Nondipper hypertension is associated with increased cardiovascular morbidity and mortality. Vitamin D deficiency is associated with cardiovascular diseases such as coronary artery disease, heart failure, and hypertension. Vitamin D deficiency activates the renin–angiotensin–aldosterone system, which affects the cardiovascular system. For this reason, a relationship between vitamin D deficiency and nondipper hypertension could be suggested. In this study, we compared 25-OH vitamin D levels between dipper and nondipper hypertensive patients. The study included 80 hypertensive patients and they were divided into two groups: 50 dipper patients (29 male, mean age 51.5 ± 8 years) and 30 nondipper patients (17 male, mean age 50.6 ± 5.4 years). All the patients were subjected to transthoracic echocardiography and ambulatory 24-hour blood pressure monitoring. In addition to routine tests, 25-OH vitamin D and parathormone (PTH) levels were analyzed. All the patients received antihypertensive drug therapy for at least 3 months prior to the evaluations. 25-OH vitamin D and PTH levels were compared between the two groups. No statistically significant difference was found between the two groups in terms of basic characteristics. The average PTH level of hypertensive dipper patients was lower than that of nondipper patients (65.3 ± 14.2 vs. 96.9 ± 30.8 pg/mL, P < .001). The average 25-OH vitamin D level of hypertensive dipper patients was higher than that of nondipper patients (21.9 ± 7.4 vs. 12.8 ± 5.9 ng/mL, P = .001). The left ventricular mass and left ventricular mass index were lower in the dipper patients than in the nondipper patients (186.5 ± 62.1 vs. 246.3 ± 85.3 g, P = .022; and 111.6 ± 21.2 vs.147 ± 25.7 g/m², P < .001, respectively). Other conventional echocardiographic parameters were similar between the two groups. Daytime systolic and diastolic blood pressure measurements were similar between dippers and nondippers, but there was a significant difference between the two groups with regard to nighttime measurements (nighttime systolic 118.5 ± 5.8 vs.130.2 ± 9.6 mm Hg, P < .001; and nighttime diastolic 69.3 ± 4.8 vs.78.1 ± 7.2 mm Hg, P < .001, respectively). Our results suggest that vitamin D deficiency has a positive correlation with blood pressure and vitamin D deficiency could be related to nondipper hypertension. The measurement of vitamin D may be used to indicate increased risk of hypertension-related adverse cardiovascular events.

Objectives: Atherosclerosis represents an active inflammation that leukocytes play a major role. Neutrophil-lymphocyte ratio (NLR) has been shown as an indicator of systemic inflammation. Our aim was to evaluate inflammatory markers in obstructive coronary artery disease (CAD) and cardiac syndrome X (CSX) and to evaluate NLR in predicting CAD in patients with typical chest pain and coronary risk factors.Methods: Eighty patients with CSX, 80 patients with obstructive CAD with unstable angina pectoris and a control group of 80 subjects were recruited into the study. Hematologic and biochemical parameters were investigated.Results: High-sensitive C-reactive protein (hs-CRP) was increased in CAD group and CSX group compared to the control group (p < 0.001); however it was comparable between CAD and CSX groups (p = 0.065). Mean NLR was higher in CAD group than CSX group and control group that the lowest value was in the control group. In CAD group, hs-CRP was positively correlated with NLR (r = 0.43, p < 0.001), and Gensini score (r = 0.54, p < 0.001). NLR was also linearly correlated with Gensini score (r = 0.49, p < 0.001). In ROC curve analysis, for the NLR of 2.26, NLR values attained 85.5% sensitivity and 43.9% specificity (p < 0.001). When cut-off value was taken as 3.05 mg/dL for CRP, CRP values attained 78.7% sensitivity and 43.6% specificity (p < 0.001). When cut-off value was taken as 9.5 (×109 /L) for white blood cell (WBC), WBC values attained 58.8% sensitivity and 34.3% specificity (p < 0.001). Conclusions: NLR seems to be usefull in prediction of obstructive CAD and can be implemented in planning for diagnostic procedures in patients with typical chest pain. Increased CRP, WBC and NLR may give insight about main pathology of CSX. Despite absence of obstructive narrowing in epicardial coronaries, it appears be salutary to treat CSX due to the similar underlying pathophysiology with obstructive CAD.

Objectives: B-type natriuretic peptide (BNP) has been extensively studied as a biomarker in heart failure. There is clear benefit of BNP in diagnosis and risk stratification of several cardiac diseases including acute coronary syndromes. Our aim was to evaluate diagnostic role of changes in BNP levels with exercise in coronary artery disease (CAD).Methods: Fifty-one patients underwent exercise stress testing (EST) for suspected CAD and consequently underwent coronary angiography (CA) were prospectively enrolled. Patients with and without at least one significant diameter stenosis in major epicardial arteries (CA+ and CA-) versus patients with and without evidence of myocardial ischemia during exercise stress testing (EST+ and EST-) were classified into 4 groups, respectively (Group 1, CA+/EST+; group 2, CA+/EST-; group 3, CA-/EST+; and group 4, CA-/EST-). All patients underwent EST. Blood was drawn from patients for determination of BNP levels 10 minutes prior to, 10 minutes after and 4 hours after EST.Results: EST parameters other than the parameters signifying myocardial ischemia didn’t differ significantly among groups (p > 0.05). Pre-exercise, post-exercise and 4h-post exercise BNP values were significantly higher in group 1 and group 2 compared to group 3 and group 4 (p < 0.05 for all comparisons between the groups for pre-exercise, post-exercise and 4h-post exercise BNP). Exercise-induced increases in BNP were higher in group 1 and group 2. Patients with significant CAD involving LAD demonstrated higher basal and exercise-induced BNP as well as BNP increases, irrespective of the EST result. Conclusions: Basal, maximal-exercise and post exercise BNP values predicted CAD, as well as CAD involving LAD irrespective of ischemic changes in EST. Our results point out potential role of BNP as an adjunct to EST in diagnosis and management of CAD.

Objectives: The purpose of the study was to determine the differences of optical coherence tomography angiography (OCTA) measurements between the patients with neovascular age-related macular degeneration (AMD) and non-neovascular early AMD. Methods: This retrospectively designed study included patients with neovascular AMD (N-AMD group) and non-neovascular early AMD (NN-AMD group). The patients had a completed ocular examination including best-corrected visual acuity (BCVA, in decimal), intraocular pressure (IOP, mmHg), and OCTA measurements such as choroidal blood flow (au) and retinal vessel density (VD, %). Results: The N-AMD group (1.46 +/- 0.28 au) showed a lower mean choroidal flow measurement than the NN-AMD group (1.73 +/- 0.32 au), (p<0.001). The patients in the N-AMD group had reduced VD measurements in all superficial and deep retinal layers compared with the NN-AMD group. However, significant differences in VD measurements were observed only in total superficial parafovea and in the superior and inferior quadrants of superficial parafovea while comparing the N-AMD and NN-AMD groups (p<0.05 for all). Almost all deep retinal VD measurements (p<0.05 for them) were significantly different in the N-AMD group except the overall and foveal zones (p=0.144 and p=0.433, respectively). Conclusion: Retinal VD is reduced in patients with N-AMD when compared to NN-AMD. This outcome offered a retinal vessel contribution to AMD pathogenesis.

Objectives: Access site complications (ASC) remain important and common adverse events after coronary angiography. The aim of this study was to evaluate the frequency and predictors of ASC in patients undergoing diagnostic coronary angiography (DCA) via the femoral artery. Methods: In this prospective analytical cross sectional study, DCA was performed in 3972 patients by transfemoral approach. The femoral access site hemostasis was obtained by manual compression in all patients. Demographic characteristics of the patients, size of the arterial sheaths, duration of compression time, patients blood pressure, medications, hemoglobin and platelet levels were recorded. All patients were evaluated for ASC (pseudoaneurysm, bleeding, dissection, hematoma). The ASC rate was calculated and ASC predictors were determined by multivariate analysis. Results: The ASC rate was 1.3% (53 of 3972 patients). The complications were more frequent in female (female: 29 of 53 [54.7%] vs male: 24 of 53 [45.3%]; p = 0.007) and chronic renal failure (CRF) patients (103 of 3919 [2.6%] vs 4 of 53 [7.5%]; p = 0.02). Hemoglobin level was lower (13.40 ± 1.73 vs 12.86 ± 1.75; p = 0.02) and manual compression time was longer (9.19 ± 3.28 min vs 14.53 ± 6.47 min; p < 0.001) in the ASC group. Clopidogrel (188 of 3919 [4.8%] vs 7 of 53 [13.2%]; p = 0.005) and low molecular weight heparin (LMWH) using were more frequent (37 of 3919 [0.9%] vs 7 of 53 [13.2%]; p < 0.001) in the ASC group. According to multivariate analysis; female gender; OR: 2.13, 95% CI: 1.14-3.99 (p = 0.017), presence of CRF; OR: 3.15, 95% CI: 1.06-9.29 (p = 0.038), manual compression time; OR: 1.23, 95% CI: 1.17-1.30 (p < 0.001) and LMWH using; OR: 15.68, 95% CI: 6.05-40.61 (p < 0.001) were predictors of ASC. Conclusions: The incidence of femoral ASC rate was 1.3% in patients with DCA. Female gender, presence of CRF, using LMWH and long manual compression time were predictors of ASC.