Aim. To assess the incidence of cardiovascular and cerebrovascular events in patients with controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension. Materials and methods. A telephone call was made to 256 patients with hypertension included in the database to assess the incidence of cardiovascular and cerebrovascular diseases. All responding patients were divided into 7 groups according to the classification of hypertension based on the achievement/non-achievement of target blood pressure values and the number of drugs taken (controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension). The target blood pressure was considered to be less than 140/90 mm Hg. Patients not adhering to medication were not included in the analysis. Results. The group of controlled hypertension included 146 (57%) patients out of 256, controlled resistant hypertension 36 (14%) patients, uncontrolled hypertension 6 (2.3%) patients, resistant uncontrolled hypertension 22 (8.6%) patients, refractory hypertension 31 (12.1%) patients. The group of probably resistant hypertension 6 (2.3%) patients, probably refractory hypertension 9 (3.5%) patients. Of the 28 events that occurred, 6 were attributed to coronary artery disease (including 3 acute myocardial infarction and 2 coronary artery stenting), 3 strokes, 6 episodes of transient ischemic attack and 10 new cases of atrial fibrillation, and 2 patients had sudden cardiac death. Significantly more often, patients with refractory hypertension developed any event compared with patients with controlled (38.7% versus 3.4%; p=0.005) and resistant hypertension (38.7% versus 13.6%; p=0.04). Also, patients from the group of probably refractory hypertension were more likely to develop events than patients with controlled hypertension (33.3% versus 3.4%; p=0.045). Patients with probably refractory hypertension significantly more often had a stroke than patients with controlled hypertension (22.2% versus 0%; p0.05), and patients with refractory hypertension significantly more often had a transient ischemic attack compared with patients from the group of controlled hypertension (12.9% versus 0.7%; p=0.03). Conclusion. Patients with refractory and probably refractory hypertension are significantly more likely to develop cardiovascular and cerebrovascular complications than patients with controlled hypertension.
The COVID-19 (COronaVIrus Disease 2019) caused more than 3.5 million deaths all over the world. Patients who have underlying comorbidity, such as cardiovascular and pulmonary diseases have shown worse prognosis. In view of this, undivided attention was focused on patients with such rare conditions as pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). There is currently limited data available regarding COVID-19 infection in CTEPH patients. The available data are mostly case studies or small case series. The aim of this publication was to describe the course of COVID-19 in patients with previously diagnosed CTEPH. Methods. The study included 92 patients with an established diagnosis of CTEPH, who were managed in the Federal State Budgetary Institution National medical research center of cardiology named after academician E.I. Chazov, Ministry of Health of the Russian Federation. 62 patients with CTEPH and confirmed COVID-19 were enrolled, including 62% women. The mean age was 55.8 ± 14.8 years. Results. The duration of COVID-19 was 14 [10; 30] days. The fever, general weakness, anosmia, and dyspnea were the most frequent presentations at diagnosis of COVID-19 in CTEPH patients. According to the multispiral computed tomography (CT) chest scans, more than half of the patients (54.2%) had mild disease (category CT-1). Most of the patients were under specific therapy (92%), mainly riociguat at an average daily dose of 5.75 ± 2.2 mg/day. All patients received anticoagulants. No need for long-term respiratory support and no lethal outcomes were registered in the study group. Conclusion. Small pilot studies demonstrated favorable clinical course of COVID-19 in CTEPH patients. This finding could be explained by the protective effect of anticoagulation and specific treatment.
This clinical case illustrates the diagnosis of a rare congenital pathology – an adult patient with pulmonary arterial hypertension and Abernethy malformation type Ib.Clinical observation: Patient S., 45 years old, with pulmonary arterial hypertension, was admitted with complaints of shortness of breath during intense physical exertion. Based on the anamnesis morbi, the diagnosis of idiopathic pulmonary arterial hypertension has been verified since 2017. Results of comprehensive examination: functional status (six-minute walk test), NTpro-BNP level, chest x-ray, echocardiography, right heart catheterization were assessed during the hospitalization. According to these there were signs of the high pulmonary arterial hypertension with systolic pressure in the lung arteries 68-70 mm Hg, extension of the trunk, right and left branches of the pulmonary artery. In order to exclude objective evidence of cardiac dysfunction, portal hypertension, an abdominal ultrasound was performed. We didn’t obtaine the information about an increase in central venous pressure, the presence of signs of portal hypertension, such as ascites, increased pressure in the portal system. However, echo signs of congenital pathology were determined - Abernethy malformation type Ib: porto-caval shunt between the superior mesenteric vein and the inferior vena cava. According to multispiral computed tomography of abdominal organs with contrast: the superior mesenteric vein and splenic vein join to form a short extra-hepatic portal vein which drains into a systemic vein (inferior vena cava). Taking into account the results of risk stratification, the patient underwent an escalation of pathogenetic therapy for the treatment of pulmonary arterial hypertension, and dynamic monitoring was recommended.Conclusion: The presented clinical case is unique in terms of diagnosing a rare congenital pathology of the hepatic blood flow – Abernethy malformation type Ib in an adult patient with pulmonary arterial hypertension.
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