Background: Optimizing blood pressure variability seems to represent a new therapeutic target in the management of hypertension. It is emphasized that scheduling at least one antihypertensive agent at bedtime, has the ability to reduce blood pressure. Aim of the study : We have proposed to test whether the divided treatment regimen also lowers blood pressure variability. Material and methods: A number of 37 treated hypertensive patients were enrolled, who underwent 24-hour ambulatory blood pressure monitoring (ABPM) at inclusion and at 8 weeks after therapeutic intervention with divided treatment regimen. BPV was assessed using average real variability. Results: The 24-hour systolic blood presure decreased from 139.5 ± 8.8 mmHg to 127.4 ± 8.9 mmHg (p <0.0001), and we noted a 2.1 mmHg drop in blood pressure variability (p <0.0001), as well as a two-fold increase in the percentage of dippers. After baseline ABPM assessment, in 15 cases an angiotensin-converting-enzyme-inhibitor was scheduled at bedtime, and in 10 cases it was given twice a day. In 17 cases a thiazide diuretic was administered in the afternoon, and in 18 cases a calcium channel blocker was administered at bedtime. Conclusions: For a more accurate management of patients with hypertension, the assessment of circadian blood pressure profile and the implementation of an individualized treatment that uses divided antihypertensive agents at bedtime or midday administration have the ability to optimize blood pressure control, restore dipper-profile, and decrease blood pressure variability.

Background: Inflammation seems to be the most important trigger for atherosclerosis. Lower extremity artery disease (LEAD) and hypertension (HTN) are the most important atherosclerotic diseases. Total blood count-derived neutrophil-lymphocyte ratio (NLR) and red cell distribution width (RDW) have been proposed as inflammatory biomarkers in cardiovascular diseases. The aim of this study was to assess the correlation with LEAD and HTN. Material and methods: In total, 134 subjects were included in the study, divided into 2 groups as follows: group 1 – patients with LEAD and HTN; group 2 – subjects with HTN, without LEAD. Complete blood count (CBC) and lipid profile were determined. To assess peripheral artery disease, the ankle-brachial index (ABI) was measured with a handheld Doppler device (BiDop ES100V3 Hadeco®). We compared the inflammatory status between the groups with the use of white blood cell count (WBC), red cell distribution (RDW), and neutrophil-lymphocyte ratio (NLR). Results: In group 1, there was a significant negative correlation between the ABI and RDW (p = 0.04, r2 = –0.24, 95% CI: 0.4647–0.0013), as well as between the ABI and NLR (p = 0.001, r2 = –0.38, 95% CI: 0.5801–0.1592). In group 2, there was a positive correlation between NLR and total serum cholesterol levels (p = 0.003, 95% CI: 0.1274–0.5472, r2 = 0.12), as well as between NLR and triglyceride levels (p = 0.002, 95% CI: 0.1387–0.5552, r2 = 0.13). Conclusion: NLR and RDW could represent first-line investigations in patients with cardiovascular disease due their cost efficiency. They can also play a role in triaging patients with atherosclerotic disease, monitoring treatment response and prognosis of the disease.

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SummaryObjective. In lower limb peripheral artery disease the most commonly used method for the assessment of the main arterial system is represented by the determination of ankle-brachial index (ABI). The post-occlusive reactive hyperaemia (PORH) is a controversial method used for the evaluation of primary collateral circulation. The follow-up of these patients has an underestimated part, their quality of life. The aim of this study is to evaluate this and highlight the importance of the PORH in the sight of optimal treatment.Method. 34 patients diagnosed with lower extremity artery disease, receiving conservative treatment, the ankle-brachial index was defined with a Doppler Bistos BT-200, 8 MHz device, the PORH was evaluated with a Bidop ES-100V, an instrument which sends information for a Smart-V-Link software. To assess the quality of life we used the VascuQol-6 test.Results. The age (mean ± SD) of the patients was 67.24±9.51, 52.92% were active smokers. A significant positive correlation was found between PORH and the results of VascuQol-6 test (p=0.02, r=0.38) and an inverse correlation between ABI <0.5 and VascuQol-6 >12. We noticed a significant difference between the VascuQol-6 result at smokers and non-smokers (p=0.02).Conclusions. The quality of life can be acceptable at patients with significant stenosis on the main artery and decreased ankle-brachial index due to presence of the collateral artery system with a maintained ability of vasodilatation represented by PORH. The efficiency of the treatmet is based on quitting smoking, starting programs which are helping patients to quit smoking would be useful.