Daily Systolic Blood Pressure Research Articles

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.

Early blood pressure assessment after acute myocardial infarction: Insights using digital health technology

ObjectiveThere is rising interest in digital health in preventive cardiology, particularly for blood pressure (BP) management. In a digital health study of early BP assessment following acute myocardial infarction (AMI), we sought to examine feasibility and the (1) proportion of post-AMI patients with controlled BP and hypotension, and (2) association between prior cardiovascular disease (CVD) and BP post-AMI. MethodsIn this substudy of the parent Myocardial infarction, COmbined-device, Recovery Enhancement (MiCORE) study, type 1 AMI patients were enrolled between October 2017 and April 2019. Participants self-monitored their BP through 30 days after hospital discharge using an FDA-approved wireless BP monitor connected with a smartphone application. Linear mixed-effects models assessed the association between prior CVD and BP trajectory post-discharge, adjusting for antihypertensive medications and a propensity score inclusive of CVD risk factors. ResultsSixty-eight AMI patients (mean age 58 ​± ​10 years, 75% male, 68% white race, 68% history of hypertension, 24% prior CVD) provided 2638 measurements over 30 days. The percentage of BP control <130/80 ​mmHg was 59.6% (95% CI: 54.3–64.9%) and <140/90 ​mmHg was 83.7% (95% CI: 80.3–87.2%). The percentage of systolic BP ​<90 ​mmHg was 1.1% (95% CI: 0.17–2.0%) and the percentage of diastolic BP ​<60 ​mmHg was 3.9% (95% CI: 2.6–5.2%). Prior CVD was associated with 12.2 ​mmHg higher mean daily systolic BP during admission (95% CI: 3.5–20.9 ​mmHg), which persisted over follow-up. There was no association between prior CVD and diastolic BP. ConclusionThe digital health program was feasible and ~40% of post-AMI patients who engaged in it had uncontrolled BP according to recent guideline cutpoints, while hypotension occurred rarely. The gap in BP control was especially large in patients in whom AMI represented recurrent CVD. These data suggest an opportunity for more aggressive secondary prevention early after MI as care models integrate digital health.

Clinical-instrumental Characteristic of the Combined Course of Chronic Gastroduodenitis and Primary Arterial Hypertension in Children

The objective: to provide clinical and instrumental characteristic of the combined course of chronic gastroduodenitis (CGD) and primary arterial hypertension (PAH) in children.Materials and methods. We examined 154 children: group I – 47 children with a combination of CGD and PAH; group II – 52 children with isolated PAH; group III – 55 children with CGD and normal blood pressure.Results. Children of group I compared with group III had nausea (p=0,046) and gastric heaviness (p=0,04) more often. Children of group I more often than in children of group II (p=0,04) and group III (p=0,02) troubled by increased fatigue. Dizziness (p=0,001), palpitations (p=0,04), and cardialgia (p=0,04) were observed more frequently s group I compared to group III. On ECG sinus tachycardia was in 40,4 % of children in group I compared with 21,2 % of children ingroup II (p=0,04) and 7,3 % of children in group III (р&lt;0,001). The voltage in group I was 29,2±1,0 mV compared to 28,9±1,2 mV in group II (p=0,85) and 25,8±1,2 mV in group III (p=0,04). By DMBP, in group I there was a tendency for higher average daily systolic blood pressure (SBP) (142,1±1,7 mm Hg and 137.8±1.4 mm Hg; p=0,05) and significantly lower diastolic blood pressure (DBP) indicators (70,7±1,1 mm Hg and 74,3±1,3 mmHg; p=0,03) compared with the group II.Conclusions. Children with combination of CGD and PAH compared with the isolated course of CGD and PAH are more common dyspeptic syndrome, signs of chronic nonspecific intoxication, tachycardia and signs of high hemodynamic load on the ECG.

Possibilities of cardiovascular events in patients with chronic obstructive pulmonary disease and newly diagnosed tuberculosis, including those associated with HIV infection, when prescribing long-acting β2-agonists

Chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis (TB) are a common pathology among respiratory diseases. Both conditions may have common risk factors, aggravating each other, accom-panied by the development of bronchial obstructive syndrome, requiring mandatory medical correction to increase the effectiveness of therapy for both the main and concomitant pathologies. The aim of the study was to study the effectiveness of treatment of TB in patients with COPD first diagnosed with tuberculosis, including those associated with HIV when prescribing long-acting β2-agonists. Materials and methods. A simple com-parative study included 60 patients of a TB dispensary aged 30–65 years. Patients were divided into 2 groups of 30 people (TB+COPD and TB+COPD+HIV), each of whom for 2 months received a long-acting β-agonist (indacaterol) as an accompanying therapy for the cor-rection of bronchial obstructive syndrome (BOS), with subsequent assessment of the effectiveness of therapy. Results. Subjectively, patients of both groups noted the rapid development of positive dynamics (short-ness of breath decreased from 1–3 days of taking the drug, coughing — within a week, tolerance to physical exertion improved), which was confirmed by indica-tors of the function of external respiration (FEV1). The state of the cardiovascular system was assessed by the results of daily monitoring of blood pressure (BPM). In the COPD+TB group, there is a certain average daily systolic blood pressure (SBP) with a tendency to nor-malize indicators, which is possibly associated with a decrease in the severity of hypoxia during bronchodi-lator therapy. In the COPD+TB+HIV group, the average daily level of SBP increased by 1 mm Hg, but given the very low starting rates, the increase in blood pressure had a positive effect on the patients' condition. The average heart rate (HR) during bronchodilator thera-py did not tend to increase. The best TB treatment re-sults were obtained in the TB+COPD group. In terms of the closure rate of TB+COPD decay cavities — 26.6%, TB+COPD+HIV — 20.0%), the TB+COPD+HIV group had longer periods of abacillation and closure of decay cav-ities, which is associa ted with the severity of the under-lying and associated diseases. The drug was well toler-ated in both groups. Conclusion. The use of 300 mcg long-acting β-adrenomimetics in the complex therapy of β2-adrenergic agonists for patients with TB+COPD and TB+ COPD+HIV can reduce the severity of bronchial obstruction syndrome, improve quality of life, increase adherence to TB treatment, thereby shortening hospi-talization and reduce the likelihood of disability of pa-tients, without the development of side effects from other organs and systems.

P4564Sympathetic renal denervation in patients with refractory arterial hypertension: 2-years follow-up

Abstract Aim To evaluate the efficacy of the sympathetic renal denervation procedure in patients with refractory arterial hypertension and heart failure. Methods The study included 72 patients with refractory arterial hypertension. We used randomization in 2 main groups: the Group I (n=36) included patients, who underwent denervation procedure of the main trunk of the renal artery and the Group 2 (n=36) - included patients who underwent denervation procedure in main trunk and also in second-order renal arteries. Additionally, patients were divided into 2 subgroups: the subgroup A (n=30) included patients, who underwent denervation procedure with a SYMPLICITY catheter, and the subgroup B (n=42) - included patients who underwent denervation procedure with a VESSIX catheter. Also, the renal denervation procedure efficacy, in patients with chronic heart failure (CHF) was analyzed. In all groups, 24-hour blood pressure monitoring, echocardiography and a 6-minute walk test were monitored. Inclusion criteria: refractory hypertension, age of patients 18–85 years, systolic blood pressure (SBP) ≥140/90 mmHg and ≥130/90 mmHg in patients with diabetes mellitus, functioning kidneys, renal arteries ≥40 mm in diameter and the length of the site up to the first bifurcation of at least 20 mm, absence of stenoses in the renal arteries, GFR≥40 ml/min/1.73m2, suitable anatomy of the renal arteries for endovascular procedure. Results 24 months result after the denervation procedure was demonstrated significantly decreased SBP in patients of both groups. In group I, it was, compared with pre-operative data (174.9±1.6 vs. 151.7±2.3 mmHg, respectively; p&lt;0.05), and in group II - 181.9±2.1 vs. 140.4±3.8 mmHg, respectively; p&lt;0.05). However, when comparing SBP values between groups, SBP in group I was significantly higher, than in group II (151.7±2.3 vs. 140.4±3.8 mmHg, respectively; p&lt;0.05). In addition, the average number of drugs in group I was decreased to 2.1±0.8 after 24th month, and in group II - to 1.4±0.6 (p&lt;0.05). When comparing SBP value in subgroup A and subgroup B, the average daily SBP also significantly difference and amounted to 147.8±1.8 vs. 138.4±3.2 mmHg, respectively; p&lt;0.05). Among the all patients included in the study, 38 patients were with CHF. The 6-minute walk test results, compared with pre-operative data, showed a significant improvement and amounted to 321.24±83.22 vs. 212.42±54.72m, respectively; p&lt;0.05. Conclusions The sympathetic renal denervation may be regarded as an effective method of treatment of patients with resistant hypertension, as well as patients with concomitant chronic heart failure. Performing denervation in the arteries of the second order, significantly improves the prognosis of patients, and in patients with concomitant heart failure significantly increases the quality of life and exercise tolerance. Acknowledgement/Funding Russian Academic Excellence Project 5-100

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&lt;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.

INCREASING OF ARTERIAL STIFFNESS INDEX IS ASSOCIATED WITH VALVULAR CALCIFICATION IN POSTMENOPAUSAL WOMEN

Objective: Aim of our study was to elucidate possible clinical association with arterial stiffness parameters in postmenopausal women. Design and method: We include into the study 254 women (mean age is 63,9 ± 6,97 years). All women were postmenopausal (mean menopausal duration is 14,9 ± 6,90 years). 81,4% of patients had arterial hypertension; 8,7% - diabetes mellitus; 41,1% - coronary artery disease; 9,4% of pts were smokers. 68,7% of patients get antihypertensive treatment and 49,9% - statins.We performed ABPM with arterial stiffness measurement, echocardiography, bone densitometry in all patients. Lipids levels, glomerular filtration rate, glucose and HbA1 level, vitamin D, Ca, P and calcitonin level were measured in all women. Results: Increasing of arterial stiffness index (ASI) was correlated with mean systolic blood pressure (SBP) according to ABPM (r = 0,526, p < 0,001), daily SBP (r = 0,522, p < 0,001) and nightly SBP (r = 0,445, p < 0,001). Also non-dipper pts had higher level of ASI.The ASI was significantly higher in patients older than 65 years (170,0 ± 32,09 mmHg vs 145,7 ± 33,87 mmHg, p = 0,039) and in women with menopause duration more than 14 years (164,0 ± 33,99 mmHg vs 145,7 ± 20,48 mmHg, p = 0,001). There were no any associations between ASI and laboratory parameters or bone mineral density. In patients with valve calcification level of central pulse pressure (50,7 ± 11,04 mmHg vs 45,9 ± 8,92 mmHg, p = 0,014) and ASI (159,6 ± 33,11 vs 146,8 ± 22,01, p = 0,026) were significantly higher compared with patients without calcification of the heart valves. According to multivariate regression analysis were the age of the patients (OR 4,19 CI[1,42—12,19], p < 0,001), the mean daily SBP according to the ABPM (OR 1,08 CI [1,01–1,18], p = 0,001) and calcification of the valve structures of the heart (OR 1,74 CI [1,01–2,47], p = 0,047)were independently associated with an increase in the ASI. Conclusions: This data indicates a general pathogenesis mechanism of the occurrence of valvular calcification and an increase in vascular stiffness.

CARDIOVASCULAR REMODELING IN PATIENTS WITH HYPERTENSION WITH DIFFERENT DEGREES OF COGNITIVE IMPAIRMENT

Introduction: Recently, the concept of vascular cognitive impairment, combining all variants of cognitive decline due to cerebrovascular insufficiency, is actively being developed. This concept goes far beyond traditionally existing ideas about the problem of vascular cognitive disturbances. The aim of the study is to demonstrate the correlation between the indices of structural and functional rearrangement of the cardiovascular system and the state of intellectualmnemonic functions in patients with hypertension. Materials and methods: A comprehensive survey of 146 patients with hypertension of the II and III stage according to ESH / ESC 2013, 2017, 2018 has been performed. The study included patients with mild and moderate cognitive impairment (CI). Depending on the state of the cognitive sphere and on the basis of the results of the neuronpsychological testing, The patients were divided into 3 groups depending on the state of the cognitive sphere and on the basis of the results of the neuron-psychological testing with further comparisons of their clinical and instrumental data. Results: According to the results of our study, it has been found that an increase of the signs of cardiovascular remodeling was observed in patients with more pronounced changes in cognitive activity. The analysis of intracardiac hemodynamic parameters in patients of the studied groups revealed more significant pathological changes in patients with cognitive impairments than in patients without them. Patients with mild and moderate CI had significantly higher heart rates, left ventricular wall thickness (LV) which led to impairment of the diastolic function of LV and had already been registered in patients without cognitive dysfunction. Moreover, it increased with the appearance (mild) and growth of the degree (moderate) cognitive impairment. The average daily values of BP (SBP, DBP) in patients of all studied groups significantly exceeded the recommended norms, while in patients with moderate CI these rates were significantly higher than those in the group with mild CI (p = 0.028). In addition, the variability of systolic blood pressure was increasing simultaneously with the deterioration of cognitive function of our patients. Also, signs of remodeling were being observed during the study of the state of peripheral vessels (increase of peripheral resistance, pulsation index, linear velocity and thickening of the intima-media complex), which is the main cause of cognitive impairment and causes their appearance and reflects their degree. Conclusions: The presented study revealed a clear correlation between the degree of cognitive impairment and the degree of changes in the daily blood pressure profile, the most important of which were the average daily systolic blood pressure and systolic blood pressure variability. On the basis of the conducted research, in the future it will be possible to predict the level of the cognitive sphere involvement, depending on the state of the daily blood pressure profile, changes of the ventricle and vessels geometry, which will enable timely diagnosis of cognitive impairment and the prescription an adequate therapy.

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.

Features of arterial pressure indicators in the postoperative period after surgical correction of aortic coarctation in children

Coarctation of the aorta is a congenital heart disease, which is characterized by a local narrowing of the vessel lumen. Such a congenital anomaly of the aorta requires surgical treatment. Manifestations of the disease can be diagnosed in the first day after birth as well as some patients can be asymptomatic. Clinical signs of aortic coarctation are heart failure, hypertension in the upper extremities, hypotension in the lower extremities, ischemic manifestations in the organs, hemodynamic disorders. Untimely treatment of aortic anomalies leads to complications or death of patient. The results of 24-hour blood pressure monitoring in children after surgical correction of aortic coarctation are presented in the article. Despite the successful surgical treatment of congenital aortic malformation, the long-term results of the operation are far from satisfactory. Almost 12–18 % of the patients having undergone surgery continue to be hypertensive with the vascular dysfunction development and without signs of recoarctation. Patients receive antihypertensive medications, sometimes their combinations, for a long time. Assessment of the daily blood pressure profile features in the postoperative period would help determine pathogenetic mechanisms of the hypertensive syndrome persistence and predict the pathological process course. The aim of the study was to assess the arterial pressure indices in children after successful surgical treatment of coarctation of the aorta. Materials and methods. The main group consisted of 24 children after surgical correction of aortic coarctation. The control group consisted of 20 practically healthy children. Results. A statistically significant decrease in the average diastolic blood pressure during a 24-hour period and daytime diastolic blood pressure and an increase in the daily systolic blood pressure index were determined in the main group children based on the results of 24-hour blood pressure monitoring. Conclusions: The majority of children had low general well-being in the postoperative period. Indicators of systolic and diastolic blood pressure measured by Korotkov method (83.3 %) and 24-hour blood pressure monitoring parameters were typical for hypertension in majority of patients (66.7 %). Abnormalities of the circadian profile (“non-dipper”, “over-dipper”) were detected in 50.0 % of the main group children.

Improving blood pressure control, organoprotection and metabolic disorders correction in patients with hypertension switching from diuretic-based combinations to fixed combination lisinopril + amlodipine + rosuvastatin

The aim of the study was to assess the possibility of fixed combination Lisinopril + amlodipine + rozuvastatin to improve arterial elesticity in patients with hypertension and high pulse wave velocity, despite previous diuretic-based combination antihypertensive therapy. Materials and methods. In an open, observational study duration of 24 weeks was included 60 patients on previous diuretic-based combination antihypertensive therapy. All participants underwent 24-hour blood pressure monitoring, applanation tonometry (augmentation index and central blood pressure), pulse wave velocity measurement, laboratory tests (lipid profile, fasting glucose, insulin resistance index - NOMA), leptin, high-sensitivity C-reactive protein before and after the switching to a fixed combination of lisinopril + amlodipine + rosuvastatin. Results. According to measurements of office blood pressure switching of patients on double combinations based on diuretics to a fixed combination of lisinopril + amlodipine + rosuvastatin, a further decrease in systolic blood pressure (SBP) by 13.7% and diastolic BP (DBP) by 18.8% was observed. According to the ABPM, the decline in the average daily SBP was 15.8%, DBP - 22.5%, average SBP - 16.2%, DBP - 19.8%. The combination of lisinopril + amlodipine + rosuvastatin reduced PWV by 15.9%, augmentation index by 13.5%, central SBP by 8.4% (p

Arterial blood pressure in schoolchildren, who were born after caesarian section

The aim of the study was to determine the blood pressure characteristics of school-age children, who were born by caesarean section. Materials and Methods . 75 school-age children ages from 12 till 16 years were investigated. They were hospitalized in the pediatric department with a diagnosis of vegetative dysfunction and with complaints of periodic increase in blood pressure. Patients were divided into two groups. The first group included 47 children, who were born by the usual way – vaginal delivery. The second group included 28 children, who were born by caesarean section. All children were investigated by 24-hour blood pressure monitoring. The daily, day and night mean values of systolic and diastolic blood pressure were studied. The normal limit values for 50, 90 and 95 percentiles relative to height, age, gender were calculated for every child individually. The indices of physical development – weight, height, BMI were assessed. Results. The mean indices of daily (p = 0.03) and day (p = 0.013) systolic blood pressure exceeding 90 centiles has been observed more frequently in the group of children born by caesarean section. The value of night systolic blood pressure exceeded 50 centiles more often among children from the 2 group (p = 0.016). The level of night systolic (6.06 ± 1.27 %) and diastolic (7.89 ± 1.58 %) pressure decreasing in children who were born by cesarean section was significantly lower than in children who were born by usual way. Odds ratio of 4.28 (p = 0.01) showed the influence of the birth by cesarean section on overweight, and on daily systolic blood pressure increasing (4.27; p = 0.02). Effect of breastfeeding duration of less than 6 months on daily systolic blood pressure exceeding 50 centiles (4.59; p = 0.01) has been found. Conclusions. Birth by caesarean section led to a greater frequency of exceeding the systolic blood pressure according to its daily monitoring in adolescents with symptoms of vegetative dysfunction, as well as a lower level of night blood pressure decreasing. Overweight and short duration of breastfeeding may have been the factors that caused blood pressure changes in examined children.

CLINICAL EVALUATION OF THE INSULIN RESISTANCE SYNDROME IN HYPERTENSIVE PATIENTS WITH NORMAL BODY WEIGHT

Objective. To evaluate the effect of insulin resistance on arterial hypertension and target organ damage in patients with normal body weight. design and methods. The study involved 95 patients with arterial hypertension 1–2 degree (essential hypertension stage I–II) with normal body weight (body mass index 18,5– 24,9 kg/m 2) aged 30–50 years. The examination included fasting blood glucose, immunoreactive insulin, the index of insulin resistance — QUICKI factor, as well as lipids, serum uric acid and microalbuminuria. In addition, patients underwent ambulatory blood pressure monitoring, duplex scanning of neck vessels, echocardiography, endothelial function assessment. Results. The rate of insulin resistance-hyperinsulinaemia syndrome was 36 % in the studied group of hypertensive patients with normal body weight. Hypertensive patients with insulin resistance had higher average daily systolic blood pressure, higher rate and more severe target organ damage (left ventricular hypertrophy, endothelial dysfunction, intima media thickness). Among metabolic disorders, dyslipidemia was predominant, in particular, hypertriglyceridemia, as well as increased total cholesterol and LDL-cholesterol, and decrease in HDL-cholesterol. conclusions. Insulin resistance and hyperinsulinaemia syndrome is registered in 36 % of hypertensive patients with normal body weight. They are characterized by high rate of hypertension and more severe target organ damage, and metabolic disorders (mainly hypertriglyceridemia).

Daily Melatonin Administration Attenuates Age-Dependent Disturbances of Cardiovascular Rhythms.

Increased blood pressure and reduced robustness of circadian rhythms are frequently reported in elderly subjects. The present study was aimed to investigate whether such changes can be reversed by daily melatonin ingestion. 97 normotensive and hypertensive volunteers of both genders and 63 to 91 years old participated. They lived in the Tyumen Elderly Veteran House on a self-chosen sleep-wake regimen to suit their personal convenience. The experiment lasted for three weeks. After one control week, part of the group (n=63) received 1.5 mg melatonin (Melaxen(TM)) each day at 22:30 h for two weeks. The other 34 subjects were placebo-treated. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) were measured using semi-automated devices at 03:00, 08:00, 11:00, 14:00, 17:00, 23:00 h each day of the first and the third week. Specially trained personnel made the measurements, taking care not to disturb subjects' sleep. Rhythm characteristics were estimated by means of single and population-mean cosinor analyses. Bingham test was used to compare rhythm parameters between groups and investigated physiologic variables. The 24-h HR rhythm was monophasic as described in other studies for young subjects though with a steeper increase in the morning. The daily SBP and DBP rhythms were bimodal. In reference to previously reported data of younger subjects, mean blood pressure of our cohort was elevated, particularly the nocturnal fall was less pronounced. Also, the overall SBP variability was higher as was the percentage of the 12-h component. Both values and also the SBP and DBP levels were reduced during melatonin treatment. The hypotensive effect of melatonin was most pronounced between 3:00 and 8:00 in the morning, i.e. at the time of the highest risk of adverse cardiovascular events, and in subjects with highest BP values before treatment. Moreover, the morning increase of HR was gentler what could have been of additional benefit. Melatonin has a direct hypotensive effect. Also, it stabilizes the internal temporal order enhancing the circadian component and the synchronization between rhythms of different physiological functions. This may further improve health and welfare of elderly subjects and particularly of those with hypertension. Taken together our data show the usefulness of melatonin for adjuvant medication.

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.

Blood pressure control and cognitive impairment--why low is not always better.

The linkbetweenbloodpressure and cognitive impairment is a complex beast. Several observational investigations have studied the association between blood pressure and cognitive function and yielded mixed results.1 Various explanations suchasheterogeneity in demographic and clinical characteristicsof studypopulations have been proposed for such discrepancies.Methodological limitations of clinical trials on antihypertensive therapy in relation to cognitive outcomes have added further complexity to this issue. While a meta-analysis of placebo-controlled trials showed amarginal benefit of lowering blood pressure in reducing the risk of dementia,2 the short-term follow-up and inclusion of healthy participants with low levels of comorbidities and high levels of cognitive functioning have limited the generalizability of these findings.3 Normal regulation of blood pressure is necessary for adequate organ perfusion and prevention of vascular damage. As shown in the Figure, high blood pressure in midlife, low blood pressure in old age, and excessive blood pressure fluctuation can all contribute to cognitive impairment. Hemodynamic stress, imposed by high blood pressure, results in endothelial dysfunction and damages cerebral vessels, which ultimately impairs thestructural and functional integrityof the brain.5 It has been shown that the degree of vascular damage in the systemic and cerebral circulation is linked with lower cerebral blood flow.6 Long-lasting cerebral hypoperfusion results inneuronal energycrisis andcell death.At the same time, damage of the brain can lead to dysregulation of blood pressure and a further decline in cerebral blood flow. Therefore, what is consideredanormal or lowbloodpressure in individualswithcognitive impairmentmaynotnecessarilymeanawellcontrolledbloodpressure. Instead, itmayhinder sufficientperfusion of a damaged brain. In this issue of JAMA Internal Medicine, Mossello et al7 showed that lowerdaytimesystolic bloodpressure in 172older personswithcognitive impairmentwasassociatedwitha faster cognitivedecline. Therewasno associationbetweenother office or ambulatory measures of blood pressure and accelerated cognitive decline. When participants were stratified for antihypertensive medication use, the association was present only in the group receiving treatment (72% of the total population). As a strength, this studyhas specifically focused on patients with cognitive impairment. Furthermore, the investigators applied ambulatory blood pressure monitoring, whichmighthelp to capture the circadiancomplexityof variation in blood pressure. Nonetheless, caution needs to be exercised when interpreting the results. Given the observational design, it cannot be concluded that antihypertensive therapy is directly responsible for the link between low daily systolic blood pressure and cognitive decline. It is likely that individuals receiving antihypertensive therapy had higher loads of overt and covert cardiovascular pathologies, which could independently lead to accelerated cognitive decline. To address this issue of confounding by indication, randomized clinical trials are warranted. An increasingbodyof evidence implies that a “one size fits all” approach in antihypertensive therapy needs to be replacedwith an individualized approach based on chronological age, biological age or the degree of systemic and cerebrovasculardamage,andhemodynamicstatus.8Wethink it is time tomove from the concept of “the lower thebetter” to the concept of “hemodynamic optimization” to decelerate the pace of cognitive decline by a proper management of blood pressure. There is anurgentneed for interventional studies among high-risk groups, applying various classes of antihypertensivemedications, to shed further light on the optimal control of blood pressure in older persons with and at risk of cognitive impairment. Related article page 578 Figure. The Circuit of Blood Pressure Dysregulation and Cognitive Impairment