Damage In Essential Hypertension Research Articles

Inverse salt sensitivity: an independent risk factor for cardiovascular damage in essential hypertension.

Salt sensitivity is a powerful risk factor for cardiovascular (CV) disease and mortality in both normotensive and hypertensive patients. We investigated the predictive value of the salt sensitivity phenotype in the development of CV events and hypertensive target organ damage (TOD) among essential hypertensive patients. Eight hundred forty-four naive hypertensive patients were recruited and underwent an acute saline test during which blood pressure (BP) displayed either no substantial variation (salt-resistant, SR individuals), an increase (salt-sensitive, SS), or a paradoxical decrease (inverse salt-sensitive, ISS). Sixty-one patients with the longest monitored follow-up (median 16 years) for blood pressure and organ damage were selected for the present study. A clinical score for TOD development based on the severity and the age of onset was set up by considering hypertensive heart disease, cerebrovascular damage, microalbuminuria, and vascular events. CV events were significantly higher among SS and ISS than in SR patients. The relative risk of developing CV events was 12.67 times higher in SS than SR and 5.94 times higher in ISS than SR patients. The development of moderate to severe TOD was 10-fold higher in SS and over 15-fold higher in ISS than in SR patients. Among the three phenotypes, changes in plasma endogenous ouabain were linked with the blood pressure effects of saline. Salt sensitivity and inverse salt sensitivity appear to be equivalent risk factors for CV events. The response to an acute saline test is predictive of CV damage for newly identified ISS individuals.

NON-INVASIVE BIOCHEMICAL SCORES OF NAFLD AND CAROTID MORPHOFUNCTIONAL ALTERATIONS IN NEVER TREATED ESSENTIAL HYPERTENSIVE PATIENTS

Objective: The non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular events. At the same time a subclinical carotid change is associated with mortality and morbidity in hypertension. However it's unclear if there is a relationship between NAFLD and subclinical carotid damage in essential hypertension (EH). We searched for relationships between biochemical non-invasive NAFLD scores and subclinical carotid damage in a group of naïve EH patients. Design and method: In 299 naïve EH subjects (age 50 ± 13 years, 132 males) we evaluated clinical characteristics, biochemical scores of liver steatosis, as liver Fat Score (LFS), and fibrosis, as NAFLD Fibrosis Score (NFS), APRI, Fibrometer, and FIB-4, presence of echographic steatosis, metabolic syndrome, diabetes, levels of glucose, insulin, HOMA, lipids, glomerular filtration rate (GFR), reactive C protein (RCP), liver tests, platelet count, smoking habit and physical activity. By ultrasound carotid examination we measured the intima-media thickness (IMT), presence of carotid plaques, and in 115 subjects we calculated the carotid stiffness indexes, as the distension coefficient, the beta-stiffness, and the Young elastic module. Results: The IMT significantly increased across quartiles of LFS (P = 0.036), NFS (P = 0.001) and FIB-4 (P = 0.003). IMT was independently associated with FIB-4 (B = 0.380, P = 0.003) and NFS (B = 0.221, P = 0.013) scores. A IMT > 0.9 mm was independently associated with FIB-4 (P = 0.042). Patients with plaques had higher APRI (P = 0.005), Fibrometer (0.023), NFS (P < 0.001) and FIB-4 (P = 0.005) scores, and prevalence of plaques increased progressively across quartiles of LFS (P = 0.046), NFS (P < 0.001) and FIB-4 (P = 0.005). There was an independent association between carotid distension coefficient and Fibrometer (B = -0.360, P = 0.029), and between beta-stiffness and Fibrometer (B = 0.340, P = 0.036). Conclusions: In naïve EH patients the carotid IMT and carotid stiffness are independently associated with non-invasive NAFLD indexes. This association could induce to a more careful evaluation of a non-alcoholic liver damage in EH patients with subclinical carotid alterations. Moreover, studies are needed to clarify if profibrotic mechanisms are the base of both damages.

The relationship of endothelial function and arterial stiffness with subclinical target organ damage in essential hypertension.

This study aimed to explore whether brachial‐ankle pulse wave velocity (baPWV) and brachial artery flow‐mediated dilation (FMD) or the interaction of both parameters are associated with subclinical target organ damage (STOD) indices in patients with essential hypertension. A total of 4618 patients registered from January 2015 to October 2020 were included. baPWV and FMD were measured to evaluate arterial stiffness and endothelial dysfunction. Whereas left ventricular hypertrophy (LVH), urine albumin‐creatinine ratio (UACR), and carotid intima‐media thickness (CIMT) were obtained as STOD indicators. On multivariable logistic regression analysis with potential confounders, higher quartiles of baPWV and FMD were significantly associated with an increased risk of STOD. In patients <65 years of age, the odds ratio (OR) of LVH, UACR, and CIMT ≥.9 mm for the fourth versus the first quartile of baPWV were 1.765 (1.390–2.240), 2.832 (2.014–3.813), and 3.075 (2.315–4.084), respectively. In interaction analysis, an increase in baPWV shows a progressively higher risk of STOD across the quartiles of FMD. Also, the estimated absolute risks of LVH, UACR, and CIMT ≥.9 mm for the first to fourth quartile of baPWV increased from 1.88 to 2.75, 2.35 to 4.44, and 3.10 to 6.10, respectively, in patients grouped by FMD quartiles. The addition of baPWV to FMD slightly improved risk prediction for STOD. BaPWV and FMD were independently associated with an increased risk of STOD in patients with essential hypertension especially among patients <65 years of age. Patients with elevated baPWV and decreased FMD parameters are at increased risk of STOD.

Angiotensin II triggers release of neutrophil extracellular traps, linking thromboinflammation with essential hypertension.

Innate immunity and chronic inflammation are involved in atherosclerosis and atherothrombosis, leading to target organ damage in essential hypertension (EH). However, the role of neutrophils in EH is still elusive. We investigated the association between angiotensin II (Ang II) and neutrophil extracellular traps (NETs) in pathogenesis of EH. Plasma samples, kidney biopsies, and surgical specimens of abdominal aortic aneurysms (AAAs) from patients with EH were used. Cell-based assays, NETs/human aortic endothelial cell cocultures, and in situ studies were performed. Increased plasma levels of NETs and tissue factor (TF) activity were detected in untreated, newly diagnosed patients with EH. Stimulation of control neutrophils with plasma from patients with untreated EH generated TF-enriched NETs promoting endothelial collagen production. Ang II induced NETosis in vitro via an ROS/peptidylarginine deiminase type 4 and autophagy-dependent pathway. Circulating NETs and thrombin generation levels were reduced substantially in patients with EH starting treatment with Ang II receptor blockers, whereas their plasma was unable to trigger procoagulant NETs. Moreover, TF-bearing NETotic neutrophils/remnants accumulated in sites of interstitial renal fibrosis and in the subendothelial layer of AAAs. These data reveal the important pathogenic role of an Ang II/ROS/NET/TF axis in EH, linking thromboinflammation with endothelial dysfunction and fibrosis.

Vitamin D and Subclinical Cardiovascular Damage in Essential Hypertension

Vitamin D deficiency is linked to cardiac dysfunction, vascular remodeling, metabolic syndrome and insulin resistance (IR). The aim of the present study was to evaluate the association between vitamin D levels and cardiovascular (CV) organ damage in a large cohort of newly diagnosed treatment-naïve hypertensive patients, and the role of IR in this context. We enrolled 500 Caucasian individuals, without CV or renal complications. Subjects underwent a complete evaluation and measurements of vitamin D, standard laboratory determinations and instrumental examination, including echocardiography and applanation tonometry. Linear regression analyses were performed to assess the correlation between pulse wave velocity (PWV) and left ventricular mass index (LVMI) with different covariates. PWV was significantly correlated with age (p &lt; 0.0001), LDL cholesterol (p &lt; 0.0001), BMI (p = 0.001), pulse pressure (PP) (p = 0.005) and high sensitivity C-reactive protein (hs-CRP) (p = 0.006), while an inverse correlation was observed with vitamin D levels (p &lt; 0.0001), Matsuda index (p &lt; 0.0001) and estimated glomerular filtration ratio (e-GFR) (p = 0.006). LVMI significantly correlated with PP (p &lt; 0.0001), hs-CRP (p &lt; 0, 0001) and age (p = 0.001), while an inverse relationship was observed with vitamin D levels (p &lt; 0.0001), Matsuda’s insulin sensitivity index (ISI) (p &lt; 0.0001) and e-GFR (p &lt; 0.0001). Vitamin D was the strongest predictor of PWV and LVMI, explaining, respectively, 28.3% and 19.1% of their variation. Our study suggests that low vitamin D might be a biomarker of end-organ damage.

Study on microalbuminuria as predictor factor for target organ damage in essential hypertension in a teaching hospital, Telangana

Background: Microalbuminuria in hypertensives is related to future development of cardiovascular morbidity. It is a simple test which is easily available. In the present study we attempted to look at the prevalence of microalbuminuria in cases of essential hypertension and also to determine its association with left ventricular hypertrophy and carotid intima-media thickness and retinopathy. Aim of the study: To study microalbuminuria as a predictor factor for target organ damage in essential hypertension. Materials and Methods: Hospital based prospective observational study done on 45 cases for duration of one year. Cases of essential hypertension were studied for microalbuminuria, for changes of left ventricular hypertrophy, left ventricular mass index distribution and for retinopathy. Results: There was a slight male predominance and the M:F ratio was 2.7:1. Majority of cases were among 40-50 years age group ie, 62.2% cases. Microalbuminuria was present in 77.7% cases. ECG changes of left ventricular hypertrophy were present in 77.7% cases. Obesity and over weight were present in 15 (33.3%) subjects. Among 35 cases with microalbuminuria, 19 patients had hypertensive retinopathy changes. Among these 19 patients, Grade II retinopathy was most common and was diagnosed in 68.4% cases. Conclusion: Microalbuminuria is common in patients with essential hypertension. Microalbuminuria can predict cardiovascular and ocular morbidity in the form of left ventricular hypertrophy, increased carotid intima-media thickness; and ocular morbidity respectively. Screening of all patients with essential hypertension will help to predict the future risk for target organ damage. Keywords: Microalbuminuria, Essential Hypertension, Left ventricular hypertrophy.

COMMON VARIANTS OF THE NDUFS8 GENE DO NOT CONFER GENETIC SUSCEPTIBILITY TO HYPERTENSIVE LEFT VENTRICULAR HYPERTROPHY IN HAN CHINESE

Objective: Left ventricular hypertrophy (LVH) is the most common target organ damage in essential hypertension. The serious degree of LVH is not proportional to the history of hypertension and level of blood pressure. It is suggested that other factors than hypertension are involved in the process of cardiac remodeling in hypertensive patients. Mitochondria dysfunction plays a vital role in the pathophysiology of hypertensive cardiac hypertrophy. The NADH dehydrogenase Fe–S protein 8 (NDUFS8) is one of the highly conserved nuclear-encoded subunits existing in human mitochondrial complex I. Defects in this subunit have been associated with Leigh syndrome, which is a diverse spectrum of clinical manifestation such as hypertrophic cardiomyopathy, psychomotor impairment, difficulty feeding and respiratory abnormalities. The study aim is to investigate whether the encoding NDUFS8 gene has associated with essential hypertension and hypertensive LVH. Design and method: In total of 1604 subjects, were Chinese-Han from Yunnan province, including 985 patients with essential hypertension (470 males and 515 females) and 619 healthy controls(240 males and 379 females). Six NDUFS8 tagSNPs (rs3751084, rs999571, rs2075626, rs1104739, rs3133269 and rs11228127) were genotyped and major haplotypes consisting of these six SNPs were reconstructed for all subjects. Results: The common genetic variants of the NDUFS8 genes have not positive associated with essential hypertension and hypertensive LVH. Haplotype GGCCTA was nominally significant associated with essential hypertension (P = 0.046). Nevertheless, no significant association was detected between the haplotype and the essential hypertension after bonferrioni corrections. Intriguingly, one NDUFS8 tagSNP (rs3751084), which showed marginally significant associated with decrease serum magnesium level, the patients’ frequency of the G allele of rs3751084 was significantly higher than among the healthy controls(P = 4.69 × 10-6). Conclusions: Our study indicated that common genetic variants of the NDUFS8 gene are unlikely to be involved in essential hypertension and hypertensive LVH. Of note, we can probably consider the rs3751084 as a significant regulator to serum magnesium level. Further studies are essential to characterize the role of the rs3751084-G in Torsades de points arrhythmia with hypomagnesemia.

Aortic pulsatility drives microvascular organ damage in essential hypertension: New evidence from choroidal thickness assessment.

Aortic pulsatility drives microvascular organ damage in essential hypertension: New evidence from choroidal thickness assessment.

Study of Urinary Glycosaminoglycans among Essential Hypertensive Patients

Introduction: Essential hypertension is a systemic disease which affects endothelial basement membrane. Changes in Glycosaminoglycans (GAG) distribution pattern on glomerular basement membrane has been noted in hypertension. Hence it seems likely that an increase excretion of GAG levels may be an indicator of reduction in renal function. The qualitative or quantitative determination of urinary GAGs may be of value and could constitute a non invasive marker to assess the renal damage in essential hypertension. Aim: Differential analysis of urinary GAGs in essential hypertensive patients. Materials and Methods: This analytical case-control observational study which was conducted from November 2014 to June 2016 in Department of Biochemistry, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India. The study group included 50 male patients with age group of 30-60 years, clinically diagnosed with essential hypertension. Control group included 50 healthy male individuals with age group of 30-60 years, blood donors visiting to hospital blood bank. Random urine sample was collected. Urine creatinine was estimated by Jaffe’s method, urine GAGs by Dimethyl methylene blue (DMMB) dye method and urine microalbumin by particle enhanced Turbidimetric inhibition immunoassay method. Correlation was tested with Spearman’s correlation coefficient. Level of significance was set for p-value &lt;0.05 with confidence interval of 95%. Results: In present study, urinary GAGs levels in essential hypertensive study group was 14.57±10.16 mg/dL and in control group was 10.09±6.04 mg/dL. Urinary GAGs levels in essential hypertensive group was significantly high (p-value=0.890) when compared with normotensive control group. But no statistical significant correlation was found between urine GAGs and urine microalbumin in hypertensive study group. Conclusion: Estimation of urine glycosaminoglycans in essential hypertensive patients is a simple, rapid and cost effective test which asseses the glomerular function. It can be used as one of the early marker for diagnosis of nephropathy before microalbuminuria sets in.

Uric Acid and Vascular Damage in Essential Hypertension: Role of Insulin Resistance.

Increased levels of uric acid (UA) have been shown to be correlated with many clinical conditions. Uric acid may adversely affect the insulin signalling pathway inducing insulin resistance (IR). Several studies report the association between arterial stiffness (AS), an early indicator of atherosclerosis, and UA. The purpose of the present study was to evaluate the association between UA and AS, considering the potential role of IR. We enrolled 1114 newly diagnosed, never-treated hypertensive patients. Insulin resistance was assessed by the homeostatic model assessment (HOMA) index. Arterial stiffness was evaluated as the measurement of the carotid–femoral pulse wave velocity (PWV). The study cohort was divided into subgroups, according to increasing tertiles of UA. The mean values of UA were 5.2 ± 1.6 mg/dL in the overall population. Pulse wave velocity was linearly correlated with UA (p < 0.0001), HOMA (p < 0.0001), high sensitivity C-reactive protein (p < 0.0001), systolic blood pressure (p < 0.0001) and LDL cholesterol (p = 0.005). Uric acid was the strongest predictor of PWV and was associated with the highest risk for increased AS. The interaction analysis showed that the joint effect of increased UA and HOMA was significantly higher than that expected in the absence of interaction under the additive model, indicating that the two biomarkers synergically interacted for promoting vascular damage. Our data showed that UA interacted with IR to increase AS in a large cohort of newly diagnosed, never-treated hypertensive patients.

P1680High density lipoprotein cholesterol (HDL-C) levels and endothelial glycocalyx integrity in treated hypertensive patients

Abstract Background Endothelial dysfunction indicates target organ damage in hypertensive patients. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity and finally to cardiovascular disease. We aimed to investigate the role of increased HDL cholesterol levels (HDL-C), which usually are considered protective against cardiovascular disease, in EG integrity in older hypertensive patients. Methods We studied 120 treated hypertensive patients older than 50 years were divided regarding HDL-C tertiles in group HDLH, (HDL-C &gt;71 mg/dl, upper HDL-C tertile) and group HDLL, (HDL-C &lt;71 mg/dl, two lower HDL-C tertiles). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranged from 5–9 micrometers) using Sideview Darkfield imaging was measured as a non-invasive accurate index of reduced EG thickness. Results PBR 5–9 was significantly decreased in group HDLH (p=0.04). In the whole population, HDL-C was inversely but moderately related with PBR 5–9 (r=−0.22, p=0.01). In a multiple linear regression analysis model, using age, BMI, smoking habit, HDL-C, LDL-C and office SBP, as independent variables, we found that BMI (β=0.25, p=0.006) independently predicted PBR 5–9 in the whole population. Differences in PBR5-9 between HDL groups Conclusions In older hypertensive patients, HDL-C ranged between 71–101 mg/dl might moderately protect EG and subsequently endothelial function. Future studies in several groups of low or high risk hypertensives are needed in order to evaluate the beneficial role of extremely elevated HDL-C regarding cardiovascular risk evaluation as well as endothelial glycocalyx as a novel index of target organ damage in essential hypertension.

HDL cholesterol levels and endothelial glycocalyx integrity in treated hypertensive patients.

Endothelial dysfunction indicates target organ damage in hypertensive patients. The integrity of endothelial glycocalyx (EG) plays a vital role in vascular permeability, inflammation and elasticity, and finally to cardiovascular disease. The authors aimed to investigate the role of increased HDL cholesterol (HDL-C) levels, which usually are considered protective against cardiovascular disease, in EG integrity in older hypertensive patients. The authors studied 120 treated hypertensive patients older than 50years were divided regarding HDL-C tertiles in group HDLH (HDL-C≥71mg/dL, upper HDL-C tertile) and group HDLL (HDL-C<71mg/dL, two lower HDL-C tertiles). Increased perfusion boundary region (PBR) of the sublingual arterial microvessels (ranging from 5 to 9µm) using Sideview Darkfield imaging (Microscan, Glycocheck) was measured as a non-invasive accurate index of reduced EG thickness. PBR 5-9 was significantly decreased in group HDLH (P=0.04). In the whole population, HDL-C was inversely but moderately related to PBR 5-9 (r=-0.22, P=0.01). In a multiple linear regression analysis model, using age, BMI, smoking habit, HDL-C, LDL-C, and office SBP, as independent variables, the authors found that BMI (β=0.25, P=0.006) independently predicted PBR 5-9 in the whole population. In older hypertensive patients, HDL-C ranging between 71 and 101mg/dL might moderately protect EG and subsequently endothelial function. Future studies in several groups of low- or high-risk hypertensives are needed in order to evaluate the beneficial role of extremely elevated HDL-C regarding cardiovascular risk evaluation as well as endothelial glycocalyx as a novel index of target organ damage in essential hypertension.

A0812 Osteopontin associated with cardiac target organ damage in essential hypertension

A0812 Osteopontin associated with cardiac target organ damage in essential hypertension

A11316 The correlation analysis between urinary renalase and early renal damage in essential hypertension

Objectives: To preliminary study the relationship among urinary renalase, blood pressure and the level of early renal damage in primary hypertension and to discuss significance of urinary renalase in primary hypertension with early renal damage by observing urinary renalase. Methods: With 164 patients diagnosed as primary hypertension(84 with early renal damage and 80 not) were,eventually,recruited in the outpatient room and the ward of the Cardiology Department of 3rd Xiangya Hospital from 09.2015 to 01.2016,when as well as 81 healthy adults. General information and biochemical data were collected. Urinary renalase,urine albumin and urine creatinine was detected. The statistical software SPSS 19.0 were used to analysis the data. Results: 1. The hypertension with early renal damage group (n = 80)had lower urinary renalase content (ug/ml) compared with the hypertension without early renal damage group (n = 84)and the healthy control group (n = 81) (1.74 ± 0.25 vs 2.32 ± 0.24 vs 4.22 ± 0.29, P < 0.05), with statistically significant differences.2. Urinary renalase was found in negative correlation to UACR both in the hypertension with early renal damage group(n = 39, r = −0.778, P < 0.05) and the hypertension without early renal damage group(n = 35, r = −0.365, P < 0.05) at the same level of blood pressure,both groups with statistically significant differences.3. It was shown,in multiple linear stepwise analysis of UACR for patients with hypertension,that UACR negatively correlated with urinary renalase but positively with systolic blood pressure, creatinine and heart rate,which was statistically significant. The area of ROC curve of the urinary renalase in hypertension with early renal damage group was 0.894. Conclusion: Urinary renalase progressive decrease may indicate early kidney damage in primary hypertension.

Possibilities of contrast-free magnetic resonance perfusion imaging for the detection of early brain damage in essential hypertension

Arterial spin labeling (ASL) is a promising non-invasive method to assess cerebral perfusion, which identifies a decrease in cerebral blood flow (CBF). Objective : to assess cerebral perfusion in middle-aged untreated patients with uncomplicated grade 1–2 hypertension compared to same-age healthy controls. Patients and methods . 33 patients with essential hypertension and 40 healthy individuals (a control group) at the age of 40–59 years were examined. 24-hour blood pressure (BP) monitoring and brain magnetic resonance imaging were performed in different modes (T1 MPRAGE, T2 TSE, T2 FLAIR, DTI, and ASL). Results . White matter hyperintensive changes were found in 7.5% of the healthy individuals and in 51.5% of the hypertensive patients (p = 0.0002). In hypertensive patients, CBF in the cortical plate of anterior frontal regions was significantly (p < 0.001) lower than that in the controls: right CBF, 39.1±5.6 and 45.8±3.2 ml/100 g/min, respectively; left CBF, 39.2±6.2 and 45.2±3.6 ml/100 g/min, respectively. In hypertensive patients with white matter hyperintensive changes, CBF was significantly lower than that in the controls: right CBF, 38.5±5.9 ml/100 g/min (p = 0.0001); left CBF, 39.2±6.7 ml/100 g/min (p = 0.002), and in those without these changes, right CBF was 39.5±5.1 ml/100 g/min (p = 0.0002); left CBF was 38.9±4.3 ml/100 g/min (p = 0.00002). Correlation analysis revealed significant inverse correlations of CBF with BP and systolic BP variability. Conclusion . Lower cerebral perfusion occurs in middle-aged untreated patients with uncomplicated grade 1–2 hypertension even in the absence of white matter hyperintensity foci.

OP-491 - Left Atrial Volume Changes is an Early Marker of End-Organ Damage in Essential Hypertension: A Multidisciplinary Approach to an Old Problem

OP-491 - Left Atrial Volume Changes is an Early Marker of End-Organ Damage in Essential Hypertension: A Multidisciplinary Approach to an Old Problem

Association between common carotid artery diameter and target organ damage in essential hypertension.

To investigate the relationship between common carotid artery diameter (CCA-D) and target organ damage (TOD) in essential hypertension. A total of 200 essential hypertensive patients were enrolled (mean age 62.5 ± 9.5, men 59.0%) and were classified into two groups by the height-adjusted mean median of CCA-D: patients with CCA-D/height less than 3.905 mm/m (n = 100, 50%) and patients with CCA-D/height more than 3.905 mm/m (n = 100, 50%). Patients with CCA-D/height more than 3.905 mm/m have higher left ventricular mass index (LVMI) (P < 0.001) and higher prevalence of left ventricular hypertrophy (LVH) (P < 0.001), higher mean common carotid intima-media thickness (P = 0.008) and higher prevalence of carotid artery sclerosis (P = 0.03), higher pulse wave velocity (PWV) (P < 0.001) and higher prevalence of increased arterial stiffness (P = 0.01), higher urinary albumin/creatinine ratio (P = 0.001) and higher prevalence of microalbuminuria (P = 0.02) and greater number of TODs (P < 0.001) compared with the patients with CCA-D/height less than 3.905 mm/m. CCA-D was significantly correlated with LVMI, PWV and logarithmically transformed urinary albumin/creatinine ratio (r = 0.299, P < 0.001; r = 0.212, P = 0.007; r = 0.224, P = 0.005, respectively) after adjusting for cardiovascular risk factors. Multivariable stepwise linear regression analysis showed that number of TODs as well as individual TOD, including LVMI, PWV and logarithmically transformed urinary albumin/creatinine ratio, were independently correlated to height-adjusted mean CCA-D (all P < 0.05). Height-adjusted mean CCA-D was an independent risk factor for individual TOD, including LVMI, PWV and urinary albumin/creatinine ratio, as well as overall number of TODs in essential hypertension.

THE MODERN VIEWS TO DIAGNOSIS OF KIDNEY DAMAGE IN PATIENTS WITH ARTERIAL HYPERTENSION FOR EARLY PREVENTION

The article discusses in detail the problem of the medico-social significance of early kidney damage in essential hypertension (EH) (according to the literature review and own research).&#x0D; Aim. To determine the prevalence of subclinical renal damage in the EAG of the first stage and to assess the diagnostic significance of the functional renal reserve (FRR).&#x0D; Materials and methods. A total of 70 patients were examined. The control group consisted of 50 people with established diagnosis of EH I stage, women - 20 (40%), mean age – 44,6±1,78 years, men - 30 (60%), average age – 46,57±2,23 years. The average duration of the EH is 3,5 ± 0,5 years. The control group included 20 practically healthy persons (11 women (55%), men - 9 (45%), average age 41,1 ± 1,96 years). All the patients underwent the following examinations: clinical examination, general clinical blood and urine tests, biochemical blood test (total protein, urea, creatinine, glucose, lipidogram) 24-hour BP monitoring, ECG, ECHO-CG, carotid ultrasound, definition FRR. The body mass index (BMI), the glomeru-laorpfhiltthratlimonosrcaotpey(aGnFdR) was calculated.&#x0D; Results. According to the FRR, the functional state of the kidneys significantly differs between subgroups of patients with EH stage I (p &lt;0.05). In patients with the control group FRR - 62.14±10.60%, compared with patients with EH of the 1st subgroup – 23,31±4,9% and the 2nd subgroup - 10±3,02%. In patients of the 2nd subgroup of FRR, although within normal limits, it is noteworthy that it is located on the lower border. When performing the correlation analysis of the data of FRR and BP, the dependence was inversely proportional (r = -0.7, p &lt;0.05).&#x0D; Conclusion. The eGFR was determined by the CKD-EPI formula in the examined patients with EH and control groups, which does not differ significantly.&#x0D; FRR in patients with EH I-II grade with the duration of the disease up to 5 years is significantly lower than in practically healthy peers; p &lt;0.05.&#x0D; In patients with EH II grade (2nd subgroup) FNR more than twice as low as patients with EAG I degree; and is 10±3,2% and 23,3±4,9% respectively; p &lt;0.05.&#x0D; Thus, according to the results of the study, it was found that FRR is a more sensitive indicator, which can help in the early diagnosis of kidney damage with EH.

Left atrial volume changes are an early marker of end-organ damage in essential hypertension: A multidisciplinary approach to an old problem.

Left atrial (LA) volume has been shown to be a predictor of adverse cardiovascular outcomes. The aim of this study was to evaluate the relation between LA phasic volumes and hypertensive end-organ damage (EOD), by using real time three-dimensional echocardiography (RT3DE) in patients with essential hypertension (HT). The study included 95 essential hypertensive patients (60±10years, 37 males). The patients were divided into three according to the presence of EOD, namely microalbuminuria and retinal vascular changes detected by direct ophthalmoscopy. The first group had no EOD. The second group (EOD+ group) had either microalbuminuria or retinal vascular changes while the third group (EOD++ group) had both renal and retinal damage. The three groups did not differ with regard to age, sex, or metabolic profile. In RT3DE measurements, there were significant differences in LA phasic volumes (LA maximal volume index, LA minimal volume index, LA pre-atrial contraction volume index, LA total stroke volume index, and LA active stroke volume index, P<.001) among the groups. Moreover, patients with more extended EOD had significantly worse LA reservoir and conduit functions. In the logistic regression analysis, the LA active stroke volume index was an independent predictor of EOD (82% sensitivity and 92% specificity, area under the curve=0.96, P<.001). RT3DE measured LA phasic volumes and mechanical functions are associated with hypertensive EOD, which might serve as a surrogate endpoint for determining cardiovascular mortality and morbidity rates in patients with essential HT.

End Organ Damage in Essential Hypertension: An Experience at a Tertiary Level Hospital in Mumbai

Background: Early detection of hypertension and assessment of target organ functions is vital for maintenance of health. Associated comorbid conditions like diabetes mellitus, obesity, hyperlipidemia, smoking and old age increases the risk for early target organ involvement. Our aim was to study the prevalence of target organ damage in essential hypertension, effect of duration and severity of hypertension on target organ damage and to study the effect of comorbid conditions on target organ damage. Methods: We included patients with recently detected hypertension as well known cases of hypertension. Both inpatients admitted in wards as well as outpatients attending the hypertension clinic and admitted in the wards were registered for this study after taking valid informed consent. Patients underwent clinical examinations after detailed clinical, family and medication related history and followed by routine and specific investigations. Results: 100 patients were included in the study, of which 61 were males, mean age of 54 years (±2.4 years). Common modes of presentation of the patients were headache, giddiness and chest discomfort. We observed that controlling hypertension in patients resulted in significant changes when investigated with fundoscopy, electrocardiogram and 2 D echocardiogram. Additionally, duration and severity of hypertension had an effect on target organ damage, which came out as statistically significant. Conclusion: Smoking, alcohol, obesity, diabetes mellitus and dyslipidaemia are independent risk factors for hypertension and target organ damage. As the duration and severity of hypertension increases the incidence of target organ damage increases. Hypertension along with other risk factors like smoking, alcohol, dyslipidaemia, obesity and diabetic mellitus magnifies the risk of complications.