Background: The clinical relevance of tissue-selectivity among angiotensin-converting enzyme (ACE) inhibitors is debated. This study aimed to compare the effects of a lipophilic (quinapril) and a hydrophilic (lisinopril) ACE inhibitor on peripheral endothelial function and coronary microvascular function in patients with de novo hypertension. Methods: In a controlled crossover trial, 33 hypertensive patients received eight weeks of quinapril (10 mg/day) and lisinopril (10 mg/day), separated by a washout period. Brachial artery flow-mediated dilation (FMD) and coronary flow reserve (CFR) were assessed via transthoracic Doppler echocardiography at baseline and after each treatment. Treatment effects were analyzed using linear mixed-effects models accounting for repeated measures. Results: At baseline, hypertensive patients exhibited significantly impaired FMD and CFR compared to healthy controls. Both treatments effectively lowered blood pressure and improved FMD and CFR from baseline ( P < 0.05). Mixed-effects analyses demonstrated a significant time effect for both parameters, whereas no significant treatment-by-time interaction was observed, indicating no differential treatment effect between quinapril and lisinopril. Exploratory comparisons suggested numerically greater improvements in FMD with quinapril. Improvements in CFR were comparable between treatments. Conclusion: In patients with newly diagnosed hypertension, both lipophilic and hydrophilic ACE inhibitors improve peripheral endothelial and coronary microvascular function. The absence of a significant differential effect, particularly for CFR, supports a predominant class effect. While quinapril showed numerically greater improvements in FMD, this did not reach statistical significance, highlighting heterogeneity across vascular beds and warranting caution in interpreting surrogate markers.

Gestational diabetes is associated with an increased risk of coronary artery disease (CAD) and adverse cardiovascular events in later life. Coronary microvascular dysfunction is a common precursor of CAD. Although microvascular dysfunction is common in gestational diabetes (GDM), the exact mechanisms remain unknown. We aimed to study the associations between coronary flow reserve (CFR) with common biomarkers of hyperglycemia, insulin resistance, inflammation and oxidative stress. Measurement of CFR was performed noninvasively using echocardiography in all patients. Patients with a low CFR (≤ 2.5) had higher HbA1c

Background The prevalence of e-cigarette use has increased in recent years, driven by the perception that e-cigarettes are less harmful compared to traditional tobacco smoking. Nevertheless, conflicting data exists regarding the potential impact of e-cigarettes on vascular health. Present study aimed to elucidate whether markers of vascular/microvascular function differs between e-cigarette and tobacco smokers, especially following acute exposure. Methods The study population consisted of 108 participants, including 39 e-cigarette users, 39 tobacco smokers and 30 never-smokers. Tobacco smokers smoked 1 cigarette in 7 min, and e-cigarette users used their device for 15 min. Coronary flow reserve (CFR), flow-mediated dilatation (FMD), and pulse wave velocity (PWV) were measured before and after smoking. Results Baseline CFR was significantly lower in both e-cigarette users and tobacco smokers as compared to controls (p < 0.001), while neither PWV (p = 0.925) nor FMD (p = 0.243) differed across groups. Compared to baseline, exposure to e-cigarettes led to a significant decrease in CFR (p < 0.001) and increase in PWV (p = 0.001), while there was a nonsignificant reduction in FMD (p = 0.053). Exposure to tobacco smoking was related to a significant decrease in CFR (p < 0.001) and FMD (p < 0.001), but not in PWV (p = 0.077). There were no interactions between the type of exposure (i.e. e-cigarette or tobacco) and changes in markers of vascular/microvascular dysfunction (Pinteraction nonsignificant for all). Conclusions Both e-cigarette users and tobacco smokers show findings compatible with coronary microvascular dysfunction at baseline. Acute exposure to either e-cigarettes or tobacco is associated with further vascular and microvascular dysfunction.

Atrial septal defects (ASD) divert flow from systemic to pulmonary circulation, and some degree of plasma volume expansion and neurohormonal activation are necessary to maintain the effective circulatory volume. The aim of the present study was to understand the patterns of neurohormonal activation in ASD patients. 16 ASD patients and 10 controls were enrolled. Fasting blood samples were collected prior to procedure and 48 h after defect closure. At baseline, renin (185.0(79.0-437.0 vs. 79.4(60.8-110.0), p = 0.04), aldosterone (20.2 ± 7.6 vs. 11.7 ± 2.8, p < 0.001), copeptin (43.6 ± 27.5 vs. 16.4 ± 8.7, p = 0.002) and both natriuretic peptides were higher in ASD patients, while noradrenaline (113.0 ± 61.3 vs. 178.0 ± 49.4, p = 0.009) and endothelin-1 (2.93 ± 2.00 vs. 5.06 ± 1.25, p = 0.006) were higher in controls. After ASD closure, only NT-proBNP reduced significantly (p = 0.02). There were negative correlations between defect area with noradrenaline (r=-0.73, p = 0.002) and with endothelin-1 (r=-0.59, p = 0.02). Present findings suggest that in patients with an ASD, there is an increase in neurohormones that are related to regulation of plasma volume (aldosterone and arginine vasopressin) with simultaneous reductions in neurohormones related to vasoconstriction in systemic and pulmonary beds (noradrenaline and endothelin-1).

BACKGROUND: Coronary microvascular dysfunction (CMD) is a common occurrence in individuals with insulin resistance (IR). Homeostatic model assessment for insulin resistance (HOMA-IR) is a widely used surrogate marker of IR, although recent studies suggest triglyceride-glucose (TyG) index is a superior marker of IR that had a better accuracy to predict type 2 diabetes or cardiovascular outcomes than HOMA-IR. OBJECTIVES: We aimed to assess the accuracy and usefulness of TyG index and HOMA-IR for predicting CMD as assessed with echocardiographic coronary flow reserve (CFR) measurement. METHODS: All cases included in the institutional CFR registry were retrospectively reviewed, and 656 cases without epicardial coronary artery disease and without major risk factors for atherosclerosis were included. A CFR <= 2.0 was defined as CMD. RESULTS: TyG index was available in all cases, while HOMA-IR was available in 398 cases. Both TyG index and HOMA-IR were associated with CMD on univariate analyses, while after adjustment for potential confounders HOMA-IR (odds ratio [OR]:1.38, 95% confidence interval [CI]:1.14-1.67, p = 0.001) but not TyG index (OR:1.48, 95% CI:0.82-2.67, p = 0.19) was associated with CMD. The predictive accuracy of HOMA-IR (c-statistic:0.63, 95% CI:0.54-0.72, p = 0.003) was higher than TyG index(c-statistic:0.55, 95% CI:0.47-0.63, p = 0.13), although the difference was not statistically significant (DeLong p = 0.23). There was strong evidence favoring a true difference between CMD vs. non-CMD groups for HOMA-IR (BF 10 :3507) but not for TyG index(BF10:0.66). CONCLUSIONS: HOMA-IR, but not TyG index, is closely associated with CMD. (c) 2024 National Lipid Association. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Objective: To investigate the impact of statin therapy on choroidal structure. Methods: A case–control study included otherwise healthy patients with hyperlipidemia. 12 patients with low-density lipoprotein (LDL) levels below 210 mg/dL were treated with lifestyle changes, while 12 patients with levels above 210 mg/dL were additionally treated with atorvastatin. Optical coherence tomography images were obtained in the third month. Results: Choroidal thinning in the temporal region was observed in the statin group (P = .031, P = .033, P = .029 at different measuring points). Total choroidal and luminal areas were thinner in the statin group (P = .046 and P = .049), while the choroidal vascularity index remained the same (P = .853). Conclusion: It is uncertain whether choroidal thinning is mediated by decreased LDL levels or by decreased inflammation and oxidative stress. It may be advantageous to investigate statins in the management of pachychoroid spectrum disorders or oxidative stress-related diseases such as age-related macular degeneration. Cite this article as: Hepokur M, Yılmaz Çebi A, Çelebi MG, Salı F, Çelik FB, Oğuz H. Effect of statin therapy on choroidal structure in patients with hyperlipidemia: A case–control study with optical coherence tomography. Cerrahpaşa Med J. 2023;47(3):313-317.

Aim: The coronary flow reserve (CFR) is a sign of endothelial dysfunction and early-stage coronary artery disease (CAD). Plasma atherogenic index (PAI) is related to subclinical CAD and may be used as a predictor of cardiovascular mortality. Our aim is to determine CFR and PAI in patients with AS and to investigate whether PAI can be used in the detection of early stage CAD. Methods: The study population comprised 48 patients, who were diagnosed with AS based on modified New York criteria and 35 healthy volunteers. PAI values were calculated with the formula log 10 triglyceride (TG) / high-density lipoprotein (HDL). Results: No difference was detected between the two groups for the demographic variables, including age, sex and BMI. The comparison of the groups for PAI and CFR demonstrated that PAI levels were observed to be significantly higher and CFR levels were observed to be significantly lower in the AS patients (p=0.01, p

Background: Inflammatory bowel disease (IBD), which is an umbrella term used for ulcerative colitis (UC) and Crohn's disease (CD), is associated with an increased risk for atherosclerotic cardiovascular disease (CVD). We aimed to investigate the association of local and systemic biomarkers of inflammation and gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) with endothelial and coronary microvascular dysfunction in IBD.Methods: A total of 56 patients with IBD (20 with UC and 36 with CD) and 34 age and gender matched controls were included. For all participants, samples were collected to analyze faecal calprotectin, and TMAO concen-trations. Ultrasound-based examinations were done to measure flow-mediated vasodilatation (FMD) and coro-nary flow velocity reserve (CFVR).Results: Patients with IBD had lower CFVR (2.07 (1.82-2.40)) and FMD (8.7 +/- 3.7) as compared to controls (2.30 (2.07-2.74), p = 0.005 and 11.9 +/- 6.8, p = 0.03). In patients with IBD, TMAO concentration (r =-0.30, p = 0.03), C-reactive protein (r =-0.29, p = 0.03) and WBC count (r =-0.37, p = 0.006) had a significant negative correlation with CFVR, and TMAO (I3 =-0.27, 95 % CI:-0.23 to-0.02) and WBC count (I3 =-0.31, 95 % CI:-0.56 to-0.06) were significant predictors of CFVR after multivariate adjustment. None of the biomarkers of inflammation or TMAO showed significant correlations with FMD. In patients with UC, TMAO showed a sig-nificant correlation with both CFVR (r =-0.55, p = 0.01) and FMD (r =-0.60, p = 0.005) while only WBC count had a statistically significant correlation with CFVR (r =-0.49, p = 0.004) in patients with CD.Conclusions: Gut microbiota-derived metabolite TMAO and biomarkers of systemic inflammation are associated with measures of endothelial/coronary microvascular dysfunction in patients with IBD.

Objective:Premature ventricular contractions (PVCs) are a common arrhythmic condition. The first approach in patients with symptomatic and frequent PVC is medical treatment, primarily beta-blockers (BB) or calcium channel blockers (CCB), but it is still unclear which of the two should be chosen. This study investigated which drug treatment would be beneficial according to patient and electrocardiography (ECG) characteristics in patients with idiopathic PVC.Methods:We retrospectively analyzed 156 patients with PVC who came to the cardiology outpatient clinic. Seventy-one patients were responsive to BB, and 85 were responsive to CCB. Their demographic and ECG characteristics were compared.Results:The male ratio was higher (p<0.001), and the left ventricular ejection fraction was lower in BB responders than in CCB responders (p<0.001). Although the mean heart rate was higher in BB responders (p<0.001), the initial PVC burden was lower in BB responders than in CCB responders (p<0.001). The PVC QRS duration was longer in BB responders than in CCB responders (p<0.001). Similarly, the coupling interval variability was higher in BB responders (p=0.006).Conclusions:The evaluation of clinical and ECG parameters in patients with frequent idiopathic PVCs may determine whether BBs or CCBs should be chosen as initial treatment. Further prospective studies are needed to verify our findings and establish their clinical applicability.

BACKGROUND AND AIMS:Microvascular disease is considered as one of the main drivers of morbidity and mortality in severe COVID-19, and microvascular dysfunction has been demonstrated in the subcutaneous and sublingual tissues in COVID-19 patients. The presence of coronary microvascular dysfunction (CMD) has also been hypothesized, but direct evidence demonstrating CMD in COVID-19 patients is missing. In the present study, we aimed to investigate CMD in patients hospitalized with COVID-19, and to understand whether there is a relationship between biomarkers of myocardial injury, myocardial strain and inflammation and CMD.METHODS:39 patients that were hospitalized with COVID-19 and 40 control subjects were included to the present study. Biomarkers for myocardial injury, myocardial strain, inflammation, and fibrin turnover were obtained at admission. A comprehensive echocardiographic examination, including measurement of coronary flow velocity reserve (CFVR), was done after the patient was stabilized.RESULTS:Patients with COVID-19 infection had a significantly lower hyperemic coronary flow velocity, resulting in a significantly lower CFVR (2.0 ± 0.3 vs. 2.4 ± 0.5, p < .001). Patients with severe COVID-19 had a lower CFVR compared to those with moderate COVID-19 (1.8 ± 0.2 vs. 2.2 ± 0.2, p < .001) driven by a trend toward higher basal flow velocity. CFVR correlated with troponin (p = .003, r: -.470), B-type natriuretic peptide (p < .001, r: -.580), C-reactive protein (p < .001, r: -.369), interleukin-6 (p < .001, r: -.597), and d-dimer (p < .001, r: -.561), with the three latter biomarkers having the highest areas-under-curve for predicting CMD.CONCLUSIONS:Coronary microvascular dysfunction is common in patients with COVID-19 and is related to the severity of the infection. CMD may also explain the "cryptic" myocardial injury seen in patients with severe COVID-19 infection.

Coronary artery disease and cardiovascular mortality are increased in patients with an exaggerated blood pressure response to exercise. The exact cause of this increase remains unknown, but previous studies have indicated the presence of endothelial dysfunction in peripheral arteries and subclinical atherosclerosis in these patients. The present study aimed to clarify whether coronary microvascular dysfunction is also present in patients with exaggerated blood pressure response to exercise. A total of 95 patients undergoing exercise testing were consecutively enrolled. Flow-mediated vasodilatation and carotid intima-media thickness were measured using standardized methods. A transthoracic echocardiography examination was performed to measure coronary flow velocity reserve. Patients with an exaggerated blood pressure response to exercise had significantly lower coronary flow velocity reserve than the controls (2.06 (1.91–2.36) vs. 2.27 (2.08–2.72), p = 0.004), and this difference was caused by a reduction in hyperemic flow velocity (57.5 (51.3–61.5) vs. 62.0 (56.0–73.0), p = 0.004) rather than a difference in basal flow (26.5 (22.3–29.8) vs. 26.0 (24.0–28.8), p = 0.95). Patients with an exaggerated blood pressure response to exercise also had a significantly greater carotid intima-media thickness and significantly lower flow-mediated vasodilatation than controls. However, an exaggerated blood pressure response to exercise remained a significant predictor of coronary microvascular dysfunction after adjusting for confounders (OR: 3.60, 95% CI: 1.23–10.54, p = 0.02). Patients with an exaggerated blood pressure response to exercise show signs of coronary microvascular dysfunction, in addition to endothelial dysfunction and subclinical atherosclerosis. This finding might explain the increased risk of coronary artery disease and cardiovascular mortality in these patients.

Objective: Cardiac resynchronization therapy (CRT) is a reliable treatment modality in patients with systolic dysfunction. However, not every patient appears to benefit from CRT. The systemic immune inflammation index (SII) is closely linked to the poor prognosis of various cardiovascular disorders. However, there is no study investigating whether SII has predictive value in determining response to CRT in dilated cardiomyopathy patients. Therefore, we intend to investigate the association between SII and response to CRT. Methods: A total of 220 patients (mean age 61.2±10.8 years; 120 men) implanted with CRT were involved in this study. Echocardiographic and laboratory measurements were evaluated prior to CRT. Response to CRT was determined as a≥ 15% decrease in left ventricular end-systolic volume at one-year follow-up. Results: Patients grouped as CRT responders and non-responders. Of these, 143 (64.6%) were considered to be CRT responders, while the remaining 77 (33.4%) were non-responders. Female sex (OR: 3.823, CI: 1.568-9.324 p=0.003), QRS duration (OR: 1.224, CI: 1.158-1.335 p

Purpose The association between hypertensive retinopathy and left atrial (LA) impairment is unknown. Accordingly, it was aimed to investigate the possible relationship between hypertensive retinopathy and LA phasic functions by means of two-dimensional speckle-tracking echocardiography (2D-STE). Methods A total of 124 hypertensive patients and 27 control subjects were included in the study. LA reservoir strain (LA(S-S)), LA conduit strain (LA(S-E)), and LA booster strain (LA(S-A)) parameters were used to evaluate LA myocardial functions. Results Hypertensive patients (with and without retinopathy) displayed an obvious reduction in the LA reservoir strain (LA(S-S))(,) and LA conduit strain (LA(S-E)). Moreover, further impairment in LA reservoir and conduit strain was found in patients with hypertensive retinopathy than in the isolated hypertensive patients. There were no significant differences in LA booster strain (LA(S-A)) among the three groups. Impaired LA(S-S) (OR: 0.764, CI: 0.657-0.888, and p < 0.001), LA(S-E) (OR: 0.754, CI: 0.634-0.897, and p = 0.001), and hypertension (HT) duration (OR: 2.345, CI: 1.568-3.507, and p < 0.001) were shown to be independent predictors of hypertensive retinopathy. Conclusion Impaired LA reservoir and conduit strain may be used to predict hypertensive patients at higher risk of developing hypertensive retinopathy, and to determine which patients should be followed more closely for hypertensive retinopathy.

Background: Atrial arrhythmias are well-known complications of atrial septal defect (ASD), and associated with substantial morbidity. After ASD closure, right atrial and ventricular enlargement regresses, however, the risk of atrial arrhythmia development continues. In this study, we aimed to investigate the relationship between the Crochetage sign, which is a possible reflection of heterogeneous ventricular depolarization due to longterm hemodynamic overload, and the development of late atrial arrhythmia after ASD closure. Methods: This retrospective study included a total of 314 patients (mean age: 39.5 (30-50) years; male: 115) who underwent percutaneous device closure for secundum ASD. The study population was divided into two groups according to the presence or absence of the Crochetage sign. The Crochetage sign was defined as an M-shaped or bifid pattern notch on the R wave in one or more inferior limb leads. Cox-regression analysis was performed to determine independent predictors of late atrial arrhythmia development. Result: Fifty-seven patients (18.1%) presented with late atrial arrhythmia. Of these 57 patients, 30 developed new-onset atrial fibrillation/atrial flutter (AF/AFL), and 27 patients with pre-procedure paroxysmal AF/AFL had a recurrence of AF/AFL during follow-up. History of paroxysmal AF/AFL before the procedure (HR: 4.78; 95% CI 2,52-9.05; p < 0.001), the presence of Crochetage sign (HR: 3.90; 95% CI 2.05-7.76; p < 0.001), and older age at the time of ASD closure (HR: 1.03; 95% CI 1.01-1.06; p = 0.002) were found as independent predictors for late atrial arrhythmia. Conclusion: The presence of Crochetage sign may be used to predict the risk of late atrial arrhythmia development after transcatheter ASD closure. (c) 2021 Elsevier Inc. All rights reserved.

Background and Aim of the study Chronic severe aortic regurgitation (AR) is associated with progressive accumulation of interstitial fibrosis and disruption of myocardial structure. After aortic valve replacement (AVR), the negative remodeling process reverses, and left ventricular ejection fraction (LVEF) improves but not in all patients. In this study, we aimed to investigate the association of fragmented QRS (F-QRS), which is a possible marker of myocardial fibrosis, with postoperative left ventricular (LV) systolic dysfunction. Methods A total of 147 consecutive patients with AVR were included in this study. F-QRS was identified by the presence of various RSR' patterns (QRS duration <120 ms) such as additional R wave (R prime)or notching of the R or S wave in at least two consecutive leads. Patients were compared in two groups based on the presence or absence of F-QRS. A logistic regression model was used to determine independent predictors of postoperative LV systolic dysfunction (LVEF <50%). Results Patients with F-QRS were associated with poor recovery of LV systolic function after AVR compared to the patients without F-QRS, regardless of preoperative LVEF (p = .008). F-QRS was found to be an independent predictor of postoperative LV systolic dysfunction (LVEF <50%). Lower preoperative LVEF and increased LV end diastolic diameter index were also found as independent risk factors for postoperative LV systolic dysfunction. Conclusions As a possible marker of myocardial fibrosis, F-QRS was associated with postoperative LV systolic dysfunction. Therefore, as a simple and convenient clinical parameter, F-QRS may be used to predict poor recovery of LVEF after AVR.

Background: The current knowledge about novel coronavirus-2019 (COVID-19) indicates that the immune system and inflammatory response play a crucial role in the severity and prognosis of the disease. In this study, we aimed to investigate prognostic value of systemic inflammatory biomarkers including C-reactive protein/albumin ratio (CAR), prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR) in patients with severe COVID-19. Methods: This single-center, retrospective study included a total of 223 patients diagnosed with severe COVID-19. Primary outcome measure was mortality during hospitalization. Multivariate logistic regression analyses were performed to identify independent predictors associated with mortality in patients with severe COVID-19. Receiver operating characteristic (ROC) curve was used to determine cut-offs, and area under the curve (AUC) values were used to demonstrate discriminative ability of biomarkers. Results: Compared to survivors of severe COVID-19, non-survivors had higher CAR, NLR, and PLR, and lower LMR and lower PNI ( P < .05 for all). The optimal CAR, PNI, NLR, PLR, and LMR cut-off values for detecting prognosis were 3.4, 40.2, 6. 27, 312, and 1.54 respectively. The AUC values of CAR, PNI, NLR, PLR, and LMR for predicting hospital mortality in patients with severe COVID-19 were 0.81, 0.91, 0.85, 0.63, and 0.65, respectively. In ROC analysis, comparative discriminative ability of CAR, PNI, and NLR for hospital mortality were superior to PLR and LMR. Multivariate analysis revealed that CAR (⩾0.34, P = .004), NLR (⩾6.27, P = .012), and PNI (⩽40.2, P = .009) were independent predictors associated with mortality in severe COVID-19 patients. Conclusions: The CAR, PNI, and NLR are independent predictors of mortality in hospitalized severe COVID-19 patients and are more closely associated with prognosis than PLR or LMR.

Background: A history of preeclampsia (pPE) and gestational diabetes (pGDM) are female-specific risk markers for atherosclerosis and future cardiovascular risk. In addition to increasing the risk of established risk factors for atherosclerosis, such as hypertension or diabetes, evidence suggests that pregnancy-related complications can also directly accelerate atherosclerosis by inducing endothelial dysfunction. A combination of both conditions is seen in a subset of patients with pregnancy, though it is not known whether this combination increases the overall risk for cardiovascular events. Aims: Present study aimed to find the impact of combined pPE/pGDM on the prevalence of coronary micro vascular dysfunction (CMD). Methods: A total of 24 patients with combined pPE/pGDM, 19 patients with isolated pPE and 63 patients with pGDM were included to the present study and a further 36 healthy women with no previous pregnancy-related complications served as controls. Coronary flow reserve was measured using echocardiography and CMD was defined as a coronary flow reserve <= 2.5. Results: Patients with combined pPE/pGDM had a high prevalence of CMD (91%), which was significantly higher than controls (5.6%, p < 0.001) and patients with pGDM (55%, p = 0.01). A history of pPE on top of pGDM was associated with an increased risk of CMD (HR:6.28, 95%CI:1.69-23.37, p = 0.006) after multivariate adjustment, but pGDM did not increase the odds for CMD in those with pPE. Conclusions: Combined pPE/pDM is associated with a very high prevalence of CMD, which may indicate an increased risk for future cardiovascular events.

Metabolic syndrome (MS) is a known risk factor of cardiovascular disease.However, it is not identified whether MS made alterations in the elasticity of the aorta in the early period before significant atherosclerosis occurred.The purpose of the study was to evaluate aortic elastic properties of patients who were newly diagnosed with MS.The research was performed among 100 patients of newly diagnosed MS (49 males; mean age 46 ± 9 years) with normal sinus rhythm, and 55 cases without MS (29 males; mean age 45 ± 9 years), matched by age .All participants underwent comprehensive physical and cardiological examination, biochemical examination, anthropological measurement and echocardiography.Aortic diameter change was significantly lower in MS group compared to control group (0.014 ± 0.04 vs 0.25 ± 0.1, p <0.01), aortic stiffness was significantly higher in the MS group (10.65 ± 4.52 vs 5.7 ± 2.42, p<0.01) compared to the age-matched control group.Multiple regression analysis shows that there is an independent relationship with each of the age, body mass index, HDL cholesterol and systolic blood pressure.Aortic stiffness index was higher in newly diagnosed MS patients compared to the control group.The vascular system can be affected even without diabetes, hypertension, hyperlipidemia, and coronary artery disease, which is excluded by history and noninvasive evaluation.

Objective: The new coronavirus disease (COVID-19) has spread rapidly all over the world and caused anxiety disorders. Recent studies have also shown that the prevalence of depression and anxiety increased during the COVID-19 outbreak. We aimed to evaluate the anxiety and depression levels during the pandemic and identify the effect of pandemic-related stress on blood pressure (BP) control in primary hypertensive patients. Method: A total of 142 patients with primary hypertension (HT) who continued to use the same antihypertensive drugs before and during the pandemic were included in the study. Twenty-four -hour Ambulatory Blood Pressure Monitoring (ABPM) and the Hospital Anxiety and Depression Scale (HADS) questionnaire were applied to patients. We retrospectively reviewed 24-h ABPM records of the same patients for the year before the pandemic. Results: Daytime, nighttime and 24 -hour-systolic blood pressure (SBP) levels as well as daytime, nighttime, and 24- hour-diastolic blood pressure (DBP) levels, were significantly elevated during the COVID-19 outbreak compared to the pre-pandemic period (p<0.001). Higher HADS-A scores (HADS-A ≥7) were significantly associated with much greater increase in BP compared to the patients with lower HADS-A scores. Conclusion: Psychological stress due to the COVID-19 outbreak led to worsening of the regulation of BP in controlled hypertensive patients whose antihypertensive treatments did not change.