Primary Arterial Hypertension Research Articles

Hypertension Induces Pro-arrhythmic Cardiac Connexome Disorders: Protective Effects of Treatment.

Prolonged population aging and unhealthy lifestyles contribute to the progressive prevalence of arterial hypertension. This is accompanied by low-grade inflammation and over time results in heart dysfunction and failure. Hypertension-induced myocardial structural and ion channel remodeling facilitates the development of both atrial and ventricular fibrillation, and these increase the risk of stroke and sudden death. Herein, we elucidate hypertension-induced impairment of "connexome" cardiomyocyte junctions. This complex ensures cell-to-cell adhesion and coupling for electrical and molecular signal propagation. Connexome dysfunction can be a key factor in promoting the occurrence of both cardiac arrhythmias and heart failure. However, the available literature indicates that arterial hypertension treatment can hamper myocardial structural remodeling, hypertrophy and/or fibrosis, and preserve connexome function. This suggests the pleiotropic effects of antihypertensive agents, including anti-inflammatory. Therefore, further research is required to identify specific molecular targets and pathways that will protect connexomes, and it is also necessary to develop new approaches to maintain heart function in patients suffering from primary or pulmonary arterial hypertension.

Association Between 25(OH)D Levels and Primary Arterial Hypertension

Abstract This study seeks to determine whether patients from a family physician’s practice have an association between 25(OH)D levels and primary arterial hypertension (AH). The study included a total of 1068 patients who were tested for vitamin D status. Data from their outpatient medical records were analysed: sex, age, body mass index, glomerular filtration rate, and the history of AH. Primary arterial hypertension was diagnosed in 63% of the patients. The mean vitamin D level in the study population was 25 ng/ml, and the largest group, or 36%, was found to have vitamin D deficiency (20–29 ng/ml). Odds ratio (OR) for hypertension was not inversely correlated with higher vitamin D levels. No statistically significant increase was observed in OR in a multi-factor analysis. The relevant hypertension ORs were 1.8 (0.4–7.5), 1.1 (0.3–4.5), 1.7 (0.4–7.2) and 0.7 (0.1–4.8) 30 ng/ml to 45 ng/ml, 20 to 29 ng/ml, 10 to 19 ng/ml, and < 10 ng/ml compared to the group of ³ 45 ng/ml. No association was found between 25(OH)D levels and the primary arterial hypertension in study participants.

HSP70 and Primary Arterial Hypertension.

Heat shock protein 70 (HSP70) production is a stress-generated cellular response with high interspecies homology. HSP70 has both chaperone and cytokine functions and may induce, depending on the context, tolerogenic anti-inflammatory reactivity or immunogenic and autoimmune reactivity. Intracellular (chaperoning transit of antigens to MHC in antigen-presenting cells) and extracellular HSP70-related effects are associated with hypertension, which is an inflammatory condition recognized as the most important risk factor for cardiovascular disease mortality. Here, we review (a) the relationship between HSP70, inflammation and immune reactivity, (b) clinical evidence relating to stress, HSP70 and anti-HSP70 reactivity with primary hypertension and (c) experimental data showing that salt-sensitive hypertension is associated with delayed hypersensitivity to HSP70. This is a consequence of anti-HSP70 reactivity in the kidneys and may be prevented and corrected by the T-cell-driven inhibition of kidney inflammation triggered by specific epitopes of HSP70. Finally, we discuss our postulate that lifelong stress signals and danger-associated molecular patterns stimulate HSP-70 and individual genetic and epigenetic characteristics determine whether the HSP70 response would drive inflammatory immune reactivity causing hypertension or, alternatively, would drive immunomodulatory responses that protect against hypertension.

Primary Arterial Hypertension and Drug-Induced Hypertension in Philadelphia-Negative Classical Myeloproliferative Neoplasms: A Systematic Review

The impact of primary arterial hypertension (HTN) in myeloproliferative neoplasms (MPNs) remains unclear, with scant literature available, mostly focusing on cardiovascular risk factors as a singular entity or on organ-specific HTN. Furthermore, available studies reporting findings on drug-induced HTN in MPNs report varying and contradictory findings. In consideration of the above, this study set out to systematically review the available literature and shed light on the occurrence of HTN in MPNs, its association with thrombosis, as well as the drugs used in MPN management that could increase blood pressure. The literature search yielded 598 potentially relevant records of which 315 remained after the duplicates (n = 283) were removed. After we screened the titles and the abstracts of these publications, we removed irrelevant papers (n = 228) and evaluated the full texts of 87 papers. Furthermore, 13 records did not meet the inclusion criteria and were excluded from the systematic review. Finally, a total of 74 manuscripts were entered into the qualitative synthesis and included in the present systematic review. Our systematic review highlights that HTN is the most common comorbidity encountered in MPNs, with an impact on both the occurrence of thrombosis and survival. Moreover, drug-induced HTN remains a challenge in the management of MPNs. Further research should investigate the characteristics of patients with MPNs and HTN, as well as clarify the contribution of HTN to the development of thrombotic complications, survival and management in MPNs. In addition, the relationship between clonal hematopoiesis of indeterminate potential, HTN, cardiovascular disease and MPNs requires examination in upcoming assessments.

Space weather and hypertensive crises at high Latitudes (in Yakutsk)

The space weather impact on the health status of people with cardiovascular diseases is quite significant and it has been shown by many researchers. To examine this relationship at high latitudes, we made a Yakutsk ambulance electronic database analysis. The significant coincidences of geomagnetic disturbance indicators (Kp-index - a global geophysical disturbance index) and the increased blood pressure emergency calls number have been determined during the high solar activity years. The blood pressure increase cases analysis shows that patients with primary essential arterial hypertension (AH) seek medical help in 57%. Furthermore, 7% of AH patients experienced a hypertensive crisis (HC) with an increase in systolic blood pressure (SBP) from 180 mm Hg, diastolic blood pressure (DBP) from 120 mm Hg. The medical data analysis and the space weather data (Kp-index) comparison demonstrate a significant coincidence, which became the main base for the conclusion that heliogeophysical disturbance effects on the cardiovascular system state of a person living at high latitudes.

A Case Report on Ambrisentan-Induced Angioedema

Ambrisentan is a selective type A endothelin receptor antagonist used to treat primary pulmonary arterial hypertension (PAH). A 52-year-old female was admitted to the emergency department with presenting symptoms of submandibular swelling and worsening dyspnea. The patient has a history of PAH on treatment. She was previously on sildenafil. All her blood parameters except renal function tests (blood urea, creatinine, potassium, and sodium) were normal during hospitalization for the management of PAH. Some months after treatment with sildenafil, she was switched to Ambrisentan by her consultant. ECG showed severe PAH (80 mmHg), mild right ventricle dysfunction, no regional wall motion abnormalities, and good left ventricle systolic function. She was diagnosed as cor pulmonale. She was dehydrated with reduced skin turgor. USG abdomen revealed bilateral renal parenchymal disease. She also complained of a puffy reddish discoloration of the skin along with angioedema. After ruling out the possibility of other factors contributing to angioedema, Ambrisentan was most likely related and was not excluded. Ambrisentan was, therefore, discontinued and replaced with tadalafil. She was seen on an outpatient basis and was symptomatically better. Health education was provided on the safe use of drugs. Through this report, we bring your attention to the possibility of such events with Ambrisentan, and cannot be neglected.

745 INTERDISCIPLINARY EVALUATION IN RESISTANT ARTERIAL HYPERTENSION

Abstract Background Arterial hypertension is a complex and in most cases multifactorial pathology. Despite the numerous pharmacological treatments available, it is estimated that in Europe only 25%-39% of hypertensive patients achieve adequate blood pressure (BP) control. Renal arteries denervation (RDN) is an additional therapeutic weapon, complementary to Optimal Medical Therapy (OMT) in patients with resistant or refractory primary (or essential) arterial hypertension. In order to improve patients management and select those who are eligible for renal denervation, our Center has established the Interdisciplinary Group for the Treatment of Resistant Arterial Hypertension (G.I.T.I.A.R.), including Cardiologists, Nephrologists, Internists and Geriatricians. Methods From January 2018 to July 2022 the G.I.T.I.A.R. held twelve meetings evaluating 62 patients with resistant or refractory forms of arterial hypertension, contraindications or intolerance to antihypertensive drugs, suspected secondary or pseudoresistant forms (i.e. linked to poor patient compliance, drugs and/or inadequate dosages, concomitant intake of substances with hypertensive effect, incorrect measurements). For each of them, medical therapy was optimized and the need for second level diagnostic tests, multi-specialist follow-up and RDN candidacy were assessed. After three, six, twelve months and then annually following RDN, the patients underwent clinical and multi-specialist evaluation (where deemed appropriate), blood tests monitoring and 24-hour ambulatory blood pressure monitoring (ABPM). Results Of the 62 patients evaluated by the G.I.T.I.A.R., 64.5% (n=40) were male. The mean age at the time of evaluation was 64 years (range 18-87). After the first collegial discussion, 46.8% (n=29) have been declared eligible for RDN, while 53.2% (n=33) of the patients was initially rejected: 39.4% of these (n=13) for suspected or ascertained secondary hypertension, 12.1% (n=4) for the possibility of further optimization of medical therapy, 48.5% (n=16) for the presence of inclusion or exclusion criteria of ongoing studies design. Among the excluded patients, six presented moderate renal artery stenosis on non-invasive imaging: in two patients (33.3%) the stenosis turned out to be hemodynamically significant on angiographic and functional evaluation (Pd/Pa measurement), so renal angioplasty was performed; RDN was performed in the remaining 66.7% (n=4), in which a hemodynamic significance of the stenosis was excluded. Of the subgroup who had optimized medical therapy, one patient (25%) was subsequently referred to RDN for failure of all pharmacological strategies, while 3 of 4 (75%) achieved adequate BP control. Conclusions Resistant arterial hypertension is associated with an increased risk of development and progression of cardiovascular and renal diseases, with a significant impact on mortality and morbidity. Renal denervation has proved to be an effective and safe therapeutic strategy, complementary to OMT, whose selection of the ideal patient actually represents one of the greatest challenges. The integrated multidisciplinary approach improves the management of the hypertensive patient, the individualization of therapy and allows the identification of subjects who may benefit from RDN.

Severe preeclampsia superimposed on secondary and resistant hypertension associated with methamphetamine use

Introduction: Preeclampsia (PE) is one of the three main causes of maternal mortality. It is called superimposed PE when, in a pregnant patient with a history of primary or secondary chronic arterial hypertension, blood pressure increases and de novo proteinuria appears or worsens and/or biochemical data such as thrombocytopenia or increased liver enzymes are added. Chronic arterial hypertension predisposes patients to developing it, with a higher risk of complications and severity. Case presentation: Here, we present the case of a 25-year-old patient with a history of crystal, crack, and cocaine use for 7 years and a diagnosis of high blood pressure since she was 22 years old, who developed severe PE resistant to antihypertensive drugs. Conclusions: The reported case showed severe hypertension in pregnancy (defined as systolic blood pressure ≥160 mm Hg or diastolic blood pressure ≥110 mm Hg), which persisted because severe hypertension continued despite the designated treatment, which, considering the patient’s age, forced us to suspect secondary hypertension. The incidence of secondary hypertension in patients with superimposed PE is rare. According to the American Heart Association, it occurs in 10% of the cases and is associated with greater maternal and fetal complications. This should be suspected in women <35 years of age with severe or resistant hypertension, without a family history of hypertension, or with biochemical parameters for hypokalemia, hyperazotemia, and albuminuria in the early stages of pregnancy.

Pathological Changes in the Lungs of Patients with a Lethal COVID-19 Clinical Course.

The novel coronavirus SARS-CoV-2 was identified in 2019 and quickly became the cause of the fifth worst pandemic in human history. Our goal for this research paper was to examine the morphology of the lungs in 88 patients that died from COVID-19 in Latvia, thus increasing the data available about the histological characteristics of SARS-CoV-2-induced disease. Lung tissue samples from 88 autopsies were visualized in hematoxylin-eosin and assessed by light microscopy. The male-to-female ratio was 56:32, and the mean age was 62 years ± 15.5 years (22-94 years). Clinically important laboratory data were assessed, including leucocyte count, CRP (C-reactive protein) and D-dimer levels. Signs of diffuse alveolar damage were found in 83/88 (94.3%; 95% CI 87.0-97.9) of patients, 38/88 (43.2%; 95% CI 33.3-53.6) in the exudative phase, and 45/88 (51.1%; 95% CI 40.8-61.3) in the proliferative phase. Vascular damage was identified in 70/88 (79.5%; 95% CI 69.9-86.7) of patients, and 83/88 (94.3%; 95% CI 87.0-97.9) had signs of thrombosis. A sparse inflammatory infiltrate of lymphocytes and macrophages was a common finding aside from cases with an identified coinfection. Eighty patients had significant co-morbidities, including coronary heart disease (49), primary arterial hypertension (41), and diabetes mellitus (34). Since our group's demographic profile and spectrum of co-morbidities were analogous to other reports, the histological findings of marked diffuse alveolar damage, widespread vascular lesions, and active thrombosis can be considered representative of severe COVID-19.

Pharmacological Treatment of Arterial Hypertension in Children and Adolescents in Lithuania.

The global prevalence of arterial hypertension (AH) in the pediatric population is increasing, but therapeutic approaches and the choice of the most suitable antihypertensive medications remains challenging. The study aimed to estimate the prevalence, treatment rates, and pharmacological treatment patterns of children and adolescents with AH in Lithuania during 2019 using real-world data. The study population consisted of citizens of Lithuania aged 0 to 17 years, who were diagnosed with AH according to the International Classification of Diseases (ICD). The analysis of reimbursed antihypertensive medication prescriptions was performed according to AH etiology and age. The overall prevalence of AH by diagnostic ICD codes in 2019 was 0.29%:0.24% for primary and 0.05% for secondary. Treatment rates were 39.8% for primary AH and 66.3% for secondary AH. Angiotensin-converting enzyme inhibitors (ACEi) were the most popular medications irrespective of the etiology of AH or age. Beta-blockers were in the second place and used more often in older children. Calcium channel blockers were the third and angiotensin receptor blockers were the fourth most frequent choices. Enalapril was the most popular agent in the ACEi group and metoprolol in the beta-blocker group. Nearly forty percent of Lithuanian children with primary AH receive pharmacological therapy compared to two-thirds with secondary AH. Although ACEi are the predominant class of antihypertensive medications, discordances with available guidelines are evident, particularly in the overuse of beta-blockers and underuse of diuretics.

Molecular mechanisms of myocardial damage in the hypertensive rats and hypertensive rats with metabolic disorders (diabetes mellitus, atherosclerosis)

Introduction: Despite the success which was achieved in the treatment of arterial hypertension, for optimization of the treatment, it is necessary to study the pathogenesis of primary arterial hypertension and target organ damage on the molecular level. Materials and methods: Our team studied the molecular mechanisms of myocardial damage during arterial hypertension and metabolic disorders. We used the spontaneously hypertensive rats (SHR) as an experimental model, and, additionally, we modeled diabetes mellitus and atherosclerosis in these rats. Results and discussion: Our study obtained evidence of a much higher level of the energy imbalance in the cardiomyocytes and more intensive production of reactive oxygen species in the SHRs with diabetes mellitus and atherosclerosis compared with the healthy animals and the animals with only hypertension. The indicated defections create an environment for further cellular damage – mitochondrial dysfunction, depletion in the thiol-disulfide system, and formation of highly reactive NO products. At the same time, we have noticed a higher activity of the Hsp70 in the hypertensive groups compared with the normotensive animals. The source of these deviations is in the formation of mitochondrial dysfunction of cardiocytes, the cause of which is oxidative modification of the protein structures of mitochondria under conditions of activation of oxidative stress reactions, insufficiency of mPT pores, and impaired mitochondrial chaperone function. The presented data give reason to believe that mitochondrial dysfunction, which develops against the background of deficient HSP70, is an integral aspect of arterial hypertension, contributes to its aggravation, and triggers a cascade of molecular and biochemical mechanisms of myocardial damage. These mechanisms include disturbances in the L-arginine-NO-synthase-NO system, production of mitochondrial iNOS oxygen radicals, neutralization of the vasorelaxant effect of NO and its transformation into an active participant in nitrous stress due to reduced intermediates of the thiol-disulfide system. The question of cause-and-effect relationships of oxidative stress remains open for discussion. Conclusion: We envisage that studies in this direction may lead to a better insight into a pathogenetic therapy of essential hypertension, diabetes mellitus, and atherosclerosis. Graphical abstract:

WITHDRAWN

SESSION TITLE: PAH with Complications SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Congenital heart disease (CHD) serves as the second most commonly associated form of primary pulmonary arterial hypertension (PAH). The prognosis of PAH related to congenital heart disease differ from other types of PAH due to factors such as defect types and sizes. The aim of the study is to compare the outcomes of PAH secondary to CHD (PAH-CHD) and PAH due to other causes. METHODS: We extracted the data from the National Inpatient Sample (NIS) database for the years 2016 to 2019 and analyzed all hospital admissions for PAH-CHD versus primary PAH due to causes other than CHD (Other PAH). We selected CHDs commonly known to be associated with primary pulmonary hypertension: atrial septal defect (ASD), ventricular septal defect (VSD), aortopulmonary window, atrioventricular septal defect, tetralogy of Fallot, patent ductus arteriosus (PDA), truncus arteriosus, double inlet left ventricle and double outlet right ventricle. We compared baseline characteristics, outcomes, and healthcare utilization between the two groups. RESULTS: Of 37,739 patients admitted with PAH, 1,355 patients had concomitant CHD and were compared with 36,384 adult PAH patients without CHD. In the PAH-CHD group, ASD was the most common associated CHD (1,195, 88%) followed by VSD (125, 9.2%) and PDA (39,2, 9%). The PAH-CHD patients were relatively younger (mean age of 53.15 vs 65.7 years), less likely to be of white race (62.36% vs 66%) and had a lower proportion of comorbid coronary artery disease (14.3% vs 28.86%), obesity (15.13% vs 22.66%), dyslipidemia (44% vs 51%), diabetes (18.08% vs 34.48%) and chronic kidney disease (19.93% vs 33.15%) [all p<0.05*]. A total of 115 (8.5%) PAH-CHD patients and 1,844 (5.07%) other PAH patients died during hospitalization. PAH-CHD patients had a higher in-hospital mortality (aOR=1.73 ;95%CI 1.08-2.76, p=0.02*). The PAH-CHD group had higher odds of having chronic respiratory failure (aOR=1.13;95%CI 1.04-1.22, p=0.003*), right ventricular failure (aOR=1.72 ;95%CI 1.12-2.6, p<0.013*), cardiogenic shock (aOR=2.1;95%CI 1.15-3.84, p=0.015*) and acute ischemic stroke (aOR=25.18;95%CI 6.78-93.46, p<0.0001*). compared to the other PAH group. PAH-CHD patients also had longer length of stay (10.6 vs 7.10 days, p=0.0009*) and higher hospitalization costs per admission ($209,507 vs $90,599, p=0.007*). CONCLUSIONS: The PAH-CHD group had higher in-hospital mortality and healthcare resource utilization than the other PAH group. PAH-CHD group were more likely to have chronic respiratory failure, right ventricular failure, cardiogenic shock and ischemic stroke. CLINICAL IMPLICATIONS: PAH-CHD seem to have higher mortality and worse PAH related in-patient complications. The difference between two groups highlights the need for further research and trials to understand the unique natural history and appropriate management of PAH-CHD patients. DISCLOSURES: No relevant relationships by Cyra-Yoonsun Kang No relevant relationships by Sandhya shri Kannayiram No relevant relationships by parnia khamooshi No relevant relationships by Viviana Reyes Pinzon No relevant relationships by Sujitha Velagapudi

OUTCOMES OF PRIMARY PULMONARY HYPERTENSION WITH CONNECTIVE TISSUE DISORDERS VS OTHER PRIMARY PULMONARY HYPERTENSION: AN ANALYSIS OF A NATIONAL INPATIENT SAMPLE

SESSION TITLE: Pulmonary Manifestations of Systemic Diseases SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 2:45 pm - 3:45 pm PURPOSE: Primary pulmonary arterial hypertension (PAH) serves as one of the serious complications of connective tissues disorders (CTDs). It has a detrimental effect on the CTD patients’ quality of life and mortality. Namely, the prevalence of PAH in systemic sclerosis (SSc) patients is as high as 12% and is associated with a less favorable outcome compared to idiopathic PAH. There has also been growing evidence that suggests an early treatment of PAH in CTDs may prevent irreversible pathologic changes in pulmonary vessels. However, the morbidity and mortality of PAH in non-SSc CTDs remains largely unknown due to the lack of large cohort studies. The aims of this study were to compare the outcomes of patients primarily admitted for primary PAH with and without CTDs. METHODS: We used the National Inpatient Sample (NIS) database for the years 2015 to 2018 to analyze all hospital admissions for primary PAH (ICD-10 CM code I27.0) with versus without CTDs. We selected CTDs most commonly associated with primary pulmonary hypertension: systemic sclerosis, systemic lupus erythematosus, mixed CTD, rheumatoid arthritis, dermatomyositis and sjögren’s syndrome. We compared baseline characteristics, outcomes and healthcare utilization between the two groups. RESULTS: From 2015 - 2018, a total of 3,010,994 patients were included in the study group. 10.9% (5479) of the study population had the CTDs. The cohort with CTDs had slightly older mean age (59.61 vs 56.42, p=0.04), more women (91.2% vs 75.5%, p<0.001), higher number of Charlson comorbidity index of more than 4 (20.2% vs 16.3%, p<0.001), but less diagnosis of diabetes (13.5% vs 31.2%, p<0.001). After adjusting for age, race, hospital regions and other comorbid conditions, the odds ratio (aOR) for mortality in patients with CTDs compared to those without CTDs was slightly increased to 1.09, albeit not significantly (95% CI: 0.46 - 2.59, p=0.838). Similarly, there existed no statistically significant differences in length of stay (LOS) (9.2 vs 8.1 days; p=0.831) or total hospital charges ($137,212 vs $117,221; p= 0.858) between the two groups. CONCLUSIONS: Hospitalizations for primary PAH with CTDs had comparable mortality, LOS, total hospital charges compared to those without CTDs. CLINICAL IMPLICATIONS: The results of the study suggest non-significant mortality differences between primary PAH associated with CTDs and those without CTDs. A large cohort study of CTD-associated PAH would be essential as the management and outcomes may differ from those of other pulmonary hypertension. DISCLOSURES: No relevant relationships by Iriagbonse Asemota No relevant relationships by Cyra-Yoonsun Kang No relevant relationships by Sandhya shri Kannayiram No relevant relationships by parnia khamooshi No relevant relationships by Viviana Reyes Pinzon

Shinrin-yoku and its role in hypertension therapy

Objective: This study aimed to evaluate the potential role of Shinrin-yoku (forest bathing) in the therapy of hypertension. Methods and materials: A literature search was conducted in the PubMed MEADLINE database of medical publications using the following keywords: Shinrin-yoku, forest bathing, hypertension, phytoncides Results: Hypertension is a serious problem in the Polish population. The data from the National Health Fund show that in 2020 almost 10 million adult Poles were affected by this disease, and over 14% of the entire pharmacy reimbursement budget was used to reimburse drugs for hypertension. Primary arterial hypertension is caused by a mixture of environmental and genetic factors, including obesity, mental stress, low physical activity, and excessive sodium intake. Although hypertension is usually asymptomatic, it contributes to serious complications such as left ventricular hypertrophy, impaired renal function, changes in the vessels of the retina, and finally to stroke or aortic dissection. The Shinrin-yoku (forest bathing) is becoming a worldwide recognized method used in preventative medicine and can play a substantial role in decreasing the number of patients suffering from hypertension. Conclusion: Shinrin-yoku (forest bathing) lowers blood pressure, heart rate, and the level of stress hormones, and therefore can be a prophylactic element in preventing the development of hypertension or an element of non-pharmacological therapy for this disease entity. Additionally, it has a positive effect on the immune system.

Associations between Heart Rate Variability Parameters and Hemodynamic Profiles in Patients with Primary Arterial Hypertension, Including Antihypertensive Treatment Effects.

Background: Autonomic nervous system (ANS) dysfunction is an important factor in the development and progression of arterial hypertension (AH) and may produce adverse hemodynamic sequelae. ANS function can be evaluated by analyzing heart rate variability (HRV). The purpose of this study was to assess the possible correlation between HRV and the hemodynamic profile of AH patients, including antihypertensive treatment effects after 12 months. Methods: The study was conducted on 144 patients with uncomplicated AH. The hemodynamic profile was assessed via echocardiography and impedance cardiography (ICG). The analyzed HRV parameters included SDNN, rMSSD, pNN50, low frequency (LF, 0.05–0.15 Hz), high frequency (HF, 0.15–0.4 Hz), total power (TP, the variance of all NN intervals), and the day, night, and 24-h low-to-high frequency ratios (LF/HF). Results: Analysis showed various correlations of HRV parameters both with arterial blood pressure and with the hemodynamic profile assessed via echocardiography and ICG. The HRV parameters of increased ANS activity showed a correlation with improved left ventricle function (LV) and lower LV afterload. Conclusions: Effective antihypertensive treatment demonstrated beneficial effects on both the ANS balance and the hemodynamic profile.

Specific deformation pattern in hypertensive patients with septal bulge and preserved systolic function.

A wide range of subclinical changes in left ventricular (LV) geometry and function can be observed, even in the early course of arterial hypertension (HTN). Aim of the study was to investigate if the appearance of isolated basal septal hypertrophy (BSH, septal bulge) in asymptomatic young and middle-aged adults with HTN could be a marker of incipient LV systolic dysfunction when other measures of global LV function are still normal. A total of 138 patients with primary arterial hypertension, aged less than 65years, with no comorbidities and with preserved LV ejection fraction (EF) were included. Complete 2D transthoracic echocardiography study was preformed according to standardized protocol, as well as deformation study using speckle tracking echocardiography. Global and regional longitudinal strain was measured in apical 4-, 2- and 3-chamber views according to 18-segments model. Global and regional circumferential and radial strains were measured in short axis view. Average was taken from each of the six basal, middle and apical LV segments. Patients were divided into two groups according to BSH presence and values were compared. Basal septal hypertrophy was found in half of the patients (53.6%). The whole cohort had altogether normal LV global systolic function, as well as global indices of radial strain (GRS 43.86 ± 10.75%) and longitudinal strain (GLS - 19.73 ± 2.19%), while global circumferential strain (GCS) was mildly reduced (GCS - 19.5 ± 2.81%). BSH patients had more expressed LV geometry changes (LV mass: 89.19 ± 24.59g/m2 vs 109.15 ± 25.33g/m2, p < 0.001; relative wall thickness: 0.3 ± 0.08 vs 0.38 ± 0.11, p < 0.001) and also revealed a specific pattern of longitudinal deformation impairment in three LV segments (basal and mid interventricular septum, basal anteroseptum). "Strain gradient" from LV base to apex (basal < mid < apical) was observed in the whole population for longitudinal and circumferential strain, and it was more pronounced in the BSH group. This group had more impaired basal LS, while apical CS was improved. Subendocardial longitudinal strain was also more impaired in the BSH group. This study brings new meaning to basal septal hypertrophy (BSH) occurrence in hypertensive patients with discrete global concentric remodeling. Regional systolic dysfunction of the basal and mid LV segments is found, while apical segments increase in deformation. This specific "strain gradient" pattern was found to be more pronounced in patients with BSH. The recognition of BHS in apparently healthy hypertensive patients with no impairment in global systolic function may suggest latent target organ damage with regional impairment of systolic function and the need to imply more aggressive treatment approach.

PB2053: PRIMARY ARTERIAL HYPERTENSION IN MYELOPROLIFERATIVE NEOPLASMS: A SYSTEMATIC REVIEW

Background: Patients diagnosed with myeloproliferative neoplasms (MPNs) are prone to experience thrombotic events and often experience a high burden of cardiovascular comorbidities. Primary arterial hypertension (HTN) remains one of the most common comorbidities in the elderly. However, the impact of HTN on MPNs is unclear. Aims: Report on the occurrence of HTN in MPNs. Describe its epidemiology, influence on development of thrombosis, HTN treatment strategies. Methods: Systematic search in PubMed/Medline, Web of Science and SCOPUS, from the inception of these databases to retrieve relevant English-written articles. Eligibility criteria: 1. Confirmed MPNs diagnosis, 2. Confirmed HTN diagnosis, 3. Studies reported on the epidemiology of HTN in MPNs, impact of HTN on the development of thrombosis or on the therapeutic options used to treat HTN in MPNs. We excluded studies investigating secondary HTN, e.g., drug-induced HTN. Results: The systematic search resulted in 590 potentially relevant manuscripts. After removal of duplicates and screening of abstracts/titles (n=503), 87 manuscripts were selected for full-text review. After applying the eligibility criteria and full-text evaluation, 25 articles were excluded and the remaining 62 were entered into the qualitative/quantitative analysis. HTN emerged as the most common comorbidity in MPNs, affecting 41-63% of primary myelofibrosis (PMF), 40-64% of essential thrombocythemia (ET), 46-90% of polycythemia vera (PV) cases. In PV, the presence of HTN was associated with decreased serum free epinephrine and aldosterone levels, reduced retinal microperfusion, elevated kidney arteries resistance, JAK2-V617F mutation and high-risk PV. In PMF, it was linked with high uric acid concentrations and elevated risk of thrombosis (OR=1.96). PV subjects with HTN were non-dippers, suffered from systolic/diastolic dysfunction as assessed by cardiac ultrasound, displayed elevated cell-free hemoglobin and nitrite/nitrate ratio, and an increased risk of thrombosis (HR=1.77). HTN in ET was associated with overall thrombosis, especially arterial thrombosis (HR=1.91-3.8). The cardio-IPSET score was superior in predicting thrombosis in ET patients with HTN. Individuals with MPNs and HTN exhibited signs of carotid artery injury, end-organ damage, increased albumin-to-creatinine ratio, P-selectin concentrations and were prone to develop kidney dysfunction. Moreover, stroke was more common in MPNs with concomitant HTN (HR=4.24) and HTN was a predictor of ischemic stroke recurrence in MPNs. The risk of thrombosis in MPNs was higher if HTN was also associated with other cardiovascular risk factors, i.e., dyslipidemia, diabetes or smoking. The risk of cerebral venous sinus thrombosis was lower in MPNs with co-occurring HTN. In terms of treatment options for patients with HTN and MPNs, angiotensin-converting enzyme inhibitors (ACEI), e.g., lisinopril, and calcium-channel blockers (CCB - nifedipine for hypertensive emergencies) have been successfully used. The recommendation to avoid the use of diuretics in patients with elevated blood viscosity, e.g., PV, remains unaltered. Summary/Conclusion: Our findings suggest that HTN is the most common comorbidity in MPNs and is associated with development of thrombosis, end-organ damage, i.e., retinal and kidney dysfunction. Integration of HTN in the current scores employed to predict the development of thrombosis and stratify MPNs subjects in warranted. Screening for HTN in MPNs is urgently needed. Accurate management strategies based on the use ACEI and CCB need further exploration in MPNs with associated HTN.

Research of the rs11064153 variant of the SCNN1A gene in patients with arterial hypertension and in healthy people in the Trans-Baikal

The aim of the study was to evaluate the putative association of the rs11064153 variant of the SCNN1A sodium channel gene with arterial hypertension (AH) among patients suffering from AH and relatively healthy people in the Trans-Baikal Territory.Design and methods. The present study included 106 patients with a confirmed diagnosis of AH. All participants were included in the study after signing informed consent. The control group consisted of 98 practically healthy people. The groups were comparable in age: the average age in the group with primary AH was 45 ± 9,7 years, in the control group— 42,5 ± 5,8 years. The number of men in group 1 was 73,6% (78/106), in group 2–55,1% (54/98) of the total number of cases (Chi-square = 7,62, df = 1, p &lt; 0,005). Molecular genetics typing of the studied genes was carried out. SNPs of the sodium channel genes SCNN1A (rs11064153) were determined by real-time polymerase chain reaction. We have evaluated the subordination of the distribution of genotypes of samples to the Hardy-Weinberg equilibrium, χ2 -test, and also estimated the odds ratio (OR).Results. Carriage of the T/T genotype in the group of patients with AH was more frequent than in the control group (97,4% and 86,6%, respectively; χ2 = 8,60, p = 0,01). Thus, carriage of the T/T genotype of the SCNN1A gene increased the likelihood of AH in patients (OR = 2,27, 95% confidence interval (CI) 1,29–4,01, p = 0,01). Among patients, the T allele was detected 1,5 times more often with a frequency of 0,78 compared with the group of healthy individuals — 0,22 (χ2 = 7,28; p = 0,007). The C/C genotype was detected only in three patients from the AH group (2,8%) and in seven patients from the control group (7,1%). It was found that the C allele of the SCNN1А gene (rs11064153) 5 times less often than in the control group, and its frequency was 0,22 versus 0,34, respectively (χ2 = 7,28, p = 0,007). The carriage of the C allele (C/C+T/C genotypes) is associated with a lower incidence in patients with AH (OR = 0.54; 95% CI 0,35–0,85, p = 0,007). In the samples examined by us, the carriage of the C allele reduced the likelihood of AH by 2,3 times.Conclusions. We have found that the T allele and the T/T genotype of the rs11064153 variant of the SCNN 1A gene increase the likelihood of developing hypertension. Carrying allele C and the C/C SCNN1A genotype (rs11064153) reduces the likelihood of developing AH.

Pharmacological Management of Primary Arterial Hypertension: A Century of Expert Opinions in Cecil Textbook of Medicine.

Advances in drug therapy for primary (or essential) arterial hypertension have contributed to a significant decrease in the frequency and severity of strokes, coronary artery disease and heart failure, and chronic renal insufficiency. What are the milestones of the changes in the expert approach to the pharmacological management of arterial hypertension in the past century? To determine the changes in the experts' approach to the management of arterial hypertension, as presented in a widely used textbook in the United States. The chapters presenting the management of arterial hypertension in the 26 editions of Cecil Textbook of Medicine published from 1927 through 2020. The pharmacological management of arterial hypertension has had 3 overlapping eras in the timeframe subject to our investigation. In the empiric era (1927-1947), experts were recommending nonspecific interventions for sedation. The premodern era (1955-1963) relied on ganglion blockers, sympathetic blockers, and direct vasodilators. The modern era (1967-2020), which includes drugs used in current clinical practice, saw the introduction of diuretics (1967), beta-blockers (1971), alpha-blockers (1982), calcium channel blockers (1985), angiotensin-converting enzyme inhibitors (1985), angiotensin receptor blockers (2000), and direct renin inhibitors (2008). The pharmacological management of arterial hypertension has been the focus of intense and successful research and development in the second half of the 20th century.

ДИАГНОСТИЧЕСКАЯ ЭФФЕКТИВНОСТЬ НОВОГО МЕТОДА ОПРЕДЕЛЕНИЯ ПОВРЕЖДЕНИЯ ПОЧЕК ПРИ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ

Objectives. To evaluate diagnostic effectiveness of a complex ultrasound method for determining kidney damage in patients with chronic heart failure (CHF). Material and methods. In 2017-2021 on the basis of the Healthcare Institution «1st City Clinical Hospital» in Minsk, a clinical and instrumental study was performed on 203 patients aged 66 (59; 75) years, of which 111 (54.7%) were women and 92 (45.3%) men. Dynamic ultrasound investigation of the kidneys was carried out in 80 patients with CHF after ≥3 months. Inclusion criteria: sinus rhythm in patients; essential (primary) arterial hypertension; chronic ischemic heart disease; congestive heart failure; informed voluntary consent of the patient to participate in the study. Exclusion criteria: glomerular, tubulointerstitial kidney disease, obstructive uropathy, renal artery stenosis, congenital kidney diseases, history of renal malignancy. Results. The method for determining kidney damage in CHF is based on the concept of establishing a complex of ultrasound signs. It includes an assessment of the total volume of the kidneys, parenchymal thickness, end diastolic blood flow velocity, pulsation index, resistance index in segmental renal arteries, and characterizes kidney damage in patients with normal or slightly reduced glomerular filtration rate (GFR) (categories C1 - C2), chronic kidney disease (CKD) with categories of GFR C3A - C4 and CHF. Conclusions. The method has a high accuracy - 98.3%, which makes it possible to recommend its use when establishing CKD in patients with CHF.