Вентиляционные нарушения и показатели артериальной ригидности у пациентов с хронической обструктивной болезнью легких

The aim of the study was to identify the correlation between ventilation disorders of the lungs and the development of arterial stiffness in patients with chronic obstructive pulmonary disease (COPD).Methods. The following parameters were evaluated in the patients (n = 61) enrolled in the study: spirometry, bodyplethysmography, cardiac-ankle vascular index (CAVI) and an ancho-brachial vascular index. Additionally, the pulse wave propagation velocity was calculated in the area from the ostium of the aorta to the infragenicular arteries.Results. According to the study results, a direct correlation, characterized by moderate to noticeable strength, was found between the parameters of pulmonary ventilation (bronchial resistance, intrathoracic gas volume, residual lung volume (RLV), total lung capacity (TLC), RLV/TLC) and the CAVI parameter, characterizing vascular stiffness on the section from the aorta ostium to the infragenicular arteries. It was shown that the best method for assessing changes in blood vessels is CAVI, which is independent of the level of blood pressure at the moment of the study.Conclusion. It has been established that if there is a correlation between impaired ventilation and arterial stiffness, the systemic nature of the lesion in COPD is confirmed, which explains the high incidence of cardiovascular diseases in patients with COPD. Целью работы явилось установление взаимосвязей между вентиляционными нарушениями легких и развитием артериальной ригидности (АР) у больных хронической обструктивной болезнью легких (ХОБЛ).Материалы и методы. У пациентов (n = 61), принявших участие в исследовании, проводились спирометрия, бодиплетизмография, оценивались показатели сердечно-лодыжечного индекса (cardial-ankle vascular index – CAVI) и анклобрахиального сосудистого индекса, выполнялся расчет скорости распространения пульсовой волны на участке от устья аорты до артерий голени.Результаты. По результатам исследования выявлена прямая корреляционная связь от умеренной до заметной силы между показателями легочной вентиляции (бронхиальное сопротивление, внутригрудной объем газа, остаточный объем легких (ООЛ), общая емкость легких (ОЕЛ), ООЛ / ОЕЛ) и показателем CAVI, характеризующим жесткость сосудов на участке от устья аорты до артерий голени. Показано, что оптимальным методом оценки изменений в сосудах является CAVI, не зависящий от уровня артериального давления на момент исследования.Заключение. Установлено, что при наличии взаимосвязи между нарушением вентиляции легких и АР подтверждается системный характер поражения при ХОБЛ, чем объясняется высокая частота встречаемости сердечно-сосудистых заболеваний у пациентов с ХОБЛ.

Comparison of the novel START vascular stiffness index with the CAVI index, assessment of their values and correlations with clinical parameters

Aim. To compare the cardio-ankle vascular index (CAVI) and the novel START vascular stiffness index and assess their values and correlations with clinical parameters.Material and methods. This multicenter study included 928 (403 men and 525 women) randomly selected patients, aged 18 to 89 years (mean age, 41±15,8 years). Inclusion criteria were age over 18 years. There were following exclusion criteria: mental disorder, severe somatic diseases and cancer, contraindications for volume sphygmography using the Fukuda Denshi VS-1500 VaSera system, no patient consent, ankle-brachial index <1,0 and >1,3. Further, according to the main parameters obtained using volum sphygmography, a novel START index was calculated. Comparison of index values and analysis of their correlation with clinical indicators, such as age, systolic blood pressure, diastolic blood pressure, pulse pressure (PP), body mass index and heart rate (HR), were carried out using simple and multiple linear regression, dispersion analysis, calculation of the Pearson coefficient (r), in the software environment R version 4.0.2.Results. Statistical analysis revealed a high correlation between START and CAVI indices (r=0,986, p<0,001). The values of both indices increase significantly with age (ANOVA p><0,001). Both START and CAVI correlate with all studied clinical parameters. However, in men, there was no relationship of the indices with PP and HR (p>0,05). According to multiple linear regression, the relationship between diastolic blood pressure at the age of 30-60 years and PP at the age of 18-40 years with the START index is more pronounced than with the CAVI index. However, further study of the mathematical model did not reveal a significant difference in the index values for groups with and without high blood pressure.Conclusion. The START vascular stiffness index significantly correlates with the CAVI index, showing no significant differences from CAVI in quantitative relationships with blood pressure, body mass index, heart rate, and sex in various subgroups of the subjects

Main results of the Ouabain and Adducin for Specific Intervention on Sodium in Hypertension Trial (OASIS-HT): a randomized placebo-controlled phase-2 dose-finding study of rostafuroxin

Background. The Ouabain and Adducin for Specific Intervention on Sodium in Hypertension (OASIS-HT) Trial was a phase 2 dose-finding study of rostafuroxin, a digitoxygenin deivative, which selectively antagonizes the effects of endogenous ouabain (EO) on Na+,K+-ATPase and mutated adducin. Rostafuroxin lowered blood pressure (BP) in some animal models and in humans. Methods. OASIS-HT consisted of 5 concurrently running double-blind cross-over studies. After 4 weeks without treatment, 435 patients with uncomplicated systolic hypertension (140-169 mm Hg) were randomized to rostafuroxin (0.05, 0.15, 0.5, 1.5 or 5.0 mg/d) or matching placebo, each treatment period lasting 5 weeks. The primary endpoint was the reduction in systolic office BP. Among the secondary endpoints were diastolic office BP, 24 h ambulatory BP, plasma EO concentration and renin activity, 24-h urinary sodium and aldosterone excretion, and safety. ANOVA considered treatment sequence (fixed effect), subjects nested within sequence (random), period (fixed), and treatment (fixed). Results. Among 410 analyzable patients (40.5% women; mean age, 48.4 years), the differences in the primary endpoint (rostafuroxin minus placebo) ranged from -0.18 mm Hg (P=0.90) on 0.15 mg/d rostafuroxin to 2.72 mm Hg (P=0.04) on 0.05 mg/d. In the 5 dosage arms combined, the treatment effects averaged 1.30 mm Hg (P=0.03) for systolic office BP; 0.70 mm Hg (P=0.08) for diastolic office BP; 0.36 mm Hg (P=0.49) for 24-h systolic BP; and 0.05 mm Hg (P=0.88) for 24-h diastolic BP. In the 2 treatment groups combined, systolic (-1.36 mm Hg) and diastolic (-0.97 mm Hg) office BPs decreased from week 5 to 10 (P for period effect ≤=0.028), but carry-over effects were not significant (P≥=0.11). All other endpoints were not different on rostafuroxin and placebo. Minor side-effects occurred with similarly low frequency on rostafuroxin and placebo. Conclusions. In 5 concurrently running double-blind cross-over studies rostafuroxin did not reduce BP at any dose. Trial Registration: NCT00415038 http://www.clinicaltrials.gov)

Status of cardiovascular system in patients with chronic obstructive pulmonary disease according to the results of a pulse wave contour analysis

The combination of chronic obstructive pulmonary disease and cardiovascular disease is an urgent public health problem, that determines more severe disease progression, worse prognosis for the patient. The aim of the work was to evaluate the status of the cardiovascular system performing a pulse wave contour analysis in patients with chronic obstructive pulmonary disease depending on the severity of bronchial obstruction. Material and Methods. Applanation tonometry was performed in 60 patients (56 men, age 63.5 [IQR 59; 70] years) with chronic obstructive pulmonary disease to assess central hemodynamic parameters. The severity of obstructive disorders was determined by spirometry after taking bronchodilator. Results. In case of progression of bronchial obstruction, a decrease in parameters characterizing coronary blood flow was detected, mainly determined by an increase in heart rate and by a decrease in the duration of diastole. In addition, higher values of augmentation pressure, corrected by heart rate of 75 bpm, pulse pressure, central pulse height at the point of maximum rise of direct pulse wave were determined in patients with more severe bronchial obstruction. These parameters indicate higher values of arterial stiffness in this group of patients. Conclusion. In patients with chronic obstructive pulmonary disease and high values of bronchial obstruction there is an imbalance in the ratio of myocardial load and actual blood supply, and increased arterial stiffness with impaired aortic damping function, that contributes to the development of cardiovascular disease in this group of patients. These factors may explain high prevalence of cardiovascular disease in this group of patients

Combined antihypertensive therapy in patients with arterial hypertension and coronary heart disease

Aim. To assess the potential of adding perindopril and indapamide CR (controlled release) to standard therapy, as a method for additional correction of cardiovascular risk factors (RFs) among patients with Stage 1-3 arterial hypertension (AH) of very high risk and coronary heart disease (CHD). Material and methods. In total, 44 patients (29 men, 15 women; age 45-80 years, mean age 56±10,7 years) with Stage 1-3 AH of very high risk and CHD were examined. At baseline and after 2, 4, and 16 weeks of the treatment, all participants underwent physical examination, office blood pressure (BP) measurement, standard laboratory tests, electrocardiography (ECG), Holter ECG monitoring, 24-hour BP monitoring, echocardiography (EchoCG), and arterial stiffness assessment. Results. All participants completed the study protocol, with no adverse effects during the treatment phase. In all patients with Stage 1-3 AH, target BP levels and improved 24-hour BP profile were achieved. In CHD patients, a reduction in the incidence of ischemic episodes and their duration was observed. There was a positive dynamics of arterial stiffness parameters. Conclusion. Perindopril and indapamide CR demonstrated good antihypertensive effectiveness, as well as cardioand vasoprotective activity in patients with very high-risk AH and CHD

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

COMBINED ANTIHYPERTENSIVE THERAPY IN PATIENTS WITH ARTERIAL HYPERTENSION AFTER THE STROKE

Aim. To evaluate influence of the combined therapy with ACE inhibitor (perindopril), diuretic (indapamide) and dihydropyridine calcium channel blocker (amlodipine) on ambulatory blood pressure (BP) monitoring indices and heart rate variability in hypertensive patients during early recovery period of stroke.Material and methods. 39 patients (28 men, 11 women) with arterial hypertension of 1-3 degrees during early recovery period after stroke were examined. They received perindopril 10 mg QD, indapamide — 1.5 mg QD. Calcium channel blocker amlodipine (5 mg QD) was added in case of insufficient effect of the ACE inhibitor plus diuretic combination.Results. The combined antihypertensive therapy in hypertensive patients after the stroke led to significant decrease of systolic and diastolic BP (by 23.5% and 18.9%, respectively), normalization of BP daily profile (a number of «dippers» enlarged by 42.2%), improvement of the wall vessel rigidity (decrease in pulse wave velocity by 12.9%) and heart rhythm variability (increase in SDNN, PNN50 and RMSSD by 7%, 20% and 25%, respectively).Conclusion. Advantages of the combined antihypertensive therapy (ACE inhibitor, diuretic, calcium channel blocker) in treatment of hypertensive patients after the stroke are shown

Endothelial vasoactive function in children and adolescents with obesity and metabolic syndrome

Endothelial vasoactive function was assessed in 66 children and adolescents aged 11-16 years, with obesity and metabolic syndrome (MS). Pathological result of rheovasography stress test was observed in 71,4% of MS children, pointing to endothelial dysfunction (ED) presence. In MS children, vasoconstriction was identified more often than in obese children -by 1, 77 times (p < 0,05). Therefore, there is a need for early ED correction in MS children

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

Consensus of Russian experts on the evaluation of arterial stiffness in clinical practice

Recently, there was plenty studies published on the arterial stiffness assessment, and importance of this was proved as an independent prediction parameter, together with standard cardiovascular risk factors. In current document, we collect and structure the available clinical and scientific data from abroad and Russian studies. The aim of current publication is the need to bring a reader the importance of demanded in clinical practice ways of arterial wall stiffness assessment, information about conditions when it is important to the assessment, and available restrictions, as the issues remaining unresolved