Cardiologia Croatica. 2018;13(7-8)

Teja Prijatelj, Mateja Grošelj, Breda Barbič-Žagar

One in three adults suffers from high blood pressure (BP), and the prevalence is expected to rise in the future due to population ageing and unhealthy lifestyles. Despite increased public awareness and access to a variety of antihypertensives, BP control remains an unmet objective. The data suggest that a significant proportion of patients with hypertension are not identified and treated, or despite the therapy do not have BP lowered to the recommended values (below 140/90 mmHg). Recently published extracts from the 2018 European Society of Cardiology and European Society of Hypertension Joint Guidelines for the Management of Arterial Hypertension emphasize that the first objective of treatment should be to lower BP below 140/90 mmHg in all patients. If the treatment is well-tolerated, BP should be targeted to 130/80 mmHg in most patients in order to maximally reduce the risk of cardiovascular events, which is the main goal of hypertension treatment. Some solutions which may help improve the BP control are discussed below.

Lidija Veterovska Miljković, Lidija Pavleska, Biljana Petreska Zović

The most important index for heart remodeling in old age, besides left ventricular hypertrophy and left atrium dilatation, also represents the progressive left ventricular diastolic dysfunction, which seems to be the most important marker for cardiac aging. To prove the association and the role of systemic inflammation present in the most frequent comorbid diseases in old age (arterial hypertension, diabetes mellitus, obesity, and chronic renal dysfunction) with the existence of diastolic dysfunction in heart failure with preserved ejection fraction in the elderly. To establish the level of inflammatory mediators: IL-6 and hs-CRP in the blood of patients in the test and control group and to correlate this with echocardiographic parameters for diastolic dysfunction as well as with the level of carotid atheromathosis. A total of 78 patients aged >65 years were investigated; cardiac failure with preserved ejection fraction was found in 60 using clinical and echocardiographic tests, as well as the presence of one or several investigated comorbidities, while 18 patients were relatively healthy elderly persons without comorbidities. All patients underwent clinical investigations, electrocardiography, laboratory analyses, echocardiography, and carotid Doppler sonography. Patients with heart failure with preserved ejection fraction had abnormalities of the heart and vascular structure, compared with the relatively healthy group of the elderly. These patients had more significant heart remodeling (concentric left-ventricular hypertrophy and left atrial dilatation), as well as diastolic dysfunction (higher E/e’, lower e’), and abnormal vascular dysfunction (changes in carotid blood vessels). The serum level of IL-6 and hs-CRP showed significant association with the parameters of diastolic dysfunction, as well as with the level of the left vascular hypertrophy, the parameters of the eft atrial remodeling, the level of the heart failure (NYHA), and carotid atheromatosis. Inflammation and oxidative stress, in addition to being the most common comorbidities in elderly, have a role in developing diastolic dysfunction, heart remodeling, and the appearance of heart failure with preserved ejection fraction.

Ingrid Prkačin, Martina Lovrić Benčić, Domagoj Marković

Traditional cardiovascular risk factors for target organ damage are the same in both women and men and include hypertension, hyperlipidemia, diabetes mellitus, smoking, and atrial fibrillation. There are several risk factors that are specific to women, such as differences in sex hormones, exogenous estrogens, and pregnancy. Further investigation into the sex-specific differences in therapeutic utilization and the sex-specific differences in the safety and efficacy of the therapeutic options is required.

Dubravka Mihaljević

The risk of cardiovascular disease increases significantly in menopause, which is associated with faster development of vascular disease and osteoporosis. Elevated blood pressure, dyslipidemia, pre-diabetes and diabetes, and chronic kidney disease contribute to cardiovascular disease development. Impaired kidney function increases total mortality and cardiovascular mortality independently of the traditional risk factors.

Martina Lovrić Benčić, Ingrid Prkačin

Today, women with ST-elevation myocardial infarction receive suboptimal management and have worse outcomes than men, with higher rates of in-hospital adverse events and higher mortality. In 2017, the American Heart Association identified “closing knowledge gaps on acute myocardial infarction and treatments for women” as a public health priority. There are sex-specific differences in the management of atrial fibrillation (AF). Women with AF receive suboptimal management and are significantly less likely to receive therapeutic anticoagulation, attempt rhythm control, or undergo invasive cardiovascular procedures. Stroke prevention still remains central to the management of AF.