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The aim of this study was to assess the relationship between 24 h blood pressure (BP) profile, extent of significant coronary artery stenosis, confirmed by coronary angiography, and cardiovascular events in patients with coronary artery disease. Coronary angiographies were performed for all included subjects and significant coronary artery stenosis was considered as ≥ 50% stenosis by atherosclerotic plaque. Twenty-four-hour ambulatory BP monitoring was performed. Major advanced cardiovascular events (MACE) included revascularization, cardiovascular mortality, total mortality, acute coronary syndromes and stroke. BP analysis revealed higher night-time systolic blood pressure (SBP) values in patients with three or more significant coronary artery stenoses than in those without significant stenosis (120.7 ± 16.4 vs 116.7 ± 14.3 mmHg,p < 0.001), lower night-time SBP dip in patients with three or more significant coronary artery stenoses than in those without significant stenosis (5.7 ± 3.2 vs 7.4 ± 6.8 mmHg,p < 0.001) and lower night-time diastolic blood pressure dip in patients with three or more significant stenoses than in patients without significant stenosis (9.4 ± 7.4 vs 11.9 ± 7.4 mmHg,p < 0.001). Night-time SBP values, night-time/daytime SBP dip and extent of significant coronary artery stenosis were risk factors for MACE, revascularization and cardiovascular mortality. In conclusion, the study shows that advanced coronary artery disease is related to blunted night-time BP dipping and cardiovascular complications. [ABSTRACT FROM AUTHOR]

Introduction. It has been reported in coronary heart disease (CHD) patients that mortality is inversely associated with body mass index (BMI), and directly associated with waist circumference (WC). The purpose of this study was to examine the association of the general obesity parameter (BMI) and the adipose tissue discriminator (WC) with cardiovascular (CV) risk in patients with CHD established by coronary angiography. Objectives. 1345 subjects with CHD were included in the PROGNOSIS (Prognostic Value of Ambulatory Blood Pressure Monitoring in Patients with Coronary Artery Disease Confirmed by Angiography) study. Patients and methods. A multivariate Cox proportional regression model adjusted for potential confounders was used to assess the relative risk of total and CV mortality according to the parameters of general obesity (BMI) and adipose tissue distribution (WC).The mean age of subjects was 63.2 ± 9.2 years, and 57% were men. Results. There was direct relationship between WC and both total mortality [hazard ratio, HR = 1.03 (95% CI 1.01-1.10), p < 0.01] and CV mortality [HR = 1.03 (95% CI 1.01-1.07), p < 0.03], but an inverse relationship between BMI and both total mortality [HR = 0.91 (95% CI 0.86-0.98), p < 0.03] and CV mortality [HR = 0.97 (95% CI 0.87-0.99), p < 0.05]. After combining WC with BMI, the group of subjects with BMI < 25 kg/m2 and WC ≥ 104 cm had the highest rates of both total and CV mortality of all CHD patients. Conclusions. Assessment based on a combination of WC and BMI is superior to assessment based on a separate estimation of these parameters in both total and CV mortality risk evaluation. [ABSTRACT FROM AUTHOR]

Objectives. The goal of our study was to estimate the impact of abnormal night-time blood pressure (BP) on cardiovascular (CV) mortality in hypertensive patients with significant atherosclerosis established in coronary angiography. Method. We enrolled 891 patients, 63.7 ± 9.4 years of age. They were divided into patients with normal daytime BP values, and patients with abnormal daytime BP values. During a follow-up period of 4.7 years in total, all-cause mortality and both CV and non-CV mortality were assessed. Results. In the group with normal daytime BP, a clinic BP value ≥ 140/90 mmHg was observed in 25.7% ( n = 161) of patients, and a night-time BP value ≥ 120/70 mmHg was observed in 37.8% ( n = 236) of patients. In the group of patients with normal daytime BP in comparison with those with abnormal daytime BP, there was lower CV mortality (5.6% vs 9.8%, p < 0.02). Abnormal daytime BP was associated with a hazard ratio of CV mortality of 1.80 (95% CI 1.08-3.00, p < 0.02), and abnormal night-time BP with a hazard ratio of 1.63 (95% CI 1.03-2.66, p < 0.04). Conclusion. Assessment of both daytime and night-time BP is essential and superior over clinic BP in CV risk evaluation in patients with coronary artery disease confirmed in coronary angiography. [ABSTRACT FROM AUTHOR]

The effectiveness of hypertension treatment remains low in many developed countries. The aim of our study was to evaluate the treatment effectiveness in hypertensives treated by general practitioners (GPs) in Poland. Twenty thousand three hundred and five hypertensive patients (mean age 60.1 ± 12.0 years, 9918 women, 10 387 men), pharmacologically treated by 677 GPs in Poland, were investigated. Blood pressure (BP) in every patient was measured twice, within approximately a 5-min interval, in a seated position, using a mercury sphygmomanometer, after a rest of at least 10 min. Mean blood pressure from both measurements was used for further analysis. Measurements were carried out by a GP in the office. Every physician investigated 30 consecutive hypertensive patients. Of the investigated hypertensive patients treated, 8.3% had systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg (7.8% in women, 8.8% in men respectively; p > 0.05). Mean SBP in the investigated group was 161.9 ± 20.4 mmHg, 162.7 ± 20.8 mmHg in women and 161.1 ± 20.1 mmHg in men, respectively; p < 0.05. Mean DBP was 95.4 ± 11.0 mmHg. The difference between mean DBP in women (95.3 ± 11.0 mmHg) and men (95.5 ± 11.1 mmHg) was not significant, p > 0.05. Mean pulse pressure (PP) for the whole group was 66.5 ± 16.3 mmHg. In this cohort, 26.7% of patients were treated with one, 37.6% with two, 26.7% with three, 8.2% with four and 0.8% with five antihypertensive drugs. Mean number of antihypertensive drugs prescribed for one hypertensive patient was 2.2 ± 1.0. Effectiveness of hypertension treatment by GPs in Poland remained unsatisfactory despite frequent implementation of combined antihypertensive drug therapy. [ABSTRACT FROM AUTHOR]