Тематичний Архів | Category Archives: Arterial hypertension

L.A. Mishchenko, O.O. Matova, M.Yu. Sheremet, K.I. Serbeniuk Comparative efficacy of spironolactone, eplerenone, nebivolol and moxonidine in patients with resistant arterial hypertension

The aim – to study the effectiveness of spironolactone, eplerenone, nebivolol, moxonidine as the 4th component of therapy in patients with resistant arterial hypertension.

Material and methods. The study involved 66 patients with true resistant arterial hypertension (RAH). The average age of patients was 51.9±1.2 years, mostly men (59.1 %). In addition to standard triple-dose fixed combination antihypertensive tharepy, all patients received in turn spironolactone (45.0±3.6 mg/day), eplerenone (47.9±2.1 mg/day), nebivolol (8.9±0.6 mg/day) and moxonidine (0.5±0.1 mg/day). After completion of each stage, after 3 months of therapy, all patients have been assessed an office blood pressure measurements and ABPM.

Results. In patients with RAH, the addition standardized therapy with a triple fixed-dose combination of antihypertensive drugs, antagonists of mineralocorticoid showed better effectiveness than nebivolol and moxonidine: the target level of BP with treatment of spironolactone was achieved in 68.2 % patients, eplerenone – 65.2 %, whereas in the groups of nebivolol and moxonidine – in 53.9 % and 56.2 %, respectively. The predictors of the effectiveness of the antagonists of the mineralocorticoid receptors are increasing plasma aldosterone concentrations (β=0.653; Р=0.002) and ARR values (β=0.542; Р=0.003), while the β-blocker and imidazolin receptor agonist were more effective in older patients (β=0.425; Р=0.02) along with increase of average daily pulse (β=0.315; P=0.04) and excretion of urine metanephrines (β=0.382; Р=0.01).

Conclusoins. Spironolactone and eplerenone are drugs of choice for adding to triple fixed-dose combination in patients with RAH. They were significantly more effective than beta-blocker (nebivolol) and an imidazolin receptor agonist (moxonidine).

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M.I. Shved, T.M. Hanych The acute coronary syndrome without ST segment elevation and concomitant essential hypertension clinical presentation features in men and women with Helicobacter pylori infection

The aim – to investigate the acute coronary syndrome without ST segment elevation and concomitant essential hypertension clinical presentation in men and women with Helicobacter pylori infection.

Material and methods. 197 acute coronary syndrome without ST segment elevation patients (age 45–83 years) with essential arterial hypertension and dyspesia were investigated according to the current clinical protocols with total antibodies to Helicobacter pylori rate detection. The patients were divided by the groups of men and women, infected and uninfected with Helicobacter pylori. The clinical presentation of acute coronary syndromes was evaluated using the 13-item Acute coronary syndrome symptoms checklist and the dyspepsia symptoms were estimated by the Likert scale.

Results. In case of Helicobacter pylori infection compared to uninfected patients a significantly higher severity of chest pain, shoulder pain and upper back pain had been revealed, while among women the chest discomfort, sweating and palpitations significantly prevailed. The intensity of dyspeptic symptoms, especially heartburn and nausea, was significantly higher among women infected with Helicobacter pylori. A significant progression of heart failure with higher prevalence of edema and liver enlargement were revealed in men infected with Helicobacter pylori versus uninfected and in men versus women regardless of Helicobacter pylori infection factor.

Conclusions. The obtained link between the total antibodies to Helicobacter pylori titer and the patients’ age, male gender, myocardial infarction history, the prevalence of edema and liver enlargement might indicate a significant clinical course deterioration and heart failure progression in elderly male patients with acute coronary syndromes without ST segment elevation and essential hypertension in case of Helicobacter pylori infection.

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L.А. Mishchenko, on behalf of the group of researchers Risk factors and socio-economic status in patients with newly diagnosed arterial hypertension: the results of the START II study

The aim – to determine the profile of newly diagnosed patients with arterial hypertension (AH) in real general practitioners’ clinical practice; to estimate the changes of working capacity and patient’s health due to prescribed AH treatment; to study the relationship between blood pressure (BP) control and the level of education, level of income and professional status.

Material and methods. In this multicenter, open-label epidemiological study START II 2024 newly diagnosed and/or untreated patients were included in 11 regional centers of Ukraine and Kyiv. During the inclusion visit the assessment of demographic, socio-economic indicators, lifestyle characteristics, anamnestic data and physical examination were performed. After these procedures, the doctors prescribed antihypertensive therapy at their own discretion. In most cases, this was the original fixed combination of perindopril and amlodipine. Its effectiveness (according to office BP measurements) was evaluated after one and three months of treatment. In addition, at the final visit (3 months of treatment), a questionnaire was conducted to examine the patient’s health changes due to prescribed AH treatment.

Results. Among newly diagnosed and/or untreated patients, 54.9 % were under 55 years old and 58 % were female. According to anamnesis, diabetes occurred in 8.9 % of patients, hypercholesterolemia – in 77.9 % of cases, the status of active smoker was reported by 25.7 % of patients. 23 % respondents assessed their level of physical activity as high and 27 % – as low. 65 % of patients considered their salt intake to be moderate, only 26 % considered it high and 9 % – low. In the structure of the patients, 48 % had higher education, mainly married – 75 % and working – 71 %, but the high level of income was noted only in 8 %. The use of a fixed combination of perindopril / amlodipine after 3 months contributed to a decrease of systolic blood pressure by 31.1 mm Hg, diastolic BP – by 14.7 mm Hg. The target levels of BP were reached in 78 % patients, therapy was more effective in patients <55 years old – 84 % vs. 73 % in the group > 55 years. In addition to age, additional negative factors in achieving blood pressure control were obesity, low level of physical activity and low level of income.

Conclusions. Women and persons under 55 years of age present the majority of newly diagnosed and/or untreated hypertensive patients in urban population of Ukraine. Most of these patients have low or moderate levels of physical activity, as well as by high or moderate level of salt intake. Almost half of patients have higher education, about 70 % are married and working, but the majority (92 %) have low and average level of income. The usage of fixed combination of perindopril/amlodipine as an initial therapy contributed to the achievement of target BP in 78 % of patients.

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L.A. Mishchenko, O.O. Matova, M.Yu. Sheremet, K.I. Serbeniuk, O.B. Kuchmenko Activity of low-grade systemic inflammation in patients with resistant arterial hypertension

The aim – to study the activity of low-grade inflammation and determine an interaction of its parameters with characteristics of humoral systems of blood pressure regulation, hypertensive heart and kidney damage in patients with resistant arterial hypertension (AH).

Material and methods. The results of examination of 129 patients with AH (72 patients with controlled AH, 57 persons with resistant AH) were included into the analysis. All patients, besides routine clinical examination, underwent 24-hours’ blood pressure monitoring, evaluation of systemiс inflammation markers (C-reactive protein, fibrinogen, IL-6, TNF-α), MMP-12 activity, cystatin C, renin, aldosterone, citrulline blood concentration; 24-hours’ excretion of albumin and metanephrine.

Results. In the resistant AH, compared to the patients with controlled arterial hypertension, higher levels of inflammation active phase proteins (C-reactive proteins – by 17.3 %, fibrinogen – by 10.6 %) and proinflammatory cytokines (IL-6 by 21.8 % TNF-α by 13 %) were detected. The activation of low-grade inflammation in patients with resistant AH has been associated with higher renin-angiotensin-aldosterone system activity: the concentration of plasma aldosterone correlated with IL-6 level (r=0.334; Р=0.03) and matrix metalloproteinase 12 activity (r=0.326; Р=0.02); active renin blood contents – with IL-6 (r=0.416; Р=0.01) and TNF-α (r=0.323; Р=0.03) levels). In patients with resistant AH the increase of left ventricle myocardial mass index was accompanied by elevation of plasma IL-6, and decrease of glomerular filtration rate was associated with growth of plasma TNF-α blood level (r=0.318; Р=0.04). Correlation of MMP-12 activity with renal impairment markers – cystatin С (r=0.405; Р=0.01) and citrulline (r=0.338; Р=0.03) was detected. In resistant AH pts increase of LVMI was accompanied by elevation of IL-6.

Conclusions. Resistant AH was characterized by more expressed activation of low – grade inflammation, compared to controlled AH, which is associated with renin-angiotensin-aldosterone system activation and hypertensive injury of heart and kidneys.

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V.I. Tseluyko, on behalf of the group of researchers Reality of arterial hypertension treatment in Ukraine: the results of «СИСТЕМА 2» cohort study

The aim – to study the control of blood pressure in patients over 55 years of age suffering from arterial hypertension as part of primary care or family practice, the concordance of the treatment to the existing guidelines, and the effectiveness of therapy revision in view of the age-specific peculiarities of treatment.

Material and methods. 102 physicians from various regions of Ukraine took part in the «СИСТЕМА 2» study. It enrolled patients over 55 years of age who sought medical advice in out-patient clinics for arterial hypertension (a total of 2,040 patients).

Results. Among patients who took antihypertensive drugs (91.6 %), the mean SBP was 167 mm Hg, and achievement of the target level was observed only in 6.9 % of the cases. In the treatment of arterial hypertension in patients over 55 years of age, the age-specific peculiarities of development and treatment of arterial hypertension, presented in the guidelines, were not taken into account. RAAS blockers are commonly used in monotherapy and in combination therapy but not diuretics and/or calcium antagonists which are recommended. Therapy revision and prescription of the fixed combination of amlodipine and indapamide provides reduction of blood pressure and achievement of the target level in 67 % cases at 3 months. At the same time, there is a high compliance rate (96.6 % at 3 months).

Conclusions. Arterial hypertension control is extremely unsatisfactory in Ukraine. Mean office SBP in patients taking antihypertensive drugs is 167 mm Hg. Only 6.9 % of patients achieve goal SBP level. In treatment of patients aged 55 and up, age pecularities are not taken into account. The most widely used are RAAS inhibitors, instead of recommended diuretics and/or calcium channel blockers. Combination of amlodipine and indapamide provides achievement of goal SBP level after 3 months of treatment in 67 % of cases with high treatment compliance. Antihypertensive effect is more pronounced in patients with higher baseline BP, in patients switched from RAAS inhibitors, in co-administration with statins and in females. Antihypertensive effect is lower in smokers.

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Ye.P. Swishchenko, L.А. Mishchenko, on behalf of the group of researchers Clinical and demographic characteristics of the patients with first diagnosed arterial hypertension: results of START study

The aim – to study demographic and clinical characteristics of the patients with newly diagnosed arterial hypertension (AH); еvaluate patients’ satisfaction with prescribed treatment and changes in well-being and working capacity of patients. The end points of the study were to evaluate the effectiveness of antihypertensive therapy, which was first prescribed by the physician.

Materials and methods. In the open multicentre epidemiological study START 1485 patients were included with newly diagnosed and/or untreated AH from 11 regional centers of Ukraine and Kyiv. During the initial visit, the researchers assessed demographic data, anamnesis and physical examination data and later physician prescribed initial antihypertensive therapy at his/her own discretion. In the majority of cases, the doctors chose an original fixed combination of perindopril/amlodipine. Its efficacy and tolerability was assessed on the 7th and 30th treatment days. Besides, during the final visit (on treatment day 30) the patients answered the questionnaire, so that their opinion about the treatment results could be reviewed.

Results. Among the patients with newly established AH diagnosis or never treated AH, 54.5 % were younger than 55 years of age; 57.8 % were females, 42.2 % were males. In 33.1 % patients AH of the 1st degree was diagnosed, in 54.6 % – AH of the 2nd degree and in 12.2 % – AH of 3rd degree was diagnosed. 77.4 % of patients had hypercholesterolemia, 24.9 % had obesity, 21.9 % were active smokers, and 8.7 % had a history of diabetes mellitus. Administration of the combination perindopril/amlodipine after 7 days decreased systolic blood pressure by 21 mm Hg, diastolic blood pressure – by 10 mm Hg; after 30 days, respectively – by 32 and 15 mm Hg (Р<0.001 for all the parameters). Blood pressure was normalized in 35.3 % patients after a week, and in 76.5 % patients – after a month of combination treatment. Conclusions. The patients profile with newly diagnosed or previously untreated AH among the urban population of Ukraine was presented in majority of cases by females and persons under 55 years of age with predominantly mild or moderate AH. AH is accompanied most frequently by hypercholesterolemia (77.4 %); each fourth patient is obese; each fifth patient is an active smoker. Usage of fixed combination of perindopril/amlodipine as initial therapy in these patients made possible to achieve target blood pressure in a week in 35.3 % of the patients, in 30 days – in 76.5 % patients, with good treatment tolerability.

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T.G. Slascheva, G.D. Radchenko, Yu.M. Sirenko, I.M. Martsovenko Factors associated with patient’s compliance to antihypertensive treatment

The aim – to evaluate factors related to the compliance and its changes during antihypertensive treatment.

Material and methods. We included 10 158 hypertensive patients, treated by 531 general practice physicians. Physicians administered antihypertensive therapy based on domestic generic drugs (bisoprolol, enalapril, fixed combination enalapril and hydrochlorthiazide, amlodipine) during 3 months. Every patient had four visits to the physician’s office with evaluation of the office blood pressure and heart rate, ECG patterns, compliance (by questionnaire).

Results. It was shown that 43.2 % hypertensive patients had low (< 50 % taking prescribed drugs) compliance baseline. Factors associated with poor compliance were older age, presence of coronary heart disease, myocardial infarction, stroke or heart failure, lifestyle (higher body mass index, smoking, alcohol abuse, low physical activity, low consumption of fresh fruits and vegetables, high salt consumption), low education and absence of work (or being retired). The level of blood pressure was higher in patients with baseline low compliance at all 4 visits. The target blood pressure was not achieved in 33.5 % patients with high compliance, in 39,9 % with baseline moderate compliance (P<0.001 vs high) and in 47.6 % (P<0.001 vs high and 0.005 with moderate) with low baseline compliance. In 61.7 % patients we noted improving of the compliance. Independent factors associated with final visit compliance were age (β=–0.024, Р=0.018), baseline compliance (β=0.61, P<0.001), level of systolic (β=–0.05, P<0.001) and diastolic (β=–0.04, P<0.001) blood pressure at the end of the study, presence of adverse reactions (β=–0.04, P<0,001), alcohol abuse (β=–0.03, P=0.004), physical activity (β=0.034, P=0.002), consumption of fresh vegetables and fruits (β=0.026, P=0.02). Conclusion. Administration of fixed combination of enalapril and hydrochlorthiazide and higher doses of bisoprolol and amlodipine, as well as printed recommendations for lifestyle modification were related to better compliance at the end of the study.

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I.O. Zhyvylo, G.D. Radchenko, Ye.Yu. Titov, Yu.M. Sirenko Structural and functional status of the systemic circulation arteries in patients with idiopathic pulmonary arterial hypertension with different functional abilities and endpoints

The aim – to study the elastic properties of the systemic circulation arteries in patients with idiopathic pulmonary arterial hypertension (IPAH) with different functional abilities and endpoints.

Мaterial and methods. 152 patients were examined: 45 of them were with IPAH, 40 patients with pulmonary arterial hypertension associated with congenital heart disease, 32 patients with arterial hypertension (AH) and 35 healthy controls. Pulse wave velocity was measured in the arteries of muscular and elastic types, also we measured cardio-ankle vascular index (CAVI).

Results. Patients with reduced (< 330 m) functional abilities (FA) compared with patients with preserved (> 330 m) FA, have significantly higher arterial stiffness: the level of right CAVI was 8.18±0.27 vs 7.02±0.23 (Р<0.005); the level of left – 8.43±0.30 vs 7.07±0.21 (Р<0.005). Comparing groups of patients with reduced FA and with AH, CAVI measurements were higher among patients with IPAH (right side 8.18±0.27 vs 7.53±0.21, Р<0.08, left side 8.43±0.30 vs 7.39±0.20, Р<0.006). The CAVI of patients who died during the observation period was significantly higher compared to the results of surviving patients: 8.60±0.42 vs 7.01±0.20 (Р<0.001) and 8.53±0.46 vs 7.03±0.17 (Р<0.001), accordingly. Conclusions. Consequently, in addition to all known risk factors for complication and 1 year mortality among patients with IPAH, it may be possible to use CAVI as an indicator of arterial lesions of the systemic circulation.

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K.M. Amosova, N.V. Shyshkina, Yu.V. Rudenko, A.B. Bezrodnyi, I.Yu. Katsitadze, S.M. Dubynska Parameters of arterial stiffness, wave reflection and ventricular-vascular coupling in patients with hypertension and heart failure with preserved and reduced left ventricular ejection fraction

The aim – to compare the relationship between brachial and central blood pressure, wave reflections parameters, pulse wave velocity and ventricular-arterial coupling in patients with hypertension and various types of heart failure (HF) with preserved or reduced left ventricular ejection fraction (LVEF), compared to patients with uncomplicated hypertension.

Material and methods. Among 180 patients with essential hypertension, 75 patients (age 57.6±10.7 years) were selected «case control» method. Patients were comparable regarding age, gender, brachial systolic blood pressure (BP), which corresponded to hypertension 1-2 degree: 25 patients with uncomplicated hypertension without HF (1st group), 25 patients with HF and LVEF ≥ 50 % (2nd group), 25 patients with HF and LVEF 30–49 % (3rd group). All patients underwent general clinical examinations, laboratory examination and determination of NT pro BNP, brachial blood pressure measurements, pulse wave analysis and measurement of the carotid-femoral pulse wave velocity (PWV) by applanation tonometry, Doppler echocardiography and calculation of the ventricular-vascular coupling parameter (Ea/Ees).

Results. Patients with HF in both groups in contrast to patients with uncomplicated hypertension had larger left atrium volume index, higher values of E/e´ and lower e´, a´, LVEF (all Р<0.05–0.01). Patients in both groups with HF were matched by e´ and E/e´ (Р>0.05). Both groups of patients with HF had lower mean brachial BP, brachial and central diastolic BP, and higher pulse pressure compared to patients with uncomplicated hypertension (Р<0.05). Patients with HF and EF < 50 %, compared with patients with HF with preserved LVEF, had higher heart rate, while all parameters of brachial and central BP didn’t differ (P>0.05). Patients with HF and EF > 50 %, compared to uncomplicated hypertension, had higher augmentation pressure (РА – 11.8±5.0 versus 8.2±6.2 mm Hg), PWV (9.4±1.9 versus 8.1±1.9 m/s) and lower pulse pressure amplification (PPA 126.5±11.4 versus 139.0±19.7 %) (all Р<0.05), in the absence of the difference in the augmentation index (AIx) (Р>0.05). Compared to patients without HF, patients with HF and EF < 50 % had lower PA (5.1±3.8 vs. 8.2±6.2 mm Hg), AIx (10.2±10.1 versus 22.6±13.9 %) (all Р<0.01), in the absence of differences in PPA and PWV (Р>0.05), which differed from patients with HF and EF > 50 % (PPA – 146.1±19.8 versus 126.5±11.4 %, and PWV – 7.8±1.7 versus 9.4±1.9 m/s, all Р<0.05). Groups of patients with HF with preserved LVEF and hypertension were comparable regarding the values ​​of Ea, Ees and Ea/Ees (Р>0.05). While patients with HF with reduced LVEF had a higher level of Ea/Ees (1.48±0.49 versus 0.65±0.15 and 0.57±0.10) because of lower level of the Ees (1.24±0.45 versus 3.17±1.18 and 3.47±0.78) compared to other two groups (all Р<0.01).

Conclusions. Patients with hypertension and HF with reduced LVEF matched by age, gender and brachial systolic blood pressure with patients with hypertension and HF with preserved LVEF had lower augmentation pressure, augmentation index and a higher level of pulse pressure amplification and lower pulse wave velocity as a result of changes of the ventricular-arterial coupling caused by the decrease of the ventricular elastance (Ees).

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K.M. Amosova, N.V. Shyshkina, O.I. Rokyta, I.Yu. Katsitadze, Yu.V. Rudenko, K.P. Lazareva, Z.V. LysakGender and age differences in the relationship between left ventricular diastolic function and central hemodynamics and vascular stiffness in patients with uncontrolled uncomplicated arterial hypertension

The aim – to determine the relationship between left ventricular diastolic function measured by echocardiography and central hemodynamics and vascular stiffness by applanation tonometry in patients with uncontrolled uncomplicated arterial hypertension, depending on age and gender.

Materials and methods. The study included 142 patients with uncontrolled uncomplicated essential hypertension of I–II stage, 1–2 degrees, aged 35–75 years (mean 57.3±14.1 years), with blood pressure (BP) ≥ 160/100 mm Hg in patients who had not previously been treated or BP ≥ 140/90 mm Hg in those who had received antihypertensive treatment. All patients underwent general clinical and laboratory examinations, measurements of brachial BP, applanation tonometry, 24-hours ambulatory BP monitoring and echocardiography. Patients were divided into groups based on gender and age: men and women ≤ 60 years and > 60 years: 36 (25.4 %), 26 (18.2 %), 36 (25.4 %) and 44 (31 %), respectively.

Results. The groups were comparable by the level of BP according to the results of 24-hours ambulatory BP monitoring, central and brachial systolic BP (SBP) (Р>0.05). In younger women, in comparison with men of the same age group, pulse pressure amplification and the difference between brachial and central SBP and PP were lower (РРА – 127.7±15.9 and 140.3±19.4 %, ∆SBP – 10.2±6.0 and 14.7±6.1, ∆PР – 11.4±6.3 and 16.0±6.0 mm Hg, respectively; all Р<0.05). While the augmentation index (AIx), AIx75, the augmentation pressure (PA) in both age groups were lower in men than in women (19.5±11.4 and 29.9±12.5; 19.0±9.7 and 28.1±10.5 %, 8.8±7.1 and 12.9±5.8 mm Hg, respectively in patients ≤ 60 years (all Р<0.05); 24.1±10.5 and 32.3±8.3, 22.8±6.1 and 28.7±6.7 %, 11.3±6.0 and 16.3±7.5 mm Hg, respectively in patients > 60 years (all Р<0.01)). In elderly women, we found a moderate positive relationship between left atrium volume index, central and brachial SBP (central SBP – r=0.65, Р=0.007; brachial SBP – r=0.59, Р=0.02) and PP (central PP – r=0.7, Р=0.002; brachial PP – r=0.63, Р=0.009), РА (r=0.65, Р=0.009), and moderate negative relationship between the pulse wave velocity (PWV) and е´ (r=–0.47, Р=0.043). In the elderly men we found a moderate positive relationship between E/A and central SBP (r=0.46, Р=0.035) and PP (r=0.61, Р=0.004), РА (r=0.71, Р=0.001) and AІx (r=0.6, Р=0.004) and between Е/е´ and AІx (r=0.41, Р=0.011), and РА (r=0.43, Р=0.007), and also negative relationship between Е/А and РРА (r=–0.58, Р=0.006), between Е/е´ and РРА (r=–0.44, Р=0.049). Conclusion. Among patients with uncontrolled uncomplicated arterial hypertension with comparable blood pressure levels throughout the day, in women, the relationship between the diastolic function by echocardiography and PWV was found, and in men older than 60 years the relationship was found between LV diastolic function and parameters of pulse wave reflection by applanation tonometry. This may point at different mechanisms of LV diastolic dysfunction and further formation of heart failure with preserved LV ejection fraction in this cohort of patients depending on gender and age.

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