Arterial Hypertension Stage Research Articles

EFFECT OF CHOLECALCIFEROL ON PULSE WAVE VELOCITY IN WOMEN WITH ARTERIAL HYPERTENSION IN PREMENOPAUSAL AND EARLY POSTMENOPAUSAL PERIODS

Abstract Objective: Aim: To assess effect of cholecalciferol on pulse wave velocity (PWV) in women with arterial hypertension (AH) in premenopausal and early postmenopausal periods who received 25 (OH)D supplementation. Design and method: Materials and methods: We investigated 102 women with AH stage II risk 3 aged 50 (48; 53) years: 50 females in premenopausal period – group I and 52 females in early postmenopausal period – group II. Serum level of 25 (OH)D was determined by the immunoenzymatic assay. In groups I and II we identified subgroups with the level of 25 (OH)D < 30ng/ml: subgroup IB (n = 25) and subgroup IIB (n = 21) respectively, in which antihypertensive therapy was supplemented with cholecalciferol 2,000 IU/day for 3 months. In subgroups IA (n = 25) and IIA (n = 31) cholecalciferol was not administered. The PWV was determined by assessing the elastic properties of blood vessels using computer rheovasography. Statistical analysis was performed by means of «STATISTICA 10.0». Results: Results: At baseline the level of 25 (OH)D was lower (p < 0,05) in subgroups IB (19,3 ± 8,5ng/ml) and IIB (18,2 ± 9,5ng/ml) than in the comparable subgroups IA (26,7 ± 11,5ng/ml) and IIA (27,4 ± 10,5ng/ml). After supplementation the level of 25 (OH)D increased (p < 0,001) in subgroup IB (37,28 ± 11,97ng/ml) and in subgroup IIB (36,4 ± 10,0ng/ml), and became higher (p < 0,001) than in the comparable subgroups I and IIA. At baseline subgroups IA and IB, IIA and IIB did not differ (p > 0,05) by PWV. Following the therapy PWV decreased (p < 0,01) in all groups. However, the PWV was significantly lower (p < 0,05) in subgroups IB (3,7 (3,1;4,3) m/s) and IIB (4,1 (3,6; 4,5) m/s) than in the comparable subgroups IA (4,2 (3,6; 5,2)m/s) and IIA (4,8 (4,0;5,6) m/s), correspondingly. Conclusions: Conclusion: Correction of 25 (OH)D level by intake of cholecalciferol 2000 IU/day for 3 months leads to reduction of PWV in women with AH.

Определение центрального артериального давления – перспективное направление выявления начальной стадии артериальной гипертензии

Определение центрального артериального давления – перспективное направление выявления начальной стадии артериальной гипертензии

The role of the IRS1 gene (rs2943640) in the comorbid course of type 2 diabetes mellitus, obesity and arterial hypertension

Type 2 diabetes mellitus (T2DM) affects more than 7 million people, resulting in 2.8 million hospitalizations and more than 300,000 deaths reported annually. Current scientific data indicate that among the world's population, arterial hypertension (AH) and type 2 diabetes mellitus (T2DM) after obesity are among the leading factors of cardiovascular risk.
 Aim of research: was to establish the prevalence of the IRS1 gene (rs2943640) polymorphism in patients with T2DM in combination with obesity and arterial hypertension/
 Material and research methods. The study involved 33 type-2 diabetic patients hospitalized to the Endocrinology Department of Ternopil University Hospital (Ternopil, Ukraine) in 2019-2020 and 10 healthy individuals.
 Inclusion criteria: clinical, laboratory and instrumental signs of T2DM, AH and obesity. Exclusion criteria from the study: signs of clinically significant neurological, mental, renal, hepatic, immune, gastrointestinal, urogenital disorder; injuries of the musculoskeletal system, skin, sense organs, endocrine system (except T2DM); or uncontrolled hematologic diseases; acute pancreatitis, unstable or life-threatening heart disease; patients with malignant neoplasms who have not been in complete remission for at least 5 years, medication (drug) dependence, and alcohol dependence.
 T2DM diagnoses were confirmed according to the 2019 Recommendations of the American Diabetes Association (ADA). The diagnosis of arterial hypertension (Stage I) was made according to 2018 ESC/ESH Guidelines for the management of arterial hypertension. Systolic (140-159 mmHg) and/or diastolic (90-99 mmHg) blood pressure were considered as the presence of Stage I AH. Left ventricular hypertrophy was confirmed by an electrocardiogram.
 Genomic DNA was extracted from peripheral blood leukocytes using a commercially available DNA isolation kit (QIAamp Blood DNA Mini Kit, QIAGEN, Germany). The IRS-1 gene rs2943640 C>A polymorphism was genotyped using the TaqMan real-time PCR method (Applied Biosystems, Foster City, CA, USA).
 Statistical analysis of the data was performed using the software STATISTICA 7.0.
 Results. The frequency distribution of the IRS1 gene (rs2943640) polymorphisms and the assessment of compliance with the Hardy – Weinberg equilibrium were performed in the experimental and control groups. It was found that the frequencies of the genotype responsible for C/A polymorphism of the IRS1 gene at T2DM, T2DM with obesity and in the combined course of T2DM with obesity and arterial hypertension did not deviate from the Hardy – Weinberg equilibrium (p> 0.05), while in the control group the selected sample did not correspond to the general population.
 The corresponding frequencies for the genotypes of the IRS1 gene were as follows: 66.7% for C/A and 33.3% for A/A in the experimental group 1; 42.9% for C/C, 57.1% for C/A in group 2; 47.1% for C/C, 29.4% for C/A and 23.5% for A/A in group 3 and 100.0% for C/A in the control group.
 Analysis of allele frequencies for the IRS1 gene in patients with T2DM and comorbidity showed that in patients with T2DM the A allele prevailed (2.0 times), while in patients with T2DM + obesity and T2DM + obesity + arterial hypertension – the C allele. It should be noted that the C allele and the A allele were equally present in the control group.
 Analysis of the odds ratio for IRS1 gene genotypes (rs2943640) in patients with T2DM, T2DM and obesity showed no statistically significant relationship between factor (presence of C or A alleles) and disease onset (p> 0.05). At the same time, the significant influence of the C/A genotype of the IRS1 gene on the development of T2DM combined with obesity and arterial hypertension (p <0.05) was established. This is confirmed by a significant difference in the dominant model of inheritance of the IRS1 gene only in the group with the combination of T2DM with obesity and arterial hypertension compared with the control group (reliability coefficient for the chi-square p <0.001).
 Conclusion. The presence of the C allele of the IRS1 gene (rs2943640) in both homozygous and heterozygous states may increase the risk of comorbid course of T2DM, obesity and arterial hypertension.

CARDIOVASCULAR MANIFESTATIONS IN HIV POSITIVE PATIENTS IN A TERTIARY CARE HOSPITAL, CENTRAL INDIA

Background: Acquired immune deficiency syndrome (AIDS) is one of the major public health problem in india .HIV estimates report (2019)(1) of the Government, India is estimated to have around 23.49 lakh people living with HIV/AIDS (PLHIV) in 2019 . in Chhattisgarh it is 42520&HIV incidence per 1,000 uninfected population is 0.1 .with the recent advancements in therapy early mortality in HIV cases are significantly reduced but cardiovascular abnormalities are frequently seen as the disease progress and is associated with decreased quality of life.
 Aims and objective: To know the pattern and prevalence of various cardiovascular manifestations in HIV positive patients and its association with CD4 count, WHO stage of disease and ART
 Material and Methods: for the period of 1.3 years from JANUARY 2019 TO APRIL 2020studyis conducted in the Department of Medicine, PT.JNM Medical College and Dr. BRAMH, Raipur. A total of 137 HIV positive patients of age>18 years, all are on ART are included.patients included in the study underwent detailed history taking, clinical examination and investigations. Details of the history, clinical examination and investigations were noted in the proforma. The cardiovascular examination in the form of chest x-ray, ECG, 2D echocardiography and NT-ProBNP was done and their correlationswith CD4 count and WHO disease stage is studied accordingly. Electrocardiogram, chest x-ray and 2D echocardiography was done immediately following blood investigation.
 Result: Majority (45.25%) of the patients involved in this study were in age group of 31-45 year with the overall average mean age of 38.86 years. Male to female ratio was 3.1:1. On x-ray cardiomegaly found in 25.5% pts baseline ECG abnormalitities seen in 47.4% pts . echocardiographic abnormality seen in 56.2% pts .The commonest finding in our study is valvular abnormalities in 55 pts (40.1%) followed by diastolic dysfunction in 45 pts(32.8%). Other less common cardiac manifestations in decreasing order of frequency were reduced LVEF in 33 pts(24%), pericardial effusion in 15 pts (10.9%),left ventricular hypertrophy in 13 pts (9.4%), pulmonary arterial hypertension in 10 pts (7.2%)and regional wall motion abnormality in 9 pts (6.5%). We found A strong statistical correlation found between CD4 count and pericardial effusion in 2D-ECHO (p= 0.0410023). Also strong statistical correlation (p=0.016456) is found between the WHO stage of disease and cardiomegaly, strong statistical correlation found between WHO staging of disease and QRS abnormalities (p= 0.02551) and inverted T wave (p= 0.000528), strong statistical correlation found between WHO stage of disease and pulmonary arterial hypertension in 2D-ECHO (p=0.006832). And statistical association found between WHO stage of disease and regional wall motion abnormality (RWMA) in 2D-ECHO (p=0.002541).
 Conclusion: The results of the study indicate that cardiovascular abnormalities in HIV infected patients are common. Cardiac involvement and cardiovascular complications are commonly seen in HIV-infected patients and can present without any clinical manifestation. The common cardiovascular manifestation seen in our study patients is valvular leaks, regional wall motion abnormality, pericardial effusion, reduced EF etc. The incidence of cardiovascular manifestations increases as the disease progresses and CD4 count decreases.
 Keywords: Prevalence, Cardiovascular, Abnormalities & HIV.
 Study Designed: Cross Sectional Observational Study.

PLASMA CONCENTRATION OF ENDOTHELIN-1 IN PATIENTS WITH HYPERTENSION ASSOCIATED WITH OBESITY, DEPENDING ON THE LYS198ASN POLYMORPHISM OF THE ENDOTHELIN-1 GENE

Endothelial dysfunction is considered one of the main mechanisms for the further development of arterial hypertension (AH) and its complications, and endothelin-1 (ЕТ-1) plays one of the key roles in this process. Endothelium is drawn into the pathological process at the earliest stages of AH development. ЕТ-1 is currently considered as a marker and predictor of the stage and consequences of AH, chronic heart failure (CHF), coronary heart disease (CHD), in particularly, acute myocardial infarction (MI), heart rhythm disorders, pulmonary hypertension, atherosclerotic vascular injury, target vascular disorders. One factor that may influence the level of ЕТ-1 is the endothelin-1 gene Lys198Asn polymorphism, which is considered by many researchers as a possible genetic marker of AH. However, the effect of this polymorphism on the level of plasma ЕТ-1 level in patients with AH of varying severity in Ukraine is understudied. The basis of this work were the materials of a complete examination of 160 patients with a verified diagnosis of AH I, stage II of 1, 2, 3 degrees (main group) and 110 apparently healthy persons (control group). Patients of the main group were divided into three subgroups: 1st group ­– 75 patients with normal body weight; 2nd group – 48 overweight patients; 3rd group – 37 patients with alimentary obesity. In obese patients, the waist circumference in women was around 103 (96–115) cm, and in men – 108 (105–116) cm, which indicates an abdominal type of obesity in these patients. As a result of the study, it was found that the level of ЕТ-1 is higher in patients with AH who suffer with overweight and obesity as compared with patients with AH and normal body weight. Also, the peptide level depends on the genotype of patients and is higher in AH patients with the genotype Asn198Asn and Lys198Asn as compared to carriers of the genotype Lys198Lys.

Philotypes of intestinal microbiotes in patients with arterial hypertension and abdominal obesity

The aim: to study the content of the main phylotypes of the gut microbiota (GM) (Firmicutes, Bacteroidetes and Actinobacteria) in residents of Ukraine – patients with arterial hypertension (AH), which occurs against the background of abdominal obesity (AO) and metabolic disorders.Materials and methods. 70 patients (residents of Ukraine) with AH stage II, 2–3 degrees (46 patients with AO and 24 with normal body weight (NBW)) were examined. The control group consisted of 20 practically healthy individuals. The survey included standard clinical, laboratory and instrumental methods. The content of the main GM phylotypes was determined by identifying the total bacterial DNA and DNA of Firmicutes, Bacteroidetes and Actinobacteria using the method of quantitative real-time polymerase chain reaction. Statistical analysis of the data was carried out using standard methods using Microsoft Excel 17.0.Results. In patients with AH in combination with AO, residents of Ukraine, significant differences were revealed in the relative content of the main phylotypes of GM, both in comparison with healthy individuals and patients with AH and NBW: a significant increase in the relative content of Firmicutes compared with the control group and a significant increase in the ratio of Firmicutes/Bacteroidetes in comparison with practically healthy individuals and with hypertension patients with NBW. In addition, in AH patients with AO, in contrast to AH patients with NBW, it was found that changes in the GM composition at the level of their main phylotypes are associated with the presence of prediabetes, an insulin resistance (IR) index, and the level of low-density lipoprotein cholesterol in the blood.Conclusions. The results of this study indicate that changes in GM can play a significant role in the pathogenesis of AH and AO in residents of Ukraine.

Effects of dihydroquercetin (DHQ “P” drops) in patients with previous transitory ischemic attacks associated with visual disorders

A study involved 48 patients aged 33 to 79 years (average age – 62.6 years) with transient ischaemic attacks (TIA) and visual disorders, caused by cerebrovascular diseases (CVD). 24 patients from this group underwent treatment by GCP criteria and medical care standards in acute brain blood supply disturbances, TIA and therapy with dihydroquercetin “DHQ” “P” drops in the dose of 7 drops, twice a day for 10 days. All the patients had arterial hypertension (AH) stage 1-2. Control group consisted of 26 men and 20 women of comparable age (n=46; average age - 65.9 years) without cerebral ischemic events and visual disorders, findings regarding neurophysiological parameters of visually evoked potentials (VEP) and microcirculatory system state (MCS) were compared. Exclusion criteria: acute heart diseases, type 1-2 diabetes mellitus, glaucoma, secondary types of arterial hypertension and AH stage 3, hemorrhages and hereditary cerebrovascular syndromes. Assessment of the “DHQ” “P” influence on such microcirculatory system parameters (retinopathy components) as perivascular edema, perivascular microhemorrhages, arterio-venular coef­ficient was carried out by results of the fundus oculi vessels computed photometry and biological microscopy of the bulbar conjunctival vessel layers. According to the data regarding distribution of TIA amount, retinopathy stage and age, correlation of TIA was conditioned by retinopathy stage and other factors except of patients’ age. Patients with TIA associated with visual disorders in presence of CVD suffered from arterial hypertension in 72.98%. Stage 1-3 of retinopathy and optic disc functional disorders were all detected. In case of therapy with “DHQ “P” the positive changes in dynamic regarding capillary permeability restoration (in 71.43%±12,07, in retinopathy stage 1-2 in comparison with 38.46% without it) were established and less pronounced – in case of perivascular microhemorrhages. Such positive effects in the conducted study were characterized as tendency pattern (OR 2.87; p=0.08 for perivascular edema and OR 2.77; p=0.08 for microhemorrhages). The efficacy of therapy with “DHQ “P” in restoration of impaired optic disk functions according to the data of VEP (for NO component of VEP; OR 2.87; p=0.041) in the dosage of 7 drops twice a day during 10 days in case of CVD was revealed; this determines the perspective of further investigation of “DHQ “P” which contains dihydroquercetin.

BLOOD PRESSURE, HYPOCHONDRIA AND DEPRESSION: MATHEMATICAL MODELS OF RELATIONSHIP

Modern clinical diagnostics has standards and medical systems for the diagnosis of hypertension, advanced information technology. Mathematical models of the relationship between systolic blood pressure and psychological indices of hypochondria and depression have been described. Methods of mathematical statistics were applied as follows: factor, cluster, discriminant, regression analyzes, Markov chains, polynomial splines and neural networks, they were implemented in software products, such as NeuroModelDBPM, "Monitoring", VerMed. The presented model of interaction of systolic arterial pressure, Hs−hypochondria, D−depression confirms an importance of these states at an initial stage of arterial hypertension and allows the allocation of four options of psychosomatic relations in patients: organ and system somatic defeats of psychosomatic character, somaticized psychiatric reactions, reactions of exogenous type. It has been shown that disharmonious personality traits, risk factors, disorder of chronobiological structure of blood pressure, left ventricular hypertrophy and its diastolic dysfunction contribute to the formation of nosogeny in hypertension. Their development is hindered by harmonious personality traits, keeping a healthy lifestyle, minimal changes in the chronobiological structure of blood pressure, a slight degree of left ventricular hypertrophy and its diastolic dysfunction. The leading cardiovascular risk factors in patients with hypertension are stress, burdened heredity, low physical activity, carbohydrate abuse, higher education and high socioeconomic status. Nosogeny in hypertension should also be considered as a risk factor, as well as should be taken into account in the stratification of the overall cardiovascular risk and accomplishing a proper adjustments. Key words: arterial hypertension, mathematical statistics, arterial pressure, hypochondria, depression, information technology.

The Effect of Aqua-trainings are in Fresh Water in Patients with Hypertension on the Microcirculation

Walking in water (Aquatic Physiotherapy) is a simple, reproducible and affordable method. Warm pool water reduces peripheral vascular resistance. Purpose of the study was to assess the effect of dosed physical activity in a fresh water on the microcirculation of patients with arterial hypertension (AH) when applied externally. Materials and methods. The study included 14 subjects (7 men, 7 women) aged 18 to 70, with AH stage I. The patients were administered aqua training course in the form of walking in a fresh water for the 30 minutes duration, the course of treatment included 10 procedures, the water temperature in the pool was 30–32C. Before and after the end of the intervention, several parameters were monitored, including the assessment of microcirculation using laser Doppler flowmetry. Results: In patients receiving aqua training in a fresh water, there was a significant decrease of arterio-venular bypass grafting by 25.0%from the initial (Wilcoxon T-test = 310.0; p = 0.004) and an increase in the muscle component of microcirculation regulation (Wilcoxon T-test = 399.0; p <0.05), which indicates an improvement in microcirculation under the influence of aqua training. The optimal duration of training in fresh water was found to be equal to five days, after which the indicators characterizing microcirculation remain at the plateau level, without significantly changing. Significantly more often, the positive effect of aqua training was achieved in the group of patients with microcirculation disorders of the type of venous stasis (χ2 = 10.6; p <0.001). Conclusion. Laser Doppler flowmetry screening may be useful method to select patients with AH in a greatest need of aquatic training.

Application of L-arginine in patients with hypertension in combination with COPD in aspect of effect on platelet activity

Objective. To investigate the relationship between platelet (Pl) adhesive activity and total cardiovascular risk (CVR) and the effect of L-arginine (Tivortin®, “Yuria-Pharm”) on morpho-functional parameters of Pl activity in patients with arterial hypertension (AH) in combination with chronic obstructive pulmonary disease (COPD).
 Materials and methods. The study included 44 patients with AH stage II in combination with COPD clinical categories A-D in the stable phase of diseases (group I) and 15 healthy individuals (group II). The calculation of the CVR by SCORE, the study of the degree of adhesion (Adh) Pl (optical turbidometry, analyzer AP 2110, Belarus). 20 patients (IA group) in addition to standard therapy of AH and COPD for 4 weeks received 4 g of L-arginine (Tivortin®, “Yuria-Pharm”), 10 patients (IB group) received only standard therapy. Before and at the end of therapy, the study was performed Pl Adh, in 10 patients of IA – transmission electron microscopy (TEM) Pl (electron microscope PEM-100-01 (SELMP, Ukraine). Statistical processing of the obtained results was performed using the program Statistica 6.1.
 Results and discussion. In group I the average age was 56.0±6.7, men – 35 (79.5 %), body mass index (BMI) – 26.3 [24.0; 30.3] kg/m2, active smokers – 25 (57 %). In group II the average age was 52.7±4.9, men – 10 (66.7 %), BMI – 25.4 [24.3; 26.2] kg/m2, active smokers were not detected. The degree of Pl Adh in group I was higher than in group II (42.0 [36.0; 52.0] %) vs 29.0 [26.0; 34.0] %; p=0.005). In patients of group I the degree of Pl Adh had a direct correlation with the CVR by SCORE (R=0.50; p=0.001). Against the background of therapy in the IA group, the degree of Pl Adh decreased from 42.0 [34.0; 52.0] % to 30.0 [26.0; 39.0] % (p=0.004), in the IB group – from 38.5 [36.0; 47.0] % to 36.0 [33.5; 43.0] % (p=0.18). According to the results of TEM of Pl in patients of IA group, the number of activated forms of Pl decreased from 45.0 [43.0; 48.0] % to 37.0 [33.0; 41.0] % (p=0.028), aggregated Pl – from 11.5 [10.0; 9.5] % to 9.5 [8.0; 12.0] % (p=0.043), degranulated Pl – from 16.5 [16.0; 20.0] % to 11.0 [9.0; 13.0] % (p=0.028). No adverse effects were identified during L-arginine therapy.
 Conclusions. Increased adhesive activity of Pl in stable patients with AH in combination with COPD is associated with the total CVR by SCORE. The use of L-arginine (Tivortin®, “Yuria-Pharm”) effectively and safely helps to reduce the functional activity of Pl in this category of patients.

Neurac (Neuromuscular Activation) in cardio-vascular rehabilitation for patients with arterial hypertension

The aim of the study: Studying influence of Neurac method on control of blood pressure in patiens with arterial hypertension. Materials and methods: For the group amount of 15 patients with arterial hypertension stage 1-2 the Neurac method was used like rehabilitation tool for treatment. Results: 65% of patients had positive response for provided treatment. For 30% of patients it was possible to reduce the dose of the medications. Conclusions: Providing of Neurac method as a non-drug treatment tool for patients with arterial hypertension helps to improve life quality of the patients, reduce the dose of antihypertensive drugs in non-invasive way.

Влияние дигидрокверцетина на артериальное давление и гемореологические параметры крыс SHR в периоды развития и стабильной артериальной гипертензии

Согласно современным представлениям, важную роль в прогрессировании артериальной гипертензии (АГ) играет изменение реологических свойств крови. К настоящему времени опубликованы работы, в которых показано улучшение гемореологических параметров за счет использования различных лекарственных средств при сердечно-сосудистых заболеваниях. Цель работы - исследование влияния дигидрокверцетина (ДГК) на артериальное давление (АД) и гемореологические параметры у крыс линии SHR в различные периоды развития АГ. Методика. Эксперименты проведены на крысах со спонтанной гипертензией (spontaneously hypertensive rats, SHR) двух возрастных групп: период развития АГ (возраст крыс SHR на начало эксперимента 5 нед) и период стабильной АГ (возраст крыс SHR на начало эксперимента 11 нед). ДГК (50 мг/кг) вводили внутрижелудочно в течение 6 нед. Крысы контрольных групп получали эквиобъемное количество крахмальной слизи по той же схеме. АД у бодрствующих крыс регистрировали неинвазивным методом (NIBP200A, «Biopac Systems, Inc.», США). Вязкость цельной крови, стабилизированной ЭДТА (в диапазоне скоростей сдвига 15-450 с-1), и плазмы (450 с-1) измеряли на ротационном вискозиметре (LVDV-II+ Pro, CP40, «Brookfield Engineering Labs Inc.») при 36 оС. Гематокрит определяли методом центрифугирования. Агрегацию и деформируемость эритроцитов исследовали на анализаторе «RheoScan-AnD 300» («Rheo Meditech, Inc.»). Результаты. У крыс SHR после 6-недельного введения ДГК в период развития АГ не наблюдалось значимых различий уровня систолического АД (САД), макро- и микрореологических показателей по сравнению с параметрами в контрольной группе. У крыс SHR со стабильной АГ введение ДГК приводило к снижению САД, ослаблению агрегации эритроцитов с увеличением их индекса элонгации и снижению вязкости крови по сравнению с контрольной группой. Заключение. Нарушение гемореологических параметров крови выражено значимо меньше у крыс SHR в начальной стадии формирования АГ. Использование ДГК в период развития АГ не оказывало статистически значимого влияния на АД. В период стабильной АГ гипотензивное действие ДГК связано в том числе с его способностью снижать вязкость крови и улучшать такие микрореологические параметры, как агрегация и деформируемость. Arterial hypertension (AH) is the most common cardiovascular disease and a risk factor for other vascular diseases and organ damage. According to current concepts, changes in blood rheology play an important role in AH progression. Drugs improving hemorheological parameters have been shown to be beneficial in cardiovascular diseases. Aim. To study the effect of dihydroquercetin (DHQ) on blood pressure (BP) and hemorheological parameters in spontaneously hypertensive rats (SHR) at different stages of AH. Methods. Experiments were performed on SHR in the period of AH development (5-week-old SHR at the beginning of experiments) and in the period of stable AH (11-week-old SHR at the beginning of experiments). DHQ (50 mg/kg) was administered intragastrically for 6 weeks. Rats of the control groups received an equal volume of starch mucilage according to the same schedule. BP was measured with a non-invasive NIBP200A (Biopac Systems, Inc., USA) instrument in conscious rats. Viscosity of K2EDTA-stabilized whole blood (shear rate range, 15-450 s-1) and plasma (450 s-1) was measured with a rotational viscometer (LVDV-II + Pro, CP40, Brookfield Engineering Labs Inc.) at 36 °C. Hematocrit was determined by centrifugation. Aggregation and deformability of red blood cells was studied with a RheoScan-AnD 300 analyzer (RheoMeditech, Inc.). Results. After 6 weeks of DHQ administration in the period of AH development, mean blood pressure (MBP) and macro- and microrheological parameters did not significantly differ from the respective values in the control group In SHR with stable AH, the DHQ treatment resulted in decreased MBP, blood viscosity, and red blood cell aggregation and increased red blood cell elongation index compared to the control group. Conclusion. Disorders of hemorheological parameters were significantly less pronounced in SHR with early AH. Perhaps for this reason, the DHQ treatment during the development of hypertension did not exert a significant effect on BP. In the period of stable hypertension, hyperviscosity syndrome progressed in SHR. The antihypertensive effect of DHQ in this period, among other things, was associated with a beneficial effect on micro-rheological parameters, including red blood cell aggregation and deformability, which was evident as decreased blood viscosity.

Abstract P084: When To Expect And Why To Analyze Cognitive Disorders In Arterial Hypertension

To study the relationship between quality of life (LQ) and cognitive impairment, as well as to identify risk factors for their development in patients with arterial hypertension (AH). Examined 509 outpatients with controlled AH stage II with SCORE risk of CVD <5 %. Non-dementia cognitive impairment were found 24,32±0,11 points on МCA scale in 164 (32.2 %). Patients also demonstrated a significant (p <0.001) decrease in the LQ indicators on all SF-36 scales compared to healthy ones by an average of 24.5-66.0 points. According to the results of correlation analysisthe most significant was the direct relationship between cognitive impairment on МCA scale and assessment of physical health (rs=+0,65; p<0,001), mental health (rs=+0,60; p<0,001), life activity limitations (rs=+0,33; p<0,001) and social activity (rs=+0,35; p<0,001), indicating an association between deterioration in LQ components and cognitive impairment.It turned out that the risk factors for developing cognitive impairment with AH were a history of cognitive impairment in close relatives (2.79 (95 % CI 1.15-6.77) compared with healthy people and 2.41 (95 % CI 1.01-5.88) - AH patients without cognitive impairment), a high vegetative index (rs +0.15; p <0.05) according to daily monitoring of BP and elevated levels of systolic BP variability in day and at night, that increased the chances of developing cognitive impairment in AH patients by 2.11 times, (rs = + 0.57 and rs = + 0.61; p<0.001). It was found that the likelihood of developing cognitive impairment exceeds 50 % (high risk) if the level of systolic BP variability is above 12 mm Hg in day (area under ROC curve AUC = 0.891; 95 % CI 0.883-0.940. (AUC = 0.891; 95 % CI 0.883-0.940; ST = 82.5 % and SP = 92.9 %) and at night – over 10 mm Hg (AUC = 0.922; 95 % CI 0.861-0.963; ST = 82.5 % and SP = 85.7 %) according to daily BP monitoring. In patients with AH for more than 10 years with dissatisfaction of life quality, even with controlled blood pressure, the presence of cognitive impairment needs to be clarified in immediate families, and pay attention to the high autonomic index and variability of systolic blood pressure monitored day and night, due to the high risk of development and progression of cognitive impairment, which worsens the prognosis of cardiovascular events.

The role of complement in arterial hypertension and hypertensive end organ damage.

Increasing evidence indicates that hypertension and hypertensive end organ damage are not only mediated by haemodynamic injury but that inflammation also plays an important role. The complement system protects the host from a hostile microbial environment and maintains tissue and cell integrity through the elimination of altered or dead cells. As an important effector arm of innate immunity, it plays also central roles in the regulation of adaptive immunity. Thus, complement activation may drive the pathology of hypertension through its effects on innate and adaptive immune responses, aside from direct effects on the vasculature. Recent experimental data strongly support a role for complement in all stages of arterial hypertension. The remarkably similar clinical and histopathological features of malignant nephrosclerosis and atypical haemolytic uraemic syndrome suggest also a role for complement in the development of malignant nephrosclerosis. Here, we review the role of complement in hypertension and hypertensive end organ damage. LINKED ARTICLES: This article is part of a themed issue on Canonical and non-canonical functions of the complement system in health and disease. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v178.14/issuetoc.

Inspiratory Muscle Training Improves Inspiratory Muscle Strength and Functional Exercise Capacity in Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension: A Pilot Randomised Controlled Study

Exercise intolerance is present even in the early stages of pulmonary arterial hypertension (PAH) and is associated with poorer prognosis. Respiratory muscle dysfunction is common and may contribute to exercise limitation. We sought to investigate the effects of inspiratory muscle training (IMT) to improve exercise capacity in PAH. Adults with PAH were prospectively recruited and randomly assigned to either IMT or a control group. At baseline and after 8 weeks, assessment of respiratory muscle function, pulmonary function, neurohormonal activation, 6-minute walk distance and cardiopulmonary exercise testing variables were conducted. Inspiratory muscle strength was assessed by maximal static inspiratory pressure (PImax). The IMT group performed two cycles of 30 breaths at 30-40% of their PImax 5 days a week for 8 weeks. Twelve (12) PAH patients (60±14 years, 10 females) were recruited and randomised (six in the IMT group and six in the control group). After 8 weeks, the IMT group improved PImax by 31 cmH2O compared with 10 cmH2O in controls, p=0.02. Following IMT, 6-minute walk distance improved by 24.5 m in the IMT group and declined by 12 m in the controls (mean difference 36.5 m, 95% CI 3.5-69.5, p=0.03). There was no difference in peak oxygen uptake between-groups (mean difference 0.4 mL/kg/min, 95% CI-2.6 to 3.4, p=0.77). There was no difference in the mean change between-groups in neurohormonal activation or pulmonary function. In this pilot randomised controlled study, IMT improved PImax and 6-minute walk distance in PAH patients.

Вплив комбінованої антигіпертензивної терапії на структурно-функціональний стан міокарда і ремоделювання сонних артерій у пацієнтів із артеріальною гіпертензією та хронічною хворобою нирок

SummaryТhe purpose is to improve the approaches to combined antihypertensive therapy(AHT) on the base of the study of myocardium structural-functional state as well as thethickness intima – media (IMT) of the carotid arteries in patients with arterialhypertension (AH) and chronic kidney disease (CKD).Materials and methods. We examined 156 patients with AH and CKD of IІ-IIIstages, which were allocated depending on the level of glomerular filtration rate (GFR)to 2 groups. Group 1 included patients with AH and CKD stage III (GFR 59–31 mL/min/1.73 m2); n = 68), group 2 – patients with AH and CKD stage II (GFR 60–89 mL/min/1.73 m2); n = 88). Combined AHT with losartan 50-100 mg per day andamlodipine 5-10 mg per day was applied to 40 (58.8%) patients with AH and CKD stageIII (subgroup 1A), and 40 (45.,5%) patients with AH and CKD stage II (subgroup 2A).Combined AHT with enalapril 10-20 mg per day and amlodipine 5–10 mg per day wasapplied to 28 (41.2%) patients with AH and CKD stage III (subgroup 1B), and 48(55.5%) patients with AH and CKD stage II (subgroup 2B). Patients in groups werecomparable by age, sex, disease duration and blood pressure level. Before and after6 months from the beginning of combined AHT patients passed a comprehensiveexamination in accordance with current standards of AH and CKD diagnosis.Results. The target blood pressure level was achieved after 6 months from treatmentbeginning in the most patients with AH and CKD: in 74 (92.5%) patients receivedlosartan and amlodipine, and in 70 (92.1%) patients received enalapril and amlodipine.During enalapril and amlodipine treatment of patients with AH and CKD stage III(subgroup 1B), no significant changes in structural-functional state of the myocardiumwere observed. When combination of losartan and amlodipine was applied to thiscategory of patients, a significant decrease of thickness of the interventricular septum by12.2% as well as thickness of the left ventricle posterior wall by 10.6% (p<0.05) wereobserved, but changes of other indices of structural-functional state of the myocardiumwere not significant. Significant decrease of thickness of the left ventricle posterior wallby 16.6%, decrease of interventricular septum thickness by 15.8%, and increase of theleft ventricular ejection fraction by 15.6% (p<0.05) were found in patients with AH andCKD stage II after 6 months of therapy with losartan and amlodipine (subgroup 2A).After 6 months of treatment with enalapril and amlodipine combination (subgroup 2B),both thickness of the left ventricle posterior wall as well as interventricular septumsignificantly decreased by 13.1% and 16.3%, respectively (p for both cases <0.05).Combined AHT with losartan and amlodipine in patients with AH and CKD stage IIhad a positive impact on the IMT with significant increase of proportion of patients withnormal IMT from 10% to 55% (p<0.05). In patients with AH and CKD after 6 months oftreatment with enalapril and amlodipine (subgroups 1B and 2B) there were notsignificant changes of the IMT.Conclusions. AHT in patients with AH and CKD stage II with combinationslosartan/amlodipine or enalapril/amlodipine had a positive influence on the processesof remodelling of the left ventricle myocardium, which led to significant reduction of thethickness of its walls. Combination losartan/amlodipine in patients with AH and CKDstage II resulted in improvement of intracardiac hemodynamics indices, particularly,increase of left ventricular ejection fraction by 15.6% (р<0.05). Combined AHT withlosartan and amlodipine in patients with AH and CKD was found to be highly effectiveindependently of GFR value, in connection with positive influence not only on processesof remodelling of the left ventricle myocardium (significant decrease of its wallthickness), but also on carotid artery remodelling processes. Latter is confirmed byincrease of the proportion of patients with normal IMT from 10% to 55% (р<0.05).

Opportunity of using dietary supplements, control of blood pressure as a complex treatment of arterial hypertension

The article presents the results of a research of evaluation of the effectiveness and safety of dietary supplements and control of blood pressure as a complex treatment in patients with the 1st and 2nd stages of arterial hypertension (AH). It was found that using the complex product blood pressure control stabilises systolic and diastolic blood pressure.

Changes in heart morphometric parameters over the course of a monocrotaline-induced pulmonary arterial hypertension rat model

BackgroundAim of this study was to assess changes in cardiac morphometric parameters at different stages of pulmonary arterial hypertension (PAH) using a monocrotaline-induced rat model.MethodsFour groups were distinguished: I–control, non-PAH (n = 18); II–early PAH (n = 12); III–end-stage PAH (n = 23); and IV–end-stage PAH with myocarditis (n = 7).ResultsPerformed over the course of PAH in vivo echocardiography showed significant thickening of the right ventricle free wall (end-diastolic dimension), tricuspid annular plane systolic excursion reduction and decrease in pulmonary artery acceleration time normalized to cycle length. No differences in end-diastolic left ventricle free wall thickness measured in echocardiography was observed between groups. Significant increase of right ventricle and decrease of left ventricle systolic pressure was observed over the development of PAH. Thickening and weight increase (241.2% increase) of the right ventricle free wall and significant dilatation of the right ventricle was observed over the course of PAH (p < 0.001). Reduction in the left ventricle free wall thickness was also observed in end-stage PAH (p < 0.001). Significant trend in the left ventricle free wall weight decrease was observed over the course of PAH (p < 0.001, 24.3% reduction). Calculated right/left ventricle free wall weight ratio gradually increased over PAH stages (p < 0.001). The reduction of left ventricle diameter was observed in rats with end-stage PAH both with and without myocarditis (p < 0.001).ConclusionsPAH leads to multidimensional changes in morphometric cardiac parameters. Right ventricle morphological and functional failure develop gradually from early stage of PAH, while left ventricle changes develop at the end stages of PAH.

Clinicopatological variants and risk factors for chronic kidney disease in rheumatoid arthritis

Study was to examine the prevalence, risk factors and histological variants of CKD in RA. 180 patients with rheumatoid arthritis were observed in the Tareev clinic of nephrology, for the period from 2014 to 2019 years. Age, gender, duration of RA, drug therapy, ESR, CRP, DAS28, renal function, proteinuria, histological variants were analyzed. Of the common population risk factors for CKD arterial hypertension, weight index, serum lipids and glucose levels were also assessed. The prevalence of CKD in RA was 19.7%. Age, presence and stage of arterial hypertension, an increase in body mass index, as well as high rates of disease activity ESR, CRP, DAS28 score and duration of RA were risk factors of CKD in RA. Age, duration of the disease, stage of AH and hypercholesterolemia were risk factors in multifactorial regression analysis. Amyloidosis was the most common histologic pattern (50.0%), followed by chronic glomerulonephritis (30.4%) and tubulo-interstitial nephritis (19.6%). Among chronic glomerulonephritis mesangial glomerulonephritis was the most frequent. Renal amyloidosis was associated with a duration of RA, presence of systemic symptoms and CRP level. An isolated decrease in GFR of less than 60 ml/min was detected in 31 (36.0%) out of 86 patients. Сonclusion. The risk factors for CKD in patients with RA are activity and duration of the disease In addition to common population factors. Amyloidosis was the most common histologic pattern associated with duration of RA and inflammatory proteins levels.

Hemodynamic Effects of a Multidisciplinary Geriatric Rehabilitation Program.

BackgroundGeriatric rehabilitation programs primarily aim at an increase of mobility and functional autonomy of the elderly. The cardiovascular effects of these programs, however, remain elusive. Since regular physical exercise is associated with numerous beneficial cardiovascular effects including a reduction of blood pressure (BP), the present prospective study investigates the hemodynamic effects of a representative standardized rehabilitation program.MethodsA total of 74 subjects who were hospitalized in a German university hospital for geriatric rehabilitation were enrolled in the study. Peripheral BP, central aortic BP, 24h-ambulatory BP, heart rate and pulse wave velocity as a measure of arterial stiffness were assessed at admission and before discharge from the hospital. The program contained 4–5 sessions of physical activity of individualized intensity per week (≥30 min/session, eg, walking, cycling, stair rising).ResultsThe mean age of the study population was 82.4±6.9 years; all patients suffered from arterial hypertension (stage 2–3) with a median number of three antihypertensive drugs. The most frequent cause for admission was injurious falls. The mean duration of the rehabilitation program was 17 days and comprised at least 20 physical activity sessions including occupational therapy. The program led to a significant improvement of mobility (Timed Up & Go 29.5±18.5 vs 19.1 ±9.3 s, p<0.001) and Barthel index of activities of daily living score (46.6±19.1 vs 69.8±16.5, p<0.001). Peripheral systolic BP decreased from 135.4±19.0 mmHg at baseline to 129.0±18.4 mmHg at follow-up (p=0.03), whereas peripheral diastolic BP, central aortic BP, 24h-ambulatory BP, heart rate and pulse wave velocity as a measure of arterial stiffness were not significantly altered (p>0.05 each).ConclusionThe present representative standardized geriatric rehabilitation program was able to improve mobility, which showed a mild effect on systolic BP but did not affect 24h-ambulatory BP.