Renal denervation (RDN) as a method of treating arterial hypertension (AH) was introduced in Croatia in 2012. A multidisciplinary team and a network of hospitals that diagnose and treat patients with ...severe forms of AH were established, and a very strict diagnostic-treatment algorithm was prepared. At monthly meetings patients with truly resistant hypertension who were candidates for RDN were discussed. According to the 2021 ESH position statement and 2023 ESH guidelines, RDN is considered an alternative and additional, not a competitive method of treating patients with various forms of AH which must be performed by following a structured procedure and the patient's preference should be considered. In view of the changes in the global scientific community, the Croatian Hypertension League brings this consensus document on RDN conducted with radiofrequency-based catheter, the only currently available method in Croatia. In this document, exclusion and inclusion criteria are shown, as well as three groups of patients in whom RDN could be considered. The new diagnostic-treatment algorithm is prepared and follow-up procedure is explained. In Croatia, RDN is reimbursed by the national insurance company, thus pharmacoeconomic analyses is also shown. Criteria required by an individual centre to be approved of RDN are listed, and plans for prospective research on RDN in Croatia, including the Croatian registry for RDN, are discussed.
Introduction: Intrauterine growth restriction (IUGR) is linked to a higher incidence of cardiovascular and renal diseases. Methods: A total of 91 healthy individuals were included, 40 women and 51 ...men, born below the 10th percentile of birth weight for gestational age. Anthropometric parameters, arterial pressure (AP), blood glucose, estimated glomerular filtration rate (eGFR), albumin/creatinine ratio, lipid profile, uric acid, renal volume by ultrasound, pulse wave velocity, central arterial pressure (cAP), and augmentation index (Aix) were measured. Results: Men have higher body mass index (BMI), waist circumference, ambulatory and continuous AP, lower eGFR, pulse, higher uric acid and LDL cholesterol, lower HDL cholesterol, higher cAP and Aix, higher corrected renal volume, and birth weight than females. Overweight men had hypertension, lower eGFR, and dyslipidemia more often. Systolic pressure correlated positively with BMI in men. In women, systolic pressure correlated positively with heart rate and negatively with gestational age. BMI affected the systolic pressure in men and eGFR in women. Conclusion: Results indicate the more unfavourable effect of IUGR on men. Higher AP, vascular dysfunction, poorer renal function, and dyslipidemia predispose men to earlier chronic disease development. Key words: intrauterine growth restriction, arterial pressure, renal function
The aims of the study were to provide data on chronic kidney disease (CKD) prevalence in rural population and to analyze the association with cardiovascular risk factors and aging. A random sample of ...2193 farmers (1333 female (F) and 860 male (M), mean age 50.61±17.12) were enrolled. Questionnaire and clinical examination were conducted. Participants provided a spot urine and fasting blood sample. Estimated glomerular filtration rate (eGFR) was estimated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Subjects were classified according to the KDIGO guidelines. The overall prevalence of CKD (eGFR <60 mL/min/1.73 m
) was 8.83% (F
. M 9.9%
. 6.3%; p<0.001). Albuminuria (albumin-to-creatinine ratio >30 mg/g) was found in 8.45% (F
. M p>0.05). Sharp increase in CKD prevalence was found to begin after the sixth decade (29.44% in subjects older than 65 years; F
. M 30.9%
. 26.8%; p<0.01). The strongest predictor factors for CKD were age >65 years (OR 22.12), hypertension (OR 6.53), albuminuria (OR 5.71), fasting blood glucose >7 mmol/L (OR 5.49), diabetes (OR 3.07), abdominal obesity (OR 2.05) and non-smoking (OR 0.41). In multivariate analysis, age (OR 1.13), female gender (OR 0.60) and diabetes (OR 1.75) were the independent predictor factors for CKD. In conclusion, CKD prevalence is high in rural population, being higher in women than in men. In both genders, eGFR significantly decreased with aging. Aging is a significant independent predictor of CKD.
OBJECTIVE: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 atherosclerotic renovascular hypertension (aRVH). A literature search failed to identify any study related to this topic. Therefore, our aim was to determine the arterial stiffness in patients with aRVH and analyze whether stenting in addition to multifactorial drug therapy has beneficial effects on markers of stiffness and the clinical course.
METHODS:In this 6-month longitudinal study, 37 patients with refractory hypertension and unilateral aRVH were enrolled. After stenting, all patients received multifactorial dug therapy including 80 mg of telmisartan. Arterial stiffness indices were determined using Arteriograph. The control group consisted of 44 patients with essential hypertension.
RESULTS:There were no differences in brachial blood pressure values between the two groups (P > 0.05). At baseline, adjusted pulse wave velocity (PWV) was higher in aRVH patients than that of essential hypertensive patients (12.8 ± 0.4 vs. 11.6 ± 0.3 m/s; P = 0.029). In the aRVH group, at the end of the follow-up, a significant decrease in the aortic augmentation index (37.7 ± 9.9 vs. 33.7 ± 11.4; P = 0.02) without changes in PWV was observed (P > 0.05).
CONCLUSION:This study is the first to show that arterial stiffness is higher in patients with refractory aRVH than in those with essential hypertension. Multifactorial therapy based on stenting and intensive medical treatment reduced central blood pressure and augmentation index. Failure to obtain PWV reduction is likely a consequence of the present irreversible structural vessel changes. Longer follow-up might enable us to resolve whether arterial stiffness indices have better predictive ability in patients with aRVH than brachial blood pressure.
Posljednjih godina svjedočimo znatnom napretku u razumijevanju patogeneze glomerularnih bolesti. Te spoznaje dovele su do preciznije klasifikacije pojedinih glomerulonefritisa, omogućile razvoj novih ...dijagnostičkih testova, kao i novih terapijskih postupaka. Navedena dostignuća omogućit će uspješnije liječenje glomerulonefritisa te manju učestalost terapijski rezistentne bolesti. U ovom pregledu bit će prikazani noviteti u dijagnostici, algoritam liječenja, osobine rezistentne bolesti i mogućnosti specifičnog liječenja pojedinih oblika glomerulonefritisa.
Dijagnoza arterijske hipertenzije, uspješnost liječenja, procjena kardiovaskularnog rizika i epidemiološki podaci tradicionalno su bili bazirani na mjerenjima arterijskoga tlaka učinjenim u ...liječničkim ordinacijama s pomoću klasičnoga živina tlakomjera. Spoznaje o varijabilnosti tlaka, o utjecaju ambijenta ordinacije i prisutnosti medicinskog osoblja na postignute vrijednosti, ali i toksičnost žive i skoro povlačenje živinih tlakomjera iz kliničke upotrebe doveli su do sve raširenije upotrebe kućnog mjerenja tlaka samomjeračima (MATS) i kontinuiranoga 24-satnog mjerenja arterijskoga tlaka (KMAT). Kombinirana primjena svih triju načina mjerenja omogućava točniju klasifikaciju i precizniji dijagnostički i terapijski algoritam. U ovome preglednom članku opisana je jednostavna tehnika mjerenja tlaka u ordinaciji koja ne smije biti podcijenjena te su prikazani prednosti i nedostaci svakoga pojedinog načina mjerenja i upozoreno je na njihovu kompatibilnost s recentnim preporukama međunarodnih društava. U posebnom odlomku opisano je i mjerenje centralnog arterijskoga tlaka, brzine pulsnog vala i određivanje augmentacijskog indeksa, dodatnih čimbenika u procjeni ukupnoga kardiovaskularnog rizika.
The objective of this study was to determine the prevalence of hypertension, overweight and obesity in Croatian adolescents. In this cross-sectional survey (the sub-study of the EH-UH study) 375 boys ...and 381 girls (mean age 15.9 +/- 0.5 years) from four high schools in the city of Koprivnica were enrolled. Blood pressure, body height and body weight were measured according to the current ESH/ESC guidelines. Data on life style were obtained from questionnaire. Average blood pressure values were higher in boys than in girls (117/74 mmHg vs. 111/69 mmHg; p < 0.001). Significantly higher blood pressure values were obtained in overweight children compared to those with normal weight (119/76 mmHg us. 115/72 mmHg; p < 0.01). Prevalence of hypertension was 8.5% in the whole group being significantly higher in boys than in girls (11.2% vs. 5.8%; p = 0.0007). As expected, prevalence of hypertension was significantly higher in obese children than in those with normal weight (20.0% vs. 6.8%; p = 0.015). A significant correlation was found between body mass index and blood pressure (p = 0.0001). The overall prevalence of obesity was 3.54% (boys 2.2%; girls 4.9%). Our results confirmed positive relationship between overweight, obesity and hypertension starting from childhood pointing again the utmost importance of preventive measures beginning from early life.
Our aim was to analyze whether birth weight contributes to future hypertension through reduced kidney volume, and whether albuminuria could be a marker of this pathway. We included 103 patients with ...newly diagnosed essential hypertension and 92 normotensive controls. Blood pressure (BP) was measured using a mercury sphygmomanometer and a ABP monitor. Kidney volume was determined by ultrasound. Data on birth weight were obtained from mothers. Albuminuria was determined in 24-hour urine samples. Hypertensive patients had lower birth weight and higher albuminuria than normotensives. There was no difference in kidney volume between the two groups. We found a negative correlation between birth weight and systolic BP in the hypertensive group. BP was significantly correlated with BMI and albuminuria in the hypertensive group. Multiple regression analysis had shown the greatest impact of BMI on BP and had also demonstrated that 24-hour systolic BP showed the greatest risk for developing albuminuria in hypertensive patients. In conclusion, birth weight influences BP values in adult age, but it is not mediated by a reduced kidney volume. A strong correlation, independent of birth weight, was observed between albuminuria and BP values. Increased BMI is the most important independent risk factor responsible for BP increase, even in an early phase of essential hypertension.
Blokatori beta-receptora u cijelom su svijetu više od trideset godina najčešće propisivani antihipertenzivni lijekovi – to se posebno odnosi na atenolol. Učinak koji su imali u sekundarnoj prevenciji ...kardiovaskularnih događaja izostao je u primarnoj prevenciji infarkta miokarda i moždanog udara u hipertoničara. Primjena blokatora beta-receptora kao lijeka prvog izbora u liječenju nekomplicirane arterijske hipertenzije dovedena je u pitanje na osnovi više metaanaliza. U odnosu na druge antihipertenzivne lijekove blokatori beta-receptora imali su veći rizik od moždanog udara i ukupne smrtnosti bez značajnijeg smanjenja rizika od nastanka infarkta miokarda. Pojavnost novonastale šećerne bolesti značajno je češća u skupini tzv. klasičnih blokatora beta-receptora, a manje je značajna
kod blokatora beta-receptora s vazodilatacijskim učinkom (karvedilol,
nebivolol) i visoko selektivnih blokatora beta-1-receptora (bisoprolol). Prema smjernicama Europskog društva za dijagnosticiranje i liječenje arterijske hipertenzije 2007. godine blokatore beta-receptora kao lijek prvog izbora treba ograničiti u
bolesnika starijih od 55 godina s prekomjernom tjelesnom masom,
intolerancijom glukoze, poremećajem lipida, pozitivnom obiteljskom anamnezom za šećernu bolest. Ostaju lijek prvog izbora u mladih hipertoničara s naglašenom simpatikotonijom i u hipertoničara s nereguliranom hipertenzijom i popratnim kardiovaskularnim komplikacijama. Prednost dajemo blokatorima s vazodilatacijskim učinkom i visoko selektivnim blokatorima beta-1-receptora.
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