Stages Of Essential Hypertension Research Articles

Changes in the indicators of stiffness and remodeling of magistral arteries in young patients at the early stage of essential hypertension under conditions of syntropy with obesity.

Aim: The study and analysis of indicators of remodeling and rigidity of magistral vessels in young essential hypertension patients with abdominal obesity and determination of the detected changes as a possible criterion for their remodeling.. Materials and Methods: 98 young people with essential hypertension and obesity were included in the study. The structure of the carotid artery and its stiffness were assessed using the ultrasound method, and the level of abdominal fat was determined using dual-energy X-ray absorptiometry. Results: Carotid Intima-Media Thickness in patients with essential hypertension reliably exceeded the corresponding indicator of the control group. We observed a significant increase in arterial stiffness indicators, which is explained by the increased stiffness of blood vessels in patients with obesity. During the correlation analysis, it was established that the relationship between the level of abdominal fat and the elasticity of the vascular wall was positive and strong, which indicated the dominant role of the abdominal type of obesity in the remodeling of the vascular wall in young patients with essential hypertension in combination with obesity. Conclusions: In young patients at the early stage of the formation of essential hypertension, there are signs of a decrease in resilient-elastic properties and remodeling of magistral vessels, whose severity is significantly stronger in combination with abdominal obesity.

Prevention and Risk Factors in Early Stage of Essential Hypertension

Prevention and Risk Factors in Early Stage of Essential Hypertension

Changes of left ventricular remodeling due to increased afterload in patients with essential hypertension

BackgroundIt is unclear whether afterload mismatch occurs during the initial stage of essential hypertension (EHT). Additionally, critical left ventricular hypertrophy (LVH) between preserved and reduced systolic functions in hypertension is also unclear. Thus, we aimed to clarify these points. MethodsForty-five normal control subjects (NCS) and 140 EHT patients participated. EHT patients were subdivided into three groups: group I, without LVH (n = 37); group II, with LVH (n = 80); and group III, with LVH and LV heart failure (LVHF) (n = 23). Routine electrocardiographic and echocardiographic parameters, V5R/V6R ratio, relative wall thickness (RWT), LV mass (LVM) index, and peak systolic wall stress (PSWS) were measured. ResultsIn group I, LV systolic functions were preserved despite the increase of PSWS. In group II, LVH advanced, but LV systolic functions remained normal. A negative T-wave was observed in 69% of group II and 100% of group III. A significant correlation between RWT and LVM index was seen in NCS and groups I and II (r2 = 0.545, P < 0.0001) but not in group III. Afterload mismatch occurred in group III due to the decrease in V5R/V6R ratio, the increase of LV end-diastolic dimension, and the LV systolic dysfunctions, which are caused by exhaustion of preload reserve. The boundary of the LVM index between groups II and III was approximately 180 g/m2. ConclusionAfterload mismatch did not occur in group I, but it was observed in group III due to the exhaustion of preload reserve.

SOME FEATURES OF ARTERIAL AND VENOUS HEMODYNAMICS IN PATIENTS WITH ESSENTIAL HYPERTENTION STAGE II WITH DIFFERENT VARIANTS OF THE BLOOD PRESSURE DAILY STRUCTURE

Aim - establish features of arterial and venous hemodynamics in patients with the 2ndstage of essential hypertension (EH) with various options of circadian structure of theblood pressure (BP).Material and methods. There were examined 52 patients with the 2nd stage of essentialhypertension (EH) with the average age of 54,8±2,12. All patients underwent daily BPmonitoring (DBPM) with the help of the hardware complex "Solvaig" (Ukraine) andangiotensiotonoreobarography according to the author's method that determined thevalues of the pressures of closing and opening the arteries and veins of the limb underthe medical cuff (as for checking BP).Results. According to the data of DBPM in “non-dippers” patients the average dailypulse blood pressure (APBP) was significantly higher in the night picker (NP), and theaverage dynamic blood pressure increased mainly during the night period.The values of the daily index in these groups “non-dippers” (ND) and NP are mainlycaused by the daily dynamics of the diastolic BP.There were detected 17(80.8%) patients of the ND group and 12 (92.3%) patients withNP rhythm that had a high level of venous closure pressure. Venous hypertension wasconfirmed according to the data of CVP by the classical method of Waldman.The proposed method of examination of patients with the 2nd stage of essentialhypertension makes it possible to detect arteriovenous hypertension and to determineit as a significant risk factor for the progression of EH and resistant to treatment form,pathogenetically justify complex AH-therapy using optimal doses of diuretics.Conclusion. Circadian variant - ND and NP "not dippers" has been revealed in mostpatients with the 2nd stage of EH (65.4%). Combined arteriovenous hypertension(AVH) was detected in 87% of thematic patients with daily ND and NP structure. Thediagnosed AVH in patients with the 2nd stage of EH is an additional risk factor for EHand requires a pathogenetically sound approach to AH-treatment with mandatory useof diuretics in optimal doses.

The frontal plane QRS-T angle may affect our perspective on prehypertension: A prospective study

ABSTRACT Backround The frontal plane QRS-T [f(QRS-T)] angle is an easy marker of myocardial repolarization and was associated with adverse cardiovascular outcomes like prehypertension (PHT). This study was aimed to investigate to evaluate the f(QRS-T) angle in patients with PHT. Methods We measured f(QRS-T) angle of 70 subjects with PHT, 109 patients with hypertension (HT), and 102 normotensive healthy volunteers. The f(QRS-T) angle was calculated from 12-lead electrocardiography. Results The f(QRS-T) angle was significantly higher in the HT and PHT groups as compared to the control group, but there was no significant difference in the f(QRS-T) angle between the HT and PHT groups. The f(QRS-T) angle was significantly and positively correlated with age, systolic blood pressure (BP) in 24 hours, average BP in 24 hours, pulse pressure in 24 hours, hemoglobin, QT dispersion, TpE distance while was negatively correlated with left ventricular ejection fraction. In multivariable analysis, we showed that systolic BP, average BP in 24 hours, pulse pressure in 24 hours, hemoglobin, QT dispersion, Tpe distance were independent predictors of higher f(QRS-T) angle. Conclusions The f(QRS-T) angle, a noninvasive measurement analyzing the dysfunction in cardiac conduction system, was increased in subjects with PHT as compared to normotensives, and the subjects with PHT had f(QRS-T) angle as higher as patients with HT did. Our findings are supportive for the hypothesis that disturbances in ventricular repolarization is present in an early stage of essential hypertension.

P2645Cardiovascular risk in patients with essential hypertension and nonalcoholic fatty liver disease comorbidity

Abstract Very often acute myocardial infarction and stroke are recorded among patients with essential hypertension (EH) and non-alcoholic fatty liver disease (NAFLD), including non-alcoholic steatohepatosis (NASP), comorbidity. The aim of the study was to improve cardiovascular risk assessment in patients with combination of second stage EH and NASP, using the metabolism indexes, structural-functional indicators of heart and blood vessels. According to the study results of 170 patients with second stage of EH (98 (57.6%) were women and 72 (42.4%) - men), mean age 49.3±0.5) it was found that NASP was confirmed in 109 (64.1%) patients (SteatoTest - 0.41 units (S1-S2)). Total cholesterol (TC), triglycerides (TG), high density lipoproteins (HDL); very low (LDL) and low density (LDL) lipoproteins; atherogenic index (IA); lipoprotein (a) (Lp (a)), insulin, HOMA index, tumor necrosis factor α (TNFα)), adiponectin were determined among all patients. The instrumental examination included electrocardiography, echocardiography, daily blood pressure monitoring (DBPM), carotid arteries ultrasound, calculation of endothelial dysfunction index (EDI) (as the ratio of endothelial-dependent to endothelial-independent vasodilation) and arterial wall stiffness (AS). Statistical processing of the results was conducted by Microsoft Excel, STATISTICA for Windows 10.0 programs. The proaterogenic lipid spectrum changes (TC (7.7%, p=0.0009), TG (19.8%, p=0.02), LDL (11,8%, p=0.0009), IA (8,8%, p=0.04), increased levels of Lp (a) (58.0%, p=0.0007) TNFα (51.4%, p=0.01), insulin resistance (HOMA index - 3.3 units), decreased adiponectin level (44.3%, p=0.0002) were reported in patients with II stage EH and NASP comorbidity compared to patients with EH without fatty liver infiltration (p&lt;0.05). Higher systolic (SBP) and pulse arterial pressure (PBP) (both office measurement and DBPM), daily SBP index “nondipper” (63.3% of patients, p&lt;0.05); increased by 2 times the frequency of the registration of atherosclerotic plaques in both carotid arteries (p&lt;0.05), increase in AS (15.7%, p=0.002) and EDI reduction (−12.5%, p=0.01) were determined in patients with II stage EH and concomitant NASP compared with EH patients without NASP. True (p&lt;0.ehz748.096601) direct correlation bonds were established between the NASP and the level of TC (rs=0.38), TG (rs=0.31), LDL (rs=0.31), Lp (a (rs=0.51), insulin resistance (rs=0.47), TNF-α (rs=0.49), night SBP and PBP (rs=0.33 and rs=0.29), variability night SBP, AS (rs=0.41), reverse – with the level of adiponectin (rs=−0.48) and EDI (rs=−0.58). Thus, in patients with second stage EH NAFLD is associated with negative metabolic changes and structural and functional desorders of heart and blood vessels and can be considered as an additional factor of the overall cardiovascular risk increasing in patients with EH.

SOME FEATURES OF FUNCTIONAL STATE OF THE CARDIOVASCULAR SYSTEM OF PATIENTS WITH IIND STAGE OF ESSENTIAL HYPERTENSION DEPENDING ON THE TYPES OF CIRCADIAN RHYTHM OF BLOOD PRESSURE

Objective - to detect the features of the functional state of the cardiovascular system ofpatients with IInd stage of essential hypertension depending on the types of circadianrhythm of blood pressure.Material and methods. All 62 patients underwent daily blood pressure monitoring usingthe "Solvаig" hardware suite with the corresponding software. According to protocol ofthe research the list of examinations included: average daily, night and daytime bloodpressure, average dynamical blood pressure for the same periods. Besides, an ultrasound examination of the heart was performed to all patients using the "En visor" apparatus(RDC.).Results. All 62 patients with essential hypertension of IInd stage with II-III degree ofblood pressure increase were divided into 3 groups due to the circadian structure ofblood pressure: " Dipper" -26; "Non dipper"-28; and "Night picker" -8. It has beenfound that the basic parameters of the central (cardiac) hemodynamics in the mentioned groups are not unambiguous. Patients with the daily index "Dipper" had theprevalence of normokinetic type of hemodynamics, in contrast to patients with "Nondipper" and "Night picker", who had predominantly hypokinetic type of hemodynamics, confirmed by ratios of these indicators to the body surface and weight. Thesteady high daily average level of blood pressure in "non-dippers" patients, especiallyin "Night pickers", contributes to the formation of a high baseline level of generalperipheral vascular resistance with adaptation in these patients to the hypokinetic typeof central hemodynamics. In addition, the parallels between the body mass index (BMI)and the left ventricular mass index (LVMI) suggest the increase of mismatch betweenBMI and LVMI, which might aggravates from "Dipper" to "Night pickers", which canexacerbate the metabolic imbalance of the myocardium. Analysis of the central venouspressure indices by the circadian rhythm of blood pressure suggests that a largeproportion of patients with low and negative DI arterial hypertension is combined withvenous hypertension, which results in changes in pathogenetic approaches to successfulantihypertensive treatment.Conclusions. 1. Patients with essential hypertension of IInd stage ("Non dipper" and"Night picker") mostly have the hypokinetic type of cerebral hemodynamics with highgeneral peripheral vascular resistance and low kinetic properties of cardiac hemodynamics. 2. Patients with low and negative daily index of circadian blood pressurestructure - "Non dippers" and "Night pickers" have a higher degree of the left ventricular wall hypertrophy and increasing inconformity of the left ventricular myocardialmass index as to the body weight index with deficiency of the myocardial mass to thebody mass, which can increase the metabolic imbalance of the myocardium. 3. According to the type of essential hypertension stage II, patients with circadian rhythmblood pressure - "Non dipper" and, especially, "Night picker"-arterial hypertension arecombined with venous (AVH), respectively, in 46% and 80% of cases, compared with'Dipper' - 40%, which possibly causes an increase in number of treatment-resistants,acceleration of essential hypertension progressions.

Visfatin Level and The Risk of Hypertension and Cerebrovascular Accident: A Systematic Review and Meta-Analysis.

High blood pressure is related with increased cerebrovascular accident. High visfatin / NAMPT(nicotinamide phosphoribosyltransferase) plasma levels may promote vascular inflammation and atherosclerotic plaque destabilization and have been evaluated as a marker for identifying stages of essential hypertension. However, its role in the pathogenesis of hypertension and cerebrovascular accident (CVA) is still uncertain. In order to review and meta-analyze observational studies investigating visfatin concentration and the risk for hypertension or CVA, a systematic search of PubMed, ovid EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) until December 07, 2016 was performed. After data extraction and quality assessment, a meta-analysis was performed using RevMan 5.3 and STATA 14.0. A total of 1693 adults from 8 studies for hypertension (974 with hypertension) and 1696 adults from 7 CVA studies (957 with CVA) were enrolled in the current meta-analysis. Cochran's Q-statistic and I2 test were applied to estimate the heterogeneity of the studies. The fixed-effects were used to compute the weighted mean difference in visfatin levels. Plasma visfatin concentration was much higher in hypertension and CVA patients than in healthy individuals. These evidences suggested the association of hypertension and CVA with higher plasma visfatin level.

A11474 Captophyte as an alternate regimen in controlling stage 1 essential hypertension

Objectives: According to NICE guidelines, first line treatment for stage 1 essential hypertension (EH) is either angiotensin converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). This clinical trial was designed to check the efficacy of a marine herbal compound vs Captopril in controlling first stage of EH (trial registration no: IRCT2015020110326N2) (patent registry number: IRIPO139350140003012176) Methods: A double blind phase 2 cross-over clinical trial was designed in patients with stage 1 EH. The hypertension was checked according to JNC-7 guidelines, biochemical tests were taken prior to initiation of anti-hypertensive medication. Inclusion criteria were: EH (Phase 1, no response to diet and exercise), no medications metabolized by CYP450. The patients were allocated randomly by random number generator. The patients either received Captopril 25 mg TID of Captophyte 2.050 g TID (compound with ACEI and renin inhibition (RI) mechanisms). After 2 weeks of treatment, patients had a washout period of 10 days with placebo and the medication was changed. During the treatment period patients were weekly monitored for blood pressure control. Data were analysed by descriptive statistics and paired t-test. Results: A total of 3600 patients were screened for EH and only 49 met the inclusion criteria (46 men and 3 women). Range of age was 25–55 yrs. SBP and DBP were 153 ± 4.53 mmHg, and 91.44 ± 2.44 mmHg, and after treatment the SBP and DBP were 130.16 ± 3.9 mmHg and 83 ± 2.41 mmHg respectively. Paired t-test was performed (p < 0.001) Conclusion: This compound which acts through RI and ACEI is equivocal to traditional ACEI in controlling HTN mainly because of chemical compounds which combat oxidative stress,(main culprit in pathogenesis of hypertension) and can be used as an alternate treatment for HTN

REAL TIME ASSESSMENT OF MICROCIRCULATION IN HYPERTENSION USING LASER SPECKLE CONTRAST ANALYSIS

Objective: Skin microcirculation has been suggested as a model of generalized microvascular function. It has also been used as a window to access endothelial function in the microvasculature. In this study we evaluated endothelial dysfunction of skin microcirculation in hypertensive patients compared to healthy, normotensive individuals using Laser Speckle Contrast Analysis (LASCA), a novel tool to assess microcirculation non-invasively, in real time and with high reproducibility. Design and method: We studied a group of 26 untreated hypertensive patients with new-onset essential hypertension without cardiovascular comorbidities, mean age 50.5 ± 15.7 years and 13 healthy individuals matched for age, sex and body mass index. In all subjects, forearm skin blood flow was recorded under standardized conditions using a laser speckle contrast imager (PeriCam PSI NR System, Perimed, Järfälla, Sweden). Post-occlusive reactive hyperemia (PORH) was assessed following a standardized protocol and data were analyzed with signal processing software (PIMSoft, Perimed). The amplitude of PORH responses was expressed as a percentage increase between peak and baseline perfusion (%), baseline Cutaneous Vascular Conductance (CVC), peak CVC and peak CVC minus baseline CVC. The CVC was calculated as the flux divided by mean arterial pressure and expressed in perfusion units (PU)/mmHg. Results: Baseline perfusion was similar between the two groups. However, during PORH patients with hypertension showed significantly lower percentage increase from baseline to peak perfusion (145.9 ± 9.72 vs 181.68 ± 12.35 %, p = 0.019). In addition, baseline CVC (0.34 ± 0.019 vs 0.43 ± 0.03 PU/mmHg, p = 0.009) and peak CVC (0.82 ± 0.04 vs 1.2 ± 0.06 PU/mmHg, p < 0.001) were significantly lower in hypertensive patients compared to controls. Finally, PORH amplitude as expressed by peak CVC minus baseline CVC (0.48 ± 0.03 vs 0.76 ± 0.04 PU/mmHg, p < 0.001) was significantly lower in hypertensive patients compared to normotensives. Conclusions: Using LASCA, a non-contact, real-time, highly reproducible and sensitive technique for the assessment of skin microcirculation, we showed that hypertensive patients demonstrate impaired microvascular responses to stimulation tests. Endothelial dysfunction is present in the very early stages of essential hypertension, long before the establishment of overt cardiovascular disease, and LASCA may represent a novel, valuable tool for its assessment.

Assessment of a diurnal blood pressure profile in patients with acute Lyme borreliosis

Aim. The purpose of the study was to investigate the character of changes in daily blood pressure profiles and to evaluate the influence of Borrelia burgdorferi infection on the course of essential hypertension in patients with acute stage of Lyme disease.Methods. 37 patients with an acute stage of Lyme disease were examined and broken down in two groups. The first group included 18 patients without essential hypertension. 19 patients with stage II of essential hypertension were included into group II. The group of comparison consisted of 32 patients with stage II of essential hypertension without Lyme disease. 26 healthy volunteers of the control group were comparable in gender and age.Results. A significant difference of the average diastolic blood pressure index during night time in patients with acute stage of Lyme disease and essential hypertension 90.0 (68.5–100.0) mm Hg versus the control group 77.0 (65.0–86.0) mm Hg at p = 0.03 was observed. When determining a type of daily blood pressure profile, some features of a blood pressure circadian rhythm were found in all groups of patients. There were ‘Dipper’ (77.7%) and ‘Non-Dipper’ (22.3%) profiles in the group of patients with acute stage of Lyme disease without essential hypertension. No ‘Over-Dipper’ and ‘Night-Peaker’ profiles were recorded in this group. 'Dipper’ (20.0%), ‘Non-Dipper’ (73.4%) and ‘Night-Peaker’ (6.6%) blood pressure profiles were typical for patients with acute stage of Lyme disease and essential hypertension. Conclusion. A 22.3% decrease in the number of patients with a ‘Dipper’ blood pressure daily profile and an equal increase in the number of ‘non-dipper’ patients are characteristic of an acute stage of Lyme disease. The number of ‘Non-Dipper’ patients with essential hypertension and acute stage of Lyme disease increases up to 73.4%. Thus, acute Lyme disease and essential hypertension tend to burden the each other’s course.Received 10 May 2017. Revised 7 September 2017. Accepted 25 September 2017.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Author contributionsConception and study design: A.V. Sandugei, M.V. Ilyin, O.A. Khrustalev, N.S. Baranova. Data collection and analysis: A.V. Sandugei, O.A. Khrustalev, N.V. Emanuilova. Statistical data analysis: A.V. Sandugei, N.V. Emanuilova, O.Yu. Churakov.Drafting the article: A.V. Sandugei, N.V. Emanuilova, V.V. Neusypin. Critical revision of the article: A.V. Sandugei, N.V. Emanuilova, V.V. Neusypin.Final approval of the version to be published: A.V. Sandugei, M.V. Ilyin, O.A. Khrustalev, N.S. Baranova, N.V. Emanuilova, O.Yu. Churakov, V.V. Neusypin

Aldosterone as a mediator of microvascular and macrovascular damage in a population of normotensive to early-stage hypertensive individuals

We investigated whether aldosterone concurrently mediates microvascular and macrovascular impairment, in a population of treatment-naïve young- to middle-aged individuals free from cardiovascular comorbidities. Newly diagnosed, never-treated essential hypertensive patients and normotensive individuals participated in the study. Pulse wave velocity (PWV) and augmentation index were estimated with applanation tonometry. Microalbuminuria was determined from 24-hour urine collections. Laboratory tests included measurement of plasma renin activity, serum aldosterone, and high-sensitivity C-reactive protein. In 221 individuals aged 42.0 ± 12.3 years, classification in the highest aldosterone tertile was associated with the highest levels of blood pressure (BP), PWV, and high-sensitivity C-reactive protein (P < .05 for all). These individuals also exhibited twice the prevalence of microalbuminuria, compared to the first tertile (P = .081). Multivariate analysis showed that the positive association between PWV and increasing aldosterone tertiles remained significant after adjustment for BP and other parameters (P = .035). Likewise, aldosterone independently predicted microalbuminuria (P = .026) in the logistic regression analysis. In treatment-naïve individuals whose BP ranges from normal to early-stage hypertension, significant interactions exist between aldosterone and indices of microvascular and macrovascular damage. These findings suggest that aldosterone concurrently modulates microvascular and macrovascular function from the very early stages of essential hypertension and is dynamically implicated in the pathogenesis of hypertensive vascular disease.

THE INDICES OF LIPID METABOLISM, OXIDATIVE-ANTIOXIDATIVE HOMEOSTASIS, CONTENTS OF FINAL NITROGEN MONOXIDE METABOLITES IN THE BLOOD OF PATIENTS WITH ESSENTIAL HYPERTENSION AND COMORBID ISCHEMIC HEART DISEASE AND TYPE 2 DIABETES MELLITUS

206 patients with essential hypertension (EH) have been examined including 30 ones with II stage of EH, 56 – with II stage of EH with comorbid ischemic heart disease (IHD), 65 – with II stage of EH and comorbid type 2 diabetes mellitus (DM), and 55 – with III stage of EH and comorbid IHD. The state of the blood lipid spectrum, the indices of oxidative-antioxidative homeostasis, total level of final nitrogen monoxide (NO) metabolites in the blood plasma have been determined. A reliable increase of the concentrations of total cholesterol, triacylglycerols, low density lipoprotein cholesterol, decreased contents of high density lipoprotein cholesterol, an increased concentration of Malone aldehyde of the blood plasma and erythrocytes, decreased contents of reduced glutathione (RG), lower activity of glutathione peroxidase (GP), catalase (CT), total level of NO final metabolites were found. Comorbid course of II-III stages of EH, HIS and type 2 DM is characterized by more pronounced and reliable disorders of lipid metabolism, activation of lipid peroxide oxidation, decreased level of RG, increased activity of GP and CT, increased contents of NO final metabolites in the blood.

Assessment of erythrocyte SOD activity in different stages of Essential Hypertension patients

Oxidative stress has been found to be associated with most of the diseases. In the past several years, much interest has arisen over the involvement of free radical metabolism in the disturbance in endothelial or intimal cells of blood vessels, which play an important role in the pathogenesis of essential hypertension (HT). Although limited information is available on the activity of antioxidant enzyme erythrocyte superoxide dismutase (SOD) and its relation with blood pressure in patients with HT, alteration in their activity with severity of disease is still obscure. The objective of present study was to estimate the activity of SOD in hypertensive subjects and to determine the variation in erythrocyte SOD activity with increasing blood pressure. In the present study, erythrocyte SOD activity was measured in 90 hypertensive subjects (30-60 years) which were categorized into three groups as pre-hypertension, stage I HT and stage II HT (depending upon their blood pressure) and statistically compared it with that of 30 healthy individuals, served as control. Erythrocyte SOD activity was found to be significantly low in each patient group as compared to control (P<0.001). These activities were also low among three groups of essential hypertension. These findings suggest that depletion in erythrocyte SOD activity with subsequent rise in blood pressure is due to its superoxide anion scavenging action against hypertension induced production of free radical in the body. Thus, erythrocyte SOD activity may be an effective marker of oxidative stress in different stages of essential hypertension and its related complications.

Preliminary Study on the Relationship Between Intracardiac Blood Flow and Diastolic Function of Left Ventricle in Patients with Essential Hypertension

Left ventricular diastolic dysfunction can be detected in the early stage of essential hypertension. Previous studies have used Ganau configuration classification with the European population criterion rather than Chinese population. In this study, we evaluate the energy loss and vortex circulation in diastolic left ventricle in patients with essential hypertension under the criterion of Chinese population and explore the relationship between intracardiac blood flow change and diastolic function. Collect the structural and hemodynamic information in left ventricular diastolic period by echocardiography. Measure the energy loss and vortex circulation in left ventricle at different phases by VFM on the offline station. 63 patients with essential hypertension and 23 volunteers as controls are included. Compared to the controls, the energy loss and vortex circulation is significantly increased in hypertension which has a correlation with the diastolic function. The subgroups under the European criterion which find no significant difference in energy loss, have significant difference in ratio from that of Chinese criterion. The study shows the different results under two criterions and indicates the Chinese criterion can acquire a better reflection of the left ventricular energy loss in hypertension patients. VFM technology can be used to analyze the left ventricular flow in patients with hypertension, providing a new method to evaluate diastolic function.

Polimorfismos de un solo nucleótido en genes de endotelina-1 y su receptor A asociados a daño cardiovascular en hipertensión arterial esencial

IntroductionThe endothelin system, for its vasoconstrictor action, is related to the development of essential hypertension (HTAe). The polymorphism analysis of their genes represents a new approach to the study of this disease. We propose to analyze the interaction between stages of essential hypertension (HTAe) and risk factors with polymorphisms 138ex1 ins/del A gene endothelin-1 (ET-1) and H323H receptor gene A ET-1 (ETRA). Patients and methodsWe included 300 patients of both sexes, unrelated, who consecutively attended the clinic hypertension medical service. Each one underwent a complete physical examination, electrocardiogram, echocardiogram, and Rx thorax. The degree of severity of hypertension was determined in stages. The determination of polymorphisms was performed by amplification followed by cutting by specific restriction enzyme from DNA obtained from peripheral blood. ResultsThe 46% of patients had HTAe controlled, 17.6% had organ damage or cardiovascular, brain or kidney disease. It was observed that the 4A/4A carriers showed lower frequency of cardiovascular disease, kidney and brain (P<.032; 95% CI: 11.1-21.4). For H323H polymorphism, the evaluation by images showed a higher frequency of the dilations of left auricular (P=.02) and auricular fibrillation (P=.03) between the T/T carrier, a higher frequency of cardiomegaly was detected in C/C patients (P=.04). ConclusionThe genotypes, 4A/4A of the ET-1 gene and the T/T from ETRA gene might be involved in worse outcome of cardiovascular damage. Their identification could help recognize subgroups of the hypertensive patients with different risk.

The Significance of Renal Functional Reserve in Еssential Hypertension

In the structure of causes of the end-stage chronic kidney disease is essential hypertension (EH) which takes the leading role. One of the pathogenic mechanisms of hypertensive nephropathy is a violation of intrarenal blood flow, which clinically manifesting with hyperfiltration. The objective: of the frequency of subclinical renal damage of patients with stage I EAH by water and salt loading and comparing these data with the standard criteria of essential nephropathy with hypertension. Patients and methods. The study involved 30 patients aged 27 to 59 years with diagnosed grade 1 essential hypertension who did not receive medical treatment and did not have the disease (lesions) of the kidneys. Mean albumin/creatin ratio of patients constituted 15,12±5,02 mg/g. According to the analysis of outpatient cards hypertension duration do not exceed during 5 years. All patients underwent 24-hour blood pressure monitoring and determining the method RFR water and salt load (under patent Ukraine 42,860) [9]. The results of daily monitoring of blood pressure (DMAT) were patients divided into two groups: the 1st group included patients who had been diagnosted the I step and I stage of EH, it comprised 22 patients (73.3%). Second group included patients who had been diagnosted the II stage of EH – 8 patients (26.7%). Results. Subclinical kidney damage were found in 8 patients (26.7%) in determining the method of water-salt load. (RFR 10±2,01% in 8 patients (26.7%) 1st group and RFR 22,31±3,9% in 22 patients (73.3%) significant difference between groups (p&lt;0.05). Among them, the state of hyperfiltration detected in 15 patients (50%) 281,55±40,66 ml/min per 1.73 m2. In eGFR 51,36±9,98 ml/min per 1.73 m2 had 6 people (20%), RFR was reduced and amounted to 11,02±6,65%. This shows that when increasing the blood pressure, kidney begins to lose its physiological reserve and its clinically possible to trace the transition state of hyperfiltration in decreased GFR. In determining GFR formula CKD-EPI reliable differences between groups were found. Conclusions. 1. Hypertension is an urgent problem and requires constant attention of the doctors of various specialties, complex problems that affect the incidence of kidney damage in the preclinical stage of hypertensive nephropathy. 2. The early hypertensive nephropathy criteria for the development of microalbuminuria may appear hyperfiltration and reduce renal functional reserve. 3. In EH patients with grade 1 hypertension, II stage, compared with patients with hypertension with I stage of kidney damage, were often observed and showed low RFR. 4. Using water-salt load for patients with EH and stages for the evaluation of kidney function can detect subclinical renal involvement, the development of microalbuminuria and reduced GFR.

PP.19.09] APELIN AND VISFATIN PLASMA LEVELS IN HEALTHY INDIVIDUALS WITH HIGH NORMAL BLOOD PRESSURE

Objective: High normal blood pressure (BP)(130–139/85–89 mmHg) seems to be related with increased cardiovascular risk compared to normal BP (120–129/80–84 mmHg) or/and optimal BP (<120/80 mmHg). Low apelin plasma levels have been associated with arterial hypertension and atherosclerosis while high visfatin plasma levels may promote vascular inflammation and atherosclerotic plaque destabilization and have been evaluated as a marker for identifying stages of essential hypertension. We sought to compare the apelin and visfatin plasma levels between subjects with high normal BP and subjects with normal or optimal BP matched for age, gender, smoking, and body mass index (BMI). Design and method: Twenty-five subjects with high normal BP (office BP 136 ± 3/88 ± 2 mmHg, age 57 ± 4 years, 76% males, 32% smokers, BMI 24.0 ± 1.7 kg/m2) and 35 subjects with normal or optimal BP (office BP 118 ± 2/78 ± 2 mmHg, age 55 ± 7 years, 63% males, 29% smokers, BMI 23.2 ± 1.4 kg/m2) were studied. The apelin and visfatin plasma levels were determined with the enzyme-linked immunosorbent assay. Results: Compared to normal or optimal BP subjects, apelin levels were significantly lower (205 ± 108 vs. 325 ± 152 pg/ml, p < 0.001) and visfatin levels significantly higher (11.0 ± 2.0 vs. 7.2 ± 0.9 ng/ml, p = 0.002) in high normal BP subjects. No significant differences were found between the 2 groups (p = NS) regarding the basic clinical characteristics, the glycemic/lipid profile and the renal function parameters. Conclusions: The emerging, from the present study, lower apelin and higher visfatin plasma levels in high normal BP subjects compared to normal or optimal BP individuals may partially explain the higher cardiovascular risk of the high normal BP group.

PS 14-39 ROLE OF THE TRIPLE COMBINATION WITH INDAPAMIDE, NITRENDIPINE AND PERINDOPRIL IN RENAL PROTECTION

Objective: To study of antihypertensive and renoprotective efficacy of indapamide, nitrendipine and perindopril combination therapy in hypertensive patients with low estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2. Design and Method: The study included 20 patients with II-III stage of essential hypertension (ESH/ESC 2013) and eGFR<60 ml/min/1.73 m2 in average age 60.17 ± 7.86 yrs. All patients were resistant to previously bi-component antihypertensive therapy. Blood pressure (BP) measured by Korotkov method. GFR estimated by MDRD formula. Levels of serum creatinine, uric acid and glucose were measured with biochemical assay method. All measurements performed before and after 24 weeks of triple combination, based on indapamide, perindopril and nitrendipine in average dose 2.15 ± 0.56 mg, 4.72 ± 1.79 mg and 12.77 ± 5.65 mg respectively. Results: During the 24 weekly antihypertensive therapy with three drug combination systolic BP decreased from 160.0 ± 15.81 to 127.3 ± 11.8 mmHg (p = 0.0001), and diastolic BP – from 98.94 ± 8.11 to 79.3 ± 6.24 mmHg (p = 0.0001). Serum creatinine level was significantly decrease from 110.59 ± 20.69 to 93.4 ± 19.67 μmol/L (p = 0.01). Plasma glucose and uric acid levels had tendency to decrease: from 5.77 ± 1.16 to 5.71 ± 1.56 mmol/L and from 6.36 ± 1.99 to 5.76 ± 1.78 mg/dL (p > 0.05) respectively. eGFR was improved during the 24 weekly treatment and increased from 51.04 ± 6.81 to 62.58 ± 13.12 ml/min/1.73 m2 (p = 0.003), eGFR elevated >60 ml/min/1.73 m2 in 50% cases. All patients finished 24-weekly therapy with good tolerability. Conclusions: 24-weekly therapy with indapamide, perindopril and nitrendipine were characterized with high antihypertensive efficacy and good tolerability. Three drugs combination also had shown renoprotective effects with significantly increase of eGFR in hypertensive patients.

PP.03.12] PULSE WAVE VELOCITY CHANGES IN PATIENTS WITH ESSENTIAL HYPERTENSION AND DIFFERENT CATEGORY OF CARDIOVACULAR RISK

Objective: Research objective was studying of the PWV features at male patients with essential hypertension (EH) stage I-II and moderate and severe cardiovascular risk. Design and method: It were surveyed 128 male patients with EH of 1–3 degrees. All patients were divided into 3 groups after stratification of risk factors for cardiovascular disease: IA group (n = 22) – patients with EH stage I and moderate CV risk; IB group (n = 22) - patients with EH stage I and high CV risk; II group (n = 84) - patients with EH stage II and high CV risk. It were investigated 2 diagnostic thresholds for detection of arterial stiffness: PWV normal level < 10 m/s and the individual threshold of PWV depending on age and hypertension grade [Arterial Stiffness’ Collaboration, 2010], which was the normal (in the range of 10th percentile - median) and high normal PWV (above median). Clinical characteristics of the observed groups are presented at the table 1.All results per category are represented as mean ± SEM (m) and median (25th to 75th percentile). Measurement of PWV was carried out using the device Arteriograph TensioMed (TensioClinic, Hungary). Results: PWV level in IA group was 7,15 (6,38; 7,70) m/s, PWV high level frequency registered in 11 (50%) patients according to age and blood pressure level. In IB group PWV value was 8,10 (7,23; 8,53) m/s, PWV high level frequency registered in 17 (77.3%) patients according to age and blood pressure level. In II group PWV value was 9,85 (8,5; 10,9) m/s and in 42 patients (50%) PWV level increased more than 10 m/s, that was testified to the target organ damage. In 22 male patients from the II group (26,20%) was individual increasing of PWV according to age and blood pressure level. Conclusions: The detected signs of arterial wall stiffness in patients with early stage of EH indicate increasing of cardiovascular risk severity and necessary for timely evaluation of pulse wave velocity for the early identifying of premature vascular aging.