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    2019 Turkish Hypertension Consensus Report
    (Kare Publ, 2019) Aydogdu, Sinan; Guler, Kerim; Bayram, Fahri; Altun, Bulent; Derici, Ulver; Abaci, Adnan; Tukek, Tufan
    The Turkish Hypertension Consensus Report was prepared for the first time in 2015 to adapt the European and American international guidelines to our clinical practice and to create a practical report that could be a basic reference for all physicians dealing with hypertensive patients. This report, which was prepared by a committee with representation from 5 leading hypertension associations, has been accepted and is widely used. New clinical studies in hypertension literature and updated international guidelines since 2015 have demanded an update of the Turkish Hypertension Consensus Report as well. In this updated 2019 report, blood pressure levels were classified as Normal, Elevated, Stage 1, and Stage 2 hypertension. A new section was added for secondary hypertension. It was specified that drug treatment may be initiated with any 1 or a combination of 4 groups of drugs (diuretics, calcium channel blockers, angiotensin-converting enzyme [ACE] inhibitors, and angiotensin receptor blockers [ARBs]), except a combination of an ACE inhibitor and an ARB. It was emphasized that beta-blockers may be a first choice for hypertension treatment in diseases such as atrial fibrillation, heart failure, and coronary artery disease. The initial recommendation for hypertension treatment is a combination therapy in patients with a blood pressure level >= 150/90 mmHg. Target blood pressure values were redefined according to age and the presence of comorbidities. The hypertension treatment algorithm was renewed; it is proposed that drug therapy can also be initiated with a risk-based approach for the group with an elevated blood pressure (systolic blood pressure: 120-139 mmHg, diastolic blood pressure: 80-89 mmHg). The threshold clinic systolic blood pressure level was reduced from 160 mmHg to >= 150 mmHg for the initiation of drug therapy in individuals 80 years of age or more. The section on the treatment of special groups has now been expanded to include pregnancy and lactation. As in the previous report, in this update, practical recommendations for the most common cases seen in the clinic were the goal, rather than a comprehensive report that addresses all aspects of hypertension. This report has evidence-based recommendations for most patients; however, it should be kept in mind that there may be differences from 1 patient to another and that physicians should take an individualized approach according to a good clinical evaluation.
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    A Cross-Sectional Study of the Prevalence of Cardiovascular Disease in Adults with Type 2 Diabetes in Turkiye: The CAPTURE Study
    (Aves, 2022) Bayram, Fahri; Bayraktaroglu, Taner; Sargin, Mehmet; Sahin, Ibrahim; Guldiken, Sibel; Dalbeler, Aysegul; Sonmez, Alper
    Objective: The primary objective of the CAPTURE study was to estimate the prevalence of cardiovascular disease (CVD) in adults with Type 2 diabetes mellitus (T2DM) across 13 countries from 5 continents. Here, we present the findings from Turkiye. Material and Methods: The non-interventional, cross-sectional CAPTURE study (NCT03811288; NCT03786406) was conducted across 15 centers in Turkiye. Standardized demographic and clinical data were collected from adults with T2DM who were treated by primary or specialist care physicians. The prevalences of CVD and its 7 subtypes were estimated. Descriptive statistics were used for data analysis. Results: Amongst the 801 participants (n=200 from primary care, n=601 from specialist care) with T2DM enrolled, 250 had established CVD, an estimated weighted prevalence of 31.2% (28.0-34.4) 95% confidence interval. Atherosclerotic CVD contributed to the majority (85.6%) of the CVD cases. An estimated 24.0% of the Turkiye sample had coronary heart disease (CHD). Heart failure was the second most predominant CVD subtype in Turkiye is correct sample (5.4%), followed by cardiac arrhythmia and conduction abnormalities (4.7%). Sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists with cardiovascular (CV) benefits were prescribed to 17.5% and 0.1% of the patients, respectively. Conclusion: Approximately 30% of participants with T2DM had established CVD in the CAPTURE Turkiye population, comparable to the global pooled prevalence. CHD was the major contributor and encompassed approximately 75% of the CVD cases. The use of glucose-lowering medication with CV benefits was low compared to the global pooled population, which may be due to the lack of reimbursement of these medications in Turkiye.
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    A Cross-Sectional Study of the Prevalence of Cardiovascular Disease in Adults with Type 2 Diabetes in Türkiye: The CAPTURE Study
    (2022) Şahin, İbrahim; Bayram, Fahri; Bayraktaroğlu, Taner; Güldiken, Sibel; Dalbeler, Ayşegül; Sönmez, Alper
    Objective: The primary objective of the CAPTURE study was to estimate the prevalence of cardiovascular disease (CVD) in adults with Type 2 diabetes mellitus (T2DM) across 13 countries from 5 continents. Here, we present the findings from Türkiye. Material and Methods: The non-interventional, cross-sectional CAPTURE study (NCT03811288; NCT03786406) was conducted across 15 centers in Türkiye. Standardized demographic and clinical data were collected from adults with T2DM who were treated by primary or specialist care physicians. The prevalences of CVD and its 7 subtypes were estimated. Descriptive statistics were used for data analysis. Results: Amongst the 801 participants (n=200 from primary care, n=601 from specialist care) with T2DM enrolled, 250 had established CVD, an estimated weighted prevalence of 31.2% (28.0-34.4) 95% confidence interval. Atherosclerotic CVD contributed to the majority (85.6%) of the CVD cases. An estimated 24.0% of the Türkiye sample had coronary heart disease (CHD). Heart failure was the second most predominant CVD subtype in Türkiye is correct sample (5.4%), followed by cardiac arrhythmia and conduction abnormalities (4.7%). Sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists with cardiovascular (CV) benefits were prescribed to 17.5% and 0.1% of the patients, respectively. Conclusion: Approximately 30% of participants with T2DM had established CVD in the CAPTURE Türkiye population, comparable to the global pooled prevalence. CHD was the major contributor and encompassed approximately 75% of the CVD cases. The use of glucose-lowering medication with CV benefits was low compared to the global pooled population, which may be due to the lack of reimbursement of these medications in Türkiye.
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    Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options
    (Springer-Verlag Italia Srl, 2022) Agcaoglu, Orhan; Sezer, Atakan; Makay, Ozer; Erdogan, Murat Faik; Bayram, Fahri; Guldiken, Sibel; Raffaelli, Marco
    Purpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole +/- beta-blocker combination for Graves' disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3-4 cytological results and papillary microcarcinoma. Conclusion This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible.
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    Patient characteristics and statin discontinuation-related factors during treatment of hypercholesterolemia: an observational non-interventional study in patients with statin discontinuation (STAY study)
    (2016) Tokgözoğlu, Lale; Özdemir, Ramazan; Ceyhan, Ceyhun; Yeter, Ekrem; Öztürk, Cihan; Bayram, Fahri; Delibaşı, Tuncay; Değertekin, Muzaffer; Keleş, İbrahim; Dinçkal, Mustafa Hakan; Fak, Ali Serdar; Aydoğdu, Sinan; Zorkun, Cafer; Tartan, Zeynep
    Abstract: Amaç: Hiperkolesterolemi tanısı ile izlenen statin kullanmakta olan hastalarda statin tedavisinin kesilmesi ile ilişkili hasta özellikleri ve sorumlu faktörlerin belirlenmesi.Yöntemler: Bu ulusal müdahalesiz gözlem çalışmasına statin tedavisini bırakmış toplam 532 (ort. yaş±SS 57.4±11.5 yıl; %52.4 kadın, %47.6 erkek) hiperkolesterolemili hasta dahil edildi. Hastaların sosyodemografik özellikleri kardiyovasküler risk faktörleri, geçmiş statin tedavisi ve tedavinin kesilmesine yönelik veriler tek vizitte kaydedildi.Bulgular: Hastalara statin tedavisini bıraktıklarında ort.±SS 4.9±4.2 yıldı, hiperkolesterolemi tanısı konulmuş olduğu tespit edildi. Statin tedavisi hekim grupları içinde en sık kardiyologlar (%55.8) tarafından başlatılırken, tedaviyi bırakma kararının büyük çoğunlukla hastalar (%73.7) tarafından alındığı; hastanın bu kararı kendi insiyatifinde almasının daha yüksek eğitim düzeylerinde (%80.4), düşük eğitim düzeylerine (%69.7) göre belirgin olarak daha yaygın (p=0.022) olduğu saptandı. TV programlarında statin hakkında yapılan olumsuz haberler (%32.9); ilacın hepatik (%38.0), renal (%33.8) ve musküler (%32.9) yan etkilerinden çekinilmesi statin tedavisinin bırakılması ile ilişkili en sık oranda saptanan faktörler idi.Sonuç: Sonuç olarak, bu müdahalesiz gözlemsel çalışmada, statin tedavisinin %74 oranda hastaların kendi kendine ilacı bırakma kararı doğrultusunda gerçekleştiği saptanmıştır. Tedavi bırakma ve ilaç dışı alternatif tedavilere yönelme kararının daha yüksek eğitim düzeyine sahip hastalarca daha sıklıkla alındığı görülmüştür. Statin tedavisinin en sık kardiyologlar tarafından başlatıldığı ve TV programlarında statin hakkında özellikle ilacın yaşamı tehdit etmeyen yan etkilerine yönelik yapılan olumsuz haberlerin yanı sıra, hastaların hiperkolesterolemi ve ilgili riskleri konusunda yeterli bilgi düzeyinden yoksun olmalarının statin tedavisinin bırakılmasında öne çıkan sorumlu faktörler olduğu anlaşılmaktadır
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    Patient characteristics and statin discontinuation-related factors during treatment of hypercholesterolemia: an observational non-interventional study in patients with statin discontinuation (STAY study)
    (Turkish Soc Cardiology, 2016) Tokgozoglu, Lale; Ozdemir, Ramazan; Altindag, Rojhat; Ceyhan, Ceyhun; Yeter, Ekrem; Ozturk, Cihan; Bayram, Fahri
    Objective: The purpose of this study was to identify patient characteristics and statin discontinuation-related factors in patients with hypercholesterolemia. Methods: A total of 532 patients (age mean+/-SD: 57.4+/-11.5 years; 52.4% women, 47.6% men) with hypercholesterolemia and statin discontinuation were included in this national cross-sectional noninterventional observational study. Data on socio-demographic characteristics of patients, cardiovascular risk factors, past treatment with and discontinuation of statin treatment were collected in one visit. Results: Mean+/-SD duration of hypercholesterolemia was 4.9+/-4.2 years at time of discontinuation of statin treatment. Statin treatment was initiated by cardiologists in the majority of cases (55.8%), whereas discontinuation of statin treatment was decided by patients in the majority of cases (73.7%), with patients with higher (at least secondary education, 80.4%) more likely than those with lower (only primary education, 69.7%) to decide to discontinue treatment (p=0.022). Negative information about statin treatment disseminated by TV programs-mostly regarding coverage of hepatic (38.0%), renal (33.8%), and muscular (32.9%) side effects (32.9%)-was the most common reason for treatment discontinuation. Conclusion: The decision to discontinue statin treatment was made at the patient's discretion in 74% of cases, with higher likelihood of patients with higher educational status deciding to discontinue treatment and switch to non-drug lipid-lowering alternatives. Cardiologists were the physicians most frequently responsible for the initiation of the statin treatment; coverage of several non-lifethreatening statin side effects by TV programs and patients' lack of information regarding high cholesterol and related risks were the leading factors predisposing to treatment discontinuation.
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    Türk popülasyonunda obstrüktif uyku apne sendromunda rol oynayan antropometrik ölçümlerin belirlenmesi
    (2019) Aydoğdu, Sinan; Güler, Kerim; Bayram, Fahri; Altun, Bülent; Derici, Ülver; Abacı, Adnan; Özin, Bülent; Tükek, Tufan; Şahin, İbrahim; Sabuncu, Tevfik; Arıcı, Mustafa; Erdem, Yunus; Ertürk, Şehsuvar; Bitigen, Atila; Tokgözoğlu, Lale
    Öz: Türk Hipertansiyon Uzlaşı Raporu, Avrupa ve Amerika kay- naklı uluslararası kılavuzları ülkemiz klinik pratiğine uyarla- mak ve hipertansiyon hastaları ile ilgilenen hekimlere temel bir başvuru kaynağı olabilecek pratik bir metin oluşturmak amacıyla ilk kez 2015 yılında hazırlandı. Hipertansiyon- la ilgili beş temel hipertansiyon derneğinin oluşturduğu bir komisyon tarafından hazırlanan bu rapor, kabul gördü ve yaygın olarak kullanılmaya başlandı. 2015 yılından sonra hipertansiyon literatüründeki yeni klinik çalışmalar ve gün- cellenen uluslararası kılavuzlar, Türk Hipertansiyon Uzlaşı Raporu’nun da güncellenmesi ihtiyacını doğurdu. Güncelle- nen 2019 raporunda kan basıncı düzeyleri Normal, Artmış, Evre 1 ve Evre 2 hipertansiyon olarak sınıflandırıldı. Sekon- der hipertansiyon için yeni bir bölüm eklendi. İlaç tedavisine dört grup ilaçtan [diüretikler, kalsiyum kanal blokerleri, anjiyo- tensin dönüştürücü enzim (ACE) inhibitörleri ve anjiyotensin reseptör blokerleri (ARB)] herhangi biri veya kombinasyonu (ACE inhibitörü ve ARB kombinasyonu hariç) ile başlanabile- ceği belirtildi. Beta-blokerlerin ise sadece atriyal fibrilasyon, kalp yetersizliği ve koroner arter hastalığı gibi hastalıklarda ilk seçenek tedavi olarak kullanılabileceği vurgulandı. Kan basıncı düzeyi ?150/90 mmHg olanlarda hipertansiyon teda- visine öncelikle kombinasyon tedavisiyle başlanması öneril- di. Hipertansiyon tedavisinde yaş ve eşlik eden hastalıkların varlığına göre kan basıncı hedef değerleri yeniden tanım- landı. Hipertansiyon tedavi algoritması yenilendi; artmış kan basıncı grubuna da (sistolik kan basıncı, 120–139 mmHg ve diyastolik kan basıncı, 80–89 mmHg) risk temelli yaklaşım ile ilaç tedavisi başlanabileceği önerisi getirildi. Yaşı 80 ve üze- rinde olan kişilerde ilaç tedavisi başlanması için eşik klinik sistolik kan basıncı düzeyi 160 mmHg’den ?150 mmHg’ye düşürüldü. Hipertansiyon tedavisinde özel hasta gruplarına gebelik ve laktasyon bölümü eklendi. Önceki raporda olduğu gibi, bu güncellemede de hipertansiyonu bütün yönleri ile ele alan kapsamlı bir rapordan çok, klinikte en sık görülen du- rumlara yönelik pratik uygulama önerilerinin sunulması he- deflendi. Bu rapor hastaların çoğu için kanıta dayalı öneriler sunmakla birlikte, hastadan hastaya farklılıkların olabileceği ve böyle durumlarda hekimin iyi bir klinik değerlendirmeye göre hastalara bireyselleştirilmiş yaklaşımlarda bulunması gerektiği unutulmamalıdır.
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    Turkish nationwide survEy of glycemic and other Metabolic parameters of patients with Diabetes mellitus (TEMD study)
    (Elsevier Ireland Ltd, 2018) Sonmez, Alper; Haymana, Cem; Bayram, Fahri; Salman, Serpil; Dizdar, Oguzhan Sitki; Gurkan, Eren; Carlioglu, Ayse Kargili
    Aims: Turkey has the highest prevalence of diabetes in Europe. It is therefore essential to know the overall cardiovascular risk and reveal the predictors of metabolic control in Turkish adults with diabetes mellitus. Methods: A nationwide, multicenter survey consecutively enrolled patients who were under follow up for at least a year. Optimal control was defined as HbA1c <7%, home arterial blood pressure (ABP) <135/85 mmHg, or LDL-C <100 mg/dL. Achieving all parameters indicated triple metabolic control. Results: HbA1c levels of patients (n = 5211) were 8.6 +/- 1.9% (71 +/- 22 mmol/mol) and 7.7 +/- 1.7% (61 +/- 19 mmol/mol), in Type 1 and Type 2 diabetes, respectively. Glycemic control was achieved in 15.3% and 40.2%, and triple metabolic control was achieved in 5.5% and 10.1%, respectively. Only 1.5% of patients met all the criteria of being non-obese, nonsmoker, exercising, and under triple metabolic control. Low education level was a significant predictor of poor glycemic control in both groups. Conclusions: Few patients with Type 2, and even fewer with Type 1 diabetes have optimal metabolic control in Turkey. TEMD study will provide evidence-based information to policy makers to focus more on the quality and sustainability of diabetes care in order to reduce the national burden of the disease. (C) 2018 Elsevier B.V. All rights reserved.