Organ Damage In Patients Research Articles

Intima-Media Thickness in Women with the History of Hypertensive Disorders of Pregnancy as a Risk Marker of the Occurrence of Cardiovascular Pathology in Advanced Reproductive and Perimenopausal Age

Over the past twenty years, it has been proven that a history of preeclampsia entails a 4-fold risk of hypertension, coronary heart disease, stroke, type 2 diabetes, metabolic syndrome in the affected women at the age of 50-55 years. Evaluation of intima-media thickness (IMT) has diagnostic value for the assessment of remodeling and atherosclerotic vascular lesions and practical importance as a predictor of vascular accidents in patients with hypertension and atherosclerosis.
 The aim. To evaluate the IMT as an integrative biomarker of the occurrence of cardiovascular pathology in women with hypertensive disorders of pregnancy in their advanced reproductive age and in perimenopausal age.
 Materials and methods. We studied 51 women at the age of 48-55 years with the history of severe preeclampsia. The women were asked to fill out a questionnaire in which they indicated the presence of a diagnosis of hypertension, angina pectoris at the time of filling the questionnaire. The diagnosis of hypertension and angina attacks as well as other descriptions of the disease were taken away from the results of the women’s questionnaire. The investigators were not given copies of medical records. The control group consisted of 20 women aged 48-55 who had no history of preeclampsia or any other hypertensive disorders of pregnancy. Ultrasound imaging of the carotid arteries was performed according to the recommendations of the American Society of Echocardiography 2020 in women of both groups using SonoAce-8000 Ex scanner (Medison, South Korea) with a linear sensor UST5524 with a frequency of 7 MHz. IMT less than 0.7 mm was taken as a normal value for women.
 Results. It was revealed that almost every fourth woman at the age of 48-55 with the history of preeclampsia had signs of early angina attacks, and 30% suffered from hypertension. A threatening fact is that almost 6% of women at the age of 48-55 had the history of vascular thrombosis which is a manifestation of early atherosclerotic vascular lesions in the group of women with gestational hypertensive disorders. It is noteworthy that 21 (41.2%) women with the history of severe preeclampsia felt healthy and did not have any complaints. Importantly, among the women surveyed who had no health complaints, 66.6% (14 of 21) had IMT 0.85±0.01 mm. This accounts for about one third (27.4%) among 51 patients. This category of women is at high risk of developing cardiovascular complications in the future and require further monitoring and detailed examination. Thrombotic complications (dynamic bowel obstruction, mesenteric vascular thrombosis) were observed in 3 (5.9 %) women at the age of 48-55 with the history of severe preeclampsia.
 Conclusions. Examinations of women with the history of preeclampsia revealed that women at the age of 48-55 had increased IMT. It should be noted that increased IMT was found both in women with cardiovascular pathology (hypertension, thrombosis, angina attacks) and in asymptomatic patients. Taking into account that increased IMT is one of the characteristics of target organ damage in patients with hypertension and the marker of cardiovascular events in asymptomatic patients, it is important to include this examination in follow-up for women with the history of severe preeclampsia in order to avoid the development of early severe cardiovascular pathologies.

Arterial Stiffness Assessment by Pulse Wave Velocity in Patients with Metabolic Syndrome and Its Components: Is It a Useful Tool in Clinical Practice?

Metabolic syndrome (MS) is not a single disease but a cluster of metabolic disorders associated with increased risk for development of diabetes mellitus and its complications. Currently, the definition of MS published in 2009 is widely used, but there are more versions of the diagnostic criteria, making it difficult to conduct scientific discourse in this area. Increased arterial stiffness (AS) can predict the development of cardiovascular disease both in the general population and in patients with MS. Pulse wave velocity (PWV), as a standard method to assess AS, may point out subclinical organ damage in patients with hypertension. The decrease in PWV level during antihypertensive therapy can identify a group of patients with better outcomes independently of their reduction in blood pressure. The adverse effect of metabolic disturbances on arterial function can be offset by an adequate program of exercises, which includes mainly aerobic physical training. Non-insulin-based insulin resistance index can predict AS due to a strong positive correlation with PWV. The purpose of this paper is to present the results of the review of the literature concerning the relationship between MS and its components, and AS assessed by PWV, including clinical usefulness of PWV measurement in patients with MS and its components.

Role of plasma 8-OXO-2’-deoxyguanosine in target organ damage in patients with hypertension and type 2 diabetes

Background: The aim of the study was to determine the prognostic value of 8-oxo-2’-deoxyguanosine (8-OHdG) plasma levels for cardiovascular complications (CVC) development in hypertension (HTN) and type 2 diabetes mellitus (T2DM) comorbidity. Material and methods: One hundred fifty-six patients (mean age 61.71 ± 0.87 years) with the combined course of HTN stage II and T2DM (group 1) and 100 non-diabetic patients with HTN stage II (mean age 60.59 ± 0.87 years, group 2) were examined. Lipid, carbohydrate metabolism, plasma insulin, plasma 8-OHdG (by ELISA), blood pressure levels were measured. Observation period was 12 months. Results: Plasma levels of 8-OHdG in the patients’ groups were significantly higher than in the controls (p < 0.001), in the group 1 higher than in group 2 (15.37 ± 0.27 ng/L vs . 14.00 ± 0.29 ng/L, respectively, p = 0.002). Plasma levels of 8-OHdG in group-2 patients who developed cardiovascular complications during observation period were significantly higher than in those without cardiovascular complications (16.47 ± 0.62 ng/L vs. 15.11 ± 0.29 ng/L, respectively, p = 0.046). The ROC analysis made it possible to propose the 8-OHdG plasma level ≥ 15.68 ng/L as an identifier for the cardiovascular complications in patients with studied comorbidity. In group 1, in patients with 8-OHdG plasma level ≥ 15.68 ng/L such cardiovascular risk factors as total cholesterol (TC) (p = 0.034), low density lipoprotein cholesterol (LDL-C) (p = 0.035), systolic blood pressure (p = 0.022), HOMA-IR (p = 0.046) were significantly higher compared with those whose level of this indicator was < 15.68 ng/L. Conclusion: Determination of the plasma 8-OHdG allows not only for assessment of the severity of oxidative stress, but also for determination of the course and prognosis in comorbidity of HTN and T2DM.

Fontan failure: phenotypes, evaluation, management, and future directions.

Management of "failing" and "failed" Fontan circulation, particularly the indications, timing, and type of re-intervention, currently remains nebulous. Factors contributing to pathogenesis and mortality following Fontan procedure differ between children and adults. Since organ systems in individual patients are affected differently, we searched the extant literature for a "failing" and "failed" Fontan reviewing the clinical phenotypes, diagnostic modalities, pharmacological, non-pharmacological, and surgical techniques employed, and their outcomes. A total of 410 investigations were synthesised. Although proper candidate selection, thoughtful technical modifications, timely deployment of mechanical support devices, tissue-engineered conduits, and Fontan takedown have decreased the peri-operative mortality from 9 to 15% and 1 to 3% per cent in recent series, pernicious changes in organ function are causing long-term patient attrition. In the setting of a failed Fontan circulation, literature documents three surgical options: Fontan revision, Fontan conversion, or cardiac transplantation. The reported morbidity of 25% and mortality of 8-10% among Fontan conversion continue to improve in select institutions. While operative mortality following cardiac transplantation for Fontan failure is 30% higher than for other CHDs, there is no difference in long-term survival with actuarial 10-year survival of around 54%. Mechanical circulatory assistance, stem cells, and tissue-engineered Fontan conduit for destination therapy or as a bridge to transplantation are in infancy for failing Fontan circulation. An individualised management strategy according to clinical phenotypes may delay the organ damage in patients with a failing Fontan circulation. At present, cardiac transplantation remains the last stage of palliation with gradually improving outcomes.

PROFILING CIRCULATING EXTRACELLULAR VESICLE SURFACE ANTIGENS IN PRIMARY ALDOSTERONISM

Objective: Primary aldosteronism (PA) is characterized by an inappropriate secretion of aldosterone. Chronic aldosterone excess exerts detrimental effects on cardiovascular system, including endothelial dysfunction and vascular inflammation. Circulating extracellular vesicles (EVs) are central players in the crosstalk between endothelium and inflammatory cells, and they may be involved in the development of organ damage in patients with PA. The aim of the present study was to assess the potential role of EVs in aldosterone-related vascular injury by evaluating a panel of 37 EV surface antigens through an innovative flow cytometry multiplex bead-based platform. Design and method: Serum EVs were isolated by immuno-capture from 32 patients with PA, 29 patients with essential hypertension (EH) and from 22 normotensive (NT) controls. EVs were characterized by nanoparticle tracking analysis, transmission electron microscopy, western blotting, and flow cytometry. Results: EV concentration was higher and diameter lower in patients with PA compared to patients with EH and NT controls and the number of particles decreased after unilateral adrenalectomy. Nineteen EV surface antigens were differentially expressed in patients with PA compared to patients with EH or NT controls, including markers from activated platelets, endothelial and immune/inflammatory cells. Supervised learning was used to combine the expression levels of EV surface markers in a specific molecular signature which discriminated patients with PA from controls (EH and NT), whereas after specific treatment the profile became similar to EH. Stimulation of human endothelial cells with PA patient-derived EVs, but not with EVs from EH, resulted in the overexpression of 5 selected genes (AKT1, CALR, CSNK2A1, FN1, and PIK3R1), previously identified by bioinformatics analysis as potential targets of differentially expressed EV antigens. Notably, the effect was specifically dependent on EV surface antigens, since it was abolished by removal of EV membrane associated proteins. The overexpression of CALR and FN1 was confirmed also at protein level. Conclusions: Our data suggest that EVs represent biomarkers of vascular inflammation and endothelial dysfunction in patients with PA, and also potential biovectors contributing to endothelial dysfunction, vascular inflammation, and accelerated organ damage by multiple signalling processes.

Vascular target organ damage in patients with Philadelphia negative myeloproliferative syndrome: A propensity score analysis

PurposeTo assess whether subjects with Philadelphia negative myeloproliferative neoplasms (Ph-MPNs) show differences in the presence of vascular, cardiac or renal target organ damage (TOD) and other vascular function parameters as compared to individuals without this condition. MethodsAn observational study was conducted. Fifty-seven subjects diagnosed with Ph-MPNs used as cases and 114 subjects without Ph-MPNs as controls. We matched the subjects with and without Ph-MPNs using the propensity scores in a 1:2 ratio using the variables gender, type 2 diabetes mellitus, high blood pressure, hyperlipidaemia and smoking. Vascular, cardiac and renal TOD were established according to the criteria of the European Society of Hypertension and Cardiology guidelines. Arterial stiffness was also assessed using the cardio-ankle vascular index (CAVI). ResultsMean age was 63.50±11.70 and 62.90±8.32 years in subjects with and without Ph-MPNs, 32 females (56%) in the first group and 62 (54%) in the second. Subjects with Ph-MPNs have a higher percentage of carotid injury than subjects without Ph-MPNs (35.1% vs. 21.1%) and higher albumin/creatinine ratio. In the logistic regression analysis, subjects with Ph-MPNs had an OR=2.382 (IC95% 1.066–5.323) for carotid injury versus those without haematological disease. ConclusionsSubjects with Ph-MPNs have twice the risk of by carotid injury than those without haematological disease.

Finerenone: a mineralocorticoid receptor antagonist for the treatment of chronic kidney disease associated with type 2 diabetes

ABSTRACT Introduction Approximately 40% of people with type 2 diabetes (T2D) also have chronic kidney disease (CKD), which substantially increases their risk of cardiovascular (CV)-related complications and mortality. Until recently, no approved therapies have directly targeted inflammatory and fibrotic pathways that drive disease progression and organ damage in patients with CKD associated with T2D. Areas covered Finerenone is a potent, selective, nonsteroidal mineralocorticoid receptor antagonist (MRA) that targets fibrosis and inflammation by blocking overactivation of the MR in the kidneys and heart. Finerenone has been associated with significant reductions in kidney- and CV-related endpoints compared with placebo and minimal effects on serum potassium and kidney function in phase III trials involving >13,000 patients with diabetic kidney disease (DKD). In addition to reviewing the clinical data, this review compares the properties of finerenone with those of the older steroidal MRAs spironolactone and eplerenone. Expert opinion Unlike spironolactone and eplerenone, finerenone has demonstrated a favorable benefit-risk profile offering an effective new treatment for patients with CKD associated with T2D. Increases in serum potassium are predictable and manageable and should not discourage the use of finerenone in clinical practice. It is important to discuss where finerenone ‘fits best’ within the current DKD management landscape.

For safe and adequate blood purification therapy in severe COVID-19 ‒ what we have learned so far.

Acute kidney injury (AKI) is defined as an increase in serum creatinine within 48 h or 1 week, or a decrease in urine output within 6-24 h. Continuous renal replacement therapy (CRRT) plays an important role in patients with severe AKI. In addition to direct cytotoxicity caused by the severe acute respiratory syndrome coronavirus 2, patients with coronavirus disease (COVID-19) experience endothelial cell damage, increased thrombogenic inflammation, and impaired immune responses. It has been reported that the more severe the case, the greater overproduction of cytokines and the more advanced the multiorgan failure. The kidney is widely recognized as one of the primary target organs; and COVID-19 positive AKI has been reported to have a greater rate of subsequent decline in renal function than COVID-19 negative AKI. Blood purification therapy has been used to prevent or alleviate organ damage in patients with moderate-to-severe COVID-19. Cytokine regulation is one of the primary therapeutic goals for these patients. Even with the widespread use of vaccines and antibody therapy, a certain percentage of patients develop moderate-to-severe diseases.

IgG4-related disease with nasopharyngeal malignancy-like manifestations

Objective:The purpose of this article was to discuss the clinical features and imaging characteristics of IgG4-related disease（IgG4-RD） in order to identify nasopharyngeal IgG4-RD at an early stage. Methods:The basic information of the patients, including age, sex, symptoms, disease duration and treatment process, was collected through the electronic case system. Laboratory tests including nasal endoscopy, EBV levels, IgG4 levels and C-reactive protein levels were recorded during hospitalization and outpatient follow-up. All radiological imaging and postoperative pathology data are collected, analyzed and summarized. Results:All patients underwent partial excisional biopsy of the lesion. The pathological findings showed inflammatory granulomatous and fibrous tissue hyperplasia with a high infiltration of lymphocytes, plasma cells and neutrophils, and immunohistochemistry examination showed IgG4+ plasma cells were more than 10 per high magnification field. Combining medical history, imaging, serological findings and relevant treatment, all four patients were diagnosed with IgG4-associated disease. And their symptoms improved significantly after hormonal and immunosuppressive treatment. Conclusion: IgG4-RD has a highly similar clinical presentation with nasopharyngeal carcinoma. Differentiation from IgG4-RD should be considered for those pathology cannot be clarified by multiple biopsies. Timely diagnosis of IgG4-RD is important to prevent secondary organ damage in patients with active disease.

Persistent cardiac organ damage in surgically and medically treated primary aldosteronism.

We compared persistent cardiac organ damage in patients treated surgically or medically for primary aldosteronism. Eighty-four patients (age 57 ± 11 years, 27% women) with primary aldosteronism underwent echocardiography at time of diagnosis and after one year of treatment (49% adrenalectomy, 51% medical treatment). Persistent cardiac organ damage was defined as presence of left ventricle (LV) hypertrophy, low LV midwall shortening, global longitudinal strain and/or enlarged left atrium both at baseline and at follow-up. At one year, a significant regression of LV hypertrophy was observed in surgically (44 vs. 22%, P = 0.039), but not in medically treated patients (60 vs. 51%, P = 0.206). The prevalence of enlarged left atrium was reduced in both groups (both P < 0.001), whereas systolic myocardial function remained unchanged. In multivariable logistic regression analysis, medical treatment [odds ratio (OR) 4.88 (95% confidence interval (CI) 1.26-18.88)] was a strong predictor of persistent LV hypertrophy independent of higher BMI [OR 1.20 (95% CI 1.04-1.38)] and presence of diabetes [OR 6.48 (95% CI 1.20-34.83), all P < 0.05]. Persistently low midwall shortening was associated with suppressed plasma renin after one year [OR 6.11 (95% CI 1.39-26.7)] and lower renal function [OR 0.96 (95% CI 0.94-0.99), both P < 0.05]. The strongest predictor of persistently low global longitudinal strain was higher HbA1c [OR 2.37 (95% CI 1.12-5.02), P = 0.024]. Persistent cardiac organ damage was more common in the medical treatment group and associated with incomplete aldosterone blockade, impaired renal function and presence of metabolic comorbidities.

Arterial stiffness and central aortic blood pressure in patients with hypertension and abdominal aortic aneurysm

Objective. To assess the arterial stiffness, peripheral and central aortic blood pressure (PBP and CBP), and to determinate their relationships with indicators of structural changes of the affected aorta in patients with hypertension (HTN) and abdominal aortic aneurysms (AAA).Design and methods. We examined 75 patients with HTN and AAA and 75 controls with HTN without AAA. Groups matched by age and gender. A PBP was measured by OMRON (Japan). Noninvasive measurements of CBP, augmentation index (AIx), augmentation pressure (AP), carotid-femoral pulse wave velocity (cfPWV) were assessed by SphygmoCor (AtCorMedical, Australia).Results. There was no difference in cfPWV between patients with AAA and control group (10,3 (2,2) vs 9,7 (2,1) m/s; р = 0,102). Age, systolic PBP, and aortic diameter were independent predictors of cfPVV in patients with AAA (β = 0,271, р = 0,029; β = 0,272, р = 0,030 и β = –0,361, р = 0,004, respectively). Patients with large aortic diameter of AAA (&gt; 60 mm) had decreased cfPWV compared with control group (8,8 (1,5) vs 9,7 (2,1) m/s; р &lt; 0,05), patients with AAA diameter less than 60 mm, on the contrary, had increased cfPVV compared with the controls (11,8 (1,7) vs 9,7 (2,1) m/s; р &lt; 0,001). Patients with AAA and patients of control group did not differ in systolic and pulse PBP (138,6 (16,4) vs 138,1 (13,6) mm Hg; р = 0,831 and 58,6 (11,8) vs 59,6 (10,2) mm Hg; р = 0,569, respectively). AIx and AP were higher in patients with AAA versus patients without AAA (27,6 (8,2) vs 21,3 (7,9)%; р &lt; 0,001 and 17,3 (6,8) vs 13,9 (5,4) mm Hg; р = 0,001, respectively). Systolic and pulse CBP were higher in patients with AAA than in patients of control group (130,0 (16,4) vs 124,9 (13,9) mm Hg; р = 0,046 and 49,5 (11,7) vs 45,7 (9,9) mm Hg; р = 0,031, respectively).Conclusions. In patients with AAA cfPWV decreased with the expansion of the maximum aortic diameter. CfPWV is not suitable for accurate arterial stiffness assessment in patients with HTN and AAA due to the apparent confounding effect of aneurysm on the biomechanical properties of the aorta. Local assessment of the elastic properties of the aorta such as computed tomography angiography and magnetic resonance imaging is required for arterial stiffness evaluation in patients with AAA. Parameters of the reflected pulse wave such as AP and AIx are increased in patients with AAA. This might contribute to the increase in central aortic BP and target organ damage in patients with HTN combined with AAA.

High prevalence of hypertension and target organ damage in patients with 11β-hydroxylase deficiency.

Prevalence of hypertension and hypertension-mediated organ damage (HMOD) had not been well studied in patients with 11β-hydroxylase deficiency (11β-OHD). The study was to assess the prevalence and risk factors of hypertension and HMOD in patients with 11β-OHD. Retrospective cohort analysis in a single medical centre. Twenty-eight patients with 11β-OHD were recruited between January 2003 and June 2021, and their diagnosis had been confirmed by Sanger sequencing. Blood pressure and clinical indicators for the assessment of HMOD occurrence were collected from the medical records. Medication adherence of antihypertensive drugs and glucocorticoids were determined by the patients' biochemistry. Logistic regression was used to identify factors associated with HMOD. Prevalence of hypertension and HMOD in the cohort was 100% and 50%, respectively. The kidneys (71.43%) are the organ most commonly damaged by high blood pressure, followed by the heart (64.29%), eyes (57.14%) and brain (21.43%). Risk factors of HMOD were hypokalemia (odds ratio [OR]: 9.16; 95% confidence interval [CI]: 1.634-51.43; p = .012), blood pressure ≥ 180/110 mmHg (OR: 22.0, 95% CI: 3.08-157.34; p = .002) and irregular glucocorticoid use (OR: 3.18, 95% CI: 1.13-8.98; p = .021). Blood pressure ≥ 180/110 mmHg was an independent predictor for HMOD. Hypertension and HMOD are prevalent in patients with 11β-OHD in our study. These findings illustrate the importance of early HMOD evaluation and optimal glucocorticoid medication in 11β-OHD patients.

A CLINICAL STUDY ON PRESENTATION OF HYPERTENSIVE EMERGENCIES IN TERTIARY CARE HOSPITAL

BACKGROUND:The clinical prole of hypertensive emergency patients presenting to hospitals in a developing country like ours is unknown. The current study sought to assess the modes of presentation, clinical prole, and spectrum of target organ damage in hypertensive emergency patients. AIM: Ÿ To evaluate the modes of presentations in patients with hypertensive emergencies. Ÿ To evaluate the modes of clinical prole. Ÿ To evaluate the modes of the spectrum of target organ damage in patients with hypertensive emergencies. MATERIALS AND METHODS: A six-month hospital-based prospective study was conducted in the Department of General Medicine, Santhiram Medical College, and General Hospital after approval from the Hospital Ethics and Research Committee. The study population included patients admitted to the hospital with severely elevated blood pressure and clinical evidence or laboratory evidence of acute target organ damage. The clinical prole and laboratory proles of fty of these patients were examined. RESULTS: Males were more likely than females to develop a hypertensive emergency. The most common symptoms were neurological decit, dyspnea, chest pain, convulsions, and vision loss. The vast majority of the patients had a history of hypertension. Higher blood pressure levels at presentation were linked to a poor outcome. Hyponatremia and hyperkalemia are two laboratory abnormalities observed in these patients. The most common type of target organ damage observed was intracerebral haemorrhage. In the current study, there was a 22% in-hospital mortality rate. CONCLUSION: Known hypertensives are more likely to present with acute target organ damage due to a hypertensive emergency. The most common mode of presentation is a neurological decit. The most common type of target organ damage in the current study was acute intracerebral haemorrhage

Hypertension-mediated organ damage in masked hypertension.

Masked hypertension - a blood pressure (BP) phenotype characterized by a clinic BP in the normal range but elevated BP outside the office - is associated with early hypertension-mediated organ damage. This study examined early target organ manifestations of masked hypertension diagnosed by home (HBPM) and ambulatory (ABPM) BP monitoring. Left ventricular (LV) structure and diastolic function measured by echocardiography, microalbuminuria, and coronary artery calcification were evaluated in 420 patients with high clinic BP (SBP 120-150 mmHg or DBP 80-95 mmHg). Evidence of hypertension-mediated organ damage was compared in patients with sustained normotension, masked hypertension, and sustained hypertension based on measurements by HBPM, daytime ABPM, and 24-h ABPM. The 420 participants averaged 48 (12) [mean (SD)] years of age; the average clinic BP was 130 (13)/81 (8) mmHg. In individuals with masked hypertension diagnosed by HBPM, indexed LV mass, relative wall thickness, and e' and E/e' (indices of LV relaxation), were generally intermediate between values observed in normotensives and sustained hypertensive patients, and were significantly greater in masked hypertension than normotensives. Similar trends were observed when masked hypertension was diagnosed by ABPM but a diagnosis of masked hypertension was not as reliably associated with LV remodeling or impaired LV relaxation in comparison to normotensives. There were trends towards greater likelihoods of detectable urinary microalbumin and coronary calcification in masked hypertension than in normotensives. These results support previous studies demonstrating early hypertension-mediated organ damage in patients with masked hypertension, and suggest that HBPM may be superior to ABPM in identifying patients with masked hypertension who have early LV remodeling and diastolic LV dysfunction.

Порівняння впливу фіксованої комбінації периндоприл/амлодипін на ураження органів-мішеней у пацієнтів з артеріальною гіпертензією з ішемічною хворобою серця та без неї (результати дослідження EPHES)

Дослідження EPHES (Evaluation of influence of fixed dose combination Рerindopril/Amlodipine on target organ damage in patients with arterial HypErtension with or without iSchemic heart di­sease — оцінка впливу фіксованої комбінації периндоприл/амлодипін на ураження органів-мішеней у пацієнтів з артеріальною гіпертензією (АГ) з ішемічною хворобою серця (ІХС) та без неї) мало за мету порівняти ефективність фіксованої комбінації (ФК) периндоприл/амлодипін щодо зниження артеріального тиску (АТ) та динаміки вираженості ураження органів-мішеней у хворих на АГ з ІХС та без неї. Матеріали та методи. У дослідження EPHES було включено 60 пацієнтів з АГ віком старше від 30 років: перша група — 30 пацієнтів без ІХС, друга — 30 пацієнтів, які мали ІХС. Строк спостереження становив 12 місяців. Усім пацієнтам у день рандомізації призначали ФК периндоприл/амлодипін у початковій дозі 5/5 мг один раз на добу. При необхідності (АТ &gt; 140/90 мм рт.ст.) дози компонентів ФК збільшували поступово кожні 2 тижні до 10/10 мг, а після 6 тижнів лікування додавався індапамід 1,5 мг. 66,7 та 96,7 % пацієнтів в першій та другій групах відповідно отримували бета-адреноблокатори. Усім пацієнтам проводили: вимірювання маси тіла та зросту, офісних рівнів систолічного АТ (САТ), діастолічного АТ (ДАТ) та частоти серцевих скорочень (ЧСС), добове моніторування АТ, визначення швидкості поширення пульсової хвилі в артеріях еластичного (ШППХе) та м’язового типів, центрального САТ, стандартизованого до ЧСС 75 уд/ хв індексу аугментації (Аіх75), біохімічне дослідження крові, електрокардіографію, ехокардіографію з допплерографією, вимірювання гомілково-плечового індексу, визначення товщини комплексу інтима-­медіа (ТКІМ). Результати. Встановлено, що призначена терапія на основі ФК периндоприл/амлодипін незалежно від наявності або відсутності ІХС ефективно (до цільових рівнів) та безпечно знижувала офісний, середньодобовий, денний, нічний та центральний АТ. При цьому достовірно зменшувалися початково підвищені денна та нічна варіабельність АТ, величина ранкового підйому САТ та частка пацієнтів з добовим профілем АТ типу «нон-дипер», проте ці показники залишалися достовірно більшими у пацієнтів з ІХС на всіх етапах лікування. Хворі з ІХС та без неї не відрізнялися за початковою величиною АІх75, і на фоні призначеної терапії спостерігалося достовірне зменшення цього показника в обох групах, проте у хворих з ІХС це зменшення АІх75 було достовірно меншим, ніж у групі без ІХС, що, імовірно, було пов’язано з більш частим застосуванням бета-блокаторів. Ефективне щодо зниження АТ лікування призводило в обох групах до достовірного зменшення ураження органів-мішеней — покращення пружно-еластичних властивостей аорти та діастолічної функції лівого шлуночка, зменшення рівня альбумінурії, гіпертрофії лівого шлуночка та розміру лівого передсердя. Ступінь зниження ШППХе був достовірно (Р &lt; 0,005) меншим у пацієнтів без ІХС, ніж у групі з ІХС — 2,5 ± 0,2 м/с проти 4,4 ± 0,5 м/с. Окрім того, незважаючи на однаковий ступінь зменшення індексу маси міокарда лівого шлуночка, покращення діастолічної функції лівого шлуночка (збільшення Е/А та зменшення Е/Е’) у групі хворих з ІХС було більшим — на 64,4 та 54,1 % проти 39,8 та 23,2 % відповідно (Р &lt; 0,05 для обох показників). Максимальна величина ТКІМ достовірно зменшилася лише в пацієнтів з ІХС. Терапія не призводила до достовірних змін біохімічних показників та добре переносилася хворими — побічні явища зареєстровані у 2 (6,5 %) в групі без ІХС та у 3 (10 %) у групі з ІХС (Р = НД між групами). Групи достовірно не відрізнялися за динамікою скарг, і серед пацієнтів з ІХС, які мали стенокардію на початку дослідження, значно зменшилася кількість приступів стенокардії за тиждень — з 2,5 ± 0,4 до 1,2 ± 0,2 (Р &lt; 0,01). Висновки. Отже, лікування АГ на основі ФК периндоприл/амлодипін було ефективним щодо зниження АТ та регресу ураження органів-мішеней незалежно від наявності ІХС. Зміни показників, що характеризують ураження органів-мішеней, дещо відрізнялися в пацієнтів з ІХС та без неї, що необхідно враховувати при виборі тактики лікування.

An evaluation of costs associated with overall organ damage in patients with systemic lupus erythematosus in the United States.

IntroductionApproximately 33–50% of patients with systemic lupus erythematosus (SLE) develop organ damage within 5 years of diagnosis. Real-world studies that capture the healthcare resource utilization (HCRU) and costs associated with SLE-related organ damage are limited. The aim of this study was to evaluate HCRU and costs associated with organ damage in patients with SLE in the USA.MethodsThis retrospective study (GSK study 208380) used the PharMetrics Plus administrative claims database from 1 January 2008 to 30 June 2019. Patients with SLE and organ damage were identified using International Classification of Diseases (ICD)-9/10 codes derived from the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. The first observed diagnosis of organ damage was designated as the index date. Selection criteria included: ≥18 years of age; ≥1 inpatient or ≥2 outpatient claims for SLE (≥30 days apart before the index date; ICD-9: 710.0 or ICD-10: M32, excluding M32.0); ≥1 inpatient or ≥3 outpatient claims for organ damage within 6 months for the same organ system code; continuous enrollment of 12 months both pre- and post-index date. The proportion of patients with new organ damage, disease severity, SLE flares, SLE-related medication patterns, HCRU and all-cause costs (2018 US$) were assessed 12 months pre- and post-index date.ResultsOf the 360,803 patients with a diagnosis of SLE, 8952 patients met the inclusion criteria for the presence of new organ damage. Mean (standard deviation (SD)) age was 46.4 (12.2) years and 92% of patients were female. The most common sites of organ damage were neuropsychiatric (22.0%), ocular (12.9%), and cardiovascular (11.4%). Disease severity and proportion of moderate/severe flare episodes significantly increased from pre- to post-index date (p < 0.0001). Overall, SLE-related medication patterns were similar pre- versus post-index date. Inpatient, emergency department and outpatient claims increased from pre- to post-index date and mean (SD) all-cause costs were 71% higher post- versus pre-index date ($26,998 [57,982] vs $15,746 [29,637], respectively).Conclusions:The economic impact associated with organ damage in patients with SLE is profound and reducing or preventing organ damage will be pivotal in alleviating the burden for patients and healthcare providers.

Are Baseline Levels of Gas6 and Soluble Mer Predictors of Mortality and Organ Damage in Patients with Sepsis? The Need-Speed Trial Database.

Soluble tyrosine kinase receptor Mer (sMer) and its ligand Growth arrest-specific protein 6 (Gas6) are predictors of mortality in patients with sepsis. Our aim is to clarify whether their measurement at emergency department (ED) presentation is useful in risk stratification. We re-analyzed data from the Need-Speed trial, evaluating mortality and the presence of organ damage according to baseline levels of sMer and Gas6. 890 patients were eligible; no association with 7- and 30-day mortality was observed for both biomarkers (p > 0.05). sMer and Gas6 levels were significantly higher in acute kidney injury (AKI) patients compared to non-AKI ones (9.8 [4.1–17.8] vs. 7.9 [3.8–12.9] ng/mL and 34.8 [26.4–47.5] vs. 29.8 [22.1–41.6] ng/mL, respectively, for sMer and Gas6), and Gas6 also emerged as an independent AKI predictor (odds ratio (OR) 1.01 [1.00–1.02]). Both sMer and Gas6 independently predicted thrombocytopenia in sepsis patients not treated with anticoagulants (OR 1.01 [1.00–1.02] and 1.04 [1.02–1.06], respectively). Moreover, sMer was an independent predictor of both prothrombin time-international normalized ratio (PT-INR) > 1.4 (OR 1.03 [1.00–1.05]) and sepsis-induced coagulopathy (SIC) (OR 1.05 [1.02–1.07]). An early measurement of the sMer and Gas6 plasma concentration could not predict mortality. However, the biomarkers were associated with AKI, thrombocytopenia, PT-INR derangement and SIC, suggesting a role in predicting sepsis-related organ damage.

Evolución de la lesión orgánica mediada por hipertensión en pacientes con hipertensión arterial resistente tras añadir espironolactona

IntroductionResistant hypertension (RH) represents an important multi-organic impact and increases the morbi-mortality. We aimed to evaluate the evolution of hypertensive mediated organ damage in patients with RH after adding spironolactone. Material and methodsRetrospective study of 58 patients with RH who started spironolactone (12.5–25mg daily). Office blood pressure, 24-h ambulatory blood pressure monitoring (24h-ABPM), urine albumin-to-creatinine ratio and echocardiographic parameters were analyzed prior to initiation of spironolactone and after 12 months of treatment. ResultsThirty-six percent of patients were women and mean age was 67.3±10.1 years. We observed a decrease in urine albumin-to-creatinine ratio (median [RIQ25–75]) of 27.0 (7.5-255.4) to 11.3 (3.1–37.8) mg/g, P = .009. This was more relevant in patients with albuminuria grade A2 and A3: 371.2 (139.5–797.4) to 68.4 (26.5–186.5) mg/g, P = .02. The echocardiographic changes were: posterior wall thickness: −1.0±0.4mm (P<.001), interventricular septal thickness: −0.6±0.5mm (P=.01), left ventricular (LV) mass index: −14.7±10.2g/m2 (P=.006), LV remodeling index: −0.04±0.036 (P=.03), without statistically significant changes in LV ejection fraction, LV end-diastolic diameter, LV end-systolic diameter, left atrial diameter, relationship between early ventricular filling wave and atrial contraction and LV filling pressure index.Systolic/diastolic office blood pressure decreased −12.5±4.9/−4.9±3.0mmHg, P<.001. In 24h-ABPM, systolic and diastolic BP had a significant decrease in diurnal and nocturnal periods and 38.1% of patients presented a favorable change in the circadian pattern, P<.001. ConclusionsAdding spironolactone to patients with RH contributes to improve hypertensive mediated organ damage by reducing albuminuria levels and echocardiographic parameters of hypertensive heart disease.

Prediction and associated factors of hypothyroidism in systemic lupus erythematosus: a cross-sectional study based on multiple machine learning algorithms

Objectives The prevalence of hypothyroidism in systemic lupus erythematosus (SLE) is significantly higher than that in the common public. While SLE itself can affect multiple organs, abnormal thyroid function may exacerbate organ damage in patients with SLE. We aimed to predict abnormal thyroid function and to examine the associated factors with multiple machine learning approaches. Methods In a cross-sectional study, 255 patients diagnosed with SLE at the rheumatology department in Xiangya Hospital between June 2012 and December 2016 were investigated. Feature engineering was used for filtering out principle clinical parameters, and five different machine learning methods were used to build prediction models for SLE with hypothyroidism. Results Feature engineering selected 11 variables with which to build machine learning models. Among them, random forest modelling obtained the best prediction performance, with an accuracy rate of 88.37 and an area under the receiver operating characteristic curve of 0.772. The weights of anti-SSB antibody and anti-dsDNA antibody were 1.421 and 1.011, respectively, indicating a strong association with hypothyroidism in SLE. Conclusions Random Forest model performed best and is recommended for selecting vital indices and assessing clinical complications of SLE, it indicated that anti-SSB and anti-dsDNA antibodies may play principal roles in the development of hypothyroidism in SLE patients. It’s feasible to build an accurate machine learning model for early diagnosis or risk factors assessment in SLE using clinical parameters, which would provide a reference for the research work of SLE in China.

Subclinical cardiac organ damage in patients with moderate to severe psoriasis treated with infliximab

Abstract Background Psoriasis is an immune mediated disease that has been associated with elevated risk of cardiovascular (CV) disease. Comorbidities, psoriasis treatment and presence of subclinical cardiac organ damage can modulate CV risk in psoriasis. Purpose To assess the prevalence and covariables of subclinical cardiac organ damage in patients with moderate-to-severe psoriasis on infliximab treatment. Methods Echocardiography was performed in 53 psoriasis patients (age 47±15 years, 30% women) and 99 control subjects (age 47±11 years, 28% women). Subclinical cardiac organ damage was defined as presence of left ventricular (LV) hypertrophy, concentric LV geometry and/or dilated left atrium. Psoriasis area and severity index (PASI) was used to assess the severity of psoriasis. Hypertension was defined as use of antihypertensive medication/history of hypertension and/or elevated ambulatory blood pressure ≥130/80 mmHg. Results Hypertension was the most common comorbidity, present in 66% of patients and 61% of control subjects (p=0.54). Smoking was more prevalent in psoriasis patients than controls (37% vs 17%, p=0.005), while other CV risk factors and antihypertensive treatment did not differ between groups. Subclinical cardiac organ damage was less prevalent in psoriasis patients than controls (51% vs. 73%, p=0.007, Figure). In the total study cohort, having psoriasis was associated with lower prevalence of subclinical cardiac organ damage independent of hypertension, smoking, age and sex (odds ratio [OR] 0.30, 95% confidence interval [CI] 0.13–0.72, p=0.007) in logistic regression analysis. Among psoriasis patients, hypertension was associated with a near seven-fold increased risk of cardiac organ damage (OR 6.88 [95% CI 1.32–35.98], p=0.022) independent of age, sex and body mass index. PASI at start of treatment or current PASI was not associated with presence of subclinical cardiac organ damage. Conclusion Psoriasis patients on infliximab treatment had less subclinical cardiac organ damage compared with controls, suggesting that inhibition of CV inflammation may attenuate cardiac organ damage in psoriasis. Hypertension was the strongest covariable for subclinical cardiac organ damage in psoriasis patients. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Western and South-Eastern Regional Health Authorities of Norway and Hjertefondet, University of Bergen.