Search

Pulse pressure (PP) is a pulsatile component of blood pressure (BP), strongly correlated with arterial stiffness (AS) and impacting prognosis. Disproportionally increased PP values in individuals with autosomal dominant polycystic kidney disease (ADPKD) should be expected, given the multifactorial cardiovascular involvement in the natural course of this disease.To investigate ambulatory PP in a group of ADPKD patients, and to examine the impact of age, sex, kidney function, hypertension, circadian rhythm, and antihypertensive drugs (AH) on studied parameters.A total of 130 ADPKD patients (median age 41 years, 35% men) who underwent 24-hour BP measurement with portable oscillometer Spacelabs 90217, were included in the study and their recordings were retrospectively analyzed. Demographic data and the medical history including antihypertensive treatment were collected, ADPKD was diagnosed based on the criteria by Pei et al., and estimated glomerular filtration rate (eGFR) was calculated according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.Pulse pressure in the whole group was 46 (IQR: 42-53) mm Hg and it was significantly higher in men than in women and during the day compared to nighttime. There was a negative correlation of PP with eGFR and a positive correlation with age. Pulse pressure was not different in ADPKD patients with or without a diagnosis of hypertension.Ambulatory PP is not substantially increased in ADPKD patients across different stages of CKD. It follows a regular pattern of being increased with age, male sex, daytime, and decreasing eGFR, but not with the diagnosis of hypertension.

Coronavirus disease 2019 (COVID-19) is a disease that has changed the life of people in all parts of our planet. The world of science and medicine is struggling with a new, previously unknown enemy: SARS-CoV-2 virus (severe acute respiratory syndrome coronavirus 2) and the pandemic of the coronavirus disease. Although most people develop only mild flu-like symptoms, approximately 13.8% of patients suffer severe pneumonia, that in around 6.1% of cases, requires admission to the Intensive Care Unit. Advanced age and comorbidities, especially diabetes mellitus and cardiovascular diseases are considered to be the major risk factors of severe course of the disease. In this article we present a data overview on prognosis of hypertensive patients, based on published clinical reports as well as recommended procedures for these patients. the article includes an analysis of controversial opinions on the angiotensin-converting enzyme inhibitors/angiotensin receptor AT1 blockers drugs influence on COVID-19 course.

The ASCOT trial was a breakthrough observation where the newer hypotensive drugs proved superior to the older generation drugs in reducing cardio-vascular complications. Large clinical trials results, despite their influence on everyday practice, do not answer the question on long term benefits of a certain therapeutic approach. This question was raised in ASOCT-Legacy trial where the authors searched the answer if the initially started therapy influences the long term prognosis and if discovered amlodipine/perindopril combination advantage will persist for the long time and result in reducing patients’ mortality. The mortality analysis in ASCOT-Legacy trial patients, after on average of 16 years of observation, indicated to 29% reduction in number of stroke deaths in newer drugs group. At the same time the patients not included in the LLA arm benefited with 21% reduction in cardiovascular deaths and 24% reduction in coronary disease mortality.

Atherosclerotic renal artery stenosis is important etiology of secondary hypertension. Optimal treatment in this disease has been widely discussed for the recent 30 years. Authors present a case of a patient with a history of arterial hypertension, chronic closure of left renal artery, left kidney atrophy and chronic kidney disease with significant blood pressure control and kidney function deterioration in a short period of time.

Background and Aims Hypertension (AH) is an early complication of autosomal dominant polycystic kidney disease (ADPKD), which significantly increases the risk of decline of kidney function and impacts cardiovascular risk. The diagnosis of AH is often delayed and the optimal control of blood pressure (BP) is difficult to achieve in this group of patients. Of note, the optimal treatment of AH in ADPKD is yet to be established. Aim of the study was to diagnose AH (including the prevalence of masked hypertension) and to evaluate the control of BP with the use of ABPM in a cohort of ADPKD patients. Method ABPMs were performed in 163 consecutive patients, with ADPKD according to Pei criteria, appointed for the first outpatient visit. Prior to the ABPM, the diagnosis based on office BP or current AH treatment was established as well as age, sex, medication intake, and eGFR (CKD-EPI formula) were recorded. The study had a cross-sectional design. Results Out of 163 performed ABPMs, 143 were eligible for further analysis. The study group consisted of 93 females and 50 males, median age was 40 (18-87) years and median eGFR was 79.5(13-90) ml/min/1.73m2. 68% of patients had CKD G1 or 2. Median systolic blood pressure (SBP) was 127 (101-157) mmHg with blood pressure variability (BPV) 12 (7.8-23); median diastolic blood pressure (DBP) was 79 (58-98) mmHg, BPV 10.8 (6.2-17.4). 35% of patients were non-dippers, 2.7% extreme dippers and 4.9% reverse-dippers. In 31 (55%), out of 56 patients without previous diagnosis of AH, masked hypertension was found. Among 87 diagnosed with AH before the measurement, 49% were treated with 1 drug, and 29% with 2, 13% with 3, and 2% with 4. The most prevalent medication was ACE-inhibitor. Among treated, only 5.5% had all ABPM values within the target. Conclusion 55% of patients previously not diagnosed with AH on the basis of office BP proved to suffer from masked hypertension. The night DBP was the most suboptimally controlled value in ADPKD patients. Whether this is a consequence of nonadherence or suboptimal treatment, needs further investigation. ABPM is an indispensable tool in managing patients inflicted with ADPKD.

Purpose: In the course of hypertension, left ventricular hypertrophy and diastolic dysfunction develop very often and may progress toward heart failure. The aim of the study was to analyze the rela...

The purpose of this article is to evaluate the utility of ultrasound in identifying carotid bodies (CBs) in patients with drug-resistant arterial hypertension.We enrolled 13 patients with drug-resistant hypertension into a trial for surgical CB excision. CT angiography (CTA) and Doppler ultrasound (DUS) of the cervical arteries were performed before surgery. CBs were identified in a blind manner at both CTA and DUS. CBs were defined at CTA as ovoid avidly enhancing structures at the inferomedial aspect of the carotid bifurcation. At DUS, CBs were defined as ovoid solid structures in the inferomedial aspect of the bifurcation.CBs were identified in 12 of 13 patients (23/26 sides) using CTA and in 11 of 13 patients (18/26 sides) using DUS. Identification of CB with DUS and CTA correlated in 17 of 18 cases; in one instance, CB was identified with DUS but not CTA. There was no statistically significant difference in size and volume of CB measured by both methods.Noncarcinogenic CBs can be visualized using DUS, with good correlation of size and location compared with CTA. The findings show that DUS can be reliably used to further examine the role of CBs in cardiovascular disorders and can be used in conjunction with therapies that target CBs.

The aim of the study was to test the hypothesis that alterations in large arteries are associated with microvascular remodelling and decreased retinal capillary blood flow.The study group comprised of 88 patients with essential hypertension and 32 healthy controls. Retinal microcirculation was evaluated by scanning laser Doppler flowmetry. Macrovascular changes were assessed on the basis of arterial stiffness measurement (carotid-femoral pulse wave velocity), its hemodynamic consequences (central pulse pressure, augmentation pressure, augmentation index) and intima media thickness of common carotid artery.Pulse wave velocity was inversely correlated to mean retinal capillary blood flow in hypertensive patients (R = -0.32, p 0.01). This relationship remained significant in multivariate regression analysis after adjustment for age, sex, central systolic blood pressure (BP) and body mass index (β = -31.27, p 0.001). Lumen diameter (LD) of retinal arterioles was significantly smaller in hypertensive then normotensive subjects (79.4 vs. 83.8, p = 0.03). Central and brachial systolic, diastolic and mean BPs were significantly correlated with LD and outer diameter of retinal arterioles. The relationship between LD and central BPs remained significant in multivariate analysis (β = -0.15, p = 0.03 for cSBP; β = -0.22, p = 0.04 for cDBP; β = -0.21, p = 0.03 for cMBP). Moreover, in a subgroup with cardiac damage central and brachial pulse pressure were positively associated with retinal wall thickness, wall cross sectional area, and wall to lumen ratio.In conclusion, the study provides a strong evidence that microcirculation is coupled with macrocirculation not only in terms of structural but also functional parameters.

Arterial stiffening is a hallmark of early vascular aging (EVA) syndrome and an independent predictor of cardiovascular morbidity and mortality. In this case-control study we sought to identify plasma metabolites associated with EVA syndrome in the setting of hypertension. An untargeted metabolomic approach was used to identify plasma metabolites in an age-, BMI-, and sex-matched groups of EVA (n = 79) and non-EVA (n = 73) individuals with hypertension. After raw data processing and filtration, 497 putative compounds were characterized, out of which 4 were identified as lysophosphaditylcholines (LPCs) [LPC (18:2), LPC (16:0), LPC (18:0), and LPC (18:1)]. A main finding of this study shows that identified LPCs were independently associated with EVA status. Although LPCs have been shown previously to be positively associated with inflammation and atherosclerosis, we observed that hypertensive individuals characterized by 4 down-regulated LPCs had 3.8 times higher risk of EVA compared to those with higher LPC levels (OR = 3.8, 95% CI 1.7–8.5, P < 0.001). Our results provide new insights into a metabolomic phenotype of vascular aging and warrants further investigation of negative association of LPCs with EVA status. This study suggests that LPCs are potential candidates to be considered for further evaluation and validation as predictors of EVA in patients with hypertension.

Introduction. Arterial hypertension (HT) affects 10.4 million adult Poles, and the blood pressure (BP) control rate is only 26%. Beyond any doubt, high blood pressure results in cardiovascular (CV) target organ damage, which markedly influences national healthcare programs. Childhood introduced cardiovascular prophylaxis offers opportunities to decrease incident HT and delay or even eliminate its consequences. Therefore we have decided to study the level of knowledge on HT and CV disease (CVD) among random 1st and 2nd grade high school students in Tricity, Poland. Material and methods. Questionnaire-based study was conducted voluntarily in two selected high schools of the Tricity agglomeration, Poland, in 2000 and repeated in 2016. All participants were presented with a 38-item questionnaire on cardiovascular risk factors knowledge as well as students’ health habits. Results. Studied group consisted of 615 students (57.6% females) at the age of 16, mean BMI 20.89 ± 2.95 kg/m2 (78% BMI norm). The evaluation of the several habits in two time-points was as follows: additional salt intake was reported by 38.3% vs. 35.1% adolescents in 2000 and 2016, respectively; p = 0.43, dining in fast food restaurants at least once a week: 13.9% vs. 44.8%; 2000/2016; p < 0.01; hours per week spent on physical activity: 5.6 ± 4.4 vs. 5.5 } 4.5; p = 0.85; students who never drank alcohol: 19.7% vs. 31.1%; p < 0.01; cigarettes ever smoking: 39.6% vs. 21.2%; p < 0.01; regular smokers: 10.2% vs. 4.1%; p < 0.05. The awareness of CV-preventive measures such as body weight reduction was presented by 88.1% vs. 93.9% students in 2000 vs. 2016; p = 0.01; regular physical activity 92.6% vs. 97.1%; P = 0.01, limiting smoking and alcohol consumption 84.2% vs. 91.2%; p = 0.01; salt reduction: 62.6% vs. 82.3%; p < 0.001. Interestingly, in 2016 the majority of students identified myocardial infarction as a consequence of AH 92.4%, which was markedly less evident in case of stroke and kidney disease (46.2%, and 28%, respectively). Conclusion. Although the awareness of negative consequences of HT and other CV-risk factors has grown over the past 15 years, the implementation of this knowledge is insufficient among high-school adolescents.

Objective The aim of this study was to examine the relationship between orthostatic hypotension, cardiovascular drug intake and mortality in a very elderly community-dwelling population (>80 years of age). Methods In 2013-2014, 224 (71 M, 31.7%) 80-year-old individuals from one primary care practice were invited to participate. Basic clinical information was gathered and blood pressure (BP) measurements were performed while sitting and after 1 and 3 min in the standing position on 209 patients. The individuals were followed till December 2016. Results Orthostatic hypotension was present, depending on applied definition, in 34.5% of the individuals at 1 min, 38.3% at 3 min; 44.9% on either 1 or 3 min, and 27.8% individuals in both measurements. Sixty-nine (30.8%) individuals died during the follow-up. Presence of orthostatic hypotension, irrespective of definition, did not have any significant association with the mortality risk in all groups. Intensive hypertension treatment (more than two drugs versus none) was associated with longer survival. In a multivariate logistic regression analysis, only age and presence of coronary heart disease/congestive heart failure had a negative predictive value on mortality. In both treated and untreated individuals, presence of orthostatic hypotension was not linked to mortality. Conclusion Although orthostatic hypotension is very common among the very elderly, its presence is not related to increased risk of death (all-cause/cardiovascular). Intensively treated elderly patients had significantly longer survival time than untreated individuals.

Background: Prevalence of obstructive sleep apnea (OSA) in patients with hypertension outnumbers the prevalence reported in the general population. Concurrently, majority of patients remain undiagnosed. Given the fact that untreated OSA contributes to ineffective hypotensive treatment, and higher rate of complications is ascribed to hypertension, early OSA diagnosis and its elimination constitutes one of the key clinical goals. Polysomnography comprises a golden standard in sleep apnea diagnosis, however it is a time-consuming and expensive procedure which requires hospitalization. Therefore, we assessed the utility of simplified polygraphic (PG) studies in the OSA screening of patients with hypertension requiring regular tertiary care. Material and methods: The study was conducted in the Outpatient Tertiary Care Clinic of the Medical University Hospital of Gdansk. We enrolled consecutive patients regardless of OSA symptoms presence (n = 243), as well as patients with OSA suspicion (n = 75). A total of 318 patients (39% females) were subjected to ambulatory, one night polygraphic study (ApneaLink™). The following signals were recorded: airflow (pressure cannula), respiratory movements, and pulse oximetry. Additionally, anthropometrics, Epworth Sleepiness Scale (ESS), selected clinical symptoms, and drug-regimen were recorded. Results: Three hundred and eight (97%) patients completed the study (10 dropouts due to study failure). Patients were 57.7 ± 11.5 years old, had BMI = 30.0 ± 5.0 kg/m 2 , and average ESS = 5.7 ± 4.6. 65.3% of all patients were characterized by AHI ≥ 5 (62.2% vs. 74.7% in Random vs. Symptomatic group, respectively; P = 0.49), whereas 27.6% of patients were diagnosed with AHI ≥ 15 (23.6% in Random group and 40.0% in Symptomatic group). In logistic regression analysis, nocturia (> 2) increased the odds of AHI ≥ 30 diagnosis approximately 3.5 times in a fully adjusted model. Conclusions: Our results justify routine polygraphic screening of hypertensive patients requiring tertiary care. Abridged medical history may substantially increase the odds for positive screening.

Introduction: Endothelial cell migration and proliferation play an important role in the growth and development of new blood vessels and endothelium healing. This process occurs in response to injury, inflammation and immune reactions. Dysfunction of the endothelium may play a significant role in development and progression of cardiovascular disease related to sleep-disordered breathing. The aim of our study was to evaluate the chemo-attractant activity of serum from obstructive sleep apnea (OSA) and normal subjects on coronary artery endothelial cell migration. Material and methods: We studied 12 severe OSA patients, free of other co-morbidities and on no treatment, along with 12 age-, body mass index, and gender matched healthy controls. Blood was collected at three time points: at 21:00 before sleep, at 6:00 after waking from sleep, and at 11.00 (after 5 h of normal daytime activity). Serum chemo-attractant activity for human coronary endothelial cells was assessed using a colorimetric cell migration assay kit. Results : In healthy subjects, serum chemo-attractant activity peaked in the morning after waking from sleep (p = 0.02). This early morning increase was blunted in severe OSA subjects, in whom chemo-attractant activity was weaker than in normal controls (p = 0.02), and did not change significantly at the different time-points (p < 0.001 vs. controls). Conclusions : Chemo-attractant activity of the serum from OSA patients is lower compared to serum from healthy subjects, especially in the morning. Altered chemo-attractant serum activity may conceivably contribute to the impairment of endothelial function in obstructive sleep apnea patients.

Background Metabolic syndrome (MS) constitutes a major determinant of cardiovascular (CV) morbidity and mortality in adults. This phenomenon in women before menopause is attenuated by gonadal hormonal activity. After menopause the CV disease (CVD) incidence among women increases dramatically, and often overtakes the prevalence observed among men. Little is known about the CV-risk characteristic of early postmenopausal women in our country. Therefore the aim of our study was to investigate the frequency and distribution of metabolic syndrome components in early postmenopausal women residing urban-rural area in central Poland. Material and Methods All women aged 65–75 years, opted for one general practice form an urban-rural area in Central Poland were invited to participate. The anthropometric measures, blood pressure and blood sampling were performed. For the purpose of the study, the modified NCEP ATP III criteria for the diagnosis of metabolic syndrome were used. Results 59.5% of eligible women accepted the invitation. Additional 5.2% of randomly selected women from initially non-responders group were added to the investigated population. In the studied group only 15.7% had normal body weight and 82.4% met the criteria for abdominal obesity (92% according to IDF). 81.9% of women were characterized by hypertension, even more met the NCEP ATP III criterion for elevated blood pressure (BP) (91.5%). Only 24.2% of studied women were treated effectively; moreover, despite treatment with three antihypertensive drugs 17.4% hypertensive women did not reach target BP values. Over one quarter of studied women suffered from diabetes mellitus, among whom 25.5% were not aware of the presence of the disease. Another 37.1% of women presented with prediabetic condition. Lipid disturbances were noted in the 25.3% and 18.4% of women for triglycerides (TG) increase and low HDL-C levels, respectively. According to modified NCEP ATP III criteria we were able to diagnose 58.8% of studied women with metabolic syndrome. Additionally, 31.9% of postmenopausal women were active cigarette smokers. Conclusions Metabolic profile of early postmenopausal women in central Poland is strikingly abnormal. High incidence of metabolic syndrome is mainly determined by extremely prevalent increased blood pressure and abdominal obesity. With relation to all identified metabolic syndrome components, the strategy aimed at the improvement of body mass status, diabetes diagnosis and especially blood pressure control appear to be of highest priority.

Objective:The aim of the study was to test the hypothesis if arterial stiffness is linked to reduction of retinal capillary blood flow and development of retinal microvascular remodelling.Design and method:The study group comprised of 88 patients with essential hypertension (n = 88, 54.3 ± 8.3 years

Objective:The aim of the study was to establish the relationship between structural and functional abnormalities of retinal microcirculation and cardiac damage defined as the presence of left ventricle hypertrophy and/or diastolic dysfunction.Design and method:The study consisted of 88 patients with

Previous studies reported that normobaric hyperoxia influences heart rate, arterial pressure, cardiac output and systemic vascular resistance, but the mechanisms underlying these changes are still not fully understood. Several factors are considered including degeneration of endothelium-derived nitric oxide by reactive oxygen species, the impact of oxygen-free radicals on tissues and alterations of autonomic nervous system function. Recently, new devices for the detailed non-invasive assessment of large and small arteries have been developed. Therefore, the aim of our study was to assess heart rate variability (HRV) as a potential indicator of autonomic balance and its relation to blood pressure and vascular properties during medical air (MAB) and 100% oxygen breathing (OXB) in healthy volunteers. In 12 healthy subjects we assessed heart rate and blood pressure variability, baroreflex sensitivity, respiratory frequency, common carotid artery diameter and its wall distensibility, as well as changes in the digital artery pulse waveform, stroke index and systemic vascular resistance during MAB and OXB. Mean and systolic blood pressure have increased significantly while digital pulse amplitude and carotid artery diameter were significantly lower during hyperoxia. Heart rate variability measures did not differ during MAB and OXB. However, the correlations between spectral HRV components and those hemodynamic parameters which have changed due to hyperoxia varied substantially during MAB (correlated significantly) and OXB (no significant correlations were noted). Our findings suggest that autonomic nervous system might not be the main mediator of the cardiovascular changes during 100% oxygen breathing in healthy subjects. It seems that the direct vascular responses are initial consequences of hyperoxia and other cardiovascular parameter alterations are secondary to them.

Background: Atrial fibrillation (AF) constitutes the most prevalent arrhythmia, affecting up-to 2% of the general population. Apart from well-established risk factors that increase the odds for the development of AF, e.g. age or arterial hypertension, recent analyses indicate that obstructive sleep apnoea (OSA) may independently, negatively modify the arrhythmia occur­rence profile. Concurrently, erectile dysfunction (ED) is a commonly neglected, potent marker of cardiovascular risk, which considerably worsens men’s psychological state. Unrecognised or untreated ED results in substantial deterioration of the patient’s therapeutic programme adherence. Because AF, OSA, and ED share multiple risk factors and clinical consequences, in 2013 the concept of their frequent concurrence — OSAFED syndrome — was proposed. Aim: The aim of the study was to evaluate the prevalence of OSAFED patients with AF in primary care practice. Methods: Retrospective analysis was carried out of data from primary care physician charts (NZOZ Esculap Gniewkowo, central Poland) including 1372 men aged 40–65 years. The primary goal was to determine the diagnosis of paroxysmal and/or perma­nent AF, which was followed by sleep apnoea screening (polygraphy) and erectile function evaluation (IIED-5 questionnaire). Results: Twenty-one (1.5%) patients with documented AF were identified. Based on the sleep-polygraphic studies, 14 (67%) of them had confirmation of OSA with mean apnoea–hypopnea index (AHI) equal to 27.5 ± 17.1. Furthermore, 11 (52%) patients met the OSAFED syndrome criteria. Patients with OSAFED syndrome had a mean score in IIEF-5 of 11.6 ± 3.5. The OSAFED-patients who were not diagnosed with all the of the syndrome components prior to the study-enrolment were characterised by substantially lower fat excess compared to their counterparts with already established OSAFED (body mass index: 30.1 ± 4.9 vs. 37.7 ± 3.9 kg/m 2 , respectively, p = 0.03). Conclusions: Frequently coexisting OSAFED syndrome components in all AF patients from the primary care setting should encourage a more active search for OSA and ED in patients with any documented form of AF. Most of the studied patients did not have the diagnosis of OSA nor ED done prior to participation in the study.

OBJECTIVE. The aim of the present study was to compare the effectiveness of Systemic COronary Risk Evaluation (SCORE) charts and European Society of Hypertension/European Society of Cardiology (ESH/ESC) hypertension guidelines for identifying high-risk hypertensive patients. METHODS. The data on hypertensive patients was collected using the Polish Hypertension Registry. We enrolled 636 patients (357 females and 279 males, mean age 54.4 (+/-) 7.9 years) from hypertension centres in Poland. RESULTS. Only 3.5% of the subjects had no additional risk factors. Thirty-six per cent of the patients had three or more risk factors. Metabolic syndrome was found in 40.1% of the patients. According to the SCORE charts, 9.0% of females and 27.2% of males had high to very high cardiovascular risk (p0.001). Taking into account risk factors and the metabolic syndrome, 55.7% of females and 56.3% of males (p = NS) had high or very high additional cardiovascular risk according to the 2007 ESH/ESC guidelines. For both females and males, the prevalence of high to very high risk was greater (p0.001) from the calculation based on the 2007 ESH/ESC guidelines than from the SCORE charts. Fifty-two per cent of patients classified as low to moderate risk according to the SCORE system, had high or very high risk according to the 2007 ESH/ESC guidelines. CONCLUSIONS. The SCORE charts seem to underestimate the burden of the cardiovascular risk among hypertensive patients. The cardiovascular risk, especially in the hypertensive female population, seems to be much higher when estimated according to the 2007 ESH/ESC guidelines.

Background: According to current ESH guidelines cardiovascular risk assessment is recommended in vast majority of patients with hypertension. However the groups of patients exist where risk assessment may be challenging. Aim: The aim of our analysis was to compare risk factors, and target organ damage profiles in two groups of hypertensive patients with discrepant results in office vs. ambulatory blood pressure values. Methods: From the outpatient hypertensive cohort (N=773) two groups were chosen – (1) white coat effect patients “WCHT” with systolic office blood pressure (OSBP) > 140 mmHg, and 24-hour systolic blood pressure < 130 mmHg; and (2) patients with normal OSBP but 24-hour SBP > 130 mmHg “MHTN”. Anthropometric measurements, together with basic cardiovascular risk factors and target organ damage assessment were performed. Results: In univariate analyses age, weight, BMI, waist circumference, as well as biochemical markers (total cholesterol, HDL, LDL-C, triglycerides, glucose levels) were comparable between the groups (P=NS, for all comparisons). MHTN patients presented with more pronounced target organ damage markers (eGFR, LVH, IMT) except for cfPWV (11.4 vs. 9.6 m/s for WCHT vs. MHTN, respectively; P

The relative accuracy of office, home and ambulatory blood pressure (BP) measurements has not been established in patients with metabolic syndrome (MS+). We set out to compare BP values obtained using different measurement modalities and their relationship to MS intensity in hypertensive outpatients. Office, ambulatory and home BPs and risk profile were ascertained. MS was defined according to ATPIII criteria. The study included a cohort of 104 men and 132 women with a mean age of 51.8 +/- 14.2 years; 40.3% had metabolic syndrome (MS+). The MS+ patients had higher home SBP (150 vs 142 mmHg, p < 0.01), were treated with more drugs (3.9 vs 3.0, p < 0.001) and had a poorer BP control on home measurements (11.6 vs 24.8%, p = 0.01). However, the clinical BP control rates were overall higher, and did not differ between two groups when daytime ambulatory (34.7 vs 27%) or office (26.7 vs 22.3%) values were employed. The deviation of home measurements was associated in a dose-dependent fashion with intensity of MS. Thus, in MS+ patients, the well standardized measurement protocols and equipment should be used to assess the antihypertensive efficacy. This is especially true for patients with high body mass index.

The authors review the present situation in epidemiology and prevention of arterial hypertension in Poland. In 2002, the NATPOL PLUS survey on representative sample of adults (n=3051, age range 18-93) was conducted. Prevalence of hypertension, diagnosed on basis of three separate visits, was 29%, awareness 67% and efficacy of treatment 12.5%. Thus, in Poland, one-third of 8.6 million hypertensives are unaware of their disease. A comparison with data from other countries should be careful due to the different methods (age range, number of readings and visits) used in the studies. The data, in concert with a decrease in awareness of one's own blood pressure (from 71% in 1994 to 59% in 2002), called for urgent preventive measures. Two large interventions were implemented under the National Programme POLKARD in 2003: the Polish 400 Cities Project aimed to increase detection and knowledge of hypertension and other risk factors among small-town and village communities, and the educational project, A Chance for the Young Heart targeted at children aged 11-14 years and using traditional teaching methods and an interactive Internet website. Also, an educational and marketing programme targeted at public opinion leaders and decision makers (trade unions, local governments, healthcare financing authorities, print media and radio, the Polish Parliament) started in 1999 and is still in process.

This review examines the impact of obesity on cardiovascular health. We will review first, relationship between obesity and hypertension. Second, we will describe obesity-related subclinical abnormalities in cardiovascular function and structure. Third, we will summarize evidence linking obesity to overt cardiovascular disease including coronary artery disease, congestive heart failure, stroke, arrhythmias and sudden cardiac death. Fourth, we will discuss the potential mechanisms underlying increased cardiovascular risk in obese subjects. Last, we will discuss contribution of sleep apnea to the link between obesity and cardiovascular disease. Despite recent progress in understanding epidemiologic and pathophysiological links between obesity and cardiovascular disease, several issues remain to be addressed in the future studies. There is a clear need to identify better markers of obesity-related subclinical cardiovascular damage. Furthermore, we should improve identification of obese subjects at highest cardiovascular risk.