Arterial Hypertension In Combination Research Articles

РАСПРЕДЕЛЕНИЕ ГЕНОТИПОВ ГЕНА SLC2A9, УРОВЕНЬ МОЧЕВОЙ КИСЛОТЫ И МЕТАБОЛИТЫ ПУРИНОВОГО ОБМЕНА У ПАЦИЕНТОВ С АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ И ФИБРИЛЛЯЦИЕЙ ПРЕДСЕРДИЙ

The aim is to investigate the frequency of genotypes and alleles of the SLC2A9 gene rs734553 polymorphism, the level of serum uric acid (sUA) and metabolites of purine metabolism in patients with arterial hypertension (AH) and atrial fibrillation (AF), as well as in healthy individuals. Material and methods. The study included 154 patients: 50 were healthy individuals (group 0), of which 22 (44%) were men and 28 (56%) were women aged 50 [45;53] years and 104 were patients with AH and AF (main group), of which 94 (90.4%) were men and 10 (9.6%) were women aged 55 [45; 61] years. The main group was divided into subgroups: subgroup I – patients with AF without a history of AH and other rhythm disorders (n=13); subgroup II – patients with AH in combination with AF (n=68); subgroup III – patients with AH without a history of AF or other rhythm disturbances (n=23). Hyperuricemia was detected in 34 (22.1%) patients, normal uric acid levels were revealed in 120 (77.9%) patients. All patients were studied using clinical, laboratory, instrumental and molecular genetic research methods. The level of sUA was determined by the enzymatic colorimetric method. Serum xanthine oxidase was measured using a method based on a solid phase sandwich-type enzyme-linked immunosorbent assay. Metabolites of purine metabolism in blood plasma were measured using the method of high-performance liquid chromatography. The SLC2A9 gene rs734553 polymorphism was determined using the polymerase chain reaction with real-time detection of results. Results. The patients with AH and AF, as compared to healthy individuals, had more severe disturbances of purine metabolism, characterized by higher concentration of sUA (330 [283; 412] µmol/l and 197 [161; 229] µmol/l (p<0.001), respectively). Also, in contrast to the group of healthy individuals, the group of patients with AH and AF demonstrated an increase in the level of adenosine (p=0.001), and a decrease in the levels of hypoxanthine and xanthine (p<0.001). There were no statistically significant differences in xanthine oxidase activity level (p>0.05), however, in 54% of patients in the main group it was higher than normal values. The dominant allele A and the dominant genotype A/A of the SLC2A9 gene rs734553 polymorphism (75%, p=0.005; 64%, p=0.001, respectively) occurred significantly more often in healthy individuals, while the recessive allele C and the heterozygous genotype A/C were found significantly more often in the group of patients with AH and AF (41.3%, p=0.005; 48.1%, p=0.003, respectively). The C/C genotype (41.7%, p=0.001) was significantly more common in patients with AH in combination with AF and hyperuricemia, compared to patients with AH combined with AF without hyperuricemia as well as healthy individuals (6.8%; 14%, p=0.001, respectively). Patients with AH in combination with AF and the C/C genotype were characterized by a significantly higher level of sUA (p=0.003) compared to patients with the A/A genotype. Conclusions. A statistically significant predominance of the recessive allele C of the SLC2A9 gene rs734553 polymorphism was established in patients with AH and AF compared with healthy individuals (p=0.005). In patients with AH in combination with AF and hyperuricemia, the C/C genotype was significantly more common (41.7%, p=0.001). Patients with AH in combination with AF and the C/C genotype were characterized by a significantly higher level of sUA (p=0.003) compared to patients with the A/A genotype.

Place of imidazoline receptor agonists in the treatment of arterial hypertension

The review is devoted to one of the most controversial issues of modern antihypertensive therapy — the role of new generation sympatholytics — selective I1-imidazoline receptor agonists (AIRs). In modern European recommendations, AIR (moxonidine rilmenidine), along with other centrally acting drugs (reserpine, alpha-methyldopa, clonidine), are mainly intended for additional therapy in rare cases of resistant hypertension, when other treatment options have been ineffective. Nevertheless, AIR invariably finds its place in Russian recommendations for the treatment of arterial hypertension (AH). This class of drugs is recommended for patients with AH in combination with metabolic syndrome and obesity. It is noted that an important property of AIR is its positive effect on carbohydrate and lipid metabolism. This information is based on an analysis of Russian and foreign studies, which convincingly indicate that this class of drugs not only provides adequate and long-term blood pressure control, but also has the above-mentioned positive metabolic effects. At the same time, AIRs are much less likely to cause side effects characteristic of older generation centrally acting drugs. Thus, AIRs have become firmly established in clinical practice in Russia for the treatment of patients with AH in certain clinical situations.

Neuroprotective efficacy of combined antihypertensive treatment with the inclusion of nitrendipine in patients with arterial hypertension

Abstract Aim To evaluate the efficacy of 12-months combined antihypertensive treatment with the inclusion of nitrendipine on cognitive functions in patients with arterial hypertension (AH). Material and methods Surveyed 59 patients with I – III AH degree (ESH / ESC, 2018) of both sexes. The average age of patients was 58,8 ± 11.6 years, the average duration of AH 11.1 ± 7.04 years. An average daily dose 13.18±7.4 mg of nitrendipine was prescribed to patients with AH in combination with other antihypertensive drugs. Furthermore, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in all patients before and after 12 months treatment. Cognitive functions were evaluated using neuro-psychological tests: the Mini-Cog test (drawing a clock, reproduction of words), Montreal Cognitive Assessment (MoCA), a self-assessment questionnaire of memory, attention, thinking, ability to cope with their affairs, ability to make decisions. The results are presented as M ± SD. Results Analysis of office BP indicators showed a good 12-month antihypertensive efficacy with the inclusion of Nitrendipine in patients with AH. In particular, the SBP before treatment was 157,8 ± 16,18 mm Hg, after – 125,5 ± 10,7 (p = 0,000); the DBP 96,35 ± 8,55 mm Hg versus 79,7 ± 5,9 mm Hg, respectively (p = 0,000); MBP (mean blood pressure) 116,8 ± 9,95 mm Hg versus 94,97 ± 7,09 mm Hg, respectively (p = 0,000). The analysis of influence of AHT with the inclusion of Nitrendipine on cognitive functions in patients with AH showed an increase in the total score on the Mini-Cog test: 3,83 ± 1,11 versus 4,49 ± 0,81 points (p = 0,000), mainly due to a significant improvement in the reproduction of words: 2,16 ± 0,87 versus 2,69 ± 0,62 points (p = 0,000). According to the MOCA scale, abstract thinking significantly improved: initially amounting to 1,37±0,66 points versus 1,81±0,5 points in dynamics (p=0,000), as well as delayed reproduction of words: 2,49±1,23 points initially versus 3,2±1,4 points in dynamics (p=0,004). Significant memory improvement was observed against the background of 12-month antihypertensive therapy based on nitrendipine, initially was 7,04±2.34 points against 8,22±1.24 in dynamics (p=0,000) and decision-making function was 7,8±2,2 points initially against 9,02±1,3 in dynamics (p=0,000). Conclusion Thus, high antihypertensive efficacy and improvement of cognitive functions were shown against the background of antihypertensive combination therapy with the inclusion of nitrendipine in patients with AH.

DIAGNOSTIC AND PROGNOSTIC VALUE OF Β2-MICROGLOBULIN IN THE DEVELOPMENT OF CARDIORENAL SYNDROME IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND ARTERIAL HYPERTENSION

Arterial hypertension is the largest pandemic in the history of mankind, which defines the structure of cardiovascular morbidity and mortality. Currently, the correlation between hypertension and various pathological conditions and diseases has been proven, which largely determines its progression and contributes to the development of cardiovascular and renal complications. These diseases include type 2 diabetes mellitus, which is spreading globally as a pandemic. The history of arterial hypertension in combination with type 2 diabetes mellitus is often accompanied by the development of cardiorenal syndrome, so it is crucial to diagnose renal dysfunction and prevent cardiovascular complications in such patients. One of these biomarkers is β2-microglobulin (β2-M), which depends on the glomerular filtration rate and tubular reabsorption.
 Materials and methods. 90 patients with AH (men/women – 48/42) and 20 control subjects were examined. During a thorough examination and follow-up of patients, they were classified into 3 groups: patients with AH – group 1 – 31 people; group 2 – AH in combination with T2DM – 31 people; group 3 – patients with AH, T2DM, and obesity – 28 people. Body weight and height were measured in all patients, and BMI = body weight/height2 (m2) was calculated. The β2-microglobulin levels in the patients' serum, cardiotrophin-1, catestatin, leptin, cystatin C, neutrophil gelatinase-associated lipocalin, and N-terminal pro-brain natriuretic peptide, 25-OH total vitamin D, serum insulin levels, glycosylated hemoglobin, lipid metabolism, and systolic and diastolic blood pressure were measured. Statistical data analysis was performed using Statistica, 12 (Stat Soft Inc, USA) and Microsoft Office Excel 2013. The data are presented as mean (M) and standard deviation (δ). Differences between groups of mean values were evaluated using the Student's t-test.
 Results and conclusions. The level of β2-M in the observed groups of patients differed significantly from that of healthy individuals. An increase in β2-M concentration allowed us to confirm the presence of tubular renal dysfunction, which was not diagnosed by conventional methods. All examined patients were divided into 2 groups depending on the β2-M level. Our data prove the role of β2-microglobulin as an independent biomarker of renal dysfunction, as well as the development of early cardiovascular complications. The data obtained from the mathematical models between creatinine and β2-microglobulin, urea and β2-microglobulin levels show a highly significant correlation between β2-microglobulin and renal function and demonstrate that β2-microglobulin is an independent factor in the prediction of renal dysfunction in patients with hypertension and concomitant type 2 diabetes mellitus. β2-microglobulin is a biomarker that should be used in the diagnosis and prognosis of early manifestations of cardiorenal syndrome.

DEPENDENCE OF CARDIOTROPHIN-1 ON BIOCHEMICAL AND HORMONAL FACTORS IN PATIENTS WITH COMORBID PATHOLOGY: ARTERIAL HYPERTENSION, DIABETES MELLITUS TYPE 2 AND OBESITY

The prevalence of arterial hypertension, type 2 diabetes mellitus (type 2 DM), and obesity is constantly increasing worldwide. Today, a complex of factors, which primarily include chronic emotional stress, pandemics of infectious diseases, military conflicts, have led to a significant increase in chronic non-communicable diseases. The aim of the study. To determine the dependence of Cardiotrophin-1 on a number of biochemical and hormonal indicators in patients with arterial hypertension, type 2 DM, and obesity, representatives of the Ukrainian population. Materials and methods. The study included 211 patients aged 49 to 65 years, who were divided into groups depending on the pathology: patients with arterial hypertension – 49 persons, Group I; patients with arterial hypertension in combination with class 1 obesity – 54 persons, Group 2; patients with arterial hypertension in combination with type 2 DM – 57 persons, Group 3; patients with arterial hypertension, type 2 DM, class 1 obesity – 51 persons, Group 4; as well as 20 persons – the Control group. Determination of the content of Cardiotrophin-1, catestatin, leptin, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), N-terminal brain natriuretic peptide (NT-proBNP), 25-OH of common vitamin D (Vitamin D3), blood levels was carried out by enzyme immunoassay on Labline-90 analyzer (Austria), using commercial test systems manufactured by FineTest (ELISA, China), BT LAB (ELISA, China), DBC (ELISA, China), Elabscience (ELISA, Canada), Monobind Inc. (ELISA, USA). Statistical data analysis was performed, using the statistical software package Statistica, 12 (Stat Soft Inc, USA), Microsoft Office Excel 2013. Data are shown as mean (M) and standard deviations (δ). An error of less than 5% was considered to be significant (p<0.05). Stepwise regression analysis was used to determine the extent of exposure of the studied indicators to the CTF-1 level, with its effectiveness assessed by one-way analysis of variance (ANOVA). Results. Thus, the study indicates that comorbid patients with arterial hypertension, type 2 DM, and obesity are predicted to develop complications from the cardiovascular system and Cardiotrophin-1 is a marker of their development. In the examined patients as a whole, the level of Cardiotrophin-1 is closely related to the peptide-hormonal complex: catestatin, leptin, cystatin C, brain natriuretic peptide, and lipocalin associated with neutrophil gelatinase. Conclusions: The serum concentration of Cardiotrophin-1 in patients with arterial hypertension increases significantly in a progression with the rate of accession of comorbid pathology and its severity. The Cardiotrophin-1 level in patients with comorbid pathology is affected by catestatin, leptin, cystatin C, NT-pro BNP, as well as the level of triglycerides, HDL-C, creatinine, and BMI. Cardiotrophin-1 can be considered as a universal biomarker for the development and progression of cardiovascular disorders in patients with comorbid pathology of arterial hypertension, type 2 DM, and obesity.

Assessment Of Fluid Retention In Patients With Paroxysmal And Long-Standing Persistent Types Of Atrial Fibrillation

Determining fluid retention in circulatory system currently remains a challenge. The objective of our study was to determine the sensitivity of individual symptoms and signs of chronic heart failure (CHF) and echocardiographic criteria for detecting fluid retention in patients with atrial fibrillation and invasively measured elevated atrial pressure. Methods — We conducted a prospective study of adult patients with a history of cardiovascular disease (coronary artery disease or/and arterial hypertension in combination with atrial fibrillation [AF]) hospitalized for radiofrequency catheter ablation. All patients underwent expert ultrasound examination of the heart using Philips HD 15 and Philips iE33 devices, as well as invasive measurement of pressure in the left and right atria at rest (n=20). Results — The sensitivity of dyspnea in patients with paroxysmal AF and long-standing persistent AF was 44.4% and 90.9%, respectively. The sensitivity of the mean E/e' ratio in patients with paroxysmal AF and long-standing persistent AF was 22.2% and 18.1%, correspondingly. According to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) algorithm, only one patient (11.1%) in the group with paroxysmal AF and 54.5% of subjects in the group with a long-standing persistent AF type had two positive criteria. The sensitivity of lower limb edema was 0% in patients with paroxysmal AF and 57.1% in those with long-standing persistent AF. The sensitivity of IVC diameter >22 mm was 80% in patients with paroxysmal AF and 57.1% in the group with long-standing persistent AF. At the same time, the sensitivity of the IVC inspiratory collapse ≤50% was significantly lower in both groups: 60% in patients with paroxysmal AF and 42.9% in subjects with long-standing persistent AF. Conclusion — Clinical symptoms and signs of chronic heart failure (CHF), as well as echocardiographic parameters reflecting an increase in the filling pressure of the heart chambers, are characterized by extremely low sensitivity in a cohort of patients with paroxysmal AF. The use of more stringent criteria for diagnosing congestion in this group of patients leads to a significant underdiagnosis of elevated filling pressure in the left chambers of the heart, which, in turn, increases the likelihood of insufficient prescription of diuretic therapy when it is objectively necessary.

Evaluation of metabolic disorders and aging rates depending on SIRT1 polymorphism in patients with arterial hypertension and subclinical hypothyroidism

There is an increase in the frequency and severity of metabolic disorders in patients with arterial hypertension (AH) in combination with subclinical hypothyroidism (SH), that is accompanied by accelerated aging rates, but the research findings on the aging rates in this category of patients are extremely few in number. Therefore, the aim of our study was to assess metabolic disorders and the aging rates depending on the SIRT1 rs7069102 polymorphism in patients with AH and SH. A total of 132 patients with a median age of 47.6 years were included in the study and divided into 3 groups: a control group (n=30), a group of patients with AH without SH (n=49) and patients with AH in combination with SH (n=53). Anthropometric parameters, biochemical parameters, pro-inflammatory and oxidative states were evaluated in all pa­tients. The aging rates were assessed using two different methods. The frequencies of SIRT1 rs7069102 genotypes carriers in the study sample of patients were 8% for the CC genotype, 51% for the CG genotype and 41% for the GG genotype. There was a significant difference in the incidence of CC homozygosity and carriers of the G allele between groups of patients with AH depending on the SH presence (p<0.001). We showed that carriers of the G allele and GG genotype of the SIRT1 gene (rs7069102) polymorphic marker with AH and SH had significantly higher (p<0.05) insulin resistance, higher levels of low-density lipoprotein cholesterol, alkaline phosphatase, C-reactive protein and lower glomerular filtration rate, which negatively affected the aging processes in this category of patients. In addition, patients with AH had a marked effect of carrying the G allele on the lipid profile and biological age of patients. Therefore, timely detection of a polymorphic variant of the SIRT1 gene may be effective in premature aging prevention in patients with AH and SH.

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.

NO-synthase and arginase activity and L-arginine content in peripheral blood lymphocytes of patients with arterial hypertension in combination with COVID-19 pneumonia

NO-synthase and arginase activity and L-arginine content in peripheral blood lymphocytes of patients with arterial hypertension in combination with COVID-19 pneumonia

Features of vascular rigidity in patients with arterial hypertension in combination with chronic heart failure and senile asthenia syndrome

Objective. The aim of the study was to evaluate the features of vascular rigidity in patients with arterial hypertension (AH) depending on the presence of chronic heart failure (CHF) and senile asthenia syndrome (SAS).Design and methods. 320 patients with AH were divided into two main groups: group 1 — patients with AH and CHF (n = 161), group 2 — patients with AH without CHF (n = 159). Depending on the presence of SAS, patients of each group were divided as follows: subgroup 1A — patients with AH, CHF and SAS (n = 84), subgroup 1B — patients with AH, CHF without SAS (n = 77), subgroup 2A — patients with AH, SAS without CHF (n = 84), subgroup 2B — patients with AH without CHF and without SAS (n = 75). To identify SAS, we used the “Age is not a barrier” questionnaire and a short battery of physical functioning tests. The parameters of vascular stiffness were determined using a device for daily monitoring of blood pressure BPLab using Vasotens technology (Peter Telegin, Nizhny Novgorod). The obtained data were processed using STATISTICA 12.0 (StatSoft Inc., USA), SPSS 21.0, MedCalc (version 9.3.5.0).Results. Analysis of the effect of SAS on vascular stiffness showed that in patients with AH, CHF and SAS, compared with patients with AH, CHF without SAS, there were statistically significantly lower values of the reflected wave propagation time (RWTT) (p = 0,001) against the background of higher values pulse wave velocity in the aorta (РWVао) (p < 0,001), arterial stiffness index (ASI) (p = 0,0001) and ambulatory arterial stiffness index (AASI) (p = 0,002), which indicates more pronounced vascular stiffness in patients with AH, CHF in the presence of SAS. In the group of patients with AH and SAS without CHF, compared with patients with AH without CHF and without SAS, higher values of РWVао (p < 0,001) and “adjusted” index of augmentation index (AIх@75) (p < 0,001) were revealed, which allows to judge the effect of SAS on the development of arterial stiffness in patients with AH without CHF. Analysis of the effect of CHF on vascular stiffness showed that in patients with AH, SAS and CHF, compared with patients with AH, SAS without CHF, statistically significantly lower values of RWTT (p < 0,001) and higher values of РWVао (p = 0,024) were noted, ASI (p < 0,001), AASI (p < 0,001), maximum rate of blood pressure rise (dP/dtmax) (p < 0,001) and AIх@75 (p < 0,001). In the group of patients with AH, CHF without SAS, compared with patients with AH without CHF and without SAS, lower values of RWTT (p < 0,001) and higher values of РWVаo (p = 0,004), ASI (p < 0,001), AASI (p < 0,001) and dP/dtmax (p < 0,001), which in turn demonstrates the contribution of CHF to the development of vascular stiffness in AH patients without SAS. CS.Conclusions. In hypertensive patients over 80 years of age, the development of both SAS and CHF was accompanied by limited compliance of the aortic walls and increased vascular stiffness in the peripheral arteries. Significantly more pronounced changes in vascular stiffness parameters were noted in patients with a combination of AH, CHF and SAS compared with those in patients with AH and CHF or AH and SAS, which indicates an increase in vascular stiffness, and, consequently, a higher risk of cardiovascular diseases in this combined pathology.

AFFECTIVE DISORDERS IN MEN WITH ARTERIAL HYPERTENSION IN COMBINATION WITH METABOLIC SYNDROME

Purpose. To study the features of affective disorders in men with arterial hypertension in combination with metabolic syndrome.
 Materials and methods. 172 men with hypertension examined, including 106 patients with metabolic syndrome. Metabolic syndrome verification carried out according to the clinical recommendations of the All-Russian Scientific Society of Cardiology in 2009. The Hospital Anxiety and Depression Scale (HADS) used to identify and assess the severity of affective disorders.
 Results. The study of the individual severity of anxiety among the surveyed men with hypertension showed that elevated levels of anxiety generally detected in 14.6% of the surveyed men with metabolic syndrome. Anxiety disorders subclinically pronounced in 12,2% of the surveyed men in this group, and clinically pronounced anxiety found in 2,4% of the surveyed. Elevated levels of depression in general detected in 18,3% of the surveyed men with metabolic syndrome. At the same time, almost 11,0% of the surveyed men in this group had depressive disorders of a subclinically pronounced nature, and clinically pronounced depression occurred in 7,3% of the surveyed.
 Conclusion. The frequency of affective disorders in men with hypertension did not depend on the presence of metabolic syndrome. The most frequent variant of metabolic syndrome in the group of men with an increased level of anxiety was four–component (58,3%), and in the group with an increased level of depression - three-component (42,8%). Among men with metabolic syndrome with both elevated levels of anxiety and elevated levels of depression, 3- and 4-component combinations of metabolic syndrome more often detected.

Analysis of the structure of drug prescriptions in patients with arterial hypertension and atrial fibrillation in conditions of comorbidity and their compliance with the STOPP/START criteria

Background. Arterial hypertension (AH) is often associated with type 2 diabetes mellitus (DM2), is one of the leading modifiable risk factors for cardiovascular disease, atrial fibrillation (AF), chronic kidney disease (CKD). Progression of renal dysfunction is a powerful predictor of the onset of AF in patients with high blood pressure. Irrational prescription of drugs is a risk factor for adverse drug reactions, which is especially important for elderly patients and leads to an increased risk of adverse clinical outcomes.Objective. To analyze the concordance of pharmacotherapy with the STOPP/START criteria in comorbid elderly patients with AH and combined DM2, CKD and AF treated in a multidisciplinary hospitals.Design and methods. Included data from medical records of 1600 patients aged ≥ 65 years with AH and/or AF admitted to multidisciplinary hospitals in Moscow from July 1, 2018 to June 30, 2019. Patients were divided into two groups — (1) AH in combination with AF (n = 822, women — 73%, median age 87 [79; 90]) and (2) control group (n = 778, women — 79,9%, median age 78 [71; 85]) Evaluation of the appointment of drugs was made according to the “STOPP/START” criteria.Results. The number of patients who were not prescribed the recommended drugs was statistically significant (p < 0,001) and higher in the AH + AF group (785 people, 95,5%) compared to the control group (623 people, 80,1%). The number of patients who were prescribed potentially non-recommended drugs was similarly statistically significant (p < 0,001) higher in the AH + AF group (439, 53,4%) compared to the control group (328, 42,2%). The most common START criteria were: 1. Statins with a documented history of coronary, cerebral or peripheral vascular disease (in the AH + AF group — 672, 81,8% of the number of patients in the group; in the control group — 464, 59,6%; p < 0,001) 2. Clopidogrel in patients with ischemic stroke or a history of peripheral vascular disease (c respectively, 324, 39,4% and 237, 30,5%; p < 0,001) 3. Warfarin/direct oral anticoagulants in AF (in the group AG + FP — 294, 35,8%). The most common STOPP criteria were: 1. Drugs that can increase constipation in chronic constipation, if there is a more suitable alternative (in the AH + AF group — 160, 19,5% of the number of patients in the group; in the control group — 47,6%; p < 0,001). 2. Drugs with anticholinergic activity in chronic constipation (respectively, 111, 13,5% and 74, 9,5%; p = 0,013). 3. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in patients with hyperkalemia (respectively, 26, 3,2 % and 94, 12,1%; p < 0,001). Similar results were obtained in the analysis of subgroups of AH + AF with concomitant DM2, CKD and without them.Conclusions. The results obtained dictate the need to optimize pharmacotherapy in elderly and very old patients with AH and comorbidities in a hospital setting. In practice, START criteria are more common than STOPP, that is, in reality, the necessary drugs are often not prescribed where they are indicated and drugs with an unfavorable safety profile are prescribed relatively rarely in elderly and senile patients.

Treatment of patients with arterial hypertension combined with chronic obstructive pulmonary disease

Purpose: to evaluate the treatment of patients with arterial hypertension in combination with chronic obstructive pulmonary disease. Materials and methods. 60 patients with arterial hypertension (AH) of II–III degree (WHO classification) incombination with chronic obstructive pulmonary disease (COPD) of I–III degree (International program «Global Strategy for Diagnosis, Management and Prevention of COPD» GOLD, 2017), that is, 32 men and 28 women aged 30 to 45 years (mean age 45.3 ± 1.6 years), were examined in the Cardiology and Internal Medicine Departments, Hospital with the Scientific and Clinical Center of Cardiology. The age of the patients is from 20 to 56 years, the average age of the examined is 45.3±1.6 years. The patients were divided into two equal groups, comparable in terms of sex, age, severity of the underlying and concomitant pathology. The doses of bronchodilator therapy did not change during the study. As the main antihypertensive therapy, the patients of the 1st group were prescribed an ARB — losartan at a dose of 50 mg per day, the patients of the 2nd group were prescribed an ACE inhibitor — enalapril 10 mg per day. The patients continued to receive previously prescribed doses of antiplatelet agents, statins, hydrochlorothiazide at a dose of 12.5 mg per day.

AFFECTIVE DISORDERS IN WOMEN WITH ARTERIAL HYPERTENSION IN COMBINATION WITH METABOLIC SYNDROME

Purpose. To study the features of affective disorders in women with arterial hypertension in combination with metabolic syndrome.
 Materials and methods. 361 women with arterial hypertension were examined, of which 270 were patients with metabolic syndrome. Verification of metabolic syndrome carried out according to the clinical recommendations of the All-Russian Scientific Society of Cardiology of 2009. A hospital anxiety and depression scale used to identify and assess the severity of affective disorders.
 Results. A study of the individual severity of affective disorders among examined women with arterial hypertension showed that increased levels of anxiety were generally detected in half 48,3% of the examined women with metabolic syndrome. In a third 28,0% of women surveyed in this group, anxiety disorders subclinically pronounced, and clinically pronounced anxiety occurred in 20,3% of those examined. Increased levels of depression detected in 39.1% of women with metabolic syndrome examined. At the same time, almost a quarter 23,6% of the women examined in this group had depressive disorders of a subclinically pronounced nature, and clinically pronounced depression found in 15.5% of those examined. At the same time, among women with metabolic syndrome, the incidence of depression was statistically significantly higher than the same rate among women without metabolic syndrome. In women with metabolic syndrome, the anxiety rate was also higher, but the differences identified had no statistical significance.
 Conclusion. The highest incidence of affective disorders was among women with metabolic syndrome. The most frequent metabolic syndrome variant in the group of women with elevated anxiety was three-pronged 44%, and in the group with elevated depression, four-pronged 43%. More often in both groups, there was a combination of metabolic syndrome components such as abdominal obesity, arterial hypertension and lipid metabolism disorders.

Efficacy of perindopril/amlodipine and valsartan/amlodipine combinations in patients with a combination of arterial hypertension and chronic obstructive pulmonary disease

Objective: to study the comparative efficacy and safety of the use of perindopril/amlodipine and valsartan/amlodipine combinations in patients with a combination of arterial hypertension and chronic obstructive pulmonary disease. Materials and methods: 85 patients with a verified diagnosis of arterial hypertension and chronic obstructive pulmonary disease were examined, the average age of patients was 60.9±1.1 years; 54% of men and 46% of women who were prescribed two variants of combination therapy (group A amlodipine/perindopril, group B amlodipine/valsartan). At the first visit and 6 weeks after the start of therapy, all patients underwent clinical, laboratory and instrumental examinations in accordance with the current protocols for the treatment of hypertension and chronic obstructive pulmonary disease, a daily blood pressure study, the frequency of depressive disorders was assessed on the Beck scale and the quality of life according to the SF-36 questionnaire. Results: the use of both antihypertensive regimens in comorbid patients was accompanied by comparable antihypertensive efficacy of therapy, contributed to the same statistically significant decrease in daily, day and night blood pressure indicators. The analysis of the indicators of the function of external respiration revealed the absence of negative dynamics of spirographic indicators in both groups. The use of both combinations of antihypertensive drugs contributed to the statistically identical recovery of both physical and mental components of the patient's quality of life. The improvement in the quality of life of comorbid patients was accompanied by a decrease in the manifestations of depressive disorders in the studied patients according to the Beck scale. The average score of the Beck scale in patients of group A before treatment was 11.6±0.97, against the background of therapy — 9.1±0.77, p <0.001. In patients of group B, it decreased from 13.0±1.06 to 9.3±0.78, p <0.001. Conclusion: the use of antihypertensive combined strategies amlodipine / perindopril and amlodipine / valsartan for the treatment of hypertension in patients with chronic obstructive pulmonary disease is characterized by comparable effectiveness of blood pressure control, which is confirmed by the data of daily monitoring of blood pressure. Effective control of blood pressure was accompanied by statistically significant (p<0.001) positive dynamics of most indicators of the quality of life of patients in both study groups and the severity of manifestations of depression. Any of the studied combinations, which demonstrated comparable efficacy and tolerability in the study, can be recommended as the first step of antihypertensive therapy in patients with arterial hypertension in combination with chronic obstructive pulmonary disease.

CONSTITUTIONAL FEATURES IN MEN WITH DIFFERENT TYPES OF LEFT VENTRICULAR REMODELING AND HAVE CORONARY HEART DISEASE

Purpose. The study of constitutional features in men with various types of left ventricular remodeling, having a comorbid association of arterial hypertension with coronary heart disease.
 Materials and methods. We examined 57 men with isolated arterial hypertension and 115 men with arterial hypertension combined with coronary artery disease. The standard method of anthropometric research used, followed by the determination of constitutional types, as well as the determination of types of geometric LV remodeling according to ultrasound examination of the heart.
 Results. The constitutional features of the frequency of unfavorable types of remodeling in men of the examined groups revealed. The largest group among the examined men, both with isolated arterial hypertension and with arterial hypertension in combination with coronary artery disease, consisted of representatives of the muscular and abdominal type of constitution. The presence of left ventricular remodeling detected in 91.2% of the examined men with isolated hypertension and in 89.6% of men with hypertension in combination with coronary artery disease. At the same time, both among men with isolated hypertension and men with hypertension in combination with coronary heart disease, the most common type of geometry was concentric left ventricular hypertrophy. It found that in all constitutional types, patients with concentric left ventricular hypertrophy were more common.
 Conclusion. Left ventricular hypertrophy was more common in all constitutional types in men of both groups. Normal geometry of the left ventricle more often observed in men with isolated arterial hypertension of the thoracic constitutional type, and among men with arterial hypertension in combination with coronary artery disease - of the muscular type.

Clinical effect, changes in the lipid structure of the erythrocyte membrane and microcirculation in patients with arterial hypertension in combination with coronary heart disease under the influence of laser therapy

To evaluate the clinical effect of LT in patients with hypertension in combination with coronary artery disease and trace its relationship with the dynamics of the structure of the lipid bilayer of the erythrocyte membrane and changes in the microvascular bed. We examined 65 male patients (mean age 50.9±6.3 years) with II-III degree AH in combination with coronary artery disease with angina pectoris. Among them, 40 patients received a 10-day course of LT, and 25 patients underwent simulated laser irradiation. At the initial stage and after 1 month, all patients underwent a bicycle exercise test, a study of the lipid composition of the erythrocyte membrane, including the main fractions of phospholipids and free cholesterol, as well as the level of intracellular Ca2+ and lipid peroxidation products - malondialdehyde and diene conjugates. Microcirculation was assessed using the method of conjunctival biomicroscopy. One month after the course of LT, patients showed a significant increase in exercise tolerance by 37.8%, a decrease in systolic blood pressure with a standard load by 9.9%. The improvement of the clinical picture occurred against the background of a decrease in the activity of lipid peroxidation and structural changes in the cell membrane: an increase in polyunsaturated fractions of phospholipids and a decrease in the cholesterol content, as well as a decrease in the Ca2+ level in the cell from 0.23 [0.19; 0.32] to 0.20 [0.16; 0.26] mmol/l. The results of the analysis of conjunctival biomicroscopy demonstrated a statistically significant decrease in the ratio of arteriolovenular calibers, a limitation of the severity of sludge syndrome by 59%, and an almost twofold (from 3.9±0.52 to 7.2±1.23 cap/mm2) increase in capillary density. The data obtained showed that in patients with hypertension in combination with coronary artery disease, LT causes positive changes in the lipid structure of the cell membrane and microcirculation parameters, which is accompanied by a hypotensive effect and an improvement in the clinical and functional state of patients.

Blood pressure variability, endothelial dysfunction, and C-reactive protein levels in arterial hypertension in combination with coronary artery disease

Background. Recently, the role of increased variability in blood pressure (BP) as a new risk factor for cardiovascular events in patients with arterial hypertension (AH) in combination with coronary heart disease (CHD) has been discussed. At the same time, the mechanisms of the participation of blood pressure variability in the development of atherosclerotic damage to the vascular wall are not well understood.
 Aim. To study the nature of the relationship between the indicators of daily BP variability, vasomotor function of the endothelium and highly sensetive C-reactive protein (hs-CRP) in patients with AH combined with CAD.
 Materials and methods. 80 patients with AH and CAD (55.50.7 years) were examined. The study assessed the BP variability according to 24-hour monitoring of BP, vasomotor function of the brachial artery endothelium, and the level hs-CRP in blood serum.
 Results. Increased indicators of diurnal BP variability were recorded in 48.8% of patients. There were revealed signs of endothelial dysfunction in patients in the form of a decrease in endothelium-dependent vasodilation (EDV) to 5.380.48% and an insufficient increase in endothelium-independent vasodilation (EIV) to 15.821.24%. Patients with increased variability of BP differed from patients with normal variability of BP by higher values of hs-CRP (2.980.71 and 1.560.33 mg/l; p0.05), a less pronounced response to administration nitroglycerin when evaluating EIV (13.231.79 and 17.700.77%; p0.05). Correlation relationships of variability of systolic BP (SBP) in the daytime with EVD were recorded (r=-0.44; p=0.012); variability of diastolic BP (DBP) in the daytime with EIV (r=-0.50; p=0.003); nighttime variability of DBP with EIV (r=-0.43; p=0.013). Relationships between the level of hs-CRP and the variability of SBP in the daytime (r=0.30; p=0.008) and with EVD (r=-0.47; p=0.007) were established. In patients with increased variability of SBP, the likelihood of registering an increased level of hs-CRP is 1.6 times higher OR 1.58 (95% CI 1.0142.451; p=0.043). In patients with depletion of the vasodilation reserve during the test with nitroglycerin (EIV), an increase in blood pressure variability is recorded 1.2 times more likely OR 1.22 (95% CI 1.0121.478; p=0.037).
 Conclusion. The revealed association of the daily variability of BP with indicators of vasomotor function of the endothelium and a marker of the inflammatory reaction of the vascular wall may indicate the presence of a pathogenetic relationship between the parameters that determine the development of adverse events in patients with AH and CAD.

Features of gene polymorphism in comorbid patients with arterial hypertension and coronary heart disease

Objective: to assess the prospects of using genetic testing for early detection of patients with arterial hypertension (AH) with a high risk of developing coronary heart disease (IHD).Material and methods: we examined 100 patients with hypertension, who were divided into 2 groups: patients with hypertension without ischemic heart disease (62%, 62 people) and patients with hypertension with ischemic heart disease (38%, 38 people). All patients underwent a standard volume of diagnostic procedures, as well as molecular genetic research. Results: the specificity of the carriage of gene polymorphism was revealed, depending on the presence of isolated AH or AH in combination with IHD in patients. Patients with AH and IHD are characterized by the presence of the CC genotype and the C allele of the ΝΟS3 gene (p = 0,040 and p = 0,035), while the TT genotype of the T‑786C polymorphic marker of the NOS3 gene is characteristic of patients with isolated AH. Conclusion: the study of the genetic aspects of comorbidity is theoretically important for understanding the mechanisms of its formation. From a practical point of view, the opportunity to use modern genetic approaches for early screening of hypertensive patients with a high risk of developing cardiac comorbid pathology is valuable.

Features of nutrition in women with arterial hypertension and abdominal obesity

Background. Currently, there is a significant increase in the percentage of women with arterial hypertension (AH) and abdominal obesity (AO), which is largely due to violations of the healthy eating norms. Therefore, the problem of studying the nutritional characteristics of women with AH in combination with AO requires further research. The study was aimed to investigate the nutritional characteristics of female patients (residents of Ukraine) with arterial hypertension and abdominal obesity. Materials and methods. We examined 75 female patients (residents of Ukraine) with AH stage II, 2–3 degrees, aged from 40 to 59 years (40 women with AO (I–II degrees) and 35 women with normal body weight (NBW). All patients underwent a routine examination. The peculiarities of the nutrition of the patients were analyzed using the questionnaire “Diary of daily nutrition”. The data obtained were analyzed using the SPSS 19 computer program for Windows XP. Results. In the group of women with AH and AO, in the vast majority of individuals (73–100 %), the diet did not meet the recommendations of a healthy diet. In the group of women with AH and NBW, the dietary pattern did not meet the recommendations of a healthy diet only in one-third of the individuals. The daily diet of women with AH and AO differed from that of women with AH and NBW by a significantly higher energy value of food, a higher frequency of meals in the evening, a higher intake of fats (including saturated fatty acids and trans-unsaturated fatty acids), carbohydrates (especially monosaccharides), and less dietary fiber intake. In both groups of women, the habit of adding salt to food was revealed, but only in the third of the individuals. Conclusions. Significant violations of the healthy eating norms were found in women with AH, which were much more pronounced in women with AO that must be taken into account when developing optimal schemes for correcting the diet in these patients.