Labile hypertension is a common problem in daily clinical practice. It is defined as a rapid, temporary rise in blood pressure to above 140/90 mm Hg, most often due to emotional stress, followed by a return to normal values. In the clinical setting, it may be due to white coat hypertension, masked hypertension, pseudopheochromocytoma, orthostatic hypertension, or supine hypertension. Labile hypertension can lead to increased cardiovascular risk. Ambulatory blood pressure monitoring is often used for the diagnosis. Alpha blockers+beta blockers and antidepressants are frequently used for treatment.
OBJECTIVE Pulse wave velocity (PWV) is the primary determiner of arterial stiffness. In daily practice, the normal range of arterial stiffness is based on large multi-center studies conducted in the USA, Europe, Asia, and Australia. The goal of this study was to identify the reference values of brachial PWV in a healthy, normotensive Turkish population with no cardiovascular risk factors. METHODS This retrospective study involved healthy, adult Turkish participants from Ankara. A total of 353 consecutive, normotensive individuals were enrolled in the study between September 2017 and January 2018 according to strict inclusion criteria, Normal PWV and 95% confidence interval values were acquired for 353 patients (mean age: 55.03±15.38 years; range: 20-95 years) who were divided into 6 age groups. RESULTS The mean PWV was 7.75±1.89 m/s (range: 4.25- 15.90 m/s). The PWV had a positive linear correlation with age (r2=0.94; p=0.00). The PWV increased gradually by an average of 5% to 9% with each decade of life until the age of 50 years, after which the average PWV increased by 16%. CONCLUSION To the best of our knowledge, this study is the first to define PWV reference values via brachial measurement in a healthy, normotensive Turkish population. These data provide important information for daily clinical practice in Turkey.
Meta-analyses of randomized controlled trials are increasingly performed to obtain more precise results. On the other hand, meta-analyses of prevalence studies are relatively rarely performed. In this review, some important points for interpretation of meta-analyses are given along with the comments on the meta-analyses of prevalence studies that are published in this issue of The Archives of The Turkish Society of Cardiology.
Objective:Cardiovascular disease (CVD) is more prevalent in almost all patients with chronic inflammatory musculoskeletal diseases than in their healthy counterparts. The aim of this study was to assess the presence of subclinical atherosclerosis in patients with psoriatic arthritis (PsA) in comparison with patients with rheumatoid arthritis (RA) and healthy controls. Methods: A total of 30 patients with PsA, 30 patients with RA, and 30 healthy controls were enrolled in this parallel group study. Demographic, clinical, and laboratory data of the groups were recorded. The Disease Activity Score-28 tool was used for joint assessment. The erythrocyte sedimentation rate and C-reactive protein level were measured as acute phase reactants. Flow-mediated dilatation (FMD) and carotid intima media thickness (CIMT) were also measured in all participants. Results: The median duration of disease in patients with PsA was 60 months (range: 8-216 months). A total of 22 of 30 (73.3%) PsA patients had a diagnosis of psoriasis and 13 (48.1%) had active disease. The study groups were similar with regard to age, gender, and body mass index data. In all, 23 (76.7%) of the PsA patients and 5 (16.7%) of the RA patients were using an anti-tumor necrosis factor alpha therapy (p<0.001). The FMD percentage was significantly smaller in both the PsA and the RA patients than in the healthy controls (p<0.001). The median CIMT was greater in the RA patients compared with the PsA patients and the healthy controls (p=0.008). There was no significant difference in FMD or CIMT between patients with and without an active joint lesion. Conclusion: Endothelial functions were impaired in PsA, as in RA, in the absence of conventional risk factors or overt CVD. This finding may show a potential association between PsA, atherosclerosis, and CVD.
Meta-analyses of randomized controlled trials are increasingly performed to obtain more precise results. On the other hand, meta-analyses of prevalence studies are relatively rarely performed. In this review, some important points for interpretation of meta-analyses are given along with the comments on the meta-analyses of prevalence studies that are published in this issue of The Archives of The Turkish Society of Cardiology.
C resynchronization therapy (CRT) is an established therapy for patients with heart failure (HF) and reduced ejection fraction who have a significant left ventricular (LV) conduction delay, as it has been proven to reduce morbidity and mortality. However, one-third of patients don’t respond favorably to CRT and therefore, the identification of patients who would be most likely to benefit from CRT has a special importance. Left bundle branch block (LBBB) QRS morphology, QRS duration >150 milliseconds, non-ischemic etiology, and female gender are referred as strong predictors for better outcomes of CRT. In addition, it should be emphasized that recent HF guidelines do not recommend CRT in patients with a QRS duration <130 milliseconds.[1]
Cardiovascular disease (CVD) in women is still not completely understood by either patients or physicians. It is perceived as a health problem that becomes manifest only after menopause; however, it is the most frequent cause of mortality in women and is often seen at an earlier age in the presence of risk factors. Moreover, the symptoms, course, and prognosis are quite different from those seen in men, and both physicians and patients remain inadequately aware of the character of the disease. In the approach to female patients, some risk factors inherent to women should be considered in addition to the classic factors. In this review article, aspects of CVD that are different in women, etiological factors, risk factors specific to women, and particular points to be taken into consideration in the treatment and diagnosis are illustrated in the form of questions and responses from experts.
Acute myocardial infarction (AMI) is associated with a high incidence of maternal and fetal complications when it develops during pregnancy or the early postpartum period. The pathophysiology involves various factors, including alterations in the vascular wall and hypercoagulability as a result of the hormonal and hemodynamic effects of pregnancy. It frequently occurs due to the development of a thrombus following a ruptured plaque. In addition, coronary artery dissection constitutes a significant cause of AMI in pregnancy. In the literature, the therapeutic approach covers a wide spectrum, ranging from conservative follow-up to percutaneous coronary intervention, urgent bypass surgery, and occasionally, thrombolytic therapy. The success rate is often low; however, maternal and fetal complications are seen more frequently during invasive interventions and bypass surgeries because of the structural changes in the coronary intima and media wall. Presently described is the case of a woman in the 36th week of pregnancy who presented with AMI. The occlusion could not be detected during the primary percutaneous intervention, and thrombolytic treatment and a stepwise percutaneous intervention were performed with a successful result.
During the neonatal period the majority of cardiac tumors seen are rhabdomyomas, and the clinical manifestations are notably variable. Symptoms of rhabdomyoma depend on the presence of intracardiac obstructions, myocardial involvement, or rhythm disturbances. Most cardiac rhabdomyomas regress in follow-up, but some need medical/surgical intervention during the neonatal period as a result of resistant atrial or ventricular arrhythmia. The present case study is a description of an 8-day-old neonate with atrial bigeminy that caused nonconducted premature pulse-related bradycardia, and cardiac rhabdomyoma-related resistant atrial flutter that were detected and successfully treated.
Objective: The aim of this study was to evaluate the adherence to recommendations for secondary prevention and the achievement of treatment targets for the control of risk factors in patients with established coronary heart disease (CHD) who were followed-up at various healthcare facilities in Turkey. Methods: According to the protocol of the international Survey of Risk Factor Management study, questionnaire forms were completed and demographic, anthropometric, and laboratory data of CHD patients who were followed-up at a total of 15 selected primary, secondary, and tertiary healthcare centers were recorded. Results: Among a total of 724 CHD patients (69.8% male; mean age: 63.3+-10.7 years) included in the study, 18.4% were current smokers, only 19.1% had normal body mass index, and 22.1% had waist circumference below the limit of abdominal obesity. Physical activity was insufficient in 53% of the patients, 47.3% had low high-density lipoprotein cholesterol value, 46% had triglyceride level above 150 mg/dL, and 67% had glycated hemoglobin value of 6.5% or above. Of all the patients, 88.1% were using antiplatelet drugs, 71.4% were using beta-blockers, 55.7% were using statins, and 41.9% were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Blood pressure was under control in 56.7% of the hypertensive patients using antihypertensive drugs, and the proportion of diabetic patients who reached glycemic control targets using antidiabetic drugs was 35.9%. Low-density lipoprotein cholesterol was below 70 mg/dL in 12.2% of the patients using statins. Conclusion: According to the data obtained, among Turkish CHD patients, the control rate of cardiovascular risk factors is low, and implementation of the recommendations regarding lifestyle modification and medication use for secondary prevention in the current guidelines are insufficient.
