Characteristics of arterial hypertension in patients after being in a combat zone in the Kharkiv region of Ukraine

Abstract

Objective — to study the characteristics of arterial hypertension (AH) in patients (representatives of the civilian population) after their stay in the combat zone in the Kharkiv region of Ukraine.
 Materials and methods. The study involved 62 patients with 2—3 degree AH (29 men and 33 women), who were examined in the Department of Arterial Hypertension and Kidney Disease at L. T. Mala NIT NAMSU before the war and 4—5 months after its start. The interval between the baseline and re‑examination was 8—9 months. All examined patients during the war were in the combat zone in Kharkiv region of Ukraine. The mean patients’ age was 52.4±4.3 years. All patients underwent general clinical, laboratory and instrumental examinations. The degree, stage of hypertension and the presence of risk factors for cardiovascular disease (CVD), established CVD and kidney disease were assessed in accordance with recent recommendations. At baseline, before the war start, all patients were administered two‑ or three‑component antihypertensive and (in the presence of elevated levels of low‑density lipoprotein cholesterol (LDL‑C) lipid‑lowering therapy in accordance with the latest guidelines. All 62 patients (100%) during their dynamic observation before the war, reached target levels of «office» blood pressure (BP). The frequency of achieving target levels of LDL‑C was significantly lower and amounted to 57%.
 Results. In patients with hypertension (representatives of the civilian population), who were in the combat zone in the Kharkiv region of Ukraine and experienced chronic wartime stress, a significant increase in the frequency of severe and uncontrolled hypertension, its crisis course and resistant form was found. Prognostically unfavorable consequences of staying in the combat zone in patients with hypertension is a significant increase in the incidence of such risk factors for CVD as increased LDL‑C blood levels, prediabetes and insulin resistance, smoking and regular alcohol consumption. Staying in the combat zone leads to a significant increase in the incidence of coronary heart disease, heart rhythm disturbances and heart failure in patients with hypertension and contributes to the accelerated development of type 2 diabetes mellitus, as well as such severe cardiovascular and cerebrovascular complications as atrial fibrillation, acute myocardial infarction, transient ischemic attack and ischemic stroke
 Conclusions. The stay of patients with hypertension in the combat zone and the related chronic stress of wartime leads to a significant worsening of hypertension course and to the development of adverse metabolic disorders and cardiovascular and cerebrovascular complications. This justifies the need to establish dynamic monitoring for this category of patients and conduct long‑term combined therapy, taking into account the characteristics of the clinical course and the presence and severity of the disease complications.