Cardiovascular Risk In Hypertensive Patients Research Articles

P113 CARDIOVASCULAR RISK FACTOR CONTROL IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY IN COLOMBIA (SNAPSHOT STUDY)

Background and objective: Hypertension is the leading preventable cause of cardiovascular (CV) disease and frequently occurs with other risk factors such as elevated blood glucose and cholesterol. This study aimed to assess the control rates of blood pressure (BP), glycated haemoglobin (HbA1c), and LDL-cholesterol (LDL-C) according to CV risk in hypertensive patients with type 2 diabetes in Colombia. Methods: SNAPSHOT, a cross-sectional, observational, multicenter, epidemiological study, involved patients enrolled by 20 investigators (mostly cardiologists [75.0%] and internists [20.0%]) in Colombia. CV risk was assessed based on the European Society of Cardiology CV disease prevention 2021 (SCORE2&2-OP) guidelines. Results: The analysis set included 459 patients; mean age (SD) was 68.7 (10.5) years, most patients were female (58.0%), and overweight or obese (73.4%). Most patients (91.7%) had at least 1 comorbidity in addition to hypertension and type 2 diabetes, including dyslipidemia in 85.6% of patients. Hypertension was treated in 97.6% of patients and considered by investigators to be controlled in 72.8% of patients, whereas only 44.4% of patients were controlled according to guidelines. Type 2 diabetes was treated in 92.2% of patients and controlled in 55.5% according to guidelines. In the subset of patients with concomitant dyslipidemia, LDL-C was treated in 95.2% and controlled according to guidelines in 25.6% of patients. The proportion of patients controlled for both hypertension and diabetes was 24.0% and the proportion controlled on all three parameters was 9.5% (Figure). Single-pill combinations were used to treat diabetes in 39.7%, hypertension in 21.4%, and dyslipidemia in 16.8% of patients. Mean (SD) systolic and diastolic BP were 131.3 (18.0) and 77.5 (10.1)mmHg, respectively; mean (SD) HbA1c was 7.0 (1.5)%; and mean (SD) LDL-C was 91.0 (43.4)mg/dL. Conclusions: This study showed a substantial unmet medical need: control rates for BP, HbA1c, and LDL-C in Colombia fell short among patients examined, emphasizing the urgency for enhanced therapeutic strategies.

P132 CARDIOVASCULAR RISK ASSESSMENT IN HYPERTENSIVE PATIENTS WITH TYPE 2 DIABETES: A CROSS-SECTIONAL EPIDEMIOLOGICAL STUDY IN COLOMBIA (SNAPSHOT STUDY)

Background and objective: Cardiovascular (CV) risk is determined by an interplay of risk factors. The goal of the study was to assess CV risk in hypertensive patients with type 2 diabetes in Colombia. Methods: SNAPSHOT, a cross-sectional, observational, multicenter, epidemiological study, involved patients enrolled by 20 investigators (mostly cardiologists [75.0%] and internists [20.0%]) in Colombia. CV risk was assessed by investigators and compared to the calculated CV risk based on ESC 2021 (SCORE2&2-OP) guidelines. Results: The analysis set included 459 patients; mean age (SD) was 68.7 (10.5) years, most patients were female (58.0%), and overweight/obese (73.4%), 21.4% were former smokers and 2.4%, active smokers. A combination of risk factors (male gender, age ≥65years, BMI≥30 kg/m2, smoking) was reported for most patients: 43.8% of patients had 1 of these risk factors, 38.1% had 2 risk factors, 6.1% had 3 risk factors, and 0.2% had all 4 risk factors. Most patients (91.7%) had at least 1 comorbidity in addition to hypertension and type 2 diabetes. Overall, 85.6% of patients had dyslipidemia, 39.7% had chronic kidney disease, and 33.8% had at least one additional CV comorbidity, mainly coronary or other arterial revascularization (18.1%) and acute coronary syndromes (13.5%). 48.4% of patients had diabetes-related target organ damage. CV risk perceived by investigators was low (0.7%), moderate (20.9%), high (35.7%) or very high (42.7%), whereas calculated CV risk according to SCORE2&2-OP was either high (34.6%) or very high (65.4%) (Figure). The prevalence of high and very high CV risk was similar when calculated according to the 2016 (SCORE1) guidelines. Investigators estimated CV risk accurately versus SCORE2&2-OP in only 41.6% of patients, while they underestimated it in 47.9% of patients. Conclusions: Hypertensive patients with diabetes in Colombia are at very high risk of CV disease, but this risk is frequently underestimated by physicians. Enhancing physician education on guideline recommendations and treatment intensification could improve risk factor control.

Comparison of Cycling and Cross Trainer on Rate Pressure Product in Hypertensive Patients: A Cross-Sectional Study

Introduction: The Rate pressure product is the valuable marker of cardiac function. It is the product of heart rate and systolic blood pressure. It plays a pivotal role in understanding the relationship between exercise and the cardiovascular system, particularly in hypertensive individuals. Hypertension is a primary risk factor for coronary heart disease, stroke, congestive heart failure, renal failure and peripheral vascular disease. The aim of the study is to determine the effect of cycling and cross trainer on rate pressure product in hypertensive patients. Methodology: A cross-sectional study includes 30 hypertensive patients with age group of 25-65 years and those who have any recent surgery or any neurological or psychological issues are excluded. Patients vitals were monitored pre exercise. Every patient does exercise on both cross trainer and cycling for 15 min each on alternate day to avoid superimpose effect of each other. Rate pressure product was calculated and compared between cross trainer and cycling exercise. Result: Result has been obtained from SPSS 20. Mean age of patients is 45.9+10.2. Comparison between cycling and cross trainer found using independent t-test (t=-2.534). There was significant difference of RPP between patients performing cycling and cross trainer. RPP of cross trainer (mean=19.09) is more than RPP of cycling (mean=18.14) having significant difference p<0.05. Conclusion: This study concluded that there is greater rate pressure product during cross trainer exercise than in cycling. This shows that more myocardial oxygen consumption is greater in cross trainer as it involves both upper and lower extremity. So, cross trainer and cycling can be used effectively for exercise prescription and preventing cardiovascular risk in hypertensive patients, but the cycling was more effective as the mean difference was low compared to cross trainer. Keywords: Static cycling, rate pressure product, cross trainer, hypertension

10-Year Cardiovascular Risk in Hypertensive Patients: Insights from Central Vietnam Using WHO 2019 Chart

Background: Assessing the 10-year cardiovascular disease (CVD) risk is crucial for effective prevention and management. Despite its significance, information is limited on CVD risk among hypertensive patients in primary care in Central Vietnam. We conducted this study to estimate 10-year CVD risk in primary care settings and explore its associated risk factors, using the 2019 WHO CVD risk chart. Methods and Results: This cross-sectional study collected socio-demographic and clinical data through a standardized questionnaire. Cardiovascular risk was estimated using the WHO CVD risk charts for Southeast Asia. The prevalence of low, moderate, and high CVD risk was 52.1%, 38.9%, and 9.0%, respectively. Notably, men had significantly higher rates of moderate (48.6%) and high (17.6%) CVD risk than women (31.4 and 2.4%, respectively) (P=0.000). Age was a significant factor, with an increasing prevalence of moderate and high CVR as age advanced. Specifically, the 50-59 age group had a moderate risk of 18.6%, rising to 69.9% in the 70-74 age group. High CVD risk increased from 0.6% to 27.6% in the same age groups. Lower educational levels were associated with a higher proportion of moderate CVD risk. Smoking and excessive alcohol consumption were linked to elevated CVD risks (25.0% and 30.0%, respectively), surpassing those without these behaviors. Similar trends were observed for individuals with diabetes, high total cholesterol, and high blood pressure. Conclusion: Approximately one-tenth of hypertensive patients face a high risk of developing CVDs within the next 10 years. A comprehensive approach, encompassing behavioral changes and the management of metabolic risk factors, is essential to reduce CVD risk effectively.

Validez en la predicción de riesgo de la escala SCORE en una población mediterránea con hipertensión arterial

Introduction and objectivesHypertension is the most prevalent risk factor globally. Calculation of cardiovascular risk in hypertensive patients before initiation of treatment is recommended. This study aimed to assess the predictive value and clinical utility of the SCORE scale in preventing cardiovascular events and all-cause mortality in patients with hypertension. MethodsPatients with hypertension from the ESCARVAL-RISK cohort were included. Cardiovascular risk was calculated using the SCORE scale. All deaths and cardiovascular events were recorded during a 5-year follow-up period. Sensitivity, specificity and predictive values were calculated for different cut-off points and the effect of different risk factors on the diagnostic accuracy of SCORE charts were assessed. ResultsIn a final cohort of 9834 patients, there were 555 cardiovascular events and 69 deaths. The recommended risk value for initiating drug treatment (5%) had a specificity of 92% for death and 91% for cardiovascular events, and a sensitivity of 20% for death and 22% for cardiovascular events. In addition, the scale classified 80.4% of patients who experienced a cardiovascular event and 78.3% of those who died as low risk. Age, body mass index, retinopathy and anticoagulant therapy were associated with reduced predictive ability of the SCORE scale, while being female was associated with better risk prediction. ConclusionsThe predictive ability of the SCORE scale for cardiovascular disease and total mortality in patients with hypertension is limited.

Association between office visit intervals and long-term cardiovascular risk in hypertensive patients.

Hypertension is a chronic disease that requires long-term follow-up in many patients, however, optimal visit intervals are not well-established. This study aimed to evaluate the incidences of major cardiovascular events (MACEs) according to visit intervals. We analyzed data from 9894 hypertensive patients in the Korean Hypertension Cohort, which enrolled and followed up 11,043 patients for over 10 years. Participants were classified into five groups based on their median visit intervals (MVIs) during the 4-year period and MACEs were compared among the groups. The patients were divided into clinically relevant MVIs of one (1013; 10%), two (1299; 13%), three (2732; 28%), four (2355; 24%), and six months (2515; 25%). The median follow-up period was 5 years (range: 1745±293 days). The longer visit interval groups did not have an increased cumulative incidence of MACE (12.9%, 11.8%, 6.7%, 5.9%, and 4%, respectively). In the Cox proportional hazards model, those in the longer MVI group had a smaller hazard ratio (HR) for MACEs or all-cause death: 1.77 (95% confidence interval [CI], 1.45-2.17), 1.7 (95% CI: 1.41-2.05), 0.90 (95% CI: 0.74-1.09) and 0.64 (95% CI: 0.52-0.79), respectively (Reference MVI group of 75-104 days). In conclusion, a follow-up visits with a longer interval of 3-6 months was not associated with an increased risk of MACE or all-cause death in hypertensive patients. Therefore, once medication adjustment is stabilized, a longer interval of 3-6 months is reasonable, reducing medical expenses without increasing the risk of cardiovascular outcomes.

RELATIONSHIP OF HYPERURACEMIA WITH METABOLIC DISORDERS IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: To study the prevalence of hyperuremia and to study its role in development of metabolic disorders in patients with arterial hypertension (AH). Design and method: The study analyzed 188 case histories of patients with AH grades 1-3 (ESC/ESH, 2018). 109 women and 79 men were studied. Mean age 62.8±10.2 years. Hyperuricemia was established with an increase in the level of uric acid > 7 mg / dl in men, > 5.7 mg / dl in women. Results: Results: For analysis, patients were divided into 2 groups: the first group consisted of patients with hyperuricemia (n = 103), the second - patients with normal levels of uric acid (n = 85). The average level of uric acid in the 1st group was 7.44±1.33 mg/dl, and in the 2nd group - 5.06±0.98 mg/dl, p<0.00001. The compared groups were similar in terms of age, office SBP and DBP. Age: 62.7±10.51 vs 62.8±10.01 years, p = 0.95; SBP - 136.82±22.09 mm Hg. vs 132.98±24.4 mmHg, p = 0.26; DBP - 85.17±10.27 mm Hg. vs 84.27±10.71 mmHg, p = 0.56. The groups also did not differ in BMI and WC: BMI-32.96±5.84 kg/m2 vs 31.24±5.00 kg/m2 p = 0.44; OT-105.44±13.75 cm vs 102.76±12.06 cm, p = 0.16. It should be noted that patients with hyperuricemia had a significantly high level of MAU: 63.24±104.06 vs 39.33±36.42 mg/l, p = 0.044. Patients with hyperuricemia had more pronounced dyslipidemia. Thus, total cholesterol was significantly high in group 1: 198.31±49.41 mg/dl vs 181.75±49.1 mg/dl, p = 0.04, LDL cholesterol 111.83±42.46 mg/dl dl vs 100.56±37.99 mg/dl, p = 0.04. TG and HDL-C did not differ between the groups. TG: 223.39±130.76 vs 189.69±122.18 p = 0.057. HDL-C: 41.92±13.54 mg/dl vs 43.30±12.87 mg/dl, p = 0.48. In the group of patients with hyperuricemia, there was a significantly high level of glucose compared with patients with normal levels of uric acid: 9.71±04.35 mmol/l vs 6.51±3.06 mmol/l, p = 0.0001. The creatinine level was also high in patients with hyperuricemia: 98.45±36.75 μmol/l vs 85.06±17.21 μmol/l, p = 0.003. Conclusions: Hyperuricemia should be considered as an additional cardiovascular risk in hypertensive patients. Hyperuricemia is associated with severe dyslipidemia and elevated levels of glycemia and creatinine in hypertensive patients.

THE PLASMA HDL-SUBFRACTION PROFILE IN HYPERTENSIVE PATIENTS WITH HIGH HDL-CHOLESTEROL LEVELS

Objective: The evaluation of cardiovascular risk (CVR) in arterial hypertension includes the estimation of high density lipoprotein (HDL-C). Although HDL-C is considered as a favorite CVR factor, the exact role that HDL-C subfraction profile play in the pathogenesis of atherosclerosis, especially in higher than usual HDL-C levels (>60 mg/dl) is currently under investigation. The aim of this study was to evaluate the plasma HDL subfraction profile of high HDL-C levels in hypertensive patients compared to normotensive subjects. Design and method: We studied 74 hypertensive patients (60 + 13 years, 62 females) and 24 normotensives, apparently healthy subjects (49 + 14 years, 22 females) with HDL-C equal or above 55 mg/dl. Cholesterol, HDL-C, and TG were determined enzymatically while LDL-C was calculated using the Friedewald formula. Plasma HDL particles were separated and determined electrophorically using Lipoprint System HDL Subfractions Kit. Aortic stiffness (c-f PWV) and central BP (cBP) were evaluated by carotid-femoral pulse wave velocity (Complior apparatus). Results: We found that hypertensive patients had increased age, BMI, office systolic and diastolic BP, PWV compared to normotensives. Regarding HDL, 10 HDL fractions were separated: fractions 1-3 were denoted as Large-HDL (L-HDL), fractions 4-7 constituted the Intermediate-HDL (I-HDL), and fractions 8-10 were denoted as Small-HDL (S-HDL) subfraction. Although HDL-C levels were similar between groups (76 + 13 vs. 81 + 17 mg/dl, p = 0.10), the percent distribution (%) of L-HDL was lower in hypertensives compared to normotensives (29.8±4.7% vs. 36.6±6.3%, p<0.001), % I-HDL was similar while % S-HDL was increased (27.3±3.7% vs. 20.4±4.4%, p<0.001). We found a significant negative correlation between L-HDL and SBP (rho = -0.48, p = 0.01) as well as cBP (rho = -0.52, p = 0.008) in younger hypertensive females before menopause (n = 26, 49 + 5 years). Conclusions: L-HDL particles, the most antiatherogenic HDL-C subfraction, were reduced in hypertensive patients with high HDL-C levels compared to normotensive subjects, suggesting that these patients are probably less protected against CV disease compared to normotensive subjects with similar HDL-C and LDL-C levels. Therefore, plasma HDL-subfraction profile might replace the HDL-C evaluation as a better biomarker of CVR in hypertensive patients, especially females before menopause.

Serum creatinine levels, traditional cardiovascular risk factors and 10-year cardiovascular risk in Chinese patients with hypertension.

Serum creatinine is associated with cardiovascular risk and cardiovascular events, however, the relationship between serum creatinine levels and cardiovascular risk is not well established in hypertensive population in Jiangsu Province. We aimed to evaluate the association of serum creatinine levels with traditional cardiovascular risk factors and 10-year cardiovascular risk in a Chinese hypertensive population. Participants were patients with hypertension registered and enrolled in health service centers in 5 counties or districts from January 2019 to May 2020 in Jiangsu Province of China followed strict inclusion and exclusion criteria, demographics as well as clinical indicators and disease history and lifestyle were collected. Participants were divided into four groups according to quartiles of serum creatinine levels, then the China-PAR model was used to calculate 10-year cardiovascular risk for each individual. A total of 9978 participants were enrolled in this study, 4173(41.82%) were males. The blood pressure level and prevalence of dyslipidemia, elderly, current smokers and drinking as well as obesity were higher in the Q4 group than the Q1 group (all P < 0.05). Multivariable logistic regression showed that serum creatinine in the Q4 group compared with that in the Q1 group was positively associated with overweight and obesity (OR=1.432, 95% CI 1.237-1.658, P<0.001), while negatively associated with physical activity (OR=0.189, 95%CI 0.165-0.217, P<0.001), and so on. Multiple linear regression showed 10-year cardiovascular risk is positively associated with serum creatinine levels after adjusting for multiple risk factors (β=0.432, P< 0.001). Serum creatinine was associated with several traditional cardiovascular risk factors and the 10-year cardiovascular risk in hypertensive patients. Creatinine-reduction and kidney-sparing therapy are essential for patients with hypertension to optimize control of cardiovascular risk.

Subendocardial Viability Ratio Predictive Value for Cardiovascular Risk in Hypertensive Patients.

Background: The subendocardial viability ratio (SEVR), also known as the Buckberg index, is a parameter of arterial stiffness with indirect prognostic value in assessing long-term cardiovascular risk. Materials and Methods: We conducted a prospective cohort study on 70 patients with uncomplicated hypertension admitted to a county medical reference hospital. We analyzed demographics, laboratory data, arterial stiffness parameters and cardiovascular risk scores (SCORE and Framingham risk scores) and aimed to identify paraclinical parameters associated with increased cardiovascular risk. Results: Of the arterial stiffness parameters, SEVR correlates statistically significantly with age, central and peripheral systolic blood pressure, as well as with heart rate. SEVR seems to have prognostic value among hypertensive patients by increasing the risk of major cardiovascular events assessed by SCORE and Framingham risk scores. SEVR correlates statistically significantly with serum fibrinogen (p = 0.02) and hemoglobin (p = 0.046). Between pulse wave velocity and lipid parameters (p = 0.021 for low-density lipoprotein cholesterol <LDL> and p = 0.030 for triglycerides) a statistically significant relationship was found for the study group. The augmentation index of the aorta also correlated with serum LDL-cholesterol (p = 0.032) and the hemoglobin levels (p = 0.040) of hypertensive patients. Conclusions: Age, abdominal circumference and Framingham score are independent predictors for SEVR in our study group, further highlighting the need for early therapeutic measures to control risk factors in this category of patients.

High HDL (High-Density Lipoprotein) Cholesterol Increases Cardiovascular Risk in Hypertensive Patients.

Emerging evidence suggests that elevated circulating levels of HDL-C (high-density lipoprotein cholesterol) could be linked to an increased mortality risk. However, to the best of our knowledge, the relationship between HDL-C and specific cardiovascular events has never been investigated in patients with hypertension. To fill this knowledge gap, we analyzed the relationship between HDL-C levels and cardiovascular events in hypertensive patients within the Campania Salute Network in Southern Italy. We studied 11 987 patients with hypertension, who were followed for 25 534 person-years. Our population was divided in 3 groups according to the HDL-C plasma levels: HDL-C<40 mg/dL (low HDL-C); HDL-C between 40 and 80 mg/dL (medium HDL-C); and HDL-C>80 mg/dL (high HDL-C). At the follow-up analysis, adjusting for potential confounders, we observed a total of 245 cardiovascular events with a significantly increased risk of cardiovascular events in the low HDL-C group and in the high HDL-C arm compared with the medium HDL-C group. The spline analysis revealed a nonlinear U-shaped association between HDL-C levels and cardiovascular outcomes. Interestingly, the increased cardiovascular risk associated with high HDL-C was not confirmed in female patients. Our data demonstrate that there is a U-shaped association between HDL-C and the risk of cardiovascular events in male patients with hypertension.

THE EFFECT OF DAPAGLIFLOZIN ON THE LEVEL OF SYSTOLIC BLOOD PRESSURE AND GLYCEMIC CONTROL IN PATIENTS WITH ARTERIAL HYPERTENSION AND TYPE 2 DIABETES

Objective: to determine the influence of dapagliflozin (D) on the level of blood pressure (BP) in patients with arterial hypertension (AH) and type 2 diabetes mellitus (T2DM). Design and method: A total of 57 patients with AH, stage II and concomitant non-severe T2DM were examined (fasting plasma glucose &lt; 9 mmol/L, glycosylated hemoglobin (HbA1c) - 7.45 ± 1.3%, mean age 52.4 ± 2.8, mean BP 162/102 ± 3.5/2.3 mm Hg, BMI 28.3 ± 2.7 kg/m2, disease duration 6.6 ± 1.7 years,). Patients were divided into 2 groups: the comparison group included 23 patients who received metformin 850 mg 2/day, lisinopril 10 mg 1/day and amlodipine 10 mg 1/day. Patients of the main group (D-group, n = 34), received dapagliflozin 10 mg in addition to standard therapy. Results: 6 months after beginning of therapy, the following results were obtained: HbA1C in the D-group was 6.28 ± 0.6%, in the comparison group – 6.56 ± 0.48% (p &lt; 0.05). A slight decrease of BMI was observed in both groups (26.3 ± 1.2 kg/m2 and 27.4 ± 1.3 kg/m2, respectively), however, the changes were insignificant. Systolic blood pressure (SBP) in the D-group was 132 ± 7.24 mm Hg., and in the comparison group - 145.5 ± 9.17 mm Hg., (p &lt; 0.05). The diastolic blood pressure (DBP) was 83.5 ± 3.8 mm Hg and 89,6 ± 4.2 mm Hg, respectively. Conclusions: the obtained data demonstrate that adding of dapagliflozin to a standard therapy of hypertension and concomitant type 2 diabetes leads both to significant decrease of SBP and improvement of glycemic control. The outcomes of our research suggest that dapagliflozin has a potential to reduce cardiovascular risk in hypertensive patients with type 2 diabetes.

Clinical significance of epicardial fat assessment in hypertensive patients with non-alcoholic fatty liver disease

Objective. To study the relationship between the thickness of epicardial adipose tissue (EAT) and indicators of the structural and functional heart characteristics and cardiovascular risk in hypertensive patients with nonalcoholic fatty liver disease (NAFLD).Design and methods. A comparative cross-sectional study was conducted involved 120 patients, aged 45 to 65 years, with hypertension (HTN) of I–II stages, degrees 1–2, with NAFLD (Fatty Liver Index (FLI &gt; 60)) and without NAFLD. A clinical examination was carried out: history, physical examination, measurement of “office” blood pressure and heart rate, anthropometric parameters (height, weight, body mass index). The indicators of carbohydrate and lipid metabolism, chronic low-intensity inflammation (C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α)) were determined, insulin resistance indices were calculated. The structural and functional state of the liver and heart was assessed by ultrasound, and the thickness of the EAT was determined. The SCORE scale was used to assess the 10-year fatal risk.Results. Indicators characterizing chronic low-intensity systemic inflammation (CRP, TNF-α) and insulin resistance (HOMA-IR metabolic index (MI), triglycerides (TG) / high-density lipoproteins (HDL)) were higher in patients with HTN and NAFLD than in patients with isolated HTN. Echocardiography showed that patients with comorbid pathology had greater EAT thickness (p &lt; 0,001) and more profound left ventricular myocardial hypertrophy (thickness of the left ventricular posterior wall (LVPW) (p = 0,019), interventricular septum (IVS) (p = 0,012), left ventricular myocardial mass (LVMM) (p = 0,029)). In the group of patients with HTN and NAFLD, the correlation analysis showed direct moderate-strong relationships between EAT thickness and TPWLV (r = 0,345, p &lt; 0,001), IVS (r = 0,344, p &lt; 0,001), LVMM (r = 0,372, p &lt; 0,001), index LVMM (r = 0,221, p = 0,015), FLI (r = 0,722, p &lt; 0,001), TNF-α (r = 0,495, p &lt; 0,001), HOMA-IR (r = 0,38, p &lt; 0,001), MI (r = 0,374, p &lt; 0.001), TG/HDL (r = 0,354, p &lt; 0,001), CRP (r = 0,30, p = 0,002), TG (r = 0,305, p = 0,001), very low density lipoprotein cholesterol (r = 0,306, p = 0,001) and medium strength inverse relationship with HDL (r = 0,30, p = 0,008). A multiple regression analysis was performed to assess the relationship between EAT thickness and the severity of chronic systemic inflammation and insulin resistance in patients with HTN and NAFLD: with an increase in TNF-α by 1 pg/ml and TG/HDL by 1, an increase in EAT thickness by 0,15 and 0,68 mm, respectively, should be expected. An increase in EAT thickness by 1 mm was accompanied by an increase in LVMM by 12,8 g. Logistic regression analysis showed a direct relation between EAT thickness and the probability of cardiovascular 10-year risk increase by 5,0% or more.Conclusions. This study showed that in patients with HTN and NAFLD, the EAT thickness was significantly higher, which strongly correlates with indicators of left ventricular hypertrophy, the severity of liver steatosis (FLI), chronic low-intensity systemic inflammation, and insulin resistance. With an increase in TNF-α and TG/HDL, an increase in the EAT thickness should be expected. EAT thickness was significantly associated with an increase in LVMM and increased chance of high and very high risk of cardiovascular complications in patients with HTN and NAFLD.

The role of tadalafil in treated hypertensive patients with erectile dysfunction.

In this issue, Kloner and colleagues showed in a pooled safety analysis that tadalafil—a phosphodiesterase type 5 (PDE-5) inhibitor—is safe in treated hypertensive patients and is not associated with increased hypotension-related treatment adverse events and major cardiovascular (CV) events.1 The safety data were extracted from 72 Phase II–IV clinical studies of tadalafil used for erectile dysfunction (ED) or benign prostate hypertrophy. PDE-5 inhibitors are vasodilating drugs that work by blocking the degradation of cyclic GMP by PDE-5 in the smooth muscle cells lining the blood vessels supplying various tissues. The increase of the intracellular cyclic GMP prolongs its duration of action resulting in increase in nitric oxide bioavailability, smooth muscle relaxation, vasodilation and increased blood flow in the corpora cavernosa, and penile erection. The main PDE-5 inhibitors are sildenafil, vardenafil, avanafil, and tadalafil. They differ in their pharmacodynamic and pharmacokinetic properties allowing targeting the treatment to the patients' needs. Avanafil has the fastest onset of action and tadalafil has the longest duration of action (half-life of 17.5 h and duration of action up to 36 h).2 ED impairs the quality of life of affected individuals and may be a prognostic marker for the development of CV disease.3 The prevalence of ED in the general population is around 15–20% and it is significantly higher in patients with hypertension,2, 4 probably due to vascular changes. Hypertension is a major modifiable risk factor for CV disease and lowering blood pressure is beneficial. Lowering blood pressure may cause or aggravate ED and it is not clear whether it is a side effect of the antihypertensive treatment or a result of the blood pressure decrease. The development of ED is one of the major reasons to withdraw antihypertensive treatment leading to inadequate blood pressure control. PDE-5 inhibitors improve ED and improve adherence to antihypertensive therapy, improve blood pressure control, and thereby may reduce CV risk in hypertensive patients with ED. The effect of PDE-5 inhibitors is not limited to the corpora cavernosa and they also vasodilate other vascular beds thereby reducing blood pressure. There was a concern that blood pressure decrease may cause CV side effects particularly in patients with CV risk factors. Kloner and colleagues in this issue showed that in subjects not receiving antihypertensive medications the incidence of hypotension related treatment emergent adverse events was low, but it was significantly higher in the tadalafil group than in the placebo group.1 Most subjects (>90%) not receiving antihypertensive medications were normotensives, and in this group, lowering blood pressure by tadalafil may increase the incidence of hypotension-related events. However, in hypertensive patients on antihypertensive medications tadalafil does not increase the hypotension related events. The co-administration of tadalafil with doxazosin, a blood pressure lowering alpha blocker is associated with a remarkable blood pressure decrease that maybe deleterious.5 However, with other antihypertensive agents tadalafil is not associated with hypotensive related side effects. The co-administration of PDE-5 inhibitors with various antihypertensive drugs, except alpha blockers, is safe. This was observed even in those who used several antihypertensive agents.1 It has been shown that all PDE-5 inhibitors are safe in treated hypertensive patients.2 The hypotensive effect of PDE-5 inhibitors should be exploit to treat resistant hypertension, particularly in those with ED. Since tadalafil has the longest duration of action it will probably be the best PDE-5 inhibitor to use for lowering blood pressure. Low dose tadalafil (5 mg daily) can improve blood pressure control and erectile function. The fact that PDE-5 inhibitors can lower blood pressure and improve erectile function suggests that lowering blood pressure by itself does not cause ED and it is probably related to the antihypertensive medications. The safety profile of tadalafil presented by Kloner in this issue may justify wider use of the drug in hypertensive patients. Wide use of tadalafil in hypertensive patients may improve erectile function and blood pressure control leading to a decrease in CV events. Further long term studies should be done to prove this concept. The author has no competing interests.

Инструментальные методики диагностики и оценки кардиоваскулярного риска у пациентов с артериальной гипертензией: обзор литературы (часть 1)

Артериальная гипертензия (АГ) остается одним из самых распространенных неинфекционных заболеваний в Украине и во всем мире, что связано с высокими уровнями инвалидности и смертности. Рутинное измерение артериального давления (АД) в клинической практике позволяет быстро оценить состояние пациента с АГ, однако приводит к недооценке некоторых клинических параметров. Эти находки побудили ученых к изучению структуры артерий и поиску методов неинвазивного измерения центрального АД. Толчком к разработке технологических основ метода контурного анализа пульсовой волны стали эксперименты со сфигмографией и сфигмоманометрией, которые показали, что в норме колебания стенки артерии происходят почти одинаково с фазами изменений давления, поскольку стенка артерии ведет себя как абсолютно упругий материал. Эта находка была положена в основу трансферной функции, которая позволяет неинвазивно измерить центральное АД. Во многих клинических исследованиях было доказано, что именно уровень центрального АД больше связан с поражением органов-мишеней. Кроме того, установлено, что различные группы антигипертензивных средств способны по-разному влиять на уровень АД в аорте. Неинвазивное измерение центрального АД позволяет нам индивидуализировать подбор терапии пациентам с АГ и провести более детальную диагностику у пациентов разного кардиоваскулярного риска. Определение скорости распространения пульсовой волны используют для диагностики жесткости артерий, при увеличении которой доказанно возрастает риск основных сердечно-сосудистых осложнений. Диагностическая процедура определения уровня АД в аорте и жесткости артерий на практике занимает много времени, требует отдельных, как правило, дорогих приборов и соответствующей подготовки оператора. В наше время разработан ряд электронных тонометров для офисного измерения АД, работа которых основана на использовании технологии регистрации пульсовой волны манжеткой, что обеспечило простое измерение АД в аорте и других параметров пульсовой волны. Один из таких приборов предложили отечественные производители.

Инструментальные методики диагностики и оценки кардиоваскулярного риска у пациентов с артериальной гипертензией: результаты собственного исследования (часть 2)

Актуальность. В предыдущей части мы подробно рассмотрели все показатели, которые можно получить с помощью контурного и скоростного анализа пульсовой волны, а также рассказали о приборе отечественного производства, который позволяет оценить эти параметры. В этой части раскрыты результаты открытого клинического испытания измерителя артериального давления ВАТ41-2 производства ООО «ИКС-Техно» (г. Киев) в режиме определения параметров жесткости сосудов и центрального давления у пациентов с артериальной гипертензией. Цель. Целью данного исследования было определить возможности использования измерителя артериального давления ВАТ41-2 для оценки центрального давления и параметров жесткости артерий путем сравнения показателей жесткости сосудов и центрального артериального давления, полученных с помощью приборов SphigmoCor и Complior. Материалы и методы. Исследование включало следующие этапы: скрининг (проверка соответствия критериям включения в исследование), период наблюдения в исследовании, который состоял из двух визитов. При условии соответствия всем критериям включения и при отсутствии критериев исключения пациента приглашали на первый визит, на котором с помощью трех приборов (SphigmoCor, Complior и ВАТ41-2 в режиме измерения параметров жесткости сосудов) последовательно в положении лежа на спине определяли следующие показатели: офисное систолическое артериальное давление (САД), диастолическое артериальное давление (ДАД), частоту сердечных сокращений (ЧСС), центральное САД, индекс аугментации, скорость распространения пульсовой волны по артериям мышечного и эластического типа, время изгнания, субэндокардиальный индекс Бакберга. Отдельно с помощью автоматического аппарата M-10 (производства Omron, Япония; класс точности высокий А/А) осциллометрическим методом измеряли уровни офисного САД, ДАД и ЧСС на плече, на основе которых происходила калибровка сигнала на аппаратах SphigmoCor и Complior. Результаты. В окончательный анализ вошли данные 69 пациентов. Результаты офисного измерения АД и ЧСС аппаратом Omron M-10 почти полностью соответствуют данным, полученным с помощью прибора ВАТ41-2. Существовала сильная достоверная корреляция результатов центрального систолического АД, измеренного с помощью аппарата ВАТ41-2, с таковыми, полученными на приборе SphigmoCor (r = 0,98; p &lt; 0,001). Также наблюдалась сильная корреляция индекса аугментации, измеренного ВАТ41-2, с результатами, полученными с помощью прибора SphigmoCor (r = 0,90; p &lt; 0,001). Лучшая корреляция отмечалась между показателем скорости распространения пульсовой волны на ВАТ41-2 и SphigmoCor, а также ВАТ41-2 и Complior. Выводы. Отечественный прибор, помимо присущей иностранным аппаратам точности, обладает еще рядом преимуществ, которые помогут облегчить работу практикующему врачу в постановке диагноза, более корректной стратификации риска и грамотном выборе антигипертензивных препаратов.

Hypertension and beyond in Indian clinical practice study: a nationwide survey assessing knowledge, attitude and practices of physicians

Background: Hypertension is the leading cause for the ever-increasing burden of mortality due to stroke and cardiovascular diseases (CVD). Treatments are complicated due to comorbidities and can lead to patient noncompliance. Patients with low existing cardiovascular risk are prone to have higher lifetime cardiovascular risk, which timely assessment necessary.Methods: A digital cross-sectional survey questionnaire about knowledge, attitude and practice habits regarding cardiovascular risk assessment was administered to 400 physicians and cardiologists across India. The questionnaire assessed various topics such as practice of hypertension diagnosis and treatment based on guidelines, cardiovascular risk calculators, occurrence of comorbidities and patient awareness on cardiovascular risk prevention.Results: Out of the 400 physicians, 398 completed the survey. About 52% physicians considered presence of multiple risk factors as vital for having cardiovascular risk. American college of cardiology/American heart association (ACC/AHA) calculator was preferred by 51.6% study participants. Cardiovascular risk estimation was vital for treatment-related decision-making according to 71% participants, while only 7.7% participants calculated cardiovascular risk in &gt;90% of their patients. Approximately 44% survey participants calculated cardiovascular risk in hypertensive patients with 2 additional risk factors, while 5.6% calculated it in &gt;70% hypertensive patients without comorbidities. About 46.6% participants reported that 30%-50% of their patients were on fixed-dose combinations of two antihypertensive medications.Conclusions: Findings from the study indicate predisposition of medical professionals towards having a risk assessment tool designed for the Indian population to timely assess and forestall long-term effects of cardiovascular risk in hypertensive patients.

Cardiovascular Risk Assessment in Hypertensive patients: A Perspective Observative Study

Congestive heart disease (CHD) is considered to be the leading cause of mortality and morbidity in both gender groups in developed and developing countries. Hypertension is one of the main mortality risks and is attributed to over 45% of all deaths from CHD. The main objective of our work was to evaluate cardiovascular risk in hypertensive patients attending a tertiary care hospital in the Khammam region. The study was a prospective observational study conducted over an 8-month period from June 2019 to January 2020. 192 subjects were selected based on the inclusion criteria. CVD risk was assessed using Q Risk 3 software and the results were presented as CVD risk and relative risk. The same number of men and women (96) was selected in the study to evaluate the influence of gender on CVD risk. Other risk factors such as BMI, marital status, literacy rate, occupation, physical activity and lifestyle were assessed to determine CVD risk. Abnormal HTN values were found in 66 men and 63 women. Age progression was found to be an important factor in CVD risk in both men and women. Social status and literacy rates in patients over 50 have also been found to cause CVD risk. Our study showed that physical inactivity, eating habits, obesity, smoking, alcohol and hypertension had a direct effect on cardiovascular risk.

INTERCONNECTION BETWEEN TUBULAR RENAL DYSFUNCTION AND GENES POLYMORPHISM IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: Objective: to assess the relationship between NGAL concentration as an indicator of tubular disorders, and genetic markers of cardiovascular risk in hypertensive patients. Design and method: Materials and methods: 89 patients of working age with hypertension (mean age 48.32 ± 8.71) were examined, who were divided into 2 groups depending on serum NGAL. Group 1 - 20 patients with NGAL levels above reference values, Group 2 - 69 patients with NGAL levels in the range of normal values. For all patients, to evaluate tubular renal function, the concentration of NGAL in serum was determined by ELISA. All patients were examined for genotypes of AGT Thr174Met, GNB3 C825T, MTHFR C677T, MTRR Ile22Met, ApoE Cys130Arg, PRARA rs4253778. Results: Results: patients in the groups did not significantly differ in age, gender, risk factors, concomitant diseases and therapy, blood pressure and lipid profile. In group 1, the occurrence of AGT, MTHFR, and PRARA gene polymorphism was significantly higher in heterozygous form than in group 2 (p = 0.002, p &lt; 0.001, and p = 0.037, respectively). Patients in the groups did not significantly differ in occurrence of GNB3, MTRR, and ApoE gene polymorphism. Correlation analysis showed a direct relationship between the concentration of NGAL in the blood and the presence of AGT gene polymorphism (r = 0.38; p &lt; 0.05), GNB3 (r = 0.33; p &lt; 0.05), MTHFR (r = 0.35; p &lt; 0.05). The association of NGAL with the polymorphism of the GNB3, MTRR, and ApoE genes was not statistically significant. Conclusions: Conclusions: in patients of working age with hypertension, tubular dysfunction, assessed by the concentration of NGAL in the blood, is associated with the presence of AGT, MTHFR, PRARA gene polymorphism in a heterozygous form.

THE ROLE OF MANIDIPINE IN HYPERTENSIVE PATIENTS WITH MICROALBINURIA

Objective: Microalbuminuria is frequent in patients with established hypertension, and predicts increased cardiovascular risk in hypertensive patients and probably renal dysfunction. It is considered a routine measurement in hypertensive patients and treatment aims to decrease its prevalence. We aim to evaluate the possible role of CCB inhibitors on hypertension and microalbuminuria. Design and method: 283 patients with hypertension and microalbuminuria were enrolled in the study, 130 men and 153 women, aged 40 to 70 years. Patients with diabetes mellitus were excluded. Manidipine 10 mg/daily was added for 6months to all patients, regardless if they received or not other anti-hypertension regimen and microalbuminuria was measured before the beginning of the treatment and after 6 months. Microalbuminuria levels were measured by 24-hour urine collection. Excretion between 30 mg/dL and 300 mg/dL was considered microalbuminuria. Results: The albumin excretion rate was decreased after 6 months of treatment by 24%. Microalbumin in 24-hour urine was reduced from a mean of 182 mg/dL to 138 mg/dL and in 15 patients (5%) microalbuminuria was not present in the second measurement (microalbumin &lt; 30 mg/dL). Blood pressure was also reduced achieving blood-pressure goals in 40% of the patients. Conclusions: This study confirms that CCB inhibitors can play a role in the management of microalbuminuria, along with their well-known blood-pressure reduction effect. Study design did not allow subgroup analysis of the results according to other medication they received. The clinical significance of this level of reduction and its effect in reducing long-term renal damage or other clinical end-points has to be evaluated in further studies.