Combination Of Hypertension Research Articles

Knowledge levels of stroke among hypertensive and diabetic patients in a tertiary hospital

BackgroundStrokes represent a major global health challenge, as they now affect up to 15 million people annually, with increasing mortality rates accompanying growing prevalence. In Saudi Arabia, hypertension (HTN) and diabetes mellitus (DM) have been identified as major contributors to stroke risk, with a combination of HTN and DM significantly magnifying the risk of strokes. While there have been global improvements in stroke prevention, recently knowledge levels vary significantly worldwide, and multiple studies in Saudi Arabia show inconsistent awareness levels. ObjectivesThis study seeks to develop insights for the development of tailored prevention programs that align with Saudi Vision 2030 in terms of enhancing quality of life. Thus, the aim of the study is to assess knowledge levels of stroke risk factors, warning signs, symptoms, and prevention methods among high-risk groups (HTN and DM patients) at King Saud University Medical City (KSUMC). MethodsThis was an analytical cross-sectional study conducted among 422 participants from June 2022 to January 2023, using a validated Arabic questionnaire taken, with permission, from previous studies. All HTN and T2DM patients in the waiting areas of the outpatient clinics at KSUMC, Riyadh were included as part of the random sampling, though patients below 20-years-old and those with other endocrine disorders were then excluded. ResultsThe majority of participants were male (64.5 %). The analysis showed that 66.1 % of participants had “poor total knowledge” of stroke factors. Half of the participants (50.5 %) had “poor knowledge” about stroke risk factors, though the most commonly identified risk factor was “hypertension”. Additionally, the findings showed that 46.4 % of participants had “poor knowledge” of stroke warning signs and symptoms, with the most commonly identified warning sign being “difficulty in speaking.” Nearly half of participants (46.4 %) had “good knowledge” of stroke prevention methods; however, “regular exercise” was the most commonly identified prevention method. ConclusionAlthough the participants displayed decent knowledge of stroke prevention methods, several notable deficits in overall knowledge of stroke factors emerged. In particular, knowledge of stroke risk factors and warning signs and symptoms among participants was inadequate. This implies that healthcare providers should seek to launch campaigns addressing stroke knowledge mainly among high-risk groups, potentially distributing brochures about stroke knowledge in the relevant clinics and seeking to provide a range of educational content by means of social media.

Prediction of various insulin resistance indices for the risk of hypertension among military young adults: the CHIEF cohort study, 2014–2020

BackgroundNon-insulin-based insulin resistance (NI-IR) indices have been reported to have an association with prevalent hypertension, however, no cohort studies to date have compared their prediction of hypertension among young adults.MethodsA total of 2,448 military men and women, aged 18–39 years, without baseline hypertension in Taiwan were followed for incident hypertension events from 2014 until the end of 2020. All subjects underwent annual health examinations including measurements of blood pressure (BP) in mmHg. Systolic BP (SBP) 130–139/diastolic BP (DBP) < 80, SBP < 130/DBP 80–89, and SBP 130–139/DBP 80–89 were respectively defined as stage I isolated systolic hypertension (ISH), isolated diastolic hypertension (IDH) and combined hypertension (CH). The cut-off levels of stage II hypertension for SBP and DBP were 140–159 and 90–99, respectively. Four NI-IR indices included the ratio of serum triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C), TyG index defined as ln[TG* fasting glucose (FG)/2], Metabolic Score for IR (METS-IR) defined as ln[(2* FG) + TG)* body mass index (BMI)/(ln(HDL-C))], and ZJU index defined as BMI + FG + TG + 3* alanine transaminase/aspartate transaminase (+ 2 if female). Multivariable Cox regression analysis was performed with adjustments for baseline age, sex, body mass index, BP, substance use, family history for early onset cardiovascular diseases or hypertension, low-density lipoprotein cholesterol, kidney function, serum uric acid and physical activity to determine the associations.ResultsDuring a median follow-up of 6.0 years, there were 920 hypertension events (37.6%). Greater TyG, TG/HDL-C and METS-IR indices were associated with a higher risk of stage I IDH (hazard ratios (HRs) and 95% confidence intervals: 1.376 (1.123–1.687), 1.082 (1.039–1.127) and 3.455 (1.921–6.214), respectively), whereas only greater ZJU index was associated with a higher risk of stage II IDH [HRs: 1.011 (1.001–1.021)]. In addition, greater ZJU index was associated with a higher risk of stage II ISH [HR: 1.013 (1.003–1.023)], and greater TyG index was associated with a higher risk of stage II CH [HR: 2.821 (1.244–6.395)].ConclusionInsulin resistance assessed by various NI-IR indices was associated with a higher risk of hypertension in young adults, while the assessment ability for specific hypertension category may differ by NI-IR indices.

Efficacy of azilsartan medoxomil in patients with hypertension and stable coronary artery disease in combination with type 2 diabetes

Aim. To study the effect of azilsartan medoxomil (AZL-M) on the 24-hour blood pressure (BP) profile in patients with hypertension (HTN), type 2 diabetes (T2D) and stable coronary artery disease (CAD).Material and methods. A total of 183 patients with CAD in combination with HTN and T2D took part in the study (100 men (54,64%), 83 women (45,36%)). All patients were previously prescribed a statin, antiplatelet therapy, a beta-blocker, and an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). At baseline, the proportion of people taking ARBs and ACEIs was 30% and 70%, respectively. All study participants were discontinued from a previously prescribed ARBs or ACE inhibitors and were prescribed 6-month AZL-M (Edarbi®) therapy. During this period, according to the study plan, patients visited the medical center to assess the effectiveness and safety of therapy and blood pressure changes.Results. The mean age of the patients was 65,0 years (60-69 years), while the mean body mass index (BMI) — 31,24 kg/m2. The mean age of female participants was higher than the mean age of males: 66,35±6,59 vs 62,72±8,82 years (p=0,002). The mean BMI in women was higher and was 33.08 kg/m2, while in men it was 30,74 kg/m2 (p=0,001). Six-month AZL-M therapy decreased 24-hour BP values. Thus, the time index of systolic blood pressure (SBP) hypertension in the daytime decreased from 63% to 12%, while at night from 70% to 10%, and the time index of diastolic blood pressure (DBP) hypertension in the daytime from 18% to 10%, and at night from 44% to 8%. The main result is confirmation of AZL-M effectiveness in relation to BP control, as well as good drug tolerability. At the visit after 1-month AZL-M therapy, target BP values were recorded in 45,4% of participants, and after six months — the proportion of people with normal 24-hour BP values was 69,9%.Conclusion. Edarbi® therapy in patients with HTN in combination with T2D and stable CAD leads to 24-hour BP normalization. At the same time, the drug has a good safety profile, since the reported adverse events were not related to the drug.

Experience of sacubitril/valsartan therapy in hypertension

The aim of the review was to analyze the antihypertensive efficacy and safety of sacubitril/valsartan combination, a representative of a new class of angiotensin receptor-neprilysin inhibitors (ARNIs), in patients with hypertension (HTN) according to clinical trials, including randomized, and meta-analyses. Randomized clinical trials conducted in different age, ethnic and clinical cohorts of HTN patients, as well as meta-analyses showed a more significant antihypertensive effect of sacubitril/valsartan compared with monotherapy with angiotensin II receptor blockers, confirmed by office blood pressure (BP) and 24-hour BP monitoring. At grade 1-2 HTN, sacubitril/valsartan showed greater reduction in systolic and diastolic blood pressure by ~5/2 mm Hg compared to valsartan or olmesartan according to 8-12-week studies. A dose-dependent effect of sacubitril/valsartan was established. A favorable experience was obtained with sacubitril/ valsartan use in various clinical variants of HTN (refractory HTN, isolated systolic HTN in the elderly, HTN in combination with heart failure, with chronic kidney disease), as well as the successful use of sac/vals in combination with other antihypertensive drugs. In long-term studies (52 weeks) in elderly patients with HTN, the positive effects of sacubitril/valsartan in reducing central aortic pressure, systolic blood pressure at night and a decrease in pulse pressure have been shown. Several meta-analyses have shown similar tolerability profiles compared to controls and no increased risk of adverse events.

Vascular stiffness, 24-hour blood pressure profile in patients with hypertension and anxiety-depressive disorders in andro- and menopausal periods

Aim. Identification and analysis of the features of vascular stiffness, 24-hour blood pressure (BP) profile, and central aortic pressure (CAP) in patients with hyper­tension (HTN) and anxiety-depressive disorders (ADDs) during andro- and meno­pausal periods.Material and methods. The study included 120 patients with uncontrolled hyper­tension in the andro- and menopausal periods, of which 60 patients with hyper­tension and ADDs (30 men and 30 women) with median age of 58 years (52-64 years), as well as the control group — 60 patients with hypertension without ADD (30 men and 30 women) with median age of 59 years (53-65 years). All persons included in the study underwent 24-hour ambulatory BP monitoring (ABPM) and assessed the arterial stiffness parameters and CAP.Results. Comparative evaluation of ABPM in the group of patients with HTN and ADDs revealed more pronounced pathological changes in the 24-hour BP profile compared to those in the control group. Andro- and menopause with a combination of HTN and ADDs characterized by significantly higher ABPM parameters than HTN without ADDs (regardless of the sex). At the same time, in the group of men with HTN and ADD in andropause, unfavorable changes in the main arterial stiffness parameters and CAP were more significant than in women with HTN and ADD during menopause (p&lt;0,05). In the control men groups, in comparison with women, more pronounced unfa­vo­-rable changes in certain vascular stiffness indicators, CAP and ABPM were recorded.Conclusion. In men and women in periods of andro- and menopause with HTN and ADDs, the features of arterial stiffness, CAP, and 24-hour blood pressure profile were verified in comparison with patients with HTN without ADDs. At the same time, the severity of unfavorable changes in the studied parameters in men with depression in andropause is more significant than in menopausal women.

Prospective follow-up of hypertensive patients with concomitant chronic respiratory diseases in routine practice. Part I. Characterization of adverse events

The most common cardiovascular disease (CVD) and risk factor for the main causes of death is hypertension (HTN), the prevalence of which in Russia is 44%. The combination of HTN and chronic respiratory diseases (CRDs) can lead to mutual influence and worsen the prognosis.Aim. To study long-term outcomes in HTN patients with CRDs under outpatient monitoring in primary health care.Material and methods. This prospective observational study of hypertensive outpatients (n=156, age, 63,4±8,8 years, men, 27,6%) was carried out, of which 49 had asthma, 20 — chronic obstructive pulmonary disease (n=69; group with CRD). The composite primary endpoint included death, myocardial infarction, cerebral stroke, transient ischemic attack, arterial revascularization, angina pectoris, peripheral arterial disease (&gt;50% stenosis), heart failure, atrial fibrillation, and ventricular premature beats &gt;30 h. There were following secondary endpoints: hypertensive crisis, hospitalization, emergency call and temporary disability due to cardiovascular diseases, asthma, chronic obstructive pulmonary disease, pneumonia, chronic respiratory failure. In addition, the following tertiary endpoints were analyzed: increased blood pressure (BP) without a hypertensive crisis, which required correction of HTN therapy, deterioration in CRD course (an increase in the ACQ-5 or CAT total score without exacerbation), acute bronchitis, other acute diseases and exacerbations of chronic ones, which required hospitalizations, new clinically significant chronic diseases not included in the primary and secondary endpoints.Results. The follow-up period was 29±8 months. The groups did not differ in relation to prevalence of primary endpoints. The frequency of secondary and tertiary endpoints was higher in the CRD group due to "respiratory" events and episodes of BP destabilization requiring correction of HTN therapy (p&lt;0,01). In HTN patients with CRDs, cumulative survival was lower, and the cumulative risk of adverse events was higher.Conclusion. Larger studies are needed in this area, as well as an analysis of the factors associated with adverse outcomes in hypertensive patients, including BP characteristics and accounting for CRDs, in order to improve preventive approaches.

Association Between Dental Calculus and Hypertension Phenotypes in Highly Fit Adults: CHIEF Oral Health Study.

Poor oral health evaluated by presence of dental calculus has been associated with hypertension (HTN) among middle- and old-aged adults. However, it is unclear for the association of HTN phenotypes with dental calculus in young adults. This study examined the association between dental calculus and HTN in 5,345 military personnel, aged 19-45 years, without antihypertensive medications therapy in Taiwan from 2018 to 2021. Dental calculus was defined as presence of supragingival calculus in any teeth, except impacted teeth, and third molar. Combined HTN (CHTN) was diagnosed as systolic blood pressure (SBP) ≥130 mm Hg and diastolic blood pressure (DBP) ≥80 mm Hg. Isolated systolic and diastolic HTN were, respectively, defined as SBP ≥130 mm Hg only (ISHTN) and DBP ≥80 mm Hg only (IDHTN). Multiple logistic regression with adjustments for sex, age, toxic substance use, anthropometrics, lipid profiles, fasting glucose, and blood leukocyte counts were used to determine the association between dental calculus and HTN phenotypes in young adults. The prevalence of those with dental calculus, CHTN, ISHTN, and IDHTN was 20.8%, 10.8%, 10.2%, and 7.0%, respectively. The dental calculus was associated a greater possibility with CHTN [odds ratio (OR) and 95% confidence interval: 1.60 (1.31-1.95)]. However, the associations of dental calculus with ISHTN and IDHTN were null [OR: 1.05 (0.81-1.27) and 1.12 (0.86-1.46), respectively]. Our findings suggest that among young adults, poor oral health manifested by presence of dental calculus was associated with a greater possibility of CHTN, while not for ISHTN and IDHTN.

Atherogenic index of plasma as an additional marker of adverse cardiovascular outcomes

Aim. Using a representative sample of the Krasnoyarsk Krai population, to evaluate the distribution of the atherogenic index of plasma (AIP), logarithmically transformed ratio of molar concentrations of triglycerides to high-density lipoprotein-cholesterol, and to identify possible associations between AIP, various cardiovascular diseases, and metabolic parameters.Material and methods. The study included a random representative sample of 1603 residents of the Krasnoyarsk and Berezovsky rural district aged 25-64 years as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. Statistical processing was performed using IBM SPSS v22 and Microsoft Excel 2021 programs. We assessed the prevalence of hypertension (HTN), coronary artery disease, myocardial infarction (MI), stroke and renal dysfunction in the whole sample and in groups with different risk depending on AIP. Differences between groups were tested by Yates’s chi-squared test and were considered significant at p≤0,05.Results. Depending on AIP value, 73,5% of participants were in the low-risk group (AIP &lt;0,10), 10,4% — in moderate risk group (AIP, 0,100,24) and 16,1% — in high-risk group (AIP&gt;0,24). The prevalence of prior MI or stroke in the moderate and high-risk group for AIP was significantly higher than in the low-risk group (p=0,024). A regular increase in HTN prevalence was registered from 42,6% in the lowrisk group to 71,4% in the high-risk group for AIP (p&lt;0,001 for all). There was a significant increase in the proportion of patients with a combination of HTN + elevated low-density lipoprotein cholesterol levels as AIP risk increased — from 28,4% at low risk to 45,2% at high risk. There were no significant differences between AIP risk groups in the prevalence of coronary artery disease and renal dysfunction.Conclusion. AIP is a simple additional estimated parameter that characterizes the atherogenic properties of plasma. Based on a cohort of Krasnoyarsk Krai subjects, an elevated level of AIP is associated with an increased prevalence of MI and strokes. Determination of AIP may be especially useful in the case of normal baseline low-density lipoprotein cholesterol levels.

DRUG THERAPY FOR PROTEIN COMPOSITION CHANGES OF BLOOD IN HYPERTENSION AND IN CASES OF COMORBIDITY

Background. The binding function of serum albumin (BFSA) and its changes in various diseases in recent years are of interest to researchers. Hypertension (HT) in combination with comorbidities, including non-alcoholic steatohepatitis (NASH) and type 2 diabetes mellitus (DM) can contribute to BFSA. Objective. The aim of this study is to evaluate the relationship between quantitative changes in BFSA, protein fractions and indicators of endogenous intoxication (EI) in HT in combination with NASH and type 2 diabetes and to suggest drug therapy of the disorders revealed. Methods. 123 patients with stage 2 HT and degree 2-3 arterial hypertension were examined; they were divided into three groups: group 1 included 28 patients without concomitant diseases, 2 – 48 patients with concomitant NASH, 3 – 47 patients with NASH and type 2 diabetes. Groups 3 and 4 were divided into two subgroups (A and B): patients of the subgroup A received basic HT therapy and additionally Antral® 200 mg 3 times a day for 60 days, B – only basic HT therapy. All patients underwent a standard clinical examination, as well as for BFSA, total protein, albumin, globulins and albumin-globulin ratio, medium mass molecules (MMM) at 280 and 254 nm and erythrocyte intoxication index (EII). The comparison group consisted of 25 healthy individuals. Results. It was found out that Antral® in patients with HT in combination with NASH and with NASH and type 2 diabetes with a statistically significant decrease in BFSA, total protein and albumin, as well as with increased indicators of EI (MSM254, MSM280 and EII) caused significant improvement in BFSA, increase of total protein, serum albumin, reduce of MSM254, MSM280, EII and strengthening of all correlations. Conclusions. Antral® therapy in patients with HT in combination with NASH as well as NASH and type 2 diabetes causes significant increase in BFSA, serum protein fractions and decreases EI.

Features of disorders of uric acid metabolism in male patients with hypertension and atrial fibrillation

Abstract Background In recent decades, a significant number of epidemiological studies showed the association between asymptomatic hyperuricemia and development of arterial hypertension (HTN) and atrial fibrillation (AF). The key enzyme participating in disintegration purines to uric acid is xanthine oxidase (XO). The accumulated data suggest the existence of a direct pathophysiological role of increased level of serum uric acid (SUA) and XO activity with a risk of HTN and AF. Purpose To evaluate the features of disorders of UA metabolism in patients with HTN and AF. Materials and methods The study included male patients 27 to 65 years, with a body mass index (BMI) less than 30 kg/m2 and more than 18.5 kg/m2. All patients were investigated of the level of a SUA, hypoxanthine/xanthine, inosine/adenosine, XO enzyme activity. Depending on the presence of AF, all patients were divided into 2 groups: group 1 (n=16) patients with HTN, group 2 (n=16) patients with HTN and AF. Results Table 1 shows the indicators of purine metabolism in the compared groups. The analysis of the results demonstrates that in group 1 the smallest level of a SUA in comparison with group 2 (0.35 [0.31; 0.41] vs 0.41 [0.39; 0.40](μmol/l), p=0.003), hypoxanthine 3.02 [1.80; 5.63] vs 7.35 [4.56; 8.25](μmol/l), p=0.008; inosine 1.59 [1.25; 4.48] vs 7.41 [1.49; 17.24](μmol/l), p=0.002. An increase level of a SUA is noted in 31.2% of patients from group 1 (5 patients out of 16) and 68.7% of patients from group 2 (11 patients out of 16). As a result of Spearman's correlation analysis in the group of patients with HTN and AF, a direct correlation was found between the experience of AF and BMI (r=0.681), SBP (r=0.487); level of hypoxanthine and inosine (r=0.808) and the inverse correlation between the level of xanthine and inosine (r=−0.547), as well as the association between the level of XO and SUA (r=0.796), XO and BMI (r=0.812). In the group of patients with HTN was determined association between the level of hypoxanthine and inosine (r=0.604), xanthine and adenosine (r=0.539), inosine and adenosine (r=0.657), a direct association between the level of XO and adenosine (r=0.642), inosine (r=0.502), BMI (r=0.791). Conclusions As a result of the study of patients with isolated HTN in combination with AF at the age of 27 to 65 years and a BMI of less than 30 kg/m2 and more than 18.5 kg/m2, an increase level of SUA and intermediate metabolites of UA synthesis such as inosine and hypoxanthine is observed compared with group with isolated HTN. An increase in level of XO is associated with an increase level of SUA and BMI. In the group of patients with HTN, an increase in level of inosine is associated with an increase level of hypoxanthine, but an increased level of inosine is associated with a decrease in level of xanthine. The XO level in this group is associated with an increase in level of adenosine and inosine, BMI. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Grodno State Medical University, Grodno, Belarus Table 1. Comparative characteristics of indicators in groups 1 and 2

Factors affecting blood pressure in patients with arterial hypertension and subclinical hypothyroidism

Background: The aim our study was to identify factors affecting blood pressure in patients with hypertension (HTN) and subclinical hypothyroidism (SH). Material and methods: One hundred and thirty-eight patients aged from 25 to 59 years were examined and divided into control group (n = 30), euthyroid patients with HTN (n = 45) and patients with HTN in combination with SH (n = 63). The levels of tumor necrosis factor-a, C-reactive protein, total hydroperoxide content, total antioxidant activity, total uperoxide dismutase activity and sirtuin 1 were measured in addition to complete blood count and routine biochemical tests. The Kruskal-Wallis H test was used to test whether there was a significant difference between the independent and its dependent variables. Results: Fewer factors affected systolic and diastolic blood pressure in patients with HTN and SH compared with euthyroid patients. These included age, waist circumference, insulin, triglycerides, very high-density lipoprotein cholesterol, and TAA. The opposite results were found in relation to the increase in pulse pressure: significant effects of gender, hemoglobin, alkaline phosphatase were observed in patients with SH and only the level of ACT had a significant influence in euthyroid patients. Conclusions: Factors associated with blood pressure and their overall number differed among patients with SH and HTN compared with euthyroid patients with HTN. Such results may be due to changes in anthropometric parameters, metabolic profile and oxidative status in patients with concomitant SH.

Effect of visceral obesity on main artery elasticity and vascular age in patients with hypertension, obesity, and type 2 diabetes

Aim. To assess the effect of visceral obesity on main artery elasticity and vascular age in patients with hypertension (HTN), obesity, and type 2 diabetes (T2D).Material and methods. A total of 320 patients with stage II-III HTN aged 4570 years were divided into 4 groups: isolated HTN (group 1), HTN and obesity (group 2), HTN, obesity and T2D (group 3), HTN and T2D without obesity (group 4). We assessed the clinical status, parameters of visceral obesity, main artery elasticity, and vascular age. We used nonparametric statistics, Spearman correlation analysis.Results. At least 50% of all patients had visceral obesity, despite no BMI-estimated obesity in groups 1 and 4: 57,5 vs 100,0 vs 100,0 vs 50,0% in groups 1, 2, 3 and 4, respectively (p&lt;0,0001).In the groups where hypertension was combined with obesity and T2D, the proportion of patients with leptin content above 32,7 ng/ml significantly increased to 80% (in total for groups 2 and 3) compared with 25,0% among HTN people without obesity (in total for groups 1 and 4). There was a significant increase in proportion of patients with a adiponectin decrease &lt;14,6 ng/ml among patients with a combination of HTN and T2D ± obesity (45% in total for groups 3 and 4) in comparison with those with HTN and without T2D ± obesity (22,5% in total for groups 1 and 2).The visceral adiposity index (VAI) was significantly higher among patients with HTN, obesity and T2D compared with those with isolated HTN and HTN in combination with T2D only (2,96 [2,36; 3,98] vs 1,87 [1,40; 2,67] vs 2,22 [1,61; 3,26], respectively). A higher proportion of subjects with adipose tissue dysfunction was noted in groups 2 and 3 compared to groups 1 and 4 (75 vs 81,1 vs 41,5 vs 53,4%, respectively, p1-2&lt;0,001, p1-3&lt;0,001, p2-4=0,023, p3-4=0,002).The proportion of patients with a pulse wave velocity &gt;10 m/s was consistently more common among patients of group 3 compared with patients in groups 1 and 2 (77,0 vs 57,9 and 55,3%, respectively, p1-3=0,004, p2-3=0,006).Vascular age was significantly lower in group 1 compared with groups 3 and 4 (64,0 [57,8; 71,0] vs 69,0 [62,0; 73,0] and 69,5 [66,0; 74,3] years, respectively), as well as in group 2 compared with group 4 (64,0 [56,5; 70,5] vs 69,5 [66,0; 74,3] years). The 5-year risk of cardiovascular events was significantly higher among patients with hypertension, obesity and T2D and those with HTN and T2D without obesity, compared with patients with isolated HTN, and with those with HTN and obesity (5,9 [3,9; 7,9] and 6,5 [4,7; 8,7] vs 4,4 [2,7; 6,8] and 3,6 [2,4; 5,8], respectively). Correlation analysis revealed the relationship between the visceral obesity parameters, main artery elasticity, vascular age and the 5-year risk of cardiovascular events, demonstrating the special aspects of HTN course in each of the studied groups.Conclusion. The paper showed peculiarities of the effect of visceral obesity on main artery elasticity and vascular age in patients with HTN in combination with obesity and T2D.

Evolution of antihypertensive combined therapy: from depressin of academician A. L. Myasnikov to modern multi-component drugs

The article shows the historical background to the emergence and subsequent development of combined antihypertensive therapy from creation of a multi-component drug to modern fixed combinations as the most effective approach in the treatment of hypertension (HTN). The authors consider that Russian scientist therapist academician of the USSR Academy of medical Sciences A. L. Myasnikov, has priority in the development of fixed drug combination concept, created depressin powder. The development of pharmacology as a science and the achievements in pharmaceutical technologies contributed to the expansion of possible drugs combination for HTN treatment, and the discovery of new diverse pathophysiological mechanisms implemented in this pathology led to the understanding of the need for combined drugs in clinical practice. The advantages of combination HTN therapy versus monotherapy include rapid achievement of the target blood pressure level, low frequency of tachyphylaxis, longer-lasting antihypertensive effect, no need to change drugs, higher compliance, effective organoprotection and cardiovascular risk reduction, positive and/or neutral effects on the main parameters of metabolism, reduced frequency and severity of side effects. Taking into account these facts, as well as the wide prevalence of HTN in the population, its high medical and social significance, the key role in atherosclerosis, it is necessary to develop new combined domestic drugs for the treatment of HTN and their inclusion in the list of vital medicines, increasing the availability of these drugs for the population on the basis of preferential programs.

Early cardiovascular multimorbidity in out- and in-patient care: age characteristics and medication therapy (data from the REKVAZA and REKVAZA-CLINIC registries)

Aim. To assess the age and sex characteristics, comorbidities and medication therapy in patients with early cardiovascular multimorbidity in out- and in-patient care. Material and methods . The REKVAZA registry includes 3,690 patients with hypertension (HTN), coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF) and their combinations, who applied to primary care facilities in Ryazan in 2012-2013. The hospital registry REKVAZA-CLINIC included 17,018 patients hospitalized due to cardiovascular disease (CVD) at the National Medical Research Center for Therapy and Preventive Medicine from April 2013 to March 2020. The groups of patients with early cardiovascular multimorbidity were compared according to two criteria: criterion 1 — age 18-49 years; criterion 2 — the age of men, 18-54 years; women, 18-64 years. The structure of CVD and related diseases, as well as cardiovascular therapy were analyzed. Results. The proportion of persons with early cardiovascular multimorbidity from the total number of patients with cardiovascular multimorbidity was as follows: using criterion 1 — 4,9% (145/2959) and 4,94% (571/11557) (p=0,66), criterion 2 — 29,0% (859/ 2959) and 18,8% (2168/11557) (p&lt;0,0001), respectively. Using criterion 2, in contrast to criterion 1, the proportion of men with early multimorbidity was 2,7 times less in the REKVAZA registry (17,1 vs 45,5%; p&lt;0,0001) and 1,8 times less in the REKVAZA-CLINIC registry (44,2 vs 80,9%; p&lt;0,0001). Among individuals with &gt;2 CVDs (HTN, CAD, HF, AF, myocardial infarction, acute cerebrovascular accident), the proportion of individuals with early development of each of the listed diseases was significantly higher in the out- and in-patient registries, when using criterion 2 (14-29%) compared to criterion 1 (2-2,5%). Among patients with early onset of CVD in the outpatient registry, when criteria 1 and 2 were used, the proportion of patients with cardiovascular multimorbidity was 41,8 and 62,7% (p&lt;0,0001), respectively; in the inpatient registry — 34,1 and 45,5% (p&lt;0,0001). That is, at the age of &lt;50 years&gt; 1/3 of patients were found to have combined CVDs. Using criterion 2, compared with criterion 1, the proportion of persons with HTN and concomitant CVD among all patients with early HTN was 1,5 times higher (62,8 vs 41,6%; p&lt;0,0001) in the outpatient register and 1,3 times higher in the inpatient one (48,9 vs 37,5%; p&lt;0,0001). The proportions of persons with HTN in combination with other CVDs were among all hypertensive patients aged &lt;45 and &lt;40 years: in the outpatient registry, 35,5% (61/172) and 33,3% (38/114) cases, respectively, and in the inpatient — 27,8% (215/772) and 26,5% (95/359), respectively. According to the data of both out- and inpatient registries, in patients with early development of HTN (&lt;50 years of age) and concomitant CVDs, compared with those without such a combination, there was a greater number of noncardiac diseases (18,3 vs 7,0%; p=0,001), diabetes (12,9 vs 4,7%; p&lt;0,0001), respectively. In the inpatient registry, in addition to diabetes, there was a greater proportion of people with gastrointestinal diseases (78,7 vs 73,2%; p=0,02) and obesity (37,9 vs 30,3%; p=0,004). Among patients &lt;50 years of age, the prevalence of those taking appropriate medications was higher than in the group of patients meeting criterion 2 — 68,0% vs 63,2%, respectively (p=0,03). Conclusion. Early cardiovascular multimorbidity in the REKVAZA and REKVAZA-CLINIC registries was detected in 14-29% of the total number of combined CVD cases when using criterion 2 and only in 2-5% when using criterion 1. However, in relation to the total number of patients with early CVD development, individuals with cardiovascular multimorbidity make up the majority. It is preferable to use age &lt;50 years as a criterion for early cardiovascular multimorbidity. But the criterion for the early development of HTN combined with other CVDs is appropriate to consider the age &lt;40 years. Persons with early cardiovascular multimorbidity, especially at the age of 18-49 years, are the target group for the implementation of preventive measures.

Hypertension Is Associated with Increased Risk of Diabetic Lung.

Lung function is often impaired in diabetic patients, especially in a restrictive pattern, which has recently been described as the diabetic lung. Since hypertension (HTN) is common in diabetic patients, our study investigated whether HTN acts as an aggravating factor in diabetic lung. Within the cross-sectional study from the 6th Korean National Health and Nutrition Examination Survey (KNHANES), fasting plasma glucose (FPG), blood pressure (BP), pulmonary function, and laboratory data were examined in 4644 subjects aged between 40 and 79 years. A multivariate regression model was used to investigate the relationship between BP, FPG, and pulmonary function. Lung function was significantly reduced in the HTN (p = 0.001), impaired fasting glucose (IFG) (p < 0.001), and diabetes mellitus (DM) (p < 0.001) groups. Next, a multivariate logistic regression model was used to derive the odds ratio (OR) of reduced lung function based on the presence of IFG, DM, and HTN. The OR of reduced forced vital capacity (FVCp < 80%) was 3.30 (p < 0.001) in the HTN-DM group and 2.30 (p < 0.001) in the normal BP-DM group, when compared with the normal BP-normal FPG group. The combination of HTN and DM had the strongest negative effect on FVC. The results presented in this study indicate that diabetes and hypertension have a synergistic association with impaired lung function.

Effect of indapamide and bisoprolol monotherapy on cerebrovascular reactivity in hypertensive patients with rheumatoid arthritis

Aim. To investigate the effect of indapamide and bisoprolol monotherapy on cerebrovascular reactivity (CVR) in patients with combined hypertension (HT) and rheumatoid arthritis (RA).Materials and Methods. A total of 66 patients with HT grade 1-2 and RA (average age of 59.0 ± 7.5 years) were included in an open-controlled randomized study in parallel groups. Group 1 included 33 patients treated with indapamide 2.5 mg/day. Group 2 included 33 patients treated with bisoprolol 6.0 ± 2.6 mg/day. We performed 24-h blood pressure monitoring and transcranial Doppler ultrasound of the middle cerebral arteries (MCA) with assessment of CVR during hyperoxia and hypercapnia tests before and after 24 weeks of treatment.Results. Indapamide treatment improved CVR parameters during hypercapnia test. The MCA peak systolic velocity increased significantly from 53.7 [34.8; 67.8] to 55.8 [37.6; 69.0] сm/s (p = 0.017). Bisoprolol treatment worsened CVR parameters during hypercapnia test. The speed modification of MCA blood flow velocity decreased significantly from 0.10 [0.05; 0.19] to 0.08 [-0.01; 017] cm/s2 (p = 0.032). The index of recovery of MCA blood flow velocity decreased significantly from 1.11 [0.95; 1.27] to 0.84 [0.78; 1.08] (p = 0.006)Conclusion. Indapamide treatment improved CVR parameters, but bisoprolol treatment worsened CVR parameters during hypercapnia test in patients with combined HT and RA.

Humoral mediators in men with acute coronary syndrome and hypertension

Objective . Cross-sectional study of lipid metabolism regulation and coronary angiographic data parameters in men admitted to the hospital due to acute coronary syndrome (ACS). Design and methods . The presence of hypertension (HTN) combined with several related biological risk factors of chronic non-infectious diseases were assessed. We included 98 men with ACS (73 patients with myocardial infarction and 25 subjects with unstable angina). All patients underwent an urgent coronary angiography. We assessed the presence of risk factors of chronic non-infectious diseases (CNID), such as HTN, abdominal obesity, dyslipidemia and hyperglycemia. Plasma levels of leptin and adiponectin were evaluated. Results. HTN was diagnosed in 81 % men with ACS. Among patients with three or more CNID risk factors, HTN is found in 100 %. The highest leptin level (12 [7,3-19,0] ng/ml) was found in patients with both HTN and abdominal obesity, compared to those with isolated HTN (2,2 [0,7-4,3] ng/ml; p = 0,0) or abdominal obesity (7,3 [7,1-8,4] ng/ml; p = 0,022). In patients with both HTN and dyslipidemia, adiponectin level is lower (21,5 [10,6-35,3] μg/ml) than in those with HTN alone (40,5 [12,8-71,6] μ g/ml ; p = 0,026). Also, in patients with combination of HTN and dyslipidemia, the coronary artery stenosis is significantly more pronounced (99,5 [90-100] %) than in those with HTN alone (70 [45-95] %; p = 0,004). In subjects with all three risk factors leptin levels (18,1 [9,5-26,4] ng/ml), the ratio leptin/adiponectin (0,7 [0,2-1,2] U) and the level of coronary artery stenosis (100 [86,2-100] %) are higher than in individuals with < 3 risk factors (4,2 [1,1-8,4] ng/ml; p = 0,0; 0,2 [0,03-0,5] U; p = 0,001 and 90 [60-100] %, respectively). Subjects with three or more risk factors of CNID show more frequently increased leptin level (n = 34; 81 %) (odds ratio (OR) = 6,4 95 % confidence interval (95 % CI) [2,3; 17,3]) and acute coronary artery stenosis (n = 40; 83 %) (OR = 2,7 CI 95 % [1,0; 7,2]). In contrast, those with less than three CNID risk factors have lower rate of increased leptin and coronary stenosis (n = 16; 40 %; p < 0,01 and n = 28; 65 %; p = 0,046, respectively). Results. In our study, HTN appeared to be the most common biological risk factor in men with ACS. Thus, when more than 3 risk factors are present, HTN seems to be an essential one. In addition, the presence of three or more biological risk factors is associated with increased leptin levels and acute coronary artery stenosis.

Long-term effects of baroreflex activation therapy: 2-year follow-up data of the BAT Neo system.

Baroreflex activation therapy (BAT) reduces office blood pressure (BP) in patients with resistant hypertension (HTN). Whereas sustained effects from the BAT Rheos device have already been reported, no long-term data on 24-h ambulatory BP (ABP) are currently available for the unilateral BAT Neo device. Patients treated with the BAT neo device for resistant hypertension were prospectively included into this observational study. Office and ABP measurements were performed before BAT implantation as well as 6, 12 and 24months after initiation of BAT. A total of 60 patients with resistant HTN (office BP 172 ± 25/90 ± 17mmHg, 24-h ABP 150 ± 16/80 ± 12mmHg, median of antihypertensive drugs 7 (IQR 6-8)) were included. After 24months, there was a significant reduction of - 25 ± 33/- 9 ± 18mmHg (n = 50, both p < 0.01) in office BP and - 8 ± 23/- 5 ± 13mmHg (n = 46, both p = 0.02) in 24-h ABP, while the number of antihypertensive medications was reduced to a median of 5 (4-6) drugs (p < 0.01). Patients with isolated systolic HTN (ISH) experienced a BP-lowering effect in office BP, but not in ABPM at month 24. Using unadjusted BP values, BAT seems to be more effective in combined hypertension (CH) than in ISH. After adjustment for baseline BP values, there was no significant difference in BP reduction between ISH and CH patients. Ambulatory SBP at baseline was the only independent correlate of BP response at month 24. BAT reduced office BP and improved relevant parameters of ABP, which is associated with a high cardiovascular risk, in patients with resistant HTN, whereas, after adjustment for baseline BP, BP reduction was not different in patients with CH compared with patients with ISH. However, randomized controlled trials are needed to confirm the effects of BAT on 24-h ABP.

Results of the surgical treatment of the aneurysms of anterior cerebral artery – anterior communicating artery complex

Objective – to establish the features of clinical presentation and to optimize surgical treatment of arterial aneurysms (AA) of the anterior cerebral artery–anterior connecting artery (ACA–AComA) complex.Materials and methods. The results of surgical treatment of 267 (100 %) patients with AA of the ACA–AComA complex during the period from 01.01.2011 till 31.12.2017 were analyzed. There were 143 (53.6 %) women and 124 (46.4 %) men. Microsurgical clipping was performed in 165 (61.8 %) cases, endovascular coiling in 122 (38.2 %) cases. The organization of the medical care, clinical and instrumental examinations, medical and surgical treatment was done according to the current protocols (the Decree of the Ministry of Health of Ukraine dated April 17, 2014, N 275, EBM Guidelines, 28.8.2017, Juha E. Jääskeläinen).Results. The AA rupture was diagnosed in 238 (89.2 %) patients. 181 (67.9 %) patients were hospitalized till the 28th day since AA rapture. The severity of the patients state according to the level of conscious during hospitalization: in conscious – 92 (34.4 %), obtunded – in 127 (47.6 %), stuporous – in 28 (10.5 %), comatose – 20 (7.5 %). The severity of subarachnoid hemorrhage (SAH) according to WFNS (World Federation of Neurological Surgeons) Grading Scale: grade I – in 63 (23.6 %) patients, grade II – in 43 (16.1 %) patients, grade III – in 78 (29.2 %) patients, grade IV – in 36 (13.5 %) patients, grade V – in 18 (6.8 %) patients. Altered mental status was found in 87 (32.6 %) patients, among them in 29 (10.8 %) patients with non-hemorrhagic presentation. Motor deficiency was diagnosed in 116 (43.4 %) patients, cranial nerve palsy – in 42 (15.7 %) patients, particular visual disturbances – in 28 (10.5 %) cases, oculomotor palsy – in 5 (1, 9 %) cases, visual and oculomotor disturbances – in 9 (3.3 %) cases.Subarachnoid hemorrhage with intracerebral hematoma was detected in 184 (77.3 %) patients. Localization of hematomas: frontal lobes – 161 (87.5 %) cases, corpus callosum – 15 (8.1 %) and/or septum pellucidum – 8 (4.4 %). The intraventricular hemorrhage was diagnosed in 81 (34 %) patients: 1–4 points according to Graeb score – in 32 (39.5 %) patients, 5–8 points – in 27 (33.3 %) patients, 9–12 points – in 22 (27.2 %) patients. Lateral or axial dislocation was found in 28 (11.8 %) cases. Cerebral vasospasm in acute period was observed in 59.7 % of patients, and in 19.3 % of patients in «cold» period.The localization of the AA of ACA–AComA complex (according to M.G. Yasargil): anterior – in 50 (18.7 %) cases, posterior – in 42 (15.7 %), superior – in 98 (36.7 %), inferior – in 35 (13.2 %), mixed projection – 42 (15.7 %) cases. Saccular aneurysms were found in 192 (71.9 %) patients, «complex» AA – in 75 (28.1 %). The size of AA in the most observations (252 (94.3 %)) was less than 15 mm. Hypoplasia or aplasia of one A1 segments of ACA we revealed in 45 (18.9 %) cases.Comorbid conditions: hypertension (HTN) – in 175 (65.5 %) patients, the combination of HTN with ischemic heart disease (IHD) – in 117 (43.8 %), hypertension, HTN in combination with systemic atherosclerosis – in 87 (32.6 %), diabetes mellitus (DM) – in 61 (22.8 %), combination of HTN, IHD, DM and systemic atherosclerosis – in 47 (17.6 %) cases.According to the timing of procedure, there were 54 (20.2 %) emergency procedure, 127 (47.6 %) urgent, and 86 (32.2 %) semi-elective. In 37 (68.5 %) cases, emergency surgical interventions were microsurgical clipping, in 32 (59.3 %) – combined. Class I of occlusion of the treated AA according to Raymond scale was achieved in 93.9 % after microsurgical clipping, and 77.5 % after endovascular coiling. Favorable outcome according to Extended Glasgow Outcome Scale (GOSE) after surgical treatment were achieved in 75.3 % with a total mortality of 7.1 %, and significant differences in outcome in groups with different timing of surgery.Conclusions. It was found that hemorrhagic presentation with the formation of intracerebral hematoma in the frontal lobes, with dislocation syndrome, intraventricular expansion, cerebral vasospasm with clinical manifestations of the I–III grade of SAH of WFNS scale, motor deficiency (43.4 % of cases), cranial nerve palsy (15.7 %) and altered mental status (32.6 %) was typical for AA of ACA–AComA complex. It was found the dependence of outcome after surgical treatment of AA of ACA–AComA complex from the timing and method of surgical procedure. The criteria for the selection of optimal surgical tactic are the type of clinical presentation of the disease, the timing after aneurysms rapture, the severity of the preoperative condition, the presence of cerebral vasospasm, anatomical and topographical characteristics of the aneurysm.

NEPHROPROTECTIVE EFFECTS OF LISINOPRIL IN THE THERAPY OF HYPERTENSIVE PATIENTS WITH OBESITY

Aim. To investigate the dynamics of biomarkers of early renal damage in patients with hypertension (HT) and obesity treated with lisinopril and diet therapy. Material and methods. The study included 120 people aged 25 to 55 years (90 patients with HT in combination with obesity and 30 HT patients without obesity). Control group was consisted of 50 healthy respondents without obesity. All HT patients received therapy with lisinopril at a dose of 10-40 mg per day with titration to target blood pressure (BP) values, patients with obesity – additionally diet therapy. Initially and after 6 months we investigated clinical and biochemical parameters, levels of leptin, resistin, cystatin C in blood serum and urine, albuminuria, NGAL (neutrophil gelatinase associated lipocalin) and interleukin 18 (IL-18) in the urine. Results. We identified the relationships between the serum cystatin C and BP, leptin, resistin, insulin-resistance index (HOMA-IR) and also metabolic indicators. In this study we revealed relationships of subclinical tubular dysfunction markers (urinary cystatin C, IL-18, NGAL) with carbohydrate and lipid metabolism, BP, hormonal activity of adipose tissue. The achievement of target BP values, normoalbuminuria and improving the glomerular filtration rate (GFR) were found after 6 months. The decrease in serum cystatin C in groups was seen: in Group 1 – from 1112 [757.0; 1400.0] to 797 [754; 825] ng/ml (р=0.001), in Group 2 – from 990 [700.0;1110.0] to 791 [770;900] ng/ml (р=0.03). Decrease in markers of tubular dysfunction was identified only in patients who reduced the body weight: urine cystatin C − from 33.0 [18.5; 50.0] to 24[15.3; 60.0] ng/ml (р=0.04) and IL-18 – from 0.33 [0.18; 0.41] to 0.21 [0.14; 0.43] pg/ml (р=0.04). Greater reduction in tubular dysfunction markers excretion was observed in the subgroup of patients with weight loss more than 5% but less than 10% of the initial value. Conclusion. The obtained relationships between markers of subclinical tubular damage and carbohydrate, lipid metabolism and adipokines prove the contribution of adipose tissue to the formation of tubular damage in patients with HT associated with obesity. Antihypertensive therapy with lisinopril contributes to the achievement of target BP values, improvement of metabolic parameters, increase in GFR, achievement of normoalbuminuria, whereas body weight loss in HT patients with obesity additionally contributes to the reduction in the manifestations of tubular dysfunction.