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Environmental noise significantly impacts human health and well-being. It is a widespread problem in Europe, where at least one in five people are exposed to harmful levels of noise. Hearing loss is the most known health effect related to noise exposure. There is, however, growing data that links noise exposure to hypertension, coronary artery disease, and stroke. According to some theories, this relationship may be explained by the indirect pathway of noise exposure, which can cause sympathetic and endocrine activation, as well as several cognitive and emotional responses, including annoyance. Noise exposure leads to stress reactions independent of cognitive involvement. There is a possibility that noise exerts its effects directly through synaptic interactions, as well as through cognitive and emotional effects. Epidemiological studies indicate that nocturnal noise exposure has more profound health consequences. Nighttime noise exposure is associated with an increase in heart rate due to sympathetic activation or parasympathetic withdrawal, and with an increase in blood pressure as well as endothelial dysfunction. Hypertension is a common condition and is an important risk indicator for other cardiovascular diseases. Previous studies showed an association between noise exposure, blood pressure and arterial hypertension. Meta-analysis of cross-sectional studies found an increase of hypertension prevalence per 10 dB increase in daytime average road traffic noise level. There is, however, some heterogeneity among these studies. Prospective studies have also found an association between aircraft noise exposure and hypertension, supporting the cross-sectional findings. The analyses, of data from the large Hypertension and Exposure to Noise near Airports (HYENA) study, showed that an increase in nocturnal aircraft noise exposure per 10 dB was associated with an increased incidence of hypertension. The meaningful effect of night-time aircraft noise on arterial hypertension was also observed in the prospective observation of the subset of individuals from that study. In a longitudinal observation of 420 participants, higher aircraft noise exposure during the night significantly associated with the incidence of hypertension. Previous cross-sectional case-control study conducted in 2015, in 2 suburban areas of Krakow, Poland, revealed an increase in blood pressure and arterial stiffness as determined by carotid - femoral pulse wave velocity in individuals exposed to increased aircraft noise levels. However, even short-term noise reduction, as experienced during the COVID-19 lockdown, may reverse those unfavorable effects. As a result of these observations, noise mitigation strategies are important for cardiovascular health.
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Objective: Cardiovascular diseases including hypertension are common comorbidities in patients hospitalized due to COVID-19. We assessed the impact of hypertension on in-hospital mortality in patients hospitalized due to COVID-19. Design and method: We retrospectively analyzed the medical records of all consecutive patients who were admitted to the University Hospital in Krakow, Poland, due to confirmed SARS-CoV2 infection from March 2020 to May 2021. Results: Overall, data of 5191 patients (mean age 61.9 ± 16.7 years) were available for analysis. Patients with preexisting hypertension (58.3% of the study population) were older and had more comorbidities than patients without hypertension (p < 0.05). In-hospital mortality was significantly higher in patients with hypertension compared to those without hypertension also after adjustment for age (22.2% vs 12.9%;P = 0.02). Age above median (64 years, odds ratio [OR] 3.93;95% confidence interval [CI] 3.23-4.83), male gender (OR 1.19;CI 1.01-1.40), a history of heart failure (OR 2.01;CI 1.58-2.56) or chronic kidney disease (OR 2.35;CI 1.86-2.96) and increased C-reactive protein levels (OR 1.09;CI 1.08-1.10), but not preexisting hypertension (OR 0.90;CI 0.74-1.09) were significantly associated with a higher risk of in-hospital death after multivariate logistic regression analysis. However, hypertension (OR 1.45;CI 1.06-1.97) was an independent predictor of in-hospital death in patients without established cardiovascular disease and antihypertensive treatment. Treatment with any first-line antihypertensive drug class in patients with hypertension at the time of hospitalization was associated with a lower risk of in-hospital death (beta-blockers OR 0.52;CI 0.41-0.65;angiotensin converting enzyme inhibitors OR 0.52;CI 0.38-0.68;angiotensin receptor blockers OR 0.24;CI 0.12-0.41;calcium channel blockers OR 0.61;CI 0.44-0.84;thiazide diuretics OR 0.40;CI 0.24-0.64). Conclusions: Besides the high prevalence, hypertension was not an independent risk factor of in-hospital death in the overall group of hospitalized COVID-19 patients. Treatment with all first-line antihypertensive medications was associated with significant reduction of in-hospital death in patients with hypertension.
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INTRODUCTION It is well known that COVID-19 affects the cardiovascular system by exacerbating heart failure in patients with preexisting conditions and troponin elevation in critically ill patients. The insight into the cardiovascular involvement and sequelae in those with no preexisting conditions is poor. We performed a systematic and comprehensive echocardiographic evaluation of patients hospitalized with COVID-19. The aim of the study was to analyze cardiac performance in subjects with no prior history of structural heart disease in relation to inflammatory markers and clinical outcome. The study is a part of CRACoV project, with prospective design and an assumed 12-month follow-up. Following data are preliminary results of baseline examinations. MATERIAL AND METHODS The study included 106 patients hospitalized with diagnosed COVID-19 infection (age 56.7 ± 12,8 years;39 women). Patients with prior heart failure, known structural heart disease, acute coronary syndrome, acute stroke or acute vascular episode as well as chronic kidney disease, chronic inflammatory or neoplasmatic disease were excluded from the study. In all participants standard clinical assessment and laboratory tests including C-reactive protein (CRP), interleukin 6 (IL-6), cardiac troponin I, N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were performed. Severity of the disease was classified according to World Health Organization criteria. An extended echocardiographic image acquisition protocol was performed in all subjects within 72-hours from admission. All analyses, including left ventricle (LV) longitudinal deformation (GLS), were performed off-line. RESULTS COVID-19 had severe course in 58 subjects, 4 patients in critical condition died during hospitalization. High-flow oxygen therapy was required in 17 subjects. LV systolic function was preserved in all subjects (mean 62.3 ± 5.2%;GLS -19.9 ± ± 6.4;CO 5.51 ± 1.47 l/min). Averaged E/Eè was 6.97 ± 1.80. Right ventricle (RV) was enlarged in 6 patients, in all RV function was preserved (TAPSE 24.6 ± 3.74 mm, RV S' 15.6 ± 3.03 mm). In one patient RV thrombus was detected. Pericardial effusion was present in 8 patients. Elevated NT-pro-BNP (>300 pg/ml) was detected in 34 patients and elevated troponin in 3 subjects. NT-pro-BNP significantly correlated with CRP (r = 0.24;P <0.01);IL-6 (r = 0.28;P <0.01) and negatively with LV GLS (r = -0.27;P = 0.01). In multiple regression the risk of high-flow oxygen therapy was related with male gender (b = -0.30;P = 0.04), CRP (b = 0.50;P <0.005), NT-pro-BNP (b = -0.28;P = 0.04) and RV diameter (b = 0.33;P = 0.02). CONCLUSIONS In subjects with COVID-19 and normal LV systolic function, elevation of NT-pro-BNP is frequent and reflects haemodynamic stress related with acute inflammatory disease. NT-pro-BNP significantly associates with the risk of severe course of COVID-19. RV diameter is independently related with worse prognosis in COVID-19.
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Objective: The COVID-19 lockdown caused unprecedented decline in environmental noise pollution. We aimed to evaluate the impact of aircraft noise exposure decrease during lockdown on blood pressure (BP) and selected hypertensionmediated organ damages. Design and method: As previously reported (J Hypertens. 2019;37) in 2015 (1st observation) we examined group of inhabitants exposed to high (>60 dB) aircraft noise living near Cracow Airport (n=101), and compared them to unexposed group (<55 dB) (n=100). In June 2020, 4 months after COVID-19 pandemic restrictions introduction, we reassessed (2nd observation) 74 and 75 participants from previously exposed and unexposed groups, respectively, using the same study protocol. We collected medical history, office and ambulatory BP, echocardiographic and arterial stiffness data. Results: In exposed to aircraft noise group the prevalence of arterial hypertension increased from 1st to 2nd observation (P<0.05). During lockdown in the noise exposed group office and 24 hour diastolic BP (DBP, P<0.022) decreased signifi-cantly, which was accompanied by a significant drop in annoyance (P=0.006). In this group in 2nd observation DBP was significantly lower than estimated DBP (i.e. calculated as a sum of DBP at 1st observation and parameter estimates of crosssectional association of DBP and age multiplied by 5.5 year-time period between observations) (P=0.047). The obtained decline in DBP from 1st to 2nd observation was grater in noise exposed than unexposed participants, even after adjustment for covariates. The carotid-femoral pulse wave velocity (PWV), initially higher in noise exposed group, decreased from 1st to 2nd observation in both groups, however this was more pronounced in the exposed than unexposed group (P=0.003). In 1st observation PWV in noise exposed participants did not show any relationship with age (Parameter Estimate (PE)=0.01 m/s/year;P= 0.71), while in 2nd observation, during aircraft noise decline caused by COVID-19 lockdown, the expected positive relation of PWV with age was reinstituted (PE=0.15 m/s/year;P<0.001). Conclusions: As our previous study indicated, aircraft noise exposure may increase BP and accelerate arterial stiffening. The decrease in BP and PWV due to noise intensity diminution, observed during COVID-19 lockdown, in fact provides evidence for this observation.