Chronic Arterial Hypertension Research Articles

Pregnant women with COVID-19 ARDS on the intensive care unit

Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease progression. Comorbidities, such as chronic arterial hypertension, diabetes mellitus, advanced maternal age and high body mass index, may predispose to severe disease. The management of pregnant COVID-19patients on the intensive care unit (ICU) is challenging and requires careful consideration of maternal, fetal and ethical issues. Description and discussion of intensive care treatment strategies and perinatal anesthesiological management in patients with COVID-19 acute respiratory distress syndrome (CARDS). We analyzed the demographic data, maternal medical history, clinical intensive care management, complications, indications and management of extracorporeal membrane oxygenation (ECMO) and infant survival of all pregnant patients treated for severe CARDS in the anesthesiological ICU of aGerman university hospital between March and November 2021. The cohort included 9 patients with amean age of 30.3 years (range 26-40years). The gestational age ranged from 21 + 3 weeks to 37 + 2 weeks. None of the patients had been vaccinated against SARS-CoV‑2. Of the nine patients seven were immigrants and communication was hampered by inadequate Central European language skills. Of the patients five had aPaO2/FiO2 index < 150 mm Hg despite escalated invasive ventilation (FiO2 > 0.9 and a positive end-expiratory pressure [PEEP] of 14 mbar) and were therefore treated with repeated prolonged prone positioning maneuvers (5-14 prone positions for 16 h each, atotal of 47prone positioning treatments) and 2 required treatment with inhaled nitric oxide and venovenous ECMO. The most common complications were bacterial superinfection of the lungs, urinary tract infection and delirium. All the women and five neonates survived. All newborns were delivered by cesarean section, two patients were discharged home with an intact pregnancy and two intrauterine fetal deaths were observed. None of the newborns tested positive for SARS-CoV‑2 at birth. High survival rates are possible in pregnant patients with CARDS. The peripartum management of pregnant women with CARDS requires close interdisciplinary collaboration and should prioritize maternal survival in early pregnancy. In our experience, prolonged prone positioning, an essential evidence-based cornerstone in the treatment of ARDS, can also be safely used in advanced stages of pregnancy. Inhaled nitric oxide (iNO) and ECMO should be considered as life-saving treatment options for carefully selected patients. For cesarean section, neuraxial anesthesia can be safely performed in patients with mild CARDS if well planned but the therapeutic anticoagulation recommended for COVID-19 may increase the risk of bleeding complications, making general anesthesia amore viable alternative, especially in severe disease.

МОРФОЛОГИЧЕСКИЕ ОСОБЕННОСТИ ПЛАЦЕНТ ЖЕНЩИН ПРИ БЕРЕМЕННОСТИ, ОСЛОЖНЁННОЙ СИНДРОМОМ ЗАДЕРЖКИ РАЗВИТИЯ ПЛОДА

Objective: To present the morphological features of placentas in pregnancies with hypertension and fetal growth restriction syndrome (FGRS) Methods: Eighty-six placentas in pregnancies with FGRS on the background of arterial hypertension are examined. Among them, there were 34 placentas from patients with chronic arterial hypertension (CAH), 24 placentas from patients with preeclampsia (PE), and 28 placentas from patients with PE in combination with CAH. All pregnant women underwent a Doppler ultrasound investigation. FGRS was diagnosed if uteroplacental-fetal circulatory disorders were combined with small for gestational age fetal size. Various types of hypertensive disorders were diagnosed in accordance with WHO recommendations. A comprehensive assessment of structural changes in the placentas included macroscopic examination, organometry and histological evaluation complemented by morphometry. Results: Placental hypoplasia, dominating magistral pattern of chorionic blood vessels, infarction foci, thrombosis of the intervillous space, and compensatory angiomatosis of the chorionic villi are the typical features of the placentas in pregnanсies with FGRS and the background hypertension. Histological signs of chorionic villi ischemia indicate placentation disorders and a decreased intensity of angiogenesis in the uteroplacental circulation. Conclusion: Hypertensive disorders during pregnancy associated with endothelial dysfunction lead to placental insufficiency (PI), causing FGRS. Keywords: Pregnancy, fetal growth restriction, placental insufficiency, hypertensive disorders, morphological evaluation..

Клинико-анамнестические факторы риска развития преэклампсии как осложнения гестационного сахарного диабета

Aim. To identify the clinical and anamnestic risk factors of preeclampsia (PE) in gestational diabetes mellitus (GDM). Design. Open-label observational prospective study. Materials and methods. The study enrolled 204 pregnant women with GDM, 70 of which had their pregnancy complicated with PE (study group) and 134 patients did not have PE (controls). In the study group, clinical and anamnestic risk factors were searched for by tracing data from primary medical records. The age of participants was 21 to 46 years old. Extragenital conditions were studied as possible risk factors of PE in GDM. Results. It has been established that GDM with PE was more likely to be associated with chronic arterial hypertension (CAH) (χ2 = 7.72, р = 0.006, odds ratio (OR) = 8.52, 95% confidence interval (CI): 1.76–41.29); a history of respiratory diseases — severe sore throat (χ2 = 6.2, р = 0.01, OR = 3.98, 95% CI: 1.40–11.27), chronic tonsillitis (χ2 = 12.84, р &lt; 0.001, OR = 4.81, 95% CI: 2.03–11.40), acute bronchitis (χ2 = 6.0, р = 0.02, OR = 7.33, 95% CI: 1.48–36.32) than GDM without PE. Conclusion. Clinical and anamnestic risk factors of PE in women with GDM are CAH, a history of respiratory diseases (acute bronchitis, severe sore throat, chronic tonsillitis). Keywords: gestational diabetes mellitus, preeclampsia, risk factors.

Pregnancies at advanced maternal age

The definition of advanced maternal age (AMA) is debated, with an increasing risk of complications from the age of35, but a threshold of40years old is adopted internationally to adjust surveillance and set the term of delivery between39 and40weeks. Patients with AMA have more comorbidities, such as type2 diabetes and chronic arterial hypertension. They are at greater risk of miscarriage, -gestational diabetes, hypertensive, thrombotic and psychiatric complications, as well as caesarean sections, placenta previa and placental abruption. Additionally, fetal and neonatal complications can occur, including genetic anomalies, fetal growth issues, stillbirths, and prematurity. AMA is a non--modifiable risk factor that must be taken into account to ensure a safe peri-natal period.

Labor induction outcomes with vaginal misoprostol in high-risk pregnancies at a tertiary center in the metropolitan region of Rio de Janeiro, Brazil.

To analyze the main indications for induction of labor with vaginal misoprostol in high-risk pregnancies as well as the main variables associated with failed induction in a tertiary center in the metropolitan region of Rio de Janeiro, Brazil. A retrospective cohort study analyzed the medical records of pregnant women who underwent induction of labor. Inclusion criteria were singleton pregnancy, gestational age ≥ 34 weeks, Bishop score ≤ 6, fetuses in cephalic presentation, and no contraindications for the use of vaginal misoprostol. The labor induction protocol consisted of vaginal misoprostol 25 mcg every 6 hours, with a maximum of eight doses (200 mcg) to ripen the cervix if Bishop's score was ≤ 6. A total of 88 cases of labor induction were analyzed. Main indications for labor induction were preeclampsia and gestational hypertension (N = 28; 31.8%), chronic arterial hypertension (N = 19; 21.6%), and gestational diabetes mellitus (N = 12; 13.6%). We observed that vaginal delivery was associated with the number of vaginal misoprostol doses (P = 0.000348). The most common indications for cesarean section were failure of labor induction (N = 21; 40%) and suspected acute fetal distress (N = 17; 33%). We did not observe a statistical difference between indication of labor induction and mode of delivery. There were no fetal deaths. Six neonates were admitted to the neonatal intensive care unit (NICU), one for respiratory distress, one for preterm delivery, and four for hypoglycemia. There was no statistical difference in the rate of NICU admission between delivery modes (P = 0.692). The main indication for cesarean section in this study was induction failure, indicating the need to review and continuously monitor the protocol to increase success rates without compromising perinatal outcomes.

ТЕРАПЕВТИЧЕСКИЙ ПОДХОД К ЛЕЧЕНИЮ ХРОНИЧЕСКОЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ БЕРЕМЕННЫХ: МЕСТО β-АДРЕНОБЛОКАТОРОВ

Abstract. The purpose of the clinical trial was to study the state of the cardiorenal system in pregnant women with chronic arterial hypertension in the second trimester of gestation under the influence of β-blocker therapy. A comprehensive assessment of the cardiorenal system was performed. The results obtained showed the positive effect of antihypertensive therapy on central and peripheral hemodynamics and the functional state of the kidneys.

Medical and biological risk factors for the development of pre-eclampsia of variable severity in pregnant women with chronic arterial hypertension

Medical and biological risk factors for the development of pre-eclampsia of variable severity in pregnant women with chronic arterial hypertension

Multivariate analysis and mathematical modeling of the informativeness of patients cases data in chronic pancreatitis associated with concomitant pathology.

Aim: To investigate and analyze homeostatic disorders in patients with a combination of Chronic Pancreatitis(CP) and Arterial Hypertension (AH) and to develop correcting ways of the detected changes. Materials and Methods: General clinical, laboratory-instrumental examination of 121 patients, who were undergoing inpatient treatment with a diagnosis of Chronic Pancreatitis in combination with Arterial Hypertension of the II stage during 2021-2022. Results: In the majority of cases of patients signs the increasing in IL-1,6 and Cortisol levels were found. A decrease in Ca to the lower limit of the norm was observed (2.18 ± 0.26 mmol/l to the data of control group patients (2.32 ± 0.12 mmol/l, p= 0.01 ), the levels of trace elements Zn and Se were determined within the reference values. The Atherogenic Index was increased 1.8 times and was significantly different from the control group date. During the FE-1 study, a decrease in the level of this indicator was revealed by 151.71±13.91 mg/g of feces, both to the values of reference values and a significant difference to the data of the control group (241.28±29.17 mg/g of feces, p<0 .05). Conclusions: Based on the multivariate linear regression analysis of the obtained data, formulas have been developed that can be used to predict the dynamics of the dependent variable (FE-1, IL-1, Selenium level, Glutathione Peroxidase, blood pressure) according to changes in the studied influencing factors.

Association of clinical, imaging and laboratory parameters with adverse effects of glucocorticoid therapy in patients with giant cell arteritis.

Giant cell arteritis (GCA) is characterized by inflammation of large and medium vessels. First-line therapy for the treatment of GCA are glucocorticoids, which are effective while potential adverse effects should be considered, especially during long-term use. The aim was to investigate the incidence of glucocorticoids' adverse effects and potential predictors for them. 138 GCA patients were retrospectively evaluated for newly developed glucocorticoid adverse effects in 2020. Potential predictors, defined as initial glucocorticoid pulse therapy, relapse of GCA and concomitant polymyalgia rheumatica as well as parameters of inflammation and endothelial dysfunction, including pulse-wave velocity and intima-media-thickness, were measured in 2012. Potential new glucocorticoid adverse effects per patient was 1 (25th-75th 0-3) of which chronic kidney disease progression (29%), bone fractures (23.2%), cataracts (18.1%), dementia, and arterial hypertension (each at 12.3%) were most commonly recorded. Significant associations were found between occurrence of any relapse and new diabetes mellitus and between initial glucocorticoid pulse therapy and new dementia (all with p < 0.05). In multivariate regression analysis, any relapse was a predictor for developing diabetes mellitus (OR 9.23 [95% CI 1.33-64.05], p = 0.025). However, no correlations were observed between endothelial dysfunction or inflammatory parameters and development of new glucocorticoid adverse effects. GCA relapses may be associated for development of diabetes mellitus potentially by increasing glucocorticoid doses. Parameters of inflammation and endothelial dysfunction are not suited predictors for glucocorticoid adverse effects.

СОВРЕМЕННЫЕ АСПЕКТЫ СОЧЕТАННОГО ТЕЧЕНИЯ ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНИ ЛЕГКИХ И АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ: В ФОКУСЕ НАРУШЕНИЕ ФУНКЦИИ ПОЧЕК

Abstract. This literature review examines the relationship between the combined course of chronic obstructive pulmonary disease (COPD) and arterial hypertension (AH) in the context of functional renal impairment that develops against the background of the disease. Features of the combined course of COPD and hypertension can also lead to an increased risk of developing renal dysfunction. For example, both diseases can cause tissue hypoxia. Studying the features of the combined course of these conditions may be useful for developing more effective programs for the prevention and treatment of complications in the cardiovascular, respiratory and urinary systems. This will reduce the risk of disability, improve the quality of life of patients and extend their lives. Thus, studying the effect of the combined course of COPD and hypertension on renal functional disorders is an important area of research that can benefit patients and help in more effective prevention and treatment of these diseases.

Factors associated to amputation in pyogenic flexor tenosynovitis in a tertiary referral center in Mexico

Background: Pyogenic flexor tenosynovitis is an aggressive closed-space infection, which affects the flexor tendon sheath of the hand with disabling sequelae. The purpose of this study is to describe the patient demographic characteristics and identify factors associated with amputation in pyogenic flexor tenosynovitis. Methods: In this retrospective single-center study, included all adult patients who presented to the emergency department from 2015 to 2021 with PFT of the hand. Descriptive summary statistics were reported on patient demographics, presenting symptoms and clinical examination features, culture results, treatment strategies, and early complications. The factors influencing amputation were identified and analyzed. Results: A total of 59 patients with PFT diagnosis were included. Most of the population was found to be immunosuppressed (34 patients). Moreover, the most common comorbidities were the combination of diabetes mellitus and systemic arterial hypertension. The third right finger was the most frequently affected region. Almost all patients were hospitalized, intravenous antibiotics, and at least one additional surgical intervention was required in 16 cases. Amputation of the infected finger occurred in 6 patients, associated with different factors: reintervention, age over forty, presence of diabetes mellitus and chronic arterial hypertension, penetrating trauma, and presence of Enterococcus faecalis in culture. Conclusions: Rapid and aggressive treatment is required to prevent devastating complications such as amputation. Adequate identification of the disease and risk factors is critical for a successful result. E. faecalis represents the most common pathogen in this study, unlike the reported literature. Thus, broad-spectrum antibiotics and surgical intervention are required.

Smartphone-Based versus Non-Invasive Automatic Oscillometric Brachial Cuff Blood Pressure Measurements: A Prospective Method Comparison Volunteer Study.

Introduction: Mobile health diagnostics have demonstrated effectiveness in detecting and managing chronic diseases. This method comparison study aims to assess the accuracy and precision of the previously evaluated OptiBP™ technology over a four-week study period. This device uses optical signals recorded by placing a patient's fingertip on a smartphone's camera to estimate blood pressure (BP). Methods: In adult participants without cardiac arrhythmias and minimal interarm blood pressure difference (systolic arterial pressure (SAP) < 15 mmHg or diastolic arterial pressure (DAP) < 10 mmHg), three pairs of 30 s BP measurements with the OptiBP™ (test method) were simultaneously compared using three pairs of measurements with the non-invasive oscillometric brachial cuff (reference method) on the opposite arm over a period of four consecutive weeks at a rate of two measurements per week (one in the morning and one in the afternoon). The agreement of BP values between the two technologies was analyzed using Bland-Altman and error grid analyses. The performance of the smartphone application was investigated using the International Organization for Standardization (ISO) definitions, which require the bias ± standard deviation (SD) between two technologies to be lower than 5 ± 8 mmHg. Results: Among the 65 eligible volunteers, 53 participants had adequate OptiBP™ BP values. In 12 patients, no OptiBP™ BP could be measured due to inadequate signals. Only nine participants had known chronic arterial hypertension and 76% of those patients were treated. The mean bias ± SD between both technologies was -1.4 mmHg ± 10.1 mmHg for systolic arterial pressure (SAP), 0.2 mmHg ± 6.5 mmHg for diastolic arterial pressure (DAP) and -0.5 mmHg ± 6.9 mmHg for mean arterial pressure (MAP). Error grid analyses indicated that 100% of the pairs of BP measurements were located in zones A (no risk) and B (low risk). Conclusions: In a cohort of volunteers, we observed an acceptable agreement between BP values obtained with the OptiBPTM and those obtained with the reference method over a four-week period. The OptiBPTM fulfills the ISO standards for MAP and DAP (but not SAP). The error grid analyses showed that 100% measurements were located in risk zones A and B. Despite the need for some technological improvements, this application may become an important tool to measure BP in the future.

Natural Substances vs. Approved Drugs in the Treatment of Main Cardiovascular Disorders-Is There a Breakthrough?

Cardiovascular diseases (CVDs) are a group of diseases with a very high rate of morbidity and mortality. The clinical presentation of CVDs can vary from asymptomatic to classic symptoms such as chest pain in patients with myocardial infarction. Current therapeutics for CVDs mainly target disease symptoms. The most common CVDs are coronary artery disease, acute myocardial infarction, atrial fibrillation, chronic heart failure, arterial hypertension, and valvular heart disease. In their treatment, conventional therapies and pharmacological therapies are used. However, the use of herbal medicines in the therapy of these diseases has also been reported in the literature, resulting in a need for critical evaluation of advances related to their use. Therefore, we carried out a narrative review of pharmacological and herbal therapeutic effects reported for these diseases. Data for this comprehensive review were obtained from electronic databases such as MedLine, PubMed, Web of Science, Scopus, and Google Scholar. Conventional therapy requires an individual approach to the patients, as when patients do not respond well, this often causes allergic effects or various other unwanted effects. Nowadays, medicinal plants as therapeutics are frequently used in different parts of the world. Preclinical/clinical pharmacology studies have confirmed that some bioactive compounds may have beneficial therapeutic effects in some common CVDs. The natural products analyzed in this review are promising phytochemicals for adjuvant and complementary drug candidates in CVDs pharmacotherapy, and some of them have already been approved by the FDA. There are insufficient clinical studies to compare the effectiveness of natural products compared to approved therapeutics for the treatment of CVDs. Further long-term studies are needed to accelerate the potential of using natural products for these diseases. Despite this undoubted beneficence on CVDs, there are no strong breakthroughs supporting the implementation of natural products in clinical practice. Nevertheless, they are promising agents in the supplementation and co-therapy of CVDs.

Abstract 17842: 3D Visualization and Quantitative Assessment of the Pulmonary Arteries on CT Using Deep Learning Segmentation

Introduction: Assessment of the pulmonary arteries (PA) on CT scan is typically qualitative and requires review of hundreds of images. PA segmentation would enable creation of 3D reconstructions that visualize the entire pulmonary arterial tree in a single image, similar to catheter angiography, and also enable quantification of pathophysiologic changes. Manual segmentation is very time-consuming, but deep-learning (DL) can automate the process. Hypothesis: A DL segmentation algorithm can be used to automatically generate 3D reconstructions of the PAs and quantify morphologic changes seen in Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and Pulmonary Arterial Hypertension (PAH). Methods: A DL algorithm based on a 3D U-Net architecture which segments PAs larger than 2 mm was trained and validated on a total of 250 contrast-enhanced CT chest. The study group included 15 CTEPH and 15 PAH patients seen consecutively in pulmonary hypertension (PH) clinic in 2022 with prior CT chest and right heart catheterization, and 10 additional patients with prior CT chest and no evidence of PH on same day echo (normal). After running the DL algorithm on CTs, 3D renderings were created from segmentations and the relative volume of the central, interlobar, and segmental/subsegmental PAs was derived. Results: 3D renderings of PAH and CTEPH patients showed larger central and interlobar PAs compared with those of normal patients, whereas segmental and subsegmental PAs were smaller and pruned in CTEPH patients (Figure). Quantitatively, the volume of the central and interlobar PAs was higher in CTEPH and PAH compared to normal (p &lt; 0.05). The combined volume of segmental/subsegmental PAs was smaller in CTEPH patients relative to normal and PAH patients (p &lt; 0.005). Conclusions: DL segmentation enables intuitive visualization and quantification of the morphologic changes to the PAs seen in conditions causing PH. This method may improve diagnosis and assessment of PH on CT.

Effect of Nicorandil on Endothelial Markers and Tissue Remodeling in Pulmonary Arterial Hypertension Model of Male Rats

Background: Chronic pulmonary arterial hypertension (PAH) is a rare, long-lasting illness that makes pulmonary artery endothelial cells (PAEC) not work properly and leads to heart failure and death. Objective: To evaluate the effect of nicorandil in the treatment of PAH compared to tadalafil in a rat model of monocrotaline-induced PAH. Methods: Monocrotaline injection (60 mg/kg) was used for the induction of PAH in male rats; healthy control and induction groups were not treated. The other 4 groups were treated with either nicorandil or tadalafil with or without treatment blockers (glimepiride and N-Nitroarginine methyl ester (L-NAME)) for 21 days orally. Serum was obtained for assessment of endothelin-1 (ET-1) and tissue harvested for nuclear factor kappa B (NFκB) by ELISA, western blot analysis of endothelial nitric oxide synthase (eNOS), and an apoptosis assay to examine the endothelial function. Results: Nicorandil showed a significant reduction in ET-1 and significant elevation in eNOS compared to the induction group, with comparable efficacy to tadalafil; blocker groups showed significantly elevated levels of ET-1 and reduced levels of eNOS compared to healthy control; NFκB was significantly inhibited in nicorandil and tadalafil groups and significantly elevated in blocker and induction groups; while in the TUNEL apoptosis assay, nicorandil showed the highest level of inhibition to apoptosis with apparently normal endothelium lining. Conclusions: Nicorandil shows anti-inflammatory, antiapoptotic, and enhanced endothelial morphology and function compared to the induction model.

Сardioprotective agents with biaromatic structure. Part 6. Beta blockers

β-Blockers are one of the oldest classes of cardioprotectors used in the treatment of cardiovascular diseases. They reduce the heart rate, have a hypotensive effect, inhibit myocardial contractility and have antiarrhythmic properties. In the series of biaromatic compounds with a linear linker, there is a quite large group of β-blockers, which in addition to two aromatic nuclei contain a 1,2-dihydroxy-3-aminopropane fragment in the linker, that is the key for the presence of β-blocking activity. Among the compounds of this group are widely used drugs nebivolol and carvedilol, which are used in the treatment of chronic heart failure and arterial hypertension.

EARLY FETAL GROWTH RETARDATION IN PREGNANT WOMEN WITH HYPERTENSIVE DISORDERS

Fetal growth retardation (FGR) is a complication of pregnancy that develops due to placental insufficiency and leads to the birth of a child with mass and growth parameters below the 10th percentile for a given gestational age. Newborns with FGR are at high risk of developing motor, neurological, cognitive and learning disorders, as well as cerebral palsy. Purpose. To determine the frequency, risk factors and perinatal outcomes in case of early fetal growth retardation (up to 32 weeks of gestation) in pregnant women with hypertensive disorders. Materials and methods. A retrospective analysis of delivery histories was performed in 116 (8.95%) cases in pregnant women with hypertensive disorders. Hypertensive disorders included: gestational hypertension - 27 (23.2%), chronic arterial hypertension combined with preeclampsia - 18 (15.5%), severe preeclampsia - 35 (30.2%), moderate preeclampsia - 36 (31.1%) cases. Early fetal growth retardation (up to 32 weeks of gestation) was in 32 (26.8%) cases, late fetal growth retardation - in 84 (73.2%) cases. Perinatal losses occurred in 4 (34.4%o) cases in pregnant women with early FGR. Results. Pregnant women with hypertensive disorders most often had concomitant kidney disease, hypertension, obesity of II-III degree, and varicose veins. The highest percentage of newborns with FGR as in pregnant women with chronic arterial hypertension of 2-3 grades (38.9%) and in women with severe preeclampsia (31.4%). The lowest average body weight (1260±52 g) was in newborns whose mothers had blood pressure above 200/130 mm Hg. The highest average body weight (1485±85 g) was in newborns whose mothers had blood pressure up to 160/100 mm Hg. Conclusions. Thus, pregnant women with hypertensive disorders are at high risk of developing a serious complication - early fetal growth retardation. The highest risk of uteroplacental circulation disorders is in pregnant women with chronic hypertension of 2-3 grades and severe preeclampsia.

Long-Term Safety, Outcome, and Clinical Effects of Subcutaneous and Intravenous Treprostinil Treatment in Patients with Severe Chronic Pulmonary Arterial Hypertension

Background: Current guidelines recommend treatment with parenteral prostacyclin analogs in patients with severe pulmonary arterial hypertension (PAH), who have insufficient response to treatment. Real-life data are sought to help physicians in treatment decisions and clinical care of patients. Objective: This study analyzed safety, clinical effects, and long-term outcomes of subcutaneous (sc) and/or intravenous (iv) treprostinil via different pump systems in consecutive patients with PAH. Methods: Thirty-seven patients with severe progressive PAH despite dual combination therapy (20 female, mean age: 52.3 ± 15 years, mean pulmonary vascular resistance: 12.1 ± 5.1 WU) were initiated with add-on treprostinil sc and were routinely clinically assessed. Changes in clinical parameters, adverse events, and outcome were analyzed retrospectively. Results: In 24 of 37 patients, treprostinil administration was continued iv via implantation of LENUS Pro® pump after 3 ± 1.3 months, 6 patients continued with sc therapy, and 7 discontinued treatment. After 3, 6, 9, and 12 months of treprostinil treatment, patients showed a significant improvement in mean 6-min walk distance and tricuspid annular plane systolic excursion compared to baseline. In 8 of the 24 patients, iv pumps required surgical revision. During a mean follow-up of 2.82 ± 1.95 years, 12 patients died, four received lung transplantation. Transplant-free survival after 1, 2, and 3 years was 85.7%, 69.2%, and 65.3%, respectively. Conclusion: sc treprostinil as add-on to double combination treatment significantly improved exercise capacity and right heart function. In most patients, treprostinil could be continued via more tolerable iv administration approach (LENUS Pro® pump), showing reasonable overall survival with respect to the severity of PAH.

#6442 HOW CAN IT BE NEPHROANGIOSCLEROSIS? HE´S BEING TREATED ONLY WITH ONE ANTIHYPERTENSIVE DRUG

Abstract Background and Aims Nephroangiosclerosis is a frequent renal disease due to chronic arterial hypertension and it is one of the main causes leading to renal replacement therapy. A minority of these patients have nephroangiosclerosis although they apparently have hypertension under control with minimal treatment. Objetives To describe the characteristics of this group of patients when compared to the rest of patients with histological diagnosis of nephroangiosclerosis. Method Observational, retrospective and descriptive study. Review of 67 patients with nephroangiosclerosis as the sole diagnosis in the renal biopsy (consecutive biopsies from 2010 to 2020). We divided the population in two different groups according to the number of prescribed antihypertensive drugs: Group 1 (0-1 antihypertensive drugs) vs Group 2 (≥2 antihypertensive drugs). Results Both groups had similar demographics and renal function/proteinuria. Both groups had the same adequate/inadequate blood pressure control, but group 1 had significantly less time of hypertension'evolution. The histological differences (although not statistically significant) are noteworthy: Group 1 had a higher percentage of global glomerulosclerosis, interstitial fibrosis and tubular atrophy than Group 2. In addition, after 3-years of follow-up, in Group 1 there were more patients requiring renal replacement therapy. We hypothesize that a factor that could explain these results could be the lower use of RASi (33.3% vs 73.9%, P = .003*) and a higher percentage of history of dyslipidemia in Group 1 (62.,5% vs 22.,2%, p=0,017*). Conclusion Patients with hypertension requiring a maximum of one drug for its control, presented histological results of more marked nephroangiosclerosis, than the group of patients with more than one drug, despite similar time of evolution and degree of blood pressure control. These findings could be related to a lower rate of RASi use. Our study reinforces the indication for RASi as a first-line hypertension treatment in this population.

THE INFLUENCE OF EXCESSIVE WEIGHT GAIN ON DISTURBANCE OF THE UTERINE-PLACENTAL BLOOD FLOW IN PREGNANT WOMAN WITH ARTERIAL HYPERTENSION

Objective: To evaluate the development of violations of uterine-placental blood flow depending on weight gain during pregnancy in women with arterial hypertension. Design and method: A prospective cohort examination of 110 pregnant women with arterial hypertension (including chronic and gestational arterial hypertension) and 80 women of the control group (practically healthy women without increasing blood pressure) was conducted. The study was conducted on the basis of perinatal centers of Astana (Kazakhstan) in 2018-2019. The weight gain for the period of pregnancy in women with hypertension and control groups was studied. The body mass index (BMI) was calculated and weight gain for the period of pregnancy in the studied groups. Results: One of the main causes of the development of complications during pregnancy by the fetus is a violation of uterine-placental blood circulation (UPC), which depends not only on blood pressure levels. Disorders of the UPC were detected in pregnant women with hypertension and control groups of 20% and 2.5%, respectively (p = 0.0003). In pregnant women with hypertension, the odds ratio of chances of the development of UPC disorders increased by 4.4 times compared to the pregnant woman of the control group. Excessive increase in body weight during pregnancy in pregnant women with hypertension was detected in 16% and in the control group 5% (p = 0.018). The relative probability of developing a violation of the UPC with an excessive increase in the weight of a pregnant woman with hypertension soared by 50%. In the control group of pregnant women with a normal pressure level, excess weight gain was detected in 6.3% and there were no violations of the UPC. Conclusions: According to the results of the study, in pregnant women with hypertension, violations of the UPC were significantly more common compared to the control group. The odds ratio of the chances of developing uterine-placental blood flow surges by 4.4 times in pregnant women with hypertension compared to pregnant women with a normal level of pressure. Excessive weight gain in pregnant women with hypertension increases the development of impaired UPC.