Modern treatment of patients with arterial hypertension and chronic coronary syndrome

2021 ◽  
Vol 14 (4) ◽  
pp. 378-383
Author(s):  
Maria Łukasiewicz ◽  
Artur Mamcarz
Keyword(s):  
Arterial Hypertension ◽  
Effective Treatment ◽  
Lifestyle Modification ◽  
Pressure Control ◽  
Correct Choice ◽  
Coronary Syndrome ◽  
Developing Heart ◽  
Poor Blood Pressure Control ◽  
Artery Disease ◽  
Very High

Approximately 1,2 billion people worldwide suffer from arterial hypertension. Among these patients, less than half receive effective treatment. Poor blood pressure control contributes to the development of complications such as stroke or coronary artery disease. A patient with such complications automatically becomes a patient at very high cardiovascular risk, and thus requires personalized and effective treatment, not only of hypertension, but also of its complications. Despite the advancement of the disease, lifestyle modification and correct choice of pharmacotherapy can protect the patient from developing heart failure and prevent acute cardiovascular events.

scholarly journals Improving Blood Pressure Control in Patients with Diabetes Mellitus and High Cardiovascular Risk

2010 ◽  
Vol 2010 ◽  
pp. 1-8 ◽  
Author(s):  
Henry L. Elliott ◽  
Suzanne M. Lloyd ◽  
Ian Ford ◽  
Peter A. Meredith
Keyword(s):  
Diabetes Mellitus ◽  
Pressure Control ◽  
Therapeutic Practice ◽  
Treatment Regimens ◽  
Channel Blocking ◽  
Patients With Diabetes ◽  
Symptomatic Coronary Artery Disease ◽  
Artery Disease ◽  
Long Acting ◽  
Very High

Patients with diabetes mellitus and symptomatic coronary artery disease are also likely to be hypertensive and, overall, are at very high cardiovascular (CV) risk. This paper reports the findings of a posthoc analysis of the 1113 patients with diabetes mellitus in the ACTION trial: ACTION itself showed that outcomes in patients with stable angina and hypertension were significantly improved when a long-acting calcium channel blocking drug (nifedipine GITS) was added to their treatment regimens. This further analysis of the ACTION database in those patients with diabetes has identified a number of practical therapeutic issues which are still relevant because of potential outcome benefits, particularly in relation to BP control. For example, despite background CV treatment and, specifically, despite the widespread use of ACE Inhibitor drugs, the addition of nifedipine GITS was associated with significant benefits: improvement in BP control by an average of 6/3 mmHg and significant improvements in outcome. In summary, this retrospective analysis has identified that the addition of nifedipine GITS resulted in improved BP control and significant outcome benefits in patients with diabetes who were at high CV risk. There is evidence to suggest that these findings are of direct relevance to current therapeutic practice.

scholarly journals Pathogenetic role of cell-free circulating mitochondrial DNA in blood in the development of arterial hypertension

2021 ◽  
pp. 50-57
Author(s):  
С.А. Лепехова ◽  
Е.А. Трофимова ◽  
С.В. Кирильчик ◽  
В.В. Киреева ◽  
Ю.К. Усольцев ◽  
...  
Keyword(s):  
Mitochondrial Dna ◽  
Cardiovascular Risk ◽  
Arterial Hypertension ◽  
High Cardiovascular Risk ◽  
Pathogenetic Role ◽  
Quantitative Indicator ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
Very High

Изучение свободно циркулирующей митохондриальной ДНК (мтДНК) плазмы крови вызывает растущий интерес. Предполагается, что показатель мтДНК может быть перспективным клиническим биомаркёром оценки рисков течения заболеваний. Целью исследования явилась оценка взаимосвязи количественного показателя мтДНК со стадией заболевания и сердечно-сосудистым риском у пациентов с артериальной гипертензией (АГ). Методы. В исследовании участвовал 70 пациентов, которые были разделены на группу с АГ (n = 51) и контрольную группу практически здоровых пациентов (n = 19). Все пациенты подписали информированное согласие на обследование и обработку данных в рамках научного исследования. Проведена оценка демографических данных, длительности заболевания АГ, факторов риска, наследственности, уровня физической активности, антропометрических данных, лабораторное и инструментальное обследование. Оценка уровня мтДНК проведена методом количественной полимеразной цепной реакции. Использовали фрагмент мтДНК с праймерами FmtMinArc 5'-CTAAATAGCCCACACGTTCCC-3' и RmtMinArc 5'-AGAGCTCCCGTGAGTGGTTA-3'. Результаты. На основании проведенного исследования оценки взаимосвязи количественного показателя мтДНК в крови пациентов с АГ, выявлено, что независимо от стадии заболевания, достоверных различий в показателях уровня мтДНК не выявлено, однако отметим, что количество копий имело тенденцию к увеличению по сравнению с условно здоровыми пациентами. При анализе сердечно-сосудистого риска обнаружено, что количественный показатель мтДНК не зависит от стадии АГ. В то же время уровень мтДНК статистически значимо повышается у пациентов с АГ очень высокого сердечно-сосудистого риска по сравнению с условно здоровыми субъектами: Me (Q1; Q3) - 56731 (42531; 129375) копий/мл против 35156 (18325; 54956) копий/мл соответственно (p = 0,015). Заключение. Уровень мтДНК у пациентов с АГ может явиться маркёром сердечно-сосудистого риска. Учитывая ранее показанную патогенетическую роль уровня мтДНК при остром коронарном синдроме, следует продолжить анализ, чувствительность которого может быть повышена за счет включения количественных показателей содержания ядерной ДНК. Studying cell-free circulating mitochondrial DNA (mtDNA) in blood plasma induces growing interest. It is assumed that an indicator of mtDNA may appear a promising clinical biomarker for assessment of the risks in the course of diseases. The aim of this study was evaluating the relationship between the quantitative indicator of mtDNA in the blood of patients with arterial hypertension (AH) and the stage of the disease and the cardiovascular risk. Methods The study included 70 patients who were divided into a group with AH (n = 51) and a control group of apparently healthy patients (n = 19). All patients signed the informed consent for examination and the processing of personal data as a part of the study. Demographic data, duration of hypertension, risk factors, heredity, physical activity, anthropometric data, results of slaboratory and instrumental examinations were recorded. Concentration of mtDNA was measured by the quantitative polymerase chain reaction. A mtDNA fragment with primers FmtMinArc 5'-CTAAATAGCCCACACGTTCCC-3' and RmtMinArc 5'-AGAGCTCCCGTGAGTGGTTA-3' was used. Results. Studying the relationships between the quantitative indicator of mtDNA in the blood and AH showed that there were no significant differences in the indicators for the level of mtDNA regardless of the AH stage. However, we noted that the number of copies tended to increase in comparison with that in conventionally healthy patients. Analysis of the cardiovascular risk showed that the quantitative indicator of mtDNA did not depend on the stage of hypertension. At the same time, the level of mtDNA was significantly increased in very high cardiovascular risk patients with AH as compared to conventionally healthy subjects: Me (LQ; UQ), 56731.2 (42531.25; 129375.0) copies/ml vs. 35156.00 (18325.00; 54956.00) copies/ml, respectively (p = 0.015). Conclusion. The level of mtDNA in AH patients is a potential a marker for cardiovascular risk as shown by the increase in mtDNA in very high cardiovascular risk patients. Taking into account the previously demonstrated pathogenetic role of the level of mtDNA in acute coronary syndrome, the analysis should be continued. The analysis sensitivity can be increased by inclusion of quantitative indicators for the content of nuclear DNA.

scholarly journals Dyslipidemia in blood pressure control among adult hypertensive patients in Kiambu County Hospital Kenya

2020 ◽  
Vol 4 (1) ◽  
pp. 11-17
Author(s):  
Monica. N. Nderitu ◽  
Jonathan Wala ◽  
Otieno O. Otieno
Keyword(s):  
Blood Pressure ◽  
Total Cholesterol ◽  
Blood Pressure Control ◽  
Lifestyle Modification ◽  
Communicable Disease ◽  
Lipid Level ◽  
Pressure Control ◽  
County Hospital ◽  
Hypertensive Patients ◽  
Poor Blood Pressure Control

Introduction: Hypertension is one of the most common non-communicable diseases with about 40% global prevalence in adults and 46% in Africa. Dyslipidemia, among other factors may lead to poor blood pressure control in hypertensive patients. Dyslipidemia occurs when someone has abnormal levels of lipids in their blood However, the role of dyslipidemia in predicting hypertension has not received adequate attention. Objectives: This study aims to determine the relationship between dyslipidemia and blood pressure control among hypertensive patients in Kiambu County Hospital Kenya. Methods: This was a cross-sectional analytical study assessing independent association between blood pressure control and dyslipidemia in a cohort of 251 hypertensive patients in a hospital set up. Multiple logistic regression model was applied to determine factors associated with poor blood pressure control. Results: In total, 251 hypertensive patients, mean age 55.7 years, females-majority (80.9%) were considered in the study. The mean systolic blood pressure was 145.1±22.4mmHg and 87.4±13.0mmHg for diastolic blood pressure. Blood pressure was poorly controlled in 56.6% of the patients. High LDL levels was diagnosed in 82.1% of the patients, 23.1% low HDL levels, 31.9% high triglycerides and 59.8% high total cholesterol levels. Patients with poorly controlled hypertension (68.7%) recorded significantly higher mean total cholesterol (221.4 mg/dl) compared to193.4 mg/dl in the wellcontrolled group (mean 193.4 mg/dl), p0.05). Conclusion: Dyslipidemia was recorded in 68% of adult hypertensive patients and was significantly associated with development of of inadequate blood pressure control. Low density lipids ( LDL) was significantly higher in the poorly controlled group where 68.7% of the patients with high level of total cholesterol had poorly controlled blood pressure. Lifestyle modification, routine lipid profile testing among hypertensive patients, early treatment on high lipid level patients, change of lifestyle and use of statin were recommended for dyslipidemia treatment. Keyword: Hypertension, cardiovascular, blood pressure, diastolic, systolic,non-communicable,disease

scholarly journals Cost-effectiveness of screening of coronary artery disease in patients with type 2 DIABetes at a very high cardiovascular risk (SCADIAB study) rational and design

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Kamel Mohammedi ◽  
Nathalie Préaubert ◽  
Tanguy Cariou ◽  
Vincent Rigalleau ◽  
Ninon Foussard ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Lower Limb ◽  
High Cardiovascular Risk ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Very High

Abstract Background Screening for coronary artery disease (CAD) remains broadly performed in patients with type 2 diabetes (T2DM), although the lack of evidence. We conduct a real-world evidence (RWE) study to assess the risk of major clinical outcomes and economic impact of routine CAD screening in T2DM individuals at a very high cardiovascular risk. Methods SCADIAB is a comparative nationwide cohort study using data from the French National Health Data System. The main inclusion criteria are: age ≥ 40 years, DT2 diagnosed for ≥ 7 years, with ≥ 2 additional cardiovascular risk factors plus a history of microvascular or macrovascular disease, except CAD. We estimated ≥ 90,000 eligible participants for our study. Data will be extracted from 01/01/2008 to 31/12/2019. Eligible participants will be identified during a first 7-year selection period (2008–2015). Each participant will be assigned either in experimental (CAD screening procedure during the selection period) or control group (no CAD screening) on 01/01/2015, and followed for 5 years. The primary endpoint is the incremental cost per life year saved over 5 years in CAD screening group versus no CAD screening. The main secondary endpoints are: total 5-year direct costs of each strategy; incidence of major cardiovascular (acute coronary syndrome, hospitalization for heart failure, coronary revascularization or all-cause death), cerebrovascular (hospitalization for transient ischemic attack, stroke, or carotid revascularization) and lower-limb events (peripheral artery disease, ischemic diabetic foot, lower-limb revascularization or amputation); and the budget impact for the French Insurance system to promote the cost-effective strategy. Analyses will be adjusted for a high-dimension propensity score taking into account known and unknown confounders. SCADIAB has been funded by the French Ministry of Health and the protocol has been approved by the French ethic authorities. Data management and analyses will start in the second half of 2021. Discussion SCADIAB is a large and contemporary RWE study that will assess the economic and clinical impacts of routine CAD screening in T2DM people at a very high cardiovascular risk. It will also evaluate the clinical practice regarding CAD screening and help to make future recommendations and optimize the use of health care resources. Trial registration ClinicalTrials.gov Identifier: NCT04534530 (https://clinicaltrials.gov/ct2/show/NCT04534530)

Study on Vitamin D deficiency in patients of diabetes mellitus presenting with Acute Coronary syndrome in a tertiary care hospital in South India

2020 ◽  
Vol 11 (5) ◽  
pp. 49-53
Author(s):  
Archana Bhat ◽  
Arunachalam Ramachandran ◽  
Pradeep Periera ◽  
Akshatha Rao Aroor
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Vitamin D ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Vitamin D Deficiency ◽  
Coronary Syndrome ◽  
Vitamin D Levels ◽  
Luminal Stenosis ◽  
Artery Disease

Background: Vitamin D, a fat-soluble vitamin has its receptor present in myriad of tissues and it modulates multiple cellular processes. Vitamin D deficiency is reported to be associated with coronary artery disease. Cardiovascular disease is the leading cause of mortality worldwide. Aims and Objective: The primary outcome was to investigate if there is a correlation of 25-OH levels with the percentage of luminal stenosis, as measured with coronary angiogram. The secondary outcome was to determine the differences in angiographically proven luminal stenosis across categories of 25-OH vitamin D levels. Materials and Methods: Thirty patients with acute coronary syndrome with diabetes mellitus were included in this cross-sectional descriptive study. All patients were tested for fasting vitamin D levels, fasting blood sugar, HbA1C and serum creatinine. Detailed history of the patients was recorded. Data was analyzed by the statistical software SPSS version 19 and p value <0.05 was considered significant. Statistical tests like Chi- square, independent t test and log regression was used. Results: In this study 30 patients undergoing coronary angiography for acute coronary syndrome, Vitamin D levels showed severe deficiency in 6.7% (2) cases while mild deficiency was seen in 50% of the cases. Patients with single vessel disease on the coronary angiogram had lower mean HbA1C (9.18) levels in our study. Patients with triple vessel disease had poorly controlled mean HbA1C levels (10.42). Conclusion: In this study we did not find any significant difference between the serum Vitamin D deficiency levels with patients with angiographic severity of the coronary artery disease. Patients with poorly controlled diabetes mellitus had more severe angiographic proven coronary artery disease.

Atypical Takotsubo Cardiomyopathy with Hypokinetic Left Mid-ventricle and Apical Wall Sparing: A Case Report and Literature Review

2020 ◽  
Vol 16 (3) ◽  
pp. 241-246
Author(s):  
Dipesh Ludhwani ◽  
Belaal Sheikh ◽  
Vasu K Patel ◽  
Khushali Jhaveri ◽  
Mohammad Kizilbash ◽  
...  
Keyword(s):  
Case Report ◽  
Takotsubo Cardiomyopathy ◽  
Systolic Dysfunction ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Reduced Ejection Fraction ◽  
Coronary Syndrome ◽  
Normal Left Ventricular ◽  
Artery Disease

Background: Takotsubo Cardiomyopathy (TTC) is an uncommon cause of acute reversible ventricular systolic dysfunction in the absence of obstructive Coronary Artery Disease (CAD). Typically manifesting as apical wall ballooning, TTC can rarely present atypically with apical wall sparing. Case report: A 62-year-old female presented with complaints of chest pain and features mimicking acute coronary syndrome. Coronary angiogram revealed no obstructive CAD and left ventriculogram showed reduced ejection fraction, normal left ventricular apex and hypokinetic mid-ventricles consistent with atypical TTC. The patient was discharged home on heart failure medications and a follow-up transthoracic echocardiogram demonstrated improved left ventricular function with no wall motion abnormality. Conclusion: This case report provides an insight into the diagnosis and management of TTC in the absence of pathognomic features.

scholarly journals Optimizing diagnosis of obstructive coronary artery disease by CT angiography: RCT's final results and 12-months follow-up

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P Dias Ferreira Reis ◽  
R Ramos ◽  
P Modas Daniel ◽  
S Aguiar Rosa ◽  
L Almeida Morais ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Functional Test ◽  
Control Group ◽  
Diagnostic Strategy ◽  
Coronary Syndrome ◽  
Tertiary Center ◽  
Safety Endpoint ◽  
Artery Disease ◽  
Primary Safety Endpoint

Abstract Aim In patients (pts) with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) may improve pt selection for invasive coronary angiography (ICA) as alternative to functional testing. However. the role of CTA in symptomatic pts after abnormal functional test (FT) is incompletely defined. Methods and results This randomized clinical trial conducted in single academic tertiary center selected 218 symptomatic pts with mild to moderately abnormal FT referred to ICA to receive either the originally intended ICA (n=103) or CTA (n=115). CTA interpretation and subsequent care decisions were made by the clinical team. Pts with high risk features on FT, previous acute coronary syndrome, previously documented CAD, chronic kidney disease (GFR&lt;60ml/min/1.73m2) or persistent atrial fibrillation were excluded. The primary endpoint was the percentage of ICA with no significant obstructive CAD (no stenosis ≥50%) in each group. Diagnostic (DY) and revascularization (RY) yields of ICA in either group were also assessed. Pts were followed up for at least 1 year for the primary safety endpoint of all cause death/ nonfatal myocardial infarction/ stroke. Unplanned revascularization (UP) and symptomatic status (SS) were also evaluated. Pts averaged 68±9 years of age, 60% were male, 29% were diabetic. Nuclear perfusion stress test was used in 33.9% in CTA group and 31.1% in control group (p=0.655). Mean post (functional) test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 32.1%. In the CTA group, ICA was cancelled by referring physicians in 83 of the pts (72.2%) after receiving CTA results. For those undergoing ICA, non-obstructive CAD was found in 5 pts (15.6%) in the CTA-guided arm and 60 (58.3%) in the usual care arm (p&lt;0.001 Mean cumulative radiation exposure related to diagnostic work up was similar in both groups (6±14 vs 5±14mSv, p=0.152). Both DY (84.4% vs 41.7, p&lt;0.001) and RY (71.9% vs 38.8%, p=0.001) yields were significantly higher for CTA-guided ICA as compared to standard FT-guided ICA. The rate of the primary safety endpoint was similar between both groups (1.9% vs 0%, p=0.244), as well as the rates of UP (0.9% vs 0.9%, p=1.000) and SS (persistent angina: 29.6% vs 24.8%, p=0.425). Conclusions In pts with suspected CAD and mild to moderately abnormal ischemia test, a diagnostic strategy including CTA as gatekeeper is safe, effective and significantly improves diagnostic and revascularization yields of ICA. Funding Acknowledgement Type of funding source: None

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