Uncontrolled arterial hypertension: main causes, features of pathogenesis and approaches to treatment

Denisova, Anastasiia R.; Романовна, Денисова Анастасия; Solntseva, T. D.; Дмитриевна, Солнцева Татьяна; Sivakova, Olga A.; Анатольевна, Сивакова Ольга; Чазова, И Е; Евгеньевна, Чазова Ирина

doi:10.26442/2075082x.2021.1.200724

Cited by 4 publications

(2 citation statements)

References 58 publications

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“… при внезапном ухудшении течения АГ у пациентов с ранее зарегистрированной стабильной нормотензией;  при тяжелой (3-я степень) АГ или неотложных состояниях, обусловленных АГ;  при резистентной АГ;  при наличии выраженного опосредованного гипертензией повреждения органов;  если наблюдаются клинические или биохимические признаки, свидетельствующие о наличии эндокринной причины АГ или хронической болезни почек (ХБП);  если наблюдаются признаки синдрома обструктивного ночного апноэ;  если наблюдаются признаки феохромоцитомы или семейный анамнез феохромоцитомы [3][4][5][6].…”

Section:  введениеunclassified

A Clinical Case of Resistant Arterial Hypertension Caused by Suprarenal Aortic Stenosis in Elderly Woman

Казакова¹,

Добросольцева²,

Галицкая³

et al. 2022

Кардиология В Беларуси

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Артериальная гипертензия является наиболее распространенным сердечно-сосудистым заболеванием у пациентов пожилого возраста. Частота вторичной гипертензии в этой возрастной группе составляет 5–10%. Несмотря на значительные достижения в диагностике и лечении симптоматических артериальных гипертензий (особенно эндокринных и реноваскулярных), актуальным остается вопрос своевременной диагностики редких форм вторичных гипертензий, особенно если они имеют стертую клиническую картину и длительный анамнез заболевания, что снижает настороженность врачей в отношении этой патологии. В статье представлен клинический случай редкой формы вторичной артериальной гипертензии – стеноза супраренальной аорты («коралловая» аорта, coral reef aorta). Выраженные кальцинированные бляшки формируются в просвете аорты и могут вызывать значительный стеноз, который проявляется ишемией кишечника, почечной недостаточностью или артериальной гипертензией вследствие ишемии почек. Ранняя диагностика этого заболевания позволяет своевременно провести оперативное лечение, назначить эффективное медикаментозное лечение и, соответственно, кардинально улучшить прогноз для таких пациентов. Arterial hypertension is the most common cardiovascular disease in elderly patients. The frequency of secondary hypertension in this age group is 5–10%. Despite significant advances in diagnosis and treatment of symptomatic arterial hypertension (especially endocrine and renovascular ones), the issue of timely diagnosis of rare forms of secondary hypertension remains relevant, especially if they have a blurred clinical picture and a long history of the disease reducing doctors’ awareness of this pathology. The article presents a clinical case of a rare form of secondary arterial hypertension – suprarenal aorta stenosis ("coral" aorta, coral reef aorta). Distinct calcified plaques are formed in aortic lumen which may cause significant stenosis manifesting as intestinal ischemia, renal failure, or arterial hypertension due to renal ischemia. Early diagnosis of this condition allows timely surgical treatment, prescription of effective medications, and therefore dramatically improves the prognosis in these patients.

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Section:  введениеunclassified

A Clinical Case of Resistant Arterial Hypertension Caused by Suprarenal Aortic Stenosis in Elderly Woman

Казакова¹,

Добросольцева²,

Галицкая³

et al. 2022

Кардиология В Беларуси

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show abstract

“…Несмотря на особое внимание к проблеме рациональной терапии АГ, наличие большого количества антигипертензивных средств, контроль уровня АД среди взрослого населения РФ составляет 49,2% [2]. В последнее время наиболее часто используется классификация АГ в зависимости от достижения целевых значений АД на фоне антигипертензивной терапии на контролируемую и неконтролируемую [3]. Очевиден наиболее неблагоприятный прогноз у пациентов с неконтролируемой АГ [4].…”

Section: Introductionunclassified

Clinical and diagnostic features of uncontrolled hypertension and including hypertensive crisis

Solntseva

Sivakova

Чазова

2023

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Aim. To study clinical and diagnostic data, risk factors, the state of target organs damage (TOD) and prevalence of clinical associated conditions in patients with a hypertensive crisis and uncontrolled arterial hypertension.Materials and methods. The study included 297 patients hospitalized at the E.I. Chazov National Medical Research Center of Cardiology over the period from September 2019 to March 2022 with the presence of uncontrolled hypertension (blood pressure (BP) above 140/90 mm Hg while taking antihypertensive therapy). Patients were spread into two groups depending on the increase in the frequency of BP: group 1 (n=149) – uncontrolled hypertension with a hypertensive crisis (increase in BP 1 or more per week and/or the presence of severe clinical symptoms), and group 2 (n=148) – uncontrolled hypertension (increase in blood pressure more than 140/90 mm Hg less than 1 per week and/ or without severe clinical symptoms). The presence of risk factors in these groups was analyzed. At the baseline and after 12 months, the presence and severity of TOD (left ventricular mass index (LVMI), chronic kidney disease (CKD), severe retinopathy), history of/occurrence of clinical associated conditions were assessed.Results. There are significant elevated levels of uric acid, triglycerides, body mass index, heart rate, blood pressure indicators among the risk factors in the group of patients with hypertensive crisis. Patients in the group 1 showed higher rates of LVMI at the baseline and during follow-up for 12 months (baseline – 107±28 g/m2, after a year of follow-up 112±27 g/m2). The glomerular filtration rate (GFR) is lower in patients with hypertensive crisis (initially – 81.5±19.04 ml/min/1.73m2, after 12 months of observation 74.8±18.06 ml/min/1.73m2). There are significant differences in coronary artery disease, atherosclerosis of the brachiocephalic arteries, type 2 diabetes mellitus (DM 2) among clinical associated conditions. After 12 months of observation, acute cerebrovascular accident, coronary artery disease and diabetes occur more often in group 1.Conclusion. Uncontrolled hypertension with a hypertensive crisis manifestation is a release of hypertension associated with severe TOD and a high prevalence of clinical associated conditions.

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Hormonal characteristics of androgen status and their relationship with the anthropometric and metabolic parameter in men depending on the severity of hypertension

Yankovskaya

Кузьминова

Пинхасов

et al. 2022

Acta biomedica scientifica

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Background. According to the literature data, long-term and poorly controlled hypertension (HTN) leads to target organs damage, and in some cases, to the development of associated diseases, the severity of which in men may be partly due to the characteristics of the androgenic status.The aim: to reveal the features of hormonal indicators of androgen status and their relationship with the anthropometric and metabolic characteristics of the therapeutic clinic male patients, depending on the severity of HTN.Materials and methods. 296 men aged 59,0 [54,0; 65,0] years with confirmed HTN were examined. All study participants in the morning on an empty stomach underwent anthropometry, determination of metabolic and androgenic status, and assessment of comorbid burden. Depending on the severity of hypertension, all patients were divided into two groups (G): G1 (n = 134) – patients with hypertension without a history of coronary artery disease or stroke; G2 (n = 162) – patients with hypertension with a history of ischemic heart disease (IHD) and/or stroke.Results. In male patients of G2 with severe HTN, a decrease in the levels of free testosterone (FT) and, to a greater extent, dehydroepiandrosterone sulfate (DHEA-S), as well as total cholesterol, high and low density lipoproteins, was revealed. The correlation analysis performed revealed statistically significant negative correlations between the levels of total testosterone (TT) and FT with body mass index, the value of the ratio of waist circumference to hips, only the level of FT – with the presence of IHD, chronic heart failure (CHF), disorders of carbohydrate metabolism and abdominal type of fat distribution, and the level of DHEA-S – with the presence of IHD and CHF.Conclusion. A decrease in FT and DHEA-S is associated with early progression of atherosclerosis and the risk of developing HTN-associated cardiovascular events, which can aggravate the course of HTN.

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Uncontrolled arterial hypertension: main causes, features of pathogenesis and approaches to treatment

Cited by 4 publications

References 58 publications

A Clinical Case of Resistant Arterial Hypertension Caused by Suprarenal Aortic Stenosis in Elderly Woman

A Clinical Case of Resistant Arterial Hypertension Caused by Suprarenal Aortic Stenosis in Elderly Woman

Clinical and diagnostic features of uncontrolled hypertension and including hypertensive crisis

Hormonal characteristics of androgen status and their relationship with the anthropometric and metabolic parameter in men depending on the severity of hypertension

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