Téma: Overview works

Arterial hypertension and diabetes mellitus

Viliam Bada

Arterial hypertension is not defined by signs and symptoms but by „numbers“ of blood pressure (BP) values. Symptoms are usually missed at the beginning of the disease. Detection of them is theč signal of impairment of target organs: brain, heart and kidneys. The only way to detect, confirm or reject hypertension is to measure BP. Human blood pressure was measured for the first time by Victor Basch, by a sphygmomanometer of his own construction. In 1896 in Turin Scipione Riva-Rocci made up a complicated elastic sack of Basch´s sphygmomanometer by an inflatable sleeve made from processed bicycle air tube. Palpatory measurement of systolic BP got simple and thanks to the neurosurgeon Harvey Cushing it started to be used in the USA. In 1905 the Russian military surgeon Nikolaj Sergejevič Korotkov added stethoscope to Riva-Rocci´s pressure measuring equipment for auscultation of vascular tones. He evaluated quality of collateral circulation in war injuries of limbs. Professor Michail Vladimirovič Janovskij one of opponents of Korotkov´s dissertation suggested using auscultation to measure not only systolic BP but also diastolic BP. The way of BP measuring was found but the basic problem – what are „standard“ BP values? – was not. American life insurances in 1917 reminded, on basis of their own statistics, higher mortality in systolic BP over 140 mmHg. Mortality in BP more than 170 mmHg reached 200 %. After 63 years in 1970 Framingham study confirmed conclusions of life insurances and high blood pressure was defined as an independent, risk factor (RF). Later then it was approved that single high blood pressure is rare and it more frequently accompanies further RF. One of commonest co-morbities is type 2 diabetes mellitus (DM2). Target values of BP in diabetic patients with microalbuminuria are the lowest recommended values: < 120/80 mmHg. Direct connection of high BP and diabetes was confirmed at the level of renal functions. Can these recommended BP values be reached? Is restoring of BP to normal important or are the numbers crucial independently from the type of used antihypertensives?

Ročník 2009  Témy časopisu Cardiology for practice 3 / 2009

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Examples of citations:
1. Shaheen NJ, Crosby NA, Bozymski EM, et al. Is there publication bias in the reporting cancer risk in Barrett´ esophagus? Gastroenterology 2000; 119: 333-338.
2. Stenestrand U, Wallentin L. Swedish Register of Cardiac Intensive Care (RIKS-HIA): Early statin treatment following acute myocardial infarction and 1-year survival. JAMA 2001; 285: 430-436.
3. LIPID Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349-1357.
4. Jurkovičová O, Spitzerová H, Cagáň S. Komorové arytmie a náhla srdcová smrť pri akútnom infarkte myokardu. Bratisl Lek Listy 1997; 98: 379-389.
5. Osborne BE. The electrocardiogram of the rat. In: Budden R, Detweiler DK, Zbinden G. The rat electrocardiogram in pharmacology and toxicology. Oxford: Pergamon Press 1981: 15-27.

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In which patients, after overcoming of a thromboembolic cerebral or peripheral event, the least suitable catheter closure is foramen ovale patents:
a. a woman before planned pregnancy
b. paroxysmal fibrillation of the atrium
c. aneurysm of the atrium septum
d. origination of an event after cough

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