Recai Alemdar

Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Engüri, Ankara, Turkey

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Publications (24)24.52 Total impact

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    ABSTRACT: Aims: We aimed to investigate the predictors of Carotid intima media thickness (CIMT) in premenopausal women. Background: CIMT was shown to be a strong coronary artery disease predictor in both pre- and postmenopausal women. Materials and methods: The study was conducted on 2298 participants. The final cohort included 783 pre-menopausal women (with a mean age of 39 ± 11). Carotid intima media thickness was measured in all of the participants. Results: Mean CIMT of premenopausal women was 0.51 ± 0.14 mm. Age- adjusted correlates of CIMT was SBP (r = 0.138; p=<0.001), DBP (r=0.095; p=0.012) and LDL/HDL (r =0.077; p=0.041) ratio. Linear regression analysis was done in order to find independent covariates of carotid intima media thickness in two different models. Only age and systolic blood pressure were independently associated with CIMT. Logistic regression analysis revealed that only age was an independent predictor of subclinical atherosclerosis . Hypertension had the highest Odds ratio with borderline significance. Conclusion: The age and systolic blood pressure were independently associated with CIMT in premenopausal healthy Turkish women. Hypertension might be the best target for a modifiable risk factor for CIMT and future cardiovascular risk in this population.
    No preview · Article · Jan 2014 · Acta Medica Mediterranea
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    ABSTRACT: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities involving several cardiovascular risk factors. Carotid intima media thickness (CIMT) is an important early screening tool to assess subclinical manifestation of cardiovascular and metabolic diseases. We aimed to investigate the impact of MetS on CIMT in a large scaled community based study. The study was conducted on 2102 participants. Carotid intima media thickness was measured in all of the participants. The study sample was divided into 4 groups; Group 1 subjects with a body mass index (BMI) < 25.0 kg/m2 [n = 499 (MetS- = 488, MetS+ = 11)], Group 2 BMI between 25.0 and 29.9 kg/m2 [n = 693 (MetS- = 559, MetS+ = 134)], Group 3 BMI between ≥ 30 kg/m2 and 39.9 kg/m2 [n = 822 (MetS- = 375, MetS+ = 477)], and Group 4 BMI ≥ 40 kg/m2 [n = 88 (MetS- = 27, MetS+ = 61)]. Carotid intima media thickness was higher in the individuals with MetS compared to their normal counterparts. Furthermore, the subgroup analysis showed that CIMT values in Group 1 (0.55±0.18 vs 0.82±0.70; p < 0.001), Group 2 (0.59±0.20 vs 0.68±0.18; p < 0.001) and Group 3 (0.61±0.15 vs 0.65±0.18; p < 0.001) were significantly higher in subjects with MetS compared to their normal counterparts, whereas the values were similar in Group 4 (0.62±0.13 vs 0.65±0.17; p = 0.363). Carotid intima media thickness of overweight, obese and normal weight individuals without MetS were lower than their counterparts with MetS. MetS had no impact on CIMT in morbid obese individuals possibly due to established insulin resistance earlier than MetS.
    No preview · Article · Sep 2013 · European review for medical and pharmacological sciences
  • D Baltaci · E Erbilen · Y Turker · R Alemdar · M Aydin · A Kaya · A Celer · H Cil · Y Aslantas · H Ozhan
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    ABSTRACT: Hypertension is one of the most common causes of atherosclerosis, morbidity and mortality in adults. A total of 11 million hypertensive patients were estimated in Turkey. The aim of this study was to investigate the prevalence, awareness and control of hypertension in Duzce and compare the current data with the literature. The visits were carried out in May and June, 2010 in Yigilca town health centre on 2298 participants (1471 female, 827 male with a mean age of 50). Data were obtained by a simple form, physical examination and sampling of blood. Hypertension was defined as a blood pressure 140 mmHg and/or 90 mmHg, and/or use of antihypertensive medication. The data of patients under control were compared with the patients who were not under control. Hypertension was detected in 964 participants. General prevalence was 42%. Hypertension awareness ratio was 70%, use of antihypertensive medication was 39% and the ratio of patients under control was 28%. Antihypertensive drug use, age and awareness were lower in the uncontrolled group. Logistic regression analysis revealed that only antihypertensive drug use and BMI < 30 were the independent predictors of hypertension under control [Odd's ratio (OR) = 3.43; 95% confidence interval (CI) = 2.54-4.64, p < 0.001 and OR = 1.69; 95% CI = 1.23- 2.32, p = 0.01; respectively]. Hypertension is one of the most important public health problems in Turkey. According to the literature data the awareness of hypertension was increased significantly in the last five years. On the other hand, control ratio was increased very little compared with the previous studies.
    No preview · Article · Jul 2013 · European review for medical and pharmacological sciences
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    ABSTRACT: Acute left main coronary artery thrombosis is a rare but potentially lethal complication of coronary angiography. Pulmonary edema, resistent ventricular arrhytmias, cardiogenic shock, and sudden death are seen in most of the patients who develop clinically acute left coronary artery occlusion. It can be seen during percutaneoous interventions or after spontaneous plaque rupture. Occurrence of complications during cardiac catheterization and coronary angiography is rare. However, complications may be fatal if they occur. Acute left main coronary artery occlusion is one of the complications that may develop during diagnostic coronary angiography. This complication is severely life-threatening. Recognition of the lesion and urgent interventional therapy can be life saver. Herein, we report a case of left main coronary artery occlusion during elective coronary angiography which was treated urgently with direct stenting, and discuss the treatment modalities in the light of literature.
    No preview · Article · Dec 2012 · Turkiye Klinikleri Cardiovascular Sciences
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    ABSTRACT: Objectives: The adipose tissue is an active immune organ. High sensitive C-reactive protein CRP (hs-CRP) is a strong independent predictor of a possible future myocardial infarction and stroke, and it has also been shown to be related to the subclinical atherosclerosis. The aim of this study was to investigate the relation between the body fat composition, metabolic syndrome, and the hs-CRP plasma levels. Methods: Total 246 consecutive Turkish subjects, admitted to the internal medicine clinic with the diagnosis of diabetes mellitus, insulin resistance or metabolic syndrome, were included into the study. The total body fat composition was measured in every participant with a commercially available bio-impedance meter. The hs-CRP levels, body composition parameters, and biochemical variables were compared. Results: The hs-CRP levels increased in parallel with the body weight in Turkish subjects. This increase was significant especially in the women. The waist circumference, body mass index (BMI), and body composition variables (visceral fat level, total body fat, and total body muscle mass) were significant correlates of the hs-CRP. The waist circumference and BMI were independent predictors of the hs-CRP. Conclusion: The waist circumference, BMI, and body composition variables (visceral fat level, total body fat and total body muscle mass) were significant correlates of the hs-CRP in Turkish adults. Body weight control may account for an important target especially in patients with the metabolic syndrome.
    No preview · Article · Jul 2012 · Endocrine regulations
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    ABSTRACT: 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. 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)). 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. BMI is an independent predictor of LV diastolic dysfunction along with age, hypertension, and diabetes mellitus.
    No preview · Article · Apr 2012 · Echocardiography
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    ABSTRACT: Central obesity is a prerequisite for the diagnosis of metabolic syndrome (MetS). Precise measurement of visceral fat by bioelectrical impedance analysis (BIA) has been validated. The aim of this study was to investigate the diagnostic performance of BIA in MetS and validate the best cutoff in a large adult cohort. The study was performed on the MELEN Study cohort-a prospectively designed survey on the prevalence of cardiometabolic risk factors in Turkish adults. The final cohort consisted of 2219 participants. Weight and visceral body composition were measured without shoes in light indoor clothes using a bioimpedance analyzer (Omron BF 510; Omron Corp, Kyoto, Japan). Plasma concentrations of cholesterol, insulin, fasting triglycerides, high-density lipoprotein cholesterol, glucose, and other biochemical variables were measured. The diagnostic performance of visceral fat measurement by BIA in patients with MetS was assessed. Metabolic syndrome was detected in 751 participants (520 women and 231 men with a mean age of 55 [12] years; 34% of the whole study population). Total body fat and visceral fat levels were higher in subjects with MetS. Correlation analyses showed that there were significant correlations between anthropometric and BIA measurements. Receiver operating curve characteristics of visceral adiposity revealed the best cutoff values as greater than 12% for men and greater than 9% for women. The diagnostic performance was good in both sexes (the sensitivity/specificity and area-under-the-curve values were 76%/75% and 0.83 for men and 83%/67% and 0.81 for women, respectively). Visceral fat measured with BIA is an easily applicable and useful method for identifying people with MetS. The best cutoff values were higher than 12% for men and higher than 9% for women.
    No preview · Article · Mar 2012 · Journal of Investigative Medicine
  • S.O. Çağlar · S. Bulur · R. Alemdar · M. Aydin · C. Başar
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    ABSTRACT: Although acute left main coronary artery (LMCA) occlusion is rare, it carries a very high mortality rate. Several studies have compared the efficacy of elective coronary artery stenting and coronary artery bypass grafting (CABG) in patients with LMCA disease. However, a definite reperfusion modality has yet to be established in ST-elevation myocardial infarction (STEMI) due to acute total occlusion of LMCA, which has catastrophic clinical results. We presented three patients with acute anterior STEMI and angiographically documented acute total occlusion of LMCA. All of them were taken to the catheterization laboratory. One patient who was referred to CABG for emergency revascularization died. One died on the 3th day of admission because of heart failure. The other patient, thrombolysis in myocardial infarction (TIMI) III flow was achieved after percutaneous coronary intervention (PCI), and he was discharged with acceptable short-term results.
    No preview · Article · Mar 2012 · International Journal of Cardiology
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    ABSTRACT: Subjects with nondipper hypertension carry a higher risk of cardiovascular events than their normotensive counterparts. The present study was designed to investigate cystatin C levels in patients with dipper and nondipper hypertension. Eighty-eight consecutive patients who had been treated with antihypertensive drugs for at least 6 months were included in the study. Dipping and nondipping patterns were detected with ambulatory blood pressure monitoring. Clinical, laboratory, and ambulatory blood pressure monitoring data of patient groups with nondipper and dipper hypertension were compared. Patients in the nondipper group were older than those in the dipper group. Serum cystatin C level was higher in the patients in the nondipper group. Cystatin C was negatively correlated with the rate of systolic blood pressure fall at night (r = -0.41; P < 0.001). Linear regression analyses revealed that only cystatin C level was a significant correlate of nocturnal systolic blood pressure decrease. Logistic regression analyses also showed that cystatin C was an independent predictor of nondipping pattern (odds ratio, 3.586; 95% confidence interval, 1.432-8.98; P = 0.006]). The present study showed that cystatin C is higher in patients with nondipper hypertension patients.
    No preview · Article · Feb 2012 · Journal of Investigative Medicine
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    ABSTRACT: Carbohydrate antigen-125 (CA-125) is emerging as a prognostic biomarker of risk in heart failure. In a prospective study, we compared the prognostic values of CA-125 and amino-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with stable heart failure.We enrolled 102 consecutive chronic, stable, systolic-heart-failure patients (68 men and 34 women; median age, 71 yr) from November 2008 through February 2010. We measured baseline NT-proBNP and CA-125 levels and compared their prognostic values. The primary endpoint was all-cause death and other major adverse events, defined as hospitalization for decompensated heart failure or acute coronary syndrome.During a mean follow-up period of 14 ± 2 months, 12 patients died and 35 others sustained major adverse events. We found that CA-125 level significantly correlated with New York Heart Association functional class, pulmonary artery pressure, microalbuminuria, creatine kinase-MB fraction, and hemoglobin, albumin, and NT-proBNP levels. Upon receiver operating characteristic curve analysis, CA-125 and NT-proBNP had similar accuracy in predicting major adverse events and death: for major adverse events, area under the curve (AUC) was 0.699 for CA-125 (P=0.002) and 0.696 for NT-proBNP (P=0.002); for death, AUC was 0.784 for CA-125 (P=0.003) and 0.824 for NT-proBNP (P=0.001). Multivariate Cox regression analysis showed that CA-125 levels greater than 32 U/mL and NT-proBNP levels greater than 5,300 pg/mL had independent prognostic value for major adverse events and death.We conclude that baseline CA-125 and NT-proBNP levels are comparably reliable as heart-failure markers, and that CA-125 can be used for prognosis prediction in heart failure.
    Full-text · Article · Feb 2012 · Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
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    ABSTRACT: There is limited data regarding treatment of acute myocardial infarction in very old patients. The very elderly population has complex co-morbidities, worse left ventricular function, poor functional status, increased risk, and reduced benefit from treatment. Contraindications to lytic therapy are common in the elderly, and the incidence of hemorrhagic stroke after thrombolytic therapy is strictly associated with age. Primary percutaneous coronary angioplasty results were also limited in octogenerians and nonagenarians. We report here two patients in 89 and 93 years who were admitted to the cardiology department with the diagnosis of acute myocardial infarction and subsequently treated with percutaneous intervention. The results of primary coronary angioplasty in old patients were also discussed in light of the literature.
    No preview · Article · Jan 2012 · Turkiye Klinikleri Cardiovascular Sciences
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    ABSTRACT: Purpose: The aim of our study was to determine the prevalence of obesity and abdominal obesity in the West Black Sea region of Turkey and to display the associated chronic diseases, especially Diabetes Mellitus (DM) in this population. Material and Method: We evaluated 2222 (1418 female, 804 male, mean age: 50) participants in Yigilca. The medical histories were recorded and physical examinations were done in all participants. Body weight categories were defined according to the body mass index (BMI) as follows: BMI <18.5 lean, 18.5-24.9 normal, 25-29.9 overweight, ≥30 obese and ≥40 morbidly obese. According to waist circumference measurements, >94 cm in males and >90 cm in females were accepted as the cut-off points for abdominal obesity. Results: The mean BMI of the participants was 30.6 in females and 27.5 in males. According to BMI, obesity prevalence was 53.1% in females and 26.9% in males. The mean obesity prevalence was 43.5% in general. Abdominal obesity prevalence was 63% in females, 46% in males and 57% in all participants. Obesity prevalence increased with age in both sexes. Especially 3/4 (75%) of females and 1/3 (33%) of males aged 50-59 years were obese. Postmenopausal females had very high (64%) obesity prevalence but the rate was %43 in premenopausal women. While DM prevalence was 12.6% according to patient history, DM prevalence increased to 18.8% by adding patients with fasting glucose >126 mg/dl. Discussion: Obesity, especially abdominal obesity and DM prevalence was found to be at exaggerated rates in both sexes being highest in postmenopausal females.
    No preview · Article · Jan 2012 · Turkish Journal of Endocrinology and Metabolism
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    ABSTRACT: 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. 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). 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.
    No preview · Article · Dec 2011 · Acta cardiologica
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    ABSTRACT: 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. 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). 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. 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). MPV is increased in patients with DHF. Also, MPV on admission is an independent predictor of in-hospital mortality and 6-month mortality.
    No preview · Article · Jul 2011 · Emergency Medicine Journal
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    ABSTRACT: Aim: The aim of the Melen Study was to investigate the cardiovascular risk profile of Turkish adults by utilizing newest techniques. Besides prevalence and types of endemic goiter will be established which was an important health problem in the Black sea region Method: 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 carotid intima media thickness, echocardiographic examination, ECG recording, bioempedance meter analysis of body composition, pulmonary function test and various biochemical analysis. Result: Twenty nine percent of the population had hypertension, 12% had diabetes mellitus and 17% were smokers. Thyroid ultrasonography revealed that 29% of the cohort had goiter. Echocardiographic measurements showed that 39% of the participants had diastolic dysfunction. Comparison of males with females showed that men had significantly higher visceral fat, triglyceride, hemoglobin and CIMT whereas women had higher mean diastolic blood pressure, HDL and total cholesterol. Conclusion: According to the histories of patients, hypertension, diabetes mellitus and smoking were very frequent among Turkish adults. Among the objectively measured variables, diastolic dysfunction, visceral adiposity and goiter were strikingly high.
    Full-text · Article · Jan 2011 · European Journal of General Medicine
  • S. Ordu · H. Ozhan · H. Uzun · R. Alemdar · I. Erden · M. Yazici · E. Gultekin
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    ABSTRACT: Background: The aim of this study is to compare cardiac function in children with and without adenotonsillar hypertrophy (ATH). Materials and methods: Ninety-one children (26 female 65 male) who were diagnosed as ATH in the pediatric outpatient clinic and twenty-three completely healthy, age-sex matched children (10 female 13 male) were included in the study. All patients underwent a complete twodimensional transthoracic echocardiographic and Doppler study. Results: Mean mitral E, A and deceleration time were significantly longer in ATH group. Also chamber areas and volumes were bigger. Pulmonary and mitral regurgitation were statistically more frequent in ATH group. Adenotonsillar grade was positively related with mean pulmonary arterial pressure (r: 0.44 p: <0.001). Mitral valve thickness was strongly correlated with tonsillar hypertrophy grade (r: 0.73; p.<0.001). Conclusions: ATH may lead to mild diastolic dysfunction and chamber dilatation. Mitral valve thickness was strongly correlated with adenotonsillar grade.
    No preview · Article · Jan 2011 · Duzce Medical Journal
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    ABSTRACT: The efficacy of olmesartan on fibrinolytic capacity has not been studied yet. Therefore, the aim of the present study was to investigate the efficacy of olmesartan on hemostatic/fibrinolytic status by measuring plasma level of plasminogen activator inhibitor-1 (PAI-1) and soluble thrombomodulin levels in patients with hypertension. Forty-two consecutive, newly diagnosed (25 women and 17 men with a mean age of 48 ± 8 years) patients with untreated essential hypertension were included in the study. Olmesartan medoxomil (20 mg/day) was started and the patients were followed up for 6 months. Baseline biochemical variables, thrombomodulin, and PAI-1 levels were compared with the levels of these variables measured at the end of the 6-month follow-up period. After 6 months of treatment with olmesartan medoxomil, there was a significant reduction in systolic and diastolic blood pressure (from 159.5 ± 10.9 to 134.6 ± 12.7 mmHg and from 98.0 ± 6.3 to 83.9 ± 7.0 mmHg, respectively). Mean plasma PAI-1 and thrombomodulin levels were also significantly decreased (59.73 ± 41.91 vs. 48.60 ± 33.65 ng/ml, P = 0.001 and 8.09 ± 2.29 vs. 6.92 ± 1.42 μg/l, P < 0.001, respectively). Olmesartan medoxomil decreased plasma PAI-1 and thrombomodulin levels after 6 months of therapy, indicating a favorable effect on fibrinolytic capacity in patients with essential hypertension.
    No preview · Article · Oct 2010 · Blood coagulation & fibrinolysis: an international journal in haemostasis and thrombosis
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    ABSTRACT: Contrast-induced nephropathy (CIN) is associated with increased morbidity, extended hospital stay, and higher costs. We compared an atorvastatin plus N-acetylcysteine (NAC) regimen with NAC alone in patients undergoing coronary angiography. A total of 130 patients (mean age 54 +/- 10; 77 men) undergoing coronary angiography were studied. Seven CIN cases occurred in the NAC group and 2 in the atorvastatin + NAC group; this difference was not significant. Baseline mean creatinine and estimated glomerular filtration rate (eGFR) were similar between the 2 groups, whereas after the procedure there was a significant creatinine decrease and eGFR increase in the atorvastatin + NAC group. Change in creatinine (baseline creatinine-creatinine after the procedure) was also significantly higher in patients taking statin plus NAC. Atorvastatin may be effective in protecting patients undergoing coronary angiography from CIN.
    No preview · Article · Oct 2010 · Angiology
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    ABSTRACT: We aimed to investigate whether there was any association between the nondipping status and sleep quality in relatively young patients with an initial diagnosis of hypertension. One hundred and thirty-three consecutive patients, diagnosed to have stage 1 hypertension by their primary physicians, were referred to our study. Patients with a history of use of any antihypertensive medication were excluded. Eligible patients underwent the Pittsburgh Sleep Quality Index (PSQI) survey, which has an established role in evaluating sleep disturbances. All patients underwent ambulatory blood pressure monitoring. There were 71 nondipper patients (mean age 44.3+/-5.3 years, 33 male/38 female) and 62 dipper hypertensive patients (mean age 43.3+/-6.3 years, 27 male/35 female). The PSQI scores, globally, were significantly higher in the nondippers compared with the dippers. It was noticed that all the components of the PSQI (sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction) were significantly higher in the nondippers. Correlation analysis showed that systolic blood pressure fall at night was inversely and significantly related with the PSQI (r=-0.46, P<0.001). Logistic regression analysis showed that the PSQI score is an independent determinant for nondipping hypertension (HT) {odds ratio=0.842 [95% confidence interval (CI)=0.748-0.947; P=0.004]}. We showed that poor sleep quality was related with a nondipping pattern, and furthermore, it was an independent predictor of nondipping in newly diagnosed stage 1 hypertensive patients.
    No preview · Article · Aug 2010 · Blood pressure monitoring
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    ABSTRACT: 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. 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. Pioglitazone treatment in type 2 diabetes mellitus produced significant improvements in measures of glycaemic control and diastolic ventricular function.
    No preview · Article · Aug 2010 · Acta cardiologica