Group Of Hypertensive Patients Research Articles

The frequency of hyperuricemia with left ventricular hypertrophy in patient with primary hypertension in Erbil city-Iraq

Background: High serum uric acid level is common in hypertension and it may be correlatedwith left ventricular hypertrophy. The frequency of hyperuricemia is not previously wellinvestigated in Erbil city. Objectives: The objective of this study was to investigate thefrequency of hyperuricemia and the association between serum uric acid levels and leftventricular hypertrophy in a group of hypertensive patients in Erbil-Iraq. Patients and methods:A cross-sectional study was conducted in Rizgary teaching hospital between September 2015and September 2016. A total of 150 consecutive adult patients presenting with primaryhypertension were included. Based on the results of the echocardiography, the patients wereclassified into two groups; Group I (patients with left ventricular hypertrophy) and Group II(patients with non- left ventricular hypertrophy). The effects of high serum uric acid level on leftventricular mass and geometry were evaluated in both groups. Results: High serum uric acidlevel was present in 38 patients (25.3%). Based on the results of echocardiographic examination,left ventricular hypertrophy was present in 78 patients (52%), 25 of them (32 %) hadhyperuricemia. The mean of serum uric acid level, means of age, systolic blood pressure,diastolic blood pressure and lipid profile significantly higher in group I patients compared tothose in group II patients. Regarding echocardiographic parameters, There were significantlyhigher in hyperuricemic patients compared to patients without hyperuricemia the means ofinterventricular septal thickness, left atrium and left ventricular mass. Conclusions: In this study,high serum uric acid level was common in hypertensive patients and it was positively associatedwith left ventricular hypertrophy and dyslipidemia.

Methods for the assessment of microcirculation in patients with hypertension

Background: Skin microcirculation is considered an easily accessible vascular bed, which can potentially be representative and helpful in evaluating, understanding the mechanisms of microvascular function and detection of its dysfunction. Many studies claim that functional changes in cutaneous circulation precede the development of arterial hypertension (HT). Identifying them at an early stage can enhance patients’ prognosis. There are methods which can be applied for these purposes. We aimed to describe available methods of skin microcirculation assessment, in the context of HT. Material and methods: The PubMed database was searched till March 2022. Research articles used in the systematic review were experimental articles, reviews and abstracts from conference materials that reported the methods of the microcirculation assessment. From 1131 records, 47 articles were included in the final review. Results: This review identified that the microcirculation examined with various methods was dysfunctional in HT patients. Standard HT treatment usually helped to achieve a partial reversal of those changes. Even though some of the methods described are non-invasive and relatively affordable, still, none of them is the standard for HT diagnosis. Conclusion: Each of the methods has its advantages and disadvantages. Photoplethysmography appears to be promising. The method is non-invasive, cheap, does not require experience, and might be synchronized with mobile devices. It is possible that the simplification of the device calibration process and the development of a method allowing for the correct interpretation of the result, regardless of e.g., the patient's skin color, could influence its wider use in the group of HT patients.

A Canadian, retrospective, multicenter experience with selexipag for a heterogeneous group of pediatric pulmonary hypertension patients.

Selexipag, an oral nonprostanoid prostaglandin receptor agonist, has led to reduced morbidity and mortality in adults with pulmonary arterial hypertension (PAH). While the adult literature has been extrapolated to suggest selexipag as an oral treatment for severe pediatric pulmonary hypertension (PH), longitudinal, multicenter data on the benefits of selexipag in this population are lacking. The purpose of this study is to present a longitudinal, multicentre experience with selexipag in a relatively large cohort of pediatric PH patients and add to the existing selexipag literature. We performed a retrospective, multicenter review describing the clinical outcomes of pediatric PH patients receiving selexipag in addition to standard oral pulmonary vasodilator therapy across three Canadian centers between January 2005 and June 2021. Twenty-four pediatric patients (fifteen female) with a mean age of 9.7 (range 2.0-15.5) years were included. Of this cohort, eighteen (75.0%) were in group 1, one (4.2%) was in group 2, four (16.7%) were in group 3, and one (4.2%) was in group 4. Twenty-two (91.7%) patients were on dual PH therapy after six months. Dosing was targeted to achieve 20-30 mcg/kg/dose orally every twelve hours. Median dose after twelve months was 30 mcg/kg/dose. Twelve months following selexipag initiation, median decreases of 0.2 cm in tricuspid annular plane systolic excursion, 3.5 mmHg in right-ventricular systolic pressure, and 6.1 mmHg in mean pulmonary arterial pressure were observed; none of these changes were statistically significant. Three patients died, one clinically deteriorated and required admission to a pediatric intensive care unit, ten had gastrointestinal symptoms, and three had flushing. Selexipag appears to be a safe and effective adjunctive therapy for pediatric PH patients and has a tolerable adverse effect profile aside from gastrointestinal disturbances. Additional prospective studies of changes in hemodynamics and functional classification over a longer period and with a larger sample are needed. Future research should aim to identify subgroups that stand to benefit from the addition of selexipag as well as optimal timing and dosing for the pediatric population.

A North American, single-center experience implanting fenestrated atrial devices and atrial flow regulators into a heterogeneous group of pediatric pulmonary hypertension patients.

The clinical deterioration commonly experienced by pediatric patients with pulmonary arterial hypertension (PAH) has motivated a shift in the treatment of pulmonary hypertension (PH) through innovations in surgical salvage interventions. The Occlutech fenestrated atrial septal defect (FASD) Occluder and the atrial flow regulator (AFR), which provides a protective, atrial-level shunt during hypertensive crises, have found an important role in treating pediatric patients with PAH. Other groups of pediatric patients with PH may also benefit from a similar protective physiology. The primary aim of this work is to present a single center's experience with AFR and FASD devices for managing a heterogeneous group of pediatric PH patients. A secondary goal is to identify hemodynamic changes and complications following device implantation. We performed a retrospective review of all pediatric PH patients who, after being found suitable, either successfully or unsuccessfully received an FASD or AFR device between January 2015 and December 2021 at the Stollery Children's Hospital in Edmonton, Canada. Fourteen patients (eight female) with a median age of 4.6 (range 0.3-17.9) years and a median body mass index of 15.1 (Q1 = 13.8, Q3 = 16.8) kg/m2 underwent device implantation: five received FASDs, eight received AFRs, and one was ultimately unable to receive an implant due to thrombosed iliac vessels and required surgical intervention. Of the fourteen patients, seven were in group 1 (PAH), one was in group 3 (lung disease), and six were in group 5 (primarily pulmonary hypertension vascular disease) under the World Symposium PH classification. All patients were on mono-, dual-, or triple-drug PH therapy. Device stabilization was not possible for two patients, who then required a repeat catheterization. Of the group 1 patients, three AFR and three FASD implants were successful, while one FASD implant was unsuccessful due to thrombosed vessels. At a six-month clinical assessment, all group 1 patients had patent devices and improved WHO FCs. This work presents a single center's experience with AFR and FASD implants in a heterogeneous group of fourteen pediatric patients with severe PH. This treatment strategy is novel in the pediatric population and so this work provides momentum for future studies of interventional cardiac catheterization procedures for pediatric patients with PH. Further collaborations are required to develop criteria to identify ideal pediatric candidates and optimally time interventions in order to maximize the benefits of this treatment.

A canadian retrospective multicenter experience with selexipag in a heterogeneous group of pediatric pulmonary hypertension patients

Abstract Funding Acknowledgements Type of funding sources: None. Background The introduction of the oral prostanoid selexipag for treating severe adult pulmonary arterial hypertension (PH) has contributed to reduced rates of death and secondary complications in PAH. Pediatric physicians have extrapolated from the adult literature to utilize this medication to treat severe pediatric pulmonary hypertension. However, longitudinal, multicenter data on the therapeutic benefits of selexipag for pediatric patients is lacking. Materials and Methods We performed a retrospective review describing the clinical outcomes of pediatric PH patients receiving selexipag for pulmonary hypertension (PH) therapy in addition to standard pulmonary vasodilator therapy across three North American pediatric PH centers between January 2005 and June 2021. Results Across three Canadian centers, 24 patients (15 female) with a mean age at diagnosis of 5.4 (0.9) years were included. Of this cohort, 19 (79.2%) had group 1 PAH, 4 (16.7%) had group 3 PH, and 1 (4.2%) had group 4 PH. Genetic syndromes were noted in 7 (29.2%) patients. Dosing was targeted to achieve 20–30 mcg/kg/dose orally every 12 hours; the mean dosage after 12 months was 31.2 (10.3) mcg/kg/dose. Twelve months following selexipag initiation, a median increase of 71.5 m (p = 0.44) in six-minute walk test distance was observed together with median decreases of 0.2 cm (p = 0.17) in tricuspid annular plane systolic excursion, 3.5 mmHg (p = 0.95) in right ventricle systolic pressure, and 6.1 mmHg (p = 0.09) in mean pulmonary artery pressure. 2 patients (8.3%) died, 1 (4.2%) was referred for a heart transplant, and 1 (4.2%) received an atrial flow regulator. One patient (4.2%) required admission to a pediatric intensive care unit during their treatment course this was related to profound desaturation, six (25.0%) had gastrointestinal symptoms, and two (8.3%) had facial flushing. Conclusion Selexipag appears to be a beneficial adjunctive therapy for selected pediatric PH patients and has a tolerable adverse effect profile aside from gastrointestinal disturbances. Further prospective studies of changes in hemodynamics and functional classification over a longer period and with a larger sample are needed.

Efekat metaboličkog sindroma na incidencu i stepen hipertrofije miokarda leve komore kod hipertenzivnih pacijenata

Metabolic syndrome (MetS) is characterized by the simultaneous presence of obesity, hypertension, dyslipidemia and hyperglycemia in an individual, which leads to an increased risk of cardiovascular disease (CVD). Left ventricular hypertrophy (LVH) is thickening of the heart muscle wall -hypertrophy of cardiomyocytes in concentric and/or elongation of cardiomyocytes and hyperplasia of connective tissue in eccentric hypertrophy with the participation of hemodynamic and non-hemodynamic factors (genetics, stress, other external factors). MetS, which essentially includesinsulin resistance, hyperinsulinemia, and hyperglycemia, alters myocardial metabolism and promotes myocardial inflammation, fibrosis, hypertrophy, and left ventricular remodeling. OBJECTIVE: To determine the impact of MetS, that is, obesity to the incidence and degree of severity of LVH in hypertensive patients with metabolic syndrome in comparison with the control group -hypertensive patients without metabolic syndrome. PATIENTS AND METHODS: Consecutive patients of the Office of Internal Medicine "Dr. Bastać" were examined, a total of 55 patients with hypertension, who were divided into two groups: the first group with MetS, 22 people, average age 56±8.5 years with BMI>30kg /m 2 and waist circumference more than 80 cm for women and >94 cm for men, the second control group without MetS-33 people, average age 52±14 years, with BMI<30kg/m 2 . Echocardiography was done for all subjects on a Power Vision 6000 Toshiba echo camera with standard echocardiographic measurements in the M, B and Doppler technique, and the mass of the left ventricular myocardium was determined for them using the Devereux formula. RESULTS: The prevalence of LVH in group 1 with metabolic syndrome (MetS) was 64%, while in the control group without (MetS) it was 36%. There was a statistically significantly higher number of patients with LVH in hypertension with MetS compared to hypertensive patients of the control group without MetS (X2, p=0.027). In the group of hypertensive patients with MetS, the degree of severity of myocardial hypertrophy, that is, the myocardial mass , was statistically significantly higher compared to the control group (respectively 302±84g versus 224±89g, p=0.0002). Arterial pressure values were higher for both systolic and diastolic blood pressure 168/106 mmHg in hypertensive patients with MetS, but did not reach statistical significance in relation to blood pressure values in hypertensive patients without MetS (156/95 mmHg, p=0.16). CONCLUSION. Patients with metabolic syndrome and hypertension have a statistically significantly higher prevalence of left ventricular myocardial hypertrophy and a highly statistically significant degree of left ventricular hypertrophy compared to the control group of hypertensive individuals without MetS. Given that mean values of arterial pressure do not differ between groups, it can be concluded that non-hemodynamic factors for the development of LVH have an important role in the induction of a more severe degree of LVH in hypertensive patients with metabolic syndrome.

The level of adipokines in young people with hypertension and abdominal obesity

Objective. To investigate the adipokine blood profile in young people with hypertension (HTN) and abdominal obesity (AO). Design and methods. In total. 530 people were included in the study, including 267 people with HTN, of which 169 had AO. In the control group (without HTN) there were 263 people comparable to the study group by gender and age. Among them there were 106 people with AO. The blood levels of adiponectin, adipsin, lipocalin-2, resistin and plasminogen activator inhibitor-1 (PAI-1) were determined in all examined patients by multiplex analysis. Statistical data processing was carried out with the use of SPSS 13.0 program. Results. The levels of adiponectin and lipocalin-2 were lower in the group of HTN patients by 1,46 (p < 0,01) and 1,14 times (p < 0,05), respectively. The level of adipsin in HTN patients was significantly higher (p < 0,01) by 19,14 % compared to the control. The levels of resistin and PAI- did not differ in the control group and the group with HTN. Adiponectin level was 1,35 times lower (p < 0,05) in the group with AO compared to those without AO, the other indicators did not differ in the AO group and controls. In the HTN group, higher levels of PAI-1 were found in the subgroup with AO. When comparing the subgroup without HTN and without AO with the subgroup with HTN and AO, a significant decrease in concentration of adiponectin and lipocalin-2 was found. For the subgroups with AO, a decrease in adiponectin levels and an increase in adipsin levels (p < 0,01) were found in HTN patients. No statistically significant difference was found for the remaining indicators. The relative chance of early onset HTN was associated with the decrease in adiponectin and lipocalin-2 levels, and with the increase in adipsin levels, regardless of gender, age and the presence of AO. Conclusions. Thus, an increased level of adipsin and a reduced level of adiponectin and lipocalin-2 can serve as potential biomarkers indicating a high probability of developing early HTN in people under 45 years of age.

Vai trò tư vấn của điều dưỡng trong kiểm soát huyết áp ở bệnh nhân tăng huyết áp đang điều trị ngoại trú tại Bệnh viện huyện Lục Ngạn

Objects: Comparison of the results of blood pressure control after 3 months between the group of hypertensive patients receiving routine treatment with the group of hypertensive patients receiving routine treatment with the consultation of nurses at Luc Ngan District Hospital, Bac Giang. Methods: A controlled intervention study with a follow-up period of 3 months at Luc Ngan district hospital, Bac Giang province. 170 hypertensive patients undergoing outpatient treatment and uncontrolled blood pressure (≥ 140/90 mmHg) were assigned to 2 groups, the nursing counseling intervention group (85 patients) and the routine care group (85 patients). Patients in the intervention group had regular followup visits and were consulted by nurses once a month, including: measuring BP, assessing lifestyle changes, estimating medication adherence and educating patients. on diseases, treatment and lifestyle changes through face-to-face interviews with KAP questionnaires (assess knowledge and lifestyle practices), 8-question Morisky scale (to assess adherence to treatment), flip picture set (for in-depth consultation for patients in the intervention group). Patients in the control group were re-examined at regular intervals without nursing consultation. The primary outcome was the difference in blood pressure between the intervention and control groups at 3-month follow-up.Results: After 3 months of intervention, the rate of reaching the target blood pressure in the intervention group was 45.9%, higher than in the control group (36.5%), but the difference was not statistically significant, p > 0.05. In the intervention group, the mean systolic and diastolic blood pressure after intervention was 142.4 ± 16.9 mmHg and 78.9 ± 11.8 mmHg, respectively, lower than the pre-intervention systolic and diastolic blood pressures. when the intervention was 156.9 ± 9.5 mmHg and 82.6 ± 11.0 mmHg, the difference was statistically significant with p<0.05. In the intervention group, the rate of adherence accordingto the Morisky scale from 70.6% before the intervention increased to 91.8% after the intervention, in the control group this rate increased slightly after the intervention (88, 8% vs 81.2%), p > 0.05.Conclusion: Counseling by nurses reduced systolic and diastolic pressure more than before the intervention, the difference was statistically significant. At the same time, the intervention increased treatment adherence of patients with uncontrolled hypertension compared with the control group, the difference was statistically significant.

Correlation of Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with serum GDF-15 in a group of hypertensive Iraqi patients

The Growth Differentiation Factor -15 (GDF-15) is a member of the transforming growth factor β superfamily. İt represents an example of the stress response cytokines. It's mostly found in cardiac myocytes, adipocytes, macrophages, endothelial cells, and vascular endothelial cells, whether they're generated normally or not. GDF-15 levels have increased and are associated with cardiovascular risk. Aim of the study: To investigate the correlation between angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) with the level of plasma GDF-15 in a group of hypertensive patients. Materials and methods: A case-control study involved 90 individuals, 60 hypertensive patients (36 on ACE inhibitors and 24 on ARBs) and 30 healthy individuals. Serum GDF-15 was measured and compared statistically between the two groups. Results: serum GDF-15 was significantly higher in both groups of hypertensive patients compared to the control group. İn addition, there was no significant difference in mean serum GDF-15 concentration between patients treated with ACE inhibitors with those treated with angiotensin II receptor blockers. Conclusion: GDF-15 increases in hypertensive patients and might be a reasonable marker of cardiovascular disease. Both ACE inhibitors and ARBs are not powerful enough to decrease GDF-15 concentration to that of the control group.

Systemic Immune-Inflammation Index: A Novel Predictor for Non-dipper Hypertension.

IntroductionThe non-dipper hypertension (HT) pattern is associated with more end-organ damage and cardiovascular events than is dipper HT. Inflammation is widely established to play a role in the pathophysiology of HT. Recently, a new inflammatory and prognostic marker called the systemic immune-inflammation index (SII) has emerged. Our goal is to determine whether there is a relationship between non-dipper HT and SII.MethodsOur study is a single-center retrospective and ninety-one patients with HT were included. All patients were analyzed with simultaneous 24-hour ambulatory blood pressure monitoring and laboratory parameters. Thirty-five patients had dipper HT while 56 patients had non-dipper HT. SII was calculated according to neutrophil, platelet, and lymphocyte counts.ResultsThe median age was 48 (45-61 interquartile range (IQR)) in the non-dipper HT group, whereas it was 54 (44-64 IQR) in the dipper HT group. Although the neutrophil level, neutrophil-lymphocyte ratio, platelet lymphocyte ratio, SII, sleeping systolic blood pressure (BP), and sleeping diastolic BP were higher (p=0.020, p=0.041, p=0.046, p=0.019, p<0.001, and p=0.001, respectively) in the non-dipper HT group, the lymphocyte level was lower (p=0.040). A multivariate logistic regression model shows that SII (odds ratio (OR)=1.023, 95% confidence interval (CI)=1.002-1.112, p=0.012) may be an independent predictor of non-dipper HT.ConclusionOur study showed that the SII level was higher in the non-dipper HT patient group than in the dipper HT group. Furthermore, SII was an independent predictor of non-dipper HT. The high SII value in hypertension patients can be used as an early warning parameter to identify non-dipper HT patients.

A CROSS SECTIONAL STUDY; COMPARISON OF DIAGNOSTIC PARAMETERS AND COMORBID CONDITIONS IN HYPERTENSION ALONE AND HYPERTENSION PLUS DIABETES

Comorbidities such as hypertension and type 2 diabetes are widespread. Hypertension is twice as common in diabetic individuals as it is in non-diabetics. The purpose of this research was to better understand the clinical profile, laboratory features, and vulnerability to end organ damage in hypertensive patients with and without diabetes. Method: This was a cross-sectional observational study conducted in the outpatient and inpatient departments of Medicine. Study participants were divided into two groups according to their presence of hypertension or diabetes mellitus. Patients were examined clinically and the data was further analysed using statistical methods. We observed th Results: e mean age of 53.08 years (±11.48) and 55.96 years (±11.23) with no associations between the age group and gender of the hypertensive patient group (p&lt;0.344) and the hypertensive diabetic group (p&lt;0.597). The most frequent symptom of presentation in both groups was a headache. There was a significant statistical difference in mean systolic blood pressure between hypertensive and hypertensive-diabetic group t (165.8) =4.643, p&lt;0.001. Our study shows a higher value of mean HbA1c, mean postprandial glucose levels, and mean fasting blood glucose levels in the hypertensive diabetic group as compared to the hypertensive group. Our study demonstrated that end organ damage Conclusion: was more prevalent in hypertensive diabetic individuals, indicating the effect of diabetes-hypertension co-morbidity on target organs.

The Relationship Between Electrocardiographic P Wave Parameters and Left Atrial Volume and Volume Indices in Patients with Hypertension

Introduction: This study was designed to evaluate the relationship between left atrial volume index, which is an important indicator of left ventricular diastolic dysfunction, and electrocardiographic parameters such as P wave duration, P wave dispersion (PWDISP), P wave terminal force (PWTF), and P wave peak time (PWPT) in hypertensive patients. Patients and Methods: A total of 58 patients with a diagnosis of hypertension between June 2017 and April 2018 were included in this retrospective study. Age-sex matched 58 healthy subjects constituted the control group. The patients without diastolic dysfunction and stage I diastolic dysfunction were included in the normal left atrial pressure (NLAP) group, while stage II and stage III diastolic dysfunction patients constituted the high left atrial pressure (HLAP) group. Results: The PWDmax, PWDISP, and PWPT which are calculated from the lead DII (PWPTDII) were found to be longer in the group of hypertensive patients (p&lt; 0.05, for all). Electrocardiographic parameters of PWDmax, PWDISP, PWTF, PWPTDII, and PWPTVI were found to be longer in patients with HLAP. Both PWPTVI (p= 0.008 r= 0.395) and PWPTDII (p&lt; 0.001 r= 0.456) were significantly correlated with left atrial volume index. Conclusion: In this study, the relationship between PWPT and diastolic dysfunction was revealed for the first time in the literature. In addition, the PWPT was found to be increased in patients with increased left atrial pressure (LAP). Our findings deserve attention because electrocardiography is an inexpensive and easily accessible diagnostic method that can be used to detect diastolic dysfunction in hypertensive patients.

Importance of uric acid threshold in its correlation with metabolic syndrome

Background and Aims : The relationship between Serum Uric Acid (SUA) and Metabolic Syndrome (MS) is still debate. Whether SUA level is part of MS diagnosis or just a marker of an unfavourable metabolic profile has not been demonstrated. Besides it’s unknown whether SUA’s addition to MS definition makes a difference in terms of prognosis. In our study we focused on evaluating in a group of hypertensive patients, the correlation between MS diagnosis and SUA defined with classic cut-off (≥6 mg/dL for women and ≥7 for men) and URRAH's threshold (>5.6 mg/dL for both sexes).

The effect of calcium channel blocker (CCB) treatment on retinal and choroidal vessels in a group of hypertensive patients

ABSTRACT Purpose The present study was designed to observe the vasoreactivity in retina and choroid after calcium channel blocker (CCB) treatment in a group of hypertensive patients. Method The study was based on 56 hypertensive patients (56 eyes) and 56 control subjects (56 eyes). Choroidal scans and the measurement of peripapillary retinal vessel diameters was performed at baseline and optical coherence tomography (OCT) scans were also performed at first month . Subfoveal choroidal thickness (SFCT) and the diameters of superior temporal artery (STA), inferior temporal artery (ITA), superior temporal vein (STV), inferior temporal vein (ITV) were compared between the groups. Results The baseline diameters of the STA, ITA were significantly decreased in the patient group compared with the control group (all p < .05). There was a significant increase at first month after the CCB treatment in comparison to baseline measurements (all p < .05). When compared with the controls, the diameter of venules showed a decrease at baseline but was not significant. After the treatment, the diameters of venules were insignificantly increased compared with baseline measurements (p = .178 and p = .275) and there were also no significant differences between the control group and the patient group in first month (all p > .05). The average choroidal thickness measurements of the hypertensive group was lower than the control group (p = .404) and there was a tendency to increase after the treatment (p = .055). Conclusion This study demonstrates that, treatment with CCB seems to improve retinal arteries and has almost no affect on the choroidal thickness in newly diagnosed hypertensive patients.

Activity of coagulation processes with comorbid hypertension and coronary heart disease

Purpose – determine the characteristics of changes of procoagulant,anticoagulant and fibrinolytic links of the hemostatic system in patients withhypertension in combination with coronary heart disease. Materials and methods. 127 people were examined - 14 healthy (control), 61 patients with stage II hypertension with concomitant coronary heart disease (group 2), 52 hypertensive patients with stage III withconcomitant coronary heart disease (group 3). There were evaluated indicators of hemostasis system: thrombin time, activated partialthromboplastin time, prothrombin index, soluble fibrin monomer complex, fibrinogen, protein C, antithrombin III of, and the time of XII-dependent fibrinolysis. Results. Patients on both study groups SFMC content significantly higher than the control group. SFMC content in patients with stage II hypertension with concomitant coronary heart disease exceed normative value of 3 times, and in the group of hypertensive patients with stage III with with concomitant coronary heart disease of 3.65 times. The content of fibrinogen in the third group of patients exceeded the indicators of the control groupby 27.6%, the difference was significant (p&lt;0,001). Also valid was the difference between the two comparable groups (p&lt;0,001). The content of protein C in hypertensive patients stage III was lower than the control values at 28,7% (p&lt;0,001). The difference between comparable groups also were significantly (p&lt;0,001). At the same time, and XII-dependent fibrinolysis in patients with stage II hypertension in combination with coronary heart disease was 3.54 times longer than the standard values (p&lt;0,001), and thecombination of hypertension III stage with CAD - 4.7 times longer than the norm (p&lt; 0.001). Conclusions. Patients with hypertension stage II and III with concomitant coronary heart disease characterized by increased blood clotting activity in the background suppression of the anticoagulant and fibrinolytic components of hemostasis. The largest contribution to the formation ofthrombophilic changes in patients of both treatment groups belongs to inhibition of fibrinolysis, which is more pronounced when hypertension stage III combined with coronary heart disease.

IMPORTANCE OF URIC ACID THRESHOLD IN ITS CORRELATION WITH METABOLIC SYNDROME

Objective: The relationship between Hyperuricemia and Cardiovascular risk has been established but whether or not a correlation between Serum Uric Acid (SUA) and Metabolic Syndrome (MS) exists is still a matter of debate. Indeed whether SUA level is part of MS diagnosis or just a pure marker of an unfavourable metabolic profile has not been demonstrated. Besides it's unknown whether SUA's addition to MS definition makes a difference in terms of prognosis. In our study we focused on evaluating in a group of hypertensive patients, the correlation between MS diagnosis and SUA defined with two different cut-off: 1) &gt; 6 mg/dL for women and &gt; 7 for men (classic cut-off); 2) &gt; 5.6 mg/dL for both sexes (recently proposed by the URRAH Project). Design and method: We enrolled 473 Hypertensive patients followed by the Hypertension Unit of San Gerardo Hospital (Monza, Italy), in which SUA was measured. Patients with Hyperuricemia were identified according to the two different thresholds. NCEP-ATP-III criteria were used for diagnosis of MS. Results: MS was diagnosed in 33.6% while Hyperuricemia was found in 14.8% of subjects according to the traditional cut-off and 35.9% according to URRAH study's cut-off. Hyperuricemia and MS coexist in 9.7% (traditional cut-off) and 17.3% (URRAH's threshold) of the population. Hyperuricemia was more frequent in MS than in non-MS subjects (29 vs 7.6%, p-value &lt; 0.0001 for cut-off 6/7 mg/dL and 51.6 vs 28.0%, p-value &lt; 0.0001 for cut-off 5.6 mg/dL). Linear regression models showed that SUA is related to MS diagnosis (β = 1.597, p-value &lt; 0.0001). At logistic analysis Hyperuricemia was strongly related to MS when defined by the HURRAH's cut-off (OR = 0.303, p-value &lt; 0.0001). The same relation is weak, although significan, when Hyperuricemia was defined by the classic cut-off (OR = 0.182, p-value &lt; 0.0001). Conclusions: Hyperuricemia is related with MS diagnosis especially when defined by the recently defined cut-off of 5.6 mg/dL.

TREATMENT WITH BLOCKERS OF THE RENIN-ANGIOTENSIN SYSTEM DOES NOT AFFECT RENAL FUNCTION IN PATIENTS WITH SEVERE COVID-19 ADMITTED TO INTENSIVE CARE UNIT

Objective: Patients with severe COVID-19 admitted to Intensive Care Units (ICU) are often challenging because of the complications related to co-existing diseases. Among these hypertension is highly prevalent and blockers of renin-angiotensin system (RAS-B) are frequently reported as home drug therapy. However the influence of these medications on renal function and mortality is matter of debate. Design and method: We retrospectively analyzed clinical data and drug treatment of 90 patients (F/M 25/65) admitted in our ICU for severe COVID-19, with lung disease severity expressed as pO2/fractional inspired oxygen (P/F) below 300 mmHg. In normotensive (n = 35) and hypertensive patients previously treated with (n = 35) or without (n = 20) RAS-B, we compared systolic and diastolic blood pressure (SBP and DBP, mmHg), serum creatinine (SC, mg/dl) and potassium (SK, mEq/L) baseline and SC peak values reached during the admission in ICU. Rate of renal replacement therapy (RRT) and mortality were also recorded. Results: Baseline mean SBP and DBP were within the normal limits and similar in normotensive and in both groups of hypertensive patients while P/F was 157 ± 71 in normotensives and 137 ± 64 vs. 94 ± 30 respectively in hypertensives with and without RAS-B. In the latter two groups, baseline, SC and SK were similar (respectively 1 ± 0.5 vs. 1 ± 0.8 and 4 ± 0.6 vs. 4 ± 0.6) and peak SC values were similar as well (respectively 1.74 ± 1.3 vs. 1.71 ± 1.7). Among the seven patients who needed RRT three and four respectively were on and off treatment with RAS-B. Overall mortality was slightly but not significantly higher in hypertensive than in normotensive patients (31/55, 56% and 15/35, 43%) but similar in those with and without RAS-B (19/35, 54% and 12/20, 60%). Conclusions: These preliminary data suggest that in patients with severe COVID-19 admitted to ICU, the use of RAS blockers for the treatment of hypertension prior to the infection does not affect renal function, the need of RRT and mortality.

RIGHT HEART PULMONARY CIRCULATION UNIT RESPONSE TO EXERCISE IN PATIENTS WITH SYSTEMIC ARTERIAL HYPERTENSION. INSIGHTS FROM THE RIGHT-NET STUDY

Objective: Systemic arterial hypertension is the main risk factor for the development of heart failure with preserved ejection fraction (HFpEF). The aim of this study was to assess the right heart-pulmonary circulation unit response to exercise doppler echocardiography (EDE) in patients with hypertension in order to evaluate the capacity of EDE to unmask a pre-HFpEF state. Design and method: EDE was performed in 155 hypertensive patients and in 145 healthy normotensive subjects on a semi-recumbent cycle ergometer with load increments of 25 watts every 2 minutes. Left ventricular (LV) and right ventricular (RV) dimensions, function and hemodynamics were evaluated. Linear mixed models were used to test the interaction between hypertension and age group on the echocardiographic parameters at peak exercise, adjusting for baseline values. Results: Impaired echo-Doppler LV and RV function was observed both at rest and peak exercise in hypertensives compared to healthy subjects. Pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance were higher in the former. The entire population was then divided into tertiles of age: at rest no significant differences were recorded for each age group between hypertensives and normotensives except for E/E’ that was higher in the hypertensives of the middle age tertile. At peak exercise, hypertensives had higher pulmonary artery systolic pressure (PASP) and E/E’ but lower tricuspid annular plane systolic excursion (TAPSE) as age increased, compared to normotensives. Differences in E/E’ and TAPSE between the 2 groups at peak exercise were explained by the interaction between hypertension and age even after adjustment for baseline values (p &lt; 0.001 for E/E’, p = 0.011 for TAPSE). At peak exercise, the oldest group of hypertensive patients had a mean E/E’ of 13.0, suggesting a significant increase in LV diastolic pressure combined with increased PASP. Conclusions: Age and hypertension have a synergistic effect on E/E’ and TAPSE at peak exercise indicating that the detrimental effect of aging on cardiac function is amplified in hypertension. EDE appears a useful tool for unmasking a pre-HFpEF state in hypertension even in patients with controlled resting blood pressure.

REDUCED ENDOTHELIAL GLYCOCALYX IS ASSOCIATED WITH HYPERTENSION BURDEN ONLY IN MALE SMOKERS WITH FIRST DIAGNOSED AND NEVER TREATED STAGE I AND II ESSENTIAL HYPERTENSION

Objective: Endothelial dysfunction may be estimated by reduced endothelial glycocalyx (EG). However, the role of EG as a hypertension mediated organ damage (HMOD) still remains controversial. Cigarette smoking represents a significant CV risk factor. Aim of this study is the investigation of the EG’s role in first diagnosed and never treated patients with stage I and II essential hypertension regarding smoking habit. Design and method: We studied 194 non-diabetic, first diagnosed and never-treated hypertensive patients (mean age=49 + 10 years, 60% males, 35% smokers). Ambulatory blood pressure monitoring (24 h ABPM) and endothelial dysfunction (PBR5–25) were estimated in each patient before treatment initiation. Results: We found that mean 24 h systolic and diastolic ABPM levels were 140 + 8 mmHg and 87 + 9 mmHg, respectively. Regarding EG, mean values of PBR5–25, PBR5-9, PBR10-19 and PBR20-25 were 2.08 + 0.3 m, 1.16 + 0.2 m, 2.22 + 0.34 m and 2.65 + 0.8 m, respectively. No correlations were found between PBR levels and 24 h ABPM regarding the whole population. However, when we performed multiple regression analysis in a subgroup of male smoker hypertensives (n = 46, mean age=47 + 11 years), a significant association (Beta = 0.29, p = 0.05) was revealed between PBR20-25 and 24 h systolic ABPM. Conclusions: In first diagnosed and never treated arterial hypertension, endothelial dysfunction, represented by reduced EG, is independently related to systolic BP burden only in male smokers. Probably EG might play a significant role regarding CV risk estimation in specific groups of hypertensive patients.

P364 IMPORTANCE OF URIC ACID THRESHOLD IN ITS CORRELATION WITH METABOLIC SYNDROME

Abstract Background The relationship between Hyperuricemia and Cardiovascular risk has been established but whether or not a correlation between Serum Uric Acid (SUA) and Metabolic Syndrome (MS) exists is still a matter of debate. Indeed whether SUA level is part of MS diagnosis or just a pure marker of an unfavourable metabolic profile has not been demonstrated. Besides it’s unknown whether SUA’s addition to MS definition makes a difference in terms of prognosis. In our study we focused on evaluating in a group of hypertensive patients, the correlation between MS diagnosis and SUA defined with two different cut–off: 1) ≥6 mg/dL for women and ≥7 for men (classic cut–off); 2) &amp;gt;5.6 mg/dL for both sexes (recently proposed by the URRAH Project). Methods We enrolled 473 Hypertensive patients followed by the Hypertension Unit of San Gerardo Hospital (Monza, Italy), in which SUA was measured. Patients with Hyperuricemia were identified according to the two different thresholds. NCEP–ATP–III criteria were used for diagnosis of MS. Results MS was diagnosed in 33.6% while Hyperuricemia was found in 14.8% of subjects according to the traditional cut–off and 35.9% according to URRAH study’s cut–off. Hyperuricemia and MS coexist in 9.7% (traditional cut–off) and 17.3% (URRAH’s threshold) of the population. Hyperuricemia was more frequent in MS than in non–MS subjects (29 vs 7.6%, p–value&amp;lt;0.0001 for cut–off 6/7 mg/dL and 51.6 vs 28.0%, p–value&amp;lt;0.0001 for cut–off 5.6 mg/dL). Linear regression models showed that SUA is related to MS diagnosis (β = 1.597, p–value&amp;lt;0.0001). At logistic analysis Hyperuricemia was strongly related to MS when defined by the HURRAH‘s cut–off (OR = 0.303, p–value&amp;lt;0.0001). The same relation is weak, although significan, when Hyperuricemia was defined by the classic cut–off (OR = 0.182, p–value&amp;lt;0.0001). Conclusions Hyperuricemia is related with MS diagnosis especially when defined by the recently defined cut–off of 5.6 mg/dL.