Objectives: Evidence suggests that renal function increasingly deteriorates in patients with apparently treatment-resistant hypertension (ATRH) in comparison with those who have non-resistant arterial hypertension (NAH). We aimed to assess the long-term decline in renal function between these patient groups and identify specific risk factors contributing to the progression of renal dysfunction. Methods: Data for 265 patients with ATRH and NAH in a hypertension excellence centre were retrospectively evaluated. Demographic characteristics, co-morbidities, laboratory findings, secondary causes of hypertension, medication and exposure to contrast agents were assessed. To address differences between groups, adjustment with linear mixed-effect models was used. Results: Data from the first 4 years of follow-up were evaluated. After adjustment for age and diabetes, which were identified as independent risk factors for renal dysfunction progression in the study cohort, the mean decrease in estimated glomerular filtration rate per year was steeper with ATRH than with NAH (-1.49 vs. -0.65 mL/min/1.73 m² per year; difference in slope, 0.83 mL/min/1.73 m² per year; 95% confidence interval [CI]: 0.25-1.41, p = 0.005). In subgroup analyses, without Holm-Bonferroni correction, the prescription of MRA indicated a faster decline in renal function in ATRH. Following correction, no specific therapeutic risk factor was associated with faster progression of renal dysfunction. Conclusions: Renal function declines twice as fast with ATRH compared with NAH, independently of age and diabetes. Larger studies are needed to reveal risk factors for renal dysfunction in patients with hypertension.

Maximal athletic performance can be limited by various factors, including restricted respiratory function. These limitations can be mitigated through targeted respiratory muscle training, as supported by numerous studies. However, the full potential of respiratory training in competitive finswimming has not been fully investigated. This case study aims to evaluate the effects of eight-week respiratory muscle training (RMT) on performance variability during the underwater phases of a 200 m bi-fins race simulation in an elite finswimmer (current world record holder and multiple world championship medalist). Performance variability was assessed based on pre-test, inter-test, and post-test data. Each measurement included pulmonary function and swim performance evaluations. In this study, underwater performance parameters, such as distance, time, velocity, and number of kicks, were assessed using video analysis synchronized with race timing and evaluated using the Dartfish software. The swimmer followed a 28-day training program with an Airofit PRO™ respiratory trainer between tests, with daily sessions targeting both inspiratory and expiratory muscles. The training involved 6–10 min of targeted exercises per day. Significant improvements were observed in Wilcoxon’s paired-sample test between the pre-test and post-test results in terms of underwater distance (p = 0.012; d = 1.26), underwater time (p = 0.012; d = 1.26), and number of underwater kicks (p = 0.043; d = 1.01), resulting in a 14.23% longer underwater distance, 14.08% longer underwater time, and 14.94% increase in underwater kicks. Despite the increased distance and time, underwater velocity remained stable, indicating improved underwater performance efficiency. Despite some improvements, it is not possible to conclude that respiratory muscle training (RMT) can contribute to improved finswimming performance during the underwater phases of a 200 m bi-fins race simulation in this particular athlete’s case. Further research with a larger sample size is necessary to fully understand the impact of RMT on finswimming performance.

This randomised, multicentre study compared the efficacy of renal denervation (RDN) versus spironolactone addition in patients with true resistant hypertension. We present the 24-month data. A total of 106 patients with true resistant hypertension were enrolled in this study: 52 patients were randomised to RDN and 54 patients to the spironolactone addition, with baseline systolic blood pressure of 159 ± 17 and 155 ± 17 mmHg and average number of drugs 5.1 and 5.4, respectively. Two-year data are available in 86 patients. Spironolactone addition, as crossover after one year, was performed in 23 patients after RDN, and spironolactone addition followed by RDN was performed in 5 patients. Similar and comparable reduction of 24-hour systolic blood pressure after RDN or spironolactone addition after randomisation was observed, 9.1 mmHg (p = 0.001) and 10.9 mmHg (p = 0.001), respectively. Similar decrease of office blood pressure was observed, 17.7 mmHg (p < 0.001) versus 14.1 mmHg (p < 0.001), while the number of antihypertensive drugs did not differ significantly between groups. Crossover analysis showed non-significantly better efficacy of spironolactone addition in 24 h systolic and office systolic blood pressure reduction than RDN (3.7 mmHg, p = 0.27 and 4.6 mmHg in favour of spironolactone addition, p = 0.28, respectively). Meanwhile, the number of antihypertensive drugs was significantly increased after spironolactone addition (+0.7, p = 0.001). In the settings of true resistant hypertension, spironolactone addition (if tolerated) seems to be of better efficacy than RDN in blood pressure reduction over a period of 24 months. However, by contrast to the 12-month results, blood pressure changes are not significantly greater.

Maximal athletic performance can be limited by various factors, including restricted respiratory function. These limitations can be mitigated through targeted respiratory muscle training, as supported by numerous studies. However, the full potential of respiratory training in competitive finswimming has not been fully investigated. This case study aims to evaluate performance variability during underwater phases in an elite Bi-Fins swimmer (current world record holder and multiple world championship medallist) over a 200m race simulation after an eight-week respiratory training using Airofit PRO™. Performance variability was assessed based on pre-test, inter-test, and post-test data. Each measurement included pulmonary function, body composition, and swim performance evaluations. The swimmer followed a 28-day training program with the AiroFit PRO™ respiratory trainer between tests. Significant improvements were observed in Wilcoxon paired-sample test between the pre-test and post-test in underwater distance (p=0.012; d=1.26), underwater time (p=0.012; d=1.26), and number of underwater kicks (p=0.043; d=1.01), resulting in a 14.23% longer underwater distance, 14.08% longer underwater time, and 14.94% increase in underwater kicks. Despite increased distance and time, underwater velocity remained stable, indicating improved underwater performance efficiency. The results suggest that the AiroFit PRO™ respiratory trainer has practical applications in finswimming training programs.

In this study, we aimed to determine the prevalence and spectrum of secondary hypertension among patients with apparently resistant arterial hypertension (aRH) and to compare the rate of decline in estimated glomerular filtration rate (eGFR) between those with primary aldosteronism (PA) and true resistant arterial hypertension (RAH). We conducted a retrospective cohort study of 790 patients with aRH referred to a hypertension excellence center. All patients fulfilled pharmacological criteria for aRH and underwent a screening protocol to evaluate secondary hypertension. We compared clinical and laboratory markers of patients with PA to those with RAH, with a median follow-up of 7 years. Secondary hypertension was identified in 213 patients (27%), with PA being the most common cause (17%), followed by renovascular hypertension (4.1%), renal parenchymal disease (3.7%), pheochromocytoma (0.8%), and Cushing's syndrome (0.6%). Compared to RAH patients, those with PA had significantly fewer cardiovascular comorbidities, lower serum potassium levels (4.13 vs. 4.23 mmol/L). Notably, patients with RAH exhibited a faster decline in renal function, specifically an additional 0.7 mL/min/1.73m² reduction per year (95% CI 0.05 - 1.35, p = 0.03), despite similar baseline eGFR and BP control. In RAH, a continuous association between higher average 24-hour systolic BP and a faster decline in renal function was observed. Systematic screening in aRH reveals a high prevalence of secondary hypertension, particularly PA. Patients with RAH showed significantly worse renal outcomes compared to those with PA, with faster renal decline associated with higher blood pressure within the RAH group, underscoring the need for early diagnosis and strict BP management.

Background and purpose: The cause of ischemic stroke (IS) remains often unclear in young patients. Relevant structural heart abnormities with known embolic potential may represent cause of IS also in young population. The use of transoesophageal echocardiography (TEE) allows reliable detection of most relevant structural pathologies. The aim was to assess frequency and spectrum of relevant cardiac abnormities in young IS patients. Subjects and methods: The study set consisted of young acute IS patients <50 years enrolled in the prospective HISTORY (Heart and Ischemic STrOke Relationship studY) study, registered on ClinicalTrials.gov NCT01541163). In all patients, the brain ischemia was confirmed on CT or MRI. Admission ECG, serum specific cardiac markers, TEE, 24-hour and 3-week ECG-Holter were performed in all patients. Results: Out of 1284 patients enrolled in the HISTORY study, 135 (73 males, mean age 40.2±8.1 years) were <40 years. In total, the relevant TEE abnormities were present in 47 (35%) of these patients. Patent foramen ovale (PFO) with evident left to right shunt was detected in 38 (28%) patients, with significant right to left shunt in 25 (19%) patients, and other atrial septal defect with clinically significant bidirectional flow in 4 (3%) patients. Significant valvular heart disease was present in 2 (1%) patients (1 bicuspid aortic valve with moderate aortic regurgitation, 1 chronic severe mitral regurgitation), and 4 (3%) patients severe left ventricular systolic dysfunction (left ventricular ejection fraction ≤35%) due to idiopathic dilated cardiomyopathy. Left atrial myxoma was detected in one patient. Conclusion: The relevant structural abnormities with embolic potential were detected using TEE in 35% of young IS patients. Routine use of TEE to elucidate the causes of stroke, has a role especially in young patients who present with cryptogenic stroke and no cardiovascular risk factors, as well as in the setting of a PFO associated with a deep venous thrombosis. Funding Acknowledgement: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): IGA LF UP, MH CZ - DRO