Course Of Arterial Hypertension Research Articles

Features of the Course of Arterial Hypertension in the Era of the COVID-19 Pandemic: Common Pathogenetic Links Between Hypertension and SARS-CoV-2

The aim of this review was to present the mechanism of infection with severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) and its possible effect on the course of arterial hypertension. Another aim was to evaluate the relationship of the renin-angiotensin-aldosterone system with the pathogenetic stages of infection caused by SARS-CoV-2 virus.

Differences in aging rates based on different methods of calculation in patients with arterial hypertension and subclinical hypothyroidism

Objective — to evaluate two distinct methods for determining biological age (BA) and aging rates among patients with arterial hypertension (AH) in combination with subclinical hypothyroidism (SH) that can be applicable to practical medical settings.
 Materials and methods. The study involved 150 patients (women 54.7%, n=82) with an average age of 47.1 [39.7;54.0] years, who were divided into three groups reciprocal by age and sex: the main group included 70 patients with AH in combined with SH, the comparison group consisted of 50 subjects with isolated AH, and control group of 30 healthy volunteers. All subjects were assessed for objective data, anthropometric status, standard clinical‑biochemical indicators, insulin, HOMA IR, C‑reactive protein (CRP), tumor necrosis factor‑alpha (TNF‑α), thyroid‑stimulating hormone (TSH), free thyroxine (T4), and sirtuin 1 (SIRT1). Additionally, the pro‑oxidant‑antioxidant balance was evaluated by assessing total hydroperoxides (THP) levels and total antioxidant activity (TAA). The assessment of BA and aging rates (ΔBA) were chosen as the main markers of premature aging and were performed with two different methods: by M. Levin et al. (ΔBA1), by authors’ own method (ΔBA2). Depending on ΔBA, patients from all three groups were divided into subgroups with normal/slowed aging rates (ΔBA ≤0) and accelerated aging rates (ΔBA >0).
 Results. According to ΔBA1 (p=0.004), 4 subjects with accelerated aging rates reveled in the controls, while in the main group the rate was 2.2 times higher than in the comparison group (40.0% versus 18%). According to ΔBA2 (p=0.0001), more people had an increased aging rates both in the main group and in the comparison group (57.1% versus 38.0%). Patients with AH and accelerated aging rates according to ΔBA1 had significant differences in the levels of SIRT1 (p=0.012), aspartate aminotransferase (AST) (p=0.012), alanine aminotransferase (ALT) (p=0.005), uric acid (p=0.011), and diastolic blood pressure (DBP) (p=0.001), and according to ΔBA2, higher levels of insulin (p=0.019), HOMA IR (p=0.013), triglycerides (TG) (p=0.011), very low‑density lipoprotein cholesterol (VLDL‑C) (p=0.020), DBP (p=0.032), and lower levels of total protein (p=0.048), compared to patients with AH and normal/slower aging rates. In the group of patients with AH combined with SH, differences in the levels of THP (p=0.023), uric acid (p=0.044), and body mass index (BMI) (p=0.046) were found among patients with different aging rates according to ΔBA1, and according to the results of the ΔBA2 assessment — in the levels of glucose (p=0.045) and uric acid (p=0.026). Among the studied patients in the AH group and in the group with a combined course of AH and SH, there were 52 patients whose aging rates (accelerated and normal/slowed) did not coincide in the assessment according to ΔBA1 and ΔBA2 : 11 patients had accelerated aging rates only according to ΔBA1, and 23 patients — only according to ΔBA2. Among the aforementioned 52 patients, 50% had elevated levels of ALT, 32.7% — AST, 3.8 — alkaline phosphatase (ALP), 90.2% — HOMA IR, 80.8% — total cholesterol (TC), 28.8% — triglycerides (TG), 26.9% had decreased levels of high‑density lipoprotein cholesterol (HDL‑C), 82.7% had elevated levels of LDL‑C, 15.4% — creatinine, 46.2% had decreased eGFR, 15.4% had elevated levels of CRP, 3.8% — TNF‑α, and 50.0% had uncontrolled levels of systolic and diastolic BP.
 Conclusions. Assessment of BA should be mandatory for patients with AH and SH to enable early detection and prevention of premature aging. As an indicator of accelerated aging rates, the combined use of ΔBA assessment based on clinical and biochemical indicators according to the method of M. Levin et al. (2018), as well on our own developed method based on the assessment of anthropometric indicators, TSH levels and the content of THP can be effective. Primary determination of BA can be conducted during regular (e.g., annual) preventive screening of patients. In case of detection of cardiometabolic disorders, repeat determination of BA can be performed after some time following their correction.

Effects of Helicobacter pylori infection on the components of metabolic syndrome. Review

The article emphasizes the ability of Helicobacter pylori (H. pylori) to influence metabolic processes and considers possible mechanisms of such influence. The data presented that H. pylori infection increases the frequency of metabolic syndrome and its components. It is emphasized that systemic chronic inflammatory processes (one of the main links in the pathogenesis of metabolic‑associated diseases) can be initiated by H. pylori due to the activation of «classical» mechanisms inherent in metabolic diseases: activation of pro‑inflammatory cytokines (tumor necrosis factor‑α, interleukins‑1, ‑6,) and adipocyte hormones. This is primarily due to the ability of H. pylori to produce cytotoxins (Cag/Vac A) and the presence of lipopolysaccharide in its own cell wall (endotoxin), which can both directly and indirectly induce a pro‑inflammatory response, including a systemic one. In support of this, the data showing that H. pylori eradication prevents repeated stenosis of the coronary arteries after stent placement, leads to an improvement in the course of arterial hypertension, and a significant decrease in the levels of C‑reactive protein. In addition, the effect of H. pylori on pro‑inflammatory cytokines and adipocyte hormones can contribute to the formation of an abnormal proatherogenic lipid profile. This is confirmed by data on the decrease in the levels of total cholesterol, triglycerides, low‑density lipoprotein cholesterol against the background of an increase in the concentration of high‑density lipoprotein cholesterol after successful eradication of H pylori. Also noted that H. pylori infection is a potential contributing factor to insulin resistance and chronic hyperglycemia, and this is also largely related to the ability of Helicobacter pylori to produce cytotoxins. Some investigators haven’t established the relationship between H. pylori and glycosylated hemoglobin levels, that can be explained by the use of serological methods for H. pylori diagnosis. The differences in research results may be associated with methodological errors, therefore, further research is needed in this direction, which will contribute to the development of preventive and therapeutic strategies.

Peculiarities of ambulatory blood pressure monitoring in patients who have suffered from COVID-19

Violations of blood pressure control in patients who have had COVID-19 can be due to many pathophysiological factors. Further study of the features of blood pressure (BP) fluctuations in this category of patients will allow to diagnose arterial hypertension (AH) on time, to identify the uncontrolled course of AH and to select the optimal tactics of patients’ management. It was suggested to determine the characteristics of BP fluctuations in patients who have suffered from COVID-19 more than 12 weeks ago, based on the results of ambulatory (daily) blood pressure monitoring. 98 patients (51 men – 52.0%, 47 women – 47.9%) who have had COVID-19 infection more than 12 weeks ago were examined. Patients were divided into 2 groups – with and without a history of AH. The groups of examinees were homogeneous in age and gender. Ambulatory blood pressure monitoring (AM BP) was carried out on the CardioTens apparatus (Meditech, Hungary) according to the standard method. According to the data of AM BP in patients with AH in the anamnesis, who have suffered from COVID-19 more than 12 weeks ago, significantly higher average indicators of daily systolic blood pressure were recorded, and significant violations of the indicators of variability of systolic blood pressure during the day and night periods, pressure load during the day period, as well as a significantly higher degree and the rate of the morning rise in systolic blood pressure. In patients without a history of AH who have suffered from COVID-19 more than 12 weeks ago, in 21.4% cases there was newly diagnosed AH, in 33.3% of cases, increased variability of systolic blood pressure was observed, mainly during the day, in 21.4% of cases, the degree and speed of the morning rise of systolic blood pressure were increased, which indicated the presence of hypertensive reactions to household loads. In patients with a history of AH, in 55.3% of cases there was observed an increase in average blood pressure values per day, during the day and night periods, which was considered as ineffective blood pressure control and required an increase in the doses of previously prescribed antihypertensive drugs or the use of additional antihypertensive drugs in the treatment regimen. In patients with AH in the anamnesis, who have suffered from COVID-19 more than 12 weeks ago, reliable violations of many indicators of AM BP, deterioration of blood pressure control were recorded. In the patients, who did not have AH and who have suffered from COVID-19 more than 12 weeks ago, the presence of a hypertensive reaction to household loads and newly diagnosed AH were odserved.

Features of the arterial hypertension course and arterial stiffness in patients with ankylosing spondylitis who get infected COVID-19

Objective: to evaluate the features of development and course of arterial hypertension (AH) and changes in vascular stiffness in patients with ankylosing spondylitis (AS) who underwent COVID-19. Materials and methods: 60 patients with a reliable diagnosis of AS were included in the study. Patients were divided into 2 groups depending on the presence of COVID - 19 in anamnesis. The main group consisted of 30 patients with AS who had suffered COVID-19 of varying severity during the previous 12 months. The comparison group consisted of 30 patients with AS who had no laboratory and clinically confirmed COVID-19 infection within the last year. Patients were interviewed regarding the severity of their previous coronavirus infection and persisting symptoms in the post-COVID-19 period. AS activity was evaluated by ASDAS (CRB, BASDAI-index). BP measurement and study of arterial stiffness parameters by oscillographic method, evaluation of the results of ambulatory BP measurement were performed. Results: 6 (20%) patients had BP destabilization at the outpatient stage during home BP measurement early after COVID-19. After 12 months, BP elevation persisted in only 2 (7%) patients, the rest had BP stabilization with withdrawal of antihypertensive drugs. No correlation between BP level, arterial stiffness and AS activity was found. There was a weak inverse correlation between the severity of coronavirus infection and the level of systolic blood pressure, between age and pulse wave velocity. No significant differences in systolic, diastolic blood pressure, pulse wave velocity, aortic augmentation index were found in patients with AS with and without coronavirus infection. In the main group, 1 fatal outcome due to the development of acute ST-elevation myocardial infarction 6 months after COVID-19 was recorded, and no adverse cardiovascular events were registered among patients in the comparison group. Conclusion: it was hypothesized that patients with AS who underwent COVID-19 would be more likely to show BP elevation than those who did not undergo COVID-19. It was found that early after COVID-19 (first three months) a reversible increase in BP without significant changes in arterial stiffness is possible. However, no significant differences in the frequency of BP elevation, BP level, and arterial stiffness were found in patients with AS and COVID-19 or without COVID-19 in anamnesis.

The course of arterial hypertension in patients with type 2 diabetes after surgical treatment of carotid artery stenotic lesions

Background. Arterial hypertension (AH) is the cause of 70–75 % of strokes. Atherosclerotic lesion of the carotid artery (CA) is a classic example of a vascular lesion in individuals with hypertension. The risk of stroke increases twice when hypertension and diabetes are combined. Carotid endarterectomy (CA), which has both a curative and preventive nature, is the main method of surgical treatment of CA stenoses. The purpose was to study the course of blood pressure in patients with type 2 diabetes and without it after CE. Materials and methods. 138 patients with arterial hypertension and CA stenosis were selected for the purpose of CE under local anesthesia. Patients were divided into two groups: 68 patients with type 2 diabetes (group I) and 70 patients without diabetes (group II). The median age of patients in group I was 64 [50–71] years, group II — 63.5 [47–68] years. Daily blood pressure monitoring (BPD) was performed 2 days before surgery (1 examination), 5–7 days after surgery (2 examinations) and 3–6 months after CE (3 examinations). The average indicators of systolic blood pressure (SBP) and diastolic blood pressure (DBP) per day, day, and night were evaluated; average pulse blood pressure (BP); variability of SBP and DBP per day, day, night. Results. Before the operation, group I, in contrast to group II, recorded significantly higher indicators: SATdb (p = 0.02), SATd (p = 0.03), SATn (p = 0.01), DBTn (p < 0, 05), PAT (p = 0.03), varDATdb (p = 0.03), varSATd (p = 0.03), varDATn (p = 0.04). During the second examination in group II, significantly more significant dynamics of DMAT indicators were noted: SATdb (p = 0.002), SATd (p = 0.02), DAPdb (p = 0.002), DAPd (p = 0.01), DAPn (p = 0.03), varSATn (p < 0.04), varDATn (p < 0.05), varSATdb (p = 0.0002), varDATdb (p = 0.0001). The dynamics of PAT and midnight SAT were insignificant. 3 months after KE, all mean values of SBP and DBP, as well as PAT, decreased significantly in patients of group II. The expressiveness of changes in SBP indicators during the day, day and night, as well as indicators of SBP variability in group II was more significant. During the third examination, the proportion of patients with a "dipper" circadian rhythm increased in the two groups (p < 0.05). In group II, the proportion of patients with an unfavorable type of daily profile "over-dipper" significantly decreased (p < 0.001), which did not occur in group I. Conclusions. Surgical treatment of carotid stenoses in patients with and without type 2 diabetes is associated with a decrease in blood pressure in the early postoperative period and is observed for several months after the operation.

INVESTIGATING INTERACTIONS OF PATHOGENETIC FACTORS IN THE DEVELOPMENT OF ARTERIAL HYPERTENSION AND OBESITY

This review is devoted to investigating the clinical, pathogenetic, and molecular mechanisms underlying the development of arterial hypertension and obesity, as well as their mutual impact on the progression of comorbidity. The literature review uncovers the mechanisms contributing to the emergence of various forms of cardioremodelling, taking into account the role of gender-specific factors. The article also presents current theoretical results and findings of clinical studies regarding how pathogenetic factors of arterial hypertension and obesity interact and influence on the progression of both diseases in case of their comorbidity. The influence of the gender, age, race, and seasonal variations in the course of arterial hypertension and obesity was highlighted as well. Special attention was paid to the issues considering the development of these diseases worldwide, age-related characteristics in the progression of this variant of comorbidity. When studying the problem of cardioremodeling in patients with arterial hypertension and in patients with comorbid arterial hypertension and obesity, two types of this pathological process (concentric and eccentric) were established. It has been shown that their development in men and women is significantly influenced by the type of obesity. This process is a gradually progressive disrupt of the structure and function of all parts of the heart, which lead to the development of structural and functional irreversible changes. This is especially clearly observed in patients with arterial hypertension and obesity, including those with type 2 diabetes.

Peculiarities of the Course of Arterial Hypertension and Stable Coronary Heart Disease in Conditions of Distress and the Feasibility of Additional Therapy

Today, in Ukraine in war conditions there are the powerful and long-term stress factors in the population, according to the intensity of the constant negative psycho-emotional impact theses stress factors form a state of distress. Distress, as an additional significant pathogenetic reason, affects the change in the prevalence and course of cardiovascular diseases. The article describes the stages and individual changes caused by distress. Diagnostic algorithms for the assessment of patients with arterial hypertension and coronary heart disease in distress conditions for a differentiated change in therapy are provided, namely the strengthening of the basic recommended therapy or the inclusion in the treatment of additional therapy: phytotherapy or vasoactive biosupplements. Among the last mentioned substances, donors of nitric oxide (NO), whose main substrate for synthesis in the body is L-arginine, have undoubted advantages. According to modern studies and meta-analyses, the use of L-arginine improves the endothelial function of blood vessels, has antioxidant properties, thanks to which it has been proven that it decreases blood pressure, reduces the feeling of anxiety, improves physical performance, reduces the number of angina attacks, including microvascular one, has a positive effect on the lipid profile in general, with a probable decrease in the level of triglycerides. Our own data on the oral use of the L-arginine biosupplement with a decrease in the variability of blood pressure, the frequency of cardiac pain, and an improvement in general well-being are presented. The presence of population-wide distress reactions makes it possible for the patient to use the supplement independently to alleviate/eliminate maladaptive effects from the cardiovascular and central nervous systems.

ARTERIAL HYPERTENSION AND WAR, WHAT TO EXPECT?

The aim. To conduct an analysis and generalize scientific publications on the influence of war factors on morbidity indicators and the clinical course of arterial hypertension.
 Materials and methods. An analysis and generalization of scientific research and publications on the specifics of morbidity among military personnel and the population affected by war has been conducted. The following methods were utilized: a systematic approach, bibliosemantic analysis, and analytical methods.
 Results: The article focuses on the influence of war factors on the incidence rates and clinical course of arterial hypertension in both military personnel and the civilian population. Through a review of historical data and modern scientific sources, the study examines the long-term effects of stress factors on the development of hypertension, the peculiarities of its clinical manifestations, and the potential for predicting complications in individuals affected by military operations. The impact of nervous tension is particularly evident among frontline soldiers, as hypertension is observed, on average, 3-4 times more frequently compared to soldiers in the rear. The article emphasizes the clear correlation between the frequency of arterial hypertension in servicemen and the duration of their frontline deployment.
 Conclusion. Severe mental trauma and negative emotions, experienced by both military personnel and the civilian population during war, can not only contribute to an increased incidence of hypertension but also lead to a significant rise in the occurrence of the disease in young individuals, with severe clinical manifestations expected.

Моніторинг стану здоров’я дітей з коарктацією аорти в післяопераційному періоді

Purpose - to improve the observation of children after surgical treatment of the aortic coarctation. Materials and methods. A retrospective analysis of 87 case histories of patients with aortic coarctation in the preoperative period was performed; 44 patients underwent daily blood pressure monitoring, nitric oxide levels in 61 children were determined in the postoperative period; histological examination of 15 coarctated aortic sites was performed; quality of life was assessed in 56 patients with aortic coarctation after surgical treatment. Results. According to daily blood pressure monitoring, an inadequate increase in blood pressure during physical and mental activity was obtained; a violation of the circadian rhythm of blood pressure with insufficient decrease in systolic and diastolic or excessive decrease in diastolic pressure was detected. The results of the assessment of blood pressure variability revealed a significant difference in the standard deviation of the mean daily diastolic blood pressure (62.5 (55; 75)), daily diastolic blood pressure (72.5 (57; 78.5)), and an increase in the circadian systolic blood pressure index (16 (11.5; 17)). The level of nitric oxide in the blood of a group of patients with arterial hypertension was 4.18±0.86 μmol/l (M±SD - mean ± standard deviation). in the control group - 5.51±0.69 μmol/l. Thus, a significant decrease in nitric oxide in the group with arterial hypertension was established (t=-5.45; p<0.001). It was also diagnosed that in the group of patients with stable arterial hypertension, the level of nitric oxide was 3.74±0.79 μmol/l, and in the subgroup of patients with labile hypertension - 4.44±0.80 μmol/l, the subgroups in the content of nitric oxide significantly differed from each other (t=2.91; p<0.01), as well as from the values of the control group: with stable arterial hypertension (t=-6.72; p<0.001) and labile arterial hypertension (t=-4.41; p<0.001). The dependence of the level of nitric oxide in serum on the time of the postoperative period and the type of arterial hypertension was established. The histological features of area of narrowing in the form of foci of necrosis of cells and fibers, areas of hypo- and anelastosis, the presence of newly formed vessels of capillary type were identified and studied. The main factors in reducing the quality of life of patients with coarctation of the aorta in the postoperative period are the presence of arterial hypertension, restriction of physical activity, parents’ оverprotection. Conclusions. Based on the data obtained, an individual observation card of a patient with aortic coarctation was created. A set of clinical, instrumental and laboratory signs that may be a leading role in the occurrence and course of arterial hypertension in children (concomitant cardiovascular and somatic pathologies, initial level of systolic and diastolic blood pressure, level of the final product of nitric oxide in serum, structural features of the aortic wall) has been determined. An original method of examination of patients with aortic coarctation in the postoperative period was proposed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Mitochondrial DNA Polymorphism in HV1 and HV2 Regions and 12S rDNA in Perimenopausal Hypertensive Women.

Estrogens enhance cellular mitochondrial activity. The diminution of female hormones during menopause may have an effect on the mitochondrial genome and the expression of mitochondrial proteins. Hence, oxidative stress and the pro-inflammatory state contribute to the formation of systemic illnesses including arterial hypertension (AH). This study aimed to determine the types and frequency of mutations in the mitochondrial DNA (mtDNA) nucleotide sequence in the hypervariable regions 1 and 2 (HV1 and HV2) and the 12S RNA coding sequence of the D-loop in postmenopausal women with hypertension. In our study, 100 women were investigated, 53 of whom were postmenopausal and 47 of whom were premenopausal (53.9 ± 3.7 years vs. 47.7 ± 4.2 years, respectively). Of those studied, 35 premenopausal and 40 postmenopausal women were diagnosed with AH. A medical checkup with 24 h monitoring of blood pressure (RR) and heart rate was undertaken (HR). The polymorphism of the D-loop and 12S rDNA region of mtDNA was examined. Changes in the nucleotide sequence of mtDNA were observed in 23% of the group of 100 women. The changes were identified in 91.3% of HV1 and HV2 regions, 60.9% of HV1 segments, 47.5% of HV2 regions, and 43.5% of 12S rDNA regions. The frequency of nucleotide sequence alterations in mtDNA was substantially higher in postmenopausal women (34%) than in premenopausal women (10.6%), p = 0.016. A higher frequency of changes in HV1 + HV2 sections in postmenopausal women (30.2%) compared to the premenopausal group (10.6%) was detected, p = 0.011. Only postmenopausal women were found to have modifications to the HV2 segment and the 12S rDNA region. After menopause, polymorphism in the mtDNA region was substantially more frequent in women with arterial hypertension than before menopause (p = 0.030; 37.5% vs. 11.5%). Comparable findings were observed in the HV2 and HV1 regions of the AH group (35% vs. 11.5%), p = 0.015, in the HV1 segment (25% vs. 11.5%), p = 0.529, and in the HV2 segment, 12S rDNA (25% vs. 0%). More than 80% of all changes in nucleotide sequence were homoplasmic. The mtDNA polymorphisms of the nucleotide sequence in the HV1 and HV2 regions, the HV2 region alone, and the 12S RNA coding sequence were associated with estrogen deficiency and a more severe course of arterial hypertension, accompanied by symptoms of adrenergic stimulation.

The risk factors for the development of metabolic disorders in patients with arterial hypertension

The purpose of our study was to analyze the scientific publications containing the latest research data on the development of metabolic disorders in patients with arterial hypertension.
 To systematize the data on risk factors for the development of metabolic disorders in patients with arterial hypertension, information in open databases such as PubMed, Scopus, Web of Science, Google Scholar and other materials of Ukrainian and foreign scientists have been analyzed. A review of the risk assessment of combined conditions in various countries worldwide has been performed. Control measures to prevent the development of complications in patients with a combination of hypertension and type 2 diabetes were considered. Emphasized the importance of early detection of metabolic disorders in patients with arterial hypertension, aimed at reducing the risk of complications. It has been established that significant prevalence of the combined course of arterial hypertension and type 2 diabetes necessitates the timely detection and correction of comorbid pathology.
 Continuous monitoring of the presence of risk factors for metabolic disorders in patients with arterial hypertension in the general population helps to identify patients who need particular attention to achieve positive results of treatment and to prevent possible complications. Research in various countries gave evidence that type 2 diabetes prevalence and development of associated diseases make the greatest challenge to health care worldwide. The close correlation between the indicators of lipid and of carbohydrate metabolism has been confirmed, indicating the need for a complex pathogenetic approach to the treatment of patients with arterial hypertension. In recent years comorbidity had a significant economic and medico‑social impact for society, thus investigation of the factors of metabolic disorders development in patients with hypertension create the basis for the development of special methods for their prevention and treatment.

Insulin resistance and heart failure with preserved ejection fraction. Pathogenetic and therapeutic crossroads

Insulin resistance, which is a fundamental pathogenetic factor of prediabetes, is closely associated with abdominal obesity on the one hand and the development of cardiovascular diseases, heart failure (HF), on the other. The pathogenetic role of insulin resistance is multifaceted and consists in the acceleration of atherosclerosis, the formation of left ventricular myocardial hypertrophy, including through mechanisms that do not depend on blood pressure, as well as the development of its diastolic dysfunction. The latter is the starting point for starting HF with preserved ejection fraction (HFpEF).Compared with patients with HF with reduced ejection fraction, the presence of HFpEF determines a higher frequency of hospitalizations not due to decompensation of heart failure, but due to concomitant diseases, such as destabilization of the course of arterial hypertension, decompensation of type 2 diabetes mellitus, curation of which, in general, has a greater impact in terms of improving prognosis. Thus, in patients with prediabetes and HFpEF, the correction of insulin resistance as the underlying cause and trigger of cardiometabolic disorders can potentially improve not only insulin-glucose homeostasis, but also the parameters of myocardial diastolic function. This literature review is devoted to the accumulated experience of using metformin as a «strategic» antidiabetic drug in HFpEF and considering potential new points of its application as a protector of the cardiovascular system.

FEATURES OF THE COURSE OF ARTERIAL HYPERTENSION IN PATIENTS AFTER COVID-19

Introduction. Arterial hypertension (AH) is one of the most common comorbidities in patients with COVID-19. A number of studies have revealed a more severe course of COVID-19 (coronavirus disease (CVD) in patients with hypertension. The problem of studying the association between AH and COVID-19 is also very relevant from an etiopathogenetic point of view, since, both in the development of COVID-19 and in the pathogenesis of AH, one of the key places is occupied by the components of the renin-angiotensin-aldosterone system (RAAS) and, first of all, turn, angiotensin-converting enzyme-2 (ACE-2) and angiotensin II (AII). It has been established that the penetration of the SARS-CoV-2 virus into the body occurs by binding to the RAAS enzyme - ACE-2. This leads to a decrease in the level of ACE-2 and to an increase in the level of AII, which initiates a cytokine storm, damage to the lungs and contributes to the development of severe CVD. On the other hand, AII is one of the most powerful vasoconstrictor factors and plays an extremely important role in the mechanisms of development and progression of hypertension. However, despite the already long period of the COVID-19 pandemic, the features of the course of hypertension in patients who have had this disease have not been adequately studied. The problem of clinical and pathogenetic relationships between AH and COVID-19 remains relevant in 2022, after the start of a new wave of COVID-19 with the dominant Omicron strain. Aim: study of the features of the course of hypertension in patients after COVID-19. Materials and methods. 82 patients with AH were examined before and 6-12 weeks after COVID-19 disease. Among the examined patients, 68 patients (83%) had moderate COVID-19, 14 patients (17%) had severe COVID-19. All patients before and after infection with COVID-19 underwent a general clinical laboratory and instrumental examination. Results. A significant negative impact of COVID-19 on the nature of the course of hypertension was revealed: an increase in the severity of hypertension, the frequency of cardiac arrhythmias, the frequency and severity of heart failure, a decrease in kidney function, destabilization of existing type 2 diabetes and development of new cases of diseases, progression of lipid metabolism disorders and coronary heart disease. A significant contribution to the worsening of the course of AH after CVD is made by the formation of «ongoing symptomatic COVID-19» and astheno-depressive syndrome. Taking into account current data, COVID-19 can directly lead to a worsening of hypertension due to a decrease in ACE-2 levels and an increase in the production of AII, which plays a key role in the pathogenesis of hypertension. Conclusions. Postponed COVID-19 significantly worsens the course of hypertension, which increases the overall risk of complications and indicates the need for timely initiation of adequate comprehensive treatment. Key words: coronavirus disease -19- COVID-19, arterial hypertension, renin- angiotensin- aldosterone system, angiotensin converting enzyme-2, angiotensin ІІ.

Characteristic of the uncontrolled hypertension course in patients of the aral sea region with uncomplicated hypertensive crisis

Abstract Purpose To study the features of the course of uncontrolled arterial hypertension (AH) in the Aral Sea region with the identification of the prevalence of various genotypes of the angiotensinogen (AGT) gene in patients with uncomplicated hypertensive crisis. Methods The genetic part included 94 patients with uncomplicated hypertensive crisis, an average age of 55.3±8.6 years, 54 (58.3%)women and 40 men (41.7%). The control group consisted of 50 healthy women and men, an average age of 52.7±6.4 years in equal proportion. The genetic study was carried out by real-time PCR with the determination of the prevalence of genotypes and alleles of genetic polymorphisms AGT 521 C>T, AGT 704 T>C. Results Patients with uncomplicated hypertensive crisis were characterized by LV hypertrophy, thickening of the intima-media thickness of the common carotid artery, and kidney damage. Henken's test showed that patients with AH require a significantly higher concentration of table salt to determine the threshold of taste sensitivity than in the control group: 0.51±0.17% versus 0.21±0.14% concentration of NaCl. The distribution of 704T>C genotypes of the AGT gene polymorphism was as follows: CC genotype 43.6%, CT genotype 45.8%, TT genotype 10.6% of cases, χ2=32.777, p=0.000; C allele – 66.5%, T allele - 33.5% of cases, χ2=40.894, p=0.000. Among healthy individuals, the distribution by genotypes showed a significant predominance of the CC genotype: CC 76%, CT 24%, TT genotype was not detected in the presented sample, χ2=67.92, p=0.000; C-allele 88%, T-allele 12%, χ2=115.52, p=0.000. The above data of the group of patients and healthy people corresponded to the theoretical Hardy-Weinberg equilibrium. The distribution of 521T>C genotypes of the AGT gene polymorphism among AH patients was as follows: CC genotype – 79.8%, CT genotype – 16%, TT genotype – 4.2% of cases, χ2=139.8, p=0.000; C-allele – 87.8%, T-allele – 12.2%, χ2=214.5, p=0.000. Among healthy individuals, a significant predominance of the CT genotype was shown: CC genotype – 40%, CT genotype – 60% of cases, χ2=42.0, p=0.000; C-allele – 70%, T-allele – 30%, χ2=32.0, p=0.000. The above data of the group of patients and healthy people did not correspond to the theoretical Hardy-Weinberg equilibrium Conclusion Patients with uncomplicated hypertensive crisis, living in the aral sea region, are characterized by severe damage of target organs, a high threshold of taste sensitivity to table salt. Based on genetic models of inheritance, a significant prevalence of the C-allele and CC genotype 704 T>C AGT gene polymorphism in healthy individuals was revealed, which characterizes the C-allele and CC genotype as protective against AH in people of the Aral Sea region. Significantly greater accumulation of the C-allele 521 C>T polymorphism of the AGT gene among AH patients is a factor of predisposition to a complicated course of AH in people of the aral sea region. Funding Acknowledgement Type of funding sources: None.

Hypotensive effects of drug combinations in elderly and old patients with controlled arterial hypertension

Aim. To assess the frequency of arterial hypotension, orthostatic hypotension, low blood pressure (BP) and their clinical manifestations in the group of elderly and senile patients with a controlled course of arterial hypertension (AH), taking combinations of drugs based on an angiotensin-converting enzyme inhibitor (ACE inhibitor).Materials and methods. The study included 171 male and female residents of Krasnodar Territory with drug-controlled AH (blood pressure - BP less than 140/90 mm Hg in the background of previous antihypertensive therapy containing an ACE inhibitor perindopril), and with diseases of atherosclerotic genesis. All patients were questioned, tested for balance control, assessed for the risk of falls according to the Morse scale, hypotension in orthostasis was determined, measured office BP, carried out daily monitoring of BP with the determination of the time indices of hypotension and low BP.Results. Most often patients took a combination of ACE inhibitors with calcium channel blockers (CCB) (28.1% of cases), beta-blockers (BB) (27.1%) or diuretics (29.1%). Assessing the risk of falls on the Morse scale, there was a significantly lower level in patients who took the combination of perindopril with CCB compared with those who received perindopril with BB (15 versus 25 points respectively, p=0.039). Patients receiving perindopril and CCB lost balance in the “legs together” position in 19.3% and in the “tandem” or “semi-tandem” position of the feet in 29.8% of cases, that could be compared to the group taking perindopril and a diuretic (22% and 33.9%, respectively) and significantly lower than in the groups with perindopril and BB therapy (34.5% and 50.9%, respectively, p1=0.037, p2=0.043). The time index of low systolic and diastolic BP during therapy with perindopril and CCB was significantly lower than the corresponding indicator in the groups of patients treated with perindopril and BB (22% and 17% versus 27% and 21%, respectively, p1=0,009, p2=0,024), and the time index of low systolic BP for the combination of perindopril and diuretic is lower than for the combination of perindopril and BB (23% versus 27%, respectively, p=0.023).Conclusion. The data obtained on the frequency of arterial hypotension, orthostatic hypotension and low BP in the group of elderly and senile patients indicate the advisability of further studying the risks of drug hypotension in order to better personalize the treatment of AH.

Specific deformation pattern in hypertensive patients with septal bulge and preserved systolic function.

A wide range of subclinical changes in left ventricular (LV) geometry and function can be observed, even in the early course of arterial hypertension (HTN). Aim of the study was to investigate if the appearance of isolated basal septal hypertrophy (BSH, septal bulge) in asymptomatic young and middle-aged adults with HTN could be a marker of incipient LV systolic dysfunction when other measures of global LV function are still normal. A total of 138 patients with primary arterial hypertension, aged less than 65years, with no comorbidities and with preserved LV ejection fraction (EF) were included. Complete 2D transthoracic echocardiography study was preformed according to standardized protocol, as well as deformation study using speckle tracking echocardiography. Global and regional longitudinal strain was measured in apical 4-, 2- and 3-chamber views according to 18-segments model. Global and regional circumferential and radial strains were measured in short axis view. Average was taken from each of the six basal, middle and apical LV segments. Patients were divided into two groups according to BSH presence and values were compared. Basal septal hypertrophy was found in half of the patients (53.6%). The whole cohort had altogether normal LV global systolic function, as well as global indices of radial strain (GRS 43.86 ± 10.75%) and longitudinal strain (GLS - 19.73 ± 2.19%), while global circumferential strain (GCS) was mildly reduced (GCS - 19.5 ± 2.81%). BSH patients had more expressed LV geometry changes (LV mass: 89.19 ± 24.59g/m2 vs 109.15 ± 25.33g/m2, p < 0.001; relative wall thickness: 0.3 ± 0.08 vs 0.38 ± 0.11, p < 0.001) and also revealed a specific pattern of longitudinal deformation impairment in three LV segments (basal and mid interventricular septum, basal anteroseptum). "Strain gradient" from LV base to apex (basal < mid < apical) was observed in the whole population for longitudinal and circumferential strain, and it was more pronounced in the BSH group. This group had more impaired basal LS, while apical CS was improved. Subendocardial longitudinal strain was also more impaired in the BSH group. This study brings new meaning to basal septal hypertrophy (BSH) occurrence in hypertensive patients with discrete global concentric remodeling. Regional systolic dysfunction of the basal and mid LV segments is found, while apical segments increase in deformation. This specific "strain gradient" pattern was found to be more pronounced in patients with BSH. The recognition of BHS in apparently healthy hypertensive patients with no impairment in global systolic function may suggest latent target organ damage with regional impairment of systolic function and the need to imply more aggressive treatment approach.

Osoblyvosti perebihu arterialnoi hipertenzii u khvorykh iz suputnim tsukrovym diabetom u postkovidnomu periodi

Introduction. Recent publications indicate that the most common comorbidities in hospitalized patients with coronavirus infection were arterial hypertension (AH), diabetes mellitus (DM), and coronary heart disease. However, the peculiarities of AH course in post-COVID-19 patients, especially with concomitant DM, are insufficiently covered in the relevant literature. The aim of the study. Тo investigate the peculiarities of hypertension course in patients with concomitant diabetes mellitus previously affected with COVID-19 infection. Materials and methods. We examined 48 patients with essential hypertension of stage II-III of 1-3 degrees, and concomitant DM, previously affected with Covid-19, 52-72 years of age. Results. It has been estimated that more than 1/3 of patients with hypertension who relapsed to COVID-19 complained of frequent headaches, palpitations, coughs, muscle and joint pain, fatigue and sleep disturbances. However, patients with concomitant DM were significantly more likely to complain of general weakness and indigestion. In many patients, regardless of the presence of concomitant pathology, in the postcocious period there was indicated an increase in C-reactive protein more than 3 mg/l and enhanced fibrinogen levels, indicating an increased risk of cardiovascular complications in this group patients. Most patients experienced worsening of blood pressure control during COVID-19 treatment. Uncontrolled hypertension was significantly more common in patients hospitalized for the treatment of acute COVID-19, regardless of DM presence. Conclusions. In patients with AH and concomitant DM significantly more often (76.0 % of cases (p is equal to 0.01)) – compared to patients with AH without DM (60.9 %) was detected uncontrolled hypertension in the post-COVID period. Worsening of blood pressure control in patients with concomitant DM is significantly more common (p value less than 0.001) in those patients who took three or more antihypertensive drugs, this notion require additional correction of antihypertensive therapy.

Features of the clinical course of arterial hypertension in alien residents of Western Siberia with the establishment of patterns of metabolic changes

Metabolic syndrome is considered as a polyetiological disease that makes a significant contribution to the increase in mortality from vascular accidents. The combination of metabolic syndrome and arterial hypertension is a complex pathogenetic duet, the diagnosis and treatment of which continues to be actively discussed.The aim of the study was to study the metabolic syndrome in patients with arterial hypertension permanently residing in the Far North, the frequency of occurrence of the main variants of the metabolic syndrome depending on the degree of hypertension in comparison between men and women.Material and methods. The study was conducted in the Khanty-Mansiysk Autonomous Okrug – YUGRA, the study period: September 2017 – November 2018. The study involved 205 patients permanently residing in the Far North: men – 82 people (40 %), women – 123 people (60 %). By age, patients are represented by two groups: group 1 – 38–43 years old (n = 98), of which 46 men (46.9 %), women – 52 people (53.1 %); group 2 – 44–50 years old (n = 107), of which 46 men (43 %), women – 61 people (57 %). By degree of AH: 1st degree AH (n = 38), including 14 men (36.84 %), 24 women (61.16 %); 2nd degree AH (n = 115), men – 53 people (46.1 %), women – 62 people (53.9 %); 3 degree AH (n = 52), men – 21 people (40.38 %), women – 31 people (59.62 %).Results – statistically significant variants of the metabolic syndrome were identified for patients with arterial hypertension living in harsh climatic and geographical conditions, an analysis of these variants was carried out in comparison between men and women, depending on the age and degree of arterial hypertension.

Features of the course of arterial hypertension in military servicemen in the conditions of the Аrctic region

Purpose.To study the frequency of occurrence of cardiovascular risk factors and the course of arterial hypertension in military personnel in the Arctic region.Materials and methods.251 male servicemen aged 23–44 years (mean age 33.7±4.9 years) were examined and studied medical records. Depending on the place of service, all the examined were divided into two groups: I — 159 military personnel serving in the Arctic, II — 92 military personnel from the Western Military District. The studied cardiovascular risk factors included dyslipidemia, tobacco smoking, high blood pressure, abdominal obesity, psychosocial factors, dietary disorders, regular alcohol consumption, physical inactivity. We also analyzed the frequency of occurrence of a confirmed diagnosis of neurocirculatory asthenia and stage I–II hypertension.Results and its discussion.The survey showed a significant increase in the incidence of most of the studied predictors of cardiovascular risk (dyslipidemia, smoking, negative psychosocial factors, dietary disorders, and regular alcohol consumption) in the Arctic region group compared to the temperate climate group. This is realized in the form of a higher incidence of arterial hypertension and a trend towards an increase in the number of cases of generalized atherosclerosis among military personnel in the Arctic. The data obtained may indicate the need for a more thorough selection for service in the Arctic region with a mandatory in-depth examination of the circulatory and metabolic systems, including electrocardiography, echocardiography, stress treadmill test, ultrasound examination of the brachiocephalic arteries with the determination of the thickness of the intima-media complex, sphygmomanometry with the determination of the stiffness and biological age of the vessels, the study of the lipid profile and fasting glycemia. It is advisable to conduct an annual examination of the military personnel of the Arctic group at the place of service with the involvement of visiting military medical commissions, which should include a cardiologist and a specialist in functional diagnostics.