Concomitant Arterial Hypertension Research Articles

The challenges in diagnosing hypertrophic cardiomyopathy in the presence of arterial hypertension: a clinical case

Aim. To describe a clinical case and analyze the challenges in diagnosing hypertrophic cardiomyopathy (HCM) in a patient with concomitant arterial hypertension (AH). Materials and methods. The article presents the clinical case of HCM in the patient with concomitant AH that was observed in an ambulatory setting in the Municipal Enterprise “Dnipropetrovsk Regional Clinical Center for Diagnostics and Treatment” of Dnipropetrovsk Regional Council. Results. A 66-year-old woman N., diagnosed by her family physician with coronary artery disease (CAD): stable angina FC II, grade 2 AH, chronic heart failure FC II NYHA, was referred to a cardiologist because of experiencing exertional dyspnea, chest pain, and uncontrolled blood pressure despite treatment compliance. Echocardiography identified concentric left ventricular hypertrophy with the left ventricular outflow tract (LVOT) obstruction (a mean gradient of 35 mmHg as per catheterization). Cardiac MRI confirmed the diagnosis and coronary angiography ruled out CAD. Adjustments to the treatment regimen, taking into account HCM with LVOT obstruction, effectively alleviated the patient’s symptoms and stabilized her blood pressure. Conclusions. It is especially important to follow the guidelines of AH management and perform echocardiography in all patients with high blood pressure, so as not to miss the signs of concomitant HCM, particularly with LVOT obstruction. In addition, in the case of HCM, it is necessary to timely detect, provide prevention and manage patients at risk for sudden cardiac death. Since HCM encompasses various diagnoses with different pathogenesis and distinct management, cardiac MRI, enzymatic or genetic testing may be needed according to guidelines. As HCM is a relatively common inherited cardiac disease, general practitioners could often encounter such patients in everyday clinical practice. Hence, they should have a certain suspicion of this diagnosis in persons with AH whose left ventricular mass meets the criteria for HCM.

RISK FACTORS AND PROGNOSTIC MODELS OF DIABETIC RETINOPATHY AND OPPORTUNITIES OF PRECISION MEDICINE (analytical review)

Background. One of the priority directions of modern medicine development is prognostication, the purpose of which is to increase the accuracy and reliability of forecasts of outcomes related to diseases. In diabetes mellitus (DM), the task of precision medicine is to adapt diagnostic and treatment methods to subgroups of the population with similar characteristics in order to achieve maximum effectiveness. Currently, most forecasting methods are too narrowly focused on the blood glucose level, which makes the wide implementation of precision medicine approaches promising. Aim: to determine risk factors, existing prognostic models and possibilities of precision medicine to improve the effectiveness of diagnosis and treatment of diabetic retinopathy (DR). Materials and methods. The search for sources of Ukrainian and foreign literature for the analytical review was conducted keywords using the open medical scientific database PubMed (USA). At the first stage, 470 sources were selected, of which 46 were selected for this article. Results. It was established that the progression of DR in the initial stages is a consistent, significant and independent predictor of proliferative DR. The condition of the retina reflects the influence of the systemic environment and, in turn, has prognostic value for cardiovascular, renal and other complications. Most of the new biomarkers have yet to be tested in clinical practice, which requires additional studies to predict DR and clinical outcomes of its treatment. Most models include age, sex, ethnicity, and lifestyle variables as predictors: smoking, medical history, glycated hemoglobin, and DM duration. Increasing age of patients, DM duration and concomitant arterial hypertension are independent predictors of microvascular complications. We collected a database including 359 patients (359 eyes) with type 2 diabetes with DR of varying severity, the results of clinical, ophthalmological and laboratory examinations. Models for predicting progression and effectiveness of individualized treatment are being developed.

The role of inflammatory biomarkers in patients with ulcerative colitis and concomitant arterial hypertension, possibilities of treatment

Objective — to evaluate and compare inflammatory biomarkers (faecal calprotectin, serum zonulin) in patients with ulcerative colitis (UC) and concomitant arterial hypertension (AH) before and after use of the mesalazine medication (Pentasa, Ferring International Center, Switzerland). Materials and methods. The study involved 96 patients with UC aged 18 to 60 years. Patients underwent outpatient blood pressure measurement to assess the presence of arterial hypertension (AH). As a result, patients were allocated into two groups: group I consisted of patients with UC and concomitant AH (n=49; mean age 41.2±12.31 years, median age 38 years) and group II included patients with UC without concomitant AH (n=47; mean age 40.2±10.82 years, median age 41 years). All patients underwent physical examination. The diagnosis of UC was confirmed histologically with a preliminary colonoscopy. Endoscopic assessment of UC severity was performed according to the Mayo ulcerative colitis system. Clinically and endoscopically, patients were classified as having mild to moderate UC activity. The assessment of changes in inflammatory biomarkers (faecal calprotectin, serum zonulin levels) was performed in the groups both before treatment and after 6 weeks of mesalazine administration at a dose of 5.0 g/daily (4.0 g per os and 1.0 g per rectum). Faecal calprotectin levels were determined by enzyme‑linked immunosorbent assay (Bühlmann fCAL Elisa). Serum zonulin levels were determined by Elisa, IDK Zonulin Elisa (Immunodiagnostic AG, Germany). Statistical processing of the data was performed using licensed statistical packages «Statistica 10». Results. The average level of faecal calprotectin in group I was (367.05±148.23) mg/g, in group II - 319.57±146.65 mg/g. The difference of faecal calprotectin levels in groups I and II before and after treatment wasn’t significant (p=0.124 and р=0.263, respectively). The mean serum zonulin level in group I was 75.09±15.94 ng/ml, and in group II - 65.98±11.40 ng/ml. Serum zonulin levels after the treatment in group I were better than in group II, p=0.041. Serum zonulin is highly sensitive for assessing intestinal permeability in patients with UC and concomitant arterial hypertension. Conclusions. The use of the Pentasa medication by patients with UC proved to be effective owing to its active anti‑inflammatory effects on pathologically altered areas of the intestinal wall. Assessment of inflammation biomarkers, such as faecal calprotectin and serum zonulin, is safe, affordable, non‑invasive methods that can be used to monitor treatment of patients with UC and concomitant arterial hypertension. Pentasa can be used in patients both with isolated ulcerative colitis and in combination with hypertension

Pathological Turbulence of the Heart Rhythm and Activation of the Antinociceptive System as Predictors of the Complicated Course of Silent Myocardial Ischemia in Patients with Post Infarction Cardiosclerosis According to the Data of Long-term Observation

To date, the issues of evaluating the course of silent myocardial ischemia (SMI) after a myocardial infarction (MI) taking into account risk factors (RF), evaluating the pathological turbulence of the heart rhythm, the state of activation of the body’s antinociceptive system, which necessitates an in-depth study of this pathology, remain unresolved, as well as new differentiated approaches to the treatment and rehabilitation of the modern category of patients. The objective: to analyze the features of the SMI course in patients with post-infarction cardiosclerosis depending on the RF. Identification of the interdependence between the degree of activation of the sympathoadrenal system and the features of the SMI course in patients with post-infarction cardiosclerosis, as well as the prognostic value for assessing the severity of the course of the disease. Materials and methods. The research was performed on the basis of the Ivano-Frankivsk Regional Clinical Cardiology Center (Ukraine). 154 patients with a silent form of coronary artery disease, which occurred in people with post-infarction cardiosclerosis, were examined. The diagnostic criteria were: episodes of SMI verified with the help of HM ECG and a test with dosed physical load. Results. Significant deviation of the ST segment which was detected during Holter monitoring of the ECG (HM ECG) in patients with SMI episodes does not mean that the absence of pain sensations in the presence of efferent nociceptive stimulation is a sign of the absence of ischemia and does not indicate an easier course of SMI compared to clinically manifest forms of CHD. The average concentration of β-endorphins in patients with lipid metabolism disorders was 4.01±0.02 ng/ml, in the presence of diabetes mellitus this indicator was equal to 4.68±0.03 ng/ml (р<0.01), and in persons with concomitant arterial hypertension it was 4.91±0.02 ng/ml (р<0.05). In subjects with two or more RFs, the similar indicator was the highest and amounted to 5.73±0.03 ng/ml (р<0.01). The point-biserial correlation coefficient was equal to 0.61 (р<0.05), which indicates a sufficiently high probability of the influence of the processes of activation of the antinociceptive system on the risk of myocardial infarction and unstable angina. Conclusions. It has been proven that the presence of postinfarction cardiosclerosis, type 2 diabetes mellitus, dyslipidemia, and arterial hypertension should be considered as factors that increase the risk of complications of coronary artery disease in patients with SMI. In the painless form of CHD, there is a probable increase in β-endorphins in the blood, which indicates the presence of pronounced afferent nociceptive stimulation, the intensity of which depends on the degree of myocardial ischemia. It has been proven that an increase of β-endorphins levels is associated with an increase in the risk of a complicated course of coronary heart disease in patients with silent myocardial ischemia. The presence in patients with SMI of myocardial ischemia, pathological turbulence of the heart rhythm, and activation of the antinociceptive system are extremely important for understanding the main links of the course of SMI and make it possible to base the approach to the therapy of such patients on a differentiated system algorithm that takes into account the discrepancy between the clinical manifestations of the disease and its real impact on coronary perfusion and the condition of the vascular wall.

WHEN AND WHERE DOES A CARRIER OF HEREDITARY TRANSTHYRETIN AMYLOIDOSIS (ILE88LEU) SHOW THE FIRST SIGNS OF THE DISEASE? DIAGNOSTIC CHALLENGES OF A NOT ONLY CARDIOGENIC MUTATION

Abstract We present the case of a 58–year–old man with a familiar history (mother affected) positive for ATTR–v (Ile88Leu) amyloidosis. The mother initially had a pure cardiac phenotype and was firstly treated with tafamidis, but progression of the disease to the nervous system warranted a switch to patisiran. Our patient carried the Ile88Leu mutation and had a medical history notable for surgically treated left carpal tunnel syndrome (CTS) and untreated right CTS. Furthermore, he was affected by systemic arterial hypertension and was a habitual smoker. He has been followed at our Institution since 2018. His first echocardiogram showed normal left ventricular ejection fraction (LVEF 65%), mild hypertrophy (anterior septum: 12 mm), and borderline values of GLS (– 16%) without any specific pattern. Further exams were executed: Bone scintigraphy (BS): negative (Perugini score 0); Coronary artery ct scan: moderate stenosis of proximal LAD; Neurologic evaluation: no signs of peripheral neuropathy. The clinical picture remained unaltered in 2020 and 2021. However, during November 2022 the patient developed atrial fibrillation (AF) and presented to the ED for dyspnea and palpitations. Electrical cardioversion was performed with success but subsequent recurrences warranted AF ablation in April 2023. At that moment, the patient was re–evaluated. Basal ECG did not show any significant alteration (FIg.1)This time, echocardiogram showed mild worsening of hypertrophy (13 mm septum), GLS – 16% with apical sparing pattern, no other major variations (Fig.2). BS was repeated and revealed grade 1 Perugini score (Fig.3). Hence, a series of clinical question arose: Should we begin a specific treatment or is the disease in an excessively early stage that does not warrant treatment? Is AF linked to concomitant arterial hypertension or might it be an early marker of disease? We questioned the usefulness of endomyocardial biopsy in this specific setting. In this case, we repeated electromyography that showed mild axonal sensitive–motor polyneuropathy. Finally, we concluded for initial signs of systemic amyloidosis ATTR–v (Ile88Leu) type with mixed phenotype (neurological+cardiac). The neurological involvement allowed us to start a gene–silencer (Patisiran). In conclusion, a periodic neurological evaluation is necessary and has crucial therapeutic implications in all genotypes. Indeed, there is increasing evidence that Ile88Leu is a not only cardiogenic mutation.

Age-related disparities in the severity course of COVID-19

COVID-19 demonstrates a different clinical severity of course in different age groups. In the present study, we present a comparative analysis regarding the risk of hospitalization and in-hospital mortality between two extreme age groups – children and young adults (0-39 years) and elderly patients (≥70 years). For the period from January to June 2022, nasopharyngeal samples of 1,611 patients at MHAT Uni Hospital (Panagyurishte, Bulgaria) were examined by PCR analysis, of which 486 had a positive result for SARS-CoV-2. From the first target group with a laboratory-confirmed diagnosis of COVID-19, there were 158 patients with an average age of 27.5 years, and only one of them was hospitalized (a 30-year-old man, unvaccinated, with bilateral pneumonia and concomitant arterial hypertension). The average age of the patients from the second target group (n=40) was 75.6 years, 29 of them were outpatients and 11 were hospitalized, among whom 5 men with an average age of 77.6 years died. The average hospital stay of the only hospitalized patient from the young age group was 6 bed days, while for patients ≥70 years of age it was 10.1 bed days. Age is among the determinants of risk of hospitalization and in-hospital mortality associated with COVID-19.

Clinical significance of endocrine disorders in the development of early vascular aging in males with abdominal obesity and concomitant arterial hypertension: An observational cohort study

Background. Visceral obesity is a risk factor in the development of metabolic and endocrine disorders leading to arterial hypertension and cardiovascular complications. Their early predictors include increased vascular stiffness and early vascular aging. The current literature lacks studies into the effects of changes in testosterone, cortisol, and aldosterone levels in serum on vascular stiffness and the development of early vascular aging in patients with visceral obesity. Objective. To determine the relationship between hypercortisolemia, hyperaldosteronemia, and hypotestosteronemia and vascular stiffness and the presence of early vascular aging in male patients with visceral obesity. Methods. An observational cohort study of 78 males aged 35–45 years (mean age 38.1 ± 6.5 years) diagnosed with abdominal obesity and grade 1 arterial hypertension was conducted. The mean waist circumference ranged 105.5 ± 6.9 cm; systolic and diastolic blood pressure ranged 152.5 ± 5.0 and 92.5 ± 5.0 mm Hg, respectively. The vascular age of the studied patients (n = 78) comprised 44.1 ± 6.2 years, which was statistically higher than their passport age (р < 0.001). The studied patients were divided into subgroups according to both total testosterone (< 12.1 nmol/l in subgroup 1A (n = 49) and ≥ 12.1 nmol/L in subgroup 1B (n = 29)) and cortisol in the evening saliva portion (> 4.5 nmol/L in subgroup 2A (n = 24) and ≤ 4.5 nmol/L in subgroup 2B (n = 24)). All the patients completed the study. To assess the hormonal status, the total testosterone sex steroid-binding globulin (SSBP) and insulin in morning serum samples were investigated. Insulin resistance was assessed based on the NOMA-IR index. The concentration of total testosterone was determined by enhanced chemiluminescence (Ortho-Clinical Diagnostics, J&J); the SSBP and insulin levels were determined by delayed fluorescence. Aldosterone content was determined by radioimmunoassay; free cortisol and testosterone were measured by luminescent LIA. Free and bioavailable testosterone concentrations in serum were calculated using an online calculator (issam.ch/freetesto.htm). The cardio-ankle vascular index (CAVI) was determined using a VaSera VS-15000N device, which automatically calculated the vascular age. Statistical analysis was performed using the Statistica 10.0 Windows package (StatSoft, Inc., USA). Results. The vascular age of patients with hypogonadism was statistically significantly ( р < 0.001) higher than their passport age and the vascular age in males without hypogonadism. The CAVI and vascular age were also statistically significantly higher in males with functional hypercorticism (р < 0.001) compared with a subgroup of patients without hypercorticism. The vascular age and CAVI increased with an increase in the salivary cortisol concentration 2200 (r = 0.5; р < 0.05) and decreased with an increase in the salivary cortisol level 900 (r = –0.5; р < 0.05). These parameters decreased with an increase in serum aldosterone obtained in the morning (r = –0.4; p < 0.05) and increased with an increase in serum aldosterone in the evening (r = 0.4; p < 0.05). In 23% (n = 18), an inversion of the daily rhythm of cortisol production was observed; in these patients, salivary cortisol levels of 2200 exceeded salivary cortisol levels of 900. The vascular age of patients with the inversion of cortisol production (49.4 ± 4.4 years) was statistically significantly ( р < 0.001) different from that of patients with normal changes in salivary cortisol concentrations (41.9 ± 4.9 years). CAVI was also higher (р < 0.001) in males with inverted fluctuations in salivary cortisol levels (7.51 ± 0.62) compared to those with normal diurnal rhythm (6.45 ± 0.69). The results of aldosterone evaluation revealed that 17% of the patients (n = 13) had higher aldosterone levels in the evening serum portion compared to the morning serum portion. In these patients, the vascular age (45.8 ± 5.1 years) was higher ( р < 0.001) than that in males with normal physiologic changes in aldosterone levels (41.6 ± 5.7 years). A similar pattern was observed when comparing vascular stiffness indices. Thus, the CAVI in men with inverted changes in aldosterone concentration (6.9 ± 0.8) was significantly higher ( р < 0.001), compared to that in men with physiological changes in blood aldosterone levels (6.4 ± 0.8). Conclusion. Endocrinologic disorders in male patients with visceral obesity and concomitant arterial hypertension (functional hypogonadism, functional hypercorticism, inverted daily rhythms of cortisol and aldosterone production) contribute to the development of early vascular aging by increasing vascular stiffness.

Angiotensin Converting Enzyme Inhibitors: Interaction Issues in Patients with Glaucoma and Arterial Hypertension. Review

The purpose of the review is to evaluate the interaction of angiotensin-converting enzyme inhibitors in patients with glaucoma and concomitant arterial hypertension using literature data. Glaucoma is the main cause of blindness and visual impairment, as well as the main cause of irreversible blindness worldwide. Pharmacotherapy, laser or surgical treatments are used to reduce IOP levels, as well as prevent deterioration of visual field defects. However, 40 % of patients develop glaucomatous neuropathy despite ongoing therapy. This prompts the investigation of alternative causes of damage to the optic nerve, and abnormal blood pressure levels, both too low and too high, are considered as a possible risk factor. Arterial hypertension occurs in 48–65 % of patients with glaucoma and is the most common systemic disease in patients with glaucoma. Currently, angiotensin converting enzyme (ACE) inhibitors are considered the “gold standard” in the treatment of arterial hypertension, in the pathogenesis of which activation of the renin-angiotensin system (RAS) plays an important role. The renin-angiotensin system (RAS) is a hormonal system responsible for regulating blood pressure and fluid and electrolyte balance in the body. Local tissue-specific RAS were found, including in the structures of the eyeball: cornea, aqueous humor, iris, ciliary body, vitreous body, retina. These data indicate that the local RAS plays an important role in the regulation of the physiology of the eye and may become a target in the development of new antiglaucoma drugs. Animal studies, as well as studies in various patient groups, show that systemic antihypertensive drugs that inhibit the RAS, such as ACE inhibitors, reduce IOP. These studies support the concept that RAS inhibitory drugs may be potential antiglaucoma drugs in the future, as ACE inhibitors can improve the outflow of intraocular fluid, thereby reducing IOP.

SST 2 AS A MARKER OF THE TREATMENT OF PATIENTS AFTER MYOCARDIAL INFARCTION WITH ACCOMPANYING ARTERIAL HYPERTENSION ON THE BACKGROUND OF TREATMENT WITH MELDONIUM AND FOLIC ACID

Coronary artery disease (CAD) is one of the leading reason of mortality in Ukraine and all over the world. Arterial hypertension (AH) is the most common manageable factor in cardiovascular morbidity. Every third Ukrainian suffers from this disease. The presence of AH in a patient often becomes the reason for the further development of stable coronary artery disease (SCAD) due to the close pathogenetic connection of both pathologies. sST2 is a modern marker of cardiac fibrosis, which can help to evaluate the effectiveness of the underlying treatment for the patients with SCAD and concomitant AH.
 The aim. To study the possibility of using sST2 as a marker of the effectiveness of treatment of patients after a myocardial infarction with accompanying arterial hypertension on the background of treatment with meldonium and folic acid.
 Materials and methods. During our study we observed 40 patients with SCAD FC II-III and concomitant AH stage III, who had an acute myocardial infarction and underwent percutaneous coronary intervention with balloon angioplasty and stenting. All examined were divided into 2 groups of 20 patients each. The first group received standard treatment. The second group in addition to standard treatment, received a combination of folic acid and meldonium. In the course of the work, a detailed analysis of the results of general clinical, laboratory and instrumental examination methods was carried out. Laboratory study of sST2 levels in blood plasma was carried out by quantitative enzyme immunoassay.
 Results. We observed improvement of all Echocardiography parameters in patients of both groups. Somewhat more significant changes were recorded in the analysis of end systolic diameter of left ventricle. So, if in the first group the decrease in this indicator occurred gradually and amounted to an average of 7-8% after 6 months of treatment, then in the group of combined application of meldonium and folic acid against the background of traditional therapy, a significant reduction in ESD by 10.5% was recorded. The indicator decreased from 4.2 cm to 3.8 cm (p<0.05). Also there was a different trend regarding the dynamics of thickness of the posterior wall during systole. In the first group the reduction of this indicator at the end of the study was 5.7% (p>0.05). In the second group this indicator decreased from 1.13 cm to 1.11 cm after 1 month of treatment and to 0.89 cm after 6 months. That is, the decrease in the first stage was only 1.8% (p>0.05), and then 26.9% (p<0.05). In the course of the study, an increase in LVEF was found among patients with SCAD with concomitant AH. The increase in this indicator after 6 months was 3-4% among all the examined, regardless of the applied drug therapy.
 We observed the decrease in the concentration of sST2 in both groups of patients. However, it was reliable only among patients to whom, in addition to standard treatment, we added a combination of meldonium and folic acid. In the group of patients on SCAD with concomitant hypertension, a weak direct correlation between the level of ST2 and LVMI was established. The correlation coefficient in this case was r=0.1033 (p>0.05).
 Conclusions. In the course of our study, the feasibility of using sST2 as a marker of the effectiveness of treatment of patients after a myocardial infarction with accompanying AH against the background of treatment with meldonium and folic acid was established. Application of myocardial cytoprotectors reliably reduced the concentration of a sST2, which makes their use in the complex treatment of patients after MI with concomitant AH reasonable.

Biomarker associated trends in mortality in myocardial infarction as an example of clinical data warehouse analyses - new opportunities of data-driven cardiovascular research

Abstract Background Healthcare data collected during clinical routine bears an immense potential for various clinical research questions. With the rapid use and development of structured electronic health records, this abundant source of data can be utilized to efficiently comprise large datasets based on actual, unselected patients. In this study, we examined 4,205 patients who presented with myocardial infarction (MI) since the implementation of a new hospital information system at a tertiary hospital. We sought to evaluate mortality trends using routinely collected biomarkers. Methods 4,205 patients admitted with MI at a high-volume tertiary hospital between September 2016 and September 2022, were retrospectively analyzed. Statistical analyses comprised data from a data warehouse sourced from the hospital information system including ICD and OPS codes, biometric data, and biomarker values. Results Of the 4,205 patients with MI, 28% (1,176) were female, the mean age was 67 years. 28% (1,171) were diagnosed with ST-segment elevation myocardial infarction (STEMI). 15% of all MI patients (645) showed coronary single-vessel disease, whereas 65% of patients (2.746) suffered from multi-vessel disease. Percutaneous coronary intervention was performed in 47% (1,961) of all included NSTEMI and STEMI patients. Concomitant arterial hypertension was present in 51% of STEMI patients compared to 65% of the NSTEMI population. Regarding STEMI, diabetes mellitus (DM) was prevalent in 22% of cases, whereas 31% in NSTEMI were diagnosed with DM. We observed a significant linear association between in-hospital mortality and peak biomarker levels of high-sensitive Troponin I (hsTnI), serum lactate, and creatine kinase myocardial band (CKMB) (figure 1). MI patients with a peak lactate measurement of > 17.01 mmol/l had a mortality rate of > 80%. Two-thirds of patients (66%) with CKMB values of > 1474.50 U/I died during the index hospitalization. Conclusion In our study, we observed significant linear associations between biomarker levels and in-hospital mortality in patients with myocardial infarction. Furthermore, we demonstrated that hospital information systems can efficiently be used to generate large, comprehensive datasets not only to characterize real-world patient populations but also to evaluate data of prognostic relevance. With careful evaluation of data quality and within the frameworks of patient privacy, future research in this field holds promising potential.

An impact of treatment initiation timing on stroke outcome: bridging the time gap

<p><strong>Aim</strong> <br />Stroke treatment is a time-critical condition. Understanding the impact of timing and types of treatment on patient outcomes can help develop and optimize stroke management strategies. The study aimed to analyse the effect of different time intervals and mechanical thrombectomy methods on outcomes of stroke patients in Kazakhstan.<br /><strong>Methods</strong> <br />The patient data, including demographic information, clinical characteristics, and specific time intervals from stroke onset to hospital admission, stroke onset to surgery initiation, and hospital admission to surgery initiation were collected. A total<br />of 100 patients were analysed. Patients’ neurological status was evaluated using the National Institutes of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), and Glasgow Coma Scale (GCS) before and after the surgical treatment.<br /><strong>Results</strong> <br />Most patients had concomitant arterial hypertension, and almost 25 % had diabetes mellitus. The average time from stroke onset to hospital admission was 123.2±7.6 minutes, and from hospital admission to surgery initiation, it was 134.7±13.1 minutes. A shorter duration from the onset of stroke to hospitalization and surgery was associated with better clinical outcomes. Our results demonstrated a statistically significant decrease in NIHSS, mRS after surgical treatment compared to baseline. The association between the extended time from stroke onset to hospitalization and<br />reduced survival rates was observed.<br /><strong>Conclusion</strong> <br />Our findings indicate the essential role of timely intervention in managing stroke patients, as well as the need for a<br />comprehensive and patient-centred approach to stroke care. </p>

Study of the quality of life of men with arterial hypertension in the dispensary account

In the article, the development of concomitant pathologies of arterial hypertension, including chronic vascular diseases, significantly reduces the quality of life and productivity of patients, and currently the decrease in the effectiveness of this anti-morbid treatment not only leads to additional financial costs, but also worsens the quality of life of the patient.The control unit included men with chronic venous disease and combined arterial hypertension. The subject of the study was the quality of life of able – bodied men with chronic venous disease and concomitant arterial hypertension. The scope of the study was 44 men with chronic venous disease (Base Group) and 16 men without chronic venous disease, but with arterial hypertension (subgroup). Criteria assigned to the named Group: A man, 30-50 years old and people with normal blood pressure. Quality of life control decisions of patients during the testing of the group, according to the quality of life survey, the total score was 790 points, of which 24 (54.5%) points were made by men with arterial hypertension. In the control group, this data generated 280 points, respectively, that is, there were about 6 (37.5%) points. Comparing these indicators, based on the results of the survey, we can conclude that the subgroup has a lower quality of life compared to the main group (χ2 =49.7, p=0.0001). [4]. As a result of a comparative analysis of each response to a survey of patients, it was found that one of the reasons for the decline in the quality of life was associated with leg pain, which showed that patients in the main group were most worried not only during active daytime, but also during night sleep. The foot pain factor was the leading factor in the main group of patients, indicating that this factor was particularly disturbing in the morning (p=0.036). In both groups studied, cases of decreased ability to work were observed when assessing the ability of patients to work. The characteristics of the decrease in cases of incapacity for work were shown in patients at the earliest level of morbidity, but all this led to the fact that men in the studied group did not lose their ability to work and did not use medications for previous venous diseases.No cases of pronounced loss of working capacity were recorded in the main group under study.Venous circulation is considered a part of the general circulatory system, for the same reason, patients with impaired arterial blood system are subject to pathological damage to the venous blood system. In the study of patients with chronic venous disease in the Scandinavian countries, it was concluded that the results of our studies, which found cardiovascular complications in most patients with chronic diseases, lead to a severe drop in the patient's quality of life, along with a decrease in the quality of life in patients with chronic venous disease among men of working age.

Features of hyperplastic processes of the endometrium in the presence of arterial hypertension

Introduction: The relevance of studying endometrial hyperplastic processes (EHP) is due to their prevalence, impact on quality of life and high risk of malignancy. The structure of EHP takes from 20 to 40% in the pathology of reproductive system in women.
 Objective: To evaluate the clinical and morphological features of hyperplastic processes of the endometrium in the presence of arterial hypertension.
 Materials and Methods: 96 women with endometrial hyperplastic processes were examined during the study. The first group consisted of 57 women with endometrial hyperplasia with arterial hypertension. The second group included 39 patients with endometrial hyperplasia without arterial hypertension All patients involved in the study, were investigated by ultrasound on the machine "MyLab50" ( «Esaote», Italy) and videohysteroscopy ( «Karl Storz», Germany).
 Results: In women of perimenopausal and postmenopausal age arterial hypertension was observed significantly more often compared to women of reproductive age (p<0.05). dysmenorrhea (40,4%; p <0.05), metrorrhagia (43,9%; p <0.05) and infertility (45,8 %; p <0.05) were significant more common for women with EHP and concomitant arterial hypertension. There are no significant differences in morphological forms between women with EHP with arterial hypertension and without hypertension. The presence of arterial hypertension had a significant effect on the risk of EHP recurrence (OR=6,0; CI=1,02-35,27; p<0,05).
 Conclusions: Arterial hypertension was significantly more common in perimenopausal and postmenopausal women. Dismenorrhea, metrorrhagia and infertility were the most common clinical manifestations of EHP in patients with arterial hypertension. The presence of arterial hypertension is a reliable predictor of the occurrence of EHP recurrences during the one year.

THE MAIN CLINICAL AND PATHOGENETIC FEATURES OF THE COMORBID COURSE OF NON-ALCOHOLIC STEATOHEPATITIS, OBESITY AND HYPERTENSION

SUMMARY. The incidence of nonalcoholic steatohepatitis (NASH) in the population is 20–40 %, in obese patients – 50–90 %. The presence of NASH significantly reduces the quality of life of patients. The presence of concomitant arterial hypertension in patients can cause a cascade of reactions of mutual burdens, which will lead to the progression of all comorbid diseases. The aim – to investigate the differences between clinical and laboratory parameters in the comorbid course of NASH on the background of obesity. In addition, we studied the state of hepatic circulation and the functional state of the endothelium depending on the presence of comorbid hypertension. Material and Methods. Systematic review with further analysis, comparison, systematization and generalization of scientific literature in MEDLINE, Cochrane and PubMed databases of relevant articles on the study of psychological characteristics of women of childbearing age diagnosed with psychogenic infertility. Results. In recent years, NASH has increasingly been seen as an additional independent risk factor for cardiovascular disease and a predictor of its complications. The course of NASH under conditions of comorbidity with obesity in comparison with the isolated course is characterized by a predominance of hypertension of II degree (60.0 %), increased variability of systolic blood pressure (SBP) during the day with increasing duration of “pressure load” during the day. The comorbid course of NASH with obesity and hypertension (HT) there is a significant activation of the processes of liver tissue fibrosis, the content of protein-bound oxyproline in the blood, fibronectin, hexosamines, sialic acids, fucose, not bound to protein due to the activation of fibroblast growth factor, in response to which there is usually inadequate compensatory activation of collagenolysis (increase in the content of free oxyproline in the blood, which was inhibited by excessively activated proteinase-inhibitory system). Conclusions. The comorbidity of NASH with HT and obesity is a powerful pathogenetic factor that worsens the quality of life of patients to a much greater extent than the severity of a single disease. It's crucial to have multidisciplinary approach in the treatment of people with comorbidity of HT with NASH on the background of obesity.

In-hospital mortality analysis in patients with acute cardiovascular pathology and co-infection with COVID-19: a registry of one site

Abstract Funding Acknowledgements Type of funding sources: None. Patients with cardiovascular pathology have a significantly higher risk of adverse events and death when complicated by concomitant COVID-19. The aim of this study was to analyze in-hospital mortality in pts with acute cardiovascular pathology (ACP) and a co-infection with COVID-19. 139 pts with ACP who were diagnosed with COVID-19 were examined. 69 (49.6%) pts had ACS (47 pts with AMI), 33 (23.7%) pts - hypertensive urgency, 24 (17.3%) pts - ADHF, 9 (6.5%) pts - tachysystolic paroxysm of atrial fibrillation, 2 (1.4%) pts - acute pulmonary embolism, and 2 (1.4%) pts - syncope. The average age was 67.9±12.7 y.o., 70 (50.4%) pts were male. Concomitant arterial hypertension was found in 87.1%, DM – 20.9%, CHF - 30.9%, COPD – 9.4% of pts, history of AMI – 20.1% and ischemic stroke – 9.4% of pts. In 79 (56.8%) pts COVID-19 was diagnosed and laboratory confirmed before hospitalization (hospitalized in 5.3±3.6 days after symptoms onset). 31 (22.3%) pts were diagnosed with COVID-19 upon admission, and 29 (20.9%) - during their stay in the hospital. 20 (15.6%) pts were vaccinated against COVID-19. The initial SpO2 level was 91.6±10.3%, while more than half of pts (53.2%) had SpO2<95% and almost every fourth (23.2%) patient had SpO2<90%. During the hospital period, 20 (14.4%) pts died. The mortality rate was 28.0% in pts with ADHF, 19.1% in pts with AMI and significantly less in pts hospitalized for unstable angina, hypertensive urgency or atrial fibrillation - 5.2% (p<0.05 in comparison with pts with AMI or ADHF). The main cause of death was the development of cardiopulmonary failure – 14 (70.0%) pts. 4 (20.0%) pts died from AMI complications, 1 - from pulmonary embolism and 1 - from acute ischemic stroke. Two critical periods of in-hospital mortality can be distinguished: 1 - the first two days of hospitalization (mainly complications of acute cardiovascular pathology and thrombotic events); 2 – from 7 to 10 days after hospitalization (development of multiple organ failure due to hypoxia and heart failure progression). The mortality rate of patients with ACP and COVID-19 was significantly higher than that of simultaneously hospitalized patients without comorbid respiratory infection (14.4% vs. 6.4%, p=0.012) and patients who were hospitalized before the pandemic (14.4% vs. 2.9%, p<0.001). Vaccinated patients were significantly less likely to develop acute kidney injury, acute hypoxic delirium, had higher average blood spO2, and less often required non-invasive ventilation. Only 1 vaccinated patient died from the development of cardiogenic shock against the background of anterior AMI and multivessel coronary artery disease (mortality – 15.7% in unvaccinated pts vs 5.0% in vaccinated, p=0.076). Co-infection with COVID-19 worsens treatment outcomes and in-hospital mortality of patients with ACP. Vaccination significantly reduces the likelihood of complications and tends to reduce mortality.

Acute kidney injury is a risk factor for in-hospital mortality in patients with acute cardiovascular pathology and concomitant COVID-19

Abstract Funding Acknowledgements Type of funding sources: None. Although respiratory failure and hypoxemia are the main manifestations of COVID-19, many patients also experience worsening kidney function. Hemodynamic disorders in patients with acute cardiovascular pathology can also worsen renal function. The aim of this study was to assess kidney function and its significance for the development of in-hospital complications in patients who were hospitalized with acute cardiovascular pathology and had a co-infection with COVID-19. 139 pts with acute cardiovascular pathology who were diagnosed with COVID-19 were examined. 69 (49.6%) pts had ACS (47 pts with AMI), 33 (23.7%) pts - hypertensive urgency, 24 (17.3%) pts - ADHF, 9 (6.5%) pts - tachysystolic paroxysm of atrial fibrillation, 2 (1.4%) pts - acute pulmonary embolism, and 2 (1.4%) pts - syncope. The average age was 67.9±12.7 y.o., 70 (50.4%) pts were male. Concomitant arterial hypertension was found in 87.1%, DM – 20.9%, CHF - 30.9%, COPD – 9.4% of pts, history of AMI – 20.1% and ischemic stroke – 9.4% of pts. The initial creatinine level was 110.7±66.1 μmol/l, eGFR CKD-EPI - 63.3±20.3 ml/min/1.73m2 (eGFR<60 ml/min/1 ,73m2 – 46.0% of patients). Patients with eGFR<60 ml/min/1.73m2 were older, more often female, often had a history of AF, had a lower level of hemoglobin and blood pressure at admission, a greater number of complications (need for NIV, inotropic therapy) and higher in-hospital mortality (25.0% vs. 5.3%, p=0.002). Acute kidney injury, which was evaluated according to KDIGO criteria (creatinine level increase ≥ 26.5 μmol/l within 48 hours or ≥ 1.5 times within 7 days) was observed in 21 (15.4%) patients (12.0% in patients with eGFR≥60 ml/min/1.73m2 and 18.8% with eGFR<60 ml/min/1.73m2, p<0.05). These patients did not significantly differ from patients without AKI in terms of basic clinical and anamnestic characteristics, but had a lower spO2 level at admission (86.9±11.2% vs. 93.4±5.0%, p=0.016). Patients with AKI had a significantly higher number of in-hospital complications: acute hypoxic delirium (47.6% vs. 8.7%, p=0.003), VTE (14.3% vs. 0.9%, p=0.070), death from of all causes (47.6% vs. 7.0%, p=0.002) and more often required organ support therapy: non-invasive/invasive lung ventilation (52.4% vs. 11.3%, p<0.001), inotropic therapy (57, 1% versus 5.2%, p<0.001). The simplified criterion of AKI (increase of creatinine level ≥ 26.5 μmol/l in comparison with the value at admission at any time during the hospital period) also made it possible to distinguish the category of patients at high risk of hospital complications and death (37.9% vs. 8.2% , p=0.004). Acute kidney injury is a powerful risk factor for in-hospital complications and mortality in patients with acute cardiovascular pathology and concomitant COVID-19 infection.

Chronic kidney disease and pregnancy: an interdisciplinary assessment of gestational risks and complications. A literature review

Chronic kidney disease represents a heterogeneous group of diseases characterized by changes in the kidneys structure and functions. It significantly increases the risks of adverse maternal and perinatal outcomes. These risks increase with worsening renal dysfunction corresponding to an increase in the degree of proteinuria and arterial hypertension. Anatomical and physiological changes in the kidneys during pregnancy are characterized by dilatation of the pelvicalyceal system, a decrease in systemic and renal vascular resistance, and an increase in the glomerular filtration rate. These clinically significant changes can complicate the diagnosis of the renal dysfunction, as well as its progression. Pregnancy can affect the kidney as it can manifest as declining kidney function, especially in the context of concomitant arterial hypertension and proteinuria, while chronic kidney disease, regardless of the stage, contributes to a higher risk of adverse pregnancy outcomes including preeclampsia, premature birth and fetal growth restriction.
 Optimization strategies of pregnancy outcomes include strict control of blood pressure, treatment of hypertension and proteinuria, and prevention of preeclampsia. The latter is difficult to diagnose in pregnant women with chronic kidney disease. Serum markers such as soluble fms-like tyrosine kinase 1 and placental growth factor may aid in definitive diagnosis. The choice of delivery mode in women with chronic kidney disease should be based on common obstetric indications. A multidisciplinary team, including an obstetrician-gynecologist, a nephrologist, an anaesthesiologist and a neonatologist, must focus on preconception medical care, antenatal care and treatment of pregnant women with chronic kidney disease for a successful pregnancy outcome.

Analysis of in-hospital complications in patients with acute cardiovascular pathology and co-infection with COVID-19: a registry of one center

The aim – to analyze in-hospital mortality in pts with acute cardiovascular pathology (ACP) and a co-infection with COVID-19.Materials and methods. 139 pts with ACP who were diagnosed with COVID-19 were examined. 69 (49.6 %) pts had ACS (47 pts with AMI), 33 (23.7 %) pts – hypertensive urgency, 24 (17.3 %) pts – ADHF, 9 (6.5 %) pts – tachysystolic paroxysm of atrial fibrillation, 2 (1.4 %) pts – acute pulmonary embolism, and 2 (1.4 %) pts – syncope. The average age was 67.9±12.7 y.o., 70 (50.4 %) pts were male. Concomitant arterial hypertension was found in 87.1 %, DM – 20.9 %, CHF – 30.9 %, COPD – 9.4 % of pts, history of AMI – 20.1 % and ischemic stroke – 9.4 % of pts. In 79 (56.8 %) pts COVID-19 was diagnosed and laboratory confirmed before hospitalization (hospitalized in 5.3±3.6 days after symptoms onset). 31 (22.3 %) pts were diagnosed with COVID-19 upon admission, and 29 (20.9 %) – during their stay in the hospital. 20 (15.6 %) pts were vaccinated against COVID-19. The initial SpO2 level was 91.6±10.3 %, while more than half of pts (53.2 %) had SpO2 < 95 % and almost every fourth (23.2 %) patient had SpO2 < 90 %.Results and discussion. During the hospital period, 20 (14.4 %) pts died. The mortality rate was 28.0 % in pts with ADHF, 19.1 % in pts with AMI and significantly less in pts hospitalized for unstable angina, hypertensive urgency or atrial fibrillation – 5.2 % (p<0.05 in comparison with pts with AMI or ADHF). The main cause of death was the development of cardiopulmonary failure – 14 (70.0 %) pts. 4 (20.0 %) pts died from AMI complications, 1 – from pulmonary embolism and 1 – from acute ischemic stroke. Two critical periods of in-hospital mortality can be distinguished: 1 – the first two days of hospitalization (mainly complications of acute cardiovascular pathology and thrombotic events); 2 – from 7 to 10 days after hospitalization (development of multiple organ failure due to hypoxia and heart failure progression). The mortality rate of patients with ACP and COVID-19 was significantly higher than that of simultaneously hospitalized patients without comorbid respiratory infection (14.4 % vs. 6.4 %, p=0.012) and patients who were hospitalized before the pandemic (14.4 % vs. 2.9 %, p<0.001). Vaccinated patients were significantly less likely to develop acute kidney injury, acute hypoxic delirium, had higher average blood SpO2, and less often required non-invasive ventilation. Only 1 vaccinated patient died from the development of cardiogenic shock against the background of anterior AMI and multivessel coronary artery disease (mortality – 15.7 % in unvaccinated pts vs 5.0 % in vaccinated, p=0.076).Conclusions. Co-infection with COVID-19 worsens treatment outcomes and in-hospital mortality of patients with ACP. Vaccination significantly reduces the likelihood of complications and tends to reduce mortality.

Стресс-эхокардиография в диагностике кардиальной дисфункции в раннем постинфарктном периоде

The purpose — to assess the importance of stress echocardiography in identifying the nature and severity of cardiac dysfunction in patients with myocardial infarction. Material and methods.86 patients were examined at the outpatient stage of rehabilitation 6 weeks after myocardial infarction with primary coronary angioplasty with stenting. Results.Echocardiography revealed left ventricular hypertrophy (LVH) in 34 patients with myocardial infarction with concomitant arterial hypertension. Patients with LVH are characterized by more pronounced structural and functional LV remodeling, which is expressed in a lower LVEF and increased LVEDD, LVESVand LVEDV(p<0.05). There were no differences in stroke volume between patients with and without LVH. The performed diastolic stress test in patients with LVH is characterized by significantly lower average early diastolic mitral annular velocity e` (7.6 vs. 9.3 cm/s, p<0.01) without differences in the peak early transmitral Doppler flow velocity E (69.8 vs 78.0, p>0.05) compared with patients without LVH. The revealed differences between patients with and without LVH are due to a higher post-exercise velocity e` in patients with normal LV geometry and a decrease in eccentric LVH subgroup. Conclusions.1) Patients with LVH in the early postinfarction period (6 weeks) have more pronounced LV systolic dysfunction, expressed in a decrease in LVEF and an increase in LVEDD, LVESV, LVEDV compared to patients without LVH.2) Left ventricular hypertrophy, in conditions of myocardial infarction, is associated with latent diastolic dysfunction, which is manifested by a lower average early diastolic mitral annular velocity e` after the stress-test.

The role of cytokines in the mechanisms of regulation of reparative processes in modeling fractures of the proximal femur secondary to the correction of concomitant arterial hypertension

article: The role of cytokines in the mechanisms of regulation of reparative processes in modeling fractures of the proximal femur secondary to the correction of concomitant arterial hypertension - Minerva Orthopedics 2022 June;73(3):287-93 - Minerva Medica - Journals