resistant hypertension
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2022 ◽  
Vol 28 (5) ◽  
pp. 41-53
Author(s):  
O. O. Matova ◽  
L. А. Mishchenko ◽  
O. B. Kuchmenko

The aim – to determine prognostic factors of improving left ventricular diastolic function (LV DF) in resistant hypertension (RH) patients (pts) treated with multicomponent antihypertensive therapy during three years.Materials and methods. 102 patients with true RH were included. Patients received triple fixed combination (blocker of the renin-angiotensin-aldosterone system / calcium antagonist / diuretic), to which has been added a fourth drug (spironolactone, eplerenone, moxonidine, torasemide or nebivolol). The state of LV DF was studied at the beginning and at the end of the study. Office and 24-h ambulatory blood pressure (BP) measurements, echocardiography, clinical characteristics, neurohumoral and proinflammatory status were assessed.Results and discussion. Impairment LV DF was detected in 75.5 % of pts. The first degree of LV diastolic dysfunction (DD) was observed in 63.7 %. The patients were divided into 2 groups: the first group included persons without initial impairment of LV DF (n=25), the second – pts with LV DD (n=77). Patients with LV DD were older, had a longer duration of hypertension, higher body mass index, 24-h urinary albumin excretion, office BP and 24-h ambulatory BP, more often (in 2 times) disorders of circadian BP rhythm and concomitant diabetes mellitus (DM). Left ventricular DD in 100 % of cases was associated with severe LV hypertrophy (LVH), increased plasma concentration of inflammatory proteins (CRP, fibrinogen), cytokines (IL-6, TNF-α), increased activity of leukocyte elastase, macrophage matrix metalloproteinase-12. The concentration in the blood of aldosterone, active renin, 24-h urinary excretion of metanephrines did not differ between the groups.Conclusions. Improvement and stabilization of LV DF occurred in parallel with regression of LVH (normalization of LVMI in 35.1 % of pts and significant decrease of LVMI in 64.9 %) against the background of decrease of BP and in the proportion of pts with disturbed circadian BP rhythm. The independent factors of the E/E’ ratio were the initial plasma concentrations of aldosterone (β=0.556; р=0.0001), glucose (β=0.366; р=0.0001), active renin (β=–0.223; р=0.004), 24-h urinary albumin excretion (β=0.188; р=0.016), age (β=0,192; р=0,023). The odds of an improvement in LV DF increased by 3.7 times, if the patient with RH had no DM, LVH regression occurred.


Biomedicines ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 137
Author(s):  
Laura E. J. Peeters ◽  
Leonardien K. Tjong ◽  
Wim J. R. Rietdijk ◽  
Teun van Gelder ◽  
Birgit C. P. Koch ◽  
...  

We aim to investigate sex differences in blood concentrations of spironolactone and the active metabolite canrenone in resistant hypertension patients. Furthermore, sex differences in adherence for spironolactone and other antihypertensive drugs (AHDs) were studied. The patients in this post hoc study had all participated in a single-blind randomized controlled trial called RHYME-RCT (Dutch Trial Register, NL6736). Concentrations in blood of several AHDs were assessed in RHYME-RCT to investigate adherence to treatment. This allowed for a comparison of drug exposure to spironolactone and canrenone between males and females. In linear regression models, no statistically significant sex differences (N = 35) in spironolactone (B =−10.23, SE = 7.92, p = 0.206) or canrenone (B = 1.24, SE = 10.96, p = 0.911) concentrations after adjustment for dose and time between sampling and intake were found. Furthermore, no statistically significant differences in non-adherence to spironolactone were found between sexes (N = 54, male 15% vs. female 38%, p = 0.100), but non-adherence to spironolactone was associated with non-adherence to other AHDs (p ≤ 0.001). Spironolactone and canrenone concentrations were not different between males and females with resistant hypertension. Although not statistically significant, females were twice as likely to be non-adherent to spironolactone compared to males, and thereby also more likely to be non-adherent to other AHDs.


Author(s):  
Christian Nejm Roderjan ◽  
Aline de Hollanda Cavalcanti ◽  
Arthur Fernandes Cortez ◽  
Bernardo Chedier ◽  
Fernanda Oliveira de Carvalho Carlos ◽  
...  

Author(s):  
Halil Akın ◽  
Önder Bilge ◽  
Bünyamin Yavuz ◽  
Selçuk Özkan ◽  
Ferhat Işık

Life Sciences ◽  
2022 ◽  
pp. 120270
Author(s):  
Amanda Sampaio Storch ◽  
Larissa Lirio Velasco ◽  
Antonio Claudio Lucas Nóbrega ◽  
Ronaldo Altenburg Odebrecht Curi Gismondi ◽  
Natália Galito Rocha

2022 ◽  
Vol 14 (1) ◽  
pp. 96
Author(s):  
A. Taleb ◽  
A. Bachir Cherif ◽  
N. Damene Debbih ◽  
M.T. Bouafia

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