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Aim. To analyze the influence of anxiety levels in women with hypertensive disorders on the pregnancy course and outcome in order to identify the relationship between the psycho-emotional state of pregnant women and the probability of developing complications or adverse consequences. Materials and methods. 120 pregnant women were examined and divided into three groups: group 1 – pregnant women with chronic arterial hypertension (CAH), n = 40; group 2 – pregnant women who developed gestational hypertension, n = 40; group 3 – pregnant women without hypertensive disorders, n = 40. The women underwent specialized psychometric testing to assess anxiety/stress levels. The analysis was carried out using the Spielberger–Hanin Scale, the Psychological Stress Scale (PSM-25) and the Impact of Traumatic Event Rating Scale (IES-R). Statistical processing of the results and graphic design were performed using a Microsoft Excel 2016 spreadsheet and the comprehensive data analysis program Statistica 10 for Windows. Results. An elevated level of state and trait anxiety according to the Spielberger–Hanin scale prevailed in pregnant women with CAH, which was an additional stress factor and required continuous monitoring even before the pregnancy onset. Evaluating the IES-R scale results, high levels of the intrusion subscale in all studied groups could be caused directly by pregnancy as a stressful factor. According to the avoidance subscale, we have seen similar results, so, pregnancy contributed to overstraining psychological defense mechanisms. However, the predominance in the group of women with gestational hypertension have suggested that high blood pressure after 20 weeks of pregnancy was one of the contributory factors in the activation of mechanisms for avoiding anxiety. The results of the hyperarousal subscale have demonstrated that the presence of hypertensive disorders (before or during pregnancy) caused the autonomic nervous system activation with the body hyperreactivity. The absence of a high level of stress according to the PSM-25 in all studied groups has demonstrated that women did not experience mental discomfort, which required the use of a wide range of methods to reduce it. Cesarean section was the prevailing delivery mode, the highest percentage was among women with CAH. This group also had the highest number of premature births and the maximum proportion of complications in newborns, indicating the influence of CAH as a negative factor in pregnancy outcomes. Conclusions. The results of this study have demonstrated that an increased level of anxiety in pregnant women could negatively affect their health, as well as the fetal development. In addition, concomitant hypertensive disorders in pregnancy could significantly complicate the pregnancy course, increasing the risk for premature birth and complications in newborns. Therefore, in today’s realities, it is extremely necessary to assess the psycho-emotional state of women in advance, involve specialist physicians, develop and implement a set of psycho-prophylactic measures to increase the neuropsychological stability of pregnant women and reduce the number of negative perinatal outcomes. [ABSTRACT FROM AUTHOR]

The aim of the work was to investigate the dynamics of endothelial markers in patients with arterial hypertension with different cardiovascular risk under the influence of the prescribed treatment during a year of observation. The first group (with a moderate risk of cardiovascular events) included 48 patients with arterial hypertension (AH). The second group consisted of 54 patients with hypertension and a high risk of cardiovascular events, namely type 2 diabetes. Each group of patients was randomized into two subgroups by blood pressure (BP) medication. In patients of subgroup 1a (n=29) and subgroup 2a (n=35) – the main subgroups – the therapy necessarily included the angiotensin II receptor antagonist losartan potas- sium in a dosage of 50-150 mg/day, depending on the blood pressure level. Patients of subgroup 1b (n=19) and subgroup 2b (n=19) – comparison subgroups were treated with antihypertensive drugs of other first-line groups according to the data of the unified clinical protocol for the treatment of hypertension. According to the ROC analysis, it was determined that the dynamics of endothelin-1 (ET-1) indicators after 9 and 12 months of therapy (a decrease of 12% or more from the initial level) can predict the normalization of indicators of the coagulation and anticoagulation systems with indicators of sensitivity and specificity – 85% (95% CI 62.1-96.6%) and 92.9% (95% CI 76.5-98.9%), respectively. A decrease in the level of Willebrand factor (fV) by 23% or more due to such a treatment time can be used as a prognostic sign in determining the regression of endothelial dysfunction with sensitivity – 75% (95% CI 50.9-91.2%), specificity – 100% (95% CI 87.5-100%). According to the given data, both in the group with moderate and with high cardiovascular risk, there is a relationship between endothelial dysfunction (ED) and the duration of hypertension, indicators of the lipid spectrum and abdominal obesity – factors that increase the viscous resistance of the blood circulation, as well as platelet hyperactivity in the bloodstream. We have also established that according to the dynamics of ET-1 indicators after 9 and 12 months of therapy (decrease by 27% or more from the initial level), it is possible to predict the normalization of indicators of the coagulation and anticoagulation systems with indicators of sensitivity – 81.8% (95% CI 59.7-94.7%), specificity – 90.6% (95% CI 75-97.9%). A decrease in the level of fV by 24.5% or more after a year of treatment can be used as a prognostic sign in determining the regression of endothelial dysfunction with sensitivity – 68.2% (95% CI 45.1- 86.1%), specificity – 71.9% (95% CI 53.3-86.2%). The obtained results testify to the dominant role of type 2 diabetes as a factor in platelet disorders of hemostasis. Taking into account the positive dynamics of the above-mentioned markers of ED during the year of treatment, their relationship with the reduction of blood pressure, indicators of the lipid spectrum and abdominal obesity, it should be noted the positive effect of angiotensin II receptor blockers (BRA II) as endothelioprotective drugs. Considering the irrefutable literary data about the absence of thrombomodulin in the blood stream, even its insignificant appearance indicates the presence of endothelial dysfunction. Determining the state and dynamics of changes in endothelial function under the influence of prescribed therapy will make it possible to improve the diagnosis of endothelial function disorders and increase the effectiveness of treatment of patients with hypertension and various cardiovascular risks. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is the most common extrapulmonary complication of the past SARS-CoV-2 infection. According to experts, almost 20% of patients with past COVID-19 have a history of atrial fibrillation and the incidence of new paroxysms of this arrhythmia ranges from 10 to 18%. Referring to the studied patients who experienced COVID-19 more than 6 months ago, the subjective perception of cardiac arrhythmia is the most frequent complaint, reported by approximately two-thirds of patients. The aim of our study was to determine the course of atrial fibrillation in patients after past 2019 coronavirus disease (COVID-19) during a dynamic 6-month follow-up after the initial hospitalization for atrial fibrillation in the specialized department of cardiac arrhythmias of the SI “National Scientific Center” “M.D. Strazhesko Institute of cardiology, clinical and regenerative medicine of the National Academy of Medical Sciences of Ukraine” depending on the clinical and anamnestic, demographic, anthropometric factors, the results of laboratory research methods and the received treatment. 36 patients were included in the study, 27 of them formed the first group, which included patients in whom the course of atrial fibrillation improved against the background of recommended antiarrhythmic treatment after initial hospitalization for AF and past COVID-19, who at the time of hospitalization had a negative PCR test, of which 17 were women and 10 were men, aged 62.38±1.83 years. The second group consisted of 9 patients including 4 women and 5 men, aged 69.88±2.60 years in whom the course of atrial fibrillation neither changed nor worsened. We determined that the number of patients in whom the course of atrial fibrillation improved during the 6-month follow-up was three times greater than those in whom the course of this arrhythmia neither changed nor worsened (75% and 25%, respectively). Patients with a more favorable course of atrial fibrillation were younger (on average by 7.5 years), three times less likely to suffer from diabetes and not often had arterial hypertension of the III stage, than those examined, in whom the course of this arrhythmia did not change or worsen. Systemic inflammation and severity of heart failure significantly worsen the course of AF within 6 months after the hospital stage of treatment. However signs of deterioration of lipid metabolism are characteristic of patients with an unfavorable course of atrial fibrillation during 6 months after hospitalization, which is probably caused by the activation of systemic inflammation in them. The improvement of the prognosis of the examined patients was probably influenced by the appointment of antiarrhythmic drugs, such as: amiodarone, flecainide, beta-blockers, statins – from the "up-stream" therapy drugs. [ABSTRACT FROM AUTHOR]

Aim. To describe a clinical case and analyze the challenges in diagnosing hypertrophic cardiomyopathy (HCM) in a patient with concomitant arterial hypertension (AH). Materials and methods. The article presents the clinical case of HCM in the patient with concomitant AH that was observed in an ambulatory setting in the Municipal Enterprise “Dnipropetrovsk Regional Clinical Center for Diagnostics and Treatment” of Dnipropetrovsk Regional Council. Results. A 66-year-old woman N., diagnosed by her family physician with coronary artery disease (CAD): stable angina FC II, grade 2 AH, chronic heart failure FC II NYHA, was referred to a cardiologist because of experiencing exertional dyspnea, chest pain, and uncontrolled blood pressure despite treatment compliance. Echocardiography identified concentric left ventricular hypertrophy with the left ventricular outflow tract (LVOT) obstruction (a mean gradient of 35 mmHg as per catheterization). Cardiac MRI confirmed the diagnosis and coronary angiography ruled out CAD. Adjustments to the treatment regimen, taking into account HCM with LVOT obstruction, effectively alleviated the patient’s symptoms and stabilized her blood pressure. Conclusions. It is especially important to follow the guidelines of AH management and perform echocardiography in all patients with high blood pressure, so as not to miss the signs of concomitant HCM, particularly with LVOT obstruction. In addition, in the case of HCM, it is necessary to timely detect, provide prevention and manage patients at risk for sudden cardiac death. Since HCM encompasses various diagnoses with different pathogenesis and distinct management, cardiac MRI, enzymatic or genetic testing may be needed according to guidelines. As HCM is a relatively common inherited cardiac disease, general practitioners could often encounter such patients in everyday clinical practice. Hence, they should have a certain suspicion of this diagnosis in persons with AH whose left ventricular mass meets the criteria for HCM. [ABSTRACT FROM AUTHOR]

Background. The combination of hypertension and type 2 diabetes mellitus (T2DM) is associated with a particularly high risk of cardiovascular and renal complications. In accordance with current international guidelines, two criteria are used to diagnose chronic kidney disease (CKD): estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (ACR). However, at present, the nature and stages of changes in urine ACR and their relationship with changes in eGFR in hypertensive patients with T2DM have not been sufficiently studied. The purpose was to investigate the frequency and severity of increased urine ACR in hypertensive patients with T2DM. Materials and methods. We examined 44 patients with stage II hypertension grade 2–3 and T2DM aged 40 to 64 years: 20 (45 %) men, 24 (55 %) women. The examination was carried out using standard clinical, anthropometric, laboratory and instrumental methods. Diagnosis of hypertension, T2DM, cardiovascular diseases, their risk factors, CKD and categories of changes in eGFR and albuminuria were assessed in accordance with European and Ukrainian guidelines. eGFR was calculated using the CKD-EPI equation, taking into account serum creatinine levels; albuminuria was diagnosed by assessing ACR in the morning urine. Results. When analyzing changes in eGFR, 41 % of hypertensive patients with T2DM had a decrease in eGFR to G3a category, which indicates the presence of kidney damage as a target organ. Analysis of changes in urine ACR allows us to identify kidney damage as a target organ (a moderate increase in urine ACR to A2 category) in a significantly larger proportion of patients — 65 % of people. A moderate increase in urine ACR is diagnosed not only in most hypertensive patients with T2DM with a decrease in eGFR to G3a category (89 % of cases), but also in 55 % of individuals with a slight decrease in eGFR (G2 category), as well as in 25 % of patients with normal or high eGFR. Determining the risk of CKD progression based on simultaneous analysis of eGFR and urine ACR indicates that the vast majority of hypertensive patients with T2DM (72 %) have an increased risk of CKD progression, and only less than a third can be classified as those at risk of CKD progression. Conclusions. An increase in urine ACR can be considered as an earlier marker of kidney damage in hypertensive patients with T2DM than a decrease in eGFR, determined by the level of creatinine in the blood serum. Evaluation of urine ACR should be carried out in addition to the determination of eGFR in all patients in this category in order to diagnose kidney damage as early as possible and predict the risk of CKD progression and cardiovascular complications. [ABSTRACT FROM AUTHOR]

Aim. To update the study on morphological changes in the hippocampal structure and blood supply in conditions of persistent arterial hypertension with a focus on the cognitive sphere state. Materials and methods. The authors independently searched and selected scientific literature for a systematic review in the PubMed, Scopus, and Cochrane databases using the following keywords: “arterial hypertension”, “cognitive functions”, “morphological and functional state of the hippocampus” in full-text articles in English and Ukrainian based on the study results with a level of evidence I–III. Results. The authors have conducted a systematic review of articles and scientific publications in PubMed, Scopus and Cochrane databases. The information of the hippocampal structure, blood supply, functions and importance for the generation of human cognitive performance in health and in conditions of persistent arterial hypertension has been processed. Conclusions. The current research results allow asserting that the hippocampus plays an important role in combining environmental signals and creating an integral and unified perception in the spatial and temporal domains. The performance efficiency depends on cellular signaling and stability, adequate blood supply, neurotransmitter balance, and the character of a receptor landscape. Experimental studies and clinical observations show cerebral arteriole reconstruction and constriction as well as decreased NO bioavailability in the hippocampus induced by chronic arterial hypertension to compensate for excessive pressure and increased blood flow pulsatility and to protect microvessels from damage. Increased vasoconstriction results in hypoperfusion and neuronal damage, which is most obvious in the hippocampal CA1 and CA3 areas and visualized as a reduced number of chaotically scattered cells with cytoplasmic vacuoles, nuclear pyknosis and nucleolysis. [ABSTRACT FROM AUTHOR]

The aim of the work is to determine the influence of angiotensin-converting enzyme (ACE) gene polymorphism on the course and effectiveness of antihypertensive therapy using the ACE inhibitor lisinopril and the beta-blocker carvedilol in patients with comorbidity of arterial hypertension and type 2 diabetes. Materials and methods. The study was carried out based on the Department of arterial hypertension and kidney disease of the L. T. Malaya Therapy National Institute of the National Academy of Medical Sciences of Ukraine. The study included 106 patients with arterial hypertension of the 2nd degree, stage II and diabetes mellitus type 2, the average age was 54.3 ± 5.3 years. All patients were divided into three groups. The first group consisted of 48 patients with the A/A genotype of the polymorphic marker 2350 A/G of the angiotensin-converting enzyme gene, the second group included 22 patients with the A/G genotype, and the third group included 36 patients with the G/G genotype. DNA of peripheral blood leukocytes was used to study the single-nucleotide polymorphism of marker 2350 A/G of the angiotensin-converting enzyme gene. A combination of lisinopril and carvedilol was used as antihypertensive therapy. Results. Direct correlations were established between the presence of A/G and G/G genotypes of the single-nucleotide polymorphism 2350 A/G of the angiotensin-converting enzyme gene with an increased body mass index (p < 0.001), higher levels of systolic and diastolic blood pressure (p < 0.001), with an increased level of fasting blood glucose (p < 0.05), the HOMA-IR (p < 0.05), an increased level of low-density lipoproteins (p < 0.05) and triglycerides of the blood (p < 0.05). Positive correlations of the specified polymorphisms with an increase in the mass index of the myocardium of the left ventricle were also established (p < 0.001). As a result of the treatment, a significant decrease in blood pressure, both systolic and diastolic, was observed in all patients (p < 0.001). A statistically significant decrease in the left ventricular myocardial mass index was found (p < 0.001) in all groups of patients. At the same time, the reduction of left ventricular myocardial hypertrophy was statistically more pronounced in patients with genotype A/A than in patients with genotypes A/G and G/G (p < 0.05). In three groups of patients, a significant (p < 0.05) decrease in BMI was observed under the influence of diet therapy and drug treatment. Among the comparison groups of patients, the statistically most significant decrease of this indicator in treatment dynamics was found in individuals with the A/A genotype. A significant decrease in fasting blood glucose levels, HOMA-IR insulin resistance index, and markers of atherogenic dyslipidemia was revealed in both patients with the A/A genotype and those with the A/G and G/G genotypes (p < 0.05). The decrease in the level of insulin resistance (IR) in patients after treatment in all studied groups had positive correlations with the decrease in indicators of left ventricular hypertrophy (LVH) (p < 0.05). Positive correlations were also observed in patients of all observation groups between a decrease in body mass index (BMI) after treatment and a decrease in LVH (p < 0.05). There were no statistically significant differences between the studied parameters between the A/G and G/G groups, both before and after treatment. This confirms that the G allele of the polymorphic marker 2350 A/G of the ACE gene is associated with the development of hypertension and LVH. Conclusions. The therapy with the combination of lisinopril and carvedilol in patients with hypertension and type 2 diabetes contributed to the effective reduction of blood pressure in three groups of patients. It was established that patients with genotypes A/G and G/G of the polymorphic marker 2350 A/G of the ACE gene had more pronounced hypertrophic changes of the myocardium than patients with genotype A/A before the start of treatment. Antihypertensive therapy was the most effective in reducing myocardial hypertrophy in patients with the A/A genotype of the polymorphic marker 2350 A/G of the ACE gene. It was found that the presence of genotypes A/G and G/G of the polymorphic marker 2350 A/G of the ACE gene can be used as a predictor not only of the development of LVH but also of metabolic disorders associated with increased BMI, glycemia and insulin resistance, expressed by shifts in atherogenic dyslipidemia in patients with comorbid hypertension and type 2 diabetes. It was established that a decrease in the degree of LVH accompanied by a decrease in IR and BMI. It has been proven that the use of antihypertensive therapy with the use of carvedilol and lisinopril in the treatment regimen in patients with unfavourable genotypes A/G and G/G of the polymorphic marker 2350 A/G of the ACE gene is effective and contributes to marked regression of LVH. It was determined that patients with the AA genotype of the polymorphic marker 2350 A/G of the ACE gene have the greatest prerequisite for the effective reduction of LVH after treatment, which was considered a favourable prognostic sign. [ABSTRACT FROM AUTHOR]

Mechanisms of beta-endocrinocyte differentiation involving c-kit may be associated with a number of processes, including signaling pathways and regulatory mechanisms. Such factors as activation of the c-kit signaling pathway, an increase or decrease in cell proliferation and survival, regulation of differentiation gene programs and stem cells are important in controlling self-preservation and regulating the cellular number and types, that are differentiated being impacted by intermittent hypoxic hypoxia, hypertension and diabetes mellitus. The aim of the work is to determine the dynamics of c-kit proliferative factor in beta cells under an exogenous influence (intermittent hypoxic hypoxia) and endogenous pathology (arterial hypertension and diabetes mellitus). Materials and methods. The study was conducted using 15 white Wistar rats and 5 spontaneously hypertensive rats (SHR), which were divided into 4 groups of 5 animals each. Group 1 - control (intact) rats, group 2 - animals with experimental diabetes mellitus, group 3 - rats with hereditary arterial hypertension (SHR), group 4 - animals exposed to the effect of intermittent hypoxic hypoxia. At the end of the experiment, the animals were euthanized, organs were harvested and processed, serial histological pancreatic sections 5 μm thick were deparaffinized and retrieved. Insulin and c-kit+ beta progenitor cells were detected by the immunofluorescence method using antibodies. Immunofluorescent reactions were studied using an AxioImager-M2 fluorescence microscope. Results. The quantitative indicator of beta cells was almost 6 times decreased in rats with diabetes mellitus. Concentrations of insulin in animals of this group were increased compared to intact animals and the marker of proliferative activity was decreased without changes in the percentage of c-kit-immunopositive beta cells. The course of hereditary arterial hypertension in SHR was accompanied by an 8-fold decrease in the number of beta cells per 1 cm², an increase in insulin in beta cells as compared to the animals of both intact and experimental diabetes groups. Regarding the c-kit expression in beta cells, it was significantly reduced only in the group of intact animals and the number of c-kit-immunopositive beta cells was almost 2.8 times decreased. In the experimental group of animals exposed to hypoxic hypoxia, the number of beta cells per measurement unit was significantly increased, the concentration of insulin in beta cells was increased as compared to the intact animals, but lower than that in rats with diabetes and hypertension. The marker of proliferative activity c-kit was decreased compared to both intact and diabetic animals. As for the number of c-kit-immunopositive beta cells, it did not differ statistically from that in intact and diabetic animals, but was higher than that in SHR. Conclusions. The development of experimental diabetes in Wistar rats and hereditary hypertension in SHR results in a significant decrease in the specific density of beta cells in the pancreas in contrast to the effect of multiple-day hypoxic training, which stimulates an increase in the density of insulin-synthesizing endocrinocytes. Experimental conditions, diabetes mellitus, hypertension and adaptation to hypoxia, are accompanied by an increase in insulin and a decrease in the c-kit expression in beta cells. However, the number of c-kit-immunopositive beta cells in the pancreatic islets significantly decreases only with the development of hereditary arterial hypertension. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is one of the leading causes of death worldwide, and arterial hypertension (AH) is the strongest risk factor for its development. The problem of hypertension is also relevant during pregnancy, as high blood pressure can be dangerous for both the mother and the fetus, causing pre-eclampsia and premature birth. According to recent data, the number of patients with hypertension will increase. Because of the polygenic and multifactorial nature of the therapeutic response to drugs, further research in this area is needed to provide evidence-based guidelines for clinicians to optimize antihypertensive therapy. The purpose of this review was to summarize information from scientific publications, meta-analyses, guidelines for the years 2018-2023 regarding variants in genes that affect the metabolism of different classes of drugs used in the treatment of hypertension, including during pregnancy, and related to the development of AH. The pathogenesis of hypertension is based on both a decrease in vasodilatation and an increase in circulating blood volume. Arterial stiffness leads to a decrease in vasodilation, and water and sodium retention leads to an increase in blood volume. Additional factors such as the renin-angiotensin-aldosterone system, the sympathetic nervous system, and gene variants affect both vasodilation and blood volume. In addition, there are complex interactions among these factors. As an innate factor, gene variants can affect all of the above simultaneously. The American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines recommend the use of medications from the following 5 classes: diuretics, calcium channel blockers (CCBs), beta-adrenergic receptor blockers (betablockers), angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers. The studies included in this review used two main approaches: candidate gene analysis and genome-wide association analysis. The polygenic nature of hypertension greatly complicates the search for clinically relevant variants and relationships between individual genes and response to medications used to treat hypertension in different ethnic groups. Candidate genes that may influence the risk of hypertension include voltage-dependent calcium channel genes (CACNA1A, CACNA1C, CACNA1S, and CACNB2), NEDD4L, ADD1, and miR. A number of genetic polymorphisms are associated with both the influence on the development of arterial hypertension and the response to treatment - eNOS, TRIB3, CYP, POR, ADRB1, ADRB2, ACE. When treating pregnant women with hypertension, the efficacy of the antihypertensive agent must be balanced against the risk to the fetus. Initial antihypertensive therapy should include an acceptable first-line agent. The development of a pharmacogenomic strategy to select the most effective and well tolerated drug treatment regimen for hypertension is of paramount importance, as it will lead to a lower number of drugs required per patient and better blood pressure control, help prevent cardiovascular and renal complications, and improve quality and length of life. [ABSTRACT FROM AUTHOR]

Background. The presence of metabolic-associated pathology, namely obesity, diabetes mellitus, dyslipidemia, and non-alcoholic fatty liver disease (NAFLD), significantly accelerates the development of the cardiovascular continuum. This is associated with an increased risk of major cardiovascular events (myocardial infarction, stroke). An important organ damage in hypertension (HTN) is the remodeling of small arteries and an increase in stiffness of large arteries. The relationship between NAFLD, dyslipidemia, hypertriglyceridemia, obesity (especially abdominal), diabetes, and HTN is well studied, but there is a lack of clinical studies examining changes in arterial stiffness in NAFLD. Aim of the research was to study the parameters of arterial stiffness in patients with NAFLD. Materials and methods. Eighty-two Caucasian patients with NAFLD (mean age (56.8 ± 1.1) years, 59.8 % men) were enrolled. Participants were divided into two groups: group 1 (n = 44) - NAFLD and concomitant HTN, group 2 (n = 38) - HTN without NAFLD. All patients underwent a standard general clinical examination, laboratory and instrumental work-up. In addition, all patients were assessed for the parameters of arterial stiffness via non-invasive arteriography. Results. Patients with NAFLD had significantly higher office systolic and diastolic blood pressure (by 15.2 and 10.4 %, respectively, p < 0.01) despite comparable drug therapy. The same trends were observed in relation to the central aortic pressure, which was 19.3 % higher in patients with NAFLD (p < 0.01), and central pulse pressure that was 35.9 % higher than in patients without NAFLD (p < 0.01). Brachial artery augmentation index in NAFLD turned to be elevated compared to patients without NAFLD (p < 0.01), but aortic augmentation index was comparable between groups. The return time interval in group 1 was 50.3 % higher than in group 2 (p < 0.01). Finally, patients with NAFLD had a significant increase in pulse wave velocity by 52.3 % compared to those without NAFLD with average value exceeding 12 m/sec (p < 0.01). Conclusions. There is an association between NAFLD and worse indices of arterial stiffness in patients with concomitant HTN. [ABSTRACT FROM AUTHOR]

Melatonin has several impacts on the cardiovascular system, including the potential to reduce blood pressure in addition to its role in regulating sleep. It has the ability to decrease adrenergic system activity and indirectly enhance endothelial function. Melatonin can provide antihypertensive effects by stimulating own receptors in the central nervous system and peripheral arteries. In addition, melatonin is a potential treatment for patients with hypertension, including the "night-peaker" category. However, the results of only a few randomized trials suggest that melatonin supplements are effective in the treatment of hypertension. Melatonin can lower blood pressure due to vasodilatation, direct blocking of Ca2+ channels and increased production of nitric oxide in the endothelium; antioxidant properties; suppression of the sympathetic nervous system, reduction of norepinephrine production, as well as activation of the parasympathetic nervous system. Because the drug is usually taken at bedtime, it may increase the duration and quality of sleep and therefore lower blood pressure during sleep. Low endogenous melatonin secretion during sleep may be associated with elevated nocturnal blood pressure and comorbid cardiovascular diseases. In addition, melatonin exhibits an excellent safety profile. Consequently, larger-scale, longer-term studies with higher patient heterogeneity, biomarker identification, and idiosyncrasies related to melatonin use are required. The aim of this narrative review is to analyze the peculiarities of the mechanisms of action, as well as the effect of exogenous melatonin on blood pressure parameters in the experiment and clinic. The search was conducted in Scopus, Science Direct (from Elsevier), and PubMed, including the MEDLINE databases. The key words used were "melatonin," "blood pressure", "hypertension", "obesity", "metabolic syndrome". We manually searched the bibliography of publications to find study results that the online search did not yield. [ABSTRACT FROM AUTHOR]

Age-related changes in the elastic properties of the arterial wall in patients with arterial hypertension increase the risk of CV events. Additional CV risk factors in women lead to gender differences in vascular stiffness. The aim: to determine changes in the elastic properties of the arterial wall in patients with hypertension depending on gender, with considering of the age-related changes. Materials and methods: 258 patients with arterial hypertension stage II were examined: 132 women (55.56±7.69 years) and 126 men (51.75±8.42 years). By age, patients were divided into 5 subgroups (37-45, 45-49, 49-54, 54-58 and 58-69 years). The following were assessed: pulse wave velocity in the aorta (PWVao), central systolic blood pressure in the aorta (SBPao), central pulse blood pressure (cPBP), augmentation index in the aorta (Aix ao) and on the brachial artery (Aix br), PWV index (PWVind), amplification blood pressure (BPamp), pulse blood pressure index (C/B indPBP). Results: In the absence of differences in peripheral hemodynamics in all groups, women aged 49-54 years had a magnification of the PWV by 2 m/s, and, in comparison with men, this difference was 1.65 m/s (p<0.05). Aix br and Aix ao were also superior to men in all groups, and in 49-54 years old, this difference was greatest and amounted to 39 % and 20 %, respectively. At this age, SBPao was also significantly raised in women, with a difference of 15 mmHg relative to men (p=0.038). In all age groups, women had negative values of the BPamp in contrast to men. In women, PWV correlated with the duration of hypertension (r=0.21; p<0.05), SBP (r=0.40), DBP (r=0.35), cPBP (r=0.43), in contrast to men, where PWVao was associated only with the heart rate (r=0.30). Conclusion: In women with hypertension, changes in vascular wall stiffness occur earlier than in men with significant growth at 49-54 years. In women, the elastic properties of arteries are associated with the level of blood pressure and duration of the disease, and in men - with the level of the heart rate. [ABSTRACT FROM AUTHOR]

Background. Non-alcoholic fatty liver disease (NAFLD) is a pressing issue in modern society. While excess circulating glucose and insulin resistance contribute to its pathogenesis, the diagnosis poses particular challenges. The purpose of the study was to identify new additional non-invasive diagnostic markers of NAFLD and the risk of developing comorbid diseases in these patients. Materials and methods. The study involved 64 men aged 39 to 62 years: 35 patients were diagnosed with non-alcoholic fatty liver disease according to EASL-EASD-EASO guidelines, 29 patients comprised the control group. The results of complete blood count, biochemical blood tests, and abdominal ultrasound were evaluated in both groups. Results. Patients with NAFLD had significantly higher body weight and body mass index, higher glucose, HOMA-IR, total cholesterol, triglycerides, low-density lipoproteins, atherogenic index, alkaline phosphatase, gamma-glutamyl transferase, alanine aminotransferase, and aspartate aminotransferase. Additional non-invasive markers of NAFLD were high body mass index, HOMA-IR, total cholesterol, triglycerides, low-density lipoproteins, atherogenic index, and alanine aminotransferase, which may also indicate future risks of type 2 diabetes and hypertension. Conclusions. Among patients with NAFLD within three years, hypertension occurred in 22.2 % of cases and type 2 diabetes in 20.0 %, which is higher than in patients without NAFLD (8.7 and 4.3 %, respectively). We found that at the time of initial examination, patients with NAFLD had higher body weight and body mass index, as well as higher glucose, HOMA-IR, total cholesterol, triglycerides, low-density lipoproteins, atherogenic index, alkaline phosphatase, gamma-glutamyl transferase, alanine aminotransferase, and aspartate aminotransferase. From these metrics, we identified high body mass index, HOMA-IR, total cholesterol, triglycerides, low-density lipoproteins, atherogenic index, alkaline phosphatase as potential non-invasive risk markers for NAFLD. This highlights the importance of studying them for the early diagnosis of type 2 diabetes and hypertension, which could improve the treatment of this cohort of patients in the future. [ABSTRACT FROM AUTHOR]

Background. Population aging has become a leading demographic feature of Ukraine. According to the World Health Organization, the number of elderly and senile people will increase to almost 40 % in the coming decades. Hypertension and type 2 diabetes mellitus (DM) are among the leading factors of cardiovascular risk. It is known that excessive oxidant stress and low-grade subclinical chronic systemic inflammation are determining factors of endothelial dysfunction, vascular reactivity disorders, increased peripheral vascular resistance, carbohydrate, and lipid metabolism disorders, which leads to increased blood pressure and plasma glucose levels. Hypertension and type 2 DM are among the leading cardiovascular risk factors. The purpose of the study was to increase the effectiveness of treatment and improve the quality of life of elderly patients with combined pathology of hypertension and type 2 DM by additional inclusion of empagliflozin and L-arginine in the basic therapy. Materials and methods. Fifty elderly patients with comorbid pathology were under our observation for second stage hypertension, coronary heart disease (functional class II) and type 2 DM in the stage of subcompensation. Participants were divided into two groups: the first one, controls (n = 25), received generally accepted basic therapy. In the second group (n = 25), the following drugs were added to the basic therapy: empagliflozin 10 mg/day, L-arginine 300 mg/day. Results. Clinical observation in outpatient conditions lasted for 3 months. Comprehensive therapy in the elderly patients with comorbid pathology of hypertension and type 2 diabetes, with the additional inclusion of empagliflozin and L-arginine to the basic therapy, contributes to a significant positive effect on the clinical course, reduces the risk of progression of this constellation. Conclusions. The application of the proposed comprehensive therapy in outpatient conditions under the control of a family doctor will significantly improve the quality of life of patients and prevent the development of complications. [ABSTRACT FROM AUTHOR]

Анотація. Подагра залишається найпоширенішим типом запального артриту у всьому світі. У структурі коморбідних захворювань при подагрі переважає артеріальна гіпертензія. У пацієнтів з артеріальною гіпертензією в поєднанні з подагрою проблема вибору лікувальної тактики лишається досить актуальною. Мета. Оцінити ефективність комбінації препаратів базисної терапії для лікування пацієнтів з артеріальною гіпертензією в поєднанні з подагрою на показники якості життя на первинному рівні надання медичної допомоги. Матеріали та методи. Сформовано дві групи пацієнтів. Перша група, 36 пацієнтів, які отримували лозартан, алопуринол, аторвастатин. Друга група, 36 осіб, які отримували раміприл, алопуринол, аторвастатин. Якість життя оцінювали за допомогою загальної стандартизованої анкети SF-36. Оцінка функціонального статусу пацієнта здійснювалася з використанням опитувальника стану здоров’я – HAQ-DI. Статистичний аналіз проводився за допомогою Statistica 6.1. Результати. У досліджуваних групах хворих оцінено якість життя пацієнтів до та після лікування. Встановлено, що до призначення лікування не виявлено достовірної різниці між групами за опитувальниками SF-36, HAQ-DI. У пацієнтів обох груп були знижені показники фізичного компоненту здоров’я (ФКЗ) та психологічного компоненту здоров’я (ПКЗ) за шкалою SF-36, зареєстровано більшу частку пацієнтів з мінімальним та помірним порушенням життєдіяльності за HAQ-DI. За результатами аналізу встановлено, що відбулося підвищення рівня якості життя за показником ФКЗ на 21,7 % у І групі та на 20,4 % у ІІ групі (p < 0,01), за показником ПКЗ – на 18,4 % та 17,5 % (p < 0,01), відповідно. Вірогідне зниження показника HAQ-DI встановлено лише у хворих, які отримували раміприл у порівнянні з вихідними даними до лікування на 33,3 % (р < 0,05). У пацієнтів І групи зростає частка хворих з мінімальними порушеннями та знижується – з помірними, а в ІІ групі – зростає поширеність мінімальних та помірних порушень, що свідчить про ефективність призначеної терапії. Висновки. Комплексна терапія (лозартан або раміприл, алопуринол, аторвастатин) протягом 6 місяців у пацієнтів з артеріальною гіпертензією в поєднанні з подагрою супроводжується достовірним покращенням якості життя за показниками ФКЗ (25,1 %, p < 0,01) і ПКЗ (17,7 %, p < 0,01) та ступеня життєдіяльності (25,0 %, p < 0,01).

Today, the issue of treatment and rehabilitation of patients with COVID-19 is extremely relevant. A disease that has shaken the medical community, even after the patient recovers, can have serious consequences for health in the future. The greatest concern in the post-covid period is caused by rather serious and long-term complications (especially in patients who have experienced a severe form of COVID-19), which include: cardiovascular (damage to the heart muscle, exacerbation and progression of hypertension), respiratory, neurological (disturbance of sensation taste and smell, sleep disorders), psychological (depression, anxiety, mood swings) outcomes. In the modern population, there is an increased level of cognitive disorders. They have multifactorial nature, in particular, one of such pathogenetic factors is arterial hypertension (AH) and its complications, the frequency of post-stroke cognitive impairment from mild to severe grade reaches 60% during the first year. On the other hand, according to observations, treatment of AH can reduce the risk of dementia development. The results of the data analysis showed a higher prevalence of cognitive impairment in patients with AH in the post-epidemic period than in patients with elevated blood pressure (BP) who did not suffer from COVID-19. The objective: to analyze the frequency of anxiety-depressive disorders and cognitive function in patients with medically controlled AH who experienced COVID-19, and to evaluate the effectiveness of additional use of a combination of L-carnitine, L-arginine and coenzyme Q10 in the post-covid period. Materials and methods. 53 patients (24 women and 29 men) with a diagnosis of AH who treated with drug antihypertensive therapy and who recovered from COVID-19, were included in a prospective single-center study. Questionnaires (MMSE, SSS-8, PHQ-9) were chosen to assess anxiety-depressive disorders and cognitive function. The study participants were divided into two groups that did not differ in age and gender. In the first group standard treatment was added with a combination of L-arginine, L-carnitine and coenzyme Q10, the patients in the second group received standard therapy. Results. An additional effect on improved BP control only when used drug therapy in a complex with a combination of L-arginine, L-carnitine and coenzyme Q10 was determined, as well as a positive effect on improved the clinical condition of patients with AH, restoration of the psychological state after a recovery from respiratory infection SARS-COV-2. Conclusions. The patients with AH who have suffered from COVID-19 often have psychological changes and impaired cognitive function under the conditions of medical BP control. The use of a combination of L-arginine, L-carnitine and coenzyme Q10 as part of complex therapy contributed to a more effective recovery of psychological and cognitive disorders, improvement of the subjective condition of patients due to the additional positive effect on the control of BP and heart rate. [ABSTRACT FROM AUTHOR]

Metabolic syndrome (MS) is a group of interrelated metabolic disorders such as high blood pressure, central obesity, insulin resistance (IR), dyslipidemia. The main mechanisms that indicate a metabolic disorder and contribute to its development are IR and a large amount of circulating free fatty acids. In turn, tissue IR is often combined with other abnormalities including disorders of uric acid metabolism, changes in the hemostasis system, endothelial dysfunction, increased levels of C-reactive protein. At the same time, metabolic disorders are a risk factor for hyperuricemia. MS occurs in 25–60 to 90 % of all gout patients. About 50 % of patients with hyperuricemia have symptoms of MS. Hyperuricemia as a component of MS is a predictor of cardiovascular mortality, development of diabetes mellitus, hypertension and nephrolithiasis. Hyperuricemia is closely related to diabetes, obesity, coronary heart disease, hypertension. On the example of a clinical case, the main components of MS are considered, as well as the issue of the relationship between hyperuricemia, gout and the components of MS. The main idea behind the creation of the MS concept is to select a population of patients at a high cardiovascular risk in whom preventive measures such as lifestyle modification and the use of adequate drugs can significantly affect the main health indicators. The goal of managing patients with MS is to minimize cardiovascular risk and mortality as much as possible. Accordingly, the therapeutic strategy should include optimal ways to modify the lifestyle; lowering blood pressure to the target level and treating comorbid conditions; reducing low-density lipoprotein cholesterol according to the risk profile: > 50 %, and < 70 mg/dL (1.4 mmol/L) in patients at a very high cardiovascular risk; > 50 %, and < 100 mg/dL (1.8 mmol/l) in highrisk patients; reducing fasting serum glucose < 126 mg/dl (7 mmol/l) or glycated hemoglobin < 7 % (53 mmol/mol); maintaining uric acid level < 6.5 mg/dL (0.387 mmol/L), in patients with gout — below 6 mg/dL (0.357 mmol/L). Thus, according to the results of the research, a causal relationship was found between insulin resistance and serum uric acid levels in patients with metabolic syndrome. The strategy for managing patients with metabolic syndrome should include screening and correction of hypertension, carbohydrate purine metabolism, dyslipidemia, and prevention of cardiovascular events. [ABSTRACT FROM AUTHOR]

Background. Post-COVID syndrome is associated with a wide range of chronic symptoms or conditions. Coronavirus disease 2019 (COVID-19) causes metabolic disorders such as hyperglycemia, insulin resistance. Insulin-like growth factor 1 (IGF-1) is associated with an impaired glucose tolerance and a higher risk of developing type 2 diabetes. Currently, the study of molecules regulating carbohydrate metabolism as potential biomarkers of post-COVID syndrome and targets for therapeutic influence is relevant. The purpose of the study was to assess the level of IGF-1 and its relationship with regulation of carbohydrate metabolism, as well as the dynamics of the evaluated indicators under the influence of drug treatment in patients with hypertension and stable coronary heart disease who suffered from COVID-19. Materials and methods. Fifty-five patients who had a mild and moderate COVID-19 were included in the study; their average age was 55.87 [40; 75] years. The results of routine laboratory tests were registered and analyzed. The content of insulin and IGF-1 was assessed by enzyme immunoassay. The HOMA-IR was calculated. Results. In patients with a moderate COVID-19 compared to those with a mild one, a significant decrease in the level of IGF-1 (р = 0.008) was found against the background of increased reference values of glucose, insulin, and HOMA-IR (р < 0.01). The influence of the degree of hypertension on the IGF-1 level was revealed (р = 0.004). An inverse relationship between IGF-1 and glucose level was noted (r = –0.28, p = 0.034). The use of meldonium contributed to a significant decrease in glucose and insulin content (p < 0.001), and an increase in IGF-1. Against the background of taking meldonium, the dynamics of the shift towards a decrease in the HOMA-IR was more significant. Conclusions. An inverse relationship was found between IGF-1 and blood glucose, regardless of the level of insulin and HOMA-IR, in patients with hypertension and stable ischemic heart disease in the post-COVID period. Meldonium has been shown to improve carbohydrate metabolism by normalizing insulin levels and reducing the phenomena of insulin resistance as a potential drug target. Meldonium improved the clinical course of ischemic heart disease and demonstrated good tolerability and safety. [ABSTRACT FROM AUTHOR]

Background. In modern conditions, an acute problem in medicine is the issue of a negative impact of war on the course of chronic noncommunicable diseases. The most common of them are hypertension and type 2 diabetes mellitus, which in most cases occur as a comorbidity. To date, a certain amount of work has been carried out to study the influence of war and chronic wartime stress on the development and progression of hypertension. However, the features of the course of hypertension and type 2 diabetes in case of their combination during a long-term stay of patients in combat zones remain unstudied. The purpose: to study changes in the nature of the disease course in patients with hypertension and type 2 diabetes — representatives of the civilian population after a long stay in the combat zone of the Kharkiv region of Ukraine. Materials and methods. Sixty-five patients (civilians) with hypertension and type 2 diabetes (30 men, 35 women) aged from 47 to 64 years were examined. All of them were examined before the start of the war and 4–5 months after staying in the combat zone. Results. In hypertensive patients with type 2 diabetes after their stay in a combat zone, hypertension became more severe (in 89 % of cases, it was uncontrolled, the frequency of hypertensive crisis and resistant hypertension increased significantly). In addition, a significant increase in the frequency of decompensation of carbohydrate metabolism was detected. The examined patients showed a progression of lipid metabolism disorders and the development of new cases of cardiovascular and cerebrovascular diseases. Conclusions. There was a pronounced negative impact of long-term stay of patients with hypertension and type 2 diabetes in a combat zone on the course of both hypertension and diabetes, which was associated with a significant increase in the incidence of cardiovascular and cerebrovascular diseases. [ABSTRACT FROM AUTHOR]

Background. Given the proven excessive activation of the renin-angiotensin-aldosterone system and the clinical manifestations of hypertension, mostly of renal origin, there is a need to optimize antihypertensive therapy aimed at an active nephroprotection. The purpose of the study is to carry out a comprehensive assessment of kidney and heart risk factors in patients with type 2 diabetes mellitus and chronic kidney disease (CKD) and to justify the administration of non-steroidal mineralocorticoid receptor antagonists to these patients. Materials and methods. In a prospective cohort study, 88 patients with type 2 diabetes were examined: group 1 — estimated glomerular filtration rate (eGFR) < 60 ml/min/m², group 2 — eGFR ≥ 60 ml/min/m² . eGFR was evaluated according to the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) formula based on serum creatinine. GFR category was defined according to the KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The albumin-creatinine ratio was calculated. The level of glycated hemoglobin (HbA1c) was assessed by the method of high-performance liquid chromatography. Aldosterone was evaluated by immunoenzymatic method. Results. In patients with eGFR < 60 ml/min/m², the albumin-creatinine ratio in daily urine is statistically significantly higher compared to group 2. Patients with eGFR < 60 ml/min/m² had an average uric acid level of 410.3 ± 98.8 μmol/l, which is statistically significantly higher than in those with eGFR ≥ 60 ml/min/m² — 321.10 ± 74.54 μmol/l. A statistically significant correlation between the level of uric acid and markers of renal dysfunction was found only in patients with eGFR < 60 ml/min/m² . Aldosterone levels were higher in the first group. No statistical difference was found between the average value of HbA1c in the studied groups. Conclusions. Numerous factors of unfavorable prognosis regarding kidney and heart risks have been identified: hypertension, increased albumin-creatinine ratio and cholesterol, unsatisfactory compensation of diabetes, obesity. There is an increase in the frequency of resistant hypertension, hyperuricemia, and hyperaldosteronism in patients with decreased eGFR. In patients with diabetic kidney damage on the background of type 2 diabetes, the administration of finerenone, a non-steroidal mineralocorticoid receptor antagonist, at a dose of 10–20 mg/day is pathogenetically justified. [ABSTRACT FROM AUTHOR]

Мета - визначити у вагітних з артеріальною гіпертензією динаміку показників прогеніторів ендотеліоцитів (ЕРС) та асиметричного диметиларгініну (ADMA) як маркерів ефективності корекції ендотеліальної дисфункції на тлі терапії L-аргініном (Тівортін, виробництва «Юрія-фарм»). Матеріали та методи. Досліджуваних вагітних поділено на дві групи: жінки з артеріальною гіпертензією в терміні 12-15 тижнів вагітності (n=29) та з вродженими не оперованими вадами серця в терміні 12-14 тижнів вагітності (n=21). Контрольну групу становили 40 здорових вагітних. Обстеження проведено до початку перорального застосування L-аргініну (Тівортіну аспартату) та через 7-8 тижнів після початку терапії. Тівортін аспартат призначали перорально по 1 мірна ложка 5 разів на добу впродовж 6 тижнів. Дослідження рівня ЕРС (фенотип CD45+/CD34+ периферичної крові) виконано методом проточної цитометрії за допомогою реагентів для визначення кластерів диференціювання CD34, CD45 виробництва «Beckman Coulter Іnc.». Результати представлено у відсотках ЕРС від загальної кількості лейкоцитів, а також в абсолютних величинах - кількості клітин на 1 мл крові в абсолютних величинах. Рівень ADMA в плазмі визначено шляхом непрямої імуноферментної методики із застосуванням тест-системи «ADMA ELISA» (виробник «Immunodiagnostik AG», Німеччина). Референтними величинами для вагітних прийнято 0,26-0,60 мкмоль/л. Результати. Після проведеного лікування L-аргініном (Тівортін) зменшився показник ADMA порівняно з висхідними даними в досліджуваних групах вагітних. Так, у вагітних з артеріальною гіпертензією показник ADMA зменшився майже на 15%, що є маркером поліпшення ендотеліальної функції. Така сама динаміка спостерігалася і в групі жінок із вродженими вадами серця. В обох досліджуваних групах вагітних кількість ЕРС збільшилася майже на 10% після додавання L-аргініну (Тівортін) до комплексу лікування. Відмічалася позитивна кореляція між зменшенням середнього рівня систолічного артеріального тиску, збільшенням кількості ЕРС і зменшенням показника ADMA після комплексного лікування. Дослідження довели наявність прямої кореляції (r=0,75) між рівнем артеріального тиску та кількістю ЕРС та зворотну кореляцію (r=-0,68) між рівнем артеріального тиску та показником ADMA. Зниження рівня артеріального тиску під час лікування супроводжувалося поліпшенням функції ендотелію, а саме - збільшенням кількості ЕРС переважно за рахунок вазодилатуючого потенціалу ендотелію. Також спостерігалося зменшення показника ADMA на тлі зниження рівня систолічного артеріального тиску під час лікування. Висновки. Встановлено клінічну значущість показника ADMA як специфічного маркера в пацієнтів з артеріальною гіпертензією: спостерігається достовірне його підвищення в пацієнтів із серцево-судинною патологією, зокрема з артеріальною гіпертензією, що підтверджує роль ендотеліальної дисфункції як провідного патогенетичного фактора розвитку артеріальної гіпертензії за відсутності анатомічних і патологічних змін судин. Концепція терапії супроводу у хворих із серцево-судинною патологією має на меті відновити адекватну біодоступність NO шляхом призначення екзогенного L-аргініну. Виходячи з отриманих результатів дослідження впливу препарату L-аргініну (Тівортін) на кількість ЕРС, які беруть активну участь у репарацїї ушкодженого ендотелію, можна зробити висновок, що цей препарат позитивно впливає на прогноз життя у хворих з артеріальною гіпертензією, відновлюючи функцію ендотелію. Дослідження виконано відповідно до принципів Гельсінської декларації. Протокол дослідження ухвалено Локальним етичним комітетом зазначеної в роботі установи. На проведення досліджень отримано інформовану згоду пацієнтів. Автори заявляють про відсутність конфлікту інтересів.

Pro-inflammatory and anti-inflammatory cytokines can be used as markers of the severity of the arterial hypertension (AH) and the risk of its complications. The objective: to analyze the significance of interleukin-10 (IL-10) and interleukin-1β (IL-1β) as markers of myocardial remodeling in patients with arterial hypertension (AH) and overweight or obesity. Materials and methods. 103 patients with AH (60 women and 43 men) took part in the study. The average age of the participants was 53.21±8.5 years, the average duration of AH - 8.2±6.3 years. The patients were divided into two groups according to the level of IL-10. The first group included 80 (78%) patients with AH and body mass index (BMI) ≥25 kg/m² who had a normal level of IL-10 (up to 32 pg/ml), the second group included 23 (22%) individuals with increased anti-inflammatory cytokine. Also, the patients were divided into two groups according to cytokine levels. The first group included 74 (72%) patients with AH and overweight or obesity (the level of IL-1β was up to 11 pg/ml), the second group included 29 (28%) patients with an elevated level of IL-1β. All subjects underwent an anthropometric measurement, clinical and laboratory examination, and determination of the level of anti-inflammatory cytokine IL-10 and pro-inflammatory cytokine IL-1β by enzyme immunoassay method. Results. The results of pro-inflammatory and anti-inflammatory cytokine concentrations (IL-1β and IL-10, respectively) were different. It was found that the level of IL-10 does not depend on the age of patients and the duration of AH, but there is a direct relationship between the level of the anti-inflammatory cytokine and BMI (35.8±5.7 kg/m² vs. 32.4±5.7 kg/m²; p<0.05) with fasting glycemia level (r=0.3; p<0.05). It is also indicated that patients AH and increased BMI have on average a significantly longer QT interval (0.40±0.07 s vs. 0.36±0.04 s; p<0.05). It was determined that 13% of patients with elevated anti-inflammatory cytokine levels had QT prolongation. In 39% of cases, an increase in the mass index of the myocardium of the left ventricle was found (twice more among women). A direct correlation between the level of homocysteine and pro-inflammatory (r=0.31; p<0.05) and anti-inflammatory cytokines (r=0.47; p<0.05) was determined. At the same time, patients with elevated levels of IL-1β had a direct correlation with left ventricular myocardial mass index (r=0.42; p<0.05) and average daily mean arterial pressure (r=0.85; p<0.005). Conclusions. The anti-inflammatory cytokine IL-10 has greater prognostic significance than the pro-inflammatory cytokine IL-1β. An increased level of IL-10 in patients with AH and BMI ≥25 kg/m² may indicate an adaptive reaction of the organism's immune response. A high level of IL-10 in this cohort of patients is associated with worse control of blood pressure levels and can be considered as a predictor of the development of cardiac arrhythmias. [ABSTRACT FROM AUTHOR]

Violations of blood pressure control in patients who have had COVID-19 can be due to many pathophysiological factors. Further study of the features of blood pressure (BP) fluctuations in this category of patients will allow to diagnose arterial hypertension (AH) on time, to identify the uncontrolled course of AH and to select the optimal tactics of patients’ management. It was suggested to determine the characteristics of BP fluctuations in patients who have suffered from COVID-19 more than 12 weeks ago, based on the results of ambulatory (daily) blood pressure monitoring. 98 patients (51 men – 52.0%, 47 women – 47.9%) who have had COVID-19 infection more than 12 weeks ago were examined. Patients were divided into 2 groups – with and without a history of AH. The groups of examinees were homogeneous in age and gender. Ambulatory blood pressure monitoring (AM BP) was carried out on the CardioTens apparatus (Meditech, Hungary) according to the standard method. According to the data of AM BP in patients with AH in the anamnesis, who have suffered from COVID-19 more than 12 weeks ago, significantly higher average indicators of daily systolic blood pressure were recorded, and significant violations of the indicators of variability of systolic blood pressure during the day and night periods, pressure load during the day period, as well as a significantly higher degree and the rate of the morning rise in systolic blood pressure. In patients without a history of AH who have suffered from COVID-19 more than 12 weeks ago, in 21.4% cases there was newly diagnosed AH, in 33.3% of cases, increased variability of systolic blood pressure was observed, mainly during the day, in 21.4% of cases, the degree and speed of the morning rise of systolic blood pressure were increased, which indicated the presence of hypertensive reactions to household loads. In patients with a history of AH, in 55.3% of cases there was observed an increase in average blood pressure values per day, during the day and night periods, which was considered as ineffective blood pressure control and required an increase in the doses of previously prescribed antihypertensive drugs or the use of additional antihypertensive drugs in the treatment regimen. In patients with AH in the anamnesis, who have suffered from COVID-19 more than 12 weeks ago, reliable violations of many indicators of AM BP, deterioration of blood pressure control were recorded. In the patients, who did not have AH and who have suffered from COVID-19 more than 12 weeks ago, the presence of a hypertensive reaction to household loads and newly diagnosed AH were odserved. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 virus, which causes coronavirus disease 2019 (COVID-19), apart from respiratory manifestations, is able to directly affect the cardiovascular system. Therefore, different from general population target values of blood pressure might be beneficial for the patients with COVID-19. The aim of this study was to investigate whether conventional blood pressure control was associated with the severity of COVID-19. From 260 patients that were hospitalised to the unit subdivision of stable patients of COVID-center between March, 2020, and December, 2020, 163 patients with confirmed infection with SARS-CoV-2 virus and hypertension were selected. The patients were distributed by hypertension control: blood pressure <140/90 mmHg (n=94) and blood pressure ≥140/90 mmHg (n=69). Routine instrumental and laboratory investigations were registered and analysed. The patients were diagnosed and treated according to national and European guidelines. The information about the control of blood pressure was taken from the patients’ medical records. The group of patients with controlled hypertension had higher prevalence of females (p=0.03), 10 years higher median of age (p<0.01) and lower frequency of obesity (p=0.04). The patients with controlled hypertension had lower median of pulmonary injury (p=0.04) and lower frequency of SpO2<92% (p=0.02). Glomerular filtration rate <60 ml/min and proteinuria were detected significantly more frequently in the patients with controlled hypertension (p=0.02). In the presented study blood pressure below 140/90 mmHg before the admission to the hospital was associated with a lower degree of pulmonary injury but with the higher frequency of nephropathy signs. Urine test and blood creatinine monitoring might be beneficial for the patients with COVID-19 and hypertension. [ABSTRACT FROM AUTHOR]

Background. Arterial hypertension (AH) is the cause of 70–75 % of strokes. Atherosclerotic lesion of the carotid artery (CA) is a classic example of a vascular lesion in individuals with hypertension. The risk of stroke increases twice when hypertension and diabetes are combined. Carotid endarterectomy (CA), which has both a curative and preventive nature, is the main method of surgical treatment of CA stenoses. The purpose was to study the course of blood pressure in patients with type 2 diabetes and without it after CE. Materials and methods. 138 patients with arterial hypertension and CA stenosis were selected for the purpose of CE under local anesthesia. Patients were divided into two groups: 68 patients with type 2 diabetes (group I) and 70 patients without diabetes (group II). The median age of patients in group I was 64 [50–71] years, group II — 63.5 [47–68] years. Daily blood pressure monitoring (BPD) was performed 2 days before surgery (1 examination), 5–7 days after surgery (2 examinations) and 3–6 months after CE (3 examinations). The average indicators of systolic blood pressure (SBP) and diastolic blood pressure (DBP) per day, day, and night were evaluated; average pulse blood pressure (BP); variability of SBP and DBP per day, day, night. Results. Before the operation, group I, in contrast to group II, recorded significantly higher indicators: SATdb (p = 0.02), SATd (p = 0.03), SATn (p = 0.01), DBTn (p < 0, 05), PAT (p = 0.03), var)DATdb (p = 0.03), varSATd (p = 0.03), varDATn (p = 0.04). During the second examination in group II, significantly more significant dynamics of DMAT indicators were noted: SATdb (p = 0.002), SATd (p = 0.02), DAPdb (p = 0.002), DAPd (p = 0.01), DAPn (p = 0.03), varSATn (p < 0.04), varDATn (p < 0.05), varSATdb (p = 0.0002), varDATdb (p = 0.0001). The dynamics of PAT and midnight SAT were insignificant. 3 months after KE, all mean values of SBP and DBP, as well as PAT, decreased significantly in patients of group II. The expressiveness of changes in SBP indicators during the day, day and night, as well as indicators of SBP variability in group II was more significant. During the third examination, the proportion of patients with a "dipper" circadian rhythm increased in the two groups (p < 0.05). In group II, the proportion of patients with an unfavorable type of daily profile "over-dipper" significantly decreased (p < 0.001), which did not occur in group I. Conclusions. Surgical treatment of carotid stenoses in patients with and without type 2 diabetes is associated with a decrease in blood pressure in the early postoperative period and is observed for several months after the operation. [ABSTRACT FROM AUTHOR]

Визначення толерантності до фізичного навантаження (ТдФН) у дітей при різних захворюваннях - важливий діагностичний аспект сучасної медицини. Цей напрям дає змогу поліпшити прогностичні можливості лікарів, а також удосконалити підходи до реабілітаційних заходів у пацієнтів із різноманітною патологією. У педіатрії наявні обмежені дані щодо вивчення ТдФН у пацієнтів з артеріальною гіпертензією та зовсім відсутні в дітей з поєднанням артеріальної гіпертензії та ожиріння. Мета - оцінити рівень ТдФН та резервів організму в дітей шкільного віку з ожирінням та артеріальною гіпертензією. Матеріали та методи. У дослідженні взяли участь 112 пацієнтів віком від 9 до 17 років. Усіх пацієнтів поділено на чотири групи. До першої групи (контрольної) залучено дітей з нормальними артеріальним тиском і нормальною масою тіла; до другої - з артеріальною гіпертензією та нормальною масою тіла; до третьої - з нормальним артеріальним тиском та ожирінням; до четвертої - з поєднанням артеріальної гіпертензії та ожиріння. Результати та висновки. За наявності в пацієнтів артеріальної гіпертензії або ожиріння відмічається зниження VO2max, більш виражене при коморбідності цих патологій. У хлопчиків з ожирінням спостерігається тенденція до підвищення максимального систолічного артеріального тиску за результатами велоергометрії (158,2±8,4 мм рт. ст.) порівняно зі здоровими дітьми (149,4±10,5 мм рт. ст.). Середні показники максимального діастолічного артеріального тиску за даними велоергометрії в усіх досліджуваних групах достовірно не відрізнялися від середніх показників контрольної групи. Ожиріння супроводжується більш вираженим зниженням судинних резервів, ніж артеріальна гіпертензія, коморбідність цих захворювань у пацієнтів асоціюється з погіршенням цих резервів порівняно з пацієнтами, в яких наявне тільки одне захворювання. Отримані результати вказують на зниження кардіальних резервів за наявності в пацієнта коморбідності артеріальної гіпертензії та ожиріння. Водночас наявність у пацієнта тільки одного з названих захворювань не супроводжується достовірним зниженням показників порівняно з контрольною групою. У пацієнтів з артеріальною гіпертензією відмічається менш ефективне використання резервів міокарда та підвищена потреба міокарда в кисні під час виконання роботи порівняно зі здоровими дітьми. Дослідження виконано відповідно до принципів Гельсінської декларації. Протокол дослідження ухвалено Локальним етичним комітетом зазначеної в роботі установи. На проведення досліджень отримано інформовану згоду батьків дітей. Автори заявляють про відсутність конфлікту інтересів.

Невпинне зростання поширеності ожиріння, артеріальної гіпертензії (АГ) та їхньої коморбідності серед дітей та дорослих потребує додаткових наукових досліджень щодо виявлення особливостей поєднаного перебігу цих захворювань, можливих шляхів удосконалення лікувальних і профілактичних заходів у пацієнтів різних вікових груп. Мета - проаналізувати показники якості життя (ЯЖ) у дітей шкільного віку, хворих на АГ та ожиріння, для подальшого удосконалення лікувальних і реабілітаційних заходів. Матеріали та методи. Обстежено 95 школярів віком від 9 до 18 років. Обстежених поділено на 4 групи: група 1 - діти з нормальним артеріальним тиском (АТ) і нормальною масою тіла (МТ); група 2 - пацієнти з АГ і нормальною МТ; група 3 - із нормальним АТ та ожирінням; група 4 - діти з АГ та ожирінням. Усім дітям визначено ЯЖ за допомогою української версії опитувальника «Pediatric Quality of Life Inventory 4.0». Також визначено частоту виникнення окремих скарг та деякі особливості життя дітей у досліджуваних групах за допомогою розробленої нами анкети. Статистичну обробку отриманих результатів виконано за допомогою програм «MedStat v 5.2» (Лях Ю.Є., Гур’янов В.Г.) та «EZR v 1.35» (Saitama Medical Centre, Jichi Medical University, Saitama Japan, 2017). Результати та висновки. Показники ЯЖ в пацієнтів з ожирінням і АГ були достовірно нижчими (p

Підвищений артеріальний тиск (АТ) відмічається в 34,8% населення України. Антигіпертензивна терапія застосовується в 34,4% пацієнтів, у 14% - лікування ефективне. Резистентність до антигіпертензивної терапії може бути зумовлена рядом причин, однією з яких є дисбаланс електролітів. Мета - проаналізувати можливості застосування комплексу Панцикор у пацієнтів з артеріальною гіпертензією (АГ) 1-2-го ступеня та гіпокаліємією для досягнення цільового рівня АТ. Матеріали та методи. Обстежено 34 (57%) пацієнти з АГ 1-го ступеня та 26 (43%) хворих з АГ 2-го ступеня. Усіх обстежених поділено на групи: A (n=17) i C (n=13) - пацієнти з АГ 1-2-го ступеня, яким призначали стандартну антигіпертензивну терапію та Панцикор (1 саше 1 раз на добу протягом 12 тижнів); B (n=17) і D (n=13) - хворі з АГ 1-2-го ступеня, яким призначали стандартну антигіпертензивну терапію. Усім хворим виконано загальноклінічне обстеження, визначення в крові рівнів калію та натрію, показників вуглеводного та ліпідного стану. Велися щоденники застосування ліків і вимірювання АТ. Результати. Після лікування зареєстровано достовірне зниження АТ: у групі А - систолічного АТ від 156,1±12,2 мм рт. ст. до 131,3±9,1 мм рт. ст. і діастолічного АТ від 99,7±6,3 мм рт. ст. до 82,1±6,2 мм рт. ст.; у групі С - систолічного АТ від 166,3±14,5 мм рт. ст. до 139,4±11,2 мм рт. ст., діастолічного АТ від 104,1±7,9 мм рт. ст. до 86,1±6,3 мм рт. ст. У групах В і D достовірного зниження показників АТ не виявлено. У пацієнтів груп А і С виявлено позитивну динаміку зниження показників глюкози крові (у групі А - з 5,4±0,8 ммоль/л до 4,2±0,6 ммоль/л; у групі С - з 4,7±1,3 ммоль/л до 4,2±1,1 ммоль/л), глікозильованого гемоглобіну (у групі А - з 5,2±1,1% до 4,6±1,2%; у групі С - з 5,1±0,8% до 4,8±0,7%), загального холестерину (у групі А - з 5,6±1,3 ммоль/л до 4,2±1,1 ммоль/л; у групі С - з 5,8±2,7 ммоль/л до 4,3±1,1 ммоль/л), ліпопротеїдів низької щільності (у групі А - з 2,9±1,1 ммоль/л до 1,5±0,4 ммоль/л; у групі С - з 3,2±1,2 7 ммоль/л до 1,8±0,7 ммоль/л). Висновки. Панцикор слід призначати хворим з АГ та гіпокаліємією для ефективного досягнення цільових рівнів АТ і стабілізації показників ліпідного й вуглеводного обмінів. Дослідження виконано відповідно до принципів Гельсінської декларації. Протокол дослідження ухвалено Локальним етичним комітетом зазначеної в роботі установи. Автори заявляють про відсутність конфлікту інтересів.

Today, in Ukraine in war conditions there are the powerful and long-term stress factors in the population, according to the intensity of the constant negative psycho-emotional impact theses stress factors form a state of distress. Distress, as an additional significant pathogenetic reason, affects the change in the prevalence and course of cardiovascular diseases. The article describes the stages and individual changes caused by distress. Diagnostic algorithms for the assessment of patients with arterial hypertension and coronary heart disease in distress conditions for a differentiated change in therapy are provided, namely the strengthening of the basic recommended therapy or the inclusion in the treatment of additional therapy: phytotherapy or vasoactive biosupplements. Among the last mentioned substances, donors of nitric oxide (NO), whose main substrate for synthesis in the body is L-arginine, have undoubted advantages. According to modern studies and meta-analyses, the use of L-arginine improves the endothelial function of blood vessels, has antioxidant properties, thanks to which it has been proven that it decreases blood pressure, reduces the feeling of anxiety, improves physical performance, reduces the number of angina attacks, including microvascular one, has a positive effect on the lipid profile in general, with a probable decrease in the level of triglycerides. Our own data on the oral use of the L-arginine biosupplement with a decrease in the variability of blood pressure, the frequency of cardiac pain, and an improvement in general well-being are presented. The presence of population-wide distress reactions makes it possible for the patient to use the supplement independently to alleviate/eliminate maladaptive effects from the cardiovascular and central nervous systems. [ABSTRACT FROM AUTHOR]

Тhe article presents the theoretical justification for the choice of active pharmaceutical ingredients of antihypertensive action for the creation of new forms of delivery – transdermal therapeutic systems. The aim: monitoring of studies on the use of angiotensin-converting enzyme (ACE) inhibitors in the development of transdermal drugs for the treatment of hypertension. Materials: open access electronic resources of scientific periodicals from around the world: Google Scholar (https:// scholar.google.com/); PubMed (https://pubmed.ncbi.nlm.nih.gov/); Sciencedirect (https://www.sciencedirect.com/); Pubchem (https://pubchem.ncbi.nlm.nih.gov/); National Library of Ukraine named after V. I. Vernadskyi (http:// www.nbuv.gov.ua/); Ukrainian Institute of Intellectual Property (Ukrpatent) (https://sis.ukrpatent.org/uk/); Industrial Property (https://base.uipv.org/searchBul/); USPTO. The United States Patent and Trademark Office (https://www. uspto.gov/patents/search); European Patent Office (EPO) (https://www.epo.org/). Methods of the research: information search, theoretical analysis and systematization of data from scientific sources, logical analysis. Results: a review of scientific sources was carried out, and an analysis of ACE inhibitors as candidates for the creation of transdermal forms for the treatment of arterial hypertension was carried out. The pharmacological and physicochemical aspects of the possibility of their use for introduction through the skin are defined. It has been established that the search and development of the latest means of treatment of arterial hypertension, which would significantly increase the duration and quality of life of patients, are extremely relevant. Transdermal drug delivery systems are one of the pharmaceutical products being developed on the world market, and their use allows overcoming the associated disadvantages of other delivery routes. Conclusions: the review of domestic and foreign literature confirmed the relevance of biopharmaceutical research in the field of development of innovative dosage forms – transdermal therapeutic systems for the treatment of hypertension. The choice of promising antihypertensive active pharmaceutical ingredients of the ACE group (enalapril maleate, lisinopril dihydrate, and captopril) is substantiated, taking into account their specific physicochemical properties that are suitable for penetration through the skin. The market for transdermal drug delivery is increasing, and there is a prospect of higher growth rates in this market in the coming years. [ABSTRACT FROM AUTHOR]

The role of the stress factor and adjustment disorders among patients of a very high-risk group, namely with hypertension against the background of type 2 diabetes, was examined in the review of domestic and foreign sources of literature from the PubMed database. The authors provide data on the classification and terminology of adjustment disorders in this category of patients, and the contribution of the stress factor and activation of neurohumoral systems in their formation is considered in the historical aspect. The issue of the role of such adjustment disorders as anxiety, depression, sleep disorders, violent behavior in the family, at work is considered separately in terms of the negative course and progression of these dangerous diseases. Data are given on a number of non-modifiable and modifiable risk factors, namely genetic, haemodynamic, neurohumoral, hormonal and cardiometabolic characteristics of patients, prevalence, morbidity and mortality from complications of hypertension and type 2 diabetes in the presence of adjustment disorders; a brief description of diagnostic and preventive approaches to the correction of adjustment disorders among patients at a very high risk are described from a cardiologist’s standpoint [ABSTRACT FROM AUTHOR]

Background. According to epidemiological studies, the prevalence of subclinical hypothyroidism is about 6 % and it depends on age, gender, region of residence and, at the same time, significantly exceeds the frequency of primary hypothyroidism. Within one year, 5 % of cases of subclinical hypothyroidism turn into the manifested form. Delayed diagnosis of the disease increases the risk of serious complications. It is still controversial whether subclinical hypothyroidism affects blood pressure because of conflicting results in published studies. Thus, the aim of this study was to assess the effects of levothyroxine replacement therapy in patients with subclinical hypothyroidism and hypertension on lipid metabolism, functional state of the endothelium and cognition. Materials and methods. Thirty-one patients with subclinical hypothyroidism and stage 2 hypertension participated in the study, among them 12 (38.71 %) men and 19 (61.29 %) women. The average age of participants was 63.19 ± 1.93 years. The study examined lipid profile, functional state of the endothelium, and cognitive functions based on the results of the Montreal Cognitive Assessment before and after 3 months of additional administration of the levothyroxine replacement therapy at a dose 25–50 µg daily. Results. The lipid analysis revealed a significant decrease in total cholesterol for 10.08 % (5.54 ± 0.17 mmol/L against 6.23 ± 0.25 mmol/L, Р < 0.05), low-density lipoprotein cholesterol for 24.5 % (3.39 ± 0.17 mmol/L against 4.49 ± 0.27 mmol/L, Р < 0.01), triglycerides for 19.42 % (1.66 ± 0.11 mmol/L against 2.06 ± 0.16 mmol/L, Р < 0.05) compared to those at baseline. At the same time, patients with subclinical hypothyroidism and hypertension showed a reliable decrease in atherogenic dyslipidemias, 64.52 against 74.19 %. We also observed a reliable improvement of the functional state of the endothelium: the mean value of the endothelium-dependent vasodilation of the brachial artery increased for 11 % (6.56 ± 0.10 % against 5.91 ± 0.05 %, Р < 0.001). The results of the neuropsychological testing showed a reliable improvement of the cognitive functions among examined patients: the average score on the Montreal Cognitive Assessment raised from 23.77 ± 0.60 at baseline to 26.65 ± 0.47 after three months of taking levothyroxine, Р < 0.001. Conclusions. Levothyroxine replacement therapy in patients with subclinical hypothyroidism and hypertension was followed by a normalization of lipid profile and a decrease in atherogenic dyslipidemias, an improvement of the functional state of the endothelium and state of cognition. [ABSTRACT FROM AUTHOR]

Background. Hypertension is the major pandemic in human history, which determines the structure of cardiovascular morbidity and mortality. There is an obvious relationship between hypertension and various diseases that largely determine its development and increase the risk of cardiovascular complications. Neuropeptides appear to have a major impact on the progression of these complications. Catestatin (CST) is one of them, which deserves special scientific and practical concern, as it has a wide range of biological effects in the body. The aim of the study: to determine the place of CST in the early diagnosis of cardiovascular and metabolic complications in patients with comorbid hypertension among the Ukrainian population. Materials and methods. One hundred and eleven patients with hypertension, type 2 diabetes mellitus, obesity (men/women - 50/61) and 20 controls were examined. All patients with hypertension, type 2 diabetes mellitus, and obesity were aged 54.37 ± 1.18 years. Following a thorough examination and supervision, they were divided into 2 groups depending on the median CST level of 2.45 ng/ml. The first group included 55 (49.5 %) patients who had a CST level below 2.45 ng/ml, the second one consisted of 56 patients (50.5 %) who had a CST level above 2.45 ng/ml. In all patients, we measured body weight, height, calculated body mass index, evaluated glycated hemoglobin levels, lipid metabolism (serum concentrations of total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and very low-density lipoprotein cholesterol); systolic and diastolic blood pressure. The content of CST, cardiotrophin 1, leptin, cystatin C, neutrophil gelatinase-associated lipocalin, N-terminal prohormone of brain natriuretic peptide, 25(OH)D, β2-microglobulin, and insulin levels in the blood serum were determined by enzyme-linked immunosorbent assay. Results. A reliable difference between the groups was found by β2-microglobulin (p = 0.008). Univariate and multivariate linear regression analysis revealed a negative correlation between CST and cardiotrophin 1, N-terminal prohormone of brain natriuretic peptide, neutrophil gelatinase-associated lipocalin, and 25(OH)D. A positive correlation was found between CST and the level of glycated hemoglobin, body mass index, and triglycerides. A statistically significant correlation was found between CST and creatinine (R = -0.21, p = 0.029), high-density lipoprotein cholesterol (R = 0.207, p = 0.029), and β2-microglobulin (R = 0.279, p = 0.0029) in the patients with hypertension. Conclusions. It has been proven that a decrease in serum catestatin concentration can be a risk factor for the development of more severe comorbidities in patients with hypertension. The detected relationships of catestatin with creatinine, urea, and β2-microglobulin suggest that CST is a predictor of chronic kidney disease in patients with comorbidities. The revealed correlation of CST with high-density lipoprotein, obesity, and body mass index suggests its importance in the prevention of atherosclerotic and metabolic complications in patients with hypertension, type 2 diabetes mellitus, and obesity. [ABSTRACT FROM AUTHOR]

It's known that pathological changes in structural and functional condition of the heart, which are caused by arterial hypertension, trigger development of chronic heart failure and disablement of population. Nowadays, it proven that candidate genes, expression products of which participate in regulating vascular tone, have considerable influence upon development of arterial hypertension, however their role in pathogenesis of arterial hypertension has not been fully clarified, and results of the respective researches significantly vary among different populations. To determine the structural and functional state of the heart in patients with hypertension depending on the polymorphism of the A1116C gene of the angiotensin II receptor type I and the T786C promoter of the endothelial NOsynthase gene we examined 86 patients, aged from 45 to 76 years. 30 people without signs of hypertension were in the control group. The structural and functional state of the heart was assessed by cardiac ultrasound according to standard methods. Studies of the A1166C allelic polymorphism of the angiotensin II receptor gene type 1 and the T786C promoter of the eNOS gene were performed by polymerase chain reaction with electrophoretic detection of results. Analysis of cardiac ultrasound showed, that in the patients – carriers of C-allele of both studied genes (AС+СС and TC+CC) left ventricular ejection fraction tended to decrease. We found a bigger thickness of the posterior wall of the left ventricle in patients with CC genotype compared to carriers of AA genotype A1166C – (1.3±0.07) cm vs. (1.1±0.05) cm (p<0.005). The mass of the left ventricular myocardium index in the group of patients with the genotype AC and CC was (157.5±7.3) g/m² and (161.5±7.1)) g/m², respectively, being by 16.7% and 19.6% more than in carriers of AA genotype of the AGTR1 gene. In the groups of patients-carriers of C-allele (TC+CC) of the eNOS gene the mass of the left ventricular myocardium index values were (155.2±11.4)) g/m² and (158.4±7.9)) g/m², respectively, which is by 5.4% and 7.5% more than in carriers of TT genotype. The mean size of the left atrium was significantly higher in patients who had AC and CC genotype of the AGTR1 gene, as well as TC and CC genotype of the eNOS gene compared with the control group. Carriers of C-allele (AC+CC genotype) of AGTR1 gene polymorphism had clearly bigger sizes of the left atrium, as compared to homozygotes by A-allele. The severity of diastolic dysfunction was higher in carriers of the CC genotype of the AGTR1 gene and the eNOS gene than in heterozygotes of the studied genes by 4.3% and 3.3%, respectively. The research shows that inheritance of CC genotype for A1166C polymorphism of the the angiotensin II type 1 receptor gene and of CC T786C polymorphism in the promoter of eNOS gene is associated with more noticeable changes in structural and functional heart condition among patients with arterial hypertension. [ABSTRACT FROM AUTHOR]

Background. Connective tissue disease, in particular rheumatoid arthritis (RA), is characterized by a progressive joint damage and polymorphism of extra-articular lesions that affect the patient’s quality of life. Although the widespread implementation of basic therapy through the use of disease-modifying antirheumatic drugs has a positive effect on social consequences, the experience gained shows the impossibility of achieving a stable remission of the disease or reducing the activity of autoimmune inflammation against the background of using these medicines in all patients for a number of reasons. One of these reasons is the presence of comorbid pathology, which requires a personalized approach to each person. The objective was to study the quality of life of patients with RA in combination with type 2 diabetes mellitus (T2DM), hypertension and obesity depending on the T-786C polymorphism of the endothelial nitric oxide synthase gene promoter. Materials and methods. A laboratory and instrumental examination involved 110 patients who were treated at the clinical base of the Department of Internal Medicine of Bukovinian State Medical University, Chernivtsi Regional Endocrinology Center, Chernivtsi Regional Clinical Hospital, and Reference Center for Molecular Genetic Research of the Ministry of Health of Ukraine. Results. When assessing the quality of life in the studied groups, a decrease in indicators on all scales was detected. Thus, in RA combined with hypertension and obesity, PF was 1.73 times lower, RP — 1.97 times, BP — 1.44 times, SF — 1.46 times, MH — 1.26 times, RE — 1.66 times, GH — 1.35 times (p < 0.05) lower than in patients with isolated RA. Taking into account the T-786C polymorphism of the eNOS gene, it can be asserted that all indicators of quality of life were reduced in the carriers of the СС genotype, in contrast to the carriers of the T-allele: PF — by 2.06 (pTT < 0.05) and 2.46 times (pTС < 0.05); RP — by 2.0 (pTT < 0.05) and 2.87 times (pTС < 0.05); BP — by 1.86 (pTT < 0.05) and 2.52 times (pTС < 0.05); SF — by 1.55 and 2.07 times (pTС < 0.05); MH — by 1.42 (pTT < 0.05) and 1.53 times (pTС < 0.05); RE — by 1.30 (pTT < 0.05) and 1.54 times (pTС < 0.05); VT — by 3.34 (pTT < 0.05) and 3.72 times (pTС < 0.05); GH — by 2.32 (pTT < 0.05) and 2.38 times (pTС < 0.05), respectively. Conclusions. When comparing the quality of life in the studied groups, it can be stated that the lowest indicators on all scales were in patients with RA combined with hypertension, obesity and T2DM and in carriers of the СС genotype of the analyzed gene, which reflected the worst physical condition and psychosocial status. [ABSTRACT FROM AUTHOR]

Background. Today, there are difficulties with the prevention and diagnosis of early stages of hypertension, especially in active and able-bodied young people. Among the factors that potentiate an increase in blood pressure, one of the components is chronic stress, which a person often faces in modern society. The purpose of study is to evaluate and compare blood cortisol and plasma malondialdehyde content in healthy individuals and in patients with stage II hypertension before and after dosed exercises. Materials and methods. Thirty patients with stage II hypertension and 10 practically healthy persons were examined. Subjects performed two-stage physical exercises on a bicycle ergometer with an intensity corresponding to 50 and 75 % of the appropriate maximum oxygen consumption of the body. The duration of the load was equal to 5 minutes at each stage with a three-minute rest between them. Blood was taken from the ulnar vein before cycling ergometry and 5 minutes after it. Blood cortisol and plasma malondialdehyde content were determined in patients before and after exercises. Results. A significant increase in cortisol content after exercises was noted in healthy individuals against the background of some decrease in patients with hypertension. It has been suggested that since people with high blood pressure already have an elevated initial level of cortisol, their threshold of stress sensitivity to physical exertion is increased. Submaximal bicycle ergometric load does not lead to an increase in blood cortisol levels in hypertensive patients. Conclusions. The background higher level of cortisol in individuals with hypertension does not increase under the influence of submaximal dosed exercises. An increase in the level of malondialdehyde can be considered a marker of the degree of stress for assessing the power of physical exertion. In view of the above, it can be stated that the activation of the sympathoadrenal system under the influence of emotional stress leads to an increase in blood pressure. There is sufficient evidence that psycho-emotional stress is a cause of white-coat hypertension and hypertension in the workplace. [ABSTRACT FROM AUTHOR]

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Background. Hypertension, type 2 diabetes mellitus (T2DM), and obesity are among the most common diseases in the world, and their growth rates are of a pandemic nature. Since cardiovascular diseases still occupy a leading place in the structure of mortality, the study of biomarkers continues that can be key in the diagnosis of early signs of cardiovascular pathology. Such promising molecule is cardiotrophin-1 (CTF-1). CTF-1 is a protein with a molecular weight of 21.5 kDa, which belongs to the interleukin-6 (IL-6) family. The purpose of this study is to evaluate the circulating level of CTF-1 in comorbid patients with hypertension, and to conduct a comparative analysis of its serum concentration in the presence of various comorbidities. Materials and methods. One hundred and eleven patients with hypertension (men/women — 50/61) aged (54.37 ± 1.18) years and 20 persons of the control group were examined. In the process of examination, they were divided into 4 groups depending on the presence of comorbid pathology: hypertension — group 1 (n = 22); hypertension combined with obesity — group 2 (n = 30); hypertension and T2DM — group 3 (n = 31); hypertension, T2DM and obesity — group 4 (n = 28). In all patients, body weight and height were measured, body mass index (BMI) was calculated, glycated hemoglobin (HbA1c) levels, lipid metabolism indicators were determined, systolic and diastolic blood pressure levels were measured. CTF-1 content in blood serum was determined by enzyme-linked immunosorbent assay. Results. A direct correlation of CTF-1 level with weight, BMI, HbA1c level, systolic and diastolic blood pressure was found (p < 0.001). The data obtained prove that CTF-1 can be a trigger for the occurrence of cardiovascular complications, since its level progressively increases with increasing severity of comorbid pathology, and its highest serum concentration is found in patients with hypertension, concomitant T2DM and obesity. The detected changes demonstrate the role of CTF-1, the adipose tissue hormone, in the development of comorbid pathology and make it possible to assert that CTF-1 is a potential biomarker of cardiovascular complications. Conclusions. The level of CTF-1 was significantly higher in patients with hypertension, T2DM, obesity compared to those with hypertension, hypertension and obesity, as well as compared to this indicator in the control group. The concentration of CTF-1 in blood serum positively correlates with the levels of systolic and diastolic blood pressure, body weight, BMI, total cholesterol and HbA1c level. The study of the relationship between the serum level of CTF-1 and metabolic and hormonal indicators in comorbid patients is a promising direction for further research. [ABSTRACT FROM AUTHOR]

Вивчення ролі дефіциту деяких мікроелементів в організмі людини не втрачає своєї актуальності протягом десятиріч. Одним із таких мікроелементів є хром. У зв’язку з його здатністю знижувати оксидативний стрес та хронічне запалення в організмі людини значну увагу приділяють вивченню ролі хрому в лікуванні ожиріння та артеріальної гіпертензії. Ряд вчених у дослідженнях показали позитивний ефект від саплементації хрому при цих захворюваннях. Однак залишається велика кількість невивчених питань. Зокрема, більшість досліджень присвячена вивченню ізольованих захворювань, тоді як у багатьох пацієнтів зазвичай наявна коморбідність декількох захворювань. Також поза увагою науковців залишається вивчення ролі цього мікроелемента в дітей. Більшість вчених наголошують на необхідності подальших досліджень у цьому напрямку. Мета - узагальнити дані літератури та результати власних досліджень щодо біологічної ролі хрому і впливу змін його вмісту на перебіг ожиріння та артеріальної гіпертензії в дітей. Результати та висновки. Сьогодні роль хрому в лікуванні та профілактиці ожиріння та артеріальної гіпертензії продовжують вивчати. За даними літературних джерел, у разі зниження рівня хрому в плазмі крові пацієнтів статистично достовірно частіше реєструють ожиріння та артеріальну гіпертензію. За даними систематичних оглядів, саплементація хрому сприяє зниженню маси тіла, а також систолічного та діастолічного артеріального тиску в пацієнтів з ожирінням та артеріальною гіпертензією. У результаті проведеного дослідження виявлено, що рівень хрому у волоссі дітей шкільного віку за наявності артеріальної гіпертензії в поєднанні з ожирінням статистично достовірно (p

Метою нашого дослідження було визначити особливості мозкового кровообігу на фоні підвищеного артеріального тиску у дівчат-підлітків віком 15–16 років. Для досягнення поставленої мети ми дослідили стан мозкової гемодинаміки у дівчат-підлітків із підвищеним артеріальним тиском та зробили порівняльний аналіз цих показників. Застосували метод варіаційної стати-стики та методику реoенцефaлoгрaфії (РЕГ) ‒ метод діагностичного дослідження, що дозволяє проаналізувати найважливіші кри-терії стану судин головного мозку і руху крові по них, і базується на вимірюванні змін кровонаповнення судин головного мозку ве-ртебро-базилярного басейну. Під час дослідження мозкового кровообігу оцінювали наступні показники реоенцефалографії: період пульсового кровонаповнення, час максимального наповнення, час запізнення реохвилі, амплітуда швидкого наповнення, дикротич-ний індекс, реографічний індекс, середня швидкість наповнення. В результаті експерименту було встановлено, що досліджувані показники у дівчат із підвищеним артеріальним тиском (гіпе-ртензією) характеризуються статистично нижчими значеннями періоду пульсового кровонаповнення (Т), часу максимального на-повнення (ах), дикротичного індексу (А1) та достовірно вищою середньою швидкістю наповнення (Vcр) при р

A third part of the world's population has a steady increased blood pressure (BP). According to scientific data, there is a tendency to increase the incidence of arterial hypertension (AH) up to 60 %. It is important in AH treatment to perform an optimal control of BP level, for this purpose it is necessary to consider both the risk factors for the disease development and the risk factors for the development of pathology complications. The objective: to identify risk factors in patients with AH and body mass index (BMI) more than 25 kg/m2. Materials and methods. The study included 339 patients with AH. The I group involved 299 persons with BMI≥25 kg/m2, and 40 patients with AH and BMI <25 kg/m2 were included in the II group. The average age of the patients was 49.4±10.7 years, the average duration of the disease - 7.5 years. Anthropometric data, daily monitoring of BP, morphological and functional state of the heart, biochemical parameters of the blood (lipidogram, transaminase and bilirubin, urea and creatinine, glucose level) were determined in all patients. The levels of interleukin-1β, interleukin-10 and homocysteine were also detected. The speed of glomerular filtration was determined accord ing to the Cockroft-Hault formula, a psycho-emotional examination was done (a questionnaire for determining of anxiety and depression levels, the presence of alexitimia). Results. The analysis of the lipidogram indicators demonstrated a higher level of atherogenicity index in patients with excess body weight (respectively 3.4±1.3 versus 3.1±1.4; p<0.05). Among patients with AH and overweight or obesity compared to patients with normal body weight, significant differences have been revealed about the frequency of complications of targetorgans (AH stage II was 2 times more common among patients in the II group). Glycemia level on empty stomach was higher in patients with overweight (5.5±1.8 mmol/l versus 4.8±0.8 mmol/l; p 0.05) and 3 times more common among patients in the I group (35.6 % versus 11.5 % of patients; p<0.05). Hyperuricemia was found in 48 % of patients. In patients with normal BMI, the level of uric acid was within reference values (p=0.015). In 27 % of patients with overweight the increased IL-10 was determined, in 45 % - IL-1β, while in patients with normal BMI these indicators were normal (p<0.05). Patients with AH had increased levels of anxiety, and patients with excess weight had a risk of depression. Conclusions. The results of the study showed that there is a clear association of increased blood pressure (BP) with weight gain. Patients with AH and high body mass index (BMI) had additional risk factors that can cause high BP and require personalized treatment. Excessive body weight causes an acceleration of the development of target organs (1.5 times more often), in particular increases the risk of progression of systolic and diastolic dysfunction of the left ventricle and sudden cardiac arrest, leads the development of atherosclerosis and immune inflammation. The association of AH and high BMI with PPARG gene (33 % of cases) was determined. [ABSTRACT FROM AUTHOR]

Arterial hypertension (AH) without proper treatment can lead to heart attack, stroke, kidney or heart failure, vision impairment and other complications. The determination of effective preventive measures to prolong siutability for military service based on the health status of experienced military persons with existing comorbid pathology is an urgent issue today and a component of national security. The objective: to analyze the effective measures that influence on the prolongation of the suitability for military service of military personnel with AH - the participants in the anti-terrorist operation / operation of the United Forces (ATO/OUF), taking into account the existing comorbid pathology. Materials and methods. 213 servicemen - the participants of the ATO/OUF with AH and comorbid pathology were examined, who were divided into two statistically homogeneous groups according to the age. The first group included 126 patients with AH stage I, the second group - 87 persons who were diagnosed with AH stage II. CIRS cumulative disease scale was used to assess comorbidity. Results. It has been established that the most important prognostic factors (predictors) that influence on the prolongation of the professional longevity of servicemen with AH - the participants of ATO/OUF with comorbid pathology are timely diagnosis and secondary prevention of atherosclerotic cardiovascular diseases, reduction of total cholesterol and triglyceride levels, the prescribtion of hypolipidemic and antiplatelet drugs therapy, normalization of carbohydrate metabolism disorders, body weight and smoking cessation. Conclusion. The «Algorithm for determination of preventive measures for prolonging suitability for military service based on the health status of servicemen with AH - the participants in ATO/OUF with comorbid pathology was developed». [ABSTRACT FROM AUTHOR]

Background. SARS-CoV-2 infection in patients with chronic kidney disease (CKD) and hypertension degree 1–2 worsens the state of the cardiovascular system and may contribute to cardiovascular events and adverse renal risks. The presence of CKD in combination with hypertension degree 1–2 and its medical correction with renin-angiotensin-aldosterone system (RAAS) inhibitors causes a significant impact on the health of patients infected with SARS-CoV-2. SARS-CoV-2 uses RAAS, namely the receptor for angiotensin-converting enzyme (ACE) 2, as a tool to enter the cell. To choose further approaches and treatment, this combination of three pathological conditions requires careful analysis and research. Objective: to study the functional state of the kidneys in patients with CKD and hypertension infected with SARS-CoV-2. Materials and methods. The article is a fragment of the BIRCOV (ARB, ACE inhibitors, DRi in COVID-19) trial, which was designed according to the POEM (Patient-Oriented Evidence that Matters). The BIRCOV (two-center, open-label, initiative-randomized, in three parallel arms) prospective study enrolled 120 patients with CKD and hypertension degree 1–2, it lasted for 1 year and was registered at ClinicalTrials.gov (NCT03336203). One hundred and twelve outpatients with degree 1–2 hypertension, 83 with combination with CKD, were selected. At the end of the study, 108 patients remained, their results are presented in the article with subsequent statistical processing. Division into groups occurred depending on the drugs received (ACE inhibitors, angiotensin receptor blockers (ARBs) or direct renin inhibitor (DRIs)). Endpoints were: estimated glomerular filtration rate (eGFR), average blood pressure, albuminuria level. In 24 patients, the urine albumin to creatinine ratio was analyzed at the beginning of SARS-CoV-2, then 2, 4, 12, 24 weeks after the onset of the disease. Mathematical processing and statistical evaluation of the research results was done in the medical statistics package. Results. All patients were divided into 3 groups depending on the drug: 35 (32 %) of them received ARBs, 42 (39 %) ACE inhibitors, 31 (29 %) DRIs. At the manifestation of SARS-CoV-2, a decrease in blood pressure was recorded during the first two weeks, with the subsequent return to baseline on week 12 in the group of people who received ACE inhibitors, the lowest indicator was in the DRI group. The use of ACE inhibitors (risk ratio (RR) 1.648, 95% confidence interval (CI) 0.772–3.519, number needed to treat (NNT) 7.0) and ARBs (RR 13.023, 95% CI 1.815–93.426, NNT 19) in the treatment of hypertension significantly increased the risk of withdrawal compared to DRIs. Patients with CKD had similar dynamics of blood pressure during 24 weeks of observation. In CKD, higher mean blood pressure values were obtained compared to other participants of the BIRCOV trial. A simultaneous decrease in eGFR and systolic blood pressure was documented, it was most pronounced in patients with CKD. The lowest results were in people who took ACE inhibitors for 0–24 weeks: the correlation coefficient was 0.815. A decrease in eGFR correlated with the degree of CKD. There was a decrease in eGFR of less than 60 ml/min during the first 4 weeks from the onset of SARS-CoV-2 in 28 people who took ACE inhibitors versus 22 who used ARBs or DRIs: absolute risk was 0.667 (RR 2.00, 95% CI 1.337–2.92, NNT 3.0). The relative risk of eGFR reduction was 16.6 (95% CI 5.263–52.360, NNT 1.774) for people receiving ACE inhibitors versus all patients with CKD, 2.049 for ARBs (95% CI 0.361–11.22, NNT 1.774) and 1.064 for DRIs versus the entire sample of people with CKD (95% CI 0.116–9.797, NNT 431.6). After 12 weeks of follow-up, eGFR almost returned to baseline in CKD stage 2–3a. An increase in the urine albumin to creatinine ratio (which did not reach the baseline within 24 weeks from the onset of the disease) was recorded in CKD patients with stable renal function during the first 12 weeks from the onset of SARS-CoV-2 (the mean values of eGFR were not statistically different within 2–24 weeks). Males had a higher risk of CKD progression to end-stage renal disease. In people with SARS-CoV-2, on the second week from the onset of the disease, a decrease in eGFR was observed with a reciprocal increase in the level of blood uric acid, which differed significantly from the baseline values. The use of dexamethasone was accompanied by a decrease in eGFR (Р ≤ 0.05) and the preservation of these disorders in people with CKD stage 3b-4 up to 24 weeks of observation (RR 0.686, 95% CI 0.264–1.780, NNT 7.636). Conclusions. The course of SARSCoV-2 in people with hypertension degree 1–2 was characterized by the development of significant hypotension among those taking ACE inhibitors, and in patients with CKD and hypertension taking ACE inhibitors — by a decrease in GFR, hypotension, an increase in albuminuria and in the urine albumin to creatinine ratio, which was transient in most cases. Albuminuria increased less significantly in patients taking ARBs and was practically unchanged when using DRIs. Patients with CKD stage 4 and hypertension degree 2 had the greatest risks of an unfavorable prognosis. The authors hypothesized about the mechanism of SARS-CoV-2 effect when using ACE inhibitors that was similar to that of ARBs (ARB effect), i.e., in people who took ACE inhibitors, the effect of reducing blood pressure was comparable to that of the dual RAAS blockade with ACE inhibitors and ARBs. [ABSTRACT FROM AUTHOR]

The aim of the study is to establish the effectiveness of treatment of severe angina pectoris in patients with hyperuricemia, taking into consideration the peculiarities of the course of coronary artery disease (CAD) in wartime, using ranolazine - a selective inhibitor of the late sodium flow in combined pharmacotherapy. Materials and methods. We studied the anti-anginal effect of ranolazine in 14 patients with CAD, stable angina pectoris III-IV functional class (FC), hyperuricemia and arterial hypertension (AH) during 6 months of the 2022 year. The effectiveness of the study drug on the clinical course of angina pectoris was assessed by questionnaire and clinical examination after three months of treatment. The results. At the end of the second week of ranolazine use, angina attacks at rest, which were registered before the start of the observation, stopped in all patients with angina pectoris III FC and 50 % with angina pectoris IV FC. In 78.6 %, the number of angina attacks and the use of nitrates decreased by more than 2 times; 21.4 % no longer had angina attacks. At the end of the first month, anginal attacks were not observed in all patients with angina pectoris III FC and 50 % with angina pectoris FC IV. In 2 patients with angina pectoris IV FC (50 %), anginal attacks continued to be registered during physical exertion and emotional stress, but no more than once a week. At the same time, there were no angina attacks at rest. The same results were obtained during the survey of patients at the end of three months of observation. Conclusions. Ranolazine is an effective component of anti-anginal therapy, significantly affecting the patient's quality of life. Therefore, we can recommend ranolazine for patients with hyperuricemia in angina attacks that persist with insufficient effectiveness of zasic therapy with first-line drugs, especially during military conflicts. [ABSTRACT FROM AUTHOR]

Background. It was established that the prevalence of reduced bone mineral density is significantly higher among patients with arterial hypertension compared to healthy subjects. The purpose of the research was to study arterial stiffness and central aortic pressure in women with arterial hypertension combined with osteoporosis. Materials and methods. 88 postmenopausal women with arterial hypertension (average age 62.7 ± 3.8 years) were included in the study, of which 35 women with osteoporosis (OP) according to dual-energy X-ray absorptiometry (DXA) data (group 1) and 33 without it (group 2). The control group consisted of 20 practically healthy women without arterial hypertension and OP. Before the start of the study, the patients did not regularly receive antihypertensive drugs. In addition to conventional studies, daily blood pressure monitoring, applanation tonometry, and DXA were performed. Statistical processing was performed using the Statistica 10.0 software package using standard variational statistics algorithms. Results. It was found that in group 1, the levels of office systolic (SBP) and diastolic blood pressure (DBP) were by 3.7 and 4.9 % (p < 0.05) higher than in group 2. According to daily blood pressure monitoring, a more pronounced increase in average daily SBP and DBP by 4.1 and 6.6 % (p < 0.05) was observed in group 1 compared to group 2. It was found that in group 1, compared to the control group and group 2, an increase in pulse wave velocity was detected by 37.2 and 26.4 %, respectively. Conclusions. In women with postmenopausal osteoporosis in combination with arterial hypertension according to data of office measurement, daily monitoring blood pressure and data of applanation tonometry, blood pressure levels and parameters of arterial stiffness were significantly higher than in patients with arterial hypertension without osteoporosis. [ABSTRACT FROM AUTHOR]

There is an increase in the frequency and severity of metabolic disorders in patients with arterial hypertension (AH) in combination with subclinical hypothyroidism (SH), that is accompanied by accelerated aging rates, but the research findings on the aging rates in this category of patients are extremely few in number. Therefore, the aim of our study was to assess metabolic disorders and the aging rates depending on the SIRT1 rs7069102 polymorphism in patients with AH and SH. A total of 132 patients with a median age of 47.6 years were included in the study and divided into 3 groups: a control group (n=30), a group of patients with AH without SH (n=49) and patients with AH in combination with SH (n=53). Anthropometric parameters, biochemical parameters, pro-inflammatory and oxidative states were evaluated in all patients. The aging rates were assessed using two different methods. The frequencies of SIRT1 rs7069102 genotypes carriers in the study sample of patients were 8% for the CC genotype, 51% for the CG genotype and 41% for the GG genotype. There was a significant difference in the incidence of CC homozygosity and carriers of the G allele between groups of patients with AH depending on the SH presence (p<0.001). We showed that carriers of the G allele and GG genotype of the SIRT1 gene (rs7069102) polymorphic marker with AH and SH had significantly higher (p<0.05) insulin resistance, higher levels of low-density lipoprotein cholesterol, alkaline phosphatase, C-reactive protein and lower glomerular filtration rate, which negatively affected the aging processes in this category of patients. In addition, patients with AH had a marked effect of carrying the G allele on the lipid profile and biological age of patients. Therefore, timely detection of a polymorphic variant of the SIRT1 gene may be effective in premature aging prevention in patients with AH and SH. [ABSTRACT FROM AUTHOR]

Hyperproduction of hormones by adrenal tissues, or (less often) by their cells ectopic into other organs, naturally leads to the development of secondary hypertension, usually refractory to classical antihypertensive drugs. Adrenal glands produce mineralocorticoids (aldosterone), glucocorticoids (cortisol), androgens and catecholamines (adrenaline, noradrenaline). Excessive secretion of these hormones, mainly each in particular, due to a tumor/hyperplasia of the corresponding structures of the adrenal gland (or as a result of ectopy) leads to a number of diseases one of the leading syndromes of which is symptomatic hypertension, usually refractory to classical antihypertensive drugs. Endocrine disorders can sometimes manifest as hypertension. The pathogenesis of hypertension is determined by the effect of adrenal hormones on vascular tone and directly on the myocardium, mineral metabolism disorders, activation of the renin-angiotensin-aldosterone system, increased production of catecholamines, and the development of atherosclerotic changes in blood vessels. Aldosterone, for example, inhibits renin synthesis, accumulates sodium in the vascular wall and increases its sensitivity to vasoconstrictor stimuli, and hypokalemia leads to the dystrophic changes in nerve fibers and the development of muscle syndrome and nephropathy. Brief excerpts from published own observations are given: primary aldosteronism, ectopic ACTH-dependent Cushing’s syndrome, androsteroma, pheochromocytoma (of the bladder, and a case with stable hypertension). A long-term increase in blood pressure was verified by corresponding hormonal status, electrocardiography data (left ventricular hypertrophy with overload) and ophthalmoscopy (hypertensive retinopathy). The timely diagnosis and adequate treatment of these diseases remains one of the urgent tasks of clinical medicine. [ABSTRACT FROM AUTHOR]

The aim was to conduct a retrospective consumption analysis of 4 groups of single pill combinations for hypertension treatment and identify potential candidates for future inclusion in the reimbursement list in Ukraine, based on retrospective consumption patterns. Materials and methods. The objects of the study were retail sales data in pharmaceutical market in Ukraine of four groups of single pill combinations used for arterial hypertension treatment. Data was provided by the marker research system "Pharmstandard" of the company of "Morion". Analytic-comparative, systematic, logical, and mathematical-statistical methods were used. Results. Single pill combinations of ACE inhibitors with diuretics were the most consumed among other combinations on 2018-2020. Retrospective evaluation of consumption patterns in period of 2018-2020 showed that combinations of captopril and hydrochlorothiazide (HCTD) 50 mg/25 mg, enalapril and HCTD 10 mg/25 mg, lisinopril and HCTD 10 mg/12.5 mg were the most consumed. Among ARB and diuretics combinations valsartan and HTCD (160 mg/12.5 mg and 80 mg/12.5 mg) and losartan and HTCD (50 mg /12.5 mg) were the most consumed among ARB and diuretics combinations. Within ACE inhibitors and calcium channel blockers (CCB) combinations the most consumed were lisinopril/amlodipine 10 mg/5 mg and a perindopril arginine/amlodipine 5 mg/5 mg. Valsartan and amlodipine holds the majority among ARC and CCB combinations, consumed in period of 2018-2020. Conclusion. Apart from the single pill combinations, enlisted in the WHO Essential medicines list, eight more single pill combination were identified, based on retrospective consumption patterns, as potential candidates for further inclusion in the reimbursement list in Ukraine. [ABSTRACT FROM AUTHOR]

Background. Uncontrolled blood pressure (BP), especially in the context of stress, is associated with a fourfold increase in the risk of developing cardiovascular events compared to patients with hypertension who have reached the target BP level. Aim: to evaluate the mechanisms of the influence of stress on the development of hypertension, types of hypertension and resistance. Materials and methods. The study included 1,146 patients with resistant hypertension who were taking 3 or more antihypertensive drugs and were treated at the department of secondary and pulmonary hypertensions of the State Institution “National Scientific Center “M.D. Strazhesko Institute of Cardiology” of the National Academy of Medical Sciences of Ukraine”. The level of office blood pressure upon admission to the department when taking 3 or more antihypertensive drugs was: systolic — 174.60 ± 0.64 mmHg, diastolic — 100.50 ± 0.38 mmHg. Patients underwent the following examinations: measurement of office blood pressure, daily blood pressure monitoring, echocardiography, measurement of nocturnal sleep apnea, general blood analysis, biochemical blood analysis, determining the levels of thyroid-stimulating hormone, triiodothyronine, thyroxine, blood renin, blood aldosterone and their ratio, urine metanephrines, blood cortisol. Results. Among patients with resistant hypertension, there were more women than men — 62.7 versus 36.7 %, respectively. In a study of people with resistant hypertension who did not reach the target level of systolic BP, significantly higher indicators of BP were observed upon admission to the hospital. They had a significantly higher blood cortisol level (155.0 ± 44.0 vs. 35.9 ± 20.8 ng/l, p = 0.026), higher left ventricular mass index (147.50 ± 3.46 vs. 135.30 ± 1.74 g/m² ), obesity was more common among them (42.9 versus 37.5 %). Conclusions. Patients with resistant hypertension who did not reach the target level of blood pressure had higher level of cortisol and left ventricular mass index compared to those who achieved the target levels of blood pressure. [ABSTRACT FROM AUTHOR]

There were examined 142 patients with recurrent headache (cephalgia) and arterial hypertension, a mean – 49.26±1.33 years, of whom 69 men, 73 women who used intermittent fasting (patients spent 24 hours without food, 1 time per week, four repetitions). The control group consisted of 32 people of comparable age without hypertension (n=32; mean age 51.0±1.99 years). The purpose of the study was to increase the effectiveness of diagnostic and therapeutic methods in patients with hypertension and headache by establishing the meaning and peculiarities of the influence of intermittent fasting on headaches, neck carotid and intracranial circulation. There were 51 (35.9%±4.03) patients aged 25-44 years’; 45-59 years – 42 (29.58%±3.83) patients; 60-75 years – 49 (34.51%±3.99) patients. It was found that the structural pathology of the main arteries of the head consisted mainly in the thickening of the intima-media from 0,8 to 1,4 mm in 62.7% at the age of 25-44 years; in 71,4% at the age of 45-59; in 51% at the age of 60-75 years. Local thickenings in the bifurcation zone from 1.5 mm without hemodynamically significant stenosis were found in 9.8% at the age of 24-44 years, in 28.6% at the age of 45- 59 years and in 49% at the age of 60-75 years. Statistical differences in linear circulatory velocity between the control group and the group of patients were significant already at the age of 25-44 years, for peak systolic velocity in the internal carotid artery (78.03±4.67 vs. 61.0±2.54 in control, p<0.05). At the age of 45-59 years, linear circulatory velocity affected all carotid and vertebral arteries, as in the group aged 60-75. The effect of intermittent fasting on aged hemodynamics consists mainly in changes of velocity of flow in arteries with better results in younger patients. Changes in the elastic-tonic characteristics of the main arteries of the head according to the index of resistance (index was 0.72±0.01 for common carotid artery and 0.63±0.01 after intermittent fasting in patients at the age of 25-44 years; 0.78±0.01 before and 0.67±0.01 after at the age of 60-75 years were revealed). The use of the intermittent fasting method caused mainly an increase in diastolic flow rates in the main arteries (with age dependences) and a decrease in systolic velocity in the age group 25-44 years. The pathophysiological interpretation of such changes is in the reducing the resistance, values of the main arteries of the head. [ABSTRACT FROM AUTHOR]