N Zakopoulos

National and Kapodistrian University of Athens, Athínai, Attica, Greece

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Publications (80)282.81 Total impact

  • Article: PP.32.01
    C. Papageorgiou · E. Koroboki · E. Manios · F. Michas · N. Zakopoulos ·
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    ABSTRACT: Objective: An increasing body of evidence indicates the implication of psychological variables in the development of hypertension. However the exact nature of this implication, is poorly understood. Since the SCL-90 is a 90-item self-report symptom inventory designed primarily to reflect the psychological symptom patterns of medical patients, the present study was designed to screen psychiatric symptoms in newly diagnosed hypertension in primary care patients. Design and method: The study population consisted of 101 newly diagnosed hypertensive patients and 53 normontesive subjects matched for age, body mass index (BMI) and gender. The participants completed the Symptom Checklist 90 (SCL-90), which provides information on the following psychological symptomatology: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism. All subjects underwent 24-hour ambulatory blood pressure monitoring (ABPM) (Spacelabs 90207) in order to establish the diagnosis of hypertension. Results: The analysis revealed that hypertensive individuals comparing to normotensive ones demonstrated higher obsessive-compulsive symptomatoology (p < 0.022), interpersonal sensitivity (p < 0.016), hostility (p < 0.001), paranoid symptomatology (p < 0.040) and psychoticism (p < 0.005). Conclusions: The present findings indicate an involvement of psychiatric symptomatology in the development of hypertension, as it is reflected by the self-rated inventory. Prospective studies are needed in order to clarify the role of this phenomenon in the pathophysiology of newly diagnosed hypertension. Copyright
    Journal of Hypertension 06/2015; 33:e420. DOI:10.1097/01.hjh.0000468695.81837.0a · 4.72 Impact Factor
  • Article: PP.18.15
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    ABSTRACT: Objective: Subjects with white-coat hypertension (WCH) present target organ damage development and cardiovascular risk similar to normotensives. However, recent studies have demonstrated that WCH may not be an entirely benign condition. The heterogeneity of WCH, regarding the type of abnormal office blood pressure (BP) (systolic, diastolic and systolic/diastolic), may be associated with increased risk of target organ damage involvement and cardiovascular risk. Aim of our study was to evaluate the associations of isolated systolic, diastolic and systolic/diastolic WCH with common carotid artery intima-media thickness (CCA-IMT). Design and method: A total of 1399 consecutive never treated individuals referred for evaluation at the Hypertension Unit of our department, underwent 24-h ambulatory BP monitoring and CCA-IMT ultrasonographic measurements. Subjects with elevated office BP (systolic BP >= 140mmHg and/or diastolic BP >= 90mmHg) and normal ambulatory BP values (24-h systolic BP <130mmHg and 24-h diastolic BP<80mmHg) were defined as WCH. Subjects with WCH were divided into three groups according to the type of the abnormal office BP: isolated systolic WCH, isolated diastolic WCH and systolic/diastolic WCH. Statistical analysis was performed by means of ANOVA and ANCOVA. Results: Our study population consisted of normotensives (19%), isolated systolic WCHs (9%), isolated diastolic WCHs (5%), systolic/diastolic WCHs (18%) and sustained hypertensives (49%). Subjects with isolated systolic WCH (0.805 mm) presented significantly higher CCA-IMT values than those with isolated diastolic (0.678 mm) and systolic/diastolic WCH (0.708 mm) and normotension (0.710 mm). CCA-IMT did not differ significantly between subjects with isolated WCH and sustained hypertension (0.759 mm). There were not statistically significant differences among subjects with normotension, isolated diastolic WCH and systolic/diastolic WCH in terms of CCA-IMT values. Conclusions: Isolated systolic WCH is associated with increased CCA-IMT values compared to isolated diastolic WCH, systolic/diastolic WCH and normotension. In contrast, CCA-IMT does not differ between subjects with isolated systolic WCH and sustained hypertension. The identification of the type of WCH may have valuable implication on the risk stratification in subjects with WCH. Copyright
    Journal of Hypertension 06/2015; 33:e294-e295. DOI:10.1097/01.hjh.0000468269.77062.eb · 4.72 Impact Factor
  • Article: PP.18.13

    Journal of Hypertension 06/2015; 33:e294. DOI:10.1097/01.hjh.0000468267.99933.f5 · 4.72 Impact Factor
  • Article: PP.18.14
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    ABSTRACT: Objective: Recent studies have demonstrated that nocturnal hypertension is better associated with target organ damage development and cardiovascular morbidity and mortality than non-dipping pattern in hypertensive patients. However, the role of nocturnal hypertension and non-dipping pattern, in terms of target organ damage involvement, in masked hypertensives (MH) is unclear. Aim of our study was to evaluate the impact of nocturnal hypertension and non-dipping on left ventricular mass index (LVMI) in untreated MH patients. Design and method: A total of 926 consecutive never treated subjects referred for evaluation at the Hypertension Unit of our department, underwent 24-h ambulatory (BP) monitoring and LVMI echocardiographic measurements. Patients with normal office BP (<140/90mmHg) and elevated daytime BP values (systolic BP >= 135mmHg and/or diastolic BP >= 85mmHg) were defined as masked hypertensives. Masked hypertension was diagnosed in 93 subjects. The degree of nocturnal systolic BP (SBP) dipping (%) was calculated as 100[1 - nighttime SBP/daytime SBP]. Dippers were defined as subjects with nocturnal SBP fall >10% and non-dippers as patients with nocturnal SBP fall <10%. Nocturnal hypertension was defined as nighttime SBP >= 120mmHg or DBP >= 70mmHg. Statistical analysis was performed by means of independent-samples T test and ANCOVA. Results: Our study population consisted of 93 MH patients. The percentage of patients with nocturnal hypertension was 70%, whereas the percentage of non-dippers was 43%. LVMI did not differ significantly between non-dippers (112 g/m2) and dippers (116 g/m2). In contrast, patients with nocturnal hypertension presented significantly (p = 0.028) higher LVMI (118 g/m2) than patients with nocturnal normotension (106 g/m2), even after adjustment for demographic characteristics and baseline risk factors. Conclusions: Nocturnal hypertension but not non-dipping pattern is associated with increased LVMI in MH patients. Copyright
    Journal of Hypertension 06/2015; 33:e294. DOI:10.1097/01.hjh.0000468268.77062.a2 · 4.72 Impact Factor
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    ABSTRACT: Renin-angiotensin system (RAS) inhibition may exert beneficiary pleiotropic effects on heart hemodynamics in hypertensive patients. We aimed to assess these effects on coronary flow reserve (CFR) and left ventricular (LV) filling pressure after acute and long-term treatment. Thirty-nine patients (48.4±6.8 years) with newly diagnosed, never-treated essential arterial hypertension were consecutively recruited from an outpatient hypertension clinic. CFR in the left anterior descending artery and the ratio of mitral inflow E wave to the averaged mitral annulus tissue velocity of the E waves (E/e' ratio), as an estimate of LV filling pressure, were assessed by Doppler echocardiography. In the acute phase of the study, consecutive eligible patients were assigned to receive po Quinapril (Q) 20 mg (n=15) or Losartan (L) 100 mg (n=14) or no treatment (n=10) and were reexamined 2 h post treatment. In the chronic phase of the study, the patients were reevaluated after 1 month on the assigned treatment. During the acute phase, CFR (P=0.005) was significantly improved in the RAS inhibition as compared with the control group, independently of blood pressure (BP) changes. The E/e' ratio was also marginally improved (P=0.053), but this effect was more pronounced in patients with E/e' ratio>8 (P=0.005). CFR and E/e' ratio were also improved after 1 month of treatment, particularly in responders after the acute phase. In hypertensive patients, RAS inhibition acutely improved CFR and E/e' ratio independently of BP changes. An acute positive response in these parameters was closely related to sustained improvement after 1 month of single-drug treatment.Journal of Human Hypertension advance online publication, 28 November 2013; doi:10.1038/jhh.2013.125.
    Journal of human hypertension 11/2013; 28(6). DOI:10.1038/jhh.2013.125 · 2.70 Impact Factor
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    ABSTRACT: Current evidence supports an association between Obstructive Sleep Apnea Syndrome (OSAS), insulin resistance, type 2 diabetes mellitus (DM) and cardiovascular disorders. The relationship is complex and still remains poorly understood. The aim of this study was to examine the potential correlation of sleep characteristics with glucose and arterial pressure values variability in non - diabetic, non-hypertensive patients with OSAS. We examined 22 subjects, 11 men and 11 women (mean age 54 ± 14,5 years), recently diagnosed with OSAS (Apnea - Hypopnea Index (AHI) ≥ 5 apneas/hypopneas per hour of sleep) by full night polysomnography (PSG). Fasting and postprandial after a 2 hour oral glucose tolerance test (OGTT) glucose and insulin levels were measured, and homeostatic model assessment of insulin resistance (HOMA(IR)) index profile as well as Matsuda insulin sensitivity index (ISI) were calculated. A 24 hour glucose monitoring with subcutaneous measurements every 5 minutes and a 24-hour arterial blood pressure (ABP) monitoring (Holter monitoring) were evaluated. AHI, a widely accepted marker of the severity of OSAS, was correlated with HOMA and Matsuda index (p = 0.016 and p = 0.022, respectively), Standard Deviation (SD) of glucose measurements (p = 0.05) and mean diastolic blood pressure (p = 0.007). Percentage of sleep time with saturation of hemoglobin with oxygen, as measured by pulse oximetry, (SpO2) < 90% was also correlated with HOMA and Matsuda index (p = 0.014 and p = 0.012, respectively), coefficient of variation (CV) of glucose measurements (p = 0.009) and SD of 24-hour systolic blood pressure. Moreover, minimum SpO2 was correlated with glucose levels (p = 0.018), Matsuda index (p = 0.30) and SD of 24-hour diastolic and systolic blood pressure (p = 0.005 and p = 0.022, respectively). Glucose and arterial pressure variability were associated with markers of OSAS severity (AHI, % sleep time with SpO2 < 90%, min SpO2), among nondiabetic patients. Thus, glucose and arterial pressure variability in OSAS may be an additional marker of cardiovascular risk as well as of future diabetes in these subjects. Nevertheless, the clinical significance of our observations remains to be confirmed by prospective studies.
    European review for medical and pharmacological sciences 07/2013; 17(14):1932-7. · 1.21 Impact Factor
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    ABSTRACT: Objective. The aim of this study was to investigate the extent of placental lesions associated with blood pressure (BP) levels in pregnancies complicated by hypertension. Methods. 55 singleton pregnancies complicated by mild hypertension were recruited and compared to 55 pregnancies complicated by severe hypertension. The histological assessment was carried out with regard to the following aspects: vessels number/field of vision, infarction, villous fibrinoid necrosis, villous hypermaturity, avascular villi, calcifications, lymphohistiocytic villitis, and thickened vessels. Statistical analysis was performed by SPSS. Results. All placental lesions were observed more often in the severe hypertension group. Vessels number was significantly decreased, and infarction and villous fibrinoid necrosis were significantly increased in the placentas of the severe hypertension group compared to the mild hypertension group (P < 0.001). Conclusion. This study supports that the extent of placental lesions in hypertensive pregnancies is correlated with hypertension level and so highlights blood pressure level as a mirror of placental function.
    Obstetrics and Gynecology International 05/2012; 2012(1):684083. DOI:10.1155/2012/684083
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    ABSTRACT: The measurement of carotid artery intima-media thickness in children and adolescents has attracted a great deal of research and clinical interest in recent years, because it can provide evidence that early arterial lesions are already present in asymptomatic subjects who have risk factors for cardiovascular disease. The aim of the present study was to investigate possible correlations between parameters of 24-hour ambulatory blood pressure monitoring (ABPM) and carotid artery intima-media thickness in obese and nonobese children and adolescents. We studied 128 children and adolescents who were referred for investigation for possible hypertension. All participants in the study underwent ABPM and ultrasound measurement of the intima-media thickness of the common and internal carotid arteries. Obesity was defined as a body mass index (BMI) the 95th percentile for age and sex. Carotid artery intima-media thickness was significantly greater in obese than in non-obese children and adolescents. Linear correlations were observed between common and internal carotid artery intima-media thickness and the BMI percentile, the BMI z score, and parameters from ABPM. Multifactorial analysis of covariance showed that obesity and age were correlated with mean carotid artery intima-media thickness, independently of sex and values of clinic blood pressure and ABPM. Obese children and adolescents have greater carotid artery intima-media thickness than nonobese subjects, independently of blood pressure. These findings suggest a possible role for childhood obesity in the early onset of carotid artery atherosclerosis.
    Hellenic journal of cardiology: HJC = Hellēnikē kardiologikē epitheōrēsē 01/2012; 53(1):41-7. · 1.23 Impact Factor

  • Journal of Hypertension 06/2011; 29:e309. DOI:10.1097/00004872-201106001-00889 · 4.72 Impact Factor

  • Journal of Hypertension 06/2011; 29:e227. DOI:10.1097/00004872-201106001-00628 · 4.72 Impact Factor

  • Journal of Hypertension 06/2011; 29:e349. DOI:10.1097/00004872-201106001-01013 · 4.72 Impact Factor

  • Journal of Hypertension 06/2011; 29:e173. DOI:10.1097/00004872-201106001-00448 · 4.72 Impact Factor

  • Journal of Hypertension 06/2011; 29:e509-e510. DOI:10.1097/00004872-201106001-01545 · 4.72 Impact Factor
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    ABSTRACT: Hypertension (HT) complicates treatment with antiangiogenic agents, including the tyrosine kinase inhibitor (TKI) sunitinib. To prospectively evaluate the prevalence and management of HT in patients with advanced renal cell carcinoma (RCC) receiving sunitinib we used 24-h ABPM and we treated HT according to guidelines of the Joint National Committee on Prevention, Detection and Evaluation and the Treatment of High Blood Pressure (JNC7). Normal 24-h ABPM at the baseline and at 2, 4 and 6 weeks of the first cycle was ensured with the successive use of hydrochlorothiazide+irbesartan, nebivolol and amlodipine. Office BP measurements were used in subsequent cycles to monitor HT. Sunitinib dose was modified only if BP was not controlled with four anti-hypertensive agents. Forty patients were included in this analysis. Twenty-one patients (53%) had baseline HT, while 12 of 14 (84%) normotensive patients required anti-HT treatment during the 1st cycle of sunitinib. HT was infrequent in subsequent cycles and increase of anti-HT medication was required in only 2 cases. Two patients permanently discontinued sunitinib due to HT. The remaining 34 (94%) required no dose modifications for HT. One cardiac event (2.8%) was observed. There was no correlation of HT with sunitinib efficacy. Sunitinib-associated HT is more frequent than previously reported. The use of 24-h ABPM for diagnosis and tailoring of HT according to JNC7 guidelines may achieve uninterrupted, full dose therapy in most patients. The substitution of such protocols for currently used Toxicity Criteria may be warranted.
    European journal of cancer (Oxford, England: 1990) 05/2011; 47(11):1660-8. DOI:10.1016/j.ejca.2011.03.033 · 5.42 Impact Factor
  • F Michas · E Manios · K Stamatelopoulos · E Koroboki · E Alexaki · R Panerai · N Zakopoulos ·

    Journal of Hypertension 06/2010; 28. DOI:10.1097/01.hjh.0000378412.19877.69 · 4.72 Impact Factor

  • Journal of Hypertension 06/2010; 28. DOI:10.1097/01.hjh.0000379220.86185.79 · 4.72 Impact Factor

  • Journal of Hypertension 06/2010; 28. DOI:10.1097/01.hjh.0000379215.63314.f9 · 4.72 Impact Factor
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    ABSTRACT: To investigate predictors of left ventricular mass corrected for height2.7 (LVMI) and left ventricular hypertrophy in patients who were found to be normotensive with both office and 24-h ambulatory blood pressure (BP) measurements. A total of 805 consecutive patients were analyzed. All patients underwent office BP measurements, 24-h ambulatory BP monitoring, laboratory measurements for cardiovascular risk factors and echocardiography. Individuals with both office and ambulatory normotension were characterized as true normotensive. LVMI was found to be 34.5 +/- 10.9 g/m2.7 in normal-weight patients and 48.7 +/- 13.0 g/m2.7 in obese patients (P < 0.0001). LVMI was found to be 41.7 +/- 10 g/m2.7 in overweight patients, significantly lower than the values of obese patients (P < 0.005) and higher than the values of normal-weight patients (P < 0.001). These results remained significant even after adjustment for age, sex, daytime and nighttime SBP, daytime and nighttime DBP, daytime and nighttime BP variability and daytime and nighttime pulse pressure (PP). In a multivariate analysis model, in which LVMI was the dependent variable and office SBP, office DBP, daytime and nighttime SBP and DBP, daytime and nighttime PPs and variabilities, day-night SBP ratio, fasting serum glucose, triglycerides, total cholesterol, age and BMI were inserted as independent variables with weighted least squares regression by sex, the predictors of LVMI were age, BMI and daytime PP (r2 = 0.31). Left ventricular hypertrophy was 17.67 times more likely in obese patients as compared with normal-weight true normotensive individuals. Obesity may represent a significant cardiovascular risk factor even in normotensive individuals. Other predictors of LVMI were ageing and daytime PP.
    Journal of Hypertension 05/2010; 28(5):1065-73. DOI:10.1097/HJH.0b013e3283370e5e · 4.72 Impact Factor
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    ABSTRACT: The extent of target organ damage has been associated with both central hemodynamics and arterial stiffening, and the time rate of blood pressure (BP) changes in essential hypertension. However, the relative significance of these parameters has not been examined. We recruited 232 consecutive uncomplicated newly diagnosed hypertensive patients and 241 normotensive individuals. Twenty-four-hour ambulatory BP monitoring was performed in all individuals. The time rate of SBP variation was computed as the first derivative of the SBP values against time. Aortic central SBP and central DBP, central pulse pressure, central augmentation index and central augmentation pressure were assessed noninvasively by pulse wave analysis. Common carotid artery intima-media thickness was measured by high-resolution ultrasonography. Median 24-h time rate of BP changes was 0.571 +/- 0.114 mmHg/min. Traditional risk factors, office SBP, several ambulatory BP monitoring parameters (24-h SBP, 24-h pulse pressure, 24-h heart rate and BP dipping), 24-h time rate of BP changes, time rate of BP changes at different time intervals, and central SBP, central pulse pressure, central augmentation index and central augmentation pressure significantly correlated with intima-media thickness. Age, sex, BMI, 24-h time rate of BP changes, time rate of BP changes measured at 0100-0600 h and 24-h heart rate remained significant associates of intima-media thickness after adjustment for confounding factors. By multivariate stepwise linear regression, 24-h time rate of BP changes and time rate of BP changes at 0100-0600 h had incremental value over traditional risk factors, other ambulatory BP monitoring parameters and central hemodynamics. These findings indicate that time rate of BP variation is superior to central hemodynamics as an associate of carotid intima-media thickness in hypertensive and normotensive individuals.
    Journal of Hypertension 11/2009; 28(1):51-8. DOI:10.1097/HJH.0b013e328331b6c8 · 4.72 Impact Factor
  • A Bamias · G Lainakis · E Manios · E Koroboki · R Gyftaki · N Zakopoulos · M.A. Dimopoulos ·
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    ABSTRACT: Hypertension may complicate treatment with antiangiogenic agents, leading to dose reductions and treatment delays. To prospectively evaluate the frequency and management of hypertension in 10 patients with advanced kidney cancer receiving sunitinib, we used 24-h blood pressure monitoring (BPM) and home BPM and homogenously treated hypertension according to guidelines of the european Society of Hypertension. Normal BP was ensured prior to sunitinib initiation with the successive use of hydrochlorothiazide + irbesartan, nebivolol, amlodipine. During treatment, additional antihypertensive therapy was introduced, if necessary. Sunitinib dose was modified only if BP was not controlled with four anti-hypertensive agents. four patients had baseline hypertension, while 5 of 6 normotensive patients required antihypertensive treatment during sunitinib administration. One patient permanently discontinued sunitinib due to hypertensive crisis but 9 patients received full dose. Sunitinib-associated hypertension is more frequent than previously reported. Aggressive BP monitoring and treatment of hypertension may achieve uninterrupted, full-dose therapy in most patients treated with sunitinib. The application of such protocols instead of commonly used toxicity criteria should be further validated.
    Journal of chemotherapy (Florence, Italy) 07/2009; 21(3):347-50. DOI:10.1179/joc.2009.21.3.347 · 1.60 Impact Factor

Publication Stats

1k Citations
282.81 Total Impact Points


  • 2005-2013
    • National and Kapodistrian University of Athens
      • • Division of Cardiology III
      • • Division of Clinical Therapeutics
      Athínai, Attica, Greece
  • 1996-2012
    • Alexandra Regional General Hospital
      Athínai, Attica, Greece
  • 2009-2011
    • Harokopion University of Athens
      Athínai, Attica, Greece
  • 2008-2010
    • National University (California)
      San Diego, California, United States
  • 1998
    • University of Ioannina
      • Division of Psychiatry
      Yannina, Epirus, Greece