Objective. To determine the predictors of the development of masked nocturnal hypertension (HTN) in treated patients of low and moderate cardiovascular risk (CVR). Design and methods. The study included 94 patients with treated HTN of low and moderate CVR without verified cardiovascular diseases. The median age was 42,24 ± 8,08 years. Patients were examined in accordance with the Clinical guidelines on HTN of the Russian Society of Cardiology, approved by the Ministry of Health of the Russian Federation (2020). Patients were divided into two groups depending on the presence or absence of masked nocturnal hypertension. The first group consisted of 54 (57,4 %) patients with masked nocturnal hypertension, the second group — 40 (42,6 %) patients with HTN and target indicators of office blood pressure (BP) and BP according to 24-hour BP monitoring. Results. A direct strong correlation between systolic BP at night and uric acid levels (r = 0,62, p < 0,001), a direct moderate relationship with the cardio-ankle-vascular index (CAVI1) (r = 0,31, p = 0,002), and an inverse moderate relationship with the concentration of high-density lipoprotein cholesterol (HDL cholesterol) (r = -0,47, p < 0,001) were found. When conducting logistic regression analysis and constructing a ROC-curve, the following predictors of the development of masked nocturnal HTN were established: an increase in uric acid > 389 μmol/l, a decrease in HDL < 1,49 mmol/l, an increase in the CAVI1 index > 6,9. Conclusions. In effectively treated patients with HTN with moderate and low CVR, the development of masked nocturnal HTN is associated with an increase in uric acid levels > 389 μmol/l, regardless of sex, an increase in the CAVI1 index > 6,9 and a decrease in HDL cholesterol levels < 1,49 mmol/l.
Aim. To determine the prevalence and show the features of the development of newly diagnosed heart failure (HF) in patients with dyspnea after a coronavirus disease 2019 (COVID-19).Material and methods. This clinical prospective observational study was conducted during 2020-2022. The study consecutively included 368 outpatients with shortness of breath, who applied to the clinic. Depending on the presence of prior COVID-19, the patients were divided into 2 groups: the first group consisted of 205 patients with shortness of breath after COVID-19, the second group — 163 patients without prior COVID-19. All patients underwent a clinical examination within 3 days after presentation with an assessment of outpatient records and other medical documents for the differential diagnosis of dyspnea. The severity of dyspnea was determined using the Modified Medical Research Council Dyspnoea Scale (mMRC). The diagnosis of HF was verified in accordance with the 2020 Russian Society of Cardiology guidelines and in some cases reclassified in accordance with the 2021European Society of Cardiology guidelines. For further analysis, 2 subgroups of patients with HF were identified depending on the presence and absence of prior COVID-19. The subgroup analysis excluded patients with acute heart failure, acute illness, and conditions requiring hospitalization and/or intensive care.Results. Among 368 patients who presented to the clinic with dyspnea during 2020-2022, 205 patients (55,7%) had COVID-19. The average period of treatment after COVID-19 was 3,5 [1,5; 22,4] months. Patients after COVID-19 applied earlier after the onset of dyspnea, which is associated with higher mMRC score. The prevalence of HF among patients with shortness of breath after COVID-19 was significantly higher than in patients without this pathology in history, and amounted to 19,0% vs 9,8% (p=0,021). Prior COVID-19 increased the relative risk (RR) of HF in patients with shortness of breath by 1,7 times. RR for HF in systolic blood pressure >140 mm Hg increased by 1,9 times, while in diastolic blood pressure >90 mm Hg — by 1,9 times, with the development of a hypertensive crisis — by 28%, with a heart rate >80 bpm at rest — by 1,4 times, with the development of type 2 diabetes — by 31%, in the presence of pulmonary fibrosis — by 2,3 times. Patients with shortness of breath after COVID-19 had more severe HF, both according to clinical tests and according to the blood concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP), mainly with the preserved ejection fraction (EF) with a higher prevalence of left atrial (LA) enlargement in combination with a decrease in right ventricular (RV) systolic function and its dilatation. In patients after COVID-19 in the presence of chronic kidney disease, the RR for HF increased by 4,5 times; in the presence of C-reactive protein >4 mg/l — by 1,6 times.Conclusion. Every fifth patient with shortness of breath 3,5 months after COVID-19 had more severe HF, both according to clinical tests and according to blood NT- proBNP concentration, mainly with preserved EF with a higher prevalence of LA increase in combination with a decrease in RV systolic function and its dilatation. The risk of HF is interrelated with the female sex and multiple comorbidities.
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