Depression and anxiety in different hypertension phenotypes: a cross-sectional study.

BACKGROUND: Hypertension is a major risk factor of cardiovascular mortality. Mood disorders represent a growing public health problem worldwide. A complex relationship is present between mood disorders and cardiovascular diseases. However, less data is available about the level of depression and anxiety in different hypertension phenotypes. The aim of our study was to evaluate psychometric parameters in healthy controls (Cont), in patients with white-coat hypertension (WhHT), with chronic, non-resistant hypertension (non-ResHT), and with chronic, treatment-resistant hypertension (ResHT). METHODS: In a cross-sectional study setup 363 patients were included with the following distribution: 82 Cont, 44 WhHT, 200 non-ResHT and 37 ResHT. The patients completed the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A). RESULTS: BDI points were higher in WhHT (7 (3-11)) and ResHT (6 (3-11.5)) compared with Cont (3 (1-6), p < 0.05). Similarly, HAM-A points were higher in WhHT (8 (5-15)) and ResHT (10.5 (5.25-18.75)) compared with Cont (4 (1-7), p < 0.05) and also compared with non-ResHT (5 (2-10), p < 0.05). ResHT was independently associated with HAM-A scale equal or above 3 points (Beta = 3.804, 95%CI 1.204-12.015). WhHT was independently associated with HAM-A scale equal or above 2 points (Beta = 7.701, 95%CI 1.165-18.973) and BDI scale equal or above 5 points (Beta = 2.888, 95%CI 1.170-7.126). CONCLUSIONS: Our results suggest psychopathological similarities between white-coat hypertension and resistant hypertension. As recently it was demonstrated that white-coat hypertension is not a benign condition, our findings can have relevance for future interventional purposes to improve the outcome of these patients.

Association between affective temperaments and arterial stiffness index in chronic hypertensive patients. / Az affektív temperamentumok és az artériás érfalmerevségi index kapcsolata krónikus hypertoniás betegekben.

Összefoglaló. Bevezetés: Az affektív temperamentumok (depresszív, cyclothym, hyperthym, ingerlékeny, szorongó) a személyiségnek olyan genetikailag meghatározott, felnottkorban stabil részei, amelyekkel jellemezhetok a környezeti ingerekre adott érzelmi válaszok. Az artériás érfalmerevségi index megmutatja, hogy az adott egyénnek a valóságban mért és az elvárt pulzushullám-terjedési sebessége (PWV) milyen arányban áll egymással; pozitív értéke számít kórosnak. Célkituzés: Célunk az volt, hogy az affektív temperamentumok kapcsolatát vizsgáljuk az artériás érfalmerevségi indexszel krónikus hypertoniás betegekben. Módszer: A bevont betegeknél tonometriás eszközzel (PulsePen) mértük a carotis-femoralis PWV-t, mely az artériás érfalmerevség legelfogadottabb markere. Az artériás érfalmerevségi indexet a mért és az elvárt PWV arányában határoztuk meg. Az affektív temperamentumokat a Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire kérdoív (TEMPS-A) segítségével objektivizáltuk. Eredmények: Vizsgálatunkba 185 beteget vontunk be, életkoruk 61,6 (49,5-69,8) év volt. Kortól, nemtol, diabetestol, alkoholfogyasztástól, dohányzástól, BMI-tol, systolés vérnyomástól, összkoleszterinszinttol és GFR-tol független kapcsolatot találtunk az artériás érfalmerevségi index és a depresszív (B = 0,009, 95% CI: 0,002-0,017, p = 0,018), a cyclothym (B = 0,009, 95% CI: 0,002-0,016, p = 0,012), az ingerlékeny (B = 0,013, 95% CI: 0,005-0,021, p<0,001) és a szorongó (B = 0,008, 95% CI: 0,003-0,013, p<0,001) temperamentum között. Következtetés: Újabb kapcsolatot sikerült kimutatni egy cardiovascularis rizikót jelzo paraméter és az affektív temperamentumok között, ami megerosíti ezen személyiségjegyek meghatározásának jelentoségét cardiovascularis prevenciós szempontból is az ismert pszichopatológiai vonatkozások mellett. Orv Hetil. 2022; 163(8): 312-318. INTRODUCTION: Affective temperaments (depressive, anxious, cyclothymic, hyperthymic, irritable) are genetically determined, adult-stable parts of the personality that characterize emotional responses to environmental stimuli. The arterial stiffness index demonstrates the ratio of the actually measured and expected pulse wave velocity (PWV) of a given individual. The positive value is considered to be abnormal. OBJECTIVE: The aim of this study was to investigate the relationship between affective temperaments and arterial stiffness index in chronic hypertensive patients. METHOD: Carotid-femoral PWV, the most accepted marker of arterial stiffness, was measured using a tonometric device (PulsePen). The arterial stiffness index was determined as the ratio of measured and expected PWVs. Affective temperaments were evaluated by the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A). RESULTS: The study included 185 patients, with a mean age of 61.6 (49.5-69.8) years. We found association between arterial stiffness index and depressive (B = 0.009, 95% CI: 0.009-0.017, p = 0.018), cyclothymic (B = 0.009, 95% CI: 0.002-0.016, p = 0.012), irritable (B = 0.013, 95% CI: 0.005-0.021, p = 0.001), and anxious (B = 0.008, 95% CI: 0.003-0.013, p = 0.001) temperaments independent of age, sex, diabetes, alcohol consumption, smoking, BMI, systolic blood pressure, total cholesterol, and GFR. CONCLUSION: An additional relationship between a cardiovascular risk measure and affective temperaments has been demonstrated, confirming the importance of determining these personality traits aiming cardiovascular prevention in addition to their known psychopathological aspects. Orv Hetil. 2022; 163(8): 312-318.

The position of Ephedrae herba in the Western medicine / Az Ephedrae herba helye a nyugati orvoslásban.

Összefoglaló. A Magyar és az Európai Hypertonia Társaság legújabb ajánlásában a gyógyszer okozta szekunder hypertoniák gyakoribb okai között szerepel az Ephedra - csikófark (kínai nevén Mahuang) fajok drogjának (Ephedrae herba) felhasználása is. Összefoglaló közleményünk célja az Ephedra nemzetségbe tartozó, a gyógyászatban is felhasznált, a VIII. Magyar Gyógyszerkönyvben és a Kínai Gyógyszerkönyvben szereplo hivatalos fajoknak a részletes bemutatása. Betekintést nyújtunk történetükbe, továbbá leírjuk a bennük található vegyületek farmakológiai tulajdonságait és azok hatásait. Ismertetjük elonyeiket, mellékhatásaikat és lehetséges gyógyszerkölcsönhatásaikat. Ezenkívül feltárjuk fogyasztó- és testsúlycsökkento szerként való használatukat, étrend-kiegészítoként történo alkalmazásuk betiltásának okát, valamint tárgyaljuk a doppinglistán való szereplésük magyarázatát is. Ezzel párhuzamosan kitérünk az Ephedra fajok orvosi gyakorlatban betöltött szerepére is: rendeltetésszeru használatuk során a fitoterápiában - foleg kombinációban alkalmazva - számos jótékony hatás érheto el, de fontos hangsúlyozni óvatos használatukat és felismerni lehetséges mellékhatásaikat. Orv Hetil. 2022; 163(9): 343-349. Summary. The Hungarian and the European Society of Hypertension guidelines mention Ephedrae herba, the drug of Ephedra species (in Chinese "Mahuang") as one of the causes of secondary hypertension. The aim of our summary is to characterize the Ephedra species used in medicine (based on the VIII. Hungarian and the Chinese Pharmacopoeia), describe their history and their components alongside with possible pharmacological effects, benefits, side-effects, and interactions with other drugs. We demonstrate the herb's history from being a popular weight-loss product to being prohibited as a dietary supplement and citing it in the World Anti-Doping Agency's list. At the same time, we explain the role of the Ephedra species in the everyday medical practice. It is important to know their benefits in detail as used in combination with other herbs in phytotherapy, and recognize their possible side effects. Orv Hetil. 2022; 163(9): 343-349.

Cross-sectional comparison of office and ambulatory pulse wave velocity by two methods, and their changes after lifestyle or medical interventions in hypertension.

OBJECTIVE: Pulse wave velocity (PWV), the most accepted biomarker of arterial stiffening can be measured by different methods and in the past decade, its 24 h monitoring has also become available. The aim of our study was to compare office and ambulatory PWVs and in a proportion of patients to compare the changes of PWVs after the initiation of lifestyle modifications or antihypertensive medication. METHODS: Office carotid-femoral PWV was measured with the tonometric PulsePen device (PP PWV), first hour and 24 h ambulatory oscillometric PWVs were evaluated with Mobil-O-Graph (MOB first hour PWV and MOB 24 h PWV, respectively). In new hypertensive patients, the measurements were repeated 3 months after the initiation of antihypertensive medication. In white-coat hypertensive patients after lifestyle modifications the measurements were repeated at 12 months. RESULTS: One hundred and five participants were involved with 22 new hypertensive and 22 white-coat hypertensive (WhHT) patients. PP PWV [8.7 (7.3-9.9) m/s] differed from MOB first hour PWV [7.3 (6.5-8.8) m/s] and MOB 24 h PWV [7.4 (6.4-8.8) m/s] as well (P < 0.05). PP PWV significantly decreased both in hypertensive [by 0.9 (0.4-1.5) m/s, P < 0.05] and WhHT patients [by 0.3 (-0.1 to 1) m/s, P < 0.05]. MOB first hour PWV did not change neither in hypertensive patients, nor in WhHT patients. MOB 24 h PWV decreased only in hypertensive patients [by 0.2 (0-0.6) m/s], which was less pronounced compared with PP PWV (P < 0.05). CONCLUSION: The significant differences observed both in the cross-sectional and in the prospective parts of our study suggests that the two methods are not interchangeable.

Comparison of Different Cardiovascular Risk Score and Pulse Wave Velocity-Based Methods for Vascular Age Calculation.

BACKGROUND: The calculation of vascular age can help patients understand the importance of adherence to healthy lifestyle and medications. However, multiple methods are available to calculate vascular age and no comparison data is available yet. Our aim was to evaluate vascular age based on the Framingham Risk Score (FRS), the Systematic COronary Risk Evaluation (SCORE) and carotid-femoral pulse wave velocity (PWV). METHODS: Consecutive subjects between the age of 40-65 years, who took part in a screening program in three general practitioner practices were involved. PWV was measured by tonometry and was compared with normal values. Vascular age was defined based on FRS and SCORE according to literature data. RESULTS: One hundred and seventy-two (172) patients were involved. The median chronological age was 55.5 (48.8-61.2) years. The median vascular age based on FRS and SCORE were 64 (54-79) years and 55 (44.2-60.7) years, respectively (p<0.05). Based on PWV, FRS and SCORE, 40.1%, 78.5% and 32% of the subjects had increased vascular age compared with chronological age, respectively (PWV+, FRS+, SCORE+, p<0.05). Fifty-eight (58) (84%) of the PWV+ subjects were also FRS+, and this proportion was high in case of SCORE+ patients as well (n=47, 85.4%). However, only moderate overlap was found between PWV+ and SCORE+ subjects as 17 (30.9%) of SCORE+ patients were also PWV+. CONCLUSION: The differences found between the calculated vascular ages and the proportion of subjects with elevated vascular age warrants further detailed comparison of different vascular age calculation methods.

Evaluation of affective temperaments and arterial stiffness in different hypertension phenotypes.

Affective temperaments (depressive, anxious, irritable, hyperthymic, and cyclothymic) are stable parts of personality and describe emotional reactivity to external stimuli. Their relation to psychopathological conditions is obvious, but less data are available on their relationship with cardiovascular disorders. The aim of this study was to evaluate affective temperaments and hemodynamic and arterial stiffness parameters in healthy subjects (Cont), in white-coat hypertensive (WhHT) patients, and in non-resistant (non-ResHT) and resistant hypertensive (ResHT) patients. In this cross-sectional study, 363 patients were included: 82 Cont, 44 WhHT, 200 non-ResHT, and 37 ResHT. The patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), and arterial stiffness was examined with tonometry (PulsePen). Significant differences were found between the Cont, WhHT, non-ResHT and ResHT groups in pulse wave velocity (7.76 ± 0.96, 8.13 ± 1.39, 8.98 ± 1.25, and 10.18 ± 1.18 m/s, respectively, p < 0.05 between Cont and non-ResHT/ResHT; p < 0.05 between non-ResHT and ResHT). Cyclothymic affective temperament points (4 (2.25-8)) were higher (p < 0.05) in the ResHT group than in the Cont (2 (0-5)) and non-ResHT (3 (1-5)) groups. The cyclothymic temperament points of the WhHT group (4 (2-7)) were also higher than those in the Cont group. ResHT was independently associated with a cyclothymic scale score above 6 (beta = 2.59 (95% CI: 1.16-5.77)), an irritable scale score above 7 (beta = 3.17 (95% CI: 1.3-7.69)) and an anxious scale score above 9 (beta = 2.57 (95% CI: 1.08-6.13)) points. WhHT was also independently associated with cyclothymic scale scores above 6 points (beta = 2.378, 95% CI: 1.178-4.802). In conclusion, white-coat and ResHT patients have specific affective temperament patterns, and the evaluation of these patterns can help to understand the psychopathological background of these conditions.

Association between Cyclothymic Affective Temperament and Age of Onset of Hypertension.

Affective temperaments represent a biologically stable core of emotional reactivity and have previously been associated with hypertension and arterial stiffening. The age, when hypertension is initiated, is influenced by different factors, but the role of personality traits in this regard is not clarified yet. Our aim was to study the association between affective temperaments and the age at onset of hypertension. In this cross-sectional study, 353 patients were included. After the evaluation of history, patients completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire. We used linear regression analysis to identify predictors of the age of onset of hypertension in the whole cohort and in male and female subpopulations. The independent predictors of the age at onset of hypertension were male sex (B = -4.57 (95% CI = -1.40 to -7.74)), smoking (B = -4.31 (-7.41 to -1.22)), and positive family history (B = -6.84 (-10.22 to -3.45)). In women, cyclothymic temperament score was an independent predictor of the initiation of hypertension (B = -0.83 (-1.54 to -0.12)), while this association was absent in men. Besides traditional factors, cyclothymic affective temperament might contribute to the earlier initiation of hypertension in women.

The role of neurotrophins in psychopathology and cardiovascular diseases: psychosomatic connections.

Cardiovascular (CV) diseases and mood disorders are common public health problems worldwide. Their connections are widely studied, and the role of neurotrophins (NTs) is already supposed in both conditions. However, data in the literature of clinical aspects are sometimes controversial and no reviews are available describing possible associations between CV risk and mood disorders based on NTs. The mostly studied NT is brain-derived neurotrophic factor (BDNF). Decreased level of BDNF is observed in depression and its connection to hypertension has also been demonstrated with affecting the arterial baroreceptors, renin-angiotensin system and endothelial nitric oxide synthase. BDNF was also found to be the predictor of CV outcome in different patient populations. Other types of human NT-s, such as nerve growth factor, neurotrophin 3 and neurotrophin 4 also seem to have both psychopathological and CV connections. Our aim was to overview the present knowledge in this area, demonstrating a new aspect of the associations between mood disorders and CV diseases through the mediation of NTs. These findings might enlighten new psychosomatic connections and suggest new therapeutic targets that are beneficial both in respect of mood disorders and CV pathology.

Inverse association between hyperthymic affective temperament and coronary atherosclerosis: A coronary computed tomography angiography study.

OBJECTIVE: A bidirectional relationship exists between psychiatric disorders and cardiovascular diseases, however less is known with regards to personality traits. Accumulating data suggest that affective temperaments are both associated with psychiatric and somatic diseases. The aim of our study was to evaluate the associations between different affective temperaments and the presence of coronary atherosclerosis. METHODS: 200 consecutive patients referred to coronary computed tomography angiography (CCTA) due to suspected coronary artery disease (CAD) were included in our study. Medical history and demographic parameters were recorded and all patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) and the Beck Depression Inventory (BDI). The presence of coronary artery disease was evaluated based on the CCTA images. RESULTS: 39 patients were free of any coronary atherosclerosis (CCTA-) and 161 had coronary atherosclerosis (CCTA+). Hyperthymic affective temperament score was higher in CCTA- subjects as compared to CCTA+ (13.1±3.0 vs 11.5±4.6, p=0.010, respectively). Hyperthymic affective temperament score showed a significant independent, inverse relationship with coronary atherosclerosis (OR: 0.91 CI: 0.82-0.99, p=0.04). CONCLUSION: Our results suggest that hyperthymic affective temperament is independently associated with the absence of CAD. It requires further research to delineate the mechanism mediating the effect of hyperthymia on better coronary artery health and establishing potential biochemical or behavioral factors, both of which could be exploited for prevention and treatment purposes. But it is plausible, that the evaluation of affective temperaments have importance both in relation with psychiatric and cardiovascular disorders.

The impact of currently recommended antihypertensive therapy on depression and other psychometric parameters: preliminary communication.

AIMS: Current evidence on the psychological effects of antihypertensive medications is controversial. The aim of this study was to evaluate the effect of current antihypertensive medication on different psychometric parameters and on serum brain-derived neurotrophic factor (BDNF) level. METHODS: Psychometric, haemodynamic, arterial stiffness and laboratory parameters were evaluated before and 3 months after the initiation of antihypertensive medication in untreated hypertensive patients (HT, n=31), and once in healthy controls (CONT, n=22). Subjects completed the following psychometric tests: Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A), Symptom Checklist 90 Revised (SCL-90), Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire, Big Five Inventory, Pain Vigilance and Awareness Questionnaire and Berkeley Expressivity Questionnaire. Amlodipine and/or perindopril compounds were preferred medications. Serum BDNF was measured with ELISA. RESULTS: Brachial systolic blood pressure, as well as pulse wave velocity were significantly improved in the HT group over the 3-month follow-up (153.3±15.9 mmHg vs. 129.5±10.0 mmHg and 8.2±1.4 m/s vs 7.5±1.6 m/s, respectively). Similarly, we found improvements in BDI (0.73 points) and in several Scl-90 subscales. Serum BDNF was not different between CONT and HT and did not change for therapy. CONCLUSIONS: Our results indicate that initiation of currently recommended antihypertensive medications in newly diagnosed patients may have a significant impact on psychological well-being of patients and could influence quality of life as well.

[A családorvosok alvási apnoéval kapcsolatos ismeretei és attitudjei. Megvalósul-e az OSAS szurése a jármuvezetok egészségi alkalmasságának vizsgálata során?] / A családorvosok alvási apnoéval kapcsolatos ismeretei és attitudjei. Megvalósul-e az OSAS szurése a jármuvezetok egészségi alkalmasságának vizsgálata során?

BACKGROUND AND PURPOSE: Obstructive sleep apnea syndrome (OSAS) without treatment can cause serious cardiovascular, cardiorespiratory, neurological and other complications. Family physicians have an important role in recognizing the disease. The aim of the study is to assess the knowledge and attitude of family physicians related to sleep apnea. Whether OSAS screening is realized during the general medical checkup for drivers. METHODS: In the cross-sectional study we used a validated OSAKA questionnaire in mandatory continuous medical education courses, supplemented with four additional questions. RESULTS: 116 family physicians and 103 family medicine residents filled out the questionnaire. Hungarian family physicians, especially male doctors lack the adequate knowledge of sleep apnea. The average score of female physicians was significantly higher than that of males (13.4±1.8 vs. 11.7±2.6, p=0.005). The more specializations the doctor has, the higher the score. Zero or one special examination holders reached 12.5±2.3 points, two special examination holders 12.7±2.2 points. three or four special examination holders reached 14.0±2.1 (p=0.05). Residents' average score was 12.1±2.4 points, which is higher than that of family doctors (p=0.012). Female residents also had higher average points than male residents (12.6±2.0 vs. 11.3±2.7; p=0.008). The size, location and type of the practice or the doctor's age did not show any statistically significant correlation with the number of points achieved. According to our regression analysis, corrected to variables in the model, we found correlation between gender and medical knowledge, but there was no correlation between age, number of specialities, body mass index and the theoretical knowledge of the doctors. In terms of attitude female GPs had higher average scores than male GPs (3.5±0.6 vs. 2.9±0.6, p<0.001). Despite the modification of the 13/1992 regulation only 39% of the practices carried out regularly the required OSAS screening as part of the medical examination for a driving licence. CONCLUSION: Despite the high prevalence and clinical importance of OSAS, GPs often do not recognize sleep apnea and they have difficulty in treating their patients for this problem.

[Opinions of Hungarian family physicians and residents on vocation and informal payment]. / Hivatással és hálapénzzel kapcsolatos vélekedések a magyarországi családorvosok és családorvos rezidensek körében.

INTRODUCTION: The changing of the family medicine can be observed in the New Millennium. Migration, the aging of the healers and informal payment are crucial to the human resource crisis of the health sector. AIM: The aim of this study was to investigate the family physicians' and residents' opinions about the vocation and informal payment. METHOD: Exploratory, quantitative study was carried out among family physicians (n = 363) and family physician residents (n = 180). The central questions of the study were the vocation, the income and the informal payment. RESULTS: The most decisive factors of the carrier choice were altruism, service and responsibility. Residents were significantly rejective (19.7% vs. 38.3%, p<0.001) about informal payment. They would accept smaller amounts of informal payment (14.3% vs. 8.9%, p<0.034), and would spend it on praxis development (1.4% vs.9.4% p<0.023). CONCLUSIONS: The attitudes of family physicians and residents are the same in case of the vocation, but on the issue of informal payment, the two generations have different opinions. Orv. Hetil., 2016, 157(36), 1438-1444.

Hyperthymic affective temperament and hypertension are independent determinants of serum brain-derived neurotrophic factor level.

BACKGROUND: Brain-derived neurotrophic factor (BDNF) has neuroprotective, proangiogenic and myogenic effects and, therefore, possibly acts as a psychosomatic mediator. Here, we measured serum BDNF (seBDNF) level in hypertensive patients (HT) and healthy controls (CONT) and its relation to affective temperaments, depression and anxiety scales, and arterial stiffness parameters. METHODS: In this cross-sectional study, affective temperaments, anxiety, and depression were studied with questionnaires (TEMPS-A, HAM-A, and BDI, respectively). SeBDNF level and routine laboratory parameters were measured as well. Arterial stiffness was evaluated with a tonometric method. RESULTS: Allover, 151 HT, and 32 CONT subjects were involved in the study. SeBDNF level was significantly higher in HT compared to CONT (24880 ± 8279 vs 21202.6 ± 6045.5 pg/mL, p < 0.05). In the final model of regression analysis, hyperthymic temperament score (Beta = 405.8, p = 0.004) and the presence of hypertension (Beta = 6121.2, p = 0.001) were independent determinants of seBDNF. In interaction analysis, it was found that in HT, a unit increase in hyperthymic score was associated with a 533.3 (95 %CI 241.3-825.3) pg/mL higher seBDNF. This interaction was missing in CONT. CONCLUSIONS: Our results suggest a complex psychosomatic involvement of BDNF in the pathophysiology of hypertension, where hyperthymic affective temperament may have a protective role. BDNF is not likely to have an effect on large arteries.

Association of affective temperaments with blood pressure and arterial stiffness in hypertensive patients: a cross-sectional study.

BACKGROUND: Affective temperaments (anxious, depressive, cyclothymic, irritable and hyperthymic) measure subclinical manifestations of major mood disorders. Furthermore, cumulating evidence suggests their involvement in somatic disorders as well. We aimed to assess associations between affective temperament scores and blood pressure and arterial stiffness parameters in hypertensive patients. METHODS: In this cross-sectional study, 173 patients with well-controlled or grade 1 chronic hypertension, with no history of depression, completed the TEMPS-A, Beck Depression Inventory (BDI) and Hamilton Anxiety Scale (HAM-A) questionnaires in three GP practices. Arterial stiffness was measured with tonometry (PulsePen). RESULTS: According to multiple linear regression analysis, cyclothymic temperament score was positively associated with brachial systolic blood pressure independently of age, sex, total cholesterol, brachial diastolic blood pressure, BDI, HAM-A and the use of alprazolam (ß = 0.529, p = 0.042), while hyperthymic temperament score was negatively related to augmentation index independent of age, sex, smoking, heart rate, BDI, HAM-A and the use of alprazolam (ß = -0.612, p = 0.013). A significant interaction was found between cyclothymic temperament score and sex in predicting brachial systolic blood pressure (p = 0.025), between irritable and anxious temperament scores and sex in predicting pulse wave velocity (p = 0.021, p = 0.023, respectively) and an interaction with borderline significance between hyperthymic temperament score and sex in predicting augmentation index (p = 0.052). CONCLUSIONS: The present findings highlight elevated blood pressure among subjects with high cyclothymic temperament as well as an increased level of arterial stiffening in subjects with low hyperthymic scores suggesting that affective temperaments may play a role in the development of hypertension and arterial stiffening and may thus represent markers of cardiovascular risk. Sex differences were also present in these associations.

[Hungarian Society for Sleep Medicine guideline for detecting drivers with obstructive sleep apnea syndrome]. / A Magyar Alvásdiagnosztikai és Terápiás Társaság módszertani ajánlása a közúti jármuvezetok egészségi alkalmasságának vizsgálatához az obstruktív alvási apnoe szindróma vonatkozásában.

Obstructive sleep apnea is the most frequent sleep-disordered breathing. The prevalence of sleep apnea in the general population is 2-4% and the main characteristics of the disease are the intermittent cessation or substantial reduction of airflow during sleep, which is caused by complete, or near complete upper airway obstruction. Decreased airflow is followed by oxygen desaturation and intermittent arousals. Untreated patients are 4-6 times more likely to cause traffic accidents than their healthy counterparts. The aims of the obstructive sleep apnea screening are to prevent and reduce the incidence of serious car accidents, which are often caused by one of the most dangerous sleep disorders. Since April 1, 2015 a modification of the 13/1992 regulation has been in force in Hungary which orders screening of obstructive sleep apnea during medical checkup of drivers. The Hungarian Society for Sleep Medicine made a guideline according to the regulation which was adapted to national circumstances and family doctors, occupational health specialists can more easily screen obstructive sleep apnea in suspected patients. In sleep ambulances the disease can be diagnosed and effective treatment can be started. Patients receiving appropriate treatment and with appropriate compliance can get their driving licence under regular care and control.

Ambulatory arterial stiffness in chronic kidney disease: a methodological review.

Cardiovascular mortality is the leading cause of death in chronic kidney disease (CKD) and end-stage renal disease (ESRD). This can be explained in part by an increased and progressive calcification of the medial layer of the large arteries leading to arterial stiffening. The prognostic value of measurements of arterial stiffness, especially pulse wave velocity (PWV), in the general population and in CKD and ESRD patients is high, and is above that of traditional risk factors with respect to cardiovascular outcome. In recent years, as an alternative to office measurements, methods for monitoring ambulatory arterial stiffness have been developed. The ambulatory arterial stiffness index (AASI) allows derivation of a parameter from ambulatory blood pressure measurements; however, doubts have emerged about the usefulness of this parameter. Recently, new oscillometric methodologies using simple brachial cuffs, such as Mobil-O-Graph, Vasotens or Arteriograph 24, have been introduced. They measure parameters of 24-h arterial stiffness including PWV, augmentation index and central blood pressure. This enables study of the 24-h variability of these parameters, which will hopefully lead to better cardiovascular risk stratification and improved cardiovascular outcomes of patients. Our review summarizes the present data and future directions of AASI and the methods for monitoring oscillometric 24-h stiffness in different patient populations and especially in CKD.

Identification of hypertensive patients with dominant affective temperaments might improve the psychopathological and cardiovascular risk stratification: a pilot, case-control study.

BACKGROUND: Although mood disorders and cardiovascular diseases have widely studied psychosomatic connections, data concerning the influence of the psychopathologically important affective temperaments in hypertension are scarce. To define a possibly higher cardiovascular risk subpopulation we investigated in well-treated hypertensive patients with dominant affective temperaments (DOM) and in well-treated hypertensive patients without dominant temperaments the level of depression and anxiety, arterial stiffness and serum Brain-derived Neurotrophic Factor (seBDNF). METHODS: 175 hypertensive patients, free of the history of psychiatric diseases, completed the TEMPS-A, Beck Depression Inventory and Hamilton Anxiety Scale questionnaires in two primary care practices. Of those 175 patients, 24 DOM patients and 24 hypertensive controls (matched in age, sex and the presence of diabetes) were selected for measurements of arterial stiffness and seBDNF level. RESULTS: Beck and Hamilton scores in DOM patients were higher compared with controls. Pulse wave velocity and augmentation index did not differ between the groups while in the DOM patients decreased brachial systolic and diastolic and central diastolic blood pressures were found compared with controls. SeBDNF was lower in the DOM group than in the controls (22.4 ± 7.2 vs. 27.3 ± 7.8 ng/mL, p < 0.05). CONCLUSIONS: Although similar arterial stiffness parameters were found in DOM patients, their increased depression and anxiety scores, the decreased brachial and central diastolic blood pressures as well as the decreased seBDNF might refer to their higher vulnerability regarding the development not only of major mood disorders, but also of cardiovascular complications. These data suggest that the evaluation of affective temperaments should get more attention both with regard to psychopathology and cardiovascular health management.

Case report of exercise and statin-fibrate combination therapy-caused myopathy in a patient with metabolic syndrome: contradictions between the two main therapeutic pathways.

BACKGROUND: Lifestyle modifications including exercise are beneficial and fundamentally part of the therapy of metabolic syndrome, although in most of the cases medical interventions are also required to reach the target values in the laboratory parameters. Statin and fibrate combination therapy is considered to be safe and effective in dyslipidaemia and metabolic syndrome. However, increased physical activity can enhance the statin and fibrate-associated myopathy. Myositis and the rare but life-threatening rhabdomyolysis are causing a conflict between exercise and statin-fibrate therapy, which is yet to be resolved. CASE PRESENTATION: We present a case of a 43-year-old Caucasian man with metabolic syndrome who had the side-effect of exercise and drug-associated myositis. The patient had only transient moderate complaints and rhabdomyolysis could be avoided with the one-month creatine kinase control, a test which is not recommended routinely by the new guidelines. CONCLUSIONS: We would like to turn the spotlight on the possible complications of statin-fibrate therapy and exercise, when strict follow-up is recommended. In this condition high number of patients can be affected and the responsibility of general practitioners is accentuated.

Impaired carotid artery elastic function in patients with tetralogy of Fallot.

Complex congenital heart diseases with abnormal formation of the aorticopulmonary septum are also associated with defective large artery elastogenesis. In the current study, we tested the hypothesis that carotid artery elastic function was impaired in patients with tetralogy of Fallot (ToF). The study included 45 Fallot-patients (male:female 27:18; age 21.0 ± 11.8 years) and 45 age- and gender-matched healthy control individuals. Carotid artery diameter, pulsatile distension, and intima-media thickness (IMT) were measured by echotracking device, and carotid blood pressure was determined using applanation tonometry. Carotid artery elasticity was characterized by compliance and distensibility coefficients, stiffness index ß, and incremental elastic modulus. All carotid artery elastic parameters showed significant differences between groups. The compliance coefficient was 36%, and the distensibility coefficient was 33% smaller, whereas stiffness index ß was 46% and incremental elastic modulus was 40% larger in Fallot-patients. Fallot-patients also had larger carotid artery IMT as compared to that of healthy individuals. Carotid artery is markedly stiffer in Fallot-patients suggesting that impaired elastogenesis is a component of the congenital abnormality. Increased large artery stiffness might contribute directly and indirectly (through impairment of baroreflex function) to the higher mortality found in ToF patients.

Adaptation of baroreflex function to increased carotid artery stiffening in patients with transposition of great arteries.

We have shown previously that TGA (transposition of great arteries) is associated with increased carotid artery stiffness. It has been established that stiffening of the barosensory vessel wall results in reduced baroreceptor activation and impaired BRS (baroreflex sensitivity). In the present study we tested the hypothesis that the increased carotid artery stiffness in TGA patients was associated with reduced cardiovagal BRS. We studied 32 TGA patients aged 9-19 years, 12+/-3 years after surgical repair and 32 age-matched healthy control subjects. Carotid artery diastolic diameter and pulsatile distension was determined by echo wall tracking; carotid blood pressure was measured by tonometry. BRS was measured using spontaneous techniques [BRS(seq) and LF(gain) (low-frequency transfer function gain)] and by the phenylephrine method (BRS(phe)). Carotid artery distensibility was markedly reduced in patients as compared with controls (5.6+/-1.9 x 10(-3) compared with 8.7+/-2.7 x 10(-3)/mmHg P<0.05, as determined using an unpaired Student's t test), but BRS was not different in patients and controls (20.3+/-14.7 compared with 21.7+/-12.7 for BRS(seq); 13.1+/-9.2 compared with 10.6+/-4.5 for LF(gain); and 19.1+/-8.6 compared with 24.8+/-7.2 for BRS(phe) respectively). Carotid artery elastic function was markedly impaired in patients with TGA, but the increased stiffness of the barosensory vessel wall was not associated with reduced BRS. It appears that attenuation of baroreceptor stimulus due to arterial stiffening may be compensated by other, possibly neural, mechanisms when it exists as a congenital abnormality.