Introduction:The effectiveness and safety of treatment with warfarin are critically dependent on maintaining the international normalized ratio (INR) in the therapeutic range. Besides the dose of warfarin, many factors which interact with the metabolism of warfarin may influence the stability of treatment and the time in which patients' INRs are in the therapeutic range. 1,2 Aim: To establish whether there is a significant seasonal variation in effectiveness of warfarin therapy in adults with atrial fibrillation in a Croatian population. Patients and Methods:We conducted an observational study of a subgroup of patients enrolled in the AMACADo -Atrial fibrillation associated thromboembolic risk MAnagement in CroatiA national Database project, involving 2326 electronic medical records of patients with AF hospitalized in UHC Zagreb from 2010 until 2015. Out of 2326 patients we selected 1110 that were treated with warfarin as permanent anticoagulant therapy, prior to hospitalization, and the rest of patients we excluded from the research. Patient were divided in two categories based on INR values higher than 2.0 (INR > 2.0) and less or equal than 2.0 (INR ≤ 2.0). Furthermore, we analyzed seasonal variation in the INR value during four seasons: spring, summer, autumn and winter. The χ 2 test was used for comparison of categorical variables. Results:Out of 239 patients admitted to hospital during summer 111 had an INR value > 2.0, (46.4%) in comparison with patients admitted during all other seasons (spring, autumn and winter) (324/871, 37.2%). Our results show that a larger proportion of patients was effectively anticoagulated during summer vs. other seasons (p=0.00950174, CI 95%). Conclusion:A seasonal variation in the INR values was observed among adults with atrial fibrillation, possibly due to many different factors such as variations in diet, hydration status and physical activity, and possibly therapy guidance. Seasonal variations in the intensity of warfarin therapy should always be considered in trials exploring thromboembolic complications of atrial fibrillation. The causes of this variations should be further investigated.

No abstract

No abstract

Objective:Prevalence of hypertension seems to be higher in patients with systemic lupus erythematosus (SLE) than in the general population, but there is scarce data on the epidemiology of hypertension in lupus nephritis (LN). Furthermore, to the best of our knowledge, there are no studies examining the trajectories of blood pressure (BP), treatment patterns and control of hypertension in LN.Design and method:We have conducted a retrospective cohort study to evaluate the prevalence, treatment and control of hypertension in patients with biopsy-proven LN. We have collected data on demographics, clinical and laboratory parameters, histopathology and office BP measurement at the time of biopsy and after long-term follow-up. BP measurement and definition of hypertension were according to 2018 ESC/ESH guidelines.Results:A total of 36 patients with biopsy-proven LN were followed up for 4.5 ± 2.9 years (81% women, mean age at biopsy 38 ± 14). Mean duration of SLE prior to biopsy was 4.3 years (min-max 0 to 27 years). Both systolic and diastolic BP decreased from the time of biopsy to last follow-up (137/85 mmHg vs. 125/79 mmHg, p < 0.001 for systolic BP and p = 0.075 for diastolic BP). Prevalence of hypertension at the time of biopsy was 58% and increased to 72% at the time of last follow-up (p = 0.22). Mean number of drugs per patient did not change (2.0 vs. 1.8, p > 0.05). Only 48% and 58% of patients with hypertension had achieved BP control (p = 0.67) and a total of 1 and 2 patients had resistant hypertension at the time of biopsy and at last follow-up, respectively. When examining treatment, 67% and 77% patients with hypertension had an ACEI/ARB, while 48% and 38% had calcium channel blocker, 43% and 35% had diuretics and 24% and 31% had beta blockers at the time of biopsy and follow-up, respectively.Conclusions:LN is associated with high cardiovascular risk and mortality as well as a high prevalence and inadequate control of hypertension. Achieving BP control is crucial and should be an important therapeutic goal in these patients.