Objective: Regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome. In this study we aimed to investigate the role of exaggerated blood pressure response (EBPR) during exercise in LVH regression in hypertensive subjects over time. Design and method: 1413 hypertensive subjects, (mean age 57 ± 11 years), 51% males, with baseline office blood pressure (BP) 144/89mmHg were followed for a mean period of 6.4 ± 3.0 years. At baseline and last follow-up visit all patients underwent office BP, laboratory tests and echocardiographical determination of left ventricular mass index (LVMI). At baseline, all subjects underwent treadmill exercise testing (Bruce protocol) in order to identify the presence of EBPR based on the systolic BP elevation at peak exercise (> or = 210 mmHg for men and > or = 190 mmHg for women). Main outcome variable was LVH Regression/prevention (LVH Regr/prev), defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. BP control was considered optimal when the mean of office BP measurements during follow-up was < 140/90 mmHg. Results: 46% of study population presented LVH Regr/prev during follow-up period. Cox-regression analysis, after adjustment for clinical and biochemical variables, revealed that low levels of baseline LVMI (HR = 0.98, 95% CI 0.97–0.99, p < 0.0001), absence of EBPR (HR = 0.81, 95% CI 0.67–0.98, p = 0.02) and optimal BP control during follow-up (HR = 1.19, 95% CI 1.01–1.56, p = 0.03) were independent predictors of LVH Regr/prev during follow-up. Conclusions: In conclusion, beyond optimal BP control, EBPR is a significant predictor of structural cardiac alterations overtime. These finding strengthens the clinical importance of EBPR during the baseline evaluation of hypertensive subjects.

Objective: Ambulatory arterial stiffness index (AASI) has been shown to predict cardiovascular morbidity and mortality in hypertensive patients. However, there are limited data with respect to its prognostic significance among patients with acute myocardial infarction (AMI). Weevaluated the relationship between AASI and long-term cardiovascular outcomes in patients withAMI. Design and method: We followed up 254patients (82.7% male; mean age 63.7 years; 71.7% hypertensives; 29.9% with diabetes mellitus) who were hospitalized because of ST-elevation MI (STEMI, 48.8%) and Non-ST–elevation MI (NSTEMI), for a period of 12 months. All patients underwent baseline estimation of clinical and laboratory parameters during their hospitalization. Patients underwent 24-hour ambulatory blood pressuremonitoring (ABPM) during the third day of hospital stay. The AASI was calculated as 1- (slope of diastolic on systolic blood pressureduring ABPM). Endpoints of interest where total and cardiovascular mortalityand cardiovascular morbidity set as hospitalization for congestive heart failure, acute coronary syndrome, stroke, ventricular tachycardia, atrial fibrillation and acute renal failure. Results: The AASI failed to predict mortality orthe composite endpoint of cardiovascular morbidity and mortality during the follow-up period either in the entire population or separately for each AMI type. However, AASI demonstrated a significant prognostic role for hospitalization for cardiovascular events in the NSTEMI population in univariate regression analysis (HR = 0.102; 95% CI: 0.048–0.155; p < 0.001). In a model of multivariate regression analysis in the same AMI group, this association was maintained (HR = 0.067; 95% CI: 0.020–0.115; p = 0.006) after adjusting for traditional risk factors and severity of coronary artery disease assessed by the number of affected main vessels. Conclusions: AASI emerges as an independent predictor of one-year cardiovascular morbidity in patients with NSTEMI. More data are required to determine the usefulness of this non-invasive tool in risk stratification and management of these patients.

Objective: Activation of platelet angiotensin receptors could potentially contribute to further progression of thrombotic events in hypertension. The aim of our study was to investigate the effect of antihypertensive therapy with ARBs on platelet function and morphology in a population of untreated hypertensive patients. Design and method: 120 untreated hypertensive patients(mean age 51 years; office blood pressure: 153/87 ± 7.3 mmHg, 55% males; 56% smokers)were divided into groups based on ARBs treatment (group 1) or no (group 2) and were prospectively followed up. Group 1 was further classified into 2 subgroups with subgroup 1 (n = 50) receiving Olmesartan and subgroup 2(n = 50)receiving Candesartan. Platelet function was assessed at baseline and at 40 days by means of a PFA-100 analyzer using epinephrine (EPI) and ADP. Time to aperture occlusion, closure time (CT),was recorded in seconds. Additionally, clotting times, mean platelet volume (MPV), vWf:Ag and fibrinogen levels were assessed. Results: At baseline, platelet activity was determined(PFA CTEPI, PFA CTADP)with no statistically significant differences between groups. At reassessment, changes in both CT- PFAEPI and CT-PFAADP were found between groups(group 1: CT-PFAEPI = 138.9 ± 22.3 sec, group 2: CT-PFAEPI = 104.9 ± 22.9 sec, group 1: CT-PFAADP = 85.5 ± 18.6 sec and group 2: CT-PFAADP = 81.5 ± 11.9 sec). However, after checking the significance of these changes (δ)it was found that only CT-PFAEPI change (δ) difference between treatment groups reached statistical significance(group 2 vs subgroup 1: δCT-PFAEPI21.8 [95% CI (2.17 – 41.4)],p = 0,025, group 2 vs subgroup 2: δCT-PFAEPI20.7 [95% CI (1.09 – 40.3)], p = 0.035, subgroup 1 vs subgroup 2: δCT-PFAEPI 1.08[95% CI (-15.3 – 17.4)], p = NS). During follow-up, treatment with ARBs was associated with significant lowering of fibrinogen (from 341.7 ± 62.2 to 316.3 ± 61.8 mg/dl, p < 0.001),MPV levels (from 10.4 ± 0.91 to 8.8 ± 0.9fL, p < 0.001) and vWf:Ag (from 103.2 ± 6.7 to 93.8 ± 7.1)with no corresponding reductions in group 2. After multivariate analysis,CT-PFAEPI changes(δ)were significantly correlated only with ARBs(p < 0.001),irrespectively of specific drug. Conclusions: The present study indicates that treatment with ARBs contributes to downregulation of platelet activity in hypertension, suggesting that it could offer additional cardiovascular benefit in hypertensive patients.

A 63-year-old man with a history of smoking and arterial hypertension and without known cardiovascular disease presented with a 2-month history of progressive shortness of breath on exertion with episodes of orthopnea and lower extremity edema. He was free of angina or syncope. His medical history was remarkable for pulmonary tuberculosis 30 years ago. The physical examination revealed an alert patient with heart rate of 95 beats per minute, normal body temperature, blood pressure of 130/80 mm Hg, and oxygen saturation of 96% on ambient air. Slightly diminished breath sounds were heard in auscultation over all fields of both lungs. His heart sounds were distant. Initial laboratory results were normal. The electrocardiogram showed a normal sinus rhythm with mild sinus tachycardia, without atrioventricular or interventricular conduction defects.

The aim of the present study was to explore hospital admissions due to heart failure in the cardiology department of a tertiary General Hospital in Athens, Greece, that does not hospitalize SARS-CoV-2 infected patients. The daily number of admissions at Cardiology Wards and Cardiology Intensive Care Unit were retrieved from hospital's database (January 1st – April 30th, 2018, 2019 and 2020). The visits at the hospital were significantly reduced by 41.1% in March 2020 and by 32.7% in April 2020 as compared to January (p for linear trend <0·001). As the number of confirmed COVID-19 cases increased in Greece (i.e., from February 26th to April 2nd) the number of visits decreased (p=0.01), whereas, the opposite observed in the period afterwards (p=0.01). The number of admitted heart failure patients in March 2020 was the lowest compared to the entire period (n = 43 cases vs. 95%CI 53-92, p<0·001), whereas the number of those admitted in April was higher compared to March, but still lower compared to the entire studied period (n = 56 cases, p<0·001). However, although hospital admissions due to heart failure showed a declining trend following the overall admissions observed during the COVID-19 period, the percent of heart failure patients among all those admitted in March and April 2020 was 17% and 20%, respectively, and was higher compared to January and February of the same year, as well as the highest throughout the entire studied period 2018 – 2020 (range from 13% to 20%).

Background and aims: One of the objectives of the ESC-EORP EUROASPIRE V survey is to determine how well European guidelines on the management of dyslipidaemias are implemented in coronary patients. Methods: Standardized methods were used by trained technicians to collect information on 7824 patients from 130 centers in 27 countries, from the medical records and at a visit at least 6 months after hospitalization for a coronary event. All lipid measurements were performed in one central laboratory. Patients were divided into three groups: on high-intensity LDL-C-lowering-drug therapy (LLT), on low or moderate-intensity LLT and on no LLT. Results: At the time of the visit, almost half of the patients were on a high-intensity LLT. Between hospital discharge and the visit, LLT had been reduced in intensity or interrupted in 20.8% of the patients and had been started or increased in intensity in 11.7%. In those who had interrupted LLT or had reduced the intensity, intolerance to LLT and the advice of their physician were reported as the reason why in 15.8 and 36.8% of the cases, respectively. LDL-C control was better in those on a high-intensity LLT compared to those on low or moderate intensity LLT. LDL-C control was better in men than women and in patients with self-reported diabetes. Conclusions: The results of the EUROASPIRE V survey show that most coronary patients have a less than optimal management of LDL-C. More professional strategies are needed, aiming at lifestyle changes and LLT adapted to the need of the individual patient.

Objective: The impact of blood pressure variability (BPV) on cardiac function has been mainly examined through the prism of congestive heart failure and hypertension, but not in the setting of an acute coronary syndrome (ACS). The aim of this study is to determine the association between in-hospital short-term BPV and the development and aggravation of cardiac dysfunction in patients with acute myocardial infarction (AMI). Design and method: A total population of 57 AMI patients [74.5% male; mean age: 67.56 years;75.4% hypertensives]underwent 24hr ambulatory BP measurement during hospitalization.At 6 months a follow-up was scheduled for each patient in order to collect data on hospitalizations for heart failure (HF), but also to assess the overall cardiovascular outcome.The latter was defined as the composite end-point ofhospitalizations for heart failure (n = 8), decline in ejection fraction (EF%) compared to the in-hospital value (n = 11), deterioration of NYHA class (n = 3) and new onset of heart failure symptoms (n = 2). In-hospital BPV was assessedusing standard deviation (SD) and average real variability (ARV). The study population was divided intoa STEMI group (n = 24) and a non-STEMI (n = 33) one. Results: BPV was not associated with hospitalizations for HF. However, when the composite end-point was assessed, ARV of systolic BP demonstrated a significant negativeassociation [B = -0.430; odds ratio, 0.651; CI, 0.473–0.895 (P = 0.008)]in the total population. A relatively significant predictive roleof ARV was shown after splitting the population into the STEMI [B = −0.531; odds ratio, 0.588; CI, 0.339–1.019 (P = 0.058)]and non-STEMI group[B = −0.4; odds ratio, 0.670; CI, 0.443–1.014 (P = 0.058)]. Multinomial logistic regression analysis of incidence of cardiovascular events highlightedsystolic BP ARVas the onlyindependent predictor during a 6-month follow-up [B = −0.508; odds ratio, 0.602; CI, 0.407–0.891 (P = 0.011)] regardless the ACS type. Conclusions: In the setting of ACS, reduced in-hospital systolic BP ARV was associated with cardiovascular morbidity during the 6 months of follow-up. This finding could be attributed to a dysautonomic state of the cardiovascular system related to the pathophysiology of ACS, linking BP regulation mechanisms to worse overall outcome in this high risk setting.

Background: SPRINT trial showed that intensive lowering of systolic blood pressure significantly reduced mortality and morbidity due to cardiovascular diseases.However, despite the fact that hypertension is a major risk factor for stroke, there was no difference in the risk of fatal and non-fatal cerebrovascular events.Purpose: The purpose of the current analysis was to analyze the association between on-treatment DBP and incidence of stroke in patients from SPRINT trial.Methods: We used data of 8944 patients from SPRINT trial obtained from the NHLBI Biologic Specimen and Data Repository Information Coordinating Center.Results: There was 110 stroke events in analyzed period, including 49 in intensive treatment and 61 in standard treated group.In subject with diastolic blood pressure lower than 70 mmHg the risk of stroke was higher than in the others (HR 1.467, 95% CI: 1.009-2.133,p=0.0445).Univariable Cox proportional hazard risk analysis showed that in whole group age >75 years, concomitant cardiovascular and chronic kidney diseases were risk factors for stroke.We found that occurrence of those risk factors was associated with lower values of diastolic blood pressure and higher pulse pressure, however not to the treatment assignment.Multivariable Cox proportional hazard risk model revealed that only age >75 years and cardiovascular diseases were significantly related to stroke events.Stroke-free survival depending on DBP Conclusion: Reduction of diastolic blood pressure below 70 mmHg may be associated with an increased risk of stroke.Therefore, intensive lowering of diastolic blood pressure should be avoided in the elderly with isolated systolic hypertension.

Background: The aim of this study was to compare the predictive ability of clinical risk scores (ACEF, EuroSCORE and EuroSCORE II) to angiographic (SYNTAX score) and combined risk scores (Global Risk Score and Clinical SXscore) towards cardiovascular death and/or major adverse cardiac events (MACE) in patients with STsegment elevation acutemyocardial infarction (STEMI) managedwith primary percutaneous coronary intervention (pPCI).Methods: A total of 685 patients successfully treated with pPCI were evaluated and the risk scoreswere calculated. The primary endpoint was the 2-year incidence of fatal cardiac events. Secondary end points were target lesion failure (TLF), repeat revascularization (RR) and MACE.Results: Patients distributed in the highest tertile of EuroSCORE II presented increased rates of CV death (CVD), all-cause mortality and MACE (p < 0.001 for all). EuroSCORE II was associated with increased C-statistics (0.873, 95% CIs: 0.784-0.962 and 0.825, 95% CIs: 0.752-0.898 respectively) for predicting CVD and MACE over competing risk scores (p < 0.05). EuroSCORE II conferred incremental discrimination (Harrell's C, p < 0.05 for all, apart from CSS for predicting CVD) and reclassification value (Net Reclassification Index, p < 0.05 for all, apart from CSS for reclassifying MACE) over alternative risk scores for study's main endpoints. EuroSCORE II independently predicted CVD (HR= 1.06, 95% CIs: 1.03-1.09, p < 0.001) andMACE (HR= 1.07, 95% CIs: 1.04-1.10, p < 0.001).Conclusion: EuroSCORE II has the best predictive ability of CVD and/or MACE after successful pPCI for the treatment of STEMI. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

A 52-year-old male was hospitalized for investigation of a syncopal episode. His past medical history was remarkable for type II diabetes mellitus and inferior wall ST-segment elevation myocardial infarction 3 months earlier, treated with primary percutaneous coronary intervention with three drug eluting stents implantation in the right coronary artery. Having excluded neurological diseases and metabolic or other common causes of syncope, the patient underwent a new coronary arteriography which depicted stent patency. Subsequently, an electrophysiological study was remarkable for the induction of syncopal sustained monomorphic ventricular tachycardia, despite the preserved ejection fraction (i.e. 55%). Thus, dual-chamber implantable cardioverter defibrillator (ICD) placement was decided.

Background: Elevated blood pressure (BP) during childhood and adolescence is not so rare and increases the risk of hypertension in adulthood. Physical activity (PA) is considered a key component for the prevention and treatment of hypertension in children and adolescents. Thus, the purpose of our study was to assess the level of PA in Greek adolescents and its relation to BP levels. Methods: The study included 496 students aged 12-17 years who were enrolled on a volunteer basis. All children were subjected to BP measurement on two different occasions during a routine school day. Demographic, socio-economic and lifestyle characteristics were assessed by means of a standard questionnaire. Information on the frequency and duration of PA and on the amount of time spent on sedentary activities was obtained by the short-form self-administered questionnaire International Physical Activity Questionnaire-IPAQ. Results: The study population was divided in three groups according to the score achieved in IPAQ questionnaire: low PA (n = 39), moderate PA (n = 230) and high PA (n = 231). Children with high PA compared to those with low PA exhibited higher systolic BP and pulse pressure levels, greater prevalence of prehypertension/hypertension status, while heart rate was significantly lower as the level of PA rose (P < 0.05 for all cases). Intense PA was positively correlated to systolic BP (r = 0.139, P = 0.003) and pulse pressure (r = 0.22, P = 0.0001). Conclusion: Intense PA is associated with higher systolic BP, pulse pressure levels and lower heart rate in healthy young adolescents. PA should be practiced at a moderate intensity level in everyday life.

INTRODUCTION The significance of microalbuminuria (MA) in paediatric essential hypertension has yet to be established. The Leontio Lyceum ALbuminuria Study (3L Study) was designed to determine the prevalence of MA among Greek schoolchildren and to evaluate these rates in relation to the children's anthropometric and lifestyle characteristics, and dietary habits. METHODS During April 2009, 498 students from the Leontio Lyceum, aged 12-17 years (7th-12th grade), were asked to participate in the 3L Study. For each child a questionnaire was completed that was developed for the purposes of the study to retrieve information on socio-demographic and lifestyle characteristics, as well as dietary habits (through a semi-quantitative Food Frequency Questionnaire), and physical activity status. Overweight and obesity were defined using the international body mass index cut-off points established for children and young people. Office blood pressure (BP) was measured on two different occasions and those students who had BP >95th percentile for gender, age and height on both occasions were considered as hypertensives. Microalbuminuria was determined as albumin to creatinine ratio >or=22 mg/g in boys and >or=31 mg/g in girls in a morning spot urine sample using a quantitative assay (DCA 2000). RESULTS The prevalence of MA was found to be 12.9% and that of childhood hypertension 5.2%. The prevalence of overweight status was 25.8% and 5.8% of the students were classified as obese. Low physical activity was reported by 7% of boys and girls, while 46.5% of the students reported participation in vigorous physical activities during a normal week. Based on the KIDMED score of each student, only 6% of them were classified as high adherers to a Mediterranean diet and 41.9% were classified as having very low diet quality. CONCLUSIONS In this paper we present the aims, design and preliminary results of an epidemiological study on MA, hypertension, increased body size and lifestyle characteristics among Greek schoolchildren.