Untreated Arterial Hypertension Research Articles

Serum Hepatocyte Growth Factor Concentration Correlates with Albuminuria in Individuals with Optimal Blood Pressure and Untreated Arterial Hypertension.

Background/Objectives: Hepatocyte growth factor (HGF) is a protective factor against acute renal injury and chronic renal fibrosis. A positive correlation between HGF and blood pressure (BP) has been established. This study aimed to determine the association between serum HGF concentration and albuminuria in subjects with optimal blood pressure (OBP) and untreated arterial hypertension (UAH), as well as its association with BP levels, serum glucose levels, and inflammatory markers. Methods: Data from 563 subjects were analyzed. Albuminuria was normalized to urine creatinine and expressed as the albumin/creatinine ratio (ACR). HGF, serum glucose, C-reactive protein, and blood leucocyte counts were measured. BP was measured and subjects were divided into optimal blood pressure (BP < 120/80 mmHg, N = 295) and untreated arterial hypertension (BP > 140/90 mmHg, N = 268) groups. Results: The subjects with UAH were significantly older and had higher values of body mass index, waist circumference, serum total and LDL cholesterol levels, triglyceride levels, fasting glucose levels, and ACR (all p < 0.001). A significant positive correlation was found between serum HGF concentration and ACR in both groups. There was no difference or correlation between HGF and BP or inflammatory markers in either group. The multivariate regression analysis identified serum HGF concentration as a strong predictor of ACR increase (Beta = 0.376, p < 0.001). Conclusion: This study found that serum HGF concentration is associated with albuminuria not only in individuals with untreated arterial hypertension, but also in those with optimal blood pressure. The results suggest that serum HGF is an independent predictor of ACR increase in both groups.

The Importance of Cardiac Magnetic Resonance in the Assessment Risk of Cardiac Arrhythmias in Patients with Arterial Hypertension.

Objectives: Arterial hypertension (AH) is one of the major risk factors for cardiovascular diseases. An association between untreated AH and arrhythmia is observed. Cardiac magnetic resonance (CMR) assesses myocardial fibrosis by detecting foci of late gadolinium enhancement (LGE). Clinical significance of LGE at the right ventricular insertion point (RVIP) is not fully established. This study aimed to assess the relationship between the presence of LGE at the RVIP determined by CMR and the incidence of arrhythmia in a group suffering from arterial hypertension. Methods: The study group consisted of 81 patients with AH (37 men and 44 women, age: 56.7 ± 7.1 years). All subjects underwent CMR and 24 h Holter ECG monitoring. Two subgroups were distinguished in the study group based on the criterion of the presence of LGE at the RVIP in CMR. The RVIP+ subgroup consisted of patients with LGE at the RVIP, while the RVIP- group consisted of patients without LGE at the RVIP. Results: The RVIP+ subgroup was characterized by higher maximum and minimum heart rates in 24 h Holter ECG recordings compared to the RVIP- subgroup (p < 0.05). The RVIP+ subgroup had a statistically significantly higher number of single premature supraventricular beats, supraventricular tachycardias, and single premature ventricular beats than the RVIP- subgroup (p < 0.05). Regression analysis documented that a longer duration of AH (counted from diagnosis) as well as the occurrence of LGE at the RVIP (assessed by CMR) are independent risk factors for arrhythmia (p < 0.05). Conclusions: Due to the possibility of detecting LGE at the RVIP, CMR may be a useful diagnostic method in estimating the risk of arrhythmias in the group of patients with AH.

Association between atmospheric air temperature and blood pressure among adult population in different seasons

BACKGROUND: The prevalence of hypertension in the Arkhangelsk region is steadily increasing. Despite the progress in the diagnostics and the availability of treatment, a half of the population are unaware of their hypertension and its potential consequences, and consequently, do not adhere to the prescribed medications. This lack of awareness, coupled with the challenging climatic conditions of the northern regions, can significantly increase the risk of acute myocardial infarctions and strokes among young adults.&#x0D; AIM: To study the association between atmospheric air temperature and blood pressure among the adult population in Arkhangelsk.&#x0D; MATERIAL AND METHODS: For the purpose of this study we used blood pressure data obtained from 2342 participants individuals aged 3569 years who participated in the Know your heart study in Arkhangelsk from November 1, 2015 to October 31, 2017. Every blood pressure measurement was linked to the time-corresponding readings of atmospheric air temperature recorded by the city meteorological station. The effect of the temperature on blood pressure was assessed using linear regression analysis separately for the warm (April 16October 15) and the cold (October 16April 15) seasons.&#x0D; RESULTS: In the warm season, in the group of participants without hypertension and in those with treated arterial hypertension, high values of atmospheric air temperature (17.526.5 С) relative to the average level (8.812.2 С) were associated with a decrease in systolic blood pressure at 7.9 mm Hg (p=0.004) and 8.5 mm Hg (p=0.012), respectively, and diastolic blood pressure by 5.1 mm Hg (p=0.002) and 4.5 mm Hg (p=0.021), respectively. In the group of participants with untreated arterial hypertension, changes in ambient air temperature above (12.317.2 С) and below (6.08.7 С) the average level for this period were associated with an increase in systolic blood pressure by 11.7 mm Hg (p=0.044) and 16.9 mm Hg (p=0.004), and diastolic blood pressure by 8.9 mm Hg (p=0.018) and 13.8 mm Hg (p 0.001), respectively. In the cold season, no effect of air temperature on blood pressure was found in persons without arterial hypertension. In persons with treated arterial hypertension, an increase in air temperature in the cold season to the levels of (1.31.1 С) relative to the average level (3.91.4 С) were associated with lower systolic blood pressure by 8.5 mm Hg (p=0.001).&#x0D; CONCLUSION: The results of the study demonstrate the association between the atmospheric air temperature and blood pressure. Patients with untreated hypertension are more susceptible to fluctuations in blood pressure parallel to changes in ambient air temperature.

#6873 HEPATOCYTE GROWTH FACTOR CORRELATES WITH SERUM GLUCOSE LEVELS IN HYPERTENSIVE SUBJECTS

Abstract Background and Aims Hepatocyte growth factor (HGF) is a pleiotropic factor derived from mesenchymal cells and is considered a humoral mediator in the interaction of epithelium and mesenchyme. The concentration of HGF in the serum is related to blood pressure (BP), but also to serum glucose concentration. Patients with type 1 and 2 diabetes have significantly higher HGF values, especially those with developed atherosclerotic disease and diabetic retinopathy. Moreover, the concentration of serum HGF in patients with diabetes is higher than that in healthy subjects, regardless of their blood pressure (BP) levels. Our aim was to determine the correlation between serum HGF levels and serum glucose levels in subjects with optimal blood pressure and untreated hypertensives. Method The subjects were divided into two groups based on the BP values. There were 295 subjects with optimal blood pressure (OBP, BP&amp;lt;120/80 mmHg) and 268 subjects with untreated arterial hypertension (AH, BP&amp;gt;140/90 mmHg). Blood pressure was measured according to ESH/ESC guidelines. Fasting blood samples were drawn, serum glucose and HGF levels were measured using commercial tests. Results The average blood pressure was 110/72 mmHg in the OBP group vs 151/92 mmHg in the AH group (p&amp;lt;0,001). Subjects with AH had significantly higher glucose levels than subjects with OBP (4,8±0,5 mmol/l vs. 5,7±1,6 mmol/l, respectively, p&amp;lt;0,001). Serum HGF concentration showed a significant positive correlation to serum glucose levels in the AH group (correlation coefficient = 0,195, p&amp;lt;0,05), but not in the OBP group (correlation coefficient = 0,045, p = 0,06). Serum HGF concentration did not show a significant correlation to blood pressure levels in both groups (all p&amp;gt;0,05). Conclusion Serum HGF concentration is associated with glucose levels in subjects with untreated arterial hypertension.

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

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

Daily profiles of blood pressure in patients with arterial hypertension of various psychotypes

Аim: to assess the influence of the patient's psychotype on the degree of nighttime reduction in blood pressure (BP) to determine predictors of an unfavorable daily BP profile.Materials and methods. The study involved 80 patients with newly diagnosed or untreated arterial hypertension (AH), with various stages, severity, risk of developing cardiovascular complications, in the absence of concomitant severe somatic pathology, who independently consulted a local therapist. All patients underwent 24-hour blood pressure monitoring in the absence of antihypertensive therapy and the psychological profile was assessed using the SMOL questionnaire.Results. The psychopathological profile of the examined AH patients corresponded to the social and psychological adaptation. Our analysis of the indices of the averaged profile of the SMOL test, depending on the degree of reduction in nocturnal systolic blood pressure (between dipper and non-dipper profiles) and diastolic blood pressure (between dipper, non-dipper and extreme dipper patterns profiles) did not reveal statistically significant differences (p &gt; 0,05). Patients with a riser daily blood pressure profile, due to the small size of the group, were not included in the comparative analysis. The average profile of SMOL of the examined patients was noted by an increase in indicators on the scales 1 – hypochondria and 3 – emotional lability.Conclusion. The variant of the daily blood pressure profile does not depend on the psychotype of the patient; it is likely that functional and structural changes that occur during the formation of hypertension affect the type of the degree of nighttime decrease in blood pressure.

PS-C16-8: CONSEQUENCES OF DISCONTINUING ANTIHYPERTENSIVE TREATMENT DURING THE FIRST WAVE OF A COVID-19 PANDEMIC

Arterial hypertension (AH), especially insufficiently and inadequately treated, is a disease with serious morbidity-mortality consequences. AH was the most common comorbidity in patients with COVID-19 infection. During the first wave of the COVID-19 pandemic, Slovakia has low number of COVID 19 patients. However, worldwide was reported 2-fold higher mortality in COVID 19 positive patients with untreated AH compared to patients with treated AH. Many patients have discontinued antihypertensive treatment due to changes in access to healthcare as well as the dissemination of unverified information. The aim of our study was to evaluate the AH treatment in patients during the first wave of the COVID-19 pandemic, to analyze the consequences of changes in AH treatment. It is a retrospective analysis of antihypertensive treatment of patients followed in the tertiary center. A total of 112 consecutive patients with AH who had a scheduled follow-up during the months of March-April 2020 were included. A telephone check-up was performed 6 months after the scheduled follow-up. These were patients with a mean age of 64 ± 18.1 years, 73 patients (65.2%) were male, and the mean number of antihypertensives per patient was 3.6 ± 2.2 drugs. Out of a total of 112 patients, 9 (8%) patients completely discontinued AH treatment, 15 (13.4%) patients discontinued ACEI / ARB without substitution, 5 (4.5%) patients discontinued ACEI / ARB with subsequent AH adjustment treatment. In the observed period March-April 2020, patients with newly diagnosed AH were absent. In our followed patient population (1.8%) were tested as COVID positive, 0 patients were hospitalized for COVID 19 infection. 4 (16,7%) patients overcame stroke, 1 (4.2%) patient overcame TIA, 1 (4.2%) was hospitalized for ACS, 2 (8.3%) for AF with rapid ventricular response, 2 (8.3%) for pulmonary edema, 2 (8.3%) patients died. In the group of patients who had adjusted treatment or did not discontinue AH treatment (a total of 88 patients) 1 (1.1%) patient overcame stroke, 1 (1.1%) was hospitalized for ACS, 1 (1.1%) for newly diagnosed AF, 1 (1.1%) patient died. Unjustified complete or partial discontinuation of antihypertensive treatment during the first wave of the COVID-19 pandemic has led to an increase in complications of arterial hypertension. Achieving BP targets should also be crucial during the COVID 19 pandemic.

THE PERSONAL TRAIT CORRELATED WITH THE NIGHT BLOOD PRESSURE LEVEL IN PATIENTS WITH ARTERIAL HYPERTENSION

Objective: The aim of our study was to determine associations between the personal trait of patients and the night blood pressure (BP) level in untreated arterial hypertension (AH) patients. Design and method: We nalysed database of several studies (200 AH patients without serious concomitant diseases). Ambulatory blood pressure monitoring (ABPM) (Spacelabs 90207) was performed after the washout period (3–7 days). After ABPM each patient completed the Russian version of the psychological questionnaire Minnesota Multiphasis Personality Inventory (MMPI) and the emotional intelligence questionnaire (EmIn, by Lyusin D.) (only 90 patients). We nalysed the following MMPI scales: L – lie scale, F – aggravation scale, K – correction scale, 1 (Hs) – hypochondria, 2 (D) – depression, 3 (Hy) – hysteria, 4 (Pd) – psychopathy, 6 (Pa) – rigidity of affect, 7 (Pt) – psychasthenia, 8 (Sc) – schrizothemia, 9 (Ma) – hypomania. We assessed the following EmIn scale scores: I - emotion self-awareness; II - management of one’s own emotions; III - control of emotional expression; IV - understanding others’ emotions; V- management of others’ emotions. We used Pearson correlation coefficient ®. Results: The initial mean ambulatory daytime systolic BP (SBP) was 142.1 ± 14.2, diastolic (DBP) - 89.5 ± 10.1 mm Hg), age - 52,7 ± 12.2 years.(M ± SD). We found the following significant correlations: 1) 9 scale scores of MMPI (optimism, good mood, cheerfulness level) had negative relationships with the night DBP (r = -0,17, p &lt; 0,05) and night SBP (r = -0,16, p &lt; 0,05) levels; 2) IV scale scores of EmIn (understanding others’ emotions) had relations with the night DBP (r = -0,28, p &lt; 0,05) and night SBP (r = -0,30, p &lt; 0,05) levels; 3) V scale scores of EmIn (management of others’ emotions) had correlations with the night DBP (r = -0,26, p &lt; 0,05) and night SBP (r = -0,26, p &lt; 0,05) parameters. Optimism, cheerfulness, good mood (9 scale scores of MMPI) was associated with the night BP decrease, but intensification of the interpersonal emotional interactions (IV, V scale - management or understanding others’ emotions) can lead to the night BP increase. Conclusions: Optimism, cheerfulness, good mood was related with the night BP decrease. But intensification of the interpersonal emotional interactions can lead to the night BP increase.

MO091: Serum Hepatocyte Growth Factor is Associated With Albuminuria in Subjects With Optimal Blood Pressure and Untreated Arterial Hypertension

Abstract BACKGROUND AND AIMS Hepatocyte growth factor (HGF) is a pleiotropic factor that has a protective role in acute renal injury. HGF prevents the development of chronic renal fibrosis in animal models via inhibition of transforming growth factor β1 expression and consequently reduces podocyte injury and proteinuria.[1,2] Serum HGF concentration is associated with systolic arterial blood pressure (BP) and is higher in hypertensive than in normotensive individuals, especially if complications of arterial hypertension are developed.[3,4] Our aim was to determine the association of serum HGF concentration and albuminuria in normotensive subjects and subjects with untreated arterial hypertension. METHOD Data from 563 subjects (57.8% women, mean age 48 years) was analyzed. After clinical examination, fasting blood and urine samples were drawn. Albuminuria was normalized to urine creatinine and expressed as an albumin/creatinine ratio (ACR). HGF was measured using a commercial test. BP was measured according to ESH guidelines. Based on BP values, subjects were divided into two groups: OBP: subjects with optimal blood pressure (BP &amp;lt; 120/80 mmHg, N = 295), and UAH: subjects with untreated arterial hypertension (BP &amp;gt; 140/90 mmHg, N = 268). RESULTS Subjects with UAH were significantly older and had higher values of body mass index, waist circumference, serum total, and LDL-cholesterol levels, triglyceride levels, fasting glucose levels, and ACR (all P &amp;lt; 0.001). Serum HGF concentrations were also higher in UAH subjects, but the difference was not significant (270.8 versus 304.2 pg/mL, P = 0.651). Subjects with ACR &amp;gt; 30 mg/g had higher values of serum HGF concentration in comparison with subject with ACR &amp;lt; 30 mg/g in both groups, but the difference again was not significant (262.1 versus 527.8 pg/ml, P = 0.747 and 328.6 versus 843.5 pg/ml, P = 0.066, respectively). Serum HGF concentration showed a significant positive correlation to ACR in both groups (P &amp;lt; 0.05). Multivariate regression analysis showed that BP was an independent predictor of ACR increase (Beta = 0.134, P = 0.028), whereas age, sex and serum glucose were not. Serum HGF concentration was also a strong predictor of the ACR increase (Beta = 0.376, P &amp;lt; 0.001). CONCLUSION Serum HGF concentration is associated with ACR in subjects with not only untreated arterial hypertension but also optimal blood pressure. We found that HGF is an independent predictor of the ACR increase in this population.

Postmenopausal bone health may be influenced by the presence of arterial hypertension and antihypertensive therapy

Introduction: Despite available evidence for a link between bone health and arterial hypertension (AH), the results of clinical trials remain conflicting. Thus, we conducted a cross-sectional study to analyze a possible association between blood pressure (BP), antihypertensive therapy and deteriorating bone health in postmenopausal women. Materials and Methods: The study included 84 women from Northeastern Bulgaria. Their mean age was 60.54 ± 7.07 years, and their mean duration of menopause was 11.45 ± 6.62 years. Bone health was assessed by dual-energy X-ray absorptiometry (DEXA) and by analysis of bone metabolic markers. Results: A significant negative correlation was established between bone mineral density (BMD) and diastolic BP. On the other hand, AH predominated in the studied population. However, among the subjects diagnosed with osteopenia and osteoporosis, a significantly higher proportion of AH was observed. In addition, differences were found according to the stage of AH and according to the intake of antihypertensive therapy, when assessing BMD and fracture risk. In subjects with newly diagnosed and respectively untreated AH as well as in the group of stage III AH, the lowest BMD and the highest fracture risk were found. Although we reported a significant difference in the mean age of women according to the presence of AH and its stages, after further analysis it was found that the presence of AH is an independent risk factor for bone health in postmenopausal women (OR = 2.14 (0.686–6.703); p = 0.015). Conclusion: According to the obtained results, we assumed that AH was risk factor for bone health in postmenopausal women, as it was associated with lower BMD and higher fracture risk. In addition, we found differences according to the stage of AH and antihypertensive therapy, which might be considered in the prevention, prophylaxis and treatment of osteoporosis.

Molecular Interactions of Arterial Hypertension in Its Target Organs.

Arterial hypertension (AH) is a major risk factor for the development of cardiovascular diseases. It is estimated that the disease affects between 10% and 20% of the adult population and is responsible for 5.8% of all deaths worldwide. Several pathophysiologic factors are crucial in AH, including inappropriate activation of the renin-angiotensin-aldosterone system, oxidative stress and inflammation. The heart, kidney, brain, retina and arterial blood vessels are prime targets of hypertensive damage. Uncontrolled and untreated AH accelerates the damage to these organs and could cause their failure. Damage to these organs could also manifest as coronary heart disease, cognitive impairment, retinopathy or optic neuropathy. For better understanding, it is important to analyze molecular factors which take part in pathogenesis of AH and hypertension-related target organ damage. In our paper, we would like to focus on molecular interactions of AH in the heart, blood vessels, brain and kidneys. We focus on matrix metalloproteinases, the role of immune system, the renin-angiotensin-aldosterone system and oxidative stress in hypertensive induced organ damage.

Can Motivational Interviewing Make a Difference in Supporting Employees to Deal with Elevated Blood Pressure? A Feasibility Study at the Workplace.

Background: To overcome the problem of a high prevalence of undiscovered or untreated arterial hypertension in people of working age, the effects of behavioral change counseling in occupational health (OH) services should be investigated. The technique of motivational interviewing (MI) to support health-related lifestyle changes by physicians and/or occupational nurses (‘health coach’) has been shown to be successful in patients with chronic diseases. In 2010, we planned a randomized controlled trial (RCT) with employees who suffer from mild arterial hypertension. A preliminary feasibility study was performed in a large manufacturing company in Germany. Methods: All employees with elevated blood pressure measured by the OH-service were invited to undergo validation by 30 self-measurements. Persons with validated elevated values and without medical treatment received either usual hypertension counseling (control group, CG) or intensified MI-counseling (intervention group, IG) by the occupational health physician. Subsequently, the IG received MI-support from the ‘health coach’ in four telephone counseling sessions. Assessed feasibility factors included organizational processes, the acceptance of the validation procedure and the MI-counseling, and as primary outcome for an RCT the extent to which participants made health-related changes to their lifestyles. Results: Initially, 299 individuals were included in Study Part A (screening). At the end of Study Part B (intervention), out of 34 participants with validated and non-treated mild hypertension, only 7 (IG) and 6 (CG) participants completed the intervention including documentation. The high drop-out rate was due to the frequent lack of willingness to perform the 30 self-measurements at home with their own equipment. Acceptance was little higher when we changed the method to two repeated measurements in the OH service. MI-counseling, especially by the health coach, was evaluated positively. Conclusions: Despite the promising counseling approach, the feasibility study showed that an RCT with previous screening in the operational setting can only be implemented with high financial and personnel effort to reach an appropriate number of subjects. This substantial result could only be achieved through this comprehensive feasibility study, which investigated all aspects of the planned future RCT.

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/).

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.

Assessment of heart rate variability parameters in the age subgroups of patients with arterial hypertension

Age is one of the main known risk factors for cardiovascular diseases. The ageing of the body and arterial hypertension are associated with progressive dysfunction of the autonomic nervous system, which may be one of the mechanisms underlying an increased cardiovascular risk. The aim of the paper was to assess heart rate variability parameters in the age subgroups of patients with arterial hypertension. The heart rate variability parameters were compared in a total of 139 patients with untreated arterial hypertension (mean age 45.2 ± 10.5 years, men – 69% of the study group) in the following subgroups distinguished by age: ≥45 years (n = 72) and &lt;45 years (n = 67). A temporal analysis of the heart rate variability parameters in 24-hour Holter ECG (SDNN, rMSSD, pNN50) was conducted for 24 hours, and for the day and night periods. In addition, a spectral analysis (LF, HF, TP, LF/HF ratio) was performed. The recorded values of SDNN, rMSSD, pNN50, TP as well as night-time HF were lower in the group of patients aged ≥45 years compared to the younger group. The results confirm that in patients with arterial hypertension older age is associated with a shift of the autonomic balance towards sympathetic activity, which may translate into an additional increase in cardiovascular risk.

Adrenomedullin and non-dipping circadian pattern in newly diagnosed essential hypertension

OBJECTIVE There is frequently a relationship between nocturnal hypertension and non-dipping pattern and endothelial dysfunction. Studies conducted previously have indicated that adrenomedullin (AM) (a potent, long-lasting, vasodilatory peptide) is capable of regulating endothelial cell function. The aim of the current research is to investigate the association between absolute night-time blood pressure (BP) and circadian BP pat-tern with serum AM and high-sensitivity C-reactive protein (hsCRP) levels in cases in whom untreated arterial hypertension has been newly diagnosed. METHODS Ambulatory BP monitoring was performed in 100 individuals with hypertension (50 dippers,50 non-dippers) and 50 healthy controls for 24 hours. Measurement and recording of AM and hsCRP serum levels were performed. RESULTS A strong correlation between night-time BP levels and AM and hsCRP levels was determined(p<0.001). On the contrary, higher AM levels were determined in the non-dipper group compared to the dipper and normotensive groups (non-dipper group, 258±27 pg/mL; dipper group, 199±30 pg/mL; normotensive group, 150±11 pg/mL; p<0.001). The non-dipper group exhibited significantly higher hsCRP levels in comparison with the remaining two groups (p=0.017). An independent association was determined between AM (p=0.014) and hsCRP (p=0.032) and a non-dipping pattern in a multivariate logistic regression analysis. CONCLUSIONS The nocturnal hypertensive and non-dipper groups exhibited increased AM levels. An independent association was identified between AM and hsCRP and a non-dipping pattern. It is implied that increased AM levels in individuals with non-dipper hypertension may be related to a longer exposure time to high BP. The mentioned findings indicate a potential future part of AM in identifying patients with hypertension that are at higher risk of target organ damage (Tab. 3, Fig. 4, Ref. 41).

PROSPECTIVE STUDY ON THE EFFECT OF PERINDOPRIL, NEBIVOLOL AND AMLODIPINE ON THE VARIABILITY OF ARTERIAL BLOOD PRESSURE

Objective:The aim of the study was to determine the impact on the variability of blood pressure of three hypotensive drugs: perindopril, nebivolol and amlodipine.Design and method:58 people with newly diagnosed, untreated arterial hypertension, in the average age of 41.2 ± 11.7 years were enrolled i

Adropin and circadian variation of blood pressure.

Nocturnal hypertension and non-dipping pattern are often associated with endothelial dysfunction. Previous studies suggested that adropin, a novel secreted energy homeostasis protein, has the unique ability to regulate endothelial cell function. This study aims to investigate the association between absolute night-time blood pressure (BP) and circadian BP pat-tern with serum adropin and high-sensitivity C-reactive protein (hsCRP) levels in patients with newly diagnosed untreated arterial hypertension. Twenty-four-hour ambulatory BP monitoring was recorded in 100 hypertensives (50 dippers, 50 non-dippers) and 50 healthy controls. Serum levels of adropin and hsCRP were measured and recorded. A strong correlation was found between night-time BP levels with adropin and hsCRP levels (p < 0.001). On the other hand, the non-dipper group demonstrated lower adropin levels compared to the dipper and normotensive groups: non dipper group, 2580 ± 457 pg/mL; dipper group, 3298 ± 530 pg/mL; normotensive group, 3681 ± 411 pg/mL; p < 0.001). HsCRP levels were significantly higher in the non-dipper group than in the two other groups (p = 0.017). In a multivariate logistic regression analysis, adropin (p = 0.012) and hsCRP (p = 0.039) were independently associated with a non-dipping pattern. Decreased adropin levels were found in the nocturnal hypertensive and non-dipper groups. Adropin and hsCRP were found to be independently associated with a non-dipping pattern. We suggest that decreased levels of adropin in non-dipper hypertensive patients might be associated with a longer duration of exposure to high BP. These results point to a possible future role of adropin in identifying hypertensive patients at higher risk of target organ damage.

NEXT GENERATION SEQUENCING HELPS IN DIFFERENTIAL DIAGNOSIS OF PATHOLOGICAL LEFT VENTRICULAR HYPERTROPHY IN ELITE ATHLETES

To detect the reason of left ventricular hypertrophy (LVH) may be difficult in some cases especially in elite athletes. Object. To evaluate the efficiency of next generation sequencing (NGS) genetic test in differential diagnostics of pathological LVH in elite athletes. Material and methods. Analysis of echocardiographic data from 791 elite athletes revealed 15 individuals with LVH &gt; 12 mm (1,9%). Based on the criteria of abnormality (asymmetric, severe and changes on electrocardiogram) 5 (0,6%) athletes were selected for genetic test. TruSight Cardio panel (“Illumina”) was used to identify variants of 174 genes with known associations to inherited cardiac conditions. Results. In 3 out of 5 athletes the pathogenic variants in MBPC3 and LMNA genes previously associated with HCM and other CMs were found. One athlete with negative genetic test result had severe untreated arterial hypertension as a possible cause for LVH. The second athlete didn’t have LVH in magnetic resonance imaging. Conclusions. In elite athletes, the asymmetric LVH should be considered as pathological finding which requires comprehensive clinical evaluation and NGS genetic test.

Muscle microcirculation alterations and relation to dipping status in newly diagnosed untreated patients with arterial hypertension-A pilot study.

The importance of abnormalities observed in the microcirculation of patients with arterial hypertension (AH) is being increasingly recognized. The authors aimed to evaluate skeletal muscle microcirculation in untreated, newly diagnosed hypertensive patients with NIRS, a noninvasive method that evaluates microcirculation. We evaluated 34 subjects, 17 patients with AH (13 males, 49±13years, BMI: 26±2kg/m2 ) and 17 healthy controls (12 males, 49±15years, BMI: 25±3kg/m2 ). The thenar muscle StO2 (%) was measured by NIRS before, during and after 3-minutes vascular occlusion to calculate OCR (%/min), EF (%/min), and RHT (minute). The dipping status of hypertensive patients was assessed. The RHT differed between AH patients and healthy subjects (2.6±0.3 vs 2.1±0.3minutes, P<.001). Dippers had higher EF than nondippers (939±280 vs 710±164%/min, P=.05). The study suggests an impaired muscle microcirculation in newly diagnosed, untreated AH patients.