Blood Pressure Figures Research Articles

Increased lipoprotein (a) as an additional factor in the failure to achieve target blood pressure levels and lipid spectrum optimal parameters in patients with arterial hypertension and multifocal atherosclerosis

Aim. To establish the frequency of achieving target of blood pressure (BP) levels and lipid spectrum parameters (LS) in patients with arterial hypertension (AH) and multifocal atherosclerotic lesion (MFAL) with normal and elevated levels of lipoprotein (a) (Lp(a)) in real clinical practice.Material and methods. The study included 110 patients with AH and MFAL, median age was 59.0 (51.0; 64.3) years. Depending on the level of Lp(a), all patients were divided into 2 groups: group 1 — 72 patients (65.5%), Lp(a) level was ≤50 mg/dl (13.2 (3.7; 21.1)), group 2 — 38 patients (34.5%) Lp(a) level was >50 mg/dl (89.5 (62.5; 110.0)). The diagnosis of MFAL included damage to two or more arterial basins according to carotid artery, abdominal aorta and lower extremities arteries duplex scan. Patients of both groups received antihypertensive, lipid-lowering, and antiplatelet therapy.Results. Patients in groups 1 and 2 showed similar blood pressure levels and frequency of antihypertensive therapy use. In both groups, the majority of patients were on a free combination of antihypertensive drugs, only a third of patients used a fixed combination. In most cases, patients of both groups did not reach the target blood pressure levels (63.9% — group 1, 55.3% — group 2), despite the fact that the average blood pressure figures were relatively low (132;83 mmHg in each group). Drug control was also unsatisfactory in both groups, regardless of the level of Lp(a). However, all drug indicators were significantly worse in group 2, despite comparable lipid-lowering therapy, which more often included statin monotherapy. Combination therapy with lipid-lowering drugs was used in patients of groups 1 and 2 only in 20.8% and 10.5%, respectively. Parameters of low-grade inflammation high-sensitivity C-reactive protein and interleukin-6 did not differ between the groups and did not exceed the reference values.Conclusion. An increased level of Lp(a) may be accompanied by drug disorders and increased BP in patients with MFAL. Due to the lack of effective Lp(a) reducing therapy, the prevention of cardiovascular events in such patients should focus on BP and lipid spectrum correction. The use of fixed combinations, including antihypertensive and lipid-lowering drugs, can lead to improved adherence to therapy, increased BP and LS control.

P133 ALTERED P-WAVE DISPERSION IN NEWLY DIAGNOSED YOUNG HYPERTENSIVES

Background and objective: P wave dispersion (Pd) is a useful electrocardiographic marker for predicting the onset of atrial fibrillation. It has been little studied in recent hypertension. The aim was to determine the behavior of maximum P wave duration (Pmax) and Pd in young hypertensive patients with recent onset and its relationship with other variables. Methods: A cross-sectional, prospective, comparative study was performed in 60 young men (30 hypertensive and 30 non-hypertensive). P wave measurements were obtained with 12-lead electrocardiogram. Statistical analysis included applications of simple linear correlation, sample means were compared by Student's t-test. Results: There were no significant differences in the baseline characteristics of both groups. Pmax (78.67 ± 5.71 ms) and Pd (42.33 ± 6.26ms) were found to be significantly prolonged (p<0.001) in the hypertensive group compared to normotensive subjects (Pmax 61.00 ± 7.69 ms; Pd 25.00 ± 8.61 ms). Pd correlated significantly (r = 0.716; p<0.001) with systolic and diastolic blood pressure (r = 0.696; p<0.001). Conclusions: Pmax and Pd are found to be increased in young patients with recent-onset hypertension, and these values increase in direct proportion to blood pressure figures.

#1182 Arterial hypertension and chronic obstructive pulmonary disease—problems of choice of therapy

Abstract Background and Aims The development of hypertension in COPD is based on the early formation of endothelial dysfunction in the small and large circulatory circles, increased sympathetic activity with an imbalance in the synthesis of catecholamines, a violation of the role of the lungs in the metabolism of vasoactive substances, oxidative stress, chronic systemic inflammation, an imbalance in the renin-angiotensin-aldosterone system (RAAS). There are few studies confirming the role of RAAS components in the pathogenesis of cardiovascular changes in patients COPD. The activity of angiotensin converting enzyme (ACE) increases with hypoxia, which may play an important role in increasing the degree of systemic hypertension. An increase in the function of the RAAS is possible both under the direct influence of hypoxia and indirectly through activation of the sympathoadrenal system. To evaluate the efficacy and tolerability of the angiotensin II receptor antagonist valsartan (Nortivan) at a dose 80-160 mg per day in patients with hypertension of 1-2 degrees and COPD of stage II-IV. Method The study design is a local, open, incomparable study on the efficacy and safety of the drug Nortivan in patients with hypertension in combination with COPD. We examined 18 patients with stage II-IV in remission, suffering from grade I and II hypertension, determined in accordance with the generally accepted classification of blood pressure levels (VNOK, 2010). Results The criteria for exclusion from the study were the presence in patients of complications of hypertension, coronary heart disease, decompensated chronic pulmonary heart, endocrine diseases requiring drug correction, kidney pathology, chronic heart failure, oral steroid therapy. 10 days in the last 6 months before inclusion in the study, oncological diseases and any other conditions that could interfere with the interpretation and evaluation of the results of the study. Patients who had not previously received antihypertensive treatment were included in the study immediately, and the rest underwent a washing period for 2 weeks. Patients received Nortivan as antihypertensive therapy for 24 weeks. The effectiveness of therapy was controlled by daily monitoring blood pressure. The choice of quality criteria for the effectiveness of therapy parameters SMAD is associated with literature data and own observations on the prevalence of diurnal blood pressure profiles in patients with hypertension and COPD with no decrease or increase in blood pressure at night, when office blood pressure figures are to a lesser extent reflect the effectiveness of antihypertensive therapy. The initial dosage was 80 mg/day. With insufficient hypotensive effect, the dose of the drug was doubled at the 4th week of treatment. The basic COPD therapy did not change throughout the study period and included anticholinergic drugs (ipratropium bromide, tiotropium bromide), beta2-adrenomimetic (fe-noterol) or a combination thereof. Initially and after 24 weeks of treatment, a complete laboratory examination was performed: a clinical blood test, a biochemical blood test. The thickness of the intima-media complex of the carotid arteries and ECG was also studied. The criterion The safety of the therapy was assessed by the indicators of respiratory function, daily pulse oximetry. Conclusion The use of the drug Nortivan has shown high efficacy and safety in patients Grade I–II hypertension in combination with stage II-IV COPD. A statistically and clinically significant normalization of SMAD indicators with correction of pathological types of daily curves due to a decrease in the number of patients with an increase in or the absence of a decrease in blood pressure during the night period. The safety of using the drug in the clinical group with bronchial obstruction syndrome was confirmed by the dynamics of ventilation indicators according to spirometry and the results of daily pulse oximetry, which showed the absence of exacerbation of hypoxia during therapy.

MONITORING OF ACUTE TENSION (BLOOD PRESSURE) INCREASES DETECTED IN HOSPITAL EMERGENCIES

Objective: To assess whether, after an acute increase in blood pressure in the hospital emergency department, the control objectives are subsequently achieved in primary care. Design and method: Cross-sectional descriptive study assessing blood pressure figures in the Emergency Department, the days elapsed until the first visit to the Primary Care Center since the incident and until the visit in which minimal control has been obtained (defined as blood pressure <140/90 mmHg). Results: 96 patients were preselected, of which only 85 met the inclusion criteria for the study, 49 women, mean age was 69 years, 72 had a previous diagnosis of Hypertension with a mean of 10 (standard deviation +/- 9) years of evolution, 66 with previous pharmacological treatment, 20 had been referred from Primary Care. The mean systolic blood pressure on arrival at the emergency room was 181 mmHg (standard deviation +/- 20) and at discharge 152 mmHg (standard deviation +/-18.5), the diastolic blood pressure on arrival at the emergency room was 91 mmHg (standard deviation +/- 16) and at discharge 82 mmHg (standard deviation +/-11.7). From the 85 patients included, 84 followed primary care controls (98%) and 60 achieved control of arterial hypertension (70.5%), with a median in days of 12 (interquartile range 3-35) and 90 respectively (interquartile range 26.5-147.5). Conclusions: This study allows us to know that a high percentage of patients consult the Primary Care after an acute increase in blood pressure but interventions could be proposed to further reduce the time of this coordination in some cases. The blood pressure goal was achieved in 70.5% of the patients, so the causes of suboptimal control in the remaining patients would have to be reviewed.

FEMALE GENDER: AN INDEPENDENT PREDICTOR OF HIGH NORMAL BLOOD PRESSURE IN LONG -TERM ADULT SURVIVORS OF CHILDHOOD, ADOLESCENT AND YOUNG ADULT CANCER

Objective: Determine the blood pressure profile in longterm adult survivors of childhood, adolescent and young adult cancer. Determine predictive factors for abnormal blood pressure figures in these patients. Design and method: 104 patients aged over 18, who had received chemotherapy with or without mediastinal radiotherapy for the treatment of neoplasia diagnosed and treated before the age of 21. High blood pressure was defined by a SBP > = 140 mmHg and/or DBP > = 90 mmHg or by the use of antihypertensive drugs. High normal blood pressure corresponded to a SBP between 130 mmHg and 139 mmHg and/or a DBP between 85 and 89 mmHg. Results: Male predominance (56.7%) with a sex ratio of 1.3. Mean current age 25.12 +/-5.40 years, age at diagnosis 13.4 ±5.13 years, duration since end of treatment of cancer 10.67 +/-5.80 years, BMI 22.77 ±4.66 kg/m2, male waist circumference (WC) 82.7 ±12.6 cm, female (WC) 78.6 ± 10.4 cm, SBP 114.5 ±11.7 mmHg, DBP 74.2 ±7.4 mmHg. Chemotherapy alone 80.8%, chemotherapy + mediastinal radiotherapy 19.2%, anthracyclines 100%, platinum salts 32%, corticoids 9%. Low HDL-cholesterol 44.7%, high normal blood pressure 24.3%, abdominal obesity 15.8%, hypertriglyceridemia 9.7%, obesity 8.7%, prediabetes 6.9%, fasting plasma glucose > = 110 mg/dl 6.9%, metabolic syndrome (MS) 3.8%. Multivariate study: Gender (OR = 3.32 95% CI 1.11 - 9.92 p=0.03) - MS (OR = 0.07 95% CI 0.06 - 0.81 p=0.03). Conclusions: Nearly a quarter of the patients in our study (24%) had a high normal blood pressure, which was associated with female gender and the presence of metabolic syndrome. These results confirm the need for early screening of cardiovascular risk factors, particularly hypertension, in long-term adult survivors of childhood, adolescent and young adult cancer.

Corticoadrenaloma: A case report from the pediatric haemato-oncology and pediatric endocrinology departments at the Hassan II University Hospital of Fez

Adrenocortical carcinoma is a rare tumor, representing 0.2% of pediatric cancers. Diagnosis is made on a combination of clinical, biological, radiological, and anatomopathological arguments. Treatment involves tumor excision surgery, sometimes supplemented by chemotherapy for forms with a high risk of recurrence. Prognosis is often reserved, with a non-negligible death rate. This report presents three cases of adrenocortical carcinoma treated at our institution between 2017 and 2023. The patients were three girls aged 5 years, 8 months, and 11 years, respectively. They were admitted for signs of hyperandrogenism and arterial hypertension. The tumor was left adrenal in all patients. The histological score was Severe Weiss 6 or 7. All patients underwent tumor resection, and they all benefited from this procedure. Despite chemotherapy in one patient, normalization of blood pressure figures postoperatively, two patients progressed to recurrence and subsequently died. The objective of this study is, through three observations, to describe the problem of the management of adrenocortical carcinoma (ACC) on the one hand, and to review the literature on the management and the prognosis of corticosteroid ACC in children.

Impact of diabetes on cardiovascular risk in patients with dyslipidemia

To determine the impact of diabetes on cardiovascular risk in patients with dyslipidemia. Observational, cross-sectional and comparative study in which cardiovascular risk was determined at 10 years in 100 patients with dyslipidemia, of these, 50 non-diabetic patients and 50 diabetic patients. Both groups had similar characteristics in terms of age, blood pressure figures, average body mass index, and HDL and LDL levels. It was observed that the diabetic group has almost double the risk compared to the dyslipidemia group, 13.7 vs. 7.9 (p = 0.014), and the calculated heart age is also higher in patients with diabetes, 80 vs. 66 years (p = 0.003). Even in patients with diabetes there is a greater difference between the real age and the age of the heart, 24 years vs. 15 years of patients without diabetes (p = 0.000). Having diabetes and dyslipidemia doubles the cardiovascular risk of patients. Little metabolic control was found in the population studied, which significantly increases complications at an early age and the economic burden on the health system and the families of patients, so it is necessary to rethink treatment strategies to improve metabolic control and with it the prognosis for the patient in the long term.

Uncontrolled blood pressure and its risk factors among hypertensive patients, Marrakech, Morocco.

Hypertension is a public health problem. Failure to control blood pressure figures is responsible for morbidity and premature mortality. This study aims to describe the characteristics of hypertensive patients followed at primary health care centers in Marrakech. Between May 2021 and December 2022, a cross-sectional study of 922 hypertension patients attending primary health care centers in Marrakech was done. To gather socio-demographic, behavioral, and clinical data, as well as hypertension treatment features and the care-patient-physician triad, a face-to-face questionnaire was employed. To identify risk factors associated with uncontrolled blood pressure, multivariate logistic regression was used. Uncontrolled blood pressure was found in 73.5% of people. The patients' average age was 63.4 ± 9.4years (mean ± standard deviation), and 524 (77.3%) were women. Tobacco consumption (Adjusted Odd Ratio of 4.34; 95% CI [1.58-11.9]); lack of self-monitoring of hypertension (AOR of 1.69; 95% CI [1.14-2.52]); a family history of hypertension (AOR of 1.58; 95% CI [1.12-2.22]); overweight or obesity (AOR of 1.73; 95% CI [1.15-2.58]); and nonadherence to antihypertensive medication (AOR of 1.58; 95% CI [1.05-2.38]) were identified as risk factors for uncontrolled blood pressure. In hypertensive individuals, the percentage of uncontrolled blood pressure is considerable. It is essential to provide therapeutic education classes for hypertension patients in order to strengthen their power and autonomy in managing their hypertension.

Differential Diagnosis of Cardiac Amyloidosis and Hypertrophic Cardiomyopathy

Diagnosis and differential diagnosis of cardiac amyloidosis and hypertrophic cardiomyopathy is difficult in some cases, which is confirmed by the presented clinical observation. The patient A., 67 years old, from the age of 59 for 7 years suffered from arterial hypertension with a maximum blood pressure of 170/100 mmHg, received hypotensive therapy. Myocardial infarction, a history of stroke denies. Since January 2018, at the age of 65, against the background of spontaneous stabilization of blood pressure figures, shortness of breath when climbing to the 2nd floor, lifting weights, suffocation at night, swelling of the shins, feet, in connection with which I turned to a doctor. When examined on an electrocardiogram, a low voltage of QRS complexes in the leads from the extremities was noted, there was no increase in the amplitude of the r wave in V1–3. Echocardiography revealed a thickening of the interventricular septum and the posterior wall of the left ventricle up to 1.9 cm without obstruction of the outlet of the left ventricle, restrictive type of diastolic dysfunction, dilation of the left and right atria, moderate pulmonary hypertension, moderate amount of fluid in the pericardial cavity. Magnetic resonance imaging of the heart revealed a pattern typical of cardiac amyloidosis: diffuse subendocardial contrast of the myocardium of both ventricles in the absence of local contractility disorders, increased myocardial thickness in all segments, hydropericardium. Biopsy of the skin and subcutaneous fat with Congo red staining and polarization microscopy revealed no amyloid deposits. No mutations in the transthyretin gene responsible for transthyretin amyloidosis (ATTR–amyloidosis) were detected during the genetic study. Sequencing of 10 genes encoding myocardial sarcomeric proteins in the MYBPC3 gene revealed a mutation c.3197C >G (p.Pro1066Arg) in a heterozygous state, previously described in patients with hypertrophic cardiomyopathy of Slavic origin. Cascade family screening for the mutation was not carried out due to the fact that the patient did not know the father, the mother died at the age of 75 from heart failure, the only son died from an accident six months before the patient’s treatment. On 15.02.2019, the patient suffered a circulatory arrest with successful resuscitation measures. For the purpose of secondary prevention of sudden cardiac death, a single–chamber cardioverter-defibrillator was implanted on 22.02.2019. Despite the ongoing therapy, the patient died in March 2019. from progressive heart failure. Thus, a clinical case is presented where magnetic resonance imaging suspected amyloid cardiomyopathy, which did not receive morphological confirmation in biopsies of extra–cardiac localization. Hypertrophic cardiomyopathy caused by mutation c.3197C >G (p.Pro1066Arg) in the MYBPC3 gene was confirmed on the basis of clinical and instrumental and molecular genetic methods. The pattern characteristic of cardiac amyloidosis described in this patient with instrumental examination methods may be due to a violation of autophagy processes previously described with a number of mutations in the MYBPC3 gene, which may lead to the accumulation of amyloid-like inclusions in cardiomyocytes. For differential diagnosis of cardiomyopathies in complex cases, endomyocardial biopsy may be required. The possibility of coexistence of genetically determined hypertrophic cardiomyopathy and amyloid heart disease is not excluded.

Factors associated with blood pressure control in hypertensive patients

Introduction: the lack of control of blood pressure levels constitutes a serious health problem. Objective: determine the factors associated with blood pressure control. Method: observational, analytical, cross-sectional study, developed between 2021 and 2023, in a sample of 140 hypertensive patients, from office 59, of the Turcios Lima Polyclinic. The documentary review and the application of instruments allowed the obtaining of information that gave rise to the analyzed variables, using descriptive and inferential statistics methods. Results: 55,0 % of the patients did not have blood pressure control, which was associated with age (p<0,001), cohabitation (p<0,001), stress level (p<0,001), trait anxiety (p<0,001) and status (p<0,001). All the risk factors evaluated showed the same behavior, with a median of 10 years since the diagnosis of the disease, with 37,9 % of the sample presenting polypharmacy. Partial adherence predominated in the study (50,7 %), being associated with pressure control (p<0,001). Conclusions: the study allowed us to identify the factors presented by patients that are related to the control of blood pressure levels. For this purpose, the sociodemographic and psychosocial spheres were analyzed, as well as the lifestyle and clinical characteristics, which made it possible to establish the variables that affect a modification of the control of said blood pressure figures.

ANEMIA IN HYPERTENSIVE PATIENTS WITH CHRONIC RENAL FAILURE, WHAT ARE THE CHARACTERISTICS?

Objective: During chronic renal failure, the progressive impairment of kidney functions results in a set of manifestations, initially biological, then clinical. Anemia and high blood pressure are common complications during chronic kidney disease. The aim of this study is to determinate the main characteristics of anemia in hypertensive patients with chronic kidney disease Design and method: This descriptive work is a retrospective cross-sectional study aimed at evaluating the iron status of 70 hypertensive chronic renal failure patients. The average age in this study was 65 years with a male predominance (51%). In our study, 70 patients with chronic renal failure of all stages participated, hypertensive and anemic. The count of the blood elements and the hemoglobin assay were done by optical measurement using the ADVIA® 2120i automaton. The assay of vit B12, folate and ferritin in the blood by enzymatic chemiluminescence. Results: In our study, the mean hemoglobin was 10.18 g/dl, In our series of hemodialysis patients, mean serum ferritin was 276±207.14 ng/ml. In our population, blood pressure averages are of the order of: 130.29 ± 22.33 mm Hg for PAS, and 69.86 ±10.16 mm Hg for DBP. Regarding patients with chronic renal failure not on dialysis 43.5% of patients had serum ferritin low. 50% had normal ferritinemia, and 6.45% of patients had elevated serum ferritin. Ford's study found 2.92% of patients with low serum ferritin, 25.05% had a normal level, and 72.02% had hyperferritinemia. At 26% of patients in our population, the blood pressure figures were > 140/90 mmHg, while 74% of patients reached the target . Conclusions: Chronic renal failure exposes to numerous hematological and cardiovascular type complications, which can themselves induce health problems, in addition Correction of anemia is not always beneficial for patients suffering from CKD in due to increased blood pressure. Perform periodic biological and hormonal analyzes. Recommend lifestyle and dietary measures in all hypertensive patients, chronic renal failure. Carry out awareness campaigns with the general public for a better understanding of chronic kidney disease

Hipertensión arterial en la enfermedad renal crónica

Chronic kidney disease (CKD) is increasingly prevalent worldwide, and it is associated with cardiovascular disease (CVD). Hypertension (HT) is therefore a cause as well as a consequence of CKD, and it affects the great majority of patients with CKD. It is highly important to control HT in individuals with CKD, as this slows down the progression of the disease and also reduces the risk of CVD. Existing treatment guidelines do not agree on the optimum target figures for blood pressure (BP) in this population. It is therefore crucially important to understand the mechanisms which contribute to the appearance of this pathology, to indicate the most suitable treatment to control it appropriately. Although non-pharmaceutical interventions are useful for reducing BP in CKD, they are rarely enough to achieve sufficient control of BP. Patients with CKD and HT often require a combination of antihypertensive drugs to achieve their target BP. Some pharmacological therapies have an action which protects the kidneys and/or the heart independently of their effect on BP, and this should be taken into account when prescribing a therapy. It is important to underline that a personalized and evidence-based management plan is still the key to achieve BP targets, reducing the risk of CVD and slowing down the progress of CKD.

CHARACTERISTICS OF THE HIGH BLOOD PRESSURE IN A TYPE 2 DIABETIC POPULATION IN THE AREA OF BLIDA (ALGERIA)

Objective: The association diabetes-high blood pressure (BP) is frequent. It increases the cardiovascular risk and accelerates the onset of degenerative complications of diabetes. The aim of the present study was to test the effect of the hypertension-diabetes association on the degenerative complications of diabetes and to determine the proportion and the factors associated with uncontrolled hypertension. Design and method: This was a cross-sectional study conducted among 2129 type 2 diabetic hypertensive patients aged 40 years or over, followed in the internal medicine department of hospital of Blida (Algeria), between February 2020 to November 2022. Results: The average age was 46 ± 6.6 years, with a female predominance (73.5%). Hypertension was present in 60.4% of normal weight patients, in 55.1% of overweight patients and 62.8% of obese patients with a significant difference (p = 0.03). Macroangiopathy was observed in 57% of patients with mainly ischemic heart disease (44%). It was significantly more frequent in patients with LDL-c greater than 1.3 g/l and hypoHDLemia less than 0.35 g/l. The proportion of uncontrolled hypertension (BP > 140/90) was 55% including 13% of cases of severe hypertension (BP > 180/110). Resistant hypertension was found in 21% of cases. This poor blood pressure control was correlated with insulin treatment (p = 0.05), insufficient physical activity (p = 0.03), treatment duration greater than 10 years (p = 0.01) and a number of tablets greater than 2 (p = 0.031). We did not find a significant difference between the level of BP control and the seniority of diabetes, the body mass index, the presence of degenerative complications, the intellectual and socioeconomic level. The analytical study showed no positive association between the onset of hypertension and the following factors: the HbA1c level and the duration of diabetes progression. We found a strong correlation between the degenerative complications of diabetes and the presence of hypertension: retinopathy (p = 0.05), neuropathy (p = 0.02), nephropathy (p = 0.001), coronary artery disease (p = 0.001), cerebrovascular accidents (p = 0.01). Conclusions: Our study highlights the positive effect of hypertension on the degenerative complications of diabetes. Optimal control of blood pressure figures is imperative to limit the development of these complications and improve life expectancy.

Nefroangioesclerosis

Nephroangiosclerosis or hypertensive nephropathy is an entity which has been known for some time, and it is defined by the damage caused by hypertension at renal level. Although its incidence and prevalence are not exactly known, it is probably increasing due to the aging of the population. The definitive diagnosis is given by renal biopsy, but in the majority of cases diagnosis is based on clinical data, and it is usually a presumptive diagnosis. These patients have long-term hypertension and kidney disease, and other causes that would explain their deterioration in kidney function have been ruled out. Proteinuria is normally below 1g in 24hours, and the kidney failure is minor. It is also usually associated with other cardiovascular risk factors or with established cardiovascular disease. Treatment is based on controlling blood pressure figures while treating other associated cardiovascular risk factors.

THE ASSOCIATION OF HYPERTENSION AND OBESITY: WHAT IMPACT ON THE LONGITUDINAL SYSTOLIC FUNCTION OF THE LEFT VENTRICLE

Objective: Hypertension and obesity are well known each result in heart failure with preserved ejection fraction. Indeed, there is ample evidence that the accumulation of adipose tissue in obese subjects negatively affects the left atrial and ventricular structure, as well as diastolic and systolic function. Predisposing factors for heart failure with preserved LVEF are advanced age, hypertension, diabetes, dyslipidemia and obesity. The development of the 2D strain has made it possible to make an early diagnosis of ventricular dysfunction in patients with cardiovascular risk factors. Design and method: This work consists of performing in a series of 128 hypertensive patients divided into two subgroups: 58 obese patients and 70 patients with normal BMI. A complete cardiographic echo study was performed in both subgroups, including LVEF by Simpson biplane method, calculation of indexed left ventricular mass and parietal relative thickness, analysis of diastolic function and finally study of longitudinal LV deformation by speckle tracking technique. Results: We note in this work that dyslipidemia and diabetes were significantly more prevalent in the HTA+obesity arm. The average blood pressure figures were slightly higher in the HTA+obesity arm. LVH was clearly predominant in the HTA+obesity arm with a more consequent decrease in the longitudinal contraction index. In obese hypertensive patients, LVH was most often concentric (53.4%). An increase in filling pressures was found in 11 obese hypertensive patients compared to only 4 non-obese hypertensive patients (p = 0.0001), with a good correlation with the decrease in GLS. These results suggest that increased BMI is closely associated with atrioventricular interaction in patients with hypertension, with a perfect correlation with impairment of longitudinal systolic function and diastolic function compared to the control group. Conclusions: Although the pathophysiological mechanism behind obesity is disputed, several possible explanations have been proposed: obesity has been considered a state of chronic volume overload, increased blood volume, neurohormonal activation, thus increasing oxidative stress. Therefore, obesity is associated with mild ventricular dilation (eccentric remodeling). However, this finding is in contrast to other studies that associate obesity with a concentric rather than eccentric remodeling of the LV.

Assessment of Oxidative Stress Markers in Hypertensive Patients under the Use of Renin-Angiotensin-Aldosterone Blockers.

As in other fields, chronotherapy applied to arterial hypertension (AHT) may have implications on oxidative stress. We compared the levels of some redox markers between hypertensive patients with morning and bedtime use of renin-angiotensin-aldosterone system (RAAS) blockers. This was an observational study that included patients older than 18 years with a diagnosis of essential AHT. Blood pressure (BP) figures were measured using twenty-four-hour ambulatory BP monitoring (24-h ABPM). Lipid peroxidation and protein oxidation were assessed using the thiobarbituric acid reactive substances (TBARS) and reduced thiols assays. We recruited 70 patients with a median age of 54 years, of whom 38 (54%) were women. In hypertensive patients with bedtime use of RAAS blockers, reduced thiol levels showed a positive correlation with nocturnal diastolic BP decrease. TBARS levels were associated with bedtime use of RAAS blockers in dipper and non-dipper hypertensive patients. In non-dipper patients, bedtime use of RAAS blockers was also associated with a decrease in nocturnal diastolic BP. Chronotherapy applied to bedtime use of some BP-lowering drugs in hypertensive patients may be linked to a better redox profile.

Using Artificial Intelligence to Develop a Multivariate Model with a Machine Learning Model to Predict Complications in Mexican Diabetic Patients without Arterial Hypertension (National Nested Case-Control Study): Metformin and Elevated Normal Blood Pressure Are Risk Factors, and Obesity Is Protective.

Diabetes mellitus is a disease with no cure that can cause complications and even death. Moreover, over time, it will lead to chronic complications. Predictive models have been used to identify people with a tendency to develop diabetes mellitus. At the same time, there is limited information regarding the chronic complications of patients with diabetes. Our study is aimed at creating a machine-learning model that will be able to identify the risk factors of a diabetic patient developing chronic complications such as amputations, myocardial infarction, stroke, nephropathy, and retinopathy. The design is a national nested case-control study with 63,776 patients and 215 predictors with four years of data. Using an XGBoost model, the prediction of chronic complications has an AUC of 84%, and the model has identified the risk factors for chronic complications in patients with diabetes. According to the analysis, the most crucial risk factors based on SHAP values (Shapley additive explanations) are continued management, metformin treatment, age between 68 and 104 years, nutrition consultation, and treatment adherence. But we highlight two exciting findings. The first is a reaffirmation that high blood pressure figures across patients with diabetes without hypertension become a significant risk factor at diastolic > 70 mmHg (OR: 1.095, 95% CI: 1.078-1.113) or systolic > 120 mmHg (OR: 1.147, 95% CI: 1.124-1.171). Furthermore, people with diabetes with a BMI > 32 (overall obesity) (OR: 0.816, 95% CI: 0.8-0.833) have a statistically significant protective factor, which the paradox of obesity may explain. In conclusion, the results we have obtained show that artificial intelligence is a powerful and feasible tool to use for this type of study. However, we suggest that more studies be conducted to verify and elaborate upon our findings.

КЛИНИКО-ГЕНЕТИЧЕСКИЕ АСПЕКТЫ РЕГРЕССА ГИПЕРТРОФИИ МИОКАРДА ЛЕВОГО ЖЕЛУДОЧКА. РЕЗУЛЬТАТЫ ПРОСПЕКТИВНОГО ИССЛЕДОВАНИЯ В ГОРНОЙ ШОРИИ

Abstract. Introduction. Left ventricular hypertrophy is an independent predictor of adverse outcomes in patients with arterial hypertension. Aim. To evaluate clinical and genetic factors, as well as the effectiveness of antihypertensive drugs classes in terms of regression of left ventricular hypertrophy in the indigenous population of Mountain Shoria within 5-year prospective observations. Material and methods. The study was based on the results of a 5-year observation of the indigenous population of Mountain Shoria. The study included 901 people aged 18 and over. At the one-stage stage (from 2013 to 2017), an anamnesis and complaints were collected, a clinical examination by a cardiologist, anthropometry, a biochemical blood test was performed, and genetic testing of polymorphisms of arterial hypertension candidate genes (ACE (I/D, rs 4340), AGT (c.803T>C, rs699), AGTR1 (А1166С, rs5186), ADRB1 (с.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (С677Т, rs1801133), eNOS (VNTR 4b/4a)), performed electrocardiography, echocardiography. The prospective stage included 263 patients with hypertension without previous antihypertensive therapy. Blood pressure figures were monitored and corrected annually, and left ventricular hypertrophy dynamics was assessed 5 years after inclusion in the study. Statistical processing of the results of the study was carried out using the program "Statistica 10.0". Results and discussion. In the Shors cohort, left ventricular hypertrophy regression was associated with a lower degree of arterial hypertension (odds ratio 1.39) and with the achievement of target blood pressure levels (odds ratio 1.71), as well as with the addition of a diuretic, indapamide retard, to renin-angiotensin-aldosterone system blockers (odds ratio 2.65). In the present study, an association was found between carriage of the D/D genotype of the ACE gene (odds ratio 0.43) and 4a/4a of the eNOS gene (odds ratio 0.35) with negative dynamics in relation to myocardial mass of the left ventricle. With respect to genotype I/I of the ADRA2B gene (odds ratio 2.00) and 4b/4b of the eNOS gene (odds ratio 2.93), an associative relationship with regression of left ventricular hypertrophy was demonstrated. Conclusion. The results obtained once again prove the promise of using genetic approaches for the early diagnosis of left ventricular hypertrophy.

Features of the daily profile of blood pressure, taking into account polymorphism of the angiotensin II type 1 receptor gene in patients with arterial hypertension after myocardial infarction

The article presents the results of a study of the daily blood pressure profile, taking into account the polymorphism of the angiotensin II type 1 receptor gene in patients with arterial hypertension with past myocardial infarction. The study involved 36 men with stage III hypertension, grade 1-3 arterial hypertension, with past myocardial infarction. The average age in the study group was 57.0 (52.0; 64.0) years, the experience of hypertension was 6.3 (4.0; 15.0) years. The average period after a heart attack was 48.0 (12.0; 144.0) months. The study of the type 1 angiotensin II receptor gene on the DNA-sorb-B test system was carried out by the polymerase chain reaction method with the restriction of products by endonuclease. 24-hour blood pressure monitoring was performed according to the standard method. It was found that, in general, in the group, the levels of systolic and diastolic blood pressure according to the median corresponded to the target ones. But the blood pressure load indicators both for the day and separately during the day and at night exceeded the normal range. In an intergroup analysis, significantly higher blood pressure figures and pressure load indices were registered in patients with the CC genotype of the angiotensin II type 1 receptor gene. In addition, this group of patients showed a high incidence of adverse variants of circadian fluctuations in blood pressure. In accordance to the daily monitoring data, only 13 (34.2%) patients achieved the target level of blood pressure: with the AA genotype – in 6 (15.9%) patients, with the AC genotype – in 6 (15.9%) patients and in 1 (2.6%) patient with CC genotype of the angiotensin II type 1 receptor gene. In 4 (10.5%) patients with the AA genotype and in 3 (7.9%) patients with the AC genotype of the angiotensin II type 1 receptor gene, achievement of the target level of blood pressure was registered in the normal range of blood pressure load indices. In other cases, the target level of arterial pressure was accompanied by an increase in pressure load indices, which indicates incomplete daily control of arterial hypertension.

Impact of the HEARTS Initiative in a second-level health institution in ColombiaImpacto da iniciativa HEARTS em um estabelecimento de atenção secundária à saúde na Colômbia

RESUMENObjetivo.Identificar el impacto de la iniciativa HEARTS en los pacientes con hipertensión arterial atendidos en un hospital colombiano.Métodos.Estudio cuasiexperimental, retrospectivo entre 2017 y 2019 con pacientes hipertensos mayores de 18 años, incluidos en la estrategia HEARTS, atendidos en el Hospital Santa Mónica del municipio de Dosquebradas, departamento de Risaralda. La unidad de análisis fue la historia clínica. Se evaluaron las metas de presión arterial (definido en la Iniciativa HEARTS como un paciente con presión arterial sistólica <140 mmHg y <90 mmHg en la presión diastólica) al momento del ingreso al programa HEARTS y un año después. Se incluyeron variables sociodemográficas, farmacológicas, clínicas, metas de presión arterial y cumplimiento de la iniciativa. Se realizaron análisis descriptivos y se aplicó regresión logística binaria (p <0.05).Resultados.Se analizaron 372 pacientes de los cuales 262 eran mujeres (70,4%). La edad media fue de 66,3 ± 12,2 años. En la primera consulta de control se reportaron 285 pacientes (76,6%) que presentaron cifras de tensión arterial en metas, en la segunda consulta este logro fue alcanzado por el 84,1% de los pacientes (n=313 diferencia media: 7,5%, IC95%: 1,8 a 13,1; p=0,005). Después de la implementación de la Iniciativa HEARTS el 77,4% en los pacientes (n=288) continuaron con el manejo inicial. Cumplir las recomendaciones HEARTS aumenta la probabilidad de estar en las metas (p=0,033; OR= 2,688; IC= 1,081 - 6,684).Conclusiones.La implementación de la Iniciativa HEARTS impactó favorablemente las cifras de tensión arterial en pacientes con hipertensión, con beneficios adicionales en variables que disminuyen el riesgo cardiovascular.