IntroductionCorrect blood pressure (BP) measurement is crucial in the diagnosis of arterial hypertension (AH), and controversy exists whether supine BP should be treated as equal to sitting BP. The aim of this study was to evaluate the relation of supine BP to sitting BP and ambulatory BP with regard to identification of diagnostic cut-offs for hypertension.Material and methodsThis study included 280 patients with AH (mean age: 44.3 ±10.6 years). The following measurements of BP were performed and analyzed: 1) sitting office blood pressure measurement (OSBP and ODBP); 2) supine BP (supSBP and supDBP), measured automatically (5 times with a 2-minute interval) during evaluation by the Niccomo device (Medis, Germany); 3) 24-hour ambulatory blood pressure (ABP) monitoring.ResultsThe mean supSBP and supDBP were found to be lower than OSBP and ODBP (130.9 ±14.2 vs. 136.6 ±15.5 mm Hg and 84.8 ±9.4 vs. 87.8 ±10.2 mm Hg, respectively; p < 0.000001). The correlations between ABP and supBP/OBP were moderate and strong (correlation coefficients in range 0.55–0.76). The ROC analysis revealed that mean supBP ≥ 130/80 mm Hg was more precise than OBP ≥ 140/90 mm Hg in diagnosing hypertension (AUC: 0.820 vs. 0.550; sensitivity 80.7% vs. 57.4%; specificity 83.2% vs. 52.7%; p < 0.0001) and the additive value derived mostly from its higher predictive power of identifying patients with increased night-time BP.ConclusionsIn young and middle-aged hypertensive patients the blood pressure during a 10-minute supine rest was lower than in the sitting position. The supine blood pressure ≥ 130/80 mm Hg was found to be a specific and sensitive threshold for hypertension.

BP (27.3% vs. 12.1%; p = 0.013). More pronounced improvement in the left ventricular diastolic dysfunction (delta E/A 0.34 vs. 0.12, p = 0.017) (Cardiol J 2016; 23, 2: 132-140)

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Background: Oral anticoagulation therapy (OAT) prevents ischaemic incidents in patients with atrial fibrillation (AF). CHA 2 DS 2 -VASc risk score of ≥2 points in men and ≥3 in women is a class I indication for OAT. OAT should also be considered as a prevention of thromboembolism in AF men with a CHA 2 DS 2 -VASc score of 1 point and women with 2 points, but the class of recommendation is lower (IIa). This study aims to assess the occurrence of left atrial appendage thrombus (LAAT) and risk factors of its formation in patients with lower class recommendation to oral antiocoagulation treatment. Methods:The study group consisted of 1,858 patients: 555 patients with class IIa indication to OAT (IIa group) and 1,303 patients with class I indication as a control group (I group). Patients were admitted to three cardiology departments. All subjects underwent transoesophageal echocardiography.Results: The incidence of LAAT was comparable in both IIa and I group: LAAT was confirmed in 30 (5.4%) subjects of IIa group and in 77 (5.9%) of I group. The prevalence of LAAT in IIa group was higher on treatment with VKAs (in comparison to NOACs) (8.4% vs. 3.4%, P=0.010), and lower in case of paroxysmal AF (in comparison to non-paroxysmal AF) (2.4% vs. 9.8%, P=0.0002). Multivariate logistic regression revealed the following variables as the independent predictors of LAAT in IIa group: treatment with VKAs (OR 2.99, 95% CI: 1.33-6.69; P=0.007), paroxysmal AF (OR 0.26, 95% CI: 0.11-0.62; P=0.002) and eGFR <60 mL/min/1.73 m 2 (OR 3.19, 95% CI: 1.42-7.16; P=0.005). Conclusions:The prevalence of LAAT in AF patients with lower class (IIa) recommendation to anticoagulants was comparable to higher (I). Treatment with VKAs, along with non-paroxysmal type of AF and eGFR <60 mL/min/1.72 m 2 were identified as the strongest predictors of LAAT in IIa group.

IntroductionPortocaval anastomosis (PCA) induces chronic liver failure with resulting well characterised metabolic consequences. The blood levels of potentially cerebrotoxic substances is greatly increased. There are also increased concentrations of aromatic amino acids, neurotransmitter precursors: TRY, PHE, TYR, HIS, which freely penetrate the blood-brain barrier. In the CNS an enhanced synthesis of neurotransmitters is facilitated. The excessive amine formation is counterbalanced either by increased catabolism (5HT, dopamine) or deposition (histamine) as demonstrated by increased cerebral indoleamine and catecholamine metabolite levels and of histamine, respectively [1,2]. The liver is the organ chiefly responsible for alcohol metabolism. Interestingly, rats with chronic liver failure caused by PCA show a higher preference for alcohol than their sham operated pairs [3,4]. The mechanism involved in the development of abnormal alcohol drinking by PCA rats remains unknown. As histamine has been shown to influence diuresis, thermoregulation and EEG activity, hypothalamic functions, which are also affected by ethanol a possible contribution of altered brain histamine system was examined. Materials and methodsWistar outbred rats with surgically constructed portocaval anastomosis (PCA) and confirmed altered hepatic function as well as sham operated controls were used. Animal procedures complied with Polish legislation concerning experiments on animals and were approved by the local care committee. To reveal the link between cerebral histamine concentration and voluntary alcohol intake, treatments were applied to decrease the high histamine concentration in PCA brains and to increase it in control animals [5]. Accordingly, alfa-fluoromethylhistidine, 50 mg/kg and L-histidine, 1000 mg/kg were used. Both these drugs were given s. c. at the beginning of dark phase of the 24 h cycle for 3 consecutive days. Throughout the experiments rats were kept in metabolic cages and had a free access to fluids: water and 10% ethyl alcohol as well as to food. The consumption and excretion were recorded daily. Results and discussionThe results are presented in Table 1. Shunted rats, although weighing less (329 ± 13 vs. 476 ± 33 g, p < 0.05), ate and drank significantly more (p < 0.05 at least) than sham rats. They also excreted more urine (p < 0.01). When given a free choice between water and 10% ethyl alcohol they preferred ethanol. Alcohol accounted for about 65-70% of fluids consumed by these animals, whilst only for about 20-25% by the controls. These data are fully in agreement with our previously published results [3,4] showing an increased alcohol preference associated with liver function impairment. Indeed, at autopsy the liver size was about 40% less in PCA rats as compared to their control counterparts. Atrophy was evident when measures were expressed in terms of liver index (liver weight to body weight ratio ¥ 100). For shunted rats the calculated liver index was 1.755 ± 0.06 (mean ± SEM) whereas it was 2.920 ± 0.090 for sham...