Muharrem Akhan | Gulhane Military Medical Academy (original) (raw)
Papers by Muharrem Akhan
Nephrology Dialysis Transplantation, 2014
Introduction and Aims: Both increased albuminuria and reduced kidney function predict blood press... more Introduction and Aims: Both increased albuminuria and reduced kidney function predict blood pressure (BP) progression in the community, and exacerbate each other's effects. We investigated associations and interactions between these two risk factors, BP changes and hypertension incidence in community-dwelling elderly men. Methods: Cross-sectional and longitudinal observational study in the Uppsala Longitudinal Study of Adult Men. 1051 men (all aged 71 years) with assessments on urinary albumin excretion rate (UAER, performed on an overnight urine collection.), 24-hour ambulatory BP monitoring (ABPM) and cystatin-C estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years, and ABPM measurements were again recorded. Results: UAER associated with ABPM measurements both at baseline and longitudinally. In longitudinal analysis, there were significant interactions between UAER and kidney function in their associations with changes of systolic BP, mean arterial pressure, and pulse pressure. After stratification for renal function state, UAER independently predicted BP changes only in those who had eGFR<60 mL/min/1.73m 2. At re-examination, 71 new cases of hypertension were recorded. In multivariable logistic models of hypertension incidence, similar interactions were observed: UAER was an independent predictor of incident hypertension only in those with reduced renal function. These associations were evident also in the subpopulation of participants with normal range UAER (<20ug/min). Conclusions: UAER, even within the normal range, associates with BP progression and hypertension incidence in community-dwelling elderly men but only in those with concurrent reduction of renal function.
Background: Studies have shown that arterial stiffness is an independent predictor of cardiovascu... more Background: Studies have shown that arterial stiffness is an independent predictor of cardiovascular diseases. Left ventricular hypertrophy (LVH) is an independent risk factor for early death. It is caused by malignant ventricular arrhythmias due to ventricular hypertrophy. In this study we aimed to investigate the relationships between arterial stiffness parameters and electrocardiographic criteria for LVH. Methods: A total of 59 subjects (30 females, 29 males) were included into the study. The subjects were the patients having arterial stiffness and electrocardiographic measurements applied in the internal medicine out-patient clinics for their chronic diseases or based upon their complaints. Results: The pulse wave velocity (PWV) was signifi cantly associated with Sokolow-Lyon ‘II’ (r=0.269; p=0.041) and the central aortic pressure (CAP) was signifi cantly associated with Sokolow-Lyon ‘II’ and Romhilt-Estes Score (r=0.303; p=0.021 and r=0.275; p=0.037, respectively) in whole grou...
PubMed, 2012
Background: There is limited information on the utility of certain echocardiographic measurements... more Background: There is limited information on the utility of certain echocardiographic measurements, such as right ventricular (RV) strain analysis, in predicting mortality in patients with acute pulmonary embolism (PE). Methods: A total of 211 patients with acute PE admitted to a medical intensive care unit (ICU) were retrospectively identified. Echocardiographic variables were prospectively measured in this cohort. The focus was on ICU, hospital, and long-term mortality. Results: The mean age was 61 6 15 years. Median Acute Physiology and Chronic Health Evaluation IV and simplified Pulmonary Embolism Severity Index scores were 60 (interquartile range, 40-71) and 2 (interquartile range, 1-2), respectively. Thirty-eight patients (18%) died during the sentinel hospitalization (13% died in the ICU). A total of 61 patients (28.9%) died during a median follow-up period of 15 months (interquartile range, 5-26 months). The echocardiographic variables associated with long-term mortality (from PE diagnosis) were ratio of RV to left ventricular end-diastolic diameter (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2-4.8), tricuspid annular plane systolic excursion (HR, 0.53; 95% CI, 0.31-0.92), and RV-right atrial gradient (HR, 1.02; 95% CI, 1.01-1.4). ICU mortality was associated with ratio of RV to LV end-diastolic diameter (HR, 4.4; 95% CI, 1.3-15), RV systolic pressure (HR, 1.03; 95% CI, 1.01-1.05), tricuspid annular plane systolic excursion (HR, 0.4; 95% CI, 0.18-0.9), and inferior vena cava collapsibility < 50% (HR, 4.3; 95% CI, 1.7-11). These variables remain significantly associated with mortality after adjusting by Acute Physiology and Chronic Health Evaluation IV score, Pulmonary Embolism Severity Index score, or the use of thrombolytic agents. RV strain parameters were not correlated with hospital or long-term mortality. Conclusions: Four simple parameters that measure different aspects of the right ventricle (ratio of RV to left ventricular end-diastolic diameter, RV systolic pressure, tricuspid annular plane systolic excursion, and inferior vena cava collapsibility) were independently associated with mortality in patients presenting with acute PE who were admitted to the ICU.
The Anatolian journal of cardiology, Sep 17, 2013
British Journal of Dermatology, Oct 31, 2013
Psoriasis vulgaris is an inflammatory disease characterized by epidermal hyperproliferation, leuc... more Psoriasis vulgaris is an inflammatory disease characterized by epidermal hyperproliferation, leucocyte adhesion molecule expression and leucocyte infiltration. Psoriasis is associated with an increased risk of cardiovascular disease. Endothelial dysfunction is widely regarded as being the initial process in the development of atherosclerosis. Human endothelial cell-specific molecule-1 (endocan) is a novel human endothelial cell-specific molecule. Previous studies suggested that endocan may be a novel endothelial dysfunction marker. To investigate the relationship between serum levels of endocan and both cardiovascular risk and disease activity in patients with psoriasis vulgaris. A total of 29 patients with psoriasis vulgaris and 35 control subjects were included in the study. Endocan, high-sensitivity C-reactive protein (hsCRP) and carotid artery intima-media thickness (cIMT) were measured in all subjects. Serum endocan levels were significantly different between the two groups (P &amp;lt; 0.001). In patients with psoriasis, serum endocan levels correlated with Psoriasis Area and Severity Index, hsCRP and cIMT (r = 0.477, P = 0.009; r = 0.484, P = 0.008; r = 0.408, P = 0.02, respectively). Circulating endocan may represent a new marker that correlates with cardiovascular risk as well as the severity of disease in patients with psoriasis vulgaris. Endocan may be a surrogate endothelial dysfunction marker and may have a functional role in endothelium-dependent pathological disorders. Whether endocan levels could become a treatment target merits further investigation.
International Journal of Cardiology, Mar 1, 2013
Hypertension isamodifiable riskfactor forcardiovascular diseasesandisassociated withseveralmetabo... more Hypertension isamodifiable riskfactor forcardiovascular diseasesandisassociated withseveralmetabolic disorders like dyslipidemia. Higher levels of triglyceride and low-density lipoprotein (LDL) are quite strong factors for the development of cardiovascular diseases. In this study, we investigated the effects of valsartan and amlodipine on the lipid profile in patients with newly diagnosed essential hypertension. We observed a beneficial effect of amlodipine on the lipid profile with a significant reduction of LDL compared to valsartan. In the treatment of hypertension, prior knowledge of the plasma cholesterol levels can be important in antihypertensive drug choice.
DOAJ (DOAJ: Directory of Open Access Journals), Mar 1, 2013
Arquivos Brasileiros De Cardiologia, Mar 1, 2013
International Journal of Cardiology, Mar 1, 2013
What is the contribution of physical activity on outcome in patients with type 2 diabetes mellitu... more What is the contribution of physical activity on outcome in patients with type 2 diabetes mellitus? Qual a contribuição da atividade física sobre o desfecho em pacientes com diabetes melito tipo 2?
SpringerPlus, 2016
Unconjugated bilirubin (UCB) plays a protective role in coronary artery disease. Red cell distrib... more Unconjugated bilirubin (UCB) plays a protective role in coronary artery disease. Red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are inflammatory biomarkers and higher levels are related to atherosclerosis and adverse cardiovascular events. We aimed to investigate the relation between UCB levels and RDW, NLR, PLR in people with Gilbert's syndrome (GS). We selected 2166 subjects (1082 with GS and 1084 healthy controls) from a database having 33,695 people. RDW, NLR and PLR were investigated in the subjects with GS and compared with the healthy controls. Linear regression analysis was used to evaluate the relation between variables. NLR and PLR were higher in the subjects with GS compared to the controls (p < 0.001). RDW was similar in both groups (p = 0.318). UCB was negatively correlated with lymphocyte counts (p = 0.040), and positively correlated with RDW (p < 0.001) and PLR (p = 0.037) in the subjects with G...
The Anatolian Journal of Cardiology, 2016
Investigation of the arterial stiffness and associated factors in patients with familial Mediterr... more Investigation of the arterial stiffness and associated factors in patients with familial Mediterranean fever Objective: Because of the ongoing and recurring inflammatory state in familial Mediterranean fever (FMF), patients may experience a high risk of cardiovascular events. Our aim was to investigate the arterial stiffness and associated factors in patients with FMF. Methods: Sixty-nine consecutive FMF patients (including 11 females) and 35 controls (including 5 females) were enrolled in the study. The demographical, clinical, and laboratory data and genetic mutations of the patients were recorded. In the study, FMF patients according to the Tel-Hashomer criteria were included, whereas patients with other known inflammatory rheumatologic disease, atherosclerotic cardiovascular disease, hypertension, diabetes, those under the age of 18 years, or those refusing to participate in the study were excluded. Arterial stiffness measurements were performed using the TensioMed device (TensoMed Ltd, Budapest, Hungary). Results: The patient and control groups were similar in terms of the mean ages, BMIs, gender, systolic blood pressures, and smoking. FMF patients had a higher pulse wave velocity (PWV) (7.73±1.3 and 7.18±1.1 m/s; p=0.03) and lower brachial and aortic augmentation indexes (-64.6±14.6% and-54.6±25.9%, p=0.041 and 4.9±7.4% and 14.0±11.5%, p=0.025, respectively) compared with the controls. Thirty-one (45%) patients were in the "during-attack" state and had higher PWV (8.17±1.6 and 7.38±0.9 m/s; p=0.027) compared with the asymptomatic patients. PWV was correlated to serum CRP, WBC, ESR, fibrinogen, and neutrophil/lymphocyte ratios (r=0.666, 0.429, 0.441, 0.388, and 0.460, respectively). The genetic mutation and predominant attack type had no effect on arterial stiffness. Conclusion: FMF patients have increased arterial stiffness during attacks compared with asymptomatic patients and controls. The impaired arterial stiffness is correlated to the severity of the inflammatory state rather than to the attack type or genetic mutations.
Arquivos Brasileiros De Cardiologia, Mar 1, 2013
Archives of endocrinology and metabolism, Jan 21, 2015
Objective There is a growing body of data supporting the association between diabetes and microci... more Objective There is a growing body of data supporting the association between diabetes and microcirculatory disfunction. We aimed to study e-selectin levels, and their associations with serum markers of inflammation and arterial stiffness in prediabetes and newly diagnosed diabetes patients in this study. Subjects and methods Sixty patients (25 females) with a newly established elevated fasting serum glucose [20 impaired fasting glucose (IFG), 20 impaired glucose tolerance (IGT), 20 newly diagnosed diabetes (T2DM)] and 17 healthy controls (13 females) were included in the study. Serum e-selectin and hs-CRP levels, and arterial stiffness parameters of the patients were studied. Results Fasting serum glucose was the most important predictor of serum e-selectin levels. Pulse wave velocity and central aortic pressures were significantly higher in IFG, IGT and T2DM groups, compared to controls (p = 0.001, < 0.001, 0.013 and 0.015, 0.002, 0.009, respectively). The mean arterial pressure...
Journal of clinical and diagnostic research : JCDR, 2013
Minerva anestesiologica, Jan 20, 2012
Swiss Medical Weekly, 2013
Renal Failure, 2013
Microalbuminuria (MA) is common in hypertensive population and is a marker for endothelial dysfun... more Microalbuminuria (MA) is common in hypertensive population and is a marker for endothelial dysfunction and a predictor of increased cardiovascular risk. A great body of data shows the importance of MA as a strong predictor of renal and cardiovascular disease (CVD) risk in hypertensive population. In this study, we aimed to compare the anti-albuminuric effects of an angiotensin II receptor antagonist, valsartan, with a calcium channel blocker, amlodipine, in newly diagnosed hypertensive patients. Totally, 20 patients were recruited into the study. Patients were randomized to one of the following intervention protocols: An (a) angiotensin II receptor blocker (valsartan, 80-320 mg/day) or (b) calcium channel blocker (amlodipine, 5-10 mg/day), for 12 weeks immediately after baseline measurements. Ten patients were randomized into valsartan group and 10 patients into the amlodipine group. Twenty-four-hour urinary albumin excretion (UAE) levels of the patient groups were measured before treatment and on the 12th week. Patients of the two groups were matched for age and body mass index. In the amlodipine group, baseline urine microalbumin levels were higher compared to valsartan group, although the difference was not statistically significant (p = 0.082). At the 12th week, there was a significant decrease in urine microalbumin levels in the amlodipine group, but no significant change was observed in the valsartan group. Amlodipine seems to be superior to valsartan in decreasing UAE. To reduce cardiovascular risks, endothelial dysfunction, and microinflammation, these factors are taken into consideration while prescribing antihypertensive drugs in hypertensive patients.
Journal of Internal Medicine, 2013
ABSTRACT We read the article &#39;Effects of individual and combined dietary weight loss ... more ABSTRACT We read the article &#39;Effects of individual and combined dietary weight loss and exercise interventions in postmenopausal women on adiponectin and leptin levels&#39; by Abbenhardt et al. with interest [1]. The authors concluded that diet-induced weight loss with or without exercise increased the serum adiponectin concentration and resulted in a reduction in leptin levels [1]. This article is protected by copyright. All rights reserved.
The Journal of Clinical Hypertension, 2013
To the Editor: We read the article “Patients With Hypertensive Crises Who Are Admitted to a Coron... more To the Editor: We read the article “Patients With Hypertensive Crises Who Are Admitted to a Coronary Care Unit: Clinical Characteristics and Outcomes” written by Hector Gonzalez Pacheco and colleagues with interest. The authors concluded that hypertensive emergency (HTNE) was associated with the worst mortality outcomes in patients who were admitted to a coronary care unit, and pattern of predominant systolic hypertension (sHTN) was most commonly observed in the study group. We thank the authors for their contribution of the study, which was successfully designed and documented. We believe that these findings will enlighten further studies about hypertensive crises (HTN-C) and its role in patient outcome. Hypertension, an important member of chronic noncommunicable diseases, is a major global public health problem that must be evaluated by each country so that prevention measures can be increased and cases of HTN-C can consequently be reduced. Patients with HTN-E are best treated in an intensive care unit with titratable intravenous hypotensive agents. The present study shows that the frequent use of intravenous vasodilators in patients with hypertensive urgency (HTN-U) was striking, and that the inappropriate use of intravenous antihypertensive agents is potentially dangerous in those patients. We thank the authors for highlighting this important problem. In the present study, patients were divided into 3 groups according to their blood pressure (BP) values (group I, predominant systolic hypertension; group II, severe systolic and diastolic hypertension; and group III, predominant diastolic hypertension) and the pattern of sHTN was most commonly observed in the HTN-C and HTN-E groups. We think the reason for this is that a number of patients were older than 60 years. As we know, there is an inexorable increase in systolic BP with aging. In addition, we think that stratification of patients according to the type of BP would give useful information in the management of HTN-C. There is also some confusion in the present study. The authors make an assumption about the worst mortality outcomes in HTN-E, and we think that the main reason of the worst mortality outcome is to perform the study in the coronary care unit, because coronary care unit mortality is always high. The authors suggested that the retrospective nature of the study and confounding acute comorbidities were associated with the worst mortality outcomes in HTNE. We think this inference is true, but the main reason is to perform the study in the coronary care unit.
Nephrology Dialysis Transplantation, 2014
Introduction and Aims: Both increased albuminuria and reduced kidney function predict blood press... more Introduction and Aims: Both increased albuminuria and reduced kidney function predict blood pressure (BP) progression in the community, and exacerbate each other's effects. We investigated associations and interactions between these two risk factors, BP changes and hypertension incidence in community-dwelling elderly men. Methods: Cross-sectional and longitudinal observational study in the Uppsala Longitudinal Study of Adult Men. 1051 men (all aged 71 years) with assessments on urinary albumin excretion rate (UAER, performed on an overnight urine collection.), 24-hour ambulatory BP monitoring (ABPM) and cystatin-C estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years, and ABPM measurements were again recorded. Results: UAER associated with ABPM measurements both at baseline and longitudinally. In longitudinal analysis, there were significant interactions between UAER and kidney function in their associations with changes of systolic BP, mean arterial pressure, and pulse pressure. After stratification for renal function state, UAER independently predicted BP changes only in those who had eGFR<60 mL/min/1.73m 2. At re-examination, 71 new cases of hypertension were recorded. In multivariable logistic models of hypertension incidence, similar interactions were observed: UAER was an independent predictor of incident hypertension only in those with reduced renal function. These associations were evident also in the subpopulation of participants with normal range UAER (<20ug/min). Conclusions: UAER, even within the normal range, associates with BP progression and hypertension incidence in community-dwelling elderly men but only in those with concurrent reduction of renal function.
Background: Studies have shown that arterial stiffness is an independent predictor of cardiovascu... more Background: Studies have shown that arterial stiffness is an independent predictor of cardiovascular diseases. Left ventricular hypertrophy (LVH) is an independent risk factor for early death. It is caused by malignant ventricular arrhythmias due to ventricular hypertrophy. In this study we aimed to investigate the relationships between arterial stiffness parameters and electrocardiographic criteria for LVH. Methods: A total of 59 subjects (30 females, 29 males) were included into the study. The subjects were the patients having arterial stiffness and electrocardiographic measurements applied in the internal medicine out-patient clinics for their chronic diseases or based upon their complaints. Results: The pulse wave velocity (PWV) was signifi cantly associated with Sokolow-Lyon ‘II’ (r=0.269; p=0.041) and the central aortic pressure (CAP) was signifi cantly associated with Sokolow-Lyon ‘II’ and Romhilt-Estes Score (r=0.303; p=0.021 and r=0.275; p=0.037, respectively) in whole grou...
PubMed, 2012
Background: There is limited information on the utility of certain echocardiographic measurements... more Background: There is limited information on the utility of certain echocardiographic measurements, such as right ventricular (RV) strain analysis, in predicting mortality in patients with acute pulmonary embolism (PE). Methods: A total of 211 patients with acute PE admitted to a medical intensive care unit (ICU) were retrospectively identified. Echocardiographic variables were prospectively measured in this cohort. The focus was on ICU, hospital, and long-term mortality. Results: The mean age was 61 6 15 years. Median Acute Physiology and Chronic Health Evaluation IV and simplified Pulmonary Embolism Severity Index scores were 60 (interquartile range, 40-71) and 2 (interquartile range, 1-2), respectively. Thirty-eight patients (18%) died during the sentinel hospitalization (13% died in the ICU). A total of 61 patients (28.9%) died during a median follow-up period of 15 months (interquartile range, 5-26 months). The echocardiographic variables associated with long-term mortality (from PE diagnosis) were ratio of RV to left ventricular end-diastolic diameter (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.2-4.8), tricuspid annular plane systolic excursion (HR, 0.53; 95% CI, 0.31-0.92), and RV-right atrial gradient (HR, 1.02; 95% CI, 1.01-1.4). ICU mortality was associated with ratio of RV to LV end-diastolic diameter (HR, 4.4; 95% CI, 1.3-15), RV systolic pressure (HR, 1.03; 95% CI, 1.01-1.05), tricuspid annular plane systolic excursion (HR, 0.4; 95% CI, 0.18-0.9), and inferior vena cava collapsibility < 50% (HR, 4.3; 95% CI, 1.7-11). These variables remain significantly associated with mortality after adjusting by Acute Physiology and Chronic Health Evaluation IV score, Pulmonary Embolism Severity Index score, or the use of thrombolytic agents. RV strain parameters were not correlated with hospital or long-term mortality. Conclusions: Four simple parameters that measure different aspects of the right ventricle (ratio of RV to left ventricular end-diastolic diameter, RV systolic pressure, tricuspid annular plane systolic excursion, and inferior vena cava collapsibility) were independently associated with mortality in patients presenting with acute PE who were admitted to the ICU.
The Anatolian journal of cardiology, Sep 17, 2013
British Journal of Dermatology, Oct 31, 2013
Psoriasis vulgaris is an inflammatory disease characterized by epidermal hyperproliferation, leuc... more Psoriasis vulgaris is an inflammatory disease characterized by epidermal hyperproliferation, leucocyte adhesion molecule expression and leucocyte infiltration. Psoriasis is associated with an increased risk of cardiovascular disease. Endothelial dysfunction is widely regarded as being the initial process in the development of atherosclerosis. Human endothelial cell-specific molecule-1 (endocan) is a novel human endothelial cell-specific molecule. Previous studies suggested that endocan may be a novel endothelial dysfunction marker. To investigate the relationship between serum levels of endocan and both cardiovascular risk and disease activity in patients with psoriasis vulgaris. A total of 29 patients with psoriasis vulgaris and 35 control subjects were included in the study. Endocan, high-sensitivity C-reactive protein (hsCRP) and carotid artery intima-media thickness (cIMT) were measured in all subjects. Serum endocan levels were significantly different between the two groups (P &amp;lt; 0.001). In patients with psoriasis, serum endocan levels correlated with Psoriasis Area and Severity Index, hsCRP and cIMT (r = 0.477, P = 0.009; r = 0.484, P = 0.008; r = 0.408, P = 0.02, respectively). Circulating endocan may represent a new marker that correlates with cardiovascular risk as well as the severity of disease in patients with psoriasis vulgaris. Endocan may be a surrogate endothelial dysfunction marker and may have a functional role in endothelium-dependent pathological disorders. Whether endocan levels could become a treatment target merits further investigation.
International Journal of Cardiology, Mar 1, 2013
Hypertension isamodifiable riskfactor forcardiovascular diseasesandisassociated withseveralmetabo... more Hypertension isamodifiable riskfactor forcardiovascular diseasesandisassociated withseveralmetabolic disorders like dyslipidemia. Higher levels of triglyceride and low-density lipoprotein (LDL) are quite strong factors for the development of cardiovascular diseases. In this study, we investigated the effects of valsartan and amlodipine on the lipid profile in patients with newly diagnosed essential hypertension. We observed a beneficial effect of amlodipine on the lipid profile with a significant reduction of LDL compared to valsartan. In the treatment of hypertension, prior knowledge of the plasma cholesterol levels can be important in antihypertensive drug choice.
DOAJ (DOAJ: Directory of Open Access Journals), Mar 1, 2013
Arquivos Brasileiros De Cardiologia, Mar 1, 2013
International Journal of Cardiology, Mar 1, 2013
What is the contribution of physical activity on outcome in patients with type 2 diabetes mellitu... more What is the contribution of physical activity on outcome in patients with type 2 diabetes mellitus? Qual a contribuição da atividade física sobre o desfecho em pacientes com diabetes melito tipo 2?
SpringerPlus, 2016
Unconjugated bilirubin (UCB) plays a protective role in coronary artery disease. Red cell distrib... more Unconjugated bilirubin (UCB) plays a protective role in coronary artery disease. Red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are inflammatory biomarkers and higher levels are related to atherosclerosis and adverse cardiovascular events. We aimed to investigate the relation between UCB levels and RDW, NLR, PLR in people with Gilbert's syndrome (GS). We selected 2166 subjects (1082 with GS and 1084 healthy controls) from a database having 33,695 people. RDW, NLR and PLR were investigated in the subjects with GS and compared with the healthy controls. Linear regression analysis was used to evaluate the relation between variables. NLR and PLR were higher in the subjects with GS compared to the controls (p < 0.001). RDW was similar in both groups (p = 0.318). UCB was negatively correlated with lymphocyte counts (p = 0.040), and positively correlated with RDW (p < 0.001) and PLR (p = 0.037) in the subjects with G...
The Anatolian Journal of Cardiology, 2016
Investigation of the arterial stiffness and associated factors in patients with familial Mediterr... more Investigation of the arterial stiffness and associated factors in patients with familial Mediterranean fever Objective: Because of the ongoing and recurring inflammatory state in familial Mediterranean fever (FMF), patients may experience a high risk of cardiovascular events. Our aim was to investigate the arterial stiffness and associated factors in patients with FMF. Methods: Sixty-nine consecutive FMF patients (including 11 females) and 35 controls (including 5 females) were enrolled in the study. The demographical, clinical, and laboratory data and genetic mutations of the patients were recorded. In the study, FMF patients according to the Tel-Hashomer criteria were included, whereas patients with other known inflammatory rheumatologic disease, atherosclerotic cardiovascular disease, hypertension, diabetes, those under the age of 18 years, or those refusing to participate in the study were excluded. Arterial stiffness measurements were performed using the TensioMed device (TensoMed Ltd, Budapest, Hungary). Results: The patient and control groups were similar in terms of the mean ages, BMIs, gender, systolic blood pressures, and smoking. FMF patients had a higher pulse wave velocity (PWV) (7.73±1.3 and 7.18±1.1 m/s; p=0.03) and lower brachial and aortic augmentation indexes (-64.6±14.6% and-54.6±25.9%, p=0.041 and 4.9±7.4% and 14.0±11.5%, p=0.025, respectively) compared with the controls. Thirty-one (45%) patients were in the "during-attack" state and had higher PWV (8.17±1.6 and 7.38±0.9 m/s; p=0.027) compared with the asymptomatic patients. PWV was correlated to serum CRP, WBC, ESR, fibrinogen, and neutrophil/lymphocyte ratios (r=0.666, 0.429, 0.441, 0.388, and 0.460, respectively). The genetic mutation and predominant attack type had no effect on arterial stiffness. Conclusion: FMF patients have increased arterial stiffness during attacks compared with asymptomatic patients and controls. The impaired arterial stiffness is correlated to the severity of the inflammatory state rather than to the attack type or genetic mutations.
Arquivos Brasileiros De Cardiologia, Mar 1, 2013
Archives of endocrinology and metabolism, Jan 21, 2015
Objective There is a growing body of data supporting the association between diabetes and microci... more Objective There is a growing body of data supporting the association between diabetes and microcirculatory disfunction. We aimed to study e-selectin levels, and their associations with serum markers of inflammation and arterial stiffness in prediabetes and newly diagnosed diabetes patients in this study. Subjects and methods Sixty patients (25 females) with a newly established elevated fasting serum glucose [20 impaired fasting glucose (IFG), 20 impaired glucose tolerance (IGT), 20 newly diagnosed diabetes (T2DM)] and 17 healthy controls (13 females) were included in the study. Serum e-selectin and hs-CRP levels, and arterial stiffness parameters of the patients were studied. Results Fasting serum glucose was the most important predictor of serum e-selectin levels. Pulse wave velocity and central aortic pressures were significantly higher in IFG, IGT and T2DM groups, compared to controls (p = 0.001, < 0.001, 0.013 and 0.015, 0.002, 0.009, respectively). The mean arterial pressure...
Journal of clinical and diagnostic research : JCDR, 2013
Minerva anestesiologica, Jan 20, 2012
Swiss Medical Weekly, 2013
Renal Failure, 2013
Microalbuminuria (MA) is common in hypertensive population and is a marker for endothelial dysfun... more Microalbuminuria (MA) is common in hypertensive population and is a marker for endothelial dysfunction and a predictor of increased cardiovascular risk. A great body of data shows the importance of MA as a strong predictor of renal and cardiovascular disease (CVD) risk in hypertensive population. In this study, we aimed to compare the anti-albuminuric effects of an angiotensin II receptor antagonist, valsartan, with a calcium channel blocker, amlodipine, in newly diagnosed hypertensive patients. Totally, 20 patients were recruited into the study. Patients were randomized to one of the following intervention protocols: An (a) angiotensin II receptor blocker (valsartan, 80-320 mg/day) or (b) calcium channel blocker (amlodipine, 5-10 mg/day), for 12 weeks immediately after baseline measurements. Ten patients were randomized into valsartan group and 10 patients into the amlodipine group. Twenty-four-hour urinary albumin excretion (UAE) levels of the patient groups were measured before treatment and on the 12th week. Patients of the two groups were matched for age and body mass index. In the amlodipine group, baseline urine microalbumin levels were higher compared to valsartan group, although the difference was not statistically significant (p = 0.082). At the 12th week, there was a significant decrease in urine microalbumin levels in the amlodipine group, but no significant change was observed in the valsartan group. Amlodipine seems to be superior to valsartan in decreasing UAE. To reduce cardiovascular risks, endothelial dysfunction, and microinflammation, these factors are taken into consideration while prescribing antihypertensive drugs in hypertensive patients.
Journal of Internal Medicine, 2013
ABSTRACT We read the article &#39;Effects of individual and combined dietary weight loss ... more ABSTRACT We read the article &#39;Effects of individual and combined dietary weight loss and exercise interventions in postmenopausal women on adiponectin and leptin levels&#39; by Abbenhardt et al. with interest [1]. The authors concluded that diet-induced weight loss with or without exercise increased the serum adiponectin concentration and resulted in a reduction in leptin levels [1]. This article is protected by copyright. All rights reserved.
The Journal of Clinical Hypertension, 2013
To the Editor: We read the article “Patients With Hypertensive Crises Who Are Admitted to a Coron... more To the Editor: We read the article “Patients With Hypertensive Crises Who Are Admitted to a Coronary Care Unit: Clinical Characteristics and Outcomes” written by Hector Gonzalez Pacheco and colleagues with interest. The authors concluded that hypertensive emergency (HTNE) was associated with the worst mortality outcomes in patients who were admitted to a coronary care unit, and pattern of predominant systolic hypertension (sHTN) was most commonly observed in the study group. We thank the authors for their contribution of the study, which was successfully designed and documented. We believe that these findings will enlighten further studies about hypertensive crises (HTN-C) and its role in patient outcome. Hypertension, an important member of chronic noncommunicable diseases, is a major global public health problem that must be evaluated by each country so that prevention measures can be increased and cases of HTN-C can consequently be reduced. Patients with HTN-E are best treated in an intensive care unit with titratable intravenous hypotensive agents. The present study shows that the frequent use of intravenous vasodilators in patients with hypertensive urgency (HTN-U) was striking, and that the inappropriate use of intravenous antihypertensive agents is potentially dangerous in those patients. We thank the authors for highlighting this important problem. In the present study, patients were divided into 3 groups according to their blood pressure (BP) values (group I, predominant systolic hypertension; group II, severe systolic and diastolic hypertension; and group III, predominant diastolic hypertension) and the pattern of sHTN was most commonly observed in the HTN-C and HTN-E groups. We think the reason for this is that a number of patients were older than 60 years. As we know, there is an inexorable increase in systolic BP with aging. In addition, we think that stratification of patients according to the type of BP would give useful information in the management of HTN-C. There is also some confusion in the present study. The authors make an assumption about the worst mortality outcomes in HTN-E, and we think that the main reason of the worst mortality outcome is to perform the study in the coronary care unit, because coronary care unit mortality is always high. The authors suggested that the retrospective nature of the study and confounding acute comorbidities were associated with the worst mortality outcomes in HTNE. We think this inference is true, but the main reason is to perform the study in the coronary care unit.