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Resistant hypertension is defined as not achieving sufficient control of blood pressure (BP), that is, maintaining BP values equal to or above 140/90 mm Hg when using 3 antihypertensive drugs, including diuretics, properly combined and at maximum doses. The uncontrolled treated hypertension should be confirmed in out‑of‑office BP measurements, preferably with 24‑hour ambulatory BP monitoring. Demographic and clinical characteristics indicate that patients with resistant hypertension are older than the general population of patients with arterial hypertension and more often suffer from comorbidities. When resistant hypertension is suspected, it is necessary to assess whether optimal pharmacotherapy has been prescribed, including appropriate combinations of antihypertensive drugs and diuretics at appropriate doses. It is also important to exclude parallel use of drugs that may have unfavorable interactions leading to an increase in BP. A common cause of pseudoresistant hypertension is a patient's failure to comply with therapeutic recommendations, including a lack of lifestyle changes and nonadherence to the prescribed medication regimen. An important step in management of resistant hypertension is targeted screening with diagnostic tests for secondary hypertension. Expanding of the drug therapy beyond a 3‑drug regimen should include a mineralocorticoid receptor antagonist, in particular spironolactone. In selected patients, device‑based hypertension treatment might be considered.

Introduction: Adherence to health‑promoting behaviors intended to mitigate modifiable risk factors plays an important role in secondary cardiovascular prevention., Objectives: We aimed to evaluate sex differences in the prevalence and control of risk factors in patients with coronary heart disease (CHD)., Patients and Methods: The study included 1236 patients who experienced acute coronary syndrome or coronary revascularization within the last 6 to 24 months. Definitions of risk factors and treatment goals were based on the 2016 European Society of Cardiology guidelines on cardiovascular prevention., Results: The prevalence of modifiable risk factors in both sexes was high, and their control inadequate. Women were older (P <0.001) and had a higher accumulation of multiple cardiovascular risk factors than men (P = 0.036). They more frequently had central obesity (P <0.001) and reduced values of glomerular filtration rate (P <0.001). Women more often experienced anxiety (P <0.001), reported lower levels of education (P <0.001) and lower income (P = 0.001), and those in the youngest age group were more likely to be exposed to second‑hand smoking (P = 0.01). A large fraction of the study patients, men and women alike, did not meet the recommended therapeutic goals. For both sexes, participation in cardiac rehabilitation programs was associated with more frequent attainment of the recommended level of physical activity (P = 0.046) and smoking cessation (P = 0.01)., Conclusions: The prevalence of cardiovascular risk factors in patients with CHD is high, especially in women. Therapeutic goals are met infrequently in both sexes. This situation calls for widening the access to educational programs and paying greater attention to their proper implementation.

Introduction: While cardiac rehabilitation (CR) improves survival outcomes in patients with ischemic heart disease (IHD), the long‑ term benefits of short term programs are still discussed., Objectives: The aim of the study was to assess the impact of CR on risk factor management in a multicenter real‑ life registry of patients with IHD., Patients and Methods: We included patients aged 80 years or younger who had been hospitalized due to acute coronary syndrome or for a myocardial revascularization procedure and interviewed 6 to 18 months later. Control of risk factors was compared between patients who participated in CR and those who did not. Propensity score matching was used to account for differences in patient characteristics between the groups., Results: Of 1012 interviewed patients (28.6% women), 35.6% were referred for CR and 76.1% of them completed the program. Those referred were younger (P <0.001), employed (P <0.001), have presented with ST‑ segment elevation myocardial infarction (P <0.001), had hypertension (P <0.001), and were current smokers (P <0.001). Logistics regression revealed that patients who participated in CR were more likely to stop smoking (odds ratio [OR], 2.42; 95% CI, 1.33-4.14), achieve acceptable glucose control (OR, 1.70; 95% CI, 1.02-2.83), and better quality of life (β = 0.12; 95% CI, 0.00-0.24) compared with those who did not participate in CR., Conclusions: Cardiac rehabilitation is moderately effective if performed only once and without a continuous support program. Further efforts to increase referrals for CR in patients with IHD must be accompanied by a long‑ term strategy to sustain the beneficial effects.

Introduction: Patients with coronary artery disease (CAD) are at high risk of recurrent cardiovascular events, and risk factor control is crucial in this population., Objectives: The aim of the study was to compare the implementation of the European Society of Cardiology guidelines regarding prevention of recurrent CAD in 2011 to 2013 with 2016 to 2017., Patients and Methods: The study included 5 hospitals with cardiology departments serving the city of Kraków and its surrounding districts. Consecutive patients with established CAD were interviewed 6 to 18 months after hospitalization in the years 2011 to 2013 and 2016 to 2017., Results: We examined 616 patients in 2011 to 2013 and 388 in 2016 to 2017 (mean [SD] age, 64.7 [8.8] years vs 66.4 [8.4] years; P <0.01). After adjusting for covariates, the proportion of patients with high blood pressure decreased by 8.9% (95% CI, -15.6% to -2.1%) and the proportion of patients with high level of low‑ density lipoprotein cholesterol declined by 9.5% (95% CI, -16.7% to -2.2%) in 2016 to 2017 compared with 2011 to 2013, whereas the proportion of smoking patients (-0.2% [95% CI, -6% to 5.5%]) and those with high glucose levels (3.9% [95% CI, -2.2% to 10%]) and a body mass index of 25 kg/m2 or greater (3.8% [95% CI, -3.9% to 11.6%]) did not change. More patients were prescribed antiplatelets, β‑ blockers, angiotensin converting enzyme inhibitors or angiotensin II receptor blockers, calcium antagonists, and anticoagulants in the second period., Conclusions: We observed an increase in the proportion of patients with CAD who were prescribed cardiovascular drugs, and consequently a slight improvement in the control of their blood pressure and low‑ density lipoprotein cholesterol. No changes were found regarding other main risk factors.

Introduction: Nighttime environmental noise exposure leads to unconscious stress reactions and autonomic arousals. These may disturb overnight sleep and the diurnal blood pressure (BP) profile, contributing to an increased risk of developing hypertension., Objectives: This study aimed to investigate the effects of chronic nighttime exposure to aviation noise on sleep disturbances and the relationship with annoyance and the BP profile., Patients and Methods: Based on acoustic maps, we selected 2 groups of normotensive participants: exposed (n = 48; mean age, 50.9 years; 29 women) and unexposed (n = 50; mean age, 49.7 years; 35 women) to nocturnal aircraft noise. We collected anthropometric and demographic data using a standardized questionnaire. Insomnia symptoms were evaluated using the Athens Insomnia Scale (AIS). In both study groups, we performed office BP measurements and 24‑hour ambulatory BP monitoring., Results: Noise‑exposed participants showed distinctive sleep disturbances, higher AIS scores (4.3 vs 2.3; P = 0.01), and an increased insomnia risk (odds ratio, 2.62; P = 0.046). With increased noise annoyance, a higher AIS score was observed (PANOVA = 0.02). Noise‑exposed individuals had higher diastolic BP at night than those unexposed (64.6 mm Hg vs 61.7 mm Hg; P = 0.03). Insomnia among noise‑exposed participants resulted in higher 24‑hour (115.2 mm Hg vs 122.2 mm Hg; P = 0.03) and nighttime (103.7 mm Hg vs 112.2 mm Hg; P = 0.02) systolic BP. A significant interaction was noted between aircraft noise exposure and the AIS score. The association of the AIS score with 24‑hour systolic BP (P = 0.048) and pulse pressure (P = 0.04) was stronger in the exposed group., Conclusions: The study results may indicate different pathomechanisms affecting BP in terms of nighttime noise and noise‑related insomnia.

Background: Body mass reduction in overweight and obese people so as to reduce blood pressure, low‑density lipoprotein cholesterol level, and the risk of type 2 diabetes as well as to lower the risk of recurrent cardiovascular events is strongly recommended in current guidelines., Objectives: To evaluate changes in body mass index (BMI) and waist circumference in patients with established coronary artery disease over a 20‑year period (1997-2017)., Patients and Methods: Consecutive patients younger than 71 years of age and hospitalized for acute coronary syndrome or myocardial revascularization procedures were recruited and interviewed 6 to 18 months after their discharge from hospital. Weight, height, and waist circumference were measured in 1997 to 1998, 1999 to 2000, 2006 to 2007, 2011 to 2013, and 2016 to 2017. The same 5 hospitals took part in the surveys each time., Results: We examined 412 patients in 1997 to 1998 (survey 1), 427 in 1999 to 2000 (survey 2), 422 in 2006 to 2007 (survey 3), 462 in 2011 to 2013 (survey 4), and 272 in 2016 to 2017 (survey 5). The proportion of obese patients was 24.5% in survey 1, 27.2% in survey 2, 34.1% in survey 3, 35.9% in survey 4, and 40.4% in survey 5 (P <0.001). The proportion of patients with central obesity also increased significantly (32.5% in survey 1, 40.5% in survey 2, 51.4% in survey 3, 48.6% in survey 4, and 61.3% in survey 5; P <0.001). BMI increased significantly in men, but not in women, whereas the mean waist circumference increased in both sexes. BMI and waist circumference increased irrespective of age and education., Conclusions: The analysis of 5 multicenter surveys showed a gradual increase in BMI and waist circumference in patients with established coronary artery disease over the course of 2 decades.

Introduction: Mortality following acute myocardial infarction (AMI) remains high despite of progress in invasive and noninvasive treatments., Objectives: This study aimed to compare the outcomes of ambulatory treatment provided by cardiologists versus general practitioners (GPs) in post‑AMI patients., Patients and Methods: We conducted a systematic search in 3 electronic databases for interventional and observational studies that reported all‑cause mortality, mortality from cardiovascular causes, stroke, and myocardial infarction at long‑term follow‑up following AMI. We assessed the risk of bias of the included studies using the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS‑I) tool. For randomized trials, we used the revised Cochrane risk of bias tool (RoB 2.0)., Results: Two nonrandomized studies fulfilled the inclusion criteria. We assessed these studies as having a moderate risk of bias. We did not pool the results owing to significant heterogeneity between the studies. Patients consulted by both a cardiologist and a GP were at lower risk of all‑cause death as compared with patients consulted by a cardiologist only (risk ratio [RR], 0.92; 95% CI, 0.85-0.99). Patients consulted by a cardiologist with or without GP consultation were at lower risk of all‑cause death compared with those consulted by a GP only in both studies (RR, 0.8; 95% CI, 0.75-0.85 and RR, 0.44; 95% CI, 0.41-0.47)., Conclusions: Patients after AMI consulted by both a cardiologist and a GP may be at lower risk of death compared with patients consulted by a GP or a cardiologist only. However, these findings are based on moderate‑quality nonrandomized studies. We found no evidence on the relation between the specialization of the physician and the risk of cardiovascular death, stroke, or myocardial infarction in AMI survivors.

INTRODUCTION Slow breathing training (SBT) has been proposed as a new nonpharmacologic treatment in patients with chronic heart failure (CHF). OBJECTIVES The aim of this study was to assess the effects of SBT on exercise capacity, hemodynamic parameters, and sleep respiratory patterns in a relatively large sample of CHF patients. PATIENTS AND METHODS A crossover open study was conducted. Patients completed, in a random order, 10- to 12‑week SBT, with 2 15‑minute sessions of device‑guided SBT each day, reaching 6 breaths/ min, and a 10- to 12‑week follow‑up under standard care. Clinical data collection, polysomnography, echocardiography, 6‑minute walk test (6MWT), and laboratory tests were performed. RESULTS A total of 96 patients (74 men, 22 women) in New York Heart Association classes I-III, with an average age of 65 years and an ejection fraction (EF) of 31%, completed the study. Home‑based SBT was safe. After training, EF and 6MWT distance improved (EF: 31.3% ±7.3% vs 32.3% ±7.7%; P = 0.030; 6MWT: 449.9 ±122.7 m vs 468.3 ±121.9 m; P <0.001), and the apnea-hypopnea index decreased (5.6 [interquartile range (IQR), 2.1; 12.8] vs. 5.4 [IQR, 2.0; 10.8]; P = 0.043). CONCLUSIONS SBT improved physical capacity and systolic heart function; it also diminished sleep disturbances. The results support the benefits of SBT as a novel component of cardiorespiratory rehabilitation programs in patients with CHF.

INTRODUCTION    Patients with established coronary artery disease (CAD) are at high risk of recurrent cardiovascular events. OBJECTIVES    The aim of the study was to identify factors related to control of hypercholesterolemia in patients after hospitalization for CAD. PATIENTS AND METHODS    The study included consecutive patients from 5 hospitals with cardiology departments serving one city in southern Poland. Patients were hospitalized for an acute coronary syndrome or for a myocardial revascularization procedure. Interviews and examinations were conducted 6 to 18 months after hospitalization. RESULTS    Overall, 83.6% of the patients were taking statins; 2.1%, fibrates; and 0.5%, ezetimibe. A statin at a high dose (≥40 mg of atorvastatin or ≥20 mg of rosuvastatin) was taken by 36.1% of the participants. Younger age and index hospitalization in a teaching hospital were significantly associated with a higher probability of taking a statin. Overall, 28.1% of the patients had good control of hypercholesterolemia (low-density lipoprotein [LDL] cholesterol levels <1.8 mmol/l), whereas 71.9%, 38.6%, 24.4%, and 10.3% had LDL cholesterol levels of 1.8 mmol/l or higher, 2.5 mmol/l or higher, 3.0 mmol/l or higher, and 4.0 mmol/l or higher, respectively. Younger age, high blood pressure, and high fasting glucose levels were related to a higher probability of having LDL cholesterol levels of 1.8 mmol/l or higher, while younger age, shorter period of education, professional inactivity, lack of cardiac rehabilitation, and high blood pressure were related to the probability of LDL cholesterol levels of 4.0 mmol/l or higher. CONCLUSIONS    The frequency of statin use is affected by age and health care-related factors, while control of hypercholesterolemia after hospitalization due to CAD is dependent mainly on patient-related and clinical factors.

Introduction: Central and peripheral blood pressure (BP) and periodontal disease (PD) are considered to be related to the risk of cardiovascular disease. However, there is scarce evidence on the association between chronic PD and BP., Objectives: The aim of the study was to assess the relation between chronic PD, antibodies against Porphyromonas gingivalis (P.g.) gingipains and central and peripheral BP in high-risk patients with previous myocardial infarction., Patients and Methods: We examined 99 patients (71 men and 28 women) 6 to 18 months after myocardial infarction. The periodontal status was assessed using the Community Periodontal Index (CPI). BP was measured noninvasively using the Mobil-O-Graph device. Antibody titers against P.g. gingipains were determined by an enzyme-linked immunosorbent assay. The association between CPI and BP was assessed using logistic regression models., Results: The mean age of participants was 60.5 ±8.7 years. After the adjustment for age, sex, smoking, diabetes, number of antihypertensive drugs, hypercholesterolemia, body mass index, and left ventricular ejection fraction, an association was found between central and peripheral BP and the CPI. Patients from the CPI 3 + 4 group were found to have almost 3 times higher odds of central BP of 130/90 mmHg or higher and more than 3 times higher odds of peripheral BP of 140/90 mmHg or higher compared with patients from the CPI 1 + 2 group., Conclusions: The severity of PD was associated with increased central and peripheral BP. The association between BP and PD may partially explain the cardiovascular risk related to chronic PD. Proteolytic activity of P.g. gingipains was not associated with BP.

Introduction: Although the differences between central and peripheral blood pressure (BP) values have been known for decades, the consequences of decision making based on peripheral rather than central BP have only recently been recognized. Recently, a U-shaped relation between sodium intake and cardiovascular risk has been suggested., Objectives: The aim of the study was to evaluate the relationship between intima-media thickness (IMT) and central and peripheral BP as well as the effect of 24-hour urinary sodium excretion on this relationship., Patients and Methods: The study included 182 subjects (mean age, 37.3 ±14.0 years, 92 men and 90 women) who were members of families randomly selected from one of the gminas (administrative regions) in southern Poland. In all patients, peripheral and central BP (using applanation tonometry), IMT, and 24-hour sodium excretion were measured., Results: Hypertension was observed in 44.5% of the participants. The mean urinary sodium excretion was 243 ±81 mmol/d. IMT was significantly more correlated with central pulse pressure (PP) compared with peripheral PP (r = 0.54 vs r = 0.27; P <0.01). After multivariate adjustments, IMT remained significantly related to central systolic BP and central and peripheral PP. When the study group was divided according to the tertiles of sodium excretion, central PP was related to IMT only in the second and third tertiles. When the study group was divided according to sex and sex-specific median values of sodium excretion, IMT was associated with central PP only in subjects with sodium excretion exceeding the median values (both in men and women)., Conclusions: IMT is more correlated with central than with peripheral BP. The association between IMT and central PP may be modulated by sodium intake. This hypothesis should be tested in larger studies.

Introduction:  Patients with resistant hypertension (RHT) are at high risk for coronary artery disease (CAD) and cerebrovascular disease (CVD), compared with the general hypertensive population., Objectives:  The aim of the study was to evaluate factors associated with RHT in a large sample of hypertensive patients under the care of general practitioners and specialists in Poland., Patients and Methods:  We included 12 375 patients (mean age, 64.0 ±12.3 years; age range, 18-98 years; women, 59%) with hypertension treated for at least 1 year. Patients were divided into 3 groups: with controlled hypertension, uncontrolled hypertension (not fulfilling the criteria for RHT), and RHT., Results:  Controlled hypertension, uncontrolled hypertension, and RHT were found in 47.3%, 27.9%, and 24.7% of the patients, respectively. The RHT rate was higher in patients visiting specialist offices (29.8%) and in patients with diabetes (32.5%), CAD (31.5%), CVD (33.3%), and impaired renal function (31.9%). Patients with RHT were characterized by the highest rate of high (23.5%) and very high (60.5%) added cardiovascular risk. An underuse of preferred antihypertensive drug combinations and aldosterone antagonists in patients with uncontrolled hypertension and RHT was observed. In a multivariate analysis, RHT was independently associated with male sex, higher pulse pressure, metabolic syndrome, diabetes, CAD, CVD, diseases requiring treatment with nonsteroidal anti-inflammatory drugs and an estimated glomerular filtration rate of less than 60 ml/min/1.73 m2., Conclusions:  The vast majority of patients with RHT carry a high or very high cardiovascular risk. In addition, the underuse of preferred antihypertensive drug combinations and aldosterone antagonists has been observed.

Obesity is a significant public health problem, associated with several comorbidities and complications. At the same time, the results of studies suggest that the relationship between obesity and survival in subjects diagnosed with cardiovascular disease is a U-shaped curve with a significantly worse prognosis among underweight and morbidly obese individuals. The association between overweight or grade I obesity and cardiovascular mortality is not clear, and numerous studies have shown an unexpected and paradoxical inverse relationship with better prognosis in this patient group, the so-called "obesity paradox". In the current review, we discuss the most important and most reliable studies regarding the prognosis and clinical course in patients with overweight or grade I obesity and essential hypertension, coronary artery disease, or heart failure, focusing on data for and against the obesity paradox.

Introduction: Hypertension and its complications are more common in postmenopausal women than before menopause. However, whether this is due to the effect of age or menopause is still unknown., Objectives: The aim of the study was to assess the effect of menopause on blood pressure (BP), left ventricular and vascular structure and function, as well as kidney function in perimenopausal women., Patients and Methods: The study involved 192 women aged 40 to 60 years (mean age, 51.73 ±1.82 years), including 152 with newly diagnosed essential hypertension and 40 normotensive controls matched for age. In all subjects, 24-hour BP monitoring was performed. Echocardiographic examination with the assessment of left ventricular mass (LVM) and systolic and diastolic function,as well as carotid ultrasound with the measurement of intima-media thickness (IMT) in the common carotid artery were performed. Carotid-femoral pulse wave velocity (PWV) was measured. Glomerular filtration rate (eGFR) was calculated and urinary albumin-creatinine ratio (UACR) was measured., Results: The study group was divided according to hypertension and menopausal status into 4 subgroups: normotensive premenopausal, normotensive postmenopausal, hypertensive premenopausal, and hypertensive postmenopausal women. Menopause did not affect BP or LVM. Differences in LVM between pre- and postmenopausal women were dependent on age and the body mass index. Hypertensive postmenopausal compared with hypertensive premenopausal women had significantly higher IMT (0.72 ±0.34 mm vs. 0.59 ±0.30 mm, P = 0.001) and a lower ratio of early to late mitral inflow velocity (E/A, 1.04 ±0.32 vs. 1.32 ±0.33, P = 0.01). PWV was higher in hypertensives compared to controls (9.7 ±1.6 m/s vs. 8.4 ±1.2 m/s, P = 0.001), without differences between premenopausal and postmenopausal women. Menopause did not affect eGFR and UACR either in the hypertensive or normotensive group., Conclusions: Left ventricular diastolic function and carotid IMT are independently associated with menopausal status in both normo- and hypertensive women. Menopause per se did not affect BP in the examined group.

The study group included 30 middle-aged patients (mean = 47.0 +/- 0.6 years) with chronic heart failure (NYHA class III and IV) in the course of primary dilated cardiomyopathy and ischemic heart disease. Enalapril in a dose of 5-10 mg/day was added to previous therapy with digitalis and diuretics. The patients were submitted for noninvasive cardiac and biochemical studies initially and at 3 months. Twenty-four patients completed the planned therapy. In 5 patients the drug had been withdrawn due to hypotension, and one patient died on the fourteenth day of observation because of heart failure worsening. After enalapril therapy 18 patients improved in NYHA functional classes. All patients showed left ventricular improvement based upon left ventricular systolic time intervals, 18 patients showed reduced peripheral vascular resistance, and in 9 patients echocardiography revealed a significant improvement of EF, CI and mVCF. Renal function also improved based upon the decrease in urea and uric acid.