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Background. The aim of the study: to investigate additional factors that affect the adherence to antihypertensive therapy in patients with hypertension in conditions of war in Ukraine. Materials and methods. The study included 1,299 hypertensive patients with an average age of 65.4 ± 14.8 years, who are residents of different regions of Ukraine. The observation period lasted 3 months, from October 1 to December 12, 2023. All patients were divided into four groups: I — a fixed three-component combination of olmesartan medoxomil/amlodipine/hydrochlorothiazide, II — a fixed two-component combination of olmesartan/hydrochlorothiazide, III — a fixed two-component therapy with olmesartan/amlodipine, IV — any other non-fixed two- or three-component antihypertensive therapy. Adherence to therapy was assessed after 1, 2, and 3 months and statistical analysis of the obtained data was performed. Results. During the first month of observation, 50 (3.8 %) patients stopped or did not even start taking antihypertensive therapy, during the second — 71 (5.5 %), during the third — 127 (9.8 %). Adherence to antihypertensive therapy is higher in younger people (up to 55 years) compared to patients aged over 65, in people with higher education, in patients taking fixed combinations, especially olmesartan/amlodipine, or olmesartan/amlodi-pine/hydrochlorothiazide, while gender had no effect on adherence. Additional factors related to adherence to antihypertensive therapy during the war were as follows: the level of danger in the region of residence, the internally displaced status of the patient or doctor. The lowest adherence to antihypertensive therapy after 3 months was registered in the internally displaced persons who suffered morally or physically and is only 34.5 % compared to patients who stayed in the place of permanent residence — 82.6 % (р = 0.0001), or to those who moved preventively — 74.3 % (р = 0.0001). Adherence to therapy also depends on the status of the doctor. Among doctors with the status of an internally displaced person, patients’ adherence to therapy is lower: 68.3 against 82 % (р = 0.0008). Conclusions. Adherence to antihypertensive therapy in Ukraine during the war depends on known factors influencing the completeness of the doctor’s recommendations, including age, educational level, concomitant diseases, the number of tablets, and specific factors caused by the war, such as activity of hostilities in the region, as well as the status of an internally displaced person, both in patients and doctors.

Background. Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality. High-risk PE patients have more severe course of disease and poor prognosis. The question of additional factors which may be associated with prognosis in such patients remains poorly understood. The aim is to identify factors associated with mortality in high-risk PE patients and to determine contribution of these factors to the risk stratification of death. Materials and methods. A retrospective analysis of 635 medical cards of patients with PE diagnosis hospitalized in Kharkiv City Clinical Hospital 8 from January 1, 2017 to January 1, 2023 was conducted. The diagnosis was verified by multispiral computed tomography pulmonary angiography (CTPA) and/or by autopsy. Patients were divided into groups: group І — high-risk (113 — 17.8 %); group II — low-risk (522 — 82.2 %). Group I was divided into subgroups: IA — 63 (55.8 %) individuals, who were discharged from the hospital with improved status, IB — 50 (44.2 %) people, who died in hospital. Clinical, anamnestic, laboratory and instrumental parameters were measured. Statistical analysis was performed. Results. Patients from group I were older, there were more women among them. In subgroup ІВ, there are more women, more cases of obesity and deep vein thrombosis. Patients from group IB had lower blood oxygen saturation (SpO2) and systolic blood pressure (SBP), lower left ventricular ejection fraction (LVEF) measured by echocardiography. Bilateral segmental pulmonary embolism according to CTPA was more common in IB group. According to uni- and multivariate analysis, independent factors affecting in-hospital mortality in patients with high-risk PE were determined, among them: female gender, presence of bifurcation thrombus, lower SBP, SpO2, LVEF. Using the additional regression analysis, the formula for individual prediction of the risk of in-hospital mortality in high-risk PE patients was created. According to the receiver operating characteristic analysis, the sensitivity of the formula is 64.0 %, specificity is 92.1 %. The SBAFS (S — SpO2, B — Bifurcation thrombus, A — Arterial hypotension, F — left ventricular ejection Fraction, S — female Sex) score was formed, where the score of 2 or more indicates additional high risk of in-hospital mortality in high-risk PE patients. Conclusion. The high-risk PE patients who died during hospitalization had more cases of obesity, hypertension, lower SpO2, SBP, and LVEF, and there were more women among them. According to the multivariate logistic regression analysis, additional independent factors associated with in-hospital mortality in high-risk PE patients are female sex, thrombus in bifurcation of the pulmonary trunk, SpO2, SBP, LVEF. The formula for risk stratification of in-hospital death in high-risk PE patients was created and validated. The SBAFS score was formed to indicate additional high risk of in-hospital mortality in high-risk PE patients.

The aim – to investigate the relation between levels of inflammatory factors and clinical course of the ischemic heart disease with and without coronary atherosclerosis. Materials and methods. We examined 105 patients with stable ischemic heart disease (IHD), age 36 to 84 years (mean age 58.5 ± 9.47 years). There were 48.6 % (n = 51) men and 51.4 % (n = 54) women. Based on angiography data, patients were divided into two groups: group I – 53 patients with IHD and non-obstructive coronary arteries (INOCA), group II – 52 patients diagnosed with stable IHD with more than 50 % stenosis. In addition to general clinical methods of examination, the levels of interleukin-6 (IL-6) and highly sensitive C-reactive protein (hsCRP) were determined in all patients. The control group consisted of 20 healthy individuals compared by age and sex. Results. According to the results, it was found that in patients with IHD the level of IL-6 was significantly higher compared to the control, in group I: 4.40 [2.12–9.56] pg/ml and 2.46 [2.29–3.47] pg/ml, respectively (p = 0.027), and in group II – 4.15 [2.80–6.68] pg/ml, which also differed from the control group (p = 0.006). There was no significant difference in the level of IL-6 between groups of patients with IHD depending on the lesion of the coronary arteries (p = 0.99). Among patients with IHD, the level of IL-6 was increased in 40.7 % (n = 22) of patients with INOCA and 34.6 % (n = 18) in patients with stenotic atherosclerosis (group II) (p = 0.22). However, the proportion of women with elevated levels of IL-6 was higher in the INOCA (66.7 %) compared to women with stenotic atherosclerosis (26.7 %) (p = 0.033). Positive correlations were found between the level of IL-6 and the incidence of ventricular arrhythmias in patients of group I (r = 0.44, p = 0.025), as well as between IL-6 and positive cycling stress-test (r = 0.39, p = 0.01), IL-6 and hsCRP (r = 0.43, p = 0.004). According to the results of multivariate regression logistic analysis, an association was established in patients with INOCA between elevated levels of IL-6 and age, hsCRP, history of myocardial infarction and the number of affected vessels (p = 0.04, p = 0.01, p = 0.04, p = 0.037 respectively). Conclusions. Significant differences in the level of IL-6 were found in patients with IHD compared to the control group. It was found that in patients with elevated levels of IL-6, there was higher proportion of women in the INOCA group, compared to the patients with stenotic atherosclerosis. An association was established in patients with INOCA between elevated levels of IL-6 and age, history of myocardial infarction and the number of affected vessels

The aim – to evaluate the peculiarities of echocardiographic parameters in patients with peripheral artery atherosclerosis of the lower extremities (PAALE), depending on the type of T(–786)C polymorphism of the promoter eNOs gene. Materials and methods. 100 male patients with PAALE were examined, average age 60.7 ± 0.9 years old. The average age of the disease manifestation is 53.76 ± 0.67 years. Patients were divided into two clinical groups: group I – 63 (63 %) men without coronary heart disease, group II – 37 (37 %) patients with CHD. Doppler ultrasound examination of the lower extremities and carotid arteries (CA), transthoracic echocardiography (EchoCG), ECG Holter monitoring and genetic analysis using polymerase chain reaction were performed. Results. 54 patients had signs of left ventricular myocardial hypertrophy (LVMH), while in the 2nd group the patients with C allele (p = 0.02) were dominant. Signs of remodeling of left ventricular myocardium (LVM) with an increase of thickness wall ratio (PTS) had 62 patients: in group I 41 (41 %) people (genotype T/T 41.5 %, C/T – 19.5 %, C/C – 39 %), in the second group – 21 (21 %) (genotypes 9.5 %, 42.9 % and 47.6 % respectively); among patients in the second group C allele was more likely to be present (p = 0.048). Systolic and diastolic dysfunction of the left ventricle myocardium were significantly more common in patients with coronary heart disease (p = 0.046; χ² = 3.95 and p = 0.02; χ² = 5.41 respectively). Correlation analysis revealed a direct connection between left ventricular (LV) systolic dysfunction and the early age of the PAALE manifestation (p = 0.00001), with presence of CHD (p = 0.005). Diastolic dysfunction in patients with the second group was associated with a history of cardiovascular disease (CVD) (p = 0.003) and arterial hypertension (AG) (p = 0.03). The presence of diabetes mellitus type 2 is associated with increased size of the left atrium (LA) (p = 0.049) and the right atrium (RA) (p = 0.02) and left ventricle end-diastolic diameter (p = 0.01), systolic dysfunction (p = 0.03), and with hereditary coronary heart disease (p = 0.02). Genetic analysis has shown that among patients with diabetes mellitus of type 2 carriers of C allele are predominated (p = 0.01). Conclusions. Among the patients with PAALE combined with CHD, the presence of the C allele the T(–786)C polymorphism of the eNOs promoter gene is associated with systolic and diastolic LV dysfunction and signs of LV remodeling. Diastolic dysfunction is associated hypertension hereditary coronary heart disease. Independent of CHD, diabetes mellitus type 2 is associated with changes of several EchoCG parameters, hereditary coronary heart disease and C allele genotype.

The aim – to determine the prevalence of Т(–786)С polymorphic gene variants of endothelial NO-synthase (eNOs) in patients with verified atherosclerosis of lower extremities arteries and their association with clinical manifestations of the disease. Materials and methods. The study involved 100 patients with verified peripheral artery disease (PAD) of the lower extremities. The control group included 35 people without changes of coronary arteries and with negative result of exercise stress test. The examination, apart from clinical tests, included determination of ankle-brachial index, selective coronary angiography, Doppler ultrasound of the lower extremities and carotid arteries as well as the estimation of their intima – media thickness. The study of allelic polymorphism of eNOs gene promoter was performed by polymerase chain reaction. Results. According to the results of genotyping of Т(–786)С gene polymorphism of eNOs the share of T/T genotypes in the control group (45.7 %) and in patients with PAD (33 %) was not different (р = 0.18), and C/T more frequently found in the control group (48.6 % vs 26 %; p = 0.01), whereas the prevalence of the C/C genotype in patients with PAD was significantly higher than in healthy individuals (41 % vs 5.7 %; p = 0.0001). The patients were divided into three groups: I group – 33 people with T/T genotype, II group – 26 people with C/T genotype and IІI group – 41 people with C/C genotype. The average age of the manifestation of PAD in patients with genotype C/C was significantly lower (50.15 ± 0.63 years) than in the group with the T/T genotype (58.45 ± 1.17 years; p = 0.001) and С/T (53.53 ± 1.28 years; p = 0.01). It was found that in the ІІІ group patients have more severe clinical manifestations of arterial insufficiency of lower limbs (according to Fontaine classification). The patients with C/C genotype had more severe course of the coronary artery disease (CAD): myocardial infarction in ІІІ group was 31.7 % (13) (vs 3.0 % (1) in І group, р = 0.005 and 7.7 % (2) in ІІ group, р = 0.045); the stable angina of ІІІ functional class was detected significantly more often in ІІІ group (29.3 % (12) vs 3 % (1), p = 0.008). Conclusions. The development of the PAD may be partly related of Т(–786)С polymorphism of the eNOs gene promoter, as evidenced by 2.74 times (p = 0.001) greater incidence of minor C allele genotype in these patients than in healthy individuals. The results of the study indicate that patients with C allele polymorphism Т(–786)С eNOs gene promoter have manifestation of the disease in younger age, clinical manifestations of lower limb ischemia is a severe, concomitant CAD is diagnosed significantly more often.