Symptomatic Arterial Hypertension Research Articles

Analysis of the Prevalence, Risk Factors, and Progression of Symptomatic Arterial Hypertension in Patients with End-Stage Chronic Kidney Disease

Analysis of the Prevalence, Risk Factors, and Progression of Symptomatic Arterial Hypertension in Patients with End-Stage Chronic Kidney Disease

Pediatric hypertension as an early manifestation of cardiovascular disease in children.

In adults, cardiovascular events associated with arterial hypertension (AH) have a major impact on morbidity and mortality. In light of recent findings, AH in children has been interpreted as early cardiovascular disease (CVD), while exposure to CV risk factors in children proves to be a predictor of subclinical CVD in adults. The American College of Cardiology/American Heart Association has recently updated the classifications for measuring blood pressure (BP) in adults and children. Primary AH in children is generally asymptomatic, and it is associated with a family history of AH, overweight/obesity, and normal morphofunctional characteristics of the urinary system. The younger the child and the higher the BP, the greater the likelihood of secondary AH. The investigation into the etiology of AH begins with a detailed anamnesis, which should include clinical information and details on the use of medication, smoking, and alcohol consumption from the perinatal period to the time of consultation. Modifying risk factors by reducing weight, decreasing alcohol consumption and increasing vegetable intake from childhood to adulthood has been associated with the resolution of AH in the childhood-adulthood transition, and with the reversal of cardiometabolic adverse effects in non-obese adult individuals. Pharmacological therapy should be initiated in cases of symptomatic AH, AH secondary to chronic kidney disease or diabetes mellitus, presence of target organ lesions, stage 2 AH with no modifiable cause and resistant AH unresponsive to lifestyle changes.

PROGNOSTIC VALUE OF DIAGNOSTICLY VALUABLE LABORATORY MARKERS OF SYSTEMIC LUPUS ERYTHEMATOSUS FOR DETERMINING THE PROBABILITY OF COMORBID SYNTROPIC LESIONS OF THE CIRCULATORY SYSTEM ORGANS


 
 Abstract. Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects almost all internal organs, among which damage to the organs of the circulatory system (OSC) is not only one of the most common, but also ranks first in the structure of the causes of mortality.
 The aim of the study. To find out the prognostic value of diagnostically valuable laboratory markers of systemic lupus erythematosus to determine the probability of comorbid syntropic lesions of the circulatory system organs.
 Materials and methods. The study included 125 patients with SLE with OSC lesions, among whom the vast majority of women (88.00%) were young (average age of patients 42.48 ±1.12 years). Patients were stratified according to the presence of comorbid syntropic lesions of the OSC, i.e. those whose frequency reliably increased with an increase in the degree of activity of SLE – these are retinal angiopathy, capillaritis, Raynaud's syndrome, reticular livedo, atherosclerosis, mitral valve insufficiency, mitral valve sealing, pericardial effusion, pulmonary hypertension, myocarditis, endocarditis, symptomatic arterial hypertension, venous thrombosis. During the study, the prognostic value of diagnostically valuable individual laboratory markers and their constellations was determined. The difference was considered statistically significant if p < 0.050. The relationship was considered confirmed if the association coefficient ≥ 0.50 or the contingency coefficient ≥ 0.30.
 The results. It was found that for determining the probability of retinal angiopathy in patients with SLE, the constellation with ↑ LDL + ↑ IA + ↑ anti-ds DNA + ↑ ANA has the best prognostic value among diagnostically valuable individual laboratory markers and their constellations; for capillaritis – a separate marker of increased activity of AlT; for Raynaud's syndrome – a separate marker ↓ C3; for reticular livedo – ↑ ESR + ↑ small CIC + ↑ anti-ds DNA + ↑ anti-Sm; for atherosclerosis – ↓ hemoglobin + ↑ LDL + ↑ ANA + ↓ C4; for mitral valve insufficiency – ↑ ESR + ↑ anti-ds DNA + ↑ ANA + ↑ antiphospholipid antibodies Ig M; for mitral valve sealing – ↑ ESR + ↑ LDL + ↑ small CIC + ↑ ANA; for pericardial effusion – erythropenia + ↑ C-RP + ↑ lupus anticoagulant; for pulmonary hypertension – hypercholesterolemia + ↑ LDL + ↑ anti-ds DNA + ↑ ANA; for myocarditis – a separate marker ↓ C4; for endocarditis – not detected; for symptomatic hypertension – ↑ LDL + ↑ anti-ds DNA + ↑ ANA + ↑ anti-SSA (Ro); for venous thrombosis – erythropenia + ↓ hemoglobin + ↑ LDL + ↑ ANA.
 Conclusions. For each comorbid syntropic lesion of the organs of the circulatory system in patients with systemic lupus erythematosus, a diagnostically valuable separate laboratory marker or their constellation has been determined, which have the best prognostic value for determining the probability of occurrence of these lesions.

Circulatory System Organs Comorbid Lesions in Patients with Systemic Lupus Erythematosus: Nature and Frequency; Characteristics Depending on Gender, Age and Disease Duration

Introduction. Systemic lupus erythematosus (SLE) is a disease with numerous clinical manifestations and an unpredictable course. It often lasts for several months or years, with alternating remissions and exacerbations. Multiple organs can be affected simultaneously with varying degrees of severity, resulting in treatment- and disease-related comorbidities, including circulatory system diseases, which are one of the leading causes of death of SLE patients. The aim of the study. To find out the nature and frequency of the circulatory system organs comorbid lesions in patients with systemic lupus erythematosus, to characterize them depending on the gender, age and the disease duration. Materials and methods. Prior to performing the study all patients signed the voluntary consent to participate in accordance with the requirements of Helsinki Declaration of Human Rights, the Council of Europe Convention on Human Rights and Biomedicine. The cohort under investigation included 112 patients with diagnosed SLE of different severity with preliminary stratification as follows: females 89.29 %, patients of working age (57.14 % – young and 39.29 % – middle aged), unemployed (58.04 %), III disability group patients (45.54 %), city residents (62.50 %). According to the results of the disease duration assessment, a significant number of patients with SLE and circulatory system organs comorbid lesions have been ill for 1–5 years (36.61 %) and more than 10 years (38.39 %). All of them were patients of the rheumatology department of the Communal Non-Profit Enterprise of the Lviv Regional Council “Lviv Regional Clinical Hospital” from 2016 to 2021.The research was carried out in several stages, during which the nature and frequency of the circulatory system comorbid lesions with respect to gender, age and disease duration were estimated. Results. While completing the study, almost half of patients with SLE were diagnosed with Raynaud’s syndrome, mitral valve insufficiency and atherosclerosis, about 1/3 – with myocarditis, retinal angiopathy, symptomatic arterial hypertension and livedo reticularis. The varicose veins of the lower extremities, hypertensive disease, diffuse cardiosclerosis, tricuspid valve insufficiency, vein thrombosis, post-thrombophlebitis syndrome, aortic valve insufficiency, capillaritis, pulmonary hypertension, coronary artery disease (CAD) including stable angina pectoris, cardiomyopathy and post-infarction cardiosclerosis were found with the decreasing frequency. Raynaud’s syndrome was significantly more often diagnosed in females and young people; retinal angiopathy, livedo reticularis and symptomatic arterial hypertension – in females and those patients whose SLE lasted for more than 10 years; myocarditis, varicose veins of the lower extremities – in males; capillaritis – in patients with the shortest duration of SLE; atherosclerosis and mitral valve insufficiency – in elderly patients and patients with SLE lasting for 6–10 years; vein thrombosis and stable angina – in elderly patients and those with SLE lasting for more than 10 years; hypertensive disease, diffuse cardiosclerosis, aortic valve insufficiency, post-infarction cardiosclerosis were the most characteristic for the elderly patients with SLE. Conclusions. In patients with systemic lupus erythematosus, a number of circulatory system organs comorbid lesions were found. Having studied their nature and frequency, characterizing them depending on gender, age and the disease duration, we found out the certain features that should be taken into consideration during the screening examination of circulatory system disorders in patients with systemic lupus erythematosus and providing them the integrated care to improve their life quality. With this in mind, systemic lupus erythematosus requires further detailed study.

Офтальмологические проявления эндокринных заболеваний

The review provides a detailed description of ophthalmic disorders associated with the most common endocrine diseases — diabetes mellitus, hypo- and hyperthyroidism, chronic adrenal insufficiency, Cushing syndrome, and obesity. Specific characteristics of ocular disorders co-occurring with these diseases are highlighted in the article. In diabetes mellitus, there is a lesion of both the periorbital region — inflammatory processes of the eyelids and conjunctiva, xanthelasm of the eyelids, and intraocular structures — the retina, macula, lens and cornea. Ophthalmological changes in thyroid pathology are manifested by a combination of various "ocular" symptoms, the most famous of which are exophthalmos, dilation of the ocular slit, eye shine, convergence disorder. However, the first complaints of patients may be unstable diplopia, swelling of the eyelids (mainly in the morning), a feeling of "clogging", dryness, lacrimation and/or photophobia, spontaneous retrobulbar pain, pain when moving the eyes, redness of the eyelids, conjunctival injection, redness and swelling of the semilunar fold and lacrimal meat, hyperpigmentation of the eyelids — a symptom Jellineka, swelling and meniscus-like drooping of the eyelids are a symptom of a Singer. Some endocrine diseases may cause symptomatic arterial hypertension, e.g. Cushing disease (syndrome), primary hyperaldosteronism (Conn's disease), acromegaly, and pheochromocytoma. Early signs of the above diseases may include eye disorders which develop prior to other manifestations due to the onset of hypertensive retinopathy. The adequate assessment of the disorders of eyes and paraorbital tissues in patients with endocrine diseases may facilitate more accurate diagnosis and timely treatment. The publication could potentially benefit ophthalmologists, therapists, endocrinologists, pediatricians and general practitioners. Keywords: ophthalmic manifestations, diabetes mellitus, hyperthyroidism, hypothyroidism, adrenal insufficiency, endocrine diseases. For citation: Gazdanova A.A., Knyazeva S.A., Marakhovskaya A.A., Protopopova Yu.V., Sedova A.A., Rakhimov J.B., Salmanov A.F., Magomedova S.A. Ophthalmic manifestations of endocrine diseases. Russian Medical Inquiry. 2023;7(9) (in Russ.). DOI: 10.32364/2587-6821-2023-7-9-4.

Mid Aortic Syndrome As a Cause of Symptomatic Arterial Hypertension and Intermittent Claudication

Mid Aortic Syndrome As a Cause of Symptomatic Arterial Hypertension and Intermittent Claudication

Дифференциальная диагностика эссенциальной артериальной гипертензии и нейроциркуляторной астении по гипертензивному типу

Neurocirculatory asthenia (NCA) of the hypertensive type (synonyms: vegetative-vascular dystonia of the hypertensive type, neurocirculatory dystonia (NCD) or hypertensive type of vegetative-vascular dysfunction) is one of the three main forms of NCA. This type includes vegetovascular disorders of the sympathetic part of the autonomic nervous system (ANS). First of all, it is characterized by an increase in systolic blood pressure (BP). Vegetative-vascular disorders syndrome with an inadequate BP response of blood pressure to any stimuli is typical for NCA. Hypertension is a chronic disease, the main manifestation of which is the syndrome of high blood pressure, which is not associated with the presence of pathological processes in which the increase in blood pressure is due to known causes (symptomatic arterial hypertension). When making an expert decision, it is necessary to use methods of non-invasive evaluation of the ANS state: the Kerdo index, the cold test, the ocular reflex (Dagnini–Aschner), the solar reflex (Toma–Ru), and the Vane– Solovyova tables.

Первинний гіперальдостеронізм: діагностика та лікування

В лекції розглядаються аспекти первинного гіперальдостеронізму (ПГА), що мають важливе соціальне і медичне значення. Підкреслюється, що в частини хворих при своєчасній діагностиці і виборі оптимальної терапевтичної тактики можливе повне вилікування. Попри вдосконалення лабораторно-інструментальних методів дослідження, медикаментозного і хірургічного лікування, проблема діагностики і терапії ПГА зберігає свою високу актуальність. Успіх лікування і прогноз у цих хворих безпосередньо залежать від настороженості терапевтів, ендокринологів і кардіологів щодо симптоматичних артеріальних гіпертензій, від знань клінічної картини, тактики обстеження і підходів до терапії.

LESCH-NYHAN SYNDROME – late diagnosis of rare disease: clinical case

Background. Lesch-Nyhan syndrome is inherent X-linked recessive genetic disorder with decreased activity of hypoxanthine-guanine phosphoribosyltransferase (HGPRT). The disease is characterized by presence of the classical triad: hyperuricemia, neurological and behavioral changes. In the article we present a clinical case of Lesch-Nyhan syndrome first diagnosed only at 16 years old despite the fact that the clinical clues were already found at the patient`s early age. Case presentation. An 18-year-old Caucasian man was admitted to the rheumatology department because of gouty arthritis. In neonatal period he was diagnosed with mild intrauterine growth restriction by hypoplastic type. Uric acid crystals were found in our patient`s urine at 6-month-old. In the first year of life, delayed motor development was noted together with permanent neurological changes which were referred to rickets. During school years, severe dysgraphia, dyslexia, dysarthria, logoneurosis warranted observation by a speech therapist. At his 12 he had been diagnosed with nephrocalcinosis, at 14 – with chronic kidney disease and symptomatic arterial hypertension. The family history was remarkable for gout in grandmother and great-grandmother, chronic pyelonephritis – in mother, urate nephropathy – in both brothers. In physical examination hyperemia and edema of the left first metatarsophalangeal joint, left ankle defiguration, funnel chest, gynecomastia, tophi on the ears were noted. On examination, some neurological disorders and mild cognitive impairment were found. In investigations hyperuricemia, arthritis of the first metatarsophalangeal joint, diffuse changes in the renal parenchyma with impaired renal excretory function were detected. Despite the clues in patient`s anamnesis, objective examination and additional investigation, as well as the presence of a family anamnesis suggesting the hereditary nature of hyperuricemia, the diagnosis of HGPRT deficiency was not made until the age of 16 years. Conclusion. The presence of Lesch-Nyhan syndrome can be assumed with the progression of muscle tone impairment and movement disorders in a child after the first six months of life in combination with high plasma uric acid concentration and its increased urinary excretion. Difficulties in the syndrome diagnosis are associated not only with a rare occurrence, but with a slight or moderate degree of central nervous system impairment that is often related by doctors to rickets or delivery trauma, as well as low accessibility of molecular genetic testing.

Case report of severe seoul infection in peripartum period

Background: We present the case of severe Seoul orthohantavirus infection in 36 y old woman with onset of disease coincided with peripartum period. Case Description: The patient was admitted to the hospital for a period of 37–38 w of pregnancy with complaints for lower abdominal pain, backache, anuria, icterus, and fever 38.6 °C. Diagnosis at admission was: Pregnancy 37–38 w, first stage of labor. Severe preeclampsia, HELLP syndrome, multi-organ failure. Low level of platelets (40 x 109/l), a significant increase of serum aminotransferases, high serum levels of creatinine and urea, pathological findings of coagulation tests, slight neutrophilic leukocytosis and anemia partially supported preliminary diagnosis. Ultrasonic examination revealed diffuse changes in the liver and kidneys parenchyma, splenomegaly, effusion into the abdominal and pleural cavities and fluid in the lower pelvis. After spontaneous vaginal delivery the patient's condition worsened, anemia and thrombocytopenia persisted and due to indications of atonic postpartum hemorrhage the hysterectomy was performed. Discussion: Based on clinical symptoms and epidemiological data the orthohantavirus infection was supposed and confirmed by detection of specific IgM antibodies (titer 1:400) by ELISA. RNA isolated from patient blood was typing by reverse transcriptase PCR (RT-PCR) and subsequent sequencing of L-segment fragment (2969–3314 bp) and hantavirus Seoul (genotype Vladivostok) was identified as ethiological agent of this case. After 2 m of the patient's intensive care (including but not limited repetitive plasma exchanges and hemodialysis) her condition gradually improved. By the time of release, the coagulation system parameters were normal with moderate anemia (red blood cells 2.96 x 1012 g/l, hemoglobin 90 g/l, hematocrit 26.7%) and lymphocytosis. However, signs of renal failure (serum creatinine level 366 mmol / l, serum urea level 15.34 mmol / l, proteinuria 0.3 g /l) persisted. The final diagnosis: Severe hantavirus infection, renal-liver-failure. Acute renal damage stage 3 according to AKIN, class I by RIFLE. Symptomatic arterial hypertension. Secondary anemia with mixed causes. Conclusion: This case is a fascinating example of how difficult to recognize renal impairments associated with hantaviruses during past trimester of pregnancy in patient with different significant risks. The case also reinforces the fact that genotype Vladivostok of Seoul virus can cause severe, life threatening disease with multisystem failure.

Roentgenoendovascular destruction of adrenal glands in the management of primary aldosteronism

Background. In the XXI century, interventional radiology is developing rapidly in the surgical treatment for endocrine pathology of adrenal glands. Until the introduction of aldosterone to renin ratio calculation as a screening test by K. Hiramatsu in 1981, primary aldosteronism was thought to be a rare pathology. Further study of the disease obtained new data on its prevalence – from 5 to 10 % among patients with hypertension and more than 20 % of patients with refractory hypertension. In Ukraine, the prevalence of primary aldosteronism among patients with refractory arterial hypertension is 1.2 %. The aim of the study was to evaluate the effectiveness of roentgenoendovascular destruction of adrenal glands (REDAG) in patients with primary aldosteronism (PA). Materials and methods. During the period from 2014 to July2018, a total of 132 patients with adrenal pathology were examined and treated at the Clinic of Hospital Surgery of ZSMU. Operative treatment for primary aldosteronism was performed in 38 patients, including 15 patients who underwent REDAG. There were 10 (66.7 %) women and 5 (33.3 %) men. The average age was 49.4 ± 14.9 years. According to CT (MRT), anatomy of adrenal neoplasms had the following localization: left-sided – in 11 (73.3 %) patients, right-sided – in 1 (6.7 %), bilateral – in 3 (20 %). The mean volume of adrenal neoplasms was 9.0 (6.3–10.0) mm. Diagnostics was performed according to the clinical practical recommendations for the diagnosis and treatment of PA (Clinical Practical Guideline – The Management of Primary Aldosteronism, 2016). Roentgenoendovascular surgery in patients with PA included destruction of the right adrenal gland in 3 (20 %) cases, of the left – in 12 (80 %). The results of the operative treatment were evaluated according to the standard criteria and clinical biochemical criteria of PASO (Primary Aldosteronism Surgical Outcomes) including the echocardiographic data. Results. The duration of the REDAG was 36.6 ± 6 minutes. Conversions, postoperative complications, lethal outcomes were avoided. The length of hospital stay was 9 (7–12) days. Comparative analysis of surgical treatment results showed a statistically significant decrease in systolic and diastolic blood pressure, aldosterone levels (P < 0.05). The control CT performed after treatment identified adrenal adenomas in the contralateral glands in 2 (13.3 %) patients. However, the follow-up clinical and laboratory diagnostics did not reveal its hormonal activity. According to PASO criteria, the complete biochemical effect was achieved in 73.3 %, complete clinical - in 66.7 %, partial biochemical effect – in 20 %, partial clinical effect – in 26.6 % of patients, failure of biochemical and clinical effects – in 6.7 %. Conclusions. Interventional methods of surgical treatment for adrenal pathology represent a complete alternative to endoscopic methods of surgical treatment in case i f it is clinically indicated. REDAG for primary aldosteronism demonstrates the statistically significant efficacy of symptomatic arterial hypertension treatment: complete biochemical effect in 73.3 %, complete clinical – 66.7%, partial biochemical effect – 20 %, partial clinical effect – 26.6 % of patients.

Selection of Patients with Resistant Arterial Hypertension for the Catheter-Based Renal Sympathetic Denervation

elaboration of algorithm for selection of patients with resistant arterial hypertension (AH) for Catheter-Based RenalSympathetic Denervation (CBRSD). We examined 284 patients with resistant AH. On stage 1 we excluded mostfrequent causes of secondary AH. In 247 patients (86.9 %) we established secondary character of AH, in 37 patients (13.1 %) AH wasfound to be essential. On stage 2 patients with essential AH were given 3-5 component hypotensive therapy. At the background of thistherapy we conducted 24‑hour ambulatory blood pressure monitoring (ABPM). CBRSD procedure was considered indicated if accordingto ABPM average 24‑hour blood pressure (BP) was above 150 and 100 mm Hg, and 24‑hour elevated BP load exceeded 60 %.In 13 of 37 patients (35 %) BP level satisfied these conditions. For CBRSD we used high frequency generator. Ablation was performedusing the Symplicity Catheter. Results were assessed in 1, 2, 9, 12, and 28 months. Target BP level at the background of minimaldoses of hypotensive drugs was achieved in 11 patients (85 %), what was confirmed by ABPM data. Levels of mean 24-4 hour systolicand diastolic BP significantly decreased from 173.9±14.9 to 143±21.3, р&lt;0.05, and from 108.2±8.7 to 91.4±13.8 mm Hg., р&lt;0.05,respectively. Index of elevated systolic BP time decreased from 78.2±14.6 to 49.8±29.6 %, р&lt;0.05. Best effect was achieved in patients with AH duration before the procedure less than 7 years. None of the patients had episodes of cerebral vascular insufficiency or heart failure progression. While determining indications to bilateral CBRSD one should be governed by such criteria as exclusion of symptomatic AH and objective proofs of AH resistance (according to ABPM at the background of hypotensive therapy).

Method for the Predicting Renal Failure Progression in Patients with Essential Arterial Hypertension I Stage

The article deals with the method of improving the prognosis of kidney damage in patients with essential arterial hypertension І stage. The principle of the method of forecasting, its advantages of use in clinical practice is described. The indexes of dynamic series, stability estimation on the value of rank correlation with the subsequent construction of the regression model of forecasting, determination of its significance by the level of determination are given.The objective: to improve the way of predicting the risk of developing kidney damage in patients with EH I stage.Materials and methods. The study was attended by 129 patients. The main group consisted of 101 patients diagnosed with essential arterial hypertension I stages according to the diagnostic criteria of the WHO/ISH, 2003 (World Health Organization/International Society of Hypertension) and Order of the Minister of Health from May, 24, 2012 No.384 [2, 4, 9]. (the average duration of the EH I stage is 3,7 ±2,1 years, women – 31 (30,7%), men – 70 (69,3%), middle age – 41,0 [33,0-47,0] years); 28 practically healthy persons in relation to the main group as a control group (women – 17 (60,7%), men – 11 (39,3%), middle age – 37,0 (31,0-46,0) years. The following criteria were not included: symptomatic arterial hypertension, valve heart failure, rhythm disturbance, chronic heart failure, chronic kidney disease, diabetes mellitus, ischemic heart disease, patients in the main group did not take antihypertensive therapy. All patients were followed by the following examinations: clinical examination, general clinical blood tests and urine, biochemical blood test (total protein, urea, creatinine, glucose, lipid profile); daily monitoring of AT (DMAT), ECG, Echo-KG and ultrasound of carotid arteries, ophthalmoscopy; and determination of renal function reserve (RFR) water and salt load (according to the Ukrainian patent number 1133692.) [3]. The statistical processing of the results was carried out using Microsoft Excel 2016, an application suite of statistical analysis software IBM SPSS Statistics 20 using a variety of methods of parametric and nonparametric statistics.Results. A prognostic regression model was built, which will help to identify patients with a high risk of kidney damage in stage EH I stage. It was revealed that the most significant factors determining the prognosis of the development of kidney damage during EH are age, gender (male), blood creatinine, rSHCFreat, and the level of DBP.Conclusion. The application of the developed and proposed prediction method will increase the accuracy of the assessment of the probability of development of kidney damage in patients with EH I stage, which will provide an adequate definition of the further tactics of patient management at the stage of primary care with the appointment of a corresponding complex of additional examinations, and therefore, more correct treatment.

Arterial hypertension in patients with non-specific aortoarteritis

Non-specific aortoarteritis (Takayasu arteritis) is a rare disease, it is a chronic vasculitis that occurs with the defeat of the aorta and main arteries, the development of stenosis of the arteries and ischemia of the relevant organs. In most cases, symptomatic arterial hypertension develops. The article presents a modern view of the peculiarities of the course of arterial hypertension, considered methods of diagnosis and treatment of this disease.

Cardiovascular risk stratification and renal functional reserve in patients with essentials hypertension

The article is devoted to the role of renal functional reserve (RFR) in essentials hypertension (EH) in the diagnosis of early kidney damage. Particular attention is paid to the effect of cardiovascular (CV) complications on RFR.The objective: to assess the functional state of the kidneys in patients with EH I stage and different total risk of CV complications.Materials and methods. The study involved 80 people with the established diagnosis EH of I stage of the I–II grade according to the WHO/ISH, 2003 (World Health Organization/International Society of Hypertension) and Order of the Minister of Health from May, 24, 2012 No.384 [2, 4, 8], in age from 18 to 60 years (women – 28 (35%), the average age is 40,1 (35,0–56,0) years, men – 57 (71%), average age – 40,2 (37,0–53,0) years. The average duration of EH stage I was 3,5 (1,2–5,0) years. Non-inclusion criteria were acute infectious diseases, symptomatic arterial hypertension, valvular heart disease, cardiac rhythm disturbances, chronic heart failure, chronic kidney disease, diabetes mellitus, coronary heart disease. Patients at the time of inclusion in the study did not take antihypertensive therapy. All patients underwent a comprehensive examination: a history, clinical examination and body anthropometric measurements (height, weight, waist and hip circumference and waist-to-thigh ratio (WTR)), complete blood count and urine tests, biochemical blood test (total protein, urea, creatinine, glucose, lipid profile, cystatin C), albumincreatinine ratio (ACR) in urine, ABPM, ECG, Echo-CG, ultrasound of carotid arteries, ophthalmoscopy. A risk factor count was used to assess the overall risk of CV complications in hypertension. In addition, RFR was determined the method water and salt load (under patentUkraine42,860) [1]. Statistical analysis of the results was carried out on a computer using the Microsoft Excel 2016 software package and IBM SPSS Statistics (version 21,USA).Results. When stratifying the risk, it was found that 56% of patients had a high risk, 20% of patients had an average risk and 24% had low risk of developing CV complications. In this case, high risk patients had 3–5 risk factors, the average – less than 3 risk factors, and patients with low risk had 1–2 or had no risk factors at all. Of all the risk factors most often met dyslipidemia, male sex, abdominal obesity and family history of premature CVD. In the course of the study, it was clear that even in patients with a low risk of CV complications, kidney damage was noted in the form of a reduced and depleted RFR.Conclusions. An important study of renal damage in EH I stage is the definition of a functional renal reserve. In patients with even a low risk of CV complications in EH I stage, a reduced and depleted RFR is defined. The most commonly depleted RFR was detected in patients with a high risk of developing CV complications.

Arterial hypertension: Modern problems

Arterial hypertension (AH) is one of the most common diseases. Despite numerous studies, many problems related to this pathology remain to be elucidated. The modern classifications of AHare contradictory and true causes of elevated blood pressure (BP) are unknown. There are no methods for diagnostics of early stages of AH nor is there adequateunderstanding of what hypertensive crises are, how they are to be classified and why they develop. Pathomorphosis of AH is practically unexplored. There are no efficient medications and therapies for the radical treatment of AH. The authors propose classification of hypertensive crisis, hypertensive disease, and symptomatic AH. It is recommended to use 24-hour blood pressure monitoring in all AH patients. New approaches to diagnostics of early stages of AH are proposed.

Symptomatic arterial hypertension associated with primary hyperaldosteronism

Objective.Primary hyperaldosteronism (PGA) (Conn’s syndrome) is a relatively rare phenomenon in therapeutic practice, occurring in 4,7–9%. In resistant hypertension (HTN) the rate of PGA achieves 10–20%. Often it results from the aldosterone-producing adrenal tumors and manifests by symptomatic HTN, neuromuscular, and renal symptoms. We present the cases of successful verification and surgical treatment of PGA. HTN patients and patients with rhabdomyolysis symptoms (increased creatine phosphokinase or lactate dehydrogenase) require further examination to exclude PGA.

Current features of clinical picture and diagnostics of pheochromocytoma

Background. Taking into consideration new data on the increased detectability and more exact diagnostic methods, revision of classical ideas of clinical picture and criteria of diagnostics of a pheochromocytoma (Ph) is required. Aim. To study current features of clinic manifestation, results of instrumental methods and factors, which influence on treatment efficiency of patients with confirmed diagnosis of Ph. Matherials and methods. There were studied 9 patients with histologically confirmed diagnosis of P (1 man 56 years old; 8 women who were 37.6 ± 5.5 years old). Next parameters were evaluated: presence of arterial hypertension (AH), specific features of P (sympathetic attack); indications for screening of Ph, the time from the appearance of indications for screening till the laboratory confirmed diagnosis, characteristics of CT (native density, size, contrast washout, specific features (cystic, heterogeneous structure with areas of necrosis and hemorrhage)), features of preoperative preparation, presence of intraoperative complications, efficiency of the surgery. Used descriptive statistics were percentage, mean M, standard deviation SD and 95% confidence interval CI. Results. AH was presented in 6 patients (67%), among whom 4 patients had specific features which indicated symptomatic AH. These 4 patients had the classic triad of Ph (44%). Indications for screening of Ph in 4 patients were specific features of Ph (time from screening indication appearance till laboratory confirmed diagnosis was 41 ± 14 mnths. (95% CI 18;63), in other 5 - adrenal incidentaloma (AI) (time from the detection of AI until the laboratory confirmed diagnosis was 13 ± 9 days (95% CI 2; 24). CT characteristics were the next: native density - 49,9 ± 12,8 HU (95% CI 40; 59,7), lesion size - 5,4 ± 1,8 cm (95% CI 4; 6,7), contrast washout - 30,1 ± 11,1 HU (95% CI 21,6; 38,6). Only 2 patients had so called specific CT features. All patients received adequate preoperative preparation with alpha-blockers. There were no any specific intraoperative complications in all cases. After surgery metanephrine and normetanephrine were within reference range. Conclusions. 1/3 of patients with Ph had not clinical manifestations. Specific CT features presented in a smaller percentage. The success of surgery entirely depends on adequate preoperative prescription of alpha-blockers.

253-POS

Objectives We studied angiotensin I levels’ influence on platelet function in pregnant women with arterial hypertension (AH). Methods 77 pregnant women with chronic hypertension (CH), 32 pregnant women with gestational hypertension (GH) and 45 healthy pregnant women (C, controls) were examined at the Clinical Hospital N 1 of Minsk city. Patients with symptomatic AH and chronic diseases were excluded from the study. Pregnant women underwent a 24-h monitoring of the arterial blood pressure (AP) using Oxford Medilog DX (“Oxford Instruments Medical System Division”, USA) during each trimester of pregnancy. On the day of investigation, angiotensin I levels were determined with the radioimmunoassay technique using multicrystalline gamma-counter LB-2111 (“Bertold”, Germany) and “Immunotech” reagents (Czech Republic). Platelets aggregation was examined using “Solar” turbodimetrical platelets aggregometer AP-2110 (Republic of Belarus). Aggregation was registered in 10 min using such aggregation inductors as adenosine diphosphate (ADF) in the concentration 2,5 × 10 −6 mol/l (“Analyze-X” reagent (Belarus)) and adrenaline in the concentration 5 × 10 −6 mol/l. Results Degree, aggregation time and speed levels, induced by ADF and adrenalin, were not significantly different among CH, GH and C by trimesters. Relationships between angiotensin I and platelets aggregation levels were found in pregnant women with AH: in CH group middle inverse correlation with aggregation speed (ADF) in I trimester rs = −0.54, with aggregation degree (ADF) in II trimester rs = −0.33, with aggregation speed (ADF) rs = −0.38, with aggregation degree (adrenalin) rs = −0.37; In GH group there is strong inverse correlation in II trimester with aggregation degree (ADF) rs = −0.83. In C group relationship between angiotensin I and any aggregation parameters along the pregnancy were not found. Conclusions The angiotensin I influence on platelets, increasing their thrombogenicity, occurs only in pregnant women with AH. Disclosures N. Tselikava: None.

Study of the relationship social and psychological characteristics of hypertensive patients, the frequency of medical emergencies and adherence of patients to treatment

The aim of the study was to investigate the relationship of psychological and social characteristics of patients with hypertension often seek emergency medical help with their adherence to treatment.Material and methods. Outpatient were examined 300 patients with hypertension (100 men and 200 women) from 35 years and older (mean age 72,1±12,8 years). Duration of hypertension ranged from 4 to 36 years old. We excluded patients with symptomatic arterial hypertension. Using questionnaires, revealed frequency of calls ambulance, the extent to which medical recommendations and regularity of antihypertensive drugs by patients. Also completed questionnaires Spielberg- Hanin for the assessment of emotional status.Results. The study showed that more frequent calls in general are more common in women than men, single patients, compared to unmarried as well as retirees compared to active patients. The proportion of women callers ambulance at least 1 time per year was 29% and was significantly (p