Daily Systolic 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.

Clinical, Metabolic and Neurohumoral Effects of L-arginine in Patients with Coronary Heart Disease in Combination with Arterial Hypertension

The objective: to analyze the impact of complex therapy using L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts and folic acid on the functional state of the endothelium, tolerance to physical activity, indicators of oxidative stress, lipid metabolism and clinical status patients with stable angina pectoris of the III functional class (FC) in comorbidity with arterial hypertension (AH) of the II grade, stage 2. Materials and methods. 100 patients with stable angina pectoris III FC and AH II grade, stage 2 aged 55–68 years participated in the study. The patients were divided into two groups: 50 patients of the 1st group received standard therapy – RAAS blocker, amlodipine, bisoprolol, acetylsalicylic acid and atorvastatin; 50 patients of the 2nd group in addition to standard therapy received a multi-component product of complex action, which includes L-arginine, ubiquinone (coenzyme Q10), Lcarnitine, lycopene, a number of plant extracts and folic acid, in a dose of 1 sachet per day. At the beginning and at the end of the study endothelial functions were assessed, daily blood pressure (BP) was monitored, physical exercise testing was performed, the weekly number of angina attacks and nitroglycerin tablet taking were recorded, oxidative status parameters were studied, quality of life was assessed, and the results were statistically processed. Results. The use of complex action preparation, which includes L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts and folic acid, as adjuvant therapy demonstrated a decrease in the level of indicators of lipid peroxidation (LPO) and an increase levels of antioxidant protection parameters. In the patients of the 2nd group a statistically significant positive dynamics of the blood pressure level was found: the median of daily systolic blood pressure (SBP) decreased to 131.78 mm (p<0.01). A significant decrease in median daytime and nighttime SBP and diastolic blood pressure (DBP) was also determined (p<0.01). The use of a multicomponent preparation of complex action led to a significant decreased of total cholesterol (CHL) by 14.5%, TG by 10.37% and low-density lipoprotein cholesterol by 12.5%. There was also an increased level of high-density lipoprotein cholesterol by 6.48% (р<0.05 for all indicators). The patients of the 2nd group demonstrated a significant increase in tolerance to physical excesses: an increase in the double product by 21.4% and the total amount of the done work by 78.4% compared to the initial values (р<0.05 for both indicators). After 2 months of treatment the difference between the groups in terms of the decrease in the weekly number of angina attacks was statistically significant (р<0.05). This positive trend was accompanied by a decrease in the median number of nitroglycerin tablets taken per week in the 2nd group from 5.4 to 3.0 (р<0.05). In the patients of the 2nd group after 2 months of observation a statistically significant improvement in quality of life indicators according to the “Seattle Angina Questionnaire” was determined (р<0.05). Conclusions. Although all study participants received identical standard antihypertensive and lipid-lowering therapy, adjuvant use of a multicomponent complex of L-arginine, ubiquinone (coenzyme Q10), L-carnitine, lycopene, plant extracts, and folic acid for 2 months demonstrated a reduction in the impact of oxidative stress with parallel restoration of antioxidant mechanisms, improvement in vascular reactivity in patients and daily control of blood pressure, contributed to the correction of the lipid profile with increased tolerance to physical exercise and, as a result of the above-mentioned effects, had a significant positive impact on the quality of life of patients.

Clinical Effects and Functional State of the Endothelium in Patients with Arterial Hypertension with a Suboptimal Level of K+ in the Dynamics of Treatment with a Potassium-Magnesium Mineral Complex

Today, electrolyte dysbalance plays an important role in the formation and progression of cardiovascular diseases. The risk of development cardiovascular events also depends on potassium and magnesium deficiency. However, the issue of risks and clinical consequences of suboptimal serum potassium remains poorly understood. The objective: to analyze the influence of the mineral complex on the clinical status, serum levels of potassium and magnesium and the functional state of the endothelium, heart rhythm and parameters of the blood lipid spectrum in patients with arterial hypertension (AH) of the 2nd grade. Materials and methods. 60 patients from 43 to 65 years old with grade 2 AH, II stage took part in the study. Patients (36 men and 24 women) were divided into two groups of 30 persons each. Patients of the 1st group received antihypertensive therapy (perindopril 5–10 mg/day or valsartan 80–120 mg/day + hydrochlorothiazide 12.5 mg) and atorvastatin 20 mg/day. Patients of the 2nd group, in addition to the above-mentioned therapy, were prescribed a mineral complex of natural potassium and magnesium, 1 sachet per day for 3 months. Endothelial function was examined for all participants, the peak blood flow index was determined, arterial blood pressure (ABP) and electrocardiogram (ECG) were monitored daily. Results. In patients of the 2nd group, gradual increased levels of K+ and Mg+ in the blood plasma were determined: the median level of K+ increased by 25.9%, and the median Mg+ concentration – by 16.4% (р˂0.01). Endothelium-dependent vasodilatation after three months of potassium-magnesium citrate use became 2.17 times higher than the initial indicator and 1.94 times higher than in the 1st group (p<0.05). In the 2nd group of patients who additionally took the mineral complex, statistically significant positive dynamics of the blood pressure level were found: after 3 months, the median daily systolic blood pressure (SBP) decreased to 133.56 mm Hg. (LQ=131.64; HQ=135.29) (p<0.01). A significant decrease in the medians of both day and night SBP and diastolic blood pressure was also determined (p<0.01). At the same time, compared to the initial values, the number of ectopic arrhythmias decreased: supraventricular extrasystoles – by 47%, single and paired ventricular extrasystoles – by 37.5% and 47.1%, respectively (p<0.01). Positive dynamics of lipid indicators were found in the patients of the 2nd group. Conclusions. Prescribing a mineral complex to patients with AH and a suboptimal level of K+ who receive therapy including a thiazide diuretic has a complex positive effect: it increases the effectiveness of antihypertensive and hypolipidemic therapy, improves the functional state of the endothelium and vasodilatation, reduces the number of heart rhythm disorders and prevents the occurrence of hypokalemia and hypomagnesemia.

Predictors of cardiovascular and renal complications in patients with resistant arterial hypertension during long-term follow-up

The aim – to evaluate the incidence of cardiovascular and renal complications and its predictors in resistant hypertensive (RH) patients during the long-term follow-up.Materials and methods. The frequency of cardiovascular and renal events was studied in 240 true resistant hypertensive patients. The duration of observation was 5.1±0.1 years. The comparison group consisted of 228 patients with controlled arterial hypertension (CAH) on a triple combination antihypertensive therapy. Cardiovascular endpoints included stroke/transient ischemic attack, myocardial infarction, cardiovascular death, myocardial revascularization, development of atrial fibrillation, hospitalization due to heart failure, and lower limb arterial disease. Kidney outcomes included dialysis or GFR decline by 40 % or greater. All the endpoints formed a composite primary endpoint. New cases of type 2 diabetes mellitus were also estimated.Results and discussion. The patients with resistant hypertension on multi-component antihypertensive therapy and significant reduction in arterial blood pressure (BP) levels (achievement of controlled office BP in 49.6 % of patients, office and ambulatory BP in 34.2 % of patients), maintained a higher risk of cardiovascular and renal events compared to patients with controlled arterial hypertension. It was found that the frequency of occurrence of the composite primary endpoint in resistant hypertensive patients was four times higher than in the group of patients with controlled hypertension – 30.0 % (72/240) versus 7.0 % (16/228) (p=0.001). The frequency of new cases of type 2 diabetes mellitus in patients with RH exceeded compared to CAH patients by 3.7 times (p=0.03).Conclusions. Independent predictors of the risk of cardiovascular and renal complications in patients with RH were the initial indicators of circulating endothelial progenitor cells if their concentration in the blood was ≤ 1818 cells/ml (HR 0.41; 95 % CI (0.21–0.79); p=0.007), the content of citrulline in the blood is more than 68 μmol/l (HR 1.13; 95 % CI (1.07–1.20); p<0.001); value of initial average daily systolic BP > 163 mm Hg (HR 1.10; 95 % CI (1.03–1.18); p=0.008).

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.

Effects of dietary nitrate and vitamin C co-ingestion on blood pressure and hand-grip strength in young adults.

Background: Co-administration of vitamin C and inorganic nitrate ([Formula: see text]) may reduce oxidative stress, boost the conversion of nitrite ([Formula: see text]) into NO and elicit positive vascular effects. Aims: We aimed to test the effects of oral inorganic [Formula: see text] and vitamin C co-supplementation on vascular function, muscular strength, and on concentrations of urinary [Formula: see text], vitamin C, 8-isoprostanes and salivary [Formula: see text] in healthy young adults. Methods: Ten young healthy participants were enrolled in a randomised, double-blind (only for the [Formula: see text] intervention) crossover clinical trial. Participants consumed in random order: 1) nitrate-rich beetroot juice and vitamin C (N+VC), 2) nitrate-rich beetroot juice alone (N) or 3) nitrate-depleted beetroot juice alone (ND). Resting blood pressure (BP) was measured at the research centre and at home. Non-invasive, continuous measurements of BP and cardiac function parameters were performed using a Finometer device. Free-living physical activity and hand-grip strength were assessed. Salivary [Formula: see text] and [Formula: see text] and urinary [Formula: see text], 8-isoprostanes and vitamin C concentrations were measured. Results: There were no significant differences for any of the vascular outcomes between the three interventions groups. However, analyses of within-intervention changes showed a significant lower daily systolic BP in the [Formula: see text]+vitamin C (N+VC) group only (P=0.04). Urinary [Formula: see text] (P=0.002) and salivary [Formula: see text] (P=0.001) were significantly higher in the N+VC group compared to the N and ND groups. Conclusion: These preliminary findings suggest that combining dietary [Formula: see text] with vitamin C could have protective effects on vascular function in young adults and could represent an effective strategy for the maintenance of healthy cardiovascular trajectories.

Effects of a laboratory-based aerobic exercise intervention on brain volume and cardiovascular health markers: protocol for a randomised clinical trial

IntroductionPhysical activity (PA) has beneficial effects on brain health and cardiovascular disease (CVD) risk. Yet, we know little about whether PA-induced changes to physiological mediators of CVD risk influence brain...

ARTERIAL WALL CONDITION IN WOMEN WITH HYPERTENSION AND POSTMENOPAUSAL OSTEOPOROSIS

Objective: The aim of the study was to investigate the indices of arterial stiffness and central aortic pressure in women with hypertension in combination with osteoporosis. Design and method: The study included 68 females (mean age 62.7±3.8 years) with hypertension, grade 2 in postmenopause including 35 females with osteoporosis (group 1) and 33 females without signs of osteoporosis (group 2) according to osteodensitometry investigation. The control group consisted of 20 healthy females (mean age 61.3±3.5 years). Before the study, the patients did not receive regular antihypertensive drugs and hormone replacement therapy. In addition to conventional studies the levels of calcium, phosphorus, alkaline phosphatase, deoxypyridinoline, parathyroid hormone, 25(OH) vitamin D, osteocalcin, C-terminal telopeptide of type I collagen in blood were determined. Fracture risk assessment (FRAX), daily blood pressure monitoring, applanation tonometry and dual-energy X-ray absorptiometry were performed. Results: It was found that in group 1 the levels of office systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 3.7% and 4.9% (p<0.05) higher than in group 2. According to the data of daily BP monitoring a more pronounced increase of mean daily SBP and DBP by 4.1% and 6.6% (p<0.05) was observed in group 1 in comparison to group 2. Indicators of pressure load according to the time index of hypertension by SBP and DBP were significantly higher by 21.7% and 25.4% during the day and 22% and 18.2% at night (all p<0.05). In patients of group 1 an increase in the aortic augmentation index of wave reflection (Aix) and the augmentation index of wave reflection, adjusted for heart rate (AIx @ HR 75) by 26.6% and 29.8% compared to patients of group 2 respectively, was revealed. It was found that in group 1, compared with the control group and group 2, an increase in pulse wave velocity by 37.2% and 26.4% respectively was detected. Conclusions: It was found that in patients with hypertension in combination with postmenopausal osteoporosis, according to office, daily monitoring and applanation tonometry, blood pressure levels and arterial stiffness parameters were significantly higher than in patients with hypertension without osteoporosis.

FEATURES OF AMBULATORY BLOOD PRESSURE MONITORING WITH DIFFERENT BLOOD PRESSURE PROFILES IN PATIENTS WITH HYPERTENSION DISEASE OF MIDDLE AND ELDERLY AGE

Background. Insufficient night-time reduction of blood pressure (BP) and night hypertension are associated with an increased risk of death regardless of the average daily BP. The study of daily BP profiles is very relevant in patients with hypertension of different age categories due to the high risk of thrombotic complications.
 Aim: of the study was to determine the peculiarities of ambulatory blood pressure monitoring (ABPM) indices in middle-aged and elderly hypertensive patients depending on the daily BP profile.
 Materials and methods. ABPM indicators were determined in 125 patients who were divided into 2 groups. 1st group (n=82) – middle-aged hypertensive patients (45-59 years old); 2nd group (n=43) – elderly hypertensive patients (60-74 years old). In the groups of middle-aged and elderly subjects 2 groups of daily BP profiles were distinguished: "dipper" and "non-dipper".
 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 systolic BP (SBP) (mm Hg), the average daly diastolic BP (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. The baseline BP level in the average daily SBP and DBP in middle-aged patients of dipper group was significantly higher by 49,6% and corresponded to 155,9±12,0 mm Hg (p<0,001) and 50,4% and was 97,3±6,1 mm Hg (p<0,01). Similar results are observed in the average BP and the maximal daily SBP and the maximal daily DBP values which were significantly higher than the control group by 21,5% (p<0,05) and equaled 110,0±3,6 mm Hg and 21,3% and amounted to 176,3±23,5 mm Hg (p<0,05) and 23,6% and amounted to 117,0±19,2 mm Hg (p<0,05). The baseline BP level in the average daily and maximal SBP, the average daily DBP and the average BP in patients of non-dipper group was significantly higher by 50,8% (p<0,01) and corresponded to 157,1±12,9 mm Hg and 27,4% and equal to 176,9±24,0 mm Hg (p<0,05), 63,8% and amounted to 106,0±1,0 mm Hg (p<0,05) and 44% and was 124,3±6,8 mm Hg (p<0,05) too. In the surveyed elderly patients only the average daily DBP was significantly different from the corresponding control indicator and was lower by 21,4% (p<0,05) and amounted to 91,5±0,7 mm Hg in dipper and 23,1% (p<0,01) and was 93,5±0,7 mm Hg in non-dipper group.
 Conclusion. Non-dipper group predominates in the structure of daily BP rhythm in elderly hypertensive patients (62,8% versus 37,2%). The average BP decreases in elderly patients of non-dipper group by 11,1% (p<0,05) reliably to patients of middle age.

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.

Effect of one-day intermittent fasting on 24-hour blood pressure profile in hypertensive and normotensive patients with overweight and obesity

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): National Academy of Medical Science of Ukraine Background The modification of eating behavior is an integral part of cardiovascular disease prevention. Intermittent fasting is a modern approach towards diet correction. However, insufficient data exists on its effect and safety on daily blood pressure and lipids. The aim of this paper was to assess the response of blood pressure, blood lipids and creatinine to acute intermittent fasting (IF) in hypertensive and normotensive patients with overweight and obesity. Methods A cohort of 65 hypertensive patients and 45 young normotensive patients with overweight and obesity included. All patients were monitored for 24 hours by Ambulatory Blood Pressure monitoring by ABMP50 Machine. All hypertensive patients were on stable antihypertensive therapy for at least 3 months and had met target office blood pressure levels. Fasting glucose (FG), blood lipids, creatinine, uric acid and high sensitive C-reactive protein (hCRP) were measured before and after fasting. All patients were asked to fast (F) for 16 hours for the first time in their lives. At the end of the fasting period, all participants in the study rated their subjective state from 1 to 10. Statistical analyses were conducted by IBM SPSS Statistics 22. Results The reaction of blood pressure on intermitted fasting was similar in both groups. Decrease of day systolic blood pressure (SBP) as well as increase of night diastolic blood pressure (DPB) was observed in both groups (TABLE 1). No significant changes of daily BP were observed in normotensive patients. Daily heart rate increased in 1st group by 1,5% (p=0.003) and decreased in 2nd group by 4,2% (p=0,002). At the same time daily SBP decreased in the group of hypertensive patients. The hypertension group (65 patients) rated their subjective state higher than 5 points and expressed that fasting was easy for them, age median 57 (51:61) years old. The normotensive group rated themselves below 5 points and expressed the difficulty of fasting and low quality of sleep, age median 26 (25:45) years old. The median BMI in 1st group 32,1 (30:35) in 2nd group 27,4 (25:30) kg/m2. The mean FG before fasting in the 1st group was 5,45(±0,61) mmol/l in the 2nd group was 4,75 (±0,55) mmol/l and after IF in the 1st group 5,36 (±0,73) mmol/l in the 2nd group 4,58 (±0,64) mmol/l (p>0.05). In hypertension group the mean of hCRP decreased from 9.95±8.02 to 4.68±2.88 (p=0.04). The level of blood creatinine and GFR had not significant changes. Conclusion One-day intermittent fasting leads to a change in blood pressure, does not cause hypotension, and is tolerated favorably in obese patients with hypertension on stable antihypertensive therapy.

Антигіпертензивна ефективність препарату Хітен (периндоприл) у хворих із м’якою та помірною артеріальною гіпертензією

Мета: вивчити антигіпертензивну ефективність і переносимість препарату Хітен (периндоприл) виробництва компанії «Ауробіндо Фарма Лімітед», Індія, у хворих з м’якою й помірною артеріальною гіпертензією. Методи. У дослідження були включені 53 пацієнти. Здійснювався контроль офісного артеріального тиску (АТ) і частоти серцевих скорочень, ефективності проведеної терапії, реєструвалися випадки розвитку побічних реакцій, проводилися амбулаторне моніторування АТ, контроль біохімічних показників сироватки крові, загальний аналіз крові. Хітен у дозі 4–8 мг 1 раз на день призначався протягом 30 днів. У випадках, коли не було досягнуто цільового рівня офісного АТ, при необхідності додавався гідрохлортіазид у дозі 12,5 мг 1 раз на день. Загальний курс лікування для одного пацієнта становив 6 місяців. Середній вік хворих становив 51,38 ± 1,40 року, індекс маси тіла — 29,50 ± 0,59 кг/м2. Вихідний рівень офісного середнього систолічного АТ (САТ) і діастолічного АТ (ДАТ) у цілому по групі становив 156,77 ± 0,66 мм рт.ст. і 95,19 ± 0,98 мм рт.ст. Результати. Встановлено, що у хворих із м’якою і помірною артеріальною гіпертензією лікування Хітеном (периндоприлом) у дозі 4–8 мг (одним або в комбінації з гідрохлортіазидом) забезпечує достовірне зниження як офісного САТ — на 28,67 мм рт.ст. і ДАТ — на 14,57 мм рт.ст., так і середньодобового САТ — на 14,14 мм рт.ст. і ДАТ — на 7,55 мм рт.ст., а також зниження індексів часу й тиску. Цільовий АТ за даними офісного вимірювання (< 140/90 мм рт.ст.) було досягнуто у 88 %, за даними добового моніторування АТ (< 130/80 мм рт.ст.) — у 78 % випадків. Відміна препарату була в 3 пацієнтів (5,6 %). Висновок. Результати проведеного дослідження свідчать про високу антигіпертензивну ефективність і добру переносимість лікування Хітеном (периндоприлом) як монотерапії, так і в комбінації з гідрохлортіазидом у хворих з м’якою та помірною АГ.

Impact of salt intake on urinary albumin excretion in patients with type 2 diabetic nephropathy: a retrospective cohort study based on a generalized additive model.

Diabetic kidney disease is an important and common cause of end-stage renal disease. Measurement of urinary albumin excretion (UAE) requires the diagnosis of the stage of diabetic nephropathy and the prognosis of renal function. We aimed to analyze the impact of lifestyle modification on UAE in patients with stage 2 and 3 type 2 diabetic nephropathy who received comprehensive medical care, using a generalized additive model (GAM), an explanatory machine learning model. In this retrospective observational study, we used changes in HbA1c, systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels; body mass index (BMI); and daily salt intake as factors contributing to changes in UAE. In total, 269 patients with type 2 diabetic nephropathy were enrolled (stage 2, 217 patients; stage 3, 52 patients). The rankings that contributed to changes in UAE over 6 months by permutation importance were the changes in daily salt intake, HbA1c, SBP, DBP, and BMI. GAM, which predicts the change in UAE, showed that with increase in the changes in salt intake, SBP, and HbA1c, the delta UAE tended to increase. Salt intake was the most contributory factor for the changes in UAE, and daily salt intake was the best lifestyle factor to explain the changes in UAE. Strict control of salt intake may have beneficial effects on improving UAE in patients with stage 2 and 3 diabetic nephropathy.

Features of the clinical course of arterial hypertension in patients with gene polymorphism under the influence of antihypertensive medicines

Arterial hypertension is a very heterogeneous disease, therefore the influence of environmental factors along with genetic factors leads to various options for the development and course of arterial hypertension. The aim of the study – to find out the effect of fixed combinations of antihypertensive drugs on the features of the clinical course of arterial hypertension in patients with gene polymorphism. We examined 86 patients. The patients were divided into 2 groups: group 1 consisted of 43 people who received a fixed combination of valsartan and amlodipine, group 2 included 43 patients who received a fixed combination of olmesartan and amlodipine. In patients of group 1, a significant decrease in average daily systolic blood pressure (SBP) in carriers of the AC genotype of the AGTR1 gene was established by 7.0% (p<0.01), as well as SBP and DBP (diastolic blood pressure) in carriers of the CC genotype by 11.3 % and 9.8% (p<0.01) respectively. Carriers of the TT, TC, and CC genotypes of the eNOS gene had a significant decrease in SBP by 7.8%, 8.3%, and 13.6% (p<0.01), respectively, and DBP was significantly different from the indicator before treatment in carriers of the CC genotype and decreased by 11.0% (p<0.02). In patients of group 2, a significant decrease in SBP in carriers of the AC genotype of the AGTR1 gene was established by 8.2 % and in DBP in carriers of the CC genotype by 11.2% (p<0.01). Carriers of TT, TC and CC genotypes of the eNOS gene had a probable decrease in the level of average daily SBP by 8.3%, 9.7% and 16.5%, respectively, compared to the level before treatment (p<0.01). In carriers of the CC genotype of the eNOS gene, BP decreased by 13.2% (p<0.01). It has been proven that the use of fixed combinations of valsartan with amlodipine and olmesartan with amlodipine in terms of its effect on the clinical course and the level of SBP and DBP in patients with arterial hypertension with a gene polymorphism is almost the same and is most pronounced in carriers of the CC genotype of the AGTR1 and eNOS genes. Keywords: valsartan, olmesartan, amlodipine.

AMBULATORY BLOOD PRESSURE MONITORING INDICATORS IN MIDDLE-AGED AND ELDERLY HYPERTENSIVE PATIENTS UNDER COMBINED ANTIHYPERTENSIVE THERAPY

It is known that arterial hypertension affects 30-35% of adult population of industrialized countries, and its prevalence reaches 40-50% among the elderly. In recent years, the issue of optimizing of treatment of hypertension in elderly people has been discussed such as choice of effective antihypertensive drugs with the least number of side effects, prevention of complications, reduced mortality, improvement of quality of life.
 The aim of the study was to substantiate the antihypertensive efficacy of the combination of enalapril and amlodipine in middle-aged and elderly hypertensive patients.
 Material and methods. Indices of ambulatory blood pressure monitoring were identified in 57 middle-aged patients (45-59 years) (group I) and 43 elderly patients (60-74 years) (group II), who underwent two-week in-patient treatment. All patients received the combined antihypertensive therapy (enalapril 10 mg twice daily and amlodipine 5 mg daily) for 2 weeks. And they were divided into 2 groups of 24 hours day's profile of blood pressure: dippers and non-dippers.
 Results. The combination of enalapril and amlodipine in elderly patients reduced the average daily diastolic blood pressure by 20,3% (p<0,05). Instead, in middle-aged patients there was the decrease in the average daily and the maximal daily systolic blood pressure by 17,3% (p<0,001) and 7,8% (p<0,05) and diastolic blood pressure respectively − by 23,2% (p<0,001) and 11,8% (p<0,05).
 Conclusions. Therefore, combined antihypertensive therapy in the elderly for 14 days was insufficient to improve significantly ambulatory blood pressure monitoring indicators. Obviously, positive changes require longer treatment.

Evaluation of the effectiveness of statin and spironolactone by the influence on indicators of vascular stiffness in patients with arterial hypertension

Abstract Introduction The possibility of slowing down vascular remodeling in hypertensive patients with the combined effect of antihypertensive drugs and statins has been studied in unitary studies. The effect of spironolactone on vascular stiffness in relation to the severity of the hypotensive effect in combination therapy has also been insufficiently studied. The aim of the research was to study the dynamics vascular stiffness parameters in hypertension patients of high/very high cardiovascular risk in addition rosuvastatin or spironolactone to combined two-component amlodipine and lisinopril therapy. Methods 90 patients (46 men and 44 women aged 51.6±8.5) with hypertension were randomized into groups: the first group received a fixed combination of amlodipine/lisinopril, the 2nd one followed the same regimen of therapy with addition of 20 mg rosuvastatin, the third - in addition to the combination of amlodipine / lisinopril received 25 mg of spironolactone. The office and ambulatory blood pressure (BP), central (aortic) BP, augmentation index (AIx), carotid-femoral and carotid-radial pulse wave velocity (PWV) were evaluated before and after a 24-week follow-up period. Results The office and average daily blood pressure decreased against the background of all therapy regimens (all p<0.0001). The degree of decrease in the above parameters was more pronounced under the influence of spironolactone, compared with taking a combination of amlodipine / lisinopril (office systolic BP (SBP) p=0.04 and diastolic BP (DBP) p=0.002, average daily SBP p=0.02 and DBP p=0.014) and office DBP in comparison with the group of additional administration of rosuvastatin (p=0.02). A decrease in central BP and AIx was noted in all groups. A more pronounced decrease in AIx occurred in the statin supplementation group relative to the standard treatment group (−5.8% and −9.0%, respectively, p=0.036). Carotid-femoral PWV significantly decreased in all groups (−0.9±1.5 m/s, −0.7±1.4 m/s, −2.2±2.6 m/s, respectively), in greater degree in the spironolactone addition group compared with the statin supplementation group (p=0.036). Carotid-radial PWV to the same extent significantly decreased only in the second (from 9.5±1.8 to 8.8±1.1 m/s (p=0.034)) and the third (from 9.8±1.3 to 8.4±1.3 m/s (p=0.0002)) groups. Conclusions The addition of a statin to a two-component combination of amlodipine / lisinopril in the treatment of hypertensive patients had an additional effect on the elastic properties of the aorta, in the form of a decrease in the augmentation index, and peripheral arteries, in the form of a decrease in PWV. The addition of spironolactone to standard therapy was accompanied by a significant increase in the antihypertensive effect and a decrease in aortic stiffness in the form of a more pronounced decrease in PWV in the carotid-femoral and carotid-radial areas. Funding Acknowledgement Type of funding sources: None.

A within-individual investigation on the relationship between day level workaholism and systolic blood pressure

ABSTRACT Most research on workaholism has been conducted at the between-person level and has considered mainly psychological outcomes of the phenomenon (e.g. burnout, job satisfaction). Building on the allostatic load model and on the idea that workaholic cognition and behaviour may show variation at the within-person level, we tested the hypothesis that fluctuations in daily workaholism would be related to parallel fluctuations in daily systolic blood pressure as reported at the end of the working day. Additionally, based on previous research and theoretical contributions in the field, we also tested the hypothesis that the daily workaholism-systolic blood pressure relationship would be particularly accentuated for women, when compared to men. Data have been collected from a sample of 61 participants who were followed for ten consecutive working days, for a total of 544 observations. In line with the hypotheses, workaholism revealed substantial variation at the day level and daily workaholism predicted daily systolic blood pressure. The workaholism-systolic blood pressure relationship was only partially mediated by the objective number of hours worked in the day and, as hypothesised, was more accentuated in women. The study contributes to advancing workaholism research by showing micro-processual (i.e. day-level) aspects of the health impairment path potentially activated by workaholism.

Dynamics of blood pressure indicators in patients with diabetes mellitus after planned percutaneous coronary intervention

Arterial hypertension (AH) is a common modifiable cardiovascular risk factor. Despite the wide choice of antihypertensive drugs, according to epidemiological studies, just over 20% of patients demonstrate effective control of hypertension. Failure to achieve the target values of blood pressure (BP) determines a high probability of developing cardiovascular events, which is also true for patients undergoing percutaneous coronary interventions (PCI). However, there is evidence that individuals who have undergone PCI show a higher percentage of achieving the target blood pressure levels. Aim of the study was to evaluate the dynamics of blood pressure indicators in patients with stable coronary artery disease (CAD) and diabetes mellitus, depending on the fact of performing PCI.Material and methods. The study was conducted at federal state budgetary scientific institution research institute of complex issues of cardiovascular diseases as a prospective, open, not comparative. The study included 75 patients with stable CAD and type 2 diabetes who regularly received therapy for at least 1 month prior to the start of participation in this study. The majority of patients 45 (60%) are represented by males. The median age was 52.64±6.96 years. 44 patients (58.81%) had a history of myocardial infarction, and 46 patients (61.33%) had previously undergone myocardial revascularization, history of stroke had 5 patients (6.66%). All patients according to the daily blood pressure monitoring at the 1st visit had average daily blood pressure values above 130/80 mmHg. Participants were divided into 2 groups: 43 patients had indications for routine PCI at the time of inclusion in the study, 32 patients had no indications for revascularization. The groups did not have significant differences in clinical and anamnestic characteristics, and regular significant differences were noted in relation to previously undergone revascularization (46.51 and 81.25%, respectively, p=0.0022) and the SYNTAX Score (14.39±9.20 and 6.13±8.28, respectively, p=0.0001). During 4 visits (1 visit, 1 month, 3 months, 6 months), ambulatory blood pressure monitoring (ABPM) was performed using the BiPiLAB system.Results. Initially according ABPM parameters group without the alleged PCI had greater variability in systolic blood pressure (SBP) in the daytime, higher values of mean diastolic blood pressure (DBP) at night, more time index of hypertension DBP at night. After 1 month of follow — up (for the group with PCI 1 month after the procedure), there were significant differences in the average daily SBP and DBP, the index of the time of hypertension DBP in the daytime, and the average daily SBP. Patients who underwent revascularization had lower ABPM values. The previously described differences in the night time DBP and the index of hypertension time at night were preserved. After 3 months of follow-up, significant differences were observed only in the indicators of night time SAD and DBP. At the end of the study (6 months of follow-up), the groups had differences only in the indicators of mean diastolic pressure at night.Conclusion. Patients who underwent PCI for 1 month after the procedure have a significant tendency to normalize (compared to the group without revascularization) blood pressure indicators. However, over time, the effect «escapes». Most likely, the short-term improvement in blood pressure is due to a temporary improvement in treatment adherence after an invasive procedure.

Influence of melatonin on blood pressure indicators with different severity of desynchronosis

Purpose. To study the dynamics of blood pressure (BP) indicators under the influence of exogenously administered melatonin (Melatonin-SZ, Severnaya Zvezda, Russia) with various manifestations of desynchronosis of circadian BP rhythms (arterial hypertension – AH, high normal blood pressure) to determine the scheme of their effective compensation. Material and methods. The study included 101 patients with desynchronosis of circadian rhythms of blood pressure – 52 patients with hypertension, constituting the first and second groups, and 49 individuals with high normal blood pressure, representing the third and fourth groups. Patients of the second and fourth groups received conservative therapy, patients of the first and third groups combined it with melatonin. All patients underwent measurements of office blood pressure, home monitoring of blood pressure (ABPM), electrocardiography, 24-hour blood pressure monitoring (ABPM). Results and discussion. In patients of the first and third groups, compared with the traditional treatment groups, by the end of the observation period, a significantly (p < 0.05) decrease in office systolic blood pressure (SBP) / diastolic blood pressure (DBP) was established: in the first group compared with the second – 1.11 / 1.13 times, in the third group compared to the fourth – 1.43 / 1.58 times; significantly more (p < 0.05) pronounced decrease in SBP / DBP during DMAD – by 1.08 / 1.17 and 1.58 / 1.62 times, respectively, Significantly (p < 0.05) more pronounced decrease in average daily, average daily and average nighttime SBP / DBP during ABPM – by 1.13 / 1.20, 1.11 / 1.20, 1.23 / 1.25 and 1.47 / 1.31, 1.42 / 1.19, 1.54 / 1.41 times, respectively; reliably (p < 0.05) more frequent registration of the dipper rhythm type SBP / DBP – 1.6 / 1.4 and 1.6 / 1.4 times, respectively. In addition, the dynamics of patients in the first and third groups showed a significant (p < 0.05) decrease in the mean daily and mean nighttime SBP / DBP variability (SBP in the first group by 27.3 and 41.3 %, respectively; DBP in the first group by 20.1 and 26.3 %, respectively; SBP in the third group by 13.5 and 25.2 %, respectively; DBP in the third group by 12.2 and 28.2 %, respectively). Conclusions. With various manifestations of desynchronosis of circadian rhythms of blood pressure (AH, high normal blood pressure), the prescription of melatonin (Melatonin-SZ, Severnaya Zvezda, Russia) at a dose of 3 mg per day 30–40 minutes before bedtime for a month against the background of non-drug therapy and antihypertensive drugs led to a significantly more effective decrease in blood pressure at its office measurement, DMAD, ABPM with an improvement in the circadian rhythm of blood pressure and normalization of blood pressure variability.

The gender-related peculiarities of the effects of telmisartan-based combined antihypertensive therapy on the dynamics of 24-hours profile of blood pressure

Objective — to evaluate the gender-related peculiarities of the effects of telmisartan-based combined antihypertensive therapy on the dynamics of 24-hours profile of blood pressure in patients with arterial hypertension depending on gender.Materials and methods. The study included 50 patients with arterial hypertension (AH), who received antihypertensive therapy and had uncontrolled arterial pressure as per the results of 24-hours ambulatory BP monitoring (DABPM). Among them were 23 men, average age (60.1 ± 2.7) years and 27 women, average age (64.4 ± 2.2) years. DABPM was performed to all patients before treatment and after 12 weeks of therapy. Prior to the study enrolment, all patients received combined antihypertensive therapy. After DABPM completion, the renin-angiotensin system (RAS) blocker used before enrolment was replaced by telmisartan in a dose of 40 — 80 mg.Results. It has been established that the average daily level of systolic blood pressure (SBP) after 12 weeks of therapy decreased significantly in men by 4.4 mm Hg and in women by 6.3 mm Hg. The average daily level of diastolic blood pressure (DBP) decreased in men by 7.1 mm Hg, in women — by 6.7 mm Hg. A decrease in the maximum SBP in the morning by 22.8 mm Hg in men and 23.4 mm Hg in women was determined. The maximal DBP in the morning decreased in men by 14.9 mm Hg, in women — by 19.1 mm Hg. The morning SBP index in men decreased by 41.5 %, in women — by 41.8 %, the morning DBP index — by 44.0 % and 33.7 %, respectively.Conclusions. After 12 weeks of telmisartan therapy, there was a significant decrease in mean daily SBP and DBP in men and women. Significant decrease in SBP and DBP in the active period was determined only in men, and decrease in SBP and DBP in the passive period was more pronounced in women. The positive effects of telmisartan therapy have been revealed in both men and women in terms of significant reduction of the maximal morning SBP and DBP, more than 40 % decrease of the morning SBP and DBP indices and the value of the morning SBP and DBP rise.