Arterial Wall Stiffness Parameters Research Articles

Вплив фіксованої комбінації метформіну SR та глімепіриду на показники вуглеводного, ліпідного обміну та жорсткість артеріальної стінки у хворих на цукровий діабет 2-го типу

З метою вивчення впливу цукрознижувальної терапії за допомогою комбінації глімепіриду й метформіну SR упродовж 12 тижнів на показники вуглеводного й ліпідного обміну, динаміку рівня адипокінів у плазмі крові та показники жорсткості артеріальної стінки великих артерій (аорти та її гілок) спостерігали 30 пацієнтів (з них 18 — жінки) з цукровим діабетом 2-го типу віком 60,10 ± 1,08 року із серед-ньою тривалістю основного захворювання 5,7 ± 0,9 року. Результати. Порівняно з початковими значеннями відзначено покращення показників вуглеводного обміну. Так, рівень HbA1c знизився на 1,7 % (р < 0,001), глікемії натще — на 22 % (р < 0,001), постпрандіальної глікемії — на 44 % (р < 0,001). Крім того, на тлі терапії спостерігалося покращення ліпідного обміну: зниження загального холестерину на 13,2 % (р < 0,01), холестерину ліпопротеїнів низької щільності — на 19,3 % (р < 0,01), тригліцеридів — на 30,6 % (р < 0,05). Спостерігалися зміни рівня адипокінів у плазмі крові: зниження рівня адипонектину з 5,98 ± 0,52 мг/мл до 4,45 ± 0,29 мг/мл (р < 0,01), а також тенденція до збільшення рівня лептину в плазмі крові з 14,6 ± 2,3 нг/мл до 18,12 ± 2,90 нг/мл (р > 0,05). Зміни швидкості пульсової хвилі в аорті та аортального індексу аугментації були статистично незначущими (р > 0,05). Зміни антропометричних показників (ваги, індексу маси тіла, окружності талії і стегон), а також загальної кількості жирової тканини, визначеної методом імпедансометрії, були статистично незначущими (р > 0,05).Висновки. Комбінована цукрознижувальна терапія глімепіридом і метформіном SR упродовж 12 тижнів призвела до статистично значущого покращення вуглеводного та ліпідного обміну, не впливала на антропометричні показники й загальну кількість жирової тканини, запобігала прогресуванню артеріосклерозу великих судин за даними показників жорсткості артеріальної стінки.

Effectiveness of personalized selection of antihypertensive therapy based on genetic polymorphism

Abstract Recent data indicate that it is important to develop the problem of genetic polymorphism in patients with arterial hypertension (AH) for the long-term possibility of using it as a justification for choosing the optimal treatment strategy. Currently, despite the availability of effective antihypertensive agents, the percentage of patients who have reached the target blood pressure level remains still not enough. A rational basis for choosing a particular class of drugs and / or their combinations in a concrete patient with AH can be the detection of genetic markers that determine the degree of sensitivity to therapy, since the relationship of its effectiveness with the genetic features is not in doubt today. Material and methods The work is based on the results of a clinical, instrumental, laboratory and genetic examination of 41 patients with AH with insufficient effectiveness of previous antihypertensive therapy. The median age and duration of the disease were 54 (32; 70) years and 7 (1; 20) years, respectively. Taking into account the identified gene polymorphism, a fixed combination of an ACE inhibitor (perindopril 10 mg) and a thiazide-like diuretic (indapamide 2.5 mg) was assigned. The comparative dynamics of blood pressure daily monitoring, left ventricle echocardiographic parameters, as well as indicators of vascular wall stiffness were analyzed before therapy and 3 months later. Results The study established a relationship between the clinical and morpho-functional features of AH in the examined patients with polymorphism of the AGT, AGTR2, CYP11B2, GNB3, NOS3 genes:-786 of their heterozygotes and “mutant” homozygotes, of which 3 polymorphic genes (AGT, AGTR2, CYP11B2) encode the activity of ACE. The obtained results allowed to establish that positive dynamics of the studied indicators was revealed in all patients. Though patients, carriers of the mutant allele C of polymorphic marker T704C AGT gene, had statistically significant more expressed benefit changes in blood pressure daily profile, echocardiographic parameters (such as left ventricular mass index, indicators of left ventricular diastolic function) and all parameters of arterial wall stiffness compared with patients who do not carry the “mutant” allele. Conclusion Thus, the selected treatment regimen demonstrated maximum antihypertensive, cardio - and vasoprotective effectiveness in the group of AH patients with the presence of the allele 704C of the polymorphic marker T704C of the AGT gene, which indicates the perspectivity of using genetic approaches to develop personalized tactics of AH patients drug treatment. Funding Acknowledgement Type of funding source: None

Changes in Arterial Wall Stiffness in Patients with Obesity and Paroxysmal Form of Atrial Fibrillation

Aim. To study changes in vascular wall stiffness in patients with obesity and paroxysmal atrial fibrillation (AF) during sinus rhythm retention.Material and methods. The study included 86 obese patients aged 38 to 72 years. Patients were divided into 2 groups: 42 patients with paroxysmal AF and obesity (Group I) and 44 patients with obesity and without rhythm disturbance (Group II). All patients were evaluated for the main parameters of arterial wall stiffness: the heart-ankle vascular index (CAVI) and the ankle-brachial index (ABI) in the right and left main arteries.Results. Body mass index (BMI) did not differ significantly between groups. The prevalence of visceral obesity in patients with paroxysmal AF was significantly higher than in patients without heart rhythm disorders. The study of vascular wall rigidity revealed a significant increase in the CAVI index in patients with paroxysmal AF compared with this in patients without cardiac arrhythmia. The average value of the CAVI index was 9.61±1.51 and 7.92±0.18, respectively (p=0.0003). In patients with obesity and paroxysmal AF, correlations were found between waist circumference to hip circumference (WC/HC) ratio and CAVI index (r=0.455, p=0.004); WC/height ratio and CAVI index (r=0.443, p=0.003); between WC and CAVI index (r=0.493, p=0.002). A positive direct relationship was found between CAVI index and the frequency of AF attacks during the year: r=0.782 (p=0.001).Conclusion. A significant increase in the CAVI index, indicating a change in vascular wall stiffness, was found in patients with obesity and paroxysmal AF when compared with overweight patients without heart rhythm disorders. The increase in the CAVI index was correlated with the increase in WC, the WC/HC ratio, and WC/height ratio. There was a significant direct relationship between the CAVI index and the frequency of arrhythmia attacks in patients with obesity and paroxysmal AF.

Age-related differences in blood pressure, ultrasound-derived arterial diameters and arterial wall stiffness parameters in horses.

Arterial rupture mainly affects older horses. The reason why older horses are more prone to arterial rupture and which underlying vascular changes predispose older horses to aortic rupture is still unclear. To investigate the effect of ageing on the equine arterial wall and blood pressure. Cohort study. Non-invasive blood pressure measurement using a tail cuff and vascular ultrasound from aorta, common carotid artery and external iliac artery was performed in 50 healthy young (3-7years) and 50 healthy old Warmblood horses (>18years). Arterial diameters and cross-sectional areas, and arterial wall thickness were measured offline. Regional arterial wall stiffness of the aorta and common carotid artery were assessed using pulse wave velocity, while lumen area/diameter change, strain, compliance and distensibility were calculated to assess local arterial wall stiffness. No difference in blood pressure was found between old and young horses. All arterial dimensions and intima-media thickness of the common carotid artery were significantly larger in old horses. A significantly higher local arterial wall stiffness was found for the aorta and the caudal common carotid artery in older horses. For the external iliac artery, no significant differences in arterial wall stiffness were found. Both aortic and carotid pulse wave velocities were higher in older horses compared with younger horses. Blood pressure was measured non-invasively. In horses, arteries stiffen with age, in combination with luminal enlargement and arterial wall thickening. This might, at least partially, explain the increased incidence of arterial rupture in older horses.

Differences in ultrasound-derived arterial wall stiffness parameters and noninvasive blood pressure between Friesian horses and Warmblood horses.

BackgroundAortic rupture is more common in Friesians compared to Warmbloods, which might be related to differences in arterial wall composition and, as such, arterial wall stiffness (AWS). Currently, nothing is known about differences in AWS between these breeds.ObjectivesComparison of AWS parameters and noninvasive blood pressure between Friesians and Warmbloods.AnimalsOne hundred one healthy Friesians and 101 age‐matched healthy Warmbloods.MethodsTwo‐dimensional and pulsed‐wave Doppler ultrasound examination was performed of the aorta, common carotid artery, and external iliac artery to define local and regional AWS parameters. Regional aortic AWS was estimated using aortic‐to‐external iliac artery pulse wave velocity (PWVa‐e) and carotid‐to‐external iliac artery pulse wave velocity (PWVc‐e). Noninvasive blood pressure and heart rate were recorded simultaneously.ResultsSystolic, diastolic, and mean arterial blood pressure and pulse pressure were significantly higher in Friesians compared to Warmbloods. No significant difference in heart rate was found. Most local AWS parameters (diameter change, compliance coefficient, distensibility coefficient) were significantly lower in Friesians compared to Warmbloods, indicating a stiffer aorta in Friesians. This difference could be confirmed by the regional stiffness parameters. A higher PWVa‐e and PWVc‐e was found in Friesians. For the cranial and caudal common carotid artery and external iliac artery, most local AWS parameters were not significantly different.Conclusions and clinical importanceResults indicate that aortic AWS differs between Friesian and Warmblood horses. Friesians seem to have a stiffer aorta, which might be related to the higher incidence of aortic rupture in Friesians.

Aortic, common carotid and external iliac artery arterial wall stiffness parameters in horses: Inter-day and inter-observer and intra-observer measurement variability.

In human medicine, local and regional arterial wall stiffness (AWS) parameters are routinely used to assess the vascular health. In horses, information regarding reproducibility of ultrasonographically derived AWS parameters is lacking. To evaluate the inter-day and inter-observer and intra-observer measurement variability of both local and regional AWS parameters in horses. Experimental study. In 10 healthy, adult Warmblood horses, B-, M-mode and pulsed-wave Doppler ultrasound images were collected on two different days from aorta, cranial and caudal common carotid arteries and external iliac artery. Heart rate and noninvasive blood pressure were recorded simultaneously. From blinded data, diastolic and systolic vessel lumen areas and diameters were measured from B/M-mode images and the velocity of the pressure wave was determined by pulsed-wave Doppler spectra. From each horse, one examination was measured again by the same observer and by a second, independent observer. Local and regional AWS parameters were calculated and inter-day and inter-observer and intra-observer measurement coefficient of variation (CV) were assessed. Low CV was found for both arterial diameter and lumen area measurements. Moderate to high CV was found for local AWS parameters, while regional AWS parameters had low CV. The number of horses investigated was too low to obtain reference values. The inter-operator variability was not evaluated. Our results show good reproducibility of aortic, carotid and external iliac artery diameter and area measurements using both B- and M-mode ultrasonography. Nevertheless, the variability of the derived local AWS parameters was relatively high. Therefore, local AWS parameters might be less suitable for follow-up studies, although they might be useful for population studies. On the other hand, regional AWS parameters showed low CV, making them valuable for both follow-up and population studies.

Influence of combined antihypertensive and hypolipidemic therapy on blood pressure and parameters of arterial wall stiffness in patients with hypertension

Arterial hypertension and atherosclerosis are some of the most global problems in modern medicine. In the last decade more attention is paid to the state of central hemodynamics and arterial stiffness in patients with cardiovascular diseases, including hypertension, as one of the markers of hypertension-mediated organ damage and as a predictor of CV events. The main method of correction and tight control of blood pressure and dyslipidemia is combined antihypertensive and statin therapy. 30 patients with arterial hypertension at stage 2 and high-cardiovascular risk were involved at this study. It was detected that long-term treatment with a fixed combination of lisinopril and amlodipine in combination with rosuvastatin leads not only to normalization of blood pressure, but also to a significant decreasing of central blood pressure and a reduction in pulse wave velocity. This can act as a criterion for the organoprotective action of the combined antihypertensive and lipid lowering treatment.

Alpha-lipoic acid and diabetic cardiac autonomic neuropathy

Alpha-lipoic acid (ALA) supplementation may provide benefits in the prevention of diabetes-related vascular and neuronal comorbidities. The mechanism of ALA influence on diabetic neuropathies pathogenesis is not well-known. Thus, further investigations aimed to understand the mechanism of action and for confirmation of the beneficial effect of ALA on biochemical parameters, dynamics of independent cardiovascular tests daily, monitoring of electrocardiography, arterial wall stiffness parameters among patients with type 2 diabetes mellitus, diabetic neuropathies and its associated comorbidities may be needed to validate this clinical findings.

Differences in the effects of various classes of antihypertensive drugs in combination therapy on indicators of arterial hemodynamics, vascular wall stiffness and structural-functional state of heart in patients with arterial hypertension of 1 — 2 degrees

The aim — to compare the effect of 6‑month treatment of patients with arterial hypertension (AH) of 1 — 2 degrees with angiotensin converting enzyme (ACE) or angiotensin II receptor blockers (ARB) in combination with a thiazide diuretic (indapamide) and dihydropyridine calcium channel blockers (CCB) in combination with a diuretic on indicators of brachial and central arterial pressure (AP), elastic properties of the arteries and the structural and functional state of the heart, depending on age.Materials and methods. The study included 320 patients (156 men and 164 women) aged from 35 to 80 years (mean age 62.8 ± 0.61 years) with uncomplicated AH of stage I — II, degree 1 — 2 (62.0 % and 38, 1 %, correspondingly). Depending on age, the patients were divided into two groups: 0.05). In both subgroups of patients aged 0.05). In the group treated with Arifam, the baseline HR values correlated with AP (r = –0.357, p 0.05). In patients aged ≥ 65 years, the antihypertensive effect of therapy with the combination of ACE inhibitor/ARB and indapamide was not accompanied by changes in MMI LV and indicators of LV systolic and diastolic function (all p > 0.05). In the group treated with Arifam there was a decrease in end‑diastolic and end‑systolic volumes (by 9.7 % (p 0.05).Conclusions. In spite of the same positive effect of 6‑month therapy with combinations of ACE inhibitors/ARB with indapamide and BPC with indapamide on brachial and central AP in older patients with hypertension of 1 — 2 degrees, the fixed combination of BPC amlodipine with indapamide (Arifam) had an advantage over the combination based on an ACE inhibitor (ARB) regarding the reduction of brachial, central, mean brachial and mean central AP, augmentation, pulse wave velocity, MMI of LV, left atrium volume index, E/e’ of LV, which was associated with an increase in heart rate (an average of 4.6 per 1 min).

Информативность показателей жесткости артериальной стенки для скрининговых исследований

comparative assessment of informativity of parameters of arterial wall stiffness - the cardio-ankle vascular index (CAVI), the augmentation index (AI) - for solution of problems of screening patients being under threat of realization of complex impact of metabolic syndrome (MS) and elevated vessel wall stiffness, both creators and markers of high risk of severe cardiovascular complications. We examined mining industry employees (n=206) with cardiac risk factors (arterial hypertension, abdominal obesity, and smoking). Comparative group comprised 75 employees of the same enterprise without above-mentioned risk factors. Studies of arterial wall stiffness included determination of CAVI and AI. The sensitivity, specifcity and accuracy of the screening method were calculated. CAVI and AI parameters had different sensitivity, specifcity and accuracy for identifying patients at risk of cardiovascular complications. AI was 2 times more sensitive than CAVI during examination of patients with only clinical and anamnestic cardiovascular risk markers and patients with clinical-anamnestic and laboratory risk markers. Specifcity of AI was lower than specifcity of CAVI and atained only 34.4% in patients with clinical-anamnestic and laboratory risk factors. At the same time, specifcity of CAVI in these patients reached 86.2%. Accuracy of AI for screening study was 1.4 times higher than that of CAVI in patients with only clinical-anamnestic risk markers, and 1.6 times higher in patients with both clinical-anamnestic and laboratory risk markers. Moreover, after comparing patient groups with individually high and normal CAVI and AI, we found the differences in metabolic laboratory risk factors (glucose, total cholesterol, triglycerides and the Atherogenic Index) only for AI. Parameters of arterial stiffness have different informative value for screening of patients with clinical-anamnestic or laboratory risk factors. AI compared with CAVI is 2 times more sensitive and 1.6 times more accurate but has lower specifcity for risk factor screening among patients being under threat of realization of complex impact of MS and elevated vessel wall stiffness.

Влияние терапии с применением фиксированной комбинации периндоприла и амлодипина на показатели эластичности магистральных сосудов и микроциркуляции у больных артериальной гипертензией и сахарным диабетом 2‑го типа

to assess in patients with arterial hypertension and type 2 diabetes the effect of perindopril / amlodipine fixed combination on arterial wall stiffness (AWF) and microcirculation, and relationship between AWF parameters and the state microcirculation. We included in this study 30 patients aged 45-65 years. All patients received fixed perindopril arginine / amlodipine besylate combination for 12 weeks. Examination included measurement of AWF of main arterial blood vessels and evaluation of the state of microcirculation. Target blood pressure was achieved in 100 % of patients. Mean values of pulse wave velocity of elastic and muscle-type vessels decreased by 8.5 and 10.3 %, respectively; number of patients with paradoxical test also significantly decreased (p>0.05). Shunting index and myogenic tone significantly decreased by 21 and 33.6 %, respectively. We also observed significant reduction of endothelium-dependent tone component (Δ%=36.3 %), significant rise of mean value of perfusion (Δ%=19.7 %), and significant increase of the respiratory test index (Δ%=4.5 %). There was a statistically significant redistribution of patients by types of microcirculation: the percentage of patients with hyperemic type increased from 26.7 to 43.3 %. In patients with arterial hypertension and type 2 diabetes mellitus perindopril arginine / amlodipine besylate fixed combination demonstrated high antihypertensive efficacy, positive effect on parameters of elasticity of main vessels and microcirculation.

Non-invasive assessment of vascular system function and damage induced by anthracycline treatment in the pediatric cancer survivors.

Anthracyclines represent one of the important classes of anti-cancer drugs; however, their major disadvantage is their profound cardiovascular toxicity. This study aimed to evaluate influence of anthracyclines on cardiovascular stiffness parameters estimated from pulse wave (PW). PW was measured in 59 cancer survivors treated with anthracyclines in childhood and in 248 healthy age-matched controls. Both patients and controls were divided into three age groups (13 - 15, 16 - 18 and 19 - 24 years). Central PW augmentation index (C-AI75) and augmentation pressure (C-AP75), both normalized to heart rate 75 bpm, were calculated as parameters of arterial wall stiffness. Central Buckberg sub-endocardial viability ratio (SEVR) was calculated as a parameter of diastolic function. Patients and controls were compared in each age group. C-AI75 and C-AP75 were significantly increased in patients in age groups 16 - 18 and 19 - 24 years. SEVR was decreased in patients in the oldest age group. Our results suggest that although toxic influence of anthracyclines to arterial wall and heart are developing during childhood and puberty, they can be detected rather in the adulthood. These changes are yet subclinical; however, their presence indicates potentially increased cardiovascular risk in childhood cancer survivors treated with anthracyclines during childhood.

PP.34.04] EFFECT OF EPLERENONE ON APNOEA-HYPOPNOEA INDEX IN PATIENTS WITH RESISTANT HYPERTENSION AND OBSTRUCTIVE SLEEP APNEA

Objective: To determine if the addition of eplerenone to the hypotensive treatment reduces the severity of obstructive sleep apnea (OSA) in patients with resistant hypertension and OSA Design and method: 38 consecutive patients with OSA (25 men and 13 women) aged 57.76+/-6.16 were referred to Department of Hypertension with diagnosis of resistant hypertension. Resistant hypertension was defined as uncontrolled hypertension despite the use of at least three hypotensive drugs including diuretics. Exclusion criteria were: secondary hypertension, myocardial infarction, stroke within six months before the study, chronic heart failure NYHA III and IV, chronic kidney failure (GFR<30 ml/min), alcohol or drugs abuse, active cancer. All subjects underwent following examinations: BP measurement with OMRON 705IT sphygmomanometer – mean value from 3 measurements after 15 min. of rest was used; 24-hour ambulatory BP monitoring using 2430TM A&D device; assessment of aortic pulse wave and arterial wall stiffness parameters of the large conduit arteries measured using applanation tonometry method with SphygmoCorPVx system by a single observer. In all patients polysomnography was performed using a all-night polysomnographic monitoring system EMBLA S4000, Remlogic with Somnologica studio 3.3.2 software. Apnea was defined as a cessation of airflow lasting for more than 10 sec. After primary evaluation eplerenone 50 mg once daily was added to existing antihypertensive treatment regimen in all subjects. After 3 months all procedures were repeated. Results: Eplerenone therapy reduced SBP24 h from 144,6+/−9,4 to 135,7+/−4,9 p < 0,05, DBP24 h from 87,8+/−7,9 to 84,1+/−4,9,p < 0,05, MAP24 h from 106,7+/−6,8 to 101,5+/−4,1 p < 0,05, PWV from 15,3+/−1,3 to 12,8+/−2,2 p < 0,05, AoAlx (%) from 31,6+/−4,2 to 27,1+/−4,6 p < 0,05, AlxHR75 (%) from 28,4+/−4,2 to 22+/−5,4 p < 0,05, AHI (/h) from 44,5+/−19,9 to 29,5+/−12,9 p < 0,05. There was a significant positive correlation between AHI and SBP24 h 0,487 p = 0,014, AHI and MAP 24 h 0,477p = 0,016 AHI and PWV 0,659 p = 0,003, AHI and AoAlx 0,436 p = 0,029, AHI and AlxHR75 0,530 p = 0,006. Conclusions: Treatment with eplerenone reduces severity of obstructive sleep apnoea in patients with resistant hypertension.

Role of assessment of arterial wall stiffness in predicting carotid artery atherosclerosis in patients with abdominal obesity

To estimate the possibility of using arterial wall stiffness (AWS) parameters as predictors for carotid artery atherosclerotic plaques (CAAPs) in patients with abdominal obesity (AO). A total of 132 patients (72% men; mean age, 45.0±5.3 years) with normal blood pressure (BP) and AO, and no cardiovascular diseases (CVD) at a SCORE risk of <5% were examined. The investigators analyzed lipid composition of blood, its levels of glucose, uric acid, and creatinine, by calculating glomerular filtration rate and performed 24-hour BP monitoring, by estimating AWS parameters, and triplex scanning of the brachiocephalic arteries. CAAPs were detected in 20 (15.2%) patients. A subgroup of persons with an aortic pulse wave velocity (PWV) of ≥75th percentile (8.0 m/sec for persons aged 31-45 years; 8.3 m/sec for those aged 46-55 years) showed higher rates of carotid atherosclerosis (CA) (44.1% versus 15.2%; p<0.01). The predictors of CAAPs were aortic PWV, average daily aortic systolic BP, and the blood levels of glucose on an empty stomach and uric acid. The analysis of AWS parameters in patients with AO and no CVD at a low SCORE risk may become a potential tool to estimate the likelihood of CAAPs. When the aortic PWV equal or greater than 8.0 m/sec for persons aged 31-45 years and 8.3 m/sec for those aged 46-55 years, CA screening is appropriate for possible further risk reclassification.

Arterial bed stiffness in patients with different cardiovascular risk factors

To investigate the specific features of changes in the arterial wall stiffness (AWS) parameters obtained by sphygmomanometry in patients with different risk factors (RFs) for cardiovascular events (CVEs). A total of 208 mining enterprise workers who had cardiovascular RFs, such as hypertension, abdominal obesity, and smoking, were examined. A comparison group consisted of 75 workers of this enterprise who had no these RFs. AWS was examined using a VaSera VS-1500 (Fukuda Denshi, Japan) to determine CAVI, ABI, UT, %МАР, AI, tb, and tba. The group of patients with a combination of RFs versus the comparison group showed a statistically significant prevalence of virtually all sphygmomanometric indices characterizing AWS, which is suggestive of a less favorable long-term prognosis in this category of patients. The patients having abnormal AWS parameters should be included in a group at risk for cardiovascular diseases and CVEs and their existing RFs be further assessed in detail for a preventive purpose. It is appropriate to incorporate volumetric sphygmomanometry in screening examination programs.

ASSESSMENT OF SITAGLIPTIN INFLUENCE ON ARTERIAL WALL STIFFNESS, RENAL FUNCTION AND RENAL CIRCULATION IN CARDIOVSCULAR PATIENTS WITH DECOMPENSATED TYPE 2 DIABETES

Aim. To study dynamics of stiffness parameters in various type arteries, renal function and renal circulation in arterial hypertension (AH) and ischemic heart disease (CHD ) with decompensated 2 type diabetes mellitus (DM2) on the sitagliptin therapy during 24 weeks. Material and methods. Totally 30 patients included, with decompensated DM2 (HbA1c &gt;7%) and AH, most having also CHD. The dynamics of carbohydrate and lipid metabolisms were assessed, arterial wall stiffness in various structural and functional types, renal function and renal circulation at the background of sitagliptine therapy during 24 weeks. Results. There was no dynamics by the parameters of arterial wall stiffness in various types of arteries, as in renal function and renal circulation among the patients in sitagliptin (n=15) and comparison (n=15) groups. However in those achieved compensation of DM2 on sitagliptin (n=8) we found a decrease of stiffnes index β of brachial artery (muscular type) by 37% from baseline (p&lt;0,01). There was no dynamics of stiffness in muscle-elastic or muscular types of arteries. Conclusion. In patients with hipertension disease and ischemic heart disease with DM2 on glucoselowering therapy there was no dynamics by the parameters of aortic, common caritid artery stiffness and renal circulation during 6 months followup. However on the therapy by dipeptidilpeptidase-4 inhibitor (sitagliptin) during 6 months and compensation of DM2 (HbA1c &lt;7%) there was a decrease of brachial artery stiffness (muscular type).

Stiffness of the Arterial Wall and Central Hemodynamics During Long-Term Combination Antihypertensive Therapy

Aim of the METR study - to assess effect of antihypertensive therapy with fixed combination of angiotensin converting enzyme inhibitor lisinopril (10 mg) and calcium antagonist amlodipine (5 mg) on parameters of arterial wall stiffness and central hemodynamics in patients with stage I-II essential hypertension (EH) and functional class II-III ischemic heart disease. Combination therapy was associated with persistent lowering of central arterial pressure, decrease of augmentation index and other parameters of arterial wall stiffness, and reduction of left ventricular myocardial mass. These changes have a potential to lower risk of cardiovascular complications and improve prognosis of patients with EH.

Measurement of arterial stiffness in subjects with and without renal disease: Are changes in the vessel wall earlier and more sensitive markers of cardiovascular disease than intima media thickness and pulse pressure?

There is increased cardiovascular (CV) mortality in subjects with chronic kidney disease (CKD). Arterial stiffness in these subjects is increased when compared to a healthy population. Markers of arterial stiffness and intima media thickness (IMT) are predictors of CV mortality. The aim of this study was to investigate whether there is any difference in markers of arterial stiffness and IMT between subjects with normal renal function and those with mild renal disease. The arterial distension waveform, IMT, diameter, and brachial blood pressure were measured to calculate Young's modulus (E) and elastic modulus (Ep) in the common carotid arteries of subjects with normal kidney function (estimated glomerular filtration rate [eGFR] >90) and those mild CKD (stage 2, eGFR 89–60). Data were available for 15 patients with normal kidney function and 29 patients with mild CKD. The subjects with mild CKD were older, but other co-variables were not significantly different. Both arterial wall stiffness parameters (E and Ep), but not IMT were significantly higher in the mild CKD group. Logistic regression demonstrated that only the arterial wall stiffness parameters (Ep and E) were independently associated with mild renal disease compared with normal, in a model adjusting for sex, age and diabetes and history of cardiovascular disease (CVD). E and Ep may be early markers of CVD in subjects with mild CKD that may manifest change before other more recognized markers such as IMT and pulse pressure.

Arterial wall stiffness in patients with essential hypertension at young age.

Research objective was investigating arterial wall stiffness in patients with hypertension at young age and assessing the relationship between subclinical target organs damage and ambulatory blood pressure monitoring (ABPM) parameters. 30 male patients aged 18-35 years with essential hypertension stage I and II, hypertension 1 and 2nd grade were surveyed. The examination included general clinical methods, echocardiography, ABPM and suprasystolic sfigmography. It was found that the pulse wave velocity (PWVao) (r = 0,557 p <0,01), central aortic blood pressure (SBPao) (r = 0,492 p <0,01) and augmentation index (AIxao) (r = 0,489 p <0.01) significantly increased with the pa­tients’ age. Abdominal obesity (r = 0,566 p <0,01) and BMI (r = 0,599 p <0,01) impacted on the PWVao acceleration. Increasing of the left ventricular mass index (LVMI) is highly associated with SBPao (r = 0,506 p <0,05) and PWVao (r = 0,434 p <0,05). According to ABPM the most significant correlation with arterial wall stiffness parameters demon­strated diastolic blood pressure (DBP) daytime level (AIxao (r = 0,418 p <0,01), with PWVao (r = 0,699 p <0.01) and SBPao (r = 0,695 p <0,01)). Thus, age, excessive body weight and obesity should be considered as unfavorable factors that worsen arterial wall stiffness in patients with hypertension at the age before 35 years. Increase of DBP levels especially during the day causes maximum negative impact on the arterial wall stiffness parameters according to ABPM. Increased SBPao and PWVao in patients with hypertension at a young age are associated with increased left ventricular mass index.

Association of arterial stiffness and cardiovascular system remodeling in patients with hypertension

Aim. To study the indices of arterial wall local stiffness and it association with structural and functional parameters of cardiovascular system remodeling in hypertensive patients. Methods. Cross-sectional population study included 213 industrial workers, among them 106 patients with stage I-II hypertension and 107 healthy individuals. The stage of arterial hypertension and additional cardiovascular risk category was performed in accordance with national guidelines. All patients underwent echocardiography, carotid arteries ultrasonography, including arterial stiffness evaluation. Results. In patients with hypertension, significant association of arterial wall stiffness indices and «intima-media» complex thickness (total impact of 91%) and echocardiographic parameters describing the left heart chambers volume were revealed. The fact of identifying the relatively high rate of altered arterial wall stiffness parameters, as well as its association with «intima-media» complex thickness in healthy individuals with normal blood pressure (total impact of 81%) may suggest that vascular wall rigidity change may premise vascular remodeling. Conclusion. Arterial wall stiffness indices may be a marker of effective control of risk factors in individuals with normal blood pressure and effect of drug therapy in patients with hypertension.