Treatment efficiency of resistant hypertension in cardiologist's office.

BACKGROUND: The target values of blood pressure have not been achieved in our population of patients sufficiently. The most difficult is a control of patients with resistant hypertension. We do not have data about efficiency treatment of these patients today. OBJECTIVES: The aim of our study was to assess current treatment status and by antihypertensive treatment modification we tried to reach an adequate blood pressure control. METHODS: Fifty two patients suffering from resistant hypertension 2-3 degree ESC/ESH with high cardiovascular risk have been observed. Reaching of the target blood pressure values was verified by 24-hour ambulatory blood pressure monitoring. RESULTS: The target blood pressure values were achieved in 50 % of patients during 18 months. We noticed a statistically significant difference (p<0.001) in a decrease of casual and 24-hour ambulatory blood pressure in the group of controlled hypertensive patients in comparison with a group where blood pressure did not decrease sufficiently. In case of 50 % patients, the target blood pressure values have not been reached in spite of more antihypertensive drugs and a higher dose. CONCLUSION: Adequately and systematically controlled patients were treated less intensively in comparison with an inadequately controlled group. 24-hour blood pressure monitoring analysis confirmed correction of the patological diurnal rhythm mostly in adequate blood pressure controlled group. In this group, we have noticed a statistically significant decrease of blood urea and creatinin levels and albumin/creatinin ratio in urine. Resistant hypertension needs multi-faceted approach with consistent control of all comorbidities in a case of problematic blood pressure control (Tab. 6, Fig. 1, Ref. 21).

Antithrombotic treatment in patients with atrial fibrillation as a risk factor of stroke.

For over two decades, valuable insights have been accumulated from epidemiologic studies and randomized trials about the risks and prevention of atrial fibrillation. Atrial fibrillation (AF) substantially raises the risk of stroke, most likely through an atrio-embolic mechanism. Warfarin and other members of its class of oral anticoagulants targeted at an international normalized ratio (INR) of 2.5 can abrogate the risk of stroke attributable to AF effectively and fairly safely. High-quality management of anticoagulation can be achieved in usual clinical care. These insights have important implications for the care of individual patients and more generally for public health. Future research is needed to specify the risk of stroke and hemorrhage among patients with AF better, particularly among older individuals, to optimize use of antithrombotic agents, and to define the role of recently developed antithrombotic drugs and invasive nondrug approaches (Tab. 3, Ref. 20). Full Text (Free, PDF) www.bmj.sk.

Perioperative cardiovascular and noncardiovascular risk in patients with colorectal cancer.

BACKGROUND: One of the factors determining the success of colorectal cancer (CC) surgery is an appropriate stratification of perioperative risk. OBJECTIVE: To evaluate the prognostic significance ofperioperative risk in patients with CC, a comparison of two groups of patients--surviving and non-surviving the CC surgery was performed. Cardiovascular and noncardiovascular risk factors, diseases and complications were compared between these two groups. PATIENTS: 60 patients (m:30, f:30), average age: 73 ys, surviving (38), non-surviving (22). METHODS: Following parameters were compared: risk factors (arterial hypertension, diabetes mellitus, hyperlipoproteinemia, smoking or alcohol consumption, malnutrition, obesity), cardiovascular diseases (history of coronary artery disease, heart failure, brain stroke, revascularisation, chronic venous insufficiency), noncardiovascular diseases (COPD, asthma, renal insufficiency, metabolic diseases, peptic ulcer disease, chronic hepatitis, pulmonary tuberculosis, bone or kidney tuberculosis, hepatopathy), complications and laboratory parameters. RESULTS: Comparison of the listed parameters in non-surviving/surviving patients: bronchopneumonia (36%/4%), perineal haemorrhage (36%/4%), hepatopathy (28%/4%), renal insufficiency (50%/16%), hypoalbuminemia (50%/16%), history of acute stroke (21%/12.5%), history of brain stroke (12.5%/7%). CONCLUSION: Risk factors (bronchopneumonia, perineal haemorrhage, hepatopathy, renal insufficiency, hypoalbuminemia) are markers of worse prognosis. The cardial markers (history of acute stroke and history of brain stroke) play a minor role (Tab. 10, Ref 3).