[Evaluation of transfer parameters in patients admitted to our hospital with ST-elevation myocardial infarction]. / ST-yükselmeli miyokart enfarktüsü ile basvuran hastalarin transfer parametrelerinin degerlendirilmesi.

OBJECTIVE: Acute coronary syndrom (ACS) is a common disease that causes severe morbidity and mortality. The most important aspect of ST-elevation myocardial infarction (STEMI) as a subgroup of ACS treatment is the rapid reperfusion of arteries. Successful results depend not only on the experience of the center but also on the rapidity in which reperfusion is achieved. In our study, the transfer parameters were evaluated in patients who were admitted to our hospital with STEMI. METHODS: Two hundred consecutive patients (160 males, 40 females) who underwent primary percutaneous coronary intervention (PCI) for acute STEMI between January 2011 and March 2013 were included in our study. Transfer parameters of symptom-to-reperfusion treatment, clinical characteristics, and laboratory parameters were recorded. RESULTS: Thirty-six patients were admitted to our hospital with ambulances; 70 patients were admitted to centers without PCI capability, with a mean transfer time to our hospital of 73.9±12.5 min. Median pain-to-first medical contact time was 105 min (range: 5-600 min), and average first medical contact-to-balloon time was 115.5 min (range: 20-414 min). Total pain-to-balloon time in females was significantly higher than males (246 min [range: 70-840 min], 195 min [range: 45-684 min], respectively, p=0.032). Mean pain-to-balloon time was significantly lower in patients delivered to the hospital by ambulance than in patients admitted to emergency departments independently (185 min [range: 45-439 min], 248 min [range: 65-840 min], respectively, p=0.017). CONCLUSION: In this study, our hospital door-to-balloon time was found compatible with the target specified in the European Society of Cardiology and American College of Cardiology STEMI guidelines; however, first medical contact-to-balloon time was found to be above that advised by the current guidelines.

The relationship between acute coronary syndrome and sildenafil.

Sildenafil is a drug used for male erectile dysfunction. Sildenafil's fatal cardiac effects except due to hypotension with simultaneous nitrate use have not been reported.We reported in this case a 70-year-old man admitted to the emergency service with chest pain, which occurs in an hour after sildenafil use. Electrocardiogram showed inferoposterior ST-segment elevation. In angiography, total circumflex artery occlusion has been seen.

Heart rate variability and heart rate recovery in patients with type 1 diabetes mellitus.

OBJECTIVE: Patients with diabetes mellitus (DM) are at an increased risk of sudden cardiac death (SCD) partly explained by cardiac autonomic neuropathy (CAN). There have been fewer studies to evaluate CAN using heart rate variability (HRV) and heart rate recovery (HRR) in patients with type 2 DM.To our knowledge, there has been no study to investigate the association between HRR, HRV and type 1 DM. The purpose of this study was to examine the changes in HRR and HRV measurements in type 1 diabetic patients. METHODS: The study population consisted of 35 consecutive patients with type 1 diabetes and 35 sex- and age-matched non-diabetic controls. We performed electrocardiography, echocardiography, Holter analysis, exercise stress test, routine biochemical tests including haemoglobin Ale, high-sensitivity C-reactive protein and evaluated the clinical characteristics. HRR was calculated by subtracting the heart rate values at the first minute of the recovery phase from the peak heart rate. Abnormal HRR was defined as HRR < or = 18 beats.The HRV analysis was performed in both time domain and frequency domain. RESULTS: In HRV analysis, type 1 diabetic patients had significantly lower time domain [SDNN (P=0.041), SDANN (P=0.016), r-MSSD (P<0.001), pNN50 (P<0.001)] and frequency domain [total power (P=0.002), VLF (P<0.001), LF (P<0.001), HF (P=0.001), LF/HF (P=0.034)] HRV parameters as compared to controls. In logistic regression analysis, the HRR (OR 0.927, 95% CI 0.872 to 0.985, P= 0.014), METs (OR 0.562, 95% CI 0.355 to 0.890, P= 0.014), pNN50 (OR 0.729, 95% CI 0.566 to 0.941, P= 0.015) and HF (OR 0.952, 95% CI 0.911 to 0.994, P= 0.027) were independently associated with type 1 DM. CONCLUSION: The results of this study showed that HRV parameters and HRR were significantly reduced in patients with type 1 versus healthy controls. We found that HRV parameters correlated with HRR in type 1 diabetic patients. There is a relationship between CAN and inflammation and also, there may be a relationship between CAN and intensive glycaemic control according to this study.

Epidemiology of atrial fibrillation in Turkey: preliminary results of the multicenter AFTER study.

OBJECTIVES: Although atrial fibrillation (AF) is one of the most common rhythm disorders observed in clinical practice, a multicenter epidemiological study has not been conducted in our country. This study aimed to assess our clinical approach to AF based upon the records of the first multicenter prospective Atrial Fibrillation in Turkey: Epidemiologic Registry (AFTER) study. STUDY DESIGN: Taking into consideration the distribution of the population in our country, 2242 consecutive patients with at least one AF attack determined by electrocardiographic examination in 17 different tertiary health care centers were included in the study. Inpatients and patients that were admitted to emergency departments were excluded from the study. Epidemiological data of the patients and the treatment administered were assessed. RESULTS: The mean age of the patients was determined as 66.8 ± 12.3 years with female patients representing 60% of the study population. While the most common AF type in the Turkish population was non-valvular AF (78%), persistent/permanent AF was determined in 81% of all patients. Hypertension (%67) was the most common co-morbidity in patients with AF. While a stroke or transient ischemic attack or history of systemic thromboembolism was detected in 15.3% of the patients, bleeding history was recorded in 11.2%. Also, 50% of the patients were on warfarin treatment and 53% were on aspirin treatment at the time of the study. The effective INR level was detected in 41.3% of the patients. The most frequent cause of not receiving anticoagulant therapy was physician neglect. CONCLUSION: These results demonstrate the necessity for improved quality of physician care of patients with AF, especially with regards to antithrombotic therapy.

Impact of body mass index on left ventricular diastolic dysfunction.

BACKGROUND: The prevalence of obesity is increasing in the developed and developing world. It is an independent risk factor for heart failure. Left ventricular (LV) diastolic dysfunction has been demonstrated to be a strong predictor of heart failure. In the present study we aimed to assess the impact of body weight on LV diastolic function. METHODS: The study was conducted on 2,228 participants (1,424 women, 804 men with a mean age of 49). Traditional and tissue Doppler echocardiographic examination were performed in all of the participants. The demographic and echocardiographic data were compared. Multivariate logistic regression analysis was used to assess the independent predictors of association of LV diastolic function. The study sample was divided into four groups: group 1 (body mass index [BMI] < 25.0 kg/m(2) ), group 2 (BMI 25.0-29.9 kg/m(2)), group 3 (BMI ≥ 30-39.9 kg/m(2)), and group 4 (BMI ≥ 40 kg/m(2)). RESULTS: Septal E was significantly lower in groups 2 and 3 compared to group 1 (P = 0.003). Septal A and septal A' were significantly higher whereas septal E' and lateral E' were significantly lower in the groups 2, 3, and 4 compared to the normal weight group (P < 0.001). Lateral A', deceleration time, and ejection time were significantly higher in obese when compared to the normal weight (P = 0.025, P < 0.001, and P = 0.009, respectively). The E/E' ratio was significantly higher in groups 2, 3, and 4 compared to the group 1 (P < 0.001). Logistic regression analysis revealed that age, BMI (OR = 1.060 [95% CI = 1.040 and 1.080]; P < 0.001), hypertension, and diabetes mellitus were independent predictors of LV diastolic dysfunction. CONCLUSION: BMI is an independent predictor of LV diastolic dysfunction along with age, hypertension, and diabetes mellitus.

Heart rate recovery index in patients with psoriasis.

OBJECTIVES: In clinical practice, autonomic functions are indirectly investigated with heart rate recovery (HRR) index measurements. Our aim was to evaluate the HRR index in patients with psoriasis, which is a systemic inflammatory disease. STUDY DESIGN: The study population included 39 psoriasis patients (18 female, mean age 48±15 years) and 40 control group (18 female, mean age 44±9 years) healthy individuals. The severity of psoriasis was calculated using the psoriasis area and severity index (PASI). None of the study patients had a PASI score >50. All of the participants underwent treadmill exercise testing using the Bruce protocol. RESULTS: According to basic clinical and demographic characteristics, both groups were similar with regard to age, body mass index, and fasting glucose and cholesterol levels. No significant differences were observed in the systolic or diastolic blood pressures or resting heart rates between the two groups. All patients and control-group participants had sinus rhythm and normal 12-lead ECG results at rest. All subjects completed the exercise tests to exhaustion without rhythm abnormalities, ischemic changes, or other complications. The maximal heart rate and metabolic equivalents achieved during the exercise stress test (EST) were similar in the psoriasis and control group (163±16 vs. 170±16, p=0.07; 9.8±0.9 vs. 10.1±1.0, p=0.24, respectively). The 1st, 3rd, and 5th minute HRR indices of patients with psoriasis were similar to those of the control group (HRR1: 30±12, 32±18, p=0.71; HRR3: 57±13, 64±17, p=0.10; HRR5: 64±15, 68±16, p=0.46, respectively). CONCLUSION: The HRR index, which is calculated by an EST and associated with autonomic nervous system function, is not effected in mild to moderate psoriasis patients.

Clinical Presentation, Electrocardiographic Findings, and Factors Related to the Hospitalization In Mad-Honey Intoxication.

Objectives: Mad-honey intoxication (MHI) often presents with all kinds of bradyarrhythmias. Despite numerous publications focused on clinical findings, we aim to evaluate poor prognostic implications, ischemia likely electrocardiography (ECG) changes, and detailed ECG findings of MHI in the largest series. Methods: This is a retrospective single-center study of 117 MHI patients admitted to emergency service. Results: The study had 26 (22.2%) females (median 52.5 years) and 91 (77.8%) males (median 51.0 years). Fifty-six (47.9%) patients had ischemia likely changes on ECG. Multivariate model demonstrated that beta-blocker usage (odds ratio (OR): 52.871; 95% confidence interval (CI): 3.618-772.554 (p=0.004)), atrioventricular junctional rhythm (AVJR) (OR: 5.319; 95%CI: 1.090-25.949 (p=0.039)), and quantity of mad-honey consumption (OR: 1.035; 95% CI: 1.008-1.063 (p=0.011)) are predictors of hospitalization. ROC curve analysis showed cutoff value of mad-honey consumption quantity 24.79 g had 57% sensitivity and 68% specificity for predicting hospitalization (AUC: 0.7, 95% CI: 0.55-0.816, p=0.027). In addition, all hospitalized cases were male. Conclusion: Our study has shown that male gender, AVJR, the quantity of mad-honey consumption, and beta-blocker usage are high-risk criteria for hospitalization in MHI patients. Furthermore, ischemia likely ECG changes is often observed with MHI even independently from hypotension or bradycardia.

Carotid intima media thickness and cardiometabolic risk associates in Turkish adults.

OBJECTIVE: Carotid intima media thickness (CIMT) is a strong predictor of future vascular events. However, data for Turkish individuals are limited and the association between cardiometabolic risk factors and CIMT has not been studied before.Therefore, we sought to investigate the CIMT and cardiometabolic risk associates in a large cohort of Turkish adults. METHODS AND RESULTS: The study was conducted on 2230 participants (1427 women, 803 men with a mean age of 49). The participants underwent a Doppler Ultrasound examination of CIMT. Mean CIMT was 0.61 +/- 0.19 mm. Age- and sex-adjusted partial correlation analysis revealed that only systolic blood pressure and smoking amount was significantly correlated with CIMT. Receiver operator characteristics (ROC) calculations showed that age had the best area under the curve (AUC = 0.84), smoking had the best sensitivity (86%) and diastolic blood pressure (> 88 mmHg) had the best specificity (74%) in predicting a person with thickened carotid intima media (> 0.8 mm). Independent predictors of thickened carotid intima media were hypertension [(odds ratio (OR) = 2.74; 95% confidence interval (CI) = 1.663-4.53; P value < or = 0.001)], systolic blood pressure [OR = 1.01; 95% CI = 1.002-1.022; P value = 0.022] and age [OR = 1.11; 95% CI = 1.079-1.136; P value < or = 0.001). CONCLUSION: Age, systolic blood pressure and smoking amount (pack/year) were the only age- and sex-adjusted associates of CIMT. Age had the best AUC in ROC analysis predicting thickened carotid artery intima media. Hypertension, systolic blood pressure and age were independent predictors of high CIMT in Turkish adults.

The prognostic value of mean platelet volume in decompensated heart failure.

BACKGROUND: Congestive heart failure (CHF) is a major public health problem that is related to substantial morbidity, impaired quality of life and diminished survival. Mean platelet volume (MPV) is an indicator of platelet activation. AIM: To investigate whether there is a difference of MPV in patients with decompensated and stable heart failure (SHF), and test the prognostic value of MPV in decompensated heart failure (DHF). METHODS: 136 consecutive patients with DHF were enrolled. 71 with SHF were also enrolled for comparison. Patients were followed up for a mean of 18±12 months. The primary endpoint was death from any cause. Clinical characteristics of patients with DHF who died during follow-up were compared with the those of the survivors. RESULTS: MPV was significantly higher in DHF group than in the SHF group. 71 patients died during the follow-up period (18±12 months). Comparison with survivors revealed that mortality was associated with age, systolic blood pressure, pulmonary artery pressure, serum creatinine, urea and MPV. MPV was determined as an independent risk factor for mortality (OR 1.553, 95% CI 1.024 to 2.354, p=0.038). Receiver operating characteristic analysis showed that MPV level on admission was a predictor of mortality (area under the curve (AUC) for in-hospital mortality was 0.716 (95% CI 0.632 to 0.789, p=0.003) and AUC for 6-month mortality was 0.815 (95% CI 0.74 to 0.877, p<0.001), respectively). CONCLUSION: MPV is increased in patients with DHF. Also, MPV on admission is an independent predictor of in-hospital mortality and 6-month mortality.

Mean platelet volume in patients with non-alcoholic fatty liver disease.

Mean platelet volume (MPV) is an indicator of platelet activation. Platelet activation and aggregation are central processes in the pathophysiology of coronary heart disease. Non-alcoholic fatty liver disease (NAFLD) is present up to one-third of the general population and the majority of patients with cardio-metabolic risk factors such as abdominal obesity, type 2 diabetes and other components of the metabolic syndrome (MS). The aim of the current study was to investigate the MPV in patients who had NAFLD. MPV values of the patients with NAFLD and of the patients without fatty liver disease were compared. NAFLD patients had significantly higher body mass index compared to the control cases. Among biochemical variables, fasting plasma glucose and triglyceride were significantly higher in the NAFLD group. NAFLD cases also had lower platelet count and higher MPV (10.43 +/- 1.14 vs. 9.09 +/- 1.25; p < 0.001, respectively). MPV was positively correlated with AST (r: 0.186, p < 0.042), ALT level (r: 0.279; p 0.002) and the presence of NAFLD (0.492; p < 0.001) but negatively correlated with platelet number (r: -0.26; p 0.004) and creatinine (r: -0.255; p 0.005). In logistic regression analysis (age, gender, NAFLD, body mass index, high-density lipid (HDL) cholesterol, systolic and diastolic blood pressure, triglyceride and fasting plasma glucose were used as covariates) only NAFLD was found to be the independent predictor of MPV (Odds Ratio (OR) 21.98) [95% confidence interval (CI): 2.404-201.048; p: 0.006]. We have shown for the first time in the literature that, patients with NAFLD have higher MPV. It may have prognostic value in NAFLD patients indicating a possible cardiovascular disease (CVD) risk increase.

The platelet functions in patients with ankylosing spondylitis: anti-TNF-alpha therapy decreases the mean platelet volume and platelet mass.

The present study was designed to investigate the interaction between platelet indices (mean platelet volume (MPV), platelet count (PLC) and platelet mass (PLM)), inflammatory markers and disease activity in ankylosing spondylitis (AS) subjects. The effects of anti-TNF-alpha therapy and conventional treatment on platelet indices were also compared. We studied 68 patients with AS (group I, 46 men, age: 36.4 +/- 6.9 years) and as control group 34 age and sex-matched healty subjects. All patients received conventional therapy (CT) at the beginning (Group I). The patients were reevaluated after 3 months according to Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score. Group II consisted of 35 subjects who responded to the CT and continued to take the same therapy for 3 months additionally. Group III consisted of 33 subjects who had a high disease activity score (BASDAI > 4) after 3 months and were accepted refractory to the CT therapy. In Group III the treatment was switched to infliximab and continued for 3 months at the standard intravenous dose. Significantly higher baseline MPV, PLC and PLM was reported as compared to controls decreased by therapy (9.12 +/- 1.20 vs. 8.35 +/- 0.94 fl, p < 0.001, 340 +/- 69 vs. 251 +/- 56 (x 10(3)/ microL) p < 0.0001, 3096 +/- 736 vs. 2110 +/- 384; p < 0.0001, respectively). In the same way, they were substantially lowered by both treatments in group II and group III. PLC and PLM were positively correlated with WBC and ESR (r : 0.44; p < 0.0001, r : 0.41; p = 0.001, r : 0.52; p < 0.0001, r : 0.41; p = 0.001), respectively) in AS patients. Additionally, MPV and PLM were positively correlated with BASDAI score (r : 0.41; p < 0.001, r = 0.29; p < 0.001 respectively). We have found that increased platelet activity reduced by therapy in AS patients. Additionally, it was correlated with inflammatory markers and disease activity. According to these results, it can be suggested that both anti-TNF-alpha and conventional therapy might contribute to a decrease in the risk of cardiovascular morbidity and mortality in AS patients.

Mean platelet volume in patients with dipper and non-dipper hypertension.

Patients with non-dipper hypertension are known to carry a high risk of cardiovascular complications. In this study, we hypothesized that non-dippers may be associated with platelet dysfunction and it can be determined by mean platelet volume (MPV). A total of 216 outpatients treated with antihypertensive drugs for at least 6 months were enrolled. Dipper and non-dipper patterns were detected and clinical, laboratory and ambulatory blood pressure recording data were matched between non-dipping and dipping groups. MPV was significantly higher in patients in non-dipping than dipping groups (p<0.001). In correlation analyses, MPV was negatively correlated with the rate of systolic and diastolic fall at night (p<0.001, r=-0.46) and (p<0.001, r=-0.43), respectively. Also MPV was correlated with nocturnal pulse pressure (p=0.001, r=0.22). Other variables were similar between non-dipping and dipping groups. The present study showed that MPV is higher in non-dipping than dipping hypertensive patients. Platelet activation or dysfunction probably is an alternative mechanism for increasing cardiovascular events in non-dippers.

The effect of non-dipper pattern of hypertension on erectile dysfunction.

BACKGROUND: The purpose of this study was to evaluate the relationship between erectile dysfunction (ED) and non-dipper pattern in hypertensive patients. METHODS: A total of 750 consecutive patients with essential hypertension, who had been evaluated with ambulatory BP monitoring, were screened for this study. One hundred and thirty-two male patients (age range 28-54 years) who had fulfilled the inclusion and exclusion criteria were included in the final analysis. Dipper and non-dipper patterns were detected and sexual function was assessed by the self-administered questionnaire of the International Index of Erectile Function (IIEF). RESULTS: There was no significant difference between the two groups regarding the number of medications taken and the proportion of each class of antihypertensive medications. Mean age, body mass index, lipid profiles, rate of smoking were similar between the two groups. IIEF score was significantly higher in non-dippers than dippers (p= 0.009). Non-dipping was also found to be an independent determinant for ED. CONCLUSION: The result of the present study further suggests that non-dipping is a risk indicator for early deterioration of erectile function in hypertensive patients.

A comparison of blood pressure and pulse pressure values obtained by oscillometric and central measurements in hypertensive patients.

OBJECTIVE: Wide pulse pressure (PP) affects the accuracy of oscillometric blood pressure measurements (OBPM): however, the degree of this impact on different patient groups with wide PPs is unclear. This study will investigate the accuracy of OBPM in achieving target BP and PP in isolated systolic hypertension (ISH) group compared with mixed hypertension (MHT) group. METHOD: A total of 115 patients (70 with ISH and 45 with MHT) were enrolled in the study. Upper arm and wrist OBPM, obtained by OmronM3 and OmronR6 devices respectively, were compared with the simultaneously measured values from the ascending aorta. The ISH was defined as a systolic blood pressure (SBP) > or =140 mmHg and a diastolic blood pressure (DBP) <90 mmHg. MHT was defined as a SBP> or =140 mmHg and a DBP> or =90 mmHg. RESULTS: The mean central arterial blood pressure (BP) and central PP were higher in the ISH group than those in the MHT group. The upper arm OBPM underestimated the central SBP in two groups (-5 mmHg, -3 mmHg, p=0.5, respectively), but overestimated DBP in the ISH group compared with MHT patients (6.8 mmHg, 1 mmHg, p=0.04, respectively). Wrist OBPM similarly underestimated to the central SBP in each group (-16 mmHg, -19 mmHg, p=0.15), whereas the sum of overestimation of DBP was significantly higher in the ISH than in the MHT group (+6 mmHg, - 1 mmHg, p=0.001, respectively). Also, each of the devices underestimated the central PP in the ISH group (about 10 mmHg) as being higher than that of the MHT group. CONCLUSION: Oscillometric devices may be used for self-BP measurement in patients with ISH without clinically important disadvantages compared with the patients with MHT. For PP measurement in patients with ISH, there were substantial differences between intra-arterial and indirect arm BP measurements.

Pioglitazone improves ventricular diastolic function in patients with diabetes mellitus: a tissue Doppler study.

OBJECTIVE: Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in glycaemic control, plasma lipids, blood pressure and inflammation. The aim of this study was to investigate the effect of pioglitazone on systolic and diastolic function in diabetic patients. METHODS AND RESULTS: Forty-nine diabetic patients were included in the study. The patients had never received thiazolidinedione therapy before. Clinical and echocardiographic variables were measured. 30 mg pioglitazone were administered. The patients were followed up for six months and all the measurements were re-evaluated for comparison. Body mass index (BMI) significantly increased after treatment. Fasting glucose, HbA1c and systolic blood pressure decreased. Insulin resistance improved and the HOMA-IR index decreased after pioglitazone treatment. Mean aortic diameter, left atrial systolic and diastolic volumes significantly decreased after therapy. Among diastolic function variables mitral E wave, E/A, ejection time and pulmonary vein peak reverse flow velocity (PVA) significantly increased whereas isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT), deceleration time, E/E' and pulmonary vein late systolic flow (PVS2) decreased after pioglitazone therapy. Among tissue Doppler variables early (E) ventricular inflow velocities measured from the tricuspid lateral annulus, the mitral septal and lateral annulus, the anterior, inferior and posterior free wall significantly increased. Late (A) ventricular inflow velocities measured from the anterior, inferior free wall and the mitral septal annulus also increased. CONCLUSION: Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in measures of glycaemic control and diastolic ventricular function.

A case of acute stent thrombosis treated successfully with intracoronary tirofiban.

Acute stent thrombosis (AST) is occasionally observed during percutaneous coronary intervention in patients with acute coronary syndrome (ACS). It may jeopardize hemodynamic status. Currently, there is no adequate solution for this problem. We report our experience with an ACS patient who developed AST associated with cardiogenic shock after percutaneous coronary stent deployment. Intracoronary administration of tirofiban immediately restored the coronary flow of the target vessel, and the disastrous condition was reversed. Our experience suggests that intracoronary administration of tirofiban can be considered as an option in cases of AST during percutaneous coronary intervention.

Syncope caused by hyperkalemia during use of a combined therapy with the angiotensin-converting enzyme inhibitor and spironolactone.

A 76 year-old woman with a history of coronary artery bypass grafting and prior myocardial infarction was transferred to the emergency room with loss of consciousness due to marked bradycardia caused by hyperkalemia. The concentration of serum potassium was high, and normal sinus rhythm was restored after correction of the serum potassium level. The cause of hyperkalemia was considered to be several doses of spiranolactone, an aldosterone antagonist, in addition to the long-term intake of ramipril, an ACE inhibitor. This case is a good example of electrolyte imbalance causing acute life-threatening cardiac events. Clinicians should be alert to the possibility of hyperkalemia, especially in elderly patients using ACE/ARB in combination with potassium sparing agents and who have mild renal disturbance.

Lifestyle modification decreases the mean platelet volume in prehypertensive patients.

Mean platelet volume (MPV) is an indicator of platelet activation. The present study was designed to investigate platelet function by measuring MPV, platelet count (PLC) and platelet mass (PLM) in prehypertensive (PHT) subjects. Additionally, we also evaluated the effects of lifestyle modification on platelet functions by measuring MPV, PLC and PLM. We selected 36 newly diagnosed PHT patients and 21 control subjects (BP < 120/80 mmHg) matched for age and sex. Lifestyle modifications (weight loss, reduced sodium intake, increased physical activity, limited alcohol consumption and the Dietary Approaches to Stop Hypertension (DASH) diet) were recommended to PHT individuals for 20 weeks. At entry into the study, although PLM and PLC values were similar between study groups, MPV values were significantly higher in the PHT group than in the control group (respectively, 10.41 +/- 0.93 fl vs. 9.56 +/- 1.04 fl, p < 0.01). Additionally, MPV was positively correlated with the systolic blood pressure (BP), body mass index (BMI) and insulin resistance (IR) in the PHT group (r: 0.41; p < 0.02, r: 0.37; p < 0.04, r: 0.35; p < 0.05, respectively). Only age and PHT were found to be independent predictors of MPV after regression analysis. The program substantially lowered BP (net reductions in systolic and diastolic BPs of 16.2 and 8.7 mmHg, p < 0.001, p < 0.001, respectively). In addition, BMI, waist circumference (WC) and IR were significantly reduced in the PHT group (p < 0.01, p < 0.01, p < 0.05, respectively). At the end of study, although PLM, PLC values were reduced in the PHT group, only the decrease in MPV reached statistical significance (respectively, 10.41 +/- 0.93 fl vs. 9.67 +/- 1.2 fl, p < 0.01). In closing, to our best notice, our study is the first to display a significant increase in MPV in PHT subjects and to show a decrease in MPV by lifestyle modification after 20 weeks. As a result, we consider that decreased platelet activation with multi-aspect effects of lifestyle modification therapy might play an important role in reducing thrombotic risk in PHT patients.