Uncomplicated Essential Hypertension Research Articles

Association of inflammatory and hematological indices with left ventricular hypertrophy in hypertensive patients

Objective. To identify an associative relationship between inflammatory indicators, hematological indices and left ventricular hypertrophy (LVH) in patients with uncontrolled arterial hypertension (HTN). Design and methods. We examined 130 patients with uncomplicated essential HTN I–II with ineffective blood pressure (BP) control (≥ 140/90 mmHg). All patients underwent a clinical examination with determination of risk factors, indicators of inflammation — high-sensitivity C-reactive protein (hs-CRP), interleukin‑1β (IL‑1β), interleukin‑6 (IL‑6), interleukin‑8 (IL‑8), tumor necrosis factor α (TNF-α), hematological indices — systemic immune inflammation index (SII), the monocyte to high density lipoprotein cholesterol ratio (MHR), the platelet to lymphocyte ratio (PLR), the neutrophil to lymphocyte ratio (NLR), and echocardiography. Results. The positive correlations were found between the indicators of nonspecific inflammation and signs of LVH — MHR and left ventricular myocardial mass index (LVMI) (r = 0,448; p < 0,001), the posterior wall thickness (PWT) of left ventricle (LV) in the diastole (r = 0,256; p = 0,003), the interventricular septum (IVS) thickness in the diastole (r = 0,311; p ≤ 0,001); the level of hs-CRP and the relative wall thickness (RWT) (r = 0,283; p = 0,002), PWT of LV in the diastole (r = 0,202; p = 0,043), IVS thickness in the diastole (r = 0,231; p = 0,011); the level of IL‑6 and the PWT of LV in the diastole (r = 0,215; p = 0,018); SII and IVS thickness in the diastole (r = 0,230; p = 0,009), the RWT (r = 0,205; p = 0,016); NLR and IVS thickness in the diastole (r = 0,227; p = 0,009), PWT of LV in the diastole (r = 0,205; p = 0,029), RWT (r = 0,206; p = 0,016). Using multiple linear regression, independent factors associated with increased LVMI in HTN patients were male sex (β = 0,201), waist circumference (WC) (β = 0,258) and MHR (β = 0,236) (p = 0,029). Independent factors for increasing PWT of LV in the diastole in HTN patients were WC (β = 0,354) and male sex (β = 0,266) (p = 0,003); increase of IVS thickness in the diastole — SII (β = 0,254), WC (β = 0,392) and male sex (β = 0,219) (p = 0,021); and an increase of RWT — hs-CRP (β = 0,333) (p = 0,001). Conclusions. In patients with uncontrolled HTN increased levels of hs-CRP, IL‑6, SII, MHR and NLR were associated with echocardiographic LVH criteria—LVMI, PWT and IVS thickness in the diastole, RWT. Independent factors for increasing LVMI were WC, male sex and MHR; IVS thickness in the diastole — SII, WC and male; RWT — hs-CRP.

Abdominal aortic calcium and geometry in patients with essential hypertension

PurposeAbdominal aorta calcium (AAC) burden and dilatation are associated with an increased risk of mortality. The purpose of this study was to investigate determinants of AAC and abdominal aorta size in patients with essential hypertension. Materials and methodsPatients with uncomplicated essential hypertension who had undergone non-enhanced abdominal CT to rule out secondary hypertension in addition to biological test were recruited between 2010 and 2018. A semi-automatic system was designed to estimate the aortic size (diameter, length, volume) and quantify the AAC from mesenteric artery to bifurcation using the Agatston score. Determinants of aortic size and those related to AAC were searched for using uni- and multivariables analyses. ResultsAmong 293 randomly selected patients with hypertension (age 52 ± 11 [SD] years) included, 23% had resistant hypertension. Mean abdominal aorta diameter was 20.1 ± 2.1 (SD) mm. Eight (3%) patients had abdominal aorta aneurysm ≥ 30 mm and 58 (20%) had dilated abdominal aorta ≥ 27 mm. Median AAC score was 38 and calcifications were detected in the infra- and supra-renal abdominal aortic portions in 59% and 26% of the patients, respectively. After adjustment for age, male sex and body surface area, abdominal aorta diameter was positively associated with diastolic blood pressure (P = 0.0019). Smoking was the single variable associated with calcified abdominal aorta (P < 0.001) after adjustment for cofactors. In patients with calcifications of abdominal aorta, the score increased with smoking history (P < 0.001), statins treatment (P < 0.01), greater number of anti-hypertensive drugs (P < 0.01), larger abdominal aorta (P < 0.05) and greater systolic blood pressure (P < 0.05). Patients with resistant hypertension had more AAC in the supra-renal abdominal aorta portion than those without resistant hypertension (P < 0.01). ConclusionIn patients with essential hypertension, abdominal aorta dilation is related with diastolic blood pressure while AAC is associated with smoking history and resistant hypertension when located to the supra-renal abdominal aorta portion.

Platelet Cyclic GMP Levels Are Reduced in Patients with Primary Aldosteronism.

Nitric oxide inhibits platelet aggregation by increasing the second messenger cyclic guanosine-3',5'-monophosphate (cGMP) through the activation of soluble guanylyl cyclase in target cells. Within this context, the oxidative stress associated with the aldosterone excess impairs the nitric oxide availability. Thus, the aim of the present study was to assess the impact of chronic aldosterone excess on the platelet nitric oxide/cGMP pathway in humans. The levels of cGMP were evaluated in platelets of male patients, 12 with primary aldosteronism (PA) and 32 with uncomplicated essential hypertension (EH), matched for age and blood pressure (BP) values. PA and EH patients were 52.8 ± 3 years old and 51.6 ± 1.6 years old, respectively. Systolic and diastolic BP were 158 ± 5.0 mmHg and 105.9 ± 2.3 mmHg in PA and did not differ compared to EH patients (156.6 ± 2.4 mmHg and 104.7 ± 1.2 mmHg). Mean aldosterone levels were significantly higher in PA (25.5 ± 8.8 ng/dL) compared toEH (8.11 ± 0.73 ng/dL), whereas potassium was significantly lower in PA (3.52 ± 0.18 mEq/L) compared to EH (4.08 ± 0.04 mEq/L). Aldosterone and potassium were inversely related (r = -0.49, p = 0.0006) in the whole study population (n = 44). Platelet cGMP was significantly lower in PA (5.1 ± 0.36 pM/109 cells) than in EH (7.1 ± 0.53 pM/109 cells), and in the entire study cohort, it was directly related to plasma potassium (r = 0.43, p = 0.0321). These results show an impairment of nitric oxide/cGMP signaling in platelets of PA patients. This effect is likely related to the potassium-depleting effect of chronic aldosterone excess. Future studies are needed to understand whether the platelet nitric oxide/cGMP system is involved in the atherothrombotic events in these patients.

Effects of two-month treatment with a mixture of natural activators of autophagy on oxidative stress and arterial stiffness in patients with essential hypertension: A pilot study

Background and aimsTrehalose, spermidine, nicotinamide, and polyphenols are natural substances that exert pro-autophagic and antioxidant properties. Their role in blood pressure (BP) regulation and preservation of vascular function in essential hypertension is unknown. The aim of this study was to evaluate the effect of a mixture of these agents on BP level, markers of oxidative stress, autophagy, endothelial function, and vascular stiffness in outpatients with grade 1 uncomplicated essential hypertension. Methods and resultsA single-centre, open-label, case–control, pilot study was conducted in adult outpatients (aged ≥18 years) receiving or not the mixture for two months along with the standard therapies. Both at baseline and at the end of the treatment the following clinical parameters were evaluated: brachial seated office BP level, central aortic pressure, pulse wave velocity, augmentation index (AI@75). Both at baseline and at the end of the treatment, a blood sample was drawn for the measurement of: H2O2, HBA%, levels of sNOX2-dp, Atg 5, P62, endothelin 1, and NO bioavailability. The mixture of nutraceuticals did not influence BP levels. Patients receiving the mixture showed a significant decrease of oxidative stress, stimulation of autophagy, increased NO bioavailability and no increase of the AI@75, in contrast to what observed in hypertensive patients not receiving the mixture. ConclusionsThe supplementation of the trehalose, spermidine, nicotinamide, and polyphenols mixture counteracted hypertension-related arterial stiffness through mechanisms likely dependent on oxidative stress downregulation and autophagy stimulation. These natural activators of autophagy may represent favourable adjuvants for prevention of the hypertensive cardiovascular damage.

GLUCOSE METABOLISM AND ATRIAL FIBRILLATION IN HYPERTENSIVE PATIENTS

Objective: We evaluated the association of abnormal glucose metabolism with risk of atrial fibrillation in hypertensive patients. Design and method: The study comprised 34.280 consecutive patients (51,87% males, mean age 58 years) with uncomplicated essential hypertension. The diagnosis of hypertension was based upon repeated office blood pressure measurements, 24 hours ambulatory blood pressure monitoring, clinical and laboratory evaluation. Patients were divided into four metabolic groups: normal glucose (NG), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (DM2). Then subdivided into three subgroups: sinus (SR), paroxysmal (PAF) and sustained (SAF) atrial fibrillation. Average glucose (eAG), hemoglobin A1c (HbA1c), insulin, homeostatic model assessment for insulin resistance (HOMA-IR) and the variation of them in relation to rhythm were assessed in each subgroup, corrected for confounders. Results: Among the patients (45,3%) with NG there was significant difference of all glucose metabolic parameters in correlation to three rhythms (glucose p = 0,004, eAG, HbA1c, insulin, HOMA-IR, p&lt;0,001). These indices were higher, in SAF and in PAF compared to the SR subgroup (glucose p = 0,011, the rest indices p&lt;0,001). In group IFG (20,3%), comparison of three rhythm indicated significant difference of glucose indices (glucose, eAG p&lt;0,05, HbA1c, insulin, p&lt;0,001) and they were increased in PAF in contrast to SR patients (p&lt;0,05). Additionally, the insulin and the HbA1c were higher in SAF comparison the SR patients, (p&lt;0,05). The eAG was comparably higher in SAF versus the PAF group, (p&lt;0,05). In group IGT (17,3%), the patients had difference in levels of indices depending the rhythm (eAG, HbA1c, insulin, HOMA-IR p&lt;0,05). Particularly the patients with SAF had higher levels of insulin and HOMA-IR than those who had SR (p&lt;0,05). In group T2DM (16,9%), there was significant difference in glucose parameters dependent the rhythm (glucose p = 0,031, insulin p = 0,002, eAG, HOMA-IR, HbA1c p&lt;0,001). The subgroup PAF showed higher values in eAG, HbA1c, HOMA-IR, (p&lt;0,05) and the subgroup SAF in glucose, insulin, eAG, HOMA-IR (p&lt;0,05), HbA1c (p&lt;0,001) in compare to SR subgroup, respectively. Conclusions: Prediabetes and diabetes increase the risk of atrial fibrillation in hypertensive patients in a level response way.

The role of inflammatory biomarkers in the arterial hypertension

Studies on both humans and animals have found evidence of a link between inflammation and hypertension (HTN). A lower serum calprotectin level was found to be independently related to HTN. The elevated ferritin–HTN link could be mediated by fatty liver disease and insulin resistance (IR). Similarly, fibrinogen was engaged in several processes that may increase the risk of HTN which including hemostasis, coagulation, and the proliferation of smooth muscle cells in the artery wall, and others. Procalcitonin monitoring could be a useful biomarker in inflammation related to atherosclerosis and early-stage HTN. Plasminogen activator 1 (PAI-1) was not just a result of HTN but also contributes to its development. Also, the positive correlation between monocyte chemoattractant protein 1 (MCP-1) levels with blood pressure were found among smokers. The high level of pentraxin 3 (PTX3) was one of the factors of increased blood pressure. Galectin 3 (Gal-3) may contribute to the onset and progression of diastolic dysfunction-complicated HTN. Increased intercellular adhesion molecules (ICAM)/vascular cell adhesion molecule 1 (VCAM-1) ligand expression, along with a drop in soluble cell adhesion molecules (sCAMs) and endocan, points to endothelium deactivation with lower blood pressure, which reduces the adherence of circulatory leukocytes to endothelium and, as a result, lowers the probability of atherosclerosis developing. The circulating levels of soluble VCAM-1 were substantially connected with left ventricular mass indexes (LVMIs) and were higher in uncomplicated essential hypertension (EH) patients with left ventricle (LV) hypertrophy than in those without LV hypertrophy.

Cardiac sympathetic dysfunction in left ventricular hypertrophy caused by arterial hypertension and degenerative aortic stenosis

BackgroundTo evaluate cardiac sympathetic innervation in hypertensive patients with left ventricular (LV) hypertrophy (H) and aortic stenosis (AS) submitted to transcatheter aortic valve implantation (TAVI). Methods and ResultsTwenty-two hypertensive elders (82 ± 5 years) with severe AS and significant LVH (> 122 g·m−2 in women and > 149 g·m−2 in men) were compared with 14 patients with uncomplicated essential hypertension (HT) with similar degree of LVH and 10 controls. 123I-metaiodobenzylguanidine (MIBG) and 99mTc-tetrofosmin SPECT acquisitions were obtained to assess sympathetic innervation and LV perfusion. The innervation/perfusion mismatch score was taken as an indicator of cardiac sympathetic dysfunction. The imaging protocol was repeated 6 months after TAVI. Regional MIBG uptake was more heterogeneous in HT and AS patients than controls, and therefore, innervation/perfusion mismatch score was higher in both AS (9 ± 8) and HT (5 ± 2) than controls (1 ± 1, P < .001). On multivariate analysis, significant LVH was the major predictor of impaired LV sympathetic innervation (OR 19.45, 95% CI 1.87-201.92; P = .013). After TAVI, no differences in measures of LV sympathetic innervation were evident, although only a marginal LV mass reduction was observed (− 5.4 ± 2.4 g). ConclusionsCardiac sympathetic innervation is impaired in patients with LVH, either with AS or not, and is not impacted significantly by TAVI procedure.

Effects of uric acid-lowering therapy in patients with essential arterial hypertension.

Asymptomatic hyperuricemia (AHU) is elevated serum uric acid (UA) without symptoms. This study aimed to determine the effects of AHU treatment with allopurinol on selected hypertension-mediated organ damage (HMOD) indices in patients with uncomplicated essential arterial hypertension (AH). Patients aged 30-70 years with AHU and AH grade 1-2 with adequate blood pressure (BP) control, without previous urate-lowering therapy (ULT), were divided into two groups: (a) ULT (receiving allopurinol) and (b) control (age- and sex-matched patients without ULT). Both received a UA-lowering diet. BP (office, 24 h and central), echocardiographic parameters, carotid intima-media thickness (IMT) and lab tests [high-sensitivity C-reactive protein (hs-CRP)] were measured at baseline and at 6 months follow-up. Of 100 participants, 87 (44 ULT, 43 controls) completed the study. At 6 months follow-up, there was a greater reduction in serum UA concentration in the ULT group than in the control group. Patients receiving allopurinol had significant reductions in office systolic and diastolic BP, central systolic BP, pulse pressure, IMT (0.773 ± 0.121 vs. 0.752 ± 0.13 mm, P = 0.044) and hs-CRP (3.36 ± 2.73 vs. 2.74 ± 1.91 mg/L, P = 0.028) compared to controls. Multivariate regression analysis revealed the independent relationship between reduction in IMT and UA lowering (P < 0.026). In patients with AH and AHU, treatment with allopurinol leads to improvement in BP control and reduction in HMOD intensity, in particular IMT. The decrease in hs-CRP concentration associated with ULT may have a beneficial effect on a patient's long-term prognosis.

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.

Self-Monitoring of Blood Pressure and Feed-back Using APP in TReatment of UnconTrolled Hypertension (SMART-BP): A Randomized Clinical Trial.

Self-monitoring of blood pressure (SMBP) is a reliable method used to assess BP accurately. However, patients do not often know how to respond to the measured BP value. We developed a mobile application-based feed-back algorithm (SMBP-App) for tailored recommendations. In this study, we aim to evaluate whether SMBP-App is superior to SMBP alone in terms of BP reduction and drug adherence improvement in patients with hypertension. Self-Monitoring of blood pressure and Feed-back using APP in TReatment of UnconTrolled Hypertension (SMART-BP) is a prospective, randomized, open-label, multicenter trial to evaluate the efficacy of SMBP-App compared with SMBP alone. Patients with uncomplicated essential hypertension will be randomly assigned to the SMBP-App (90 patients) and SMBP alone (90 patients) groups. In the SMBP group, the patients will perform home BP measurement and receive the standard care, whereas in the SMBP-App group, the patients will receive additional recommendations from the application in response to the obtained BP value. Follow-up visits will be scheduled at 12 and 24 weeks after randomization. The primary endpoint of the study is the mean home systolic BP. The secondary endpoints include the drug adherence, the home diastolic BP, home and office BP. SMART-BP is a prospective, randomized, open-label, multicenter trial to evaluate the efficacy of SMBP-App. If we can confirm its efficacy, SMBP-App may be scaled-up to improve the treatment of hypertension. ClinicalTrials.gov Identifier: NCT04470284.

Associations of METS-IR insulin resistance index with components of cardiometabolic risk in patients with hypertension

Objective — to accurate some possible associations of insulin resistance (IR) index METS‑IR with blood pressure (BP) level, parameters of visceral obesity (VO), values of lipid, carbohydrate and uric exchange in persons with essential hypertension (EH) who were the representatives of nonorganized population of Kharkov’s region.&#x0D; Materials and methods. The retrospective study included some data about 165 patients (pts) — 74 (44.8 %) females and 91 (55.1 %) males aged to 20 — 65 years old (an average age is 56.42 ± 1.18 years old) with EH of I — II stages who had been examined and undergone treatment in the clinics of the L. T. Mala National Therapy Institute of NAMS of Ukraine (Kharkiv). Uncomplicated EH in pts included in the study was combined with the components of cardiometabolic risk (CMR) such as excessive body mass (EBM), VO, intolerance to glucose, hyperuricemia, nonalcoholic fatty liver disease and dyslipoproteinemia). The persons with type 2 diabetes mellitus were excluded from the study. Among anthropometric measures derived from the history cases there was body mass index (BMI) and based on it some parameters of VO such as body fat percentage (BFP), total fat mass (TFM) and fat mass index (FMI). The data about pts’ BP as well as data about serum glucose and uric acid (UA) levels had been also taken from the history cases. For analysis of lipid exchange state the characteristics of pts’ lipid profile measured by enzyme method on analyser such as total cholesterol (TC), high‑density lipoprotein cholesterol (HDL‑C), triglycerides (TG), very‑low density lipoprotein cholesterol (VLDL‑C), low‑density lipoprotein cholesterol (LDL‑C), coefficient of atherogenity (CA) and non‑high‑density lipoprotein cholesterol (non‑HDL‑C) as a difference between TC and HDL‑C were derived from the history cases. The values of lipid ratios reflected a functional state of lipid transport systems such as direct cholesterol transport system, reverse cholesterol transport system and system of lipoprotein lipolysis which were closely associated with IR had been calculated additionally.&#x0D; Results. It was established that in persons with EH combined with EBM and VO included in the study the secondary lipid abnormalities increased CMR more significantly than glycemia and uricemia and it was confirmed by correlations of METS‑IR index with lipid exchange values and lipid ratios characterized the state of direct cholesterol transport system, reverse cholesterol transport system and system of lipoprotein lipolysis. The pts with EH and VO compared with persons who had EBM are shown to have more significant pathological deviations in the system of lipoprotein lipolysis of TG‑containing VLDL promoted a reduction in HDL synthesis and reverse cholesterol transport disorder and combined with elevation of METS‑IR index.&#x0D; As a whole independently on IR there were no significant correlations of METS‑IR index with BP level, serum glucose and parameters of VO such as BMI, BFP, TFM and FMI in pts with EBM and VO included in the study. There was a weak association between METS‑IR index and serum concentration of UA (r = 0.337; p = 0.004 in pts with EBM and r = 0.301; p = 0.004 in pts with VO). But in the case of IR presence in persons with EBM some associations of METS‑IR index with age (r = 0.391; p = 0.029), BFP (r = 0.544; p = 0.002), TFM (r = 0.436; p = 0.014), FMI (r = 0.513; p = 0.003) and serum UA level (r = 0.443; p = 0.013) were found.&#x0D; Conclusions. METS‑IR index for CMR evaluation and confirmation of IR presence is concluded to be worth calculated in persons without type 2 diabetes mellitus and BMI &gt; 25 kg/m2 who had hypertriglyceridemia and/or low HDL‑C independently on glycemia level.&#x0D;

“To be or not to be?” Prospects and possibilities of CNP application as a signal indicator of structural and functional changes of the myocardium in essential hypertension and chronic heart failure

Annotation. In recent decades, the number of studies on the role of known and new biomarkers in the diagnosis of cardiovascular problems, among which your place is in the family of natriuretic peptides, has been growing for a long time. However, one of its representatives, vascular natriuretic peptide (CNP), has been restored, and the question of determining its final role still remains open. The aim of the study was to supplement the data on the possibility of using CNP as a biomarker of structural and functional changes in the myocardium in uncomplicated and complicated essential hypertension (EH) in postmenopausal women with polymorphic variants of the BNP gene. We examined 180 women aged 40-65 living in the Podillia region of Ukraine: 62 women with uncomplicated EH with left ventricular hypertrophy (LVH), 51 women with EH complicated by chronic heart failure (CHF), and 67 women without symptoms cardiovascular pathology, which formed the control group. All patients underwent a standardized general clinical, instrumental and laboratory examination. Genotyping of the BNP gene was performed by polymerase chain reaction. Plasma concentrations of natriuretic peptide were determined by plate solid-phase enzyme-linked immunosorbent assay. Mathematical processing was performed using the standard statistical package Statistica 10.0, using parametric and nonparametric statistical methods. The frequency of distribution of polymorphic gene variants in the population was checked according to the Hardy-Weinberg equilibrium. It was found that among the polymorphic variants of the BNP gene in women aged 40-65 years, the frequency of carriers of the T381C genotype and C allele significantly prevails, while inheriting a certain type of polymorphic variant of the BNP gene does not affect the concentration of CNP in blood plasma in all examined groups. Significantly the highest level of plasma concentration of CNP, which was 6.63±0.13 pmol/ml, was determined in members of the group with EH complicated by CHF. In groups of women with both uncomplicated EH and EH complicated by CHF, BMI is inversely correlated with plasma CNP levels.

CILNIDIPINE DECREASES LEFT ATRIAL VOLUME INDEX SUPERIOR THAN ATENOLOL IN THE PATIENTS WITH HYPERTENSION

Objective: This study was designed as a prospective, randomized, double-blind, parallel-group to test whether cilnidipine achieves greater left ventricular (LV) mass reduction and improves LV diastolic function than does atenolol. Design and method: Seventy-two patients with uncomplicated essential hypertension and increased LV mass index at screening echocardiography were randomly assigned and forced-titrated to 20 mg/d cilnidipine or 100 mg of atenolol for 36 weeks. Echocardiography, ambulatory blood pressure monitoring, biochemical studies including NT pro-BNP and 24-hours urine microalbumin were measured at baseline and after 36-weeks therapy. Results: Clinical examination and blinded echocardiogram in a per-protocol analysis of 28 cilnidipine-treated and 26 atenolol-treated patients revealed similar reductions in systolic/diastolic pressure (-16.5/8.9 mmHg versus -23.9/14.8 mmHg) and LV mass index (-21.4 g/m2 versus -19.5 g/m2). Interestingly, cilnidipine-treated group showed reduction on left atrial (LA) volume index but atenolol-treated group showed more enlarged LA (-5.1 % versus 7.3 %, p = 0.035). Conclusions: Both cilnidipine and atenolol similarly and effectively reduced blood pressure and LV mass index. However, only cilnidipine reduced LA volume index, whereas atenolol increased. Cilnidipine may provide more beneficial effect on the management in essential hypertension with diastolic dysfunction.

DIET, PSORIASIS AND HYPERTENSION: CONTROLLED CLINICAL TRIAL OF PERSONALIZED FOOD AVOIDANCE DIETARY APPROACH TO STOP HYPERTENSION

Objective: Lifelong observational study of psoriasis (with eschewal of suppressive drug treatments) and dietary dependence of its phenotypic expression. Develop an inductive model of the diet – genome interaction that engenders chronic disease. Test this model by conducting an open controlled trial of Personalized Food Avoidance Dietary Approach to Stop Hypertension (PFADASH). Design and method: Lifelong textual and photographic diary records (cpcpsoriasis.blogspot.com) inspired an inductive model of the diet – genome interaction in which amphiphilic fats promote adverse gene expression effects of flavour enhancers and non-sugar sweeteners. This promotes immune dysfunction and chronic disease. Nine eligible consenting adults with uncomplicated essential hypertension were recruited for an open trial of the PFADASH (‘phase 6’ clinical trial involving withdrawal from postulated egregious dietary exposures). Baseline and monthly assessments included BP, anthropometry, clinical, drug/toxin exposure, ADTR. Quarterly assessments included dietetic, pharmaceutic, exercise, sociological, echocardiogram and laboratory markers of ‘metabolic syndrome’. PFADASH dietary counselors were trained by the Principal Investigator. Detailed Dietary Counselling and Compliance Assessment and Scoring (DCCAS) guidelines were developed. Study participants were counseled on which foods to avoid (PFA) and which to take (DASH). Study participants with ‘GOOD’ dietary compliance were compared with ‘FAIR / POOR’ diet compliers (controls) as regards blood pressure (BP) control, antihypertensive drug treatment requirement (ADTR) and other outcome parameters from the assessments listed above. Results: Comparing four FAIR/POOR diet compliers with three GOOD compliers, differences (95% CI) between mean values were 5.5 (0–11.1) mmHg for home BP, 14.7 (7.9–24.4) mmHg for automated office BP and 1.92 (0.45–3.40) for ADTR score. 2-way ANOVA confirmed improved BP control (p &lt; 0.0001) and reduced ADTR (p = 0.0008) in GOOD compliers. GOOD compliers exhibited more significant improvements in BMI, abdominal circumference and triceps skinfold thickness than FAIR/POOR compliers (using 2-way ANOVA and linear regression, p &lt; 0.05). Conclusions: These results support the postulated diet – genome interaction model i.e. nutritoxi-epigenetic aetiopathogenesis of immune dysfunction and chronic disease. As part of personalized medicine, personalized nutrition should emphasize adverse dietary exposure avoidance, reducing current over-reliance on suppressive drug treatments.

Частота геріатричного синдрому немічності у хворих на гіпертонічну хворобу в похилому та старечому віці

The aim – to determine the frequency and severity of Frailty syndrome in elderly patients with essential hypertension on the basis of geriatric instruments.Materials and methods. 120 elderly patients with uncomplicated essential hypertension were investigated by conducting a survey on the questionnaire FRAIL and modified phenotype Frailty, Short Physical Performance Battery.Results and discussion. The frequency of Frailty syndrome in elderly hypertensive’s significantly depend on the method used and was 17.2, 10.9 and 11.1 % while exploring the FRAIL questionnaire, the Frailty phenotype and the Short Physical Performance Battery, respectively. The predominant form of physical disorders was prefrail, its registration, depending on the method of diagnosis, varied from 20,2 % up to 68 %. The incidence of Frailty geriatric syndrome increased with age, it was more common in women than in men when measured by the FRAIL questionnaire and the Frailty phenotype.Conclusions. In elderly patients with uncomplicated essential hypertension the registration of Frailty depends on the methods used. PreFrailty proved to be the predominant form of physical disorder.

Influence of metabolic and proinflammatory factors on diastolic heart failure formation in females with essential hypertension

Relevance.Diastolic chronic heart failure (CHF) is a characteristic complication of essential hypertension (EH).&#x0D; Materials and methods.62 females with EH were examined. The first group (n=47, mean age 51.56.2 years) persons with EH complicated by diastolic CHF, the second group (n=15, 49.86.7 years) persons with uncomplicated EH. The diagnosis of CHF in females of the first group is confirmed by the data of the test with 6-minute walking, increased blood content of the N-terminal precursor of the brain natriuretic peptide, the presence of left atrial dilatation, hypertrophy and disturbed left ventricle (LV) relaxation. The levels of indices of lipid, carbohydrate, purine metabolism, mediators of systemic inflammation (С-reactive protein), tumor necrosis factor alpha (TNF-a), interleukin-6 (IL-6) were studied and a correlation analysis of the whole set of laboratory data with 6-minute walking test results and an integral index of diastolic LV dysfunction (E/e).&#x0D; Results. Females with EH complicated initial manifestations of diastolic heart failure, characterized by significantly higher, but the corresponding values of the reference range, the content in blood TNF-a, IL-6 compared with females with uncomplicated EH. In females with hypertension complicated initial manifestations of diastolic heart failure is established significant correlation between blood levels of atherogenic lipids and lipoproteins, glucose, uric acid, CRP, TNF-a, IL-6 on the one hand and indices characterizing reduced tolerance to physical load, diastolic LV dysfunction.&#x0D; Conclusion.Formation of diastolic heart failure clinical syndrome as well as disturbances of LV relax function in hypertensive females allows participation of metabolic factors and pro-inflammatory pattern.

The relationship between the indicators of the retina condition and other target organ changes in uncomplicated essential hypertension

Background. Changes in retinal microcirculation are considered a subtle indicator of the other target organ damage in hypertension and might have prognostic value. Objective. To establish the relationship between diameters of retinal arterioles and venules, foveal avascular zone (FAZ) area, subfoveal choroid thickness with parameters of left heart and kidneys in middle-aged patients with essential hypertension (EH) stage I-II. Design and methods . A total of 115 people (86 males, 29 females) aged 45-59 years were examined and divided into 2 groups. The main group consisted of 70 patients with EH stage I or II. The control group comprised 45 normotensive practically healthy individuals. Patients with diabetes mellitus, impaired liver function, clinically significant ophthalmic pathology were not included. The following data were analyzed: anamnesis including smoking status; routine blood hemodynamic and biochemical parameters, serum procollagen III N-terminal propeptide (PIIINP); albumin-creatinine ratio in a single morning portion of urine, diurnal albuminuria; parameters of 24-h ambulatory blood pressure monitoring; quantitative electrocardiography (ECG) markers of left ventricular hypertrophy; transthoracic echocardiography; fundus state. Based on the scanning laser ophthalmoscopy, the central retinal arterial (CRAE) and venous (CRVE) equivalents, arteriovenous ratio (AVR) were calculated. Using the method of optical coherence tomography angiography, we determined the FAZ area and subfoveal choroid thickness. Statistical data were processed using the StatSoft Statistica 10. Results. Compared with normotensive individuals, patients with hypertension were characterized by lower values of CRAE (p = 0,009), larger FAZ area (p = 0,019), and comparable values of CRVE, AVR, subfoveal choroid thickness (p > 0,05 for each indicator). Correlation analysis showed that in hypertensive AVR correlated with low-density lipoprotein cholesterol level (r = -0,3; p < 0,05); FAZ area with female gender (r = 0,42; p < 0,05); FAZ area with PIIINP level (r = 0,3; p < 0,05); FAZ area with diurnal albuminuria (r = 0,37; p < 0,05); CRVE with R wave amplitude in aVL lead of ECG (r = 0,31; p < 0,05); CRAE with left atrial volume index (r = -0,3; p < 0,05); subfoveal choroid thickness with age (r= -0,3; p = 0,01). Conclusions. Middle-aged patients with uncomplicated EH are characterized by the lower CRVE values and larger FAZ area compared to normotensive individuals. In EH stage I-II, retinal microcirculation parameters are associated with indicators reflecting the other target organ damage, in particular, the left atrial volume index, R wave amplitude in aVL lead of the standard ECG, diurnal albuminuria, and serum PIIINP concentration.

Coronavirus disease 2019 (COVID-19): angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and cardiovascular disease.

Coronavirus disease 2019 (COVID-19): angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers and cardiovascular disease.

ISCHEMIC MITRAL REGURGITATION: PROBLEM EXTENT IN CARDIOVASCULAR SURGERY CLINIC

The aim of the study was to evaluate the prevalence, etiology, mechanisms and severety of all cases of MR, including IMR, in the patients population with suspected or proved CAD before coronary arteries evaluation and surgery or intervention. Materials and methods: The study prospectively included 370 patients with verified or suspected (angina pectoris suspicion or manifested CHF) CAD of all clinical forms (stable, unstable, post-AMI, prior revascularization, etc.). MR evaluation by TTE included examining type of MR (organic or functional, Carpentier type) and its severity by vena contracta (VC) width and establishing effective regurgitant orifice (ERO) and regurgitant volume (RVol) by PISA method according to existing guidelines. Additional criteria (left atrium (LA) dimensions, LV diastolic filling and filling pressure markers, pulmonary veins flow and secondary pulmonary hypertension and right chambers involvement, etc.) were also widely used. Results: Majority of all patients were men - 280 out of 370 pts (75.7%). Mean age of pts was 62.4±8.96 years, and men were in general significantly younger (61.5±9.2 vs. 65.3±7.6 years, p=0.0004). 145 (39.2%) pts had verified AMI previously (126 men and 19 women, p<0.0001). 22 (5.95%) pts previously underwent CABG surgery (19 men and 3 women, p<0.0001), and 99 patients - PCI with coronary stenting (81 men and 18 women, p<0.0001). 42 (11.3%) pts proved to have no significant CAD as per CAG results: 24 (57.1%) pts had no significant cardiac pathology at all, 12 (28.6%) pts had uncomplicated essential hypertension, 5 (11.9%) pts had non-coronary dilated cardiomyopathy (DCM) and 1 (2.4%) pt had non-obstructive hypertrophic cardiomyopathy (HCP) with clean coronary arteries. In patients with CAD MR is a frequent finding (up to one-half of the studied population) regardless of gender. Predominant majority (84.1%) of MR according to TTE findings is mild (grade I), without significant influence upon heart load and remodeling, and, thus, requiring no additional surgeon interventions. Most of cases of such pathological MR resolved after myocardial revascularization or sustained without dynamics being physiological (13.2% of all MR cases). Most of moderate-to-severe MR cases were classified as IMR, being accompanied by appropriate LV remodeling features, requiring revascularization and/or mitral valvuloplasty or replacement (all cases of severe IMR or organic MR). Correlations results of MR ERO and RVol with certain heart chambers remodeling and load indices seem to make them a "gold standard" for MR severity evaluation, especially in CAD patients with potential indications for MV surgery that should accompany surgeon revascularization, as it is widely accepted today. Conclusions: In the patients with various forms of chronic and acute CAD IMR is a frequent finding, but the majority of MR cases are mild and requiring no additional interventions. No gender difference in MR prevalence were found. Severe MR cases in all CAD patients population are rather rare (below 10%), but always require surgical repair. Moderate-to-severe IMR is the most frequent (approximately 75%) etiology for significant MR in CAD patients, requiring close TTE follow-up for optimal intervention timing on the basis of left and right chambers remodeling and load indices. MR ERO and RVol are trustworthy quantitative MR severity indices, significantly correlating with main LV and LA remodeling and load indices, as well as with some secondary right chambers overload predictors.

Influence of age and body mass index on arterial stiffness and left ventricular hypertrophy in patients with arterial hypertension II stage.

За результатами чисельних досліджень було встановлено і запропоновано референтні нормативні значення для центрального артеріального тиску та його ампліфікації в пацієнтів з різним серцево- судинним ризиком. Проте можливість їх практичного застосування в пацієнтів різних вікових груп повністю не вивчена. Було обстежено 132 пацієнти з неускладненою есенціальною артеріальною гіпертензією, що не отримували антигіпертензивну терапію (23 жінки та 109 чоловіків), яких було розподілено на 3 групи залежно від віку (ВООЗ, 2012): I група включала 47 пацієнтів молодого віку, II група - 50 пацієнтів середнього віку та III група – 35 пацієнтів літнього віку. Вимірювання центрального систолічного артеріального тиску (цСАТ), ампліфікаційного САТ, швидкість розповсюдження пульсової хвилі (ШРПХ) проводили за допомогою артеріографа Tensioclinic (Tensiomed, Hungary). Ураження органів-мішеней включало гіпертрофію лівого шлуночка (ГЛШ), яку визначали за ехокардіографічним індексом маси міокарда лівого шлуночка, скоригованим до поверхні тіла ( г/м2) або зросту (ГЛШ2,7) і ШРПХ в аорті >10 м/с. Встановлено, що використання персоналізованого підходу при обстеженні хворих на артеріальну гіпертензію дозволяє підвищити ефективність діагностики зумовлених гіпертензією субклінічних уражень органів. Таким чином, для виявлення ураження судинної стінки у хворих молодого віку з артеріальною гіпертензією і надмірною масою тіла та ожирінням слід використовувати референтні значення ШРПХ і цСАТ відповідно до вікової норми. Саме в цій групі пацієнтів виявлено найбільш несприятливий вплив судинної жорсткості та індексу маси тіла (ІМТ) на формування гіпертрофії лівого шлуночка. Разом з тим в осіб похилого віку необхідно використовувати референтні значення цСАТ залежно від ступеня артеріальної гіпертензії.Based on the cumulative data of scientific research reference values for the central blood pressure and its amplification were proposed in patients with different cardiovascular risk factors. Still, the possibility of its practical implementation in patients of different age groups has not been fully studied. There were examined 132 untreated patients (23 females and 109 males) with uncomplicated essential hypertension, which were divided into 3 groups depending on age (WHO, 2012): I group included 47 patients of the young age, II group - 50 middle-aged patients and III group – 35 elderly patients. Measurements of central systolic blood pressure (cSBP), SBP amplification (SBP Amp), pulse wave velocity (PWV) were carried out by Arteriograph Tensioclinic (Tensiomed, Hungary). Target-organ damage included LVH which was determined by echocardiographic left ventricular mass index (LVMI), adjusted for body surface (g/m2) or height (LVMI2,7), aortic PWV>10 m/s. It was established that the use of a personalized approach in the examination of patients with arterial hypertension makes it possible to increase the efficiency of diagnosis of hypertensive-mediated subclinical organ damage. So in order to identify impairment of the vascular wall in patients of a young age with hypertension, with overweight and obesity, the reference values of PWV and cSBP in accordance with the age norm should be taken into account. It was particularly in this cohort of patients that the greatest adverse effect of vascular stiffness and body mass index (BMI) on the formation of left ventricular hypertrophy was revealed, while in elderly people it is necessary to use the reference values of cSBP, depending on the degree of hypertension.