Early vascular remodeling role in arterial hypertension pathogenesis among young patients

Aim. To investigate vascular wall stiffness in young patients, for examining early vascular remodeling role in arterial hypertension (AH) pathogenesis in young age. Material and methods. The study included 291 individuals: 169 normotensives and 122 AH patients aged 16-34 years. All participants underwent volume sphygmography (VaSera-1000, «Fukuda Denshi», Japan), blood pressure (BP) measurement in upper and lower extremity basins, elastic and muscular vessel elasticity assessment. Results. In young age, high elastic vessel stiffness was observed in 13.6% of normotensives, and in 50% of AH patients. For muscular vessels, this parameter was 11.2% and 35%, respectively. In systolo-diastolic AH, muscular vessel stiffness increased, in isolated systolic AH (ISAH) – elastic or elastic and muscular vessel stiffness is increased. About 50% of young ISAH individuals had increased BP on upper extremities only – «pseudo-hypertension». Conclusion. Early vascular remodeling plays an important role in AH pathogenesis among young people

Fosinopril – a drug of choice in chronic heart failure prevention and treatment

Aim. To study ACE inhibitor fosinopril effects on remodeling, diastolic filling of left and right ventricles (LV, RV), ectopic myocardial activity, heart rate variability, endothelial function, and microcirculation in patients with arterial hypertension (AH) and LV diastolic dysfunction (LVDD). To study fosinopril effects on clinical status, central hemodynamics, remodeling, LV and RV diastolic filling in patients with chronic heart failure (CHF) and LV systolic dysfunction (LVSD). Material and methods. In total, 40 patients with Functional Class II-IV CHF (NYHA), and LV ejection fraction below 40%, as well as 72 patients with AH and LVDD, were examined. Echocardiography, 24-hour ECG monitoring, duplex ultrasonography, laser Doppler flowmetry were performed. Results. In patients with CHF and LVSD, fosinopril treatment improved clinical status, central hemodynamics, remodeling parameters, normalized LV and RV diastolic filling. In patients with AH and LVDD, the drug beneficially influenced heart remodeling, LV and RV diastolic filling, endothelial function, microcirculation, as well as reduced sympathetic tonus and ectopic myocardial activity, decreasing sudden arrhythmic death risk. Conclusion. Fosinopril is a drug of choice in CHF and LVSD treatment, as well as for CHF prevention in patients with AH and LVDD

Age dynamics of blood pressure in various vascular basins among healthy people and patients with arterial hypertension

Aim. To study blood pressure (BP) levels in various vascular basins, as well as to investigate the role of aorta and large artery elasticity (stiffness) in arterial hypertension (AH) development.Material and methods. In total, 447 normotensive people and 855 AH patients aged 17-90 years were examined. BP in upper and lower extremity basins and arterial stiffness for elastic and muscular type vessels were measured by volume sphygmography method (VaSera-1000, «Fukuda Denshi», Japan). In 218 participants, pulse wave (PW) contour analysis and central BP measurement were performed by applanation tonometry method (SphygmoCor, «AtCor Medical», Australia).Results. Age BP dynamics for upper and lower extremity basins was similar in normotensives and AH patients. In calf arteries, comparing to brachial artery (BA), BP was more dependent on aorta and large artery stiffness, reflecting damping function of the latter. In BA, BP was more dependent on reflected waves (pressure augmentation) and PW amplification. Measuring lower extremity BP gives a chance to diagnose aorta stiffness-related AH earlier than traditional В A measurement of В P. The latter diagnoses AH only when elastic vessel stiffness increases enough.Conclusion. Measuring BP in upper and lower extremity basins improves AH diagnostics and arteriosclerosis stage assessment