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    Antihypertensive treatment of a patient with normal blood pressure: Case report and call for paying attention
    (Wolters Kluwer, 2025) Atmaca, Hasan; Erol, Mustafa Kemal; Yetkin, Ertan
    The current 2024 European Society of Cardiology (ESC) guideline for the management of elevated blood pressure and hypertension defines blood pressure less than 115/65 mmHg by ambulatory blood pressure monitoring (ABPM) as nonelevated, blood pressures in-between 115–129 and 65–79 mmHg as elevated blood pressure, and hypertension as ≥130/80 mmHg. There, might be patients seeking medical attention for the symptoms, apparently nonspecific but suggestive of hypertension with optimal, or not elevated, or elevated blood pressure values. A female patient with complaints of headache and dizziness lasting for 2 months has been evaluated in cardiology outpatient clinic and assessed by ABPM. It has been told that she had previously blood pressure of 90–100/50–60 mmHg and was suffering from headache when systolic blood pressure exceeds 110 mmHg. Her 24-h ABPM revealed systolic and diastolic blood pressure as 106/63 mmHg showing nighttime decrease compared with daytime pressures (98/59 mmHg and 108/68 mmHg, respectively). Thereafter, she was instructed to keep continuing the life-style modification and given to beta-blocker (bisoprolol 5 mg) as an antihypertensive treatment. At the end of the 2 weeks of follow-up period, she was headache-free and was feeling comfortable and well with a mean home blood pressure of 98/56 mmHg. We have presented prosperous antihypertensive treatment of a female patient suffering from headache and dizziness with a numerically normal or nonelevated blood pressure. In the presence of symptoms and having not elevated or elevated blood pressure levels, patients’ history on previous measure of blood pressure might facilitate our decision-making process.
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    Clinical significance of coronary artery tortuosity in chronic coronary syndrome & stable angina: Insights from gensini scores
    (Kare Publishing, 2024) Özyaşar, Mehmet; Doğduş, Mustafa; Yılmaz, Ahmet; Altıntaş, Mehmet Sait; Yetkin, Ertan
    OBJECTIVE This study investigated the clinical significance of coronary artery tortuosity (CAT) in chronic coronary syndrome (CCS) by using Gensini scores. METHODS The retrospective single-center study involved 388 patients undergoing coronary angiography for chest pain, excluding those with acute coronary syndromes or prior coronary interventions. Demographic, clinical, and angiographic data were collected and categorized based on the presence or absence of CAT. Categorical variables were analyzed using appropriate statistical tests, with significance set at p < 0.05. RESULTS Analysis of 388 patients revealed that CAT was associated with older age (p <0.001), female gender (p <0.001), lower smoking (19.3% vs. 29.6%, p=0.025), and hypertension (53.5% vs. 38.7%, p=0.05). There was a slightly higher, nearly significant, prevalence of diabetes in the CAT group (22.8% vs. 14.5%, p=0.051). Furthermore, CAT correlated with diastolic dysfunction (p=0.04) and inversely with coronary atherosclerosis severity, as indicated by lower Gensini scores correlating with higher CAT scores (p=0.039 and p=0.049, respectively). Univariate analysis confirmed CAT's association with older age (p <0,001), female gender (p <0,001), hypertension (p=0,004), diabetes (p=0,039), diastolic dysfunction (p=0,003), and Gensini score (p=0,012). Multivariate analysis further identified significant correlations with age (p=0,001), female gender (p <0,001), and Gensini score (p=0,049). CONCLUSIONS Our findings indicate that older age and female gender predict CAT development in CCS patients. The lower Gensini scores associated with CAT may possibly be due to a reduced atherosclerotic plaque burden in these patients. Further research into this relationship could inform the development of treatment and management strategies for coronary atherosclerosis.
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    Reply to the letter to the editor: 'Coronary atherosclerosis burden and coronary artery tortuosity'
    (Kare Publishing, 2025) Özyaşar, Mehmet; Doğduş, Mustafa; Yılmaz, Ahmet; Altıntaş, Mehmet Sait; Yetkin, Ertan
    To the Editor, First, we would like to thank the author1 and the editorial team for their attention to and interest in our work. We deeply value your constructive criticism and contributions, which we see as an opportunity for further improvement. Collateral circulation plays a significant role in the prognosis of coronary artery disease.2 We acknowledge the importance of considering the effect of collateral circulation when calculating Gensini scores.3 In our retrospective study, while evaluating cases of chronic coronary syndrome that underwent coronary angiography, the coronary collateral flow assessment (Rentrop) score (3) was 0 in all cases. However, we accept that this detail should have been clarified more explicitly in our article. Our study aimed to minimize confounding factors as much as possible to realistically examine the relationship between coronary artery tortuosity and coronary atherosclerosis. While we acknowledged in the limitations section of our study that this might introduce a potential bias in patient selection,4 we accept that it would have been beneficial to explicitly state that we sought to eliminate the effect of collateral circulation. One of the key strengths of our study is the large patient cohort, along with the meticulous exclusion of other confounding factors. In conclusion, while recognizing the importance of collateral circulation, we believe that our study provides important information about the relationship between coronary artery tortuosity and atherosclerotic plaque burden. We hope this research contributes to a deeper understanding of coronary artery disease and offers a new perspective for future studies.