Frequency Of Arterial Hypertension Research Articles

Features of Coronary Atherosclerosis in Patients with Coronary Artery Disease Residing in the Far North

Aim: To evaluate the features of coronary artery disease (CAD) in patients in the Far North and determination of the potential impact of extreme climatic factors on the development of coronary atherosclerosis. Material and Methods. Using the “Register of performed coronary angiography operations”, 5,679 patients with coronary artery disease were selected, who underwent coronary angiography at the Tyumen Cardiology Research Center. The main study group consisted of 2,590 patients permanently residing in the YamaloNenets Autonomous Okrug and 3,089 patients residing in the South of the Tyumen Region. Results. Patients with permanent residence in the Yamalo-Nenets Autonomous Okrug were on average younger (53.20 ± 7.49 versus 56.79 ± 8.34 years, p < 0.001), men were more common among them. In the extreme North there were more smokers (40.7 vs. 32.0%, p < 0.001) and alcohol users (19.7 vs.15.0%, p < 0.001), and more frequent myocardial infarction in anamnesis (57.1 vs. 48.2%, p < 0.001). At the same time, in patients permanently residing in the South of the Tyumen Region, a burdened hereditary history of CAD was more often determined, and the frequency of arterial hypertension and dyslipidemia was higher. In groups balanced by baseline clinical and demographic characteristics, including CAD risk factors, patients from the Yamal-Nenets Autonomous Okrug had more frequent lesions of the three main coronary arteries: anterior descending artery (42 vs. 35%, p < 0.001), circumflex artery (25 vs. 23%, p = 0.038) and right coronary artery (42 vs. 38%, p = 0.007). It should be noted that in balanced groups in patients permanently residing in the Far North, occlusive lesions of the coronary arteries were statistically significantly more likely to be determined (54 vs. 47%, p < 0.001). Also, between the compared groups, statistically significant differences were found in the type of left ventricle (LV) myocardial remodeling, but these differences were not determined in the balanced groups. Also, in the group of patients permanently residing in the Far North, there was a trend towards a decrease in the LV ejection fraction (53.6 ± 8.6% vs. 54.2 ± 8.7, p = 0.074).Conclusion. In patients with verified coronary artery disease living in the Far North, a more frequent and pronounced atherosclerotic lesion of the coronary bed is determined. These pathological changes are probably due to the complex impact of unfavorable natural and climatic environmental factors.

Hypertension as predictive factor for bevacizumab-containing first-line therapy in metastatic breast and colorectal cancer in BRECOL (GEICAM/2011-04) study

BackgroundRetrospective data suggest an association between bevacizumab efficacy and the incidence of arterial hypertension (AHT). Additionally, epigenetic mechanisms have been related to AHT.MethodsThis prospective observational study conducted by GEICAM Spanish Breast Cancer Research Group included metastatic breast (MBC) or colorectal (mCRC) cancer patients treated with bevacizumab-containing chemotherapy as first-line treatment. Blood pressure (BP) levels were measured (conventional and 24-h Holter monitoring) at baseline and up to cycle 3. Primary endpoint assessed BP levels increase as predictive factor for progression-free survival (PFS). Germline DNA methylation profile was explored in pre-treatment blood samples; principal component analysis was used to define an epigenetic predictive score for increased BP levels.ResultsFrom Oct-2012 to Jul-2016, 143 (78 MBC and 65 mCRC) patients were included. The incidence of AHT according to guidelines was neither predictive of PFS nor of best overall tumor response (BOR). No statistically significant association was observed with systolic BP nor diastolic BP increment for PFS or BOR. Grade 3 and 4 adverse events were observed in 37 and 5% of patients, respectively. We identified 27 sites which baseline methylation status was significantly associated to BP levels increase secondary to bevacizumab-containing chemotherapy.ConclusionsNeither the frequency of AHT nor the increase of BP levels were predictive of efficacy in MBC and mCRC patients treated with bevacizumab-containing chemotherapy.Clinical trial registryClinicalTrials.gov Identifier: NCT01733628.

ARTERIAL HYPERTENSION AMONG MEDICAL WORKERS. ANALYSIS. EVALUATION

The aim. To examine the impact of individual medical and social factors, including work experience, lifestyle and living conditions, excess body weight, metabolic syndrome, types of circadian rhythms of blood pressure, and heredity, on the frequency of arterial hypertension (hypertensive disease - HD) formation.
 Materials and methods. The study involved the collection of anamnestic data, conducting interviews, performing objective examinations, and monitoring blood pressure in 391 medical workers, predominantly from therapeutic, surgical, and intensive care backgrounds. The obtained data were statistically processed using probability assessment criteria, risks assessed through odds ratio (OR), and ROC analysis.
 The results. The study revealed that only 33% of medical workers have a normal body weight. The risk of developing hypertensive disease (HD) is 3.24 times higher in the group with excess body weight and 8.72 times higher in the group with obesity compared to the examined subjects with normal body weight (p<0.0001). Daily blood pressure monitoring results showed a statistically significant difference in 12 out of the 21 studied parameters (p<0.05) between patients with HD, with and without metabolic syndrome. This indicates that the presence of metabolic syndrome affects the severity of hypertensive disease. Additionally, a statistically significant difference (p<0.05) was observed in the distribution of circadian rhythm types of blood pressure between groups with and without hypertension. It was established that there is a predominance of unfavorable types of circadian blood pressure rhythm in medical worker groups experiencing high professional psycho-emotional stress (78.1-85.5%). Recognizing the risk factors for HD occurrence in medical workers can significantly enhance the effectiveness of a comprehensive hypertensive disease prevention program, leading to reduced blood pressure levels and a lower frequency of complications.
 Conclusions. It has been established that excess body weight is a risk factor for the development of hypertensive disease (HD) in medical personnel. The presence of metabolic syndrome has been proven to affect the severity of the hypertensive disease course. There is a certain association between disruptions in circadian blood pressure rhythms, professional psycho-emotional stress, and the development of arterial hypertension in medical workers of certain specialties. The prognostically significant threshold level of work experience for the formation of a group at an increased risk of developing HD is 11 years.

ARTERIAL HYPERTENSION AND WAR, WHAT TO EXPECT?

The aim. To conduct an analysis and generalize scientific publications on the influence of war factors on morbidity indicators and the clinical course of arterial hypertension.
 Materials and methods. An analysis and generalization of scientific research and publications on the specifics of morbidity among military personnel and the population affected by war has been conducted. The following methods were utilized: a systematic approach, bibliosemantic analysis, and analytical methods.
 Results: The article focuses on the influence of war factors on the incidence rates and clinical course of arterial hypertension in both military personnel and the civilian population. Through a review of historical data and modern scientific sources, the study examines the long-term effects of stress factors on the development of hypertension, the peculiarities of its clinical manifestations, and the potential for predicting complications in individuals affected by military operations. The impact of nervous tension is particularly evident among frontline soldiers, as hypertension is observed, on average, 3-4 times more frequently compared to soldiers in the rear. The article emphasizes the clear correlation between the frequency of arterial hypertension in servicemen and the duration of their frontline deployment.
 Conclusion. Severe mental trauma and negative emotions, experienced by both military personnel and the civilian population during war, can not only contribute to an increased incidence of hypertension but also lead to a significant rise in the occurrence of the disease in young individuals, with severe clinical manifestations expected.

Случай диагностики коарктации аорты во время беременности

The aim is to demonstrate the case of diagnosis of aortic coarctation during pregnancy, the complexity of choosing therapy tactics, the possibilities of telemedicine and percutaneous angioplasty with stenting. The frequency of arterial hypertension among pregnant women in the Russian Federation is 5–30%. According to the Russian Ministry of Health, over the past decade, hypertensive complications during pregnancy occupy the 4th place in the list of causes of maternal mortality. This, in turn, makes us very wary of hypertension during pregnancy and resort to immediate treatment. In the case of aortic coarctation, any careless administration of antihypertensive therapy can lead to the development of complications in the fetus and its death. However, with proper interdisciplinary management, most cases of adverse outcomes are preventable.

Burnout syndrome and risk factors for the development 
 of cardiovascular pathology in coal industry workers suffering 
 from occupational diseases

Introduction. Emotional burnout is a condition common among workers in “helping” occupations. The syndrome of emotional burnout among workers of the main occupations of the coal industry has not been studied enough, especially in terms of its relationship with such indicators of mental health as personal, situational anxiety and alexithymia. The relationship between emotional burnout syndrome and risk factors for the development of cardiovascular diseases has not been sufficiently studied.
 The purpose of the study to investigate the relationship of emotional burnout syndrome with the level of personal, situational anxiety and alexithymia, and the frequency of risk factors for the development of cardiovascular diseases, such as smoking, overweight, arterial hypertension and low physical activity in coal industry workers with occupational diseases.
 Materials and methods. Two hundred seventy-two coal miners with occupational diseases (dust lung pathology, diseases of the musculoskeletal system, vibration disease) were examined using questionnaires by V.V. Boyko, Spielberger-Khanin, and Toronto Alexithymia Scale. According to the survey, the frequency of smoking and low physical activity was determined, the frequency of arterial hypertension and overweight was identified by the results of a clinical examination.
 Results. The prevalence of emotional burnout syndrome was 27.9%. A higher frequency of personal anxiety (61.1%), situational anxiety (57.1%) and alexithymia (94.7%) was revealed in emotional burnout syndrome. The frequency of smoking, arterial hypertension tended to increase with emotional burnout, the frequency of overweight, and low physical activity did not differ.
 Limitations. The study was limited to a sample of 272 coal miners with occupational diseases, examined using questionnaires by V.V. Boyko, Spielberger-Khanin, and Toronto Alexithymia Scale.
 Conclusions. Emotional burnout syndrome is associated with the development of personal and situational anxiety, alexithymia and may be a risk factor for the development of cardiovascular diseases.

Особливості перебігу вагітності та пологів у жінок із ранньою та пізньою формами затримки росту плода

Purpose - to determine the features of the course of pregnancy and childbirth in women who had complications from the group of major obstetric syndromes (MОS), which were clinically manifested by early and late forms of fetal growth retardation syndrome (GRS). Materials and methods. A prospective analysis of the characteristics of the course of pregnancy and childbirth was conducted in 99 women who had complications from the group of MОS and were clinically manifested by fetal GRS, of which the Group I - 21 pregnant women with an early form of GRS, the Group II - 78 pregnant women with a late form of GRS. The diagnosis of GRS was established on the basis of ultrasound and Doppler examination data using percentile curves. Statistical processing of research results was carried out using standard Microsoft Excel 5.0 and Statistica 6.0 programs. Results. The analysis of the course of the II trimester in the Group II of pregnant women showed that the threat of termination of pregnancy occurred in 22 (28.2%) cases, with the transition to isthmic-cervical insufficiency and was 5 (6.4%) cases. An increase in the frequency of arterial hypertension was noted up to 3 (14.3%) cases in the Group I of pregnant women, while acute respiratory diseases in 6 (7.7%) cases and gestational pyelonephritis in 4 (5.1%) cases occurred only in the Group II female patients. The diagnosis of placental insufficiency and GRS was made more often in the Group I and amounted to 6 (5.8%) cases. In the III trimester of pregnancy in the examined patients, it was found that the diagnosis of placental insufficiency was in 7 (33.3%) patients, preeclampsia in 6 (28.6%) pregnant women and arterial hypertension in 3 (14.3%) patients and met reliably more often in the Group I (p<0.05), and such complications as fetal distress in 4 (5.1%) cases, acute respiratory diseases in 6 (7.7%) cases occurred only in the Group II. It was established that in the group with the early form of GRS, the average delivery time was 31 weeks, and in the group with the late form of GRS - 39 weeks. The frequency of delivery by caesarean section in the Group I was significantly higher and amounted to 13 (61.9%) cases against 21 (26.9%) cases in the Group II (p<0.05). Conclusions. The course of pregnancy in women with various forms of the GRS syndrome has its own characteristics, namely: with the early form of the GRS, pregnancy is significantly more often complicated by the threat of termination, gestational anemia, bacterial vaginosis, early development of placental insufficiency, and preeclampsia, which in turn leads to a significant increase in the frequency of cesarean delivery autopsy in case of premature pregnancy. The research was conducted according to principles of Declaration of Helsinki. Protocol of research was proved by local ethical committee, mentioned in institution’s work. Women’s informed consent was obtained for the study. No conflict of interests was declared by the authors.

Assesmen of atherosclerotic lesions of the carotid artery and risk factors for rheumatoi arthritis patients

Aim . To study and evaluate risk factors and analyze carotid artery intima-media thickness parameters as an early predictor of atherosclerosis in patients with rheumatoid arthritis. Materials and methods . The study involved 86 patients (women - 67, men - 19) observed in the State Institution “City Medical Center №2”, Dushanbe, aged from 37 to 67 years (mean age - 56.5±2.9 years). The diagnosis of rheumatoid arthritis was established according to the American College of Rheumatologists/EULAR 2010 criteria. The examination program included general clinical and instrumental methods (examination of common and accessible parts of internal and external carotid arteries), estimation of lumen size, the thickness of intima-media complex (TCIM), straightness of its course, atherosclerotic plaques of carotid arteries (ABS), echocardiography (ECHO-KG). Results and discussion . Thus, in the absence of significant gender differences in the frequency of arterial hypertension and increased intima-media thickness (the earliest manifestation of atherosclerotic vascular lesions), hypercholesterolemia and long-term glucocorticoid intake were more frequently recorded in women. Undoubtedly, each of the considered risk factors makes a definite contribution to the development of vascular atherosclerosis and the instability of their organic changes. However, the significance of these risk factors in the thickening of the intima-media complex of vessels may differ. Conclusion . Data correlated with intima-media thickness show sex differences, the significance of risk factors, and an increase in intima-media thickness despite the duration of glucocorticoid therapy. The factors mentioned are more significant in men, while in women, intima-media thickness is closely related to the duration of rheumatoid arthritis, total cholesterol levels, and blood pressure.

Abstract TMP12: COVID-19 Increases The Risk Of In-Hospital Acute Stroke Mortality: A Cohort Study

Introduction: Coronavirus disease (COVID-19) infection has an increased risk for neurological complications. Stroke has been associated with COVID-19 in 1-3% of hospitalized patients. Methods: This is a retrospective cohort study of stroke patients admitted in a health center in Brazil. We aimed to investigate whether the exposure to COVID-19 was associated with an increase in acute stroke mortality. The primary outcome was in-hospital mortality. Results: The cohort included 1191 stroke patients (54% male). All strokes were included: Ischemic stroke (81.2%), hemorrhagic stroke (14.9), cerebral venous thrombosis (2.1%) and subarachnoid hemorrhage (1.3%). Stroke associated with COVID-19 represented 5.4% of all patients. Mean age was 64.4 years (SD 0.5) and did not differ between groups. Sex distributions were equal in patients with or without covid-19. The prevalence of stroke type and the TOAST classification were similar in both groups. Mean NIHSS score was 8.7 (SD 6.3) being significantly higher in COVID-19 patients (p=0.036). COVID-19 patients disclosed a higher frequency of previous ischemic heart disease (OR: 3.5 - CI: 1.86-6.46). The frequency of arterial hypertension, diabetes mellitus, tobacco and alcohol use, and atrial fibrillation were similar for both groups. COVID-19 patients disclosed higher odds for in-hospital infection (OR: 4.5; CI: 2.67-7.48). Mortality rate was higher for COVID-19 patients (44.6% against 20.1% in non-Covid-19 group) in all subtypes of stroke. The mortality risk was twofold for COVID-19 stroke patients (CI: 1.62-2.92). Multivariate logistic regression considering mortality as the primary outcome and adjusted for multiple confounders disclosed an adjusted OR of 2.3 for COVID-19 infection (CI: 1.1-4.9) (Figure). Conclusion: In this cohort study, COVID-19 infection was an independent risk factor for mortality in stroke patients, regardless of comorbidities, age, sex and NIHSS.

The frequency of arterial hypertension in young people with different types of diabetes mellitus

Objective. Arterial hypertension (AH) and diabetes mellitus (DM) are frequent comorbid diseases, which are associated with a high level of disability and mortality. According to the literature hypertension occurs in 50–80% of patients with type 2 diabetes (DM2) (which constitute more than 90% of the population with type 2 diabetes), compared with 30% of patients with type 1 diabetes (DM1). Comparative studies on the frequency of AH in young patients with different types of DM in the Siberian region have not been conducted. The aim of the research work was to study the frequency of AH and associations of AH with clinical and laboratory parameters in various types of DM diagnosed before the age of 45 years.Design and methods. 174 patients with the onset of DM from 18 to 45 years old were included. They were under observation at the Research Institute of Internal and Preventive Medicine — Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences: in 20 patients DM1 was verified (group 1), in 80 — DM2 (group 2), 20 had HNF1A-MODY (Maturity-Onset Diabetes of the Young) (group 3), 36 had GCK-MODY (group 4), 18 had LADA (“latent autoimmune diabetes in adults”) (Group 5). All patients was done a clinical examination, determination of indicators of carbohydrate metabolism and basic biochemical parameters.Results. All groups were comparable in terms of gender, age, and duration of DM. AH of 1–2 degrees in group 1 was detected in 5 patients (25,0%), in 2 — in 20 people (25,0%), in 3 — in 5 (25,0%), in 4 — in 4 (11,1%), in 5 — in 4 (22,2%), significant differences were not identified. In different types of DM the development of AH is associated with various clinical and laboratory parameters. In DM1, the development of AH has a correlation with the age of the patient, with the level of low-density lipoprotein cholesterol; in DM2 — with the duration of diabetes, the patient’s age, body mass index, glucose level, lipid spectrum and diabetic complications; with HNF1A-MODY— with diabetic complications; with GCK-MODY — with the duration of diabetes, the age of the patient, with the level of total cholesterol, with the development of nephropathy; with LADA — with indicators of carbohydrate metabolism and triglycerides.Conclusions. It is necessary to screen for the presence of AH for any type of DM in young people. It is necessary to take into account the clinical and laboratory parameters associated with the AH depending on the type of DM.

Monitoring an open population of the middle-organized Siberian city: fifteen-years trends of arterial hypertension in men

Arterial hypertension remains one of the most common diseases in the developed countries of the world, while there is a tendency to increase the frequency of arterial hypertension as the level of urbanization increases. According to epidemiological studies in the Siberian region at the end of the last century, an unfavorable epidemiological situation regarding the prevalence of hypertension among people of economically desirable age was revealed both in men of organized populations employed in the oil and gas complex of the Far North region and in open urban populations of varying degrees of urbanization. The aim of the study was to determine the dynamics of the levels and prevalence of arterial hypertension in men of working age over a 15-year period of monitoring the open population of the mid-urban city of Western Siberia. Material and methods. Two simultaneous epidemiological studies were conducted among men aged 25–64 over four decades of life in the Central Administrative District of Tyumen in 1996 and 2010. The screening participant was informed about the history of high blood pressure and taking antihypertensive drugs for two weeks before the examination was taken into account. AH was recorded at systolic blood pressure levels of 140 mm Hg. Art. and / or diastolic blood pressure ≥ 90 mm RT. Art. Results. According to the 15-year monitoring of men in the open population of the mid-urbanized city of Western Siberia, a positive trend was identified for a decrease in the prevalence of hypertension due to the age category of 25–34 years. A decrease in the prevalence of hypertension in young men over a 15-year period of the population monitoring was established in connection with the positive dynamics of a decrease in systolic blood pressure levels in the age category of 25–34 years. Conclusion. The results of this work can serve as a basis and starting point for the development of a comprehensive preventive program in the open population of Tyumen, the effectiveness of which largely depends on an objective assessment of the motion vector of the epidemiological situation with respect to the main risk factors for cardiovascular diseases in various age categories.

Cardiovascular pathology in diff erent forms of primary hyperparathyroidism

Objective: To study the frequency and features of the clinical course of cardiovascular pathology in patients with diff erent clinical forms of primary hyperparathyroidism (PHPT). Materials and Methods: A retrospective analysis of case histories of 48 patients who received inpatient treatment for PHPT in the endocrinological or surgical departments of two large hospitals in Arkhangelsk from 2005 to 2015 was performed.Results: Among the revealed cases of PHPT, the symptomatic form of PHPT was the most common (88%). Th e analysis showed a high frequency of arterial hypertension (AH) (69%) with a more severe course in patients with a mixed form of PHPT. Th e level of parathyroid hormone (PTH) was higher in patients with AH compared with patients without hypertension and PHPT (p = 0.008). Left ventricular hypertrophy was detected in 60% of patients with a mixed form of PHPT. In a mild form, this complication was not observed. Th e relationship between the level of total blood calcium and PTH and the interventricular septum thickness was revealed by the results of echocardiography (p = 0.036 and p = 0.012). Th e inverse relationship between the duration of the QT interval and the level of ionized blood calcium was shown (p = 0.022).Conclusions: Changes in phosphorus-calcium metabolism provoked by PHPT aff ect the state of the cardiovascular system, which determines the need for increased attention of various specialists to this type of complications in PHPT, timely indication of treatment, and improvement of the quality of patient’s life.

Association of Vital Exhaustion with Risk Factors for Cardiovascular Diseases, Quality of Life and Lifestyle in 41-44-Year-Old Muscovite Men.

(1) Background: Vital exhaustion (VE) is no less of an important risk factor (RF) for cardiovascular diseases (CVD) and cardiovascular events than the well-known RFs. Insufficient knowledge of the relationship between VE and CVD RF, quality of life, and lifestyle was the rationale for this study. (2) Methods: We examined 301 Muscovite men 41–44 years of age. The categorization of RFs for CVD was carried out in accordance with conventionally considered criteria. In order to evaluate the lifestyle and quality of life in study participants, we were offering them a self-filling questionnaire developed by I.A. Gundarov. The presence of VE signs was assessed using a 14-item short version of the Maastricht Vital Exhaustion Questionnaire scale (MVEQ). All study subjects were classified into three ordered groups depending on the distribution of VE indicators by tertiles: Group 1 consisted of men with a low VE (0–2 points), Group 2 included males with a medium VE score (3–5 points), and Group 3 comprised subjects with high VE scores (6–14 points). To analyze the obtained data, we used one-way analysis of variance (ANOVA), Pearson’s chi-squaredtest (χ2), Goodman and Kruskal’s gamma, and linear regression analysis. (3) Results: We established that every third male (36.8%) had VE signs, while 10.6% of men had high VE levels. With an increase of VE in men, the frequency of arterial hypertension (AH) was increasing as well, and it was significantly higher in men with a high VE compared to their peers with a low VE (48.4% versus 33%; p = 0.03). A significant linear relationship was discovered between VE levels and excessive alcohol consumption (p = 0.001). The strongest linear associations were found between the VE level, and both psychosocial stress indicator and the amount of consumed ethanol. Self-assessment of personal happiness, job and sleep satisfaction, residential living conditions, and spiritual needs, as well as psychosocial stress indicator, total amount of consumed ethanol, and muscle strength (hand-grip dynamometry), were independent determinants of the VE level, and, collectively, they explained 46.6% of its variability. The greatest contribution to VE was made by the personal happiness level, explaining 25.5% of its variability. The proportions of the VE variance uniquely explained by various factors were as follows: 9.3% by the psychosocial stress, 4.9% by job satisfaction, 2.8% by sleep satisfaction, 2.3% by total consumption of ethanol, 1.6% by muscle strength, 1.1% by living conditions in the residential neighborhood, and just 0.8% by spiritual needs. (4) Conclusion: High VE levels in 41–44-year-old men are associated with AH, sedentary behavior, excessive alcohol consumption, and lower values of most indicators of both lifestyle and quality of life.

Regular use of non-steroidal anti-inflammatory drugs can effectively control pain and global health in patients with moderate activity of rheumatoid arthritis

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to control pain in rheumatoid arthritis (RA). However, many aspects of the therapeutic effect of NSAIDs in RA have not been sufficiently studied. In particular, this concerns the effect of NSAIDs on the inflammatory activity of the disease.Objective: to study the comparative efficacy and safety of NSAIDs in RA patients with moderate and low disease activity.Patients and methods. The study group consisted of 404 patients with RA, 69% women and 31% men, mean age 58.6±10.0 years, with moderate and low disease activity – DAS28<5.1 (mean value 3.7±1.5), who initially had moderate or severe pain: >4 cm on the visual analog scale (VAS) 0–10 cm. All patients received DMARDs, mostly methotrexate 15 to 25 mg weekly, 8.2% biological agents, 18.6% glucocorticoids. All patients were prescribed NSAIDs at the full therapeutic dose. The results of treatment were evaluated after 2 weeks, 1, 3 and 6 months. Criteria of efficacy were the dynamics of pain (10 cm VAS), Patient Global Health (PGH on a 10-cm VAS), the change in the tender joints count (TJC) and swollen joints count(SJC), and dynamics of RA activity (DAS28).Results and discussion. 54.2% of patients received aceclofenac, 19.8% nimesulide, 14.3% meloxicam, 9.1% diclofenac, 2.6% – other NSAIDs. After 2 weeks, the pain decreased from 6.3±1.2 cm to 4.5±1.5 cm on VAS (p<0.001). The severity of pain continued to decrease further, and after 6 months of observation was 4.0±1.2 (p< 001, compared with the baseline level). A similar result was observed for the TJC, SJC, and PGH: the dynamics of these indicators, in comparison with the baseline level, was statistically significant after 2 weeks and after 1, 3, and 6 months of observation (p< 0.05). There was a decrease in the disease activity by DAS28: from 3.7±1.5 to 3.4±1.1 after 3 months (p=0.041) and 3.1±0.9 after 6 months (p=0.02). The effectiveness of aceclofenac and other NSAIDs for pain reduction, TJC, SJC, PGH and DAS28 did not differ. The tolerability of aceclofenac was better than of other NSAIDs: the frequency of dyspepsia after 2 weeks was 23.3% and 36.2% (p=0.004). The frequency of arterial hypertension and edema in patients who used aceclofenac, after 2 weeks and 6 months was slightly lower than in patients treated with other NSAIDs, but the difference was not statistically significant.Conclusion. The use of NSAIDs can effectively control the pain and other symptoms of RA, as well as the disease activity by DAS28 in patients with moderate or low disease activity. Aceclofenac is not inferior to other NSAIDs in analgesic potential and exceeds them in tolerability.

The role of PNPLA3 and TM6SF2 polymorphisms on liver fibrosis and metabolic abnormalities in Brazilian patients with chronic hepatitis C

BackgroundDespite the growing body of knowledge about TM6SF2 and PNPLA3 polymorphisms in non-alcoholic fatty liver disease, their influence in the spectrum of HCV liver disease is not yet fully defined. Besides that, admixed populations, such as Brazilians, were not included in most of the studies.MethodsThis cross-sectional study enrolled 365 treatment-naïve patients with HCV and 134 healthy individuals. TM6SF2 (rs58542926 c.499C > T) and PNPLA3 (rs738409 c.444C > G) polymorphisms were evaluated regarding their association with clinical and laboratory data, histological liver steatosis and fibrosis, and with components of the metabolic syndrome.ResultsIn HCV subjects, the frequencies of TM6SF2 CC and CT + TT were 89% and 11%, while PNPLA3 frequencies of CC and CG + GG were 51.4% and 48.6%. In the univariate logistic regression analysis, the TM6SF2 CT + TT genotype in HCV was associated with significant liver fibrosis (p = 0.047; OR 1.953; 95% CI 1.009–3.788). In comparison to the CT + TT genotype, the TM6SF2 CC genotype in HCV was associated with older age (p = 0.002), higher frequency of arterial hypertension (p = 0.032), obesity (p = 0.030), metabolic syndrome (p = 0.014) and lower total cholesterol levels (p = 0.036). The PNPLA3 GG subjects had lower body mass index than CG/ CC individuals (p = 0.047). None of the polymorphisms, or their combinations, was independently associated with hepatic steatosis or fibrosis. On the other hand, older age, lower serum levels of total cholesterol, and higher serum levels of alanine aminotransferase and alkaline phosphatase were associated with liver fibrosis in the multivariate logistic regression analysis.ConclusionIn this evaluation of an admixed HCV population, neither TM6SF2 nor PNPLA3 polymorphisms were independently associated with hepatic steatosis or fibrosis. Other factors seem more influential than these specific polymorphisms in isolation. More studies are warranted to clarify the role of the TM6SF2 and PNPLA3 polymorphisms in Brazilians with HCV.

Obesity and Pancreatic Cancer: A Matched-Pair Survival Analysis.

Background: Morbid obesity is a risk factor for pancreatic ductal adenocarcinoma (PDAC). However, the impact of obesity on postoperative outcomes and overall survival in patients with PDAC remains a controversial topic. Methods: Patients who underwent pancreatic surgery for PDAC between 1997 and 2018 were included in this study. Matched pairs (1:1) were generated according to age, gender and American Society of Anesthesiologists status. Obesity was defined according to the WHO definition as BMI ≥ 30 kg/m2. The primary endpoint was the difference in overall survival between patients with and without obesity. Results: Out of 553 patients, a total of 76 fully matched pairs were generated. Obese patients had a mean BMI-level of 33 compared to 25 kg/m2 in patients without obesity (p = 0.001). The frequency of arterial hypertension (p = 0.002), intraoperative blood loss (p = 0.039), and perineural invasion (p = 0.033) were also higher in obese patients. Clinically relevant postoperative complications (p = 0.163) and overall survival rates (p = 0.885) were comparable in both study groups. Grade II and III obesity resulted in an impaired overall survival, although this was not statistically significant. Subgroup survival analyses revealed no significant differences for completion of adjuvant chemotherapy and curative-intent surgery. Conclusions: Obesity did not affect overall survival and postoperative complications in these patients with PDAC. Therefore, pancreatic surgery should not be withheld from obese patients.

Effective strategies for prevention of cardiovascular complications in elderly patients with arterial hypertension and obesity (clinical example)

The frequency of arterial hypertension has a clear tendency to increase with age. The presence of obesity imposes additional difficulties on the choice of antihypertensive therapy regimen due to the variety of pathophysiological mechanisms of raising blood pressure in patients with a combination of hypertension and obesity. This article presents the clinical case of a 68-year-old patient with hypertension and obesity, discusses a comprehensive approach that includes diet, regular physical activity, cognitive training and pharmacotherapy with the fixed combination of amlodipine with telmisartan and the imidazoline receptor agonist moxonidine. The choice of this combination is due to the following reasons: the ultra-prolonged action of both drugs, which allows you to control blood pressure during the day, including in the morning, when there is the greatest number of cardiovascular events; organoprotective properties; improving carbohydrate metabolism; reducing the risk of diabetes; antiatherosclerotic properties. The choice of moxonidine is due to the need of effective control of blood pressure, reduction of the activity of the sympathetic nervous system, because hypersympathicotonia is one of the central pathogenetic mechanisms for raising blood pressure in patients with hypertension and obesity, and the decrease in resting heart rate less than 80 bpm (an independent risk factor for cardiovascular complications in hypertension). Dietary recommendations will help to reduce body weight and blood pressure, slow the progression of atherosclerosis, prevent the development of cardiovascular catastrophes, and improve the quality of life. The aim of physical activity is reducing body weight, improve cognitive functions and reduce cardiovascular risks. Cognitive training will help improve cognitive function and, consequently, increase patient adherence to treatment. After six weeks of complex treatment, the patient noted the achievement of the target blood pressure, weight loss, improved mood, increased exercise tolerance, improved quality of life, as well as a decrease in proteinuria, which completely disappeared after another three months of therapy.

Temporal pattern of cardiovascular risk factors depending on outpatient care status

Aim. To study the temporal pattern of cardiovascular risk factors and cardiovascular disease (CVD) in the adult cohort depending on outpatient care status.Materials and Methods. We analyzed the incidence of CVD in the adult cohort (n = 1170) admitted to Research Institute – Ochapovsky Regional Clinical Hospital # 1 in 2015 (baseline) and after 3 years of follow-up. Groups were stratified according to the outpatient care status.Results. After 3 years of follow-up, the proportion of patients adhered to unhealthy diet decreased by 32.2%, 28.8% and 28.0% in groups without regular outpatient care, with regular outpatient care, and with regular outpatient care and CVD, respectively, as compared to baseline. Similar trend was observed regarding low physical activity (reduction by 50.3%, 24.7% and 21.8%, respectively) and tobacco smoking (45.6%, 63.0% and 61.8%, respectively). However, patients without regular outpatient care demonstrated an increase in overweight and obesity by 19.2%. Notably, the frequency of arterial hypertension increased by 48.33% in patients without regular outpatient care but decreased by 24% in those with regular outpatient care and CVD.Conclusion. During 3-year outpatient observation, we found a trend to a reduction in prevalence of cardiovascular risk factors, also in patients with CVD. Nevertheless, patients without regular outpatient care showed a statistically significant increase in prevalence of overweight, obesity and arterial hypertension.

P0716RAAS INHIBITION MODULATES KYNURENINE LEVELS IN A CKD POPULATION WITH AND WITHOUT TYPE 2 DIABETES MELLITUS

Abstract Background and Aims Kynurenine pathway of tryptophan metabolism is involved in the pathophysiology of chronic kidney disease (CKD) and diabetes mellitus (DM), mainly through the inflammation-induced activity of indoleamine 2,3-dioxygenase (IDO). Renin-angiotensin-aldosterone system inhibitors (RAASis) [angiotensin converting enzyme inhibitors (ACEis) and angiotensin II receptor antagonists (ARBs)] are recommended in these conditions to decrease proteinuria, slow CKD progression and reduce cardiovascular risk. The interactions between RAAS and the kynurenine pathway and the potential effects of RAASis have been reported in few experimental models but whether these drugs influence kynurenine levels in humans is unknown. We performed a single-centre cross-sectional observational study to evaluate tryptophan and kynurenine serum levels and IDO activity in CKD patients with and without type 2 DM, their correlations with markers of renal dysfunction, and their relationship with RAAS-inhibiting therapy. Method We enrolled 72 consecutive adult patients with CKD, of which 38 had DM, who were admitted to the Unit of Nephrology and Dialysis of our Hospital. Of them, 55 were receiving RAASis whereas 17 were not. Tryptophan was assessed by HPLC (high-performance liquid chromatography) analysis with an UltiMateTM 3000 chromatograph (Thermo Fisher Scientific, 168 Third Avenue Waltham, MA, USA); kynurenine was measured using an enzyme-linked immunosorbent assay (ELISA) kit (Catalogue n. K 7728; Immundiagnostik AG, Bensheim, Germany); IDO activity was calculated with the formula (kynurenine/tryptophan) x 100. Results Patients receiving RAASis and patients not under therapy only differed for frequency of arterial hypertension (100% vs 76.47%; P=0.002) and kynurenine levels, the latter being significantly lower in the treated group compared to the untreated one (1.56 ± 0.79 vs 2.16 ± 1.51 µmol/l; P=0.0378). Kynurenine did not correlate with estimated glomerular filtration rate (eGFR), proteinuria or albuminuria in the whole study cohort. Conversely, in patients not receiving RAASis it was inversely related to eGFR (r=-0.4862; P=0.0478) and directly related to proteinuria (ρ=0.493; P=0.0444) and albuminuria (ρ=0.542; P=0.0247); moreover, it varied across classes of albuminuria, being lower in patients with normoalbuminuria (0.98 ± 0.55 µmol/l) and higher in those with micro- (2.63 ± 1.53 µmol/l) and macroalbuminuria (3.09 ± 1.61 µmol/l) at the ANOVA test (F=4.008; P=0.042). In the same group, the relationship between IDO activity and eGFR was significant (ρ=-0.554; P=0.0210) and IDO activity differed across classes of albuminuria (F=3.702; P=0.05). Moreover, IDO activity was higher in patients with history of cardiovascular disease compared to those with no such history [10.22 (8.39 to 22.92) vs 7.57 (4.76 to 8.09) %; P=0.0343] whereas tryptophan had an opposite behaviour (17.00 ± 2.06 vs 22.00 ± 3.78 µmol/l; P=0.0036). Conclusion We observed lower kynurenine levels in CKD patients treated with RAASis compared to untreated patients, independently of the presence of DM, and a significant association between kynurenine and markers of renal damage only in the group not receiving RAASis. We could hypothesize that kynurenine may play a role in the pathophysiology of renal damage, as already suggested, and that drugs interfering with RAAS activation may act also by reducing kynurenine levels, in addition to their already known effects at the renal level. Indeed, kynurenine synthesis results to be higher in states of inflammation and RAAS has pro-inflammatory and pro-fibrotic actions; accordingly, RAASis could reduce the enzymatic activity responsible for kynurenine increase and this could be one of the mechanisms mediating the beneficial effects of RAAS inhibition on CKD progression. This may be relevant because kynurenine has shown pro-thrombotic effects and is emerging as a potential new biomarker of CKD.

Gender and age related features of metabolically healthy obesity phenotype prevalence

Aim. The study objective was to assess the age and gender characteristics of the metabolically healthy obesity phenotype (MHO) prevalence, taking into account various classifications. Materials and methods. The materials used are the cross-sectional studies of the population cohort (Health, Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) project, Novosibirsk), with the total of 3,197 people, among them 857 men (26.8%) and 2,340 women (73.2%), with BMI ≥ 30 kg/m². The MHO is defined according to different classifications: 1. IDF (International Diabetes Federation, 2005) – Waist circumference (WC) ≥ 94 cm in men and ≥ 80 cm in women and one or none of the components of metabolic syndrome (MS); 2. NCEP ATP III (the National Cholesterol Education Program Adult Treatment Panel III, 2001) in the presence of 2 and / or less components of the metabolic syndrome and 3. RSC (The Royal Society of Chemistry) – the index of waist circumference / hip circumference (WC / HC) ≤ 0.9 in men and ≤ 0.85 in women. Results. According to IDF the frequency of MHO in the group was 23.2%; NCEP ATP III – 41.8; RSC criteria – 27.1%. The frequency of MHO was higher in women than in men, and it significantly decreased with the age in women population. In all classifications, increased average blood pressure (BP) level, with normal average values of the level of triglycerides (TG) and high-density lipoprotein (HDL) is typical for persons with MHO. The surveyed according to the RSC criteria people with MHO demonstrate higher frequency levels of all cardio metabolic risk factors than those surveyed with the use of other criteria of MHO. Conclusion. The frequency of MHO varies depending on the used classification. In women, the frequency of MHO is reliably higher than in men. With the age, a significant reduction of the frequency of MHO in women is manifested. The frequency of arterial hypertension and abdominal obesity, the level of fasting blood glucose and LDL (low density lipoprotein), hypertriglyceridemia is higher in persons with MHO according to the criteria RSC.