Cases Of Arterial Hypertension Research Articles

Issues of differential diagnosis of diseases accompanied by impaired patency of renal arteries at a young age

The article considers the most common causes of renal artery patency, diagnostic process algorithms and differential diagnosis for renal artery stenosis at different ages. The first significant clinical manifestation of renal artery stenosis of various etiologies is arterial hypertension (AH). It is poorly controlled AH, including resistant AH, developing at a young age, that is the basis for the diagnostic search for secondary causes of high blood pressure, including narrowing of the renal arteries. The article presents a clinical case of uncontrolled AH in a young man. A comprehensive assessment of clinical manifestations, laboratory and instrumental examination results made it possible to diagnose unilateral renal artery stenosis of atherosclerotic genesis.

RELATIONSHIP OF T704C AGT GENE POLYMORPHISM WITH RESISTANT ARTERIAL HYPERTENSION IN UZBEK POPULATION

Objective: to study the association of T704C polymorphism of AGT gene with resistant arterial hypertension (AH) in Uzbek population. Design and method: Study included 178 patients with AH I–III degree of both sexes. The mean age of patients was 57.15 ± 11.01 years, duration of AH was 9.55 ± 5.75 years. Genotyping of the T704C polymorphism of the AGT gene was performed using real-time PCR using gene-specific primers of allele-specific probes. Relative risk (RR) was calculated using genetic models. Calculations were performed using the online program “Calculator for calculating statistics in case-control studies”. The results of all studies were considered statistically significant at p<0.05. Results: Patients were divided into two groups: 1 - patients with resistant AH (cases, n = 61) and 2 - patients with controlled hypertension (controls, n = 117). TT genotype - determined in 16.4%, TC genotype - in 32.8%, CC genotype - 50.8%, 2 = 16.279, p = 0.000. The allelic distribution showed the predominance of C allele: C allele - 67.2%, T allele - 32.8%, ⇙2 = 27.557, p = 0.000. In group 2, C allele in 52.6%, T allele in 47.4%, respectively, ⇙2 = 1.034, p = 0.309. The ratio of TT:TC:CC- genotypes was as follows: 20.5%: 53.8%: 25.6%, ⇙2 = 33.923, p = 0.000. An analysis revealed an association of the C allele T704C of the AGT gene polymorphism with resistant AH. 61 patients with resistant AH of group 1, the C allele was more common than in patients with of group 2 (67.2%; ⇙2 = 7.05; P = 0.008; OR = 1.85, 95% CI 1.17-2.92) and 32.8% had T allele. Accumulation of CC genotype among patients of group 1 (50.8%; ⇙2 = 11.59; P = 0.003; OR = 3.00, 95% CI 1.56-5.75), while TC genotype was found in 32, 8% of cases and TT genotype in 16.4% of cases. Whereas in the 2nd group, the CC genotype was less common - in 25.6% of cases than the TCgenotype (53.8%) cases. Conclusions: The results obtained indicate a significantly greater accumulation of the C-allele of T704C polymorphism of the AGT gene among patients with resistant hypertension. The C allele and CC genotype T704C of AGT gene polymorphism are associated with resistant hypertension in the Uzbek population.

Secondary arterial hypertension and endogenous hypercortisolism in general medical practice

Arterial hypertension (AH) is a widespread syndrome in clinical practice. In most cases, the blood pressure increase is essential (primary) in nature. Meanwhile, many clinical situations require exclusion of secondary AH due medications and other substances, renal, endocrine, cardiovascular, neurological pathology. A special place in the structure of the endocrine AH is engaged in pathology caused by excessive production of cortisol. Despite its heterogeneous origin, endogenous hype rcortisolism (EH) has a certain similarity in clinical manifestations. The article describes two clinical cases of AH in 32-year-old women with different pathogenetic variants of endogenous hypercortisolism (EH). The presented medical histories are the basis for the discussion of features of the clinical and laboratory manifestations of EH, principles of the differential diagnos is and modern approaches to treatment. The aim of this publication is to draw attention of doctors of various specialties to early detection of EH, the timely elimination of which significantly improves the quality and increases the life expectancy of patients.

ARTERIAL HYPERTENSION IN PATIENTS WITH LONG DURATION TYPE 1 DIABETES MELLITUS

Objective: Prognosis in Type 1 diabetes mellitus (T1DM) patients is constantly improving and the role of other cardiovascular risk factors, e.g. hypertension is gradually increasing. The effective management of both conditions is important for the prevention of cardio-vascular diseases (CVD). Aim: to assess the blood pressure (BP) in patients with long-duration T1DM compared to controls and to evaluate arterial hypertension (AH) management in them. Design and method: A study of 124 patients of T1DM at a mean age 42.68 ± 10.4 years, 53% males, with a median duration of T1DM 24 years and mean HbA1c 8.42 ± 1.75% and 59 age- and sex matched controls. BP was measured twice with a calibrated sphygmomanometer and the mean of both measurements was used. AH was defined as BP> 140/90 mm Hg or history of AH or on antihypertensive treatment. Results: The mean systolic BP (SBP) in T1DM patients was significantly higher than in controls – 128.17 ± 18.87 vs 121.13 ± 1.26, p = 0.008, with no interaction with gender. Diastolic BP was not significantly higher – 80.28 ± 10.02 vs 77.98 ± 10.72, p = 0.16. AH was twice more prevalent in T1DM patients than in controls – 67 (54%) and 17 (27%), resp. (p = 0.001). It was due to already known hypertension - 51 (41%) vs 12 (20%), p = 0.001 while incident AH cases were equally found in T1DM and controls – 15 (25.4%) vs 4 (25%). Control of AH < 140/90 mmHg was achieved in only 35.8% of the patients with T1DM and in 37.5% of the controls, while BP< 130/80 mm Hg was even less frequent in both categories – 13.4% vs 12.5% (p = NS). Untreated were 24 (29%) of all hypertensive participants, combination treatment was prescribed in 32 (39%) and monotherapy – in 26 (32%). ACE-inhibitors were the preferred antihypertensive class, followed by beta-blockers, ARBs, diuretics, and CCBs. Conclusions: SBP is significantly higher in T1DM patients than in their healthy peers, irrespective of gender. The prevalence of AH is higher in diabetic patients with long duration even at still relatively younger age. The BP control is far from optimal in the studied population which requires more aggressive management to prevent CVD occurrence.

Relationship between dietary stereotypes and arterial hypertension among residents of Siberia

Objective to evaluate the dynamics and identify the relationship between empirically obtained dietary stereotypes and the presence of arterial hypertension (AH) according to a prospective study among the population of a large region of Siberia.Design and methods. A clinical and epidemiological prospective group study of the population aged 35 to 70 years was carried out. The baseline study included 1124 women (70,3%) and 476 men (29,7%). The mean age was 54,9 ± 9,75 years and 52,6 ± 10,0 years, respectively, p < 0,001. The followup period was 3 years from the first visit of the respondent. An adapted questionnaire (Questionnaire Food Frequency (FFQ)) was used to assess the frequency of food consumption. To identify latent factors (stereotypes of eating behavior), we used factor analysis (method of principal components). The association of eating habits with the presence of AH was assessed using logistic regression analysis. The critical level of significance when testing statistical hypotheses in the study was taken to be ≤ 0,05.Results. In men, the prevalence of AH was the highest among those who adhered to the fruit and vegetable dietary stereotype (75,0%), the minimum was in men who followed the mixed stereotype (60,1 %, p = 0,034). Among women, as well as among men, the maximum prevalence of AH was observed in people with a fruit and vegetable diet (71,1 %), and the minimum was observed in those with a protein-carbohydrate diet (63,2 %, p = 0,049). Among those who followed the fruit and vegetable stereotype, new cases of AH were identified in 30,9 %, protein-carbohydrate — 33,3 %, mixed — 35,7 % (p = 0,846). The structure of nutrition of the population has undergone changes during the observation period. So, 5 main stereotypes of eating behavior were determined: vegetable, protein-carbohydrate, fruit, dairy and mixed. The prevalence of AH did not differ statistically significantly among individuals with different nutritional stereotypes at the prospective stage (p = 0,337): the maximum prevalence of AH was observed among individuals who followed the vegetable stereotype (77,6%), and the minimum — fruit (67,6%). When conducting a logistic regression analysis, after leveling the influence of gender and age, no statistically significant associations were found between nutritional stereotypes and the development of AH.Conclusions. 1. Over three years of observation, the prevalence of AH among residents of a large industrial region of Siberia increased from 66,4% to 72,0%. 2. With the help of factor analysis, three nutrition stereotypes were identified: fruit and vegetable, protein and carbohydrate, and mixed. During the three-year period of observation, the diet of the inhabitants of Siberia has changed: 5 main stereotypes of eating behavior have been identified — vegetable, protein-carbohydrate, fruit, dairy and mixed. 3. At the basic stage, AH was more common among people who followed the fruit and vegetable diet, especially among young men. During the prospective phase of the study — in individuals who preferred the vegetable stereotype.

TO THE QUESTION OF CHOOSING OPTIMAL APPROACHES TO THE PREVENTION OF ARTERIAL HYPERTENSION IN THE WORK PLACES IN THE ORGANIZED POPULATION OF BAKU CITY

Introduction. Due to the growing prevalence of arterial hypertension (AH) among the adult population of industrialized countries, the issues of prevention and treatment of this disease are under the close attention of researchers and are among the most pressing problems of modern cardiology.Material and methods. The survey of 110 employees (84 women and 26 men) of one of the scientific libraries of Baku city was conducted with the help of a set of standard methods of epidemiological research in cardiology.Results of the research. The presence of AH was found in 26.4% of persons in the institution under study. Moreover, 15.5% of them were patients with AH, the remaining 10.9% were patients who did not know about their disease. In order to determine the possible risk of new cases of AH in this institution, a comparative analysis of the frequency of occurrence of the main risk factors (RF) of cardiovascular disease (CVD) among the surveyed staff with the presence and absence of AH was conducted. Although all patients without AH were younger than 40 years of age, the incidence of major RF of CVD was noted, in some cases close to that of patients with AH.Conclusion. The received data testify to the fact that the introduction of preventive measures aimed at the correction of the RF of CVD taking into account the specific conditions and specifics of work in the institution under study will significantly reduce the possibility of new cases of AH among the investigated category of patients.

LB.03.08] RENAL FUNCTIONAL DISTURBANCIES IN PATIENTS WITH RESISTANT ARTERIAL HYPERTENTION IN COMBINATION WITH RENAL ARTERY ABNORMALITIES

Objective: The aim of this study was to assess clinical renal disturbances in patients with resistant arterial hypertension (AH) in combination with renal artery abnormalities (RAA) in 4 years follow-up study. Design and method: 15 patients (6 males, 9 females) aged 44.1 ± 2.0 years with resistant AH (history of AH 16.5 ± 2.1 years) and RAA were examined; ambulatory blood pressure (BP) monitoring (ABPM) mean average of diurnal BP for systolic blood pressure (SBP) and diastolic blood pressure (DBP) as 160.9 ± 3.8 mmHg and 102.8 ± 2.7 mmHg, respectively; BMI 27.9 ± 1.4 kg/m2. The group was compared to the group of patients (n = 28, 11 males and 17 females) with normal renal arteries; aged 45.4 ± 1.8 years, history of AH 14.9 ± 1.3 years; diurnal SBP 158.2 ± 3.6 mmHg and DBP 95.8 ± 2.6 mmHg; BMI 29.3 ± 1.2. BP remained uncontrolled high despite the prescription of 4 antihypertensive drugs. The cases of pseudo-resistant AH had been excluded. Renal function features was evaluated by the dynamic nephroscyntigraphy in all the patients and the level of microalbuminuria was estimated (immunochemical analysis) initially and in 4 years follow-up. Results: Initially the patients with RAA had the level of urine microalbumin 39.38 ± 15.2 mg and in 4 years – 54.74 ± 20.7 mg, respectively (p > 0.05). And in the comparison group the level of microalbuminuria was stated at first point as 51.15 ± 24.9 mg and 4 years later - as 65.45 ± 24.4 mg (p > 0.05). Initially dynamic nephroscyntigraphy analysis presented maximum agent evacuating time (T max) as 6.15 ± 0.8 min and 4 years later – 3.7 ± 0.5 min (p < 0.05). In the comparison group this level was 6.45 ± 0.4 min and 5.7 ± 0.6 min, respectively (p > 0.05). Conclusions: As at first point and as 4 years later the level of microalbuminuria in patients with RAA had no significance differences with the comparison group. Maximum nephroscyntigraphy agent evacuating time (T max) significantly decreased in the main group in the 4 years follow-up period, and in patients with normal renal arteries there were no such changes. The findings may reveal severe growth rate of hypertensive nephrosclerosis of functioning renal parenchyma in patients with resistant AH and RAA.

OS 30-03 GENDER DIFFERENCES OF AN ARTERIAL HYPERTENSION RISK IN POPULATION WITH SLEEP DISTURBANCE IN RUSSIA / SIBERIA

Objective: To determine the gender differences influence sleep disturbances (SD) on the risk of arterial hypertension (AH) in the open population 25–64 years in Russia / Siberia. Design and Method: As part of the third screening WHO program «MONICA-psychosocial» a random representative sample of the population of both sexes aged 25–64 in Novosibirsk was surveyed in 1994 (men: n = 657 44.3 ± 0.4 years, the response −82.1%; women: n = 689, 45.4 ± 0.4 years, the response −72.5%). Registration of socio-demographic data and determining of SD were made. 229 cases of new-onset AH in women and 46 cases in men were identified over 16-year period. Results: In general population aged 25–64 years 48.6% of men and 65.9% of women had SD. The social gradient in both men and women with SD had the following differences: marital status structure is not significantly different, but widowhood increased the risk of AH in men over HR = 14.6, than women HR = 5.6 (p < 0.0001). Low level of education was associated with SD in women more likely HR = 10.3, the same picture was in occupational groups. Over 5 years men with SD had higher risk of AH HR = 5.4 than women HR = 4.35. After 10 years the risk of AH was higher in women HR = 2.68 than men HR = 2.3. After 16 years there was a tendency in AH risk in men HR = 1.2 (p < 0.05) but not in women HR = 1.05 (95%CI 0.73- 1.48; p > 0.05). Conclusions: SD are more prevalent in women than in men. The risk of AH was higher among widowed men than in women. The low level of education was significantly associated with SD, only women. At the same time the risk of AH was higher in men than women with SD.

CARDIOVASCULAR DISEASES AND VITAL EXHAUSTION: LONGITUDINAL STUDY IN RUSSIA/SIBERIA (WHO MONICA — PSYCHOSOCIAL PROGRAM)

Aim. To study prevalence rates of vital exhaustion and its effects on 14-year risk of cardiovascular disease (CVD) (arterial hypertension (AH), myocardial infarction (MI), and stroke) development and genetic traits in open population of 25–64-yearold men in Russia/Siberia (West Siberia metropolis, Novosibirsk). Material and methods. Random representative sample of 25–64-year-old men was studied in a framework of WHO MONICA-Psychosocial Program (MOPSY) in 1994. Maastricht Questionnaire (MQ) was used to assess vital exhaustion. Genotyping for variable number of tandem repeats (VNTR) polymorphisms in DRD4 and DAT genes was performed. All new cases of AH, MI, and stroke were registered among people without CVD for 14 years (from 1994 to 2008). Statistical analysis was done by using software package SPSS 11.5. Cox proportional hazards regression model was used for evaluation of risk coefficient (hazard ratio (HR) taking into account time-adjusted control. Х2 test was used to assess statistical significance of differences between the groups. Results. In the study population, the vital exhaustion rate was 66,8%. Hazard ration was significantly increased (AH: HR=3,2; MI: HR=2,7; stroke: HR=3,2) in men with vital exhaustion compared with vital exhaustion-free individuals in open population during the first five years of observation. Multifactorial modeling showed that vital exhaustion together with concomitant social gradient determined development of AH, MI, and stroke in open population of 25–64-year-old men. Allele 7 of DRD4 and genotype 9/9 of DAT gene were associated with high level of vital exhaustion. Conclusion: Open population of 25–64-year-old men (Russia/Siberia, Novosibirsk) showed high level of vital exhaustion, a predictor for risk of developing CVD. Vital exhaustion is significantly associated with certain VNTR polymorphisms of DRD4 and DAT gens.

PROSPECTIVE STUDY OF TABLE SALT TASTE SENSITIVITY THRESHOLD INFLUENCE ON CARDIOVASCULAR COMPLICATIONS

Aim. To evaluate prognostic significance of TSTST in cardiovascular complications development. Material and methods. Totally 162 persons studied, of those 67 with arterial hypertension (AH) and 95 their close relatives of the 1 grade of relativity, healthy at the moment of the first examination in 1998. Second study of the group has been done in 16 years, in 2014. Totally 28 families studied. In 16 years, 101 person had arterial hypertension, and in 34 it had been developed during the observation period. Ischemic heart disease (IHD) was diagnosed in 38 patients, diabetes (DM) — in 21 (all had 2nd type). For 16 years, the brain stroke (BS) developed in 15 participants, in 6 cases it was fatal, and myocardial infarction (MI) — in 13 participants, in 10 cases fatal. Totally 15 patients died (9,3%), one — from melanoma. The participants at the baseline were studied for the TSTST by Henkin R. J. method under Konstantinov E. N. modification. For the second study in 16 years a protocol was created included the results of anthropometric and hemodynamic data, and the cases of AH, IHD, MI and BS, and the death. Results. In the group of those died comparing to the others, were higher levels of TSTST at the baseline (2,52±0,39 vs 1,38±0,16, р<0,05). During 16 years among 54 participants with high TSTST (more than 0,64) died 14 — 25,9%, and from 47 participants with normal TSTST died 1 — 2,13%. In analysis of the influence of TSTST on cardiovascular outcomes, it was shown that the risk of fatal and nonfatal cases of BS increased with TSTST, but the risk of MI did not differ significantly. In addition, the survival of the patients was significantly lower in the case of higher TSTST in BS, as in MI. In survival analysis for the influence of TSTST on nonfatal cases of MI and BS there were no such influence. Conclusion. High TSTST in AH patients increases the risk of fatal and nonfatal cases of BS, fatal MI during 16 years of study. High TSTST is followed by the increase of the risk of new onset of AH, and higher mean values of BP in AH. The decrease of general survival and 16-year survival of AH patients due to fatal cases of BS and MI is caused by higher TSTST.

P1-157 Arterial hypertension: psychosocial factors and risk of development during the period of 20 years in men 25–64 years of age in Russia

We aimed to investigate the influence of psychosocial factors on the risk of arterial hypertension (AH) development over a 20 year period in men aged 25–64 years in Russia.Materials and...

COX-2 inhibitors and arterial hypertension: an analysis of spontaneous case reports in the Pharmacovigilance database

To evaluate the main characteristics of case reports of arterial hypertension (AH) related to COX-2 inhibitor (coxib) use in real-life practice. This study was based on spontaneous reports of adverse drug reactions (ADRs) submitted to the French Pharmacovigilance system. Associations between AH and the different groups of those using non-steroidal anti-inflammatory drugs (NSAIDs: rofecoxib, celecoxib and non-selective NSAIDs) were compared using calculation of the odds ratio (OR) with 95% confidence intervals (CIs). In France, between 1 April 2000 and 30 November 2003, 34 AH cases related to coxibs were reported. Case reports include predominantly patients older than 65 years, with a previous story of essential AH. Most AH (60%) occurred during the first 15 days of treatment. The AH was reported significantly more frequently for rofecoxib than celecoxib. The OR for development of AH with rofecoxib versus celecoxib was 3.3 (1.6-6.9). The AH was also reported more frequently with coxib (2.8%) than with non-selective NSAID (0.5%) use, OR = 5.9 (3.8-9.0). This study shows that coxibs are associated with a risk of AH in real-life practice. More spontaneous reports of AH to the French Pharmacovigilance system concern rofecoxib than celecoxib (and coxibs than non-selective NSAIDs). This ADR is of special epidemiological importance due to both the risks of AH and the large use of coxibs.

La dissection aortique chez les Noirs. À propos de six cas congolais

Introduction – The authors report on six cases of aortic dissection (AD). The work intended to bring out AD characteristics and attempt to define a profile of African patients who manifested this disease. The diagnosis of AD was determined on the basis of: clinical and radiological criteria (six cases); echocardiographic data (five cases); aortographic and surgical informations (two cases). Patients and methods – There were three males and three females with an average age of 40.2 years, with a variation of ±10.6 years (from 17 to 49). The frequency of AD was estimated at 1.8/10 000 admissions considering all causes and 5.4/10 000 for cardiovascular disease. Strain was the only triggering factor – noted in two cases (Observations 2 and 3). All patients suffered from severe arterial hypertension (AHT) of which there was one case of renovascular AHT based on the Takayasu arteritis. All symptoms and physical findings were the same described in litterature. Operations were successful on two patients. The four unoperated patients died (tamponade: two cases, undetermined cause: two cases). Conclusion – The authors conclude as to the similarity of the AD charts described in the literature. However they stress the almost exclusive role of AHT in African studies series as well as that, in rare cases, of Takayasu's disease. They recommend preventing AD through the sustained and effective treatment of AHT.