scholarly journals Orthostatic hypertension in cardiovascular risk stratification in hypertensive patients

2021 ◽  
Vol 26 ◽  
pp. 4221
Author(s):  
E. Yu. Gubareva ◽  
O. V. Fatenkov ◽  
I. V. Gubareva ◽  
D. A. Klimenko ◽  
L. Yu. Shvan ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Active Role ◽  
Diagnostic Methods ◽  
Regulatory Mechanisms ◽  
Hypertensive Patients ◽  
Orthostatic Hypertension ◽  
Sympathetic Nervous ◽  
Poor Outcomes ◽  
Hypertension Development ◽  
Care Costs

Hypertension (HTN) is an important modifiable risk factor for cardiovascular disease associated with poor outcomes and high health care costs. The assessment of cardiovascular risk (CVR) according to the current ESC/ESH guidelines for the treatment of hypertensive patients presents a number of difficulties and initiates the search for new diagnostic methods that contribute to understanding the patient's phenotype, personalizing diagnostic and treatment tactics, and improving the outcomes of hypertensive patients. Regulatory mechanisms involved in the body's orthostatic response, such as activation of the sympathetic nervous system, catecholamine production, endothelial function, significantly contributes to maintaining blood pressure levels. Their violation plays an active role in hypertension development, which allows considering orthostatic HTN in a hypertensive patient as a marker of CVR stratification. The article discusses the diagnostic criteria for orthostatic HTN, its pathophysiological mechanisms and possible use as a marker of CVR stratification.

scholarly journals Antihypertensive Efficacy of Fixed Combination of Amlodipine and Ramipril in Patients with Arterial Hypertension and Very High Cardiovascular Risk

2019 ◽  
Vol 14 (6) ◽  
pp. 840-845
Author(s):  
O. Yu. Korennova ◽  
S. P. Podolnaya ◽  
E. P. Prihodko ◽  
E. A. Turusheva ◽  
S. N. Starinskaya ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Fixed Combination ◽  
Antihypertensive Drugs ◽  
Antihypertensive Efficacy ◽  
High Cardiovascular Risk ◽  
Hypertensive Patients ◽  
Coronary Artery Stenting ◽  
History Of ◽  
Very High

Aim. To evaluate the antihypertensive efficacy and tolerability of a fixed combination of amlodipine and ramipril in hypertensive patients with very high cardiovascular risk. Material and methods. A retrospective cohort study of real clinical practice of prescribing antihypertensive drugs according to 255 medical records of outpatient hypertensive patients with a history of acute coronary syndrome (ACS) and coronary artery stenting was performed in the first part. An open observational study was performed in the second part. 69 people older than 18 years with a history of ACS and coronary artery stenting, without reaching the target blood pressure (BP) level while using free combinations of antihypertensive drugs and with indications for a fixed combination of ramipril and amlodipine were included into the study. Analysis of self-monitoring of BP, office BP, daily BP monitoring (ABPM) and patients’ adherence to treatment (Morisky-Green test) initially, after 4 and after 12 weeks of taking the fixed combination of ramipril and amlodipine was performed to assess the clinical efficacy of the studied drug. Results. It was found that 42.0% of patients did not follow the recommendations for regular intake of antihypertensive drugs. So, hypertension of all patients regarded as false-refractory, which was the basis for the prescription of the fixed combination of ramipril and amlodipine in accordance with clinical guidelines for the diagnosis and treatment of hypertension. After 4 weeks of therapy, there was significant decrease in office BP with the achievement and preservation of the target level by the 12th week, normalization to the 12th week of day and night BP variability in 54.9% of patients. 78.0% of patients followed medical recommendations for regular administration of antihypertensive drugs, none of the patients had adverse events. Conclusion. The use of fixed combinations of drugs, in particular, amlodipine and ramipril as a part of multicomponent therapy in hypertensive patients with very high cardiovascular risk, led to the achievement of target BP by the 4th week of therapy and stable preservation of antihypertensive effect in 12 weeks of treatment as well as gradual normalization of day and night BP variability in more than half of patients. Fixed combination of ramipril and amlodipine allowed to improve adherence of patients to cardiovascular diseases.

scholarly journals POS1065 CIRCULATING ENDOTHELIAL CELLS AS A MARKER OF CARDIOVASCULAR DISEASES IN PATIENTS WITH PSORIATIC ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 811.1-811
Author(s):  
S. Smiyan ◽  
A. Bilukha ◽  
B. Koshak
Keyword(s):  
Endothelial Cells ◽  
Cardiovascular Risk ◽  
Psoriatic Arthritis ◽  
Cardiovascular Diseases ◽  
Endothelial Damage ◽  
Diagnostic Methods ◽  
Circulating Endothelial Cells ◽  
Control Group ◽  
Cardiovascular Morbidity And Mortality ◽  
Increased Risk

Background:Psoriatic arthritis (PsA) is a chronic inflammatory joint disease which develops in patients with psoriasis. Mortality among patients with PsA is 1.28 times higher than population levels and in most cases it is caused by cardio-vascular diseases (CVD). Those patients have increased risk of clinical and subclinical CVD, mostly due to endothelial dysfunction (ED) and accelerated atherosclerosis. Elevated levels of circulating endothelial cells (CEC) have been described in different cardiovascular pathologies, suggesting their potential use as diagnostic biomarkers for dysfunction of endothelium.Objectives:To identify the potential role of circulating endothelial cells as a marker of cardiovascular diseases in patients with psoriatic arthritis.Methods:In total, ninety-four patients with PsA, who fulfilled the disease criteria (CASPAR) were examined using standard diagnostic methods (including C-reactive protein (CRP), lipid profile) and evaluation endothelium-dependent vasodilation in response to reactive hyperemia (EDVD). Circulating endothelial cells were determined in the peripheral venous blood samples by flow cytometry and counted according to a standardized protocol using a fluorescence microscope after acridine orange labeling. The control group, which were consisted from thirty healthy adults were also examined.Results:CEC were quantified in patients with PsA (7,15 ± 0,19 cells mL−1) and in the control group (4,05 ± 0,11 cells mL−1). Comparing two groups of patients, endothelial circulating cell level was significantly different (p = 0.0001). Finally, we analyzed the relationship between CEC count, comorbidities, cardiovascular risk factors and EDVD in patients with PsA. Increased CEC levels were associated with obesity (r=0,62), duration of disease (r=0,65), age (r=0,67), increased CRP (r=0,76), high blood pressure (r=0,87) and decreased EDVD (r=–0,91).Conclusion:CEC counts were significantly higher in patients with PsA, positively correlated with the main factors of CVD, and another specific marker of ED - EDVD. Elevated CEC levels were also associated with high concentrations of CRP, which plays a direct role in promoting vascular inflammation, vessel damage and clinical CVD events. In conclusion, increased CEC counts provide a direct proof of endothelial damage in patient with PsA and a clinically informative diagnostic tool for endothelial damage in pre-symptomatic CVD. As CEC are one of the most sensitive biomarker for ED, further efforts should concentrate on improving the sensitivity of its detection in order to increase diagnostic sensitivity.References:[1]Maura Farinacci, Thomas Krahn, Wilfried Dinh, et al. Circulating endothelial cells as biomarker for cardiovascular diseases. Res Pract Thromb Haemost, Vol. 3, Issue, 2019, P.49-58;[2]C. Horreau, C. Pouplard, E. Brenautet, et al. Cardiovascular morbidity and mortality in psoriasis and psoriatic arthritis: a systematic literature review. J Eur Acad Dermatol Venereol, Vol. 27, Issue 3, 2013, P.12-19;[3]Frank Verhoeven, Clément Prati, Céline Demougeot, Daniel Wendling. Cardiovascular risk in psoriatic arthritis, a narrative review. Joint Bone Spine, Vol. 87, Issue 5, 2020, P.413-418;Disclosure of Interests:None declared.

Oral Yohimbine Increases Blood Pressure and Sympathetic Nervous Outflow in Hypertensive Patients

1993 ◽  
Vol 22 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Ehud Grossman ◽  
Talma Rosenthal ◽  
Edna Peleg ◽  
Courtney Holmes ◽  
David S. Goldstein
Keyword(s):  
Blood Pressure ◽  
Hypertensive Patients ◽  
Sympathetic Nervous

Therapieziele bei der Hypertoniebehandlung

2017 ◽  
Vol 142 (19) ◽  
pp. 1420-1429 ◽  
Author(s):  
Rainer Düsing
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Systolic Blood Pressure ◽  
Measurement Procedure ◽  
Treatment Goals ◽  
High Cardiovascular Risk ◽  
Hypertensive Patients ◽  
Optimal Target ◽  
Elderly Hypertensive ◽  
Intervention Trials

AbstractThe optimal target blood pressure (BP) in the treatment of hypertensive patients remains controversial. Recently, the systolic blood pressure trial (SPRINT) has proposed that a target systolic blood pressure of < 120 mmHg provides prognostic benefit in elderly hypertensive patients at high cardiovascular risk. The results of SPRINT contrast with several other intervention trials which have investigated the effect of intense BP lowering (Secondary Prevention of Small Subcortical Strokes [SPS3], Action to Control Cardiovascular Risk in Diabetes [ACCORD], Heart Outcomes Prevention Evaluation [HOPE]-3). The differences in outcomes in SPRINT vs. other intervention trials are, to a large extend, due to an "unobserved" BP measurement procedure utilized in the SPRINT trial. Thus, a BP goal of < 120 mmHg, at least by conventional BP measurement, remains unproven. Independent of SPRINT the controversial evidence with respect to BP targets calls for further studies and, possibly, for more individualized treatment goals.

scholarly journals The Condition of Cognitive Functions in Patients with Stage 1 and Stage 2 Hypertension of 2-3 Degrees, with Moderate and High Cardiovascular Risk and Gender Characteristics of the Revealed Disorders

2021 ◽  
Vol 1-2 (33-34) ◽  
pp. 14-18
Author(s):  
V. Skybchyk ◽  
◽  
O. Pylypiv ◽  
Keyword(s):  
Blood Pressure ◽  
Cognitive Impairment ◽  
Cardiovascular Risk ◽  
Cognitive Functions ◽  
Healthy Individuals ◽  
High Cardiovascular Risk ◽  
Hypertensive Patients ◽  
Female Patients ◽  
Male Patients ◽  
Stage 1

Context. It is known that in addition to transient ischemic attacks and insults, hypertension is often the cause of asymptomatic brain damage, including cognitive impairment (CI). Most of these studies show a positive relationship between midlife hypertension and cognitive decline at the advanced age. CI significantly affect the quality of life of patients, reduce the ability to learn, acquire new knowledge and skills, force them to change their usual way of life and often stop or reduce professional activities. Objective. To analyze the condition of cognitive functions in patients with stage 1 and stage 2 hypertension of 2nd-3rd degrees, with moderate and high cardiovascular risk and evaluate their gender peculiarities. Materials and methods. The study included 90 patients with stage 1 and stage 2 hypertension. The average age of patients with hypertension was 49.66 ± 8.74 years old. The average course of the disease was 7.7 ± 3.9 years. The comparison group consisted of 46 healthy individuals with normal blood pressure levels and without hypertension in anamnesis (the average age - 45.88 ± 3.03 years old). Applied methods included general clinical, methods of neuropsychological testing (MMSE, GPCOG, W. Schulte test), standard general clinical and biochemical laboratory methods (blood lipid spectrum, blood glucose, creatinine with GFR, electrolytes), instrumental (12-lead ECG, ambulatory monitoring of blood pressure, echocardiography in B-, D-modes), and statistical methods. Results. Patients with hypertension scored significantly less on the MMSE scale (26.82 ± 1.41 scores vs. 28.89 ± 0.82 scores, p = 0.001) and GPCOG (6.63 ± 1.88 scores vs. 8.35 ± 0.71 scores, p = 0.001) compared with healthy individuals and spent more time on performing Walter Schulte test (46.51 ± 8.59 seconds vs. 36.69 ± 6.77 seconds, p = 0.001). Moderate CI were detected in 36 patients (40.00 %) among the examined hypertensive patients; it means that the total score of MMSE was 24-26 scores (the norm is 27-30 scores). The total score on the MMSE scale was 25.47 ± 0.88 in hypertensive patients with CI and was significantly lower than in hypertensive patients without CI (р = 0.001). Cognitive functions in patients with CI were characterized by poorer indices of memory, counting and executive functions. It should be noted that the revealed changes had more reliable manifestations in male hypertensive patients. In particular, the total score on the MMSE scale was 26.57 ± 1.37, while in female ones it was 27.19 ± 1.41 scores (p = 0.04). CI on the MMSE scale were diagnosed in 43.4 % (n = 23) of male patients and in 35.1 % (n = 13) of female patients. The total score was also higher on the GPCOG scale in female patients - 6.89 ± 1.85 scores vs. 6.45 ± 1.89 scores, p = 0.26. Instead, the time to complete the tasks according to the Walter Schulte tables was longer in male patients - 47.74 ± 8.85 seconds vs. 47.73 ± 7.99 seconds, p = 0.10, respectively. The parameters of counting functions were significantly lower (p = 0.01) in the group of male hypertensive patients compared with female ones. Besides, men had lower indicators of short-term memory and orientation, women reproduced worse verbal material, but the difference was statistically insignificant (p-value more than 0.05). The sum of scores on the MMSE scale conversely correlated with male gender (r = -0.22, p = 0.03). The risk of low values of MMSE indices in male patients with hypertension was 42.00 % higher than in female ones (OR = 1.42 ± 0.32, with 95% CІ [0.18-2.65]). Conclusions. Hypertension is a significant independent risk factor for developing new cases of cognitive impairment. In particular, among the patients with stage 1 and stage 2 hypertension of 2nd-3rd degrees, with moderate and high cardiovascular risk, moderate cognitive impairment was revealed in 36 patients (40,00 %), the revealed changes were more manifested in male hypertensive patients.

scholarly journals “A STUDY OF MICROALBUMINURIA IN NON DIABETIC HYPERTENSIVE PATIENTS”

2020 ◽  
pp. 1-3
Author(s):  
Anup Latne ◽  
Prabhakar Jirvankar
Keyword(s):  
Cardiovascular Risk ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Low Grade ◽  
Major Public Health Problem ◽  
Sectional Study ◽  
Tertiary Care Centre ◽  
Cross Sectional ◽  
Hypertensive Patients

Hypertension is a major public health problem all over the world. The incidence of hypertension is increasing year after year and the prevalence of hypertension is increasing day by day due to increased life expectancy and aging population and their sedentary lifestyle. Hypertension is known to cause microvascular changes and increased cardiovascular risk from it. Microalbuminuria possibly reflects a state of increased renal endothelial permeability and is an easily measured marker of rather diffuse endothelial dysfunction, low grade inflammation and vascular disease burden2. Microalbuminuria has been determined as an important prognostic indicator and has been reported to be associated with increased cardiovascular risk and progressive renal damage. Reliable data on the prevalence of microalbuminuria in the general population and its association with cardiovascular risk factors is limited. Till now, there is little data available regarding screening and early treatment of hypertensive patients with microalbuminuria, as in the case of microalbuminuric non diabetic subjects. With these perspective this cross sectional study of microalbuminuria in non-diabetic hypertensive patients was undertaken to study prevalence of microalbuminuria in Non Diabetic hypertensive patients. Objectives: To determine the prevalence of microalbuminuria in non-diabetic hypertensive patients and to correlate the presence of microalbuminuria with the patients of different clinical profiles. Materials and Methods: This was observational, cross sectional study of Patients diagnosed with hypertension either admitted in ward or attending OPD of Medical College and Tertiary Care Centre. Urine microalbumin creatinine ratio was used for estimation of microalbuminuria. Conclusion: It was proved that microalbuminuria prevalence was directly proportional to the duration of hypertension, the stage of hypertension. Prevalence of microalbuminria was low in ACE inhibitor and ARB treated hypertensive patients.

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