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Kocełak P, Mossakowska M, Puzianowska-Kuźnicka M, Sworczak K, Wyszomirski A, Handzlik G, Stefański A, Zdrojewski T, Chudek J. Prevalence and risk factors of untreated thyroid dysfunctions in the older Caucasian adults: Results of PolSenior 2 survey. PLoS One 2022; 17:e0272045. [PMID: 35994462 PMCID: PMC9394816 DOI: 10.1371/journal.pone.0272045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/13/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction To determine the prevalence of treated and untreated thyroid dysfunction and to identify factors associated with increased risk of undiagnosed thyroid dysfunction in older adults. Methods The population of 5987 community-dwelling Polish Caucasian seniors aged 60 years and above who participated in the PolSenior 2 study (2018–2019). Population-based cross-sectional multidisciplinary study in design. Data from structured questionnaires, geriatric tests, and scales were obtained from all study participants who underwent anthropometric and blood pressure measurements during three home visits. Assessment of thyroid function was based on TSH serum measurements. Results The prevalence of thyroid dysfunction in the Polish population aged 60 years or above was estimated at 15.5% (21.5% in women and 7.2% in men), with 3.2% of undiagnosed individuals among them. The prevalence of hypothyroidism and hyperthyroidism in the studied group was 13.9% (19.4% in women and 6.3% in men) and 1.6% (2.1% in women and 0.9% in men) respectively, untreated hypothyroidism was revealed in 21.9% (in 160 out of 732 subjects) and untreated hyperthyroidism in 34.2% of subjects (in 41 out of 120 participants). In multiple regression analysis independent risk factors for thyroid disorders being untreated were older age (> 75 years), male sex, a low education level (primary or lower), and low utilization of medical services. Conclusions One-fifth of Polish Caucasian seniors with hypothyroidism and one-third with hyperthyroidism are untreated. Older, poorly educated and rarely utilizing medical services seniors, especially men, are more frequently untreated for thyroid dysfunction and some of them do not benefit from contemporary achievements in medicine.
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Affiliation(s)
- Piotr Kocełak
- Medical Faculty in Katowice, Department of Pathophysiology, Pathophysiology Unit, The Medical University of Silesia, Katowice, Poland
- * E-mail:
| | | | - Monika Puzianowska-Kuźnicka
- Department of Geriatrics and Gerontology, Medical Centre of Postgraduate Education, Warsaw, Poland
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, Warsaw, Poland
| | - Krzysztof Sworczak
- Department of Endocrinology and Internal Diseases, Medical University of Gdańsk, Gdańsk, Poland
| | - Adam Wyszomirski
- Faculty of Medicine, Department of Adult Neurology, Medical University of Gdańsk, Gdańsk, Poland
| | - Gabriela Handzlik
- Medical Faculty in Katowice, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, Katowice, Poland
| | - Adrian Stefański
- Division of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland
| | - Tomasz Zdrojewski
- Division of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland
| | - Jerzy Chudek
- Medical Faculty in Katowice, Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, Katowice, Poland
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Dąbrowska E, Harazny JM, Miszkowska-Nagórna E, Stefański A, Graff B, Kunicka K, Świerblewska E, Rojek A, Szyndler A, Gąsecki D, Wolf J, Gruchała M, Laurent S, Schmieder RE, Narkiewicz K. Aortic stiffness is not only associated with structural but also functional parameters of retinal microcirculation. Microvasc Res 2020; 129:103974. [PMID: 31923388 DOI: 10.1016/j.mvr.2020.103974] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/22/2019] [Accepted: 01/01/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The aim of the study was to test the hypothesis that alterations in large arteries are associated with microvascular remodelling and decreased retinal capillary blood flow. METHODS The study group comprised of 88 patients with essential hypertension and 32 healthy controls. Retinal microcirculation was evaluated by scanning laser Doppler flowmetry. Macrovascular changes were assessed on the basis of arterial stiffness measurement (carotid-femoral pulse wave velocity), its hemodynamic consequences (central pulse pressure, augmentation pressure, augmentation index) and intima media thickness of common carotid artery. RESULTS Pulse wave velocity was inversely correlated to mean retinal capillary blood flow in hypertensive patients (R = -0.32, p < 0.01). This relationship remained significant in multivariate regression analysis after adjustment for age, sex, central systolic blood pressure (BP) and body mass index (β = -31.27, p < 0.001). Lumen diameter (LD) of retinal arterioles was significantly smaller in hypertensive then normotensive subjects (79.4 vs. 83.8, p = 0.03). Central and brachial systolic, diastolic and mean BPs were significantly correlated with LD and outer diameter of retinal arterioles. The relationship between LD and central BPs remained significant in multivariate analysis (β = -0.15, p = 0.03 for cSBP; β = -0.22, p = 0.04 for cDBP; β = -0.21, p = 0.03 for cMBP). Moreover, in a subgroup with cardiac damage central and brachial pulse pressure were positively associated with retinal wall thickness, wall cross sectional area, and wall to lumen ratio. CONCLUSION In conclusion, the study provides a strong evidence that microcirculation is coupled with macrocirculation not only in terms of structural but also functional parameters.
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Affiliation(s)
- Edyta Dąbrowska
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland; First Department of Cardiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland.
| | - Joanna M Harazny
- Department of Pathophysiology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland; Clinical Research Centre, Department of Nephrology and Hypertension, Univerity Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany
| | - Eliza Miszkowska-Nagórna
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Adrian Stefański
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Beata Graff
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Kunicka
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Świerblewska
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Rojek
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Anna Szyndler
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Dariusz Gąsecki
- Department of Neurology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | | | - Roland E Schmieder
- Clinical Research Centre, Department of Nephrology and Hypertension, Univerity Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Germany
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
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Dąbrowska E, Harazny JM, Miszkowska-Nagórna E, Stefański A, Graff B, Kunicka K, Świerblewska E, Rojek A, Szyndler A, Wolf J, Gruchała M, Schmieder RE, Narkiewicz K. Lumen narrowing and increased wall to lumen ratio of retinal microcirculation are valuable biomarkers of hypertension-mediated cardiac damage. Blood Press 2019; 29:1-10. [PMID: 32228237 DOI: 10.1080/08037051.2019.1657769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 08/09/2019] [Accepted: 08/15/2019] [Indexed: 12/30/2022]
Abstract
Purpose: In the course of hypertension, left ventricular hypertrophy and diastolic dysfunction develop very often and may progress toward heart failure. The aim of the study was to analyze the relationship between abnormalities of retinal microcirculation and cardiac damage defined as left ventricular hypertrophy and/or diastolic dysfunction.Materials and methods: The study comprised 88 patients with essential hypertension. The group was divided into two subgroups: hypertensives without cardiac damage (n = 55) and with cardiac damage (n = 33). Control group comprised 32 normotensive subjects. Scanning laser Doppler flowmetry was used to evaluate retinal microcirculation. Echocardiography was used to assess cardiac damage.Results: Lumen diameter of retinal arterioles was significantly smaller in patients with cardiac damage vs. controls (77 vs. 84 µm, p = 0.02). Additionally, there was an evident trend with respect to lumen diameter (LD) across all three studied subgroups; i.e.: the smallest dimeters were present in cardiac damage patients, moderate size in hypertensives' without cardiac damage, and the largest diameters in healthy controls (pfor trend < 0.01). Lumen diameter was inversely correlated with cardiac intraventricular septum diameter (R = -0.25, p = 0.02), left ventricular mass (R = -0.24, p = 0.02), and left atrial volume (R = -0.22, p = 0.04). Wall to lumen ratio was associated with intraventricular septum diameter (R = 0.21, p = 0.044) and left atrial volume (R = 0.21, p = 0.045). In multivariable regression analysis, lumen diameter was independently associated with intraventricular septum diameter (β = -0.05, p = 0.03), left ventricular mass (β = -1.15, p = 0.04), and left atrial volume (β = -0.42, p = 0.047); wall to lumen ratio was independently associated with intraventricular septum diameter (β = 3.67, p = 0.02) and left atrial volume (β = 30.0, p = 0.04).Conclusions: In conclusion, retinal arterioles lumen diameter and wall to lumen ratio were independent biomarkers of cardiac damage. Retinal examination performed by means of scanning laser Doppler flowmetry might be a valuable tool to improve cardiovascular risk stratification of hypertensive patients.
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Affiliation(s)
- Edyta Dąbrowska
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Joanna M Harazny
- Department of Pathophysiology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
- Department of Nephrology and Hypertension, Clinical Research Centre, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Eliza Miszkowska-Nagórna
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Adrian Stefański
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Beata Graff
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Kunicka
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Ewa Świerblewska
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Agnieszka Rojek
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Anna Szyndler
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Jacek Wolf
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Marcin Gruchała
- First Department of Cardiology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Roland E Schmieder
- Department of Nephrology and Hypertension, Clinical Research Centre, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
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Khursa R, Voitikova M, Stefański A, Wolf J, Narkiewicz K. Hemodynamic phenotypes and its association with blood pressure changes at continuous positive airway pressure therapy in obstructive sleep apnoea hypertensive patients. Arterial Hypertension 2018. [DOI: 10.5603/ah.a2018.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kanarek-Kucner J, Stefański A, Barraclough R, Gorycki T, Wolf J, Narkiewicz K, Hoffmann M. Insufficiency of the zona glomerulosa of the adrenal cortex and progressive kidney insufficiency following unilateral adrenalectomy - case report and discussion. Blood Press 2018; 27:304-312. [PMID: 29742971 DOI: 10.1080/08037051.2018.1470460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Primary aldosteronism (PA) is the most common cause of secondary hypertension and bilateral adrenal hyperplasia (BAH) and aldosterone-producing adenoma (APA) seem to be the most common causes of PA. Unilateral adrenalectomy (UA) is the preferred treatment for APA, although the benefits are still difficult to assess. CASE REPORT We present a case report of a 69-year old man with a 30 year history of hypertension and probably long-standing PA due to APA, with typical organ complications. Since repeated abdominal CT scans were equivocal, not showing radiological changes characteristic for PA, the diagnosis of APA was delayed and was only finally confirmed by adrenal venous sampling which demonstrated unilateral aldosteronism. The patient underwent UA, complicated by mineralocorticoid deficiency syndrome and increased creatinine and potassium levels. At 12 months follow-up the patient still had hyperkalemia and was fludrocortisone dependent. CONCLUSIONS Older patients and patients with long-lasting PA who are treated with UA may demonstrate deterioration of renal function and develop transient or persistent insufficiency of the zona glomerulosa of the remaining adrenal gland necessitating fludrocortisone supplementation. Transient hyperkalemia may be observed following UA as a result of the prolonged effects of aldosterone antagonists and/or transient mineralocorticoid/glucocorticoid insufficiency. Additionally, the level of progression of chronic kidney disease after UA is difficult to predict. There likely exists a group of patients who might paradoxically have higher cardiovascular risk due to significant deterioration in kidney function not only resulting from the removal of the aldosterone induced glomerular hyperfiltration phenomenon. Identification of such a group requires further detailed investigation.
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Affiliation(s)
- Joanna Kanarek-Kucner
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Adrian Stefański
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Rufus Barraclough
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Tomasz Gorycki
- b Department of Radiology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Jacek Wolf
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Krzysztof Narkiewicz
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
| | - Michał Hoffmann
- a Department of Hypertension and Diabetology, Faculty of Medicine , Medical University of Gdansk , Gdansk , Poland
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Yanchuk S, Perlikowski P, Wolfrum M, Stefański A, Kapitaniak T. Amplitude equations for collective spatio-temporal dynamics in arrays of coupled systems. Chaos 2015; 25:033113. [PMID: 25833435 DOI: 10.1063/1.4915941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We study the coupling induced destabilization in an array of identical oscillators coupled in a ring structure where the number of oscillators in the ring is large. The coupling structure includes different types of interactions with several next neighbors. We derive an amplitude equation of Ginzburg-Landau type, which describes the destabilization of a uniform stationary state and close-by solutions in the limit of a large number of nodes. Studying numerically an example of unidirectionally coupled Duffing oscillators, we observe a coupling induced transition to collective spatio-temporal chaos, which can be understood using the derived amplitude equations.
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Affiliation(s)
- S Yanchuk
- Weierstrass Institute for Applied Analysis and Stochastics, Mohrenstrasse 39, 10117 Berlin, Germany
| | - P Perlikowski
- Division of Dynamics, Technical University of Lodz, 90-924 Lodz, Poland
| | - M Wolfrum
- Weierstrass Institute for Applied Analysis and Stochastics, Mohrenstrasse 39, 10117 Berlin, Germany
| | - A Stefański
- Division of Dynamics, Technical University of Lodz, 90-924 Lodz, Poland
| | - T Kapitaniak
- Division of Dynamics, Technical University of Lodz, 90-924 Lodz, Poland
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Stefański A, Majkowska L, Ciechanowicz A, Frankow M, Safranow K, Parczewski M, Moleda P, Pilarska K. Association between the Pro12Ala variant of the peroxisome proliferator-activated receptor-gamma2 gene and increased 24-h diastolic blood pressure in obese patients with type II diabetes. J Hum Hypertens 2006; 20:684-92. [PMID: 16625233 DOI: 10.1038/sj.jhh.1002040] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of the study was to examine an association between the Pro12Ala polymorphism of the peroxisome proliferator-activated receptor (PPAR)-gamma2 gene and blood pressure values assessed by 24-h ambulatory blood pressure monitoring (ABPM) in obese patients with long-lasting type II diabetes. Two hundred and fourteen obese patients (95 men and 119 women) with above 10-year history of type II diabetes were recruited for the study. In all the patients, ABPM was performed and other parameters, including age, body mass index (BMI), waist/hip ratio (WHR), haemoglobin A1c (HbA(1c)), serum lipids and creatinine were also evaluated. The Pro12Ala polymorphism was analysed by polymerase chain reaction-restriction fragment length polymorphism. Two subgroups of patients were compared: (a) Pro/Pro: homozygotic Pro/Pro (n=154) and (b) Ala: Ala allele carriers (Ala/Ala+Ala/Pro) (n=60). The studied groups were not different when age, BMI, WHR, HbA(1c), lipids, creatinine and frequency of hypertension were compared. A similar ratio of patients from both groups were treated with angiotensin-converting enzyme inhibitors, calcium channel blockers, diuretics, beta-blockers and alpha-blockers. A difference was observed in a mean 24-h (Ala: 71.9+/-8.1 vs Pro/Pro: 69.4+/-7.8 mm Hg, P=0.034) and a mean night time (Ala: 67.1+/-7.8 vs Pro/Pro: 64.5+/-8.4 mm Hg, P=0.025) diastolic blood pressure, which was significantly higher in patients with Ala variant. There was also a trend towards a higher mean daytime diastolic blood pressure in this group. It seems that the Pro12Ala variant is associated with an increased mean 24-h diastolic blood pressure in obese diabetic patients. Different reaction for antihypertensive medication depending on a variant of the PPAR-gamma2 gene should also be considered as a possible cause of the presented results.
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Affiliation(s)
- A Stefański
- Department of Endocrinology, Hypertension and Metabolic Diseases, Pomeranian Medical University, Szczecin, Poland.
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