Arterial Hypertension Syndrome Research Articles

A clinical case of drug-induced arterial hypertension caused by glycyrrhizic acid

Background: In clinical practice, drug-induced arterial hypertension (AH) often remains undiagnosed, since the identification of an ethical disease in this form of AH avoids the initiation of antihypertensive therapy. A critical part in the differential diagnosis of hypertension and planning of long-term strategies for managing a patient requires a thorough study of the properties of the drugs taken and the pathophysiological mechanisms that depend on the increase in high blood pressure against the background of taking one or another substance. Clinical case description: Assumption of pregnancy in a random 57-year-old Caucasian female patient with AH syndrome and history of AD crisis during the year. Against the background of two-component antihypertensive therapy, indapamide 2.5 mg + telmisartan 80 mg, increased blood pressure. From the anamnesis of life, it is noteworthy that the patient should keep records with a hepatologist; with a diagnosis of chronic viral hepatitis C with moderate activity, she takes Phosphogliv. Physical examination confirmed the presence of grade 2 hypertension; no signs of target organ detection were found. Laboratory and instrumental research showed cytolytic syndrome of minimal activity (AST, 74.8 U/l; ALT, 60.5 U/l), hypokalemia (K+ 2.1 mmol/l), unknown etiology, aldosterone within the normal range, metanephrine (80.4 pg/ml at a rate of 64 pg/ml), and normetanephrine (276 pg/ml at a rate of 176 pg/ml) in blood plasma are increased. MSCT of the kidneys and adrenal glands revealed no enlarged formations. Drug-induced arterial hypertension was clinically diagnosed. Concomitant diseases: Chronic viral hepatitis C, moderate activity. Varicose veins, venous infection of the extremities. Dynamics and outcome. After the abolition of glycyrrhizic acid, blood pressure and potassium levels in the blood plasma returned to normal, which is not recommended to take antihypertensive drugs. Conclusion: An exceptional clinical situation is a pronounced manifestation of a rare side effect of glycyrrhizic acid in the form of drug-induced hypertension.

СИНДРОМ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ ПРИ ФЕОХРОМОЦИТОМЕ И ГОРМОНАЛЬНО-НЕАКТИВНОЙ АДРЕНОКОРТИКАЛЬНОЙ АДЕНОМЕ НАДПОЧЕЧНИКА

Introduction. The syndrome of arterial hypertension (AH) can be in patients with functioning and non-functioning masses of the adrenal glands which requires a thorough examination to exclude secon¬dary AH of origin. Aim. Identification of clinical, laboratory and radiological features of the AH syndrome in pheochromocytoma (PCC) and adrenocortical adrenal adenoma (incidentaloma). Materials and methods. A retrospective analysis of the clinic, biochemical, hormonal, radiological methods of examination was carried out in 15 patients referred for surgical treatment with a diagnosis of pheochromocytoma. During the postoperative histological examination of the removed masses of the adrenal glands, the diagnosis of PCC was confirmed in 8 out of 15 patients, in 7 patients instead of PCC, adrenocortical adenoma of was diagnosed. Results. Comparative analysis of the results of clinical, laboratory and radiological examination of patients with PCC and non-functioning adrenocortical adenoma with arterial hypertension syndrome showed that arterial hypertension syndrome in PCC has the following features: a crisis course of hypertension with its characteristic symptoms (headache, tremor, profuse sweating, palpitations), passing without treatment with the development of severe weakness after the crisis. Patients with PCC, compared with patients with adrenocortical adenoma, had a lower body mass, high levels of metanephrine, and on computed tomography (CT), the tumors were larger with high contrast uptake in the unenhanced and delayed phases. The reasons for the overdiagnosis of PCC in patients with adrenocortical adenoma in the presence of hypertension were: underestimation of clinical manifestations and an increase in the level of normetanephrine in daily urine, as well as a slight increase in the unenhanced density of contrast uptake on CT in 2 of 7 patients.

The development risk assessing of hypertension in underground workers during the psychological support

Introduction. For the purpose of studying the psychovegetative state, predictors of hypertension and the risk of its development, including in the age aspect, we have examined sixty underground workers of a chromium ore mining enterprise (the main group), whose working conditions belong to the classes 3.3-3.4. Scientists divided the main group into two subgroups: <45 years (n=20, age 38.45±2.95 years), and >45 years (n=40, age 50.90±1.46 years). The comparison group consists of 49 ground workers whose working conditions belong to the class 3.2. We formed two subgroups from the comparison group: 23 employees aged 38.0±2.8 years, (comparison group <45 years); and 26 employees aged 49.2±2.1 years, (comparison group >45 years). The study aims to research and substantiate the predictors of the development of hypertension of underground workers, depending on age and psychovegetative status. Materials and methods. Experts have investigated the state of the cardiovascular system by clinical, functional and laboratory diagnostics. We have investigated the psychovegetative status with an assessment of the level of neuropsychiatric tension, anxiety, attention, subjective reflection of psychovegetative distress. Results. Experts have identified the decreased attention (OR 7.50; 95% CI - 2.39-23.58), increased personal anxiety (OR 11.06 95% CI - 4.35-28.10) and an increase in the number of psychovegetative complaints (OR 22.50; 95% CI - 7.09-71.41) in the patient group with arterial hypertension syndrome. We identified the identified predictors of arterial hypertension in the analysis of ROC in the psychosomatic module: age >44 years, experience >15 years, number of psychovegetative complaints >1, increased serum uric acid >298 μmol/l, pulse pressure >41 mm Hg.st. The module confirms the inversion of psychovegetative adaptation into psychosomatic disorders with an increased risk of hypertension with increasing age. Limitations. The data obtained are specific to a specific group of miners, the methodological approach of this study can be used in other professional groups. Conclusion. When identifying a psychosomatic module, it is advisable to include employees in the risk group for hypertension. Within the framework of corporate programs for the preservation of health and the prevention of production-related diseases, it is advisable to carry out psychological support for employees of dangerous professions with the study of psychovegetative status. Ethics. The scientists have conducted research in compliance with ethical principles and with the voluntary informed consent of the participants.

Prevalence and long-term trends of arterial hypertension in adolescents aged 14-18 years in Novosibirsk (1989-2019) according to the new international guidelines for management of high blood pressure in adolescence

The high prevalence of arterial hypertension (AH) among the adult population of many countries of the civilized world, incl. Russia (about 40% among people of working age) indicates the need for early detection and prevention of this disease. Assessment of blood pressure (BP) levels in adolescence presents certain methodological difficulties. To date, 3 guidelines based on the results of large population studies of children and adolescents have been developed in the world pediatric practice. However, the application of these guidelines is still not consistent, especially regarding the assessment of BP levels in adolescence.Objective. To study the prevalence and trends of elevated BP levels, including AH, among adolescents aged 14–18 years in Novosibirsk using the main international definitions.Design and methods. In one of the districts of Novosibirsk, cross-sectional population surveys of random representative samples of schoolchildren aged 14–18 years of both sexes were carried out with an interval of 5 years. Seven screenings were carried out from 1989 to 2019, 4579 adolescents were examined. The study program for adolescents was the same for all screenings and included standard questionnaire, measurement of BP by auscultatory method, anthropometry (height, body weight, chest circumference, waist and hips), the study of nutrition by the 24-h dietary recall method, collection of family history by postal parental interviews, biochemical blood tests. BP was measured twice with an interval of 2–3 minutes (before and after filling out the questionnaire), in a sitting position, on the right arm, with an aneroid sphygmomanometer. Systolic BP was recorded with the appearance of the first Korotkoff tone (I phase), diastolic BP — with the disappearance of the tones (V phase). The average of two measurements was included in the analysis. The prevalence of elevated BP levels was assessed using international criteria. To date, several guidelines have been proposed for the diagnosis of elevated BP and AH in adolescence, using both the percentile method (4th report of NHBPEP 2004) and the methods of fixed (AAP 2017) and mixed criteria (ESH 2016 / Russian recommendations 2020). Statistical analysis was performed using the SPSS package for Windows 13,5.Results. The frequency of prehypertension according to the criteria of the 4th report was 40,3% among boys and 26,4% among girls (P < 0,05), the frequency of elevated BP according to the AAP 2017 criteria was 20,4 % and 12,5% in boys and girls, respectively (P < 0,05), the prevalence of high normal BP was 24,6% and 13,5% (P < 0,05) according to the ESH 2016 criteria. The frequency of AH syndrome according to the AAP 2017 criteria was significantly higher when using 4th report definitions and ESH 2016. According to the criteria of 3 different guidelines, there were a fluctual trends of AH in adolescents in Novosibirsk over a 30-year period, without a pronounced trend to decrease or increase. The prevalence of AH according to the AAP 2017 criteria was 2–3 times higher than when using percentiles (4th report) or mixed (percentiles + fixed cut-off points) European criteria (ESH 2016) during all the period.Conclusions. Long-term population studies of adolescents aged 14–18 in Novosibirsk made it possible to study the frequency and trends of elevated levels of BP and AH syndrome in adolescence and to conduct a comparative study of a number of international and domestic criteria.

Pathophysiological characteristics of the development of arterial hypertension in Yorkshire Terriers with alimentary obesity

Relevance.The study of the pathogenesis of obesity in domestic animals is an urgent problem in veterinary medicine, which is associated with the high prevalence of this pathological condition and a significant risk of complications from the cardiovascular system. The aim of the study was to present the pathophysiological characteristics of the development of arterial hypertension syndrome in obesity in Yorkshire Terrier dogs.Methods.In a comparative aspect, clinical, tonometric, electrocardiographic, echocardiographic and biochemical parameters were studied in obese patients (n = 13) and clinically healthy dogs (n = 7).Results.Our study shows the negative role of obesity in the development of arterial hypertension syndrome in Yorkshire Terrier dogs. It was also found that obesity in dogs is accompanied by impaired lipid metabolism, oxidative stress, the development of arterial hypertension and a tendency to the development of concentric hypertrophy of the left ventricular myocardium and hepatopathy.

СОСТОЯНИИ СИСТЕМЫ СИНТЕЗА ОКСИДА АЗОТА ПРИ КОМОРБИДНОМ ТЕЧЕНИЕ БРОНХИАЛЬНОЙ АСТМЫ И ГИПЕРТОНИЧЕСКОЙ БОЛЕЗНИ

Comorbidity is a common condition in medical practice. The presence of comorbid conditions in a patient makes a great contribution to the course and prognosis of the underlying disease, as well as the development of complications [12]. At the same time, diseases occurring with broncho-obstructive syndrome and arterial hypertension syndrome are widespread throughout the world [13, 14]. The aim of this study was to assess the degree of endothelial dysfunction associated with impaired nitric oxide synthesis, based on the state of the NO/NOS/ADMA system and genetic polymorphisms of the nitric oxide synthetase gene in patients with bronchial asthma combined with essential hypertension. Materials and methods Three groups of patients, 96 people each, were formed, corresponding in age and gender structure with a diagnosis of bronchial asthma (BA group), essential hypertension (EH group) and their joint course (BA+EH group). Serum concentrations of asymmetric dimethylarginine, symmetric dimethylarginine, genetic polymorphisms of nitric oxide synthase (synthases NOS3 786T/C and NOS3 894G/T) were determined. To determine the role of other factors in increasing the concentration of ADMA and SDMA, multiple linear regression analysis was performed. Results: according to the results of the study, for a group of patients with a combination of bronchial asthma and hypertension, there are increased levels of ADMA and SDMA, the T allele NOS3 786C/T is more common in hypertension, in multiple linear regression significant factors in increasing ADMA are the presence of hypertension, bronchial asthma, body mass index and glomerular filtration rate, for SDMA - the presence of hypertension, asthma and glomerular filtration rate. Conclusions: The comorbidity of bronchial asthma and arterial hypertension is associated with an increased serum concentration of ADMA and SDMA. The presence of the TT genotype of the NOS3 786C/T polymorphism is associated with an increased incidence of arterial hypertension in patients with asthma.

Value of psychological adaptation of labor-intensive underground workers in formation of arterial hypertension regarding age aspect

Objective. To study the prerequisites for the development of hypertension based on the manifestation of psychovegetative dysfunction and some changes in the biochemical and functional parameters of CVS in the age aspect. Psychological adaptation of a group of underground miners in conditions of intensive labor was analyzed on the basis of indicators of psycho-vegetative status taking into account the influence of professional and psychosocial factors. In connection with the established diagnosis i.e. arterial hypertension (AH) syndrome, especially in middle-aged persons, it is of interest to study the indicators of psycho-vegetative status in the age aspect and to compare them with some changes in biochemical and functional state of cardiovascular system (CVS) in this contingent of patients.
 Materials and methods. The results of the study of psycho-vegetative status of 60 underground miners with AH syndrome (age 46.8 2.0 years, experience 22.0 2.4 years) using the method of psychophysiological testing as well as analysis of some clinical, functional and laboratory parameters are presented.
 Results. The adaptive psycho-vegetative phenotypes in a group of underground workers with AH syndrome in the age aspect were identified.
 Conclusions. With an increase in the length of service among labor-intensive workers, the characteristics of psycho-vegetative status change qualitatively in the form of elevated anxiety and neuro-psychical stress with a decrease in the function of attention combined with a negative relationship of these parameters with increasing age, that is accompanied by dysfunction of CVS; studying of this aspect allows identifying the prerequisites for the development of hypertension so as to form a risk group in time.

АЛГОРИТМ СТРАТИФИКАЦИИ СЕРДЕЧНО-СОСУДИСТОГО РИСКА У МУЖЧИН В ВОЗРАСТЕ 18-29 ЛЕТ С СИНДРОМОМ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ

Background: Arterial hypertension (AH) is a leading factor of cardiovascular risk (CVR), and stratification of CVR in young patients with AH is an important area of clinical research. Aim: to develop an algorithm for CVR stratification in men aged 18-29 years with AH syndrome (AHS). Materials and methods: 165 men underwent a complete physical examination, which included standard clinical, laboratory and instrumental methods, ergomtry test, analysis of heart rate variability, pulse wave velocity determination. Results: The clinical characteristics and features of the cardiovascular system functioning at rest and during ergometry test have been determined, depending on the nosological form of AHS and the established CVR. The algorithm has been developed based on the assessment of the type of hemodynamic response and determination of the probability of cardiovascular outcomes within 10 years. Conclusion: the proposed algorithm enables to optimize therapeutic, diagnostic and preventive measures in men aged 18-29 years with AHS.

Arterial hypertension syndrome sustained by an unexpected association of pheochromocytoma and vesicoureteral reflux nephropathy

Arterial hypertension syndrome sustained by an unexpected association of pheochromocytoma and vesicoureteral reflux nephropathy