Arterial Hypertension Stage Research Articles

Prolongation of Professional Longevity of Patients with Arterial Hypertension in Military Personnel Participating in Modern Armed Conflicts

Arterial hypertension (AH) without proper treatment can lead to heart attack, stroke, kidney or heart failure, vision impairment and other complications. The determination of effective preventive measures to prolong siutability for military service based on the health status of experienced military persons with existing comorbid pathology is an urgent issue today and a component of national security. The objective: to analyze the effective measures that influence on the prolongation of the suitability for military service of military personnel with AH – the participants in the anti terrorist operation / operation of the United Forces (ATO/OUF), taking into account the existing comorbid pathology. Materials and methods. 213 servicemen – the participants of the ATO/OUF with AH and comorbid pathology were examined, who were divided into two statistically homogeneous groups according to the age. The first group included 126 patients with AH stage I, the second group – 87 persons who were diagnosed with AH stage II. CIRS cumulative disease scale was used to assess comorbidity. Results. It has been established that the most important prognostic factors (predictors) that influence on the prolongation of the professional longevity of servicemen with AH – the participants of ATO/OUF with comorbid pathology are timely diagnosis and secondary prevention of atherosclerotic cardiovascular diseases, reduction of total cholesterol and triglyceride levels, the prescribtion of hypolipidemic and antiplatelet drugs therapy, normalization of carbohydrate metabolism disorders, body weight and smoking cessation. Conclusion. The «Algorithm for determination of preventive measures for prolonging suitability for military service based on the health status of servicemen with AH – the participants in ATO/OUF with comorbid pathology was developed».

Profile of Risk Factors for Hypertension Among Overweight Patients

A third part of the world’s population has a steady increased blood pressure (BP). According to scientific data, there is a tendency to increase the incidence of arterial hypertension (AH) up to 60 %. It is important in AH treatment to perform an optimal control of BP level, for this purpose it is necessary to consider both the risk factors for the disease development and the risk factors for the development of pathology complications. The objective: to identify risk factors in patients with AH and body mass index (BMI) more than 25 kg/m2. Materials and methods. The study included 339 patients with AH. The I group involved 299 persons with BMI≥25 kg/m2, and 40 patients with AH and BMI <25 kg/m2 were included in the II group. The average age of the patients was 49.4±10.7 years, the average duration of the disease – 7.5 years. Anthropometric data, daily monitoring of BP, morphological and functional state of the heart, biochemical parameters of the blood (lipidogram, transaminase and bilirubin, urea and creatinine, glucose level) were determined in all patients. The levels of interleukin-1β, interleukin-10 and homocysteine were also detected. The speed of glomerular filtration was determined accord ing to the Cockroft–Hault formula, a psycho-emotional examination was done (a questionnaire for determining of anxiety and depression levels, the presence of alexitimia). Results. The analysis of the lipidogram indicators demonstrated a higher level of atherogenicity index in patients with excess body weight (respectively 3.4±1.3 versus 3.1±1.4; p<0.05). Among patients with AH and overweight or obesity compared to patients with normal body weight, significant differences have been revealed about the frequency of complications of targetorgans (AH stage II was 2 times more common among patients in the II group). Glycemia level on empty stomach was higher in patients with overweight (5.5±1.8 mmol/l versus 4.8±0.8 mmol/l; p>0.05) and 3 times more common among patients in the I group (35.6 % versus 11.5 % of patients; p<0.05). Hyperuricemia was found in 48 % of patients. In patients with normal BMI, the level of uric acid was within reference values (p=0.015). In 27 % of patients with overweight the increased IL-10 was determined, in 45 % – IL-1β, while in patients with normal BMI these indicators were normal (p<0.05). Patients with AH had increased levels of anxiety, and patients with excess weight had a risk of depression. Conclusions. The results of the study showed that there is a clear association of increased blood pressure (BP) with weight gain. Patients with AH and high body mass index (BMI) had additional risk factors that can cause high BP and require personalized treatment. Excessive body weight causes an acceleration of the development of target organs (1.5 times more often), in particular increases the risk of progression of systolic and diastolic dysfunction of the left ventricle and sudden cardiac arrest, leads the development of atherosclerosis and immune inflammation. The association of AH and high BMI with PPARG gene (33 % of cases) was determined.

Obstructive sleep apnea syndrome and cardiovascular risk factors in the antihypertensive therapy "escape" phenomenon

To assess the role of obstructive sleep apnea and other cardiovascular (CV) risk factors in the development of the antihypertensive therapy (AHT) efficacy "escape" phenomenon in patients with arterial hypertension (AH). The data of 75 patients with AH stage I-II, grades 1-3 were proceeded. All patients included in the study underwent night respiratory monitoring. After AHT prescription, blood pressure (BP) was monitored by three measurement methods (office, daily monitoring and self-control of blood pressure) - initially, in 1, 3 and 6 months after the inclusion - in order to confirm the initial therapy efficacy and to identify or exclude the "escape" phenomenon. In 36.0% of patients, the "escape" phenomenon was diagnosed in 1 or 3 months of observation. When comparing the group with the "escape" phenomenon, an initially higher level of systolic BP was revealed according to office measurements, 24-hour monitoring and self-control BP monitoring (134.0±4.7 mmHg vs 126.0±8.5 mmHg; 129.0±2.3 mmHg vs 121.0±7.7 mmHg; 131.0±8.2 mmHg vs 121.5±6.2 mmHg resp.; р<0,05). There were no differences in sleep apnea and CV risk factors between the groups. However in patients with a minimal SpO2≤85% during sleep, there were a higher levels of office systolic BP both before the AHT prescription, and during its use (157.6±10.4 mmHg vs 152.4±8.1 mmHg resp., р<0,05; 132.0±6.8 vs 127.1±8.9 mmHg resp.; р<0,05), and mean 24-hour systolic BP (125.7±5.9 vs 121.6±8.2 mmHg resp.; р<0,05) - compared with patients with a minimum SpO2>85%. The higher BP level in patients with lover nocturnal hypoxemia does not allow us to exclude the delayed negative impact of obstructive sleep apnea, especially severe, on the BP profile in case of initially successful AH control.

Scoring of Professional Longevity of Patients with Arterial Hypertension of Military Personnel – the Participants of Modern Armed Conflicts

The prediction of ability for military service by the health of patients who are experienced (with war experience) military persons with arterial hypertension (AH) with existing comorbid pathology is an urgent issue of today and a component of national security. The objective: to analyze the of factors that influence on the prognosis of health service for the military service of patientsmilitary personnel with AH – the participants of anti-terrorist operation / operation of the united forces (ATO / OUF), taking into account the available comorbid pathology. Materials and methods. Medical card of 213 military personnel – ATO/OUF participants with AH and comorbid pathology were analyzed. The first group included medical cards of 126 patients with AH stage I, the second group – medical cards of 87 patients with AH stage II. Clinical and laboratory, instrumental methods of research and consultation of narrow specialists and cumulative CIRS disease scale, which provides a separate total assessment of the condition of each of the organ systems on the range of Likert scale were used. Results. During the study, the professional longevity was forecasted using program Statistica SSP 10.0 and the forecasting of professional longevity using IBM SPSS 23.0. The most important prognostic factors that affect the change in the category of suitability for military service for the health of patients with AH of military personnel – ATO/OUF participants with comorbid pathology were determined, namely: age, sum of points on the cumulative CIRS scale and stage of AH (87.0 –91.8 % of the correct classifications of generated artificial neural networks, the area index under the ROC-curve AUC 0.971–0,992). Conclusions. Based on the statistics obtained data in the construction and analysis of artificial neural networks, the “algorithm for predicting a category of suitability for military service for the health of patients with arterial hypertension of military personnel – ATO/OUF participants with comorbid pathology” was developed.

Functional state of skin microvascular bed according to laser doppler flowmetry in patients with arterial hypertension combined with hypercholesterolemia

Introduction. The great importance of risk factors, such as arterial hypertension (AH) and low-density lipoprotein cholesterol (LDL-H), for development of cardiovascular diseases, makes highly relevant to obtain the data of the nature of microcirculation (MC) changes that are a key link of maintaining homeostasis under their concomitant influence. Aim – to evaluate functional state of skin microvascular bed using laser Doppler flowmetry in patients with arterial hypertension (AH) and combined with hypercholesterolemia. Materials and Methods. The study involved 37 practically healthy volunteers and 94 patients with 2–3 stage of AH, which were divided into 2 groups: Gr.1 with LDL-CH level ≤3.5 mmol/l (n = 35) and Gr.2 with LDL-H level &gt;3.5 mmol/l (n = 59). MC of the forearm skin was assessed by laser Doppler flowmetry. Parameters of basal blood flow, the amplitude-frequency spectrum of its fluctuations, nutritional MC, and parameters of occlusion test were evaluated. Results. Analyzing rhythm structure of blood flow fluctuations, statistically significant decrease in standardized parameters of their amplitude in endothelial and myogenic frequency ranges was revealed in patients with elevated LDL-CH levels compared to patients of Gr.1 by 19.7 % and 9.7 % (р = 0.045), respectively, which indicated weakening of endothelial function and constriction of precapillary segment of MC. These changes were accompanied by decrease in reserve of microvascular blood flow by 9.1 % in Gr.2 of patients (p = 0.044) with pronounced trend towards reduction of capillary perfusion and activation of blood flow through arteriolovenular shunts. Conclusion. More pronounced functional disorders of MC, characterized by endothelial dysfunction, constriction of precapillary segment, and decrease in reserve potential of tissue hemoperfusion were revealed in AH patients with atherogenic hyperlipidemia vs AH patients.

EFFECT OF CHOLECALCIFEROL ON RATE OF MORNING BLOOD PRESSURE RISE IN WOMEN WITH ARTERIAL HYPERTENSION IN PREMENOPAUSAL AND EARLY POSTMENOPAUSAL PERIODS

Objective: To assess effect of cholecalciferol on rate of morning blood pressure (BP) rise in women with arterial hypertension (AH) in premenopausal and early postmenopausal periods. Design and method: We investigated 102 women with AH stage II risk 3 aged 50 (48; 53) years: 50 females in premenopausal period – group I and 52 females in early postmenopausal period – group II. Serum level of 25(OH)D was determined by the immunoenzymatic assay. In groups I and II we identified subgroups with the level of 25(OH)D&lt; 30ng/ml: subgroup IB (n = 25) and subgroup IIB (n = 21) respectively, in which antihypertensive therapy was supplemented with cholecalciferol 2,000 IU/day for 3 months. In subgroups IA (n = 25) and IIA (n = 31) cholecalciferol was not administered. The rate of morning BP rise was calculated by the ratio of the BP rise value to its time using daily monitoring of BP. Results: At baseline the level of 25(OH)D was lower (p &lt; 0,05) in subgroups IB (19,3 ± 8,5ng/ml) and IIB (18,2 ± 9,5ng/ml) than in the comparable subgroups IA (26,7 ± 11,5ng/ml) and IIA (27,4 ± 10,5ng/ml). After supplementation the level of 25(OH)D increased (p &lt; 0,001) in subgroup IB (37,28 ± 11,97ng/ml) and in subgroup IIB (36,4 ± 10,0ng/ml), and became higher (p &lt; 0,001) than in the comparable subgroups I and IIA. At baseline, subgroups IA and IB did not differ (p &gt; 0,05) by rate of morning SBP/DBP rise. In subgroup IIB rate of morning DBP rise was higher (p = 0,04) than in subgroup IIA. After therapy in subgroup IB there was a decrease rate of morning SBP/DBP rise (p &lt; 0,05); in subgroup IA, rate of morning SBP/DBP rise did not change (p &gt; 0,05). In subgroup IIA, there was no decrease (p = 0.62) rate of morning DBP rise, while in subgroup IIB, rate of morning DBP rise in the decreased (p &lt; 0,05) compared to the baseline and in comparison with rate of morning DBP rise in subgroup IIA after therapy (p = 0,04). The contribution of cholecalciferol to the dynamics of rate of morning DBP rise was established: F = 4,33, p = 0,04. Conclusions: Correction of 25(OH)D level by intake of cholecalciferol 2000 IU/day for 3 months leads to reduction of rate of morning BP rise in women with AH.

Arterial hypertension and remodelling of the right ventricle.

In the case of long-term and physiological loads (e.g. during pregnancy or regular athletics training), reversible morphological changes occur in the heart - cardiomyocytes undergo hypertrophy; however, this is not accompanied by impairment of left ventricular function or myocyte metabolism. However, in the course of various pathological processes, as time goes by, gradually permanent morphological changes occur. These changes are referred to as remodelling of the heart muscle, which, regardless of the primary cause, can lead to the development of chronic heart failure. The study was performed on post-mortem material of 35 human hearts obtained from forensic sections and anatomopathological sections of people who died of non-cardiac causes (mainly traffic accidents, suicide attempts, strokes, acute infections); material was fixed in a 4% formalin solution. The hearts were subjected to macro- and microscopic assessment. During microscopic assessment the features of remodelling were evaluated. In vivo and echocardiographic tests, as well as macroscopic evaluation of post-mortem material, suggest the presence of some kind of right ventricular muscle remodelling; however, classic microscopic observations, presented in this study, do not provide such unambiguous evidence. Thus, the question arises: why and how the right ventricular function is disturbed, sometimes at early stages of arterial hypertension.

Features of vascular motor endothelial function in hypertensive patients with chronic heart failure

Abstract Funding Acknowledgements Type of funding sources: None. The main part of the pathogenesis of arterial hypertension (AH) is a remodeling of the vascular system and the state of the vascular endothelium, which functions as a trigger mechanism for the implementation vasoregulating mechanisms. Vascular endothelium is involved in the provision of local processes of hemostasis, proliferation, migration of blood cells in the vessel wall, which is also associated with the regulation of vascular tone and the development of atherosclerosis. Purpose To study the vascular motor endothelial function in hypertensive patients with chronic heart failure (CHF). Methods Vascular mechanisms of pathogenesis have been studied in 172 patients aged (54,2±6,2) years, men 84 and women 88, with uncomplicated hypertension II-III degree. Echographic system Acuson Sequoia 512 was used for ultrasound imaging of the heart. The diameter of the brachial artery (D, mm), flow velocity (V, m/s), the ratio D/V, Δd (%) - an increase in the diameter of the artery decompression, ΔdN (%) - an increase in the diameter of the artery sample with nitroglycerin and the ratio Δd/ΔdN were measured. Results Due to the reduction in brachial artery diameter (with AH stage II 55, l% and AH stage III 48.7%, p &amp;lt;0.01) decreased blood flow velocity in the whole group is 36.4%, which is as much depended on the degree of hypertension (p &amp;lt;0.01). Conducting tests for decompression and nitroglycerin showed that reduced growth in brachial artery diameter in the total group on the decompression was compared with the normal 51.1%: in AH II degree - by 48.8% and III level by 52.2% (p&amp;lt;0.01). The test with nitroglycerin: the larger group of hypertensive patients reduced vasodilation was 21.1%, II degree - 13.8%, and III degree - 30.7% (p&amp;lt;0.01). Conducting tests for decompression showed that normal type vasodilatory response occurred only in 27.4% of patients, with II degree in 33.8% and AH III in 22% of patients. Reduced response to decompression was 60% of patients with AH II - in 43.2%, and III degree - at 56.8% and constrictor - in 12.6% of them in AH II degree at - 6.2% and 17 % at AH III. The test with nitroglycerin: normal vascular reaction occurred in 33.5% of patients, decreased in 59.9% and constrictor in 9.6% of patients. Reduced vasoconstrictor response to nitroglycerin was more common in patients with AH II degree. Cunclusion These results define the nature of the preferred choice of antihypertensive drugs such as normalizing pressure and have a positive effect on the endothelium, which is also associated with a reduction of myocardial hypertrophy and vascular wall.

EFFECTS OF INSPIRATORY MUSCLE TRAINING ON FUNCTIONAL CAPACITY AND QUALITY OF LIFE IN PULMONARY HYPERTENSIVE PATIENT

Background: Exercise intolerance is present even in the early stages of pulmonary arterial hypertension (PAH) and is associated with poor prognosis. Respiratory muscle dysfunction is common and may contribute to exercise limitation. Objective: To determine the effects of inspiratory muscle training (IMT) in pulmonary hypertensive patient. Methodology: A randomized control trial was conducted at Services Hospital Lahore after approval from Medical Superintendent. A total of n=18 subjects were randomly allocated into two groups, both group received deep breathing exercise (DBE) and 2nd group received additionally Inspiratory muscle training (IMT) with pressure threshold Inspiratory muscle training device. All participants received 12 sessions in two weeks; the duration of each session was of 20 minutes. The outcome variables were functional capacity and quality of life (SF-36). In functional capacity, of the blood pressure (BP), heart rate (HR), partial pressure of oxygen (SpO2), distance walk (6min walk test) and level of dyspnea were recorded The data was evaluated at baseline and after 12th session. Results: The mean age of patients was 58.11±7.11 years, with 9 male and 9 female. After 2 weeks, the general health, social activities and energy were significantly (p&lt;0.05) improved in experimental group. But no significant difference (p≥0.05) was observed between the group regarding activity limitation, physical and emotional health items of quality of life (SF-36). When comparing the Blood pressure and heart rate, no significant difference was observed between the groups, after 2 weeks of intervention (p≥0.05). While SpO2,6 MWT and dyspnea score was significantly (p&lt;0.05) improved in experimental group as compare to control group. Conclusion: The Deep breathing and inspiratory muscle training both are equally effective with respect to improving the quality of life but IMT is more efficient as compared to Deep breathing for improving dyspnea and it also improves the pulmonary functional and exercise capacity. Key words: breathing exercises, dyspnea, inspiratory muscle training, pulmonary hypertension, quality of life.

THE LEVEL OF LEUKOTRIENE B4 IN PATIENTS WITH ARTERIAL HYPERTENSION AND CORONAVIRUS DISEASE

Relevance. Patients with comorbid pathology, including arterial hypertension (AH), coronary artery disease, type 2 diabetes, and cerebrovascular disease have been shown to be at risk for coronavirus disease (COVID-19). Currently, among the pathogenetic mechanisms of vascular endothelial damage are considered direct effects of SARS-COV-2 virus, as well as proinflammatory cytokines, which lead to a «cytokine storm» with unpredictable consequences for the patient. In this aspect, the role of leukotriene B4 (LTB4) – one of the first candidates to provoke a hyperimmune inflammatory response in the progression of COVID-19 – was insufficiently elucidated.&#x0D; Objective: to investigate the level of leukotriene B4 (LTB4) in patients with AH with and without coronavirus disease 2019.&#x0D; Methods. 78 people with AH and overweight or obesity who were treated at the Lviv Emergency Hospital were examined. All patients were divided into 2 groups: group 1 (n=37) – persons with AH (stage І-ІІІ, grade 1-3); group 2 (n=41) – patients with AH (stage І-ІІІ, grade 1-3), COVID -19 and interstitial lung disease.&#x0D; Anthropometric measurements with a determination of body mass index (BMI), echocardiography, a blood test, biochemical blood test with determination of glucose, alanine aminotransferase, aspartate aminotransferase, creatinine, and urea were performed. Serum blood samples for the examination of LTB4 (Elabscience Elisa Kit) were taken and processed using ELISA method.&#x0D; Results. Saturation was significantly lower in patients of group 2, while heart rate and body temperature were higher (p &lt; 0,01) compared to group 1. There was a significant decrease in hemoglobin level, increase in ESR, glucose, and LTB4 in individuals with AH and COVID-19, which is probably due to the presence of inflammation in the lung tissue in coronavirus infection. The concentration of LTB4 ranged from 370 to 3600 pg/l in patients of group 2. 19 individuals (46,3%) of group 2 had a higher level of LTB4 than the median value, which is probably associated with a more severe course of coronavirus infection. A positive correlation between LTB4 and BMI (rs= 0,369; p &lt; 0,05) was found in individuals with AH.&#x0D; Conclusions. The level of LTB4 is higher in patients with AH and COVID – 19 than in individuals with AH, due to the severity of the inflammation process in this comorbid pathology.

Current views on the assessment of vascular wall elasticity in pregnant women with arterial hypertension

Introduction. Arterial hypertension is the most common somatic pathology in pregnant women. Arterial hypertension is a factor of high risk for the development of severe preeclampsia, placental insufficiency, intrauterine growth restriction, premature birth, maternal and perinatal mortality, nervous disorder and vascular heart disease of newborns and women’s distant cardiovascular disorders. The pathogenesis of gestational complications is associated with pathology of placentation, endothelial dysfunction and a decrease in vascular elasticity. The pathogenesis has not studied yet. Nowadays there are no tests with enough sensitivity and specificity ensuring early diagnostics and risk identification at development of great obstetric syndromes. Aim of the study was to improve our understanding about a clinical and prognostic role of vascular wall elasticity in pregnant women with arterial hypertension. Materials and Methods. We searched publications and analyzed literature using various scientific databases, including Index Medicus, PubMed/MEDLINE, Embase, Cochrane Library and Russian scholarly journals related to obstetrics, gynecology, cardiology for the last 9 years. Results and Discussion. Today changes in the elastic properties of arteries is a modern marker of a high risk of cardiovascular events in patients with essentialhypertension. Endothelial dysfunction develops already in the early stages of arterial hypertension and initiates structural changes in the vascular wall and an increase in arterial stiffness. High activity of the sympathetic nervous system is the cause of changes in the elastic properties of arteries in pregnant women with arterial hypertension. Conclusion. The role of vascular wall elasticity in pregnant women with arterial hypertension is of tremendous importance and deserves close attention. The study of elastic properties of vessels is relevant for assessing the risk of gestational complications in pregnant women with arterial hypertension.

Indole-3-acetic acid correlates with monocyte-to-high-density lipoprotein (HDL) ratio (MHR) in chronic kidney disease patients.

Indole-3-acetic acid is a protein-bound indolic uremic toxin deriving from tryptophan metabolism. Increased levels are associated with higher thrombotic risk and both cardiovascular and all-cause mortality. An emerging biomarker of cardiovascular disease is the monocyte-to-high-density lipoprotein ratio (MHR). The main purpose of this study was to investigate the association of indole-3-acetic acid with MHR and other markers of cardiovascular risk in patients with chronic kidney disease (CKD). We enrolled 61 non-dialysis CKD patients and 6 dialysis patients. Indole-3-acetic acid levels were measured with ELISA technique. In the whole cohort of 67 patients, indole-3-acetic acid was directly related to Ca × P (ρ = 0.256; P = 0.0365) and MHR (ρ = 0.321; P = 0.0082). In the 40 patients with previous cardiovascular events, indole-3-acetic acid correlated with uric acid (r = 0.3952; P = 0.0116) and MHR (ρ = 0.380; P = 0.0157). MHR was related with fibrinogen (ρ = 0.426; P = 0.0010), arterial hypertension (ρ = 0.274; P = 0.0251), C-reactive protein (ρ = 0.332; P = 0.0061), gender (ρ = -0.375; P = 0.0017; 0 = male, 1 = female), and CKD stage (ρ = 0.260; P = 0.0337). A multiple regression analysis suggested that indole-3-acetic acid might be an independent predictor of MHR. This study shows a significant association between indole-3-acetic acid and MHR. Prospective studies are required to evaluate if decreasing indole-3-acetic acid concentrations may reduce MHR levels and cardiovascular events and improve clinical outcomes.

Antihypertensive effect of Equisetum arvense L.: a double-blind, randomized efficacy and safety clinical trial

BackgroundEquisetum arvense L. (EA) is a traditional phytomedicine used as a diuretic agent worldwide and regulated strictly by European Medicine Agency (EMA) and Brazilian National Health Surveillance Agency (ANVISA). However, few studies evaluating its efficacy and safety have been published and no clinical trial assessing its antihypertensive effect has been reported to date. PurposeTo assess antihypertensive effect, safety and tolerability of EA compared to hydrochlorothiazide (HCTZ). MethodsThis is a double-blind randomized clinical trial, allocating 58 systemic arterial hypertension (SAH) stage I patients (both sexes, 25–65 years old) into two groups (EA and HCTZ). All patients underwent biochemical and cardiologic checkup prior to and during interventions. The EA standardized dry extract (900 mg/day) or HCTZ (25 mg/day) were administered for 3 months and follow-up visits were conducted every 30 days. Efficacy established goals were systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) decreases ≥ 10.0 mmHg and/or casual blood pressure (CBP) < 140/90 mmHg. ResultsEA treatment demonstrated a significant antihypertensive effect, promoting a mean decrease of SBP and DBP by 12.6 and 8.1 mmHg, respectively, and resulting a CBP mean of 134.0/84.5 mmHg at the end of intervention on the SAH stage I patients (CBP mean of 148.5/95.7 mmHg). There were no significant statistical differences between EA and HCTZ interventions on blood pressure decrease, and before-after treatments regarding to biochemical tests and signs of acute toxicity, renal, hepatic and hematologic alterations. A slight trend but no significant difference were observed between adverse events from EA (3.58%) and HCTZ (4.68%) groups. ConclusionEA standardized dry extract was successfully applied to the SAH stage I patient treatment, decreasing effectively SBP ad DBP values to the reference normal ranges, and demonstrating a well-tolerability profile similar to HCTZ intervention.

Особливості перебігу артеріальної гіпертензії, поєднаної з дисплазією сполучної тканини, у практиці сімейного лікаря

Актуальність. Поєднання артеріальної гіпертензії (АГ) та дисплазії сполучної тканини (ДСТ) є одним із недостатньо вивчених питань. ДСТ супроводжується порушеннями структури та функції судин, сприяє розвитку раннього атеросклерозу та серцево-судинних ускладнень. У хворих на АГ, поєднану з ДСТ, часто зустрічаються порушення ритму та провідності серця, значно поширені зміни з боку органів зору, внутрішніх органів та кістково-суглобової системи. Мета. Покращити діагностику та лікування АГ, поєднаної з ДСТ, на основі вивчення клінічного перебігу, вираженості зовнішніх і внутрішніх симптомів ДСТ, ліпідного спектра крові, гострофазових показників, сечової кислоти та інструментальних методів обстеження. Матеріали та методи. Проведено клінічне дослідження, в яке включено 75 хворих на АГ ІІ стадії 1–3-го ступеня з проявами ДСТ, середній вік яких становив 63,5 ± 4,2 року, які перебували на стаціонарному лікуванні в кардіологічному відділенні Комунальної міської клінічної лікарні швидкої медичної допомоги м. Львова. Методи дослідження включали клінічні (огляд, пальпація, перкусія, аускультація), лабораторні (ліпідний спектр крові, С-реактивний протеїн, серомукоїди та сечова кислота), інструментальні (електрокардіографія, ехокардіографія, добове моніторування артеріального тиску, езофагогастродуоденоскопія, ультразвукове дослідження (УЗД) внутрішніх органів і судин нижніх кінцівок, УЗ-дуплексне обстеження сонних і хребтових артерій, рентгенологічне дослідження кістково-суглобової системи), консультації офтальмолога, невропатолога, травматолога, стоматолога. Діагностика недиференційованої ДСТ визначалася за методикою Т.М. Кадуріної та співавт. (2009). Розрахунок діагностичного коефіцієнта для кожної ознаки дисплазії проводили за методикою, розробленою В.М. Яковлевим та співавт. (2008). Пацієнти були розподілені на 3 групи:1-ша група — 12 пацієнтів з АГ II стадії 1-го ступеня, 2-га група — 26 пацієнтів з АГ II стадії 2-го ступеня, 3-тя група — 30 пацієнтів з АГ II стадії 3-го ступеня. Контрольна група — 7 пацієнтів з АГ ІІ стадії 1–3-го ступеня без проявів ДСТ. Результати. При порівняльному аналізі хворих з АГ у 90,67 % спостерігався ряд зовнішніх і внутрішніх симптомів дисплазії сполучної тканини, у 9,33 % були відсутні прояви ДСТ. У 3-й групі хворих спостерігали більше зовнішніх і внутрішніх фенотипових ознак ДСТ та їх вираженість порівняно з 1-ю та 2-ю групами, що прогнозує тяжкість клінічного перебігу захворювання. Висновки. У хворих на АГ спостерігається значне поширення ДСТ: чим більше ознак ДСТ, тим тяжчий клінічний перебіг гіпертонії. У хворих з АГ, поєднаною з ДСТ, поширені зміни з боку серцево-судинної системи, органів зору, внутрішніх органів та кістково-суглобової системи порівняно з групою хворих без ДСТ. При порівнянні групи хворих з АГ і наявністю ДСТ відмічаються вищі показники активності запального процесу та ліпідного спектра крові, ніж у хворих без ДСТ. Своєчасне виявлення АГ, поєднаної з ДСТ, систематичний диспансерний нагляд за хворими, проведення комплексу заходів, спрямованих на покращення структури та функції сполучної тканини, корекція імунодефіциту дозволяють покращити результати перебігу даної патології.

Pulse rate and blood pressure changes during low-irradiance PDT compared with conventional PDT in the treatment of facial actinic keratoses: A retrospective study.

Conventional photodynamic therapy (c-PDT) is a highly effective treatment for actinic keratoses. Besides pain as the main side effect, blood pressure (BP) increases and hypertensive crises may occur during treatment. Reducing the irradiation intensity while keeping the total dose constant (low-irradiance PDT) can achieve a clinically relevant reduction in pain. This study aimed to evaluate the influence of li-PDT on the BP and pulse (PR) during therapy and the incidence of post-interventional hypertension compared with c-PDT. We retrospectively analyzed the treatment data of 79 patients (39 c-PDT and 40li-PDT). BP and PR measurements were performed in all patients before PDT, at mid-exposure, and immediately after PDT. In addition, the pain was assessed by using the visual analog scale. Patients treated with li-PDT reported significantly lower pain than those receiving c-PDT (p<.0005). Additionally, they showed less systolic (SBP) and diastolic (DBP) BP increase (∆SBP: p<.0005, ∆DBP: p=.015) and overall lower absolute BP values (SBP: p<.0005, DBP: p=.008) compared with c-PDT. They were also significantly less likely to develop post-interventional hypertension (p=.037) or higher stages of arterial hypertension. Regarding PR, there was no difference in absolute values between both groups, but the increase from onset to half irradiation duration was significantly higher in c-PDT (p=.013). Li-PDT is an excellent option to reduce the elevation of arterial BP and decrease the incidence of post-interventional hypertension and hypertensive crisis. This finding has considerable relevance, especially with the risk profile of many PDT patients in mind (advanced age and cardiovascular history).

STATE OF AUTONOMIC REGULATION AND CEREBROVASCULAR REACTIVITY IN PATIENTS WITH HEADACHE WITH ARTERIAL HYPERTENSION.

The aim: A comprehensive assessment of the state of the autonomic nervous system and cerebrovascular reactivity of the cerebral blood flow in the patients with the headache accompanied by arterial hypertension (AH) and somatoform autonomic dysfunction (SAD). Materials and methods: We conducted the clinical, autonomic regulation and Doppler sonography examination of 124 young patients (18-45 years old), including 51 men and 73 women in the conditions of the clinical base of the Kharkiv Medical Academy of Postgraduate Education in 2018-2021. All patients with cephalgias were divided into three groups: with AH stage II (Group I - 41 patients), AH stage I (Group II - 40 patients), SAD (Group III - 43 patients). The control group consisted of 50 patients of the corresponding gender and age. Results: The intensity of cephalalgia in patients with SAD was maximum. The autonomic tone (AT) was changed in 68.5%examined patients. It had a pronounced shift towards sympathicotonia. According to the visual analogue scale the maximum intensity of cephalgias was against the sympathicotonia. In the groups with organic lesions of the cerebral vessels the latent period delay was registered with the progression of the organic pathology. The regularity was revealed - the shortening of the evoked skin sympathetic potentials latency with the severity of cephalalgia, which can be interpreted as an increase in ergotropic effects with the realisation of the pain syndrome. The obtained data on the state of the AT indicate the depletion of the ergotropic processes with the progression of cerebral ischemia with a known increase in parasympathicotonia. In the patients of SAD group the CrCO2 and KrFNTvalues were significantly increased, in AH stage I group they slightly exceeded the standard values , in AH stage II group they were reduced. The reactivity to the orthostatic loads and functional metabolic test in all groups exceeded the control values. Conclusions: 1. The cephalgic syndrome is one of the main symptoms of the autonomic dysfunction and arterial hypertension; the frequency and intensity of the headache increases with the hyperreactivity of the sympathetic system. 2. The SSP data indicate that the sympathetic activity triggers and maintains the pain syndrome, and can also be realized in the form of arterial hypertension. 3. The dysfunction of the central link of the GSR indicates the instability of the autonomous regulation, the work of the limbic-reticular complex, which is clinically manifested by the changes in the cerebral vascular tone. 4. The cerebrovascular hyperreactivity as a sign of the search for the optimal sanogenetic variant of the cerebral hemodynamics in patients with SAD and AH stage I occurs predominantly due to the vasodilatory component. 5. In the patients with AH stage II the vasoconstrictor reactions are observed with the depletion of the vasodilation reserves, which is a marker of the autoregulation failure.

Эндотелиальная дисфункция, жесткость сосудистой стенки и их коррекция препаратами периндоприла и лозартана у пациентов с хронической ишемической болезнью сердца, артериальной гипертензией и хронической болезнью почек после коронарного стентирования

Objective. To study the state of arterial stiffness and endothelial function in patients with coronary heart disease (CHD), arterial hypertension (AH) in combination with chronic kidney disease (CKD) and to determine the effect of Perindopril and Losartan therapy on these indices including after coronary stenting. Materials and Methods. The study involved 73 patients with coronary heart disease (CHD), AH and CHD stage 2-3a. The comparison group consisted of 30 patients with CHD and AH without renal pathology. Patients with CKD were divided into 3 subgroups: the 1st - on conservative therapy with Perindopril 10 mg; the 2nd - with Losartan 100 mg daily; the 3rd - those who underwent coronary stenting and were treated with Perindopril 10 mg daily. Arterial stiffness, plasma levels of endothelin-1 (ET-1), metabolites of nitric oxide were assessed initially and after 12 weeks of therapy. Results. The patients with CHD and hypertension had a more severe endothelial dysfunction (ED) and more significant arterial stiffness. There was a correlation between GFR and PWV levels (r = -0.75; p = 0.001), nitric oxide levels (r = 0.58; p&lt;0.01), ET-1 (r = -0.72; p &lt; 0.01). After 12 weeks of therapy, all three subgroups showed a statistically significant decrease in ET-1 and vascular wall stiffness. Conclusion. Patients with CHD and AH, CKD had more profound ED and the severity of arterial stiffness. The use of Perindopril and Losartan in complex therapy resulted in a glomerular filtration rate increase, was accompanied by a corrective effect on ED and decreased arterial stiffness, especially in patients undergoing coronary stenting.

Ulcerating Stasis Dermatitis of the Forearm Associated With Arteriovenous Graft and Central Vein Stenosis

Stasis dermatitis is a pathologic condition of the skin that most commonly occurs in the lower limb, where it is caused by chronic venous insufficiency. Stasis dermatitis of the upper limb is rare. A 45-year-old male, resident in Angola, presented to the emergency department with an ulcer encompassing the entire left forearm. Past medical history comprised arterial hypertension and end stage renal disease treated with hemodialysis. Dialysis access consisted of a left brachial-basilic AV graft obtained 4 years before. The patient also reported that a right internal jugular vein catheter was used previously during the maturation of the left brachial-basilic AV graft. Stenosis of the left brachiocephalic vein was documented at angiography. Angioplasty was performed, with complete resolution of the wound 2 months after admission. The differential diagnosis of extensive ulcer of the forearm must include neoplasms, cellulitis, and/or deep tissue infection with secondary ulceration, but it is also important to maintain suspicion for venous stasis syndrome as a rare but possible cause of these lesions.

Influence of Meldonium on Blood Lipid Spectrum and Echocardiography Parameters in Patients with Coronary Heart Disease and or Withoutconcomitant Arterial Hypertension

Introduction. Coronary heart disease (CHD) is one of the main causes of high mortality, disability and reduced quality of life for patients in both Europe and Ukraine. Modern drug therapy of coronary heart disease in combination with arterial hypertension (AH) does not always achieve a satisfactory therapeutic effect. The use of meldonium, which has antioxidant properties, has a positive effect on NO release and has a lipid-lowering effect is promising for patients with AH. The aim of the study. To evaluate the influence of meldonium on lipid metabolism and echocardiography parameters in combination therapy in patients with CHD with stable angina and concomitant AH. Materials and methods. We examined 66 patients with CHD, stable angina pectoris II-III functional class, 40 of them with concomitant AH stage II-III. Patients were divided into 2 groups of 40 and 26 patients, respectively. The first group included patients with CHD and concomitant AH, the second - without pre-existing hypertension. Each of the groups was further divided into 2 subgroups: 1) Patients who were prescribed meldonium at a dose of 750.0 mg/d for 6 months in addition to the basic therapy of the underlying disease (n = 20 for CHD + AH and n = 14 for CHD without hypertension). 2) Patients who continued basic antianginal, disaggregating, hypolipidemic therapy (n = 20 for CHD + AH and n = 12 for CHD without hypertension). Serum levels of triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol were assessed. Indicators of cardiac hemodynamics were determined by echocardiography with assessment of left ventricular end systolic and diastolic volumes and diameters (LVESV, LVEDV, LVESD, LVEDD respectively), the thickness of the interventricular septum and posterior wall of the left ventricle (IVST, LVPWT respectively), pulmonary artery pressure (PAP), LV myocardial mass (LVM) and LV myocardial mass index (LVMI). Results. The use of meldonium for 6 months in patients with CHD and concomitant AH led to a decrease in the concentration of total cholesterol from 5.07 to 4.34 mmol/l and LDL from 2.07 to 1.70 mmol/l. In the group of patients without concomitant hypertension there was a decrease in the concentration of total cholesterol from 4.80 to 3.93 mmol/l, LDL from 1.62 to 1.18 mmol/l and an increase in HDL from 1.18 to 1.37 mmol/l. At 6-month administration of meldonium as a part of combination therapy of patients with CHD with concomitant AH, there is a decrease in LVM from 216.90 g to 181.50 g and LVMI from 109.10 g/m2 up to 91.20 g/m2. In patients without concomitant hypertension, a decrease in LVM from 232,20 g to 183.90 g and LVMI from 121.50 g/m2 to 96.40 g/m2 was observed. Conclusions. Our study showed that meldonium has a positive effect on lipid metabolism and echocardiography. In the group of patients with coronary heart disease and concomitant hypertension on the background of additional use of meldonium for six months, we registered a decrease in TC, LDL and AI. LVPWT, PAP, LVM and LVMI also significantly decreased. In the group of patients with coronary heart disease without concomitant hypertension, we registered a decrease in TC, LDL, AI and an increase in HDL. LVM and LVMI also decreased significantly. Therefore, we consider it appropriate to use meldonium in the complex treatment of patients with coronary heart disease with stable angina and concomitant hypertension. Keywords: coronary heart disease, arterial hypertension, meldonium, echocardiography, blood lipid spectrum.

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.