Arterial Hypertension In Combination Research Articles

THE FEATURES OF PARAMETERS OF AMBULATORY CENTRAL AORTIC PRESSURE MONITORING IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES MELLITUS

Aim: to evaluate the features of the parameters of ambulatory central aortic pressure monitoring (CAP) in patients with arterial hypertension (AH) in combination with diabetes mellitus (DM) type 2. Materials and methods: 120 patients with stage II-III of AH aged from 40 to 65 years old were included into the research. The 1st (the main) group (n = 80) consisted of patients with AH and DM of type 2, the 2nd group (control) consisted of patients (n = 40) with «isolated» AH. The groups were comparable in terms of the main clinical and demographic characteristics. The parameters of CAP were determined using a multifunctional complex BPLab (Petr Telegin, Russia). Results: Pulse aortic pressure (PADao) was significantly higher in patients with AH and type 2 DM than in the group of patients with AH without type 2 DM (54,0 ± 10,1 vs 46,3 ± 6,7 mm Hg) mainly due to an increase in PADao during the day (52,2 ± 9,9 vs 48,1 ± 4,9 mm Hg, p < 0,05). The overall index of augmentation (IA) was statistically significantly higher in the main group of patients than in the control group (32,9 ± 7,3 vs 26,8 ± 13,7 mm Hg) due to an increase in IA overnight in patients with AH and type 2 DM in comparison with those with «isolated» AH (37,2 ± 9,8 vs 22,6 ± 10,7 mm Hg, p < 0,05). Conclusion: The more unfavorable parameters of the ambulatory profile of the CAD were noted in the group of patients with AH and type 2 DM, compared with the group of patients with «isolated» AH. It reflects the increase in rigidity of the main arteries. The obtained data testify the patients with AH and type 2 DM to a higher risk of cardiovascular complications than the patients with «isolated» AH. It is necessary to take into account the effect of drugs on the elasticity of the vascular wall when choosing antihypertensive therapy in persons with AH in combination with type 2 DM.

FEATURES OF THE STRUCTURAL AND THE FUNCTIONAL STATE OF KIDNEYS AND THE FUNCTION OF ENDOTHELIUM IN HYPERTENSIVE PATIENTS WITH METABOLIC DISTURBANCES

THE AIM : to study the features of the structural and the functional state of the kidneys in relation to the functional state of the endothelium in patients with arterial hypertension (AH) in combination with metabolic disorders. PATIENTS AND METHODS . The study included 351 patients with AH in the age from 40 to 70 years old with unachieved target values of arterial blood pressure (BP). Patients were divided into four groups, comparable in age, sex, frequency of smoking, duration of AH, the level of office systolic blood pressure (SBP) and diastolic blood pressure (DBP), depending on the presence of concomitant diseases: obesity, MS, type 2 diabetes. Clinical examination with analysis of the body composition was performed, structural and functional parameters of the kidneys, functional state of the endothelium were determined. RESULTS . The study revealed regular features of changes in the structural and functional parameters of the kidneys in patients with “isolated” AH and in individuals with AH in combination with comorbid pathology in the form of a statistically significant increase of kidney volume, percentage of patients with an uneven contour of the kidneys, impaired structure and changes in echogenicity of the parenchyma, decrease tubular and glomerular functions of the kidneys when AH combines with metabolic disorders. We noted parallelism in structural and functional changes of the when MS components were attached to the AH. CONCLUSION. The revealed reliable correlation relationships between the structural and functional state of the kidneys and endothelial dysfunction confirm the progression of renal and endothelial damage when MS components are associated with AH.

THERAPY OF ARTERIAL HYPERTENSION AND PREVENTION OF CARDIOVASCULAR DISEASES IN WOMAN OF REPRODUCTIVE AGE SUFFERING FROM MIGRAINE. CLINICAL REVIEW

A clinical case of the arterial hypertension in combination with migraine is considered in a woman of a reproductive age. The tactics of the antihypertensive therapy is discussed from the point of view of therapy of arterial hypertension and prevention of cardiovascular diseases and prevention of migraine attacks. Existing recommendations on prevention of cardiovascular and cerebrovascular diseases in women are analyzed and an algorithm of the drug therapy based on the available data about the general nature of pathophysiological mechanism of development of arterial hypertension and migraine is provided.

Medical and social risk factors for cardiovascular disease among elderly and old people

Background: Ageing is a natural biological process, manifested in a gradual decrease in the adaptive capacity of the organism. The causes of social alienation among elderly people have a multifactorial nature. Stroke is a very dangerous disease since it disrupts the work of the most important organ - the brain. The problem of stroke prevention has been particularly relevant in the past decade. Aims and Objectives: The research was conducted to study the state of medical and social risk factors for the development of cardiovascular disease among elderly and old individuals. Materials and Methods: This study was conducted among 2481 individuals over employable age. Of this number, in 84 patients with ischemic stroke individual risk factors were studied. Their health was characterized by a high incidence of cardiovascular diseases (CVD) and severe disability. The main types of pathology among elderly and old people are CVD. Results: The main factor leading to the development of stroke, especially recurrent, is arterial hypertension in combination with ischemic heart disease, heart failure, cardiosclerosis, and paroxysmal atrial fibrillation. Conclusions: Recurrent stroke is characterized by increasing cognitive dysfunction against the background of worsening mental and motor disorders of the heterogeneous nature, which defines a high degree of disability due to stroke.

SOME FEATURES OF ARTERIAL HYPERTENSION, TAKING PLACE ON THE BACKGROUND OF OBESITY IN MEN OF WORKING AGE, EMPLOYEES IN THE SYSTEM OF INTERNAL AFFAIRS

Aim. The aim of the study was to reveal the peculiarities of arterial hypertension, that occurs in male law enforcement officers of working age against the background of obesity, to evaluate the factors associated with obesity that affect hypertension. Materials and methods. The study included men of working age working in the system of internal affairs bodies and hospitalized on a scheduled basis in a cardiological hospital with the main diagnosis — arterial hypertension. All studied patients were divided into two groups, the first group included patients with arterial hypertension in combination with obesity, the second group included hypertension and normal body weight. All patients underwent a general clinical and indepth anthropometric examination. Instrumental examination of patients included echocardiography, 24-hour blood pressure monitoring and pulse oximetry. In addition, all patients had an assessment of the risk of obstructive sleep apnea syndrome and studied psycho-emotional status using standard questionnaires. Results and discussion. A comparative analysis of the two groups showed that significant differences were observed with respect to some anthropometric indicators. In patients with obesity, more pronounced signs of myocardial remodeling were revealed by the results of echocardiography. Also, patients of this group were more likely to develop obstructive sleep apnea syndrome, greater propensity to anxiety, combined with eating disorders, more often in a restrictive type. A comparative analysis of the diurnal blood pressure profile of the two groups showed no significant differences, but obese patients required significantly more intensive antihypertensive therapy to achieve target blood pressure figures. Conclusion. Obesity leads to more pronounced myocardial remodeling in working age men with arterial hypertension. More intensive antihypertensive therapy is required for compensation arterial hypertension in the case of obesity. Patients with obesity tend to develop a syndrome of obstructive sleep apnea and are characterized by a high level of anxiety and eating disorders.

Prolonged release verapamil: application in clinical practice

The review shows the results of the use of prolonged release verapamil (Isoptin® SR) in clinical practice. Numerous randomized clinical studies confirm the high efficiency and safety of Isoptin® SR in patients with arterial hypertension, as well as in patients with arterial hypertension in combination with ischaemic heart disease, chronic obstructive pulmonary diseasesand disorders of carbohydrate and lipid metabolism. The advantage of Isoptin® SR (verapamil) application in case of supraventricular arrhythmias has been proven.

Violations of coagulation hemostasis in patients with arterial hypertension in combination with osteoarthrosis

Objective: To define violations of coagulation hemostasis in patients with arterial hypertension (HT) and osteoarthrosis (OA). Materials and Methods: The study involved 70 people. The main group included 25 patients (age 40-65 years) with hypertension stage II, combined with knee OA stage 2 according to Kellgren-Lawrence. The first comparison group consisted of 15 patients with hypertension stage II, the second comparison group consisted of 15 patients with OA stage 2, the control group - 15 almost healthy people. Results and Discussion: In patients with OA dominated violation of coagulation hemostasis. In patients with hypertension and hypertensive OA was observed violation of platelet hemostasis in combination with coagulation disorders. Indicators of aPTT, activated recalcification time, prothrombin ratio and INR were significantly lower in patients of all studied groups in comparison with the control group. At the same time there were significantly increased rates: SFMC, autoсoagulation test and XII-dependent lysis. Conclusion: hypercoagulation disorders with normal platelet function prevailed in patients with OA. Patients with HT and HT in combination with OA had hypercoagulation with increased platelet function, which may contribute to the risk of thrombus formation.

Analysis of Polymorphism of Angiotensin System Genes (ACE, AGTR1, and AGT) and Gene ITGB3 in Patients with Arterial Hypertension in Combination with Metabolic Syndrome.

Changes in the frequencies of genotypes and mutant alleles of ACE, AGTR1, AGT, and ITGB3 genes were analyzed in patients with arterial hypertension coupled with metabolic syndrome (N=15) and compared with population data and corresponding parameters in patients with isolated hypertension (N=15). Increased frequency of genotype ID of ACE gene (hypertension predictor) was confirmed for both groups. In case of isolated hypertension, M235M genotype (gene AGT) was more frequent, in case of hypertension combined with metabolic syndrome, the frequency of genotypes A1166C and C1166C of the gene AGTR1 was higher in comparison with population data. Comparison of mutant allele frequencies in the two groups showed that at the 90% significance level allele T of the AGT gene was more frequent in hypertension coupled with metabolic syndrome (OR=1.26) and genotype A1166A of the AGTR1 gene was more frequent in the group with isolated hypertension.

Assessment of Efficiency of Medicamentous Therapy in Correction of Structurally Functional Changes of The Cardiac Muscle at Patients With Arterial Hypertension in Combination With Bronchial Asthma

Bronchial asthma (BA) is a serious problem. It was found that the frequency of arterial hypertension (AH) detection in patients with asthma is about 30 %. At patients practically all types of violations of a warm rhythm meet a bronkhoobstruktivny syndrome. Emergence of rather new preparations - If-blockers, opens new opportunities in correction of heart rate (HR) and a cardioprotection at a combination of AH and BA. To assess therapy diltiazem-retard and ivabradine on structurally functional changes of a cardiac muscle and HR at patients with AH in combination with BA. Patients (n=91) with BA with AH 1, 2. All patients were outpatients and taken therapy on BA with inhaled corticosteroids. The patients used a 2-agonists. All patients were performed the echocardioscopy on Acuson 128XP/ 10c (USA). Holter monitor ECG (HM-EKG) was found myocardium ischemia - 18 patients, research was continued by 73 persons. The patients were divided into 2 groups. In the first group made n=37, age 53+/-7,64, received diltiazem-retard. The second group included n=36, age 51,2+/-7,13 years - ivabradine. Duration of observation is 12 weeks. Therapy ivabradine and diltiazem at patients BA according to HM-EKG reliable decrease in frequency of registration of ventricular extrasistoliya in days and heart rate (HR) (<0,05), the quantity of supraventricular extrasistoliya per day doubtfully decreased. Diltiazem wasn't more effective concerning decrease in HR, ventricular and supraventricular extrasistoliya, when comparing with ivabradine (>0,05). The result of 12 week therapy ivabradine at patients with a combination of AH and BA more significant was observed in comparison with diltiazem, regression a hypertrophy of the left ventricle, improvement of diastolic function and almost full regression of warm ektopiya. The tendency was to decrease and stabilization arterial pressure and decrease in HR to purpose level.

Analysis of influence of omega-3-polyunsaturated fatty acids on biochemical values of the blood and adipokines content in patients with arterial hypertension, osteoarthritis and its combination with optimal and increased body weight

Combination of arterial hypertension and osteoarthritis especially on the background of overweight leads to the heavier clinical course of diseases.The aim of research was to study is it any therapeutic advantage in the use of omega-3-polyunsaturated fatty acids (PUFA) in patients with arterial hypertension (AH), osteoarthritis (OA) and its combination in the aspect of hypolipidemic influence and adipokines level.Materials: There were examined 100 patients, 35 – with AH, 35 – with OA and 30 – with AH in combination with OA. The men-women ratio was 2,5:1, the mean age – 49,6±8,9 years. The mean AH duration was 7,4±3,8 years, the clinical presentation of disease corresponded with II stage. The prescription of osteoarthritis was 8,4±4,6 years the clinical presentation corresponded with OA 2-3 stages without the signs of synovitis.The control examinations were carried out in the group of practically healthy persons (n=22) comparable with the patients of other groups on age and sex. The blood for biochemical studies was taken on the first day of being in hospital approximately at the same time 9-10 a.m. fasting. The adipokines level was detected using immune-enzyme analysis.Depending on nosology all patients received the basal therapy that included: at AH – ACE inhibitors (lisinopril, enalapril), at OA – non-steroid anti-inflammatory preparations (meloxicam, ibuprofen, diclofenak sodium), chondroprotectors (mukosat, alflutop). Patients with the signs of dyslipidemia received hypolipidemic medical preparations (rosuvastatin).All patients with signs of hyperglycemia were randomly divided in two groups that included equal number of persons with all variants of nosologies. The group of comparison (50 persons) received depending on nosology basal therapy that included: at AH – ACE inhibitors (lisinopril), at OA – non-steroid anti-inflammatory preparations (meloxicam, ibuprofen, diclofenak sodium), chondroitin sulfate preparations (mukosat, alflutop). Patients with the signs of dyslipidemia received hypolipidemic medical preparations (rosuvastin). Patients of the main group (50 persons) were additionally prescribed with preparation that contains omega-3-PUFA – Epadol Neo as a source of omega-3-PUFA, 1 capsule 2 times for day for two month.All data were assessed using methods of variation analysis.Results. The standard therapy of the group of comparison partially improved dyslipidemic changes. The content of general cholesterol was decreased from 5,8±0,41 to 4,7±0,32 mmol/l (p&lt;0,05). The use of omega-3-PUFA resulted in further improvement (4.4±0,22 mmol/l) in the main group. The same positive dynamics was detected for other indices – the high-density lipoprotein (HDL) content increased after treatment from 1,5±0,11 to 1,6±0,21 mmol/l in the group of comparison and to 1,76±0,13 (p&lt;0,05) in the main group; triglycerides content in the main group and in the group of comparison came back to the normal values: 2,3±0,14 mmol/l before treatment; 1,8±0,08 mmol/l (p&lt;0,05) and 1,6±0,01 mmol/l (p&lt;0,05) in the group of comparison and іn the main one respectively.The treatment with the use of standard preparations has no influence on both adipokines level. Additional use of omega-3-PUFA significantly and reliably decreased the leptin content in the blood of patients with AH and overweight: from 49,2±5,48 ng/ml to 16,5±3,48 ng/ml (p&lt;0,05). The less dynamics was observed in patients with OA and combination of AH and OA: the decrease of leptin level in blood from 40,5±4,3 to 34,1±4,94 ng/ml (p&lt;0,05) and from 55,4±6,62 ng/ml to 38,6±3,62 ng/ml (p&lt;0,05).Adiponectin content was sensitive to treatment. Positive statistically reliable changes were observed in patients of the main group with all studied pathologies (isolated AH, OA and its combination) after 2 month of use of omega-3-PUFA.Conclusions: The use of omega-3-PUFA in the complex treatment is effective for patients with AH and AH with concomitant OA as to hyperlipidemia correction. It favors the renewal of natural balance of adipokines: diminishes the leptin level, increases the adiponectin content

Верапамил замедленного высвобождения: возможности применения в клинической практике

The review shows the results of the use of prolonged release verapamil (Isoptin® SR) in clinical practice. Numerous randomized clinical studies confirm the high efficiency and safety of Isoptin® SR in patients with arterial hypertension, as well as in patients with arterial hypertension in combination with ischaemic heart disease, chronic obstructive pulmonary diseasesand disorders of carbohydrate and lipid metabolism. The advantage of Isoptin® SR (verapamil) application in case of supraventricular arrhythmias has been proven.

Магнитотерапия и квч-пунктура в коррекции цереброваскулярных, эндотелиальных и гемостазиологических показателей у больных артериальной гипертензией с рефлекторными синдромами шейных дорсопатий

Examination of 167 men (the average age 47.3±7.4 years) with a diagnosis of arterial hypertension I-II degree in combination with reflex syndromes of dorsopathies cervical spine was carried out. These patients received basic therapy by ACE inhibitors, b-blockers and were divided randomly into 4 groups. The patients of the 1st group (41 people) received in addition to basic therapy for 18 days, a low-frequency magnetic therapy by means of apparatus of the &amp;#34;ALIMP-1&amp;#34; on the collar area and a puncture of biologically active points by electromagnetic radiation of extremely high frequency (EHF-puncture) by means of the apparatus &amp;#34;Stella-2&amp;#34; in the &amp;#34;scanning&amp;#34; (59-63 GHz); in the 2nd group (42 people) there were the basic medical complex and EHF-puncture, in the 3rd (44 people) – the main medical complex and magnetic therapy; in the 4th (40 people) was conducted only basic treat-ment. After treatment, the volumetric rate of blood flow through the vertebral artery increased in the patients of the 1st group by 1,4 times on the right and by 1,3 times on the left; in the 2nd – by 1,3 times on the right and on the left, in the 3rd – by 1,2 times on both sides, and in the 4th – by 1,1 times; identical changes of this indicator was detected on the internal carotid artery. The resistance index in the vertebral artery decreased to the end of treatment in the 1st group by 17,1% on the right and by 21,1% on the left; in the 2nd – by 16,9% on the right and by 12,4%, while in the 3rd – by 9,0% on the right and by 12,3 on the left, and in the 4th group was 7,2% on the right and 11,3% on the left (p&amp;#62;0.05). Identical values of the index in the internal carotid artery in the 1st group decreased by 20,3% on the right and by 17,4% on the left; in the 2nd group – by 16,4% on the right and by 9,0% on the left, in the 3rd - by 6,9% on the right and by 12,7 on the left, and in the 4th group - by 9,6% on the right and by 11,3% on the left. Unidirectional dynamics occurred in respect of the pulsation index and cerebro-vascular reactivity. The content of nitric oxide in the serum after treatment in the 1st group increased by 1,3 times and has reached to regulatory parameters; in the 2nd and 3rd changes were identical, and in the 4th there was a tendency to improve. The level of endothelin-1 decreased in patients of the 1st group by 1,2 times, in others – the changes were not significant. The level of VWF is decreased in patients of the 1st group by 1,2 times (p&amp;#60;0.05), in other groups there were no significant changes. In the 1st group of patients there were a reduction in thrombin and ADP-aggregation by 1,4 times, in the 2nd and 3rd the parameters has reached to the control parameters, in the 4th there was a tendency to improve. Thus, the inclusion of low-frequency magnetic therapy and EHF-puncture in the medical complexes in pa-tients with arterial hypertension in combination with dorsopathies cervical spine contributes to increase functional reserve of cerebral circulation, to improve of endothelial and hemostatic parameters.

Structural and functional changes of cardiovascular system in primary hypothyroidism co-existent with hypertension

Objective. To analyze relationship between thyroid status and target organ damage system in patients with arterial hypertension in combination with primary hypothyroidism (subclinical and compensated). Design and methods. We enrolled 42 women with primary hypothyroidism and concomitant hypertension aged from 50 to 75 years old. Patients were divided into two comparable groups, the first group included 24 hypertensive patients with subclinical hypothyroidism, the second group included 18 hypertensive patients with compensated hypothyroidism. All patients underwent echocardiography and assessment of endothelial function. Lipids were measured in all patients. Results. Target organ damage, including left ventricular hypertrophy, left ventricular diastolic dysfunction, and endothelial dysfunction were comparable in both groups. The associations between thyrotrophic hormone and the levels of cholesterol and triglycerides were also similarin both groups. Conclusions. Subclinical hypothyroidism is neither associated with worsening of hypertension-related target organ damage, nor affects significantly lipid profile.

Features of clinical-functional parameters of the heart, vessels and microcirculation in patients with arterial hypertension in the combination to chronic obstructive pulmonary diseases

The clinical and functional status of the heart, peripheral vessels and microcirculation. The features of structural-functional state of the heart and peripheral vessels. Showing violations cardiohemodynamic and peripheral blood flow. Identified various pathological hemodynamic types. The worst-case remodeling and blood flow disturbances were detected in patients with arterial hypertension in combination to chronic obstructive diseases of lungs against pulmonary hypertensia.

Parameters of high-density lipoproteins in patients with arterial hypertension in combination with other components of metabolic syndrome

Parameters of HDL (concentrations of cholesterol, apoprotein A1, and phospholipids and phospholipid composition) determining their functional properties were studied in patients with arterial hypertension in combination with other components of metabolic syndrome (abdominal obesity, hyperlipidemia, and impaired glucose tolerance). Patients with isolated arterial hypertension did not differ from the control group by the concentration of apoprotein A1 and HDL cholesterol, but had lower content of HDL phospholipids and changed phospholipid composition: lower ratio of phosphatidylcholine and higher relative contents of lysophosphatidylcholine, sphingomyelin, and phosphatidylethanolamine. Parameters of HDL in patients with arterial hypertension associated with other components of metabolic syndrome did not differ from those in patients with isolated arterial hypertension. The observed changes in HDL in patients with arterial hypertension alone or in combination with other components of metabolic syndrome can impair functional capacity of HDL in reverse cholesterol transport, which increases the risk of atherosclerosis.

Macular circulation in patients with diabetes mellitus with and without arterial hypertension

BACKGROUNDPrevious fluorescein angiographic studies have shown alterations in the macular microcirculation in patients with diabetes mellitus and arterial hypertension. In both diseases capillary blood velocity was reduced and capillary density...

Cerebral vasoparalysis, arterial hypertension and brain edema (author's transl)

The present studies were performed in order to determine whether "filtration edema" will develop as a consequence of cerebral vasoparalysis, vasoparalysis in combination with arterial hypertension or arterial hypertension alone. A series of dogs, anaesthetised with i.v. Chloralose-Urethane were exposed 1) to cerebral vasoparalysis, produced by hypercapnia (PaCO2 about 150 mm Hg) and hypoxaemia (PaO2 40-60 mm Hg); 2) to arterial hypertension and 3) to a combination of cerebral vasoparalysis and arterial hypertension. Following cerebral vasoparalysis and arterial hypertension, a significant decrease of total cerebrovascular resistance and moderate increase of venous resistance was observed. Regional cerebral blood flow (133Xe), intracranial pressure, as well as the pressure in postcapillary venous outflow (sinus sagittalis wedge pressure and confluence sinuum pressure) were increased. Neither normotonic vasoparalysis nor vasoparalysis in combination with slight arterial hypertension (MABP more than 90 min above 180 mm Hg) resulted in cerebral edema. In contrast, cerebral vasoparalysis in combination with severe arterial hypertension (MABP more than 90 min above 220 mm Hg) resulted in a statistically significant increase in the water content in the white matter without evidence of protein extravasation. Multiple small foci of Evans blue extravasates, however, were found in the cortex following arterial hypertension in combination with vasodilation, indicating a damage of the blood brain barrier. In these blue stained cortical areas the water content was significantly in creased. The following conclusions were drawn from the results. Vasoparalysis during normotension does not produce brain edema despite the slightly elevated hydrostatic pressure gradient between intravasal and extracellular space. Only considerable increase of this hydrostatic pressure gradient caused by a combination of vasoparalysis with severe arterial hypertension is able to produce brain edema in the white matter. In addition, acute hypertension may cause minor multifocal damage of the blood brain barrier in the cerebral cortex. It is concluded that so-called brain swelling, which has been described by several authors in states of cerebral vasoparalysis, is not predominantly caused by brain edema but by vascular congestion. The clinical aspects of the result are discussed.