Daily Blood Pressure Profile Research Articles

Эпизоды симптомной гипотонии у больных с артериальной гипертензией: взаимосвязь с показателями суточного профиля артериального давления

Эпизоды симптомной гипотонии у больных с артериальной гипертензией: взаимосвязь с показателями суточного профиля артериального давления

The value of assessing cerebrovascular reactivity in hypertension and comorbid pathology

The review presents the rationale for the importance of studies on the reactivity of cerebral vessels, the classification of cerebrovascular reactivity (CVR) and the threshold values of quantitative indicators of the reserve phase and autoregulation of cerebral blood flow in healthy volunteers. Features of CVR in hypertension are described depending on the clinical course, daily blood pressure profile, the presence of comorbid pathology, the treatment approaches in treatment CVR disorders. We discuss the evidence-based data on the role of CVR assessment in diagnosing latent cerebral circulation insufficiency, prediction of cerebrovascular complications, monitoring the effectiveness and safety of drug and devise-based therapy of hypertension associated with abnormal CVR.

LEFT VENTRICULAR GLOBAL FUNCTION INDEX AND BLOOD PRESSURE PARAMETERS IN UNTREATED PATIENTS WITH HYPERTENSION

Objective: The left ventricular global function index (LVGFI) is a novel marker that incorporates LV structure in the assessment of LV cardiac performance.Typically, LVGFI is assessed with MRI, but recently proposed a technique for calculating this index by echocardiography. It was previously shown that a decrease in LVGFI may be a predictor of adverse outcomes in young patients with hypertension and a preserved ejection fraction. The study aimed to elucidate the association between LVGFI and the features of the daily profile of blood pressure in untreated patients with essential hypertension (EH). Design and method: We included in the study 104 patients with EH (51 men (49%) and 53 women (51%)). Mean age 58,7 ± 11,73 years. All patients had no history of blood pressure-lowering treatment. All patients underwent echocardiography and ambulatory blood pressure monitoring (ABPM). LVGFI (%) was defined as left ventricular (LV) stroke volume/LV global volume∗100% where LV global volume was calculated as the sum of the LV mean cavity volume ((LV end-diastolic volume + end-systolic volume)/2) and myocardium volume (LV mass/density). End-diastolic and end-systolic volume were obtained using Teichholz method. Results: The mean LVGFI was 30,21 ± 7,32%. We performed a correlation analysis of the main clinical characteristics and parameters of ABPM with LVGFI. We found slight correlation between age (r = -0,215, p = 0,028) and body mass index (r = -0,378, p < 0,0001) with the LVGFI. There were no significant associations between office blood pressure and echocardiography parameters. Also mean daily, daytime and night systolic and diastolic blood pressure were not correlated with LVGFI. The most significant associations were found between ABPM systolic (r = -0,307, p = 0,002) and diastolic (r = -0,355, p < 0,0001) blood pressure variability. Patients with the impaired circadian rhythm of blood pressure by type of over-dipper had the lowest LVGFI (26,84 ± 3,301%) compared with patients with normal circadian rhythm (32,43 ± 6,908%) and non-dipper patients (30,49 ± 7,773%), p = 0,041. Conclusions: Lowering of LVGFI is associated with high blood pressure variability and over-dipper circadian rhythm of blood pressure.

Combined antihypertensive and psychocorrective therapy in patients with arterial hypertension and anxiety-depressive disorders: are there any advantages?

Relevance. Arterial hypertension (AH) and anxiety-depressive disorders (ADD) are comorbid pathologies that are common in clinical practice. At the same time, the possibility of including an antidepressant in antihypertensive therapy for optimal control of hypertension, as well as to ensure a vasoprotective effect, has not been studied enough.
 Aim. To compare the effect of traditional antihypertensive therapy and therapy, including an antidepressant, on indicators of the daily profile of blood pressure (BP), stiffness of the vascular wall and central aortic pressure (CAP), the severity of anxiety and depression, as well as on cognitive function (CF) in patients AH and ADD.
 Materials and methods. The study included 90 patients with AH and ADD, who were randomized into two groups: group 1 patients who received a fixed combination of an angiotensin II receptor blocker and a diuretic, a b-blocker and an antidepressant; group 2 persons who took only three-component antihypertensive therapy. Before and after 24 weeks, all patients underwent a general clinical examination, 24-hour BP monitoring ABPM (BpLab Vasotens, Petr Telegin, Russia) with an assessment of the daily profile of BP, CAP and vascular stiffness. In addition, testing was carried out on the HADS, CES-D scales; CF were rated according to the Montreal scale.
 Results. In the group of patients treated with an antidepressant, it was noted that the target BP level was achieved more quickly when lower doses of angiotensin II receptor blockers were prescribed. After 6 months of therapy in both groups, there was a comparable positive dynamics of the main indicators of ABPM. In group 1, a statistically more pronounced decrease in both peripheral and CAP at night was recorded. In both groups of patients, a decrease in the augmentation index was noted; however, a statistically significant improvement in the parameters of the speed of propagation of the pulse wave in the aorta and the time of propagation of the reflected wave was recorded only in persons receiving antidepressant. In group 1, there was a regression of ADD, as well as a significant improvement in CF.
 Conclusions. The use of sertraline as part of a combination antihypertensive therapy in patients with AH and ADD contributed to a more rapid achievement of target BP values, a significant improvement in ABPM (especially at night), vascular wall stiffness and CAP. It is also important that the appointment of sertraline was accompanied by a regression of anxiety-depressive symptoms, an improvement in CF.

Gender Differences in Vascular Stiffness Indicators and Daily Blood Pressure Profile in Patients with Arterial Hypertension and Depressive Disorders.

Aim To study gender-related characteristics of vascular wall stiffness (VWS), central blood pressure (CBP), and BP diurnal profile in patients with arterial hypertension (AH) and depression.Material and methods This prospective, noninterventional study enrolled 161 patients, including 98 patients with AH and depression (50 (51 %) men and 48 (49 %) women) and 63 patients with AH without depression (32 (50.8 %) men and 31 (49.2 %) women. The 24-h BP monitoring (24-h BPM) with a BPLab Vasotens hardware system was performed for all patients. The following indexes were evaluated: mean diurnal, mean daytime, and mean nighttime systolic and diastolic BP (SBP and DBP); daytime and nighttime SBP and DBP time index; SBP and DBP variability; and suite of metrics characterizing VWS and CBP. Depression was diagnosed with the Hospital Anxiety and Depression Scale (HADS) and the Zung Self-Rating Depression Scale. Statistical analyses were performed using the STATISTICA 12 software.Results In the patient group with AH and depression, practically all indexes of 24-h BPM were higher for men than for women (р<0.05). Most 24-h BPM parameters did not differ in groups of men and women without depression. Independent of gender, 24-h BPM parameters were significantly higher in patients with both AH and depression than in AH patients without depression. Adverse changes in major indexes of VWS and CBP, were more pronounced in men than in women with AH and depression (р<0.05). Adverse changes in most VWS and CBP indexes were more statistically significant for men with AH and depression than for men without depression.Conclusion The presence of depression in men and women with AH was associated with significant pathological changes in both BP diurnal profile and CBP and VWS parameters. Furthermore, adverse changes in indexes were more pronounced for men with depression than for women. The study results should be taken into account in administration of antihypertensive and psychocorrective drug therapy to personalize the treatment and provide not only optimization of diurnal BP profile but also vasoprotection.

Особенности взаимосвязи реоэнцефалографических показателей и суточного профиля артериального давления при артериальной гипертензии у женщин в климактерическом периоде

The incidence of arterial hypertension (AH) in women increases significantly with the onset of menopause. Age-related hypoestrogenism leads both to an increase in blood pressure (BP) and to a violation of its daily profile. It can lead to impaired cerebral blood flow. Objective: to study the features of cerebral disorders in women in the perimenopausal period with and without hyper-tension using rheoencephalography, as well as their relationship with some indicators of the daily blood pressure profile. Materials and methods. A clinical and instrumental examination of 190 women in the climacteric period (141 people with hypertension and 49 without hypertension) was carried out, who were divided into groups depending on the presence of hypertension and the period of perimenopause. Instrumental research included 24-hour blood pressure monitoring and rheoencephalography. Results. The onset of menopause was accompanied by an increase in the degree of arterial hypertension, with an in-crease mainly in systolic blood pressure. Changes in its daily profile was also noted, especially insufficient or excessive de-crease at night, as well as an increased speed and magnitude of the morning rise both in women with hypertension and without it. The revealed disorders were more pronounced in postmenopausal women and were accompanied by changes in cerebral circulation, which can lead to ischemic and hemorrhagic cerebral complications. Conclusion. Comparison of indicators of rheoencephalography and daily monitoring of blood pressure in menopausal women revealed changes in cerebral circulation, most pronounced in the presence of arterial hypertension and after meno-pause.

Структурно-функціональний стан лівого шлуночка у хворих з гіпертонічною хворобою та ревматоїдним артритом під впливом різних схем лікування

Hypertensive disease is one of the most common diseases in the world and the leading cause of death and disability from cardiovascular diseases among the population. Recent studies have indicated that patients with hypertension in combination with rheumatoid arthritis have a higher risk of cardiovascular complications and mortality. Ukrainian recommendations for the management of patients with hypertension for 2018 indicated that angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are more effective in regressing left ventricular hypertrophy. The purpose of the study was to compare the effect of long-term therapy with valsartan in combination with indopamide and amlodipine on the structural and functional state of the left ventricular myocardium and the level of blood pressure in patients with arterial hypertension in combination with rheumatoid arthritis. Material and methods. The study included hypertensive patients in combination with rheumatoid arthritis. The patients were divided into 3 groups: the first group consisted of 17 patients with essential hypertension in combination with rheumatoid arthritis who took valsartan at a dose of 80 mg at home. The second group included 17 patients who were transferred to additional administration of the drug indapamide at a dose of 15 mg. The third group consisted of 18 patients whose dose of amlodipine was increased from 5 to 10 mg Results and discussion. In the daily blood pressure profile, the time-averaged values of systolic blood pressure and diastolic blood pressure were calculated for three-time intervals of 24 hours, day and night. Left ventricular remodeling was assessed by the relative left ventricular thickness - the ratio of the sum of the thickness of the interventricular septum and the thickness of the posterior wall to the final diastolic size of the left ventricular. The norms were considered to be an indicator of relative wall thickness <0.45. When studying the analysis of the effect of 4-week monotherapy of valsartan at a dose of 80 mg / day on the level of blood pressure and daily blood pressure profile, we revealed a statistically significant decrease in blood pressure by -14.1±2.2 / -8.2±1.4 mm Hg. Art. (P <0.01), mean daily values of systolic blood pressure (24) by 15.1±2.4 mm Hg. Art. (P <0.001), diastolic blood pressure (24) on September 8±1.7 mm Hg. Art. (P <0.001), day and night mean values and indicators of systolic blood pressure and diastolic blood pressure. Analysis of 24-week monotherapy with amlodipine (the average dose of which was 10 mg / day) in 15 patients revealed a decrease in blood pressure by 24.1±3.6 / 15.2±2.3 mm Hg. Art. (P <0.01) and its normalization in 9 out of 15 patients (60%). According to the ABPM data, a significant decrease in systolic blood pressure and diastolic blood pressure was revealed within 24 hours, both in the daytime and at night. The target level of 24-hour AO was achieved in 6 (40%) patients. Valsartan therapy and their combination with indapamide led to regression of left ventricular hypertrophy in all patients, normalization of left ventricular geometry in 33% of patients. In 24 patients with concentric left ventricular hypertrophy, in (25%) left ventricular myocardial mass index and left ventricular geometry normalized, in 4 (17%) patients, left ventricular hypertrophy became eccentric, in 1 (4%) it turned into concentric remodeling, in 10 (54%) patients it remained without changes. Conclusion. Therefore, valsartan and its combination with indapamide in these patients led to regression of left ventricular hypertrophy, normalization of left ventricular geometry in 33% of patients, improvement of left ventricular diastolic function in 88.2%

Clinical and psychological aspects of true arterial hypertension and white coat hypertension

Abstract Purpose To compare the clinical and psychological features, as well as echocardiographic and ambulatory blood pressure monitoring (ABPM) data in patients with true arterial hypertension (AH) and white coat hypertension (WCH). Methods Were studied 154 subjects (58 men and 96 women, average age 52.9±0.7 years) with increased office blood pressure. The control group consisted of 31 healthy individuals (12 men and 19 women, average age 51.5±2.4 years). All individuals underwent ABPM, Doppler echocardiography, and psychological status studies using the MMPI and Spielberger tests. Results ABPM confirmed the presence of AH in 127 (47 men and 80 women, average age 53.3±0.8 years) of 154 examined patients. 27 patients (17.5%) were diagnosed with WCH - 11 men and 16 women, the average age of 50.8±1.4 years. Among healthy individuals, dippers prevailed, while among AH patients the proportion of dippers was significantly lower (p<0.001) compared with the control group, and a larger number of non-dippers, over-dippers and night-peakers was noted (p<0.01). The distribution of patients with WCH by the type of the daily profile of blood pressure (BP) did not significantly differ from that in healthy individuals (p>0.05). Patients with AH compared with healthy patients had higher average values of the left ventricular (LV) posterior wall as well as interventricular septum thickness, left atrium diameter, and LV myocardial mass index. We found no signs of LV hypertrophy in WCH patients and healthy individuals. The correlation analysis confirmed a reliable relationship between most echocardiographic parameters and ABPM in AH patients (p<0.05). The results of the MMPI and Spielberger tests revealed higher levels of reactive and personal anxiety in patients with AH compared with healthy individuals. Patients with WCH were characterized by disharmonious personality profiles and, in comparison with the control group, more pronounced hypochondriac, hysteroid, and psychasthenic features. Compared with AH patients, subjects with WCH were characterized by less pronounced depression, isolation, rigidity of anxious affect, as well as a more pronounced demonstrative behavior. Conclusions In people with AH patients the structural and functional characteristics of the heart there correlate with the ABPM results. In contrast, echocardiographic findings in individuals with WCH do not significantly differ from those in healthy subjects. Individuals with WCH have more pronounced hypochondriacs, anxious-suspicious and hysteroid personality traits, while for patients with AH depression, isolation, and rigidity of anxious affect are more common. Funding Acknowledgement Type of funding source: None

The Influence of Metabolic Therapy on Daily Blood Pressure Monitoring Dynamics in Hypertensive Patients

The objective: is to assess the efficiency of metabolic therapy on blood pressure indicators based on the results of daily blood pressure monitoring in hypertensive patients.Materials and methods. The results of daily blood pressure monitoring in patients with stage II hypertension of 2–3 degrees are presented. 50 patients (including 28 men and 22 women) were examined. The mean age of patients was 44.6±10.9 years. Hypertensive patients received basic combination antihypertensive therapy with individually selected doses of ramipril / amlodipine in combination with metabolic therapy with0.5 g of quercetin. Сorvitin dissolved in 50 ml of isotonic sodium chloride solution intravenously / 2 times a day after 12 hours during 5 days; during next 30 days of outpatient treatment patients received 40 mg of quercetin orally 3 times a day. All patients underwent daily blood pressure monitoring using HEACO ABPM 50 device.Results. The use of combined antihypertensive and metabolic therapy contributes to the normalization of blood pressure during the day, allows achieving target blood pressure levels in most patients which is manifested by the improvement of the daily blood pressure profile based on the results of the daily blood pressure monitoring.Conclusion. The use of quercetin (corvitin, quartin) in complex therapy with the use of combination antihypertensive drug ramipril / amlodipine reveals an additional antihypertensive effect which can be successfully used in the treatment of hypertensive patients.

Features of cerebral autoregulation and reactivity in patients with arterial hypertension in older age groups with orthostatic hypotensive reactions

Aim. To study the condition of cerebrovascular autoregulation and reactivity in different variants of orthostatic hypotensive reactions (OНR) in elderly patients with hypertension (АН).
 Materials and methods. 50 patients with AH were examined (80% of women) aged 60 to 82 years (68.55.3). The duration of hypertension is from 2 to 43 years (16.811.6 years).The daily blood pressure profile was evaluated by the method of daily monitoring of blood pressure (BPLab, Russia). A study of OНR was carried out using an active orthostatic test (AOP) with continuous monitoring of cerebral blood flow (CBF) and with a minute measurement of blood pressure by the oscillometric method and continuous non-invasive measurement of SBP (systolic blood pressure) and DBP (diastolic blood pressure) in the finger artery (Task Force Monitor CNSystems Austria). The CBF velocity in the middle cerebral artery (SMA) was estimated using a transcranial sensor with a frequency of 2 MHz on an Angiodin-2K ultrasound machine (BIOSS company, Russia). In SMA, systolic (Vs), diastolic (Vd), average cerebral blood flow velocity ACBF (Vm), pulsation index (Pi), and vascular resistance index (Ri) were recorded. The difference between the indicators was calculated initially and during AOP (in the first 30 seconds and for 3 minutes): Vm30s, %, Vm3m, %. Reactivity was assessed using a hypercapnic test (HCP) with breath holding. The relative change in the CBF indicators in the MCA was calculated by the formula: Kr = (Vm1Vm2)100%/Vm1, where Kr is the reactivity coefficient, Vm1 ACBF at rest; Vm2 ACBF during the test. Statistical analysis was performed using the non-parametric MannWhitney method using Statistica 6.0.
 Results. In 17 (34%) patients with AH, OGR was detected. In 6 (12%) examined patients, initial OHR (IOH) was detected, in 6 (12%) classic OHR (COH), in 5 (10%) there was a combination of COH+IOH. According to the ABPM data, in patients with OHR compared with patients without OHR, there were no significant differences in the daily level of blood pressure (mmHg), SBP: 131.712.2 vs 131.313.8, p0.05; DBP 74.311.8 vs 75.38.9, p0.05). In AOP, patients with OHR significantly decreased Vm in orthostasis compared with patients without OHR, both in the first30 seconds and at 3 minutes (Vm30s: 25.05.5 vs 30.44.7, p0.05; Vm3m: 27.05.2 vs 31.24.7, p0.05; Vm30s,%: 17.06.5 vs 8.34, 1, p0.05; Vm3m,%: 11.76.3 vs 5.82.4, p0.05). When performing HCТ between patients with OHR and without OHR, statistically significant differences in the indices Pi (0.790.08 vs 0.780.16, p0.05) and Ri (0.510.09 vs 0.530.07, p0.05) was not detected, however, in patients with OHR there is a tendency to a less pronounced increase in АCBF at the peak of HCT compared with patients without OHR (36.86.4 vs 40, 06.6, p=0.13). In patients with OHR, the cerebral reactivity coefficient was lower than in patients without OHR (13.43.9 vs 20.76.6, p0.05).
 Conclusions. In patients with AH of older age groups with OHR, a statistically significant decrease in ACBF in orthostasis was revealed. Patients with IOH showed a decrease in ACBF in the first seconds of orthostasis with its subsequent stabilization. Persons with COH have preserved the mechanisms of cerebral autoregulation in the first seconds of orthostasis, but with prolonged orthostatic load (3 minutes), the effectiveness of autoregulatory mechanisms decreases. OHR in patients with hypertension of older age groups is associated with a decrease in cerebral reactivity.

Когнітивна дисфункція у пацієнтів з артеріальною гіпертензією залежно від рівня загального холестеролу

SummaryObjective. Arterial hypertension (AH) is one of the most important risk factors forthe development of chronic vascular brain damage, significant symptoms of which arecognitive disorders.The aim of the research was to study the characteristics of the clinical picture,extracranial haemodynamics, indices of higher brain functions in patients with AH,depending on total cholesterol (TC) plasma level.Materials and methods. Were examined 157 patients (119 males, 38 females) whowere allocated into 3 groups according to the plasma level TC: the first group (n=48)included patients with the mean TC level (7.3±0.7) mmol/L; the second (n=58) group ofpatients with the TC level (5.8±0.8) mmol/L; the third (n=51) – with the TC level(4.7±0.5) mmol/L.Results. It was found that, with an increase in plasma TC level from the desiredlevel to a higher one, patients with AH develop the signs of chronic cerebral ischemia.The daily blood pressure profile is disturbed due to the insufficient degree of nightlydecline. The elastotonic characteristics of the vascular wall of the extracranial arterieschanges with the increase of the asymmetry of blood flow, which is accompanied withneurasthenic disorders of the anxious-depressive type as well as a significant decreasein cognitive functions.Conclusions. The severity of cognitive dysfunction must be taken into account whenconducting preventive measures and assessing the prognosis in patients with AH andconcomitant hypercholesterolemia.

CHANGES OF COGNITIVE FUNCTION IN PATIENTS WITH HYPERTENSION WITH CONCOMITANT DIABETES MELLITUS TYPE 2

Relevance. Till now there is no clear clinical trial understanding of the relationship between hypertension (AH) and the patient's cognitive function.
 Objective: the investigation of changes in cognitive function in patients with hypertension with concomitant type 2 diabetes mellitus (DM2).
 Materials and methods. 215 people were examined: Group I (n = 131) – stage II hypertensive disease (HD); Group II (n = 46) – HD, combined with diabetes mellitus2; Group III, control (n = 38) – without a diagnosis of HD and diabetes mellitus2. All examined blood pressure (BP), echocardiogram. Clinical complaints, anamnestic data, and neuropsychiatric testing data were used to diagnose moderate cognitive impairment (MCI). Used modified diagnostic criteria J. Touchon, R. Petersen. To assess cognitive function used: Short scale of assessment of mental state (Mini-Mental State Examination - MMSE); Frontal Assessment Battery (FAB); clock drawing test; test for literal and categorical associations; Schulte tables; the Global Deterioration Scale (GDS) and the Clinical Dementia Rating (CDR).
 Result. In patients with HD, the most significant risk factors for moderate cognitive impairment are hypercholesterolemia and overweight (with OR 1.8), obesity (OR 1.6), the presence of concomitant diabetes mellitus2, which, especially in overweight, significantly impairs cognitive function ( OR 2.56). Deterioration of cognitive function correlates with the duration of HD, cholesterol levels. Concomitant diabetes mellitus2 in patients with HD creates a statistically significant additional negative effect on the results of cognitive function. In patients with HD with a distorted daily blood pressure profile, the neurodynamic component of cognitive function is first of all affected - conceptualization, repetition, the reaction of choice. The relationship between cognitive function and daily monitoring of blood pressure often have a U-shaped relationship, where the maximum indicators of cognitive function are at the level of the optimal recommended blood pressure figures (130-139 mm Hg for SBP, and 75-85 mm Hg for DBP, and the daily index within 10%).
 Conclusions. There is a dependence on changes in cognitive function on the presence of risk factors and signs of subclinical damage to target organs. The nonlinear U-shaped character of the relationship between the average daily, average night, and average daily blood pressure and the results of screening tests and scales for assessing cognitive function are shown.

The Influence of Overweight on the Structural and Geometric Parameters of the Left Ventricular Myocardium and the Daily Blood Pressure Profile in Middle-aged Military Personnel

The Influence of Overweight on the Structural and Geometric Parameters of the Left Ventricular Myocardium and the Daily Blood Pressure Profile in Middle-aged Military Personnel

FEATURES OF THE DAILY PROFILE OF ARTERIAL PRESSURE AND THE POSSIBILITY OF DOCLINE DIAGNOSTICS OF ARTERIAL HYPERTENSION IN CHILDREN WITH TYPE 1 DIABETES

Diabetic nephropathy takes a leading place among diseases requiring replacement therapy for renal failure, and is also a leading cause of disability and mortality among patients with type 1 diabetes. The development of arterial hypertension is one of the markers of the formation of diabetic nephropathy. We performed a prospective cohort study. A comprehensive clinical and instrumental examination of 78 children with type 1 diabetes was carried out. The features of changes in the daily profile of blood pressure and microcirculatory disorders in children before the formation of diabetic nephropathy were revealed. A mathematical model is developed for predicting the development of arterial hypertension by determining microcirculation parameters using a laser Doppler flowmeter. Early diagnosis will allow timely prescribing of pathogenetic treatment, improving the prognosis of this category of patients.

Особливості лікування хворих з артеріальною гіпертензією із супутнім ожирінням: невідоме про відоме

Introduction. Arterial Hypertension is the most common disease of the circulatory system. Today we can talk about it as a non-infectious epidemic. Obesity is a risk factor and a frequent comorbid condition in hypertension. The aim. Given the role of dopamine metabolism as one of the pathogenetic triggers of hypertension and obesity, to study the effect of a dopamine receptor agonist bromocriptine in this category of patients. Materials and methods. We examined 111 hypertensive patients with concomitant obesity and 18 hypertensive patients without obesity with dopamine (DA) metabolism disorders. 24 patients with concomitant obesity received the dopamine receptor agonist bromocriptine and the calcium antagonist amlodipine to correct their DA metabolism disorders. The level of DA was determined according to the daily excretion of DA in the urine by fluorometric method. Determination of angiotensin II (ATII) was performed using enzyme-linked immunosorbent assay. The concentration of lipids was determined using the enzymatic colorimetric method, blood pressure was assessed using Daily Monitoring of Blood Pressure (ABPM), the condition of the endothelium was determined using D.S Celermajer’s endothelium-dependent vasodilation assessment. Results. Concomitant obesity leads to a deeper impairment in the dopaminergic system, RAAS, lipid spectrum and endothelial status. Bromocriptine and amlodipine treatment resulted in a significant increase in urinary DA excretion by 1.77 times (77.4%) and a trend towards blood ATII increase, which confirms the assumption of similar mechanism of action of dopamine agonists and angiotensin II receptor antagonist; positivization of lipid spectrum parameters: significant reduction of total cholesterol by 5.7%, TG by 14.01%, LDL by 5.5%. Regarding other lipid metabolism, such as HDL, there was a trend towards increase by 4.6%, combined with a significant improvement in endothelium-dependent vasodilation by 54.8%, lower blood pressure and a positive modulating effect of the combination of these drugs on the daily blood pressure profile against the background of a significant decrease in body weight by 8.8%.

Clinical-hemodynamic efficiency of fixed combined hypotensin therapy for patients with heavy arterial hypertension

The efficacy of treatment was evaluated by the fixed combination drug «Exforge-H» in 40 patients suffering from grade 3 arterial hypertension. All patients underwent general clinical and laboratory and instrumental examination (electrocardiography, echocardiography, 24-hour blood pressure monitoring) before and after 6 months of treatment. It was established that treatment with «Exforge-H» statistically reliably reduces the level of blood pressure, normalizes the variability and daily blood pressure profile. So, two weeks after the start of treatment, the systolic and diastolic pressure levels during clinical measurement decreased by 32,1±2,7 and 30,4±1,9 mm Hg. Art. respectively. After 3 months of treatment, 60% of patients showed achievement of the target level of blood pressure, and after 6 months - 96%. High hypotensive efficacy of treatment was also demonstrated during the daily monitoring of blood pressure in all its indicators. A significant decrease in systolic and diastolic pressure was observed during the day and night hours. The amplitudes of systolic and diastolic pressure variability have also been improved. At the same time, the variability of systolic pressure during the day was reduced by 46%, diastolic - by 49%, and at night by 59,3 and 52,8%, respectively, indicating a normalization of blood pressure during the day. All this was also accompanied by a decrease in the clinical manifestations of the disease. So, after 6 months of treatment, 84% of patients had positive clinical dynamics: a decrease in cardiac and cerebral symptoms, as well as emotional lability, which positively correlated with a decrease in the level of clinical blood pressure. The cardioprotective effect of the drug is expressed in the form of regression of left ventricular hypertrophy. In general, the use of the three-component fixed drug «Exforge-H» (valsartan - 80 mg, amlodipine - 5 mg and hydrochlorothiazide - 12,5 mg) is manifested by an increased antihypertensive effect due to the influence of its constituents side effects and the development of metabolic changes.

The effect of three-component antihypertensive treatment on the structural and functional state of the heart and daily blood pressure profile in patients with hypertension grade 3

Aim. To study the effect of a fixed combination of perindopril arginine (10 mg) + indapamide (2.5 mg) + amlodipine (5 mg) on the daily profile of blood pressure and the structural and functional state of the heart in patients with hypertension grade 3.
 Methods. 80 patients with hypertension receiving various variants of treatment [50 patients (experimental group) receiving fixed combination of perindopril arginine (10 mg) + indapamide (2.5 mg) + amlodipine (5 mg) and 30 patients (control group) receiving combination of lisinopril with hydrochlorothiazide (10/12.520/25 mg) and amlodipine (5 mg)] underwent electrocardiography, Doppler echocardiography, daily monitoring of blood pressure at there points: at the beginning, after 2 weeks and 6 months of the treatment. Statistical significance of the indicators was determined by Students t-test. To compare the double changes, 2 was used. Statistical difference between the groups was considered significant if p 0.05.
 Results. In 86% of patients from the experimental group, a decrease in systolic blood pressure by 20 mm Hg or more and/or diastolic blood pressure by 10 mm Hg was noted, which persisted for 6 months. After 6 months of treatment, according to daily monitoring of arterial pressure, the average daily systolic and diastolic blood pressure significantly decreased by 15.9 and 18.6% (р 0.001), and the values of variability of average systolic and average diastolic pressure at night and daytime by 4 and 4.2%, respectively (р 0.001). A decrease in the morning rise rate of systolic and diastolic blood pressure was also achieved (р 0.001). During treatment, a number of patients with a daily curve of the dipper type increased due to a decrease in non-dippers and night pickers (р 0.001).
 Conclusion. Positive antihypertensive result after treatment with a combination of perindopril arqinine + indapamide + amlodipin was achieved in the early stages of treatment and was observed as a long-term stable hypotensive effect; a number of patients with normal daily rhythm of blood pressure increased, decrease of the severity of hypertrophy and size of the left ventricle was observed and its diastolic function became normal.

Office and 44-hour ambulatory blood pressure and central haemodynamic parameters in the patients with end-stage renal diseases undergoing haemodialysis

To assess the incidence of blood pressure (BP) control and various phenotypes of BP by comparing the results of office and 44-hour ambulatory brachial and central BP measurement in patients with end-stage renal disease (ESRD) on program hemodialysis (HD). In 68 patients ESRD receiving renal replacement therapy we evaluated office peridialysis BP and performed 44-hour ambu latory monitoring (ABPM) of brachial and central BP during peridialysis period using a validated oscillometric device BPLabVasotens (OOO "Petr Telegin"). Results were considered statistically significant with p<0.05. The frequency of control of peripheral office BP before the HD session was 25%, after - 23.5%; control of central BP - 48.6% and 49%, respectively. According to office measurement the frequency of systolic-diastolic hypertension was 44.1%, isolated systolic hypertension - 25%, isolated diastolic hypertension - 5.9%. The values of peripheral and central office systolic BP (SBP) before and after HD were not consistent with the corresponding mean and daily SBP levels for 44 hours and for the first and second days of the interdialysis period. The frequency of true uncontrolled arterial hypertension (AH) according to peripheral ABPM was 66.5%, masked uncontrolled AH - 9%. Circadian rhythm abnormalities for 44-h peripheral BP were detected in 77%, for central - in 76%. In 97% of patients agreement between phenotypes of the daily profile of peripheral and central BP was observed. 73% of patients had a significant increase in peripheral and central SBP and pulse pressure (PP) and an increase in the proportion of non-dippers from the 1st to the 2nd day. Patients with ESRD on HD were characterized by poor control of BP control and predominance of unfavourable peripheral and central ambulatory BP phenotypes. A single measurement of clinical peripheral and central BP in the peridialysis period was not sufficient to assess the control of hypertension in this population. The 24-h BP profiles in the 1st and 2nd days of interdialysis period had significant differences.

Modification of the daily blood pressure profile in hypertensive patients with type 2 diabetes mellitus

Objective. To evaluate the effect of combinations azilsartan medoxomil / chlorthalidone (Az-M/Chl) vs. perindopril / indapamide (Pr / Yn) regarding the modification of the daily blood pressure profile (BP) and augmentation index level in hypertensive patients (hypertension 2 nd degree, HTN), the blood pressure profile “nondipper” or “night-peaker” and type 2 diabetes mellitus (DM). Design and methods . The study included 51 HTN (mean age 73 ± 11,7 years) patients (25 patients in the group Az-M / Chl and 26 patients in the group Pr / Yn, the groups were comparable by the main clinical parameters) with blood pressure profile “non-dipper” or “night-peaker”, DM (compensation stage). All patients have been receiving stable but ineffective antihypertensive therapy for at least 3 months before inclusion. The level of salt consumption was defined by the questionnaire “Charlton: SaltScreener”. Ambulatory 24-hour blood pressure monitoring (ABPM) was performed using BPLab® device (software Vasotens, Russia) which enables analysis of central hemodynamics. Statistica 10.0 software and software R using readxl, psych, ggplot2, ggpubr, gridExtra packages were used for statistical data processing. Results. Twenty-seven (53 %) patients reported consumption of more than 6 g of salt per day: 14 (56 %) patients in the Az-M / Chl group, and 13 (50 %) patients in the Pr / Yn group. Mean daily BP was 161,2 / 102 ± 8,77 / 9,31 mm Hg in the Az-M / Chl group, and 158,3 / 96,7 ± 10,4 / 7,21 mm Hg in the group Pr / In (p > 0,05); mean daily systolic BP (MAP) was 161,2/102,0 ± 8,8 / 9,3 mm Hg and 158,3 / 96,7 ± 10,4 / 7,2 mm Hg, respectively (p > 0,05); aortic augmentation index — 4,88 ± 15,9 % and 2,7 ± 10,9 %, respectively (p > 0,05). At randomization (baseline), the non-dipping BP profile was found in 86,3 % (n = 44) patients, and the night-peaker profile — in 13,7 % (n = 7) patients. At the final visit, all patients achieved target BP level; mean daily systolic BP was 130,2 ± 8,8 and 139,9 ± 8,2 mm Hg in the Az-M/Chl and Pr / In groups, respectively (W = 140, p-value = 0.000497). The Az-M / Chl group demonstrated a more significant reduction in arterial stiffness. In addition, in the AZ-M / Chl group, 18 (72 %) patients showed change to a dipping BP profile, while only 5 (19 %) patients demonstrated the change in the Pr / Yin group. Conclusion . The combination of azilsartan medoxomil/chlorthalidone showed a more significant compared with the combination of perindopril/indapamide: (1) a decrease in mean blood pressure per day; (2) the effect on the modification of the daily profile of blood pressure; (3) alteration of GI in aorta.

Structural and hemodynamic changes in the carotid arteries in young healthy individuals with concentric remodeling of the left ventricle and with normal heart geometry

Remodeling of the heart and blood vessels is a complex multifactorial process that determines the prognosis of a patient with different cardiovascular pathologies. The aim of this work is to study in a comparative aspect the features of the hemodynamics of the carotid arteries as marker vessels of the elastic type and the daily blood pressure profile in young healthy individuals with concentric remodeling of the left ventricle and with normal heart geometry. The study involved practically healthy individuals from 18 to 42, aged 25.3±0.6 years, 56 (73.7%) men and 20 (26.36%) women. All study participants were divided into two equal groups depending on the value of the relative wall thickness of the left ventricle (RTW) for 38 people: for RTW>0.42 (concentric remodeling of the left ventricle) and for RTW≤0.42 (normal geometry of the left ventricle). The following research methods were used: echocardiography, 24-hour blood pressure monitoring, duplex scanning of the neck vessels. Statistical analysis of the study results was calculated using the methods of variational statistics using the StatSoft complex “Statistica” v.12. Although the average daily values of blood pressure and the degree of its nightly decline in both groups did not differ significantly, the speed of the morning rise and the variability of systolic pressure were significantly higher in patients with concentric remodeling than without it. That is, even in the absence of symptoms of cardiovascular disease and a history of a rise in blood pressure, the hemodynamic factor of a fast morning increase in blood pressure can take part in the formation of changes in the geometry of the heart in practically healthy young people. Changes in the speed-time parameters of blood flow in the common carotid arteries in the absence of wall thickening (intima-media complex) and a parallel increase in the lumen of the internal jugular veins found in the study indicate structural and hemodynamic vascular remodeling associated with concentric remodeling of the left ventricle in young, practically healthy persons.