left ventricular mass reduction after chronic treatment with angiotensin-converting enzyme inhibitors, in a large population of hypertensive patients., Methods: We evaluated untreated patients with mild to moderate essential hypertension, before and 6 months after treatment with angiotensin-converting enzyme inhibitor monotherapy or angiotensin-converting enzyme inhibitor-low-dose thiazide combination. Left ventricular mass index, relative wall thickness and geometry pattern were derived from echocardiography. Dipping state was determined with 24-h ambulatory blood pressure monitoring at enrollment., Results: Overall, left ventricular mass index decrease in the 1400 patients (mean age 52.5 years) who completed the study was 12.9% of baseline value (P<0.00001). After adjusting for pretreatment value, left ventricular mass index reduction was similar with all angiotensin-converting enzyme inhibitors used [P= NS (not significant)], but it was higher in nondippers than dippers (14.1 vs. 12.3%, P<0.0001) and in patients with than without baseline left ventricular hypertrophy (14.6 vs. 11.3%, P<0.0001). We observed a stepwise augmentation of left ventricular mass index decrease with worsening left ventricular geometry (P<0.001). In multivariable analysis, impaired left ventricular geometry and blunted nocturnal blood pressure fall before treatment were independent predictors of a high left ventricular mass index reduction after treatment, independent of blood pressure fall, pretreatment left ventricular mass index, and other potential confounders., Conclusion: In essential hypertension, left ventricular geometry and dipping state are independent determinants of left ventricular mass reduction with angiotensin-converting enzyme inhibitor treatment. All angiotensin-converting enzyme inhibitors are efficient in decreasing left ventricular mass.
- Published
- 2007
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19. Beneficial effects of angiotensin II type 1 receptor blocker antihypertensive treatment on inflammation indices: the effect of smoking.
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Kyvelou SM, Vyssoulis GP, Karpanou EA, Adamopoulos DN, Gialernios TP, Pietri PG, Cokkinos DV, and Stefanadis CI
- Subjects
- Biomarkers blood, Blood Pressure drug effects, C-Reactive Protein drug effects, Female, Humans, Hypertension blood, Hypertension complications, Inflammation complications, Male, Middle Aged, Risk Factors, Serum Amyloid A Protein drug effects, Treatment Outcome, Angiotensin II Type 1 Receptor Blockers therapeutic use, C-Reactive Protein metabolism, Hypertension drug therapy, Inflammation blood, Serum Amyloid A Protein metabolism, Smoking adverse effects
- Abstract
The effect of long-term angiotensin II type 1 receptor blocker (ARB) therapy on inflammation indices has not been fully investigated in a hypertensive population. The authors evaluated 323 consecutive nondiabetic patients (mean age, 57 years; 176 men; 92 smokers) with high renin activity and uncomplicated essential hypertension whose blood pressure levels normalized (from 163.9/100.7 mm Hg to 131.6/82.8 mm Hg) after 4 weeks of ARB or ARB/diuretic treatment. All patients underwent full laboratory evaluation (routine examination of blood and urine, liver, kidney, thyroid function, and lipid and glucose profiles), including measurement of high-sensitivity C-reactive protein and serum amyloid A levels, at drug-free baseline, which was repeated after 6 months of ARB or ARB/diuretic treatment. A significant (P<.001) overall decrease was noted in both high-sensitivity C-reactive protein (-0.41+/-1.56 mg/dL) and serum amyloid A (-0.62+/-2.03 mg/dL), but a smaller decrease in high-sensitivity C-reactive protein and serum amyloid A change was seen in the smoker subgroup compared with nonsmokers (P<.05), indicating that the ARB or ARB/diuretic anti-inflammatory effect may be adversely affected by smoking status.
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- 2007
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20. Effects of antihypertensive treatment with angiotensin II receptor blockers on lipid profile: an open multi-drug comparison trial.
- Author
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Kyvelou SM, Vyssoulis GP, Karpanou EA, Adamopoulos DN, Zervoudaki AI, Pietri PG, and Stefanadis CI
- Subjects
- Acrylates pharmacology, Aged, Angiotensin II Type 1 Receptor Blockers therapeutic use, Antihypertensive Agents therapeutic use, Benzimidazoles pharmacology, Benzoates pharmacology, Biphenyl Compounds pharmacology, Blood Pressure drug effects, Female, Humans, Imidazoles pharmacology, Irbesartan, Life Style, Losartan pharmacology, Male, Middle Aged, Telmisartan, Tetrazoles pharmacology, Thiophenes pharmacology, Valine analogs & derivatives, Valine pharmacology, Valsartan, Angiotensin II Type 1 Receptor Blockers pharmacology, Antihypertensive Agents pharmacology, Hypertension blood, Hypertension drug therapy, Lipoproteins blood
- Abstract
Introduction: Dyslipidaemia is associated with high risk for cardiovascular disease and lipid management is arguably necessary, especially in hypertensive subjects. There is an implication that angiotensin receptor blockers (ARB) are characterised by a beneficial effect on lipid profile in addition to their blood pressure lowering properties. This study was conducted to evaluate blood pressure control and the plasma lipid profile in hypertensive patients after six months' treatment with ARB., Methods: We studied 2438 consecutive, untreated patients with uncomplicated essential hypertension (mean blood pressure [BP] 167/100 mmHg). All patients underwent full lab and echo examination at drug-free baseline, which was repeated after at least 6 months of ARB monotherapy., Results: Overall, ARB treatment reduced BP levels significantly (p<0.0001). Evaluating lipid profile changes, a significant (p<0.0001) reduction was noted in total cholesterol (TC: from 220 +/- 39 to 216 +/- 36 mg/dL), low density lipoprotein cholesterol (LDL: from 146 +/- 35 to 141 +/- 33 mg/dL), ratio of TC to high density lipoprotein cholesterol (HDL) (from 4.80 +/- 1.35 to 4.64 +/- 1.25), apolipoprotein (Apo) B (from 129 +/- 32 to 124 +/- 28 mg/dL), and triglyceride levels (from 130 +/- 63 to 128 +/- 61 mg/dL, p=0.015), while ApoA1 and lipoprotein(a) levels were not significantly affected (149 +/- 23 vs. 149 +/- 22 and 24.9 +/- 26.3 vs. 24.7 +/- 26.4 mg/ dL, respectively, p=NS). Additionally, HDL levels increased from 48.2 +/- 12.2 to 48.8 +/- 11.9 mg/ dL, p<0.0001. According to the individual agent used, a different effect on lipid indices was observed., Conclusions: ARB antihypertensive therapy may have a uniquely beneficial metabolic effect in addition to blood pressure lowering.
- Published
- 2006
21. The Effect of Smoking on Inflammation, Prothrombotic State and Endothelial Dysfunction in Patients with Essential Hypertension.
- Author
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Vyssoulis, Gregory P., Karpanou, Eva A., Kyvelou, Stella-Maria G., Adamopoulos, Dionysios N., Vlachopoulos, Charalambos B., Cokkinos, Dennis V., and Stefanadis, Christodoulos I.
- Subjects
SMOKING ,CARDIOVASCULAR diseases risk factors ,PLASMINOGEN ,FIBRINOGEN ,HOMOCYSTEINE ,HYPERTENSION - Abstract
Objective: Smoking is a modifiable cardiovascular risk factor. It has been reported to affect inflammatory, coagulation indices and homocysteine. The purpose of the present study was to evaluate the effect of smoking on inflammatory, coagulation indices and homocysteine as well as on traditional risk factors, in a large cohort of patients with essential hypertension. Methods: The study comprised 4000 consecutive patients, with uncomplicated essential hypertension (2572 non-smokers and 1428 smokers). Inflammatory indices such as high-sensitivity C-reactive protein (hsCRP), white blood cell count (WBC) and serum amyloid A (SAA) as well as coagulation markers such as serum fibrinogen, plasminogen activator inhibitor (PAI-1) and homocysteine were measured in all patients. Finally, all patients were asked about their smoking habits and, thus, information about smoking intensity and smoking duration was obtained. Results: All studied markers were significantly higher in smokers compared with non-smokers after adjusting for age and gender (p < 0.001). Furthermore, hsCRP, serum fibrinogen and WBC were positively associated with both increasing smoking intensity and time since smoking initiation, while SAA was positively associated with smoking intensity (p = 0.003) and PAI-1 with smoking duration (p = 0.003). No such association was noticed with homocysteine (p = not significant). Conclusions: Smoking affects inflammatory, coagulation indices, homocysteine and traditional risk factors in patients with essential hypertension independently of age and gender. [ABSTRACT FROM AUTHOR]
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- 2009
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22. The impact of third-generation Beta-blocker antihypertensive treatment on endothelial function and the prothrombotic state: Effects of smoking
- Author
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Vyssoulis, Gregory P., Marinakis, Andreas G., Aznaouridis, Konstantinos A., Karpanou, Eva A., Arapogianni, Athina N., Cokkinos, Dennis V., and Stefanadis, Christodoulos I.
- Subjects
HYPERTENSION ,BLOOD pressure ,SMOKING ,CARDIOVASCULAR diseases - Abstract
Background: The significance of β-blockers in the treatment of cardiovascular diseases is well established. The effect of vasodilating β-blockers on endothelial function and prothrombotic state has not been investigated.Methods: The study comprised 550 consecutive patients with uncomplicated essential hypertension. They were treated with celiprolol, carvedilol or nebivolol monotherapy (171, 179, and 200 patients, respectively), achieving comparable blood pressure reduction. Plasma levels of fibrinogen and homocystine and serum levels of plasminogen activator inhibitor–1 (PAI-1) were obtained before and 6 months after initiation of treatment.Results: The three drugs differentiated in regard to homocystine (P < .00001) and fibrinogen level changes (P = .00003), but not (P = NS) in PAI-1 change. In smokers, differentiation was found in all three parameters (P = .0002, P = .001, and P = .006 for fibrinogen, PAI-1, and homocystine, respectively), but in nonsmokers differentiation was found only in homocystine change (P = .00003). In smokers, fibrinogen, PAI-1, and homocystine were reduced more (P = .002, P = .0009, and P <.0001, respectively) than in nonsmokers in the whole study cohort. The effect of nebivolol was more prominent in smokers than nonsmokers in reducing all three parameters (P = .0001, .003, and .003, respectively), whereas in celiprolol and carvedilol-treated groups, differentiation between smokers and nonsmokers was significant (P = .00003 and .01, respectively) only in homocystine level change.Conclusions: In hypertensive smokers, nebivolol resulted in a significant decrease of plasma PAI-1, fibrinogen and homocystine. Celiprolol also significantly affected these parameters but to a lesser degree, whereas carvedilol had no significant favorable action. In nonsmokers, homocystine was reduced significantly by nebivolol. We conclude that smoking status should be a determinant of antihypertensive treatment choice. [Copyright &y& Elsevier]
- Published
- 2004
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23. Proinflammatory effect of abnormal nocturnal blood pressure fall in essential hypertension
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Vyssoulis, Gregory P., Aznaouridis, Konstantinos A., Karpanou, Eva A., Antonakoudis, Georgios H., Zervoudaki, Alexandra I., Triantafyllou, Athanassios, Dimitrakopoulos, Socrates A., Cokkinos, Dennis V., and Stefanadis, Christodoulos I.
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- 2005
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24. Effects of dietary salt intake on nocturnal blood pressure fall in essential hypertension
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Vyssoulis, Gregory P., Karpanou, Eva A., Triantafyllou, Athanassios, Deligeorgis, Alexandros D., Aznaouridis, Konstantinos A., Pietri, Panagiota A., Cokkinos, Dennis V., and Stefanadis, Christodoulos I.
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- 2005
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25. BLOOD PRESSURE RESPONSE TO CATHETER-BASED RENAL SYMPATHETIC DENERVATION IN PATIENTS WITH RESISTANT HYPERTENSION: DATA FROM A NATIONAL MULTICENTER 1-YEAR-FOLLOW-UP STUDY.
- Author
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Tsioufis, Konstantinos P., Ziakas, Antonios, Dimitriadis, Kyriakos, Davlouros, P., Marketou, Maria, Kasiakogias, Alexandros, Kordalis, Athanasios, Nikolopoulou, Lefki, Thomopoulos, Costas, Petroglou, D., Tsiachris, Dimitris, Doumas, Michail, Karvounis, Charalampos, Alexopoulos, Dimitrios, Vardas, Panagiotis, Kallikazaros, Ioannis, Stefanadis, Christodoulos I., Papademetriou, Vasilios, and Tousoulis, Dimitris
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- *
BLOOD pressure , *DENERVATION , *HYPERTENSION - Published
- 2017
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26. HIGH LEVELS OF FIBRINOGEN, BUT NOT FIBRINOGEN GENETIC VARIANTS PREDICT CORONARY ARTERY DISEASE IN SUBJECTS WITH HYPERTENSION AND DIABETES MELLITUS TYPE 2.
- Author
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Papageorgiou, Nikolaos, Briasoulis, Alexandros, Hatzis, George, Kozanitou, Maria, Charakida, Marietta, Miliou, Antigoni, Androulakis, Emmanouel, Tsioufis, Konstantinos, Siasos, Gerasimos, Toutouzas, Konstantinos, Papaioannou, Spyridon, Latsios, George, Pallantza, Zoi, Stefanadis, Christodoulos I, and Tousoulis, Dimitris
- Subjects
- *
FIBRINOGEN , *CONGENITAL heart disease , *HYPERTENSION , *TYPE 2 diabetes , *ATHEROSCLEROSIS , *GENETIC polymorphisms - Published
- 2015
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27. IMPACT OF MULTI-ELECTRODE RENAL SYMPATHETIC DENERVATION ON SHORT-TERM BLOOD PRESSURE VARIABILITY IN PATIENTS WITH DRUG-RESISTANT HYPERTENSION: INSIGHTS FROM THE ENLIGHTN I STUDY.
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Tsioufis, Konstantinos P., Papademetriou, Vasilios, Tsiachris, Dimitris, Kasiakogias, Alexandros, Kordalis, Athanasios, Thomopoulos, Konstantinos, Dimitriadis, Kyriakos, Tousoulis, Dimitris, Stefanadis, Christodoulos I, Parati, Gianfranco, and Worthley, Stephen
- Subjects
- *
KIDNEY diseases , *DENERVATION , *BLOOD pressure , *DRUG resistance , *PATIENTS , *THERAPEUTICS , *HYPERTENSION - Published
- 2015
- Full Text
- View/download PDF
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