Real-World Treatment of Hypertension on Hemodialyses Data from a Large Polish Database.

INTRODUCTION: The prevalence of hypertension among patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD) ranges from 72 to 88% depending on applied diagnostic criteria and the chosen method of blood pressure measurement. Despite the guidelines recommending the widespread use of renin-angiotensin system blockers (RASBs) in patients with kidney disease, their utilization in patients on HD may be suboptimal, especially in patients with preserved diuresis. This hesitance that often steams from concern is often due to fear of a decrease in eGFR and a subsequent decrease in diuresis. The aim of this study was to compare clinical characteristics, blood pressure, safety, and HD adequacy indices in hypertensive HD patients on multiple antihypertensive drug regimens, including diuretic treated with RASB (RASB group) or without RASB (no-RASB) with preserved residual diuresis. We sought to examine the real-life use of RASB in HD patients in relation to their clinical characteristics, blood pressure, safety, and HD adequacy. METHODS: From a database of 5,879 patients receiving HD (mean age 65.2 ± 14.2 years, 60% of males) of the largest provider of HD in the country, we selected the subgroup treated with at least three antihypertensive medications including diuretics. We compared patients treated with RASB to counterparts without RASB (no-RASB). RESULTS: The RASB group has similar age and gender proportions as well as BMI and bioimpedance compared to counterparts. However, dry body mass was significantly lower in the RASB group (78.1 ± 18.3 kg vs. 80.0 ± 18.2 kg, p < 0.017). Prevalence of diabetes mellitus was similar in both groups, but RASB-treated patients have cardiovascular diseases more frequently (70.1 vs. 60.8%; p < 0.001). Systolic blood pressure and the number of antihypertensive drugs used were significantly higher in RASB patients than in counterparts (146 ± 16 mm Hg vs. 144 ± 15 mm Hg; p < 0.001 and 4.1 ± 0.9 vs. 3.5 ± 0.5; p < 0001, respectively). RASB-treated patients have significantly longer dialysis vintage (52.7 ± 44.4 months vs. 40.2 ± 40.9 months; p < 0.001) and dialysis time (722 ± 87.1 min/week vs. 713 ± 93.4 min/week; p < 0.017) than counterparts. Serum potassium was slightly but significantly higher in RASB (5.3 ± 0.8 mmol/L vs. 5.1 ± 0.7 mmol/L; p < 0.01). CONCLUSIONS: In the real world setting, RASB can be safely used in HD patients treated with diuretics with preserved residual diuresis. Given that many HD patients present numerous multimorbidities, RASB should not only be considered as an additional hypotensive drug in poorly controlled hypertension but also in other compelling indications in HD patients. The tendency toward hyperkalemia in HD patients could be effectively managed with appropriate diet and HD prescription adjustments.

Resistant hypertension in dialysis.

Hypertension is the most common finding in chronic kidney disease patients, with prevalence ranging from 60% to 90% depending on the stage and etiology of the disease. It is also a significant independent risk factor for cardiovascular disease, progression to end-stage kidney disease and mortality. According to the current guidelines, resistant hypertension is defined in the general population as uncontrolled blood pressure on three or more antihypertensive drugs in adequate doses or when patients are on four or more antihypertensive drug categories irrespective of the blood pressure control, providing that antihypertensive treatment included diuretics. The currently established definitions of resistant hypertension are not directly applicable to the end-stage kidney disease setting. The diagnosis of true resistant hypertension requires confirmation of adherence to therapy and confirmation of uncontrolled blood pressure values by ambulatory blood pressure measurement or home blood pressure measurement. In addition, the term "apparent treatment-resistant hypertension," defined as an uncontrolled blood pressure on three or more antihypertensive medication classes, or use of four or more medications regardless of blood pressure level was introduced. In this comprehensive review we focused on the definitions of hypertension, and therapeutic targets in patients on renal replacement therapy, including the limitations and biases. We discussed the issue of pathophysiology and assessment of blood pressure in the dialyzed population, management of resistant hypertension as well as available data on prevalence of apparent treatment-resistant hypertension in end-stage kidney disease. To conclude, larger sample-size and even higher quality studies about drug adherence should be conducted in the population of patients with the end-stage kidney disease who are on dialysis. It also should be determined how and when blood pressure should be measured in the group of dialysis patients. Additionally, it should be stated what the target blood pressure values in this group of patients really are. The definition of resistant hypertension in this group should be revisited, and its relationship to both subclinical and clinical endpoints should be established.

Retroperitoneal Fibrosis Is Still an Underdiagnosed Entity with Poor Prognosis.

BACKGROUND: Retroperitoneal fibrosis (RPF) is a rare disease characterized by the presence of inflammatory and fibrous retroperitoneal tissue that often encircles abdominal organs including the aorta and ureters. Data on the incidence of this disease are limited. SUMMARY: The disease may be idiopathic or secondary to infections, malignancies, drugs, or radiotherapy. The idiopathic form is an immune-mediated entity and a part of the broader spectrum of idiopathic diseases termed chronic periaortitis, characterized by a morphologically similar fibroinflammatory changes in the aorta and surrounding tissues. Taking into account the dominant symptoms and clinical characteristics of patients with periaortitis, 2 subtypes of disease could be distinguished. The vascular subtype includes patients with nondilated aorta or with inflammatory abdominal aortic aneurysm, both with and without involvement of adjacent structures and with numerous risk factors for atherosclerosis. In the renoureteral subtype, obstructive uropathy manifesting with hydronephrosis and acute kidney injury is the predominant finding. Due to the variety of symptoms, diagnosis of RPF remains challenging, difficult, and often delayed. A series of diagnostic tests should be performed, in order to confirm the diagnosis idiopathic RPF. Laboratory workup includes evaluation of inflammatory indices and immunological studies. A biopsy and histopathological evaluation may be necessary to confirm diagnosis and differentiate the disease. Computed tomography, magnetic resonance imaging, and positron emission tomography are the modalities of choice for the diagnosis and follow-up of this disease. Management of ureteral obstruction, hydronephrosis, and aortic aneurysms often requires surgical evaluation and treatment. The pharmacological treatment of RPF has been evaluated in a few randomized trials and is mainly based on observational studies. Steroid therapy remains the gold standard of treatment. KEY MESSAGES: Nowadays, multidisciplinary team approach with clinical and diagnostic experience in both primary and secondary RPF as well as 2 major subtypes should be offered. Centers specialized in rare diseases with collaboration with other units and referral system yield the best possible outcomes.

Retroperitoneal fibrosis, a rare entity with urorenal and vascular subtypes - preliminary data.

INTRODUCTION: Retroperitoneal fibrosis (RPF) is a rare disease associated with the formation of hard inflammatory and fibrous tissue in the retroperitoneum. Taking into consideration the fact that RPF is a rare disease with different subtypes, we compared the basal clinical and biochemical characteristics of the vascular and urorenal subtypes. PATIENTS AND METHODS: From January 2005 until December 2021, 27 patients were identified as vascular subtype (18 males) and 11 as urorenal subtype (9 males). RESULTS: Patients with a primary urorenal origin had significantly worse kidney function as reflected by serum creatinine and eGFR (both p < 0.001); they also had higher serum cholesterol (p < 0.01). Hypertension, diabetes, hyperlipidemia and nicotinism were significantly more prevalent in vascular subtype (all p < 0.001). CONCLUSION: Vascular subtype is more prevalent in our study with more cardiovascular risk factor present. Due to the diversity of symptoms, diagnosis of RPF becomes a challenge for specialists as well as therapy.

Influence of Forward Head Posture on Myotonometric Measurements of Superficial Neck Muscle Tone, Elasticity, and Stiffness in Asymptomatic Individuals With Sedentary Jobs.

OBJECTIVE: The objective of the study was to assess the influence of forward head posture on the mechanical parameters and pressure pain threshold of superficial neck muscles in clinically nonsymptomatic individuals with sedentary jobs. METHODS: Twenty-five office workers with forward head posture and 25 office workers with normal head posture were matched for sex, age, body mass index, and the nature and duration of their work and were compared at a single point. The study participants were divided into study groups on the basis of photometric craniovertebral angle measurements. The upper trapezius, sternocleidomastoid, and splenius capitis mechanical properties were assessed in the sitting position. Primary outcome measures were muscle stiffness (N/m), muscle tone (Hz), and muscle elasticity. The secondary variable was perceived pain threshold. RESULTS: No significant differences between the groups were found for biomechanical properties and perceived pain threshold in the studied muscles. CONCLUSION: Forward head posture has no impact on muscle stiffness, tone, and elasticity, nor does it increase the pressure sensitivity of superficial neck muscles in healthy, mildly symptomatic office workers. It is most likely that not incorrect posture of the cervical spine, but probably other factors combined with forward head posture, like comorbid acute and chronic cervical pain and musculoskeletal disorders or prolonged sitting, contribute to changes in active myofascial tone and tensegrity as well as increased pressure sensitivity of neck muscles.

Short-Term Effects of Kinesio Taping® on Electromyographic Characteristics of Paraspinal Muscles, Pain, and Disability in Patients With Lumbar Disk Herniation.

Context: Kinesio taping® (KT) is a therapeutic modality frequently used in the clinical practice for the treatment of various musculoskeletal disorders. It is often applied in patients with chronic low back pain to decrease pain and improve functional capacity. However, it is not known, whether thoracolumbar fascia KT technique can decrease back pain, restore normal activity of paraspinal muscles, and improve functional capacity in patients with lumbar disk herniation (LDH). Objective: To evaluate the impact of 7-day new KT stabilizing application on lumbar paraspinal muscles function, pain perception, and disability in patients with LDH. Design: A randomized controlled trial. Setting: Human Performance Laboratory. Patients: A number of 38 patients with LDH were randomized into KT (n = 19) and placebo taping (n = 19) groups. Interventions: Both groups received the same "x" type application running over the back along fibers of superficial lamina of the posterior layer of thoracolumbar fascia. Main Outcome Measures: The primary outcome measures were flexion-relaxation and extension-relaxation ratios calculated from electromyographic activity of lumbar multifidus and longissimus thoracic muscles. Pain intensity rating (Quadruple Visual Analogue Scale), pressure pain thresholds of the lower back, Roland-Morris Disability Questionnaire score, back extension force, and flexion range of motion (ROM) were among secondary outcomes. Results: KT application did not affect the lumbar multifidus and longissimus thoracic muscles flexion-relaxation and extension-relaxation ratios, lower back pressure pain thresholds, back flexion ROM, and back extension force (no group × time interaction [GTI]). KT and placebo taping comparably decreased disability level (time effect: F1,36 = 22.817, P < .001; GTI: F1,36 = 0.189, P = .67), average pain (time effect: F1,36 =39.648, P < .001; GTI: F1,36 = 2.553, P = .12), and the worst pain (time effect: F1,36 = 36.039, P < .001; GTI: F1,36 = 0.003, P = .96) intensity. Conclusion: Seven-day KT does not normalize lumbar paraspinal muscle function and is not superior to placebo in reducing disability and pain intensity in patients with LDH.

Effect of morphological and functional changes in the secundines on biometric parameters of newborns from dichorionic twin pregnancies.

OBJECTIVES: The aim of the study was to determine if, and to what extent, structural and functional changes of the secundines influence biometric parameters of neonates from dichorionic twin pregnancies. MATERIAL AND METHODS: The study included neonates from dichorionic, diamniotic twin pregnancies, along with their secundines. Based on histopathological examination of the secundines, the mass and dimensions of the placenta, length and condition of the umbilical cord, chorionicity, focal lesions, and microscopic placental abnormalities were determined for 445 pairs of twins. Morphological development of examined twins was characterized on the basis of their six somatic traits, while birth status of the newborns was assessed based on their Apgar scores. Statistical analysis included Student t-tests, Snedecor's F-tests, post-hoc tests, non-parametric chi-squared Pearson's tests, and determination of Spearman coefficients of rank correlation. RESULTS: The lowest values of analyzed somatic traits were observed in twins who had placentas with velamentous or marginal cord insertion. Inflammatory lesions in the placenta and placental abruption turned out to have the greatest impact of all analyzed abnormalities of the secundines. Inflammatory lesions in the placenta were associated with lower values of biometric parameters and a greater likelihood of preterm birth. Neonates with a history of placental abruption were characterized by significantly lower birth weight and smaller chest circumference. CONCLUSIONS: Morphological changes in the secundines have a limited impact on biometric parameters of neonates from dichorionic twin pregnancies. In turn, functional changes exert a significant effect and more often contribute to impaired fetal development.

The effect of statins on sympathetic activity: a meta-analysis.

OBJECTIVE: Beyond lipid-lowering properties, statins decrease sympathetic nervous activity. Due to the limited number of studies and included participants, a meta-analysis of randomized, placebo-controlled studies using microneurography (MSNA) was performed to assess sympatholytic effect of statins. METHODS: We conducted a comprehensive search of online databases (Cochrane, Embase, and EBSCO) for published human studies up to April 2014. Randomized controlled trials (parallel and crossover design) were eligible for inclusion if results of statins versus placebo treatments on sympathetic activity were measured with MSNA. RESULTS: Data from five studies with a total number of subjects n = 82 were included into the meta-analysis. MSNA expressed as bursts/min and as bursts/100 heartbeats was lower in the statin group than in the placebo group with a mean difference of -4.37 95% CI (-7.03; -1.70), p < 0.0013 and -5.85 95% CI (-7.56; -4.13), p < 0.0001, respectively. No significant publication bias was observed. Meta-regression revealed no significant effect of baseline total cholesterol or dose of statin. No change in blood pressure and heart rate was observed. CONCLUSIONS: Published data show that regardless of type and dose, statins reduce sympathetic activity measured by microneurography. The role of decreased sympathetic outflow during statin therapy on clinical end points needs to be clarified.

Differences in Isokinetic Strength of the Knee Extensors and Flexors in Men With Isolated and Combined Cruciate-Ligament Knee Injury.

CONTEXT: The extent of knee extensor and flexor weakness after disruption of knee ligaments affects a rehabilitation output and functional recovery and may give prognostic information on a possible risk of development of knee osteoarthritis. OBJECTIVE: The hypothesis tested was whether patients with a multiple-ligament tear would have larger abnormalities in strength of the knee extensors and flexors than patients with an isolated-ligament rupture. DESIGN: Cross-sectional study, level III. SETTING: Outpatient orthopedic clinic. PARTICIPANTS: 3 groups of recreationally active men: noninjured control (CON, n = 12), with an anterior cruciate ligament injury (ACLI, n = 10), and with combined anterior and posterior cruciate ligament injury (APCLI, n = 9), matched according to age, body mass, and height. INTERVENTION: All patients received conservative treatment and rehabilitation and awaited ligament reconstruction surgery. MAIN OUTCOME MEASURES: Isokinetic maximum-repetition peak torque per body mass (PT/BM) and total work (TW), PT and TW limb-symmetry index (LSI), and flexor-to- extensor PT ratio were evaluated during concentric knee extension-flexion movements at lower (60°/s) and higher (240°/s) isokinetic velocities. RESULTS: The main finding was that compared with the individuals with ACLI, patients with APCLI produced in their injured limbs lower mean TW (extension: 30.3%, flexion: 28.2%) and had lower mean TW LSI (extension 74% in APCLI vs. 91.6% in ACLI; flexion 61.3% in APCLI vs. 90.8% in ACLI) at the higher but not lower speed of isokinetic testing. However, at the lower velocity the quantified size of reduction in PT/BM and TW was greater in subjects with APCLI than ACLI as compared with the CON individuals. CONCLUSIONS: After bi-cruciate-ligament injury the capacity to produce torque by concentric muscle contractions throughout knee-extension and -flexion movements performed with high speed is lower in injured limbs than after isolated anterior cruciate ligament tear.

Effects of sensorimotor foot training on the symmetry of weight distribution on the lower extremities of patients in the chronic phase after stroke.

[Purpose] To assess the effects of sensorimotor foot stimulation on the symmetry of weight distribution on the feet of patients in the chronic post-stroke phase. [Subjects and Methods] This study was a prospective, single blind, randomized controlled trial. In the study we examined patients with chronic stroke (post-stroke duration > 1 year). They were randomly allocated to the study group (n=8) or to the control group (n=12). Both groups completed a standard six-week rehabilitation programme. In the study group, the standard rehabilitation programme was supplemented with sensorimotor foot stimulation training. Each patient underwent two assessments of symmetry of weight distribution on the lower extremities with and without visual control, on a treadmill, with stabilometry measurements, and under static conditions. [Results] Only the study group demonstrated a significant increase in the weight placed on the leg directly affected by stroke, and a reduction in asymmetry of weight-bearing on the lower extremities. [Conclusion] Sensorimotor stimulation of the feet enhanced of weight bearing on the foot on the side of the body directly affected by stroke, and a decreased asymmetry of weight distribution on the lower extremities of patients in the chronic post-stroke phase.

Does Nordic walking improves the postural control and gait parameters of women between the age 65 and 74: a randomized trial.

[Purpose] To assess the effect of 12-weeks Nordic walking training on gait parameters and some elements of postural control. [Subjects and Methods] Sixty-seven women aged 65 to 74 years were enrolled in this study. The subjects were divided into a Nordic Walking group (12 weeks of Nordic walking training, 3 times a week for 75 minutes) and a control group. In both study groups, a set of functional tests were conducted at the beginning and at the end of the study: the Forward Reach Test (FRT) and the Upward Reach Test (URT) on a stabilometric platform, and the analysis of gait parameters on a treadmill. [Results] The NW group showed improvements in: the range of reach in the FRT test and the URT test in compared to the control group. The length of the gait cycle and gait cycle frequency also showed changes in the NW group compared to the control group. [Conclusion] A 12-week NW training program had a positive impact on selected gait parameters and may improve the postural control of women aged over 65 according to the results selected functional tests.

Iron Management and Anemia in Patients on the Active Kidney Transplant List.

INTRODUCTION: Iron metabolism disorders and anemia are one of the main complications of end-stage renal disease that may affect the evaluation process for kidney transplantation. The study aimed to assess the iron metabolism in hemodialysis patients in relation to waiting list status. STUDY METHOD: The study included 5068 hemodialysis patients, including those on the active waiting list (N = 449) and those who were not eligible for the waitlist (N = 4619). Demographic and biochemical data, Charlson's comorbidity index, duration of hemodialysis therapy and, respectively, hemoglobin, ferritin, and transferrin saturation levels were compared in both groups of patients. RESULTS: Patients on the active waiting list were significantly younger -53.2 vs 67.2 years (P < .001), with a lower Charlson comorbidity index score: 3.33 vs 4.42 (P < .001). The duration of hemodialysis therapy was similar: 66.0 vs 63.2 months (P = .416), the incidence of anemia according to World Health Organization (90.6%, vs 91.2%) and KDIGO (72.4% vs 70.4%). The degree of anemia correction in terms of hemoglobin concentration and transferrin saturation was comparable in both groups and amounted to an average of 10.9 g/dL (P = .349) for hemoglobin concentration and 32.7% vs 33.4% (P = .513) for transferrin saturation. However, there was a statistically significant difference in ferritin concentration: 554 ug/L vs 733 ug/L (P = .001). CONCLUSIONS: Patients on the active list have significantly lower ferritin levels despite similar duration of hemodialysis treatment and comparable hemoglobin values. This may be due to lower inflammation, and less frequent blood transfusions, and lead to a lower risk of immunization and an increased chance of potential kidney transplantation.

Polish Cultural Adaptation and Reliability of the Fugl-Meyer Assessment of Motor Performance and Sensory Assessment Scale in Stroke Patients.

Background and Purpose: The Fugl-Meyer Assessment of Motor Performance and Sensory Assessment Scale (FMA) is the most commonly used and recommended outcome measure for the sensorimotor impairment of the upper and lower limbs in stroke patients. The aim of this study was to perform cross-cultural translation and adaptation of the scale into Polish and to evaluate the FMA's reliability of motor performance and sensation of the upper and lower limb sections among ischemic stroke patients. Methods: The Polish version of the FMA (FMA-PL) was developed using a forward-backward translation performed by a group of experts and then evaluated by a panel of judges according to international guidelines. The study involved 86 patients (F = 30, M = 56, i.e., 35%; the average age of patients was 64 ± 12 years, 36 with right-sided stroke and 50 with left-sided stroke). The FMA-PL was carried out twice by two experienced neurological physiotherapists with a 2 h gap between assessments (test-retest and inter-rater). The reliability of the outcome measure was defined by calculating the intraclass correlation coefficient (ICC). The standard error of measurement (SEM) and the minimum detectable change (MDC) were also calculated. The internal consistency of the test was determined by the Cronbach's alpha indicator. Results: Three domains were evaluated on the FMA-PL scale. From the whole test, results were obtained in the range of 12-124 points: 64 points for FMA-UE-PL 2, 34 points for FMA-LE-PL 4, and 24 points for FMA-S-PL 0. The ICC values were in the range of 0.99-1.00 for the total FMA-PL score and the results of each domain. The SEM and MDC for the entire FMA-PL calculated for test-retest measurements were 0.22 and 1.60, respectively. The SEM and MDC for the total FMA-PL score obtained during repeated measurements of the same investigator were 1.3 and 3.5 points, respectively. The Cronbach's alpha values calculated for the total FMA-PL, FMA-UE-PL, FMA-LE-PL, and FMA-S-PL items amounted to 0.938-0.939, 0.932-0.934, and 0.634-0.722, respectively. Conclusions: The Polish version of the FMA is a consistent and reliable outcome measure for the motor and sensory evaluation of the upper and lower limbs for patients in subacute and chronic stroke stages.

Blood pressure control and primary prevention of stroke: summary of the recent clinical trial data and meta-analyses.

Stroke is the second most common cause of death worldwide and of adult disability, but in the near future the global burden of cerebrovascular diseases will rise due to ageing and adverse lifestyle changes in populations worldwide. The risk of stroke increases at blood pressure levels above 115/75 mm Hg and high blood pressure (BP) is the most important modifiable risk factor for stroke, associated with 54 % episodes of stroke worldwide. There is strong evidence from clinical trials that antihypertensive therapy reduces substantially the risk of any type of stroke, as well as stroke-related death and disability. The risk attributed to BP is associated not only with absolute values but also with certain parameters describing BP diurnal pattern as well as short-term and long-term variability. Many studies reported that certain features of BP like nocturnal hypertension, morning surge or increased variability predict an increased stroke risk. However, there is no accepted effective modality for correction of these disturbances (chronotherapy, certain classes of antihypertensive drugs). In the elderly, who are mostly affected by stroke, the primary prevention guidelines recommend treatment with diuretics and calcium channel blockers to lower blood pressure to the standard level.

The influence of elevated heart rate assessed by automated office blood pressure measurement on the risk of cardiovascular events.

INTRODUCTION: The predictive value of heart rate (HR) assessed using an automated office blood pressure measurement (AOBPM) remains unknown. OBJECTIVES: This study aimed to determine the impact of AOBPM HR on the risk of cardiovascular events in hypertensive patients with and without prior cardiovascular disease (CVD). PATIENTS AND METHODS: Data of 9361 participants of the Systolic Blood Pressure Intervention Trial (median follow­up, 3.26 years) were used to perform a post hoc analysis based on baseline AOBPM HR levels (<50, 50-60, 60-70, 70-80, and >80 bpm). Clinical composite end point (CE) was defined as myocardial infarction (MI), acute coronary syndrome other than MI, heart failure exacerbation, stroke, or cardiovascular death. Cardiovascular­related and all­cause mortalities were also evaluated. RESULTS: A total of 1877 participants with and 7484 individuals without CVD were included. Those with higher baseline HR were less frequently men and more often smokers, had higher body mass index and estimated glomerular filtration rate, lower baseline systolic blood pressure, and higher diastolic blood pressure. No differences were observed in the CE frequency, its components, and all­cause death between the baseline HR groups. Elevated HR (>70 bpm) was associated with a higher risk of CE, MI, and cardiovascular death in a multivariable Cox model. Moreover, the model determining the MI risk showed a J­shaped relationship with HR and a significant interaction term (P = 0.049) between HR and CVD history. CONCLUSIONS: High AOBPM HR is associated with a higher risk of cardiovascular events and mortality, whereas low HR may result in higher MI risk in patients with previous CVD.

Apparently Resistant Hypertension in Polish Hemodialyzed Population: Prevalence and Risk Factors.

BACKGROUND: The aim of this study was to assess the prevalence, characteristics, and determinants of apparent treatment-resistant hypertension (aTRH) in an unselected large population of patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) throughout the country. METHODS: A database of 5879 patients (mean age 65.2 ± 14.2 years, 60% of males receiving hemodialysis) was obtained from the biggest provider of hemodialysis in the country. Hypertension and aTRH were defined using pre- or/and post-dialysis BP values. Patients with and without aTRH (non-aTRH) were compared. RESULTS: Using pre- and post-dialysis criteria, hypertension was diagnosed in 90.7% and 89.1% of subjects, respectively. According to pre- and post-dialysis blood pressure criteria, aTRH incidences were 40.9% and 38.4%, respectively. The hypertensive patients with aTRH versus non-aTRH were younger, had a higher rate of cardiovascular disease, lower dialysis vintage, shorter time on dialysis, higher eKt/V, higher ultrafiltration, higher pre- and post-dialysis BP and HR, and higher use of antihypertensive drugs. Factors that increase the risk of aTRH according to both pre- and post-dialysis BP criteria were age-OR 0.99 [0.98-0.99] and 0.99 [0.98-0.99], the history of CVD 1.26 [1.08-1.46] and 1.30 [1.12-1.51], and diabetes 1.26 [1.08-1.47] and 1.28 [1.09-1.49], adjusted OR with 95% CI. CONCLUSIONS: In the real-life world, as much as 40% of HD patients may have aTRH. In ESKD HD patients, aTRH seems to be multifactorial, influenced by patient-related rather than dialysis-related factors. Various definitions of aTRH preclude easy comparisons between studies.

The objective evaluation of effectiveness of manual treatment of spinal function disturbances.

BACKGROUND: The aim of this paper is the evaluation of effectiveness of manual therapy in the treatment of functional disturbances of the spine. MATERIAL/METHODS: The study subjects were 40 persons aged 45-60 years, in whom degenerative changes in intervertebral discs and physical limitations within the spine were found (NMR), which were manifested as pain. Subjects were randomly divided into 2 groups of 20 persons each. The first group went on a monthly rehabilitation tour, where the manual therapy methods were applied. The second group was treated by means of physical methods. In order to verify the results of effectiveness of the therapies, the examination of the sectional mobility and the evaluation of the spinal curvatures before and after the completion of the therapy were made by means of a tensiometric electrogoniometer. RESULTS: The percentage differences in significance result from the lower value of parameter t1 in the group of persons treated physically. The dynamics of changes in the parameters in the sectional mobility in both tested groups was highest in the cervical and lumbar spine. The manually treated group had greater dynamics of changes in functional parameters of the spine. CONCLUSIONS: Manual therapy is an effective method for treatment of functional changes and early structural changes within the spine, and may be used as supplementary therapy in relation to the standard model of treatment of spinal pain.

Answering Clinical Questions Using Machine Learning: Should We Look at Diastolic Blood Pressure When Tailoring Blood Pressure Control?

Background: The guidelines recommend intensive blood pressure control. Randomized trials have focused on the relevance of the systolic blood pressure (SBP) lowering, leaving the safety of the diastolic blood pressure (DBP) reduction unresolved. There are data available which show that low DBP should not stop clinicians from achieving SBP targets; however, registries and analyses of randomized trials present conflicting results. The purpose of the study was to apply machine learning (ML) algorithms to determine, whether DBP is an important risk factor to predict stroke, heart failure (HF), myocardial infarction (MI), and primary outcome in the SPRINT trial database. Methods: ML experiments were performed using decision tree, random forest, k-nearest neighbor, naive Bayesian, multi-layer perceptron, and logistic regression algorithms, including and excluding DBP as the risk factor in an unselected and selected (DBP < 70 mmHg) study population. Results: Including DBP as the risk factor did not change the performance of the machine learning models evaluated using accuracy, AUC, mean, and weighted F-measure, and was not required to make proper predictions of stroke, MI, HF, and primary outcome. Conclusions: Analyses of the SPRINT trial data using ML algorithms imply that DBP should not be treated as an independent risk factor when intensifying blood pressure control.

Consistency among Office, Home, and Ambulatory Blood Pressure Values in Women with Chronic Hypertension and History of Eclampsia or Preeclampsia.

Adequate control of blood pressure (BP) is essential to prevent complications in pregnant women with a history of eclampsia or pre-eclampsia. However, the importance of office (OBPM), home (HBPM), and ambulatory (ABPM) BP measurements for proper control and prognosis in high-risk pregnancy is unknown. The present study aimed to compare BP values obtained during these three different BP measurements in women with a history of eclampsia or pre-eclampsia. This study included 79 pregnant women with chronic hypertension and a documented history of eclampsia or pre-eclampsia in previous pregnancy/pregnancies. Every fifth week of the study, all participants underwent ABPM, HBPM and OBPM. BP values from the 10th, 25th, and 37th weeks of pregnancy were evaluated. Therapy was intended to meet the ABPM treatment goal of <130/80 mmHg. Day, night, and 24 h ABPM systolic BP values were lower than HBPM and OBPM values at each study visit. Night and 24 h ABPM diastolic BP values were lower than HBPM and OBPM values, while day 24 h ABPM values were slightly higher than HBPM and OBPM values. ABPM provides different BP values than OBPM and HBPM. Target BP for ABPM in high-risk pregnancy hypertension should be estimated based on the predictive value of adverse pregnancy outcomes.