Target Blood Pressure Levels Research Articles

The Effectiveness of Combination Antihypertensive Therapy in Women With Hypothyroidism and the Metabolic Syndrome

Evaluating the effectiveness of the various options of combination antihypertensive therapy (AHT) in women with arterial hypertension (AH) and metabolic syndrome (MS) and hypothyroidism. The study included 163 women with hypertension, metabolic syndrome, and hypothyroidism, the median age of 53.5 (48-60) years; in 73 (44.8%) women were diagnosed with subclinical hypothyroidism (SH), 90 (55.2%) - overt hypothyroidism (OH). Patients with both SH and OH, depending on the source of the heart rate (HR) was appointed as one of the following combination of AHT. If heart rate <75 beats/min, patients (n=100) received a combination of the dihydropyridine calcium antagonist (AA) amlodipine 5 mg/day, and angiotensin receptor blockers II (ARB) losartan 50 mg/day, with heart rate >75 beats/min (n=63) - a combination of amlodipine 5 mg/day and imidazoline receptor agonist (IRA) moxonidine 200 micrograms/day. The failure to achieve target blood pressure (BP) after 4 weeks of dose drugs doubled with subsequent evaluation of the effectiveness even after 4 weeks. At baseline and after 6 months of therapy, all patients underwent daily blood pressure monitoring (DBPM). At 8 weeks, the use of a combination of AA+ARB target BP level was registered in 26 (59%) of 44 women with SH and 34 (60.7%) of the 56 - OH. In the group of women who took the AA+IRA, after 8 weeks of the target blood pressure was observed in 24 (82.8%) of 29 patients with SH and 28 (82.4%) of 34 - to OH. Register the target blood pressure was observed significantly more frequently (p<0,05) when using a combination of AA+IRA compared with AA+ARBs as with SH and OH. As a result of the combination of DBPM AA and ARBs in patients with SH and OG provided a significant reduction in average daily, daytime and nighttime systolic and diastolic blood pressure (SBP and DBP), the time index of SBP and DBP during the day and night hours. The therapy of AA and IRA regardless of the severity of hypothyroidism, there was a significant improvement in all indicators DBPM: average daily, daytime and nighttime SBP and DBP, time index and variability in SBP and DBP during the day and at night. Furthermore, as in the SH and OH significantly more pronounced positive changes most DBPM parameters were recorded using IRA in combination with AA compared with a combination AA+ARB. Significant increase in the number of women with optimal BP daily profile "dipper" observed only when using amlodipine and moxonidine. In women with hypertension, hypothyroidism and MS, regardless of the severity of decline of thyroid function and combination of the dihydropyridine AA IRA had an advantage over the AA combination with ARBs, since most patients provided achieving target blood pressure and clinically significant positive impact on BPM indicators. The results can be used in selecting the optimal AHT in patients with hypertension, MS, and the manifest subclinical hypothyroidism.

Decreased Serum Levels of Klotho Protein in Chronic Kidney Disease Patients: Clinical Imortance

To determine the role of serum Klotho (s-Klotho) protein levels changes in patients with different stages of chronic kidney disease (CKD). The study involved 130 patients with CKD stages 1–5D (mean age ― 41±6.7 years). Serum levels of parathyroid hormone (PTH), calcium, phosphorus and s-Klotho protein (ELISA method) at baseline and after 1 year of follow-up were examined in all the patients so as the blood pressure (BP), including central (aortic), pulse wave velocity ― with the help of «Sphygmоcor» (Australia), echocardiography, radiography of the abdominal aorta in a lateral projection were also performed. Ehen comparing the s-Klotho levels in patients with different CKD stages, it was found that the level change associated with the reduction of glomerular filtration rate (GFR) ahead of phosphorus and PTH increase in serum, stared at 3A CKD, whereas hyperphosphatemia and PTH increase started at 4–5 CKD stages. According to ROC analysis, decreasing of s-Klotho levels below 387 pg/ml was indicated a calcification risk of abdominal aorta increased with an 80% sensitivity and 75% specificity. In addition, a strong negative relationship of low s-Klotho levels and heart remodeling was found. When comparing the patients with hypertension who were receiving antihypertensive monotherapy, the highest serum levels of Klotho protein were observed in those of them whose target blood pressure level was achieved primarily through Angiotensin II Receptors Blockers (ARB), compared to those who was administered another drug group (p<0.01) or has not reached the target blood pressure level (p=0,008). The change of serum Klotho levels (decrease) in CKD progression is associated with the degree (increase) of cardiovascular calcification and remodeling (the development of left ventricular hypertrophy, and cardiomyopathy) and it can be seen as an early independent marker of the cardiovascular system lesions in CKD. Our preliminary data of the effect of blood pressure correction on s-Klotho levels may indicate the possibility of drug maintaining serum Klotho levels and it requires further research.

AN OBESE PATIENT “PORTRAIT” BY THE RESULTS OF OUTPATIENT CARDIOVASCULAR REGISTRY “PROFILE”

Aim. To assess the opportunities for registry methodology for comparative evaluation of clinical and anamnestic characteristics of cardiological patients with and without obesity; to draw a “portrait” of the obese patients, common for the cohort studied. Material and methods. The data analyzed from outpatient PROFILE registry during January 2011 to 31 august 2015: totally 1531 primary patient included, of those body mass index (BMI) collected in 1371. In 565 there was obesity of various grade, in 806 BMI was not higher than 30 kg/m2. The analysis done of retrospective data. Results. According to PROFILE results, obesity was found in 41,2% of patients, and those with obesity were younger (p=0,003). Among them men and women number was equa — 50,8% and 49,2%, resp. For the obese there were characteristic presence of dyspnea, oedema and low level of physical activity (p=0,0001). The obese had 1,5-3 times more common arterial hypertension, 2 type diabetes, chronic heart failure (p=0,0001), glucose tolerance disordered (p=0,001), dyslipidemia (p=0,012). Regardless that the obese took medications more commonly (p=0,006), they more rarely reached target level of blood pressure (BP), than those non obese (p<0,05). Almost nobody of those with obesity had prescribed therapy against overweight, except 73 patients that participated in 2 clinical trials. Conclusion. The data from outpatient registry PROFILE has confirmed the main information on obesity in cardiological patients: a “portrait” is drawn of the obese, cardiovascular risk factors (CRF) formulated, and comorbidities. The data demonstrates more difficult achievement of target BP in the obese with regular medication treatment, and highlights insufficient attention of physicians to diagnostics and especially treatment of obesity, as underestimation of the overweight problem by patients themselves.

Control of cardiovascular risk in patients with diabetes

Prevalence of diabetes mellitus (DM) is a version of pandemic, in Russia as well, nowadays. Mortality of patients suffering from DM is associated with the development of macrovascular complications and successful prevention of these complications depends on the complex approach to identify and to correct all modifiable risk factors, included in risk indexes. According to many experts’ point of view, key moments in reducing the risk of cardiovascular complications in patients with DM are to achieve target blood pressure and target levels of lipid metabolism, including the application of non-drug therapies. However, the appearance of new data concerning the possibility of antihyperglycemic therapy, no doubt, will change our point of view on managing cardiovascular risk in patients with DM, in particular empagliflozin, which can influence on cardiovascular outcomes.

Target Blood Pressure for Treatment: Should Current Recommendations Be Changed?

The guidelines on the management of hypertension released by European and US Task Forces in 2013 and 20141,2 recommend target blood pressure (BP) levels below 140/90 mm Hg in most hypertensive patients, with higher values (<150/90 mm Hg) in the elderly. However, recent randomized trials as well as new meta-analyses of the available data have obtained results that are not consistent with these recommendations, rather supporting the possibility for antihypertensive treatment to pursue much lower BP goals in both middle-age and old individuals. Aim of this editorial is to review the results of these recent studies to assess whether any change of BP target during antihypertensive treatment may be proposed. The Systolic Blood Pressure Intervention Trial (SPRINT) was performed in 9361 patients with a high cardiovascular risk and an entry systolic BP (SBP) of 130 to 180 mm Hg3 who were randomized to an intensive (SBP 500 primary events, which gives its conclusion an adequate statistical power. Yet, as mentioned in several commentaries,4,5 some aspects and results of the trial are not easy to be interpreted, suggesting to deal with its conclusion with a degree of caution. For example, SPRINT did not enroll patients …

What Should Be the Target Blood Pressure in Elderly Patients With Diabetes?

Hypertension is very common in elderly subjects with type 2 diabetes. The coexistence of hypertension and diabetes can be devastating to the cardiovascular system, and in these patients, tight blood pressure (BP) control is particularly beneficial. Little information is available regarding the target BP levels in elderly hypertensive patients with type 2 diabetes, and therefore extrapolation from data in the general population should be done. However, it is difficult to extrapolate from the general population to these frail individuals, who usually have isolated systolic hypertension, comorbidities, organ damage, cardiovascular disease, and renal failure and have a high rate of orthostatic and postprandial hypotension. On the basis of the available evidence, we provide arguments supporting the individualized approach in these patients. Target BP should be based on concomitant diseases, orthostatic BP changes, and the general condition of the patients. It is recommended to lower BP in the elderly patient with diabetes to <140-150/90 mmHg, providing the patient is in good condition. In patients with isolated systolic hypertension, the same target is reasonable providing the diastolic BP is >60 mmHg. In patients with coronary artery disease and in patients with orthostatic hypotension, excessive BP lowering should be avoided. In elderly hypertensive patients with diabetes, BP levels should be monitored closely in the sitting and the standing position, and the treatment should be tailored to prevent excessive fall in BP.

The major arteries and skin microcirculatory vessels status and antihypertensive therapy effect on them in hypertensive patients with high and very high cardiovascular risk

Aim: to assess the state of the large blood vessels and skin microcirculatory vessels and the effects of angiotensin II receptor blockers (ARB) on them in hypertensive patients with high and very high cardiovascular risk (CVR). Subjects and methods. We examined 59 hypertensive patients aged 35-60 years, of which 29 high CVR subjects and 30 very high CVR (without antihypertensive therapy within 2 weeks prior to the study). In all subjects the evaluation of target organ damage, laser Doppler flowmetry (LDF) with initial perfusion parameters registration and amplitude-frequency spectrum of LDF-grams analysis, registration of central blood pressure, local stiffness parameters and photoplethysmography (PTMG) were performed. The second study was carried out after 2 weeks of antihypertensive treatment with ARB. Results. A significant increase in endothelial rhythm amplitude and coefficient of variation in very high risk hypertensive patients in comparison with a group of high-risk patients was found. In the group of very high-risk hypertensive patients central arterial pressure, augmentation index and local stiffness values were higher (n/a), the rate of carotid arteries extensibility was significantly reduced. There was a significant large vessels impairment in very high risk group according PTMG data. Target blood pressure level achieved in up to 80% of patients after 2 weeks treatment. During the re-examination a statistically significant improvement in the large arteries was found, LDF parameters also improved, but significant values was not reached. Conclusion. The findings suggest that with increasing degree of CVR in patients with hypertension there is a progressive deterioration of both large vessels and microcirculation state. After short-term antihypertensive therapy the function of large vessels improve in very high risk hypertensive patients, but the state of the microvasculature not changes significantly.

Management of hypertension for patients undergoing dialysis therapy

Hypertension is very prevalent among patients undergoing dialysis therapy: hemodialysis (HD) and peritoneal dialysis (PD). Although it is recognized as a great risk of cardiovascular mortality for these populations, how to regulate blood pressure (BP) is poorly understood. For HD patients, we should pay much attention to methods of measuring BP. Out-of-center BP levels and BP variability should be evaluated by ambulatory BP monitoring and home BP measurement because they are closely associated with cardiovascular mortality. Although target BP levels are not clear, several clinical guidelines suggest <140/90 mmHg. However, it must be determined for each individual patient with careful considerations about comorbidities. Based on the underling pathophysiology of hypertension in patients on dialysis, maintaining an appropriate volume of body fluid by dietary salt restriction and optimization of dry weigh should be considered as a first line therapy. Inhibitors for renin-angiotensin system may be suitable to reduce BP and mortality for those patients on dialysis. These drugs may also be effective for preserving residual renal function and peritoneal function for PD patients. β-blockers may have potentials to improve survival for HD patients and can be added to anti-hypertensive medications. Lacking large-scale and good quality clinical trials, there are many questions to be answered. Much effort should continuously be made to create evidences for better management of hypertension for patients on dialysis therapy.

The results of a survey of physicians about the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2014 and its clinical use.

The current study investigated physicians' awareness and use of the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2014 (JSH2014) and is based on the results of a survey performed by the Publicity and Advertisement Committee of JSH. A questionnaire was used to survey physicians' awareness of the JSH2014, their recommended target blood pressure for hypertensive patients with complications and their use of antihypertensive drugs. Physicians who downloaded a PDF version of JSH2014 during the 6 months after its publication (April-September 2014) were asked to complete an online questionnaire. Of the 7872 respondents, 91% were aware of the JSH and complied partially, mostly or completely with it in their practice. With reference to hypertensive patients, ∼70% of physicians who completed the questionnaire recommended a target blood pressure (BP) of 140/90 mm Hg for an office BP value, and 40% recommended 135/85 mm Hg for a home BP value. Physicians recommended target BP levels of 130/80 mm Hg for patients with diabetes or chronic kidney disease (50-63% of physician surveyed) and for elderly patients with diabetes or kidney disease (45-55% of respondents), whereas they recommended 140/90 mm Hg for elderly patients with low cardiovascular disease risk (56-60% of physician surveyed) and for patients with chronic-phase stroke (40-47% of respondents). The most commonly prescribed combination of antihypertensive drugs was angiotensin receptor blocker (ARB) with calcium channel blocker. In addition, physicians' first choice of drug for patients with diabetes or chronic kidney disease was most often ARB. Overall, the survey results showed that the new recommendations from the JSH2014 accurately reflect daily clinical practices for hypertension management used by Japanese physicians.

PHARMACOTHERAPY OF ARTERIAL HYPERTENSION IN ELDERLY PATIENTS: FOCUS ON OCTOGENARIANS

Pharmacotherapy of arterial hypertension in the elderly is discussed. Russian and international guidelines are presented with a focus on target levels of blood pressure and drugs of choice in these patients. Issues of efficacy and safety of antihypertensive therapy in patients aged 80 years and older are considered.

CLINICAL EFFICACY OF COMBINATION THERAPY WITH PERINDOPRIL AND INDAPAMIDE IN PATIENTS WITH MILD AND MODERATE ARTERIAL HYPERTENSION

Aim: to study hypotensive and organo-protective efficacy of cornbination therapy with perindopril and indanarnide in patients with rnild and rnoderate arterial hypertension. Material and methods. According to the protocol in the study included 23 patients with I-II grade of arterial hypertension (ESC/ ESH 2013), of both genders. All patients took the cornbination preparation Arnra forte (GMP, Georgia), containing 4 тд of perindopril and 1.25 rrig of indaparnide. At the stage before the treatrnent and 12 weeks of therapy was rneasured an office blood pressure by Korotkov's rnethod and carried out arnbulatory blood pressure rnonitoring (ABPM) ("BR-102 plus Recorder" (SCHILLER, Switzerland)). Antirernodeling efficacy was assessed by the dynarnics of cardiac echo geornetry and ultrasound (US) of vessels pararneters. Also was evaluated the clinical tolerance and rnetabolic effects of the drug. The pararneters of central hernodynarnics and vascular stiffness were rneasured by applanation tonornetry. Results are presented as M±SD. Results of research. 12-week cornbination therapy with perindopril and indaparnide is characterized by high antihypertensive efficacy, with a decrease in rnean blood pressure to 18%, and achievernent the target level of blood pressure in 100% patients with rnild and rnoderate arterial hypertension. According to the ABPM showed a significant decrease of average daily SBP and DBP, as well as a significant decrease in the speed of rnorning SBP surge. Thus it was not iriarked episodes of hypotension at night. Reliable antirernodeling efficacy of perindopril and indaparnide is expressed in reducing LVMI, reducing of EDD and reliably reducing the thickness of IMC against the background of 12-week treatrnent. 12-week cornbination therapy with perindopril and indaparnide showed renal protection efficiency, expressing in a significant decrease in blood creatinine level and alrnost twofold reduction of MAU level. Perindopril and indaparnide in the rnode of cornbination therapy in patients with rnild and rnoderate arterial hypertension showed rnetabolic neutrality in relation to lipid and carbohydrate metabolism, clinical safety. A side effect as dry cough was observed in one patient only at the end of 12-weeks treatrnent (4.3%). Conclusion. Therefore, our research showed a high antihypertensive efficacy of cornbination therapy with perindopril and indaparnide with the available cardio-, vaso-, and nefroprotection, rnetabolic neutrality and clinical safety that recommends the preparation for the treatrnent of patients with rnild and moderate arterial hypertension.

Cardiovascular Risk Factor Targets and Cardiovascular Disease Event Risk in Diabetes: A Pooling Project of the Atherosclerosis Risk in Communities Study, Multi-Ethnic Study of Atherosclerosis, and Jackson Heart Study

Controlling cardiovascular disease (CVD) risk factors in diabetes mellitus (DM) reduces the number of CVD events, but the effects of multifactorial risk factor control are not well quantified. We examined whether being at targets for blood pressure (BP), LDL cholesterol (LDL-C), and glycated hemoglobin (HbA1c) together are associated with lower risks for CVD events in U.S. adults with DM. We studied 2,018 adults, 28-86 years of age with DM but without known CVD, from the Atherosclerosis Risk in Communities (ARIC) study, Multi-Ethnic Study of Atherosclerosis (MESA), and Jackson Heart Study (JHS). Cox regression examined coronary heart disease (CHD) and CVD events over a mean 11-year follow-up in those individuals at BP, LDL-C, and HbA1c target levels, and by the number of controlled risk factors. Of 2,018 DM subjects (43% male, 55% African American), 41.8%, 32.1%, and 41.9% were at target levels for BP, LDL-C, and HbA1c, respectively; 41.1%, 26.5%, and 7.2% were at target levels for any one, two, or all three factors, respectively. Being at BP, LDL-C, or HbA1c target levels related to 17%, 33%, and 37% lower CVD risks and 17%, 41%, and 36% lower CHD risks, respectively (P < 0.05 to P < 0.0001, except for BP in CHD risk); those subjects with one, two, or all three risk factors at target levels (vs. none) had incrementally lower adjusted risks of CVD events of 36%, 52%, and 62%, respectively, and incrementally lower adjusted risks of CHD events of 41%, 56%, and 60%, respectively (P < 0.001 to P < 0.0001). Propensity score adjustment showed similar findings. Optimal levels of BP, LDL-C, and HbA1c occurring together in individuals with DM are uncommon, but are associated with substantially lower risk of CHD and CVD.

CLINICAL EFFECTS AND RENOPROTECTIVE FACILITIES OF OLMESARTAN AND LERKANIDIPINEAS MONOTHERAPY AND WHEN COMBINED APPLICATION IN PATIENTS WITH ARTERIAL HYPERTENSION

The evaluation of the clinical efficacy and renoprotective effects of olmesartan and lercanidipine as monotherapy and when combined application in patients with arterial hypertension (AH) 1-2 degrees and microalbuminuria (MAU).It is established that the degree of blood pressure (BP) reduction and corrective influence on diurnal BP profile were similar in groups of monotherapy with olmesartan and lercanidipine. In the group of combined application of the studied drugs target BP levels were achieved in 88% of cases in the monotherapy group and 78% (1G) and 76% (2 G).Revealed renoprotective effects of olmesartan and lercanidipine as when used in monotherapy and in combination in patients with arterial hypertension of 1-2 degrees, and MAU, revealed reliable decrease in MAU. The greatest reduction in MAU was achieved in the combination therapy group.

The Stroke Prevention Programme: a programme of research to inform optimal stroke prevention in primary care

BackgroundThe management of cardiovascular (CV) risk factors in community populations is suboptimal. The aim of this programme was to explore the role of three approaches [use of a ‘polypill’; self-management of hypertension; and more intensive targets for blood pressure (BP) lowering after stroke] to improve prevention of CV disease (CVD) in the community.Research questions(1) Is it more cost-effective to titrate treatments to target levels of cholesterol and BP or to use fixed doses of statins and BP-lowering agents (polypill strategy)? (2) Will telemonitoring and self-management improve BP control in people on treatment for hypertension or with a history of stroke/transient ischaemic attack (TIA) in primary care and are they cost-effective? (3) In people with a history of stroke/TIA, can intensive BP-lowering targets be achieved in a primary care setting and what impact will this have on health outcomes and cost-effectiveness?DesignMixed methods, comprising three randomised controlled trials (RCTs); five cost-effectiveness analyses; qualitative studies; analysis of electronic general practice data; a screening study; a systematic review; and a questionnaire study.SettingUK general practices, predominantly from the West Midlands and the east of England.ParticipantsAdults registered with participating general practices. Inclusion criteria varied from study to study.InterventionsA polypill – a fixed-dose combination pill containing three antihypertensive medicines and simvastatin – compared with current practice and with optimal implementation of national guidelines; self-monitoring of BP with self-titration of medication, compared with usual care; and an intensive target for systolic BP of &lt; 130 mmHg or a 10 mmHg reduction if baseline BP is &lt; 140 mmHg, compared with a target of &lt; 140 mmHg.ResultsFor patients known to be at high risk of CVD, treatment as per guidelines was the most cost-effective strategy. For people with unknown CV risk aged ≥ 50 years, offering a polypill is cost-effective [incremental cost-effectiveness ratio (ICER) of £8115 per quality-adjusted life-year (QALY)] compared with a strategy of screening and treating according to national guidelines. Both results were sensitive to the cost of the polypill. Self-management in people with uncontrolled hypertension led to a 5.4 mmHg [95% confidence interval (CI) 2.4 to 8.5 mmHg] reduction in systolic BP at 1 year, compared with usual care. It was cost-effective for men (ICER of £1624 per QALY) and women (ICER of £4923 per QALY). In people with stroke and other high-risk groups, self-management led to a 9.2 mmHg (95% CI 5.7 to 12.7 mmHg) reduction in systolic BP at 1 year compared with usual care and dominated (lower cost and better outcome) usual care. Aiming for the more intensive BP target after stroke led to a 2.9 mmHg (95% CI 0.2 to 5.7 mmHg) greater reduction in BP and dominated the 140 mmHg target.ConclusionsPotential for a polypill needs to be further explored in RCTs. Self-management should be offered to people with poorly controlled BP. Management of BP in the post-stroke population should focus on achieving a &lt; 140 mmHg target.Trial registrationCurrent Controlled Trials ISRCTN17585681, ISRCTN87171227 and ISRCTN29062286.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme. Additional funding was provided by the NIHR National School for Primary Care Research, the NIHR Career Development Fellowship and the Department of Health Policy Research Programme.

Russian multicentre type 2 diabetes screening program in patients with cardiovascular disease

Aim.To evaluate the prevalence of undiagnosed type 2 diabetes mellitus (T2DM) among patients with cardiovascular disease.Materials and methods.T2DM screening programs among patients with cardiovascular disease were held from 2013 to 2014 in several Russian cities. In total, 1001 patients aged ≥40 years with hypertension and/or atherosclerotic disease and without prior diagnosis of T2DM were screened in outpatient cardiology clinics. T2DM diagnosis was based on fasting plasma glucose levels, glycated haemoglobin (HbA1c) and/or oral glucose tolerance test (OGTT) results. Blood pressure (BP), family history of T2DM, cardiovascular disease, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride levels were analysed.Results.Fasting glucose was measured in 1000 (99.8%) patients, HbA1c was measured in in 623 (62.2%) and OGTT was performed in 286 (2.6%). Fasting glucose detected 8% of newly diagnosed T2DM; among patients who underwentHbA1c measurement, the prevalence of T2DM was 10.91%, and among patients who underwent OGTT, the prevalence was 13.99%. Depending on the chosen test, the prevalence of undiagnosed pre-diabetes (impaired fasting glycaemia and impaired glucose tolerance) was in the range of 14.4%–36.4%. The majority of patients with T2DM diagnosed by OGTT did not have target blood pressure and lipid levels; 67.5% had elevated systolic BP, 47.5% had elevated diastolic BP, 90.9% had high LDL (≥1.8 mmol/l) and 52.9% had high triglyceride levels (≥1.7 mmol/l).Conclusion.A high prevalence of undiagnosed T2DM (from 8% to 13.99%, depending on the diagnostic criteria) and pre-diabetic state in patients with cardiovascular disease may require screening for T2DM in this high-risk group.

ASSESSMENT OF PARAMETERS OF RENAL FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND ABDOMINAL OBESITY WITH A HISTORY OF ACUTE CEREBROVASCULAR ACCIDENT, DEPENDING ON THE TARGET LEVELS OF SYSTOLIC BLOOD PRESSURE IN THE RECOVERY PERIOD OF THE STROKE

Background: Essential arterial hypertension is one of the most common causes of chronic kidney disease. Timely identification of asymptomatic chronic kidney disease may help to prevent development of renal failure and maintain kidney functioning. Aim: To assess changes in renal function parameters in patients with arterial hypertension and abdominal obesity with a history of a stroke, depending on the target levels of systolic blood pressure (SBP) during the recovery period of stroke. Materials and methods: We assessed 88 patients with arterial hypertension with a history of an acute cerebrovascular accident within the last 1 to 6 months (mean age, 58.8±9.5 years). During 2 to 4 weeks of their hospital stay, their antihypertensive treatments were titrated to reach the chosen target levels of blood pressure. Thereafter, the patients were followed up for 8 to 12 months with baseline and follow-up measurements of their antropometric and clinical chemistry parameters including blood urea nitrogen and serum creatinine and estimated glomerular filtration rate (CKD-EPI). Chronic kidney disease was diagnosed by albumin and creatinine measurements with calculation of albumin/creatinine ratio in the morning urine portion. Results: There was a positive correlation between office SBP and serum creatinine (r=0.5, р=0.01), serum albumin (r=0.4, р=0.003) and creatinine in the morning urine portion (r=0,5, р=0.0001). Hip circumference negatively correlated with serum creatinine and albumin/creatinine ration at the end of the follow-up (r=-0.3, р=0.04 and r=-0.3, р=0.04, respectively). Bodyweight correlated positively with the glomerular filtration rate (r=0.3, р=0.04), whereas waist to hip ration correlated with urine albumin at the end of the follow-up (r=0.3, р=0.01). Multiple regression analysis showed an association between mean office SBP and serum creatinine (β=0.43, р=0.04), urine albumin (β=0.33, р=0.02) and urine creatinine level (β=0.39, р=0.005). Conclusion: We found an association between SBP and renal function. SBP levels below 135 mm Hg are associated with an improvement of the renal function, whereas SBP levels below 124 mm Hg are associated with a significant decrease in renal function assessed by glomerular filtration rate and albumin/creatinine ratio. The efficacy of antihypertensive treatment in the recovery period after an acute cerebrovascular accident should be assessed with consideration of renal function measured by glomerular filtration rate and microalbuminuria levels.

Влияние комбинированной антигипертензивной терапии на жесткость артериальной стенки у пациентов мужского пола с артериальной гипертензией, ожирением и синдромом обструктивного апноэ сна

Goal: to study the effectiveness of combination antihypertensive therapy (AHT) and its influence on the indices characterizing the arterial stiffness of various types in patients with arterial hypertension (AH) in combination with obesity and severe obstructive sleep apnea (OSA). Material and methods. The study included 27 male patients with hypertension [143.0 (142.0; 150.0)/91.0 (85.3; 94.8) mm Hg. century], obesity [body mass index of 33.8 (32.0; 37.2) kg/m2] and OSA was severe [the index of apnea/hypopnea - AHI - 46.8 (33.3; 63.4) events per hour] who underwent AHT titration to achieve target values of blood pressure (BP), a fixed combination of the calcium antagonist amlodipine (10 mg) and the angiotensin-converting enzyme inhibitor perindopril (5-10 mg). At baseline and after 4-6 weeks when reaching target blood pressure was assessed pulse wave velocity (PWV) using different instrumental techniques. Carotid-femoral PWV (CFSP) was determined by applanation tonometry (SphygmoСor AtCor, Australia), aortic PWV - ultrasonic technique in the descending aorta (thoracic spine), the ankle-brachial PWV - using volumetric sphygmography (VaseraVS-1000 Fukuda Dens, Japan). Results. The target pressure (according to clinical blood pressure, daily monitoring blood pressure) on the background of amlodipine 10 mg and perindopril 5 mg was 58% patients and 42% of patients reached the target level of blood pressure against the background amlodipine 10 mg and perindopril 10 mg. On a background of 4-6 weeks of admission AHT 33.8% increase in the number of patients with a normal circadian profile of blood pressure - «dipper». Upon reaching the target blood pressure revealed a significant decrease CFSP, ankle-brachial PWV and aortic PWV 11.4, 11.0 and 15.4%, respectively. Conclusion. A fixed combination of perindopril arginine and amlodipine in patients with arterial hypertension of the 1st degree in the presence of obesity and OSA allows achieving a good level of BP control, to improve the performance of the daily profile and to improve the elastic properties of large arteries, which has a beneficial protective effect in these patients.

COMPARISON OF EFFECTIVENESS OF COMBINATION ANTIHYPERTENSION THERAPY IN WOMEN WITH ABDOMINAL OR GLUTEO-FEMORAL OBESITY

Aim. To study the influence of combinational antihypertension therapy including inhibitor of angiotensin converting enzyme (ACEi) or direct renin inhibitor (DRI) on the parameters of 24-hour blood pressure monitoring (ABPM) in postmenopausal women in different obesity patterns. Material and methods. Totally, 168 women studied with arterial hypertension (AH) in postmenopause: 97 with abdominal obesity (AO) and 71 with gluteofemoral (GFO). Patients were randomized to groups of ACEi therapy and diuretic or DRI and diuretic. Follow-up lasted for 24 weeks. Results. In 4 weeks of therapy with the usage of maximal ACEi dosages, target level of blood pressure (BP) was reached in 30 from 42 (71,4%) women with AO and 27 from 32 (84,4%) with GFO, and maximum dose of DRI led to target pressure achievement in 37 from 41 (90,2%) women with AO and 30 from 33 (90,9%) with GFO. Others required addition to the therapy a dihydropyridine calcium antagonist. In 6 months of therapy in all groups of patients there was positive dynamics of the main 24-hour profile parameters. Conclusion . Combination of ACEi or DRI with indapamide retard have significant antihypertension effect in women with AH in AO and GFO. In addition, combination of DRI with diuretic is better than of ACEi that was showed by the prevalence and speed of target BP achievement, more significant dynamics of ABPM parameters and positive changes in patients spread upon physiologic and pathologic types of 24-hour profile in 24-week therapy, especially in AO.

Management of Diabetic Nephropathy

There are a few changes in the management of diabetic nephropathy (DN) in 2015 Korean Diabetes Association (KDA) Clinical Practice Guideline. Among them, restricting protein intake in patients with DN has been in controversy. Several guidelines in other countries recommend not to reduce the daily protein intake less than 0.8 g/kg/day in patients with DN, which is in agreement with the KDA guideline. Although the current KDA recommendation does not comment about high protein intake, several guidelines warn a high protein intake (> 1.3 g/kg/day) since it aggravates the progression of DN. The other issue is a target blood pressure (BP) in DN. It has been recommended that BP should be maintained at a lower level in patients with DN than in diabetic patients without nephropathy. Recently, failure to demonstrate the beneficial effects of lowering BP in reducing mortality or cardiovascular disease lead to increase the optimal BP target in diabetes from 130/80 to 140/90 mm Hg. Therefore, BP target should be individualized based on their comorbidities and life expectancy in DN patients. In this section, we recommend the optimization of BP control to reduce the risk or slow the progression of DN, rather than specify target BP levels.

The prevalence of arterial hypertension in Krasnoyarsky territory: the data from the epidemiology study ESSE-RF

Objective. To estimate the prevalence, awareness, treatment and control of arterial hypertension (HTN) among adult inhabitants of Krasnoyarsky territory based on the data from Russian multicenter epidemiological study ESSE-RF. Design and methods. The study included 1603 subjects 25 to 64 years old selected by the systemic multistage stratified randomization among urban and rural inhabitants of Krasnoyarsky territory. Office blood pressure (BP) was measured twice by the automatic tonometer “Omron” on the right hand in the sitting position. HTN was defined as systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg or self-reported previously elevated BP or use of antihypertensive treatment (HTNT). Treatment efficacy was defined as proportion of achieved target BP among individuals who received HTNT, and BP control was assessed as proportion of achieved target BP level among all hypertensives. Results. The gender distribution was 653 males (40,7%) and 951 females (58,3%). The median level of systolic BP was 133,4 ± 0,5 mm Hg, diastolic BP— 82,9 ± 0,3 mm Hg. The median prevalence of HTN was estimated at 49,4% and appeared to be higher as compared with average Russian parameter 44% (based on the date of 10 regions from the ESSE-RF study). The median prevalence of HTN was estimated at 56,3% in men and 43,7% in women. The HTN prevalence in rural community was significantly higher as compared with urban community (63,4 ± 2,4 vs. 44,2 ± 1,5%, p < 0,01). The median rate of HTN awareness in Krasnoyarsky territory was 77,9% (average rate in Russia based on the ESSE-RF study results was 73,1%). The median rates of HTNT, treatment efficacy and BP control in Krasnoyarsky territory was estimated at 59,5%, 31,6% and 18,8%, respectively. Target BP level was achieved significantly more often among female, than male hypertensives, except those aged 25–34 years. Conclusions. Thus, estimated prevalence of HTN in Krasnoyarsky territory is higher than average Russian indices based on the data of ESSE-RF study from 10 regions. The median HTN prevalence among men is higher than in women. The rural inhabitants are more likely to have HTN compared with urban inhabitants. Despite high rates of HTN awareness and HTNT, the treatment efficiency in Krasnoyarsky territory appeared to be lower as compared with average Russian ESSE-RF indices.