Risk Of Arterial Hypertension Development Research Articles

Correlation between angiotensin-converting-enzyme 2 gene polymorphisms and systemic sclerosis.

Systemic sclerosis (SSc) is a disease with cardiovascular impairment and polymorphisms of the gene coding of angiotensin-converting-enzyme 2 (ACE2) may account for its development. Three single nucleotide polymorphisms of ACE2 (C>G rs879922, G>A rs2285666 and A>G rs1978124) were found to increase the risk for development of arterial hypertension (AH) and cardiovascular (CVS) diseases in different ethnicities. We investigated associations of polymorphisms rs879922, rs2285666 and rs1978124 with the development of SSc. Genomic DNA was isolated from whole blood. Restriction-fragment-length polymorphism was used for genotyping of rs1978124, while detection of rs879922 and rs2285666 was based on TaqMan SNP Genotyping Assay. Serum level of ACE2 was assayed with commercially available ELISA test. 81 SSc patients (60 women, 21 men) were enrolled. Allele C of rs879922 polymorphism was associated with significantly greater risk for development of AH (OR=2.5, p=0.018), but less frequent joint involvement. A strong tendency to earlier onset of Raynaud's phenomenon and SSc was seen in carriers of allele A of rs2285666 polymorphism. They had lower risk for development of any CVS disease (RR=0.4, p=0.051) and tendency to less frequent gastrointestinal involvement. Women with genotype AG of rs1978124 polymorphism had significantly more frequent digital tip ulcers and lower serum level of ACE2. Polymorphisms of ACE2 may account for the development of AH and CVS disorders in SSc patients. Strong tendencies to more frequent occurrence of disease specific characteristics distinct to macrovascular involvement will require further studies evaluating significance of ACE2 polymorphisms in SSc.

Ризик і предиктори розвитку артеріальної гіпертензії у хворих на системну склеродермію

Актуальність. Пацієнти із запальними захворюваннями суглобів (ЗЗС), до яких можна зарахувати системну склеродермію (ССД), мають підвищений ризик кардіоваскулярних (КВ) ускладнень порівняно із загальною популяцією. Артеріальна гіпертензія (АГ) є потужним фактором, що піддається модифікації та впливає на КВ-ризики у пацієнтів із ЗЗС. Мета. Дослідити ризик і пре­диктори розвитку АГ у хворих на ССД. Матеріали та методи. Ми провели 5-річне проспективне спостереження за 73 пацієнтами, які перебували у регіональному регістрі. Дослідження ризику розвитку АГ проводилося за допомогою процедури Каплана — Мейєра. Обчислення впливу предикторів на ризик розвитку АГ проводилося за допомогою регресії Кокса. Результати. П’ятирічний ризик розвитку АГ при ССД становить 20,3 %. Ризик розвитку АГ через 1, 3 та 5 років — 18,2, 25,0 та 19,4 % відповідно. Отримано показники впливу початкових клініко-лабораторних показників на ризик розвитку АГ (відношення ризиків): вік > 45 років — 2,04, дифузна склеродермія — 0,65, синдром Рейно — 1,17, набряк кистей — 1,74, артрит — 0,99, пневмофіброз — 1,84, анемія — 0,78, швидкість осідання еритроцитів (ШОЕ) > 25 мм/год — 1,68, С-реактивний протеїн (СРП) > 5 мг/л — 1,52, ревматоїдний фактор (РФ) > 14 МО/мл — 1,48, протеїнурія — 1,09. Висновки. П’ятирічний ризик розвитку АГ при ССД становить 20,3 %. Найбільший вплив на ризик розвитку АГ при ССД показали: вік > 45 років, наявність набряку кистей, пневмофіброзу, ШОЕ > 25 мм/год, СРП > 5 мг/л, РФ > 14 МО/мл. У пацієнтів, які мали АГ у дебюті ССД, у п’ятирічній перспективі можна очікувати збільшення зустрічальності протеїнурії та зниження швидкості клубочкової фільтрації.

THE ROLE OF ORTHOSTATIC TEST IN PROGNOSIS OF ARTERIAL HYPERTENSION DEVELOPMENT IN YOUNG ADULTS

The aimof this study was to assess the role of orthostatic test in prognosis of arterial hypertension (AH) in young adults.Materials and methods.842 young adults 20–29 years old with the level of blood pressure (BP) <140/90 mm Hg were enrolled in a prospective study. Active orthostatic test was performed. Observation period was 5 years. After that 2 groups were assigned according to BP level: group 1 – with AH (BP level >140/90 mm Hg), group 2 – with normal BP level (<140/90 mm Hg).Results.Physiological type of orthostatic reaction was found in 542 persons (64.4 %), primary hypersympathicotonic type – in 79 (9.4 %), secondary hypersympathicotonic – in 93 (11.1 %), hyposympathicotonic – in 94 (11.2 %), sympathicoasthenic – in 34 (4.0 %). 78 persons were withdrawn from the study for different reasons during observation period. AH was diagnosed in 144 (18.8 %) persons (group 1), normal BP – in 620 (81.2 %) participants (group 2). In group 1 hypersympathicotonic response to orthostatic test was observed in 102 (70.8 %) persons, in group 2 – in 47 (7.6 %) participants (р <0,001). By the results of univariate logistic regression analysis male sex (OR 10.8; 95 % CI 7.6–15.3), body mass index >25 kg/m2 (OR 7.2; 95 % CI 5.7–9.1), smoking (OR 5.6; 95 % CI 4.5–7.0), high normal BP (OR 10.7; 95 % CI 6.9–14.5) and hypersympathicotonic orthostatic response (OR 13.6; 95 % CI 10.0–18.7) were significant risk factors of AH. By the results of multivariate analysis body mass index >25 kg/m2, high normal BP and hypersympathicotonic orthostatic response were independent risk factors.Conclusion.Hypersympathicotonic orthostatic response with increased body mass index and high normal BP are the risk factors of AH development during next 5 years in young adults. It is reasonable to use orthostatic test in assessing the risk of AH development in young people.

Predictive significance of raised blood pressure in children and adolescents (32-year prospective follow-up)

Although on the first glance, the prevention of arterial hypertension (AH) is effective since childhood and adolescence, further research is needed, as it is not well known how to make it effective.Aim. Based upon the analysis of 32-year long dynamics of various levels of blood pressure (BP), to define the efficacy of screening investigations in children.Material and methods. A 32-year long prospective, cohort study conducted, the observation of males beginning at age 11-12 y. o. In 32 years, among 1005 participants, 303 (30,1%) were investigated, and the cohort consisted finally of 290 persons. The assessment included: surveying, triple BP measurement, pulse count, body mass and height measurement, triceps skin folds thickness measurement, as scapular and abdominal, waist and hip circumference, total cholesterol measurement, as the high density, and level of triglycerides, electrocardiogram.Results. Among the males that at the age 12 were in the upper 20% (5th quintile) by systolic BP, in 32 years almost one quarter remained in the same quintile. The stability of raised BP the parameters influence such as body mass and skin fold thickness. Combination of raised systolic BP in high body mass in 13 y. o. adolescents does increase the risk of AH at 43 y. o. the same grade that does an isolated body mass increase — this witness on the decrease of baseline BP values role in hypertension developemnt with remaining role of body mass. The risk of AH development with the baseline age 15 y. o. was significantly higher in combination of overweight and AH.Conclusion. For AH prevention, even in childhood and adolescence it necessary to monitor closely those with raised systolic BP and overweight, and active prevention should start before the age 20 y. o.

Prevention of Arterial Hypertension in Adolescents with Existing Risk Factors in Rural Clinics

The objective: to determine the frequency and impact of risk factors among adolescent children in the countryside on the possibility of arterial hypertension (AH) development and to devise the family doctor recommendations for its prevention. Patients and methods. The cohort study of 214 children at the age of 12–17 years who attend Khotiv educational complex «Secondary school of I–III levels – gymnasium» in Kiev region was implemented in order to identify the elevated numbers of blood pressure (BP) and the impact of risk factors on the development of hypertension in future. The sociological poll about the existing risk factors for cardio-vascular disease, the measurement of height and weight with the following bodymass index (BMI) calculation, the Rufe’s test for evaluating the physical efficiency, the BP measurement in the office, the electrocardiography (ECG), the blood pressure daily monitoring (BPDM) and the ophthalmoscopy were carried out. Results. Pre-hypertension was revealed among 29 children that made 13,6±2,3% of respondents, and arterial hypertension was diagnosed for 25 children that made 11,6±2,2%. Arterial hypertension was detected 2.5 times more often among boys in comparison with girls (8,3±1,9% and 3,3±1,5% accordingly). Most of respondents with arterial hypertension were 141year1old children. The most common complaints of the respondents were sleep disturbance (59,3±3,6%), exertional dyspnea (57,0±3,4%), headache (41,1±3,4%) and rapid fatigue (21,0±2,8%). The following risk factors as sex, hereditary factor for arterial hypertension especially combined with diabetes, myocardial infarction, stroke; smoking of respondents, smoking of parents, overuse of products containing the excess of table salt, insufficient use of vegetables and fruit (less than 200 g/day or no daily usage), the use of energy drinks, inactive way of life, low physical activity, the change of body weight (the overweight and the underweight) were significant. Conclusions. The frequency of arterial hypertension among the examined children who live in the countryside is 11.6%, including 8.3% among boys and 3.3% among girls. The main risk factors of arterial hypertension are the overweight, the underweight, the family history of arterial hypertension, the smoking of parents and physical inactivity of children. It has been found out that the absolute risk of arterial hypertension development in future is 40 per cent higher among the smokers, 10 per cent higher among the children whose parents smoke, 20 per cent higher among the dyspn(o)eic respondents, 20 per cent higher among the underweight children, 30 per cent higher among the overweight children, 30 per cent higher among the children with the changes of the fundus of eye, 20 per cent higher among the children with sinus tachycardia and 40 per cent higher among children with a single supraventricular extrasystole or sinus arrhythmia.

Risk of arterial hypertension development due to T393C gene polymorphism of α-subunit of G-protein

According to foreign researchers, T393С gene polymorphism of α-subunit of the G-protein (rs7121) affects the sympathetic-adrenal system and the risk of hypertension. There are also data on the dependence of the manifestations of this polymorphism on the associated risk factors. However, these data are contradictory, which may be explained by ethnic differences in patients. In Ukraine there were no studies on this issue. We have studied 166 hypertensive patients and 90 healthy individuals. Determination of the polymorphism was performed by polymerase chain reaction with subsequent analysis of restriction fragments. The study found no statistically significant difference in the distribution of genotypes T393T, T393С, С393С in patients with hypertension and healthy subjects (p>0,05). The risk for hypertension in carriers of genotypes T393T + T393С relatively to С393С genotype was not significantly different (OR=1,44, 95% CI 0,74-2,80; p=0,283). During the analysis of the effect of smoking on the manifestations of T393С gene polymorphism α-subunit of the G-protein, no statistically significant difference were found (p>0,05). T393C gene polymorphism of α-subunit of G-protein did not affect the risk of hypertension.

Risk of arterial hypertension and personal anxiety in 25—64 years old female population: A 16-year epidemiological study based on the WHO program «MONICA-psychosocial»

Objective. To determine the effect of personal anxiety on the relative risk of arterial hypertension (AH) in female population 25–64 years during 16 years. Design and methods. Within the framework of the third screening of the WHO «MONICA-psychosocial» program random representative sample of women aged 25–64 years (n = 870), who were residents of one district in Novosibirsk, were surveyed. Personal anxiety was measured by Spilberger’s test. From 1995 to 2010 women were followed up for 16 years for the incidence of AH. Cox proportional regression model was used for the estimation of relative risk. Results. During the fi rst 5 years the relative risk of AH development was 2,38 times higher (95 % CI = 1,137–4,993; p < 0,05); for 10 years — 1,85 times higher (95 % CI = 1,075–3,194; p < 0,05); for 16 years — 1,46 times higher (95 % CI = 0,992–2,040; p < 0,05) in women with high levels of anxiety. The rate of AH incidence was higher in married women, managers, physical labour employees and in those with low level of education. Conclusion. Risk of AH incidence in population of women aged 25–64 years with high level of personal anxiety was the highest during the fi rst 5 years of follow-up. Incidence of AH is affected by occupation and marital status, educational level.

The Association Between Polymorphism of Lys198Asn of Endothelin-1 Gene and Arterial Hypertension Risk in Kazakh People

Aim: We researched frequency distribution of genotypes and alleles Lys198Asn of polymorphism of endothelin -1 gene associated with arterial hypertension development in Kazakh people Method: The research included 120 patients suffering arterial hypertension of 2-3 degree, average, high and very high degree of risk, and control group included 80 actually healthy person of Kazakh nationality. Result: The research discovered that development of arterial hypertension in the present ethnic group associated with polymorphism of endothelin-1 gene. Conclusion: At that, allele 198Asn and AsnAsn genotype of endothelin-1 gene act as marker of increased risk of arterial hypertension development.

Effect of stress on the development of arterial hypertension

The system of cardiovascular regulation is the most sensitive to the influence of negative social and psychological factors which play an important role in the beginning and development of arterial hypertension (AH) in most patients. In the present article we describe the results of clinical studies on the assessment of the impact of emotional stress, informational overload, occupational stress, degree of social integration and insomnia on the risk of AH development. In the recent studies it was demonstrated that depression, anxiety level and psycho-emotional stress are independent risk factors for cardiovascular pathology, which should be considered together with other generally recognized cardiovascular risk factors. The clinicians are faced with the task to develop optimal ways of influence on psychosocial risk factors. So it is necessary to clearly identify the most important of them, the mechanisms of their negative effect on cardiovascular pathology, as well as the implementation of preventive measures aimed at the prophylaxis of AH and its negative consequences.