O006 Early vascular ageing in children with sleep disordered breathing: evidence of vascular hypertrophy and hyperplasia

Children with sleep disordered breathing (SDB) have evidence of increased blood flow velocity and sympathetic overactivity. Sympathetic overactivity leads to peripheral vasoconstriction, increased vascular resistance and consequently, increases blood flow velocity. Early vascular ageing involves premature arterial thickening and stiffening that leads to changes in vascular function. Both increased blood flow velocity and sympathetic overactivity are promoters of arterial remodelling and hence, early vascular ageing. No studies have directly histologically investigated arterial wall structure in children with SDB and how it relates to vascular function. Thirty-six children scheduled for tonsillectomy underwent polysomnography to determine SDB severity and resting brachial artery blood flow velocity (velocity time integral and peak systolic velocity) using Doppler ultrasound. The dorsal lingual artery (tonsil) was stained using hematoxylin and eosin techniques to examine arterial wall structures. Increased velocity time integral correlated with increased arterial medial thickness (r = 0.50, P<0.01), arterial smooth muscle cells (r =0.43, P<0.05) and arterial smooth muscle layers (r=0.45, P<0.01). These relationships remained significant after controlling for body-mass index (BMI). Increased BMI was associated with increased velocity time integral (r=0.61, P<0.01), arterial medial thickness (r=0.37, P<0.05) and arterial medial area (r=0.36, P<0.05). SpO2nadir (TST/REM) was inversely associated with arterial medial area (r=-0.35; r=-0.38, P<0.05). These results demonstrate that increased blood flow velocity is associated with changes in arterial wall composition in children with SDB. This suggests that paediatric SDB, a treatable disorder, is potentially a modifiable risk factor for early vascular ageing and resultant cardiovascular disease in adulthood.

Sepsis or sympathetics? Paroxysmal sympathetic hyperactivity after pontine stroke

A 64-year-old man from nursing home with a pontine stroke 3 months ago, ventilator-dependent, presented with episodic fever, tachycardia and tachypnoea occurring several times a day. He was evaluated for sepsis and pulmonary embolism and was treated empirically with broad-spectrum antibiotics. But these episodes persisted. Due to the episodic nature and typical symptoms of sympathetic overactivity, in the setting of prior brain injury, paroxysmal sympathetic hyperactivity was considered. His antibiotics were discontinued, and he was treated symptomatically with baclofen and bromocriptine, which resulted in a partial reduction of these episodes.

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

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.