Background. The angiotensin-(1-7) is a new component of the renin-angiotensin system, the product of the degradation of angiotensin II and its functional antagonist, but its role in hypertension with type 2 diabetes (T2D) is not clear. The aim of the study was to investigate the levels of angiotensin-(1-7) in patients with hypertension and T2D and determine its relations to hemodynamic and cardiac structural and functional parameters. Material and methods. We examined 70 patients with hypertension and T2D. Investigation protocol included physical examination, standard transthoracic echocardiography and determination of the angiotensin-(1-7) blood levels by ELISA. Control group consisted of 16 healthy volunteers. Results. The angiotensin-(1-7) levels in observed patients were significantly lower than in volunteers [105.51 (89.13;121.17) ng/L vs. 132.75 (125.06; 142.87) ng/L, p < 0.001]. The levels of the angiotensin-(1-7) significantly negatively correlated with duration of hypertension (r = -0.29, p < 0.05), systolic blood pressure (BP) (r = -0.38, p < 0.05), diastolic BP (r = -0.36, p < 0.01), average BP (r = -0.32, p < 0.01), left ventricular (LV) internal dimension at end-diastole (r = -0.37, p < 0.01), LV mass (r = -0.40, p < 0.001), LV mass index (r = -0.41, p < 0.001). In patients with LV hypertrophy, angiotensin-(1-7) levels were significantly lower than in patients without LV hypertrophy [101.9 (88.2; 117.7) ng/L vs. 129.3 (117.5; 136.8) ng/L, p < 0.01] and in patients with diastolic LV dysfunction -lower than in the patients with normal diastolic function [101.1 (87.9; 116.6) ng/L vs. 121.1 (105.5; 128.9) ng/L, p < 0.01]. Conclusions. The angiotensin-(1-7) can be considered as an important pathogenetic factor in the development of hypertension with T2D, a BP regulator and a cardioprotective agent that prevents the development of remodeling and diastolic dysfunction of the LV.
Background: Arterial hypertension (AH) remains the most common cardiovascular (CV) risk factor worldwide. Methods: Seventy five moderate-to-severe hypertensive patients with abdominal obesity aged from 48 to 66 years (45/30 men and women respectively) were selected from the entire cohort (n = 375) according to the inclusion and exclusion criteria. The patients were divided into two subgroups depending on the arm of antihypertensive therapy lines. The first subgroup of patients (n = 36) received a non-fixed combination of oral antihypertensive agents: perindopril (4-8 mg daily), indapamide (1.25-2.5 mg daily) and amlodopine (5-10 mg daily). The second subgroup of patients (n=39) received fixed-dosed combination of these antihypertensive agents aforementioned in the ranged doses (4 mg/1.25mg/5 mg; 4 mg/1.25mg/10 mg; 8 mg/2.5 mg/5 mg; 8 mg/2.5mg/10 mg) in the same manner. The examinations of the clinical status, office, and ambulatory blood pressure values were carried out at baseline in 3 and 6 months after study entry. Results: The frequencies of BP target levels after treatment were higher in the fixed-dose combination group than in the non-fixed combination (at 3 months: 80% versus 58%, p<0.05 and at 6 months: 85% versus 53%, p<0.05). The adherence to triple fixed-dose combination was also higher in comparison with one to non-fixed combination (at 3 months: 82% versus 64%, p<0.05 and at 6 months: 87% versus 61%, p<0.05). It has been established that low-dose of perindopril/indapamide/amlodopine (4mg/1.25/10mg and 8mg/2.5/5mg) were used frequently in fixed-dose combination cohort of patients than in non-fixed combination (15% versus 0%, P<0.05, and 33% versus 19%, p<0.05, respectively). At the same time, maximum doses of these agents (8mg/2.5mg/10mg) were required for achieving target BP levels in a significantly lower proportion of patients receiving fixed-dose combination as compared to patients receiving non-fixed combination (52% versus 81%, p<0.05). Additionally, the triple fixed-dose combination has proved to be better in restoring ambulatory blood pressure monitoring profile than non-fixed combination. Conclusion: Achievement of target blood pressure levels in patients with uncontrolled arterial hypertension and abdominal obesity was possible at lower doses of perindopril, indapamide, and amlodipine when used as a fixed-dose combination rather than non-fixed (free) combination. Key words: abdominal obesity, antihypertensive therapy, arterial hypertension, fixed-dose combination of antihypertensive agents, non-fixed combination of antihypertensive agents Cite this article : Koval S M, Snihurska I O, Starchenko T G, Penkova M Y, Mysnychenko O V, Yushko K O, Lytvynova O M, Vysotska O, Berezin A E. Efficacy of fixed dose of triple combination of perindoprilindapamide-amlodipine in obese patients with moderate-to-severe arterial hypertension: an open-label 6-month study. Biomed. Res. Ther.; 6(11):3501-3512. 3501 History •
Цель работы-анализ и обобщение литературных данных о роли нарушений кишечной микробиоты в патогенезе артериальной гипертензии и определение перспектив дальнейших исследований. Результаты. В статье приведены результаты исследований, которые свидетельствуют о значительной роли нарушений различных компонентов кишечной микробиоты в развитии артериальной гипертензии у экспериментальных животных и людей. Накопленные данные позволяют рассматривать кишечную микробиоту как часть сложной системы, принимающей участие в регуляции артериального давления. В работах с применением фекальной трансплантации показано, что пересадка фекального трансплантата от гипертензивных животных и больных артериальной гипертензией нормотензивным
Aim: The aim of the work was to study the circulating microRNA-133a levels in blood plasma of patients with arterial hypertension (AH), hypertensive heart disease (HHD), and left ventricular (LV) diastolic dysfunction (DD). Materials and Methods: A total of 48 patients with grade 2–3 AH and HHD at the age of 52.23 ± 7.26 (23 patients had LV DD [main group] and 25 patients had normal LV diastolic function [comparison group]) and 21 practically healthy individuals of comparable gender and age were examined. Diagnosis of AH and HHD was carried out according to the 2018 ESC/ESH recommendations. LV DD was determined according to the 2016 ASE/EACVI recommendations. Plasma microRNA-133a level was obtained by polymerase chain reaction using the CFX96 Touch System (BioRad), ≪TaqMan microRNA Assay≫ and ≪TaqMan® Universal PCR Master Mix≫ reagent kits (Thermo Fisher Scientific, USA). Results: We have found that in patients from the main and comparison groups plasma microRNA-133a levels were significantly lower than in practically healthy individuals (0.094 [0.067, 0.147]) and (0.182 [0.102, 0.301]) vs. (0.382 [0.198,0.474]), p = 0.002 and p = 0.04, respectively. In all this among patients with AH, HHD, and LV DD, plasma microRNA-133a levels were significantly lower than in patients with AH, HHD, and normal diastolic function ( p = 0.03). In the main and comparison groups there was a statistically significant negative relationship between plasma microRNA-133a level and left ventricular mass index (LVMI) ( R = −0.40, p = 0.003 and R = −0.35, p = 0.04, respectively). Conclusions: The findings suggest the significant role of decreased microRNA-133a levels in blood plasma of patients with AH in the pathogenesis and development of both HHD and LV DD.
Національний фармацевтичний університет, м. Харків, Україна ПАТОГЕНЕТИЧНЕ ЗНАЧЕННЯ АПЕЛІНУ В РОЗВИТКУ АРТЕРІАЛЬНОЇ ГІПЕРТЕНЗІЇ Резюме. Наведено аналіз результатів зарубіжних, вітчизняних і власних досліджень щодо патогенетичної ролі пептиду апеліну в розвитку артеріальної гіпертензії та її ускладнень. Показана взаємодія апеліну з механізмами регуляції артеріального тиску, компонентами ренін-ангіотензинової системи, процесами ураження органів-мішеней. Обговорюється можливість застосування апеліну та його синтетичних аналогів як потенційно нового класу лікарських засобів для лікування артеріальної гіпертензії та її ускладнень. Ключові слова: апелін, артеріальна гіпертензія, ренін-ангіотензинова система, ремоделювання серця, терапевтичні можливості.
The aim: to study the possibilities of improving the carbohydrate and lipid metabolism in patients with arterial hypertension (AH) with abdominal obesity (AO) by correcting gut microbiota (GM) disorders.Materials and methods. 34 patients with 2-3 degree AH and with I-II degree AO were examined using generally accepted methods. Determination of the quantitative composition of GM was carried out by the method of polymerase chain reaction using the test system «COLONOFLOR-16 (metabolism)» («ALFA-LAB», RF). Statistical data analysis was carried out using Microsoft Excel 17.0. using standard methods.Results. The addition of the probiotic Flora Champ GastroStress Relief (Abbott) which contains Lacto bacillus acidophilus, Bifidobacterium animalis subsp. lactis and Lactobacillus casei to standard antihypertensive therapy for 8 weeks leads to positive changes in the quantitative composition of GM: a significant increase in the amount of Lactobacillus spp. and Bifidobacterium spp. These changes in GM are associated with a significant decrease in insulin resistance and in blood levels of atherogenic lipid fractions.Conclusions. The prospects for the use of probiotics for the correction of disorders of carbohydrate and lipid metabolism in patients with arterial hypertension with abdominal obesity are shown.K e y w o r d s : arterial hypertension, abdominal obesity, gut microbiota.
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