ObjectivesThis paper aims to evaluate the association between serum uric acid (SUA) levels, arterial hypertension (HT) prevalence, blood pressure values control, kidney function and intima media thickness (IMT), as a surrogate marker of early atherosclerosis, in a representative group of Romanian adult population.Materials and methodsThe study sample consists in 1920 adults included in SEPHAR III (Study for the Evaluation of Prevalence of Hypertension and cArdiovascular Risk in Romania) survey (mean age 48.63 years, 52.76% females) collecting data for SUA levels, blood pressure (BP) measurements, kidney function by estimated glomerular filtration rate (eGFR) and carotid IMT. SUA levels between 2,40–5,70mg/dl in females and 3,40–7,00mg/dl in males respectively were considered normal. HT and HT control were defined according to the current guidelines. IMT evaluation was assessed by B-mode Doppler ultrasound evaluation.ResultsHypertensive subjects had significantly higher values of SUA compared with normotensive subjects, hypertensive patients were 1.713 times more likely to have higher values of SUA. Among treated hypertensive patients, those without optimal BP control had significantly higher SUA levels compared with those with optimal BP control, the presence of hyperuricemia increasing the odds of suboptimal BP control by 1.023. Hyperuricemic subjects had significantly lower eGFR values compared with normouricemic ones, on an average with 14.28ml/min/1.73m2 by Modification of Diet in Renal Disease formula (MDRD) and with 16.64ml/min/1.73m2 by Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EPI), with an indirect association between SUA levels and eGFR values (rs = -0.319 / -0.347), independent of age. IMT values recorded in hyperuricemic subjects were significantly increased, on an average with 0.08mm, compared with normouricemic subjects, with a direct association between SUA levels and IMT values (rs = 0.263), independent of BP values.ConclusionThe results of our study offers support that increased SUA levels are associated with arterial hypertension and with suboptimal BP control in treated hypertensive subjects. The decline in kidney function, independent of age, and also increased IMT values as a marker of atherosclerosis, were also correlated with elevated SUA values. Hyperuricemia screening may have a role in identifying patients at risk of developing HT and lowering SUA levels may improve not only BP control in treated HT patients but also decrease total cardiovascular mortality by slowing the progression of atherosclerosis and renal failure in hypertensive patients.

Patients with end stage renal disease (ESRD) on hemodialysis (HD) are predisposed to higher rates of major cardiovascular events, through several well-known pathophysiological mechanisms. The rates of all-cause mortality are 6 to 10fold greater for these patients compared with general population. Furthermore, diabetes mellitus, history of cardiovascular disease, dialysis duration, and residual diuresis are factors related to cardiovascular events in hemodialysis. Whilst structural and functional echocardiographic abnormalities in dialyzed patients have been the surrogate for several survival studies, the predictive value of these echo parameters, are not clearly established in this field .In dialysis patients, it is still unclear which echo parameter is the best in determining cardiovascular outcome. The purpose of our study was to investigate the role of Doppler Echocardiography and Tissue Doppler Imaging (TDI) abnormalities, in providing predictive parameters for this particular population. The survival rates were analyzed by Kaplan�Meier curves and cardiac events predictors by Cox�s proportional-hazards model. We found correlations between several echo measurements and cardiovascular events, especially diastolic dysfunction and impaired left ventricular parameters. We strongly recommend the use of these echocardiographic parameters in early detection of patients at high risk in order to reduce morbidity and mortality.

Heart rate variability and the presence of late potentials are independent predictor factors for cardiac death and electrical vulnerability of the ischemic myocardium, especially after myocardial infarction(MI). Respiratory infection are known to be associated with MI both through direct action of the pathogen and by altering the hemodynamic status, through tachycardia and a rise in myocardial oxigen demand. Our paper wants to highlight that respiratory infection during subacute and late recovery phase of myocardial infarction can aggravate the electrical vulnerability of the myocardium and increases the arrhythmic risk. We analysed heart rate variability and the presence of late potentials on signal-averaged ECG in patients who developed acute respiratory infection after MI. All parameters of heart rate variability were signifficantly decreased in our target group. Incidence of late potentials did not differ between the two groups, meaning that the electrophysiological substrate of arrhythmias was not influenced by respiratory infection. Ventricular arrhythmias were more severe and frequent in the infection group. Respiratory infectious disease in early and late recovery phase after acute myocardial infarction, increases the risk of life threatening arrhythmias. It must be emphasized the need to consider prevention and early treatment of respiratory viral or bacterial infections, particularly in patients with cardiac ischemic disease.

Fundamento: A hiperuricemia é um achado frequente em pacientes com hipertensão arterial e há evidências cada vez maiores de que essa entidade seja também um fator de risco para doença cardiovascular.Objetivo: No contexto da população em processo de envelhecimento, este estudo tem o objetivo de avaliar níveis de ácido úrico sérico e a prevalência e o controle da hipertensão arterial em um subgrupo da população de adultos romenos (>65 anos), em relação à influência da idade nesses parâmetros.Método: A amostra do estudo consiste em 1920 adultos incluídos na pesquisa SEPHAR III, dos quais 447 eram pacientes idosos (>65 anos de idade). Durante as duas visitas do estudo, três aferições de pressão arterial (PA) foram realizadas em intervalos de 1 minuto, e foram realizadas medições de níveis de ácido úrico sérico, função renal por taxa de filtração glomerular, pressão arterial e espessura íntima-média. A hipertensão e os controles foram definidos de acordo com as diretrizes atuais. A avaliação da espessura íntima-média foi determinada pela avaliação por ultrassom Doppler modo B. Um nível de significância p < 0,05 foi adotado para a análise estatística.Resultados: Pacientes adultos tinham níveis de ácido úrico sérico significativamente mais baixos, se comparados a pacientes idosos, independentemente dos níveis de taxa de filtração glomerular. Pacientes adultos tinham níveis de espessura íntima-média , comparados a pacientes idosos.Conclusão: De forma semelhante às pesquisas anteriores, neste estudo, a idade representou um dos fatores contribuintes ao nível aumentado de ácido úrico sérico. Também foi obtido um aumento da prevalência da hipertensão arterial com a idade, com um mau controle da pressão arterial.

Study basis: As a byproduct of protein metabolism, serum uric acid is a controversial risk factor and is the focus of several recent studies in the field of cardiovascular disease. Whether serum uric acid is involved in the development of these pathologies alone or in conjunction with other factors is a matter of debate. Objective: The objective of this study is to assess the direct relationship between serum uric acid and the ejection fraction. Methods: A retrospective study of 303 patients with heart failure, classified according to the ESC guidelines, was conducted, and several parameters, along with the relationship between serum uric acid and ejection fraction, were characterized. Results: A direct relationship between the level of serum uric acid and the ejection fraction was established (p = 0.03); patients with higher uric acid had an increased risk of having a lower ejection fraction. Conclusions: Serum uric acid, even when asymptomatic, is linked with the level of the ejection fraction of the left ventricle.