Purpose of ReviewThe aim of this review was to summarize collected data on the role of orexin and orexin neurons in the control of sleep and blood pressure.Recent FindingsAlthough orexins (hypocretins) have been known for only 20 years, an impressive amount of data is now available regarding their physiological role. Hypothalamic orexin neurons are responsible for the control of food intake and energy expenditure, motivation, circadian rhythm of sleep and wake, memory, cognitive functions, and the cardiovascular system. Multiple studies show that orexinergic stimulation results in increased blood pressure and heart rate and that this effect may be efficiently attenuated by orexinergic antagonism. Increased activity of orexinergic neurons is also observed in animal models of hypertension.SummaryPharmacological intervention in the orexinergic system is now one of the therapeutic possibilities in insomnia. Although the role of orexin in the control of blood pressure is well described, we are still lacking clinical evidence that this is a possibility for a new approach in the treatment of cardiovascular diseases.

Background: Subarachnoid hemorrhage (SAH) is rare but potentially life-threatening cause of acute headache. First diagnostic test performed in the Emergency Department (ED) for acute "thunderclap" headache is computed tomography of the head (CT) without contrast enhancement. Negative non-contrast head CT may be erroneously interpreted as an exclusion of SAH and lead to ED discharge. The consequences of overlooking SAH are of special interest to the Emergency Physician. The aim of this study was to assess prevalence and clinical picture of CT-negative cases of SAH admitted to the ED. Material and methods: Retrospective analysis of charts of patients admitted to the ED and diagnosed with SAH during 18 consecutive months. Results: Our data gives information about clinical picture of patients with CT-negative SAH and their further clinical course. Out of 126 patients diagnosed with SAH, 5 (4.0%) were diagnosed with SAH despite negative non-contrast head CT scan. All cases were diagnosed by means of lumbar puncture and analysis of cerebrospinal fluid. In all patients with CT-negative SAH computed tomographic angiography (CTA) was performed and no vascular abnormalities were found. In one case digital subtraction angiography was performed due to equivocal CTA picture and it demonstrated small unruptured aneurysm of the medial cerebral artery. All patients with CT-negative SAH were admitted to a neurological ward and later discharged from the hospital without neurological deficit. There were no episodes of clinical deterioration and none of the patients required an urgent neurosurgical intervention. Conclusions: Although lumbar puncture remains a gold standard in exclusion of SAH, head CT scan without contrast enhancement appears to be a satisfying diagnostic tool in ED.

Background: Arterial hypertension (AH) is the most important modifiable risk factor for cardiovascular diseases in Poland and around the world. Unfortunately, despite its potentially catastrophic consequences, more than 30% of hypertensive patients in Poland remain undiagnosed. Therefore, emergency department (ED) triage may play a role in screening of a significant proportion of the population. The present study aimed to assess the prevalence of hypertension in patients reporting to the ED by verifying ad hoc measurements with ambulatory blood pressure monitoring (ABPM). Methods: The study included 78,274 patients admitted to the ED of the University Clinical Center in Gdansk from 01.01.2019 to 31.12.2020, with elevated blood pressure values (systolic blood pressure [SBP] > 140 mmHg and/or diastolic blood pressure [DBP] > 90 mmHg) during triage according to the inclusion and exclusion criteria. Results: Out of 34,597 patients with SBP > 140 mmHg and/or DBP > 90 mmHg, 27,896 patients (80.6% of patients) had previously been diagnosed with AH. Finally, a group of 6701 patients with elevated values of arterial blood pressure in triage, who had not yet been diagnosed with AH, was identified. This accounted for 8.6% of patients admitted to the ED. Ultimately, 58 patients (26 women and 36 men) agreed to undergo ABPM. Based on the analysis, AH 32 patients were diagnosed with AH (55.2%). Conclusions:The ED plays an essential role in diagnosing hypertension among people reporting to the ED for various reasons. There is a high probability of a diagnosis of AH in a group of patients who have elevated blood pressure values during triage and have not yet been diagnosed with hypertension.