Uncomplicated Arterial Hypertension Research Articles

Patient Adherence and Duration of Continuous Treatment With Various Arbs in Patients With Uncomplicated Arterial Hypertension in the USA Based on The Analysis of the Truven Health Analytics MarketScan Database.

To discuss two aspects that can be used to improve the adherence to therapy in patients with arterial hypertension (AH): 1) which of the angiotensin II receptor blockers (ARBs) provides the highest adherence rates; 2) how various factors influence adherence rates. An analysis of one of the world's largest clinical practice databases, Truven Health Analytics MarketScan (currently Merative MarketScan), was performed. The analysis included data on patients of both sexes aged 30 to 65 years who had been diagnosed with uncomplicated AH (at least once between March 1, 2012 and January 1, 2018) and prescribed monotherapy with one of ARBs. The exclusion criteria were heart failure and the treatment with two or more ARBs (simultaneously or sequentially) during the treatment period. Ultimately, the study included 717,099 patients with uncomplicated AH, who were divided into four groups based on the prescribed drug: azilsartan (n=4276), candesartan (n=6023), losartan (n=586,857), and valsartan (n=119,943). Adherence to treatment was evaluated by two parameters: duration of continuous therapy and medication possession ratio (MPR). The individual effect of each factor (specific ARB used for therapy, patient gender, age, initial ARB dose, patient co-payment per day of treatment) on the adherence to treatment was assessed using a regression analysis. The adherence to the ARB therapy was generally high. The MPR was the lowest in the azilsartan group and the highest in the candesartan group. However, the parameters that potentially influenced both the MPR and the duration of continuous therapy (patient's gender and age, initial ARB dose, co-payment size) differed significantly between the groups receiving different ARBs. The regression analysis showed that both adherence parameters and the duration of continuous therapy were higher in patients receiving candesartan than in patients receiving azilsartan, losartan or valsartan, when the effect on the adherence of other factors available for study (age, gender, initial dose of the drug, and the absolute size of co-payment for a day of therapy) was excluded. The lowest adherence to therapy was observed in the azilsartan treatment group (p<0.01). The study provided data for comparing the adherence of patients with uncomplicated AH to the therapy with different ARBs. Further study of adherence to treatment will provide additional data that will allow an optimal selection of drugs for the treatment of AH in patients with potentially poor adherence.

Features of the clinical course of arterial hypertension in patients with vitamin D deficiency.

Aim: To determine the peculiarities of the daily prof i le of blood pressure in patients with arterial hypertension (AH) and vitamin D def i ciency and insuf f i ciency, to evaluate the parameters of the lipid prof i le and quality of life in these patients. Materials and Methods: A total number of 97 patients with uncomplicated AH stage 1 and 2 were divided into 3 groups depending on the level of vitamin D in the blood serum. All patients underwent office blood pressure (BP) measurement and daily ambulatory BP monitoring for 24 hours, biochemical blood test with the determination of indicators of lipid metabolism, questionnaires for quality of life indicators. Statistical processing of the study results was carried out using "IBM SPSS Statistics 22". Results: "Non-dippers" are most often identif i ed in groups 1 and 2. Their prevalence is 1.8 times higher than in group 3 (p <0.05). The frequency of "night-peack-ers" in group 1 is 1.7 times higher than in group 2 and 2.6 times higher than in group 3 (p < 0.05). Patients with AH and vitamin D def i ciency have severe lipid metabolism disorders (p < 0.05). The correlation analysis shows a direct relationship of average strength between them and average daily systolic and diastolic BP indicators (р<0.05). Conclusions: Patients with AH and vitamin D def i ciency has an increase in cardiovascular risk, which is manifested by increase in pressure load indicators, frequency of detection of "night-peakers" and lipid metabolism disorders which is worsens of vascular accidents prognosis.

Factors, associated with major adverse events in rural males with arterial hypertension at long-term follow-up

Background and Aims : To study the factors, associated with major adverse events (MAEs) in rural males with uncomplicated arterial hypertension (HTN) at long-term follow-up.Methods: The prospective study enrolled 160 rural males with uncomplicated primary HTN (mean age 50 ± 6 years). We analyzed clinical and instrumental data. High-to-very high SCORE cardiovascular risk was identified in 102 (63,7%) patients. Blood pressure visit-to-visit variability (VVV) was assessed by standard deviation and coefficient of variation (CV) (derived from the four consecutive visits). Left ventricular (LV) hypertrophy (by echo) was detected in 129 (80,6%) patients. The median of follow-up was 27 months (interquartile range 24-30 months). During the follow-up period, 14 (8,8%) patients presented with MAEs (totally, 17 events): acute cerebrovascular event (n=9); myocardial infarction (n=2); first-onset atrial fibrillation (AF) (n=2); AF transition in permanent pattern (n=2); and relative LV ejection fraction decline >10% (n=2).Results: At multivariable analysis, the factors, associated with MAEs at long-term follow-up, were as follows: SCORE cardiovascular risk (per 1 % increase: HR 1,09 (95% CI 1,01-1,17); р=0,034); mean arterial pressure (MAP) (per 1 mm Hg increase: HR 1,23 (95% CI 1,07-1,41); р=0,003); CV (MAP) (per 1% increase: HR 1,41 (95% CI 1,08-1,83); р=0,012); and LV myocardial mass, indexed by height2,7 (per 1 g/m2,7 increase: HR 1,07 (95% CI 1,03-1,11); р=0,001).Conclusions: Long-term MAEs in rural HTN males were associated with SCORE cardiovascular risk, MAP, MAP VVV (by CV) and LV myocardial mass index (by height2,7). These factors should be taken into account while MAEs risk stratification in rural males with uncomplicated HTN. Background and Aims : To study the factors, associated with major adverse events (MAEs) in rural males with uncomplicated arterial hypertension (HTN) at long-term follow-up. Methods: The prospective study enrolled 160 rural males with uncomplicated primary HTN (mean age 50 ± 6 years). We analyzed clinical and instrumental data. High-to-very high SCORE cardiovascular risk was identified in 102 (63,7%) patients. Blood pressure visit-to-visit variability (VVV) was assessed by standard deviation and coefficient of variation (CV) (derived from the four consecutive visits). Left ventricular (LV) hypertrophy (by echo) was detected in 129 (80,6%) patients. The median of follow-up was 27 months (interquartile range 24-30 months). During the follow-up period, 14 (8,8%) patients presented with MAEs (totally, 17 events): acute cerebrovascular event (n=9); myocardial infarction (n=2); first-onset atrial fibrillation (AF) (n=2); AF transition in permanent pattern (n=2); and relative LV ejection fraction decline >10% (n=2). Results: At multivariable analysis, the factors, associated with MAEs at long-term follow-up, were as follows: SCORE cardiovascular risk (per 1 % increase: HR 1,09 (95% CI 1,01-1,17); р=0,034); mean arterial pressure (MAP) (per 1 mm Hg increase: HR 1,23 (95% CI 1,07-1,41); р=0,003); CV (MAP) (per 1% increase: HR 1,41 (95% CI 1,08-1,83); р=0,012); and LV myocardial mass, indexed by height2,7 (per 1 g/m2,7 increase: HR 1,07 (95% CI 1,03-1,11); р=0,001). Conclusions: Long-term MAEs in rural HTN males were associated with SCORE cardiovascular risk, MAP, MAP VVV (by CV) and LV myocardial mass index (by height2,7). These factors should be taken into account while MAEs risk stratification in rural males with uncomplicated HTN.

Efficacy of Dynamic Еlectric Neurostimulation in the Complex Treatment of Patients with Arterial Hypertension

Low adherence of patients with arterial hypertension to regular therapy increases the risk of fatal complications. Patients’ motivation for treatment can be increased by non-drug methods of exposure. Aim. To evaluate the effectiveness of the inclusion of dynamic electric neurostimulation in the treatment regimens of patients with arterial hypertension to control blood pressure (BP) levels. Material and methods. 60 patients aged 25-55 years old with verified diagnosis of arterial hypertension (I-II degree) were examined in Novosibirsk City Clinical Hospital № 2. The 1st group (the main group, n=30) received a 15-day course of acupuncture of the neiguan point from the apparatus «Leomax-Cardio Compact» in addition to the standard therapy; the 2nd group (comparison group, n=30) received the standard treatment complex and simulation of acupuncture exposure. Patients were trained to use the «LeomaxCardio compact» device and to perform self-monitoring of arterial pressure (BP) from the UA-767 (AND) device. The checkup included carbohydrate, lipid metabolism, kidney function, electrocardiography assessment, daily BP monitoring. Results and discussion. By the end of observation, the target BP levels in the 1st group patients were 70.0% achieved, we managed to correct the variability of systolic and diastolic BP relative to the initial values by 1.3 and 1.6 times respectively, to decrease the rate of morning rise of systolic BP by 1.3 times, to increase the frequency of the variant of daily BP profile “dippers” by 1.3 times and to decrease the number of “non-dippers” by 1.7 times, which differed from the similar indicators in the 2nd group. Electro-puncture with «LeomaxCardio Compact» may have an antihypertensive effect due its effect on the suprasegmental parts of the autonomic nervous system. Conclusion. Inclusion of electropuncture from the device Leomax-Cardio Compact in the treatment regimens of patients with uncomplicated arterial hypertension allows to correct the neurovegetative regulation, which allows effective control of the target values of systemic hemodynamics

Associations between Heart Rate Variability Parameters and Hemodynamic Profiles in Patients with Primary Arterial Hypertension, Including Antihypertensive Treatment Effects.

Background: Autonomic nervous system (ANS) dysfunction is an important factor in the development and progression of arterial hypertension (AH) and may produce adverse hemodynamic sequelae. ANS function can be evaluated by analyzing heart rate variability (HRV). The purpose of this study was to assess the possible correlation between HRV and the hemodynamic profile of AH patients, including antihypertensive treatment effects after 12 months. Methods: The study was conducted on 144 patients with uncomplicated AH. The hemodynamic profile was assessed via echocardiography and impedance cardiography (ICG). The analyzed HRV parameters included SDNN, rMSSD, pNN50, low frequency (LF, 0.05–0.15 Hz), high frequency (HF, 0.15–0.4 Hz), total power (TP, the variance of all NN intervals), and the day, night, and 24-h low-to-high frequency ratios (LF/HF). Results: Analysis showed various correlations of HRV parameters both with arterial blood pressure and with the hemodynamic profile assessed via echocardiography and ICG. The HRV parameters of increased ANS activity showed a correlation with improved left ventricle function (LV) and lower LV afterload. Conclusions: Effective antihypertensive treatment demonstrated beneficial effects on both the ANS balance and the hemodynamic profile.

Non-invasive myocardial work indices in arterial hypertension: relevance to hypertension grade assessed by 24-hour blood pressure monitoring

Abstract Funding Acknowledgements Type of funding sources: None. Background. A novel approach to non-invasive myocardial work (MW) assessment was shown to be of clinical value in different scenarios. It based on left ventricle (LV) pressure-global longitudinal strain (GLS) loops computation. Systolic LV pressure is assumed to be equal to brachial cuff systolic pressure. However, single blood pressure (BP) measurement during echocardiography may be influenced by many factors, e.g. «white-coat» effect. The purpose of this study was to evaluate MW indices in patients from mild to severe arterial hypertension (AH) assessed by 24-hour ambulatory blood pressure monitoring. Methods. The study enrolled 90 males (mean age 47 ± 9 years) with uncomplicated arterial hypertension (AH), divided into 3 groups (mild AH, moderate AH, severe AH). All patients underwent conventional echocardiography, speckle tracking echocardiography with LV pressure-strain loops computation and 24-hour BP monitoring at the same day. The AH grade was assessed by DABL criteria. MV indices were calculated with specific software by integrating LV global longitudinal strain data and non-invasively estimated LV pressure. The following parameters were calculated: global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). The values are given as median and interquartile range. Results. The patients in groups were comparable by demographic and clinical characteristics. We didn"t find any difference between groups by conventional echocardiographic parameters, including LV wall thickness, LV mass index, LV ejection fraction and LV GLS. The significant difference was present between three groups in all MW indices (Table). The patients with severe AH had higher GWI, as well as GCW and GWW compared to patients with mild and moderate AH. The GWE was significantly decreased in patients with highest BP values. Conclusions. Myocardial work indices are more sensitive markers of LV function in patients with AH compared to standard parameters. Integration of systolic BP, assessed by 24-hour BP monitoring in MW analysis may potentially give more precise characteristics of LV function in hypertensive patients. Abstract Figure.

Retrospective analysis of drug utilization and rational drug use in treatment of essential arterial hypertension in Bulgaria: Generic perception

Aim: To analyze drug utilization and rational drug use in treatment of essential arterial hypertension in Bulgaria by using quantitative and qualitative parameters at national level. To assess generic penetration as a part of rational drug use. Materials and methods: Design: retrospective study of publicly accessible data from registries of National health insurance fund for the period January–December 2017. The analyses are in accordance with ATC/DDD methodology of WHO. The data was processed via descriptive statistical methods. Results: The analyzed population includes 185 671 patients with essential arterial hypertension—13.33% of all hypertensive patients. The expenses for 2017 are 9 796 940.12 BGN (Bulgarian leva; 1 Euro=1.95,585 BGN). The expense per patient per year is 52.76 BGN, monthly expense is 4.40 BGN and daily expense is 0.14 BGN. The sum of 9 796 940.12 BGN is divided into two groups—expenses for monoproducts 65.88% and expenses for combined products 34.12%. Blockbusters are INNs lercanidipine and nebivolol. The total expenses for uncomplicated essential arterial hypertension are 1.22% of the total expenses. With this resource, 1.6 DDD/Patient/Day is provided. Discussion: In Bulgarian therapeutic practice, the most prescribed products are beta-blockers nebivolol and bisoprolol, calcium antagonist lercanidipine, and centrally acting antiadrenergic agents rilmenidine and moxonidine. Sartanes are represented mainly by valsartan. In all section analyses, the considerable use of lercanidipine is evident. Reference (original) medicinal products are mainly prescribed, while the market share of generic products, both in terms of costs and DDD, is significantly lower. Obtained results are inconsistent with European recommendation, while lack of national pharmacotherapeutic guideline poses a serious challenge.

Peculiarities of development of antihypertensive action of multicomponent herbal drug Carvelis in middle-aged patients with uncomplicated arterial hypertension

Background. In more than a third of middle-aged individuals, the syndrome of arterial hypertension is determined by a combination of psychoemotional disorders and autonomic dysfunction. The purpose of the research was to study the features of psychoemotional disorders and autonomic homeostasis in 78 middle-aged patients with uncomplicated arterial hypertension and their correction by the use of Carvelis in comprehensive antihypertensive therapy. Materials and methods. The main group consisted of 40 patients with hypertension. They were prescribed a herbal complex Carvelis with standard antihypertensive treatment. Dose of Carvelis was 30 drops 3 times a day for 6 months. The second group was a control one, which included 38 hypertensive patients, who received only antihypertensive therapy. During the first visit, all patients had certain disorders of cerebral and subcortical structures, associated with signs of autonomic dysfunction, deterioration of emotional state and significant psychological stress. Results. The prescription of Carvelis for 6 months allowed achieving a decrease in blood pressure: systolic blood pressure — by 12.8 mmHg, diastolic — by 12.3 mmHg, whereas a decrease in blood pressure in the control group was less (5.0 and 5.3 mmHg, respectively) and insignificant. The antihypertensive effect of Carvelis treatment was realized through its components — hawthorn, valerian, lemon balm, motherwort. They reduced the activity of the sympathetic link of the autonomic nervous system: SDNN and RMSSD increased significantly— by 54.2 and 55.7 %, respectively, and reached physiological limits. The positive dynamics of the integrated indicators of autonomic balance and fractal index in these patients showed a more complete restoration of vagosympathetic interactions at the vascular level of homeostasis. The use of Carvelis led to the harmonization of emotional state and reduction in the level of psychological stress, which was characterized by a decrease in the index of emotional excitability by 24.5 % and anxiety — by 17,3 %, state of depression — by 21.5 % (Hospital Anxiety and Depression Scale). The analysis of systemic parameters of homeostasis regulation showed that 6-month treatment with Carvelis increased significantly the general level of bioenergy, the state of vascular regulation reserves and operative control of autonomic vascular regulation. These changes were consistent with the level of activity of the vasomotor center of vascular tone regulation, the indicators of which decreased significantly.

Leukocyte telomerase concentration is inversely associated with central wave reflection in patients with hypertension

Abstract Introduction Telomere length and telomerase are biomarkers of aging and cardiovascular diseases. Arterial stiffness is associated with vascular age and higher risk of cardiovascular diseases. Decreased reparative cell's potential may cause vascular ageing and predispose to the progression of hypertension. Objective To determine association leukocyte telomerase concentration (TC) and relative telomere length (RTL) with arterial stiffness in hypertensive patients. Material and methods The study included 120 people (70 patients with uncomplicated arterial hypertension (AH) and 50 normotensive individuals). Mean age of hypertensives was 54.8±9.3 and of normotensives was 50.2±9.73 years. Dietary habits, smoking, level of physical activity, body mass index, waist circumference, presence of obesity, blood pressure (BP) level, family history of cardiovascular deseases, depressive episodes and psychological stress according the international questionnaires, glucose; cholesterol, angiotensin II, renin and aldosteron in blood were assessed in the participants. Aortic BP, aortic pulse pressure, augmentation index (AIx), AIx adjusted for heart rate 75 beats per minute (Aix@HR75), pulse wave velocity (PWV) were determined by the applanation tonometry. RTL of peripheral blood leukocytes was performed by real-time PCR. The leukocyte TC was measured using the enzyme immunoassay. Results There were no differences between patients with AH and normotensives in both leukocyte TC (4.9 (4.0; 8.0) versus 6.2 (4.1; 9.4), p=0.281) and RTL (0.94 (0.86; 1.0) versus 0.96 (0.83; 1.0), p=0.978). In hypertensive and normotensive groups the mean systolic aortic BP were 130.6±17,7 and 109.9±11.7 mmHg (p&amp;lt;0.001), aortic pulse pressure – 41.5±9,7 and 33.6±10,4 mmHg (p&amp;lt;0.001), Aix@HR75 – 16.0 (7.0; 28.0) and 27.0 (13.0; 35.0)% (p=0.004), PWV –7.9±1.4 and 8.1±1,7 m/s (p=0.409) respectively. In patients with AH the mean leukocyte TC was lower with an increased Aix@75 (&amp;gt;25%) in contrast to the group of patients with normal Aix@75 (4.45 (3.9; 7.8) versus 7.97 (4.6; 10.0) ng/ml; p=0.043). Based on the multivariate logistic regression analysis independent factors influencing on the Aix@75 were leukocyte TC &amp;lt;5 ng/ml with the family history of AH (OR=1.9, 95% CI: 1.1–3.4; p=0.036), the degree of AH combined with decreased salt sensitivity (OR=3.1; 95% CI: 1.3–7.5; p=0.010) and age (OR=1.2; 95% CI: 1.1–1.2; p=0.001). Conclusions Decrease of the leukocyte telomerase concentration associated with the raise of augmentation index in patient with uncomplicated AH. As a parameter of central wave reflection the augmentation index may considered as an early sign of biological and vascular aging in hypertension. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The state program of scientific research “Fundamental and applied sciences for medicine”

Dynamics of left ventricle myocardial deformation, soluble ST2 and cardiotrophin-1 in hypertensive women on combined valsartan/hydrochlorothiazide therapy

Abstract Funding Acknowledgements Type of funding sources: None. Background. The treatment-induced regression of left ventricular hypertrophy (LVH) is associated with improved prognosis in patients with arterial hypertension. However, the assessment of LVH by echo is restricted by substantial measurement variability and low sensitivity to changes during follow-up. The alternative approach could be the dynamic evaluation of myocardial deformation parameters and biochemical markers of cardiac remodeling. The purpose of this study was to assess the dynamics of left ventricle (LV) myocardial deformation, soluble ST2 and cardiotrophin-1 levels in hypertensive women treated with combination of valsartan/hydrochlorothiazide. Methods. The study involved 100 postmenopausal women (mean age – 57.7 ± 4.3 years) with uncomplicated arterial hypertension. All patients were treated with combination of valsartan (80-320 mg; average dose 195 mg) and hydrochlorothiazide (12.5 mg). Ambulatory blood pressure monitoring, conventional and 2-dimensional speckle tracking echocardiography were performed before and 6 months after treatment. The concentrations of cardiotrophin-1 and soluble ST2 were determined by ELISA method. The data are presented as median and interquartile range. Results. Treatment with valsartan/hydrochlorothiazide was effective and well tolerated. Target blood pressure level was achieved in 64 % of the patients. The LV global longitudinal strain (GLS) raised significantly after 6 months of treatment (Table). We found the reduction of mechanical dispersion - parameter, which indirectly reflects myocardial tissue homogenicity. The levels of circulating cardiotrophin-1 and soluble ST2 decreased by 37.93% and 19.74%, respectively (p &amp;lt; 0.0001). Conclusions. The 6-month therapy with valsartan/hydrochlorothiazide was associated with improvement of myocardial deformation parameters with concomitant reduction of soluble ST-2 and cardiotrophin-1 levels. These markers could be more sensitive than standard parameters for hypertensive patients" follow-up. However, this approach should be confirmed in future studies. Parameter Baseline 6-month p Office SBP, mm Hg 148 (140; 157) 135 (124; 143) &amp;lt;0.0001 Office DBP, mm Hg 89 (82; 96) 81 (74; 87) &amp;lt;0.0001 LV GLS, % -19.6 (-18.1; -21.1) -20.4 (-18.9; -21.8) 0.01 Mechanical dispersion, ms 43 (37; 51) 41 (37; 48) 0.04 Cardiotrophin-1, pg/ml 12.2 (9.4; 16.81) 8.5 (6.26; 10.82) &amp;lt;0.0001 Soluble ST2, ng/ml 25.3 (17.93; 29.72) 18.2 (13.93; 25.96) &amp;lt;0.0001 Values are given as median and interquartile range

The coArtHA trial\u2014identifying the most effective treatment strategies to control arterial hypertension in sub-Saharan Africa: study protocol for a randomized controlled trial

BackgroundArterial hypertension is the most prevalent risk factor for cardiovascular disease in sub-Saharan Africa. Only a few and mostly small randomized trials have studied antihypertensive treatments in people of African descent living in sub-Saharan Africa.MethodsIn this open-label, three-arm, parallel randomized controlled trial conducted at two rural hospitals in Lesotho and Tanzania, we compare the efficacy and cost-effectiveness of three antihypertensive treatment strategies among participants aged ≥ 18 years. The study includes patients with untreated uncomplicated arterial hypertension diagnosed by a standardized office blood pressure ≥ 140/90 mmHg. The trial encompasses a superiority comparison between a triple low-dose antihypertensive drug combination versus the current standard of care (monotherapy followed by dual treatment), as well as a non-inferiority comparison for a dual drug combination versus standard of care with optional dose titration after 4 and 8 weeks for participants not reaching the target blood pressure. The sample size is 1268 participants with parallel allocation and a randomization ratio of 2:1:2 for the dual, triple and control arms, respectively. The primary endpoint is the proportion of participants reaching a target blood pressure at 12 weeks of ≤ 130/80 mmHg and ≤ 140/90 mmHg among those aged < 65 years and ≥ 65 years, respectively. Clinical manifestations of end-organ damage and cost-effectiveness at 6 months are secondary endpoints.DiscussionThis trial will help to identify the most effective and cost-effective treatment strategies for uncomplicated arterial hypertension among people of African descent living in rural sub-Saharan Africa and inform future clinical guidelines on antihypertensive management in the region.Trial registrationClinicaltrials.govNCT04129840. Registered on 17 October 2019 (https://www.clinicaltrials.gov/).

Tachycardia: The hidden cardiovascular risk factor in uncomplicated arterial hypertension.

Early detection and management of elevated blood pressure is crucial in reducing the burden of cardiovascular disease (CVD). The importance of an absolute risk assessment and patient risk stratification has been highlighted in the European hypertension guidelines since 2003. Amongst numerous risk factors influencing patient prognosis, elevated heart rate (HR) has been indicated as important predictor of future risk of hypertension, coronary heart disease, sudden cardiac death, heart failure, CVD, stroke, total cancer and mortality. Given that resting HR can be easily determined in clinical practice and modified by lifestyle changes as well as beta-blocker therapy, it seems reasonable that lowering resting HR should be a potential target to reduce disease burden and premature mortality. However, there is a lack of outcome studies of HR lowering in tachycardia-related hypertension. This review outlines the underlying mechanisms of early course hypertension pathophysiology with the critical role of the sympathetic nervous system activation, the prognostic significance of fast HR and the mechanistic rationale for the use of non-pharmacological approaches and/or highly long-acting cardioselective beta-blockers with some consideration given to betaxolol properties.

Arterial hypertension: the accent on the target organs’ protection

Background. Prolonged untreated arterial hypertension (AH) is accompanied by the damage of target organs (brain, eyes, kidneys, heart and large vessels). This problem can be prevented by the stable control of blood pressure (BP).&#x0D; Objective. To identify the main strategies for the target organs protection in AH.&#x0D; Materials and methods. Analysis of the available guidelines and literature data; the own study of L-arginine (Tivortin, “Yuria-Pharm”) administration.&#x0D; Results and discussion. BP lowering is an integral part of improving the outcome in patients with AH. Reduction of systolic BP by 10 mm Hg leads to the reduction of stroke risk by 27 %, heart failure risk – by 28 %, coronary heart disease risk – by 17 %. The primary goal of treatment of all patients with AH is to achieve the BP level &lt;140/90 mm Hg, in case of good tolerability – &lt;130/80 mm Hg. More intensive treatment with the achievement of BP &lt;130/80 mm Hg provides a more pronounced reduction of the risk of cardiovascular events. Reduction of systolic BP &lt;120 mm Hg is not reasonable. In patients with AH and chronic kidney disease, the target systolic BP should be 130-140 mm Hg. It is important to achieve normalization of BP quickly (within 3 months of treatment), as an early control of this parameter provides a better prognosis (VALUE study). The treatment strategy for uncomplicated AH involves initial therapy with a two-component combination in a single tablet (angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) + calcium channel blocker (CCB) or diuretic). At the next stage, a triple combination (ACEI/ARB + CCB + diuretic) is prescribed. According to the indications, β-blockers can be added at any stage. It is necessary to use drugs with proven organoprotective properties based on the target organs affection and concomitant nosological conditions of each individual patient. Even in patients with resistant AH long-term antihypertensive therapy improves renal function and reduces left ventricular hypertrophy. Additional ways of organoprotection in hypertension include the influence on the vascular endothelium condition. According to the results of our own study, the inclusion of L-arginine (Tivortin, “Yuria-Pharm”) into the basic therapy of AH can significantly reduce albuminuria compared with the control group (basic therapy without L-arginine), as well as improve the flow-dependent vasodilation (from 6.7 to 13.6 %, whereas in the control group this parameter has changed from 6.5 to 9.8 %; p&lt;0.001). In the L-arginine group, the glomerular filtration rate also increased significantly, while in the control group this indicator decreased. The renal artery resistance index also decreased (from 0.68 to 0.65 units; no changes were recorded in the control group).&#x0D; Conclusions. 1. To prevent the damage of target organs, it is necessary to quickly and stably reduce BP to the target values. 2. It is advisable to prescribe antihypertensive drugs with proven organoprotective properties. 3. L-arginine (Tivortin) improves the condition of the endothelium, thereby promoting vasodilation and improving renal function.

Healthy diet and telomerase activity in patients with uncomplicated arterial hypertension

Abstract Introduction Telomere length is considered as a novel biomarker indicating the risk of a cell's age, metabolic disturbances and age-related diseases. The available evidence suggests that healthy diet with antioxidant nutrients, fruits and vegetables, Mediterranean diet can influence on telomere length. Telomerase enzyme answers the end replication problem that counters telomere shortening. The effects of the nutrition on telomere length and telomerase activity required further study. Objective To evaluate the association of the healthy diet with relative telomere length (RTL) and telomerase activity (TA) in patients (pts) with uncomplicated arterial hypertension (AH). Material and method The clinical and genetic examinations were performed in 90 people (42 patients with uncomplicated arterial hypertension (AH) and 48 normotensive individuals). Mean age of hypertensive pts was 51.5±9.3 and of normotensives was 48.5±10.2 years. RTL of peripheral blood leukocytes performed by previously validated real-time PCR. TA was determined by enzyme immunoassay method. Dietary habits, alcohol intake, smoking, level of physical activity, body mass index, waist circumference, presence of obesity, blood pressure (BP), glucose and cholesterol levels, depressive episodes and psychological stress according the international questionnaires were evaluated. Results Mean RTL was 0.86±0.14 in group of hypertensive pts and 0.91±0.10 in normotensives, p=0.139. The median TA was higher in normotensives – 5.9 ng/ml (IQR 4.1–9.6) than hypertensive pts – 4.0 ng/ml (IQR 3.3–7.3), p=0.004.The association was found between TA and more frequent consumption per week of vegetable and fish in both groups (r=0.501, p=0.005 and r=0.447, p=0.013 in hypertensive pts; r=0.297, p=0.045 and r=0.316, p=0.036 in normotensives, accordingly). In hypertensive pts also was found relation TA with daily fruit intake (r=0.493; p=0.006) and trend toward to dietary salt consumption (r=−0.316; p=0.08). Among normotensives there was negative trend to relation TA with daily consumption of meat (r=−0.291; p=0.056). There were no association RTL, TA with age, alcohol intake, smoking, levels of glucose and cholesterol, BP, obesity and psychological risk factors in two groups except for the relation TA with waist circumference in normotensives (r=−0.427; p=0.003). Conclusion The data suggests that the healthy diet with regular intake of fish, vegetable and fruit can influence on telomerase activity in patients with uncomplicated AH as well as in normotensive individuals. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Budget

Is insulin resistance play a role in left atrium dysfunction in young hypertensive patients?

Abstract Insulin resistance with normoglycemia could lead to subclinical inflammation, left atrium enlargement and ventricular systolic and diastolic dysfunction. The aim of our study was to analyzed associations between markers of insulin resistance and parameters of left atrium function in young hypertensive patients. Methods 965 young people were screened, among which 64 (6.6%) had high normal blood pressure and 57 (5.9%) had arterial hypertension. 121 patients with uncomplicated arterial hypertension grade 1–2 were included to the study (81% male, mean age 25.6 (7.3) years, 22 (18%) had obesity, 51 (42%) were smokers). All patients undergone clinical and laboratory evaluation, 24-h blood pressure monitoring, echocardiography. LA function were evaluated by 2D-speckle tracking echocardiography with left atrial reservoir strain (LASr), left atrial booster strain (LASb), left atrial conduit strain (LACs). Insulin level, serum glucose, was measured by using overnight fasting blood sampling between 7 am and 9 am. Insulin resistance was evaluated by HOMA-IR. Results Mean office systolic BP was 132 [122; 138]; diastolic BP – 70 [63; 76]. LAVI was 23 [19; 27] ml/m2. Mean insulin was 8.1 [5.4; 12.3] mIU/l, HOMA-IR – 1.9 [1.2; 2.8]. Correlations between LASr and body mass, waist circumference, insulin level, uric acid, HOMA-IR, E/e', LASb and insulin, HOMA-IR, uric acid, LASc and body mass, waist circumference, insulin level were revealed (p&amp;lt;0.05). Independent association LASc with BMI (B −0.22, p=0.02), LASb with insulin level (B −0.37, p=0.02), LASr with insulin (B −0.37, p=0.02) and with left ventricular (LV) global longitudinal strain (B −0.32, p=0.046) were confirmed in multiple stepwise regression model. Associations between endomyocardial LASb and insulin, HOMA-IR, endomyocardial LASr and body mass, waist circumference, insulin, uric acid, HOMA-IR, E/e', LASra and insulin and HOMA-IR, LASre with body mass, waist circumference, insulin, uric acid, HOMA-IR (p&amp;lt;0.05) were found during correlation analysis. Multiple stepwise regression showed independent associations endomyocardial LASb with HOMA-IR (B −0.44, p=0.005), endomyocardial LASr with HOMA-IR (B −0.46, p=0.003) and with LV global longitudinal strain (B −0.31, p=0.04), LASra with HOMA-IR (B −0.46, p=0.008), LASre with body mass (B −0.48, p=0.036) and with insulin (B −0.38, p=0.001). Conclusion Left atrium reservoir function is load dependent and influenced by LV function. For subclinical left atrium remodeling assessment booster function should be analized along with reservoir function. In young hypertensive patients insulin level were independently associated with left atrial dysfunction. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Project 5-100

1230 The atrial stiffness index in hypertensive women with indeterminate diastolic function

Abstract Background Despite new 2016 ASE/EACVI guidelines on diastolic function (DF), there is still significant amount of patients with indeterminate results. The left atrial (LA) longitudinal strain could provide additional information in case of inconclusive results. Recenty, a new LA stiffness index was proposed as ratio between E/e" and LA global longitudinal strain (GLS). The purpose of this study was to test the diagnostic utility of LA stiffness index in hypertensive women with inderterminate DF. Methods The study enrolled 100 postmenopausal women (mean age 57 ± 4 years) with uncomplicated arterial hypertension, divided into 3 groups (normal DF, indeterminate DF, diastolic dysfunction). The DF was assessed with both 2009 and 2016 ASE/EACVI algorithms. LA longitudinal strain was measured as peak of deformation curves with R-wave variant of ECG triggering. The LA GLS was measured by averaging 12 segmental values. The atrial stiffness index was calculated as E/e" ratio to LA GLS. Results The prevalence of indeterminate DF was higher with assessment by 2016 algorithm (53 % vs 38 %). The E/e" ratio was significantly increased in patients with indeterminate DF compared to normal function (Table). LA GLS was decreased only in patients with inconclusive resuts by 2009 algorithm. LA stiffness index was increased gradually according to diastolic abnormalities severity. The significant difference between three groups was only found with categorization of patients by 2016 algorithm. Conclusions The novel LA stiffness index could be additional parameter of DF assessment in case of indeterminate results. However, it needs further validation in simultaneous echo-invasive studies. LA mechanics in diastolic dysfucntion Parameter Normal diastolic function Indeterminate function Diastolic dysfunction p 2009 guidelines Prevalence, % 31 38 31 E/e" ratio 8,07 (7,36-9,6) 9,91 (8,44-11,6)* 11 (10,52-13)*^ p &amp;lt; 0,0001 LA GLS, % 34,8 (30,2-39,9) 30,8 (26,5-34,9)* 28,9 (24,2-36)* p = 0,028 LA stiffness index 0,24 (0,18-0,31) 0,32 (0,27-0,39)* 0,37 (0,31-0,46)* p &amp;lt; 0,0001 2016 guidelines Prevalence, % 40 53 7 E/e" ratio 8,8 (7,74-10,1) 10 (8,6-11,7)* 14 (12-14,9)*^ p &amp;lt; 0,0001 LA GLS, % 34,2 (28,4-39,1) 30,8 (26,5-34,8) 29,6 (25,1-37,8) p = 0,18 LA stiffness index 0,27 (0,2-0,34) 0,33 (0,27-0,4)* 0,47 (0,38-0,59)*^ p = 0,001 The values are given as median and interquartile range. * - compared to normal function ^ - compared to indeterminate result

Pecularities of Arterial Hypertension Prevalence and Intervisit Variability of Blood Pressure in Khmelnytskyi Region

The objective: to carry out the comparative analysis of arterial hypertension (AH) prevalence in rural and city population of Khmelnytskyi region, and to establish the frequency of patients with high intervisit variability of blood pressure (IVBP) in rural population.Materials and methods. We carried out the analysis of prevalence of AH and its major complications (myocardial infarction and cerebrovascular accident) in rural and city population of Khmelnytskyi region in dynamics during the period 2016–2018, based on official statistical data (form 12). The IVBP was studied in a random sample of 160 rural males with uncomplicated AH. Systolic blood pressure (BP), diastolic BP and the pulse BP were measured at each visit to doctor. IVBP was assessed by the standard deviation (SD) value, calculated from the BP recordings at the four visits to doctor. We also calculated the variation coefficient as a SD/average BP ratio.Results. It was established that the prevalence of AH in the population of Khmelnytskyi region was high (39 352,5 per 100 000 inhabitants), accompanied by the higher prevalence of stroke, in comparison with average stroke prevalence inUkraine. The prevalence of AH in rural population exceeded the corresponding index in the urban population, and was characterized by considerable variations in certain rural areas. The frequency of high IVBP in rural AH males was 51,25%. The high IVBP among males was mainly caused by significant variation of systolic BP (50,62%), and high variability of diastolic BP was observed only among 12,5% of patients with AH. The lipid profile changes and hypertension-mediated organ damage (namely heart and kidneys) were more pronounced in patients with high IVBP, as compared to males with low IVBP.Conclusions. The prevalence of AH in the population of Khmelnytskyi region is high, with the higher value in rural population as compared to the city one. The prevalence of stroke in Khmelnytskyi region remains high, with the tendency to increase during the last several years. Such unfavorable dynamics could be at least partially related to the high frequency (more than 50%) of patients with AH and high IVBP.

The effectiveness of therapy with valsartan and hydrochlorothiazide and its effect on the left atrial myocardium condition in women with arterial hypertension in postmenopause

Purpose - to evaluate the effectiveness of the combination of valsartan and hydrochlorothiazide and its effect on the structural and functional parameters of the left atrial myocardium in postmenopausal women with arterial hypertension.Materials and methods. An open prospective controlled study included 100 postmenopausal women with uncomplicated arterial hypertension. Transthoracic and speckle tracking echocardiography was performed on a Vivid E9 XDClear Console 4D Expert 100 ultrasound scanner (General Electric, USA) with ECG-synchronization. Ambulatory blood pressure monitoring was performed using the device ABPM-04 (Meditech, Hungary). After 6 months of treatment with the antihypertensive combination of valsartan and hydrochlorothiazide, all women were re-examined in full. Statistical analysis of the results was performed using the Statistica 13.0 software package. All tests were two-way, statistically significant considered differences at P < 0.05.Results. As a result of our study, office systolic and office diastolic blood pressure in postmenopausal women with arterial hypertension significantly decreased (P < 0.001) due to a 6-month treatment with valsartan and hydrochlorothiazide. The target level of blood pressure, according to office measurements, was reached by 64 % of patients. A significant decrease of the SBP time index in the daytime in 1.6 times (P = 0.012), morning rise of SBP (P = 0.021) and the average pulse blood pressure (P = 0.012) was observed. Analysis of the LA deformation dynamics under the 6-month antihypertensive therapy did not reveal significant changes in the longitudinal strain of the LA in postmenopausal women with AH, unlike left ventricular strain.Conclusions. Combined antihypertensive therapy with valsartan and hydrochlorothiazide in postmenopausal women is effective, safe and well-tolerated. The use of this therapy for 6 months does not significantly affect the size and deformation properties of the left atrium, in contrast to the positive structural and functional remodeling of the left ventricle.

P3574Association of the plasma aldosterone, arterial stiffness and left atrium volume index in hypertensive patients

Abstract Relative aldosterone excess is related with arterial stiffness, endothelial dysfunction and profibrotic effects on the heart. We aimed to evaluate the association of plasma aldosterone and pulse wave velocity (PWV) with left ventricular (LV) diastolic function in patients with uncomplicated arterial hypertension (AH). Methods The study included 74 patients (41% male), mean age 62.0±8.2 years. Among these patients 22 (30%) had diabetes mellitus, 60 (81%) had dyslipidemia, 8 (11%) were smokers. All patients undergone clinical and laboratory evaluation, echocardiography and applanation tonometry. Plasma aldosterone concentration (PAC) was measured by using overnight fasting blood sampling between 7 am and 9 am. Results Mean PWV was 11.3±2.4 m/s, heart rate (H) was 72±10 bpm, aortic systolic BP was 160±21 mm Hg, aortic diastolic BP was 89±10 mm Hg, aortic pulse pressure was 60±19 mm Hg, augmentation index normalized for HR of 75 beats/min (AIx75) was 15±10%, LVMI was 124±33 g/m2, LAVI was 36±6 ml/m2, E/e' was 10.8±4.6. In simple analysis PAC significantly (p&lt;0.05) correlated with brachial (r=0.29) and aortic diastolic BP (r=0.27), LAVI (r=0.32), E/e' (r=−0.41). After adjustment in multivariate regression model gender, waist circumference, creatinine, AIx, LV global longitudinal strain relationship between E/e' and PAC was lost. E/e' was significantly associated only with female gender (β=0.64, p=0.0008). Also multivariate regression analysis showed significant association of LAVI with brachial systolic BP (β=0.41, p&lt;0.0001), PWV (β=0.94, p&lt;0.0001), and PAC (β=0.75, p&lt;0.0001). Conclusion Brachial systolic BP, PWV and PAC were independently associated with LAVI in patients with uncomplicated AH and herewith LAVI was more dominantly influenced by increased arterial stiffness and plasma aldosterone.

MARKERS OF BONE REMODELING, 25-HYDROXYCHOLECALCIFEROL LEVEL AND LIPID METABOLISM PARAMETERS IN ELDERLY WOMEN WITH UNCOMPLETED ARTERIAL HYPERTENSION

Objective: To make a comparative analysis of the parameters of bone remodeling lipid, calcium – phosphor exchange and 25-hydroxycholecalciferol (25(OH)D) level in elderly women with uncomplicated arterial hypertension (AH) and without it Design and method: The study included 44 patients with AH stage I-II (mean age - 69.1 ± 0.7 years, average duration of postmenopausal period - 18.4 ± 0.9 years) and 30 practically healthy women (mean age - 69.3 ± 1.2 years, average duration of postmenopausal period - 19.4 ± 1.2 years). All patients underwent general clinical and laboratory examination with determination of lipid level in blood, level 25(OH)D, parathyroid hormone, propeptide procollagen of type 1 aminoterminal (P1NP), β-isomerized C-terminal telopeptides (β-CTx), ionized calcium and phosphorus in serum, daily monitoring of blood pressure (BP), echocardiography and applanation tonometry. Results: In patients of the main group, compared with the control group, hypercholesteremia was revealed (total cholesterol (TCh) level of 6.3 ± 0.18 and 4.6 ± 0.1 mmol/L, low density lipoproteins (LDL) 3.8 ± 0.2 mmol / L and 2,1 ± 1,2, triglycerides (TG) 1,8 ± 0,1 and 1,0 ± 0,1 mmol / l, respectively, all p < 0,001), insufficiency and deficiency 25(OH)D (23, 76 ± 1.1 ng / ml and 28.18 ± 2.1 ng / ml, p < 0.05), secondary hyperparathyroidism (parathyroid hormone (PTH) - 64.6 ± 3.9 ng / ml and 39.56 ± 1.1 ng / ml, p < 0.001), accelerated resorption of bone tissue (β-CTx 0.57 ± 0.03 and 0.45 ± 0.03 ng / ml, p < 0.01). A direct propotional correlation between the level of TCh, LDL and P1NP (r = +0.417; r = +0.481, all p < 0.01) indicates a link between hypercholesterolemia and bone remodeling activity in elderly patients with uncomplicated hypertension.. Conclusions: In elderly women with controlled uncomplicated hypertension compared with healhy ones of corresponding age, lesion of mineralization of bone tissue is associated with decrease in the level of 25(OH) D, hypercholesterolemia, secondary hyperparathyroidism