scholarly journals Optimization of Pharmacotherapy Within the Framework of a Patient-oriented Approach in the Treatment of Hypertension in Multimorbidity Patients (Clinical Case and Literature Review)

2021 ◽  
Vol 17 (1) ◽  
pp. 124-132
Author(s):  
O. D. Ostroumova ◽  
I. A. Alyautdinova ◽  
S. N. Litvinova ◽  
A. V. Arablinskij ◽  
A. A. Kirichenko
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Target Organ Damage ◽  
Left Ventricular ◽  
The Body ◽  
Favorable Effect ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Ii Receptor ◽  
Additional Risk ◽  
Sympathetic Overactivity

Arterial hypertension (AH) remains one of the main causes of disability and death worldwide, including in Russia. At the same time, the risks of coronary and cerebrovascular events increase in the presence of additional risk factors. The most common modifiable risk factors are metabolic disorders, including pre-diabetes, dyslipidemia, peripheral arterial atherosclerosis, and obesity, which also imposes certain features on the choice of optimal pharmacotherapy. Currently, the terminology of comorbid conditions continues to be discussed depending on their pathogenesis and the presence or absence of dominance of one disease over others, i.e. polymorbidity, comorbidity and multimorbidity. At the same time, “associative polymorbidity” is distinguished with a certain set of diseases that often occur in conjunction with each other with individual susceptibility of the body. One of the most common phenotypes of polymorbidity occurring in all age groups in both sexes is cardiometabolic, which is based on the formation of insulin resistance, sympathetic overactivity and chronic inflammation. This article provides a clinical example of the use of a fixed combination of angiotensin II receptor blocker telmisartan and calcium channel blocker amlodipine with the addition of an I1-imidazoline receptor agonist moxonidine in real clinical practice in a polymorbid cardiometabolic patient with target organ damage (left ventricular hypertrophy and microalbuminuria). High antihypertensive (favorable effect on 24-hour blood pressure, especially in the early morning) and organoprotective effectiveness of this combination, its possibilities in correcting additional risk factors (reduced heart rate, body weight and a positive effect on metabolic parameters), due to a synergistic effect on the central pathogenetic mechanisms of hypertension and obesity – insulin resistance and sympathetic overactivity.

Candesartan, an angiotensin II receptor blocker, improves left ventricular hypertrophy and insulin resistance

Metabolism ◽  
2004 ◽  
Vol 53 (6) ◽  
pp. 777-781 ◽  
Author(s):  
Futoshi Anan ◽  
Naohiko Takahashi ◽  
Tatsuhiko Ooie ◽  
Masahide Hara ◽  
Hironobu Yoshimatsu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Angiotensin Ii ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Receptor Blocker ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Ii Receptor

Prevalence and prognostic impact of left ventricular systolic dysfunction after acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.J Jernberg ◽  
E.O Omerovic ◽  
E.H Hamilton ◽  
K.L Lindmark ◽  
L.D Desta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
Funding Source ◽  
Additional Risk Factor ◽  
Additional Risk

Abstract Background Left ventricular dysfunction after an acute myocardial infarction (MI) is associated with poor outcome. The PARADISE-MI trial is examining whether an angiotensin receptor-neprilysin inhibitor reduces the risk of cardiovascular death or worsening heart failure (HF) in this population. The aim of this study was to examine the prevalence and prognosis of different subsets of post-MI patients in a real-world setting. Additionally, the prognostic importance of some common risk factors used as risk enrichment criteria in the PARADISE-MI trial were specifically examined. Methods In a nationwide myocardial infarction registry (SWEDEHEART), including 87 177 patients with type 1 MI between 2011–2018, 3 subsets of patients were identified in the overall MI cohort (where patients with previous HF were excluded); population 1 (n=27 568 (32%)) with signs of acute HF or an ejection fraction (EF) <50%, population 2 (n=13 038 (15%)) with signs of acute HF or an EF <40%, and population 3 (PARADISE-MI like) (n=11 175 (13%)) with signs of acute HF or an EF <40% and at least one risk factor (Age ≥70, eGFR <60, diabetes mellitus, prior MI, atrial fibrillation, EF <30%, Killip III-IV and STEMI without reperfusion therapy). Results When all MIs, population 1 (HF or EF <50%), 2 (HF or EF <40%) and 3 (HF or EF <40% + additional risk factor (PARADISE-MI like)) were compared, the median (IQR) age increased from 70 (61–79) to 77 (70–84). Also, the proportion of diabetes (22% to 33%), STEMI (38% to 50%), atrial fibrillation (10% to 24%) and Killip-class >2 (1% to 7%) increased. After 3 years of follow-up, the cumulative probability of death or readmission because of heart failure in the overall MI population and in population 1 to 3 was 17.4%, 26.9%, 37.6% and 41.8%, respectively. In population 2, all risk factors were independently associated with death or readmission because of HF (Age ≥70 (HR (95% CI): 1.80 (1.66–1.95)), eGFR <60 (1.62 (1.52–1.74)), diabetes mellitus (1.35 (1.26–1.44)), prior MI (1.16 (1.07–1.25)), atrial fibrillation (1.35 (1.26–1.45)), EF <30% (1.69 (1.58–1.81)), Killip III-IV (1.34 (1.19–1.51)) and STEMI without reperfusion therapy (1.34 (1.21–1.48))) in a multivariable Cox regression analysis. The risk increased with increasing number of risk factors (Figure 1). Conclusion Depending on definition, post MI HF is present in 13–32% of all MI patients and is associated with a high risk of subsequent death or readmission because of HF. The risk increases significantly with every additional risk factor. There is a need to optimize management and improve outcomes for this high risk population. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis

Investigation of the prevalence of cardiovascular risk factors in obese patients diagnosed with metabolic syndrome in childhood and examination of left ventricular function by echocardiography

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Güzin Özden ◽  
Ayşe Esin Kibar Gül ◽  
Eda Mengen ◽  
Ahmet Ucaktürk ◽  
Hazım Alper Gürsu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Blood Pressure ◽  
Metabolic Syndrome ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Left Ventricular ◽  
Atherogenic Index ◽  
Volume Index ◽  
Common Component

Abstract Objectives The objective of this study is to investigate the cardiovascular risk factors associated with metabolic syndrome (MetS), which is increasingly becoming prevalent in childhood obesity. Methods A total of 113 patients, 76 of whom were between the ages of 10 and 17 (mean age: 14.5 ± 1.8 years) and diagnosed with obesity (30 non-MetS and 46 MetS using IDF) and 37 of whom constituted the control group, participated in the study. Echocardiographic examination and atherogenicity parameters (Atherogenic index of plasma [AIP: logTG/HDL], total cholesterol/HDL, and TG/HDL ratio and non-HDL) were evaluated. Results The most common component accompanying obese MetS was found to be hypertension and low HDL. While obesity duration, body mass index (BMI), blood pressure, fasting insulin, insulin resistance, atherogenicity parameters were determined to be significantly higher in the obese-MetS group. Echocardiography showed that while the thickness, volume, and diameter of LV end-diastolic wall, left ventricular mass (LVM), LVM index (LVMI g/m2) and relative wall thickness (RWT) were significantly high in the MetS group, however, mitral E/A ratio was significantly lower (p<0.05). Change in LV geometry consistent with concentric remodeling (increased RWT, normal LVMI) was visible in obese groups. LVM were positively significantly related to BMI, waist circumference, insulin resistance, blood pressure, LDL level, and negative to mitral E/A ratio. In the obese-MetS group, LVMI was positively correlated to office systolic BP, left atrium end-diastolic volume/index. Conclusions LVMI and atherogenicity parameters that were found to be significantly higher in obese MetS exhibit increased cardiovascular risk in childhood.

Cardiovascular events in patients with type 2 diabetes

2002 ◽  
Vol 2 (1_suppl) ◽  
pp. S4-S8
Author(s):  
Erland Erdmann
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Risk Factor ◽  
Adverse Effects ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Increased Risk

Diabetes is a common risk factor for cardiovascular disease. Coronary heart disease and left ventricular dysfunction are more common in diabetic patients than in non-diabetic patients, and diabetic patients benefit less from revascularisation procedures. This increased risk can only partly be explained by the adverse effects of diabetes on established risk factors; hence, a substantial part of the excess risk must be attributable to direct effects of hyperglycaemia and diabetes. In type 2 diabetes, hyperinsulinaemia, insulin resistance and hyperglycaemia have a number of potential adverse effects, including effects on endothelial function and coagulation. Risk factor modification has been shown to reduce the occurrence of cardiovascular events in patients with diabetes; indeed, diabetic patients appear to benefit more in absolute terms than non-diabetic patients. There is thus a strong case for intensive treatment of risk factors, including insulin resistance and hyperglycaemia, in patients with type 2 diabetes.

scholarly journals Cardiovascular risk profile in patients with arterial hypertension who first seek medical attention

2018 ◽  
Vol 17 (5) ◽  
pp. 5-10
Author(s):  
D. V. Nebieridze ◽  
T. V. Kamyshova ◽  
A. A. Sarycheva ◽  
A. S. Safaryan
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Arterial Hypertension ◽  
Target Organ Damage ◽  
Density Lipoprotein ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Medical Attention ◽  
Cardiovascular Morbidity And Mortality

Aim.Objective assessment of cardiovascular risk (CVR) in patients with arterial hypertension (AH), who first contact with primary care setting.Material and methods. 300 patients (age 40-65 years) with sustained increase in arterial pressure and first seek medical attention were included in the study. All patients underwent medical examination, history taking to identify risk factors, blood pressure measurement and anthropometric research, biochemical blood assay to estimate levels of total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, glucose. Based on the specified parameters, the risk was determined by SCORE (Systematic Coronary Risk Evaluation). After the risk assessment, all patients underwent an echo-cardiography, duplex ultrasonography screening of the brachiocephalic arteries and determination of microalbuminuria to detect target organ damage. According to results of a complex survey, the risk was reclassified based on the presence of target organ damage.Results.The study showed that patients with sustained AH who first seek medical attention have a large number of risk factors and their combinations, among which the most common are dyslipidemia (89,3%), smoking (37,7%) and obesity (28,3%). Patients with AH who first seek medical attention without clinical signs of atherosclerosis often have various disorders of target organs, such as left ventricular hypertrophy — 67,3%, thickening of carotid intima-media complex — 46,3%, atherosclerotic plaques in carotid arteries — 34,7%, microalbuminuria — 25,3%, as well as different combinations thereof. After a complex examination, the CVR profile of patients changes increases. According to SCORE 60% of patients with low and mean risk is reclassified to high risk.Conclusion.One of the most important tasks of health care system in Russia is to increase the efficiency of the CVR stratification systems, as well as to develop a new standards of examination of patients with AH on an outpatient stage, in order to reduce cardiovascular morbidity and mortality.

scholarly journals Cardiac Remodeling in Patients with Childhood-Onset Craniopharyngioma - Results of HIT-Endo and KRANIOPHARYNGEOM 2000/2007

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A638-A639
Author(s):  
Panjarat Sowithayasakul ◽  
Leona Katharin Buschmann ◽  
Svenja Boekhoff ◽  
Hermann Lothar Muller
Keyword(s):  
Risk Factors ◽  
Insulin Resistance ◽  
Hormone Replacement Therapy ◽  
Cardiac Remodeling ◽  
Disease Duration ◽  
Hormone Replacement ◽  
Left Ventricular ◽  
Male Gender ◽  
Childhood Onset ◽  
Hypothalamic Obesity

Abstract Hypothalamic obesity caused by childhood-onset craniopharyngioma results in long-term cardiovascular morbidity. Knowledge about clinical markers and risk factors is rare. A cross-sectional study on transthoracic echocardiographic parameters was performed to determine the associations with clinical and anthropometric parameters in 36 craniopharyngioma patients recruited in HIT-Endo and KRANIOPHARYNGEOM 2000/2007. BMI correlated with the thickness of interventricular septum in diastole (IVSd) (r=0.604, p&lt;0.001) and left ventricular posterior wall thickness in diastole (LVPWd) (r=0.460, p=0.011). In multivariate analyses on risk factors for cardiac remodeling, sex hormone replacement therapy, BMI and male gender were positively correlated with increased left ventricular internal diameter in diastole (LVIDd), R2=0.596, F=10.323, p&lt;0.001. BMI and insulin resistance were selected as significant independent determinants of IVSd, produced R2=0.655, F=29.441, p&lt;0.001. Due to wide range of disease duration, 17 pediatric and 19 adult patients were analyzed separately. In the adult subgroup (age at study ≥18 years), BMI correlated with IVSd (r=0.707, p=0.003), LVPWd (r=0.592, p=0.020) and LVIDd (r=0.571, p=0.026). In the pediatric subgroup (age at study &lt;18 years), no correlation between cardiac parameters and BMI was observed. Only LVIDd correlated with disease duration (r=0.645, p&lt;0.001). All cardiac functions were within the normal range, indicating no association with functional impairments. We conclude that cardiac remodeling in patients with childhood-onset craniopharyngioma correlated with the degree of hypothalamic obesity, disease duration, sex hormone replacement therapy, male gender and insulin resistance. As echocardiography has limited sensitivity in patients with obesity, further research on more sensitive techniques for cardiac diagnostics in craniopharyngioma patients is warranted.

scholarly journals Efficacy of Lozartan and Enalapril in mild-to-moderate hypertensive patients with different polymorphisms of type 2 bradykinin receptor and angiotensinogene genes

2007 ◽  
Vol 13 (1) ◽  
pp. 61-68
Author(s):  
S. N. Shulenin ◽  
A. N. Kuchmin ◽  
M. V. Zubakova
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Receptor Gene ◽  
Left Ventricular ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Ii Receptor ◽  
Pressure Monitoring ◽  
Hypertensive Patients ◽  
Bradykinin Receptor

The aim of the study was to investigate the influence of bradykinin type 2 receptor and angiotensinogen genes polymorphism on clinical features of hypertension and efficacy of the angiotensin II receptor blocker (Losartan) and ACE inhibitor (enalapril) in patients with mild-to-moderate hypertension. We examined 140 hypertensive patients; mean duration of hypertension constituted 9,3±2,7 years. Ambulatory blood pressure monitoring, ECHO-cardiography and genes polymorphism definition were done in all patients, with the repeated blood pressure monitoring used as a criteria of treatment efficacy. As a result it was determined, that blood pressure was higher in patients with T/T polymorphism of angiotensinogen gene and +9/+9 polymorphism of type 2 bradykinin receptor gene. Left ventricular mass index was higher in patients with M/M and +9/+9 polymorphisms, and the antihypertensive effect of the drugs was higher in patients with +9/+9 polymorphism.

scholarly journals Risk Factors for Nephrotoxicity Associated with Cisplatin

2017 ◽  
Vol 70 (2) ◽  
Author(s):  
Karine Almanric ◽  
Nathalie Marceau ◽  
Ariane Cantin ◽  
Émilie Bertin
Keyword(s):  
Risk Factors ◽  
Serum Creatinine ◽  
National Cancer Institute ◽  
Enzyme Inhibitor ◽  
Facteurs De Risque ◽  
Angiotensin Ii Receptor Blocker ◽  
Angiotensin Ii Receptor ◽  
Increased Risk ◽  
Premier Cycle ◽  
Concomitant Medications

<p><strong>ABSTRACT</strong></p><p><strong>Background:</strong> Cisplatin-induced nephrotoxicity occurs in about one-third of patients who receive this chemotherapy drug. In late 2012, the study institution began measuring serum creatinine on day 7 after administration of cisplatin to identify patients with acute renal failure.</p><p><strong>Objective:</strong> To evaluate the extent of nephrotoxicity associated with cisplatin and the influence of risk factors for nephrotoxicity.</p><p><strong>Methods:</strong> This retrospective study involved patients who received a first cycle of cisplatin-based chemotherapy between November 1, 2012, and November 1, 2013. Patients’ medical records were reviewed to determine the increase in creatinine level (graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events) and the influence of certain prespecified risk factors, such as age, concomitant medications, initial dose of cisplatin, and related medical conditions.</p><p><strong>Results:</strong> Among the 80 patients evaluated, 14 (17%) experienced no increase in the level of serum creatinine (grade 0), 44 (55%) experienced a grade 1 increase, 19 (24%) a grade 2 increase, and 3 (4%) a grade 3 increase; no patients experienced a grade 4 increase. Patients with the greatest risk of a grade 2 or 3 increase were those treated with hydrochlorothiazide (odds ratio [OR] 9.35, 95% confidence interval [CI] 2.49 to 35.14) or an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (OR 5.02, 95% CI 1.76 to 14.32). After adjustment, only hydrochlorothiazide was associated with an increased risk of nephrotoxicity (OR 5.39, 95% CI 1.04 to 28.07). Among patients taking hydrochlorothiazide, the average incremental increase in serum creatinine was 59.9 μmol/L (95% CI 34.3 to 85.4 μmol/L).</p><p><strong>Conclusions:</strong> Taking hydrochlorothiazide was associated with a significant increase in serum creatinine following cisplatin therapy. On the basis of these results, patients should stop taking hydrochlorothiazide before undergoing cisplatin-based chemotherapy.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte :</strong> La néphrotoxicité associée au cisplatine se produit chez environ le tiers des patients qui reçoivent ce médicament de chimiothérapie. À la fin de 2012, l’établissement de santé des auteurs a commencé à mesurer la créatinine sérique au jour 7 après l’administration de cisplatine afin de repérer les patients atteints d’insuffisance rénale aiguë.</p><p><strong>Objectif :</strong> Évaluer le degré de la néphrotoxicité associée au cisplatine et déterminer si des facteurs de risque favorisent cette néphrotoxicité. Méthodes : Cette étude rétrospective a été menée auprès de patients ayant subi un premier cycle de chimiothérapie à base de cisplatine entre le premier novembre 2012 et le premier novembre 2013. Les dossiers médicaux<br />des patients ont été examinés afin de détecter les cas d’augmentation de créatinine sérique (qui ont été classés selon les critères pour une terminologie commune des événements indésirables du National Cancer Institute) et l’influence de facteurs de risque préétablis (âge, médicaments concomitants, dose initiale de cisplatine et pathologies associées).</p><p><strong>Résultats :</strong> Parmi les 80 patients analysés, 14 (17 %) n’affichaient aucune augmentation du taux de créatinine sérique (degré 0), 44 (55 %) présentaient une augmentation de degré 1, 19 (24 %) affichaient une augmentation de degré 2 et 3 (4 %) présentaient une augmentation de degré 3; aucun ne présentait une augmentation de degré 4. Les patients qui couraient le plus grand risque de connaître une augmentation de degré 2 ou 3 étaient ceux traités avec l’hydrochlorothiazide (risque relatif approché [RRA] de 9,35, intervalle de confiance [IC] à 95 % de 2,49 à 35,14) ou d’un inhibiteur de l’enzyme de conversion de l’angiotensine ou d’un bloqueur des récepteurs de l’angiotensine II (RRA de 5,02, IC à 95 % de 1,76 à 14,32). Après ajustement, seul l’hydrochlorothiazide était associé à une augmentation du risque de néphrotoxicité (RRA de 5,39, IC à 95 % de 1,04 à 28,07). Parmi les patients qui prenaient de l’hydrochlorothiazide, l’augmentation différentielle moyenne de créatinine sérique était de 59,9 μmol/L (IC à 95 % de 34,3 à 85,4 μmol/L).</p><p><strong>Conclusions :</strong> La prise concomitante d’hydrochlorothiazide a été associée à une augmentation significative de la créatinine sérique après un traitement de cisplatine. Considérant ces résultats, les patients devraient cesser de prendre de l’hydrochlorothiazide avant de recevoir une chimiothérapie à base de cisplatine.</p>

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