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Background Hypertension is a major risk factor of cardiovascular mortality. Mood disorders represent a growing public health problem worldwide. A complex relationship is present between mood disorders and cardiovascular diseases. However, less data is available about the level of depression and anxiety in different hypertension phenotypes. The aim of our study was to evaluate psychometric parameters in healthy controls (Cont), in patients with white-coat hypertension (WhHT), with chronic, non-resistant hypertension (non-ResHT), and with chronic, treatment-resistant hypertension (ResHT). Methods In a cross-sectional study setup 363 patients were included with the following distribution: 82 Cont, 44 WhHT, 200 non-ResHT and 37 ResHT. The patients completed the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A). Results BDI points were higher in WhHT (7 (3–11)) and ResHT (6 (3–11.5)) compared with Cont (3 (1–6), p  < 0.05). Similarly, HAM-A points were higher in WhHT (8 (5–15)) and ResHT (10.5 (5.25–18.75)) compared with Cont (4 (1–7), p  < 0.05) and also compared with non-ResHT (5 (2–10), p  < 0.05). ResHT was independently associated with HAM-A scale equal or above 3 points (Beta = 3.804, 95%CI 1.204–12.015). WhHT was independently associated with HAM-A scale equal or above 2 points (Beta = 7.701, 95%CI 1.165–18.973) and BDI scale equal or above 5 points (Beta = 2.888, 95%CI 1.170–7.126). Conclusions Our results suggest psychopathological similarities between white-coat hypertension and resistant hypertension. As recently it was demonstrated that white-coat hypertension is not a benign condition, our findings can have relevance for future interventional purposes to improve the outcome of these patients.

Objective Central systolic blood pressure (cSBP) and augmentation index (Aix) can be evaluated in office and also in ambulatory condition, during 24-h monitoring. The aim of our study was to measure cSBP and Aix in the office and in 24-h setting cSBP with two calibration methods and also Aix. Thereafter, we aimed to compare their changes after the initiation of lifestyle modifications or antihypertensive medications. Methods Office cSBP and Aix were measured with the tonometric PulsePen device (PP-cSBP, PP-Aix, respectively), while 24-h ambulatory cSBP and Aix (24 h-Aix) were evaluated with Mobil-O-Graph. For the calculation of 24-h cSBP both systolic/diastolic and systolic/mean BP calibration methods were considered (24 h-cSBPC1 and 24 h-cSBPC2, respectively). In new hypertensive patients (HT) the measurements were repeated 3 months after the initiation of antihypertensive medication while in white-coat hypertensive patients (WhHT) 12 months after lifestyle modifications. Results 105 patients were involved including 22-22 HT and WhHT subjects, respectively. PP-cSBP (128 ± 13 mmHg,) was higher than 24 h-cSBPC1 (118 ± 9 mmHg, p  < 0.05), but equal with 24 h-cSBPC2 (131 ± 11 mmHg). PP-Aix (14 ± 14%) was lower than 24 h-Aix (22 ± 7%, p  < 0.05). For medical intervention PP-cSBP (Δ16 mmHg) decreased more, than 24 h-cSBPC1 (Δ10 mmHg, p  < 0.05) and 24 h-cSBPC2 (Δ9 mmHg, p  < 0.05). Conclusions Office tonometric and 24 h oscillometric cSBP values differ depending on the calibration. When examining the effect of antihypertensive treatment, the more marked changes in office tonometric cSBP suggests its higher variability compared with 24 h oscillometric central SBP. During follow-up, the two calibration methods of 24 h-cSBP seems not to be interchangeable.

Background Supine hypertension, a consequence of autonomic neuropathy, is a rarely recognized pathological condition. Reported diseases in the background are pure autonomic failure, multiple system atrophy, Parkinson’s disease, diabetes and different autoimmune disorders. Methods In our case report we present a case of supine hypertension which developed in a patient decades after kidney transplantation. The patient was followed for 25 months and we demonstrate the effect of the modification of antihypertensive medications. Results At the time of the diagnosis supine hypertension appeared immediately after laying down (office sitting Blood Pressure (BP): 143/101 mmHg; office supine BP: 171/113 mmHg) and on Ambulatory Blood Pressure Monitoring (ABPM) extreme reverse dipping was registered (daytime BP: 130/86 mmHg, nighttime BP: 175/114 mmHg). After the modification of the antihypertensive medications, both office supine BP (office sitting BP: 127/92 mmHg; office supine BP: 138/100 mmHg) and on ABPM nighttime BP improved markedly (daytime BP: 135/92 mmHg, nighttime BP: 134/90 mmHg). Conclusion In conclusions, our case report points out that autonomic neuropathy-caused supine hypertension and extreme reverse dipping can develop in chronic kidney disease, after kidney transplantation. The modification of the antihypertensive medications can slowly restore this pathological condition.

Affective temperaments represent a biologically stable core of emotional reactivity and have previously been associated with hypertension and arterial stiffening. The age, when hypertension is initiated, is influenced by different factors, but the role of personality traits in this regard is not clarified yet. Our aim was to study the association between affective temperaments and the age at onset of hypertension. In this cross-sectional study, 353 patients were included. After the evaluation of history, patients completed the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire. We used linear regression analysis to identify predictors of the age of onset of hypertension in the whole cohort and in male and female subpopulations. The independent predictors of the age at onset of hypertension were male sex (B = −4.57 (95% CI = −1.40 to −7.74)), smoking (B = −4.31 (−7.41 to −1.22)), and positive family history (B = −6.84 (−10.22 to −3.45)). In women, cyclothymic temperament score was an independent predictor of the initiation of hypertension (B = −0.83 (−1.54 to −0.12)), while this association was absent in men. Besides traditional factors, cyclothymic affective temperament might contribute to the earlier initiation of hypertension in women.

Background Affective temperaments (depressive, anxious, cyclothymic, irritable and hyperthymic) have important role in psychopathology, but cumulating data support their involvement in vascular pathology, especially in hypertension as well. The aim of our study was to evaluate their associations with 24-h peripheral and central hemodynamic parameters in untreated patients who were studied because of elevated office blood pressure. Methods The oscillometric Mobil-O-Graph was used to measure the 24-h peripheral and central parameters. Affective temperaments, depression and anxiety were evaluated with Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, Beck and Hamilton Anxiety Scale (HAM-A) questionnaires, respectively. Results Seventy four patients were involved into the study (45 men). In men after the adjustment for age, irritable affective temperament score was associated with nighttime peripheral and central systolic blood pressure ( β = 1.328, std. error = 0.522, p = 0.015 and β = 1.324, std. error = 0.646, p = 0.047, respectively). In case of nighttime peripheral systolic blood pressure this association remained to be significant after further adjustment for smoking, alcohol consumption, sport activity and body mass index and became non-significant after adjustment for Beck and HAM-A scores. In case of nighttime central systolic blood pressure the association lost its significance after the adjustment for smoking, alcohol consumption and sport activity. Conclusion Irritable affective temperament can have an impact on nighttime peripheral and central systolic blood pressures in untreated men with elevated office blood pressure.

A patient with the complaint of moderately elevated blood pressure came to our office. Important data in his history was kidney transplantation in 1985, due to glomerulonephritis and since that time he was in regular nephrology care. He also had chronic lumboischialgia, chronic hypertension and stage 3b chronic kidney disease. He was included into our screening program, in which arterial stiffness and central hemodynamics were also registered with Mobil-O-Graph. Besides moderately elevated office blood pressure (143/102 mmHg, heart rate: 68/min), in ABPM extreme reverse dipping phenomenon (24 h average: 140/93 mmHg; daytime average: 130/86 mmHg; night-time average: 175/114 mmHg) was found, which was unknown until that time. The blood pressure elevation appeared immediately in supine position. Antihypertensive medications were modified. Ultrasound of the transplanted kidney did not confirm compression of the renal artery; on ECHO left ventricular hypertrophy was found. Neuropathy test described autonomic neuropathy. After the modification of antihypertensive medications, the extreme reverse dipping phenomenon was attenuated, but still present. Benfotiamine + Pyridoxine (200/200 mg daily) was started by a rheumatologist, because of chronic back pain. After a year of their administration in an ABPM control the neuroprotective medication was ineffective for the recovery of the extreme reverse dipping phenomenon, but 19 months following the initiation, the supine hypertension phenomenon was further attenuated. In conclusions, in patients decades after kidney transplantation autonomic neuropathy can lead to supine hypertension and extreme reverse dipping phenomenon on ABPM, which can be influenced with the modification of antihypertensive medications and probably with neuroprotective agents.

Background Our aim was to study the predictive power of integrated central blood pressure-aortic stiffness (ICPS) risk categories on cardiovascular (CV) mortality in end-stage renal disease (ESRD) patients. Methods This is a secondary analysis of a prospective study of 91 ESRD patients on hemodialysis therapy. At baseline, pulse wave velocity (PWV), central systolic blood pressure (cSBP) and central pulse pressure (cPP) were measured and patients were followed up for CV mortality for a median 29.5 months. Based on the shape of the association of each individual ICPS parameter with the CV outcome, patients were assigned ICPS scores: one point was given, if either the cSBP value was in the 3rd, or if the PWV or cPP was in the 2nd or 3rd tertiles (ICPS range: 0–3). We then evaluated the role of ICPS risk categories (average: 0–1, high: 2, very high: 3 points) in the prediction of CV outcomes using Cox proportional hazard regression analysis and compared its discrimination (Harrell’s C ) to that of each of its components. Results We found a strong dose—response association between ICPS risk categories and CV outcome (high risk HR = 2.62, 95% CI: 0.82–8.43, p for trend = 0.106; very high risk HR = 10.03, 95% CI: 1.67–60.42, p = 0.02) even after adjustment for multiple potential confounders. ICPS risk categories had a modest discrimination ( C : 0.622, 95% CI: 0.525–0.719) that was significantly better than that of cSBP (d C : 0.061, 95% CI: 0.006–0.117). Conclusion The ICPS risk categories may improve the identification of ESRD patients with high CV mortality risk.

Affective temperaments (depressive, anxious, irritable, hyperthymic, and cyclothymic) are stable parts of personality and describe emotional reactivity to external stimuli. Their relation to psychopathological conditions is obvious, but less data are available on their relationship with cardiovascular disorders. The aim of this study was to evaluate affective temperaments and hemodynamic and arterial stiffness parameters in healthy subjects (Cont), in white-coat hypertensive (WhHT) patients, and in non-resistant (non-ResHT) and resistant hypertensive (ResHT) patients. In this cross-sectional study, 363 patients were included: 82 Cont, 44 WhHT, 200 non-ResHT, and 37 ResHT. The patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A), and arterial stiffness was examined with tonometry (PulsePen). Significant differences were found between the Cont, WhHT, non-ResHT and ResHT groups in pulse wave velocity (7.76 ± 0.96, 8.13 ± 1.39, 8.98 ± 1.25, and 10.18 ± 1.18 m/s, respectively, p < 0.05 between Cont and non-ResHT/ResHT; p < 0.05 between non-ResHT and ResHT). Cyclothymic affective temperament points (4 (2.25-8)) were higher (p < 0.05) in the ResHT group than in the Cont (2 (0-5)) and non-ResHT (3 (1-5)) groups. The cyclothymic temperament points of the WhHT group (4 (2-7)) were also higher than those in the Cont group. ResHT was independently associated with a cyclothymic scale score above 6 (beta = 2.59 (95% CI: 1.16-5.77)), an irritable scale score above 7 (beta = 3.17 (95% CI: 1.3-7.69)) and an anxious scale score above 9 (beta = 2.57 (95% CI: 1.08-6.13)) points. WhHT was also independently associated with cyclothymic scale scores above 6 points (beta = 2.378, 95% CI: 1.178-4.802). In conclusion, white-coat and ResHT patients have specific affective temperament patterns, and the evaluation of these patterns can help to understand the psychopathological background of these conditions.

Background The evaluation of arterial stiffness and central haemodynamics represent a new tool of cardiovascular (CV) risk stratification. Our aim was to create an integrated central pressure-stiffness risk score (ICPS score) which incorporate the predictive potential of identical parameters. Methods 100 chronic kidney disease patients on conservative therapy (CKD 1–5) were involved in our study. Pulse wave velocity (PWV), augmentation index (Aix), central systolic blood pressure (csys) and central pulse pressure (cPP) were measured. Patients were followed for 59.7 months and CV morbidity and mortality were registered. Patients were classified into tertiles based on their PWV, Aix, csys and cPP values. After the analysis of the predictive values of the tertiles of the identical parameters, patients were scored. One score was given, when a patient had a third tertile value of PWV, csys or cPP or a second or third tertile value of Aix. Then the CV outcome was analyzed with Cox regression analysis of the groups of patients with different scores. Results During follow-up 37 CV events occurred. Compared with the zero-point group (n = 21), the one-point group (n = 25) did not have significantly increased odds ratio (OR) for CV events (OR: 1.10; 95% confidence interval (CI): 0.27–4.44), but the risk has been significantly elevated in the two-point group (n = 29, OR: 4.59, CI: 1.39–15.22) and it increased further in the three-point group (n = 16, OR: 9.03, CI: 2.22–36.65), as well as in the four-point group (n = 9, OR: 11.84, CI: 2.52–55.64). Conclusion The ICPS score can help in the identification of chronic kidney disease patients with high CV risk.

Background Our aim was to study the predictive power of ICPS risk categories on CV mortality in hemodialysis patients. Methods In our retrospective cohort study 91 patients were involved from two dialysis centers. Pulse Wave Velocity (PWV), central systolic blood pressure (cSBP) and and central pulse pressure (cPP) were measured with tonometric method, patients were followed for a median of 29.5 months and CV mortality was registered. Patients were classified into tertiles based on their PWV, cSBP and cPP values. After the analysis of the predictive values of the tertiles of the identical parameters, patients were scored. One score was given, when a patient had a third ter-tile value of cSBP or a second or third tertile value of PWV or cPP. Then the CV outcome was analyzed with Cox regression analysis of the groups of patients with different ICPS scores and three ICPS risk categories were defined: average (0–1 point), high (2 points) and very high (3 points). Results During follow-up 31 events occurred. After adjustment for multiple factors, compared with the average ICPS risk category group (n = 35; 38%), those, who were in the high risk group (n = 33; 30%) showed a tendency for significantly higher hazard ratio (HR) of CV mortality (HR = 2.62, 95% confidence interval (CI):0.82–8.43), while patients in the very high ICPS risk category(n = 23; 21%) hadamarkedly increased risk (HR = 10.03, CI:1.67–60.42). Conclusions The ICPS risk categories can help in the identification of hemodialysis patients with high CV risk.