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Optimalan terapijski pristup u RVH još je uvijek sporan. U ovoj studiji provedena je analiza kojim bolesnicima i kada endovaskularna intervencija s implantacijom stenta uz medkamentnu terapiju može biti korisna, te da li povišena razina BNP prije zahvata može biti prediktor uspješnog ishoda na arterijski tlak i bubrežnu funkciju. U svakodnevnoj kliničkoj praksi liječnici još uvijek imaju otpor propisivanju lijekova koji inhibiraju RAAS, čak i nakon zahvata. Stoga je analizirana sigurnost i mogući pozitivni učinci sartana u bolesnika s RVH nakon stentiranja. Krutost arterija je neovisan čimbenik kardiovaskularnog rizika. Starija dob, povišen arterijski tlak i povećana aktivnost RAAS povećavaju krutost arterija u bolesnika s RVH. U literaturi nema dosadašnjih istraživanja u vezi s ovom temom. Cilj je ove studije odrediti krutost arterija u bolesnika s RVH, te analizirati ima li stentiranje udruženo s polimorfnom medikamentnom terapijom povoljan učinak na markere krutosti. Uključeno je 37 bolesnika s RVH. Uključni kriteriji su : kreatinin u serumu 5 mmol / L), trudnoća i nefrotska proteinurija. Ambulantno mjerenje AT, augmentacijskog indeksa (AIx), pulsnog vala ( PWV), centralng AT i GFR određivani su prije, 48 sati nakon stentiranja, te u periodu praćenja od 6-36 mjeseci. Bolesnicima je nakon stentiranja u terapiju uključen telmisartan (80mg). Do značajnog smanjenja razine NT-proBNP( > 30%) dolazi u većine bolesnika 48 sati nakon stentiranja. Značajan pad AT i poboljšanje bubrežne funkcije zabilježen je u ovoj skupini bolesnika nakon 6 - mjesečnog praćenja. Značajno smanjenje Aix može se objasniti poboljšanom bubrežnom funkcijom, ali također biti posljedica liječenja sartanima. PWV se nije smanjio u prvih 6 mjeseci nakon stentiranja, ali bilježi se značajno smanjenje nakon 36 mjeseci. Rezultati ove studije pokazuju da stentiranje u RVH uz medikamentnu terapiju ima povoljan učinak na AT i bubrežnu funkciju već 6 mjeseci nakon postupka. Terapija srtanima u ovih je bolesnika sigurna i može doprinijeti ukupnom povoljnom učinku. Zaključno, ovo je prva studija koja je pokazala da je arterijska krutost veća u bolesnika s RVH nego u bolesnika s EH.NT-proBNP i markeri arterijske krutosti određeni prije stentiranja, nisu prediktor ishoda u odnosu na arterijski tlak i bubrežnu funkciju, niti nakon ukupnog perioda praćenja., Optimal therapeutic approach in renovascular hypertension (RVH) is still controversial. Beside debate on whom and when intervention might be beneficial, this study analyzed whether elevated BNP levels before the intervention can be a predictor of a successful outcome on blood pressure and renal function. In everyday clinical practice physicians are still reluctant in prescribing drugs that inhibit renin-angiotensin system after the procedure. This study also analysed safety and possible positive effects of sartans in patients with RVH after procedure. Arterial stiffness is an independent cardiovascular risk factor. Aging, high blood pressure and increased renin-angiotensin system activity contribute to increased arterial stiffness in patients with RVH. A literature search failed to identify any study related to this topic. Therefore, aim of this study was to determine the arterial stiffness in patients with RVH and analyzing whether stenting in addition to multifactorial drug therapy has beneficial effects on markers of stiffness and the clinical course. Thirty seven patients with RVH were enrolled. The inclusion criteria were: serum creatinine 5 mmol/L), pregnancy and nephrotic proteinuria. Office and ambulatory blood pressure (BP), augmentation index (AIx), pulse wave velocity (PWV), central mean BP (MAP) , eGFR and serum potassium were determined before stenting, 48 hours 6 and 36 months after the intervention. Telmisartan 80 mg (on top) was induced in all patients after stent placement. Significant decrease in NT-proBNP( > 30%) had most of the patients 48 hours after stenting. Significant decrease in BP and improvement in kidney function were observed in this cohort of RAH subjects six months after stenting already. Significant decrease in AIx could be explained with improved renal function but also might be due to the treatment with sartans. PWV is not decreased 6 months after stenting, but decreased significantly after 36 months. Results of this study indicate that intervention in RAH, at least six months after the intervention has beneficial effect on BP and kidney function. Treatment with sartans after stenting in patients with RVH is safe and might contribute to overall positive effect. In conclusion, this study is the first to show that arterial stiffness is higher in patients with refractory RVH than in those with essential hypertension. NT-proBNP and markers of arterial stiffness determined before revascularization were not predictors of either BP or kidney function outcome.

This report describes data collected by the Croatian Registry of Renal Biopsies (CRRB) for the year 2019. Patients and methods: nine centers (82%) provided data for 255 native kidney biopsies. We assessed the anthropometric data, data on serum creatinine concentration (sCr), 24 h proteinuria, haematuria, serum albumin level, arterial hypertension, histological diagnosis, and complications after renal biopsy. Results: examined group consisted of 58% males, median age 58 y (18-80 y) and 42% women, median age 57 y (20- 86 y). Males had a more impaired renal function at the time of renal biopsy, nephrotic syndrome, and hypertension. The most prevalent clinical presenta tion were urinary abnormalities (34.9%). Among all biopsy cases, primary glomerular diseases were the most often found histology group (41.5%), and IgA nephropathy was the most frequent diagno sis(47.1%). Among secondary glomerular diseases, pauci-immune glomerulonephritis (PIGN) was most often found (30.9%). The highest proteinuria was observed in minimal change disease and dia betic nephropathy (DN). The highest sCR values were found in membranoproliferative glomerulone phritis (MPGN) and necrotizing vasculitis. Patients with MPGN and DN had the highest blood pressure levels. Conclusion: CRRB provides important data on the epidemiology of biopsy-proven kidney diseases from the whole territory of Croatia.

Prikaz MSCT vođenih biopsija bubrega u jednom centru

Izmještaj referelanog centra za glomerularen bolesti za IgA nefropatiju

Objective: The role of adiponectin in hypertension (HT) is still a matter of debate. Obtained conflicting results could be mostly explained with diversity of subjects included in different studies. Our aim was to analyze association of adiponectin and its gene polymorphisms with blood pressure (BP) in a group of normotensive (NT) and untreated HT subjects with normal kidney function. Design and method: Analyses was conducted in 192 subjects (68 m ; age 44 (IQR 31–53)). Those with diabetes, treated HT and chronic kidney disease (eGFR < 60 ml/min) were excluded. BP was measured using Omron M6 device following ESH/ESC guidelines. Adiponectin concentration was determined by ELISA. Genotyping was done using PCR-FRET. Genetic association analyses were done with Arlequin and haplotype analysis with Unphased. Results: There were no differences in plasma adiponectin values (mg/L) between HT and NT (9.75 ; iqr:7.44–17.88 vs.11.35 ; iqr:7.43–12.63 ; P = 0.17) and no associations with systolic or diastolic BP (P > 0.05). Ninety-three persons had genotype −11377C/C, 77 had −11377C/G and 18 −11377G/G ; minor allele frequency (MAF) 30%, with no difference between NT and HT. Polymorphism −11377C > G was not associated with HT in the dominant, codominant, overdominant, recessive or additive model (all p > 0.05). Polymorphism −11391G > A (164 were dominant homozygots and 22 were heterozygots ; MAF 12%, with no difference between NT and HT) also was not associated with HT (OR 2.12 [0.73–6.16]). Haplotype analysis established three haplotypes, C-G (freq. 64%), G-G (30%), C-A (6%) which showed no association with HT well. Conclusions: In our group of NT and untreated HT with normal kidney function adiponectin was not associated with BP even after adjustment for other risk factors. Even more, we did not find an association of two common adiponectin gene polymorphisms with HT. Adiponectin-BP relationship is complex and differs between specific populations. Our conclusions should not be extrapolated to subjects with other characteristics. Studies on larger number are needed.

doi: 10.1097/01.hjh.0000492249.42673.0b

doi: 10.1097/01.hjh.0000468595.61811.1b

Introduction: High daily sodium intake is associated with various deteriorating effects on cardiovascular(CV) system. Sodium sensitivity(SS) of blood pressure(BP) increases CV and overall mortality. Recently, estimation of SS risk from the ABPM data in regular every- day conditions and habitual diet was proposed. Our aim was to analyse prevalence and characteristics of subjects with high SS risk in cohort of subjects from our ABPM database. Design and Methods: In this retrospective study we analysed data on 485 subjects(64.9% men). ABPM was performed on regular working day using SpaceLab device. Subjects were divided into 3 classes of SS: low risk if dippers and a 24-h heart rate(HR) ≤70 bpm (LSS) ; high risk if non-dippers and a 24-h HR of >70 bpm (HSS) ; intermediate risk with the remaining combinations(dippers with HR>70 bpm or non- dippers with HR ≤ 70 bpm). Patients were classified as “dippers” when nocturnal mean arterial pressure fall was >10% and „non- dippers“otherwise. Results: Prevalence of HSS subjects was 22.6% with no gender difference. We failed to observe an increase in SS by ageing. No difference in age (48.5 (20-87) vs.53(19-88) ; p>0.05) and eGFR (92.9± 9.4 vs.95.9±12 ; p>0.05) was observed between HSS and LSS subjects. HSS subjects had lower BMI (25.9(21.8-29.4) vs.27.5(24.8- 29.9) ; p=0.03) and waist circumference (89.5(78- 104) vs.92(83-104) ; p=0.031)than LSS. Interestingly we failed to determine difference in systolic BP (127.5(120- 139)vs. 126(119- 133) ; p=0, 3171) and pulse pressure (52(46-59) vs.53(47- 58) ; p=0.485) values between HSS and LSS.However, there were more masked hypertension in HSS, and more white coat hypertension in LSS groups (χ2 =13.55 ; p

Intrauterini zastoj u rastu (IUGR) je povezan s povećanom incidencijom kardiovaskularnih bolesti (KV) kasnije u životu. Budući da povišena razina urične kiseline (UK) u serumu korelira s vaskularnom disfunkcijom i hipertenzijom, naš cilj je bio istražiti utječe li razina urične kiseline na arterijski tlak (AT) i vaskularnu funkciju u mlađih muškaraca rođenih nakon IUGR.

Objective: Intrauterine growth retardation (IUGR) has been associated with an increased incidence of adult cardiovascular disease (CV). Elevation of serum uric acid (UA) is related to vascular disfunction and hypertension. Our aim was to investigate whether UA have some influence on blood pressure and vascular function in young adult men born after IUGR. Design and method: A total of 95 healthy men (21.0+0.89 years) born small for gestational age (SGA) and 90 healthy men (21.5+1.02 years) born appropriate for gestational age (AGA) were enrolled. Anthropometric parameters, office and ambulatory blood pressure (BP), fasting blood glucose, lipid profile, eGFR, carotid intima media thickness (cIMT), pulse wave velocity (PWV), central blood pressure (cBP), aortic and brachial augmentation index (Aix) were determined in all participants. Birth parameters were obtained from medical records. Hyperuricemia was defined as UA >380 µmol/L. Results: SGA subjects had higher levels of UA compared to controls (342.5 vs. 308.7 ; p

OBJECTIVE: Prehypertension has been recognized as a condition associated with increased cardiovascular risk. Our aim was to analyse differences in characteristics of prehypertensives, normotensives and hypertensives, with emphasis on renal function in prehypertension. DESIGN AND METHODS: Out of 2489 subjects enrolled in Croatian rural study, 933 (405 male, 528 female) were eligible for further analysis. Exclusion criteria were antihypertensive treatment, diabetes mellitus, pregnancy, chronic terminal diseases, dementia, immobility and missing data. Blood pressure (BP) and heart rate (HR) were measured following the ESH guidelines. BMI and waist circumference (WC) were determined. Fasting blood was analysed for glucose(FBG), insulin, total cholesterol(T-C), HDL, LDL, triglycerides(TG), serum creatinine, haematocrite(Hct), C reactive protein(CRP) and white blood cell count(WBC). HOMA index was used to calculate insulin resistance and MDRD formula to estimate glomerular filtration rate (eGFR). Albumin to creatinine ratio (ACR) and alpha1 microglobin to creatinine ratio (alpha1CR) were determined. Subjects were divided in three groups: normotensives (=140/90 ; N=341). RESULTS: Prehypertensives were significantly older and more obese, dyslipidemic, had higher CRP, Hct and HOMA index values than normotensives (p0.05). Additionally prehypertensives had a trend of lower eGFR (80.6 vs. 81.3, p=0.754) and significantly higher ACR and alpha1CR than normotensives (4.9 vs. 4.0, p=0.003 ; 4.9 vs. 4.2, p=0.009 respectively). In comparison with hypertensives, prehypertensives were significantly younger, less viscerally obese, had lower HR, FBG and T-C (p0.05). CONCLUSION: Prehypertensives significantly differ from normotensives in metabolic disturbances and renal impairment. Not only albuminuria but also proximal tubule damage is observed in prehypertension. However no differences between prehypertensives and hypertensives in majority of the measured variables were found, all of which could contribute to increased cardiovascular risk in prehypertensives. Higher values of alpha1 microglobin excretion might point on early proximal tubule damage in prehypertension.

Conclusion: We found different circulatory patterns in young adult men born SGA compared to AGA controls mainly characterized by hyperkinetic circulation. Obesity and premature birth has an additional unfavorable effect on BP and target organ damage as well as different hemodynamic properties characterized by increased TPR in premature SGA.

BACKGROUND: Heart rate (HR), although often neglected, is identified as a potential independent cardiovascular risk factor. Some studies found differences in HR between hypertensives (HT), prehypertensives (PH) and normotensives(NT), while others observed opposite. OBJECTIVE: Our aim was to analyze HR considering the blood pressure (BP) categories, in adults included in our epidemiologic survey. SUBJECTS AND METHODS: Nine hundred and nineteen untreated subjects (407 men and 512 women) were enrolled on the door-to-door basis. BP and HR were measured according to the ESH/ESC guidelines. Subjects were classified into groups as follows: I 180/110 mmHg ; VII systolic BP>140 and diastolic BP

U radu su prikazani rezultati istraživanja unosa bilnih čajeva u endemskom području.

Although increased rates of cardiovascular (CV) events in subjects born small for gestational age (SGA) were reported, discussion about additional unfavourable effects of premature birth continues. Our aim was to determine CV risk factors and subclinical organ damage in young men born SGA and to analyse the relation and effects of premature birth on CV risk profile and target organ damage. Subjects and Methods: A total of 95 healthy men (21.0 + 0.89 years) born SGA and 90 healthy men (21.5 + 1.02 years) controls with normal intrauterine development were enrolled. Height, weight, body mass index (BMI), waist circumference (WC), office and ambulatory blood pressure (BP), heart rate (HR), fasting blood glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, albumin/creatinine ratio (ACR), eGFR, kidney volume (KV), left ventricular mass index (LVMI), carotid intima media thickness (cIMT) and pulse wave velocity (PWV) were measured in all participants. Birth parameters were obtained from medical records. Results: Higher systolic BP (p = 0.048), 24h BP variability (p = 0.044) (BPV), pulse pressure (PP) (p = 0.008), HR (p = 0.001), altered lipid profile (χ2 = 6.827 p = 0.009), cIMT (p = 0.001), LVMI (p = 0.032), and smaller kidney volume (p < 0.001) and eGFR (p < 0.001) were observed in the whole SGA group. When prematurity was taken into account, higher ambulatory systolic BP (p = 0.001), BPV (p = 0.013), PP (p = 0.002), ACR (p = 0.038), LVMI (p = 0.031) and lower KV (p < 0.001) were found only for very preterm born participants (< 32 weeks). Multiple regression analysis showed pregnancy duration as key determinant of ambulatory systolic BP (ß = -0.54, p = 0.003). Altered lipid profile was more pronounced in the group born SGA at term (χ2 = 7.247 p = 0.027) There were no differences in BMI, WC, FPG, and PWV (p > 0.05) between the SGA participants born prematurely and at term. Conclusion: We found that only very premature birth has an additional unfavourable effect on systolic BP and subclinical target organ damage in young men born SGA. Because of higher risk for developing sustained hypertension and premature cardiovascular incidences, those subjects should be monitored more closely from early adulthood. Our results are in agreement with previous findings showing increased systolic BP, metabolic disturbances, impaired kidney growth and target organ damage to be the characteristics of SGA subjects.

Objective: Prehypertension is often accompanied with other metabolic disturbances that additionally increase cardiovascular (CV) risk. Our aim was to estimate total CV risk in prehypertension using European Heart Score. Design and Method: CV risk factors and Heart Score were analysed in 1375 subjects enrolled in epidemiologic survey conducted in rural part of Croatia. Treated hypertensives and individuals with acute illness, chronic terminal disease, pregnancy, dementia, immobility and those taking NSAID or corticosteroids were excluded. Blood pressure (BP) and heart rate were measured with OMRON device following ESH guidelines. Height, weight, body mass index (BMI), waist circumference (WC) and smoking status were determined. Fasting blood and urine samples were obtained for analysis of glucose (FBG), total (T-C), LDL and HDL cholesterol, triglycerides (TG) and urine albumin to creatinine ratio (ACR). European Heart Score was calculated. Subjects were divided into three groups regarding BP values: optimal BP (< 120/80) (OBP), prehypertension (120/80-139 /89) (PH), untreated hypertensives (≥ 140/90)(HT). ANOVA, Kruskal-Wallis and posthoc tests were used while the level of significance was set at < 0.05. Results: Four hundred ninety five subjects (216 men, 279 women), mean age 47.75 (range 19-90) were divided into three groups: OBP (N = 131), PH (N = 174), HT (N = 190). The percentages of smokers were 47.3%, 29.9% and 24.61% in OBP, PH and HT, respectively (p < 0.001). Significantly higher values of age, FBG, T-C, LDL, TG, BMI, WC and ACR (p < 0.001), and nonsignificantly higher values of HDL were found in HT vs PH. Significant differences in age, BMI, WC, T-C and LDL (p < 0.001) were found between PH and OBP while nonsignificantly higher values of FBG, TG and ACR were observed. As expected, Heart Score was highest in HT group (HT vs PH and OBP, p < 0.001). However, significant difference was also found in Heart Score between PH and OBP group (p < 0.001). Conclusion: Using Heart Score we found global CV risk to be significantly higher in PH than in OBP, indicating that PH should not be ignored, and beside life style changes in some subjects even drug therapy might be considered.

To present characteristics of patients and endovascular procedures in treatment of atherosclerotic renal artery stenosis and uncontrolled arterial hypertension.

Renovascular hypertension is one of the most common forms of secundary hypertension.

Objective: Increased arterial stiffness (AS) has been shown to predict cardiovascular mortality in patients with essential hypertension (EH). Ambulatory arterial stiffness index (AASI) was proposed as a surrogate measurement method for determination of AS. Although, some authors showed prognostic value of AASI, this is still a controversial issue. Our aim was to analyze AASI in 66 normotensive subjects (NT) and 114 patients with EH (divided in stage1 (47), stage 2 (41) and stage 3 (26)). Design and Methods: Detailed clinical exam was performed in all patients. Blood pressure (BP) was measured using mercury sphygmomanometer (RR) and ambulatory blood pressure monitor (ABPM) Spacelabs 90207 following the ESH/ESC guidelines. AASI was defined as 1 minus the regression slope of diastolic over systolic BP values obtained from ABPM. Results: NT were the youngest and had the lowest values of BMI (p0.05). The highest values of AASI were determined in stage 1 (0.392 0.054) and NT (0.386 0.036) being significantly different from results obtained in stage 2 and 3 (0.369 0.042 ; 0.362 0.048, respectively ; p¼0.01). Significant differences were observed between NT, stage1, 2 and 3 in pulse pressure values (PP) obtained using either RR (41.6 7.9 vs. 46.2 8.5 vs.51.6 12.3 vs.55.1 13.8, respectively ; p

Hypertension is not a characteristic of endemic nephropathy and occurs only at the advanced stages of the renal disease.

aim was to determine the presence of target organ damage in our group of patients at the time of diagnosis.

The majority of adrenal incidentalomas (AI), adrenal masses discovered incidentally during diagnostic investigation of non-adrenal disorders, are benign and non-functional. Interestingly, no studies with ambulatory blood pressure monitoring (ABPM) in patients with AI have been published so far. In this case-control study, we analyzed ABPM data of 57 patients with AI (12 men, 45 women) and 103 patients with essential hypertension (EH) (60 men, 63 women). ABPM was performed using a SpaceLabs 90207 device. Classification and interpretation of ABPM data were done according to the ESH/ECS guidelines. Average daytime values were higher in the EH than in the AI group (136 ± 9/87 ± 10 vs. 133 ± 21/80 ± 15), as well as blood pressure load (BPL) for systolic and diastolic BP (46.5 ± 30.6 vs. 37.9 ± 30.2 ; 41.6 ± 32.0 vs. 26.4 ± 31.4 mmHg, respectively). On the contrary, average nighttime values were higher in the AI than in the EH group (125 ± 21/73 ± 14 vs. 119 ± 13/71 ± 11). There were no differences in nighttime BPL between EH and AI. In the AI group, BPL was higher during nighttime than during daytime for both systolic and diastolic BP (47.0 ± 32.3 vs. 37.9 ± 30.2 ; 29.6 ± 31.0 vs. 26.4 ± 31.4, respectively). No differences in BP variability were observed between EH study suggest that further investigations are needed before any final conclusion could be made.

The aim of this study was to analyze prevalence of hypertension in patients with primary glomerulonephritis diagnosed, treated, and monitored in our department

Arterial stiffness estimated by pulse wave velocity and augmentation index predicts cardiovascular and renal morbidity and mortality. Our aim was to analyse arterial stiffness in a random sample of hypertensive patients.