Complications In Hypertensive Patients Research Articles

Irregularities of Coagulation in Hypertension.

This review article summarizes the role of coagulation in the pathogenesis of hypertension. It specifically focuses on significant factors and markers associated with coagulation, including D-dimer, fibrinogen and fibrin, prothrombin, P-selectin, soluble urokinase plasminogen activator receptor, thrombomodulin, tissue factor, tissue plasminogen activator, von Willebrand factor, β-thromboglobulin, and Stuart-Prower factor. D-dimer levels were elevated in hypertensive individuals compared to healthy controls, and the levels increased with the severity of hypertension. These findings indicate that increased coagulation activity of fibrin plays a role in the development of thromboembolic complications in hypertensive patients. Additionally, both fibrinogen levels and D-dimer levels displayed a positive correlation with the duration of hypertension, suggesting that these biomarkers were positively associated with the length of time an individual had been hypertensive. Increased systolic and diastolic blood pressures have been linked to higher levels of prothrombin time and activated partial thromboplastin time in individuals with hypertension as well as those with normal blood pressure. Also, the presence of P-selectin, produced by activated platelets and endothelial cells during angiotensin II stimulation, played a role in the development of cardiac inflammation and fibrosis associated with hypertension. Moreover, the change in systolic blood pressure was associated with baseline soluble urokinase plasminogen activator receptor (suPAR) in hypertensive participants, and the change in suPAR levels was associated with the development of hypertension. Moreover, it was observed a decrease in thrombomodulin expression in the placenta of preeclamptic patients, suggesting its potential involvement in placental dysfunction, possibly driven by an imbalance in angiogenic factors. Tissue factors and autophagy might have significant implications in the pathogenesis of chronic thromboembolic pulmonary hypertension, particularly in the context of vascular remodelling. Likewise, ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) might be a promising biomarker for the early detection of pulmonary arterial hypertension and the von Willebrand factor is a candidate prognostic biomarker. The arterial β-thromboglobulin levels were significantly lower than venous levels. This article concludes that D-dimer, fibrinogen and fibrin, prothrombin, P-selectin, soluble urokinase plasminogen activator receptor, thrombomodulin, tissue factor, tissue plasminogen activator, von Willebrand factor, and β-thromboglobulin are important factors involved in the pathogenesis of hypertension.

Sex Differences in Atrial Fibrillation and Associated Complications in Hypertensive Patients with Left Ventricular Hypertrophy: The LIFE Study.

There is no consensus on whether biological differences account for the higher risk of stroke seen in females compared to males with atrial fibrillation (AF). Capitalizing on The Losartan Intervention for Endpoint study, a multicenter randomized clinical trial randomizing 9,193 patients and followed for at least four years, we aimed to identify sex differences in the risk of stroke in the presence of AF in patients with hypertension and left ventricular hypertrophy (LVH). 342 Patients had a history of AF, and 669 developed new-onset AF. History of AF and new-onset AF were more prevalent among males (5.0% vs. 2.9% and 3.0% vs. 0.9%) in patients aged 55-63 years, but the relative difference decreased with age. Females with new-onset AF tended to have a higher risk of stroke than males (HR 1.52 [95% CI 0.95-2.43]). However, females with a history of AF did not have a higher risk than males (HR 0.88 [95% CI 0.5-1.6]). In patients with new-onset AF, the relative higher stroke risk in females increased with age. Among patients with a history of AF, stroke risk was comparable and increased with age in both sexes. Among patients with hypertension and LVH, females with new-onset AF had a higher risk of stroke than males, especially in patients above 64 years. However, the risk did not differ between the sexes among patients with a history of AF.

STUDY OF THYROID PROFILE, URIC ACID, CREATININE AND LIPID PROFILE IN PRE-ECLAMPSIA PATIENT

Objectives: (1) To evaluate and compare the thyroid profile and lipid profile in preeclampsia in a normotensive pregnant female in the third trimester of pregnancy. (2) To estimate and compare serum uric acid and serum creatinine in preeclampsia in normotensive pregnant females. Methods: In the present study, 154 patients, of which 79 preeclampsia (cases) and 75 (controls), were selected randomly and matched with their gestational age in patients who attended an ANC clinic at the Department of Obstetrics and Gynecology, NSCB Medical College, Jabalpur, from March 2016 to August 2017. All patients were evaluated for their lipid profile, thyroid profile, serum uric acid, and serum creatinine. The study includes patient’s specific detailed clinical history, physical examination findings, and a report of relevant investigations recorded from the patient who presented with pre-eclampsia and normotensive pregnant female attending the ANC Clinic of N.S.C.B. Medical College, Jabalpur. Results: The most common age group for preeclampsia was 20–24 years. Preeclampsia was most common in the nullipara as compared to the multipara. Pre-eclampsia cases commonly occur in low-socioeconomic and rural areas. In this study, pre-eclamptic women showed higher serum concentrations of total cholesterol (221.60±22.55), low density lipoprotein (LDL) (134.44±16.96), Very LDL (48.48±6.88) and Triglyceride (243.50±32.33) when compared to normotensive women, which was statistically significant. In this study, a statistically significant decrease in HDLC (34.55±5.37) was observed in pre-eclamptic women. An increase in serum creatinine was observed in women with pre-eclampsia. The mean serum creatinine level was (1.21±0.47). Conclusion: Our study concludes that nulliparous and low-socio-economic women had a higher risk of pre-eclampsia. Maternal age between 20 and 24 years are more prone to develop pre-eclampsia. Serum uric acid levels are significantly higher in pre-eclampsia patients and could be a useful indicator of maternal and fetal complications in hypertensive patients.

PENGARUH PERAN KELUARGA DALAM PENCEGAHAN DAN PENANGANAN PERILAKU AGRESIF PRE HOSPITAL PADA KLIEN ODGJ

ABSTRACTThe phenomenon of hypertension is a deadly silent killer, meaning that hypertension cannot directly kill the sufferer but can trigger complications, such as: the risk of heart attack, heart failure, stroke, and kidney failure.The family has a role or function to carry out nursing care practices, namely to prevent health problems or treat sick family members. Family is the closest person who can provide support, care and affection to family members who suffer from hypertension and have a history of inpatient and outpatient care.Objective: To determine the influence and differences in the role of the family before and after the effective self-management intervention for preventing complications in hypertensiveMethods: The study used a quasi-experimental design with a pre-test and post-test nonequivalent control group design. The study population was all patients who had a history of hypertension who visited the Kasihan I Health Center, Bantul, DI Yogyakarta from January to August 2022, with a total sample of 30 people, carried out by purposive sampling. The data collection instrument used a respondent characteristic questionnaire, and a questionnaire about knowledge of family roles with effective self-health management interventions for preventing complications in hypertensive patients Data were analyzed univariately and bivariately with q-square test (95% CI).Results: There is an influence in the form of an increase in the role of the family, seen from the difference in the average value from pretest to posttest only 0.7 in the respondents' answers. There is a difference from the pre-test value to the post-test value, seen from the significance of p = 0.000 (p <0.05) after being given treatment/intervention about the role of the family with effective self-management interventions towards preventing complications in hypertensive patientsConclusion :There are influences and differences after the intervention was carried out on respondents regarding the role of the family with self-health management interventions effective in preventing complications in hypertensive patients

PS-C02-8: ROLE OF STATIN THERAPY IN HYPERTENSION, PLEIOTROPIC EFFECT IN REDUCING NEW-ONSET AF AND ISCHEMIC STROKE

Introduction: Hypertension is considered the most important risk factor for stroke in the general population, is the most common comorbidity in patients with atrial fibrillation (AF), and is prevalent in approximately 80 to 90% of subjects with AF enrolled in recent clinical trials. Statin drugs have potent anti inflammatory and antioxidant effects that have the potential to prevent AF. Patients who had ischemic stroke complications due to episodes of AF are usually asymptomatic, thus primary prevention of AF in hypertensive patients is very important. Objectives: To determine the effectiveness of statin in reducing the incidence of new onset AF and ischemic stroke complications in hypertensive patients. Methods: We included 180 subjects in this retrospective cohort study using medical records at Sanglah General Hospital from 2018 to 2020. Subjects were divided into hypertensive subjects who were treated with a statin and hypertensive subjects who were not given statins, and we tracked the incidence of new onset AF. Pearson chi square test was used to determine the association of baseline characteristics, comorbidities, and medications, including statin, on the outcome of new onset AF, ischemic stroke, and side effects of statin. The progression of new onset AF between groups was also compared with the Kaplan Meier curve. Results: Our subjects who used statin were 39.4%, the mean age for all was 51.51+12.31 with 28,3% new onset AF, 7,2% ischemic stroke, and 2.2% all cause death. Statin in hypertensive patients significantly reduced the incidence of new onset AF (PR 0.174; 95%CI 0.079–0.38; P < 0.001) with a longer AF free period (19.16 + 2.57 vs 13.68 + 0.67 months; 95%CI 5.01–5.84; P = 0.014) and ischemic stroke free period (23.72 + 0.71 vs 16.57 + 1.06 month; 95%CI 5.01–5.84; P = 0.003), without any significant relationship with the adverse effect of statin. The incidence of AF was significantly high in hypertensive subjects with comorbid heart failure (HF) however, the AF free period remains longer if hypertensive patients with HF are given statin (19.16 + 2.57 vs 13.68 + 0.67 month; 95%CI 5.01–5.84; P = 0.014). Conclusion: Statin administration has the potential to be an effective treatment for primary prevention of the incidence of new onset AF and ischemic stroke in hypertensive patients without significant side effects.

Incident atrial fibrillation and heart failure in treated hypertensive patients with left ventricular hypertrophy

Abstract Background Hypertension and left ventricular hypertrophy (LVH) are predictors of atrial fibrillation (AF) and heart failure (HF). The incidence rates of AF and HF and especially the combination of these two complications in hypertensive patients with LVH receiving antihypertensive treatment are unknown, and so are the association with risk levels of other cardiovascular diseases and death in hypertensive patients with LVH who develop new onset AF and HF. Purpose We aimed to investigate the appearance and severity of AF and HF in 8,702 hypertensive patients aged 55–80 years with LVH receiving antihypertensive treatment in a prospective and randomized clinical trial primarily designed to investigate the preventive effect on a composite endpoint of myocardial infarction, stroke and cardiovascular death. Methods Included were patients who had sinus rhythm in ECG and no history of AF or HF when they were randomly allocated to blinded study medication with losartan or atenolol. Additional medication was given with hydrochlorothiazide and calcium antagonist if needed to gain blood pressure control. Incident AF was detected by annual ECGs and from adverse event reports submitted by the 930 clinical investigators. Incident HF was diagnosed according to Framingham criteria. Endpoints including incident HF, myocardial infarction, stroke and cardiovascular death were reported with relevant documentation by the investigators, and adjudicated by an expert endpoint committee. Results Incident AF occurred in 679 patients (7.8%) and HF in 246 patients (2.8%) during 4.7±1.1 years mean follow-up. Incident AF was associated with a >4-fold increased risk of developing subsequent HF (HR=4.7; 95% CIs, 3.1–7.0; P<0.001) in multivariable Cox analyses adjusting for age, sex, race, randomized treatment, standard cardiovascular risk factors and incident myocardial infarction. The development of HF as a time-dependent variable was associated with a multivariable-adjusted 3-fold increase of the primary study endpoint (HR=3.11; 95% CIs, 1.52 to 6.39; P<0.001) which was the composite of myocardial infarction, stroke or cardiovascular death. Incident HF was associated with a >3-fold increased risk of developing subsequent AF (HR=3.3; 95% CIs, 2.3–4.9; P<0.001). This development of AF was associated with more than a 2-fold increase of the composite of myocardial infarction, stroke or cardiovascular death in multivariable Cox analysis (HR=2.26; 95% CIs, 1.09–4.67; P=0.028). Conclusions Incident atrial fibrillation and heart failure are associated with increased risk of the other in treated hypertensive patients with left ventricular hypertrophy. These hypertensive patients who subsequently develop both atrial fibrillation and heart failure during antihypertensive treatment have particularly high risk of an additional composite endpoint consisting of myocardial infarction, stroke or cardiovascular death. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The study originally received support from Merck & Co., Inc.

Surgical treatment of portal hypertension complications in patients with liver cirrhosis

Objective: Improving the results of surgical treatment of portal hypertension complications in patients with liver cirrhosis.Material and methods: The results of medical care for 328 patients with liver cirrhosis, who were treated in the surgical departments of the central district and city hospitals of the Krasnodar Region, were analyzed. The effectiveness of minimally invasive surgical treatment of portal hypertension complications in 832 patients with liver cirrhosis treated at the Regional Clinical Hospital no. 2 of the Ministry of Health of the Krasnodar Region were also evaluated.Results: The mortality rate in patients with liver cirrhosis, admitted in first-level institutions of medical care due to acute bleeding from esophageal varices, reached 26.3%. In conditions of surgical treatment of complications of portal hypertension in a third-level institution of specialized care it did not exceed 4.7%.Conclusion: The optimal approach to the surgical treatment of patients with liver cirrhosis is to stop the bleeding from esophageal varices at the first stage of medical care and to treat portal hypertension complications using minimally invasive technologies in a multidisciplinary clinic involving a multidisciplinary team of doctors.

MO120: Kidney Biopsy—Safety at Neprology Gold Standard

Abstract BACKGROUND AND AIMS Percutaneous renal biopsy is a fundamental technique for the diagnosis of numerous renal pathologies. However, it is an invasive technique that requires operator experience and is associated with adverse outcomes. Bleeding complications such as haematuria or perirenal hematoma are frequent, but generally self-limiting, and may rarely be severe to the point of culminating in hypovolemic shock or death. The objectives of this study are to identify the rate of adverse outcomes and potential predictors of adverse outcomes related to the procedure. METHOD A retrospective analysis of patients undergoing native kidney biopsy at a tertiary centre, between 2015 and 2019 was carried out, based on the demographic and clinical characteristics of the population, analyses (creatinine at admission, pre-procedure and post-procedure blood counts) and control at 24 h after biopsy) and imaging methods (renal ultrasound 24 h after biopsy). RESULTS A total of 176 patients were selected, with a mean age of 48.1 ± 17.6 years. They were mostly caucasian (80.1%) and there was a predominance of females (55.7%). Approximately 46.6% had arterial hypertension, although all had their blood pressure controlled at the time of the biopsy. Mean pre-biopsy creatinine value was 2.0 ± 1.7 mg/dL. Mean pre-biopsy haemoglobin value was 12.1 ± 2.0 g/dL and 24 h post-biopsy 11.8 ± 2 .0 g/dL. There was an overall complication rate of 30.1%, corresponding to 5 cases of haematuria, 36 minor hematomas and 8 major hematomas. There were no deaths and there was no need for surgical intervention to control the bleeding. The only predictor of post-biopsy complications was age, with younger patients having fewer complications (43.9 ± 16.2 versus 50.0 ± 17.9, P = .036). There was no correlation between pre-biopsy creatinine or haemoglobin values and the occurrence of complications, nor was there a greater number of complications in hypertensive patients. CONCLUSION Although bleeding complications were relatively frequent in this sample, serious events were rare, as this reinforces the safety of this procedure (which provides valuable information about the prognosis and decision of the therapy to be instituted). The presence of arterial hypertension and the pre-biopsy creatininemia value did not increase the risk of complications related to the procedure.

Clinical and pathogenetic aspects of formation, early diagnosis, and medicated correction of cardiorenal disorders in men with hypertension against the background of purine metabolism disturbance

Aim: to review literary sources and analyse the modern view of the mechanisms of development of kidney and heart damage in patients with combination of hypertension (HP) and hyperuricemia and methods of their medicated correction. Materials and methods. A review of the scientific literature for the last 10 years was done. It demonstrates that today high levels of uric acid (UA) are considered not only as a consequence of deteriorating renal function, but also as one of the factors of renal damage. The role of the kidneys in the pathogenesis and development of hypertension is the subject of a lively debate, whose significance is determined by the presence of a long period of latent renal dysfunction. According to the literature, in patients with essential hypertension, a direct correlation was found between the uric acids level and the left ventricular diastolic dysfunction (LVDD). Early diagnosis of heart lesions is possible using speckle-tracking echocardiography, which is an innovative technology for studying myocardial deformation, allowing subclinical diagnosis of heart muscle lesions. This technique is informative in hypertension even in the absence of hypertrophy and LVDD. The article also elucidates modern methods for diagnosing kidney damage against the background of hypertension, in particular, lipocalin associated with neutrophil gelatinase (NGAL). However, the significance of this biomarker in impaired renal function under conditions of hyperuricemia has not been studied. According to the literature, cystatin C is a marker of early diagnosis of cardiovascular events and a marker of renal glomerular function in the absence of an increase in serum creatinine levels. The role of this marker has been proven for many diseases of the kidneys and the cardiovascular system; however, there are no data on their definition as markers of damage to the heart and kidneys in hypertension in conditions of hyperuricemia. Conclusions. The identification of causal relationships and mechanisms of complications in hypertensive patients with purine metabolism disturbance needs further study. Therefore, early diagnosis of structural and functional changes in the main target organs (in particular, the heart and kidneys) and the determination of biochemical markers (NGAL, cystatin C) to identify their functional disturbances at the preclinical stage are important.

Karakteristik Demografi Terkait Komplikasi Pada Penderita Hipertensi di Kota Semarang

Objective and Background: The increase in the prevalence of hypertension shows that hypertension is a top priority for health problems, the higher the hypertension rate the higher the risk of complications. In 2020, Puskesmas Bandarharjo became the health facility with the highest number of hypertension cases, namely 12,692 with DM complications by 45%, complications from heart disease 30%, and stroke 25%. This study aims to determine the risk factors for the incidence of complications in hypertensive patients in the work area of the Bandarharjo Public Health Center, Semarang City. This study focuses on risk factors for demographic characteristics such as age, gender, heredity, and level of community knowledge of the incidence of complications. Methods: This research is analytic observational with a case-control approach design. This study used a purposive sampling technique with a sample size of 31 cases and 31 controls. Meanwhile, data analysis was carried out by univariate, bivariate using the chi-square test, and multivariate analysis with the help of SPPS version 24. The Results: showed that there was a relationship between age (p = 0.000), family history / descent (p = 0.005), education level (p = 0.011. There was no relationship between gender (p = 0.610). Conclusions: the need to increase health promotion in the context of controlling complications of hypertension patients in the Bandarharjo Community Health Center working area for the surrounding community.

Behavioral Factors Associated with Medication Nonadherence in Patients with Hypertension.

Medication nonadherence is associated with an increased risk of complications in hypertensive patients. We investigated behavioral factors associated with medication nonadherence in hypertensive patients in southern Taiwan. Using questionnaires, we collected data regarding clinicodemographic characteristics and nonadherence behaviors from 238 hypertensive patients. We assessed the self-reported prevalence of specific behaviors of medication nonadherence and investigated factors associated with each behavior using multivariable logistic regression analysis. The most common behavior of medication nonadherence was forgetting to take medication (28.6%), followed by discontinuing medication (9.2%) and reducing the medication dose (8.8%). Age ≥ 65 years (adjusted odds ratio [aOR] = 0.32, 95% confidence interval [CI] = 0.15–0.69) and male sex (aOR = 2.61, CI = 1.31–5.19) were associated with forgetting to take medication. The presence of comorbidities (diabetes, kidney disease, or both) and insomnia (aOR = 3.97, 95% CI = 1.30–12.1) was associated with reducing the medication dose. The use of diet supplements was associated with discontinuing the medication (aOR = 4.82, 95% CI = 1.50–15.5). Compliance with a low oil/sugar/sodium diet was a protective factor against discontinuing medication (aOR = 0.14; 95% CI = 0.03–0.75). The most pervasive behavior associated with medication nonadherence among hypertensive patients was forgetting to take medication. Age <65 years, male sex, comorbidities, insomnia, noncompliance with diet, and the use of dietary supplements were specifically associated with medication nonadherence.

What people really know about hypertension and other cardiovascular disease risk factors. Recommendations vs reality

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The WOBASZ II project was financed by the resources available to the Minister of Health as part of the POLKARD National Program to Equalise Accessibility to Cardiovascular Disease Prevention and Treatment for 2010–2012, the goal of which was to monitor the epidemiological situation in Poland in the field of cardiovascular diseases. Cyclically, new guidelines are developed to prevent cardiovascular diseases (CVD). But unfortunately their implementation in clinical practice is poor. The aim of the study was 1) to evaluate the awareness of CVD prevention principles in a representative sample of adult residents of Poland with diagnosed hypertension (HT); 2) to investigate the prevalence of modifiable CVD risk factors such as obesity, hyperlipemia, smoking, low physical activity, excessive intake of sodium, insufficient fruit and vegetable consumption in the daily diet, and to determine the extent to which recommendations for CVD prevention are implemented in everyday practice; 3) to evaluate how knowledge of CVD risk factors affects the control of HT. The study covered 2783 individuals with diagnosed HT. 72,2% knew the term ‘risk factor’. Spontaneously listed risk factors for CVD: HT 36,8%, smoking 43,3%, overweight and obesity 28,5%, unhealthy food 30,9%, increased cholesterol level 25,3%, and low physical activity 25,1%. Complications that can be caused by untreated HT, were listed by 72,6% to be a stroke, heart diseases by 57,8%, atherosclerotic lesions in the arteries by 17,7%, kidney disease by 9,5%, and vision disorder by 9,2%. Prevention methods other than medication were listed by more physical activity 38,8%, reduction of body weight in overweight people 45,5%, stop smoking 43,7%, conducting a regular lifestyle 42,1%, limiting fat intake 38,3%, restrictions on drinking alcohol 37,5%, daily consumption of vegetables and fruits 20,6%. No prevention method has been mentioned by 10,5% of patients. 73.2% declared knowledge of the upper limits of the correct blood pressure (BP), but only 10.2% gave the correct values. Overweight was found in 39% of patients, obesity in 36.7%, smoking in 21.3%, low physical activity (&amp;lt;30 min 4-7/week) in 33.4%, sodium intake &amp;gt;1.5g/day in 58.0%, low (&amp;lt;200g/day) consumption of fruits in 84.1%, and vegetables in 70.6%. Controlled BP was only found in 23% and controlled hyperlipidemia only in 11.2% of subjects. During medical visits, about 9.2% of patients did not receive any recommendations for pharmacological treatment even if their BP did not reach the therapeutic goal. Knowledge about CVD risk factors [hypercholesterolemia OR 1,63; HT 1,53; low physical activity 1,24, overweight and obesity 1,23, knowledge about complications of HT [stroke or cerebral ischemia 1,77, heart disease 1,52, nephropathy 1,51, atherosclerosis 1,48, retinopathy 1,38, knowledge about non-pharmacological treatment like regular consumption of vegetables and fruits 1,33 increases the chance of achieving BP control. The knowledge about CVD risk factors and possible complications of HT in patients with HT is low. Factors that have a significant impact on a BP control are: knowledge of CVD risk factors, possible complications of HT and the recommendations given during visits about increasing physical activity and a healthy diet, as well as home and office BP measurements.

Indentify a High-Risk Group of Cardiovascular Complications in Hypertensive Patients by Analyzing Heart Rate Variability and Heart Rate Turbulence Parameters

Indentify a High-Risk Group of Cardiovascular Complications in Hypertensive Patients by Analyzing Heart Rate Variability and Heart Rate Turbulence Parameters

Biochemical and Chemical Lipid Profile and Blood Pressure Assessment in Arterial Hypertension with Chronic Kidney Disease

Accelerated atherosclerosis and cardiovascular diseases are frequent complications in hypertensive patients with chronic kidney disease (CKD), being mainly driven by cardiovascular risk factors as lipid disorders and an unfavorable blood pressure profile. The objectives of the study were to evaluate the lipid profile and to assess the characteristics of blood pressure (BP) in patients with primary arterial hypertension associating chronic kidney disease (CKD) in a primary care population in Timis County, Romania. Lipid disorders were highly prevalent in hypertensive patients with CKD, consisting in hyper LDL-cholesterolemia in 50.3%, hypertriglyceridemia in 52%, low HDL-cholesterol levels in 35.8%. More than 2 lipid abnormalities were present in 68.8% of CKD hypertensive. CKD hypertensive patients, compared with those without CKD, presented a BP profile with higher systolic and diastolic office BP. On ambulatory blood pressure monitoring they also registred higher systolic and diastolic BP, the systolic BP (SBP), both for 24 h SBP, day-time and night-time SBP being statistically significant higher than in hypertensive patients without CKD. The circadian 24 h BP profile demonstrated in the CKD hypertensive population an unfavourable nocturnal profile in 67%, consisting of a high prevalence of the non-dipping profile and of nocturnal riser pattern.

Serum Levels of Antibodies to Advanced Glycation End Products in Patients with Type 2 Diabetes Mellitus and Hypertension.

Proteins containing advanced glycation end products are highly immunogenic and anti-advanced glycation end products antibodies (anti-AGEs antibodies) are found in the sera of diabetics. Enzyme-linked immunosorbent assay (ELISA) was used for measuring levels of anti-advanced glycation end products antibodies in sera of 93 patients with type 2 diabetes mellitus and arterial hypertension (mean age 61.4±11.3 years, diabetes duration 9.88±3.12 years; hypertension duration 9.28±4.98). These values were compared to serum anti-AGEs antibodies in 42 age and sex matched controls. Diabetics were divided in two groups according to presence or absence of microangiopathy, group 1 (n=67) and group 2 (n=26), respectively. Serum levels of anti-AGEs antibodies in patients with type 2 diabetes mellitus and arterial hypertension were statistically significantly higher than those in the control group (1.39±0.39 vs. 1.05±0.32), (p<0.05). Group 1 showed significantly higher levels of anti-AGEs antibodies than those of healthy controls (1.53±0.14 vs. 1.05±0.32), (p<0.01). Anti-AGEs antibodies levels were higher in patients with microvascular complications than these in patients without complications. Anti-AGEs antibodies correlate with diastolic blood pressure (r=0.26, p=0.05) and body mass index (r=0.37, p=0.03). We found significantly higher percentage of positive patients for anti-AGEs antibodies (mean+2SD) in group 1 than in group 2. Determining the levels of serum anti-AGEs antibodies can help physicians make early diagnosis and prognosis of the severity of late diabetic complications in hypertensive patients.

Evaluation of YKL-40, C- reactive protein and uric acid levels in hypertensive patients

Hypertension is a major public health problem and leads to severe complications such as cardiovascular disease, stroke, renal and other vascular complications. YKL-40 is a human glycoprotein related to chitinase protein family encoded by chitinase 3‐like 1 (CHI3L1) gene. Recently many studies reported that YKL-40 play a role in the progression of atherosclerosis and other diseases. So, in this view the present study focused to evaluate YKL-40 levels and to find out the association with C- reactive protein (CRP) and uricacid in hypertensive patients.The present study was to assess YKL-40 levels in hypertensive patients compared with healthy volunteers and to correlate these levels with C- Reactive protein and uricacid. Fifty hypertensive patients with 35 to 50 years age group were selected according to JNC-8 for this study and 50 healthy volunteers age matched subjects were selected as controls. Serum YKL-40 and CRP was estimated by ELISA, uric acid and other routine investigations were carried out by ERBA EM-360 fully automated analyzer. YKL-40, CRP, uricacid levels were significantly increased in hypertensive patients compared with healthy volunteers. Serum YKL-40 levels positively correlated with CRP Uricacid, triglycerides, LDL, systolic blood pressure and negative correlation with HDL cholesterol levels. YKL-40 is considered as potential diagnostic marker for the assessment of vascular complications in hypertension. Regular monitoring might be useful for reduction of vascular complications in hypertensive patients. Further longitudinal studies are required for confirm it.

Identification of cardiac organ damage in arterial hypertension: insights by echocardiography for a comprehensive assessment.

: Arterial hypertension, a widespread disease, whose prevalence increases with age, represents a major risk factor for cardiovascular events, causing damage in several organs, including the heart. In this context, echocardiography has a clear and pivotal role, being able to assess cardiac morphology and detect haemodynamic changes induced by this disease. 2018 European Society of Cardiology/European Society of Hypertension guidelines on AH identified main echo parameters such as left ventricular mass, relative wall thickness and left atrial volume, for detecting cardiac organ damage. The present review highlights the advantage of additional echocardiographic parameters such as diastolic measurement and both thoracic and abdominal aortic dimensions. An overlook on aortic valve should also be suggested to detect aortic regurgitation and stenosis, both frequent complications in hypertensive patients. In this kind of comprehensive assessment, the combination of standard and advanced echocardiography (speckle tracking echocardiography and, with a lesser extent, three-dimensional echocardiography) could be considered to improve the diagnostic accuracy, stratify prognosis and address management in arterial hypertension.

Comparison between I-gel and endotracheal tube for hemodynamic stability and perioperative complications in hypertensive patients undergoing elective surgery under general anaesthesia

Comparison between I-gel and endotracheal tube for hemodynamic stability and perioperative complications in hypertensive patients undergoing elective surgery under general anaesthesia

P1567 Left atrial function - association with left ventriculoarterial function in hypertensive patients

Abstract BACKGROUND Vascular stiffness and left atrial volume index (LAVI) are predictors of cardiovascular complications in hypertensive patients. The correlation of left atrium (LA) with left ventricle (LV) – arterial functional changes has not been well established. PURPOSE To investigate the relationship between LA remodeling and ventriculoarterial function. METHODS We studied 70 consecutive middle-aged patients (54 ± 13 years), separated in two groups: 55 with mild to moderate hypertension and duration up to 5 years and 15 healthy controls. All parameters for arterial stiffness – 24-hour central systolic pressure (cSys24h), central pulse pressure (cPP24h), augmentation index 24h (Aix24h) and 24-hour pulse wave velocity (PWV24h) were measured non–invasively with oscillometric method by Mobil-O-graph PWA. All patients underwent standard two-dimentional echocardiography with Spackle tracking analysis for LA and LV global longitudinal strain (GLS). RESULTS Statistically significant differences in parameters of vascular stiffness were found in patients with hypertension in comparison with healthy controls: cSys24h (116.64 ± 10.52 vs. 108.4 ± 6.19 mm Hg, p &amp;lt; 0.001), cPP24h (47.64 ± 9.43 vs. 40.4 ± 4.98 mmHg, p &amp;lt; 0.001), PWV24h (8.59 ± 1.49 vs. 6.29 ± 0.91 m/s, p &amp;lt; 0.0001). Patients with hypertension have higher LV filling pressures: E/e ratio (9.62 ± 3.13 vs. 7.62 ± 1.58, p &amp;lt; 0.006), higher velocities of A–wave transmitral blood flow (85.15 ± 16.88 vs. 64.57 ± 13.76 cm/s, p &amp;lt; 0.0001), dilated LA (LAVI: 33.78 ± 10.68 vs. 24.96 ± 4.89 ml/m², p &amp;lt; 0.001) and reduced LA GLS (29.34 ± 3.45 vs. 41.33 ± 4.37%, p &amp;lt; 0.0001) in comparison to control group. There were no statistically significant differences in Aix24h and cardiac output between the two groups. There is moderate positive correlation between LAVI with cPP24h (r = 0.491, p &amp;lt; 0.0001) and cSys24h (r = 0.366, p &amp;lt; 0.004). We found moderate positive correlation between LAVI and LV mass index (r = 0.386, p &amp;lt; 0.002). PWV24h correlated moderately and positively with LAVI (r = 0.404, p&amp;lt; 0.0001), and negatively with LA GLS (r = -0.471, p &amp;lt; 0.0001). CONCLUSION: LA remodeling is determined by the high 24-hour values of non-invasively measured central systolic pressure and pulse wave velocity. The parameters of arterial stiffness - cSys24h, cPP24h correlate positively with LA. PWV24h correlates negatively with reservoir strain of the left atrium. Using the method in clinical practice can improve risk stratification and therapeutic management. Further investigations are needed for prognostic and therapeutic value of LA remodeling.

The Role of Community Nurses in the Prevention of Complications on Hypertension Patients in Integrated Health Centers

Complications of hypertensive patients are expected to continue to increase. Integrated Health Center of Sikumana, Kupang City is one of the major health centers that have a high case of hypertension complications in Kupang City, NTT Province. The objective of this study is to determine the role of community nurses in the prevention of complications in hypertensive patients at the Integrated Health Center of Sikumana, Kupang City. The research method is descriptive with a survey design. The population in research is nurses in the Integrated Health Center of Sikumana, Kupang City comprising 21 people. The sample was taken from the total population with inclusion criteria of PNS (civil servant) and PTT (non-permanent employee) nurses from the government, minimum education of Nursing D-III, and working period ≥ 2 years. The results showed 52.4% of nurses assessed risk factors for complications in hypertensive patients, 81% formulated nursing diagnoses, 76.2% developed intervention plans, 76.2% implemented, 54.5% conducted community empowerment, 85.7% conducted health education, 95.5% conducted referral in prevention complications in hypertensive patients. It can be concluded that the role of community nurses in the prevention of complications in hypertensive patients in Integrated Health Center of Sikumana, Kupang City has largely been conducted well, and it is recommended that nurses at the Integrated Health Center have participated actively in following various training and work on the community nursing process to comply with the latest instructions and regulations.