scholarly journals Resistant arterial hypertension: clinical and pathogenetic peculiarities and predictors of therapy effectiveness

2019 ◽  
Vol 26 (4) ◽  
pp. 77-89
Author(s):  
L. A. Mishchenko ◽  
O. G. Kupchynska ◽  
O. O. Matova ◽  
K. I. Serbeniuk ◽  
O. V. Gulkevych
Keyword(s):  
Arterial Hypertension ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Fixed Dose ◽  
Low Grade ◽  
Plasma Aldosterone Concentration ◽  
Tnf Α ◽  
Resistant Arterial Hypertension

The aim – to evaluate the features of the target organs damage, neurohumoral and proinflammatory status and to determine the predictors of the effectiveness of antihypertensive therapy in patients with resistant arterial hypertension (RAH). Materials and methods. The study included 257 patients with apparent RAH. The secondary hypertension was revealed in 8.5 % of patients. After 3 months therapy with triple fixed-dose combination (FDC) of antihypertensive drugs in maximum tolerated doses, patients were distributed into two groups – true RAH (n=103) and patients with pseudo resistant AH (PRAH) (n=132). We performed the comparative analysis of clinical characteristics, target organ damage degree, features of neurohumoral (plasma concentration of aldosterone and active renin, 24 – hour urinary metanephrines) and proinflammatory (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor – α (TNF-α) in plasma) status among groups. The predictors of effectiveness of the 4th antihypertensive drug addition (spironolactone, eplerenone, nebivоlol, moxonidine) to triple FDC in patients with RAH were studied. Results and discussion. Higher levels of office and ambulatory blood pressure (BP), frequent (up to 14 %) disturbance of BP rhythm as night-peaker type, high BP morning surge are typical for RAH patients. 95 % of RAH patients had concentric left ventricular hypertrophy and 80 % – carotid atherosclerosis, a lower glomerular filtration rate and higher level of urinary albumin excretion rate (UAER). RAH patients had higher level of CRP – by 17.3 % (p=0.02), IL-6 – by 21.8 % (p=0.01), TNF-α – by 13 % (p=0.003) in comparison with PRAH patients. The predictors of spironolactone and eplerenone efficacy are plasma aldosterone concentration (β=0.653; p=0.002), aldosterone-renin ratio (β=0.542; p=0.003), UAE (β=–0.362; p=0.01) and the level of CRP (β=–0.315; p=0.03). Conclusions. Higher level of BP, target organ damage, more expressed activation of low – grade inflammation, sympathetic and renin-aldosterone-angiotensin systems activity are typical for RAH patients. The most effective drugs in addition to three – component FDC are MRA – spironolactone and eplerenone, which lead to the achievement of target BP at 48.5 % and 46.9 % (according to office and ambulatory testing) RAH patients. Nebivolol application contributed to BP normalization at 39.7 % and moxonidine – at 41.2 % RAH patients.

scholarly journals Effects of irbesartan on phenotypic alterations in monocytes and the inflammatory status of hypertensive patients with left ventricular hypertrophy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jingsi Zhang ◽  
Lina Yang ◽  
Yanchun Ding
Keyword(s):  
Ventricular Hypertrophy ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Dependent Manner ◽  
Concentration Dependent Manner ◽  
Hypertensive Patients ◽  
Inflammatory Status ◽  
Tnf Α

Abstract Background Circulating monocytes and tissue macrophages play complex roles in the pathogenesis of hypertension and the resulting target organ damage. In this study, we observed alterations in the monocyte phenotype and inflammatory state of hypertensive patients with left ventricular hypertrophy (LVH) and studied the effects of irbesartan in these patients. This study might reveal a novel mechanism by which irbesartan alleviates LVH, and it could provide new targets for the prevention and treatment of hypertensive target organ damage. Methods CD163 and CD206 expression on monocytes and IL-10 and TNF-α levels in the serum of hypertensive patients with or without LVH and of healthy volunteers were detected. Furthermore, we treated monocytes from the LVH group with different concentrations of irbesartan, and then, CD163, CD206, IL-10 and TNF-α expression was detected. Results We found, for the first time, that the expression of CD163, CD206 and IL-10 in the LVH group was lower than that in the non-LVH group and healthy control group, but the TNF-α level in the LVH group was significantly higher. Irbesartan upregulated the expression of CD163 and CD206 in hypertensive patients with LVH in a concentration-dependent manner. Irbesartan also increased the expression of IL-10 and inhibited the expression of TNF-α in monocyte culture supernatants in a concentration-dependent manner. Conclusions Our data suggest that inflammation was activated in hypertensive patients with LVH and that the monocyte phenotype was mainly proinflammatory. The expression of proinflammatory factors increased while the expression of anti-inflammatory factors decreased. Irbesartan could alter the monocyte phenotype and inflammatory status in hypertensive patients with LVH. This previously unknown mechanism may explain how irbesartan alleviates LVH. Trail registration The study protocols were approved by the Ethical Committee of the Second Affiliated Hospital of Dalian Medical University. Each patient signed the informed consent form.

scholarly journals Efficacy of a fixed-dose combination (amlodipine/losartan) in the treatment of a patient with arterial hypertension, dyslipidemia and obesity

2020 ◽  
pp. 74-78
Author(s):  
V. P. Mikhin
Keyword(s):  
Arterial Hypertension ◽  
Clinical Case ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Fixed Dose Combination ◽  
Fixed Dose ◽  
High Cardiovascular Risk ◽  
Steady Level ◽  
Dose Combination

The article substantiates the feasibility of combination antihypertensive therapy in patients with arterial hypertension without target organ damage and high cardiovascular risk. The authors consider a clinical case of the use of amlodipine and losartan in a fixed-dose combination (Lozap AM) as part of complex therapy in a patient with arterial hypertension, dyslipidemia and obesity. The clinical case showed the ability of the drug to both achieve a steady level of target blood pressure and improve its daily profile by transferring the Night-peaker type to the Non-dipper type.

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 Organ-protective effect of fixed-dose combination antihypertensive therapy with eprosartan and hydrochlorothiazide for subclinical and clinical target organ damage in hypertensive patients

2012 ◽  
Vol 9 (4) ◽  
pp. 28-34
Author(s):  
N A Koziolova ◽  
A V Bushmakina ◽  
N A Kovalevskaya ◽  
I M Shatunova
Keyword(s):  
Cardiovascular Risk ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Fixed Dose Combination ◽  
Fixed Dose ◽  
Once Daily ◽  
Dose Combination ◽  
Organ Changes

Aim: to evaluate the efficiency of starting fixed-dose combination therapy with eprosartan and hydrochlorothiazide on the clinical and subclinical parameters of target organ damage in patients with hypertensive disease (HD) irrespective of baseline blood pressure (BP) and cardiovascular risk. Subjects and methods. The study consisted of two parallel substudies. Substudy 1 that screened 3536 workers from industrial enterprises identified 395 (13%) hypertensive patients. Among them, there were 50 (12,7%) untreated patients with HD who had three-component target organ damages: left ventricular hypertrophy, hypertensive nephropathy, peripheral artery lesion. Sixty (15,2%) untreated patients with Stage 1 HD without clinical signs of organ changes were recorded among the same cohort in Substudy 2. In both substudies, Group 1 received a fixed-dose combination of eprosartan mesylate 600 mg once daily and hydrochlorothiazide 12,5 once daily regardless of baseline BP at the onset of the study. Group 2 had monotherapy with enalapril and/or its combination with hydrochlorothiazide depending on the degree of BP elevation and the group of a cardiovascular risk. Results. Starting fixed-dose combination antihypertensive therapy (eprosartan + hydrochlorothiazide) irrespective of baseline BP and cardiovascular risk versus monotherapy with enalapril and/or its free combination with hydrochlorothiazide, which was used in terms of BP level and cardiovascular risk ensured a more significant regression of both clinical and subclinical target organ damages during 6-month therapy according to the changes in left ventricular mass (LVM), LVM index, and tissue inhibitor of type 1 matrix metalloproteinases, microalbuminuria and glomerular filtration rate, intima-media complex thickness during carotid Doppler ultrasound study, and pulse wave velocity in different segments, as evidenced by volumetric sphygmoplethysmography. Conclusions. The use of a fixed-dose combination of eprosartan and hydrochlorothiazide in untreated patients of able-bodied age regardless of baseline BP and cardiovascular risk ensures the regression of target organ damages and the prevention of their development in the absence of organ changes.

scholarly journals Antihypertensive Pharmacotherapy in Correcting the Indicators of Innate Immunity in Patients with Essential Arterial Hypertension

2020 ◽  
Vol 6 (4) ◽  
pp. 13-18
Author(s):  
Evgeniia V. Gavriliouk ◽  
IrinaIrina V. Evsegneeva ◽  
Vadim P. Mikhin
Keyword(s):  
Innate Immunity ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Vascular Lesions ◽  
Left Ventricular Myocardium ◽  
Essential Arterial Hypertension

Introduction: The study of indicators of innate immunity in patients with arterial hypertension in clinical trials makes it necessary to correct them in order to reduce vascular inflammation in arterial hypertension to prevent damage to target organs and development of cardiovascular complications. The aim of the study was to assess the effectiveness of antihypertensive therapy to correct indicators of innate immunity in patients with essential arterial hypertension. Materials and methods: Patients with essential arterial hypertension (EAH) (II stage, 3rd degree) were divided into 3 groups: the 1st group included the patients with hypertrophy of the left ventricular myocardium; the 2nd group included the patients with atherosclerotic vascular lesions; the 3rd group included the patients with chronic kidney disease. As an initial antihypertensive pharmacotherapy, all the patients with essential arterial hypertension were prescribed perindopril (5–10 mg/day) and amlodipine (5–10 mg/day). Results and discussion: Changes in innate immunity indices in patients with essential arterial hypertension (II stage, 3rd degree) are differentiated depending on the affected target organ. The antihypertensive pharmacotherapy with perindopril and amlodipine in patients with essential arterial hypertension has various corrective effects on impaired innate immunity, depending on the nature of target organ damage. Regardless of target organ damage, ноу antihypertensive therapy with perindopril and amlodipine does not affect the reduced functional and increased metabolic activities of peripheral blood neutrophils. Conclusion: The results obtained dictate the need for further clinical studies of other classes of antihypertensive drugs and their combinations in the correction of innate immunity indices in order to effectively prevent the progression of target organ damage. Graphical abstract

scholarly journals Features of target organ damage in patients with resistant arterial hypertension

HYPERTENSION ◽  
2020 ◽  
Vol 13 (2-3) ◽  
pp. 66-74
Author(s):  
L.A. Mishchenko ◽  
O.G. Kupchynska ◽  
O.O. Matova ◽  
K.I. Serbeniuk ◽  
O.V. Gulkevych ◽  
...  
Keyword(s):  
Arterial Hypertension ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Target Organ ◽  
Resistant Arterial Hypertension

scholarly journals Features of Cardiovascular Risk Factors, Target Organ Damage in Patients with Diabetes Mellitus Type 2 and Arterial Hypertension

Kardiologiia ◽  
2019 ◽  
Vol 59 (9) ◽  
pp. 20-28
Author(s):  
S. Kh. Mehdiyev ◽  
I. I. Mustafaev ◽  
M. N. Mamedov
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Type 2 Diabetes ◽  
Arterial Hypertension ◽  
Target Organ Damage ◽  
Organ Damage ◽  
Left Ventricular ◽  
Target Organ ◽  
Target Organs

Aim: to investigate relationship between arterial hypertension (AH) and risk factors / subclinical damage of target organs in patients with type 2 diabetes mellitus (DM2). Methods. We included into this clinical epidemiological study 528 patients with DM2 (30.5 % men, 69.5 % women; mean age 54.1±0.3 years; 80.3 % with AH, 19.7 % without AH), who answered questions of the ARIC study questionnaire related to risk factors. Also, we studied features of target organ damage and laboratory indicators. Results. In comparison with normotensives patients with AH more frequently had ischemic heart disease (12.7±1.6 % vs. 5.8±2.3 %, p<0.05), chronic heart failure (CHF) (30.9±2.2 % vs. 9.6±2.9 %, p<0.001), atherosclerosis of vessels of lower extremities (69.8±2.2 % vs. 53.8±4.9 %, p<0.01) and cerebral vessels (50.9±2.4 % vs. 28.8±4.4 %, p<0.001), history of stroke (5.0±1.1 % vs. 0 %, p<0.05), hypertonic angiopathy (14.5±1.8 % vs. 6.5±2.5 %, p<0.05), low level of high density lipoprotein (87.3±2.2 % vs. 74.5±6.4 %, p<0.05), electro- and echocardiographic signs of left ventricular hypertrophy (75.6±2.1 % vs. 45.4±5.1 %, p<0.001; 61.1±2.6 % vs. 24.4±4.7 %, p<0.001, respectively), lowering of left ventricular ejection fraction (12.5±1.7 % vs. 7.8±2.8 %, p<0.001), diastolic disfunction of the left ventricle (52.6±2.7 % vs. 23.2±4.7 %, p<0.001), atherosclerosis of the aorta (38.0±2.6 % vs. 20.7±4.5 %, p<0.01), lowering of the ankle-brachial index (left – 29.8±2.3 % vs. 14.9±3.5 %, p<0.01; right – 31.5±2.3 % vs. 9.9±3.0 %, p<0.001, respectively), increased intima-media thickness of the right carotid artery (84.6±5.0 % vs. 60.0±11.0 %, p<0.05). Conclusion. In patients with type 2 diabetes and AH, in order to develop strategy of macro- and microvascular complications prevention, it is necessary to conduct early screening of risk factors and subclinical damage of target organs.

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