Degree Of Arterial Hypertension Research Articles

INFLUENCE OF CORONAVIRUS INFECTION ON VASCULAR REMODELING PARAMETERS IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: to evaluate the effect of COVID19 on arterial stiffness parameters and microalbuminuria (MAU) baseline and in dynamics against the background of antihypertensive therapy (AHT) in patients with arterial hypertension (AH). Design and method: 74 male and female patients with I-III degree of AH (ESH/ESC, 2018) were included in the study. Age was 53.54±1.92, duration of AH was 8.61.2 groups were identified: 1stgroup with AH who had suffered COVID19, no more than a month (N=42) and 2ndgroup with AH not suffered COVID19 (N=32).Vascular stiffness was determined by applanation tonometry using SphygmoCor apparatus (AtCor Medical, Australia); central systolic BP (CSBP), central diastolic BP (CDBP), central pulse pressure (CPP), aortic augmentation (AA), augmentation index (AIx), pulse wave velocity (PWV) were studied. The level of MAU was determined by enzymatic analysis on the biochemical analyser Daytona TM by Rendox (UK), which allows estimating MAU within the range of 30-300 mg/l and higher. The study was conducted before and after 6 months of AHT.p<0.05. The results are presented as μ±SD Results: The level ofMAU in 2ndgroup being 25,5±20,3 mg/l, in 1stgroup being 32,8±27,9 mg/l, but the difference was not significant (p>0,05). There was a significant decrease of MAU level in group I of patients: from 32,8±27,9 mg/l to 20,1±19,2,4 mg/l in dynamics (p<0,02). In 1st group, cSBP decreased from 154.86±24.11 to 134.38±13.9 mmHg (p<0.001) and in 2nd from 163.84±19.87 to 139.47±19.41 mmHg (p<0.001); cPP in 1stgroup decreased from 74.79±22.02 to 53.67±13.32 mmHg (p<0.001) and in 2ndgroup- from 78.84±14.48 to 54.71±12.46 mmHg (p<0.001). (p<0.001) and in 2ndgroup from 78.84±14.48 to 54.71±12.46 mmHg (p<0.001); PWV in 1stgroup decreased from 10.6±2.3 to 9.32±2.21 m/s (p<0.05) and in 2nd from 11.21±3.02 to 9.89±2.12 m/s (p<0.001). AA was significantly reduced only in 2nd: 19.24±7.67 mmHg before and 14.31±7.57 mmHg after(p<0.02) compared to 1stgroup: 15.67±6.97 before and 14.5±6.08 mmHg after treatment (p>0.05). Conclusions: The analysis of central haemodynamics and arterial stiffness parameters revealed positive dynamics of 6-month AHT in both studied groups of patients with advantage in the 2ndgroup. AA index significantly decreased only in the 2ndgroup. The level of MAU initially exceeded normal values in the 1stgroup

Аналіз предикторів виникнення несприятливих серцево-судинних і цереброваскулярних подій після операції Бенталла

The aim – to analyze the risk factors for the occurrence of major adverse cardiac and cardiovascular events in the early period after the Bentall procedure.Materials and methods. The study analyzed the medical records of adult patients (aged 18 to 75 years) who underwent Bentall procedure for ascending aortic aneurysm between 2012 and 2021. Univariate and multivariate analysis (logistic regression) were used to determine prognostic risk factors.Results and discussion. In patients with MACCE grade 3 hypertension was observed by 14.4 % (p = 0.048) more often, duration of cardiopulmonary bypass was by 14.1 % (p = 0.017) longer, the cross-clamping of the aorta duration was by 16.3 % (p = 0.039) longer, and the lactate level at the end of the surgery was by 23.6 % (p = 0.036) higher compared to patients without MACCE. Further multivariate logistic regression analysis established two main predictors of the development of MACCE in the early postoperative period – the presence of the 3rd degree arterial hypertension (OD 2.030 95 % CI 0.578–7.161, p = 0.018) and the duration of aortic clamping (OD 1.102 95 % CI 0.931–2.136, p = 0.018).Conclusions. The 3rd degree arterial hypertension and the duration of aortic clamping were independent predictors of the development of MACCE in the early postoperative period.

Arterial hypertension in the Arctic: the role of stress and autonomic dysfunction, gender differences

Introduction. Psychological stress and autonomic dysfunction are recognized as risk factors for cardiovascular diseases, but they affect cardiovascular risk differently in men and women.Aim: To study gender differences in factors influencing the probability of detecting arterial hypertension (AH) from the perspective of the role of stress, autonomic dysfunction and nonspecific inflammation in rotational shift workers in the Arctic region.Material and Methods. In the medical unit of the gas production company “Gazprom dobycha Yamburg” (polar settlement of Yamburg, 68°21’40”N) we simultaneously examined 99 men and 81 women with AH 1,2 degree of AH and normotensive persons comparable in age (p = 0.450), work experience in the Arctic (p = 0.956), number of years of rotational shift work (p = 0.824), level of office systolic (SBP) (p = 0.251) and diastolic blood pressure (DBP) (p = 0.579). Questionnaires were used to determine the level of general stress (PSM25 scale), occupational stress (Vaisman questionnaire); assessment of autonomic nervous system (ANS) function (Wayne A.M. questionnaire); 24-hour blood pressure monitoring was performed; biochemical blood test for biomarkers of inflammation, cortisol, brain natriuretic peptide precursor, homocysteine, folliclestimulating hormone was carrued out.Results. Vegetative manifestations (asthenization, increased fatigue, meteorological dependence, headaches) were significantly more often observed in women. Among men with AH, individuals with high levels of neuropsychological tension predominated, every fifth M had a high level of occupational stress. The median scores on the Wayne A.M. questionnaire were significantly higher in women, regardless of BP, and moderate ANS disorders were significantly more prevalent. According to logistic regression data, a significant effect on the probability of AH in men was the number of stress scores (OR = 1.050; 1.029–1.171, p = 0.001), indicators of nocturnal DBP variability (OR = 1.295; 1.109–1.511, p = 0.001) and nonspecific inflammation: rise in high-sensitivity C-reactive protein (hs-CRP) increased the probability of AH by 1.5 times (OR = 1.532; 1.212–1.937, p = 0.001), IL-1β – by 7 times (OR = 7.275; 3.235–16.361, p = 0.001). The probability of AH in women increased by the values of the daily variability of SBP (OR = 1.154; 1.019–1.306, p = 0.024), hs-CRP by 1.5 times (OR = 1.479; 1.226–1.783, p = 0.001), tumor necrosis factor-alpha (TNF-α) (OR = 1.111; 1.001–1.244, p = 0.044), level of IL-6 increased the probability of AH by 1.7 times (OR = 1.676; 1.149–2.958, p = 0.035), the number of scores on ANS questionnaire had a significant effect (OR = 1.055; 1.006–1.107, p = 0.026).Conclusion. In the conditions of the rotational shift work in the Arctic, gender differences were revealed in the stress perception and the severity of ANS dysfunction with a clear relationship between stress, inflammation and AH in men. ANS dysfunction in women was a trigger of nonspecific inflammation and AH. The identified gender differences will help to reveal vulnerable groups among men and women and develop targeted interventions for individuals in the Arctic region.

Analysis of the frequency of CYP2C9, AGTR1, AGT, ACE, CYP11B2 gene Polymorphisms occurrence in patients with newly diagnosed 1–2 degree arterial hypertension

Analysis of the frequency of CYP2C9, AGTR1, AGT, ACE, CYP11B2 gene Polymorphisms occurrence in patients with newly diagnosed 1–2 degree arterial hypertension

STUDY OF RISK FACTORS FOR CARDIOVASCULAR DISEASES AND CENTRAL HEMODYNAMICS IN SENIOR STUDENTS

HighlightsThe article examines the prevalence of risk factors for cardiovascular diseases (CVD) and the state of central hemodynamics (CHD) in senior students. Aim. To study the risk factors for CHD and CVD in senior students with the aim of early detection of arterial hypertension (AH) and the implementation of therapeutic and prophylactic measures.Methods. The study involved 223 senior students of medical universities in Moscow aged 20-27 years (the mean age was 22.8±0.17 years). The following cardiovascular risk factors were assessed for each student: age, gender, smoking, physical activity, genetic predispositions; body mass index. The indicators of CHD were studied by volumetric compression oscillometry using a portable automated software-hardware complex for non-invasive research of central hemodynamics (“SHCNIR CHD vco-“Globus” device).Results. The presence of CVD risk factors in senior students was revealed in 52.5% of cases; more than two risk factors were found in 19.3% of cases; 1st degree arterial hypertension (AH) in 11.2% of cases; “white coat hypertension” in 10.8% of cases; genetic predisposition to CVD in 30.0% of cases; overweight in 17.0% of cases; obesity in 5.4% of cases; low physical activity in 23.8% of cases; smoking in 16.1% of cases. An altered CHD profile was found in 62.1% of students. An increase in total peripheral vascular resistance at normal blood pressure levels was noted in 31.8% of cases. Indicators of total peripheral vascular resistance, mean blood pressure, systolic and diastolic blood pressure were significantly higher in the group of students with CHD risk factors.Conclusion. Outpatient follow-up groups should include students with established risk factors for cardiovascular diseases, diagnosed AH, and with altered indicators of CHD. Preventive examinations should include a simple method for studying hemodynamics – compression oscillometry.

CARDIOVASCULAR RISK AMONG MEN OF WORKING AGE WITH ARTERIAL HYPERTENSION DEPENDING ON THE ARTERIAL PRESSURE DIURNAL PROFILE

Aim: to investigate the relationship between cardiovascular risk (CVR) and different types of diurnal blood pressure (BP) profile among men of working age with arterial hypertension (AH).
 Materials and methods. The study included 83 men of working age (average age 48±2 years) with II stage, 2 and 3 degrees of AH. The risk of death due to cardiovascular diseases during the next 10 years was assessed using the SCORE scale. All patients underwent ambulatory BP monitoring (ABPM), according to the results of which the following diurnal BP profiles were identified: 23 (28%) patients – normal (optimal) level of nocturnal decrease in BP («dipper»; daily index (DI) 10-20%); 10 (12%) – excessive nocturnal lowering of BP («over-dipper»; DI >20%); 38 (46%) – insufficient nocturnal lowering of BP («non-dipper»; DI <10%); and 12 (14%) patients had an inverted diurnal curve («night-peaker»; DI <0%).
 Results and discussion. According to the SCORE scale, the CVR profile in «dipper» group (n=23) was as follows: low – 6 (26%) patients; moderate – 15 (65%); and high – 2 (9%). Among 10 patients of «over-dipper» group, 7 had low, 2 – moderate, and 1 – high CVR. In «non-dipper» group (n=38), there were 4 (11%) patients with low CVR, 10 (26%) with moderate, 14 (37%) with high, and 10 (26%) with very high CVR. At the same time, 7 out of 12 patients of «night-peaker» group showed very high CVR, 3 – high, and 2 – moderate (overall p<0,001). The frequency of patients with high CVR was higher in the pooled «non-dipper» and «night-peaker» group (pathological BP profile; n=50), as compared to the pooled «dipper» and «over-dipper» group (n=33): 34% vs. 9%, respectively. At the same time, the pooled «dipper» and «over-dipper» group was characterized by the higher frequency of patients with moderate (52%) and low CVR (39%), in contrast to the pooled «non-dipper» and «night-peaker» group (24% and 8%, respectively). Finally, all 17 patients with very high CVR had an abnormal diurnal BP profile (34% in the pooled «non-dipper» and «night-peaker» group) (overall p<0,001).
 Conclusions. It was established that, according to ABPM, 60% of men of working age with the AH of II stage, 2- and 3-degrees, had pathological BP profiles of the «non-dipper» and «night-peaker» types. Individuals diagnosed with nocturnal rise or insufficient diurnal BP decrease have a higher risk of cardiovascular death in the next 10 years according to SCORE. Patients with a «non-dipper» and «night-peaker» diurnal BP profiles require more aggressive drug therapy and re-examination with ABPM to control the normalization of the diurnal BP profile.

Neuroprotective efficacy of combined antihypertensive treatment with the inclusion of nitrendipine in patients with arterial hypertension

Abstract Aim To evaluate the efficacy of 12-months combined antihypertensive treatment with the inclusion of nitrendipine on cognitive functions in patients with arterial hypertension (AH). Material and methods Surveyed 59 patients with I – III AH degree (ESH / ESC, 2018) of both sexes. The average age of patients was 58,8 ± 11.6 years, the average duration of AH 11.1 ± 7.04 years. An average daily dose 13.18±7.4 mg of nitrendipine was prescribed to patients with AH in combination with other antihypertensive drugs. Furthermore, office systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured in all patients before and after 12 months treatment. Cognitive functions were evaluated using neuro-psychological tests: the Mini-Cog test (drawing a clock, reproduction of words), Montreal Cognitive Assessment (MoCA), a self-assessment questionnaire of memory, attention, thinking, ability to cope with their affairs, ability to make decisions. The results are presented as M ± SD. Results Analysis of office BP indicators showed a good 12-month antihypertensive efficacy with the inclusion of Nitrendipine in patients with AH. In particular, the SBP before treatment was 157,8 ± 16,18 mm Hg, after – 125,5 ± 10,7 (p = 0,000); the DBP 96,35 ± 8,55 mm Hg versus 79,7 ± 5,9 mm Hg, respectively (p = 0,000); MBP (mean blood pressure) 116,8 ± 9,95 mm Hg versus 94,97 ± 7,09 mm Hg, respectively (p = 0,000). The analysis of influence of AHT with the inclusion of Nitrendipine on cognitive functions in patients with AH showed an increase in the total score on the Mini-Cog test: 3,83 ± 1,11 versus 4,49 ± 0,81 points (p = 0,000), mainly due to a significant improvement in the reproduction of words: 2,16 ± 0,87 versus 2,69 ± 0,62 points (p = 0,000). According to the MOCA scale, abstract thinking significantly improved: initially amounting to 1,37±0,66 points versus 1,81±0,5 points in dynamics (p=0,000), as well as delayed reproduction of words: 2,49±1,23 points initially versus 3,2±1,4 points in dynamics (p=0,004). Significant memory improvement was observed against the background of 12-month antihypertensive therapy based on nitrendipine, initially was 7,04±2.34 points against 8,22±1.24 in dynamics (p=0,000) and decision-making function was 7,8±2,2 points initially against 9,02±1,3 in dynamics (p=0,000). Conclusion Thus, high antihypertensive efficacy and improvement of cognitive functions were shown against the background of antihypertensive combination therapy with the inclusion of nitrendipine in patients with AH.

Characteristics of arterial hypertension in patients after being in a combat zone in the Kharkiv region of Ukraine

Objective — to study the characteristics of arterial hypertension (AH) in patients (representatives of the civilian population) after their stay in the combat zone in the Kharkiv region of Ukraine.
 Materials and methods. The study involved 62 patients with 2—3 degree AH (29 men and 33 women), who were examined in the Department of Arterial Hypertension and Kidney Disease at L. T. Mala NIT NAMSU before the war and 4—5 months after its start. The interval between the baseline and re‑examination was 8—9 months. All examined patients during the war were in the combat zone in Kharkiv region of Ukraine. The mean patients’ age was 52.4±4.3 years. All patients underwent general clinical, laboratory and instrumental examinations. The degree, stage of hypertension and the presence of risk factors for cardiovascular disease (CVD), established CVD and kidney disease were assessed in accordance with recent recommendations. At baseline, before the war start, all patients were administered two‑ or three‑component antihypertensive and (in the presence of elevated levels of low‑density lipoprotein cholesterol (LDL‑C) lipid‑lowering therapy in accordance with the latest guidelines. All 62 patients (100%) during their dynamic observation before the war, reached target levels of «office» blood pressure (BP). The frequency of achieving target levels of LDL‑C was significantly lower and amounted to 57%.
 Results. In patients with hypertension (representatives of the civilian population), who were in the combat zone in the Kharkiv region of Ukraine and experienced chronic wartime stress, a significant increase in the frequency of severe and uncontrolled hypertension, its crisis course and resistant form was found. Prognostically unfavorable consequences of staying in the combat zone in patients with hypertension is a significant increase in the incidence of such risk factors for CVD as increased LDL‑C blood levels, prediabetes and insulin resistance, smoking and regular alcohol consumption. Staying in the combat zone leads to a significant increase in the incidence of coronary heart disease, heart rhythm disturbances and heart failure in patients with hypertension and contributes to the accelerated development of type 2 diabetes mellitus, as well as such severe cardiovascular and cerebrovascular complications as atrial fibrillation, acute myocardial infarction, transient ischemic attack and ischemic stroke
 Conclusions. The stay of patients with hypertension in the combat zone and the related chronic stress of wartime leads to a significant worsening of hypertension course and to the development of adverse metabolic disorders and cardiovascular and cerebrovascular complications. This justifies the need to establish dynamic monitoring for this category of patients and conduct long‑term combined therapy, taking into account the characteristics of the clinical course and the presence and severity of the disease complications.

The role of serum immunoglobulin e in patients with immunoglobulin А-nephropathy

THE AIM. To determine the frequency of elevated serum immunoglobulin E (IgE) levels in patients with immunoglobulin A nephropathy (IGAN) and to establish its relation to clinical and morphological, laboratory manifestations and disease course. PATIENTS AND METHODS. The study enrolled 47 patients with primary IGAN, age 32 (27 ÷ 39) years. Daily proteinuria (PU), hematuria, serum creatinine, degree of arterial hypertension (AH) and glomerular filtration rate (GFR) were analyzed. Blood concentration of total IgE was determined by enzyme immunoassay, and allergen-specific IgE antibodies to 57 allergens (domestic, epidermal, fungal, vegetable, food) using a commercial kit "EUROLINE Atopy Screen (IgE)" ("Euroimmun", Germany). RESULTS . In patients with IGAN, serum total IgE was found to exceed the normal value in 55 % of cases, with a concentration of 89.4 (47.5 ÷ 198.7) IU/ml and correlation with GFR (R=0.32, p=0.02) and creatinine (R=-0.40, p=0.01) was detected. Patients with elevated IgE levels showed a reduced incidence of AH (p=0.01), tubular atrophy and interstitial fibrosis (T1) (p=0.03). A correlation analysis revealed that the severity of endothelial proliferation decreased with increasing IgE concentration (R=– 0.40, p=0.02). The highest prevalence among allergens was shown for specific IgE to domestic mites Dermatophagoides farinae (42,1 %), specific activity of 31,4 (1,7 ÷ 71,3) u.u. was noted to Dermatophagoides pteronyssinus. There was a correlation between IgE concentration to Dermatophagoides pteronyssinus and PU (R=-0.51, p=0.01) and between the amount of IgE to Dermatophagoides farinae and the percentage of half moon (R=-0.55, p=0.01). The five-year event-free survival rate was 67 ± 19 % in the IgE group within normal limits and 100 % in the IgE group above normal limits (p=0.008). CONCLUSION. The presence of elevated concentrations of total and specific IgE indicated a more favourable course of IGAN.

THE INFLUENCE OF DEPRESSION IN HYPERTENSIVE ELDERLY PATIENTS

Objective: Depression and cardiovascular diseases are two common pathological entities in the elderly, their incidence increasing with advancing age. Clinicians have empirically observed that depression is an independent risk factor for hypertension, thus showing the need to demonstrate this hypothesis through clinical trials and also the correlation of depression with the occurrence of other cardiovascular diseases. Design and method: The study was carried out on 127 patients in the Emergency County Hospital dr. Pompei Samarian Calarasi, with cardiovascular disease, including hypertension, and/or depression. The presented study is observational, analytical, retrospective. The study group was randomized according to inclusion and exclusion criteria established prior to patient selection. Results: Hypertension is very common in the elderly. We observe a significant increase in blood pressure values with age. Patients at low, moderate, and high cardiovascular risk tend to have mild or moderate depression, and those at very high risk tend to have moderate or severe depression. Depression influences cardiovascular risk factors, favoring the increase of serum cholesterol and triglyceride values and favoring the decrease of serum HDL-cholesterol values, the influence of depression being statistically significant. The proportion of patients with hypertension who associate depression increases with increasing blood pressure values. To emphasize the importance of depression in hypertension, we excluded patients with metabolic syndrome. It has been observed that in these patients the association between depression and hypertension increases, emphasizing the fact that depression represents a cardiovascular risk factor. Studying the relationship between the severity of depression and the degree of arterial hypertension, it was observed that in patients with high blood pressure, the degree of depression is high. Conclusions: Considering all these aspects, we emphasize the importance of the correct and early diagnosis of depression in elderly patients, this being an important risk factor for cardiovascular diseases, including hypertension, often ignored in medical practice.

FEATURES OF MYOCARDIA DEFORMATION PROPERTIES IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: Determination of myocardium deformation properties depending on degree of arterial hypertension and the presence/absence of left ventricular hypertrophy (LVH) in patients with arterial hypertension. Design and method: 74 patients of both sexes, with I–III degrees of AH (ESC/ESH, 2018) were studied. Average age of patients was 58.72 ± 11.9 years; AH duration was 10.8 ± 7.2 years. Speckle-tracking EchoCG was performed to obtain an objective and quantitative assessment of global and regional myocardial function using the ACUSON x 700 PV 2.0 manufactured by SIEMENS. Among the parameters for assessing the longitudinal deformation of the left ventricle, we have chosen: global longitudinal strain -GLS (%); Strain Rate-SR. To study the segmental LV contractility, analyzed the apical 4-chamber, 3-chamber and 2-chamber section. Results are presented as M±SD. Results: The patients were divided into 3 groups: I- patients with AH I degree, n = 21 (28.4%); II n = 28 patients with II degree of AH (37.8%); III n = 25 (33.8%) patients with III degree of AH. A comparative analysis of groups showed that in patients with grade III AH, the indicators of GLS and the rate of myocardial deformation are significantly lower than in groups of patients with grades I and II of AH. The index of GLS in group III was: 10.3±3.6%, while in group I - 18.1±4.4% and in group II - 11.8% (p = 0.000). The same was noted in terms of SR: 1.0±0.3 s-1 versus 1.5±0.6 s-1 and 1.1±0.5 s-1, respectively (p = 0.001). To study the deformation properties of the myocardium, patients were divided into 2 groups: patients with LVH and without LVH. In 1st group, the GLS index was lower, 14.9±5.8%, than in 2nd group – 17.9±6.1% (p<0.05); the SR index in the group of patients with LVH was also lower- 1.64±0.75 s-1, than in the group of patients without LVH - 1.87±0.81 s-1 (p<0.05). Conclusions: Thus, significant violations of the deformation properties of LV are formed in patients with AH with an increase of degree of AH and the presence of LVH.

BLOOD LEVELS OF INTERLEUKIN-17A IN PATIENTS WITH ARTERIAL HYPERTENSION AND ITS RELATIONSHIP WITH THE CHARACTERISTICS OF THE COURSE OF DISEASE

Objective: One of the most important links in the pathogenesis of arterial hypertension (AH) is currently considered to be the activation of subclinical inflammation. Interleukin-17A (IL-17A) is a proinflammatory cytokine produced by cells of the immune system, predominantly Th17 lymphocytes. The objective of the study was to evaluate the changes in blood levels of IL-17A in patients with AH and its relationship with the characteristics of the course of the disease. Design and method: The study involved 65 patients with grade 2-3 AH (34 men and 31 women aged 37 to 59 years) and 22 practically healthy individuals in the control group (12 men and 10 women aged 19 to 47 years). Patients were examined using standard clinical, laboratory and instrumental methods. The scope of the study also included the determination of blood levels of IL-17A and highly sensitive C-reactive protein (hsCRP) by the enzyme immunoassay. Examination of all patients and persons of the control group was carried out before the start of the war in Ukraine. Results: A significant increase in blood levels of IL-17A was established in general in the group of patients with 2-3 degree AH ((7.12 [4.74;10.67]) pg/mL, P <0.05) in comparison with practically healthy individuals ((3.24 [0,96;4,59]) pg/mL). The highest blood levels of IL-17A were found in patients with AH with a more pronounced increase in blood pressure (BP) up to the 3rd degree of AH ((9.87 [5.98;13.56]) pg/mL, P<0.05) compared with the levels of this factor in patients with 2nd degree of AH ((5.85 [3,66;8,12]) pg/mL). Significant positive correlations were found between blood levels of IL-17A and hsCRP (P = 0,023), left ventricular mass index (P = 0,027) and systolic BP (P = 0,036). Conclusions: In patients with grade 2-3 AH, a significant increase in blood levels of proinflammatory cytokine IL-17A and its relationship with indicators of activation of subclinical inflammation, the severity of hypertrophic remodeling of the heart, and the severity of hypertension were found.

Metabolic syndrome in patients with arterial hypertension living in the Far North (on the example of the Khanty-Mansi Autonomous Okrug — Yugra)

BACKGROUND: Metabolic syndrome currently continues to occupy a leading position in medicine and remains one of the main reasons for discussions among scientists around the world. WHO experts defined the problem of metabolic syndrome as an «epidemic of the 21st century», since its prevalence is currently, according to some estimates, from 10% to 40% among the adult population of the planet.AIM: To study the metabolic syndrome in patients with arterial hypertension living in the Far North; to determine the main variants of the metabolic syndrome that are characteristic of people with arterial hypertension in harsh climatic and geographical conditions and to analyze the frequency of occurrence of the identified variants of the metabolic syndrome depending on the degree of arterial hypertension and gender differences.MATERIALS AND METHODS. This study is presented in the form of 4 main stages: determination of metabolic syndrome variants characteristic of patients with AH living in the North, analysis of the frequency of occurrence of the identified main variants of the metabolic syndrome depending on gender, degree of AH and time spent in the Far North. Study period: March 2018–February 2019.The main inclusion criteria for this study were: the presence of metabolic syndrome, a confirmed diagnosis of arterial hypertension (AH) of 1–3 degrees based on generally accepted criteria (ESH / ESC, 2018), residence in the Far North for at least 1 year. For the diagnosis of MS, the IDF criteria, 2005, were adopted. By design, the work is in the nature of an observational one-sample study, which was conducted in the Khanty-Mansiysk Autonomous Okrug — Yugra, Nizhnevartovsk (KhMAO-Yugra).RESULTS. The study involved 235 people, of which: men — 109 people (46.4±4,77%), women — 126 people (53.6±4,44%). The age of the study participants was 38±7.1 years. According to the degree of AH (according to the criteria, ESH / ESC from 2018), patients are presented as follows: 1st degree AH — 59 people (25.1± 2,83%); 2nd degree AH — 73 people (35.1± 3,11%); 3rd degree AH — 103 people (39.8± 3,19%). By the time of residence in harsh climatic conditions, all patients who took participation in this study were divided into three groups: group 1 — the residence time was from 1 year to 5 years. This group included 56 people (23.8±5,7%). 2 group — the period of stay in the Far North was from 6 to 11 years and this group is represented by 81 patients (34.5±5,3%) , group 3 — patients living in CS conditions for more than 11 years — 98 people (41.7±4,9%). № 1 — WC ≥ 94 cm in men and ≥ 80 cm in women + BP level ≥ 130/85 mm Hg + decrease in HDL cholesterol ≤ 1.03 mmol / L. This combination of the main structural units of MS was observed in 43 +/-3.23% of cases (p<0.0016). Option number 2 — waist ≥ 94 cm in men and ≥ 80 cm in women + BP level ≥ 130/85 mm. rt. Art. + decrease in HDL-C ≤ 1.03 mmol/l + increase in triglycerides ≥ 1.7 mmol/l + increase in fasting glucose ≥ 5.6 mmol/l* — this combination of MS components occurred in 57+/-3.23 % of cases in all patients participating in the study (p<0.0011).CONCLUSION. With an increase in the time spent in the Far North in patients with hypertension, who initially have a 3-component variant of the metabolic syndrome, there is a tendency towards an increase in the main components of the metabolic syndrome.

PS-C34-8: INFLUENCE OF RISK FACTORS IN THE DEVELOPMENT OF ARTERIAL STIFFNESS IN PATIENTS WITH UNCONTROLLED ARTERIAL HYPERTENSION

Introduction: Arterial stiffness is an unfavorable prognostic marker in patients with arterial hypertension (AH). Early diagnosis of the development of arterial stiffness contributes to the selection of pathogenetic therapy aimed at vascular protection. As noted in the recommendations for hypertension, markers of vascular damage in hypertension are pulse pressure (PP) and pulse wave velocity (PWV) > 10 m/s. However, in the conditions of practical medicine in our republic, there is no possibility of applanation tonometry to assess PWV. Aim: to search for risk factors associated with the early development of arterial stiffness in patients with uncontrolled hypertension. Material and Methods: 133 patients with an average age of 59.13 ± 8.18 years with uncontrolled hypertension, 22.5% of who were smokers. All patients underwent office blood pressure measurements, ECG, duplex scanning of the carotid arteries, applanation tonometry to determine PWV (Sphygmocor, Atcor, Australia) on the segment of the carotid-femoral artery, lipid spectrum, creatinine, and blood serum glucose. Results: Office systolic, diastolic and pulse BP (SBP, DBP and PP) were 164.92 ± 19.0 mm Hg, 99.2 ± 9.08 mm Hg, 65.73 ± 13.67 mm Hg, which corresponded to 2 degrees of arterial hypertension. Central SBP, DBP and PP: 166.96 ± 29.75 mm Hg, 84.8 ± 14.59 mm Hg, PD 81.96 mm Hg. respectively. An increase in PP characterized the development of vascular stiffness in patients with uncontrolled hypertension. At the same time, PWV was 10.8 ± 2.03 m/s; in 60% of patients, PWV exceeded the standard values (> 10 m/s). There was a thickening of the thickness of the intima-media complex (IMC) of the common carotid artery up to 1.11 ± 0.18 mm. The correlation analysis performed showed a direct correlation between PWV and the age of patients (r = 0.383, p = 0.0001), tobacco smoking (r = 0.2, p = 0.004), SBP (r = 0.15, p = 0.046), blood glucose level (r = 0.2, p = 0.008), CMM thickness (r = 0.3, p = 0.0001). Conclusion: The results showed an association of age, SBP, smoking, fasting glucose levels, IMT thickness with the development of arterial stiffness in patients with uncontrolled hypertension. These markers can be determined at the primary health care level and included in the stratification of the risk of vascular damage in patients with uncontrolled hypertension.

PS-C14-9: DIFFERENTIAL DIAGNOSIS OF HYPERTROPHIC CARDIOMYOPATHY AND HYPERTENSIVE HEART DISEASE

Objective: To conduct a differential diagnosis of hypertrophic cardiomyopathy and hypertensive heart. Material and Methods: The study included 40 patients with hypertrophic cardiomyopathy without left ventricle outflow tract obstruction, mean age 57.3 ± 9.5 years, 26 women and 30 patients with hypertensive heart, mean age 49.0 ± 8.7 years, 21 men. Results: The diagnosis of hypertrophic cardiomyopathy was established on the basis of clinical and anamnestic data, electrocardiography and echocardiography, genetics, upon detection of left ventricle myocardial hypertrophy with a maximum wall thickness of > 15 mm without dilatation of its cavity in the absence of other heart diseases. Hypertensive heart was diagnosed in patients with left ventricle myocardial hypertrophy > 12 mm due to hypertension. Hypertonic disease was detected according to the data of 24 hour blood pressure monitoring when systolic blood pressure > 135 mm Hg was recorded during wakefulness, diastolic > 85 mm Hg. The patients of both groups were comparable in terms of gender and age. Left ventricle myocardial mass index, interventricular septum thickness in diastole in patients with hypertrophic cardiomyopathy significantly exceeded those in patients with hypertensive heart. The thickness of the posterior wall of the left ventricle was almost the same in both groups. The maximum pressure gradient in hypertrophic cardiomyopathy at a load of 9 to 22 mm Hg. According to blood pressure monitoring data, arterial hypertension was detected in 65% of patients with hypertrophic cardiomyopathy. The degree of arterial hypertension was higher in patients with hypertensive heart. Exercise tolerance in patients with hypertension was higher than 111.0 ± 22.2. The maximum systolic blood pressure at the peak of physical activity in hypertrophic cardiomyopathy was significantly lower than in hypertensive heart 159.6 ± 21.1 and 196 ± 7.9 mmHg. Dyspnea as a reason for discontinuation of the test was more often observed in hypertrophic cardiomyopathy, 39% and 5%. In 26% of patients with hypertrophic cardiomyopathy, frequent ventricular extrasystole occurred at the height of the load, and no rhythm disturbances were recorded in patients with hypertensive heart. Conclusion: According to echocardiography data, there was no significant difference; systolic blood pressure at the height of the load in patients with hypertensive heart was significantly higher. Despite the above differences between patients with hypertrophic cardiomyopathy and hypertensive heart, it is not possible to single out an absolute sign that allows for a differential diagnosis. Important is the history of the disease, complaints and genetic analysis to identify mutations in hypertrophic cardiomyopathy.

N-[2-(5-metoksi-1H-indol-3-il)]acetamid može da koriguje arterijsku hipertenziju kod ljudi koji imaju problema sa spavanjem

Introduction. Sleep disturbance is a frequent complaint of patients suffering from arterial hypertension (AH) for a long time. A hidden and uncontrolled increase in blood pressure (BP) makes the course of physiological processes more difficult, disrupts the regulation of biological rhythms, and increases the risk of cardiovascular complications even with a short duration of AH. At the same time, chronic sleep disorders contribute to the development of hypertension, defining the role of a new socially significant risk factor. An important role in the pathogenesis of insomnia is played by a deficiency in melatonin (MT) synthesis, which negatively affects the cardiovascular system (CVS). Aim. The aim of the paper was to study the features of central and vascular hemodynamics in patients with the 1st degree AH and to evaluate the clinical effectiveness of antihypertensive therapy with synthetic analog of prolonged-release MT at the onset of the disease. Methods. Instrumental examination included registration of an electrocardiogram, office measurement of blood pressure with an automatic tonometer, non-invasive automatic blood pressure monitoring for 24 hours. The severity of insomnia was assessed by somnological questionnaires. Representatives of the 1st group (n = 34) took monotherapy with the ACE inhibitor ramipril, participants of the 2nd group (n = 33) took the ACE inhibitor ramipril in combination with a synthetic analogue of melatonin. Results. The results of a randomized open prospective study including 78 participants reveal the activity of the renin-angiotensin-aldosterone system (RAAS), hypersympathicotonia at night and desynchronosis due to a possible deficiency in the MT secretion. Pharmacological antihypertensive therapy with the addition of prolonged release MT analog was accompanied by a significant improvement in the clinical condition of hypertensive patients. Positive dynamics of indicators of systemic hemodynamics and functional arterial parameters of stiffness was noted. Conclusion. The article describes the probable benefits of melatonin as part of combination antihypertensive therapy in patients with early-stage hypertension and insomnia. Additional introduction of MT at the onset of the AN as a physiological regulator of circadian biological rhythms is substantiated.

Potentials for patients with severe arterial hypertension, by using antihypertensive pharmacotherapy combined with ozone therapy and nasal laser therapy.

Background: More people die each year from cardiovascular diseases than from any other cause. Arterial hypertension (AH) is a particularly important public health issue in Mongolia which has one of the highest mortality rates from hemorrhagic stroke in the world. Antihypertensive pharmacological therapy combined by other non-medication therapy is well-studied in patients with mild and moderate AH. However, studies that have investigated combination of low intensity laser irradiation and ozone therapy in patients with severe AH are lacking. The objective of the present work was to develop methods using low intensity laser irradiation therapy (LLLT) combined with major autohemotherapy (MAH) for the patients presenting with AH. 
 Studies have shown that LLLT is capable of inducing a photobiological response within the cells which modifies the micro and macrovascular response; this accompanies evidence showing the systemic effects even using in nasal laser irradiation (NLI). 
 Oxygen-ozone therapy exerts a positive effect on the platelet aggregation, cell remodeling, cytoskeletal elements organization and mitochondria structure. Due to O2-O3 therapy is an effective method in hypertension, and it diminishes the hypoxia state of various tissues. 
 In recent years, scientists have made great progress in the area of pharmacotherapy for patients with AH. Drugs help to achieve the target level of arterial blood pressure, particularly in patients with mild and moderate AH. With a higher degree of AH (severe arterial hypertension – the 3rd degree of arterial hypertension) the effectiveness of pharmacological therapy decreases and to achieve the target level of arterial blood pressure it is necessary to use a combination of all major groups of antihypertensive medicines.
 
 Method and Result: The study was held at Wellness Med Hospital Mongolia since the beginning of 2021 until the end of year. The study included a total of 60 patients of any age (63% of men and 37% of women) having AH associated with coronary heart disease and abnormal blood lipid spectrum. Initially, clinical-instrumental and laboratory examination, blood pressure registration and daily arterial blood pressure monitoring were carried out. Suitable drugs were selected for all the patients. 3 months after starting drug treatment the patients were divided in 2 groups each comprising 30 patients matched for age, sex, severity of clinical conditions, and character. The patients of the first group were prescribed combination with NLI and ozone therapy (MAH) in addition to drugs. For ozone therapy used Ozomed smartline ozone generator by Hansler Medical, Germany. The total dose of ozone to be given at each session will vary according to the general condition of the patient. Intervals from daily to weekly and twice a week. Ten to twelve treatments are considered as one course of treatment. Also, as cycles to be given once or more times per year. It may vary from less than 1000 µg to 3000 µg. This procedure is in line with the Madrid Declaration (ISCO3/QAU/01/03). The ozone concentration in the O2-O3 gas mixture were between 20 µg/ml to 35 µg/ml. The volume of blood to use varies between 50 mL and 100 ml. For NLI therapy we used Semiconductor laser Therapeutic apparatus Model W-001 by Fithope, China. The laser watch with nasal laser irradiation with 650nm (5mW) of lights. Used this equipment same day with Ozone therapy for about 30-40 minutes each time. If AH was higher used the laser therapy longer time. 
 The second group of patients continued receiving drugs alone. 3 months later, average daily blood pressure (BP), systolic BP and diastolic BP were compared in both groups. Three months after both groups demonstrated a significant decrease in SBP and DBP, but these indicators remained higher than normal and did not reach the target level. Three months after the inclusion of MAH+NLI in the comprehensive treatment, the first group demonstrated a significant decrease in BP (systolic and diastolic), not only in comparison with the initial data, but also with the data observed three months after PT. After 6 months SBP and DBP in the first group were significantly lower compared with those of patients in the second group. The inclusion of MAH+NLI in addition to multicomponent antihypertensive drugs is a promising treatment option for severe AH. 
 
 Discussion: Drug therapy is not sufficient for the elimination of cellular-tissue and microcirculatory disorders in case of severe AH, it should be advisable to include MAH+NLI into the multicomponent treatment, and positive changes in the indicators of the 1st group of patients after the inclusion of MAH+NLI are suggestive of it. 
 The oxygen-ozone therapy and LLLT seem to have no adverse events or side effects. Moreover, it is very cost-effective, as standard treatment costs can be reduced by 25% also.

EFFECTIVENESS OF ADDITION OF METFORMIN TO STATIN THERAPY FOR PRODIABETOGENIC CHANGES CORRECTION IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY

The aim: to study the effectiveness of adding metformin to statin therapy to correct prodiabetogenic changes in patients with arterial hypertension (AH) and abdominal obesity (AO). Materials and methods. We examined 65 patients with 2-3 degrees of AH in combination with AO of I-II degrees, atherogenic dyslipidemia and insulin resistance (IR) aged 47-59 yrs: group 1 – 35 patients who were treated with statins (atorvastatin) against the background of standard combinations of antihypertensive drugs, metformin was added; group 2 – 30 patients who did not receive metformin. The examination included generally accepted methods. Statistical data analysis was carried out using standard methods using Microsoft Excel 7.0 and SPSS 19.0 application packages. Results. The addition of metformin to atorvastatin against the background of standard antihypertensive therapy and recommendations for the normalization of lifestyle allowed a significant reduction in IR and the incidence of prediabetes in hypertensive patients with AO after 16 weeks of treatment. In patients who did not receive metformin, there was no decrease in these indicators. In the group of patients who used metformin, a significantly higher frequency of achieving target blood pressure levels was revealed than in the group of patients in whom this drug was not used. Conclusions. The effectiveness of the use of the insulin sensitizer metformin for the correction of pro-diabetogenic changes associated with statin therapy in patients with AH, which occurs against the background of AO, atherogenic dyslipidemia, and IR, has been shown.

Features of the clinical course of arterial hypertension in alien residents of Western Siberia with the establishment of patterns of metabolic changes

Metabolic syndrome is considered as a polyetiological disease that makes a significant contribution to the increase in mortality from vascular accidents. The combination of metabolic syndrome and arterial hypertension is a complex pathogenetic duet, the diagnosis and treatment of which continues to be actively discussed.The aim of the study was to study the metabolic syndrome in patients with arterial hypertension permanently residing in the Far North, the frequency of occurrence of the main variants of the metabolic syndrome depending on the degree of hypertension in comparison between men and women.Material and methods. The study was conducted in the Khanty-Mansiysk Autonomous Okrug – YUGRA, the study period: September 2017 – November 2018. The study involved 205 patients permanently residing in the Far North: men – 82 people (40 %), women – 123 people (60 %). By age, patients are represented by two groups: group 1 – 38–43 years old (n = 98), of which 46 men (46.9 %), women – 52 people (53.1 %); group 2 – 44–50 years old (n = 107), of which 46 men (43 %), women – 61 people (57 %). By degree of AH: 1st degree AH (n = 38), including 14 men (36.84 %), 24 women (61.16 %); 2nd degree AH (n = 115), men – 53 people (46.1 %), women – 62 people (53.9 %); 3 degree AH (n = 52), men – 21 people (40.38 %), women – 31 people (59.62 %).Results – statistically significant variants of the metabolic syndrome were identified for patients with arterial hypertension living in harsh climatic and geographical conditions, an analysis of these variants was carried out in comparison between men and women, depending on the age and degree of arterial hypertension.

Особливості змін деяких показників системи гемостазу у хворих на хронічне легеневе серце бронхо-легеневого генезу в стадії декомпенсації та в умовах його коморбідності з гіпертонічною хворобою

The purpose of the study is to research and analyze the peculiarities of some indices of hemostasis system changes and define their possible role in the formation of a vascular lesion in the patients with chronic cor pulmolale of broncho-pulmonary genesis during decompensating stage and in conditions of its comorbidity with hypertensive disease. Materials and methods. The retrospective study and analysis of indices of hemostasis system (platelet count, thrombin time, prothrombin time, antithrombin - III, plasma tolerance to heparin, plasmin lysis, fibrinogen, soluble fibrin) in 96 patients with chronic obstructive pulmonary disease and decompensated chronic cor pulmolale with signs of circulatory insufficiency of the 2nd stage (female – 34, male – 62, mean age – 57.5±1.2) were carried out. 32 patients with the isolated pathology formed the comparative group whereas 64 patients with the comorbid hypertensive disease of the 2nd stage, of the 2nd degree of arterial hypertension, built the main group. The obtained research results of the patients of the main and comparative groups were compared both in groups and with the indices of practically healthy individuals (n = 15) of the same gender and age. Results and discussion. The obtained results indicated to a certain extent the presence of a significant increase of coagulation potential, an increase of fibrinolysis system activity and the disorder of “external way” of blood coagulation. It doesn’t exclude the change of procoagulant factors content/activity and can be considered as a result of their intensive using. The foregoing changes were the most significant (it concerns all indices) in the patients with chronic cor pulmolale and comorbid hypertensive disease. Our results confirm to a certain extent the following idea of scientists. Hypercoagulation and activation of the platelets together with the chronic systemic inflammation and oxidative stress are general pathogenic mechanisms of chronic obstructive pulmonary disease and cardiovascular diseases, particularly of the arterial hypertension. It is reflected clearly as a very important constituent part of “mutual burden” syndrome in case of a comorbid course. Conclusion. The peculiarity of the hemostasis system changes in patients with decompensated chronic cor pulmolale of broncho-pulmonary genesis is an increase of its coagulation potential; the most significant its manifestations with activation and simultaneous suppression of fibrinolytic activity are typical of the patients with the comorbid hypertensive disease (it can be considered as manifestations of the chronic disseminated intervascular coagulation syndrome). The increased coagulation potential of a hemostasis system in the patients with decompensated chronic cor pulmolale of broncho-pumonary genesis should be considered as a marker of the risk of the thrombogenic vascular complications development; it is necessary to carry out the periodical monitoring of its indices with the purpose of prevention of the development of cardiovascular events both in the isolated course of chronic cor pulmolale and in the conditions of comorbidity with hypertensive disease