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Background: Data regarding cardiac damage in Romanian hypertensive adults are scarce. Our aim was to assess hypertension-mediated subclinical and clinical cardiac damage using a post-hoc echocardiographic analysis of a national epidemiological survey. Methods: A representative sample of 1477 subjects was included in the SEPHAR IV (Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in an Adult Population in Romania) survey. We retrieved echocardiographic data for 976 subjects, who formed our study group. Cardiac damage included left ventricular (LV) hypertrophy (defined as an LV mass > 95 g/m2 in females and > 115 g/m2 in males), coronary artery disease (CAD), and LV diastolic and systolic dysfunction. Results: Hypertension prevalence was 46.0% in SEPHAR IV and 45.3% in our study subgroup. Hypertensives had a higher prevalence of LV hypertrophy, CAD, diastolic dysfunction (p Conclusion: The prevalence of cardiac damage in Romanian hypertensives is high. Both non-modifiable risk factors (such as age and gender) and modifiable (such as dyslipidemia and systolic blood pressure) risk factors are independent predictors of cardiac damage in hypertensives.

Initially, renal resistive index (RRI) was investigated to improve diagnosis in kidney diseases, but failed to meet this goal. Recently many papers highlighted the prognostic significance of RRI in chronic kidney disease, in the estimation of revascularization success of renal artery stenoses or the evolution of the graft and recipients in renal transplantation. Moreover, RRI gained importance in prediction of acute kidney injury in critically ill patients. Along with RRI study in renal pathology have been revealed correlations of this index with parameters of systemic circulation. The theoretical and experimental premises of this connection were reconsidered, and studies for analyzing the link between RRI and arterial stiffness, central and peripheral pressure or left ventricular flow were conducted with this purpose. A high amount of data is currently indicating that RRI is influenced more by pulse pressure and vascular compliance than by renal vascular resistance – assuming that RRI reflects the complex interplay between systemic circulation and renal microcirculation and should be considered as a marker of systemic cardiovascular risk beyond its prognostic relevance for kidney disease. In this review we will go through clinical research that revealed the implications of RRI in renal and cardiovascular disease.

The gender effects in arterial hypertension (HT) epidemiology remain poorly clarified to date. We present an up-to-date review of the data regarding gender disparities in HT’s prevalence, awareness, treatment, and control. Based on the data from three consecutive national-representative SEPHAR (Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in Romania) surveys conducted between 2005 and 2016, we provide insights into gender differences in HT’s epidemiology and their 11- years the evolutionary trend in a high-CV risk European country. Our data displays gender effects in different age-dependent epidemiological patterns in terms of hypertension prevalence, awareness, treatment, and control, mainly due to hormonal status. Hypertension’s prevalence is higher in younger men and older women. Although women are more often aware of their hypertensive condition and receive more often antihypertensive treatment, BP control is lower in older women compared to men of the same age, mainly due to a higher treatment side-effect rate. There is no solid evidence that different antihypertensive drugs exhibit different effects in lowering BP values between genders. In high CV risk European countries like Romania, if all the influencing conditions remain similar to those in the past 11 years, gender discrepancies in terms of HT's prevalence will diminish over time, awareness and treatment of hypertension will continue to be higher in females than in men, with an upward trend of BP control predicted only for women, while in men HT treatment control rate is expected to stagnate.

Peripheral arterial disease is associated with very high cardiovascular risk. The main symptom is intermittent claudication, which strongly affects the quality of life. Therefore, treatment goals in peripheral arterial disease consist of the reduction of cardiovascular events and the relief of symptoms. An increase in pain-free walking distance, evaluated based on the Initial Claudication Distance, was also a strong positive prognostic factor in patients with peripheral arterial disease. Our objective was to reassess whether sulodexide is effective in improving Initial Claudication Distance. For this, we searched the literature according to the PRISMA checklist for double blind clinical trials assessing the improvement in the Initial Claudication Distance after 90 days of standard therapeutic regimen with sulodexide in adult patients with peripheral arterial disease. We found and assessed for bias in 11 studies eligible for review and meta-analysis. Data extracted from those studies favoured the sulodexide group, showing an overall difference in Initial Claudication Distance of +68.9 (CI 95%; ± 11.9 m) at the end of treatment (p

The aim of this study was to assess the basic biochemical and clinical characteristics of patients with hypertension and type 2 diabetes mellitus (T2DM), office blood pressure (BP) and 24-h BP profile, their risk factors and associated comorbidities. Compared with non-diabetics, hypertensive patients with T2DM were older, with a longer duration of hypertension (5.9 vs. 4.7 years), greater office blood pressure and ambulatory BP values, increased incidence of multiple risk factors, target organ damage and cardiovascular disease. Biochemical data in hypertension with T2DM revealed significantly high levels of LDL cholesterol, triglycerides, creatinine, micro- and macro-albuminuria and a reduced estimated glomerular filtration rate. The presence of diabetes was associated with obesity, represented by a BMI ]30 kg/m2 (OR 2.08 [95% CI 1.26-3.45], p = 0.004), abdominal obesity (OR 1.85 [95% CI 1.11-3.04], p = 0.016), high LDL cholesterol (OR 2.02 [95% CI 1.22-3.35], p = 0.006) and high triglycerides (OR 1.86 [95% CI 1.11-3.11], p = 0.017).

To estimate the trend in arterial hypertension's prevalence, awareness, treatment, and control in Romania, starting from the latest national survey Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in Romania III that has a crucial importance for the development of prevention strategies at national level.A representative sample of 1970 Romanian adults (mean age 48.38 years, age range 18-80 years, 52.5% women, 72.58% response rate), was enrolled. During the two study visits, three blood pressure (BP) measurements were performed at 1-min interval. Hypertension was defined as study SBP at least 140 mmHg and/or study DBP at least 90 mmHg at both study visits or previously diagnosed hypertension, regardless of BP values. BP control was defined as SBP less than 140 mmHg and DBP less than 90 mmHg in hypertensive patients.General hypertension prevalence is 45.1% (19.1% newly diagnosed hypertension, 80.9% awareness of hypertension), increasing with age, regardless of sex and area of residence. Although the majority (72.2%) of hypertensive patients were treated (51.9% with two or more drugs), only 30.8% of them had controlled BP values. Following the evolution from the last 11 years, it is expected that in 2020 the prevalence of hypertension to be up to 44%, the awareness up to 96.2%, treatment of hypertension up to 83.7%, and BP control up to 36.6%.Hypertension's prevalence in Romania is on the rise despite the increase in awareness, treatment, and control. Possible explanations of this trend might be the increasing incidence of unhealthy lifestyle and diet, including high salt intake, and a general increase in the prevalence of obesity, diabetes mellitus, and dyslipidemia.

High blood pressure values are recorded in almost 50% of patients with cardiogenic pulmonary edema. Not in all of these cases hypertension is the primary cause of the event but rather an associate and aggravating factor, except for “hypertensive pulmonary edema.” Usually, patients presenting with this condition have a long history of uncontrolled arterial hypertension, with left ventricular hypertrophy and preserved ejection fraction. Signs of myocardial ischemia are lacking, and the clinical evolution is typical for flash pulmonary edema (FPE): sudden and severe flooding of pulmonary alveolar spaces, with rapid recovery after the onset of treatment.

Aortic diseases can become life-threatening conditions; therefore accurate imaging of the aorta has a major importance in clinical practice. Despite the advances represented by the most recently introduced techniques, such as computed tomography and magnetic resonance, echography remains essential for the detection of the aortic pathology and follow-up. It is rapid, cost-efficient, and with good accuracy. Meanwhile, it avoids irradiation and nephrotoxicity. Echography is mandatory for choosing and monitoring surgical or endovascular treatment, as well as for rapid detection of periprocedural complications. This chapter will focus on the role of echography for the assessment of aorta in normal and various pathological settings.

The objectives of the study were to evaluate the prevalence of microalbuminuria (MAU) in patients with hypertension, monitored in primary care and to analyse the correlation between MAU, risk factors and associated parameters. Material and methods. During 2010-2014 we evaluated a number of 910 patients from 19 family medicine offices of Timiş County. The general practitioners took a standardized history, performed a physical examination, measured height, weight, blood pressure, ABPM and heart rate, calculated body mass index and tested urine for MAU with Arkray test strips. The patients with hypertension and MAU were referred to diagnosis centres where they underwent echocardiography. Results. After exclusion of patients with a history of renal disease and diabetes, MAU was present in 61 cases, 7.1%. The mean age of the MAU positive patients was 56±13.1 years, ranging from 29 to 79. The duration of hypertension was under 5 years in 4 (2.44%) patients, between 5-10 years in 35 (57.3%) and over 10 years in 22 (36%) Six patients with MAU (9.83%) had mild hypertension, 25 (40.9%) moderate and 30 (49.1%) severe hypertension. LVMI was 125 ± 28 g/m2 in the MAU absent group and 157 ± 56 g/m2 in the MAU present group (

Objective:Tray to explain the high prevalence of dyslipidemia in Romania by evaluating the prevalence of familial hypercholesterolemia.Design and method:A representative sample of 2377 adults were enrolled in ExTEND survey after signing a written informed consent and evaluated by a study questionnai

INTRODUCTION: Comparing results of representative surveys conducted in different East-European countries could contribute to a better understanding and management of cardiovascular risk factors, offering grounds for the development of health policies addressing the special needs of this high cardiovascular risk region of Europe. The aim of this paper was to describe the methodology on which the comparison between the Romanian survey SEPHAR II and the Polish survey NATPOL 2011 results is based. MATERIAL AND METHODS: SEPHAR II, like NATPOL 2011, is a cross-sectional survey conducted on a representative sample of the adult Romanian population (18 to 80 years) and encompasses two visits with the following components: completing the study questionnaire, blood pressure and anthropometric measurements, and collection of blood and urine samples. RESULTS: From a total of 2223 subjects found at 2860 visited addresses, 2044 subjects gave written consent but only 1975 subjects had eligible data for the analysis, accounting for a response rate of 69.06%. Additionally we excluded 11 subjects who were 80 years of age (NATPOL 2011 included adult subjects up to 79 years). Therefore, the sample size included in the statistical analysis is 1964. It has similar age groups and gender structure as the Romanian population aged 18-79 years from the last census available at the moment of conducting the survey (weight adjustments for epidemiological analyses range from 0.48 to 8.7). CONCLUSIONS: Sharing many similarities, the results of SEPHAR II and NATPOL 2011 surveys can be compared by a proper statistical method offering crucial information regarding cardiovascular risk factors in a high-cardiovascular risk European region.

The objective of this paper is to present the profile of the Romanian hypertensive patient as revealed by the analysis of hypertensive subjects from SEPHAR II survey.A total number of 798 hypertensive subjects identified by SEPHAR II survey were analyzed in terms of socio-demographic characteristics, cardiovascular risk factors, subclinical target organ damage, established target organ disease, total CV risk and HT awareness, treatment and control. The profile of the Romanian hypertensive patients was built using the mod of every above mentioned target variables.The majority of hypertensive subjects were females (54.9%), mean age of 57.42 +/- 13.38 years, coming from the South region (17.8%), living in urban areas (59.5%) and aware of their condition (69.5%), associating most often other 4 CV risk factors among which physical inactivity (67.3%), visceral obesity (60.4%) and hypercholesterolemia (61.3%) are the most prevalent, having therefore a very high added CV risk (60.3%). Despite the widespread use of at least 2 antihypertensive drugs (72.3%), an effective treatment was recorded only in a quarter of treated hypertensives.The profile of Romanian Hypertensive patient is: middle aged female living in urban area of the South region of the country, with secondary education and a low average income, sedentary lifestyle, nonsmoker and aware of BP values, having visceral obesity, a high total cholesterol and LDL-cholesterol levels and normal HDL-cholesterol and triglyceride levels, having metabolic syndrome, nondiabetic and associating 4 other cardiovascular risk factors and therefore having a high added cardiovascular risk.

East European countries have reported high prevalence of Arterial Hypertension (AHT). In order to investigate the data for Romania, we firstly performed a national survey—the Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in Adult Population in Romania (SEPHAR). A representative population was selected using stratified proportional sampling, including 2017 adult subjects,≥18years old. The general prevalence of AHT was 44,92%, higher in men (50,17%) than in women (41,11%) (P<.0001) and predominant in rural areas (49,47%) in comparison to the urban ones (41,58%) (P<.02). AHT awareness attended 44,26%, rising with age, significantly lower in men (34,58%) than in women (52,8%) (P<.0006). We have found a 38,85% proportion of treated hypertensive persons, worse for men (30,11%) then for women (46,56%) (P<.003). The rate of AHT control was 19,88%, with no significant differences between gender. In conclusion, we estimated for Romania a high prevalence of AHT, a level of awareness and treatment lower than in many European countries and a rate of treatment control at the inferior limit of the European average. Males, characterized by a higher prevalence of AHT, were also less aware and less treated than women.