Systolic Arterial Hypertension Research Articles

АРТЕРИАЛЬНАЯ ГИПЕРТЕНЗИЯ У ПАЦИЕНТОВ СТАРШИХ ВОЗРАСТНЫХ ГРУПП: КЛИНИКО-ПАТОГЕНЕТИЧЕСКИЕ ОСОБЕННОСТИ, ВЫБОР ОПТИМАЛЬНОЙ ГИПОТЕНЗИВНОЙ ТЕРАПИИ

Arterial hypertension is one of the main risk factors for the development of complications of diseases of the cardiovascular system, the prevalence of which increases with age. The mechanisms of increasing blood pressure in old age are different, the most significant of them is an increase in the stiffness of the artery wall. Isolated systolic arterial hypertension holds a distinct place in elderly and senile patients. The treatment of hypertension in patients of older age groups is much more difficult than in young and middleaged patients, due to the more frequent development of side effects of antihypertensive therapy, as well as the lack of sufficient studies conducted in this category of patients.

Causal effect of interleukin (IL)-6 on blood pressure and hypertension: A mendelian randomization study.

To examine whether circulating interleukin-6 (IL-6) levels (CirIL6) have a causal effect on blood pressure using Mendelian randomization (MR) methods. We used data from genome-wide association studies (GWAS) of European ancestry to obtain genetic instruments for circulating IL-6 levels and blood pressure measurements. We applied several robust MR methods to estimate the causal effects and to test for heterogeneity and pleiotropy. We found that circulating IL-6 had a significant positive causal effect on systolic blood pressure (SBP) and pulmonary arterial hypertension (PAH), but not on diastolic blood pressure (DBP) or hypertension. We found that as CirIL6 genetically increased, SBP increased using Inverse Variance Weighted (IVW) method (for ukb-b-20175, β = 0.082 with SE = 0.032, P = 0.011; for ukb-a-360, β = 0.075 with SE = 0.031, P = 0.014) and weighted median (WM) method (for ukb-b-20175, β = 0.061 with SE = 0.022, P = 0.006; for ukb-a-360, β = 0.065 with SE = 0.027, P = 0.014). Moreover, CirIL6 may be associated with an increased risk of PAH using WM method (odds ratio (OR) = 15.503, 95% CI, 1.025-234.525,P = 0.048), but not with IVW method. Our study provides novel evidence that circulating IL-6 has a causal role in the development of SBP and PAH, but not DBP or hypertension. These findings suggest that IL-6 may be a potential therapeutic target for preventing or treating cardiovascular diseases and metabolic disorders. However, more studies are needed to confirm the causal effects of IL-6 on blood pressure and to elucidate the underlying mechanisms and pathways.

Assessing the Risk of Hypertension in Chronic, Elderly Patients during the COVID-19 Pandemic: A Prospective Study.

This study considers care management for older chronic patients during and after the COVID-19 pandemic. To identify groups of variables at previous time points as a basis for deriving efficient classification models during and after a pandemic situation and to quantify the effect of each variable within the model to predict levels of worsening risk in diastolic and systolic arterial hypertension (AHT). In this prospective longitudinal study, data were collected at three time points: before, during, and after the COVID-19 pandemic period. The study included 148 patients with an average age of 81.6 years. During the study period, mean systolic blood pressure among this population rose by 5 mmHg to 128.8 mmHg; the number of patients with systolic blood pressure > 140 mmHg rose by 45.3%; among those with diastolic blood pressure > 90, the number rose by 41.2%; mean triglycerides levels rose to 152.6 mg/dL; cholesterol levels rose to 147 mg/dL; and LDL cholesterol rose to 112.2 mg/dL. Meanwhile, mean levels of HDL cholesterol decreased to 46.5 mg/dL. Binary-response logistic regression models were constructed to identify the most relevant variables for predicting AHT risk during and after the pandemic. The heart rate (OR = 1.79; 95% CI: 1.22-2.72) and body mass index (OR = 1.75; 95% CI: 1.08-2.94) variables were significant at the population level (p < 0.05) for diastolic and systolic AHT in the pandemic period risk models. The body mass index variable was also significant for diastolic AHT in the post-pandemic period risk model (OR = 1.97; 95% CI: 1.32-2.94), whilst the triglycerides variable was significant in the systolic AHT post-pandemic period risk model (OR = 1.49; 95% CI: 1.01-1.86). Bad control of arterial hypertension in older patients with chronic disease is associated with elevated levels of LDL cholesterol, total cholesterol, systolic blood pressure, heart rate and triglycerides, and lower levels of HDL cholesterol.

INCREASED ARTERIAL STIFFNESS ASSOCIATED WITH BLOOD PRESSURE IS THE PREVALENT HYPERTENSION MEDIATED ORGAN DAMAGE IN YOUNG PATIENTS WITH FIRST DIAGNOSED SYSTOLIC HYPERTENSION

Objective: Early onset arterial hypertension (AH) is associated with a considerably increased risk for cardiovascular (CV) disease if left untreated. Hypertension mediated organ damage (HMOD) evaluation is necessary in order to estimate cardiovascular risk in each hypertensive patient. We investigated the incidence of HMOD in young first diagnosed and never-treated patients with systolic arterial hypertension (SH) trying to identify those young patients in high CV risk based on the presence of HMOD. Design and method: In 220 patients, &lt;50 years [median (IQR) age = 43(38-47) years], with SH diagnosed by ambulatory blood pressure monitoring (24-h ABPM), CV risk factors [smoking, obesity (BMI), hyperlipidemia] and 5 HMOD [arterial stiffness (PWV), left ventricular diastolic dysfunction [(DD (EEa)], cardiac hypertrophy (LVMI), coronary arteries microcirculation (CFR), and carotid intima-media thickness (cIMT)] were evaluated before treatment initiation. Results: Smoking (40%) and obesity [median (IQR) BMI = 30(26-32) kg/m2] were found in young hypertensives. HMOD were found in 50% of hypertensives (&gt;1 HMOD while 10% had &gt; 2 HMOD. The most prevalent HMOD were the increased cIMT (32%), PWV (19%), LVH (9%), impaired CFR (6%) and DD (1%). Only PWV (beta = 0.27, p&lt;0.001) and LVMI (beta = 0.41, p&lt;0.001) were associated to systolic BP burden (Figure). In a subgroup analysis, the population with &gt;2 any studied HMOD was older with increased office BP and 24-h ABPM, impaired lipid profile and increased levels of LVMI, PWV, CFR and cIMT compared to the rest of the hypertensives. Conclusions: The presence of &gt;2 any studied HMOD (PWV, LVMI, cIMT, E/Ea, CFR) in young hypertensives characterizes a truly “high-risk population”. Arterial stiffness represents the predominant HMOD in the whole population as well as in the “high-risk hypertensive population”.

Hypertension-Mediated Organ Damage In Young Patients With First-Diagnosed And Never Treated Systolic Hypertension.

Early onset of untreated arterial hypertension is associated with an increased risk for cardiovascular (CV) diseases. The evaluation of hypertension-mediated organ damage (HMOD) helps estimating CV risk. We investigated the incidence of HMOD in young first, diagnosed and nevertreated patients with systolic arterial hypertension (SH) to identify high CV-risk patients based on the presence of HMOD. CV risk factors [smoking, obesity (body mass index, BMI)], hyperlipidemia and 5 HMODs [arterial stiffness (pulse wave velocity, PWV), left ventricular diastolic dysfunction [(DD (E/Ea)], cardiac hypertrophy (left ventricular mass index, LVMI), coronary artery microcirculation (CFR), and carotid intima-media thickness (cIMT)] were evaluated before treatment initiation in 220 patients, aged ≤50 years [median (interquartile range, IQR) age=43(38-47)], with SH diagnosed by ambulatory blood pressure monitoring (24-h ABPM). Smoking (40%) and obesity [median (IQR) BMI=30(26-32) kg/m2](40%) were found in young hypertensives. HMOD was found in 50% of hypertensives (10% had ≥2 HMOD). The most prevalent HMODs were increased by cIMT (32%) and PWV (19%), LVH (9%), impaired CFR (6%) and DD (1%). Only PWV (beta=0.27, p<0.001) and LVMI (beta=0.41, p<0.001) were associated with systolic BP burden. In a subgroup analysis, patients with ≥2 HMOD were older with increased office BP and 24- h ABPM, impaired lipid profile, and increased LVMI, PWV, CFR, and cIMT compared with the rest of the hypertensives. The presence of ≥2 of the studied HMOD (PWV, LVMI, cIMT, E/Ea, CFR) in young hypertensives characterizes a "high-risk population". Arterial stiffness represents the predominant HMOD and in the whole population and "high-risk population".

Dose-dependent cardiovascular disorders in a rat model with exacerbated emphysema: Implication of inflammation

Chronic obstructive pulmonary disease (COPD) is currently the third cause of death worldwide. Emphysema is an abnormal enlargement of air spaces in the lungs, with destruction of alveolar parishes. Cardiovascular disorders are the most frequent and serious comorbidities of COPD. Their interconnection is poorly understood but several hypotheses have been proposed, including hyperinflation, oxidative stress, and inflammation. In a rat model with exacerbated elastase (ELA)-induced emphysema that develops heart failure with preserved ejection fraction, our goal is to (1) describe the relationship between exacerbated emphysema and cardiovascular hemodynamic disorders, (2) characterize the inflammation status 24 h and 5 weeks after an exacerbation. The model includes a weekly intra-tracheal instillation of ELA, during four weeks with doses of 4, 6 or 10UI. At week 4, lipopolysaccharide (LPS) was instillated with ELA to mimic an exacerbation and approximate clinical conditions. Experiments were performed 24 hours after the last intra-tracheal instillation (ELA + LPS) and at week 9 just before sacrifice. In vivo, we did a cardiac stress test on metabolic treadmill, whole body plethysmography, echocardiography, arterial pressure, and collected blood samples. Ex vivo, we explanted the heart/lung block to assess pulmonary compliance and histology analyses. We identified a respiratory functional impairment proportional to the dose of elastase instilled. An exercise intolerance appeared after the exacerbation and persisted 5 weeks later. We observed a diastolic dysfunction after the exacerbation and at week 9, with a significantly dose dependent increased E/E’ ratio, correlated with the extent of emphysema. A systolic and diastolic arterial hypertension appeared at week 9, especially in the 10UI elastase group. There was an increased lung compliance and decreased elastance. The characterization of inflammation is under investigation. This ELA-LPS animal model presents a chronic profile of heart failure with preserved ejection fraction linked in a dose-dependent manner to the intensity of the emphysema. Cardiopulmonary changes are accompanied by a reduction in exercise tolerance as well as arterial hypertension. This model seems useful to better understand the mechanisms of cardiac changes induced by emphysema. At length, we aim to develop an inhibition of T1 or T2 inflammation pathway, to determine the part played by this inflammation.

Benefits of IV Clonidine in Premedication on Sympathetic Hyperactivity Related to Surgical Incision

Background: Clonidine stimulates the α2 receptors of the sympathetic nervous system which have a negative presynaptic feedback effect inducing a reduction in the secretion of adrenaline and noradrenaline. The main objective of our study was to evaluate the beneficial effects of clonidine on the hemodynamic response to surgical incision. Patients and Methods: This was a prospective, single-center, randomized, single-blind clinical trial that took place over a period of 4 months in the anesthesia department of the Essos hospital center in Yaoundé. All patients over the age of 18, ASA I or II, admitted for scheduled surgery were included in the study. The patients were randomly divided into two groups by drawing lots: group A (clonidine) and group B (non-clonidine). All patients in group A received clonidine IV (3μg/kg). Heart rate, systolic blood pressure, and diastolic blood pressure were observed at different times during the surgical procedure. Results: During the study period, 35 met the inclusion criteria: 20 patients for group A and 15 patients for group B. The average age was 34 years. The sex ratio was in favor of the male gender in both groups: 2.3 in group A and 2.7 in group B. ASA class 1 was the most represented (74.3%); visceral surgery most performed of all specialties in the two groups 55% (n=11) for group A and 53% (n=8) for group B. The systolic and diastolic arterial pressure curves are parallel in the two groups. There is a slight variation in PAS and PAD in group A "clonidine" compared to the baseline values. A tendency towards systolic arterial hypertension is observed in the “non-clonidine” control group. The heart rate remains stable in group A, while tachycardia is observed at the same time for the participants in group B. Conclusion: Clonidine is an alpha 2 adrenergic receptor agonist which makes it possible to limit the hypersecretion of catecholamines, potentially deleterious for the fragile patient, at the surgical incision.

24-hour blood pressure monitoring in patients with polycythemia vera

Aim. To study the parameters of 24-hour blood pressure monitoring in patients with polycythemia vera and to determine their informational value for the diagnosis of heart damage.Materials and methods. Blood pressure parameters were monitored daily in 63 patients with I–IIB stage polycythemia vera and 52 healthy individuals to determine the occurrence of their pathological types. The sensitivity and specificity of the studied parameters were evaluated using ROC analysis for early diagnosis of heart damage in polycythemia patients. The obtained information was processed in Statistica 25.0.Results. An analysis of blood pressure load showed that 47.6%, 30.1% and 34.9% of polycythemia patients suffer from systolic arterial hypertension (p = 0.012), daytime diastolic arterial hypertension (p = 0.03), and nocturnal diastolic arterial hypertension (p = 0.001), respectively. In comparison with healthy individuals, polycythemia patients experienced a higher variability of systolic (p&lt;0.002) and diastolic (p&lt;0.001) blood pressure, as well as the morning surge of systolic pressure (p = 0.014), more frequently. In 69.8% of polycythemia patients, pathological types of 24-hour blood pressure profile – with either insufficient or excessive nocturnal reduction – were observed. Informative parameters of heart damage in polycythemia patients were found to include blood pressure load, minimum daytime systolic and diastolic blood pressure, and the rate of nocturnal decrease in diastolic pressure.Conclusions. (1) Systolic-diastolic arterial hypertension was detected in half of polycythemia patients, with pathological types of 24-hour blood pressure profile observed in the majority of patients. (2) The parameters of 24-hour blood pressure monitoring can be used for early diagnosis of heart damage in patients with polycythemia vera.

Latent Hypertension and Dysautonomia Among Athletes With Office Prehypertension During One Year Training Macrocycle

The research topicality is needed to diagnose in time and correct properly athletes’ autonomic dysfunction (especially among sportspeople with pre-pathological states). The study of latent hemodynamic changes and detection of dysautonomia among prehypertension athletes (particularly those who train heavily) is a promising way to raise sportsmen’s health and achievements. The research purpose is a hemodynamic profile study of athletes with office prehypertension during different training macrocycle periods. Methods. The research comprised 30 athletes of acyclic activity. Their average age was 23.1 (2.71) years. Females were nine individuals (30%). We monitored arterial blood pressure and heart rate in each macrocycle period, carried out the dysautonomia test and established anamnesis and complaints. Results. For prehypertension athletes, the most challenging moment was the competition period. Therefore, the systolic arterial hypertension rate within preparation, competitive and transition training periods was 17%, 47% and 7% (χ2=14.53; р0.001) while the diastolic one was 17%, 37% and 7% respectively (χ2=8.75; р=0.012). Significantly, we observed an increasing possibility of arterial blood pressure rise over normal values among dysautonomia athletes during the competition period (RR=3.27 (р=0.01); OR=8.33 (р=0.006)). However, during the preparation and recovery periods, arterial hypertension possibility was not significant (р0.05). Conclusions. In the competition period of training macrocycle is highly expectable development of arterial hypertension of latent course in athletes with office prehypertension. Besides, the relative risk of latent arterial hypertension in extra-training time increases if there are other symptoms of dysautonomia, but these changes are not persistent. However, their proper diagnosing and correcting may lead to athletes’ better health and achievements.

Blood pressure target achievement in older adults with hypertension and chronic heart failure with preserved ejection fraction: the impact of adipose tissue function

Objective. To assess the impact of adipose tissue dysfunction for target blood pressure levels achieving in arterial hypertension (AH) and chronic heart failure with preserved left ventricular ejection fraction (HFpEF) in real clinical practice.Materials and methods. We examined 91 elderly patients (&gt; 75 y.o.) with AH and HFpEF during hospital admission. The mass and mass fraction of adipose tissue, serum levels of adipokines (adiponectin, leptin) and proinflammatory cytokines (TNFa and IL6) were assessed. Steady normotension at discharge was used as a marker of the target blood pressure level achievement possibility.Results. By the time of the planned discharge, stable normotension was recorded in 24.2% of patients. In senile patients with failure to achieve normotension, isolated systolic AH was most common - 55.1%. Patients with persistent hypertension at the time of the planned discharge were characterized by a low ability of adipose tissue to secrete adiponectin: 0.05 (0.03; 0.12) vs 0.37 (0.12; 0.5) μg/mL/kg (p = 0.037 ). The minimum values of adiponectin (corrected for adipose tissue mass) were in patients with systolic-diastolic AH (0.04 (0.03; 0.06) μg/ml/kg, Jonkhier-Terpstra test, p = 0.033). A regression model for achieving normotension in senile patients with HFpEF was built with a total percentage of correct classifications of 93.8% before bootstrap and 95.8% after: the maximum values of the Wald statistics were achieved with respect to the predictors "adiponectin", "TNF-a" and "heart rate".Conclusion. The development of adipose tissue dysfunction, accompanied by a decrease in the “rescue hormone” adiponectin synthesis, is associated with the failure to achieve normotension during medication of the inpatient treatment in senile patients with AH and HFpEF.

Immobilization of Captive Kulans (Equus hemionus kulan) Without Using Ultrapotent Opioids.

Etorphine is widely used in zoological medicine for the immobilization of large herbivores. All reported immobilization protocols for kulans use etorphine as the primary immobilizing agent. However, etorphine can trigger severe side effects and is highly toxic for humans, its availability is occasionally limited for use in wildlife medicine. Therefore, two different alpha-2 agonist-based protocols for the general anesthesia of kulans were investigated and compared with the standard etorphine immobilization. In total, 21 immobilizations were performed within the scope of routine husbandry management at the Serengeti-Park Hodenhagen. Kulans were darted using a ketamine–medetomidine–midazolam–butorphanol (KMMB) protocol (n = 8, treatment group (TG) 1), a tiletamine–zolazepam–medetomidine–butorphanol (TZMB) protocol (n = 7, treatment group (TG) 2), or an etorphine–acepromazine–detomidine–butorphanol (EADB) protocol (n = 6, control group). Vital parameters included heart rate, respiratory rate, arterial blood pressure (invasive), end tidal CO2 (etCO2), electromyography and core body temperature, which were all assessed every 10 min. For blood gas analysis, arterial samples were collected 15, 30, 45 and 60 min after induction. Subjective measures of quality and efficacy included quality of induction, immobilization, and recovery. Time to recumbency was longer for TG 1 (9.00 ± 1.67 min) and TG 2 (10.43 ± 1.79 min) compared to the induction times in the control group (5.33 ± 1.93 min). Treatment group protocols resulted in excellent muscle relaxation, normoxemia and normocapnia. Lower pulse rates combined with systolic arterial hypertension were detected in the alpha-2 agonist-based protocols. However, only in TZMB-immobilized kulans, sustained severe systolic arterial hypertension was observed, with significantly higher values than in the TG 1 and the normotensive control group. At 60 min following induction, medetomidine and detomidine were antagonized with atipamezole IM (5 mg/mg medetomidine or 2 mg/mg detomidine), etorphine and butorphanol with naltrexone IV (2 mg/mg butorphanol or 50 mg/mg etorphine), and midazolam and zolazepam with flumazenil IV (0.3 mg per animal). All three combinations provided smooth and rapid recoveries. To conclude, the investigated treatment protocols (KMMB and TZMB) provided a safe and efficient general anesthesia in kulans with significantly better muscle relaxation, higher respiration rates and improved arterial oxygenation compared with the immobilizations of the control group. However, the control group (EADB) showed faster recoveries. Therefore, EADB is recommended for ultra-short immobilizations (e.g., microchipping and collaring), especially with free-ranging kulans where individual recovery is uncertain, whereas the investigated treatment protocols are recommended for prolonged medical procedures on captive kulans.

Clinical and anamnestic features and the nature of medical care for patients of older age groups as factors of unfavorable prognosis of myocardial infarction

Objective: to study the features of the anamnestic background, clinical course, as well as the nature of medical care for elderly patients with acute myocardial infarction (MI) and to assess their impact on the prognosis of the disease. Material and methods: the study included patients 60 years and older who survived acute MI and registered in the «Register of Acute Myocardial Infarction»(Tomsk) (n=410). The study conducted a 5-year prospective follow-up of patients with an assessment of their vital status. The Statistica V10.0 application software package («StatSoft Inc.») was used for statistical processing of the data obtained. Results: the analysis showed that 90% of patients had a history of comorbid pathology. In almost 20% of patients, the onset of the disease was characterized by an atypical clinical picture, which in more than a third of cases was represented by a low-symptomatic form. The presence of atypical MI manifestation lengthened the prehospital stage of medical care due to the late treatment of patients for medical help (120 [49; 311.5] minutes), as well as longer time before the first medical contact (26.5 [20;40] minutes (p=0.005)). A fifth of patients were treated for acute MI in non-core hospitals, where the hospital mortality rate among elderly patients reached 65.7%, which was 3 times higher than the same indicator in specialized cardiology departments (19.7%, p&lt;0.001). Conclusion: the main factors affecting the long-term postinfarction period in elderly patients were: isolated systolic arterial hypertension, diabetes mellitus, impaired renal function, a history of myocardial infarction and acute cerebrovascular accident.

Early Stage Identification of COVID-19 Patients in Mexico Using Machine Learning: A Case Study for the Tijuana General Hospital

Background: The current pandemic caused by SARS-CoV-2 is an acute illness of global concern. SARS-CoV-2 is an infectious disease caused by a recently discovered coronavirus. Most people who get sick from COVID-19 experience either mild, moderate, or severe symptoms. In order to help make quick decisions regarding treatment and isolation needs, it is useful to determine which significant variables indicate infection cases in the population served by the Tijuana General Hospital (Hospital General de Tijuana). An Artificial Intelligence (Machine Learning) mathematical model was developed in order to identify early-stage significant variables in COVID-19 patients. Methods: The individual characteristics of the study subjects included age, gender, age group, symptoms, comorbidities, diagnosis, and outcomes. A mathematical model that uses supervised learning algorithms, allowing the identification of the significant variables that predict the diagnosis of COVID-19 with high precision, was developed. Results: Automatic algorithms were used to analyze the data: for Systolic Arterial Hypertension (SAH), the Logistic Regression algorithm showed results of 91.0% in area under ROC (AUC), 80% accuracy (CA), 80% F1 and 80% Recall, and 80.1% precision for the selected variables, while for Diabetes Mellitus (DM) with the Logistic Regression algorithm it obtained 91.2% AUC, 89.2% accuracy, 88.8% F1, 89.7% precision, and 89.2% recall for the selected variables. The neural network algorithm showed better results for patients with Obesity, obtaining 83.4% AUC, 91.4% accuracy, 89.9% F1, 90.6% precision, and 91.4% recall. Conclusions: Statistical analyses revealed that the significant predictive symptoms in patients with SAH, DM, and Obesity were more substantial in fatigue and myalgias/arthralgias. In contrast, the third dominant symptom in people with SAH and DM was odynophagia.

Стан ендотеліальної функції у хворих похилого віку з дисциркуляторною енцефалопатією та ізольованою систолічною і систоло-діастолічною артеріальною гіпертензією

Актуальність. Дослідження функції ендотелію у хворих із дисциркуляторною енцефалопатією (ДЕ) та артеріальною гіпертензією (АГ) нечисленні і свідчать про її порушення. Відсутність однозначних даних про ендотеліальну дисфункцію (ЕД) у літніх хворих з ДЕ та ізольованою систолічною артеріальною гіпертензією (ІСАГ) або систоло­діастолічною артеріальною гіпертензією (СДАГ) визначила характер дослідження. Його мета — вивчити ЕД у хворих похилого віку з ДЕ 2­го ступеня та АГ 2­ї стадії (ІСАГ або СДАГ). Матеріали та методи. Досліджено 104 хворі (45 чоловіків і 59 жінок, середній вік 67,3 ± 4,4 року) з ДЕ, з яких 32 пацієнти без підвищеного артеріального тиску (1­ша група), у 35 хворих мала місце СДАГ (2­га група), у 31 — ІСАГ (3­тя група). Групи формувалися рандомізовано, були однорідними за віком, статтю та давністю захворювання (p &gt; 0,05). 86,7 % хворих на тлі медикаментозної терапії мали стабільну помірну АГ. За рівнем систолічного артеріального тиску хворі 2­ї і 3­ї групи не розрізнялися (p &gt; 0,05). Пульсовий артеріальний тиск у хворих 3­ї групи був достовірно вище, ніж у 2­й (на 17 %; p &lt; 0,05), частіше у пацієнтів 3­ї групи спостерігався кризовий характер перебігу АГ (на 14 %; p &lt; 0,05). Тільки 16 (15,4 %) хворих регулярно приймали статини і мали нормальні показники ліпідограми, у всіх інших індекс атерогенності був істотно підвищений (p &lt; 0,05), не розрізняючись між різними групами (p &gt; 0,05). Судиннорушійну функцію ендотелію визначали на плечовій артерії ультра­ звуковим методом D. Celermajer, оцінювали ендотелійзалежну (ЕЗВД) і ендотелійнезалежну вазодилатацію (ЕНВД). Зміст ендотеліну­1 (ЕТ­1) досліджували методом імуноферментного аналізу. Рівень оксиду азоту оцінювали спектрофотометричним методом за сумарною концентрацією стабільних метаболітів (NOx), нітритів (NO2) і нітратів (NO3). Результати. У всіх групах ЕЗВД і ЕНВД були нижче норми, величина обох показників у хворих 2­ї групи була вірогідно нижче, ніж в 1­й (р &lt; 0,05), в 3­й — нижче, ніж у 2­й (р &lt; 0,05). Концентрація ЕТ­1 в 1­й групі становила 0,92 ± 0,04 фмоль/мл і знаходилась на верхніх межах допустимого рівня, тоді як у пацієнтів 2­ї і 3­ї групи мало місце істотне підвищення ЕТ­1 вище показника 1­ї групи — на 14,3 % (р &lt; 0,05) і 39,8 % (р &lt; 0,001) відповідно, при цьому концентрація ЕТ­1 у хворих 3­ї групи була вірогідно вище, ніж у 2­й (р &lt; 0,05). Рівень стабільних кінцевих метаболітів оксиду азоту у хворих всіх груп був нижче норми, причому всі показники (NO2, NO3, NOx) у пацієнтів 2­ї групи були вірогідно нижчими, ніж в 1­й (р &lt; 0,05), і суттєво вищими, ніж в 3­й (р &lt; 0,05). Кореляційний аналіз виявив тісний зворотний зв’язок між концентрацією ЕТ­1 і NO2 як у хворих ІСАГ, так і СДАГ, тоді як у нормотензивних хворих відзначена кореляційна залежність слабкої сили. Висновки. У пацієнтів похилого віку з ДЕ і АГ має місце більш напружене функціонування вазодилатуючої системи порівняно з нормотензивними хворими, яке пов’язане з порушенням ендотеліальної функції. ЕД у хворих з ДЕ та ІСАГ більш значна, ніж у пацієнтів з ДЕ і СДАГ, що слід ураховувати при розробці стратегії лікування.

Aspects of treatment of isolated systolic arterial hypertension in the elderly in the practice of a family doctor

This article is devoted to the treatment of isolated systolic arterial hypertension in the elderly, based on the current ESH/ESC recommendations.

Heart remodeling in elderly patients with isolated systolic arterial hypertension and chronic heart failure with preserved left ventricular ejection fraction

The aim of the work was to study the structural and functional state of the left ventricle (LV) in elderly patients with isolated systolic arterial hypertension (ISAH) and chronic heart failure with preserved ejection fraction (CHF with PEF). Materials and methods. After receiving an informed consent, 134 elderly patients with ISAH were enrolled in the study. The main group included 91 patients aged 71.1 ± 3.5 years with ISAH and ejection fraction (EF) of the LV &gt;50 % and a level of natriuretic peptide (NT-proBNP) &gt;125 pg/ml. Among them, there were 61 women (67 %) and 30 (33 %) men. The comparison group consisted of 43 patients (27 women and 16 men aged 70.4 ± 3.7 years) with ISAH, LV EF &gt;50% and NT-proBNP &lt;125 pg/ml. The geometric changes of the LV were evaluated taking into account the LV myocardial mass index and the relative LV wall thickness. Results. Cardiac remodeling in elderly ISAH patients with CHF and PEF was represented by the following geometric variants of the LV. In the main group patients, concentric LV hypertrophy (LVH) prevailed – 73 (80.2 %) patients, while in the comparison group, concentric modeling (CR) – 25 (58.1 %) patients (P &lt; 0.01 by criterion χ2). CR in the ISAH patients with CHF and PEF was diagnosed in 18 (19.8 %) cases. Concentric LVH was verified in 18 (41.9 %) patients of the comparison group (P &lt; 0.01). It was determined that the hyperfunction of the left atrium (LA) in the patients with ISAH without CHF was compensatory. The maximum volume index of the LA (VILAmax.) in these patients was in the range of 27–32 ml/m2. Hyperfunction of the LA in the ISAH patients with CHF and PEF was accompanied by a statistically significant increase in VILAmax. over 34 ml/m2. Conclusions. The prevalence of ISAH among elderly patients is 35.6 %. The formation of a hypertensive heart in the ISAH patients with CHF and PEF is characterized by a predominant concentric LVH (80.2 %) and hyperfunction of the LA. A significant increase in the LA volumes testifies to increase in its contribution to the LV filling with the formation of LV diastolic dysfunction. The presence of concentric LVH and an increase in VILAmax. ≥34 ml/m2 is a criterion for identifying individuals at high and very high risk among elderly ISAH patients with CHF and PEF.

Self-Care in Type 2 Diabetes Patients with Urgency Lower Limb Amputation: The Influence of Sex, Marital Status and Previous Amputations.

AimLower limb amputation (LLA) is a severe consequence of type 2 diabetes mellitus (T2DM), and can affect up to 1% of T2DM patients, leading to an increased risk of premature mortality. Among the factors to predict LLA, it has been highlighted sex, marital status, and previous amputation. However, there is a lack of information about the association between these predictive factors, self-care, and urgency LLA in T2DM patients.PurposeTo verify the behavior of self-care and to relate it with the predictive factors (sex, marital status, and previous amputation) in urgency LLA T2DM patients.Patients and MethodsNon-interventional study, with 106 T2DM patients who were in the postoperative period of urgency LLA caused by complications resulting from T2DM. A structured questionnaire was used for sociodemographic and clinical characterization of the sample as well as the Summary of Diabetes Self-Care Activities (SDSCA) tool. It was used the Wilcoxon, Friedman, and Mann–Whitney tests (median, nonparametric populations) to assess the significance of the differences between groups (sex, marital status, and previous amputation), also Spearman correlation coefficient to assess the association between the data (comparison between diagnostic time, sex, previous amputation, ethnicity and systolic arterial hypertension) and a logistic regression analysis considering the item SDSCA related to sex, age and marital status (with partner).ResultsSignificant differences (p<0.05) in the questions “Specific Food” and “Foot care” were found when the participants were grouped by sex. In the relation to marital status, significant differences (p<0.05) were observed for the question “Specific Food”. No differences were found between groups with or without previous amputation.ConclusionBy SDSCA tool, we were able to report that T2DM patients submitted to urgency LLA presented differences in self-care, particularly for sex and marital status.

The Spread of Thyroid Diseases and the Algorithm for Diagnosing Thyroid Dysfunction

Diseases of the thyroid gland are considered one of the most common endocrinopathies. This is due to the influence of ecologically unfavorable environmental factors, bad habits, malnutrition, comorbid conditions and genetic predisposition. Determining an algorithm for diagnosing thyroid dysfunction for the timely detection of diseases is expedient and relevant. The objective: to analyze the state of the spread of thyroid diseases among the population of the Kiev region and to determine the diagnostic algorithm based on the identification of the main clinical syndromes of thyroid dysfunction. Materials and methods. Among the adult population of the Kiev region, a high level of morbidity and spread of thyroid diseases is recorded. The increase in the number of cases occurred, first of all, due to the newly diagnosed patients with hypothyroidism, thyroiditis. The manifestation of most diseases is associated with the development of thyroid dysfunction. Under the hypothyroidism one can observe and diagnose the following: a syndrome of neuropsychiatric disorders with slowing down of motor activity, decrease in cognitive functions; syndrome of vegetative-trophic disorders with cutaneous mucinosis, polyneuropathy; syndrome of cardiovascular changes with decreased myocardial contractility, slow blood flow, progressive development of atherosclerosis; anemic syndrome; digestive tract syndrome with impaired motor and secretory functions of the gastrointestinal tract; syndrome of hormonal disorders with decreased secretion of thyroid hormones, especially T4, increased levels of TSH (in primary hypothyroidism) or decreased TSH (in secondary and tertiary). Results. Thyrotoxicosis in patients is determined by an enlarged thyroid gland with the development of: thyrotoxic cardiomyopathy and systolic arterial hypertension; thyrotoxic encephalopathy, syndrome of neuropsychiatric disorders with a predominance of excitation processes, vascular dysfunction; thyrotoxic ophthalmopathy, ectodermal disorders syndrome along with a decrease in TSH production and an increase in the level of free fractions T4, T3. Conclusions. The algorithm for diagnosing hypofunction and hyperfunction of the thyroid gland provides for: clarification of complaints and anamnesis data, examination of the patient, additional laboratory and instrumental examination, which includes the study of the thyroid status, possible autoaggression, analysis of metabolic processes, assessment of pathomorphological changes in the thyroid gland.

Elderly Patient with Hypertension in General Practice: Clinical Features and Antihypertensive Therapy

The prevalence of arterial hypertension (AH) increases with age: among people over 60 years old this index is more than 2 times higher in the general population, 2/3 of people over 65 years old suffer from hypertension. Among patients 65–89 years old with hypertension, 2/3 patients have isolated systolic hypertension (ISAG). Features of hypertension in the elderly patients are: lability of blood pressure (BP), increasing frequency of pseudohypertension, high frequency of «white coat hypertension», decreased sensitivity of pressor factors for antihypertensive drugs, high frequency of resistant to treatment of hypertension. The new recommendations of the European Society of Cardiology for the diagnosis and treatment of hypertension emphasize 2 groups of elderly patients: 65–79 years old and ≥80 years old, which described the epidemiological features, the prevalence of risk factors for cardiovascular events, blood pressure levels for antihypertensive therapy and target blood pressure, and the recommended principles of drug therapy that are different from young and middle-aged patients. For most patients, fixed combinations are indicated as starting AGT, but monotherapy is recommended for the treatment of hypertension in very elderly patients (over 80 years old) and elderly patients over 65 years old with senile asthenia. The decreasing of blood pressure should be gradual, taking into consideration the increased risk of orthostatic reactions at this age. European and American experts recommend os first-line drugs low doses of thiazide diuretics and calcium channel antagonists (mainly dihydropyridine), which are especially indicated in isolated systolic arterial hypertension to effectively reduce the frequency of cardiovascular complications in the treatment of elderly patients with hypertension.

Дисфункция миокарда левого желудочка и показатели суточного профиля артериального давления у больных артериальной гипертензией со старческой астенией

Aim. To study and analyze the systolic and diastolic left ventricle (LV) function, parameters of the ambulatory blood pressure (BP) monitoring in patients over 65 years of age with arterial hypertension, depending on the presence of frailty. Materials and methods. We examined 77 patients over 65 years of age (25 men and 52 women) with arterial hypertension, who were divided into two groups: with the presence of frailty (38 people) and its absence (39 people). To detect frailty, we used the "Age is not a hindrance" questionnaire validated in Russia and the "Get up and go" test. The examination included echocardiography with tissue doppler and ambulatory BP monitoring. Results. In both groups, LV systolic function remained within normal values, while diastolic function was impaired. In the group of people without frailty, type 1 of left ventricular diastolic dysfunction prevailed in 63% of cases, in the group with frailty, type 2 of left ventricular diastolic dysfunction with increased filling pressure was registered in 77% of cases. In both groups, both isolated systolic arterial hypertension and normal indicators of SBP and DBP were recorded during the day. Systolo-diastolic hypertension and hypotension have been presented by individual cases. At the same time, significant differences (p&lt;0.05) in the groups were revealed by the index of time of hypertension SBP at night and were higher in patients with frailty. Correlations were found between the time index of hypertension and SBP at night with the volume index of the left atrium in groups with frailty (0.34; p&lt;0.05) and without frailty (0.40; p&lt;0.05), as well as the time index of hypertension and SAD at night with the maximum rate of regurgitation on the tricuspid valve (0.42; p&lt;0.05) and with estimated systolic pressure in the pulmonary artery (0.41; p&lt;0.05) in the group with frailty. Conclusion. In the group of patients with arterial hypertension older than 65 years without frailty, violations of the left ventricular diastolic function by the type of slowing relaxation predominate, while in the group of patients with senile asthenia, violation of the left ventricular diastolic function by the type of pseudonormalization with increased filling pressure prevails. Features of the ambulatory BP monitoring of patients with hypertension older than 65 years with the presence of frailty are higher values of the time index of hypertension SBP at night. An increase in the time index of hypertension and SBP in patients with hypertension older than 65 years with frailty is associated with an increase in the volume of the left atrium, the rate of tricuspid regurgitation and systolic pressure in the pulmonary artery. The obtained data may indicate an adverse effect of frailty on the progression of heart failure in patients with arterial hypertension, which requires a comprehensive approach with the participation of a geriatrician in the management of such patients. Keywords: arterial hypertension, frailty, echocardiography, left ventricle, systolic function, diastolic function, ambulatory blood pressure monitoring, blood pressure For citation: Fomina ES, Nikiforov VS, Frolova EV, Reshetnik DA. Left ventricular myocardial dysfunction and parameters of ambulatory blood pressure monitoring in patients with arterial hypertension and frailty. Consilium Medicum. 2021; 23 (1): 80–83. DOI: 10.26442/20751753.2021.1.200476