The impact of nocturnal hypertension and nondipping status on left ventricular mass: a cohort study.

OBJECTIVE: Ambulatory blood pressure monitoring provides a unique tool in the evaluation of night-time blood pressure (BP), having a critical role in the detection of a blunted nocturnal fall and of elevated night-time BP. Both nondipping status and nocturnal hypertension are associated with increased cardiovascular risk and target organ damage. The aim of our study was to investigate the impact of both nondipping status and nocturnal hypertension on left ventricular mass (LVM), assessed by means of echocardiography in a consecutive cohort of untreated participants. METHODS: A total of 937 individuals were assessed by means of ambulatory blood pressure monitoring and echocardiography. Participants were divided into dippers and nondippers with or without systolic nocturnal hypertension (SNH). SNH was defined as night-time systolic blood pressure of 120 mmHg or more, and nondipping status was defined as an average reduction in systolic blood pressure at night less than 10% compared with the daytime BP. RESULTS: Dippers and nondippers with SNH presented significantly higher values of left ventricular mass index compared with dippers and nondippers without SNH, respectively. Multiple regression analysis revealed that age (ß=0.182, P<0.001), male gender (ß=0.168, P<0.001), body mass index (ß=0.080, P=0.011), and nocturnal SBP (ß=0.174, P=0.037) were significant and independent determinants of LVM. Nondipping status was not found as an independent factor associated with LVM (P=0.136). CONCLUSION: Nocturnal hypertension rather than nondipping status seems to be an independent factor associated with left ventricular mass index. The concomitant presence of both nondipping status and nocturnal hypertension is associated with higher LVM, indicating an enhanced cardiovascular risk.

Impact of masking effect on subclinical carotid atherosclerosis in normotensives and untreated masked hypertensive and hypertensive patients.

OBJECTIVES: The masking effect (ME) is present in masked hypertensive patients; however, both normotensive and hypertensive individuals may show a similar phenomenon. Previous studies have shown that ME has been associated with left ventricular hypertrophy and microalbuminuria in treated hypertensive patients. The aim of our study was to evaluate the association between the magnitude of systolic ME and the extent of common carotid artery intima-media thickness (CCA-IMT) development in normotensive individuals and untreated masked hypertensive and hypertensive patients. PARTICIPANTS AND METHODS: A total of 1154 individuals underwent 24 h ambulatory blood pressure (BP) monitoring and carotid artery ultrasonographic measurements. The final study population included 360 patients with systolic ME (daytime systolic BP higher than office systolic BP). The participants were divided into three groups according to office and daytime BP values: normotensives, masked hypertensives, and hypertensives. RESULTS: Masked hypertensives presented significantly higher systolic ME (-14.6 mmHg) than their normotensive (-8.2 mmHg) and hypertensive (-9.5 mmHg) counterparts. However, systolic ME was associated significantly with CCA-IMT only in the group of masked hypertensives (r=-0.399, P<0.001). The multivariate linear regression analyses showed significant and independent associations of CCA-IMT with the following factors: age (B=0.028, 95% confidence interval: 0.001-0.055; P=0.044) and systolic ME (B=-0.034, 95% confidence interval: -0.066 to -0.003; P=0.034). A 10 mmHg decrease in systolic ME correlated to an increase of 0.034 mm in the CCA-IMT. CONCLUSION: Systolic ME was associated significantly with CCA-IMT values in masked hypertensives. Both normotensive and hypertensive participants have failed to show similar associations.

Association of isolated systolic, isolated diastolic, and systolic-diastolic masked hypertension with carotid artery intima-media thickness.

Masked hypertension (MH) is associated with advanced target organ damage. However, patients with MH constitute a group of individuals with heterogeneous characteristics concerning their ambulatory blood pressure (BP) status. The aim of this study was to evaluate the association of isolated systolic MH, isolated diastolic MH, and systolic/diastolic MH with carotid artery intima-media thickness (CIMT). A total of 101 patients with MH underwent carotid artery ultrasonographic measurements. The patients were divided into three groups according to office and daytime BP values: isolated systolic MH, isolated diastolic MH, and systolic/diastolic MH. Patients with isolated systolic (n=36) (0.771 mm) and systolic/diastolic MH (n=37) (0.775 mm) had significantly (P<.05) higher CIMT values than those with isolated diastolic MH (n=28) (0.664 mm), even after adjustment for baseline characteristics and risk factors. Patients with isolated systolic and systolic/diastolic MH presented significantly higher CIMT values compared with patients with isolated diastolic MH.

Lipid lipoprotein profile alterations in Greek infertile women with polycystic ovaries: influence of adipocytokines levels.

AIM: To correlate serum and follicular fluid (FF) leptin and visfatin levels with lipid lipoprotein levels in women with and without polycystic ovary syndrome (PCOS) undergoing ovarian stimulation. MATERIALS AND METHODS: We studied 90 PCOS women and 94 age- and weight-matched controls, enrolled in the In Vitro Fertilization (IVF) program. RESULTS: Total cholesterol, low-density lipoprotein (LDL)-cholesterol, triglycerides, apolipoprotein B and lipoprotein(a) levels were significantly elevated, while high-density lipoprotein (HDL)-cholesterol and apolipoprotein A1, lower in PCOS subjects. Serum and FF visfatin levels were increased in PCOS women and correlated positively with body-mass index (BMI), lipoprotein(a) and triglycerides, and negatively with apolipoprotein A1. Leptin levels were comparable between groups and positively correlated with BMI and LDL-cholesterol, and negatively with apolipoprotein B. CONCLUSION: Lipid lipoprotein alterations are common in reproductive-age PCOS women increasing the risk for cardiovascular diseases later in life. Leptin and visfatin play significant roles in lipid metabolism and further research is required in this area.

Leptin levels in women with polycystic ovaries undergoing ovarian stimulation: relation to lipoprotein profiles.

AIM: To investigate serum and follicular fluid (FF) leptin levels in normally-ovulating women and subjects with polycystic ovary syndrome (PCOS) undergoing controlled ovarian stimulation and correlate them with their lipid lipoprotein profile. MATERIALS AND METHODS: We included 70 PCOS women (35 lean and 35 overweight or obese) and 76 age- and weight-matched non-PCOS controls (39 lean and 37 overweight or obese). RESULTS: Serum levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein B, lipoprotein(a) and homocysteine in women with PCOS were significantly higher compared to control groups while levels of high-density lipoprotein (HDL) cholesterol and apolipoprotein A1 were significantly lower. Serum leptin levels did not differ between groups and were lower than FF levels. Serum and FF leptin levels were positively correlated and were significantly decreased when apolipoprotein B levels increased. CONCLUSION: PCOS women exhibit lipid metabolism abnormalities putting them at increased risk of developing early atherosclerosis.

Short-term beat-to-beat but not ambulatory blood pressure variability is correlated to carotid intima-media thickness.

OBJECTIVES: Several studies have shown that blood pressure (BP) variability derived from ambulatory blood pressure monitoring (ABPM) is associated with target organ damage development. However, the use of discontinuous ABPM to assess rapid BP changes is unavoidably limited by the long frequency at which automated measures are scheduled. The aim of our study was to identify whether ABPM-derived variability or short-term beat-to-beat BP variability is better associated with common carotid artery intima-media thickness (CCA-IMT) in untreated hypertensive patients. PARTICIPANTS AND METHODS: A total of 85 individuals underwent 24-h ABPM and carotid artery ultrasonographic measurements. Three 5-min recordings of noninvasive beat-to-beat BP were made under standardized conditions. The time rate (TR) of BP variation was defined as the first derivative of the BP values against time. The study population was divided into normotensive and hypertensive participants according to 24-h BP values (130/80 mmHg). RESULTS: Hypertensive patients (n=45) presented significantly higher TR of 24-h BP variation (P<0.05) and beat-to-beat TR of systolic BP variation (P<0.05) than their normotensive counterparts (n=40). The multivariate linear regression analyses in hypertensive patients showed significant and independent associations of CCA-IMT with the following factors: 24-h systolic blood pressure (SBP) (B=0.065, 95% confidence interval: 0.006-0.124; P=0.033) and TR of beat-to-beat SBP (B=0.013, 95% confidence interval: 0.005-0.020; P=0.002). A 10 mmHg/min increase in the TR beat-to-beat SBP variation correlated to an increase of 0.013 mm in the CCA-IMT values. CONCLUSION: Short-term beat-to-beat TR of BP variation is associated independently with CCA-IMT values and presents a better predictor of target organ damage involvement than BP variability indexes derived from ABPM.

Correlation of visfatin levels and lipoprotein lipid profiles in women with polycystic ovary syndrome undergoing ovarian stimulation.

The aim of this study was to determine serum and follicular fluid (FF) visfatin levels in age and weight-matched women with polycystic ovary syndrome (PCOS) and normally ovulating subjects undergoing controlled ovarian stimulation and correlate them with their lipid and lipoprotein levels. We included 80 PCOS women (40 lean and 40 overweight) and 80 age- and weight-matched controls, enrolled in the IVF program. In PCOS women, we determined significantly increased serum and FF visfatin as well as serum levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, apolipoprotein B, lipoprotein(a) and homocysteine, while high-density lipoprotein cholesterol and apolipoprotein A1 were significantly lower compared to controls. Serum visfatin levels positively correlated with total cholesterol, LDL cholesterol, triglycerides, lipoprotein(a) and homocysteine levels and negatively with apolipoprotein A1. FF visfatin levels positively correlated with triglycerides and homocysteine and negatively with apolipoprotein A1. Dyslipidemia is common in reproductive age women with PCOS exposing them to risk for cardiovascular diseases. However, the detailed role of visfatin on lipoprotein lipid profile awaits further clarification through future investigation.

Inflammation on the cervical papanicolaou smear: evidence for infection in asymptomatic women?

BACKGROUND: The significance of the possible presence of infection on the Pap smear of asymptomatic women based on cytological criteria is practically unknown. MATERIALS AND METHODS: A total of 1117 asymptomatic nonpregnant women had Pap smear tests and vaginal as well as cervical cultures completed (622 with and 495 without inflammation on the Pap smear). RESULTS: Out of the 622 women with inflammation on Pap test, 251 (40.4%) had negative cultures (normal flora present), while 371 (59.6%) women had positive cultures with different pathogens. In contrast, the group of women without inflammation on Pap test displayed significantly increased percentage of negative cultures (67.1%, P < 0.001) and decreased percentage of positive cultures (32.9%, P < 0.001). Bacterial vaginosis was diagnosed more frequently in both groups and significantly more in the group with inflammation on Pap smear compared to the group without inflammation (P < 0.02). CONCLUSIONS: A report of inflammatory changes on the cervical Pap smear cannot be used to reliably predict the presence of a genital tract infection, especially in asymptomatic women. Nevertheless, the isolation of different pathogens in about 60% of the women with inflammation on the Pap smear cannot be overlooked and must be regarded with concern.

Fatal lower limb infection by Trichosporon asahii in an immunocompetent patient.

Trichosporon (T.) asahii can cause superficial skin infections and can be an opportunistic pathogen that produces potentially fatal systemic infections in immunocompromised hosts. We report a case of lower limb infection due to T. asahii in an immunocompetent patient who displayed no evidence of underlying disease. There is a strong possibility that our patient had been colonized at the infection site as part of the normal skin flora. After one-month bed rest due to an accidental fall and fracture of the right shoulder blade, a 61-year-old woman experienced severe edema and redness in the right lower limb and received topical treatment with iodine solution and antibiotics without improvement. She presented at our Outpatient Clinic with cellulitis and lymphedema. Samples collected from the affected areas revealed T. asahii and the patient was referred to a hospital for infectious diseases for appropriate therapy. The patient was treated with wound dressings until she was admitted to our intensive care unit when her general condition abruptly deteriorated. Despite in vitro susceptibility results, therapy with liposomal amphotericin and voriconazole could not change the fatal outcome. Nowadays, physicians must suspect this emerging difficult-to-treat fungal pathogen and treatment must start promptly in these infections.