IntroductionChildhood hypertension is defined based on the normative distribution of blood pressure (BP), but from the age of 18 years high BP is diagnosed using adult criteria. We compared the rates of diagnosis of hypertension in a group of 18-year-old subjects using BP percentiles and the adult criteria.Material and methodsBlood pressure was measured by registered nurses in 1472 18-year-old high-school students (780 men and 692 women). Also weight, height and waist circumference were recorded.ResultsThe prevalence of hypertension was 9% (16.2% in men and 0.9% in women, p < 0.001) using adult cut-off values and 14.7% (21.9% in men and 6.6% in women, p < 0.001) using percentile charts. Obesity was diagnosed in 2.4% and overweight in 13% of subjects, respectively. The relative risk ratio of diagnosing hypertension according to the adult criteria in overweight or obese subjects was 2.94 (95% CI 2.25-3.86) in men and 6.44 (95% CI 3.51-11.82) in women.ConclusionsOur study indicates high prevalence of hypertension in 18-year-old students – especially in men – and the importance of obesity as a risk factor of hypertension. The use of percentile charts instead of adult cut-off values increases the prevalence of hypertension in men by 35% from 16.2% to 21.9% and in women more than 7 times, i.e. from 0.9% to 6.6%. It seems reasonable to use higher (i.e. 98th) percentile values for definition of high blood pressure.

IntroductionThe interactions between ARAS, independent on severity, and cardiovascular risk, and mortality are complex and not fully researched. The aim of this study was the assessment of the risk of cardiovascular events and mortality in patients with hemodynamically non-significant (NS-RAS) and significant renal artery stenosis (S-RAS) diagnosed with ultrasonography.Material and methodsThe study group consisted of all consecutive patients (n = 2,059) who underwent Doppler ultrasound of the renal arteries during a four years’ time. The patients were divided, according to the renal aortic ratio (RAR) into: hemodynamically significant RAS (S-RAS; RAR ≥ 3.5), hemodynamically non-significant RAS (NS-RAS; 1 < RAR < 3.5) and normal RAR (control group; RAR ≤ 1). The risk of cardiovascular events and death was estimated using Cox’s proportional hazard model including severity of RAS, age and gender, based on the data from the National Health Fund on causes of hospitalization, deaths and statistics on percutaneous coronary angioplasty procedures.ResultsS-RAS was found in 112 patients (5.4 %), NS-RAS in 313 patients (15.2 %) and 1634 patients (79.4 %) were qualified to control group. NS-RAS group had an increased risk of stroke (7.0 % vs. 3.0 %; HR 1.77; p = 0.032). S-RAS patients were at increased risk of heart failure (16.1 % vs. 5.2 %, HR 2.19; p = 0.002) and death (19.6 % vs. 4.3 %; HR 3.08; p < 0.001).ConclusionsThe presence of hemodynamically non-significant renal artery stenosis is an indicator of systemic atherosclerotic changes in vital organs and an important cardiovascular risk factor for stroke.

Background: Renal artery stenosis (RAS) reflects more widespread atherosclerosis deposition and is associated with high morbidity and mortality. According to the guidelines, a discrepancy in the size of the kidneys of over 15 mm found in an ultrasound should initiate the RAS diagnostic algorithm. This study aims to find the optimal threshold for renal asymmetry that better reflects the frequency of a significantly abnormal renal-aortic ratio (RAR), justifying further RAS diagnostic workup, than the currently used cut-off of 15 mm difference in renal diameters. Methods: The analysis included 1175 patients (mean age: 52 years, IQR: 38–66, men/women: 597/578) who underwent Doppler ultrasonography screening of renal arteries with recorded kidney size and RAR calculation. Ultrasound features of RAS were defined as a RAR greater than 3.5 or signs of renal artery occlusion. Receiver operating characteristic (ROC) curves were created and analyzed for absolute differences in kidney size and abnormal RAR. We calculated the area under the curve (AUC) and optimal cut-off values for sensitivity and specificity analysis. Results: The final analysis included 169 patients with a significant difference in renal dimension. RAS features were met in 61 patients. According to ROC curve analysis, the optimal index of renal asymmetry was 12 mm. The sensitivity and specificity for this method were 82.0% and 83.3%, respectively, and AUC was 86.3%. Conclusion: Changing the definition of a significant difference in kidney size from 15 mm to 12 mm increases sensitivity and specificity for abnormal RAR and this finding may accelerate the diagnosis of RAS.

Effective treatment, but also proper diagnosis of cardiovascular diseases, remains a major challenge in everyday practice. A quick, safe, and economically acceptable non‐invasive procedure should play a leading role in cardiovascular risk assessment before invasive diagnostics is performed. The staging of subclinical atherosclerosis may help in further clinical decisions. Safe, widely available, and relatively inexpensive, ultrasonography is a promising examination that should find wider application in clinical practice. The latest ESC guidelines emphasize the usefulness of carotid ultrasound in the diagnosis of coronary artery disease (CAD) and subclinical assessment of atherosclerosis, which help to determine the level of cardiovascular risk. Ultrasound examination of peripheral arteries, especially superficial vessels such as the femoral arteries, is quite easy, quick, and accurate. Other vascular beds, such as iliac and renal, are more demanding to examine, but can also provide valuable information. This review summarizes important studies comparing the severity of atherosclerosis in ultrasound‐visible vascular beds in patients with established CAD. We especially emphasize the benefits of the combined assessment of atherosclerosis features, which were characterized by high sensitivity and specificity in the diagnosis of CAD and other serious cardiovascular diseases.

Background: Despite advantages of ambulatory and home blood pressure monitoring, office blood pressure measurement remains the principal method for the diagnosis and management of hypertension. There still seems to be too little evidence to date showing variation in blood pressure during a medical visit and the current recommendations are mainly based on expert's opinions. The aim of this study was to evaluate the difference between the first two blood pressure measurements performed during a preventive examination and to verify whether the second measurement could influence clinical decisions in non-hypertensive patients. Material and methods:The study included 52 consecutive patients without history of hypertension or other cardiovascular diseases. Blood pressure and heart rate (HR) were measured twice, the first reading after 5 minutes rest and the second 1 minute later. Results: Significant differences were found between the first (fBPM) and second (sBPM) blood pressure measurements, both systolic blood pressure (SBP) 142.4 mm Hg [interquartile range (IQR): 130.8-152.0] vs. 138.1 mm Hg (IQR: 125.8-149.5), p < 0.001 and diastolic blood pressure (DBP) 85.8 mm Hg (IQR: 80.0-91.5) vs. 83.9 mm Hg (IQR: 77.0-90.3), p < 0.001, and heart rate (HR) 73.1/min (IQR: 64.8-80.0) vs. 71.8/min (IQR: 64.8-77.3), p < 0.001. In 63.5% of the participants, the difference between the measurements was over 5 mm Hg for SBP values and in 23.1% of the participants for DBP values. According to fBPM, 53.8% of the patients met the criteria for the diagnosis of hypertension and according to sBPM 48.1% (NS). Conclusion:We demonstrated substantial discrepancies between blood pressure values taken during the first and the second preventive medical check-up visit performed in the workplace. Preventive examination in the workspace is associated with similar number of false-positive results when hypertension status is evaluated as compared to regular office visits.