Arterial Hypertension Stage Research Articles

The association of systemic inflammatory biomarkers with metabolic dysfunction-associated steatotic liver disease and arterial hypertension

Objective — to explore the relationship between metabolic dysfunction‑associated steatotic liver disease (MASLD) on the background of arterial hypertension (AH) and blood inflammatory markers including C‑reactive protein (CRP), Interleukin‑6 (IL‑6), IL‑4, haptoglobin and pentraxin‑3 (PTX‑3). Materials and methods. We examined 102 patients with MASLD. They were divided into 3 groups: group A included 52 patients with isolated MASLD, group B — 23 patients with MASLD and AH stage I, and group C — 27 patients with MASLD and AH stage II. The control group (group D) comprised 20 apparently healthy people. Patients with viral hepatitis, liver cirrhosis, alcoholic liver disease, and AH stage III were excluded. Systemic inflammatory biomarkers analyses were performed using electrochemiluminescence, immunoenzymatic, and immunoturbidimetry techniques. Results. The systemic inflammatory biomarkers analyses revealed significantly higher levels of CRP (p=0.001), IL‑6 (p=0.01), haptoglobin (p<0.05) and PTX‑3 (p<0.01) and decreased levels of IL‑4 (p<0.05) in group B and group C in comparison with the group A and control group (p1 <0.01, p2=0.01). Also, there was a significant increase of CRP (p=0.01), IL‑6 (p=0.01), and PTX‑3 levels (p<0.05) in group B compared with group C. However, the relationship between the IL‑4 (p>0.05) and haptoglobin (p>0.05) levels and the progression of the AH stages have not been confirmed in our study. Conclusions. Our findings indicate the direct relationship between the systemic inflammatory biomarkers’ involvement in developing liver tissue inflammation and the further progression of MASLD. The obtained data indicate the relationship of AH and its stages with the development of chronic systemic inflammatory response in patients with MASLD and AH comorbid course.

SOCIO-DEMOGRAPHIC AND CLINICAL PREDICTORS OF FAILURE TO ACHIEVE THE TARGET LEVEL OF BLOOD PRESSURE IN OUTPATIENTS WITH ISOLATED ARTERIAL HYPERTENSION AND IN COMBINATION WITH CARDIOVASCULAR COMORBIDITY

The problem of achieving the target level of blood pressure (TBP) is extremely relevant today, as arterial hypertension (AH) is the leading modifiable risk factor for cardiovascular complications.The aim of the study is to investigate the relationships between achievement/failure of TBP and socio-demographic and clinical characteristics in outpatients with isolated AH and in combination with cardiovascular comorbidity and to determine probable predictors of failure to achieve TBP.Material and methods. The study was carried out on the basis of the municipal non-profit enterprise “Gulsk outpatient clinic for general practice of family medicine” of the Strievsky village council, the village of Striyevo, Zvyagelsky district, Zhytomyr region The study involved 140 patients with AH, divided into three groups: isolated AH (n=60), AH+coronary heart disease (CHD) (n=35), AH+CHD+chronic heart failure (HF) (n=45). Patients were considered to have achieved the TBP if their office BP was <140/90 mm Hg when measured twice with an interval of 1 month.Results. The absence of statistically significant changes according to achievement/failure of TBP between outpatients with isolated AH and AH with cardiovascular comorbidity (χ2=3.37; p=0.185) was revealed, while in the group with isolated AH 65.00%, in the group with AH + CHD – 45.71%, in the group of AH + CHD + HF – 57.78% of people did not reach the TBP. Analyzing the relationships between the achievement/failure of TBP and age, gender, social status and modifiable risk factors (smoking, alcohol abuse and salt abuse), statistically significant differences were found only in relation to salt abuse in outpatients with AH and cardiovascular comorbidity (in the group of AH + CHD 100.00%, and in the group AH + CHD + HF 96.15% of people who abuse salt did not reach the TBP). The results of the logistic regression analysis showed that the female gender is by 4.1 times more likely to be associated with failure to achieve TBP compared to the male gender in the group with isolated AH, by 3.5 times – in the group of AH+CHD, by 3.4 times – in the group of AH+CHD+HF; salt abuse increases the risk of not reaching the TBP in the group with isolated AH by 19.4 times; by 20.8 times – in the group of AH + CHD; by 21.1times – in the group of AH + CHD + HF. Analyzing the relationship between achievement/failure of TBP and clinical characteristics of outpatients with isolated AH, the duration of the disease in persons who did not reach TBP is 2.0 times longer than the catamnesis of persons who reached TBP (p<0.001); the degree and stage of arterial hypertension significantly affects achievement/failure of TBP (χ2=22.27; p<0.001 and χ2=7.66; p=0.022, respectively). The results of the logistic regression analysis show that an increase in BP (in particular, each subsequent degree of AH) is more often associated with failure to achieve TBP both in patients with isolated AH and in patients with AH and cardiovascular comorbidity: by 2.7 times in the group with isolated AH; by 2.8 times in the group of AH + CHD; by 3.0 times – in the group of AH+CHD+HF.Conclusions. Female gender, salt abuse, and the degree of AH are statistically significant factors associated with an increased risk of not reaching the target blood pressure level both in outpatients with isolated AH and in patients with AH combined with cardiovascular comorbidity.

Unraveling the Complex Molecular Interplay and Vascular Adaptive Changes in Hypertension-Induced Kidney Disease.

Angiogenesis, the natural mechanism by which fresh blood vessels develop from preexisting ones, is altered in arterial hypertension (AH), impacting renal function. Studies have shown that hypertension-induced renal damage involves changes in capillary density (CD), indicating alterations in vascularization. We aimed to elucidate the role of the apelin receptor (APLNR), neuronal nitric oxide synthase (nNOS), and vascular endothelial growth factor (VEGF) in hypertension-induced renal damage. We used two groups of spontaneously hypertensive rats aged 6 and 12 months, representing different stages of AH, and compared them to age-matched normotensive controls. The kidney tissue samples were prepared through a well-established protocol. All data analysis was conducted with a dedicated software program. APLNR was localized in tubular epithelial cells and the endothelial cells of the glomeruli, with higher expression in older SHRs. The localization of nNOS and VEGF was similar. The expression of APLNR and nNOS increased with AH progression, while VEGF levels decreased. CD was lower in young SHRs compared to controls and decreased significantly in older SHRs in comparison to age-matched controls. Our statistical analysis revealed significant differences in molecule expression between age groups and varying correlations between the expression of the three molecules and CD.

Gender differences in the elastic properties of the arterial wall in patients with arterial hypertension during the age-related evolution

Age-related changes in the elastic properties of the arterial wall in patients with arterial hypertension increase the risk of CV events. Additional CV risk factors in women lead to gender differences in vascular stiffness. The aim: to determine changes in the elastic properties of the arterial wall in patients with hypertension depending on gender, with considering of the age-related changes. Materials and methods: 258 patients with arterial hypertension stage II were examined: 132 women (55.56±7.69 years) and 126 men (51.75±8.42 years). By age, patients were divided into 5 subgroups (37–45, 45–49, 49–54, 54–58 and 58–69 years). The following were assessed: pulse wave velocity in the aorta (PWVao), central systolic blood pressure in the aorta (SBPao), central pulse blood pressure (cPBP), augmentation index in the aorta (Aix ao) and on the brachial artery (Aix br), PWV index (PWVind), amplification blood pressure (BPamp), pulse blood pressure index (C/B indPBP). Results: In the absence of differences in peripheral hemodynamics in all groups, women aged 49-54 years had a magnification of the PWV by 2 m/s, and, in comparison with men, this difference was 1.65 m/s (p <0.05). Aix br and Aix ao were also superior to men in all groups, and in 49-54 years old, this difference was greatest and amounted to 39 % and 20 %, respectively. At this age, SBPao was also significantly raised in women, with a difference of 15 mmHg relative to men (p=0.038). In all age groups, women had negative values of the BPamp in contrast to men. In women, PWV correlated with the duration of hypertension (r=0.21; p<0.05), SBP (r=0.40), DBP (r=0.35), cPBP (r=0.43), in contrast to men, where PWVao was associated only with the heart rate (r=0.30). Conclusion: In women with hypertension, changes in vascular wall stiffness occur earlier than in men with significant growth at 49–54 years. In women, the elastic properties of arteries are associated with the level of blood pressure and duration of the disease, and in men - with the level of the heart rate

Autophagy and ubiquitin-dependent proteolysis processes in left ventricular mass loss in pulmonary arterial hypertension

The goal of this study was to evaluate the intensity of autophagy and ubiquitin-dependent proteolysis processes occurring in myocardium of left ventricle (LV) in subsequent stages of pulmonary arterial hypertension (PAH) to determine mechanisms responsible for LV mass loss in a monocrotaline-induced PAH rat model. LV myocardium samples collected from 32 Wistar rats were analyzed in an early PAH group (n = 8), controls time-paired (n = 8), an end-stage PAH group (n = 8), and their controls (n = 8). Samples were subjected to histological analyses with immunofluorescence staining, autophagy assessment by western blotting, and evaluation of ubiquitin-dependent proteolysis in the LV by immunoprecipitation of ubiquitinated proteins. Echocardiographic, hemodynamic, and heart morphometric parameters were assessed regularly throughout the experiment. Considerable morphological and hemodynamic remodeling of the LV was observed over the course of PAH. The end-stage PAH was associated with significantly impaired LV systolic function and a decrease in LV mass. The LC3B-II expression in the LV was significantly higher in the end-stage PAH group compared to the early PAH group (p = 0.040). The measured LC3B-II/LC3B-I ratios in the end-stage PAH group were significantly elevated compared to the controls (p = 0.039). Immunofluorescence staining showed a significant increase in the abundance of LC3 puncta in the end-stage PAH group compared to the matched controls. There were no statistically significant differences in the levels of expression of all ubiquitinated proteins when comparing both PAH groups and matched controls. Autophagy may be considered as the mechanism behind the LV mass loss at the end stage of PAH.

Hemostasis parameters in patients with arterial hypertension, multifocal atherosclerosis and risk factors

Aim. To determine the features of hemostasis system disorders and the possibility of their correction in patients with arterial hypertension (AH) and multifocal atherosclerotic lesions (MFA) with risk factors indicated.Materials and methods. The study included 135 patients (mean age 53.7 ± 7.76 years), including 80 patients with controlled AH stage and II (group 1) and 55 patients with controlled AH stage III who had ischemic stroke (group 2). Among all patients studied, 33 patients (24.4 %) were smokers. All 135 patients received comparable antihypertensive, antiplatelettherapy (acetylsalicylic acid at a dose of 100 mg/day), had MFA and target lipid spectrum values.Results. Procoagulant shifts are noted already in patients with AH stage I and II, especially in the presence of smoking. Such indices of global thrombodynamics test as initial clot growth rate, average clot growth rate, clot size significantly exceed the reference values and indicate high prothrombogenic potential in patient with AH and MFA. Prescription of dual antiplatelet therapy allows normalization of identified disorders. Presence of risk factors (smoking) aggravates existing hemostasis disorders in patients with AH and MFA.Conclusion. Smoking cessation, optimization of risk factors and complex antihypertensive, hypolipidemic and antithrombotic therapy are the basis of treatment of patients with AH and MFA and can be considered as priority measures to reduce morbidity and mortality in this patient population.

VITAMIN D AND INDICATORS OF AMBULATORY BLOOD PRESSURE MONITORING IN WOMEN WITH ARTERIAL HYPERTENSION IN THE EARLY POSTMENOPAUSAL PERIOD

Objective: To assess plasma 25(OH)D levels and indicators of ambulatory blood pressure monitoring (ABPM) in women with arterial hypertension (AH) stage II risk 3 in the early postmenopausal period. Design and method: We investigated 52 women with AH stage II risk 3 aged 52 (50; 54) years of age who are in the early postmenopausal period - group I. Serum level of 25(OH)D was determined by the immunoenzymatic assay. The level of 25(OH)D in the blood plasma was determined by enzyme immunoassay. In group I we identified subgroup IB (n=21) with vitamin D deficiency/insufficiency - level of 25(OH)D<30ng/ml and subgroup IA (n=31) without vitamin D deficiency. ABPM was carried out with a Watch BP 03. Statistical analysis was performed by means of «STATISTICA 10.0». Results: The level of 25(OH)D was lower (p<0,05) in subgroup IB (18,2±9,5 ng/ml) than in the comparable to subgroup IA (27,4±10,5 ng/ml). In subgroup IB, compared with subgroup IA, the values of mean night diastolic (DBP) were higher (p<0,05) (73,0 (69,0;79,0) mm Hg versus 68,8±7,4 mm Hg), time index (TI) DBP at night (14,3 (12,5; 33,4)%, versus 12.5 (0,0;12,5)%,), speed of morning rise DBP (16,5(11,0;22,0) mm Hg/hour versus 10,0(8,5;17,3) mm Hg/hour), systolic variability (SBP) during the day (36,0(29,0;43,0) mm Hg versus 25,0(22,0; 38,0) mmHg). TI DBP at night exceeded the threshold value in 42,9% of women in subgroup IB versus 17,2% (p< 0,05) of subjects in subgroup IA. Morning rise speed DBP in subgroup IB did not correspond to the norm in 81% of cases compared to subgroup IA – 37,9% (p = 0,004). Inverse moderate correlations were established in subgroup IB between the level of 25(OH)D in the blood plasma and a number of ABPM indicators: average night SBP (R =-0,37, p=0,004), TI SBP night (R=-0,42, p=0,04), average night DBP (R=-0,43, p=0,03), TI DBP night (R=-0,39, p=0,05). Conclusions: In women with AH stage II risk 3 in the early postmenopausal period, with a deficiency/insufficiency of the level of 25(OH)D in the blood plasma, excess of a number of ABPM indicators was more common than with its optimal level.

Factor Analysis for Predicting the Structural Reorganization of the Microvasculature of the Kidneys in Patients with Glomerulonephritis and Arterial Hypertension

Objectives. Evaluation of the relationship of clinical, laboratory and morphological factors with remodeling of small-diameter renal arteries in patients with glomerulonephritis (GN) and arterial hypertension (AH). Materials and methods. The study included 105 patients (average age 37.1±1.2 years) with primary GN and hypertension who had indications for morphological investigation of kidney tissue. All patients underwent a standard examination for kidney disease, a morphological study of kidney tissue with a description of the changes that occur in the presence of glomerulonephritis, corresponding to the individual severity of the pathological process. The presence of signs of a tubulointerstitial component of damage (or tubulointerstitial component — TIC) in the form of tubulointerstitial infl ammation (TIV), fi brosis (TIF) was assessed. Vasometry of the interlobular artery (IA) was performed. The value of the intima-media complex (IMC) was considered to be a sign of IA remodeling. A sign of MA remodeling was considered to be an intima-media complex (IMC) value of more than 30.43 μm. Results. Among clinical and laboratory risk factors, an increase in systolic blood pressure has a statistically signifi cant effect on the likelihood of increasing IMC (χ2-criterion = 5.76, p = 0.016), arterial hypertension stage (χ2-criterion = 9.45, p = 0.002), blood urea level (χ2-criterion = 8.11, p = 0.004), decrease in glomerular fi ltration rate (χ2-criterion = 5.0, p = 0.025), increase in the stage of chronic kidney disease (χ2-criterion = 10.32, p = 0.001). The presence of signs of GN progression, such as an increase in erythrocyte sedimentation rate (ESR) or proteinuria, did not have a statistically significant effect on the risk of IA remodeling (p>0.05). The increase in IA IMC is affected by the presence of hyalinosis of glomerular capillary loops (χ2-criterion = 7.56, p = 0.006), periglomerular hyalinosis (χ2-criterion = 6.96, p = 0.008), sclerosis of the glomerulus (χ2-criterion = 3.9, p = 0.048), increased fibrosis of tubulointerstitium (χ2-criterion = 12.16, p = 0.0005). Conclusion. In GN and AH, remodeling of small-diameter renal vessels occurs due to the influence of AH and its severity, tubulointerstitial changes in the renal tissue. New risk factors for vascular remodeling have been obtained — changes in the glomerulus. At the same time, the inflammatory and autoimmune mechanisms of GN were not associated with changes in the vascular wall. The role of hypertension is decisive in changing the structure of small-diameter kidneys.

The potential effect of natural antioxidants on endothelial dysfunction associated with arterial hypertension.

Arterial hypertension represents a leading cause of cardiovascular morbidity and mortality worldwide, and the identification of effective solutions for treating the early stages of elevated blood pressure (BP) is still a relevant issue for cardiovascular risk prevention. The pathophysiological basis for the occurrence of elevated BP and the onset of arterial hypertension have been widely studied in recent years. In addition, consistent progress in the development of novel, powerful, antihypertensive drugs and their appropriate applications in controlling BP have increased our potential for successfully managing disease states characterized by abnormal blood pressure. However, the mechanisms responsible for the disruption of endogenous mechanisms contributing to the maintenance of BP within a normal range are yet to be fully clarified. Recently, evidence has shown that several natural antioxidants containing active ingredients originating from natural plant extracts, used alone or in combination, may represent a valid solution for counteracting the development of arterial hypertension. In particular, there is evidence to show that natural antioxidants may enhance the viability of endothelial cells undergoing oxidative damage, an effect that could play a crucial role in the pathophysiological events accompanying the early stages of arterial hypertension. The present review aims to reassess the role of oxidative stress on endothelial dysfunction in the onset and progression of arterial hypertension and that of natural antioxidants in covering several unmet needs in the treatment of such diseases.

ПРОГНОСТИЧЕСКАЯ МОДЕЛЬ ВЕРОЯТНОСТИ УВЕЛИЧЕНИЯ СТАДИИ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ ПОСЛЕ ВИРУСНОЙ ПНЕВМОНИИ, ВЫЗВАННОЙ SARS-COV-2

Abstract. Introduction. An alarming aspect and area of study are represented by the COVID-19 consequences. Arterial hypertension is one of the most frequently reported comorbid pathologies in patients with severe-course COVID-19 requiring the patient’s hospitalization. Given the similarity of some pathogenetic mechanisms underlying arterial hypertension and COVID-19, there is no doubt about their interinfluence. One of the common pathogenetic links of arterial hypertension and COVID-19 is endothelial dysfunction. Objective: To develop a prognostic model of the probability of an increase in the stage of arterial hypertension in 6 months after viral pneumonia caused by SARS-COV-2. Material and Methods: The study included 45 patients with a confirmed diagnosis of COVID-19 (virus identified) with arterial hypertension. This group of patients was dynamically monitored for 6 months after discharge from the hospital. The duration of inpatient treatment was 14 [10-16] bed days. The level of biomarkers of endothelial dysfunction - endothelin-1 and the N-terminal precursor of natriuretic peptide C-type was determined in blood serum by enzyme immunoassay. The dynamics of the levels of these biomarkers during the hospital stay is regarded as positive with a decrease in the level of more than 10% and as insufficient – with an increase, unchanged values or a decrease to 10% inclusive. Results and discussion. The final prognostic model included: the level of the N-terminal precursor of natriuretic peptide C-type upon admission to the hospital and the dynamics of its level in the hospital. The model was statistically significant (p=0,028). Based on the values of regression coefficients, the level of the N-terminal precursor of natriuretic peptide C-type has a direct relationship with the probability of an increase in the stage of arterial hypertension after 6 months in patients with arterial hypertension after viral pneumonia caused by SARS-COV-2. An increase in the level of the N-terminal precursor of natriuretic peptide C-type by 1 pg/ml upon admission increases the risk of an increase in the stage of arterial hypertension by 1,3 times. The absence of positive dynamics of the level of the N-terminal precursor of natriuretic peptide C-type during inpatient treatment increases the likelihood of an increase in the stage of arterial hypertension by 19,6 times. The diagnostic sensitivity of the developed prognostic model was 86,7%, diagnostic specificity – 80,0%, diagnostic efficiency – 84,4%. Conclusions: The prognostic model developed by us, including as a predictor the level of the N-terminal precursor of natriuretic peptide C-type at admission and its dynamics in the hospital, can be used to individually predict an increase in the stage of arterial hypertension within 6 months after viral pneumonia caused by SARS-COV-2.

Features of the clinical course of arterial hypertension in patients with vitamin D deficiency.

Aim: To determine the peculiarities of the daily prof i le of blood pressure in patients with arterial hypertension (AH) and vitamin D def i ciency and insuf f i ciency, to evaluate the parameters of the lipid prof i le and quality of life in these patients. Materials and Methods: A total number of 97 patients with uncomplicated AH stage 1 and 2 were divided into 3 groups depending on the level of vitamin D in the blood serum. All patients underwent office blood pressure (BP) measurement and daily ambulatory BP monitoring for 24 hours, biochemical blood test with the determination of indicators of lipid metabolism, questionnaires for quality of life indicators. Statistical processing of the study results was carried out using "IBM SPSS Statistics 22". Results: "Non-dippers" are most often identif i ed in groups 1 and 2. Their prevalence is 1.8 times higher than in group 3 (p <0.05). The frequency of "night-peack-ers" in group 1 is 1.7 times higher than in group 2 and 2.6 times higher than in group 3 (p < 0.05). Patients with AH and vitamin D def i ciency have severe lipid metabolism disorders (p < 0.05). The correlation analysis shows a direct relationship of average strength between them and average daily systolic and diastolic BP indicators (р<0.05). Conclusions: Patients with AH and vitamin D def i ciency has an increase in cardiovascular risk, which is manifested by increase in pressure load indicators, frequency of detection of "night-peakers" and lipid metabolism disorders which is worsens of vascular accidents prognosis.

Controlled hypoxia-hyperoxytherapy as a component of a targeted approach in the rehabilitation of patients with multimorbidity: a single-center, randomized, placebo-controlled, prospective study

BACKGROUND: Multimorbidity is one of the most important public health problems, leading not only to a deterioration in the functional abilities of an individual, but also to an increase in the disability of the population, which determines the need to use effective measures in the treatment and rehabilitation of patients with multimorbid pathology.&#x0D; AIM: The aim of this study was to evaluate the effect of a two-week medical rehabilitation program including the respiratory therapy method based on short-term intermittent exposure to hypoxia and hyperoxia on the dynamics of hypoxia-inducible factor-1 (HIF-1) and C-reactive protein in patients with multiple chronic diseases. The novelty of this study is due to the peculiarities of the study group — patients with multimorbid pathology.&#x0D; MATERIALS AND METHODS: A single-center, randomized, placebo-controlled, prospective study (NCT05053672, ClinicalTrials.gov) included 42 patients aged 43 to 68 years with multimorbid pathology: generalized osteoarthritis — 61.9%, knee OA — 21.4%, hip OA — 16.7%, controlled arterial hypertension stage I–II — 90.5%, post-Covid syndrome — 100%. Patients were randomized into 2 groups by the method of numbered identical containers. According to clinical and demographic characteristics of patients, concomitant pathology, C-reactive protein and HIF-1 levels, the studied groups were comparable. The main group (27 patients) received a course (8–10 sessions) of individually dosed hypoxy-hyperoxytherapy on the basis of biofeedback (reoxytherapy) against the background of the standard complex of medical rehabilitation. The comparison group (15 patients) received sham reoxy therapy (placebo treatment) along with standard rehabilitation.&#x0D; RESULTS: The data obtained as a result of the study in multimorbid patients using reoxy-therapy clearly demonstrated reduction of clinical symptoms, improvement of general well-being according to visual analogue scale and decrease of C-reactive protein as a classical marker of inflammation against the background of stabilization of HIF-1 dynamics.&#x0D; CONCLUSION: The use of biofeedback-based short-term intermittent exposure to hypoxia and hyperoxia (reoxy therapy) in patients with different initial characteristics in terms of clinical health status and multimorbid pathology is reasonable taking into account modern personalized approaches to medical rehabilitation.

Dynamics of lipid metabolism in hypertensive patients who have had COVID-19 when the L-arginine + dihydroquercetin complex is included in the combined antihypertensive pharmacotherapy

Purpose: To evaluate data on the dynamics of lipid metabolism in patients with arterial hypertension stage II who have had COVID-19, when the L-arginine complex + dihydroquercetin. Materials and methods: The article provides data on the dynamics of lipid metabolism in patients with arterial hypertension stage II who have had COVID-19, when the L-arginine complex (500 mg tablets 1 time per day) + dihydroquercetin (25 mg tablets 2 times) is included in combination antihypertensive therapy per day. Results: In patients who received combination antihypertensive therapy, which included statins (group 1), the target triglyceride value (&lt;1.7 mmol/l) was not achieved. The target value for calculated low-density lipoprotein cholesterol (&lt;3.7 mmol/L) was also not achieved. More significant changes in lipid metabolism were detected in patients (group 2) who took the L-arginine + dihydroquercetin complex as part of combined antihypertensive therapy, which included statins. Thus, in patients of group 2, total cholesterol and triglycerides decreased significantly (by 20-30%). There was also a significant decrease in this group of patients (by 30%) in the calculated indicator of low-density lipoprotein cholesterol and its target value was achieved (&lt;3.7 mmol/l), namely 3.13±0.19 mmol/l. Summary: the inclusion of the L-arginine complex (tablets 500 mg 1 time per day) + dihydroquercetin (tablets 25 mg 2 times per day) in the combined AHT + statins in patients with stage II hypertension who have had COVID-19 is more effective than the combination AHT + statins affect OB, which is manifested by an improvement in its key indicators (TC, TG, LDL-C and HDL-C), as well as the calculated indicator of non-HDL-C.

SST 2 AS A MARKER OF THE TREATMENT OF PATIENTS AFTER MYOCARDIAL INFARCTION WITH ACCOMPANYING ARTERIAL HYPERTENSION ON THE BACKGROUND OF TREATMENT WITH MELDONIUM AND FOLIC ACID

Coronary artery disease (CAD) is one of the leading reason of mortality in Ukraine and all over the world. Arterial hypertension (AH) is the most common manageable factor in cardiovascular morbidity. Every third Ukrainian suffers from this disease. The presence of AH in a patient often becomes the reason for the further development of stable coronary artery disease (SCAD) due to the close pathogenetic connection of both pathologies. sST2 is a modern marker of cardiac fibrosis, which can help to evaluate the effectiveness of the underlying treatment for the patients with SCAD and concomitant AH.&#x0D; The aim. To study the possibility of using sST2 as a marker of the effectiveness of treatment of patients after a myocardial infarction with accompanying arterial hypertension on the background of treatment with meldonium and folic acid.&#x0D; Materials and methods. During our study we observed 40 patients with SCAD FC II-III and concomitant AH stage III, who had an acute myocardial infarction and underwent percutaneous coronary intervention with balloon angioplasty and stenting. All examined were divided into 2 groups of 20 patients each. The first group received standard treatment. The second group in addition to standard treatment, received a combination of folic acid and meldonium. In the course of the work, a detailed analysis of the results of general clinical, laboratory and instrumental examination methods was carried out. Laboratory study of sST2 levels in blood plasma was carried out by quantitative enzyme immunoassay.&#x0D; Results. We observed improvement of all Echocardiography parameters in patients of both groups. Somewhat more significant changes were recorded in the analysis of end systolic diameter of left ventricle. So, if in the first group the decrease in this indicator occurred gradually and amounted to an average of 7-8% after 6 months of treatment, then in the group of combined application of meldonium and folic acid against the background of traditional therapy, a significant reduction in ESD by 10.5% was recorded. The indicator decreased from 4.2 cm to 3.8 cm (p&lt;0.05). Also there was a different trend regarding the dynamics of thickness of the posterior wall during systole. In the first group the reduction of this indicator at the end of the study was 5.7% (p&gt;0.05). In the second group this indicator decreased from 1.13 cm to 1.11 cm after 1 month of treatment and to 0.89 cm after 6 months. That is, the decrease in the first stage was only 1.8% (p&gt;0.05), and then 26.9% (p&lt;0.05). In the course of the study, an increase in LVEF was found among patients with SCAD with concomitant AH. The increase in this indicator after 6 months was 3-4% among all the examined, regardless of the applied drug therapy.&#x0D; We observed the decrease in the concentration of sST2 in both groups of patients. However, it was reliable only among patients to whom, in addition to standard treatment, we added a combination of meldonium and folic acid. In the group of patients on SCAD with concomitant hypertension, a weak direct correlation between the level of ST2 and LVMI was established. The correlation coefficient in this case was r=0.1033 (p&gt;0.05).&#x0D; Conclusions. In the course of our study, the feasibility of using sST2 as a marker of the effectiveness of treatment of patients after a myocardial infarction with accompanying AH against the background of treatment with meldonium and folic acid was established. Application of myocardial cytoprotectors reliably reduced the concentration of a sST2, which makes their use in the complex treatment of patients after MI with concomitant AH reasonable.

The relationship of asymmetric dimethylarginine levels with uncontrolled arterial hypertension and hypertension disease stage

Background: Patients with treatment-resistant hypertension have a worse cardiovascular prognosis compared to those who achieve their target levels of blood pressure (BP). One of biochemical and clinical markers of a decreased response to antihypertensive therapy can be asymmetric dimethylarginine (ADMA), a molecule that reduces formation of nitric oxide and promotes endothelial dysfunction and vasoconstriction.&#x0D; Aim: To assess the status of the nitrogen oxide synthesis system and clinical and laboratory profile in patients, depending on the hypertensive disease stage, who achieved or not achieved their target BP levels during hospitalization.&#x0D; Materials and methods: We performed аn observational retrospective uncontrolled study in a consecutive sample of 192 patients aged 45–65 years who were admitted to the City Clinical Hospital No. 25 (city of Novosibirsk) with a diagnosis of uncomplicated hypertensive crisis. On the day of discharge, the patients were retrospectively divided into 2 groups. Group 1 included patients who achieved their target BP during hospitalization (target BP group, n = 116). Group 2 included patients with uncontrolled hypertension, in whom the administration of three antihypertensive drugs including a diuretic in optimal or maximal tolerated doses did not result in the achievement of the target BP below 140 and/or 90 mm Hg during hospitalization (non-target BP group, n = 76).&#x0D; The following parameters were measured: ADMA, symmetrical dimethylarginine (SDMA), N-monomethyl-L-arginine (NMMA), and total nitric oxide.&#x0D; Results: Serum ADMA concentrations (Me [Q25%; Q75%] were increasing with the stage of hypertension: stage I, 0.75 µmol/L [0.66; 0.78], stage II, 1.14 µmol/L [0.87; 1.39], stage III, 1.38 µmol/L [1.22; 1.49] (p 0.0001, Kruskal-Wallis test). In the pairwise comparison, the difference between all these subgroups was significant at p 0.01. In the patients with uncontrolled arterial hypertension ADMA levels were increased compared to those in the target BP group: 1.2 µmol/L [0.99; 1.47] vs 1.07 [0.79; 1.34] µmol/L (p = 0.002). The proportion of patients with type 2 diabetes mellitus among those with uncontrolled arterial hypertension was 31.2% (24/76), while in the target BP group there were only 3.5% of such patients (4/116) (odds ratio 12.57, 95% confidence interval 4.15–38.05; p = 0.00001).&#x0D; Conclusion: ADMA measurement may help identify patients with a potential poor response to antihypertensive therapy. This should be taken into account when choosing a treatment regimen and BP monitoring. In addition, ADMA seems to be a promising target for the development of new drug classes.

Risk factors for ischemic stroke in men and women aged 45–74 years

Stroke is one of the leading causes of death and primary disability and contributes significantly to the global burden of disease. Identification of individuals at high risk of ischemic stroke (IS) is an important component of disease prevention. The differences between risk factors (RF) for stroke in men and women are not well understood.Objective: to determine the predictive value of RF for the development of IS in men and women aged 45–74 years.Material and methods. The study included 728 patients (380 men and 348 women) aged 45–74 years, including 392 patients (247 men and 145 women) with IS in the carotid artery basin (main group) and 336 patients (133 men and 203 women) with vascular cognitive impairment (comparison group). To build predictive models to assess the impact of RF on the development of IS in men and women, we used the logistic regression method with stepwise exclusion of variables according to the Wald algorithm.Results. The predictive regression model of IS in men includes atherosclerotic stenosis of the internal carotid arteries [odds ratio (OR) 3.571; 95% confidence interval (CI) 1.792–7.114], in a predictive regression model in women – diabetes mellitus type 2 (OR 5.074; 95% CI 1.768–14.561) and a history of IS (OR 6.857; 95% CI 1.825–25.762). Other risk factors for the development of IS (atrial fibrillation, history of transient ischemic attack, arterial hypertension stage) affected both men and women.Conclusion. Atherosclerotic stenosis of the internal carotid arteries was found to be a sex-specific prognostic factor for IS in men, and type 2 diabetes mellitus and a history of IS in women.

“The impact of statins addind to the fixed combination antihypertensive therapy on the arterial stiffness in patients with moderate and severe hypertension"

AimThe objective of this study was the evaluation of the arterial stiffness, which changed after adding statins to the guidelines recommended dual or triple fixed combination antihypertensive therapy in patients with moderate to severe arterial hypertension. Materials and methodsIt was included 99 patients in total being diagnosed with moderate and severe arterial hypertension (2nd and 3rd stages of arterial hypertension) without diabetes. Those patients were divided into 2 groups. The first group (n = 59) was assigned to the dual or triple fixed combination antihypertensive therapy plus including statins.Patients in the second group (n = 40) received only the dual or triple fixed combination antihypertensive treatment following the recommended guidelines without any statins. The CAVI index was performed in order to measure in all participants before and at the end of the follow-up period. Furthermore, the Office (Clinic BP) Blood Pressure (BP) was monitored in assigned participants as well as the Ambulatory Blood Pressure Monitoring (ABPM). The laboratory investigations also took place such as the standard blood test, the urine and biochemistry analysis and the estimated Carotid Intima-Media Thicknesses with Ultrasound. The study-duration was 6 months. ResultsOffice BP and ABPM had decreased significantly and equally in both treatment groups. The total cholesterol (TC) and LDL cholesterol had decreased significantly in the statin group on 1,76 mmol/l (30%, p < 0,05) and 1,51 mmol/l (41%, p < 0,05) respectively. In the group without statin therapy, there was no changes in the level of TC and LDL cholesterol. In the group without statins, it was noted a significant decrease in the level of BP, however, the CAVI index level was shown the growth to +0,9 units on the right side and +1,0 units on the left.In the group without statin's treatment, the CAVI index was changed from 7.73 ± 0.17/7.62 ± 0.19 units to 8.63 ± 0.22/8.62 ± 0.12 units on the right/left site after treatment (p < 0,05). It means there was an increase in the stiffness of the arterial wall in terms of cardio-vascular index CAVI in the group without added statin after 6 months of the therapy. In the group with added statin after 6 months of the therapy, the CAVI had not have any changes. It can be seen from the observed figures: the CAVI on the right/left site was 8.32 ± 0.16/8.33 ± 0.19 initially and 8.44 ± 0.16/8.24 ± 0.15 units treatment (p > 0,05) afterwards.We did not note any impact of statin therapy on the BP level. However, a significant correlations was found between the CAVI index with age and the serum level of blood Triglycerides before treatment, including LDL Cholesterol and HDL Cholesterol, duration of hypertension, the blood glucose level, the Potassium level and the Maximum Thickness of Intima-Media of Carotid Arteries in the statins group. ConclusionThe adding of the statin to the current fixed dual or triple combination of the antihypertensive therapy could prevent the progression of arterial stiffness in patients with 2nd and 3rd stages of arterial hypertension.

UNDERSTANDING THE REALITY OF HIGH BLOOD PRESSURE SCREENING AND MONITORING IN THE RURAL POPULATION FROM THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE: “THE SILENT KILLER HUNT”

Objective: Arterial hypertension (AH) is the most important independent risk factor for cardiovascular diseases. Unfortunately, less than half of adults with hypertension are diagnosed and treated. It is well known that home blood pressure (BP) monitoring is a useful method for follow-up and for detecting patients with asymptomatic hypertension. Home BP monitoring is inexpensive and well-accepted by patients, which are both great benefits for the screening method. The prevalence of AH in Croatia differs by region, in addition, residents of rural areas have poorer access to healthcare. The aim of this study was to find the prevalence of AH in subjects who did not report a medical history of AH and to find the prevalence of subjects who own home BP monitors in rural areas. Design and method: A total of 214 participants (opportunistic screening) were asked about previous AH diagnoses and whether they own a home BP monitor in our cross-sectional survey. BP was measured following ESH guidelines using Microlofe oscillometric device. AH stage 1 was considered if systolic BP was 130 mmHg or higher, or diastolic 80 mmHg or higher. Results: Out of a total of 214 respondents, 120 respondents (56%) reported that they had AH. In a group who answered that either they didn’t have or didn’t know if they had AH, high BP was measured in 61.96%. Interestingly, only 46 (21.5%) reported that they do not have a home BP monitor, and 168 participants (78.5 %) confirmed having a BP monitor at home. Conclusions: Our results revealed poor awareness of AH and showed the utility of the AH screening intervention, particularly in rural areas. More research is needed to determine the best screening methods and further applications for the general population. Our findings may also help healthcare workers to understand the potential of home BP monitoring for their patients because a large number of survey respondents even in rural areas own a BP monitor. This discovery can enhance the quality of patient education, patient-physician relationship, and follow-up practice for successful BP monitoring.

BLOOD LEPTIN LEVELS IN HYPERTENSION PATIENTS WITH ABDOMINAL OBESITY

The purpose of this study is to investigate the changes in blood leptin level of patients with arterial hypertension, who has or has no concomitant abdominal obesity. The study included 87 patients (45 men and 42 women), aged from 32 to 71 years; among them 47 patients had abdominal obesity, and 40 patients had normal body weight. Arterial hypertension stage 2 was diagnosed in 46 (53%) people, stage 3 – in 41 (47%) people, abdominal obesity class 1 was found in 56 (64%) people, class 2 – in 31 (36%) people. Among the patients included in the study, burden of hereditary risk factors was found in 67 patients (77%). The control group included 25 healthy individuals who had normal body weight (body mass index &lt;25 kg/m²), waist circumference &lt;88 cm (in women) and &lt;102 (in men), normal levels of glucose, triglycerides and fasting high-density lipoprotein cholesterol. The study has found out the patients with arterial hypertension and concomitant obesity have significantly higher levels of systolic and diastolic blood pressure, heart rate, significant disorders of lipid, purine, and carbohydrate metabolism, disorders of leptin synthesis; leptin resistance, insulin resistance occurred in significantly higher number of cases than compared with the group of patients with arterial hypertension and normal body weight. The studied groups of patients differed in terms of carbohydrate metabolism: the average fasting blood glucose level was significantly higher in people with arterial hypertension with obesity than in patients with hypertension without obesity. A statistically significant difference remained when comparing with the control group, where the average blood glucose was by 0.9 mmol/l (16.1%) lower than in hypertensive patients with abdominal obesity. A statistically significant increase in the level of blood leptin was found in the group of women suffering from arterial hypertension with abdominal obesity, in comparison with women suffering from arterial hypertension without obesity and the control group of individuals. There has been revealed a reliable positive correlation between the level of blood leptin and the level of blood uric acid.

Vascular age detected by volumetric sphygmography in patients with arterial hypertension

Aim. Assessment of vascular age by volumetric sphygmography and its relationship with the main clinical and laboratory parameters in patients with arterial hypertension. Materials and methods. 46 patients with arterial hypertension were examined, including 26 women (56.5%) and 20 men (43.5%). The mean age was 67.0 [60.0; 73.5] years. Clinical and laboratory parameters were analyzed, including body mass index, lipidogram, fibrinogen, blood creatinine levels, and glomerular filtration rate. Vascular age was assessed using the BPLab-Vasotens apparatus (LLC Petr Telegin, Russia). Results. Vascular age in patients with arterial hypertension was 69.0 [64.0;76.0] years and did not differ statistically from the passport age (p&gt;0.05). Positive relationships were found between vascular age and the level of pulse pressure (r=0.65, p&lt;0.001), index of reflection (augmentation) of pulse wave growth (r=0.29, p=0.04). No relationship was found between the stage of arterial hypertension, the presence of comorbid pathology, body mass index, lipid profile, creatinine, glomerular filtration rate, fibrinogen, and vascular age. In men, vascular age was less than in women – 65.5 [59.0; 70.5] years and 72.5 [67.0; 78.0] years, respectively (p = 0.02). In the group of women, the augmentation index of pulse wave growth and the level of fibrinogen were higher than in the group of men. Conclusions. There were no statistically significant differences in passport and vascular age, determined by volumetric sphygmography, in patients with hypertension at various stages of the disease, depending on the presence of comorbid pathology, lipid status, and renal dysfunction. When analyzing hemodynamic parameters, direct links were established between vascular age and pulse arterial pressure, the index of reflection (augmentation) of the pulse wave increase. In the group of women with a higher indicator of vascular age, an increase in the augmentation index of the increase in pulse wave and fibrinogen was revealed.