Pub Date : 2023-08-16DOI: 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。
{"title":"The efficacy of antihypertensive therapy according to the results of the CONSONANCE program: is achieving the target blood pressure level the sole criterion?","authors":"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","doi":"10.18705/1607-419x-2023-29-4-419-431","DOIUrl":"https://doi.org/10.18705/1607-419x-2023-29-4-419-431","url":null,"abstract":"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.","PeriodicalId":37695,"journal":{"name":"Arterial Hypertension (Russian Federation)","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135021590","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}
Pub Date : 2023-05-29DOI: 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.
{"title":"History of the study of arterial hypertension from Cesalpino to the 21<sup>st</sup> century","authors":"A. S. Galyavich","doi":"10.18705/1607-419x-2023-29-4-432-435","DOIUrl":"https://doi.org/10.18705/1607-419x-2023-29-4-432-435","url":null,"abstract":"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.","PeriodicalId":37695,"journal":{"name":"Arterial Hypertension (Russian Federation)","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135831800","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}
Pub Date : 2023-05-15DOI: 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.
{"title":"Prognostic value of echocardiographic parameters of cardiac remodeling in patients with hypertension and obstructive sleep apnea","authors":"A. Yakovlev, I. A. Efremov, A. Ryabikov, N. Yakovleva, I. V. Shirokih, S. Shilov, A. Teplyakov, E. Grakova, K. V. Kopyeva, N. A. Kokoulina","doi":"10.18705/1607-419x-2023-29-2-164-174","DOIUrl":"https://doi.org/10.18705/1607-419x-2023-29-2-164-174","url":null,"abstract":"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.","PeriodicalId":37695,"journal":{"name":"Arterial Hypertension (Russian Federation)","volume":"127 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86413094","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}
Pub Date : 2023-05-15DOI: 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。
{"title":"The relationship of epicardial adipose tissue and metabolic syndrome","authors":"I. Mustafina, A. Dolganov, М. K. Kutlubaev, N. Zagidullin","doi":"10.18705/1607-419x-2023-29-2-186-193","DOIUrl":"https://doi.org/10.18705/1607-419x-2023-29-2-186-193","url":null,"abstract":"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.","PeriodicalId":37695,"journal":{"name":"Arterial Hypertension (Russian Federation)","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75159834","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}
Pub Date : 2023-05-15DOI: 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.
{"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}
Pub Date : 2023-05-15DOI: 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.
{"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}
Pub Date : 2023-05-15DOI: 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.
{"title":"Clinical and laboratory characteristics of COVID-19 in hospitalized hypertensive patients","authors":"A. Abilbayeva, A. Tarabayeva, G. Idrisova, R. Yegemberdiyeva, A. Abdrakhmanova, A. M. Sadykova, A. Duisenova","doi":"10.18705/1607-419x-2023-29-2-150-163","DOIUrl":"https://doi.org/10.18705/1607-419x-2023-29-2-150-163","url":null,"abstract":"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.","PeriodicalId":37695,"journal":{"name":"Arterial Hypertension (Russian Federation)","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77162674","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}
Pub Date : 2023-05-15DOI: 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.
{"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}
Pub Date : 2023-05-14DOI: 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.
{"title":"The HFA-PEFF diagnostic algorithm for diagnosing heart failure with preserved ejection fraction in hypertensive patients","authors":"O. E. Vilkova, N. Grigoryeva, M. O. Petrova, D. V. Solovyova","doi":"10.18705/1607-419x-2023-29-2-211-219","DOIUrl":"https://doi.org/10.18705/1607-419x-2023-29-2-211-219","url":null,"abstract":"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.","PeriodicalId":37695,"journal":{"name":"Arterial Hypertension (Russian Federation)","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74779509","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}
Pub Date : 2023-05-14DOI: 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.
{"title":"Circulating biomarkers for the hypertension development predicting: are there any prospects?","authors":"K. Protasov","doi":"10.18705/1607-419x-2023-29-2-124-137","DOIUrl":"https://doi.org/10.18705/1607-419x-2023-29-2-124-137","url":null,"abstract":"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.","PeriodicalId":37695,"journal":{"name":"Arterial Hypertension (Russian Federation)","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85097087","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}