This paper presents state of the art of the problem of diagnosis and treatment of orthostatic hypotension (OH). It focuses on the developed algorithms for diagnostics of classical orthostatic hypotension (COH), initial orthostatic hypotension (IOH) and delayed orthostatic hypotension (DOH). It describes the necessary methods for the differential diagnosis of the OH causes. Comparative analysis of the European Society of Cardiology and American College of Cardiology/American Heart Association/Society of Cardiac Rhythm was performed. The treatment options for different groups of patients with orthostatic hypotension are described.

Objective: The main aim of study was to investigate the association between subcutaneous (SF), visceral (VF), periaortic (PF), epicardial (EF) fat and carotid artery intima-media thickness (CIMT) in patients with abdominal obesity (AO) and whith metabolic syndrome (MS). Design and method: 127 patients 18–45 y.o. (average age 38,4 ± 6,0) with AO (men (M) – 58,3%) were enrolled in study. Height, weight, BMI, waist circumference, blood tests (fast glucose (FG) and glucose tolerance (GT), lipid profile) were measured. MS was defined as AO (cut-off of > 80 cm in women (W) and > 94 cm in M) plus > 1 sign: HDL < 1,30 (w)/1,04 (m)mmol/l; triglycerides > 1,7mmol/l; FG > 5,6mmol/l; violation GT; BP > 140/90mmHg. The averaged TIM was measured on both sides in a longitudinal section in the distal third of thein left and right carotid artery at a distance of 1 cm proximal to the bifurcation, calculated as the maximum value of the two average values obtained during two successive measurements and direct access two consecutive measurements lateral access. SF, VF, PF, EF (range: -150 to -30 HU) was measured by computed tomography. We calculated ratio subcutaneous to visceral fat (RSV). 24 hour blood pressure monitoring was performed. We formed 2 groups: AO (AO plus 1 or less sing of MS) and MS. Results: No statistically significant difference between the groups was found in the assessment of TIM.Tab. 1. Correlations CIMT with age r = 0,406 (p = 0,000), BMI r = 0,225 (p = 0,000), WC r = 0,031 (p = 0,000), TG r = 0,215 (p = 0,013), daytime SBPm r = 0,187 (p = 0,031), with volume of VF r = 0,326 (p = 0,000), EF r = 0,329 (p = 0,000), PF r = 0,440 (p = 0,000), LDL r = 0,182 (p = 0,037) were found. An inverse correlation was found with RSV r = -0,241 (p = 0,005) and with HDL r = -0,239 (p = 0,005). Conclusions: This study shows the role of PVT and other fat depots in the development of structural and functional disorders of the vascular wall in young people. The revealed correlations prove the existence of a close pathogenetic relationship between obesity, lipid metabolism disorders and the state of the vascular wall.

Objective: The main aim of study was to investigate the association between periaortic fat (PF) and metabolic parameters, subcutaneous (SF), visceral (VF), epicardial (EF) fat in patients with abdominal obesity (AO). Design and method: 127 patients 18–45 y.o. (average age 38,4 ± 6,0) with AO (men (M) – 58,3%) were enrolled in study. Height, weight, BMI, waist circumference, blood tests (fast glucose (FG),glucose tolerance (GT), insulin, HOMA-IR, lipid profile) were measured. MS was defined as AO (cut-off of > 80 cm in women (W) and > 94 cm in M) plus > 1 sign: HDL < 1,30 (w)/1,04(m)mmol/l; triglycerides > 1,7mmol/l; FG > 5,6mmol/l; violation GT; BP > 140/90mmHg. SF, VF, PF, EF (range: -150 to -30 HU) was measured by computed tomography. We calculated ratio subcutaneous to visceral fat (RSV). 24 hour blood pressure monitoring was performed. We formed 2 groups: AO (AO plus 1 or less sing of MS) and MS. Results: Tab. 1. Correlations PF with sex r = 0,223 (p = 0,009), with BMI r = 0,347 (p = 0,000), with WC r = 0,525 (p = 0,000), with uric acid r = 0,425 (p = 0,000), FG r = 0,27 (p = 0,002), insulin level r = 0,40 (p = 0,000), with HOMA r = 0,41 (p = 0,000), TG r = 0,32 (p = 0,000), HDL r = -0,37 (p = 0,000), LDL r = 0,23 (p = 0,005), with VF r = 0,55 (p = 0,000), SF r = 0,31 (p = 0,000), EF r = 0,69 (p = 0,000), RSV r = -0,300 (p = 0,000) were found. Conclusions: PF are directly related to most of metabolically parameters. PF in people with abdominal obesity is involved in metabolic syndrome.

No abstract

Obesity plays a key role in the epidemic of type 2 diabetes mellitus (DM), cardiovascular and cerebrovascular diseases. Most studies confirm the association of increased arterial stiffness with obesity. However, the interrelation of various fat depots with one of the main indicators of vascular wall stiffness - the cardiovascular vascular index (CAVI) is currently not clear. The purpose of this study is to assess arterial stiffness in people with abdominal obesity without metabolic syndrome (MS) and with MS, the connection of fat depots (visceral, subcutaneous, perivascular, epicardial fat) with the stiffness parameter CAVI. Materials and methods. 68 people with abdominal obesity (AO) at the age of 18-45 years. The study included height, weight, BMI, waist circumference, and biochemical blood tests (fast glucose and glucose tolerance, uric acid, creatinine, GFR - MDRD, lipid profile, insulin, HOMA-IR). 24-hour blood pressure monitoring, computed tomography (Aquilion One Vision Edition, Toshiba, Japan) with the definition of subcutaneous, visceral, perivascular, epicardial fat, and also calculated the ratio subcutaneous to visceral fat. It was determined CAVI on the VaSera 1000 unit (Fukuda Denshi, Japan) to assess arterial stiffness. Abdominal obesity was derteming by cut off waist circumference >80 cm for women and >94 cm for men. As a result, we were formed 2 groups: persons with abdominal obesity and the presence of no more than one additional risk factor (metabolically healthy) - group 1, persons with MS (abdominal obesity in combination with 2 and more extra risk factors) - group 2, the control group consisted of healthy individuals (n=15) without obesity - group 0. Results. There was no statistically significant difference between CAVI groups. Correlations of CAVI with age r=0.340 (p=0.005), with daytime mean systolic blood pressure - SBPm average (r=0.280, p=0.021) and with mean diastolic blood pressure - DBPm average (r=0.329, p=0.006), with night SBPm average (r=0.233, p=0.014) and with DBPm average (r=0.297, p=0.014), with the volume of periaortic fat (r=0.218, p=0.074) were found. An inverse correlation was found between CAVI and BMI (r=-0.279, p=0.021), with subcutaneous fat depot (r=-0.285, p=0.019) and with the ratio of subcutaneous to visceral fat (r=-0.303, p=0.012). According to the multivariate regression analysis, the most significant impact on CAVI is exerted by age, daytime SBPm, BMI, and the volume of periaortic fat