Articles signed on MÆDICA, JCM:

The Role of Obstructive Sleep Apnea in Developing Gestational Hypertension and Preeclampsia

MÆDICA - a Journal of Clinical Medicine | Vol. 11, nr. 4, 2016

ISSN 1841-9038 | e-ISSN 2069-6116
ISSN-L 1841-9038

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Laura LUNGEANU-JURAVLE, Natalia PATRASCU, Oana Claudia DELEANU and Mircea CINTEZA

ABSTRACT

Gestational hypertension and preeclampsia are the most frequent medical complications in pregnancy and major causes of maternal and fetal morbidity and mortality. It is also known that these conditions are associated with a long term increased cardiovascular global risk for these young women. Obstructive sleep apnea (OSA) seems to be not only a frequent pathology associated with pregnancy but also an independent factor for developing gestational hypertension. It is well known the relationship between gestational hypertension, preeclampsia and intrauterine growth restriction of the foetus so the outcomes of this pathologies are important for both mother and child. Increasing awareness of OSA among pregnant women with gestational hypertension and preeclampsia is important given the potential benefits of the treatment with continuous positive airway pressure (CPAP) on these patients.
Keywords: Gestational hypertension, preeclampsia, obstructive sleep apnea, continuous positive airway pressure, pregnancy

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Assessment of Systolic and Diastolic Cardiac Function beyond Traditional Markers in Hypertensive Patients. Role of Cardiac Reserve

Natalia PATRASCU

ABSTRACT

Background: the mechanical performance of the cardiac pump should be evaluated not only at rest but also in relation to its response to peak stimulation, since the earliest consequence of the cardiac pump capacity in the evolution of heart failure is the decrease of the maximal performance. This can be assessed by measuring the cardiac functional reserve, usually by a physical or a pharmacological stress test combined with echocardiography imaging.

Content and comments: in symptomatic heart failure, the main purpose is to objectively identify the point to which the impairment of the pump function is irreversible. Moreover, there is growing evidence that the functional systolic and diastolic reserve is decreased even in the early, subclinical stages of cardiac dysfunction that exists for example in hypertensive disease and that the decrease seems to be related to the number of the associated cardiovascular risk factors.

Conclusion: thus, better preventive and therapeutic strategies could be established by detecting a reduced functional reserve in this category of patients at high risk of heart failure development, with important public-health implications.

Keywords: functional reserve, stress test with dobutamine, subclinical heart failure, beta-blockers, tissue Doppler imaging, speckle tracking

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Diastolic Heart Failure in Hypertension: Possible Preventive Benefits of Nebivolol Beyond Lowering Blood Pressure

Natalia PATRASCU

ABSTRACT

Arterial hypertension is one of the most prevalent cardiovascular diseases and one of the most important causes of heart failure with low or preserved ejection fraction. Although many drugs are highly effective in lowering blood pressure, the optimal treatment for preventing progression to heart failure is still uncertain. Beta-blockers, a class of drugs with well-established indications and benefits for both hypertension and heart failure seem to show different pharmacological properties with different consequences on the cardiovascular hemodynamic. The third class beta-blocker nebivolol, by its particular mechanism of vasodilatation mediated by nitric oxide release, has been proven to provide substantial benefits beyond the effect of blood pressure lowering, such as reversal of endothelial dysfunction, improvement of ventricular-arterial coupling, improvement of coronary flow reserve and an overall improvement of the diastolic function which is independent of the changes in ventricular geometry. Thus, nebivolol seems to be superior to other “classical” beta-blockers for the reversal of subclinical left ventricular dysfunction in hypertensive patients, before the onset of overt heart failure. This could be an important fact to take into consideration especially for the early stages of heart failure with preserved ejection fraction for which the optimal management is not established yet.

Keywords: beta-blockers, nebivolol, diastolic dysfunction, longitudinal function, conduit arterial stiffness

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Articles signed on MÆDICA, JCM:

The Role of Obstructive Sleep Apnea in Developing Gestational Hypertension and Preeclampsia

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