Achieve Target Blood Pressure Levels Research Articles

FOLLOW-UP OF SURVIVAL PATIENTS WITH RESISTANT ARTERIAL HYPERTENSION

Objective: Resistant arterial hypertension (RAH) contributes to high mortality worldwide. Aim of the study: to assess 7-year follow-up survival and development of a composite end point (CEP) in patients with RAH. Design and method: The analysis includes 50 patients with RAH who were discharged from hospital. After 7 years discharge from the hospital, the patients underwent office BP measurement. Adverse events or death were reported as the composite endpoint (CEP). The average age of patients as of 2016 was 57.89 ± 11.81 y.o. 16% had type 2 diabetes (n=8). Results: After 7 years, in 32% (n=16) developed CEP, and 10% (n=5) of them died. The BMI increased from 30.87 ± 6.30 to 33.80 ± 6.90 kg/m2 (p<0.05). 20% had smoke (n=10), but 8% (n=4) (quit smoking after developing CEP). After 7 years, 48.88% of patients (n=22) controlled office blood pressure below 140/90 mmHg and 51.11% did not (n=23). Among patients who reached the target office BP (130.73 ± 6.61/81.59 ± 4.13 mmHg), there was a decrease in the number of drugs from 3.76 ± 0.19 to 2.85 ± 0.14, p<0.05. 45% (n=10) from the group took fixed combinations. Among patients who did not reach target office BP (148.04 ± 7.49/92.17 ± 4.66 mmHg), there was also a decrease in the number of drugs from 3.52 ± 0.18 to 2.50 ± 0.13, p<0.05 – patients decision. After regression analysis the main factors that were associated with the occurrence of CEP in patients with RAH were: the presence of diabetes (β= 5,237, p= 0,032) smoking (β=4,326, p= 0,037), increased body weight (β =3,423, p=0,024), failure to achieve target blood pressure levels (β =4,152, p=0,041) Conclusions: Mortality among patients with RAH were 10% during 7 years. The total composite endpoint were 32%. Did not reach the target office BP in patients with RAH the factors for the development of combined end point was diabetes mellitus, smoking and weight gain.

ФИКСИРОВАННАЯ КОМБИНАЦИЯ ИРБЕСАРТАН/ГИДРОХЛОРТИАЗИД В ЛЕЧЕНИИ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ

Almost a third of the population of the Republic of Belarus suffers from elevated blood pressure which results in a high risk of cardiovascular disease developing. Despite the availability of numerous antihypertensive drugs, more than 40% of patients receiving antihypertensive therapy do not achieve target blood pressure levels and continue to be at an increased risk of cardiovascular events. A fixed combination drug irbesartan/hydrochlorothiazide, which includes two active ingredients in one dosage form of a tablet, is an anti-hypertensive combination balanced on the basis of clinical and pharmacological properties, which is approved by the Ministry of Health of the Republic of Belarus for use in patients when indicated in case of essential arterial hypertension. This fixed-dose combination is intended for adult patients whose blood pressure is not adequately controlled by irbesartan or hydrochlorothiazide monotherapy. The clinical efficacy and safety of this combination was demonstrated in randomized clinical trials, including patients with a combination of hypertension and type 2 diabetes, metabolic syndrome, and obesity. The use of the fixed-dose combination of irbesartan/hydrochlorothiazide leads to a more rapid decrease in blood pressure compared to irbesartan monotherapy, allows the majority of patients with severe hypertension to achieve the target blood pressure, and increases drug compliance. Thus, the irbesartan/hydrochlorothiazide combinationis a valuable addition to clinicians’ armamentarium for the treatment of hypertension.

The cardiovascular polypill as baseline treatment improves lipid profile and blood pressure regardless of body mass index in patients with cardiovascular disease. The Bacus study.

Pharmacological treatment with lipid-lowering and antihypertensive drugs has been proposed as a strategy to improve excess cardiovascular (CV) risk among obese individuals. The present study aimed to assess whether the CV polypill (Sincronium®) could be an effective strategy to help improve CV risk factor control in obese/overweight individuals requiring secondary prevention. This was an observational, retrospective study reviewing the hospital medical records of 479 patients with established CV disease who initiated treatment with the CV polypill between 2013 and 2019 at a general hospital in Mexico. Patients were grouped as normal weight, overweight or obese according to their initial body mass index (BMI). We collected blood pressure (BP), lipid profile, and vascular age at the last visit recorded during the period following treatment. At the end of the study, all assessed lipid parameters improved compared to baseline regardless of the initial BMI category (all p<0.001). There was an increase from baseline regarding the proportion of patients with at target low-density lipoprotein cholesterol after treatment (2.3% vs. 30.1%; p<0.001), more than 80% of patients achieved triglyceride levels <200 mg/dL (p<0.001), and more than 80% achieved target BP levels in all BMI subgroups (p<0.001). The subanalyses in the elderly population yielded similar results, with a significant overall improvement in lipid and BP control after initiating the CV polypill strategy. The use of the CV polypill as baseline therapy for secondary prevention seems to be a reasonable strategy that enhances CV risk factor control regardless of the patient's BMI.

Effect of cortisol on achieving target blood pressure levels in patients with resistant hypertension and chronic kidney disease

Background. Resistant hypertension is defined as failure to achieve the target blood pressure (BP), despite treatment with at least three antihypertensive drugs that include a diuretic, and is associated with a poor prognosis. This is caused by organ damage from long-term exposure to high blood pressure, and is also linked to diabetes mellitus, chronic kidney disease and obesity. The purpose of the work is to evaluate biological markers associated with failure to achieve the target level of blood pressure in patients taking 3 or more antihypertensive drugs, depending on the presence of chronic kidney disease. Materials and methods. The study included 1146 patients with resistant hypertension who took 3 or more antihypertensive drugs. They were examined using both instrumental and laboratory methods with the measurement of office blood pressure upon admission to the hospital and upon discharge, evaluation of biochemical blood parameters, levels of creatinine, blood lipids, renin, blood aldosterone, cortisol. Results. The average age of the patients was 57.90±0.37 years. There were more women than men— 62.7 versus 36.7%. The body mass index was 31.00±0.19kg/m2. The average office systolic/diastolic BP upon admission to the hospital was 174.60±0.64/100.50±0.38 mmHg. 22.4% of patients had glomerular filtration rate (GFR) &lt;60ml/min/1.73m2. In the subgroup with GFR ≥60ml/min/1.73m2, the achievement of the target BP was 44.76%, which is significantly higher than in patients with GFR &lt;60ml/min/1.73m2 (12.56%, p&lt;0.05). Blood cortisol level in the subgroups with failure to reach the target level of office blood pressure was 127.72±4.20 μg/dl (with GFR&lt;60 ml/min/1.73m2) and 163.71±15.20 μg/dl (GFR ≥60ml/min/1.73m2), which was significantly higher compared to the patients with the target BP level: 6.02±0.90 μg/dl (with GFR &lt;60ml/min/1.73m2; p&lt;0.05) and 47.84±4.40 μg/dl (in the subgroup with GFR ≥60ml/min/1.73m2; p&lt;0.05). Conclusions. In patients with resistant hypertension, elevated blood cortisol content, regardless of GFR, was associated with failure to achieve the target level of office blood pressure.

Identification of sex characteristics of obesity and hypertension in the adult population of the Vladimir region

Aim. To identify sex characteristics of the prevalence of obesity and hypertension (HTN) in the adult population of the Vladimir region.Material and methods. The study included 1350 people, men and women aged 30-69 years from 5 cities of the Vladimir region (Vladimir, Kovrov, Murom, Yuriev-Polsky and Vyazniki). The response rate was at least 80%. In total, 1174 people completed the study, including 424 men (36,1%) and 750 women (63,9%). The survey was conducted according to a standard questionnaire, including socio-demographic parameters and behavioral risk factors. In all patients, anthropometric parameters, blood pressure, heart rate and resting electrocardiography were assessed.Results. The average body mass index among women was significantly highercompared to men (29,9±6,2 kg/m2 vs 28,3±4,7 kg/m2, p&lt;0,001), while waist circumference among men exceeded similar parameters among women (95,5±11,7 cm vs 91,9±15,3 cm, p&lt;0,001). Sex differences in anthropometric indicators have a number of features in different cities. Every third man is obese, while among women this figure was significantly higher (33,7% vs 42,1%, p&lt;0,001). Every second man and 2/3 of women had abdominal obesity (53,1% and 71,6%, p&lt;0,001). The prevalence of HTN among men and women was comparable (41,5% and 39,9%, respectively). Electrocardiographic signs of left ventricular (LV) hypertrophy are detected in every third respondent, while its prevalence between men and women did not differ statistically (30,5% and 35,5%, respectively).Conclusion. In the surveyed population of men and women of the Vladimir region, the prevalence of obesity and HTN were comparable. The prevalence of obesity and abdominal obesity has sex differences due to the greater severity among women. Hypertension is also highly likely to be associated with LV hypertrophy. Obviously, in order to correct obesity and HTN, lifestyle changes at the population level must be combined with the use of antihypertensive therapy to achieve target blood pressure levels and regress LV hypertrophy.

ВАЗОПРОТЕКТИВНЫЕ ВОЗМОЖНОСТИ КОМБИНАЦИЙ СОВРЕМЕННЫХ АНТИГИПЕРТЕНЗИВНЫХ ПРЕПАРАТОВ У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТОНИЕЙ, САХАРНЫМ ДИАБЕТОМ 2 ТИПА И НЕАЛКОГОЛЬНОЙ ЖИРОВОЙ БОЛЕЗНЬЮ ПЕЧЕНИ

The aim of the study was to compare the effectiveness of the effect of combinations of azilsartan medoxomil (Az-M) with amlodipine (Aml) and olmesartan medoxomil (Ol-M) with Aml on achieving target blood pressure levels (CPP), parameters of vascular wall stiffness and central aortic pressure (CAP) in patients with arterial hypertension (AH), combined with type 2 diabetes mellitus (DM2) and non-alcoholic fatty liver disease (NAFLD). Materials and methods: 137 patients with uncontrolled hypertension combined with DM2 and NAFLD were examined. Patients were randomized into 2 groups: group 1 (n=68) was assigned a combination of Az-M with Aml at an initial dosage of 40/5 mg/day, in group 2 (n=69) patients received a fixed combination of Ol-M/Aml 20/5 mg/day. In addition to the general clinical examination, initially, after 4, 8, 12 and 24 weeks, they measured office blood pressure. Determination of the parameters of vascular wall stiffness and CAP was performed initially and after 24 weeks of the study. Taking into account the persons who did not reach the blood pressure target and dropped out of the study after 12 weeks, the evaluation of the studied parameters was carried out in 59 and 58 patients for groups 1 and 2, respectively. Results: the study demonstrated high antihypertensive efficacy of both combinations of antihypertensive drugs: the frequency of achievement of blood pressure control by patients of the 1st and 2nd groups after 12 weeks of treatment was 86.8% and 84.1% of cases, respectively. However, a more pronounced vasoprotective efficacy was characteristic of the combination of Az-M with Aml: in the 1st group of patients, there was a more pronounced positive dynamics of vascular wall stiffness and CAP.

Diversity of hypertension in obesity

Induced hypertension (HTN) is one of the HTN types, the pathogenetic mecha­nisms of which are well studied: its main cause lies in the dysfunction of visceral adipose tissue, which leads to renin-angiotensin-aldosterone system activation, imbalance of the sympathetic and parasympathetic systems, renal involvement, and then to vascular endothelium dysfunction and, in fact, to an increase in blood pressure and HTN consolidation. However, within this HTN form, some mechanisms can be distinguished that, in obesity, play a special role. This review describes such additional mechanisms as chronic inflammation, excessive salt intake, dys­biosis, environmental factors. Understanding these HTN features in obesity has es­sential for achieving target blood pressure levels. In addition, the review pays special attention to such HTN forms in obesity as masked and nocturnal, the timely diagnosis of which is extremely important for the timely initiation of therapy and improving the prognosis.

Comparison between the Efficacy of Amlodipine with Captopril in the Management of Uncontrolled Blood Pressure in the Emergency Department

Objective: To compare the efficacy of Amlodipine with Captopril in the management of patients presenting to the emergency department with uncontrolled blood pressure.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Emergency Department, Combined Military Hospital, Malir Pakistan, from Jul to Dec 2021.&#x0D; Methodology: A total of 127 individuals presenting to the Emergency Department with two readings of uncontrolled blood pressure (Systolic blood pressure ≥ 160mmHg and Diastolic blood pressure ≥90mmHg) were included. They were administered a tablet of Captopril 12.5mg per oral and a tablet of Amlodipine 10mg per oral on the turn by turn basis. Patients were observed for 3 hours and monitored for the reduction in blood. The efficacy of medication was judged based on the ability to achieve target blood pressure reduction, which was at least a 20-30% reduction in systolic blood pressure.&#x0D; Results: Out of 127 individuals, 65(51.2%) patients were given a tablet of Captopril 12.5mg orally, and 62(48.8%) were given a tablet of Amlodipine 10mg orally. The mean reduction in systolic blood pressure was 20.73±5.17 in all patients. In addition,target blood pressure reduction was achieved in 35(53.8%) individuals of the Captopril-Group and 33(53.2%) of the Amlodipine-Group, with a total of 68(53.5%) individuals achieving target blood pressure within 3 hours after medication.&#x0D; Conclusion: Both medications were efficient in achieving target blood pressure levels. However, no drug was superior to another in reducing blood pressure in an emergency.

THE ROLE OF PHYSICAL ACTIVITY IN THE TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY

The study aimed to assess the impact of physical activity on the dynamics of neurohumoral and cardio hemodynamic indicators in patients with arterial hypertension and concomitant obesity under different pharmacotherapy regimens. Materials and Methods: Two hundred patients with stage II arterial hypertension grade 2 and obesity grade I–II were examined using clinical-anamnestic, anthropometric, biochemical, automated immunological analysis, spectrophotometric and instrumental methods. Per the research objective, patients underwent a re-evaluation after six months of prescribed treatment. Non-pharmacological treatment included dietary therapy aimed at weight correction, with recommendations to increase physical activity primarily through brisk or moderately brisk walking for at least 45 minutes daily. Pharmacological treatment followed the European recommendations in 2018, involving dual antihypertensive therapy. The combination included perindopril and amlodipine. Patients who achieved target BP levels within 3 months of treatment continued to receive the prescribed therapy. For the rest of the patients, a third antihypertensive drug, indapamide, was additionally prescribed. In addition to assessing the achievement of target blood pressure levels after 6 months and at interim stages of the study, patients' adherence to recommendations regarding expanding physical activity was evaluated. Patients were divided into groups with sufficient and reduced physical activity accordingly. Statistical analysis of the obtained data was conducted using the SPSS 17 software package (IBM), Microsoft Office Excel-2003. The data are presented as mean values ± standard deviation. Significance was established at the level of p &lt; 0.05 in all cases. Results of the study: Patients who achieved target blood pressure levels on dual antihypertensive therapy and had sufficient physical activity after six months of treatment differed significantly from patients with low physical activity levels. They exhibited lower values of the pulse wave velocity in the carotid artery and abdominal aorta, a considerably higher degree of endothelium-dependent vasodilation, lower values of end-systolic and end-diastolic diameters, left ventricular mass, a lower E/e´ ratio, and showed better dynamics in metabolic and pro-inflammatory indicators. Additionally, they had a higher level of antioxidant protection. Patients who reached the target blood pressure levels on three-component antihypertensive therapy and engaged in sufficient physical activity after six months displayed significant differences compared to patients with low physical activity. These differences included a more substantial reduction in the pulse wave velocity in the carotid artery, an increase in endothelium-dependent vasodilation, lower indicators of carbohydrate metabolism, reduced levels of pro-inflammatory and pro-oxidant activity, lower levels of leptin, and a more pronounced increase in adiponectin. Conclusions: Physical activity is a crucial factor influencing the treatment outcomes for patients with arterial hypertension and obesity across different antihypertensive therapy regimens. Irrespective of the chosen antihypertensive therapy option, physical activity positively impacted cardiovascular remodelling, the dynamics of metabolic and pro-inflammatory indicators, and the equilibrium within the oxidative stress-antioxidant protection system and activity of the renin-angiotensin-aldosterone system.

EFFECTIVENESS OF ADDITION OF METFORMIN TO STATIN THERAPY FOR PRODIABETOGENIC CHANGES CORRECTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY

The aim: to study the effectiveness of adding metformin to statin therapy to correct prodiabetogenic changes in patients with arterial hypertension (AH) and abdominal obesity (AO). Materials and methods. We examined 65 patients with 2-3 degrees of AH in combination with AO of I-II degrees, atherogenic dyslipidemia and insulin resistance (IR) aged 47-59 yrs: group 1 – 35 patients who were treated with statins (atorvastatin) against the background of standard combinations of antihypertensive drugs, metformin was added; group 2 – 30 patients who did not receive metformin. The examination included generally accepted methods. Statistical data analysis was carried out using standard methods using Microsoft Excel 7.0 and SPSS 19.0 application packages. Results. The addition of metformin to atorvastatin against the background of standard antihypertensive therapy and recommendations for the normalization of lifestyle allowed a significant reduction in IR and the incidence of prediabetes in hypertensive patients with AO after 16 weeks of treatment. In patients who did not receive metformin, there was no decrease in these indicators. In the group of patients who used metformin, a significantly higher frequency of achieving target blood pressure levels was revealed than in the group of patients in whom this drug was not used. Conclusions. The effectiveness of the use of the insulin sensitizer metformin for the correction of pro-diabetogenic changes associated with statin therapy in patients with AH, which occurs against the background of AO, atherogenic dyslipidemia, and IR, has been shown.

Застосування комплексу на основі магнію та калію (Панцикор) на перебіг артеріальної гіпертензії І-ІІ стадії 1-2-го ступеня з гіпокаліємією

High blood pressure (BP) is noted in 34.8% of the population of Ukraine. Antihypertensive therapy is used by 34.4% of patients, by 14% - a treatment is effective. Resistance to antihypertensive therapy can be caused by a number of reasons, one of which is electrolyte imbalance. Purpose - to analyze the possibilities of using the complex Panzikor in patients with arterial hypertension of the I-II degree and hypokalemia to achieve the target level of blood pressure. Materials and methods. It is examined 34 (57%) patients with hypertension of the 1st degree and 26 (43%) patients with hypertension of the 2nd degree. All subjects were divided into groups: A (n=17) and C (n=13) - patients with AH of 1-2 degree who were prescribed standard antihypertensive therapy and Panzikor (1 sachet once a day for 12 weeks); B (n=17) and D (n=13) - patients with hypertension of 1-2 degree who were prescribed standard antihypertensive therapy. All patients underwent a general clinical examination, determination of potassium and sodium levels in the blood, carbohydrate and lipid parameters. Diaries of medication use and blood pressure measurement were kept. Results. After treatment, a significant decrease in blood pressure was recorded: in the Group A - systolic blood pressure from 156.1±12.2 mm Hg to 131.3±9.1 mm Hg and diastolic blood pressure from 99.7±6.3 mm Hg to 82.1±6.2 mm Hg; in the Group C - systolic blood pressure from 166.3±14.5 mm Hg to 139.4±11.2 mm Hg, diastolic blood pressure from 104.1±7.9 mm Hg to 86.1±6.3 mm Hg. In the Groups B and D, no significant decrease in blood pressure was found. Patients of the Groups A and C showed positive dynamics of blood glucose reduction (in the Group A - from 5.4±0.8 mmol/l to 4.2±0.6 mmol/l; in the Group C - from 4.7±1.3 mmol/l to 4.2±1.1 mmol/l), glycosylated hemoglobin (in the Group A - from 5.2±1.1% to 4.6±1.2%; in the Group C - from 5.1±0.8% to 4.8±0.7%), total cholesterol (in the Group A - from 5.6±1.3 mmol/l to 4.2±1.1 mmol/l; in the Group C - from 5.8±2.7 mmol/l to 4.3±1.1 mmol/l), low density lipoproteins (in the Group A - from 2.9±1.1 mmol/l to 1.5±0.4 mmol/l; in the Group C - from 3.2±1.2 7 mmol/l to 1.8±0.7 mmol/l). Conclusions. Panzikor should be prescribed to patients with hypertension and hypokalemia to effectively achieve target blood pressure levels and stabilize lipid and carbohydrate metabolism indicators. The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. No conflict of interests was declared by the authors.

PSUN115 Features of Metabolic and Hemodynamic Parameters in Obese Patients with True and Pseudo-Resistant Hypertension

Abstract Given the negative contribution of obesity-associated metabolic disorders to the formation of cardiovascular complications, adequate blood pressure (BP) control is very important in patients with arterial hypertension (AH) and obesity comorbidity. Objective to conduct a comparative assessment between metabolic and hemodynamic parametersinobese patients with true and pseudo-resistant AH. Methods The study included 302 patients with uncontrolled AH and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target BP in dual therapy were transferred to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP (they received the fourth drug spironolactone). All patients were additionally examined 6 months after the initiation of antihypertensive therapy. Results A comparative assessment of BP levels was carried out between non-resistant and resistant patients: at the initial stage of enrolling patients, there was no significant difference in BP between non-resistant and subsequently resistant patients; after 3 months of follow-up (after prescribing double fixed combinations), there was a significant difference in the indicators of both office and out-of-office BP in resistance and non-resistance; despite the achievement of target BP levels after 6 months of therapy, in the presence of resistance, both office, home and most ABPM indicators were significantly higher than in non-resistance. An assessment of the possible causes of pseudo-resistance showed that most often, pseudo-resistance was observed in patients with non-compliance with recommendations to increase physical activity (55.26%) and reduce the calorie intake of food consumed (44.77%), as well as with poor compliance to the prescribed therapy (42.11%). At the same time, high salt intake, chronic kidney disease, obstructive sleep apnoea, and the white-coat phenomenon also contributed to the formation of pseudo-resistance. More than half of the patients (63.16%) had a combination of several factors that could contribute to the formation of pseudo-resistance. If at the stage of enrolling patients into the study and 3 months after the start of therapy there was no significant difference in BP levels between true and pseudo-resistant patients, then after 6 months of antihypertensive therapy, patients with true resistance had significantly higher levels of office SBP (p&amp;lt;0.01) and 24 h average SBP according to ABPM data (p&amp;lt;0.05) compared with pseudo-resistant patients. Obese patients with true resistance had also significantly lower BMI and LDL-cholesterol (p&amp;lt;0.05) as well as higher levels of aldosterone and SBP (p&amp;lt;0.05) compared with pseudo-resistance. Conclusions Even when target BP levels in antihypertensive therapy are achieved, obese resistant patients are characterized by higher levels of office and out-of-office BP, compared with non-resistance. Compared with pseudo-resistance, the presence of true resistance in obesity is associated with higher SBP and aldosteron levels, as well as lower BMI and LDL-cholesterol. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Blood pressure target achievement in older adults with hypertension and chronic heart failure with preserved ejection fraction: the impact of adipose tissue function

Objective. To assess the impact of adipose tissue dysfunction for target blood pressure levels achieving in arterial hypertension (AH) and chronic heart failure with preserved left ventricular ejection fraction (HFpEF) in real clinical practice.Materials and methods. We examined 91 elderly patients (&gt; 75 y.o.) with AH and HFpEF during hospital admission. The mass and mass fraction of adipose tissue, serum levels of adipokines (adiponectin, leptin) and proinflammatory cytokines (TNFa and IL6) were assessed. Steady normotension at discharge was used as a marker of the target blood pressure level achievement possibility.Results. By the time of the planned discharge, stable normotension was recorded in 24.2% of patients. In senile patients with failure to achieve normotension, isolated systolic AH was most common - 55.1%. Patients with persistent hypertension at the time of the planned discharge were characterized by a low ability of adipose tissue to secrete adiponectin: 0.05 (0.03; 0.12) vs 0.37 (0.12; 0.5) μg/mL/kg (p = 0.037 ). The minimum values of adiponectin (corrected for adipose tissue mass) were in patients with systolic-diastolic AH (0.04 (0.03; 0.06) μg/ml/kg, Jonkhier-Terpstra test, p = 0.033). A regression model for achieving normotension in senile patients with HFpEF was built with a total percentage of correct classifications of 93.8% before bootstrap and 95.8% after: the maximum values of the Wald statistics were achieved with respect to the predictors "adiponectin", "TNF-a" and "heart rate".Conclusion. The development of adipose tissue dysfunction, accompanied by a decrease in the “rescue hormone” adiponectin synthesis, is associated with the failure to achieve normotension during medication of the inpatient treatment in senile patients with AH and HFpEF.

Трехкомпонентная комбинированная антигипертензивная терапия у больных артериальной гипертензией с абдоминальным ожирением. Данные 9-месячного наблюдения

Актуальность. Сочетанное течение первичной артериальной гипертензии (АГ) и абдоминального ожирения (АО) характеризуется рефрактерностью к антигипертензивной терапии и значительным повышением сердечно-сосудистого риска. Перспективным подходом к терапии данных больных является раннее применение фиксированных комбинаций антигипертензивных препаратов первой линии. Цель работы состояла в исследовании эффективности фиксированной комбинации периндоприла, индапамида и амлодипина в сравнении с нефиксированной комбинацией указанных препаратов у больных с АГ в сочетании с АО. Материалы и методы. Обследованы 75 больных с АГ II–III степени в сочетании с АО І–ІІ степени (45 мужчин и 30 женщин) в возрасте от 48 до 66 лет. Все больные были разделены на две подгруппы в зависимости от вида антигипертензивной терапии. Первая подгруппа больных (26 пациентов) получала нефиксированную комбинацию периндоприла, индапамида и амлодипина. Вторая подгруппа (29 больных) получала фиксированную комбинацию указанных препаратов. Обследование проводили до начала лечения и через 3, 6 и 9 месяцев. В качестве гиполипидемического препарата все больные получали аторвастатин в суточной дозе 20 мг. Указанная терапия проводилась на фоне рекомендаций по коррекции образа жизни. Результаты. Установлено, что частота достижения целевых уровней артериального давления (АД) у больных, которые получали фиксированную комбинацию препаратов, через 9 месяцев лечения была достоверно выше, чем у больных, которые получали нефиксированную комбинацию. По данным суточного мониторирования АД, фиксированная комбинация назначенных препаратов значительно лучше нормализовала такие параметры, как среднесуточное и среднедневное диастолическое АД (ДАД), средненочное систолическое АД (САД) и ДАД, а также степень ночного снижения и среднесуточную вариабельность САД и ДАД. Апробированная трехкомпонентная фиксированная комбинация давала возможность достичь целевых уровней АД на более низких дозах примененных компонентов, чем нефиксированная комбинация. Выводы. Фиксированная комбинация периндоприла, индапамида и амлодипина в сравнении с нефиксированной у больных АГ в сочетании с АО проявляет достоверно большую антигипертензивную эффективность по данным как офисного измерения АД, так и суточного мониторирования АД на фоне большей приверженности больных к лечению. Для достижения целевых уровней АД у больных АГ в сочетании с АО требуются более низкие дозы компонентов фиксированной комбинации, чем нефиксированной.

Независимые факторы сердечно-сосудистого риска: гипергомоцистеинемия и жесткость сосудов у больных с артериальной гипертензией

Актуальность. Определение факторов риска и проведение предварительной оценки общего сердечно-сосудистого риска (ССР) у пациентов с артериальной гипертензией (АГ) — самая важная задача в клинической практике. У большинства пациентов, помимо повышенного артериального давления (АД), отмечаются и другие факторы ССР, усиливающие друг друга, что приводит к увеличению общего ССР. Одним из факторов ССР является жесткость артерий. Определение жесткости артерий проводят с помощью метода определения скорости распространения пульсовой волны (СРПВ). Вторым независимым фактором риска развития сердечно-сосудистых заболеваний является повышенный уровень гомоцистеина (ГЦ) в крови. Цель: оценить связь гипергомоцистеинемии (ГГц) с жесткостью сосудов у пациентов с АГ. Материалы и методы. Наше исследование было выполнено в рамках исследования ХИПСТЕР в Украине. В исследование было включено 40 пациентов с I и II степенью АГ (средний уровень офисного систолического (САД)/диастолического АД — 155,88/92,60 ± 1,63/1,43 мм рт.ст.), частота сердечных сокращений — 71,40 ± 1,29 уд/мин. Средний возраст больных составил 55,85 ± 2,09 года (26–74). Пациентов с уровнем ГЦ ≥ 10 мкмоль/л определяли как пациентов с ГГц (Н-тип АГ). Жесткость сосудов определяли по СРПВ. Результаты. Нами выявлено, что в начале исследования 75% (30 пациентов с мягкой и умеренной АГ) имели Н-тип АГ с повышенным уровнем ГЦ. Пациенты с Н-типом АГ (ГГц) и АГ без ГГц не отличались по возрасту, длительности АГ. При этом пациенты с Н-типом АГ имели большие массу тела, индекс массы тела (ИМТ). Офисное САД у пациентов с Н-типом АГ в начале и через 6 месяцев лечения было выше по сравнению с пациентами без ГГц (156,45 ±1,04 мм рт.ст. против 152,55 ± 1,41 мм рт.ст. в начале (р &lt; 0,05) и 130,65 ± 0,96 мм рт.ст. против 126,97±1,08мм рт.ст. через 6 месяцев (р &lt; 0,05)). ИМТ в начале исследования с Н-типом АГ — 30,72 ± 0,39 кг/м2 против 28,34 ± 0,69 кг/м2 без ГГц (р &lt; 0,05). Пациенты с Н-типом АГ хуже достигали целевых уровней АД на фоне лечения, и у них изначально были высокие показатели АД. Пациенты с Н-типом АГ по сравнению с пациентами без ГГц имели более выраженную степень инсулинорезистентности (по уровню индекса НОМА), меньшую скорость клубочковой фильтрации как в начале, так и в конце лечения. По данным суточного мониторирования АД до начала лечения пациенты с Н-типом АГ по сравнению с пациентами с АГ без ГГц имели достоверно более высокий уровень САД. После регрессионного анализа уровень гомоцистеина ассоциировался со СРПВ по артериям эластичного типа (СРПВэл) независимо от степени снижения АД (СРПВэл (6 месяцев), м/с, β = 0,307, Р = 0,001). Выводы. Мужской пол, индекс массы тела, скорость клубочковой фильтрации, уровень глюкозы крови, уровень офисного и центрального артериального давления ассоциировались с повышением уровня гомоцистеина крови у пациентов с артериальной гипертензией.

Resistant arterial hypertension: the search of new approaches to antihypertensive drug therapy

Improving the effectiveness of drug therapy and reducing the risk of adverse cardiovascular and renal outcomes in patients with resistant hypertension (HTN) remains an unsolved problem of cardiology. The results of the PATHWAY-2, PATHWAY-3 and ReHOT studies have shown the clinical efficacy of spironolactone, amiloride and, to a lesser extent, the antiadrenergic drugs clonidine, bisoprolol and doxazosin in improving blood pressure (BP) control in this patient population. However, the inclusion of spironolactone and other known drugs in antihypertensive therapy does not ensure the achievement of target BP level in a significant proportion of these patients. The review presents the results of clinical studies of new approaches aimed at increasing the effectiveness of drug therapy in resistant HTN including sodium-glucose cotransporter type 2 inhibitors, brain aminopeptidase A inhibitors, and new antagonists of endothelin receptors.

Fixed combination of ramipril and indapamide in patients with hypertension and non-alcoholic fatty liver disease: focus on the large arteries

Objective.To assess the effect of antihypertensive therapy with ramipril and indapamide on the elasticity of the vascular wall of the large arteries in relation to insulin resistance and chronic low-intensity inflammation in patients with hypertension (HTN) and non-alcoholic fatty liver disease (NAFLD).Design and methods.An open prospective controlled study was conducted: 30 patients with HTN stage I–II in combination with NAFLD (Fatty Liver Index (FLI) &gt; 60) at the age of 45–65 years were included. Washout period was scheduled 5–7 days before the baseline examination, followed by the prescription of one of the fixed combinations of ramipril (2,5/5 mg/day) and indapamide (0,625/1,25 mg), depending on the required dosage (Konsilar-D 24 VERTEX AO, Russia) and were given recommendations on lifestyle changes and weight loss. A clinical examination was carried out, indicators of daily blood pressure (BP) monitoring and central aortic pressure (CAP), pulse wave velocity (PWV), lipid and carbohydrate metabolism, chronic low-intensity inflammation and the severity of insulin resistance before and after treatment were analyzed.Results.After 24-week therapy with a fixed combination of ramipril and indapamide at an average dosage of 4,04 ± 1,24 and 1,01 ± 0,31 mg, respectively, 100% of patients with HTN and NAFLD achieved target BP levels. According to 24-hour BP monitoring data, a significant decrease in systolic BP (SBP) and diastolic BP (DBP) was observed, both in the daytime (Δ12 mm Hg, р = 0,0001; Δ5,5 mm Hg, р = 0,0019, respectively), and at night (Δ13,5 mm Hg, р = 0,0006; Δ5,5 mm Hg, р = 0,0054, respectively). In addition, there was a significant decrease in CAP in the daytime (SBPao p = 0,0011, DBPao p = 0,0022) and night hours (SBPao p = 0,0015, DBPao p = 0,00124), and a statistically significant decrease in augmentation index (day p = 0,0460, night p = 0,0182). When evaluating clinical data and bioimpedance measurements, a decrease in waist circumference (p = 0,0000), hip circumference (p = 0,0001), the proportion of subcutaneous (p = 0,0134) and visceral (p = 0,0019) fat was found, which may indicate a decrease in the severity of visceral obesity. Also, during treatment, there is a decrease in the severity of insulin resistance (and the concentration of tumor necrosis factor alpha (TNF-α) (p &lt; 0,0001) and CRP (p = 0,0002) in blood plasma. Finally, fixed combination of ramipril and indapamide led to a significant decrease in vascular stiffness (p = 0,0166) and a decrease in the proportion of patients with PWV paradoxical test (p = 0,0320). Correlation analysis showed that increased stiffness of the large arteries in patients with HTN and NAFLD is closely related to insulin resistance and lipid metabolism. At the same time, after 24-week therapy by a fixed combination of ramipril and indapamide, a decrease in the vascular stiffness in patients with HTN and NAFLD significantly correlated with the TNF-α concentration.Conclusions.A 24-week therapy by the fixed combination of ramipril and indapamide iin patients with HTN and NAFLD is associated with the persistent decrease in BP and CAP, both during the day and at night. There was a decrease in the vascular rigidity in muscular arteries. The treatment and recommendations for changing the lifestyle are associated with the decrease in the severity of abdominal obesity and insulin resistance, as well as the decrease in the severity of low-intensity systemic inflammation in patients with HTN and NAFLD, and a significant correlation was established between a decrease in TNF-α and an increase in the vascular elasticity of muscle and elastic type arteries.

FEATURES OF HEMOSTASIS IN DIFFERENT TYPES OF 24 HOURS DAY'S PROFILE OF BLOOD PRESSURE IN HYPERTENSIVE PATIENTS OF DIFFERENT AGE GROUPS

In most patients of both groups revealed changes in hemostasis in the direction of increasing the aggregation properties of platelets. However, more pronounced trends in such changes were found in patients with insufficient blood pressure at night.&#x0D; Given the fact that not only in the absence of control over hypertension and failure to achieve target blood pressure levels, but also with different daily blood pressure profiles, there is a high probability of thrombotic complications. That is why it was important for us to find out the peculiarities of the state of platelet aggregation indicators depending on 24 hours day’s profile of blood pressure. To date there are only isolated reports of hemostasis in this category of individuals. We conducted such studies in middle-aged and elderly patients.&#x0D; The aim of the study was to identify the baseline levels of hemostasis indices depending on 24 hours day’s profile of blood pressure in middle-aged and elderly hypertensive patients.&#x0D; Material and methods. We performed the comparative assessment of status of hemostasis in 30 middle-aged (group I) and 30 elderly patients (group II) respectively to clarify this issue in our work. Patients of the surveyed groups were comparable in age, sex and related pathology. Control group consisted of 15 patients for every of the surveyed groups (group III the middle-aged and group IV the elderly respectively) matched with basic by age and gender.&#x0D; Conclusions. Thus, in hypertensive patients there is an increase in platelet activity with age which is more pronounced when stimulating ADP in non-dipper group compared to dipper. In addition in older patients the most significant changes are determined in spontaneous and adrenaline-induced aggregation compared with middle-aged patients.

Fixed dose combination of olmesartan and amlodipine in patients with hypertension and abdominal obesity. Data of 3-month observation of efficacy and adherence to therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background Essential hypertension (H), which is combined with abdominal obesity (AO), is characterized by the early formation of refractoriness to antihypertensive therapy. In this regard, it is urgent to search for the most effective therapy regimens, among which fixed combinations (FC) of drugs have recently attracted considerable interest. Purpose To study the efficacy of FC olmesartan (O) and amlodipine (F) and adherence to it in patients with H and AO. Methods. 60 patients with grade 2 H with AO of I-II degrees (36 men and 24 women aged 48 to 62 years) were examined using standard clinical, biochemical and instrumental methods. Before enrollment in the study, all patients received various non-FC two-component combinations of antihypertensive drugs, however, target blood pressure (BP) levels were not achieved by any patient. After inclusion in the study, all patients were transferred to FC O and A, which was prescribed once a day , taking into account BP levels in the following daily doses: 20/5 mg; 40/5 mg and 40/10 mg. The examination was carried out for 3 months with dose adjustments every 7-10 days. Results. The use of FC O and A made it possible to achieve the target BP level after 3 month of therapy in 72% of patients with H and AO. At the same time, high adherence to this therapy was also noted: 80% of patients continued to receive this therapy for 3 months. It was found that in order to achieve target BP levels, in 84% of patients it was necessary to use O and A in a daily dose of 40/10 mg, in 16% of patients -in a dose of 40/5 mg. The tested FC was characterized by a low incidence of side effects, the most frequent of which was leg edema (in 7% of patients) and good tolerability (therapy withdrawal rate was 3%). Conclusion. The established high antihypertensive efficacy and tolerability of FC O and A in patients with H and AO indicates the promise of its widespread use in this category of patients.

Hemodynamic and metabolic disorders in obese patients with resistant hypertension

Abstract Resistant hypertension (RH) is an important cause of cardiovascular morbidity and mortality. Both true and pseudo-resistant arterial hypertension (AH) represent a big problem not only in blood pressure (BP) control, but also in those possible adverse cardiovascular events, the development of which is associated with failure to achieve target BP levels. The aim of the study was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant AH. Material and methods The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target BP levels after 3 months on dual therapy were additionally assigned a third antihypertensive drug. Of the 98 patients who were assigned triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy. Results After 6 months of therapy, patients with RH had higher body mass index (BMI) and higher BP levels compared to patients without this condition. Patients with RH also had more pronounced cardiovascular remodeling, higher levels of triglycerides, insulin, HbA1c, more pronounced insulin resistant (IR), which was confirmed by greater HOMA-IR, greater imbalance of adipokines, proinflamation activity and higher activity of the renin-angiotensin-aldosterone system (RAAS). A comparative assessment of pseudo-resistance and true resistance showed that patients with true resistance differed from pseudo-resistant patients with significantly lower BMI (p=0.02). In addition, in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone (p=0.04), higher activity of oxidative stress (malonic dialdehyde, p=0.01 and diene conjugates, p=0.03), a lower level of total antioxidant protection (p=0.00), a higher level of adiponectin (p=0.00), and a lower level of leptin (p=0.00), compared with pseudo-resistant patients. Conclusions Patients with resistant hypertension differed from hypertensive obese patients without resistance with higher BMI and BP, higher levels of triglycerides, insulin, HbA1c, more pronounced IR, cardiovascular remodeling, imbalance of oxidative stress - antioxidant protection system, higher proinflammatory and RAAS activity. Patients with true resistance differed from pseudo-resistant patients with significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress - antioxidant protection and less pronounced adipokines imbalance. Funding Acknowledgement Type of funding source: None