Age and sex differences in sleep disorders as risk factors and markers of hypertension in young people with normal body weight

Objective. To assess age and sex differences in sleep disorders as risk factors and markers of hypertension (HTN) in 18–39-year old people with normal body weight. Design and methods. We performed a cross-sectional study based on the internet survey of 18–39-year-old people with body mass index of 18–25 kg/m2 (n = 2094). The unvalidated questionnaire included 42 questions about various types of sleep disorders and sleep-associated symptoms (0 — never, 1 — rarely, 2 — from time to time, 3 — quite often, 4 — almost all the time). Results. The probability of detecting HTN in young men with normal body weight is higher than in women with similar characteristics (p < 0,001). In women, the probability of detecting HTN decreases, starting with the youngest category (18–24 years old), reaching a minimum in the age group 30–34 years old and then starts to increase. By the age of 40, the indicators for men and women become similar. Based on a multivariate analysis, the risk of HTN in young people with normal body weight is associated with both gender and age (p = 0,022). The contribution of gender to age-related changes in sleep complaints was found for snoring (p < 0,001), sleep apnea (p < 0,001), early awakenings (p = 0,002). The contribution of gender was also noted for various symptoms — daytime sleepiness, some symptoms of restless legs syndrome (RLS), anxiety, depression, leg cramps (p < 0,001) and nocturnal heartburn (p < 0,001). The contribution of age was noted for snoring (p < 0,001), sleep apnea (p < 0,001), early awakenings (p < 0,001) and for a variety of symptoms — daytime sleepiness, some symptoms of RLS, anxiety, nocturnal cough, and nocturnal choking. Conclusions. Our data can be considered when developing measures for HTN prevention, can be recommended for clinical use, as well as in subsequent clinical studies using validated questionnaires.

Sympathoadrenal activity and sleep: in the search for a marker of hyperarousal in insomnia

Objective. To assess subjective and objective sleep characteristics and urinary metanephrine levels in patients with insomnia. Design and methods. We included patients with insomnia complaints and those without sleep– related complaints (control group) 18–75 years old. Subjective evaluation of the main sleep characteristics during the last month was assessed by the Pittsburgh Sleep Quality questionnaire, daytime sleepiness — by the Epworth Sleepiness Scale. For objective sleep evaluation we performed one-night polysomnography (PSG). Within 1 week after the PSG, daily urine was collected to determine the level of metaepinephrine. Results. The groups did not differ by age, mean sleep duration over the past month, number of night awakenings by the Pittsburgh Questionnaire, and level of daytime sleepiness. Sleep latency in insomnia group was 15 minutes longer than in the control group. PSG showed higher apnea-hypopnea and desaturation indices in the control group. There were no differences in daily urinary metanephrine excretion in the main and control groups. Correlation analysis showed no significant association between the metanephrine levels and the severity of somnolence and the index of periodic limb movements. Conclusions. Our analysis showed no significant differences in the daily urine metanephrine levels and the main PSG sleep characteristics among subjects with and without insomnia. Further work is required to clarify markers of insomnia and their negative health effects.

Organoprotective properties of combination therapy with ramipril and indapamide in hypertensive patients with non-alcoholic fatty liver disease

Objective. To assess the effect of combined antihypertensive therapy with ramipril and indapamide on the structural and functional state of the heart, blood vessels, kidneys, autonomic nervous system and liver in hypertensive patients with non-alcoholic fatty liver disease (NAFLD). Design and methods. We performed a prospective controlled study including 30 patients with hypertension (HTN) stages I–II, 1–2 degrees with NAFLD (fatty liver index (FLI) > 60) aged 45 to 65 years. Five-seven days before the initial examination, patients discontinued antihypertensive drugs, after the washout period one of the fixed combinations of ramipril (2,5/5 mg/day) and indapamide (0,625/1,25 mg) was prescribed depending on the required dosage and recommendations on lifestyle changes and weight loss were given. Clinical examination, measurement of “office” blood pressure (BP), ambulatory BP monitoring (ABPM), central aortic pressure (CAP), pulse wave velocity (PWV), echocardiography and heart rate variability assessment were performed. The functional state of the kidneys and the structural and functional state of the liver were also assessed before and after treatment. Results. After 24-week therapy with a fixed combination of ramipril and indapamide (an average dosage 4,04 ± 1,24 and 1,01 ± 0,31 mg, respectively) target BP levels was achieved. According to ABPM, both daytime and nocturnal systolic BP (SBP) and diastolic BP (DBP) decreased. In addition, CAP (SBPao, DBPa) and augmentation index decreased. There was also a decrease in the stiffness of the arterial wall in muscle-type vessels (PWVm) (p = 0,0166) and in the number of patients with paradoxical test (p = 0,0320). There was a significant increase in creatinine clearance (Cockroft–Gault) after treatment (p = 0,0439) with no increase in glomerular filtration rate (CKD-EPI) (p = 0,1617). There was a significant change in the structural and functional indicators of the heart: increased left ventricular (LV) ejection fraction (p = 0,0398), decreased LV posterior wall thickness (p = 0,0457), LV end-systolic diameter (p = 0,0286), relative wall thickness (p = 0,0419) and LV myocardial mass index (p = 0,0002). There was a decrease in SDNN < 50 (p < 0,0001) and increase in RMSSD (p < 0,0001), which indicates a decrease in the sympathetic activity and an increase in parasympathetic regulation. Also the number of patients with normotonic type of autonomic reactivity in the orthostatic test increased after treatment (12 (24,0%) vs 19 (63,3%), p = 0,0456). The liver function and structure also improved showing decrease in total bilirubin (p = 0,0038) and gamma-glutamyltransferase (p = 0,0498), as well as the indices of liver steatosis (p = 0,0278) and fibrosis (p = 0,0166). Conclusions. Thus, combined antihypertensive therapy with ramipril and indapamide is well tolerated by patients, highly effective and demonstrates organoprotective properties regarding the heart, blood vessels, kidneys, autonomic nervous system and liver.

Hypersomnia and excessive daytime sleepiness in ischemic stroke

A number of studies have demonstrated a high incidence of sleep disturbances in patients with stroke. The paper reviews the variants of wakefulness disorders observed in ischemic stroke, taking into account the current terminology, as well as methods for their diagnosis. Currently, the origin of post-stroke hypersomnolence and its pathophysiology remain debatable. Various mechanisms including orexin ligand deficiency, degeneration of orexin neurons, as well as disruption of the links between the histaminergic and orexinergic systems are considered as links in the pathogenesis of hypersomnolence caused by ischemic stroke. The paper discusses the pathophysiology of hypersomnia and excessive daytime sleepiness in patients with ischemic stroke, demonstrates various points of view on the relationship of these pathological phenomena with ischemic stroke. A hypothesis on the compensatory nature of hypersomnia and excessive daytime sleepiness in acute ischemic stroke and their possible neuroprotective effect on the brain in patients with stroke is presented.

Blood pressure profiles in patients with arterial hypertension and obstructive sleep apnea in different age groups

Background. Obstructive sleep apnea (OSA) is frequently associated with hypertension (HTN), and about 50 % hypertensive patients have concomitant OSA. Episodes of transient upper airway obstruction affect the daily blood pressure profile, leading to nocturnal HTN. Although the general relationship between OSA and the daily blood pressure profile is known, the association between the frequency of various daily blood pressure profiles and OSA severity as well as the age-specific differences remain unknown. The aim of the study was to determine the daily blood pressure profiles in patients with HTN and OSA, depending on the OSA severity and age. Design and methods. The study included 236 HTN patients underwent treatment in the period from 2008 to 2021 years and were diagnosed with OSA by cardiorespiratory monitoring: 84 patients had mild OSA (apnea/hypopnea index (AHI) < 15 episodes/h), 46 patients — moderate OSA (15 ≤ AHI < 30 episodes/h), and 106 patients — severe OSA (AHI ≥ 30 episodes/h). The control group included 140 HTN patients without OSA. Both groups were divided into 3 age subgroups: younger than 45 years, 45–59 years and ≥ 60 years. At baseline, all patients underwent cardiorespiratory monitoring (“Kardiotekhnika‑07–3/12P”, Inkart, St Petersburg, Russia) and 24-hour blood pressure (BP) monitoring (BPLab, Nizhny Novgorod, Russia). Results. We found an association between the distribution of daily BP profiles and age, which differs from that in HTN patients without OSA. Non-dipper and night-peaker BP profiles are predominant in young and middle age. Among OSA patients, the severity of OSA was associated with the BP profiles only in the young and middleage groups. Unfavorable BP profiles (non-dipper and night-peaker) were more common in patients with severe OSA, which was not observed in elderly subgroup. In the elderly, compared to younger patients, the overdipper profile was the most common and its frequency was not associated with OSA severity. Conclusions. The study shows the relationship between the age of patients with HTN and OSA, the OSA severity and the distribution of daily BP profiles.

Incidence of ischemic stroke in patients with periodic limb movements in sleep: one-year follow-up

Objective. To assess the influence of periodic limb movements in sleep on the incidence of acute cardiovascular events. Design and methods. Fifty-six participants aged 60–75 years were included in the study. Eligibility criteria included no history of acute cardiovascular events and the presence of 1 or more risk factors for cardiovascular diseases. Nocturnal actigraphy and cardiorespiratory monitoring were performed. Patients with apnea/hypopnea index > 5/h were excluded (n = 6). Based on periodic limb movements index (PLMI) two groups were formed: main (PLMI ≥ 15/h, n = 26) and controls (PLMI < 15/h, n = 24). The groups were prospectively observed during 1 year. The endpoints of the study were cases of acute cardiovascular events. Results. Despite the similar prevalence of common risk factors for cardiovascular diseases in two groups, the patients with PLMI ≥ 15/h have a higher incidence of ischemic stroke within 1 year (odds ratio 1,07). Conclusions. Elevated PLMI might be regarded as a potential predictor for higher risk for ischemic stroke. Nevertheless, further investigations in the field are needed.

Parameters of arterial stiffness in hypertensive patients with and without subclinical carotid atherosclerosis

Objective. To assess the relationship between arterial stiffness parameters in hypertensive patients with and without atherosclerotic lesions.Design and methods. We included 127 subjects who were divided into 3 groups: patients with hypertension (HTN) without atherosclerosis (n = 42); patients with HTN and subclinical atherosclerosis (SА) (n = 52) and control group which consisted of individuals without HTN, SA, or coronary artery disease (n = 33). All groups matched by age and gender. All subjects underwent following examinations: ultrasonography of extracranial segments of carotid arteries, 24-hour blood pressure monitoring with the assessment of arterial stiffness parameters.Results. In subjects with HTN compared to controls, pulse wave velocity in aorta (PWVao) was significantly higher (11,3 ± 1,5; 12,3 ± 1,8 vs 10,4 ± 1,3 m/s; p < 0,05), as well as pulse pressure (PP) (46,4 ± 9,8; 45,6 ± 10,6 vs 39,9 ± 6,5 mmHg; p < 0,05), central pulse pressure (PPао) (35,5 ± 8,5; 34,9 ± 8,5 vs 30,9 ± 5,4 mmHg; p < 0,05), and arterial stiffness index (ASI) (141 (127, 159); 139 (128,5, 160,5) vs 126 (118, 138) mmHg; p < 0,05). In subjects with HTN and SA, PWVao was significantly higher compared to other groups (p < 0,05). No significant difference in augmentation index was found (–32,5 (–45, –12); –22 (–36, –12); –37 (–50, –17); p = 0,25). Аmbulatory arterial stiffness index was higher in controls (0,5 ± 0,2) compared to HTN group (0,4 ± 0,2; p = 0,05), while HTN and SA group did not differ significantly (0,5 ± 0,2; p = 0,3). PWVao above 11,15 m/s is associated with 4,3 (2,3–8,2) times higher rate of atherosclerosis plaque detection.Conclusions. In HTN patients, arterial stiffness is changed compared to healthy individuals. PWVao above 11,15 m/s is associated with 4,3 (2,3–8,2) times higher rate of atherosclerosis plaque detection. In patients with HTN and SA arterial stiffness is higher, which might have additional predictive value in risk stratification.

Cardiac troponins in hypertension: mechanisms of increase and diagnostic value

The understanding of the diagnostic and prognostic value of many biomarkers of cardiovascular diseases (CVD), including cardiac troponins (cTnT and cTnI), is changing significantly with the development of methods for their determination. New highly sensitive immunoassays can detect minimal concentrations of cardiac troponin protein molecules in biological fluids (several ng/L or less), allowing the detection of cTnT and cTnI in all healthy individuals. Along with this, there are opportunities to use cTnT and cTnI both to assess the risk of developing CVD in healthy people, and to identify and monitor many early pathological conditions that pose a risk to the cardiovascular system and the life of patients. These pathological conditions include hypertension (HTN), which is the direct cause leading to coronary heart disease, acute myocardial infarction, stroke, and other CVD. A number of recent studies reported the possibility of using highly sensitive cTnT and cTnI in the management of HTN patients. In this article, we consider in detail the diagnostic and prognostic value of cardiac troponins in HTN, we also discuss the main possible mechanisms underlying the increase in cTnT and cTnI in human body fluids.

Orthostatic hypotension and atrial fibrillation: is there a relationship?

Orthostatic hypotension (OH), a possible marker of autonomic dysfunction, reflects the inability of reflex cardiovascular mechanisms to compensate for the fall in venous return in the upright position. This is a manifestation of structural and functional abnormalities of the cardiovascular system. Significance of the orthostatic hypotension is underestimated, while it is associated with all-cause mortality and cardiovascular disease. The article reviews the relationship between atrial fibrillation (AF) and OH. The pathogenetic mechanisms of OH are considered, including various subgroups, e. g. elderly patients. The article also discusses the relationship between OH, AF and cerebrovascular complications. Available evidence suggests that impaired orthostatic hemodynamic response should be considered as a new risk factor for AF. Further research is needed for better understanding of the association between AF and OH, as well as their management.

Cardiac troponins in hypertension: mechanisms of increase and diagnostic value

The understanding of the diagnostic and prognostic value of many biomarkers of cardiovascular diseases (CVD), including cardiac troponins (cTnT and cTnI), is changing significantly with the development of methods for their determination. New highly sensitive immunoassays can detect minimal concentrations of cardiac troponin protein molecules in biological fluids (several ng/L or less), allowing the detection of cTnT and cTnI in all healthy individuals. Along with this, there are opportunities to use cTnT and cTnI both to assess the risk of developing CVD in healthy people, and to identify and monitor many early pathological conditions that pose a risk to the cardiovascular system and the life of patients. These pathological conditions include hypertension (HTN), which is the direct cause leading to coronary heart disease, acute myocardial infarction, stroke, and other CVD. A number of recent studies reported the possibility of using highly sensitive cTnT and cTnI in the management of HTN patients. In this article, we consider in detail the diagnostic and prognostic value of cardiac troponins in HTN, we also discuss the main possible mechanisms underlying the increase in cTnT and cTnI in human body fluids.