The 2008 European Society of Cardiology/European Society of Hypertension guidelines recommend the first-line prescription of two antihypertensive drugs in single-pill combinations (SPCs), also known as fixed-dose combinations, for the treatment of most patients with hypertension. This recommendation is based on a large amount of data, which shows that first-line treatment with SPCs supports reaching blood pressure targets rapidly and reducing cardiovascular outcome risk while keeping the therapeutic strategies as simple as possible and fostering adherence and persistence. As this approach constitutes a big shift from the stepped-care approaches that have been dominant for many years, practicing physicians have expressed concerns about using SPCs as first-line agents. In this review, we will discuss the barriers to the uptake of this recommendation. We will also offer suggestions to reduce the impact of these barriers and address specific concerns that have been raised.

Patients over 40 years of age with AO and ED should also be examined for TDS and metabolic syndrome. In this group of patients we found that 113/167 patients (67.6%) had total TST below 14 nmol/l, and sufficient level of TST seems to be above this level.

The aim of our study was to verify the effi ciency of catheter ablation of atrial fi brillation (CA AF) according to the "atrial fi brillation (AF) burden"(time spent in AF) and symptoms related to AF. METHODS: We retrospectively analysed a selected set of 133 patients with atrial fi brillation (81% men, 19% women) who underwent an invasive therapy in the form of CA AF and at the same time had an implanted longterm ECG loop recorder (Reveal XT) in a period of eight years. We investigated AF burden and objective symptoms of AF by data obtained from a long-term implantable ECG loop recorder. Subjective symptoms related to AF were identifi ed during outpatient controls. RESULTS: Firstly, our results demonstrate for the fi rst time a clinically relevant increase in the occurrence of asymptomatic episodes of AF after CA AF. Secondly, when analysing AF symptoms and AF burden at the same time, CA AF in terms of reduction of symptoms and shortening the time in AF had a better effect in patients undergoing 1 procedure (CA AF) compared to patients undergoing repeated procedures (re CA AF). CONCLUSION: The increase in the occurrence of asymptomatic episodes of AF is of considerable importance both for the clinical evaluation of ablation effi cacy and for individualized clinical management of patients, especially with respect to antithrombotic therapy (Fig. 10, Ref. 19). Text in PDF www.elis.sk. KEY WORDS:atrial fi brillation, symptoms of atrial fi brillation, atrial fi brillation burden, catheter ablation of atrial fi brillation, continuous ECG monitoring.

AIM Today we have not the established and single clinical mode to identifying hypertensive (HT) patients in risk for paroxysmal atrial fibrillation (pAF). Some non-invasive VCG and high-resolution VCG (Hi-Res) for P and QRS loops are available for ECG/VCG measurements in clinical practice via routinely used ECG/VCG equipment (General Electric). It is possible, that especially P wave and P loop values can reflect the abnormal status in atrial myocardium prior the pAF onset. MATERIAL AND METHOD We studied 276 HT patients in sinus rhythm: group I (n=133, without documented pAF), group II (n=129, with well-documented pAF) and group III (n=14, patients after successful radiofrequency ablation for AF or atrial flutter). ECG parameters were evaluated: (1) heart rate in SR; (2) VCG P loop and QRS loop non-filtered/filtered duration: nPd, fPd, nQRSd, fQRSd; (3) other Hi-Res P and QRS parameters: HFLAd, RMS(40)v; (4) angle between axes P-QRS and QRS-T loops; (5) echoCG parameters: LA dimension, LV ejection fraction, width of IVS ad posterior wall. RESULTS In group II a III the non-filtered parameters (nPd, nQRSd) and filtered parameters (fPd, fQRSd) were significantly longer than in group I (for nPd : 135.9 ms, 145.1 ms vs. 129.0 ms, p<0.05; for nQRsd : 104.2 ms, 110.0 ms vs. 99.0 ms, p<0.01; for fPd: 143.0 ms, 154.9 ms vs. 133.0 ms, p<0.005; for fQRSd 119.7 ms, 125.9 ms vs. 113.0 ms, p<0.005). P loop axis analysis is significantly higher in loop II and III vs. group I (+48.2 gr., +53.4 gr. Vs. 48 gr., p<0.01). Angle P-QRS is significantly wider in group II and III vs. group I (38.7 gr., 42.1 gr. Vs. 25.0 gr, p= 0.005. EchoCG parameters were not significantly different (LA dimensions for groups I,II,III: 39.8, 42.7 and 42.0 mm, n.s.; LVEF for groups I,II,III> 59.7, 57.8 and 58.1, ns.). CONCLUSIONS HT patients with verified pAF in documentation have more abnormal P and QRS wave/loop parameters than HT patients without history of pAF. According to our results, the most informative ECG and VCG factors for possible future pAF are: fPd, fQRSd, angle between loop axes P-QRS. ECG/VCG parameters (non-filtered and especially after filtration via to Hi-Res analysis) have potential to improve the risk stratification for possible future pAF.

Polyunsaturated omega-3 fatty acids (ω-3 PUFA) are important components of cell membrane affecting its function and their deficiency is deleterious to health. We have previously shown that spontaneously hypertensive rats (SHR) are prone to lifethreatening arrhythmias that are reduced by ω-3 PUFA intake. Purpose of this study was to explore plasma and red blood cells (RBC) profile of ω-3 and ω-6 PUFA as well as to determine ω-3 index, a risk factor for sudden cardiac death, in aged SHR and the effect of ω-3 PUFA intake. Male and female 12-month-old SHR and age-matched Wistar rats fed with ω-3 PUFA (200 mg/kg BW/day/2 month) were compared with untreated rats. Composition of ω-3 PUFA: alfa linolenic acid, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as well as ω-6 PUFA: linoleic acid and arachidonic acid was analyzed by gas chromatography. Results showed sex- and strain-related differences of basal ω-3 and ω-6 PUFA levels in plasma and RBC as well as in response to ω-3 PUFA intake. Comparing to Wistar rats ω-3 index, expressed as a percentage of EPA+DHA of total fatty acids, was lower in SHR and it increased due to consumption of ω-3 PUFA. Findings support our hypothesis that lower ω-3 index may be also a marker of increased propensity of the hypertensive rat heart to malignant arrhythmias.