Vol 18, No 4 (2021)

Original Article

Blood pressure variability, endothelial dysfunction, and C-reactive protein levels in arterial hypertension in combination with coronary artery disease

Musikhina N.A., Petelina T.I., Gapon L.I., Kostousova A.I.

Abstract

Background. Recently, the role of increased variability in blood pressure (BP) as a new risk factor for cardiovascular events in patients with arterial hypertension (AH) in combination with coronary heart disease (CHD) has been discussed. At the same time, the mechanisms of the participation of blood pressure variability in the development of atherosclerotic damage to the vascular wall are not well understood.

Aim. To study the nature of the relationship between the indicators of daily BP variability, vasomotor function of the endothelium and highly sensetive C-reactive protein (hs-CRP) in patients with AH combined with CAD.

Materials and methods. 80 patients with AH and CAD (55.5±0.7 years) were examined. The study assessed the BP variability according to 24-hour monitoring of BP, vasomotor function of the brachial artery endothelium, and the level hs-CRP in blood serum.

Results. Increased indicators of diurnal BP variability were recorded in 48.8% of patients. There were revealed signs of endothelial dysfunction in patients in the form of a decrease in endothelium-dependent vasodilation (EDV) to 5.38±0.48% and an insufficient increase in endothelium-independent vasodilation (EIV) to 15.82±1.24%. Patients with increased variability of BP differed from patients with normal variability of BP by higher values of hs-CRP (2.98±0.71 and 1.56±0.33 mg/l; p<0.05), a less pronounced response to administration nitroglycerin when evaluating EIV (13.23±1.79 and 17.70±0.77%; p<0.05). Correlation relationships of variability of systolic BP (SBP) in the daytime with EVD were recorded (r=-0.44; p=0.012); variability of diastolic BP (DBP) in the daytime with EIV (r=-0.50; p=0.003); nighttime variability of DBP with EIV (r=-0.43; p=0.013). Relationships between the level of hs-CRP and the variability of SBP in the daytime (r=0.30; p=0.008) and with EVD (r=-0.47; p=0.007) were established. In patients with increased variability of SBP, the likelihood of registering an increased level of hs-CRP is 1.6 times higher OR 1.58 (95% CI 1.014–2.451; p=0.043). In patients with depletion of the vasodilation reserve during the test with nitroglycerin (EIV), an increase in blood pressure variability is recorded 1.2 times more likely OR 1.22 (95% CI 1.012–1.478; p=0.037).

Conclusion. The revealed association of the daily variability of BP with indicators of vasomotor function of the endothelium and a marker of the inflammatory reaction of the vascular wall may indicate the presence of a pathogenetic relationship between the parameters that determine the development of adverse events in patients with AH and CAD.

Systemic Hypertension. 2021;18(4):165-168
pages 165-168 views

Knowledge of senior students in the definition, classification, and approaches to the treatment of arterial hypertension. Final results of the PHYSTARH project

Bontsevich R.A., Vovk Y.R., Gavrilova A.A., Batishcheva G.A., Goncharova N.I., Elizarova I.O., Ketova G.G., Barysheva V.O., Bikkinina G.M., Myronenko O.V.

Abstract

Background. Arterial hypertension is a modifiable risk factor for the development of life-threatening cardiovascular complications. Early diagnosis and optimal treatment are the key to success in the fight against this pathology.

Aim. To analyze the knowledge of senior medical students from different regions in the basic issues of hypertension.

Materials and methods. The article presents the results of the first stage of the multicenter PHYSTARH study (the full name of the project is Physicians’ and undergraduates’ knowledge in arterial hypertension treatment). An anonymous questionnaire (pharmacoepidemiological survey) was conducted among 314 senior medical students from 6 cities of Russia and Ukraine.

Results. The study revealed the average level of senior students’ knowledge. The average level of correct answers to the questions in the first part of the questionnaire was 49.4%. The minimum level of correct answers was obtained in the questions of determining hypertension by the value of home blood pressure monitoring, determining the degree of hypertension for a blood pressure of 140/110 mm Hg, the incidence of resistant hypertension, indications for drug correction of high normal blood pressure, the choice of the optimal class of drugs for initial antihypertensive therapy. The maximum level of correct answers was registered only for the question about the definition of hypertension.

Conclusion. The results of the study indicate an insufficiently high level of students’ basic knowledge in the classification and treatment of hypertension.

Systemic Hypertension. 2021;18(4):169-174
pages 169-174 views

The efficiency of two-level electrovectorcardiographic diagnostics of left ventricular hypertrophy in the medical examination of urban and rural population

Riabykina G.V., Vishniakova N.A., Fedorova V.S.

Abstract

Background. The incidence of arterial hypertension continues to grow. By 2025 the number of patients will increase to 1.5 billion that makes it necessary to develop and implement effective approaches in the diagnosis and treatment of hypertension in practical health care.

Aim. Evaluate the effectiveness of two-level diagnostics of left ventricular hypertrophy (LVH).

Materials and methods. The distance of the first level of LVH diagnostics in outpatient departments with a territorial is more than 20 km. It was performed by remote electrocardiography, including medical examination of the population. Automatic conclusion of the devices was sent to the personal office of the functional diagnostics doctor. At the second level, the electrocardiograph software was used to convert ECG-12 into a vectorcardiogram (VKG) to clarify LVH. The ECG reports were returned to the device of the doctor/paramedic for further work with the patient. When using scalar ECG criteria for LVH, the most sensitive index was the Sokolov–Lyon index – 24.2% of cases, then the Cornell product – 19.8% of cases. In the second level of ECG diagnostics, the sensitivity of the method in detecting LVH increased more than 3 times: in terms of the maximum loop vector modulus (M QRS 1.8 mV), 72%, the sensitivity of the total index Rx+Sz (2.7 mV) was 58% of cases, the deviation of the spatial angle QRS-T>90° was 42.5%, the spatial area of the loop QRS (S QRSxyz 2.7 mV2), the area of the loop QRS in the horizontal plane (S QRSxz>2.2 mV2) – 41.5%, the orientation angle of the maximum loop vector t in the horizontal plane (angle Txz>70°) was detected in 38% of patients. These indicators were found with the same frequency in both groups of examined individuals.

Conclusion. The use of remote two-level ECG and ECG diagnostics allowed to increase the detection of LVH in rural and urban populations by 3 times.

Systemic Hypertension. 2021;18(4):175-179
pages 175-179 views

Predictors of cardiovascular complications in patients with arterial hypertension and comorbid pathology

Murkamilov I.T., Fomin V.V., Yusupov F.A., Sabirov I.S.

Abstract

Aim. To study the relationship between central arterial pressure (BP) and cystatin C in patients with arterial hypertension and comorbid pathology, depending on gender differences.

Materials and methods. The study involved 162 patients aged 39 to 82 years, suffering from hypertension and comorbid pathology. The average age of the surveyed was 58.6±10.3 years. The following nosological forms were revealed: coronary heart disease – 40.7% of the examined, overweight – 33.9%, 1st degree obesity – 30.8%, type 2 diabetes mellitus – 29.0%, chronic obstructive disease lungs – 16.6%, cerebrovascular diseases – 13.5%. All participants underwent general clinical examinations. The concentration of the lipid spectrum was investigated: the levels of total cholesterol, triglycerides, cholesterol high density lipoproteins (HDL cholesterol) and low density lipoprotein cholesterol (LDL cholesterol) and plasma cystatin C. Glomerular filtration rate (GFR) was calculated according to F. Hoek's formula (80.35/cystatin C – 4.32=GFR). Study of central aortic pressure (CAP), mm Hg Art., was carried out using the device "AngioScan". Echocardiography was performed on a "Vivid q" apparatus (USA, 2014) according to the generally accepted technique. All examined patients were divided into 2 subgroups. The 1st subgroup includes women, the 2nd – men.

Results. In patients with hypertension and comorbid pathology, the most common abnormalities were an increased level of LDL cholesterol (58%), a decreased level of HDL cholesterol (51.8%), hypercholesterolemia (54.3%), hypertriglyceridemia (43.8%) and tachycardia (40.7%). In 51.8% of the surveyed, and more among males, the achievement of the target blood pressure level was detected. In women, the indicators of average age, body mass index, the content of total cholesterol, LDL cholesterol and HDL cholesterol were significantly higher. In male patients, the indicators of the diameter of the aortic outflow tract, end systolic and diastolic dimensions of the left ventricle (LV) significantly exceeded those of women, and the ejection fraction of the LV was significantly lower. The prevalence of LV hypertrophy (LVH) was 37% in the total sample, and it was higher in women than in men (45.9 and 26.6%, respectively, p=0.012). At the same time, the frequencies of concentric and eccentric types of LVH in both subgroups were similar. The incidence of LV concentric remodeling in women and men was 5.7 and 13.3%, respectively (p=0.001). In both subgroups, a negative correlation was found between the LV myocardial mass index and the calculated GFR. A positive correlation was noted between the levels of systolic blood pressure and CAP, the concentrations of cystatin C and plasma triglycerides.

Conclusion. In hypertension, the structure of comorbid pathology is dominated by coronary heart disease, obesity and type 2 diabetes mellitus, when hyper- and dyslipidemia were often detected. The incidence of LVH in the general group of subjects was 37.0%, and in women this indicator was higher. In the subgroup of men, cases of LV concentric remodeling were significantly more frequent. An increase in the level of CAP and systolic blood pressure, as well as the concentration of cystatin C, was associated with an increase in the LV myocardial mass index, especially in the subgroup of women.

Systemic Hypertension. 2021;18(4):180-185
pages 180-185 views

Case Report

Possibilities of a new glucagon-like peptide-1 receptor agonist Semaglutide in improving left ventricular diastolic function in a patient with arterial hypertension and type 2 diabetes mellitu

Azimova M.R., Zhernakova J.V.

Abstract

The emergence of new classes of glucose-lowering drugs that can further reduce cardiovascular risk (CVR) have fundamentally changed the approach to the management of patients with type 2 diabetes mellitus. The most significant changes concerned the strategy of choosing glucose-lowering therapy with a change in priorities from the glycemia level to CVR, which plays a key role in choosing a class of antidiabetic drugs. At the same time, the mechanisms responsible for lowering CVR remain largely unclear. Of undoubted interest is the study of effects of a new glucagon-like peptide-1 receptor agonist, Semaglutide, on the preclinical stage of diastolic dysfunction. The article presents a clinical case of the use of Semaglutide in a patient with arterial hypertension and type 2 diabetes mellitus.

Systemic Hypertension. 2021;18(4):186-192
pages 186-192 views

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