Andrzej Rynkiewicz

Bio: Andrzej Rynkiewicz is an academic researcher from University of Warmia and Mazury in Olsztyn. The author has contributed to research in topics: Coronary artery disease & Familial hypercholesterolemia. The author has an hindex of 23, co-authored 172 publications receiving 17380 citations. Previous affiliations of Andrzej Rynkiewicz include Gdańsk Medical University.

Joint position statement of the Polish Cardiologic Society, the Polish Gynaecological Society and the Polish Menopause and Andropause Society on the effect of postmenopausal hormone replacement therapy on the cardiovascular system.

Abstract: The group of experts representing the Polish Cardiologic Society, the Polish Gynecological Society and the Polish Menopause and Andropause Society has issued this Joint Position Statement based on the review of available literature on the effect of postmenopausal hormone replacement therapy on the cardiovascular system. The results of older clinical and epidemiological studies are confronted with the most recently published data. The importance of type, doses and delivery route of hormones is discussed with respect to the cardiovascular safety of HRT.

Znaczenie stresu w patogenezie nadciśnienia tętniczego. Część I The role of the stress in the pathogenesis of hypertension. Part I

Abstract: Summary Stress is an inescapable part of the modern life. It is an adaptive response and the body’s reaction to events. Stress also plays a great role in the development of hypertension. The evidence is based on the indicators that people with high blood pressure experience an increase in overall activity of nervous system involved in response to stress. It is also known that people with hypertension have increased activity of particular structures in the brain that respond to stress. Finally, people with high blood pressure release higher amount of the stress hormones than people with normal blood pressure.

The Association between Ambulatory Blood Pressure and Fasting Insulin and Glucose Plasma Levels in Normotensive Premenopausal Women

Abstract: Podwyzszone stezenia glukozy i insuliny w osoczu krwi są związane ze zwiekszonym ryzykiem wystąpienia nadciśnienia tetniczego i choroby wiencowej. Niewiele jest doniesien na temat związku insulinemii i glikemii na czczo z ciśnieniem tetniczym krwi u kobiet z prawidlowymi wartościami ciśnienia tetniczego w wieku przedmenopauzalnym. Celem pracy byla ocena wplywu stezenia insuliny i glukozy na czczo na profil dobowy ciśnienia tetniczego u kobiet z prawidlowym ciśnieniem w wieku przedmenopauzalnym. Material i metody Badanie wykonano w grupie 88 kobiet (średni wiek 46 ± 4 lata) bez nadciśnienia tetniczego w wywiadzie, wśrod ktorych byly 22 kobiety zdrowe, 33 pacjentki z zespolem policystycznych jajnikow, a 33 wykazywaly zaburzenia sekrecji estrogenow. U wszystkich badanych wykonano 24-godzinne monitorowanie ciśnienia tetniczego skurczowego i rozkurczowego (SBP i DBP). Wyniki Wykazano istotną korelacje miedzy stezeniem insuliny na czczo a średnim dobowym skurczowym i rozkurczowym ciśnieniem tetniczym. Wspolczynniki korelacji wynosily odpowiednio r = 0,41, p W badanej grupie zaobserwowano ponadto istotną korelacje miedzy nocną czestotliwością akcji serca a glikemią i insulinemią na czczo (odpowiednio: r = 0,29, p Wniosek Stezenie insuliny w osoczu na czczo jest związane ze średnim dobowym, a takze dziennym i nocnym ciśnieniem tetniczym krwi skurczowym i rozkurczowym u kobiet z prawidlowym ciśnieniem w wieku przedmenopauzalnym. Wzrost stezenia insuliny na czczo u kobiet z prawidlowymi wartościami ciśnienia w wieku przedmenopauzalnym moze byc czynnikiem ryzyka wystąpienia nadciśnienia tetniczego.

The successful treatment of cardiogenic shock with primary percutaneous coronary intervention (T-stenting) of total occluded unprotected left main performed during cardiopulmonary resuscitation.

Abstract: A 61-year-old male with no previous cardiovascular history was admitted to the coronary care unit suffering from acute angina. On presentation the patient was conscious, the heart rate was 100 bpm, and the blood pressure was 80/60 mm Hg. Standard electrocardiogram displayed prominent ST-segment elevation in the anterolateral leads. The initial treatment was 300 mg of aspirin, 600 mg of clopidogrel, and intravenous bolus of unfractioned heparin, all given in the ambulance. In the catheterisation laboratory, sudden cardiac arrest occurred and the patient was subsequently defibrillated. The patient needed defibrillation because of ventricular fibrillation followed by pulseless electrical activity. A cardiopulmonary resuscitation (CPR) was started. Through the left femoral artery a balloon for intra-aortic balloon counterpulsation (IABP) was introduced. The coronary angiogram of the left coronary artery (LCA) selectively engaged with a 6 French EBU-4 guiding catheter revealed an acute total occlusion of the left main stem (LMS) (Fig. 1A). During the CPR, a manual thrombectomy was performed and the blood flow in left anterior descending artery was restored (Fig. 1B). The left circumflex artery (LCX) was opened after a second thrombectomy (Fig. 1C). The patient received a subsequent intracoronary bolus of abciximab. Finally, the culprit lesion localised in the distal portion of the LMS was treated with a second-generation everolimus eluting stent 3.5/18 mm deployed at 20 atmospheres (Fig. 1D), and post dilated with a 4.0/15 mm non-compliant balloon. The final kissing-balloon inflation was complicated with a dissection of the ostial portion of the LCX (Fig. 1E). It was subsequently covered with a 3.0/18 mm drug eluting stent using a “T and protrusion” technique (Fig. 1E, inset). As percutaneous coronary intervention of the LCA was accomplished, the angiography of the right coronary artery showed no significant disease. After the procedure, the patient was transferred to the coronary care with catecholamine infusion and IABP 1:1 support. On the third day of hospitalisation, the patient received a red blood cell transfusion due to the large local haematoma and severe anaemia. IABP was removed 6 days after baseline; the patient was weaned from the respirator and extubated. In 4-month follow-up the patient remained asymptomatic with New York Heart Association class II. The control angiography revealed a good result in both left main and left circumflex arteries with no signs of in-stent restenosis (Fig. 1F). Figure 1. A. Acute occlusion of the left main coronary artery; B. The angiographic result after manual thrombectomy in left anterior descending artery; C. The angiographic result after manual thrombectomy in left circumflex artery (LCX); D. The angiographic result after implantation of drug eluting stent to the left main; E. Ostial dissection in LCX after kissing balloons and the final angiographic result; F. The angiographic follow-up after 4 months A C

Effects of isometric exercise on left ventricular function assessed with polycardiography in patients with early type I diabetes

Abstract: 15 patients with controlled type 1 diabetes lasting up to 24 months underwent the study. The control group consisted of 22 healthy men. Noninvasive examinations were carried out at rest and during a 3-minute isometric exercise of a load equal to 30% maximal effort. Rest systolic and diastolic blood pressures (SBP and DBP) were almost the same in both groups. Also exercise peak SBP and DBP did not significantly differ in examined groups. Rest PEP/LVET ratio were significantly lower in diabetics (means = 0.313 vs means = 0.348 in the control group; p less than 0.002). Peak isometric exercise PEP/LVET ratio significantly increased to 0.333 in diabetics, comparing with its rest value, whereas significantly decreased to 0.333 in the control group. Results indicate increased resting left ventricular contractility in patients with early, type 1 diabetes and impairment of a left ventricular adaptation for the isometric exercise in comparison with the control group.

2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

Abstract: ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …

Standards of Medical Care in Diabetes

Abstract: XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012)

Abstract: ABI : ankle–brachial index ACCORD : Action to Control Cardiovascular Risk in Diabetes ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation AGREE : Appraisal of Guidelines Research and Evaluation AHA : American Heart Association apoA1 : apolipoprotein A1 apoB : apolipoprotein B CABG : coronary artery bypass graft surgery CARDS : Collaborative AtoRvastatin Diabetes Study CCNAP : Council on Cardiovascular Nursing and Allied Professions CHARISMA : Clopidogrel for High Athero-thrombotic Risk and Ischemic Stabilisation, Management, and Avoidance CHD : coronary heart disease CKD : chronic kidney disease COMMIT : Clopidogrel and Metoprolol in Myocardial Infarction Trial CRP : C-reactive protein CURE : Clopidogrel in Unstable Angina to Prevent Recurrent Events CVD : cardiovascular disease DALYs : disability-adjusted life years DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Trial ED : erectile dysfunction eGFR : estimated glomerular filtration rate EHN : European Heart Network EPIC : European Prospective Investigation into Cancer and Nutrition EUROASPIRE : European Action on Secondary and Primary Prevention through Intervention to Reduce Events GFR : glomerular filtration rate GOSPEL : Global Secondary Prevention Strategies to Limit Event Recurrence After MI GRADE : Grading of Recommendations Assessment, Development and Evaluation HbA1c : glycated haemoglobin HDL : high-density lipoprotein HF-ACTION : Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing HOT : Hypertension Optimal Treatment Study HPS : Heart Protection Study HR : hazard ratio hsCRP : high-sensitivity C-reactive protein HYVET : Hypertension in the Very Elderly Trial ICD : International Classification of Diseases IMT : intima-media thickness INVEST : International Verapamil SR/Trandolapril JTF : Joint Task Force LDL : low-density lipoprotein Lp(a) : lipoprotein(a) LpPLA2 : lipoprotein-associated phospholipase 2 LVH : left ventricular hypertrophy MATCH : Management of Atherothrombosis with Clopidogrel in High-risk Patients with Recent Transient Ischaemic Attack or Ischaemic Stroke MDRD : Modification of Diet in Renal Disease MET : metabolic equivalent MONICA : Multinational MONItoring of trends and determinants in CArdiovascular disease NICE : National Institute of Health and Clinical Excellence NRT : nicotine replacement therapy NSTEMI : non-ST elevation myocardial infarction ONTARGET : Ongoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial OSA : obstructive sleep apnoea PAD : peripheral artery disease PCI : percutaneous coronary intervention PROactive : Prospective Pioglitazone Clinical Trial in Macrovascular Events PWV : pulse wave velocity QOF : Quality and Outcomes Framework RCT : randomized clinical trial RR : relative risk SBP : systolic blood pressure SCORE : Systematic Coronary Risk Evaluation Project SEARCH : Study of the Effectiveness of Additional Reductions in Cholesterol and SHEP : Systolic Hypertension in the Elderly Program STEMI : ST-elevation myocardial infarction SU.FOL.OM3 : SUpplementation with FOlate, vitamin B6 and B12 and/or OMega-3 fatty acids Syst-Eur : Systolic Hypertension in Europe TNT : Treating to New Targets UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use VITATOPS : VITAmins TO Prevent Stroke VLDL : very low-density lipoprotein WHO : World Health Organization ### 1.1 Introduction Atherosclerotic cardiovascular disease (CVD) is a chronic disorder developing insidiously throughout life and usually progressing to an advanced stage by the time symptoms occur. It remains the major cause of premature death in Europe, even though CVD mortality has …

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)

Abstract: Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults. Evidence was drawn from randomized controlled trials, which represent the gold standard for determining efficacy and effectiveness. Evidence quality and recommendations were graded based on their effect on important outcomes. There is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg; however, there is insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, so the panel recommends a BP of less than 140/90 mm Hg for those groups based on expert opinion. The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years. There is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. There is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes. Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.

2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)

Abstract: Because of new evidence on several diagnostic and therapeutic aspects of hypertension, the present guidelines differ in many respects from the previous ones. Some of the most important differences are listed below: 1. Epidemiological data on hypertension and BP control in Europe. 2. Strengthening of the prognostic value of home blood pressure monitoring (HBPM) and of its role for diagnosis and management of hypertension, next to ambulatory blood pressure monitoring (ABPM). 3. Update of the prognostic significance of night-time BP, white-coat hypertension and masked hypertension. 4. Re-emphasis on integration of BP, cardiovascular (CV) risk factors, asymptomatic organ damage (OD) and clinical complications for total CV risk assessment. 5. Update of the prognostic significance of asymptomatic OD, including heart, blood vessels, kidney, eye and brain. 6. Reconsideration of the risk of overweight and target body mass index (BMI) in hypertension. 7. Hypertension in young people. 8. Initiation of antihypertensive treatment. More evidence-based criteria and no drug treatment of high normal BP. 9. Target BP for treatment. More evidence-based criteria and unified target systolic blood pressure (SBP) (<140 mmHg) in both higher and lower CV risk patients. 10. Liberal approach to initial monotherapy, without any all-ranking purpose. 11. Revised schema for priorital two-drug combinations. 12. New therapeutic algorithms for achieving target BP. 13. Extended section on therapeutic strategies in special conditions. 14. Revised recommendations on treatment of hypertension in the elderly. 15. Drug treatment of octogenarians. 16. Special attention to resistant hypertension and new treatment approaches. 17. Increased attention to OD-guided therapy. 18. New approaches to chronic management of hypertensive disease