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This article discusses the treatment of panic disorder in terms of cognitive behavioral psychotherapy. Panic disorder is one of the most common anxiety disorders. The etiology of panic disorder assumes the coexistence of genetic and environmental factors. Panic attacks often accompany other mental and somatic diseases. The constant feeling of intense anxiety with a number of somatic symptoms affects the deterioration of everyday functioning, significantly reducing one's quality of life. The global situation caused by SARS-CoV-2 may correlate with the increase in the incidence of panic disorder. The introduction of appropriate therapeutic interventions at the earliest possible stage of the disease gives patients a chance for long-term remission. So far, it has been proven that the best results of pharmacological treatment are achieved thanks to the antidepressant and benzodiazepine drug groups. One of the non-pharmacological interventions with the highest clinical effectiveness is cognitive-behavioral psychotherapy. Compared to other trends, cognitive-behavioral therapy is characterized by the most reliable research proving its high effectiveness. Psychotherapy of panic disorders in the cognitive-behavioral approach includes a complete conceptualization of the patient's problem, taking into account individual theoretical models. Treatment of panic attacks is based on a protocol which takes into account both cognitive and behavioral interventions, e.g. psychoeducation, cognitive restructuring, breathing training, relaxation exercises and both interoceptive and in vivo exposures. Research results indicate that this therapy is an alternative form of treatment for panic disorders. Sources indicate that the effectiveness of interventions based on cognitive-behavioral therapy is comparable to that of pharmacotherapy. [ABSTRACT FROM AUTHOR]

Aim. Increased arterial stiffness is a risk factor for cardiovascular disease (CVD). Adult men with untreated hypertension are at risk of future CVD. The study aimed to compare the effects of a submaximal exercise on the recovery of the two descriptors of arterial pressure waveform, i.e. stiffness index (SI) and reflection index (RI), between men with untreated hypertension (HA) and healthy peers. Material and Methods. The study included 70 Caucasian men with untreated primary HA and 30 normotensive men. Blood pressure, SI and RI were determined by photoplethysmography before and 6 minutes after a submaximal (up to 85% of age-predicted maximal heart rate) exercise on a treadmill. Results. Baseline SI was higher in HA than control men (6.06 [0.66] vs. 6.61 [0.84] m/s; p=0.0019) and remained significantly increased during post-exercise recovery only in HA men (7.59 [1.6] vs. 6.18 [0.85] m/s; p<0.0001). Pre-exercise RI did not differ between HA and healthy men (50.74 [14.17] vs 48.9 [14.86]%). Six minutes after the exercise, RI higher in HA patients than in healthy men (45.26[15.33] vs 36.2 [13.18]%; p=0.0058). Conclusions. Arterial stiffness is higher in men with HA both at rest and 6 minutes after exercise. Compared with healthy men, those with HA have more increased arterial tone and impaired vasodilation but only during the recovery. It suggests that untreated HA patients have abnormal mechanical properties of arterial pressure waveforms during the post-exercise recovery. [ABSTRACT FROM AUTHOR]

INTRODUCTION    There is an inverse relationship between high‑density lipoprotein cholesterol (HDL-C) levels and the risk of atherosclerosis. OBJECTIVES    The aim of the present study was to assess the oxidant-antioxidant balance in elderly people with different concentrations of HDL-C. PATIENTS AND METHODS    A total of 541 people aged 60 years or older were examined, of whom 90 individuals with no acute or severe chronic disorders had their waist circumference, body mass index, percentage of body fat, and blood pressure measured. Fasting and 120‑minute glycemia was determined in an oral glucose tolerance test, following which 15 patients with type 2 diabetes were excluded. Fasting plasma levels of lipids, total antioxidant status, and thiobarbituric acid-reacting substances (TBARS), as well ast the activity of erythrocyte superoxide dismutase 1 (SOD‑1) were assessed. Based on HDL-C levels, participants were divided into the high HDL‑C group (≥40.0 mg/dl and ≥50.0 mg/dl for men and women, respectively; n = 50) and the low HDL‑C group (<40.0 mg/dl and <50.0 mg/dl for men and women, respectively; n = 25). RESULTS    The groups did not differ in terms of age, blood pressure, body mass index, percentage of body fat, and glucose concentration. The high HDL‑C group had lower waist circumference (P <0.02) and lower triglyceride concentrations (P <0.00001). Increased TBARS levels (P <0.0005) was observed in the low HDL‑C group. There were no differences in SOD‑1 activity and total antioxidant status between the groups. CONCLUSIONS    HDL-C levels, which are known to reflect the antiatherogenic activity of HDL, including antioxidant properties, may indicate increasing oxidative stress in healthy elderly individuals.

Introduction: The aim of this study was to assess the costs associated with mild hypertension (HTN) in Poland and to compare the costs of 3-year ambulatory care for those diagnosed with mild HTN (group A) and those diagnosed with mild HTN and comorbidities (group B)., Material and Methods: The researchers undertook a retrospective study of a group of 120 patients treated for 3 years (2006-2008) (60%, n = 72 women and 40%, n = 48 men), taking into account the broadest possible social perspective. Medical and non-medical direct costs as well as indirect costs were calculated., Results: The total costs of the 3-year pharmacotherapy in group A equalled 49,985.65 EUR, or 833.09 EUR per patient, whereas in group B the costs were twice as high: 105,691.55 EUR in total or 1,761.53 EUR per patient. Indirect costs for group A patients totalled 3,468.80 EUR (578.13 EUR per patient) and 4,579.20 EUR for group B patients (572.40 EUR per patient). Total direct costs (medical and non-medical) and indirect costs for group B patients were much higher, amounting to 130,228.14 EUR and 2,666.55 EUR per patient, which was double the costs in group A, where costs were 74,184.96 EUR and 1,756.73 EUR per patient., Conclusions: The costs of HTN treatment in Poland are very high and are growing, like in other countries. Potential solutions include developing better patientdoctor communication to improve compliance, and increasing the chances of more effective and less expensive therapy by prescribing cheaper generic drugs, limiting polypharmacy and improving availability of novel therapeutic methods.

Unlabelled: Endothelium dysfunction is well established factor contributing to the development of atheroslerotic plaque. It is characterized by, among other, impaired vasodilatation and increased expression of adhesion molecules. The aim of the study was to estimate changes of serum selectin levels and blood vessels stiffness under the influence of short term physical effort in young healthy men characterized by various lifestyles., Material and Methods: The study was performed on 28 healthy men aged 22 to 34. The study involved personal interview, electrocardiography, treadmill exercise test, non-invasive endothelial function assessment (using PulseTrace PCA 2) and collecting blood samples for serum E-, L- and P-selectin measurement. The given population was divided into smoking and non-smoking groups, as well as into groups with different level of physical activity assessed according to the International Physical Activity Questionnaire., Results: In regard to serum selectin levels under the influence of short term physical effort E-selectin concentration didn't change significantly in any group, P-selectin level was lower in non-smoking group (p < 0.01) and in group with vigorous physical activity (p < 0.005), L-selectin level decreased in non-smokers (p < 0.005) and in groups taking moderate (p < 0.05) and vigorous exercise (p < 0.05). Baseline SI (stiffness index) value differed significantly between smoking and nonsmoking groups (p < 0.005). SI value didn't change significantly under effort in any group. RI (reflection index) value in measurements made after physical effort was significantly lower in each of examined groups, but decrease was better marked among non-smokers (p < 0.005) than in smokers (p < 0.05)., Conclusions: The study revealed that individuals who undertake physical activity regularly, benefit from each single physical effort, because of decrease in serum concentration of proinflammatory molecules such as L-selectin and P-selectin. Short term physical effort does not influence the level of selectins in smokers. Smokers are characterized by increased arterial stiffness compared to nonsmokers. Short term physical effort leads to peripheral vasodilatation, expressed by decreasing RI value, but vasodilatation effect does not appear in smokers. It seems that pulse contour analysis obtained by finger photopletysmography may be treated as method of endothelium function screening among healthy men with the presence of atherogenesis modifiable risk factors.

Objectives: Adiponectin is a novel plasma protein produced exclusively in adipocytes. Despite early data, its relationship with obesity and diabetes has been recently questioned. Since plasma lipids influence diabetes and obesity, of concern is whether any associations between plasma lipids and adiponectin exist., Design and Methods: The aim of this study was to measure adiponectin levels and to investigate their associations with plasma cholesterol fractions and triglycerides in 73 obese non-diabetic subjects (44 women and 29 men), and 43 obese diabetic subjects (28 women and 15 men), aged 52.7+/-11.2 and 53.1+/-11 years, respectively, and matched for age, sex and BMI. The WHO definitions of obesity and diabetes were used. Adiponectin was determined by an enzyme-linked immunosorbent assay., Results: No correlations between adiponectin and total and LDL cholesterol levels were shown (for the whole cohort: r=0.0130; p=0.8899, and r=0.0807; p=0.3958, respectively). A positive correlation between HDL cholesterol levels and adiponectin occured predominantly in obese women without diabetes (r=0.4531; p=0.0023), resulting in an overall statistical trend in the whole cohort (r=0.2243; p=0.0164). A negative correlation between serum adiponectin and triglycerides was found (r=-0.3413; p=0.0002)., Conclusion: Adiponectin correlated only with TG and partially with HDL but not with LDL and total cholesterol in the study group of obese diabetic and obese non diabetic subjects. In view of these results we suggest that the role of adiponectin in human metabolism is unclear and merits further investigation.

Background: Endothelin (ET) is the strongest endogenic substance causing vasoconstriction. The aim of this study was to assess the influence of ACEI therapy on serum concentration of ET-1 plasma activity in young patients with essential mild-to-moderate hypertension., Design and Methods: 19 persons with essential mild-to-moderate hypertension were enrolled into study (14 male and 5 female). The average age of this group was 17.6+/-1.4 years. The patients were untreated or there was a 7 day wash out period. The blood pressure and serum concentration of ET-1 plasma were measured before enrolling and after 6 weeks of trandolapril (2 mg per day) therapy. The concentration of endothelin-1 was measured using RIA methods., Results: In analyzed group there was a significant both SBP and DBP lowering after the ACEI therapy. SBP was reduced from 142.6+/-9.7 to 129.3+/-8.4 mmHg (p<0.003), DBP from 85.7+/-6.9 to 79.8+/-8.6 mmHg (p<0.01). The average serum concentration of endothelin-1 was: before treatment 9.33+/-1.9 fmol/ml and after therapy 8.96+/-2.2 fmol/ml., Conclusion: The treatment with ACEI drug (trandolapil) induced the significant decrease of SBP and DBP in young hypertensives. 6-weeks trandolapril therapy was associated with the reduction of serum concentration of ET-1, but not statistically significant.

Unlabelled: It has been proved that effectiveness of monotherapy in mild hypertension is about 50%; in the other half of patients the dose of previously used drug should be increased or combined therapy should be recommended. THE AIM OF THE STUDY was to compare treatment with angiotensin convertase enzyme inhibitor--ACE-I (enalapril 10 mg bid--group 1) to therapy with ACE-I combined with calcium antagonist (enalapril 5 mg bid + nitrendipine 20 mg qd--group 2)., Material and Methods: In a prospective, open, randomised crossover study we assessed 44 hypertensive subjects (17 women, 27 men), aged 35-69 years (mean age 48.6 years) with poorly controlled hypertension treated with enalapril 5 mg twice daily. Mean initial systolic blood pressure was 150.8 < or = 9.9 mmHg, diastolic 94.7 +/- 5.3 mmHg respectively. The influence of the treatment regimen on the quality of life (QoL) was estimated by a questionnaire., Results: The effectiveness of both used procedures did not differ statistically--in both groups mean blood pressure reduction was similar (14/8 mmHg in 4 weeks), also percentage of patients with well controlled hypertension (about 50%) did not differ significantly. In the group with changes regimen from monotherapy to combined therapy the improvement of systolic blood pressure was found to be statistically significant (p<0.05); in the case of combined therapy replaced with monotherapy such an improvement was not observed. In the subgroup with the isolated systolic hypertension combined therapy was considerably more effective. The improvement of QoL was noted in both groups, mainly in the initial phase of the study., Conclusion: In mild hypertension ACE-I and calcium antagonist combination is effective in blood pressure reduction and in the improvement of the quality of life. Nitrendipine in a dose 20 mg in an once daily regimen is a potent and safe hypotensive agent, particularly in isolated systolic hypertension.

The objective of this study was to evaluate the urinary albumin excretion and plasma biochemistry in patients with essential hypertension and impaired glucose tolerance. We studied 82 untreated patients (35 women and 47 men, mean aged 41 +/- 13) with mild to moderate hypertension. Body mass index (BMI) for study subjects was 29.1 +/- 5.0 kg/m2 and mean office blood pressure at entry was 152/97 mmHg. After an oral glucose tolerance test (OGTT) glucose, group was divided into impaired glucose tolerant (n = 16; IGT) and normoglycemic (n = 66; NormGLU) subgroups; patients with diabetes were excluded. 24-hour urinary albumin excretion (UAE) was estimated by the radioimmunoassay during two separate days. The median UAE in the IGT group was 16.0 +/- 28.6 mg/day and in NormGLU group 7.2 +/- 10.7 mg (p < 0.01). The prevalence of microalbuminuria was higher in IGT group (37 vs 18%). In the IGT subgroup total cholesterol, triglycerides and systolic blood pressure were higher. The presence of impaired glucose tolerance in hypertensive patients is correlated with increased urinary albumin excretion, which indicates significant role of metabolic disorders in inducing microalbuminuria.

Unlabelled: The inflammatory process contributes to the development of atherosclerotic changes. The aim of this study was to evaluate concentrations of selected acute phase proteins (APP) and their glycosylation profile in hypertensive subjects. 92 hypertensive patients (53 men and 39 women, average age 45.1 yrs) were recruited to the study. Hypertension was proved to be essential, mild to moderate (mean blood pressure values were 141/87 mmHg). The control group comprised 75 healthy persons in comparable age. In all subjects assessment of C-reactive protein (CRP), alpha 1-acid glycoprotein (AGP), alpha 1-antichimotripsin (ACT), transferrin, alpha 1-antitripsin (rocket immunoelectrophoresis method) and C3c and C4c complement fractions (radial immunoelectrophoresis according to Mancini) were performed. Evaluation of glycosylation profile and reactivity coefficient (RC) for AGP were done by means of affinity immunoelectrophoresis with concanavalin A as a ligand (according to Bøg-Hansen). When compared to the control group hypertensive subjects had significantly higher C-reactive protein and interleukin 6 concentrations. Level of transferrin (negative APP--decreasing in the course of the inflammatory process) was statistically lower in the studied group. Hypertensive patients were also found to have elevated AGP-AC values proving acute character of the inflammatory reaction. The intensification of the inflammatory reaction was greater in the subgroup of hypertensive patients with unsatisfactory control of blood pressure., Conclusions: 1. Hypertension may evoke the acute phase reaction. 2. Quantitative and qualitative changes in acute phase proteins observed in hypertension prove that hypertension itself is an acute inflammatory condition. 3. Markers of acute phase response are particularly strongly expressed in smokers and subjects with insufficient control of blood pressure. The most probable factor leading to the enhanced acute phase response in hypertension is interleukin 6.

The aim of this study was to assess the influence of 3 hypotensive drugs on the metabolic disorders: dyslipidemia, insulin resistance, hyperuricemia. There were 39 patients aged 20-55, with mild-to-moderate essential hypertension. The patients with other serious diseases or treated earlier with cholesterol or uric acid lowering drugs were excluded. Patients were divided into 3 groups, each was treated during 8 weeks with one drug: gr 1--trandolapril (T), gr 2--felodipine ER (F), gr 3--rilmenidine (R). Glucose and insulin in oral glucose tolerance test, I/G proportion, serum lipids and uric acid were tested before and after therapy. The therapy did not influence lipid parameters: LDL, HDL, triglyceride. In the T group there could be observed a significant reduction of total cholesterol value. Examined drugs did not induce changes in serum carbohydrate. The significant reduction of serum uric acid could be observed only after F therapy. Analysed drugs are very useful in therapy of hypertension with metabolic disorders.

The aim of this study was to evaluate the influence of blood pressure variability and circadian rhythm on left ventricular mass and urinary albumin excretion rate (UAE) in patients with essential hypertension. 82 untreated patients (35 women and 47 men; mean age 41.1 +/- 13.7) were recruited to this study. Mean office blood pressure at entry was 152/97 mmHg. Ambulatory blood pressure monitoring (ABPM) was performed using an Medilog ABP recorder (Oxford). Blood pressure variability was estimated as the standard deviation (SD) of systolic and diastolic ambulatory blood pressure. Urinary albumin excretion (UAE) was estimated by the radioimmunoassay during two separate days. Echocardiography was used to measure left ventricular mass and left ventricular mass index (LVMI). The median urinary albumin excretion for the whole group was 8.2 mg/day; in 18 patients (21.9%) microalbuminuria was present. Left ventricular mass index in a whole group was 109.1 g/m2; in 23 subjects (28.0%) left ventricular hypertrophy (LVH) was found. Patients with microalbuminuria as well as with left ventricular hypertrophy had higher office and 24 hour ambulatory systolic and diastolic blood pressure and higher systolic blood pressure variability. During ABPM 18 patients with absent nocturnal fall in blood pressure (non-dippers) were found; they did not display more frequent prevalence of target organ damage. Increased 24-hour blood pressure variability present in hypertensive subjects with both microalbuminuria and left ventricular hypertrophy may suggest that this phenomenon plays role in development of target organ damage.