scholarly journals Antihypertensive and vasoprotective effectiveness of the chronopharmacotherapy in patients with arterial hypertension after acute cerebrovascular accident

Kardiologiia ◽  
2019 ◽  
Vol 59 (1S) ◽  
pp. 25-33 ◽  
Author(s):  
V. V. Skibitsky ◽  
A. V. Fendrikova ◽  
S. V. Opolskaya
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Cerebrovascular Accident ◽  
Vessel Wall ◽  
Vascular Wall ◽  
Aortic Pressure ◽  
Single Time ◽  
Acute Cerebrovascular Accident ◽  
Central Aortic Pressure ◽  
Wall Stiffness

Aim. To evaluate the effectiveness of combined antihypertensive chronopharmacotherapy and estimate the daily blood pressure profle (BP) parameters, such as: stiffness of the vascular wall and central aortic pressure in patients with arterial hypertension (AH) who underwent transient ischemic atack (TIA) or ischemic stroke (IS).Materials and methods. 235 patients with hypertension who underwent acute cerebrovascular accident were examined. Tere were 116 patients with TIA and 119 with IS. All patients were randomized in 4 groups according to regimen of antihypertensive drugs combination. Te 1st group (n = 59) included patients with AH, who underwent TIA and received indapamide retard 1.5 mg and valsartan 160 mg in the morning regiment of drug therapy. Te 2nd group (n = 57) included patients with AH, who underwent TIA and received indapamide retard 1.5 mg in the morning and valsartan 80 mg twice a day (morning and evening). Te 3rd group (n = 47) included patients with AH, who underwent IS and received indapamide retard 1.5 mg and valsartan at a dose of 160 mg in the morning. Te 4th group (n = 56) included patients with AH, who underwent IS and received indapamide retard 1.5 mg in the morning and valsartan 80 mg twice a day (morning and evening). Ambulatory blood pressure monitoring (ABPM), central aortic pressure (CAP) measurement and vessel wall stiffness values were evaluated before treatment and afer 12 months of therapy.Results.Before the start of combined antihypertensive chronopharmacotherapy, most of the parameters for ABPM, vessel wall stiffness values and CAP in groups 1 and 2, 3 and 4 were comparable. Achievement of the target level of BP afer 8 weeks of treatment, was signifcantly more ofen in groups with a double sartan therapy (group 2 and group 4) in compare with its single time application only in the morning hours (group 1 and group 3) (p<0.05). Statistically signifcant positive dynamics of the main values of the daily profle of blood pressure, stiffness of the vascular wall and central aortic pressure (p <0,05) were registered in all groups. However, more pronounced decline of main parameters of ABPM, stiffness of the vascular wall and central aortic pressure values were noted in group with double use sartan therapy in compare with single time sartan therapy in the morning time. (p <0.05). Signifcant positive dynamics of the main values of the ABPM, stiffness of the vascular wall and CAP were registered in patients who underwent IS and received double application sartan therapy (4th group) in compare with patients with TIA (2nd group) (p = 0.02).Conclusion.Double use sartan therapy, combined with a thiazide diuretics in patients, who underwent IS or TIA more ofen promotes to get target values of blood pressure, improve the main values of the ABPM, stiffness of the vascular wall and CAP in compare with single time sartan therapy in the morning time

scholarly journals COMPARISON OF INFLUENCE OF VARIOUS REGIMENS OF DRUG INTAKE ON 24 HOUR bLOOD  PRESSURE, CENTRAL AORTIC PRESSURE AND VASCULAR WALL STIFFNESS IN SYSTEMIC  HYPERTENSION PATIENTS WITH ISCHEMIC STROKE

2018 ◽  
pp. 56-66 ◽  
Author(s):  
V. V. Skibitsky ◽  
A. V. Fendrikova ◽  
S. V. Opolskaya
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Vessel Wall ◽  
Vascular Wall ◽  
Aortic Pressure ◽  
Once Daily ◽  
Wall Stiffness ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim. To assess and compare the efficacy of combination antihypertension drugs influence with various dosage regimens during 24 hour, on the parameters of daily blood pressure (BP) profile, central aortic pressure (CAP) and vessel wall stiffness in arterial hypertension (AH) patients with ischemic stroke (IS).Material and methods. To the study, 177 AH patients included, with IS within last 4 weeks. All patients were randomized to 3 groups depending on the regimen of antihypertensive drugs combination intake during 24 hours. At baseline and in 12 months of therapy all patients underwent 24 hour BP monitoring (ABPM), CAP measurement and vessel wall stiffness evaluation. Results. In 8 weeks of antihypertension therapy, target pressure level achievement was significantly more common in b. i.d. valsartan (group 3) comparing to once daily in the morning (group 1) or evening (group 2) (p<0,05). In all groups there were statistically significant positive changes in ABPM, CAP and stiffness. Also, in the group 2 there was significantly (p<0,05) more prominent decrease of the main ABPM, CAP and stiffness parameters than in the group 1. Valsartan b. i.d. led to significantly more prominent (p<0,05) improvement of the main ABPM, CAP and stiffness parameters improvement comparing to both variants of its once daily regimens. In 12 months of chronopharmacotherapy, in all groups, there was significant (p<0,05) increase of “dipper” 24 hour BP profile patients. Differences of the groups of “dippers” and “non-dippers” by the 12th month of treatment were significant for 3rd and 1st (p=0,0004), 3rd and 2nd (p=0,04) groups with the benefit for group 3.Conclusion. Two times a day or only evening intake of valsartan with thiazidelike diuretic in the morning facilitated more significant improvement of the main parameters of ABPM, CAP and vascular wall rigidity comparing to just morning intake. B.i.d. valsartan regimen led to significantly (p<0,05) more commonly reached target BP level, improved normalization of 24 hour BP in most of patients, led to more significant improvement of the main ABPM, CAP and vascular stiffness parameters comparing to once daily morning or evening regimen.

scholarly journals Features of arterial hypertension in postmenopausal women with abdominal obesity: The role of inflammatory response markers, leptin, and female sex hormones in the pathogenesis of vascular wall stiffness

2019 ◽  
Vol 34 (3) ◽  
pp. 103-113 ◽  
Author(s):  
K. S. Avdeeva ◽  
T. I. Petelina ◽  
L. I. Gapon ◽  
N. A. Musikhina ◽  
E. V. Zueva
Keyword(s):  
Blood Pressure ◽  
Inflammatory Response ◽  
Arterial Hypertension ◽  
Postmenopausal Women ◽  
Sex Hormones ◽  
Abdominal Obesity ◽  
Vascular Wall ◽  
Female Sex Hormones ◽  
Wall Stiffness ◽  
Group 2

Background. Despite overall efforts, arterial hypertension remains one of the most significant medical and social problems. The risk of developing arterial hypertension is tripled in obese individuals compared with people who have normal body weight. According to clinical studies, individual biochemical markers can be predictors of initiation of remodeling processes in systems at a preclinical level. Endothelial dysfunction is the initial stage in the development of atherosclerosis. Mechanisms of the vascular inflammatory response in arterial hypertension with obesity can be considered a factor that largely determines the onset and course of the disease, a cause of its aggravation, development, and progression. Cardiovascular risk factors, genetic predisposition, deficit of sex hormones, and aging affect the endothelium function.Aim. To study specifics of hypertension in postmenopausal women with abdominal obesity and to evaluate the role of inflammatory response markers, leptin, and female sex hormones in the pathogenesis of vascular wall stiffness.Material and Methods. The study included 164 patients divided into three groups. Group 1 consisted of 42 healthy women aged 44.43 ± 14.26 years; group 2 comprised 62 hypertensive women aged 60.69 ± 7.09 years; group 3 comprised 60 hypertensive women with abdominal obesity aged 57.24 ± 7.40 years. Patients of all groups received 24-hour blood pressure monitoring, sphygmography, and assessment of sex hormones, lipids, inflammatory, and biochemical parameters in blood serum.Results. Results of analysis showed that patients of group 3 had significantly higher blood pressure compared with that in group 2. Higher pulse wave velocity was observed in women of group 2. Groups 2 and 3 had lower levels of sex hormones and significant increases in the levels of inflammatory markers compared with those in control group. Multiple multidirectional correlations between the studied parameters were revealed.Conclusions. Features of hypertension in postmenopausal women with obesity consist in a systolic-diastolic variant of hypertension, an increase in systolic blood pressure variability at night, an increase in diastolic blood pressure during the daytime, and increases in systolic and diastolic blood pressure at night. The method of logistic regression allowed to identify biochemical markers that determine the elastic properties of the vascular wall in this category of patients, namely: leptin, highsensitivity C-reactive protein, and endothelin-1. 

Gender Differences in Vascular Stiffness Indicators and Daily Blood Pressure Profile in Patients with Arterial Hypertension and Depressive Disorders

Kardiologiia ◽  
2021 ◽  
Vol 60 (12) ◽  
pp. 83-89
Author(s):  
A. V. Fendrikova ◽  
V. V. Skibitskiy ◽  
A. V. Skibitskiy
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Depressive Disorders ◽  
Depression Scale ◽  
Pressure Profile ◽  
Vascular Wall ◽  
Men And Women ◽  
Wall Stiffness ◽  
Study Results ◽  
Diurnal Profile

Aim      To study gender-related characteristics of vascular wall stiffness (VWS), central blood pressure (CBP), and BP diurnal profile in patients with arterial hypertension (AH) and depression.Material and methods  This prospective, noninterventional study enrolled 161 patients, including 98 patients with AH and depression (50 (51 %) men and 48 (49 %) women) and 63 patients with AH without depression (32 (50.8 %) men and 31 (49.2 %) women. The 24-h BP monitoring (24-h BPM) with a BPLab Vasotens hardware system was performed for all patients. The following indexes were evaluated: mean diurnal, mean daytime, and mean nighttime systolic and diastolic BP (SBP and DBP); daytime and nighttime SBP and DBP time index; SBP and DBP variability; and suite of metrics characterizing VWS and CBP. Depression was diagnosed with the Hospital Anxiety and Depression Scale (HADS) and the Zung Self-Rating Depression Scale. Statistical analyses were performed using the STATISTICA 12 software.Results In the patient group with AH and depression, practically all indexes of 24-h BPM were higher for men than for women (р<0.05). Most 24-h BPM parameters did not differ in groups of men and women without depression. Independent of gender, 24-h BPM parameters were significantly higher in patients with both AH and depression than in AH patients without depression. Adverse changes in major indexes of VWS and CBP, were more pronounced in men than in women with AH and depression (р<0.05). Adverse changes in most VWS and CBP indexes were more statistically significant for men with AH and depression than for men without depression.Conclusion      The presence of depression in men and women with AH was associated with significant pathological changes in both BP diurnal profile and CBP and VWS parameters. Furthermore, adverse changes in indexes were more pronounced for men with depression than for women. The study results should be taken into account in administration of antihypertensive and psychocorrective drug therapy to personalize the treatment and provide not only optimization of diurnal BP profile but also vasoprotection.

scholarly journals Association between H-type arterial hypertension and vascular stiffness (a pilot study)

2021 ◽  
Vol 23 (1) ◽  
pp. 32-41
Author(s):  
Yu. M. Sirenko ◽  
O. L. Rekovets ◽  
O. O. Torbas ◽  
S. M. Kushnir ◽  
O. Yu. Sirenko
Keyword(s):  
Blood Pressure ◽  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Blood Pressure Level ◽  
Vascular Wall ◽  
Vascular Stiffness ◽  
Wall Stiffness ◽  
Body Weights ◽  
Total Homocysteine ◽  
The Relationship

Increased arterial stiffness is an important determinant of cardiovascular risk. Elevated total homocysteine (HC) levels appeared to be an independent risk factor for cardiovascular disease (CVD). To date, clinical studies on the relationship between HC and pulse wave velocity (PWV) assessment have shown conflicting results. Aim. To estimate the prevalence of hyperhomocystinemia (HHc) among patients with mild to moderate arterial hypertension and the effect of HHc on the vascular wall stiffness. Materials and methods. Our study was carried out as a part of the HYPSTER study in Ukraine. The study included 40 patients with I and II degree of arterial hypertension (AH) (average office systolic blood pressure (SBP)/diastolic (DBP) – 155.88/92.60 ± 1.63/1.43 mm Hg), heart rate – 71.40 ± 1.29 beats/min. The average age of the patients was 55.85 ± 2.09 (26–74) years. Patients with HC levels ≥10 μmol/l were defined as patients with H-type AH (HHc). Arterial stiffness was determined by PWV. Results. We found that at the beginning of the study, 75 % (30 patients with mild and moderate hypertension) had H-type hypertension with an increased level of HC. Patients with H-type AH and AH patients without HHc did not differ in age and AH duration. At the same time, patients with H-type AH had higher body weights and BMI. Office SBP in patients with H-type hypertension was higher compared to patients without HHc (156.45 ± 1.04 mm Hg vs. 152.55 ± 1.41 mm Hg at the beginning (P < 0.05) and 130.65 ± 0.96 mm Hg vs. 126.97 ± 1.08 mm Hg after 6 months (P < 0.05)) of treatment, respectively. BMI in H-type AH was 30.72 ± 0,39 kg/m2 vs. 28.34 ± 0.69 kg/m2 without HHc (P < 0.05) at the beginning of the study. It was difficult to achieve target levels of BP in the patients with H-type hypertension during the treatment and they had high initial blood pressure values. In contrast to the patients without HHc, H-type AH patients had a more pronounced degree of insulin resistance (according to the HOMA index), lower GFR both at the beginning and at the end of the treatment. According to ambulatory BP monitoring, H-type AH patients presented with a significantly higher SBP level before starting the treatment compared to those with AH without HHc. The regression analysis revealed an association between HC and PWVel, regardless of the degree of BP reduction (PWVel (6 months), m/s, β = 0.307, P = 0.001). Conclusions. Hyperhomocystinemia was observed in 75 % of patients with arterial hypertension. Homocysteine levels were associated with vascular stiffness, regardless of the reduction in blood pressure level.

The clinical significance of vascular wall stiffness and central aortic pressure in men with gout

2017 ◽  
Vol 263 ◽  
pp. e172
Author(s):  
Tatyana Medvedeva ◽  
Natalya Kushnarenko ◽  
Kiril Kushnarenko ◽  
Marina Gubanova
Keyword(s):  
Clinical Significance ◽  
Vascular Wall ◽  
Aortic Pressure ◽  
Central Aortic Pressure ◽  
Wall Stiffness

scholarly journals Comparative characteristics of indicators of peripheral arterial and central aortic pressure, remodeling of the left ventricular myocardium in salt-sensitive and salt-resistant patients with arterial hypertension

2021 ◽  
Vol 18 (2) ◽  
pp. 94-100
Author(s):  
Vitaliy V. Skibitskiy ◽  
Vladimir Yu. Vasil'ev ◽  
Aleksandra V. Fendrikova ◽  
Stanislav N. Pyatakov
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
Peripheral Blood ◽  
Ventricular Myocardium ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Left Ventricular Myocardium ◽  
Myocardial Remodeling ◽  
Central Aortic Pressure ◽  
Peripheral Blood Pressure

Background. Changes in the vascular wall, in particular, an increase in its stiffness and an increase in pressure in the aorta, as well as hypertrophy of the left ventricular myocardium are factors that determine a poor prognosis in patients with arterial hypertension. At the same time, the peculiarities of changes in arterial stiffness indices and left ventricular myocardial remodeling in patients with different sensitivity to salt loading have not been adequately studied. Aim. To conduct a comparative analysis of the values of peripheral blood pressure and central aortic pressure, indicators of left ventricular myocardial remodeling in salt-sensitive and salt-resistant patients with arterial hypertension. Materials and methods. The study involved 180 patients with arterial hypertension: 96 men and 84 women. The median age was 59 years. Salt sensitivity test was performed according to V.I. Kharchenko. All patients underwent 24-hour blood pressure monitoring, echocardiography. Indicators of peripheral arterial pressure and central aortic pressure, remodeling of the left ventricular myocardium were determined. Results. According to the results of the test V.I. Kharchenko, 88 patients were classified as salt-sensitive, 92 as salt-resistant. After a salt sensitivity test in salt-sensitive patients, the main indicators of peripheral blood pressure and central aortic pressure exceeded those in salt-resistant patients in the daytime, at night, and throughout the day as a whole. In the group of salt-sensitive individuals, statistically more significant negative changes in echocardiographic parameters were recorded; a significant number of salt-sensitive patients were diagnosed with prognostically unfavorable variants of left ventricular myocardial remodeling. Conclusion. In salt-sensitive patients with arterial hypertension, compared with salt-resistant patients, there are higher values of both peripheral blood pressure and central aortic pressure, more significant negative changes in echocardiographic parameters with the formation of concentric hypertrophy and eccentric remodeling of the left ventricular myocardium. It can be assumed that the assessment of salt sensitivity makes it possible to verify patients with the most unfavorable changes in parameters of ambulatory blood pressure monitoring and significant remodeling of the left ventricular myocardium. This approach can be used to individualize pharmacotherapy in patients with arterial hypertension and increase its effectiveness.

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