Changing approaches to the management of patients with arterial hypertension, reflected in international recommendations regarding, including diagnosis, determination of a cardiovascular risk, ...required to return to the issue of the place of fundoscopy in routine clinical practice. Recent studies have clarified the prevalence of various retinopathy options using new, highly accurate instruments. A large number of works are devoted to the study of the prognostic role of fundoscopy, and here the opinions of researchers are unequivocal: the detection of signs of the initial stages of retinopathy has a very little effect on patient management. It should be agreed with the opinion of experts from the European Cardiology Society that fundoscopy is indicated mainly in patients with difficult to control or resistant hypertension, and is not recommended for people with mild to moderate hypertension, not suffering from diabetes, with the exception of young patients.
Background. Arterial hypertension plays a decisive role in the development of atrial fibrillation, being the most important risk factor. Purpose. Analyze the literature on modern concepts of the ...relationship between blood pressure variability and atrial fibrillation. Material and methods. We analyzed 53 literature sources. Results. Information about the modern mechanisms of atrial fibrillation formation in arterial hypertension has been obtained. Approaches to the choice of antihypertensive therapy in patients with arterial hypertension and atrial fibrillation have been described. Conclusions. Based on the studies presented in the literature, it was found that blood pressure variability has an additional contribution to cardiovascular risk. Reducing blood pressure variability can be added as one of the important strategies in the treatment of arterial hypertension and atrial fibrillation.
Introduction. Uncontrolled hypertension is observed in 65-92% of hypertensive patients. It plays an important role in the development of adverse cardiovascular events and survival, which depend on ...subclinical target organ damage. There are reports on the relationship between ineffective hypertension control and left ventricular (LV) hypertrophy or large arteries stiffness. However, the nature of the remodeling in uncontrolled hypertension remains poorly understood. Objective: to study the character and relationship of left ventricular and arterial remodeling depending on effectiveness of hypertension control. Design and method. We performed a study of 363 hypertensive patients (160 men and 203 women aged 50,8 ± 1,2 years) without comorbidities, which were divided into 3 groups according to the effectiveness of blood pressure (BP) control: 160 patients with controlled hypertension, 142 patients with uncontrolled hypertension and 61 patients with resistant hypertension. Uncontrolled BP based on measured systolic BP≥140 mmHg and diastolic BP≥90 mmHg. Remodeling indexes of left ventricular, elastic (common carotid) and muscular (brachial) artery were evaluated by the ultrasonic method. The severity and character of diastolic dysfunction, hypertrophy, types of remodeling and stiffness were assessed. Statistical processing of the results was performed using Student's t criterion and Pearson correlation analysis. Results and discussion. According to the results of the study, uncontrolled hypertension affected the development of subclinical cardiovascular lesions negatively. Thus, LV hypertrophy was detected more frequently in the third group (91,8% in resistant hypertension versus 46,8% in controlled hypertension, p<0,05). Differences in LV geometry with increasing of concentric remodeling types were also observed more frequently in the third group, where concentric remodeling and concentric hypertrophy types were founded in 14,8% and 59,0%, respectively. Subclinical arterial remodeling was founded in all groups, which was accompanied by an increasing mass of arterial segment and arterial stiffness, but most often in uncontrolled and resistant hypertension. There were unidirectional remodeling of both types of arteries and LV. LV hypertrophy had a direct relationship with the arterial mass by using correlation analysis. Violation of the geometry of both type of arteries was similar to the changes of LV geometry and was more particularly observed in the third group too (more than half of the patients with resistant hypertension had concentric types of remodeling). Thus, concentric hypertrophy of the common carotid artery was found in 42,2% of patients with concentric left ventricular hypertrophy, compared with 3,1% (p <0,05) in the group with normal left ventricular geometry. In contrast, normal left ventricular geometry was associated with normal type of geometry of the common carotid artery in 76.3% of patients, against 11,2% (p <0,05) in the group with concentric left ventricular hypertrophy. Similarly, a close correlation between diastolic dysfunction and arterial stiffness was found. Conclusion. Hence, remodeling of left ventricular, elastic and muscular arteries in uncontrolled and resistant hypertension is systemic and unidirectional. Established relationship between the severity and types of ventricular and arterial remodeling indicates a systemic effect of common pathogenic factors. Overall, these structural changes manifest increasing markers of adverse vascular events, most significantly in uncontrolled and resistant hypertension, which has the negative prognostic significance.
The article presents a review of the literature on the role of hypertension in the mechanisms of atrial fibrillation, therelationshipbetweenwhichincreases the risk of cardiovascular disease and ...mortality. The importance of taking into account the increased variability of BP in the development of target organ damage and adverse cardiovascular events is shown. Approaches to the choice of antihypertensive therapy in patients with hypertension and atrial fibrillation have been identified. It has been found that reducing BP variability can be added as one of the most important strategies in the treatment of hypertension and atrial fibrillation.
Current guidelines do not suggest considering blood pressure variability in the management of hypertensive patients. At the same time, a sufficient evidence base has been accumulated on the ...relationship of blood pressure variability with damage to target organs, the development of stroke, myocardial infarction, cardiovascular mortality, and kidney disease. In general, assessing the effect of blood pressure variability on the course of arterial hypertension, it can be assumed that it is not as significant as the absolute values of blood pressure, but this effect has been proven, regardless of the degree of hypertension. And if a practitioner finds an increased variability in blood pressure in his patient, he should know what recommendations should be given to him. Not all traditional lifestyle modification factors that are suggested for hypertensive patients affect blood pressure variability in the same way as blood pressure readings. Thus, we were unable to find evidence of the influence of increased consumption of table salt, physical activity, «chronic psychological stress» on the variability of blood pressure in the general population. At the same time, dietary habits, alcohol abuse, smoking status affect the level of blood pressure, blood pressure variability in both healthy individuals and patients with arterial hypertension. The same effect is exerted by the relative intake of minerals with food, toxic agents (lead). If in individuals of the general population an increase in body weight leads to an increase in blood pressure, then in patients with arterial hypertension such an effect is nonlinear, depending on the type of obesity. It should be emphasized once again that the presence of psychoemotional disorders symptoms of anxiety, depression – in patients with arterial hypertension contributes both to an increase in the level of blood pressure, but also to its variability.
The article presents a review of the literature on the role of myocardial fibrosis in the development of myocardial remodeling in patients with arterial hypertension. Information about the state of ...the structure and function of the extracellular matrix in health and disease is generalized. The characteristics of myocardial fibrosis biomarkers detection in the circulating blood are reflected.
Purpose of the study. assessment of relationship between the thickness of the intima-media complex, indicators of carotid artery rigidity state and cognitive dysfunction as a marker of brain damage ...and the study of their prognostic significance in the development of cognitive impairment in arterial hypertension patients. Material and methods. The subject of the examination was a group of 69 patients with stage II arterial hypertension, grade 2–3, not receiving any antihypertensive therapy or being treated irregularly, aged 51,38 ± 0,94 years. The control group consisted of 12 practically healthy, normotensive individuals aged 54,25 ± 2,74 years, without cognitive impairment. The Montreal Scale (MoCA test) was used to assess cognitive functions. The state of the carotid artery was studied with the help of sonography with recording the thickness of the intima-media complex; Peterson and Young modules, linear tensile properties, radial tension of the vessel wall, parameter β, local pulse wave velocity were calculated. Results. There was a significant increase in the thickness of the intima-media complex in patients without cognitive impairment (0,83 ± 0,02; p < 0,05) and with cognitive impairment (0,89 ± 0,03; p < 0,05) relative to healthy individuals (0,68 ± 0,03) in the absence of significant differences between groups of patients (p > 0,05). Of the remaining indicators of vascular rigidity, only β parameter differed from the control group in patients without cognitive impairment, while in patients with cognitive impairment all studied parameters differed from the control group (p < 0,05). A correlation was established between cognitive impairment and the thickness of the carotid intima-media complex (only with increased values of the carotid intima-media complex thickness – r = 0,62; p < 0,05), with the stiffness index (r = –0,392; p < 0,05), local SPV SA (r = –0,326, p < 0,05). Analysis of the area under the ROC curve 0,60 ± 0,07 (95% CI: 0,47–0,74; p = 0,124) for the indicator of the intima-media complex to determine the likelihood of the development of cognitive impairment in patients with hypertension indicates the unsatisfactory quality of the model. Conclusions. Value of carotid intima-media complex thickness and other indicators of vascular rigidity to determine the likelihood of developing cognitive impairment in patients with poor-quality hypertension (AUC below 0,60) cannot serve as a marker for predicting cognitive dysfunction in patients with hypertensive disease.
Acute and chronic steroid-refractory graft-versus-host disease (srGVHD) is a life-threatening complication of allogeneic stem cell transplantation. There are a number of reports on case series ...describing efficacy of ruxolitinib in both acute and chronic srGVHD. We conducted a prospective study (NCT02997280) in 75 patients with srGVHD (32 acute, 43 chronic, 41 adults, and 34 children). Patients with chronic GVHD had severe disease in 83% of cases, and acute GVHD patients had grade III-IV disease in 66% of cases. The overall response rate (ORR) was 75% (95% CI 57-89%) in acute GVHD and 81% (95% CI 67-92%) in chronic. Overall survival was 59% (95% CI 49-74%) in acute group and 85% (95% CI 70-93%). The major risk factors for lower survival were grade III-IV gastrointestinal involvement (29% vs 93%, p = 0.0001) in acute form and high disease risk score in chronic (65% vs 90%, p = 0.038). Toxicity was predominantly hematologic with 79% and 44% of grade III-IV neutropenia in acute and chronic groups, respectively. There was no difference between adults and children in terms of ORR (p = 0.31, p = 0.35), survival (p = 0.44, p = 0.12) and toxicity (p > 0.93). The study demonstrated that ruxolitinib is an effective option in acute and chronic srGVHD and can be used both in adults and children.
5-Amino-3-(cyanomethyl)-1
H
-pyrazole-4-carbonitrile enters into condensation reactions with β-diketones and dibenzalacetone to form 2-(cyanomethyl)pyrazolo1,5-
a
pyrimidine-3-carbonitrile ...derivatives. The reaction with cyanoguanidine in an acid medium leads to the formation of 2,4-diamino-7-(cyanomethyl)pyrazolo1,5-
a
1,3,5triazine-8-carbonitrile. Structure of the obtained compounds was confirmed by spectral data, as well as the results of a quantum chemical study of possible reaction routes for the reaction of 5-amino-3-(cyanomethyl)-1
H
-pyrazole-4-carbonitrile with benzoyltrifluoroacetone. Bioavailability parameters were predicted for the obtained products
in silico
, and possible protein targets were predicted by protein-ligand docking.
A simple approach was proposed to the synthesis 5-benzoyl-2-imino-4-thiazolines by the reaction of α-thiocynatoacetophenone with various aryl amines and triethyl orthoformate. Structure of the ...prepared compounds was confirmed by IR spectrophotometry and NMR spectroscopy, including two-dimensional HMBC and HSQC experiments.
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