Effects Of Antihypertensive Therapy Research Articles

#1182 Arterial hypertension and chronic obstructive pulmonary disease—problems of choice of therapy

Abstract Background and Aims The development of hypertension in COPD is based on the early formation of endothelial dysfunction in the small and large circulatory circles, increased sympathetic activity with an imbalance in the synthesis of catecholamines, a violation of the role of the lungs in the metabolism of vasoactive substances, oxidative stress, chronic systemic inflammation, an imbalance in the renin-angiotensin-aldosterone system (RAAS). There are few studies confirming the role of RAAS components in the pathogenesis of cardiovascular changes in patients COPD. The activity of angiotensin converting enzyme (ACE) increases with hypoxia, which may play an important role in increasing the degree of systemic hypertension. An increase in the function of the RAAS is possible both under the direct influence of hypoxia and indirectly through activation of the sympathoadrenal system. To evaluate the efficacy and tolerability of the angiotensin II receptor antagonist valsartan (Nortivan) at a dose 80-160 mg per day in patients with hypertension of 1-2 degrees and COPD of stage II-IV. Method The study design is a local, open, incomparable study on the efficacy and safety of the drug Nortivan in patients with hypertension in combination with COPD. We examined 18 patients with stage II-IV in remission, suffering from grade I and II hypertension, determined in accordance with the generally accepted classification of blood pressure levels (VNOK, 2010). Results The criteria for exclusion from the study were the presence in patients of complications of hypertension, coronary heart disease, decompensated chronic pulmonary heart, endocrine diseases requiring drug correction, kidney pathology, chronic heart failure, oral steroid therapy. 10 days in the last 6 months before inclusion in the study, oncological diseases and any other conditions that could interfere with the interpretation and evaluation of the results of the study. Patients who had not previously received antihypertensive treatment were included in the study immediately, and the rest underwent a washing period for 2 weeks. Patients received Nortivan as antihypertensive therapy for 24 weeks. The effectiveness of therapy was controlled by daily monitoring blood pressure. The choice of quality criteria for the effectiveness of therapy parameters SMAD is associated with literature data and own observations on the prevalence of diurnal blood pressure profiles in patients with hypertension and COPD with no decrease or increase in blood pressure at night, when office blood pressure figures are to a lesser extent reflect the effectiveness of antihypertensive therapy. The initial dosage was 80 mg/day. With insufficient hypotensive effect, the dose of the drug was doubled at the 4th week of treatment. The basic COPD therapy did not change throughout the study period and included anticholinergic drugs (ipratropium bromide, tiotropium bromide), beta2-adrenomimetic (fe-noterol) or a combination thereof. Initially and after 24 weeks of treatment, a complete laboratory examination was performed: a clinical blood test, a biochemical blood test. The thickness of the intima-media complex of the carotid arteries and ECG was also studied. The criterion The safety of the therapy was assessed by the indicators of respiratory function, daily pulse oximetry. Conclusion The use of the drug Nortivan has shown high efficacy and safety in patients Grade I–II hypertension in combination with stage II-IV COPD. A statistically and clinically significant normalization of SMAD indicators with correction of pathological types of daily curves due to a decrease in the number of patients with an increase in or the absence of a decrease in blood pressure during the night period. The safety of using the drug in the clinical group with bronchial obstruction syndrome was confirmed by the dynamics of ventilation indicators according to spirometry and the results of daily pulse oximetry, which showed the absence of exacerbation of hypoxia during therapy.

АРТЕРИАЛЬНАЯ ГИПЕРТЕНЗИЯ У ПАЦИЕНТОВ СТАРШИХ ВОЗРАСТНЫХ ГРУПП: КЛИНИКО-ПАТОГЕНЕТИЧЕСКИЕ ОСОБЕННОСТИ, ВЫБОР ОПТИМАЛЬНОЙ ГИПОТЕНЗИВНОЙ ТЕРАПИИ

Arterial hypertension is one of the main risk factors for the development of complications of diseases of the cardiovascular system, the prevalence of which increases with age. The mechanisms of increasing blood pressure in old age are different, the most significant of them is an increase in the stiffness of the artery wall. Isolated systolic arterial hypertension holds a distinct place in elderly and senile patients. The treatment of hypertension in patients of older age groups is much more difficult than in young and middleaged patients, due to the more frequent development of side effects of antihypertensive therapy, as well as the lack of sufficient studies conducted in this category of patients.

Changing Concepts About Optimal Target Blood Pressure and the Therapeutic Advantages of Azilsartan for Achieving it

The article discusses current issues of the treatment of arterial hypertension. According to presented data, so-called therapeutic nihilism is becoming one of the main barriers to achieving target blood pressure (BP). This nihilism is that despite evidence of the effectiveness of achieving lower BP values, practitioners do not intensify antihypertensive therapy sufficiently to achieve such values. The article specially addresses new criteria for the effectiveness of antihypertensive therapy, which reflect the therapy sustainability. The most commonly used indicator is the duration of the period, during which systolic BP remains in the therapeutic range. The prognostic significance of such indicators is discussed. In these conditions, it is very important to use the most effective antihypertensive drugs for initial antihypertensive therapy, including as a part of combination therapy. This tactic provides more frequent achievement of BP goals without the need for dose adjustment. In this regard, a systematic review was performed, which included sufficiently large randomized studies of the antihypertensive effectiveness of azilsartan medoxomil. This systematic review will provide comprehensive information on a possible role of using the angiotensin II receptor blocker azilsartan as a basic drug for the treatment of a wide range of patients with high BP. Most of the studies included in the systematic review assessed the effectiveness of combination therapy including azilsartan.

Assessment of Left Ventricular Hypertrophy Incidence and Antihypertensive Therapy Efficacy in Hypertensive Patients

Objectives: This study aimed to assess the incidence of left ventricular hypertrophy (LVH) in hypertensive individuals in Karachi, Pakistan, and to evaluate the effectiveness of antihypertensive therapy in preventing LVH. Methodology: A total of 200 hypertensive patients were referred from the Cardiac OPD to the Radiology department of Medicare Cardiac and General Hospital, Karachi, for echocardiography. Echocardiographic measurements of cardiac chambers were performed by expert echocardiographers, and left ventricular mass (LVM) was calculated using the formula recommended by the American Society of Echocardiography. Results: Among the hypertensive patients, 100 had uncontrolled blood pressure (≥140/90 mmHg) while 100 had controlled blood pressure (≤130/80 mmHg). The female-to-male ratio was 3:1, with ages ranging from 21 to 80 years. Patients with uncontrolled hypertension exhibited a higher mean body mass index (29 ± 5 kg/m2) and significantly elevated LVM (mean 154 ± 4 g/m2). Angiotensin receptor inhibitors were the most commonly prescribed and effective antihypertensive agents, either as monotherapy or in combination therapy (60%), demonstrating utility in preventing LVH. Conclusion: This study highlights a high incidence of LVH in uncontrolled hypertensive individuals compared to those with controlled hypertension. Transthoracic echocardiography emerged as a highly valuable, non-invasive tool for measuring LVM and assessing the effectiveness of antihypertensive therapy.

Влияние генетического полиморфизма генов, кодирующих мишень действия, на эффективность антигипертензивной терапии

Arterial hypertension is one of the main modifiable factors of cardiovascular events, which affects an increasing number of people around the world. In addition to the low adherence of patients to treatment, the wrong choice of medications, the presence of concomitant diseases and an unhealthy lifestyle, the effectiveness of antihypertensive therapy may be associated with genetic polymorphism. Genetic polymorphisms can influence through genes involved in the pathogenesis of hypertension, which are able to modify the effects of drugs; modifications in the mechanisms of interaction of drugs with genes; polymorphisms in metabolic enzymes; genes associated with drug carriers, and genes involved in complex cascades and metabolic reactions. The article reviews the results of studies of the relationship of polymorphic alleles of genes responsible for the pharmacodynamic response to therapy with angiotensin converting enzyme inhibitors and angiotensin II receptor blockers as the main drugs for the treatment of hypertension according to clinical guidelines for the treatment of hypertension in adults.

Fibroblasts under pressure: cardiac fibroblast responses to hypertension and antihypertensive therapies.

Approximately 50% of Americans have hypertension, which significantly increases the risk of heart failure. In response to increased peripheral resistance in hypertension, intensified mechanical stretch in the myocardium induces cardiomyocyte hypertrophy and fibroblast activation to withstand increased pressure overload. This changes the structure and function of the heart, leading to pathological cardiac remodeling and eventual progression to heart failure. In the presence of hypertensive stimuli, cardiac fibroblasts activate and differentiate to myofibroblast phenotype capable of enhanced extracellular matrix secretion in coordination with other cell types, mainly cardiomyocytes. Both systemic and local renin-angiotensin-aldosterone system activation lead to increased angiotensin II stimulation of fibroblasts. Angiotensin II directly activates fibrotic signaling such as transforming growth factor β/SMAD and mitogen-activated protein kinase (MAPK) signaling to produce extracellular matrix comprised of collagens and matricellular proteins. With the advent of single-cell RNA sequencing techniques, heterogeneity in fibroblast populations has been identified in the left ventricle in models of hypertension and pressure overload. The various clusters of fibroblasts reveal a range of phenotypes and activation states. Select antihypertensive therapies have been shown to be effective in limiting fibrosis, with some having direct actions on cardiac fibroblasts. The present review focuses on the fibroblast-specific changes that occur in response to hypertension and pressure overload, the knowledge gained from single-cell analyses, and the effect of antihypertensive therapies. Understanding the dynamics of hypertensive fibroblast populations and their similarities and differences by sex is crucial for the advent of new targets and personalized medicine.

Modern ideas about the consequences of sympathoadrenal hyperactivation in hypertensive patients with metabolic disorders: modulation possibilities

The prevalence of hypertension (HTN) in the Russian Federation and the world continues to grow. This is largely due to the epidemic of obesity and related conditions — metabolic syndrome and type 2 diabetes. The most common and proven hypothesis of the relationship between hypertension and obesity is the activation of the sympathetic nervous system. However, modern research shows that the consequences of sympathetic hyperactivation are not limited only to hemodynamic effects, but extend to many organs and systems. Long-term sympathetic hyperactivation can lead to insulin resistance and type 2 diabetes. Neurotransmitters affect fat cells by increasing lipolysis and leading to increased fatty acid release, the liver by increasing gluconeogenesis, and pancreatic β-cells by decreasing insulin secretion. The sympathetic nervous system plays an important role in energy management by regulating metabolic rate. Obese individuals have significantly less pronounced postprandial thermogenesis, despite a higher insulin response, while the hemodynamic response to isometric or heterometric exercise is reduced. Chronic stress serves not only as a trigger for behavioral disorders, but also directly leads to various physiological disorders, including through sympathetic activation. However, the choice of antihypertensive agents affecting the sympathetic activity in patients with obesity and metabolic disorders is very limited. According to current guidelines, β-blockers are not the drugs of choice in patients with uncomplicated HTN, since it has a weaker evidence base compared to other classes of drugs and have metabolic and other side effects. Therefore, selective I1-imidazoline receptor agonists, and in particular, moxonidine may be the drugs of choice in this category of patients. Moxonidine in combination therapy of patients with HTN and metabolic disorders, including metabolic disorders in menopause, as well as with a physiological estrogen decrease, significantly improves the effectiveness of antihypertensive therapy and increases the achievement of target blood pressure. In addition, its metabolic effects improve prognosis of such patients.

Features and Comparative Characteristics of Fucosylated Glycans Expression in Endothelial Glycocalyx of Placental Terminal Villi in Patients with Preeclampsia Treated with Different Antihypertensive Regimens.

Antihypertensive therapy is an essential part of management of patients with preeclampsia (PE). Methyldopa (Dopegyt®) and nifedipine (Cordaflex®) are basic medications of therapy since they stabilize blood pressure without affecting the fetus. Their effect on the endothelium of placental vessels has not yet been studied. In this study, we analyzed the effect of antihypertensive therapy on the expression of fucosylated glycans in fetal capillaries of placental terminal villi in patients with early-onset PE (EOPE) and late-onset PE (LOPE), and determined correlation between their expression and mother's hemodynamic parameters, fetoplacental system, factors reflecting inflammatory response, and destructive processes in the endothelial glycocalyx (eGC). A total of 76 women were enrolled in the study: the comparison group consisted of 15 women with healthy pregnancy, and the main group comprised 61 women with early-onset and late-onset PE, who received one-component or two-component antihypertensive therapy. Hemodynamic status was assessed by daily blood pressure monitoring, dopplerometry of maternal placental and fetoplacental blood flows, and the levels of IL-18, IL-6, TNFα, galectin-3, endocan-1, syndecan-1, and hyaluronan in the blood of the mother. Expression of fucosylated glycans was assessed by staining placental sections with AAL, UEA-I, LTL lectins, and anti-LeY MAbs. It was found that (i) expression patterns of fucosylated glycans in eGC capillaries of placental terminal villi in EOPE and LOPE are characterized by predominant expression of structures with a type 2 core and have a similar pattern of quantitative changes, which seems to be due to the impact of one-component and two-component antihypertensive therapy on their expression; (ii) correlation patterns indicate interrelated changes in the molecular composition of eGC fucoglycans and indicators reflecting changes in maternal hemodynamics, fetoplacental hemodynamics, and humoral factors associated with eGC damage. The presented study is the first to demonstrate the features of placental eGC in women with PE treated with antihypertensive therapy. This study also considers placental fucoglycans as a functional part of the eGC, which affects hemodynamics in the mother-placenta-fetus system.

The Effect of Antihypertensive Therapy on Skeletal Muscle Mass and Bone Mineral Density in Patients With End-Stage Kidney Disease

ObjectiveSarcopenia and osteoporosis substantially influence health and lifespan. However, the variables affecting skeletal muscle mass (SMM) or bone mineral density (BMD) remain unknown. Design and MethodsFrom August 1, 2018, to July 31, 2019, we conducted a single-center, observational cohort study with 291 Japanese adult patients on maintenance hemodialysis due to end-stage kidney disease (ESKD), who had their femoral neck BMD measured using dual-energy X-ray absorptiometry. After 1-year follow-up, we measured annual changes of BMD (ΔBMD) and SMM (ΔSMM), which was calculated through a modified creatinine index (mg/kg/day) using age, sex, serum creatinine, and single-pooled Kt/V for urea. The factors associated with ΔSMM/ΔBMD or progressive loss of SMM/BMD, defined as ΔSMM/ΔBMD <0 per year respectively, were analyzed with multivariable, linear regression or logistic regression models. ResultsThe median age of the patients was 66 years and 33% were female. Dialysis vintage and β-blocker-use were inversely correlated to ΔSMM. In comparison to nonusers, β-blockers users had 2.5-fold-higher SMM loss odd ratios [95% confidence interval (CI), 1.3–4.8]. The risk for SMM loss caused by β-blockers was not increased in users of renin-angiotensin system inhibitors (RASis). The ΔBMD was negatively correlated to the usage of calcium channel blockers (CCBs). The risk of developing osteosarcopenia, which was defined as annual loss of both SMM and BMD, increased in CCBs users. ConclusionThe use of β-blockers is associated with an elevated risk of developing sarcopenia, whereas RASis may minimize this effect in patients with ESKD. The CCB therapy was associated with a faster decline of BMD.

L-Arginine-eNOS-NO Functional System in Brain Damage and Cognitive Impairments in Cerebral Small Vessel Disease.

Cerebral small vessel disease (CSVD) is a significant cause of cognitive impairment (CI), disability, and mortality. The insufficient effectiveness of antihypertensive therapy in curbing the disease justifies the search for potential targets for modifying therapy and indicators supporting its use. Using a laser-assisted optical rotational cell analyzer (LORRCA, Mechatronics, The Netherlands), the rheological properties and deformability of erythrocytes before and after incubation with 10 μmol/L of L-arginine, the nitric oxide (NO) donor, blood-brain barrier (BBB) permeability assessed by dynamic contrast-enhanced MRI, clinical, and MRI signs were studied in 73 patients with CSVD (48 women, mean age 60.1 ± 6.5 years). The control group consisted of 19 volunteers (14 women (73.7%), mean age 56.9 ± 6.4 years). The erythrocyte disaggregation rate (y-dis) after incubation with L-arginine showed better performance than other rheological characteristics in differentiating patients with reduced NO bioavailability/NO deficiency by its threshold values. Patients with y-dis > 113 s-1 had more severe CI, arterial hypertension, white matter lesions, and increased BBB permeability in grey matter and normal-appearing white matter (NAWM). A test to assess changes in the erythrocyte disaggregation rate after incubation with L-arginine can be used to identify patients with impaired NO bioavailability. L-arginine may be part of a therapeutic strategy for CSVD with CI.

Evaluation of office and ambulatory blood pressure in the practice of a primary care physician. Guidelines

The guidelines contain data on modern approaches to blood pressure assessment, the basic rules for its measurement, data interpretation, making conclusion, including with combined evaluation of clinical and ambulatory measurement data. Information on the diagnosis of hypertension, evaluation of the effectiveness of antihypertensive therapy using clinical and ambulatory blood pressure measurement, both with their separate and combined use, is reflected. Aspects related to the measurement of blood pressure when standing and the diagnosis of hypotension are briefly covered. The guidelines are intended for primary care physicians (internists, general practitioners, cardiologists, neurologists and other specialists), students of medical universities and postgraduate education institutions.

Hemodynamic effects of antihypertensive therapy in patients with hypertension and rheumatoid arthritis comorbidity

Hemodynamic effects of antihypertensive therapy in patients with hypertension and rheumatoid arthritis comorbidity

Gender features of left ventricular myocardial remodeling in patients with arterial hypertension and anxiety and depressive disorders and possibilities of complex antihypertensive and psychocorrective pharmacotherapy

Relevance. Anxiety-depressive disorders are a frequent companion of arterial hypertension (AH). It is known about the deterioration of the prognosis in patients with a combination of these conditions. At the same time, it is unclear whether complex antihypertensive therapy (AHT) with the inclusion of an antidepressant will improve the control of hypertension, slow down target organ damage, and whether it will be equally effective in men and women.The aim of the study – identify gender characteristics of the structural and functional state of the myocardium of the left ventricle (LV) and the effect of antihypertensive therapy with and without the inclusion of an antidepressant on left ventricular myocardial remodeling in patients with AH and ADD, taking into account the gender of the patient.Materials and methods. The study included 182 patients: 62 with AH (32 men and 30 women) and 120 – with AH and anxiety-depressive disorders (30 men – group 1, 30 women – group 2). Patients with AH and anxiety-depressive disorders were randomized into 2 subgroups (A and B). Patients of subgroup A received a fixed combination of an angiotensin II receptor blocker and a diuretic, a beta-blocker and an antidepressant, patients of subgroup B received similar antihypertensive therapy without including an antidepressant. All patients at inclusion in the study and after 24 weeks underwent a general clinical examination, office measurement of blood pressure (also after 4,8,12 weeks), 24-hour blood pressure monitoring, echocardiography, testing on the HADS, CES-D scales, and a psychiatrist's consultation.Results. Men and women with AH and anxiety-depressive disorders, the negative changes in the main parameters of the LV structural and functional state were more significant than in patients with a normal psychoemotional status. At the same time, in women with anxiety-depressive disorders, LV hypertrophy (LVH) was more pronounced than in men. Target levels of blood pressure were achieved faster in the groups treated with antidepressant, however, intergroup differences reached the level of statistical significance only in women. Complex pharmacotherapy led to a more significant improvement in LV structural and functional state than traditional AHT, especially in women. The use of an antidepressant led to a reduction in anxiety and depressive symptoms, which was not observed in patients only with AHT groups.Conclusions. Patients with AH and anxiety-depressive disorders develop more pronounced remodeling of the LV myocardium than patients with AH with a normal psychoemotional status, especially in women. The combined use of sertraline and antihypertensive drugs contributes to a more rapid achievement target levels of blood pressure, a significant improvement in LV structural and functional state, which is more pronounced in women than in men. It is also important to normalize the psycho-emotional status against the background of an integrated approach to the pharmacotherapy of patients with AH and anxiety-depressive disorders.

Effect of Nitrendipine and Amlodipine on Cognitive Functions of Patients with Arterial Hypertension

Background: Arterial hypertension (AH) is one of the main factors causing a high risk of cardiovascular complications and mortality. The existence of a relationship between high blood pressure (BP) and the risk of developing central nervous system pathology, primarily stroke, and cognitive impairment, has been shown. The purpose of this study was a comparative assessment of the effect of 12-month antihypertensive therapy (AHT) with the inclusion of nitrendipine (NIT) or amlodipine (AML) on cognitive functions (CF) in hypertensive patients. Methods and Results: The study included 111 patients of both genders aged 30-75 years with AH Grades 1-3 (ESC/ESH, 2018). All patients underwent the following examinations: assessment of traditional risk factors, physical examination, clinical and biochemical laboratory methods, 12-lead ECG, echocardiography, pulse contour analysis, and 24-hour ambulatory blood pressure monitoring, neuropsychological tests (Mini-Cog test, Montreal Cognitive Assessment (MoCA) test, Hospital Anxiety and Depression Scale (HADS), and self-assessment questionnaire for memory, attention, thinking, ability to cope with one's affairs, and ability to make decisions). After the screening stage, all patients were discontinued from previous therapy and assigned to the 2 regimes of AHT. Group 1 included 58 AH patients who received NIT as monotherapy or as part of combination AHT; Group 2 included 53 patients who received AML as monotherapy or as part of combination AHT. Correlation analysis between the parameters of DBPP and the MoCA test revealed a weak but statistically significant negative correlation between the total MoCA score and the average 24-h SBP (rs=-0.33, P=0.015). In addition, there was a weak but statistically significant negative correlation between the total MoCA score and the daytime SBP variability and daytime DBP variability (rs=-0.40 and rs=-0.35, respectively, P=0.000 in both cases). A weak but statistically significant negative correlation was found between the total Mini-Cog score and PWV and PPc (rs=-0.24, P=0.01 and rs=-0.27, P=0.007, respectively). Analysis of the office BP indicators showed high antihypertensive efficacy of 12-month therapy in both groups, regardless of the therapy regimens. A comparative analysis of the effect of AHT with the inclusion of NIT or AML on CF in AH patients showed the advantages of combined AHT with the inclusion of NIT. Amlodipine treatment did not significantly affect any test score. Thus, in Group 1, after 12 months of therapy, there was an increase in the total Mini-Cog score from 3.8±1.08 points to 4.55±0.75 points (P&lt;0.001), while in Group 2, there was a non-significant decrease in this score from 4.26±0.98 points to 3.92±0.95 points (P&gt;0.05). There was also an increase in the total MoCA score in Group 1 from 23.3±2.8 points to 25.08±2.6 points (P&lt;0.001), while in Group 2, there was a non-significant decrease in this score from 24.06±2.73 points to 23.07±2.7 points (P&gt;0.05). It should be noted that only in Group 1 did we find a significant improvement in CF, such as abstraction, delayed recall, memory, and attention, as well as a significant improvement in work-coping and decision-making. In Group 1, the HADS Depression score decreased from 4.6±3.7 points to 3.32±2.95 points (P&lt;0.05), HADS Anxiety score decreased from 7.01±5.37 points to 4.95±3.75 points (P&lt;0.02). At the same time, in Group 2, in contrast, the HADS Depression score and the HADS Anxiety score did not significantly change. Conclusion: A weak but statistically significant negative correlation was found between the total MoCA score and the daytime SBP/DBP variability in AH patients. A weak but statistically significant negative correlation was found between the total Mini-Cog score and pulse wave velocity and central pulse pressure. A pronounced antihypertensive efficacy of 12-month combination therapy was noted, with the inclusion of both NIT and AML. The NIT-based treatment contributed to a significant increase in the total Mini-Cog score and the total MoCA score and a substantial improvement in CF. Abstraction, delayed recall, memory, attention, work-coping, and decision-making significantly improved, compared to AML-based treatment. The presented data allow a differentiated approach to tactics for treating AH patients with severe cognitive impairment.

ANTIHYPERTENSIVE EFFICACY OF A STRATEGY FOR SWITCHING FROM FREE COMBINATIONS TO A FIXED TRIPLE COMBINATION AS ASSESSED BY VASCULAR STIFFNESS PARAMETERS

Objective: To evaluate the 24-hour blood pressure (BP) control and the effect of the triple fixed combination (TFC) amlodipine/indapamide/perindopril on the arterial stiffness parameters according to 24-hour blood pressure monitoring (ABPM) data in patients with uncontrolled hypertension (HTN). Design and method: The study involved 78 patients with insufficient BP control, against the background of previous combination therapy. All patients received TFC amlodipine/indapamide/perindopril. The patients were divided into three amlodipine/indapamide/perindopril therapy groups: 1-5/1.25/5mg, 2-5/2.5/10mg, 3-10/2.5/10mg. Control visits were after 4 weeks, 12 weeks, 24 weeks of therapy. At each visit, the achievement of the target BP level &lt;130/80mmHg was assessed, as well as the effect of therapy on the parameters of arterial stiffness (pulse wave velocity (PWVao), pulse pressure (PP), agumentation index (Aix), arterial stiffness index (ASI) and central aortic pressure parameters (systolic aortic pressure (SBPao), diastolic pressure in the aorta (DBPao), central pulse pressure (PPao)) according to ABPM. Results: When screening, AHT included 2 drugs - 12 (15.3%) patients, 3 or more - 66 (84.6%), free combinations of drugs 56 (71.8%), FC - 32.1%, respectively. Data analysis showed a decrease PWVao (11.39 ± 1.32 m/s vs 9.98 ± 0.91 m/s, p &lt; 0,05) as well as ASI (174 (138,253) vs 139 (107,196) mmHg; p &lt;0.001) and Aix -29,9(-41,12) vs - 33,7(-53, 9) p&lt;0,05. There was a statistically significant decrease in the parameters the central pressure in the aorta. In the analyzed group of patients, the initial blood pressure was 160.8 ± 10.3/91.5 ± 8.1 mm Hg, after 24 weeks the blood pressure decreased to 121.3 ± 3.5/73.6 ± 4.2mm Hg.st. (p &lt;0.001). According to ABPM data, daily BP significantly (p &lt;0.001) decreased from 153.9 ± 9.04/8.38 ± 9.18 to 120.3 ± 4.7/73.4 ± 4.7 mm Hg after 24 weeks of TFC therapy. Similar patterns were received for the night BP. Conclusions: Indicators of vascular stiffness, together with target BP figures, can serve as criteria for monitoring the quality of blood pressure and have been used to assess the effectiveness of antihypertensive therapy when switching patients to TFC amlodipine/indapamide/perindopril.

The dynamics of hypertension and renal function in CKD and non-CKD patients affected with COVID-19 – final results of BIRCOV trial

Introduction and aim. There is evidence in the literature about a change in the effectiveness of inhibitors of the renin-angiotensin system (iRAS) in people with COVID-19. Considering different mechanisms of pressure reduction by different iRAS groups, one can expect differences in people with COVID-19 receiving these drugs. The aim of angiotensin-converting enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB) and direct renin inhibitors (DRi) usage in COVID-19 (BIRCOV study) was to pinpoint clinical and laboratory differences in people with hypertension who received iRAS and suffered coronavirus infection. Material and methods. An open prospective trial of 108 patients was performed in subjects suffering from COVID-19 who have been receiving iRAS: ACEi, ARB or DRi as basic antihypertensive therapy. The disease follow-up was 12 and 24 weeks. A blood pressure (BP) measurement was performed the week before COVID-19 and up to 24 weeks from the disease onset. Subanalysis in patients with chronic kidney disease (CKD) was performed. Results. In patients with COVID-19, a change in the effectiveness of antihypertensive therapy depending on the type of drug in the iRAS group has been documented in the first 4 weeks from the onset of the disease. The use of ACEi had significantly increased the risk of severe hypotension, unlike ARBs that do not cause hypotension. The synchronous decline of estimated glomerular filtration rate (eGFR) and systolic BP was more pronounced in CKD patients followed by albuminuria incidence. The greatest decrease in eGFR was in people taking ACEi. Conclusion. People with grade 1-2 hypertension who are constantly receiving RAS inhibitors suffering from COVID-19 may develop hypotension with ACEi. COVID-19 leads to transient albuminuria and decreased glomerular filtration rate, which is especially dangerous for people with CKD 4-5.

PROTECTIVE EFFECTS OF CALCIUM CHANNEL BLOCKERS IN HYPERTENSIVE NON-VACCINATED PATIENTS WITH COVID-19

Objective: Analysis of the effects of antihypertensive therapy on the prognosis and outcome of hypertensive non-vaccinated patients with COVID-19. Design and method: The study included 90 hypertensive non-vaccinated patients who underwent cardiovascular assessment in 2019 and suffered from COVID-19 in 2020. The cardiovascular evaluation included laboratory, heart ultrasound, exercise stress test, and 24h Holter ECG. The aim of our study was to analyze the effects of clinical and demographic characteristics and antihypertensive therapy on the prognosis and outcome of hypertensive non-vaccinated patients with COVID-19. Data were obtained by completing a telephone-based questionnaire. All pts were divided into three groups according to the way of treatment – pts who were treated ambulatory (A group, 56 pts), pts who were hospitalized and required oxygen therapy (H group, 25 pts), and patients who died due to COVID-19 (D group, 9 pts). Results: Groups didn’t differ in the presence of dyslipidemia. Obesity was the most prevalent in the A group (A 30.4%, H 20%, and D 11.1%), and smoking status in the H group (H 48%, A 33.9%, and D 33.3%). Diabetes was highly present in the D group (D 44.4%, H 25%, and A 32%), coronary artery disease in the H group (H 52%, A 41%, and D 33.3%), as well as atrial fibrillation (H 32%, A 28.57%, D 22.22%). Complex heart arrhythmias on 24h Holter ECG were the most prevalent in the H group (H 50%, A 20%. D 19.44%), and pts from the H group had the worst strain tolerance on exercise stress test (H 5.62 ± 2.37min, A 5.86 ± 2.77, and D 6.84 ± 3.39). Groups didn’t differ in using beta-blockers, diuretics, angiotensin II receptor antagonists, or angiotensin-converting enzyme inhibitors. On the other hand, only 28.57% of pts from the D group were taking calcium channel blockers (CCBs), while this percentage was significantly higher in the H (75%) and in the A group (52%). Conclusions: Our study showed that CCBs had a protective effect on the prognosis and outcome in hypertensive non-vaccinated pts with COVID-19.

Maternal haemodynamics in Hypertensive Disorders of Pregnancy under antihypertensive therapy (HyperDiP): study protocol for a prospective observational case–control study

IntroductionHypertensive disorders of pregnancy (HDP) are associated with a high incidence of maternal and perinatal morbidity and mortality. HDP, in particular pre-eclampsia, have been determined as risk factors for future...

Features of the treatment of arterial hypertension in elderly patients

Arterial hypertension (AH) is one of the most common problems in the elderly and one of the most important cardiovascular risk factors. AH in the elderly has features with a high incidence of ISAH and is characterized by a high level of SBP and a low level of DBP, which creates certain problems for the safety of treatment. The need for antihypertensive therapy in elderly patients has received convincing evidence of the effectiveness of reducing mortality and cardiovascular complications. The purpose of this scientific review was to raise awareness of the problem of treating hypertension in elderly patients, including those with low DBP. The results of studies and meta-analyzes evaluating the efficacy and safety of standard and intensive SBP reduction in elderly patients, as well as the results of the effect of antihypertensive therapy on DBP levels, especially at baseline low DBP (&lt;70 mmHg), are presented. The studies identified the main groups of antihypertensive drugs that provide an effective and safe reduction in blood pressure in elderly patients, have a cardioprotective effect and do not adversely affect comorbidities. These include: diuretics of the thiazide-like group, calcium channel blockers, as well as additional indications and concomitant conditions – ACE inhibitors and antigotensin II receptor blockers. Several meta-analyses have shown the benefit of intensively lowering SBP &lt; 120 mmHg before the standard target level SBP &lt; 140 mmHg. in elderly patients as a lower risk of fatal and non-fatal cardiovascular events and overall mortality. Thus, the impact of intensive SBP reduction was beneficial in preventing 1 case of MACE (NNT = 38) and in preventing 1 case of total mortality (NNT = 85); while the rate of harm in the form of arterial hypotension was significantly high (NNH = 778). With regard to the effect on the level of DBP in elderly patients with hypertension or ISAH, an inverse relationship between DBP and adverse coronary events was revealed and a J-curve was described, confirmed in a number of studies (INVEST, ARIC, SPRINT). Moreover, with an initially low DBP (&lt;70 mmHg), a significant increase in the frequency of outcomes and the relative risk of outcomes was noted. It is not easy to decide on antihypertensive therapy in such situations. The evidence base of studies suggests the benefit of lowering SBP for the prevention of cardiovascular events in elderly patients, but with caution and individual approach. It is important to take into account individual patient characteristics such as cognition, autonomy, and frailty/frailty when setting target BP.

Endothelial dysfunction in the pathogenesis of arterial hypertension: new diagnostic methods

ENDOTHELIAL DYSFUNCTION IN THE PATHOGENESIS OF ARTERIAL HYPERTENSION: NEW DIAGNOSTIC METHODS Tetiana V. Talaieva State Institution «National Scientific Center «M. D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Sciences of Ukraine», 5, Svyatoslava Khorobroho Str., Kyiv, Ukraine 03151 Introduction. Arterial hypertension (AH) remains the most widespread disease of the circulatory system, as well as one of the leading risk factors for the development of cardiovascular diseases. Recent studies indicate that endothelial dysfunction may play a key role in the pathogenesis of hypertension. Endothelial dysfunction is associated with damage and accelerated apoptosis of endothelial cells (ECs), and quite often these changes occur before morphological and clinical signs of the disease appear. The researches of the last decades established that the most important properties of the endothelium - restoration and preservation of structural and functional integrity and its reparative activity are directly related to circulating endothelial progenitor cells - precursor cells of endotheliocytes (ECCs). The use of various markers for the determination of ECCs in circulating blood, the determination of the content of exfoliated endothelial cells and the reserve function of the bone marrow (ability to produce ECCs) makes it possible to assess the function of the endothelium and the risk of the development and progression of cardiovascular diseases. Purpose: using the flow cytometry method to evaluate the possibility of determining the content of ECCs in the blood, desquamated ECs and the reserve function of the bone marrow (ability to produce ECCs) as markers of endothelial dysfunction. Materials and methods. 153 patients with AH were included in the study. All patients underwent complaint registration, history taking, general clinical examination, including office blood pressure measurement and daily blood pressure monitoring, physical examination, brachial artery compression test to assess endothelium-dependent vasodilatation. The number of ECCs of peripheral blood was determined by the method of flow cytometry with the help of reagents for the determination of differentiation clusters CD34, CD45, CD31, CD133 manufactured by "Beckman Coulter Inc.". In the conditions of the test with dosed physical load, the blood content of ECCs was determined on a bicycle ergometer before and after 60 minutes. after completing the test on 55 patients with hypertension. The results. In the studies, complex determination of various markers on the surface of the ECCs was used. At baseline, the number of ECCs (CD34+/CD45-/+) was 22 % lower in patients with hypertension, and 28 % lower in patients with resistant hypertension than in practically healthy donors (р &lt; 0.05). The number of ECCs (CD133+ CD31+ CD45-/+) in patients with hypertension was 25 % less than in the norm. The number of desquamated cells exceeded the norm by 152 % (р &lt; 0.001). In patients with hypertension, there was a decrease in the reserve function of the bone marrow to produce ECCs in response to ischemia caused by stress. The obtained data are confirmed by the results of the brachial artery compression test. Based on the results of the analysis in the groups with controlled and resistant hypertension, it was found that the last index of EDVD was 25 % lower than in the group of patients with hypertension that is well controlled (р &lt; 0.05). The use of standard therapy for 12 weeks was accompanied by an increase in the number of ECCs in patients, which indicated the restoration of endothelial function after the treatment. Conclusions. In patients with hypertension, a decrease in the content of ECCs in the blood was noted. The resistant course of hypertension is associated with greater manifestations of endothelial dysfunction. Determination of ECCs using the flow cytometry method provides important additional information about endothelial dysfunction as a risk factor for the development and progression of hypertension, and can also be used to assess the effectiveness of antihypertensive therapy. Keywords: arterial hypertension, endothelium, dysfunction, endothelial progenitor cells.