Primary hyperaldosteronism is the leading cause of secondary hypertension, often presented with hypokalemia and even rare with its consequences. We describe a case of a 62-year-old man admitted to the emergency department with rhabdomyolysis from severe hypokalemia. Hypertension with hypokalemia and metabolic alkalosis should bring to the doctor’s attention the possibility of primary aldosteronism, which should also be confirmed by elevated plasma aldosterone concentration, a decreased plasma rennin levels, and high aldosterone/rennin ratio. The diagnosis of primary hyperaldosteronism was confirmed by an abdominal computed tomography, which revealed a solid mass at the posterior crus of the left adrenal gland. After the treatment of hypokalemia, neuromuscular symptoms regressed. Blood pressure and potassium levels normalized after laparoscopic adrenalectomy were performed. This rare clinical case highlights the diversity of the clinical presentation of primary hyperaldosteronism and emphasizes the need to be alert to the possibility of the presence of primary hyperaldosteronism in a patient who presents with hypertension and rhabdomyolysis induced by severe hypokalemia.

Background: Penetrating aortic ulcer (PAU) is a rare condition characterized by an aortic wall irregularity caused by the ulceration of an atheromatous plaque extending through the intima into the aortic media. PAU accounts for only 2–7% of acute aortic syndromes. Often, this disease remains asymptomatic while still having the potential to cause serious complications, making careful diagnosis essential. Case presentation: An 84-year-old female with a long-standing history of hypertension and peripheral artery disease was admitted to the hospital due to headache, dizziness, and tinnitus. Physical examination revealed blood pressure of 220/74 mm Hg. Laboratory tests revealed normocytic anemia (11.4 g/dL) and elevated creatinine levels [1.26 mg/dL, estimated glomerular filtration rate (eGFR) 43.1 mL/min]. Carotid artery ultrasound showed significant stenosis (70–90%) of the left internal carotid artery. Given the patient’s comorbidities, further evaluation of the renal arteries was conducted. Doppler ultrasound revealed left renal artery stenosis and suspicion of PAU. Subsequent computed tomography angiography (angio-CT) confirmed the diagnosis, revealing an aneurysmal dilation up to 27 mm, beginning 58 mm above the aortic bifurcation. Contrast enhancement extended toward the aortic protrusion, suggesting an atherosclerotic plaque ulcer or a partially coagulated pseudoaneurysm. Antihypertensive and lipid-lowering therapy was administered, and the patient was referred to vascular specialists. Conclusions: In high-risk patients, assessing the possibility of aortic disease is essential. However, the infrequent location of PAU and its asymptomatic course requires vigilant diagnostics and poses a significant risk of complications. Strict blood pressure control remains crucial as hypertension is a strong predisposing factor.

Resistant hypertension (RH), defined as a high blood pressure that remains uncontrolled despite treatment, is still a major medical challenge. During the last decade, several studies have demonstrated the promising effects of exercise on the category of hypertensives. This review summarizes the existing literature on the effects of exercise therapy on patients with RH. From the literature search conducted in PubMed (January 1980 – December 2023), 12 papers (6 with acute- and 6 with chronic exercise) were selected. Despite the few studies, the acute hemodynamic burden and the post-exercise response in patients with RH were within clinically acceptable limits and may vary according to the intensity and duration of the exercise protocols. Chronic exercise, especially warm-water exercise, effectively lowers blood pressure in patients with RH without serious adverse events or complications. Based on recent scientific evidence, patients with RH need to change their lifestyle by adopting systematic exercise for the optimal treatment of their disease. Future investigations are required to explore the exact exercise mechanisms that benefit patients with RH.

Background: Cystatin C (Cys C), deemed as a glomerular renal function biomarker with unique properties to be an independent predictor of cardiovascular disease (CVD), remains a matter of investigation among different categories of patients. The aim of the study is a determining the diagnostic and prognostic value of Cys C in the development of cardiovascular complications in patients with arterial hypertension (AH) and different comorbidities, such as type 2 diabetes mellitus (T2DM) and obesity, as a supplement to estimated glomerular filtration rate (eGFR). Material and methods: 111 patients with AH (men/women — 50/61) and 20 control subjects were examined. All patients with AH at the age of 54.37 ± 1.18. During a thorough examination and follow-up of patients, they were classified into 4 groups depending on the comorbidities they had: patients with AH — group 1 (22 people); patients with AH in combination with obesity — group 2 (30 people); AH in combination with T2DM — group 3 (31 people); patients with AH, T2DM — group 4 (28 people). Cys C content and insulin levels in blood serum were measured by enzyme-linked immunosorbent assay on a Labline-90 analyzer (Austria) with commercial test systems manufactured by Elabscience (ELISA, China) and Monobind Inc. (ELISA, USA), according to the instructions included in the kits. Results: It has been proven that an increase in Cys C levels are associated with a decrease in eGFR in comorbid patients with T2DM (r = –0.676; p = 0.038) and without it (r = –0.589; p = 0.016). A significant increase in Cys C levels and cardiovascular accidents in comorbid patients was found. Conclusions: Cys C is a significant marker for predicting cardiovascular risk in comorbid patients with AH.

Summarizing WOBASZ studies, hypertension prevalence increased with age and gender adjustments. Despite a minor drop in awareness, treatment and control rates improved from past studies but remain inadequate. This underscores the urgent need for increased awareness and better treatment strategies to address hypertension effectively. The data on hyperlipidemia are very alarming. There is a critical need for more effective dyslipidemia prevention and treatment strategies. Over a decade, the WOBASZ Studies observed a 27% surge in diabetes prevalence. Additionally, there was a notable 50% increase in individuals with impaired fasting glucose. The prevalence of obesity has increased significantly in Poland over the last decade, particularly in men. It is concerning that every fourth inhabitant of Poland is now obese. Abdominal obesity is observed in every third man and nearly every second woman, with an excess of abdominal fat increasing in both sexes. Physical activity is another topic that requires significantly more attention as it is really insufficient among Polish population. Poland, regrettably, continues to be among the countries where the issue of tobacco smoking remains very much present, resulting not only in health consequences but also socioeconomic implications. Data from WOBASZ studies indicate a significant gap between the perceived and actual nutritional adequacy among Polish individuals, highlighting the urgent need for improved dietary practices. Addressing CVD prevention is a critical objective at both personal and societal levels, necessitating active engagement from healthcare professionals and policymakers. We propose a change, potentially somewhat controversial, in the approach to prevention and treatment.

BACKGROUND: Left ventricular hypertrophy (LVH) is a well-known risk factor for cardiovascular events. Even though, there are many electrocardiographic (ECG) criteria for LVH, they still provide poor performance, especially among obese patients. The aim of this study was to examine the sensitivity and specificity in obese and nonobese patients, with obesity defined using body mass index (BMI), visceral fat level (VFATL) and waist hip ratio (WHR). MATERIAL AND METHODS: Overall, 1722 patients were included in the study. All patients underwentcomplete physical examination, office blood pressure measurement, analysis of body composition, 12-lead ECG, M-mode two-dimensional echocardiography. Six standard ECG criteria for LVH were analyzed, including: Cornell voltage criteria, Cornell duration criteria, Sokolow- Lyon voltage criteria, Sokolow-Lyon product criteria, R I + S III and R wave of aVL. Sensitivity and specificity of those criteria was evaluated for patients with and without obesity. Transthoracic echocardiography was used as a reference method to detectLVH. RESULTS: In obese patients, Cornell duration criteria showed the best performance and should be used in detecting LVH. Increased amount of adipose tissue and presence of obesity, defined by different indicators, decreased sensitivity and specificity values of ECG criteria; however, only several criteria showed statistical significance. Sokolov-Lyon voltage and Cornel voltage were evaluated to have good sensitivity in nonobese women patients, but their performance was insufficient in obese women. CONCLUSION: LVH should not be diagnosed using ECG criteria without assessment of patients obesity. Preferred parameter, from discussed in this study, to assess patients obesity is VFATL.

Background: Diagnosis of hypertension (HT) in epidemiological studies sometimes requires careful clinical evaluation. This may be particularly challenging in the subgroup of patients taking antihypertensive drugs for indications other than HT. Material and methods: The PolSenior2 study was conducted on a representative sample of Polish residents aged 60 or older. Blood pressure measurements were taken three times during two separate visits in a total of 5,981 people (2,920 men and 3,044 women). The diagnosis of HT was made according to the European Society of Cardiology and European Society of Hypertension (ESC/ESH) criteria. On this basis, 4607 people were classified as having HT. Among them, 424 respondents were taking antihypertensive drugs, but were not aware of having the disease. Additional analysis was performed, consisting of a detailed telephone questionnaire and additional clinical assessment of potential comorbidities. The researchers managed to contact 269 people, of whom 265 agreed to participate in the study. Results: Based on the answers obtained, the respondents were divided into four subgroups: A. 54 (20.4%) respondents confirmed they had been diagnosed with HT and admitted that they considered the fact of taking medications as the absence of the disease; B. 79 (29.8%) respondents were not aware of HT, but the available clinical data indicated taking antihypertensive drugs due to HT; C. 79 (29.8%) of the respondents declared having HT, which may indicate that during the study they gave the wrong answer or their answer was incorrectly recorded by the research team member; D. 53 (20.0%) respondents answered "I don't know/I don't remember". There were no differences in the distribution of responses between those with elevated and normal blood pressure, or between the age groups of 60-79 and over 80. 1. A small percentage of patients with HT (approx. 1.5%) may confuse good control of the disease with being cured of it. This indicates the need for better patient education. 2. On the other hand, some patients take antihypertensive drugs for reasons other than HT. Therefore, accurate determination of the diagnosis of HT in epidemiological studies requires obtaining complete medical documentation with detailed data on the reasons for prescribing drugs and comorbidities.

The aim of this study was to establish the relationship between metabolic disorders, overweight and obesity with markers of accelerated ageing in patients with hypertension. Materials and methods: One hundred sixteen patients (the age 35-65 years, women 62.3%) with stage 1-2 grade 1-2 hypertension and low/moderate cardiovascular risk (CVR) were included in the study. 34 patients (27.59%) were obese, 50 patients (43.1%) were overweight, 32 patients (29.31%) had normal weight. Anthropometric, clinical, biochemical and molecular genetic methods (relative telomere length (RTL-b), telomerase activity (TA) and 5-methylcytosine global methyl level (GML) in DNA of blood mononuclear cells) were used. Epigenetic age was calculated using the DNAm PhenoAge epigenetic clock. The increase markers of carbohydrate metabolism [glycated haemoglobin (HbA 1c ), fasting plasma glucose (FPG), insulin, homeostasis model assessment of insulin resistance (HOMA-IR)], changes of lipid metabolism indicators [an increase in triglycerides (TG) and a decrease in high-density lipoprotein cholesterol (HDL)] were revealed in the obese group, compared with the normal weight group (p < 0.05). We didn't find differences in RTL-b in any groups (p > 0.05). But at the same time obese patients had higher GML and lower TA (p < 0.05). The accelerated ageing (by DNAm PhenoAge epigenetic clock) was association with higher visceral fat%, higher levels, TG, very low-density lipoprotein cholesterol, all parameters of carbohydrate metabolism (HbA 1c , FPG, Insulin, HOMA-IR) and lower HDL-C (p < 0.05). Conclusions: Pathological weight gain associated with the progression of metabolic disorders and accelerated ageing in patients with hypertension and low/moderate cardiovascular risk.

BACKGROUND: Hypertension is one of the most common diseases worldwide, especially in Viet Nam. Screening for early-stage chronic kidney disease (CKD) in patients with hypertension remains controversial. We aimed to analyze the sensitivity and specificity of serum cystatin C and serum creatinine in detecting early-stage kidney function loss as a complication in hypertensive patients. MATERIAL AND METHODS: From January 2013 to October 2018, 304 patients first-time diagnosed with primary hypertension at University Medical Center Ho Chi Minh City participated in this cross-sectional study. Collected data includes anthropometric indicators, measured glomerular filtration rate (GFR) by plasma 99mTc-diethylenetriaminepentaacetic clearance, serum cystatin C (ScysC), and serum creatinine (Scr). RESULTS: ScysC level was significantly reciprocal correlation between renal radiography (r = 0.781, p < 0.001). The cutoff value for the identification of GFR < 80 mL/min/1.73 m² was ScysC > 1.06 mg/L with a sensitivity of 90.8% and specificity of 90.6%, AUC was 0.90. The sensitivity and specificity of ScysC for the identification of GFR < 70 mL/min/1.73 m² and GFR < 60 mL/min/1.73 m² was 96.6%, 100% and 98.8%, 99.3%, respectively. Among 14 estimated glomerular filtration formulas used in this study, eGFR-cysC-Filler-Lepage had the highest sensitivity and specificity for identifying GFR < 80 mL/min/1.73 m² (79.8% and 100%, respectively). eGFR-cysC-LeBrion had the highest sensitivity and specificity for the identification of GFR < 70 mL/min/1.73 m² and GFR < 60 mL/min/1.73 m² (97.6%, 96.9% and 100%, 97%; respectively). CONCLUSION: The sensitivity and specificity of ScysC were significantly higher than Scr. The eGFR-cysC-Filler-Lepage formula had the highest sensitivity and specificity in detecting the early stages of CKD.

Background: Aortic knob width (AKW) is the measurement of the radiographic configuration composed of the foreshortened aortic arch and a part of the descending aorta. We investigated the relationship between the nondipper pattern and AKW. Material and methods: All patients’ office blood pressure measurements and 24-hour ambulatory blood pressure readings were recorded. A blood pressure drop of less than 10% was defined as non-dipping. The patients were grouped into Group 1; dipper pattern (37 patients; 22F, and mean age 49.2 ± 11.7 yrs) and Group 2; non-dipper pattern (64 patients; 37F, and mean age 53.7 ± 13.1 yrs). On posteroanterior chest radiography, the widest point of the aortic knob was measured along the straight imaginary line from the lateral edge of the trachea to the left lateral wall of the aortic arch. Results: AKW was significantly higher in Group 2 compared to group 1 (36.7 ± 5.7 vs. 30.7 ± 4.5 mm, p &lt; 0.001). The mean daytime and night-time systolic blood pressures, the mean night-time diastolic blood pressure levels, 24-hour mean blood pressure and mean pulse pressures were higher; percentage of nocturnal drops was significantly lower in Group 2 compared to Group 1. AKW was determined to be the parameter that was mostly related to the non-dipper pattern. A ROC analysis revealed that the area under the curve values for AKW values of non-dippers were 0.796 (95% CI: 0.707–0.884, p &lt; 0.001). Conclusion: AKW is significantly higher in non-dipper individuals compared to dippers. AKW values above 32.6 mm on the chest radiograph may be associated with non-dipper pattern especially in hypertensive individuals.