Daily Diastolic Blood Pressure Research Articles

Influence of dapagliflozin on cardiovascular remodeling in hypertensive patients with accompanying type 2 diabetes

Aim. To compare the results of 12-week treatment of patients with stage II hypertension (HTN) with accompanying diabetes mellitus (DM) type 2 between the combination of metformin + dapagliflozin and metformin monotherapy by studying changes in the elastic properties of the common carotid arteries (CCA), echocardiographic indicators, 24-hour ambulatory blood pressure monitoring (ABPM) and laboratory parameters of lipid and carbohydrate metabolism. Materials and methods. 24 patients with stage II HTN with type 2 DM were involved in the study, the average age was 60.4 years, 50 % – men. Patients in the first group were randomized to receive metformin, and the second group – to receive a combination of metformin and dapagliflozin. At inclusion and after 3 months of treatment, basic anthropometric data, laboratory indicators of lipid and carbohydrate metabolism, ABPM, echocardiography, and indicators of CCA local stiffness were studied. Statistical analysis was performed, the probability of differences is at the level of p < 0.05. Results. In both observation groups, there was a comparable decrease in SCORE 2-Diabetes range, glucose and glycated hemoglobin, total cholesterol, LDL cholesterol, average daily systolic blood pressure (SBP), daily SBP load, day and night pulse BP, as well as an increase in speed systolic movement of the lateral fibrous ring of the mitral valve (S lat). Only in the metformin + dapagliflozin group a decrease in the adipose tissue level, the average daily diastolic blood pressure (DBP), the burden of DBP, the size of the left atrium and right ventricle, an increase in the movement speeds of the medial (e’med), lateral (e’lat) ring of the mitral and of the tricuspid (e’tk) valve in the period of early diastolic filling of the ventricles, velocities of systolic movement of the medial fibrous ring of the mitral (S med) and tricuspid (S tk) valves, a decrease in the ratio E/e’, and an improvement in the elastic properties of general carotid arteries were observed. Conclusions. In persons with HTN stage II with DM type 2 the addition of dapagliflozin to the treatment regimen was associated with better control of blood pressure, improvement of diastolic function and longitudinal contractility of the left ventricle, elastic properties of CCA.

Peculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disordersPeculiarities of the daily profile of blood pressure and heart activity in patients with arrhythmias depending on the severity of cognitive disorders

Background. The purpose of our work was to reveal the dependence of changes in the cognitive sphere on the peculiarities of the daily profile of blood pressure (BP) and heart activity in patients with arrhythmias. Materials and methods. We examined 139 patients with different clinical forms of arrhythmias. All of them underwent extended neuropsychological testing, a study of the daily BP profile and heart activity. Hemodynamic status was assessed by daily BP and ECG monitoring. Average daily, average daytime and nighttime systolic (SBP), diastolic blood pressure (DBP) and heart rate (HR) were evaluated. The analysis of spectral indicators of heart rate variability was performed to assess the state of the autonomic nervous system. Correlations of hemodynamic indicators with the results of neuropsychological testing were determined. Results. In patients with cognitive disorders (CD), there was an increase in SBP in all periods of the day, most pronounced in patients with moderate CD (p = 0.049). In patients with mild CD and without CD, there were no significant intergroup differences in the level of average daily, daytime and night SBP, DBP and pulse pressure (p > 0.05). Patients with moderate CD had significantly higher SBP and time index of SBP at the expense of average daytime and average night values of these indicators compared to those without CD (p < 0.05). During the active period of the day, time index of DBP was significantly higher in patients with moderate CD (p = 0.002) who also had an increase in average daily, daytime and night SBP variability compared to participants without CD (p = 0.041). The differences between the groups were not significant in terms of DBP variability (р = 0.07). In 61 (54 %) patients with CD, non-dipper SBP prevailed in the structure of disorders of the daily BP profile, with the highest indicators in moderate CD (55.6 %). The presence of adverse daily DBP profiles — night-peaker (6.2 %) and over-dipper (8.8 %), which prevailed in patients with moderate CD, is hidden behind normal indicators of the daily BP index. Increased average SBP24 (odds ratio (OR) = 3.26, 95% confidence interval (CI): 1.45–5.35, p < 0.001), DBP24 (OR = 3.06, 95% CI: 1.41–4.79, p < 0.001), average HR24 (OR = 2.67, 95% CI: 1.32–4.14, p < 0.001), average SBP24 variability (OR = 2.13, 95% CI: 1.11–3.32, p < 0.001) are the main factors of central hemodynamic disorders that increase the risk of developing CD in patients with arrhythmias. Conclusions. The identified associations between cognitive dysfunction, indicators of daily BP monitoring and heart activity are important in the context of their comprehensive accounting for optimizing an individualized approach to patient management and predicting the development of CD.

PECULIARITIES OF 24 HOUR AMBULATORY BLOOD PRESSURE MONITORING INDICES IN HYPERTENSIVE PATIENTS OF DIFFERENT AGE GROUPS

Relevance. Until now, there is an ongoing debate about the value of different indicators of blood pressure (BP) − systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse blood pressure (PBP) as predictors of essential hypertension (EH). In this regard the issue of target BP levels in patients of different ages remains studied incompletely. Objective is to determine peculiarities of 24 hour ambulatory blood pressure monitoring indices in patients with essential hypertension, stage II of different age groups. Materials and methods. ABPM indicators were determined in 130 patients who were divided into 4 groups. 1st group (n=57) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old); 3rd group (n=15) – middle-aged patients without EH – control for the 1st group; 4th group (n=15) − elderly patients without EH − control for the 2nd group. Indices of ABPM were determined using a portable recorder ABPM-04 (company "Meditech", Hungary). Measurements of BP were performed every 15 minutes during the day (from 6 to 22 hours) and every 30 minutes at night (from 22 to 6 hours). We determined the following indices: the average daily SBP (mm Hg), the average daly DBP (mm Hg), the average BP (mm Hg); the maximal daily SBP (mm Hg), the maximal daily DBP (mm Hg). The daily index (DI) was also calculated − the percentage of BP decrease at night compared to daytime BP calculated in % DI of SBP, DI of DBP, DI of average BP. Results. In group 1 the average and maximal DBP were lower than in group 2 by 7,4% (p<0,001) and 13,1% (p<0,05), respectively. In group 1, the average daily and maximal SBP decreased by 3,8% and 4,1%, respectively; average heart rate by 3,8%; DI of SBP by 7,8% and DI of average BP by 5,8% but the data were unreliably smaller compared to the data of middle-aged patients. In group 1, the maximal DBP, DI SBP and DBP were not significantly different from the corresponding indicators in the control group. The maximal DBP was higher by 29,3% and amounted to 115,6±21,0 mm Hg and DI SBP and DI DBP are lower by 11,1% and 17,9%, respectively; and were equal to 9,6±7,4 and 13,8±8,1, respectively. In the 2nd group the following parameters decreased unreliably (p>0,05): heart rate by 8,6% and was 63,0±9,1/min., DI SBP by 17,6% and was 8,9±5,5%; DI DBP by 16,1% and was 14,1±7,1%; DI of average BP– by 20,4% and was equal to 11,3±6,1%. Conclusions. It is found that with the age DBP decreases with steadily increased SBP in hypertensive patients. The average daily and the maximal daily DBP are significantly less by 7,4% (p<0,001) and 13,1% (p<0,05) accordingly in elderly patients compared with the middle-aged.

Magnesium Levels and Diastolic Blood Pressure (DBP) as a Vasospasm Prediction Metric in Patients With Aneurysmal Subarachnoid Hemorrhage (SAH).

IntroductionVasospasm is a significant cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (SAH). The purpose of this study is to evaluate a possible link between vasospasm in patients with aneurysmal SAH and magnesium and blood pressure levels.MethodsSubjects were selected based on chart review of patients presenting to a comprehensive stroke center in Southern California with aneurysmal SAH. 27 were included based on the following criteria: patients greater than 18 years of age, aneurysmal SAH, clinically symptomatic vasospasms and at least one diagnostic confirmation - either from a transcranial doppler (TCD) or digital subtraction angiogram (DSA). The following exclusion criteria also applied: 1) incomplete documentation in the medical record; 2) patients <18 years of age; and 3) patients without TCD measurements.ResultsIn an overall analysis of all patients with or without vasospasm, it was found that the presence of vasospasm was significantly correlated with diastolic blood pressures (DBPs) on day of vasospasm with an r value of 0.418 and p<0.001. Average daily DBPs throughout hospital stay were also correlated with vasospasm with an r-value of 0.455 and p<0.001. Changes in magnesium overall were also significantly related to left Lindegaard ratios with an r value of -0.201 and p value of 0.032. Lindegaard ratios were significantly correlated with age with r values of 0.510, p<0.001, and r=-0.482, p<0.001 for left and right, respectively. A change in magnesium was inversely correlated to the left Lindegaard ratio with an n of 31 and p value of 0.014 (r= -0.439) in patients with vasospasm. We also found a lower incidence of vasospasm in patients older than 65.ConclusionMonitoring magnesium and increases in DBP might be effective as a prophylactic adjunct method in patients with SAH in an effort to predict clinical vasospasm.

Значення впливу контролю глікемії на варіабельність ритму серця та артеріального тиску в пацієнтів із цукровим діабетом 1-го типу

Актуальність. Ураження серцево-судинної системи при цукровому діабеті (ЦД) залишається провідною причиною смертності пацієнтів із даним захворюванням. Мета дослідження: визначити зміни варіабельності ритму серця (ВРС) й артеріального тиску (АТ) у пацієнтів із ЦД 1-го типу залежно від тривалості захворювання і контролю глікемії. Матеріали та методи. Обстежено 46 пацієнтів. Середній вік хворих становив 29,40 ± 3,18 року, тривалість захворювання — 12,50 ± 1,84 року, індекс маси тіла — 23,10 ± 0,73 кг/м2. Усі пацієнти перебували на інсулінотерапії за базисно-болюсною схемою, добова доза інсуліну становила 45,00 ± 3,76 Од. Пацієнти були розподілені на дві групи за рівнем НbА1с: група 1 (n = 2) із НbА1с ≤ 7,5 % і група 2 (n = 26) із НbА1с &gt; 7,5 %. Групи були розподілені на підгрупи за відсутністю (А) або наявністю (В) гіпоглікемії. Всім пацієнтам проводилися добовий моніторинг електрокардіограми за Холтером і моніторинг АТ протягом 24 годин паралельно з тривалим моніторингом глюкози крові. Результати. У пацієнтів із ЦД 1-го типу збільшення тривалості захворювання характеризується вірогідним зниженням ВРС як за часовими, так і за частотними показниками, а саме спостерігаються зниження RMSSD, pNN50% і підвищення LF/HF. Варіабельність добового АТ реалізується переважно за рахунок підвищення добових показників діастолічного артеріального тиску. Наявність епізодів гіпоглікемії помітно впливає як на часові, так і на спектральні показники ВРС незалежно від рівня HbA1c. Висновки. Епізоди гіпоглікемії супроводжуються підвищенням систолічного і діастолічного артеріального тиску і збільшенням частоти серцевих скорочень. Частота виникнення гіпоглікемічних епізодів зростає зі збільшенням тривалості ЦД 1-го типу незалежно від показника HbA1c.

THE EFFECT OF ADD-ON THERAPY OF LIRAGLUTIDE AND EMPAGLIFLOZIN ON AMBULATORY BLOOD PRESSURE IN PATIENTS WITH POORLY CONTROLLED TYPE 2 DIABETES MELLITUS

Objective: It is known that both liraglutide and empagliflozin, except for their anti-hyperglycaemic effect, have a favorable effect on major cardiovascular outcomes. Furthermore, it has been shown that they reduce systolic (SBP) and to a lesser extent diastolic blood pressure (DBP). Therefore, the purpose of this study is to evaluate the effect of liraglutide and empagliflozin on ambulatory BP in patients with poorly controlled type 2 diabetes (T2D). Design and method: 42 patients [20 men, mean age (± SD): 60.6 ± 9.4 years, were randomized to liraglutide therapy. 32 patients (16 men, mean age: 64.8 ± 7.1 years), were randomized to empagliflozin therapy. All patients underwent a complete clinical examination, laboratory testing, and ambulatory BP recording on baseline and three months after initiation of treatment with liraglutide and empagliflozin. Ambulatory BP was measured with the oscillometric Mobil-O-Graph NGW 24-hour ambulatory BP and PWA monitor (IEM; Stolberg, Germany). Results: In the liraglutide group, daytime SBP and DBP, mean change from baseline was –4.0 mmHg (P = 0.26) and –3.6 mmHg (P = 0.05). Nighttime SBP and DBP, mean change from baseline was –8.9 mmHg (P = 0.009) and –5.6 mmHg (P = 0.009). In the empagliflozin group, for daytime SBP and DBP, mean change from baseline was –1.4 mmHg (P = 0.61) and 0.2 mmHg (P = 0.91), respectively. For nighttime SBP and DBP, mean change from baseline were –8.9 mmHg (P = 0.03) and –4.5 mmHg (P = 0.02), respectively. Liraglutide caused higher daytime SBP and DBP decline from baseline than empagliflozin (P = 0.005). No statistically significant differences were observed for nighttime SBP and DBP between the two study groups. Conclusions: The results of the present study showed a favorable effect of 3-month therapy with liraglutide had a favorable effect on daily DBP and SBP and DBP during the night. A favorable effect of 3-month therapy with empagliflozin on nighttime SBP and DBP was also observed. Liraglutide caused higher daytime SBP and DBP decline from baseline than empagliflozin.

443-P: Effect of 3-Month Therapy with Liraglutide on Ambulatory Blood Pressure in Patients with Type 2 Diabetes Mellitus

Background and Aims: Liraglutide, has been found to reduce systolic (SBP) and to a lesser extent diastolic blood pressure (DBP). The purpose of this study is to evaluate the effect of liraglutide on ambulatory BP in patients with poorly controlled type 2 diabetes (T2D). Materials and Methods: A total of 42 patients (20 men) with T2D, mean age (± standard deviation) 60.6 ± 9.4 years, HbA1c 8.5 ± 1.1%, body mass index 37.1 ± 5.3 Kg/m2, duration of T2D 10.1 ± 4.3 years, were included. All patients underwent a complete clinical examination, laboratory testing, and ambulatory BP recording both on entry into the study and three months after initiation of treatment with liraglutide (background antidiabetic therapy remained stable during the study period). Ambulatory BP was measured with the oscillometric Mobil-O-Graph NGW 24-hour ambulatory BP and PWA monitor (IEM; Stolberg, Germany). Results: At baseline, mean daytime SBP and DBP were 128.0 ± 11.2 and 77.2 ± 11.0 mmHg, respectively. After 3-month liraglutide therapy, daytime SBP and DBP were: 124.0 ± 7.8 and 73.5 ± 7.8 mmHg, respectively. Daytime SBP and DBP, mean change from baseline was -4.0 mmHg (P=0.26) and -3.6 mmHg (P=0.05). Nighttime mean SBP and DBP at baseline, were127.5 ± 12.6 and 73.7 ± 14.2 mmHg. After 3-month therapy, the above values were as follows: 118.6 ± 11.1 and 68.1 ± 9.8 mmHg, respectively. Nighttime SBP and DBP, mean change from baseline was -8.9 mmHg (P=0.009) and -5.6 mmHg (P=0.009). In accordance, pulse pressure change was: 53.9 ± 8.6 (baseline) to 50.6 ± 11.2 mmHg (3 months) and for heart rate: 75.9 ± 10.1 (baseline) to 77.8 ± 14.3 bpm (3 months). Pulse pressure and heart rate change from baseline was -3.2 mmHg (P=0.14) and -1.9 bpm (P=0.36), respectively. Conclusion: In accordance with the existing data, 3-month therapy with liraglutide had a favorable effect of ambulatory BP, in terms of daily DBP and SBP and DBP during the night. In contrast, no significant effect on heart rate was observed despite the existing data. Disclosure A. Papazafiropoulou: None. L. Mpoumi: None. M. Rallatou: None. S.S. Papantoniou: None. A. Kamaratos: None. S. Antonopoulos: None. A. Melidonis: None.

Analysis of indicators of daily blood pressure profile in patients wi th type 1 diabetes, depending on the course of the disease

The aim: to study the features of daily profile and circadian rhythm of blood pressure (BP) in groups of patients with type 1 diabetes mellitus (T1DM), depending on glycemic control. Materials and methods: 63 patients with T1DM, age: 18-45 years without hypertension were examined. Patients were divided into groups: Group 1 — HbA1c≤7.0% (n=21), Group 2 — HbA1c&gt;7.0% (n=42). 10 sex- and agematched healthy controls were included. Results: Patients with T1DM had a significantly higher pulsatile blood pressure (PBP) per night, higher daily systolic blood pressure (SBP) variability, compared with healthy controls, and significantly higher daily SBP area index (SPAI24), daily SBP time index (SPTI24), daily diastolic blood pressure (DBP) area index (DPAI24), daily DBP time index (DPTI24). The double product (DP) was higher in patients with T1DM in the daytime and within 24 hours compared to control (p=0.002) and (p=0.001) respectively. Pathological profiles of daily blood pressure were found. In group 1, according to the dipping in SBP 28.57% of patients were non-dippers, 4.76% were extreme dippers. In group 2, the non-dipper profile had 33.33%, the reverse dipper had 2.38%, and extreme dipper had 11.90% of patients. According to the dipping in DBP: in group 1 33.33% were non-dippers, and 9.53% were extreme dippers. In group 2 non-dippers — 19.04%, extreme dippers — 2.38%, extreme dippers — 38.10%. HbA1c directly correlates with: (DPAI24) (ρ=0,301; р=0,014), DPAI night (ρ=0,292; р=0,010), DPTI24 (ρ=0.292; p=0.012), DPTI night (ρ=0.268; p=0.018). Conclusions. The daily blood pressure profile in patients with T1DM without arterial hypertension is characterized by insufficient decrease in BP at night, an increase in the average daily DBP, PBP, as well as DPAI24, DPTI24, DP and the variability of the average daily SBP. Poor glucose control led to led to an increase in hemodynamic load. It is the risk factor cardiovascular complications in patients with T1DM.

ПРОГНОЗИРОВАНИЕ РИСКА ВОЗНИКНОВЕНИЯ ПРОТРОМБОТИЧЕСКИХ ИЗМЕНЕНИЙ У ПОДРОСТКОВ С ЭССЕНЦИАЛЬНОЙ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ

Today, the problem of early diagnosis of hematological changes predisposing to the development of thrombotic complications in patients with essential hypertension (EH) is an urgent problem that requires close attention not only of physicians, but also of pediatricians. The aim of the study was the development of prognostic criteria for risk of prothrombotic changes (PC) in adolescents with EH, timely preventive measures and prevention of thrombotic complications. Sixty adolescents with EH without PC and 37 adolescents with EH and PC were examined. We used the following methods: clinical anamnestic (including genealogy), functional and ultrasound, laboratory, mathematical and statistical. To create a mathematical model of forecasting, discriminant analysis was used, with the help of which from the 59 proposed predictors the algorithm selected 8 most informative features: the C777T polymorphism of the 5,10-methylenetetrahydrofolate reductase gene, the A66G gene of the methionine synthase reductase gene, the daily diastolic blood pressure level, the level of the nocturnal systolic arterial pressure-time index of hypertension, systolic blood pressure during the day, weighed down by thrombotic genealogically history, early onset of thrombosis, burdened thrombotic genealogical history. Our method for predicting the risk of developing PC allows to place adolescents with EH having an increased risk of developing these coagulation shifts in a separate group, to identify thrombogenic risk in adolescence and, if necessary, to initiate preventive measures in time to reduce the incidence of thrombotic complications of EH and mortality of patients.

Особенности интра- и экстракраниального кровотока, структурно-геометрическая и функциональная перестройка сердца и состояние вегетативной нервной системы у больных гипертонической болезнью II стадии в зависимости от статуса курильщика

Систематическое курение табака является серьезной угрозой для здоровья населения, особенно для лиц с повышенным риском сердечно-сосудистых заболеваний. Остаются нерешенными вопросы, в какой степени табакокурение влияет на прогрессирование артериальной гипертензии, нарушение вегетативного баланса, мозговой кровоток, поражение органов-мишеней.Цель. Анализ особенностей состояния мозгового кровотока, структурно-геометрической и функциональной перестройки сердца, нарушений вегетативного баланса у больных гипертонической болезнью (ГБ) ІІ стадии.Материал и методы. Обследовано 100 пациентов: 53 мужчины и 47 женщин. Средний возраст пациентов составил 52,51 ± 1,46 года. В зависимости от статуса курения (не менее 10 лет) все пациенты были разделены на 2 группы: в группу курильщиков включено 30 пациентов, в группу некурящих — 70. Всем больным проведено общеклиническое обследование с измерением массы тела и роста, с расчетом индекса массы тела, офисное измерение артериального давления (АД) и частоты сердечных сокращений, лабораторные исследования, суточное мониторирование АД, ультразвуковое исследование экстра- и интракраниальных артерий шеи и головы, определялась вариабельность сердечного ритма, выполнялась трансторакальная эхокардиоскопия. Результаты. У больных ГБ, имеющих статус курильщика, выявлено статистически достоверное увеличение мощности спектра в диапазоне низких частот на 16,5 % (р = 0,04), снижение мощности спектра в диапазоне высоких частот на 18,2 % (р = 0,04), увеличение симпатовагального индекса на 70,0 % (р = 0,01), повышение среднесуточного систолического АД (САД) на 6,5 % (р = 0,04) и среднесуточного диастолического АД (ДАД) на 7,9 % (р = 0,04), размера левого предсердия в диастолу на 8,1 % (р = 0,014), в систолу на 10,8 % (р = 0,026), толщины задней стенки левого желудочка (ЛЖ) сердца на 6,1 % (р = 0,028), толщины межжелудочковой перегородки в диастолу на 11,6 % (р = 0,004), в систолу на 10,7 % (р = 0,034), индекса массы миокарда ЛЖ на 12,2 % (р = 0,034), диастолического внутримио-кардиального напряжения на 13,9 % (р = 0,025), удлинение периода изометрического расслабления на 33,3 % (р = 0,026), индекса сосудистого сопротивления в русле правой общей сонной артерии (ОСА) на 3,3 % (р = 0,033), в русле правой средней мозговой артерии (СМА) на 8,5 % (р = 0,05), в бассейне левой СМА на 7,1 % (р = 0,042), превышение показателя «резерв вазоконстрикции» в 4,63 раза (р = 0,029) в бассейне левой внутренней сонной артерии (ВСА) и в 3,01 раза (р = 0,031) — в русле правой ВСА. Получено достоверное повышение у женщин-курильщиц по сравнению с мужчинами-курильщиками индекса сопротивления в ВСА справа на 10,8 % (0,65 ± 0,02 у.е. против 0,58 ± 0,01 у.е.; р = 0,03) и максимальной линейной скорости кровотока в ВСА слева на 22,0 % (2,88 ± 0,08 см/с против 2,36 ± 0,04 см/с; р = 0,05). При этом у женщин-курильщиц наблюдались достоверно меньшие значения систолодиастолического индекса в русле ОСА справа на 8,7 % (3,55 ± 0,19 у.е. против 3,86 ± 0,16 у.е.; р = 0,027) и индекса сопротивления в русле левой СМА на 4,9 %, чем у мужчин-курильщиков (0,450 ± 0,034 у.е. против 0,472 ± 0,024 у.е.; р = 0,027).Выводы. Курение у гипертоников ассоциируется с повышением активности симпатического и угнетением парасимпатического звеньев вегетативной нервной системы. Курильщики, страдающие ГБ, имеют достоверно более высокие цифры среднесуточного САД на 6,5 % (р = 0,04), среднесуточного ДАД на 7,9 % (р = 0,04) по сравнению с некурящими больными с ГБ. Модулирующее влияние курения на процессы патологического ремоделирования сердца у гипертоников проявляется в увеличении систолического и диастолического размеров левого предсердия, толщины стенок и массы миокарда левого желудочка, без расширения полостей сердца, при этом наблюдается увеличение диастолического внутримиокардиального напряжения левого желудочка. Структурная перестройка сердца у гипертоников под влиянием табакокурения создает условия для снижения активной релаксации и изменения диастолического наполнения левого желудочка: увеличения вклада позднего наполнения и удлинения времени изометрического расслабления. Нарушения мозгового кровотока у больных гипертонической болезнью, имеющих статус курильщика, по сравнению с некурящими гипертониками характеризуются более выраженным спазмом артерий каротидного бассейна, о чем свидетельствует повышение индексов сосудистого сопротивления и показателя «резерв вазоконстрикции» в общих сонных и средних мозговых артериях у курильщиков. Показатели кровотока в вертебробазилярном бассейне у курящих и некурящих гипертоников достоверно не различаются. Гендерные различия показателей допплерографии магистральных артерий шеи и головы у больных гипертонической болезнью, имеющих статус курильщика, характеризуются более высоким сосудистым сопротивлением в общих и внутренних сонных артериях у женщин, в средних мозговых артериях у мужчин.

RENAL DENERVATION IN THE TREATMENT OF RESISTANT HYPERTENSION: RESULTS OF A ONE-YEAR OBSERVATIONAL STUDY

Aim. To study the effect of renal denervation on blood pressure (BP), myocardium function and vegetative status in patients with resistant hypertension (HT). Material and methods. Patients with a provisional resistant HT diagnosis (n=62; 41.3% male) were included into the study. 17 patients were selected for renal denervation after correction of previous antihypertensive therapy and examination to exclude symptomatic HT. Two patients refused the procedure, 1 patient hadn’t undergone renal denervation due to anatomical features (renal artery diameter &lt;4 mm). Renal denervation was performed in 14 patients. Office and average daily BP, kidney function, the severity of left ventricular hypertrophy and heart rate variability were assessed initially and after the intervention. Results. Office systolic BP (SBP) decreased from 165 to 150 mm Hg (p=0.016), diastolic BP (DBP) - from 110 to 95 mm Hg (p=0.019) 12 months after the renal denervation. Average daily SBP decreased from 148 to 137 mm Hg (p=0.092), average daily DBP - from 90 to 80 mm Hg (p=0.401). Plasma creatinine level and glomerular filtration rate remained within the reference range at a baseline and in 12 months. Left ventricular hypertrophy measured by echocardiography has not changed significantly. No significant heart rate variability dynamics has been found. Conclusion. Renal denervation is a promising treatment for resistant HT. The effect of renal denervation on the dynamics of left ventricular hypertrophy and heart rate variability requires updating.

Вплив добового ритму артеріального тиску, прозапальних і метаболічних факторів серцево-судинного ризику на розвиток гіпертензивної нефропатії у хворих на гіпертонічну хворобу

Із метою визначення взаємозв’язку функціонального стану нирок із добовим профілем артеріального тиску (АТ), показниками вуглеводного та ліпідного обміну у хворих на гіпертонічну хворобу (ГХ) були обстежені 98 хворих на ГХ II–III стадії, 1–2-го ступеня.Усім пацієнтам проводили офісне вимірювання та добове моніторування АТ. Визначали вміст ліпідів, сечової кислоти та рівень С-реактивного протеїну (СРП) у плазмі крові, а також швидкість клубочкової фільтрації (ШКФ) за кліренсом ендогенного креатиніну та мікроальбумінурію.Установлено, що у хворих на ГХ погіршення функціонального стану нирок асоціюється з порушенням добового ритму АТ за типом non dipper, збільшенням варіабельності систолічного АТ (САТ) за добу, хронічним гемодинамічним перенавантаженням протягом доби: найбільш тісний кореляційний зв’язок ШКФ установлено з середньонічними значеннями САТ за всі періоди доби та з середньодобовим діастолічним АТ (r = –0,384, p &lt; 0,001). У хворих на ГХ виявлено достовірну обернену кореляцію ШКФ з індексом НОМА (r = –0,417; р &lt; 0,001), умістом інсуліну й глюкози в плазмі крові натще (r = –0,248, р &lt; 0,05; r = –0,397, р &lt; 0,001 відповідно) та рівнем інсуліну на 60-й хвилині глюкозотолерантного тесту (r = –0,308; р &lt; 0,001). За допомогою багатофакторного регресійного аналізу встановлено, що факторами, пов’язаними незалежно від рівня АТ зі зниженою ШКФ у хворих на ГХ, є СРП (β = –0,285, р &lt; 0,01), загальний холестерин (β = –0,249, р &lt; 0,03), мікроальбумінурія (β = –0,242, р &lt; 0,05) та індекс НОМА (β = –0,238, р &lt; 0,05).Підвищення рівнів сечової кислоти, тригліцеридів та СРП у плазмі крові у хворих на ГХ пов’язано з поглибленням проявів гіпертензивної нефропатії (зниження ШКФ та підвищення рівня мікроальбумінурії).Гіпертензивна нефропатія у хворих на гіпертонічну хворобу асоціюється з порушеннями ліпідного обміну — підвищенням у плазмі крові рівнів загального холестерину, ліпопротеїдів низької щільності та тригліцеридів.

Blood Pressure-Lowering Efficacy of Amiloride versus Enalapril as Add-On Drugs in Patients with Uncontrolled Blood Pressure Receiving Hydrochlorothiazide

A large proportion of patients with hypertension need a second drug to reach satisfactory control of blood pressure (BP), but there are few well-designed controlled trials comparing the efficacy of drugs added as a second option. In a double-blind randomized clinical trial, 82 patients with uncontrolled BP, receiving hydrochlorothiazide 25 mg daily, were selected to receive amiloride 2.5–5 mg/day (n = 39) or enalapril 10–20 mg/day (n = 43). Ambulatory blood pressure monitoring (ABPM) was done before and after 12-weeks of treatment. Office BP was measured in the 4th, 8th, and 12th weeks. The doses of amiloride and enalapril were doubled in the fourth week, and propranolol was added in the 8th week if office BP was above 140/90 mm Hg. There was a greater BP reduction in patients treated with enalapril. The ABPM δ values between the groups were 3.6 ± 2.2, 3.9 ± 2.2, and 1.1 ± 2.7 mmHg for 24-h, daily, and nightly systolic blood pressure, respectively, favoring enalapril. For diastolic blood pressure (DBP), the deltas were 1.7 ± 2.0, 3.2 ± 1.5, and 1.2 ± 1.9 mmHg, respectively (p = 0.039 for daily DBP). Office SBP decreased more and sooner in patients allocated to enalapril (p = 0.003). More patients taking amiloride required propranolol to control BP (p = 0.035). Potassium increased 0.3 mEq/L on the average in both groups. Cough, albeit predominantly mild, was reported more frequently by participants treated with enalapril. We conclude that enalapril is more effective than amiloride to lower BP of patients on hydrochlorothiazide with uncontrolled BP.Trial registration: ClinicalTrials.gov identifier: NCT00394394.