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The efficacy of antihypertensive therapy according to the results of the CONSONANCE program: is achieving the target blood pressure level the sole criterion? 根据辅音项目结果进行降压治疗的疗效:是否达到目标血压水平是唯一的标准?
Q4 Medicine Pub Date : 2023-08-16 DOI: 10.18705/1607-419x-2023-29-4-419-431
Yu. M. Lopatin, S. V. Nedogoda, A. S. Galyavich, V. V. Kashtalap, G. I. Nechaeva, N. P. Lyamina, A. O. Nedoshivin, L. G. Ratova, I. I. Shaposhnik, A. O. Konradi
Objective . This study aims to assess the efficacy of single-pill combination ramipril/indapamide (Konsilar-D 24) in patients with grade 1 and 2 hypertension who did not achieve blood pressure (BP) control through previous therapy or did not receive antihypertensive treatment in routine clinical practice. The assessment is based on home BP monitoring (HBPM), long-term BP variability, and quality of life according to the visual analog scale (VAS) EuroQol. Design and methods . A multicenter open observational program involved 358 CONSONANCE program patients who provided home BP monitoring (HBPM) data and self-monitoring diaries for all visits. Among them, 326 patients (91,1 %) evaluated their well-being using VAS at each visit. The program protocol was approved by the independent ethics committee of the Almazov National Medical Research Centre (protocol № 200219 от 11.02.2019). All participants provided written informed consent before inclusion. Clinical BP changes were evaluated at baseline, 0,5, 1, 3 and 6 months into treatment. Patients measured their BP daily for the initial 2 weeks and then at least 3 times a week. The average of two consecutive measurements represented each reading. The effectiveness criterion for HBPM was achieving an average BP < 135/85 mm Hg. Visit-to-visit BP variability was assessed using standard deviation (SD). Patients self-assessed their quality of life by the VAS EuroQol scale from 1 to 100 points. Statistical analysis was performed with the use of Statistica 10. Quantitative variables were presented as means and standard deviations, and their changes were evaluated using paired Student’s t-test. Qualitative features were compared using McNemar’s test with Yates’ continuity correction. A p-value < 0,05 denoted statistical significance. Results . After 2 weeks of treatment, 268 (74,9 %) patients achieved clinical BP < 140/90 mm Hg, the number increased up to 356 (99,4 %) after 6 months. For home BP, 271 (75,7 %) and 326 (91,1 %) patients reached the target after 2 weeks and after 6 months, respectively. Visit-to-visit BP variability, while on unchanged antihypertensive therapy, was 4,1 ± 2,3 / 2,5 ± 1,1 mm Hg for clinical BP and 4,5 ± 3,5 / 2,8 ± 1,9 mm Hg for home BP. The initial VAS score was 54,7 ± 19,1 points, increasing to 86,6 ± 6,1 points after 6 months of treatment (a change of 31,9 ± 18,5 points; p < 0,0001). Conclusions . Optimizing antihypertensive therapy with the single-pill combination ramipril/indapamide (Consilar D 24) effectively reduces both clinical and home BP, leading to the swift achievement of the target BP level for most patients with previously uncontrolled arterial hypertension. Treatment with this single-pill combination also reduces visit-to-visit BP variability and enhances patients’ quality of life in real clinical settings.
目标。本研究旨在评估雷米普利/吲达帕胺(konsilar - d24)单片联合用药对1级和2级高血压患者的疗效,这些患者在既往治疗中未达到血压(BP)控制或在常规临床实践中未接受降压治疗。评估基于家庭血压监测(HBPM)、长期血压变异性和根据视觉模拟量表(VAS) EuroQol的生活质量。设计和方法。一项多中心开放观察项目涉及358名辅音项目患者,这些患者提供了所有就诊的家庭血压监测(HBPM)数据和自我监测日记。其中,326例患者(91.1%)在每次访问时使用VAS评估他们的健康状况。该方案方案由阿尔马佐夫国家医学研究中心的独立伦理委员会批准(方案№200219科夫11.02.2019)。所有参与者在纳入前均提供书面知情同意。在治疗后的基线、0、5、1、3和6个月评估临床血压变化。患者在最初两周每天测量血压,然后每周至少3次。两次连续测量的平均值代表每个读数。HBPM的有效性标准为达到平均血压<使用标准差(SD)评估访间血压变异性。患者通过VAS EuroQol量表自评生活质量,评分范围从1到100分。使用Statistica 10进行统计分析。定量变量以均值和标准差表示,使用配对学生t检验评估其变化。采用McNemar检验和Yates连续性校正对定性特征进行比较。p值<0,05为有统计学意义。结果。治疗2周后,268例(74.9%)患者达到临床血压和血糖水平;140/90 mm Hg, 6个月后增加到356例(99.4%)。对于家庭血压,271例(75.7%)和326例(91.1%)患者分别在2周和6个月后达到目标。在抗高血压治疗不变的情况下,每次就诊时的血压变异性,临床血压为4.1±2.3 / 2,5±1.1 mm Hg,家庭血压为4,5±3,5 / 2,8±1.9 mm Hg。初始VAS评分为54,7±19,1分,治疗6个月后增至86,6±6,1分(变化为31,9±18.5分;p & lt;0, 0001)。结论。优化雷米普利/吲达帕胺单丸联合抗高血压治疗(Consilar D 24)有效降低临床和家庭血压,导致大多数先前未控制的动脉高血压患者迅速达到目标血压水平。使用这种单药组合治疗还可以减少每次就诊的血压变异性,并提高患者在实际临床环境中的生活质量。
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引用次数: 0
History of the study of arterial hypertension from Cesalpino to the 21<sup>st</sup> century 从Cesalpino到21世纪动脉高血压的研究历史&lt;sup&gt;st&lt;/sup&gt;世纪
Q4 Medicine Pub Date : 2023-05-29 DOI: 10.18705/1607-419x-2023-29-4-432-435
A. S. Galyavich
The article describes the main milestones in the study of hypertension (HTN). In a chronological aspect, the main discoveries in the field of hypertension since the 16 th century are presented. The contribution of Russian scientists to the field and approaches to its treatment is noted. The facts related to the development of national recommendations on HTN is presented.
本文介绍了高血压(HTN)研究中的主要里程碑。在时间顺序方面,介绍了自16世纪以来高血压领域的主要发现。注意到俄罗斯科学家对该领域的贡献及其治疗方法。介绍了与制定关于HTN的国家建议有关的事实。
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引用次数: 0
Prognostic value of echocardiographic parameters of cardiac remodeling in patients with hypertension and obstructive sleep apnea 高血压合并阻塞性睡眠呼吸暂停患者心脏重构超声心动图参数的预后价值
Q4 Medicine Pub Date : 2023-05-15 DOI: 10.18705/1607-419x-2023-29-2-164-174
A. Yakovlev, I. A. Efremov, A. Ryabikov, N. Yakovleva, I. V. Shirokih, S. Shilov, A. Teplyakov, E. Grakova, K. V. Kopyeva, N. A. Kokoulina
Objective. To study the prognostic value of echocardiographic parameters of early cardiac remodeling in patients with hypertension (HTN) and obstructive sleep apnea (OSA). Design and methods. The study included 59 men with HTN and OSA (with an apnea/hypopnea index > 15 per hour). At baseline, all patients underwent polysomnography and echocardiography with an additional assessment of the global longitudinal strain (GLS). At baseline and at 12-month follow-up, a 6-minute walk test was performed. After 12 months, the clinical course of the disease was assessed. The criteria for an unfavorable course were episodes of hospitalization, the development of acute coronary syndrome, cerebral stroke, paroxysmal atrial fibrillation, worsening of chronic heart failure with a transition to a higher NYHA functional class. Results. In groups with favorable and unfavorable clinical course, some baseline echocardiographic parameters differed significantly: interventricular septal thickness (p = 0,037), left ventricular myocardial mass index (LVMI) (p = 0,003), tricuspid annular plane systolic excursion (TAPSE) (p < 0.001), GLS (p = 0,019), peak tricuspid regurgitation (p = 0,027), left atrial volume index (p = 0,048). Regression analysis showed that baseline TAPSE and LVMI had predictive value for an unfavorable clinical course. Conclusions. Our results confirm that certain echocardiographic parameters, in particular, LVMI and TAPSE, are predictors of the development and progression of cardiovascular complications in OSA patients.
目标。探讨高血压(HTN)合并阻塞性睡眠呼吸暂停(OSA)患者早期心脏重构的超声心动图参数对预后的价值。设计和方法。该研究包括59名HTN和OSA患者(呼吸暂停/呼吸不足指数> 15 /小时)。在基线时,所有患者都进行了多导睡眠图和超声心动图检查,并对全局纵向应变(GLS)进行了额外的评估。在基线和12个月的随访中,进行了6分钟步行测试。12个月后,评估疾病的临床病程。不良病程的标准是住院发作、急性冠状动脉综合征、脑中风、阵发性心房颤动、慢性心力衰竭恶化并过渡到更高的NYHA功能等级。结果。在临床病程有利组和不利组中,一些基线超声心动图参数差异显著:室间隔厚度(p = 0.037)、左心室心肌质量指数(LVMI) (p = 0.003)、三尖瓣环平面收缩偏移(TAPSE) (p < 0.001)、GLS (p = 0.019)、三尖瓣反流峰(p = 0.027)、左心房容积指数(p = 0.048)。回归分析显示基线TAPSE和LVMI对不良临床病程有预测价值。结论。我们的研究结果证实,某些超声心动图参数,特别是LVMI和TAPSE,是OSA患者心血管并发症发生和进展的预测因子。
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引用次数: 0
The relationship of epicardial adipose tissue and metabolic syndrome 心外膜脂肪组织与代谢综合征的关系
Q4 Medicine Pub Date : 2023-05-15 DOI: 10.18705/1607-419x-2023-29-2-186-193
I. Mustafina, A. Dolganov, М. K. Kutlubaev, N. Zagidullin
Visceral obesity is a key link in the metabolic syndrome and can affect the development of cardiovascular diseases. Objective. The aim of the study was to identify the clinical, laboratory and instrumental characteristics of patients with coronary artery disease, to analyze adverse cardiovascular events after coronary bypass surgery, according to the thickness of the epicardial adipose tissue (EAT). Design and methods. The study included 178 patients who underwent coronary bypass surgery. The median values of the thickness of the EAT was 0,4 cm. The patients were divided into 2 groups: group 1 — epicardial fat < 0,44 cm (n = 84) and group 2 — epicardial fat > 0,44 cm (n = 94). Results. The frequency of metabolic syndrome in group 1 was 59,5 %, while in group 2 — 74,5 % (p = 0,017). The thickness of the EAT correlated with blood glucose (r = 0,28, p = 0,003), body mass index (BMI) (r = 0,27, p = 0,010), waist circumference (r = 0,26, p = 0,001). End-diastolic volume of the left ventricle (p = 0,016), stroke volume (p = 0,014), thickness of the interventricular septum (p = 0,010), mass of the left ventricular myocardium (p = 0,048), left ventricular myocardial mass index (p = 0,035) were higher in the group with a higher content of EAT. The metabolic syndrome was a significant predictor of the EAT thickness. Conclusions. The EAT thickness is associated with the metabolic syndrome and its components.
内脏型肥胖是代谢综合征的关键环节,可影响心血管疾病的发展。目标。该研究的目的是根据心外膜脂肪组织(EAT)的厚度,确定冠状动脉疾病患者的临床、实验室和仪器特征,分析冠状动脉搭桥手术后的不良心血管事件。设计和方法。该研究包括178名接受冠状动脉搭桥手术的患者。EAT厚度中位数为0.4 cm。将患者分为2组:1组-心外膜脂肪< 0.44 cm (n = 84); 2组-心外膜脂肪> 0.44 cm (n = 94)。结果。1组代谢综合征发生率为59.5%,2组为- 74.5% (p = 0.017)。EAT厚度与血糖(r = 0,28, p = 0,003)、体重指数(BMI) (r = 0,27, p = 0,010)、腰围(r = 0,26, p = 0,001)相关。左心室舒张末期容积(p = 0.016)、每搏容积(p = 0.014)、室间隔厚度(p = 0.010)、左心室心肌质量(p = 0.048)、左心室心肌质量指数(p = 0.035)在EAT含量高的组均较高。代谢综合征是EAT厚度的重要预测因子。结论。EAT厚度与代谢综合征及其组成部分有关。
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引用次数: 0
Predictors for success of renal denervation in patients with resistant arterial hypertension 顽固性高血压患者肾去神经治疗成功的预测因素
Q4 Medicine Pub Date : 2023-05-15 DOI: 10.18705/1607-419x-2023-29-2-175-185
A. Orekhov, L. Karazhanova, A. Chinybayeva, Sholpan Zhukusheva, A. Konradi
Objective. Development of principles for personalized selection of patients for renal denervation (RD) based on the evaluation of procedural response predictors. Design and methods. In the period from 2016 to 2022, 91 patients with resistant arterial hypertension (RHTN) underwent a RD procedure using 2 types of catheters — monopolar and spiral. All patients were assessed for basic demographic, clinical, functional, and laboratory characteristics. The reassessment was carried out on the 7th day, then after 6 and 12 months. A predictive model for determining the probability of response to RD was constructed using the logistic regression method. Results. The final analysis included data from 91 RHTN patients, the mean age was 57,79 ± 9,5 years. At baseline, patients received 4,5 ± 1,4 antihypertensive drugs. Initial office systolic blood pressure (SBP) was 190 (interquartile range (IQR) 100; 140, 240) mm Hg, diastolic blood pressure (DBP) — 100 (IQR 60; 80, 140) mm Hg. Among the responders, a significant reduction in blood pressure (BP) was achieved, with maintenance of the antihypertensive effect during 1 year of follow-up (p < 0,001 for SBP and DBP). The multivariate regression analysis showed that the initial DPB (p < 0,001), the diameter of the right (p = 0,049) and left renal arteries (RA) (p = 0,038) were significant predictors. Based on these data, a prognostic model was developed (p < 0,001). Conclusions. Our results confirmed effectiveness and safety of RD. The stability of the clinical effect is important. However, there was a high variability in the degree of BP reduction after the procedure. The initial DBP, the diameter of the left and right RA, and the use of drugs that reduce the activity of the sympathetic nervous system can be used as possible predictors of response to RD.
目标。基于程序性反应预测因子评估的肾去神经支配(RD)患者个性化选择原则的发展。设计和方法。2016年至2022年期间,91例顽固性动脉高血压(RHTN)患者使用单极和螺旋两种导管进行了RD手术。对所有患者进行基本的人口学、临床、功能和实验室特征评估。分别于第7天、第6个月和第12个月进行重评。采用logistic回归方法建立了确定RD响应概率的预测模型。结果。最终分析数据来自91例RHTN患者,平均年龄为57,79±9.5岁。在基线时,患者接受了4,5±1,4种降压药。初始办公室收缩压(SBP) 190(四分位间距(IQR) 100;140,240) mm Hg,舒张压(DBP) - 100 (IQR 60;在应答者中,血压(BP)显著降低,并在1年随访期间保持降压效果(收缩压和舒张压p < 0.001)。多因素回归分析显示,初始DPB (p < 0.001)、右肾动脉直径(p = 0.049)和左肾动脉直径(p = 0.038)是显著的预测因子。基于这些数据,我们建立了预后模型(p < 0.001)。结论。我们的结果证实了RD的有效性和安全性,临床效果的稳定性是重要的。然而,手术后血压降低的程度有很大的可变性。初始舒张压、左右RA直径以及降低交感神经系统活动的药物的使用可作为RD反应的可能预测因素。
{"title":"Predictors for success of renal denervation in patients with resistant arterial hypertension","authors":"A. Orekhov, L. Karazhanova, A. Chinybayeva, Sholpan Zhukusheva, A. Konradi","doi":"10.18705/1607-419x-2023-29-2-175-185","DOIUrl":"https://doi.org/10.18705/1607-419x-2023-29-2-175-185","url":null,"abstract":"Objective. Development of principles for personalized selection of patients for renal denervation (RD) based on the evaluation of procedural response predictors. Design and methods. In the period from 2016 to 2022, 91 patients with resistant arterial hypertension (RHTN) underwent a RD procedure using 2 types of catheters — monopolar and spiral. All patients were assessed for basic demographic, clinical, functional, and laboratory characteristics. The reassessment was carried out on the 7th day, then after 6 and 12 months. A predictive model for determining the probability of response to RD was constructed using the logistic regression method. Results. The final analysis included data from 91 RHTN patients, the mean age was 57,79 ± 9,5 years. At baseline, patients received 4,5 ± 1,4 antihypertensive drugs. Initial office systolic blood pressure (SBP) was 190 (interquartile range (IQR) 100; 140, 240) mm Hg, diastolic blood pressure (DBP) — 100 (IQR 60; 80, 140) mm Hg. Among the responders, a significant reduction in blood pressure (BP) was achieved, with maintenance of the antihypertensive effect during 1 year of follow-up (p < 0,001 for SBP and DBP). The multivariate regression analysis showed that the initial DPB (p < 0,001), the diameter of the right (p = 0,049) and left renal arteries (RA) (p = 0,038) were significant predictors. Based on these data, a prognostic model was developed (p < 0,001). Conclusions. Our results confirmed effectiveness and safety of RD. The stability of the clinical effect is important. However, there was a high variability in the degree of BP reduction after the procedure. The initial DBP, the diameter of the left and right RA, and the use of drugs that reduce the activity of the sympathetic nervous system can be used as possible predictors of response to RD.","PeriodicalId":37695,"journal":{"name":"Arterial Hypertension (Russian Federation)","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84217569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Sleep-disordered breathing in the acute phase of ischemic stroke 缺血性中风急性期睡眠呼吸紊乱
Q4 Medicine Pub Date : 2023-05-15 DOI: 10.18705/1607-419x-2023-29-2-194-200
M. Bochkarev, L. Korostovtseva, M. S. Golovkova-Kucheryavaya, V. E. Zheleznyakov, Y. Sviryaev, S. N. Yanishevsky
Objective. Sleep-disordered breathing (SDB) is a common cardiovascular risk factor. The aim of our study was to assess the occurrence and features of SDB in patients with acute supratentorial ischemic stroke. Design and methods. Patients 18-89 years of age with acute ischemic stroke admitted to the stroke intensive care unit within 24 hours after the symptom onset underwent respiratory monitoring during the first day of hospitalization. 1616 patients were screened between 2018 and 2021 years, respiratory monitoring was performed in 583 patients, and data from 281 patients [mean age 67 (30; 89) years, 146 males (52 %)] were included in the final analysis. Results. The mean respiratory disturbance index was 11,8 (0; 88)/h. SDB was detected in 182 patients (69,2 %), with mild severity in 28,6 %, moderate in 24,2 %, and severe in 47,2 %. Prevalent obstructive apnea type was observed in 71,1 %, central type in 14,2 %, and mixed type in 14,7 %. The TOAST stroke subtype distribution was the following: unspecified etiology was diagnosed in 52 %, cardioembolic in 26 %, atherothrombotic in 11 %, lacunar in 9 %, and other established etiology in 2 %. The majority of patients had mild stroke severity (89,4 %), moderate and severe stroke was diagnosed in 10,5 %. No significant differences in the main indices of the type and severity of sleep apnea were found in the groups based on severity and pathogenetic type of stroke. Conclusions. Our results correlate with the worldwide prevalence of SDB in patients with ischemic stroke (69,2 % and 71,1 %). Further analysis with inclusion of more patients with moderate and severe stroke is required, as well as a prospective study to assess the prognostic impact of SDB.
目标。睡眠呼吸障碍(SDB)是一种常见的心血管危险因素。我们的研究目的是评估急性幕上缺血性脑卒中患者SDB的发生和特征。设计和方法。18-89岁急性缺血性卒中患者在症状出现后24小时内入住卒中重症监护病房,在住院第一天进行呼吸监测。在2018年至2021年间对1616名患者进行了筛查,583名患者进行了呼吸监测,281名患者的数据[平均年龄67岁(30岁;89岁,男性146例(52%)]纳入最终分析。结果。平均呼吸障碍指数为11.8 (0;88) / h。182例(69.2%)患者检出SDB,其中轻度28.6%,中度24.2%,重度47.2%。常见阻塞性呼吸暂停型占71.1%,中心型占14.2%,混合型占14.7%。TOAST卒中亚型分布如下:病因不明的占52%,心脏栓塞的占26%,动脉粥样硬化血栓形成的占11%,腔隙性的占9%,其他确定的病因占2%。以轻度脑卒中为主(89.4%),中度及重度脑卒中占10.5%。睡眠呼吸暂停类型和严重程度的主要指标在卒中严重程度和发病类型组间无显著差异。结论。我们的研究结果与缺血性脑卒中患者SDB的全球患病率相关(69.2%和71.1%)。需要纳入更多中重度脑卒中患者的进一步分析,以及评估SDB对预后影响的前瞻性研究。
{"title":"Sleep-disordered breathing in the acute phase of ischemic stroke","authors":"M. Bochkarev, L. Korostovtseva, M. S. Golovkova-Kucheryavaya, V. E. Zheleznyakov, Y. Sviryaev, S. N. Yanishevsky","doi":"10.18705/1607-419x-2023-29-2-194-200","DOIUrl":"https://doi.org/10.18705/1607-419x-2023-29-2-194-200","url":null,"abstract":"Objective. Sleep-disordered breathing (SDB) is a common cardiovascular risk factor. The aim of our study was to assess the occurrence and features of SDB in patients with acute supratentorial ischemic stroke. Design and methods. Patients 18-89 years of age with acute ischemic stroke admitted to the stroke intensive care unit within 24 hours after the symptom onset underwent respiratory monitoring during the first day of hospitalization. 1616 patients were screened between 2018 and 2021 years, respiratory monitoring was performed in 583 patients, and data from 281 patients [mean age 67 (30; 89) years, 146 males (52 %)] were included in the final analysis. Results. The mean respiratory disturbance index was 11,8 (0; 88)/h. SDB was detected in 182 patients (69,2 %), with mild severity in 28,6 %, moderate in 24,2 %, and severe in 47,2 %. Prevalent obstructive apnea type was observed in 71,1 %, central type in 14,2 %, and mixed type in 14,7 %. The TOAST stroke subtype distribution was the following: unspecified etiology was diagnosed in 52 %, cardioembolic in 26 %, atherothrombotic in 11 %, lacunar in 9 %, and other established etiology in 2 %. The majority of patients had mild stroke severity (89,4 %), moderate and severe stroke was diagnosed in 10,5 %. No significant differences in the main indices of the type and severity of sleep apnea were found in the groups based on severity and pathogenetic type of stroke. Conclusions. Our results correlate with the worldwide prevalence of SDB in patients with ischemic stroke (69,2 % and 71,1 %). Further analysis with inclusion of more patients with moderate and severe stroke is required, as well as a prospective study to assess the prognostic impact of SDB.","PeriodicalId":37695,"journal":{"name":"Arterial Hypertension (Russian Federation)","volume":"43 1-6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77487727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Clinical and laboratory characteristics of COVID-19 in hospitalized hypertensive patients 住院高血压患者COVID-19的临床和实验室特征
Q4 Medicine Pub Date : 2023-05-15 DOI: 10.18705/1607-419x-2023-29-2-150-163
A. Abilbayeva, A. Tarabayeva, G. Idrisova, R. Yegemberdiyeva, A. Abdrakhmanova, A. M. Sadykova, A. Duisenova
Objective. To identify clinical and laboratory differences of COVID-19 in patients with hypertension (HTN), as well as to identify factors associated with its severe course in these patients. Design and methods. A retrospective analysis of case histories of 940 patients with COVID-19 was performed. Statistical analysis was carried out by the method of contingency tables using Pearson's Chi-square test with Bonferroni correction, multiple logistic regression analysis and ROC-analysis were also applied. Results. The group of patients with COVID-19 and HTN showed a number of significant differences compared with the group of patients without HTN history. The study group was characterized by higher rates of females, people over 65, patients with severe COVID-19. They were more likely to have diabetes mellitus, coronary heart disease, and chronic kidney disease. On admission, in the group of HTN patients, leukocytosis and elevated blood glucose levels were more common, as well as pneumonia, shortness of breath and low saturation (p < 0,05). Multivariate logistic regression analysis showed that the presence of coronary heart disease (odds ratio (OR) = 3,492, 95 % confidential interval (CI): 2,016-6,048), leukocytosis (OR = 1,376, 95 % CI: 1,540-7,703), thrombocytopenia (OR = 1,779, 95 % CI: 1,031-3,071) and low SpO2 saturation (OR = 3,265, 95 % CI: 1,996-5,341) were associated with severe COVID-19 in hypertensive patients. ROC-analysis showed that the combination of the identified factors increases power of their association with the severe COVID-19 in HTN patients (AUC = 0,766). Conclusions. 1. Some indicators of hospitalized COVID-19 patients with HTN are different compared to patients with no HTN history. 2. Factors associated with severe COVID-19 in individuals with HTN do not differ from those in the general population of COVID-19 patients. 3. Severe COVID-19 in patients with HTN was strongly associated with the low SpO2 saturation and the presence of concomitant coronary heart disease.
目标。目的探讨高血压患者(HTN)中COVID-19的临床和实验室差异,并确定与这些患者重症病程相关的因素。设计和方法。回顾性分析940例新冠肺炎患者的病例史。采用列联表法进行统计分析,采用Pearson卡方检验,Bonferroni校正,并采用多元logistic回归分析和roc分析。结果。与没有HTN病史的患者相比,COVID-19和HTN患者组有许多显著差异。研究小组的特点是女性、65岁以上的人、严重的COVID-19患者的比例更高。他们更容易患糖尿病、冠心病和慢性肾病。入院时,HTN组患者白细胞增多、血糖升高、肺炎、呼吸短促、低饱和度更为常见(p < 0.05)。多因素logistic回归分析显示,冠心病(优势比(OR) = 3,492, 95%可信区间(CI): 2,016-6,048)、白细胞增多(OR = 1,376, 95% CI: 1,540-7,703)、血小板减少(OR = 1,779, 95% CI: 1,031-3,071)和低SpO2饱和度(OR = 3,265, 95% CI: 1996 -5,341)与高血压患者重症COVID-19相关。roc分析显示,确定的因素组合增加了它们与HTN患者中严重COVID-19的相关性(AUC = 0.766)。结论:1。住院的新冠肺炎合并HTN患者与无HTN病史患者的部分指标存在差异。2. HTN患者中与严重COVID-19相关的因素与普通人群中的COVID-19患者没有差异。3.HTN患者的严重COVID-19与低SpO2饱和度和合并冠心病密切相关。
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引用次数: 0
Management of pregnant women with pheochromocytoma: clinical cases and literature review 孕妇嗜铬细胞瘤的处理:临床病例及文献复习
Q4 Medicine Pub Date : 2023-05-15 DOI: 10.18705/1607-419x-2023-29-2-220-230
E. Shelepova, N. A. Osipova, A. A. Kuznetcova, A. S. Aitkulova, R. A. Bairova, U. Tsoy, I. Zazerskaya
Objective. To represent clinical cases of pheochromocytoma (PCC) during pregnancy and to draw attention to diagnostics, choice of proper treatment and delivery method. Design and methods. Both domestic and forensic scientific and medical publications about hypertension and PCC were analyzed. We also represent four clinical cases of the patients with PCC, who were observed and treated in Perinatal Centre of Almazov National Medical Research Centre. Results. In three cases hypertension had been diagnosed before present pregnancy, and in two cases it had been treated as essential hypertension. One woman registered increased blood pressure (BP) during pregnancy for the first time. In three cases hypertensive crises were registered. Two caesarian sections were performed because of fetoplacental circulation disorders and high risks of antenatal fetal death, both before full term. Two natural births occurred at full term and at 34 weeks due to the development of spontaneous labor. In all cases PCC was diagnosed during pregnancy, confirmed by histology and immunohistochemistry after adrenalectomy in the postpartum period. Conclusions. All patients with PCC during pregnancy must be followed by a multidisciplinary team including obstetricians, cardiologists, endocrinologists, surgeons, anesthesiologists and neonathologists. Early diagnosis and proper treatment significantly improve prognosis during pregnancy for both mother and fetus. Specialists must exclude PCC if any urgent cardiovascular situation developed during pregnancy, including first detection of increased BP.
目标。介绍妊娠期嗜铬细胞瘤(PCC)的临床病例,并提请注意诊断,选择适当的治疗和分娩方式。设计和方法。分析了国内外有关高血压和PCC的科学和医学出版物。我们还报告了在阿尔马佐夫国家医学研究中心围产期中心观察和治疗的4例PCC患者的临床病例。结果。其中3例高血压在妊娠前确诊,2例作为原发性高血压治疗。一名妇女在怀孕期间首次记录血压升高。记录了3例高血压危象。由于胎胎盘循环障碍和产前胎儿死亡的高风险,在足月前进行了两次剖腹产。两个自然分娩发生在足月和34周,由于自然分娩的发展。所有病例均在妊娠期间诊断为PCC,并在产后肾上腺切除术后通过组织学和免疫组织化学证实。结论。所有妊娠期PCC患者必须由包括产科医生、心脏科医生、内分泌科医生、外科医生、麻醉科医生和新生儿科医生在内的多学科团队进行随访。早期诊断和适当治疗可显著改善妊娠期母胎预后。如果怀孕期间出现任何紧急心血管情况,包括首次检测到血压升高,专家必须排除PCC。
{"title":"Management of pregnant women with pheochromocytoma: clinical cases and literature review","authors":"E. Shelepova, N. A. Osipova, A. A. Kuznetcova, A. S. Aitkulova, R. A. Bairova, U. Tsoy, I. Zazerskaya","doi":"10.18705/1607-419x-2023-29-2-220-230","DOIUrl":"https://doi.org/10.18705/1607-419x-2023-29-2-220-230","url":null,"abstract":"Objective. To represent clinical cases of pheochromocytoma (PCC) during pregnancy and to draw attention to diagnostics, choice of proper treatment and delivery method. Design and methods. Both domestic and forensic scientific and medical publications about hypertension and PCC were analyzed. We also represent four clinical cases of the patients with PCC, who were observed and treated in Perinatal Centre of Almazov National Medical Research Centre. Results. In three cases hypertension had been diagnosed before present pregnancy, and in two cases it had been treated as essential hypertension. One woman registered increased blood pressure (BP) during pregnancy for the first time. In three cases hypertensive crises were registered. Two caesarian sections were performed because of fetoplacental circulation disorders and high risks of antenatal fetal death, both before full term. Two natural births occurred at full term and at 34 weeks due to the development of spontaneous labor. In all cases PCC was diagnosed during pregnancy, confirmed by histology and immunohistochemistry after adrenalectomy in the postpartum period. Conclusions. All patients with PCC during pregnancy must be followed by a multidisciplinary team including obstetricians, cardiologists, endocrinologists, surgeons, anesthesiologists and neonathologists. Early diagnosis and proper treatment significantly improve prognosis during pregnancy for both mother and fetus. Specialists must exclude PCC if any urgent cardiovascular situation developed during pregnancy, including first detection of increased BP.","PeriodicalId":37695,"journal":{"name":"Arterial Hypertension (Russian Federation)","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75741508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The HFA-PEFF diagnostic algorithm for diagnosing heart failure with preserved ejection fraction in hypertensive patients HFA-PEFF诊断方法在高血压患者保留射血分数心力衰竭诊断中的应用
Q4 Medicine Pub Date : 2023-05-14 DOI: 10.18705/1607-419x-2023-29-2-211-219
O. E. Vilkova, N. Grigoryeva, M. O. Petrova, D. V. Solovyova
The main causes of chronic heart failure (CHF) are hypertension (HTN) and coronary heart disease (CHD). One of the diagnostic methods for heart failure with preserved ejection fraction (HFpEF) can be the HFA-PEFF diagnostic algorithm, according to which diastolic stress test (DST) is indicated for patients with an intermediate probability of heart failure (HF). Objective. The aim of the study was to compare the incidence of HFpEF in patients with HTN with CHD and hypertensive patients without CHD by transthoracic echocardiogram using a DST according to the diagnostic algorithm HFA-PEFF. Design and methods. The study enrolled 45 patients with HTN and symptoms of HF who were divided into two groups according to the presence of CHD: patients with HTN and CHD (group I), patients with HTN without CHD (group II). The major and minor criteria of the HFA-PEFF diagnostic algorithm were evaluated to make the diagnosis of HFpEF. The DST was performed applying a passive leg raising test in patients with an intermediate probability of HFpEF. Results. According to the major and minor criteria of the HFA-PEFF: 7 (21,9 %) patients in group I and 3 (23,1 %) patients in group II did not have HFpEF. The confirmed HFpEF in group I was detected in 2 (6,2 %) patients, and none patients demonstrated confirmed HFpEF in group II. The remaining patients had an intermediate probability of HFpEF. DST with passive leg raising allowed to additionally diagnose HFpEF at an early stage in 6 (26,1 %) patients with HTN and CHD and in 1 (10 %) patient with HTN without CHD. Conclusions. The HFA-PEFF diagnostic algorithm using major and minor criteria allows to make the diagnosis of HFpEF in patients with HTN and symptoms of HF and, according to this algorithm in patients with HTN and CHD was detected more often, compared to patients with HTN without CHD.
慢性心力衰竭(CHF)的主要原因是高血压(HTN)和冠心病(CHD)。保留射血分数心力衰竭(HFpEF)的诊断方法之一可以是HFA-PEFF诊断算法,根据HFA-PEFF诊断算法,对心力衰竭(HF)概率中等的患者进行舒张压力测试(DST)。目标。本研究的目的是根据HFA-PEFF诊断算法,采用DST经胸超声心动图比较HTN合并冠心病患者和高血压无冠心病患者HFpEF的发生率。设计和方法。本研究招募了45例伴有HF症状的HTN患者,根据是否存在冠心病分为HTN合并冠心病患者(I组)和HTN合并无冠心病患者(II组),通过评价HFA-PEFF诊断算法的主要标准和次要标准进行HFpEF的诊断。在中度HFpEF患者中应用被动抬腿试验进行DST。结果。根据HFA-PEFF的轻重标准:I组7例(21.9%),II组3例(23.1%)未发生HFpEF。在第一组中有2例(6.2%)患者检测到确诊的HFpEF,而在第二组中没有患者表现出确诊的HFpEF。其余患者发生HFpEF的概率为中等。在6例HTN合并冠心病患者(26.1%)和1例HTN合并冠心病患者(10%)中,被动抬腿的DST可以在早期额外诊断出HFpEF。结论。采用主要标准和次要标准的HFA-PEFF诊断算法可以对HTN和HF症状患者的HFpEF进行诊断,根据该算法,HTN合并冠心病患者的检测频率高于无冠心病的HTN患者。
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引用次数: 0
Circulating biomarkers for the hypertension development predicting: are there any prospects? 循环生物标志物对高血压发展的预测:有前景吗?
Q4 Medicine Pub Date : 2023-05-14 DOI: 10.18705/1607-419x-2023-29-2-124-137
K. Protasov
The problem of finding reliable predictors of the arterial hypertension (HTN) development in people with initially normal blood pressure level has not been resolved yet. Objective. The purpose of this review was to present and analyze current data on the role and prospects for the use of circulating serum biomarkers in predicting the HTN development. To establish the predictive value of biomarkers and their causal relationships with HTN, the results of prospective and retrospective cohort studies, studies of Mendelian randomization, randomized controlled trials, systematic reviews and meta-analyses on the study of both previously known and relatively new potential risk factors for HTN were analyzed: uric acid, vitamin D, homocysteine, inflammatory biomarkers, soluble ST2, natriuretic peptides, and cardiac troponins. There is evidence of an independent prognostic value of uric acid and inflammatory biomarkers (C-reactive protein) in the HTN development and the possibility of their use as risk markers of HTN. Despite the found relationships of all considered biomarkers with the level of blood pressure in cross-sectional and experimental studies, their causal role in the HTN development in studies of a high level of evidence has not received unambiguous confirmation.
在最初血压水平正常的人群中寻找动脉高血压(HTN)发展的可靠预测因素的问题尚未得到解决。目标。本综述的目的是介绍和分析循环血清生物标志物在预测HTN发展中的作用和前景的现有数据。为了建立生物标志物的预测价值及其与HTN的因果关系,我们分析了前瞻性和回顾性队列研究、孟德尔随机化研究、随机对照试验、系统评价和荟萃分析的结果,分析了已知的和相对较新的HTN潜在危险因素:尿酸、维生素D、同型半胱氨酸、炎症生物标志物、可溶性ST2、利钠肽和心脏肌钙蛋白。有证据表明尿酸和炎症生物标志物(c反应蛋白)在HTN的发展中具有独立的预后价值,并有可能将其用作HTN的风险标志物。尽管在横断面和实验研究中发现了所有被认为的生物标志物与血压水平的关系,但在高水平证据的研究中,它们在HTN发展中的因果作用尚未得到明确的证实。
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引用次数: 0
期刊
Arterial Hypertension (Russian Federation)
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