Aim To study the incidence of heart failure (HF) in patients with arterial hypertension (AH), symptoms of HF, and left ventricular ejection fraction (LV EF) ≥50 % using a novel, modified HFA-PEFF diagnostic algorithm and to evaluate the liver hydration status and density depending on the established HF profiles and the prognostic significance of this algorithm.Material and methods This study included 180 patients (median age, 72 years) with AH, symptoms of HF, and LV EF ≥50 %. The incidence of chronic HF with preserved ejection fraction (CHFpEF) was studied with the stepwise, modified HFA-PEFF diagnostic algorithm, and long-term outcomes were assessed at 3, 6, and 12 months of follow-up. The hydration status was determined by a bioimpedance vector analysis, and the liver density was measured by indirect fibroelastometry. The following tests were performed for all patients: standard, general clinical and laboratory examination with evaluation of CH symptoms (including N-terminal pro-brain natriuretic peptide test); extended echocardiography with assessment of structural and functional parameters of the heart; a KCCQ questionnaire was used for evaluation of patients’ condition and quality of life (QoL). Long-term outcomes were studied by phone calls at 3, 6, and 12 months following discharge from the hospital/visit (worsened QoL, repeated hospitalization for cardiovascular causes, cardiovascular death or all-cause death).Results The following profiles were determined by the HFA-PEFF algorithm: with CHFpEF, with intermediate probability of HF, and without HF (58.9, 31.1, and 10 %, respectively). The study showed that patients with CHFpEF compared to patients of the intermediate group and without HF, had higher levels of brain natriuretic peptide, more pronounced signs of congestion according to results of the bioimpedance vector analysis and a higher liver density according to results of indirect fibroelastometry of the liver, which allowed identification of a group of patients with a high probability of CHFpEF. The diagnosis of HF by HFA-PEFF had an adverse prognostic significance with respect of worsened QoL according to the KCCQ questionnaire, and of repeated admission for HF during a year.Conclusion In AH patients with symptoms of HF and LV EF ≥50 %, CHFpEF was detected with the HFA-PEFF algorithm in 58.9 % of cases. Patients with AH and verified CHFpEF had a high incidence of hyperhydration and increased liver density. A diagnosis of CHFpEF by the HFA-PEFF algorithm had an adverse prognostic significance with respect of long-term outcomes.
Objective: We aimed to assess diagnostic scales (H2FPEF, HFA-PEFF) on a frequency of revealing HFpEF in patients with arterial hypertension (AH) and symptoms of heart failure (HF). Design and method: Study included 180 high risk hypertensive patients with at least one symptom or sign of HF and left ventricular ejection fraction (LV EF) more or equal 50%, 54,4 % female, 72.3 ± 9.4 years (M ± SD), obesity 54.4 %, diabetes mellitus 38.9 %, atrial fibrillation 61 %, chronic kidney disease 60 %, estimated glomerular filtration rate (eGFR) 57.5 ± 16.33 ml/min/1.73 m2, NT-proBNP level 121 (51.7; 287.7) pg/ml. Patients with significant valvular heart disease, acute coronary syndrome, acute infections, pulmonary embolism, neoplasm, eGFR < 30 ml/min/1.73 m2, body mass index > 40 kg/m2 were not included. HFpEF was assessed by ESC HFA-PEFF and H2FPEF algorithms. Stress-echo with passive leg raising (PLR) was used to detect impaired LV diastolic function reserve and the increase in LV filling pressure. Results: Using ESC HFA-PEFF score patients were divided into 3 groups: low probability/absence of HF in 8.6 % of cases (<2 points), 37.9% of patients have confirmed HF (5 points), patients with intermediate risk of HF and required for stress echocardiography – 53.6 % (2–4 points). After the stress-ECHO HFpEF was additionally detected in 13.3% of patients. Low (<2 points), intermediate (2–5 points) and high probability (>5 points) of HFpEF was identified in 7.4, 60 and 32.6 % of patients according to H2FPEF score. Conclusions: Thus, the frequency of HFpEF using HFA-PEFF was 60%. Stress - ECHO with PLR increases the verifying of HFpEF in 13.3%. High probability of HFpEF according to H2FPEF score was 32.6%. Considering the differences in HFpEF detection using different algorithms, further research are recommended.
Objective: We aimed to study the effects of a fixed AZL-M/CLD combination on central BP in patients with AH and HFpEF. Design and method: This 12-week study evaluated effects of a fixed-dose combination AZL-M/CLD (n = 30) vs non-fixed-dose combinations of iACE/ARB and thiazide/ thiazide-like diuretics (n = 30) on central BP (cBP), arterial stiffness and pulse wave velocity (PWV) in patients with AH and HFpEF. Patients with EF < 50%, significant valvular disease, ACS, permanent AF, neoplasm, eGFR < 30 ml/min/1.73 m2, BMI > 40 kg/m2 were not included. The initial doses could be titrated to meet BP targets during weeks 4 to 12: in 1 group to 40/25 mg, in the control group up to the maximum daily dose. Results: The mean age in the study group was 67 ± 11 years (M ± SD), 36% (10 /30) males, SBP/DBP 140 ± 12/84 ± 9 mmHg (M ± SD), DM 30% (9/30), obesity 61,2% (18/30), paroxysmal AF 20% (6/30), CKD 57% (16/30), eGFR 63 [44.1;72.8]. In the control group: 66 ± 10 years (M ± SD), 40% (12 /30) males, SBP/DBP was 141 ± 11/82 ± 10 mmHg (M ± SD), DM 30% (9/30), obesity 55 % (16/30), paroxysmal AF 26% (7/30), CKD 61% (18/30), eGFR 65 [46.3;76.1]. During observation, the level of pBP in the study group decreased from 140 ± 12/84 ± 9 mmHg to 120 ± 15/71 ± 12 mmHg (p < 0.05); cBP from 131 ± 15/84 ± 10 to 117 ± 14/78 ± 9 mmHg (p < 0.05) and PWV from 11.7 (9.4;13.4) to 10.1 (8.7;12.3) m/s (p < 0.05). The levels of pBP in the control group decreased from 141 ± 11/82 ± 11 mmHg to 128 ± 16/79 ± 9 mmHg (p < 0.05), cBP from 132 ± 14/85 ± 9 to 127 ± 16/82 ± 13 mmHg (p < 0.05), PWV from 11.5 (9.5; 13.6) to 10.2 (9.2.;12.8) m/s p < 0.05. The t-test indicated significant differences between this two groups in peripheral BP, cBP and PWV (p = 0.004, p < 0.01, p < 0,05 respectively). Conclusions: There is significant antihypertensive effect and reduction of arterial stiffness in patients with AH and HFpEF treated with AZL-M/CLD.
Aim. To study the effects of azilsartan medoxomil/chlorthalidone (AZM/CTD) and losartan/hydrochlorothiazide (LOS/HCT) combinations for NTproBNP levels, 6-minute walk test results, hydration status along with their antihypertensive efficacy according to clinical and 24-hour blood pressure in patients with hypertension and heart failure with preserved ejection fraction (HFpEF).Material and methods. An open randomized study included 56 patients with uncontrolled or untreated hypertension and HFpEF. Patients randomized to receive the AZM/CTD 40/12.5 mg/day (group 1; n=28) or LOS/HCT 100/12.5 (group 2; n=28) within 4 weeks. Patients who did not achieve the target BP <140/<90 mm Hg study drug dose was intensified: in the first group, an increase in the dose of AZM/CTD 40/25 mg/day, in the second group, an increase in the dose of LOS/HCT 100/25 mg/day. The observation period was 12 weeks. All patients underwent a clinical examination with an assessment of symptoms and/or signs of HF, laboratory and instrumental studies, including NT-proBNP, ambulatory blood pressure (BP) monitoring, applanation tonometry, a 6-minute walk test (6MWT), echocardiography. In order to assess the status of hydration, bioimpedance vector analysis (BIVA) was performed. HFpEF was diagnosed according to the HFA-PEFF algorithm. The results were considered statistically significant at p<0.05.Results. After 12 weeks, 92% of patients in the first and 78% of patients in the second group reached the target clinical BP (р<0,05). Average daily BP <130/ <80 mm Hg was reached by 82% of patients treated with the combination of AZM/CTD, compared with 67% treated with the combination of losartan/HCT (p<0.05). After 12 weeks, patients from both groups showed a significant decrease in systolic and diastolic blood pressure, central blood pressure, and a decrease in pulse wave velocity, which was more significantly significant in the first group of patients (p<0.05). During therapy in both groups of patients, a significant decrease in the level of NT-proBNP was observed: in the first group from 300 [199; 669] pg/ml to 156 [157; 448] pg/ml (p=0,003), in the second group from 298 [180; 590] pg/ml to 194 [140; 360] pg/ml (p=0,006), an increase in the distance during the 6MWT from 317 [210; 398] m to 380 [247; 455] m (p=0,006) in in the first group and an improvement in the hydration status according to the BIA data, but more significantly significant in the first group (p<0.001).Conclusion. In patients with hypertension and HFpEF, therapy with the AZM/CTD combination compared with LOS/HCT is accompanied by a more pronounced antihypertensive effect in terms of ambulatory and peripheral blood pressure, central blood pressure, NTproBNP levels, increased distance in 6MWT and achievement of euvolemia status.
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