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Fragoulis C, Polyzos D, Mavroudis A, Tsioufis PA, Kasiakogias A, Leontsinis I, Mantzouranis E, Kalos T, Sakalidis A, Ntalakouras J, Andrikou I, Dimitriadis K, Konstantinidis D, Thomopoulos C, Tsioufis K. One-year outcomes following a hypertensive urgency or emergency. Eur J Intern Med 2024; 120:107-113. [PMID: 37872037 DOI: 10.1016/j.ejim.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/06/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023]
Abstract
There are scarce data on the comparative prognosis between patients with hypertensive emergencies (HE), urgencies (HU), and those without HU or HE (HP). Our study aimed to compare cardiovascular (CV) outcomes of HE, HU, and HP during a 12-month follow-up period. The population consisted of 353 consecutive patients presenting with HE or HU in a third-care emergency department and subsequently referred to our hypertension center for follow-up. After both groups completed scheduled follow-up visits, patients with HU were matched one-to-one by age, sex, and hypertension history with HP who attended our hypertension center during the same period. Primary outcomes were 1) a recurrent hypertensive HU or HE event and 2) non-fatal CV events (coronary heart disease, stroke, heart failure, or CV interventions), while secondary outcomes were 1) all-cause death, 2) CV death, 3) non-CV death, and 4) any-cause hospitalization. Events were prospectively registered for all three groups. During the study period, 81 patients were excluded for not completing follow-up. Among eligible patients(HE = 94; HU = 178), a total of 90 hospitalizations and 14 deaths were recorded; HE registered greater CV morbidity when compared with HU (29 vs. 9, HR 3.43, 95 % CI 1.7-6.9, p = 0.001), and increased CV mortality (8 vs. 1, HR 13.2, 95 % CI 1.57-110.8, p = 0.017). When opposing HU to HP, events did not differ substantially. Cox regression models were adjusted for age, sex, CV and chronic kidney disease, diabetes mellitus, and smoking. During 1-year follow-up, the prognosis of HU was better than HE but not different compared to HP. These results highlight the need for improved care of HU and HE.
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Affiliation(s)
- Christos Fragoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Dimitrios Polyzos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Andreas Mavroudis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Panagiotis-Anastasios Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Alexandros Kasiakogias
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Ioannis Leontsinis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Emmanouil Mantzouranis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Theodoros Kalos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Athanasios Sakalidis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - John Ntalakouras
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Ioannis Andrikou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Kyriakos Dimitriadis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Dimitris Konstantinidis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece
| | - Costas Thomopoulos
- Department of Cardiology, Helena Venizelou Hospital, 2 Helena Venizelou Street, 11521 Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 114 Vassilissis Sofias Avenue, 11527 Athens, Greece.
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Sideris K, Andrikou I, Thomopoulos C, Tatakis F, Kariori M, Manta E, Kalos T, Soulaidopoulos S, Drogkaris S, Konstantinidis D, Tsioufis K. Blood pressure control measures and cardiovascular outcomes: a prospective hypertensive cohort. Blood Press 2022; 31:228-235. [PMID: 36123788 DOI: 10.1080/08037051.2022.2118662] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/02/2022]
Abstract
PURPOSE We investigated whether blood pressure (BP) control measures, visit-to-visit BP variability, and time in therapeutic range (TTR) are associated with future cardiovascular outcomes in hypertensive patients. MATERIALS AND METHODS Among 1,408 hypertensive patients without cardiovascular disease, we prospectively evaluated the incident major cardiovascular events over 6 years. In newly diagnosed patients, antihypertensive drug treatment was initiated. We estimated two markers of on-treatment BP control, (1) visit-to-visit BPV as the coefficient of variation of office systolic BP (BP-CV), and (2) TTR calculated as the percentage of office systolic BP measurements within 120-140mmHg across visits. RESULTS The hypertensive cohort (672 males, mean age 60 years, 31% newly diagnosed) had a mean systolic/diastolic BP of 142/87 mmHg. The mean number of visits was 4.9 ± 2.6, while the mean attained systolic/diastolic BP during follow-up was 137/79 mmHg using 2.7 ± 1.1 antihypertensive drugs. The BP-CV and TTR were 9.1 ± 4.1% and 45 ± 29%, respectively, and the incidence of the composite outcome was 8.3% (n = 117). After adjustment for relevant confounders and standardization to z-scores, BP-CV and TTR were associated with a 43% (95% CI, 27-62%) increase and a 33% (95% CI, 15-47%) reduction in the outcome. However, the joint evaluation of TTR and BP-CV in a common multivariable model indicated that a standardized change of TTR was associated with the outcome to a greater extent than BP-CV (mean hazard ratios of 30% vs. 24%, respectively). When combined with the higher BP standardized-CV quartile, the lower TTR quartile predicted the outcome by 2.3 times (95% CI, 1.1-5.4) compared to the inverse TTR and BP-CV quartile pattern. CONCLUSION High BP-CV or low TTR was associated with future cardiovascular events in a cohort of treated hypertensive patients. As a determinant, the extent of TTR value appears greater than BP-CV when these measures are considered in the same multivariable model.
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Affiliation(s)
- Konstantinos Sideris
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Ioannis Andrikou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | | | - Fotis Tatakis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Maria Kariori
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Eleni Manta
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Theodoros Kalos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Sotirios Drogkaris
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitris Konstantinidis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Soulaidopoulos S, Stamoulopoulos I, Fragoulis C, Kalos T, Xydis P, Konstantinou K, Chrysohoou C, Tsioufis K. Peak oxygen consumption is associated with the inotropic reserve in patients with heart failure with reduced ejection fraction undergoing cardiopulmonary testing. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The role of cardiopulmonary exercise testing (CPET) in the prognostic evaluation of heart failure with reduced ejection fraction (HFrEF) is powerful and well-established. Nevertheless, the value of CPET in predicting left ventricular inotropic reserve in HFrEF remains unknown.
Purpose
The investigation of possible associations between CPET variables and left ventricular contractile reserve in patients with HFrEF.
Methods
Consecutive patients aged ≥18 years old with a diagnosis of heart failure and a left ventricular ejection fraction ≤40%, as assessed by echocardiography, were prospectively enrolled. Demographic and clinical data were recorded. All subject underwent CPET with either a Bruce or a modified Bruce protocol. Peak oxygen consumption (VO2), carbondioxide production (VCO2), minute ventilation to carbon dioxide production (VE/VCO2) slope, minute ventilation (VE), and VO2/heart rate (HR) values were calculated, while hemodynamic parameters during the test were also measured.
Results
In total, 191 patients with HFrEF were included in the analysis. The mean age was 58.8±11.8 years and 30 (15.7%) patients were women. Ischemic heart disease was the etiology of HFrEF in 101 (52.9%) patients, whereas 90 (47.1%) patients had a history of dilated cardiomyopathy. The mean exercise time was 7.6±.3 minutes. Mean peak VO2 and VE/VCO2 slope values were calculated at 19.1±6.1 ml kg–1 min–1 and 43.7±10.1, respectively. According to peak VO2 values, 70 patients (37.2%) were in Weber class A, 57 (29.8%) in class B, 48 (25.1%) in class C and 15 (7.9%) in class D. In univariate analysis, the change between rest and peak systolic blood pressure (ΔSBP), which is considered to reflect the left ventricular inotropic reserve, was positively correlated to the peak VO2 (p<0.001), the total pulmonary ventilation (VE) (p<0.001) and the peak heart rate during exercise (p=0.02). In multivariable analysis, peak VO2 was independently, linearly associated with the ΔSBP during CPET (Figure 1) (β=0.661, p=0.022). In Roc analysis, it was found that a cut-off value for peak VO2 of 16 ml kg–1 min–1 exhibits 64% sensitivity and 60% specificity in predicting a ΔSBP>40mmHg during exercise (area under the curve: 0.657, p<0.001 – Figure 2).
Conclusion
The peak oxygen consumption during cardiopulmonary testing represents an acceptable predictor of inotropic reserve in patients with HFrEF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Soulaidopoulos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens , Athens , Greece
| | - I Stamoulopoulos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens , Athens , Greece
| | - C Fragoulis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens , Athens , Greece
| | - T Kalos
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens , Athens , Greece
| | - P Xydis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens , Athens , Greece
| | - K Konstantinou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens , Athens , Greece
| | - C Chrysohoou
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens , Athens , Greece
| | - K Tsioufis
- Hippokration General Hospital, First Department of Cardiology, Medical School of Athens , Athens , Greece
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Kalos T, Dimitriadis K, Manta E, Fragoulis C, Konstantinidis D, Tatakis F, Leontsinis I, Andrikou I, Karioiri M, Kouremeti M, Drogaris S, Polyzos D, Filippou C, Tsioufis C. Parameters indicating development of hypertension in three-year follow-up study of subjects with high normal blood pressure. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity followed by arterial stiffening are linked with development of hypertension (HTN).
Purpose
The aim of this study was to assess the relation of HRE with sympathetic drive as assessed by muscle sympathetic nerve activity (MSNA) and arterial stiffness in subjects with high normal BP who developed hypertension in a 3 year follow up.
Methods
100 subjects with high normal office BP [systolic BP=130-139 mmHg and diastolic BP=85-89 mmHg] underwent a treadmill exercise stress test. Arterial stiffness was evaluated based on carotid to femoral pulse wave velocity (PWV). Sympathetic drive was assessed by MSNA levels. Follow up was every 6 months for 3 years, where BP was measured at both office (OffBP) and ambulatory blood pressure monitoring (ABPM). All participants offered lifestyle advises. Endpoint was development of HTN diagnosed either from OffBP or from ABPM. Then they were divided into Group I: those developed HTN and Group II: those remained normotensive.
Results
Mean age 54±8 years, 42 males, baseline offBP: 132/82 mmHg, ABPM: 122/76 mmHg). Out of them, 50 subjects developed HRE (BP ³210mmHg in men and ³190 mmHg in women) and 40 HTN. Group I developed higher HRE (75% vs. 13%, p=0.026), higher levels of PWV (8.35 vs 7.5 m/sec, p=0.043) and MSNA levels (37 vs. 31 bursts, p=0.04), while did not differ at their metabolic profile. Echocardiographically left ventricular mass index did not differ statistically as E/A ratio of mitral valve inflow (0.92 vs 1.05, p=0.034). Those who developed HTN was related to night systolic BP from ABPM (116 vs 112 mmHg, p<0.04), as also to intermediate stage intervals of 3 min (160 vs 147 mmHg, p=0.068) and 6 min (181 vs 164, p=0.035) of Bruce protocol. A novel metric, the SBP/MET-slope [(peak SBP—resting SBP)/(peak MET-1)] found to add crucial information. Regarding those who developed HTN, SBP/MET-slope was higher in all stages till peak exercise (stage 1: 6.25 vs 4.25, stage 2: 7.6 vs 5.3, peak: 7.22 vs 5.1, p=0.035). It was noticed that they performed a higher exercise capacity (10 vs 11.5 METs) and additionally differ significantly in their maximal heart rate (HR) at peak exercise (154 vs 164, p=0.001).
Conclusion
In subjects with high normal BP, a HRE, the intermediate BP intervals along with the SBP/MET-slope, identifies a state of systemic vascular resistance, arterial stiffening and sympathetic overdrive, as reflected by increased PWV and MSNA levels respectively. Additionally, exercise capacity demonstrates cardiovascular functional tolerance. These findings suggest that exercise testing provides determining clinical information regarding the overall cardiovascular status, proving its superior prognostic value as a hypertension screening tool, that alarms the physician to warn the patient to take action.
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Affiliation(s)
- T Kalos
- Hippokration General Hospital, Athens, Greece
| | | | - E Manta
- Hippokration General Hospital, Athens, Greece
| | - C Fragoulis
- Hippokration General Hospital, Athens, Greece
| | | | - F Tatakis
- Hippokration General Hospital, Athens, Greece
| | | | - I Andrikou
- Hippokration General Hospital, Athens, Greece
| | - M Karioiri
- Hippokration General Hospital, Athens, Greece
| | - M Kouremeti
- Hippokration General Hospital, Athens, Greece
| | - S Drogaris
- Hippokration General Hospital, Athens, Greece
| | - D Polyzos
- Hippokration General Hospital, Athens, Greece
| | - C Filippou
- Hippokration General Hospital, Athens, Greece
| | - C Tsioufis
- Hippokration General Hospital, Athens, Greece
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Leontsinis I, Mantzouranis EK, Dimitriadis K, Manta E, Thomopoulos C, Kalos T, Dris E, Ntalianis A, Avramidis D, Stougiannos PN, Patsourakos N, Tousoulis D, Tsioufis K. DISTINCTIVE CHARACTERISTICS AMONG MINOCA AND TAKOTSUBO PATIENTS AND THEIR PROGNOSTIC VALUE IN A MULTICENTER PROSPECTIVE COHORT. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02034-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Leontsinis I, Papademetriou V, Chrysohoou C, Kariori M, Dalakouras I, Tolis P, Fragoulis C, Kalos T, Tatakis FP, Dimitriadis K, Doumas M, Sambatakou H, Pirounaki M, Mihas C, Katsiki N, Bhaskar S, Tsivgoulis G, Tousoulis D, Banach M, Tsioufis K. Hypertensive urgencies during the first wave of the COVID-19 pandemic in a tertiary hospital setting: a U-shaped alarming curve. Arch Med Sci 2022; 18:982-990. [PMID: 35832718 PMCID: PMC9266735 DOI: 10.5114/aoms/141243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic provoked unprecedented disturbance in hypertension care, while alarming concerns arose about its long-term consequences. We investigated the trends of emergency visits and admissions regarding uncontrolled hypertension in order to assess the impact of COVID-19 spread on population behavior towards hypertension urgencies during its first wave. MATERIAL AND METHODS Data from daily unscheduled visits and admission counts in the Cardiology sector were collected from the Emergency Department database of a tertiary General Hospital in Athens, Greece for the period January 15th to July 15th 2020. These data were compared with those from the previous year. Cases of patients who presented with hypertensive urgency or who were admitted due to uncontrolled hypertension were separately analyzed. RESULTS A total of 7,373 patient records were analyzed. Hypertension urgency cases demonstrated a U-shaped distribution in 2020, showing a declining trend during the rapid virus spread, an image that was reversed after the transmission rate's decline. COVID-19 incidence in Greece was inversely associated with uncontrolled hypertension admissions during its declining phase (r = -0.64, p = 0.009), whereas total attendance exhibited a similar correlation during the first and the following months of the pandemic (r = 0.677, p = 0.031, r = -0.789, p = 0.001). Uncontrolled hypertension rate on admission was positively related to the national incidence of COVID-19 cases during the first months of 2020 (r = 0.82, p = 0.045). CONCLUSIONS Hypertensive urgency-related visits followed a U-shape distribution during the pandemic's first wave with the attendance nadir coinciding with the virus spread peak. This is a complex phenomenon, closely related to increased levels of public stress, disruptions in health care services and to a lesser extent to the imposed restrictions in transportation. The initial relative increase in uncontrolled hypertension-related admissions rate, combined with the later increase of hypertensive urgencies may be indicative of blood pressure deregulation among the studied population, which is multifactorial and potentially detrimental.
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Affiliation(s)
- Ioannis Leontsinis
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Papademetriou
- Cardiology Department, Georgetown University and Veterans Affairs Medical Center, Washington, District of Columbia, USA
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kariori
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Dalakouras
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayotis Tolis
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Fragoulis
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Kalos
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotios-Panagiotis Tatakis
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyriakos Dimitriadis
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Helen Sambatakou
- Second Department of Internal Medicine, HIV Unit, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Pirounaki
- Department of Internal Medicine, Hippokration General Hospital, Athens, Greece
| | - Constantinos Mihas
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Niki Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Athens, Greece
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Sonu Bhaskar
- Department of Neurology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz (MUL), Lodz, Poland
- Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
| | - Konstantinos Tsioufis
- First Cardiology Clinic, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Drogkaris S, Thomopoulos C, Kalos T, Manta E, Tsioufis C. Net clinical benefit of direct oral anticoagulants in atrial fibrillation patients with or without diabetes mellitus: A meta-analysis of outcome trials. Diabetes Res Clin Pract 2021; 182:109147. [PMID: 34793880 DOI: 10.1016/j.diabres.2021.109147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the net clinical benefit following direct oral anticoagulants (DOACs) vs warfarin by diabetes status in patients with non-valvular atrial fibrillation. METHODS We searched 3 electronic databases through end-February 2021 to identify relevant outcome trials in patients with and without diabetes mellitus (DM). All-cause death, non-fatal stroke/systemic embolism and major bleedings defined net clinical benefit. Outcome risk ratios and 95% confidence interval (CI), and absolute risk outcome reduction per 1000 treated patients were assessed. RESULTS Four trials of DOACs vs warfarin compared 22,087 patients with DM to 49,592 patients without DM. CHADS2 and 10-year fatal cardiovascular risk were higher in patients with vs those without DM (3.7 vs 2.5 and 28.4% vs 23.4%, respectively). DOACs were associated with more favorable net clinical benefit compared to warfarin in patients with and without DM (relative risk reduction, 0.85 [95% CI, 0.81-0.89] and 0.87 [95% CI, 0.79-0.96]; absolute risk reduction per 1000 patients treated, -33 [95% CI, -45, -21]) and -24 [95% CI, -43, -5]), but interaction test was not significant by relative and absolute numbers (P = 0.68 and P = 0.44, respectively). CONCLUSION Net clinical benefit following DOACs was not different between patients with and without DM over a period of 2.2 years.
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Affiliation(s)
- Sotirios Drogkaris
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Theodoros Kalos
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Manta
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Costas Tsioufis
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Lazaros G, Anastassopoulou C, Hatziantoniou S, Kalos T, Soulaidopoulos S, Lazarou E, Vlachopoulos C, Vassilopoulos D, Tsakris A, Tsioufis C. A case series of acute pericarditis following COVID-19 vaccination in the context of recent reports from Europe and the United States. Vaccine 2021; 39:6585-6590. [PMID: 34635376 PMCID: PMC8491922 DOI: 10.1016/j.vaccine.2021.09.078] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/14/2022]
Abstract
Background COVID-19 vaccines were efficacious and safe in clinical trials. We report nine events of acute pericarditis (AP) in eight patients following COVID-19 vaccination with BNT162b2 (6/9), AZD1222 (2/9) and mRNA-1273 (1/9). Methods All patients were referred for AP temporally linked with COVID-19 vaccination. Chest pain was the most common clinical manifestation. Alternative etiologies were excluded upon thorough diagnostic work up. AP diagnosis was established according to ESC guidelines. Findings Five events occurred after the first vaccine dose and four after the second. The mean age in this cohort was 65.8 ± 10.2 years and the men/women ratio 3/5. All events resolved without sequelae; two events were complicated by cardiac tamponade requiring emergent pericardial decompression. Hospitalization was required in four cases. Interpretation Although causality cannot be firmly established, AP has emerged as a possible complication following COVID-19 vaccination. Further investigation is indispensable to fully characterize this new entity.
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Affiliation(s)
- George Lazaros
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Hatziantoniou
- Laboratory of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
| | - Theodoros Kalos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stergios Soulaidopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilia Lazarou
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Charalambos Vlachopoulos
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- Second Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Department, School of Medicine, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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9
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Fragoulis C, Dimitriadis K, Siafi E, Iliakis P, Kasiakogias A, Kalos T, Leontsinis I, Andrikou I, Konstantinidis D, Nihoyannopoulos P, Tsivgoulis G, Thomopoulos C, Tousoulis D, Muiesan ML, Tsioufis KP. Profile and management of hypertensive urgencies and emergencies in the emergency cardiology department of a tertiary hospital: a 12-month registry. Eur J Prev Cardiol 2021; 29:194-201. [PMID: 34718521 DOI: 10.1093/eurjpc/zwab159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/12/2021] [Accepted: 09/08/2021] [Indexed: 12/11/2022]
Abstract
AIMS Currently there are scarce epidemiological data regarding prevalence, clinical phenotype, and therapy of hypertensive urgencies (HU) and emergencies (HE). The aim of this article was to record the prevalence, clinical characteristics, and management of patients with HU and HE assessed in an emergency department (ED) of a tertiary hospital. METHODS AND RESULTS The population consisted of patients presenting with HE and HU in the ED (acute increase in systolic blood pressure (BP) ≥ 180 mmHg and/or diastolic BP ≥120 mmHg with and without acute target organ damage, respectively). Of the 38 589 patients assessed in the ED during a 12-month period, 353 (0.91%) had HU and HE. There were 256 (72.5%) cases presented as HU and 97 (27.5%) as HE. Primary causes for both HU and HE were stress/anxiety (44.9%), increased salt intake (33.9%), and non-adherence to medication (16.2%). Patients with HU reported mainly dizziness/headache (46.8%) and chest pain (27.4%), whereas those with HE presented dyspnoea (67%), chest pain (30.2%), dizziness/headache (10.3%), and neurological disorders (8.2%). In HE, the underlying associated conditions were pulmonary oedema (58%), acute coronary syndrome (22.6%), and neurological disorders/stroke (7.2%). All HE cases were hospitalized and received intensive healthcare, including dialysis. CONCLUSION This 1-year single-centre registry demonstrates a reasonable prevalence of HU and HE contributing to the high volume of visits to the ED. Stress, increased salt intake and non-adherence were main triggers of HE and HU. Dizziness and headache were the prevalent symptoms of HU patients while heart failure was the most common underlying disease in patients with HE.
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Affiliation(s)
- Christos Fragoulis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Kyriakos Dimitriadis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Eirini Siafi
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Panagiotis Iliakis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Alexandros Kasiakogias
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Theodoros Kalos
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Ioannis Leontsinis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Ioannis Andrikou
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Dimitrios Konstantinidis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Petros Nihoyannopoulos
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Georgios Tsivgoulis
- Second Neurologic Department (Clinic), Medical School, University of Athens, Attikon Hospital, Athens, Greece
| | | | - Dimitrios Tousoulis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Maria L Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Konstantinos P Tsioufis
- First Cardiologic Department (Clinic), Medical School, University of Athens, Hippokration Hospital, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
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10
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Kalos T, Dimitriadis K, Konstantinidis D, Tatakis F, Drogkaris S, Manta E, Dri E, Thomopoulos C, Tousoulis D, Tsioufis K. Parameters of treadmill exercise test and sympathetic activation are linked to the development of hypertension in subjects with high normal blood pressure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity followed by arterial stiffening are linked with development of hypertension.
Purpose
The aim of this study was to assess parameters related to the development of hypertension in a 3 year follow in subjects with high normal BP.
Methods
One hundred consecutive subjects with high normal office BP (54±8 years, 42 males, baseline office BP: 132/82 mmHg, 24-hour BP: 122/76 mmHg) at baseline underwent a negative for ischemia treadmill exercise test. Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV) values and sympathetic drive was assessed by muscle sympathetic nerve activity (MSNA) based on established methodology. SBP/MET-slope defined as: peak systolic BP–resting SBP)/(peak MET-1) was assessed. Follow up was scheduled every 6 months for 3 consecutive years, where BP was measured both in the office and with ambulatory blood pressure monitoring. End point was the development of hypertension diagnosed from office blood pressure measurements and confirmed from ambulatory blood pressure monitoring.
Results
Patients who developed hypertension (n=35) compared to those who remained normotensives (n=65) had at baseline higher prevalence of HRE (75% vs. 13%, p=0.026), higher levels of carotid to femoral PWV (8.35 vs. 7.5 m/sec, p=0.043) and MSNA (37 vs. 31 bursts per minute, p=0.04), while their metabolic profile did not differ at the follow up (p=NS for all). In those who developed hypertension, SBP/MET-slope was higher in all Bruce protocol stages till peak exercise (stage 1: 6.25 vs. 4.25, stage 2: 7.6 vs. 5.3, peak exercise: 7.22 vs. 5.1; p<0.05 for all). Additionally, those who remained normotensives compared to those who developed hypertension exhibited a higher exercise capacity (10 vs. 11.5 METs, p<0.05) and maximal heart rate at peak exercise (154 vs. 164, p=0.001).
Conclusion
In subjects with high normal BP, those who develop hypertension during follow-up are characterized by more frequent HRE accompanied with lower exercise capacity, arterial stiffening and sympathetic overactivation. These results suggest that exercise BP response, along with PWV and MSNA estimation could contribute to identify high normal BP subjects who are more prone to become hypertensives.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- T Kalos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - K Dimitriadis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Konstantinidis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - F Tatakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - S Drogkaris
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - E Manta
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - E Dri
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - C Thomopoulos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Tousoulis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - K Tsioufis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
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11
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Fragoulis C, Dimitriadis K, Konstantinidis D, Tatakis F, Kariori M, Kalos T, Thomopoulos C, Androulakis G, Tousoulis D, Tsioufis K. Comparison of cardiovascular events and estimation of hazard ratio for hypertensive patients with and without hypertensive urgencies after a 12-month follow up. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Few epidemiological data show a worst prognosis of hypertensive emergencies compared with hypertensive urgencies (HU). To the best of our knowledge, there is even fewer published evidence comparing prognosis of hypertensive patients (HP) with and without HU.
Purpose
The purpose of our prospective study was to record the prevalence and clinical characteristics of patients with HU assessed in the emergency department (ED) in a tertiary Hospital and to compare them with HP without urgencies for new events and hard-end points for a 12-month follow-up.
Methods
The study population consisted of 256 patients presenting at the ED with acute increase in blood pressure (BP) (systolic BP≥180mmHg and/or diastolic BP≥120mmHg) with absence of acute hypertension-mediated target organ damage in a period of one year. Each of these participants were matched one-to-one by age, gender and history of hypertension with HP with either controlled, grade 1 or grade 2 hypertension attending our Hypertension excellence center the same period. However, 78 of HU did not conclude the follow up and 5 could not be matched with HP for the above covariates and were therefore excluded. Both groups, 173 of HU and 173 of controls, concluded 12 months follow up for fatal and non fatal cardiovascular events, including acute coronary syndrome, stroke, newly diagnosed heart failure or deterioration of NYHA class, and composite end points such as stroke-myocardial infarction and overall cardiovascular disease outcome.
Results
The mean age of all patients was 64.9±12.5 years (64±12.2 for controls and 65.7±12.7 for HU), 48.8% were males (49.1% of controls and 48.6% of HU) and 26.6% had a history of smoking (22.5% of controls and 30.6% of HU). Overall, 15 (5.5%) patients had nonfatal clinical cardiovascular events and 4 (1.2%) had fatal cardiovascular events. Cox regression models were adjusted for age, gender, smoking, previous cardiovascular disease, diabetes mellitus and the population. The frequency of the composite stroke-myocardial infarction event was statistically significant higher in HU (5 vs 4, p<0.0001, Hazard Ratio for HU 181.7, 95% Confidence Intervals 19.7–1677.2) adjusted for the rest covariates. In addition, there was a higher trend for stroke in the group of HU (p=0.067) and in patients with a history of diabetes mellitus irrespective of group (p=0.055). Finally, the Cox regression analysis identified age (p=0.035) and history of cardiovascular disease (p=0.038) as independent predictors for death, and smoking (p=0.035) as independent predictor for overall cardiovascular events.
Conclusions
Our study emphasizes the higher trend for cardiovascular outcomes, especially stroke, in the group of HU compared with HP without urgencies, while it highlights the necessity for more intensive follow-up for the first group and the need for further research in this pathological entity.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Fragoulis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - K Dimitriadis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Konstantinidis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - F Tatakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - M Kariori
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - T Kalos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - C Thomopoulos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - G Androulakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Tousoulis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - K Tsioufis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
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12
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Thomopoulos C, Andrikou I, Konstantinidis D, Iliakis P, Kalos T, Polyzos D, Drogkaris S, Siafi E, Tousoulis D, Stergiou GS, Tsioufis C. Isolated diastolic vs. systolic hypertension phenotypes and outcomes: prospective cohort of newly diagnosed individuals with hypertension. J Hypertens 2021; 39:2001-2008. [PMID: 34102665 DOI: 10.1097/hjh.0000000000002887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS To evaluate whether different hypertension phenotypes, namely, isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and systolic/diastolic hypertension (SDH) have a differential outcome effect by clinic and ambulatory blood pressure (BP) measurements. METHODS We prospectively evaluated in 569 never-treated patients with sustained hypertension (age 52.6 ± 11.6 years; men 55%; clinic BP 150 ± 15/95.5 ± 10 mmHg, systolic/diastolic; 24-h ambulatory BP 128.9 ± 12.6/80.6 ± 9.7) the incidence of major cardiovascular (CV) events within 5 years, after adjustment for confounders, including the rate of BP control and the weighted follow-up BP. RESULTS All participants received antihypertensive drug treatment (mean number of drugs 1.9 ± 1.1; follow-up visits 4.6/patient). Average clinic BP achieved during follow-up was 136 ± 12.6/83.9 ± 9.4 mmHg, with 39% of participants having clinic BP less than 140/90 mmHg in at least 75% of their visits, and 24% in 25-75% of visits. Prevalence of hypertension phenotypes defined using BP differed from that using ambulatory BP, whereas integration of both BP measurements reclassified the initial phenotype to another in 18% of participants. Although, no differential outcome effect was observed between clinic IDH and SDH assessed using clinic or ambulatory BP measurements, clinic BP-based ISH was associated with a higher outcome incidence than the IDH and SDH phenotypes (hazard ratio 4.8, 95% confidence interval 1.4-17.0, P = 0.015). ISH diagnosed by integration of clinic and ambulatory BP, also increased the outcome (hazard ratio 4.0, 95% confidence interval 1.0-15.6, P = 0.046). CONCLUSION In hypertensive patients at low/moderate CV risk, IDH and SDH phenotypes defined by clinic BP measurements, equally determined CV events but to a lower extent compared with ISH.
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Affiliation(s)
| | - Ioannis Andrikou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital
| | - Dimitris Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital
| | - Panagiotis Iliakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital
| | - Theodoros Kalos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital
| | - Dimitrios Polyzos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital
| | - Sotirios Drogkaris
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital
| | - Eirini Siafi
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital
| | - George S Stergiou
- Third Department of Medicine, Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital
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13
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Manta E, Kouremeti M, Kakouri N, Kasiakogias A, Konstantinidis D, Papakonstantinou P, Kalos T, Liatakis I, Tousoulis D, Tsioufis C. Correlations of attended and unattended blood pressure with sympathetic nervous system activity in essential hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Measurement of unattended blood pressure (BP) may provide additional information over conventionally attended BP. Moreover, hypertension is related to sympathetic drive while there are scarce data on the diverse links of attended and unattended BP with muscle sympathetic nerve activity (MSNA) in hypertensive patients.
Purpose
The aim of this study was to appraise the relation of BP levels in the attended and unattended setting with MSNA in patients with essential hypertension.
Methods
We studied 117 patients with essential hypertension (age: 58±11 years, 60 males, office BP: 142/85±17/10 mmHg, 24-hour BP: 133/80±11/9 mmHg). In all participants sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography). Both unattended BP (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements, at 1-minute intervals, after 5 minutes) and attended BP were measured with the same device, on the same day of MSNA recording, in random order. Patients were divided into the combined attended and unattended hypertensive group when BP≥140/90 mmHg in both attended and unattended BP estimations and to the attended hypertensive group when only attended BP≥140/90 mmHg.
Results
Patients with combined attended and unattended hypertension (n=70) compared to those with attended hypertension (n=47) did not differ regarding 24-h ambulatory BP levels, glucose levels, renal function and left ventricular mass index (p=NS for all). Moreover, patients with combined attended and unattended hypertension compared to those with attended hypertension were characterized by greater levels of MSNA (43.7±9.9 vs 37.7±9.7 bursts per minute, p=0.032). In all participants, sympathetic nerve traffic as assessed by resting MSNA was related to attended systolic BP (r=0.270, p=0.003), attended diastolic BP (r=0.344, p=0.001), unattended systolic BP (r=0.263, p=0.004) and unattended diastolic BP (r=0.274, p=0.003).
Conclusions
The phenotype of combined attended and unattended hypertension compared to attended hypertension is accompanied by higher sympathetic nervous system activation. Moreover, the close association of MSNA with attended and unattended BP levels in essential hypertension, further supports the key role of sympathetic drive in modulating BP.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Manta
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - M Kouremeti
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - N Kakouri
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - A Kasiakogias
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Konstantinidis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - P Papakonstantinou
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - T Kalos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - I Liatakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Tousoulis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - C Tsioufis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
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14
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Andrikou E, Dimitriadis K, Andrikou I, Kasiakogias A, Tatakis F, Dimitriadi M, Anastasiou A, Kintis K, Kalos T, Iliakis P, Tousoulis D, Tsioufis C. Blood pressure response in exercise is associated with future cardiac structural alterations in hypertensive patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) is often observed in individuals without known cardiovascular disease. Although it is generally considered as an abnormal response and a risk factor for hypertension development, its clinical significance remains controversial. On the other hand, regression of left ventricular hypertrophy (LVH) is independently associated with improved cardiovascular outcome.
Purpose
In this study we aimed to investigate the role of EBPR during exercise in LVH regression in hypertensive subjects over time.
Methods
1413 hypertensive subjects, (mean age 57±11 years), 51% males, with baseline office blood pressure (BP) 144/89mmHg were followed for a mean period of 6.4±3.0 years. At baseline and last follow-up visit all patients underwent office BP, laboratory tests and echocardiographical determination of left ventricular mass index (LVMI). At baseline, all subjects underwent treadmill exercise testing (Bruce protocol) in order to identify the presence of EBPR based on the systolic BP elevation at peak exercise (> or =210 mmHg for men and > or =190 mmHg for women). Main outcome variable was LVH Regression/prevention (LVH Regr/prev), defined as: LVH at baseline visit with normal LVMI values at last visit or absence of LVH at baseline and last visit. BP control was considered optimal when the mean of office BP measurements during follow-up was <140/90mmHg.
Results
46% of study population presented LVH Regr/prev during follow-up period. Cox-regression analysis, after adjustment for clinical and biochemical variables, revealed that low levels of baseline LVMI (HR=0.98, 95% CI 0.97–0.99, p<0.0001), absence of EBPR (HR=0.81, 95% CI 0.67–0.98, p=0.02) and optimal BP control during follow-up (HR=1.19, 95% CI 1.01–1.56, p=0.03) were independent predictors of LVH Regr/prev during follow-up.
Conclusions
Beyond optimal BP control, EBPR is a significant predictor of left ventricular mass changes overtime. Hence, ETT can provide clinical relevant information, including EBPR, which may help in the improvement of risk stratification of hypertensive subjects.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- E Andrikou
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - K Dimitriadis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - I Andrikou
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - A Kasiakogias
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - F Tatakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - M Dimitriadi
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - A Anastasiou
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - K Kintis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - T Kalos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - P Iliakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Tousoulis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - C Tsioufis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
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15
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Kalos T, Tsioufis C, Dimitriadis K, Vogiatzakis N, Kasiakogias A, Iliakis P, Konstantinidis D, Xanthopoulou M, Kakouri N, Laina A, Andrikou E, Tousoulis D. P5466Exaggerated exercise blood pressure response is accompanied by increased sympathetic activity and arterial stiffness in subjects with high normal blood pressure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
The clinical importance of a hypertensive response to exercise (HRE) in subjects with high normal blood pressure (BP) is not fully elucidated, while sympathetic overactivity and arterial stiffening are linked with adverse cardiovascular prognosis.
Purpose
The aim of this study was to assess the relation of HRE with sympathetic drive as assessed by muscle sympathetic nerve activity (MSNA) and arterial stiffness in subjects with high normal BP.
Methods
42 subjects with high normal office BP [defined as office systolic BP=130–139 mmHg and office diastolic BP=85–89 mmHg (age: 53±9 years, 29 males, office BP: 134/84 mmHg, 24-hour BP: 114/72 mmHg)] with a negative treadmill exercise test (Bruce protocol) were divided into those with HRE (n=12) (peak exercise systolic BP ≥210mmHg in men and ≥190 mmHg in women) and those without HRE (n=30). Arterial stiffness was evaluated on the basis of carotid to femoral pulse wave velocity (PWV) values. In all participants sympathetic drive was assessed by MSNA estimations based on established methodology (microneurography).
Results
Subjects with a HRE compared to those without exhibited higher waist circumference (108.2±5.3 vs 94.7±9.2 cm, p=0.001) and were characterized by greater levels of carotid to femoral PWV (8.5±0.8 vs 7.0±0.9 m/sec, p<0.001) and sympathetic nerve traffic as reflected by MSNA levels (41.1±1.5 vs 32.1±1.9 bursts per 100 heart beats, p<0.001), while did not differ regarding metabolic profile and left ventricular mass index (p=NS). In the total population, peak exercise systolic BP was related to 24-h systolic BP (r=0.229, p<0.05), PWV (r=0.218, p=0.002), and MSNA (r=0.214, p<0.05). Moreover, MSNA was related to waist circumference (r=0.33, p=0.004) and office systolic BP levels (r=0.31, p<0.05) but there was no association with PWV values (p=NS).
Conclusion
In subjects with high normal BP, a HRE identifies a state of arterial stiffening and sympathetic overdrive, as reflected by increased PWV and MSNA levels respectively. These finding suggest that exercise testing provides additional clinical information regarding the vascular status and modulation of sympathetic tone in this setting.
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Affiliation(s)
- T Kalos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - C Tsioufis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - K Dimitriadis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - N Vogiatzakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - A Kasiakogias
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - P Iliakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Konstantinidis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - M Xanthopoulou
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - N Kakouri
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - A Laina
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - E Andrikou
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Tousoulis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
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16
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Kasiakogias A, Tsioufis C, Iliakis P, Konstantinidis D, Liatakis I, Kalos T, Koutra E, Kakouri N, Kouremeti M, Leontsinis I, Andrikou I, Sideris K, Dimitriadis K, Mantzouranis M, Tousoulis D. VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND TIME IN THERAPEUTIC RANGE AS PREDICTORS OF CARDIOVASCULAR EVENTS. J Hypertens 2019. [DOI: 10.1097/01.hjh.0000571156.22612.29] [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]
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17
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Tsioufis C, Konstantinidis D, Nikolakopoulos I, Vemmou E, Kalos T, Georgiopoulos G, Vogiatzakis N, Ifantis A, Konstantinou K, Gennimata V, Tousoulis D. Biomarkers of Atrial Fibrillation in Hypertension. Curr Med Chem 2019; 26:888-897. [DOI: 10.2174/0929867324666171006155516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/05/2017] [Accepted: 12/30/2017] [Indexed: 12/20/2022]
Abstract
Background:
Atrial fibrillation (AF) is the most frequently encountered cardiac
arrhythmia globally and substantially increases the risk for thromboembolic disease.
Albeit, 20% of all cases of AF remain undiagnosed. On the other hand, hypertension amplifies
the risk for both AF occurrences through hemodynamic and non-hemodynamic
mechanisms and cerebrovascular ischemia. Under this prism, prompt diagnosis of undetected
AF in hypertensive patients is of pivotal importance.
Method:
We conducted a review of the literature for studies with biomarkers that could
be used in AF diagnosis as well as in predicting the transition of paroxysmal AF to sustained
AF, especially in hypertensive patients.
Results:
Potential biomarkers for AF can be broadly categorized into electrophysiological,
morphological and molecular markers that reflect the underlying mechanisms of adverse
atrial remodeling. We focused on P-wave duration and dispersion as electrophysiological
markers, and left atrial (LA) and LA appendage size, atrial fibrosis, left ventricular
hypertrophy and aortic stiffness as structural biomarkers, respectively. The heterogeneous
group of molecular biomarkers of AF encompasses products of the neurohormonal
cascade, including NT-pro BNP, BNP, MR-pro ANP, polymorphisms of the ACE and
convertases such as corin and furin. In addition, soluble biomarkers of inflammation (i.e.
CRP, IL-6) and fibrosis (i.e. TGF-1 and matrix metalloproteinases) were assessed for predicting
AF.
Conclusion:
The reviewed individual biomarkers might be a valuable addition to current
diagnostic tools but the ideal candidate is expected to combine multiple indices of atrial
remodeling in order to effectively detect both AF and adverse characteristics of high risk
patients with hypertension.
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Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitris Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Ilias Nikolakopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Evi Vemmou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Theodoros Kalos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Georgios Georgiopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikolaos Vogiatzakis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Aris Ifantis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Konstantinou Konstantinou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Vasiliki Gennimata
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Georgiopoulos G, Tsioufis C, Kalos T, Magkas N, Roussos D, Chrysohoou C, Sarri G, Syrmali K, Georgakopoulos P, Tousoulis D. Serum Uric Acid is Independently Associated with Diastolic Dysfunction in Apparently Healthy Subjects with Essential Hypertension. Curr Vasc Pharmacol 2018; 17:99-106. [DOI: 10.2174/1570161116666171226124959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/05/2017] [Accepted: 12/09/2017] [Indexed: 12/22/2022]
Abstract
Objectives: Accumulating evidence suggests a direct role of Uric Acid (UA) on Left Ventricular
(LV) diastolic function in chronic kidney disease and Heart Failure (HF) patients. Recently, UA
has been linked to LV Hypertrophy (LVH) and Diastolic Dysfunction (DD) in women with preserved
Ejection Fraction (pEF) but not in corresponding men. We sought to assess if UA could predict indices
of DD in hypertensive subjects with pEF independently of gender.
</P><P>
Method: We consecutively recruited 382 apparently healthy hypertensive subjects (age: 61.7±10.7,
women: 61.3%, median EF: 64%). In 318 patients in sinus rhythm, LV mass-indexed to body surface
area-was calculated (LVMI). LVH was set as an LVMI >116g/m2 or 96 g/m2 in men and women, respectively.
The ratio of early transmitral peak velocity (E) to the mitral annular early diastolic velocity
(Em) was used as an approximation of mean left atrial pressure (E/Em).
</P><P>
Results: UA [median (interquartile range): 5.4(2) mg/dl] independently predicted E/Em (adjusted coefficient:
1.01, p =0.026) while an interaction term between gender and UA was no significant (p=0.684).
An ordinal score of DD was calculated taking into account increased E/Em, left atrium dilatation and
LVH. Women with increased UA had 254% increased odds (adjusted OR=2.54, p=0.005) to be classified
in the upper range of the DD score.
</P><P>
Conclusion: In hypertensive subjects without HF, UA is independently associated with the presence of
DD in both genders and correlates with its severity in women. Further prospective studies are warranted
to evaluate the association of UA with adverse cardiovascular outcomes in high-risk populations such as
HF with pEF.
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Affiliation(s)
- Georgios Georgiopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Theodoros Kalos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Nikos Magkas
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitris Roussos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Georgia Sarri
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Kyriaki Syrmali
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Panos Georgakopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Kalos T, Tsioufis C, Dimitriadis K, Kasiakogias A, Konstantinidis D, Liatakis I, Katsi V, Tolis P, Andrikou E, Koutra E, Tousoulis D. P669Exaggerated exercise blood pressure response is accompanied by increased sympathetic activity and arterial stiffness in subjects with high normal blood pressure. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Kalos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - C Tsioufis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - K Dimitriadis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - A Kasiakogias
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Konstantinidis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - I Liatakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - V Katsi
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - P Tolis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - E Andrikou
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - E Koutra
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Tousoulis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
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Dimitriadis K, Tsioufis C, Andrikou E, Andrikou I, Fragoulis C, Iliakis P, Kalos T, Kasiakogias A, Konstantinidis D, Koutra E, Leontsinis I, Liatakis I, Petras D, Tousoulis D. P1542Changes in uric acid independently predict coronary artery disease in essential hypertension: Data from a Greek 8-year-follow-up study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K Dimitriadis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - C Tsioufis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - E Andrikou
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - I Andrikou
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - C Fragoulis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - P Iliakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - T Kalos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - A Kasiakogias
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Konstantinidis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - E Koutra
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - I Leontsinis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - I Liatakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Petras
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Tousoulis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
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Dimitriadis K, Tsioufis C, Kasiakogias A, Konstantinidis D, Andrikou I, Iliakis I, Kalos T, Tolis P, Katsarou R, Kallikazaros I, Tousoulis D. P6574Isolated systolic hypertension versus combined systolic-diastolic hypertension as predictors of atrial fibrillation: Data from a 8-year-follow-up study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Dimitriadis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - C Tsioufis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - A Kasiakogias
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Konstantinidis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - I Andrikou
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - I Iliakis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - T Kalos
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - P Tolis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - R Katsarou
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - I Kallikazaros
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
| | - D Tousoulis
- First Cardiology Clinic, University of Athens,Hippokration Hospital, Athens, Greece
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22
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Andrikou I, Tsioufis C, Dimitriadis K, Konstantinidis D, Kasiakogias A, Kouremeti M, Andrikou E, Karapati I, Kalos T, Fragoulis C, Liatakis I, Koutra E, Kyriazopoulos K, Thomopoulos C, Tousoulis D. Uric acid as an independent predictor of coronary artery disease in essential hypertension: Data from an 8-year-follow-up study. Clin Exp Pharmacol Physiol 2018; 45:866-869. [DOI: 10.1111/1440-1681.12928] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/30/2018] [Accepted: 02/16/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Ioannis Andrikou
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Costas Tsioufis
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Kyriakos Dimitriadis
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Dimitrios Konstantinidis
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Alexandros Kasiakogias
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Mairi Kouremeti
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Eirini Andrikou
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Ioanna Karapati
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Theodoros Kalos
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Christos Fragoulis
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Ioannis Liatakis
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Evaggelia Koutra
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Konstantinos Kyriazopoulos
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Costas Thomopoulos
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic; Medical School; National and Kapodistrian University of Athens; Hippokration Hospital; Athens Greece
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Tsioufis KP, Dimitriadis K, Damianaki K, Konstantinidis D, Kalos T, Galanakos S, Andrikou E, Katsarou R, Konstantinou K, Petras D, Tousoulis D. EXERCISE HEART RATE DURING TREADMILL TEST IS RELATED TO RENAL FUNCTIONAL RESERVE IN ESSENTIAL HYPERTENSIVE PATIENTS: A NOVEL LINK BETWEEN THE HEART AND THE KIDNEYS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32349-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Tsioufis KP, Kalos T, Kasiakogias A, Dimitriadis K, Konstantinidis D, Katsarou R, Kouremeti M, Kyriazopoulos K, Galanakos S, Tousoulis D. EXAGGERATED EXERCISE BLOOD PRESSURE RESPONSE IS ACCOMPANIED BY INCREASED SYMPATHETIC ACTIVITY AND ARTERIAL STIFFNESS IN SUBJECTS WITH HIGH NORMAL BLOOD PRESSURE. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32050-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tsioufis KP, Kasiakogias A, Konstantinidis D, Kalos T, Mallios C, Andrikou I, Koutra E, Thomopoulos K, Dimitriadis K, Kallikazaros I, Tousoulis D. COMBINED PATTERNS OF OBESITY AND SMOKING STATUS FOR PREDICTION OF CORONARY ARTERY DISEASE: A FOLLOW-UP STUDY ON TREATED HYPERTENSIVE PATIENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32397-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Tsioufis KP, Dimitriadis K, Kasiakogias A, Konstantinidis D, Kalos T, Mantzouranis M, Aragiannis D, Annousis G, Fragoulis C, Konstantinou K, Tousoulis D. ACUTE DETRIMENTAL EFFECTS OF E-CIGARETTE AND TOBACCO CIGARETTE SMOKING ON BLOOD PRESSURE AND SYMPATHETIC NERVE ACTIVITY IN HEALTHY SUBJECTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32347-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Tsioufis KP, Dimitriadis K, Koutra E, Kalos T, Fragoulis C, Nikolopoulou L, Konstantinidis D, Koumelli A, Konstantinou K, Karapati I, Tousoulis D. EFFECTS OF IVABRADINE ON SYMPATHETIC OVERDRIVE AND ARTERIAL STIFFENING IN HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME: A 6 MONTH FOLLOW-UP STUDY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32348-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tsioufis KP, Dimitriadis K, Kasiakogias A, Konstantinidis D, Galanakos S, Kalos T, Karapati I, Andrikou E, Mantzouranis M, Fragoulis C, Tousoulis D. URIC ACID PREDICTS CORONARY ARTERY DISEASE BUT NOT STROKE IN ESSENTIAL HYPERTENSION: DATA FROM A GREEK 8-YEAR-FOLLOW-UP STUDY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32346-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tsioufis C, Georgiopoulos G, Oikonomou D, Thomopoulos C, Katsiki N, Kasiakogias A, Chrysochoou C, Konstantinidis D, Kalos T, Tousoulis D. Hypertension and Heart Failure with Preserved Ejection Fraction: Connecting the Dots. Curr Vasc Pharmacol 2017; 16:15-22. [DOI: 10.2174/1570161115666170414120532] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/16/2017] [Accepted: 01/20/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Georgios Georgiopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Oikonomou
- Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece
| | - Costas Thomopoulos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece
| | - Alexandros Kasiakogias
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Christina Chrysochoou
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Theodoros Kalos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Tsioufis C, Dimitriadis K, Kordalis A, Doumas M, Konstantinidis D, Kalos T, Mahfoud F, Papademetriou V, Tousoulis D. Renal Denervation Therapy: Can it Contribute to Better Blood Pressure Control in Hypertension? Curr Vasc Pharmacol 2017; 16:66-69. [DOI: 10.2174/1570161115666170426151649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/17/2017] [Accepted: 01/20/2017] [Indexed: 11/22/2022]
Affiliation(s)
- Costas Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Kyriakos Dimitriadis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Athanasios Kordalis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Michalis Doumas
- 2ndPropedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
| | - Dimitris Konstantinidis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Theodoros Kalos
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Felix Mahfoud
- Klinik furInnereMedizin III, Universitatsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Vasilios Papademetriou
- Veteran Affairs Medical Center and Georgetown University, Washington, D.C, United States
| | - Dimitrios Tousoulis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
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Dimitriadis K, Tsioufis C, Kasiakogias A, Georgiopoulos G, Kalos T, Kyriazopoulos K, Annousis G, Andrikou E, Tousoulis D. [PP.01.14] URIC ACID AS A PREDICTOR OF CORONARY ARTERY DISEASE BUT NOT STROKE IN ESSENTIAL HYPERTENSION. J Hypertens 2017. [DOI: 10.1097/01.hjh.0000523226.56980.50] [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]
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Tsioufis C, Dimitriadis K, Kasiakogias A, Konstantinidis D, Kalos T, Mantzouranis M, Aragiannis D, Anoussis G, Fragoulis C, Kontantinou K, Tousoulis D. P4429Acute detrimental effects of electronic cigarette and tobacco cigarette smokingon blood pressure and sympathetic nerve activity in healthy subjects. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kalos T, Tsioufis C, Dimitriadis K, Kasiakogias A, Konstantinidis D, Syrmali K, Andrikou E, Kyriazopoulos K, Koufakis N, Anoussis G, Aragiannis D, Vogiatzakis N, Thomopoulos C, Tousoulis D. 5034Comparison of the predictive role of left ventricular mass and arterial stiffness for coronary artery disease in patients with essential hypertension: Data from a Greek 8-year-follow-up study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Andrikou E, Tsioufis C, Kalos T, Konstantinidis D, Dimitriadis K, Fragoulis C, Iliakis P, Liatakis I, Koutra E, Andrikou I, Tousoulis D. P3556Alterations in arterial properties as determinant of albuminuria regression in hypertensive subjects: results from a prospective study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3556] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Konstantinidis D, Tsioufis C, Dimitriadis K, Kalos T, Andrikou E, Georgiopoulos G, Vogiatzakis N, Roussos D, Tousoulis D. 290Arterial stiffness independently predicts stroke in patients with essential hypertension: Data from a Greek 8-year-follow-up study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.290] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Konstantinidis D, Tsioufis C, Dimitriadis K, Kasiakogias A, Kouremeti M, Kalos T, Leontsinis I, Kintis K, Liatakis I, Koutra D, Tousoulis D. P1728Isolated systolic hypertension versus combined systolic-diastolic hypertension as predictors of atrial fibrillation: Data from a Greek 8-year-follow-up study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1728] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kalos T, Tsioufis C, Dimitriadis K, Katsi V, Konstantinidis D, Syrmali K, Koutra E, Vogiatzi G, Peskesis G, Tousoulis D. P648Exaggerated exercise blood pressure response is accompanied by increased sympathetic activity and arterial stiffness in subjects with high normal blood pressure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p648] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Andrikou I, Tsioufis C, Kalos T, Konstantinidis D, Vogiatzi G, Kasiakogias A, Fragoulis C, Iliakis P, Liatakis I, Koutra E, Andrikou E, Tousoulis D. P4551Nocturnal hypertension versus Nondipping status for prediction of cardiac and renal alterations in hypertensives: a follow-up study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4551] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dimitriadis K, Tsioufis C, Kasiakogias A, Thomopoulos C, Konstantinidis D, Kalos T, Leontsinis I, Kintis K, Liatakis I, Koutra E, Tousoulis D. P5458Isolated systolic hypertension versus combined systolic-diastolic hypertension as predictors of coronary artery disease and stroke: Data from a Greek 8-year-follow-up study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5458] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dimitriadis K, Tsioufis C, Konstantinidis D, Andrikou I, Kalos T, Kouremeti M, Matzouranis M, Georgiopoulos G, Vogiatzakis N, Koumelli A, Konstantinou K, Tousoulis D. P657Uric acid predicts coronary artery disease but not stroke in essential hypertension: Data from a Greek 8-year-follow-up study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p657] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tsioufis K, Dimitriadis K, Kasiakogias A, Kalos T, Liatakis I, Koutra E, Nikolopoulou L, Ella R, Lau E, Papademetriou V, Tousoulis D. TCT-764 EFFECTS OF MULTIELECTRODE RENAL DENERVATION ON SYMPATHETIC NERVE ACTIVITY AND INSULIN RESISTANCE IN METABOLIC SYNDROME. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.794] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dimitriadis K, Tsioufis C, Andrikou E, Konstantinidis D, Kalos T, Liatakis I, Koutra E, Tousoulis D. [PP.29.04] IVABRADINE THERAPY FAVORABLY MODULATES SYMPATHETIC OVERDRIVE AND ARTERIAL STIFFENING IN HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000492213.26601.56] [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]
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Tsioufis KP, Dimitriadis K, Kasiakogias A, Kalos T, Koutra E, Vasileiou P, Andrikou E, Milkas A, Tousoulis D. LEFT VENTRICULAR MASS VERSUS PULSE WAVE VELOCITY AS PREDICTORS OF CORONARY ARTERY DISEASE IN PATIENTS WITH ESSENTIAL HYPERTENSION: DATA FROM A GREEK 6-YEAR-FOLLOW-UP STUDY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32011-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tsioufis KP, Dimitriadis K, Kordalis A, Kasiakogias A, Roussos D, Liatakis I, Kalos T, Koutra E, Syrseloudis D, Kallikazaros I, Tousoulis D. WAIST CIRCUMFERENCE VERSUS OTHER OBESITY INDICES FOR PREDICTION OF CORONARY ARTERY DISEASE IN ESSENTIAL HYPERTENSION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61403-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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