THIRTY-TWO-YEAR DYNAMICS AND PROGNOSTIC SIGNIFICANCE OF BASELINE LEVELS OF SYSTEMIC PRESSURE IN TEENAGE BOYS

Aim. To evaluate the 32-year dynamics and prognostic significance of the baseline levels of arterial pressure (BP) in teenage boys.Material and methods. Thirty-two-year prospective cohort follow-up of males, beginning from the age 11-12 y.o. In 32 years, among 1005 participants, 303 (30,1%) assessed, and the cohort consisted of 290. The investigation included: standard questionnaires; three-time BP measurement; pulse rate; anthropometry; triceps, scapula and abdominal skin folds measurement, waist and hip circumference; total cholesterol measurement, as high density lipoproteides and triglycerides.Results. The prevalence of arterial hypertension slightly declines in 12 to 15 years, and then increases at 17-22 years with high increase at 33 years, with further stabilization. All tracking coefficients (Pearson correlation) for systolic BP (sBP) were statistically significant, but decreased from the age 33 to 43 (from 0,35 to 0,17). For the diastolic BP-5 (dBP5) statistic significance was found only by 22 years, dBP4 — by 33 years. There was significant correlation of sBP and dBP with body mass index and anthropometry. In 30 years, the stabilized increase (fifth quintile) remains by sBP and dBP for every fifth. From the first to the fifth, every tenth switched by sBP and every fifth by dBP.Conclusion. Measurement of BP in childhood and teenage is worthful, as there is significant relation of sBP and dBP in teenage with its adult level. Every fifth teenager with increased BP at childhood remain it in 30 years. Also, every tenth with low BP shows its increase in 30 years. The special attention should be paid for primary prevention of arterial hypertension in obese children and those with raised BP. It is important to search for new markers of prognosis

Is cardiovascular risk factors prevention necessary from childhood? What do prospective studies show

The analysis provided of prospective studies of dynamics of the main cardiovascular risk factors (RF) from childhood until adulthood. The importance of such study is posed by insufficient effectiveness of prevention programs in adult population. Many issues not solved on the development of scientifically based approaches to early prevention in childhood and adolescence: what does facilitate RF formation, and what age is the most vulnerable? What determines resistibility of the RF and their transformation to adult life? What is the risk grade for CVD development in adult age, of children and adolescents? If in general it is clear, what population aim should be fulfilled for early CVD prevention: policy making, increase of a school importance, food industry reorganization, physical culture and sport programs realization, — it is still not known, what does determine RF stabilization or their spontaneous normalization. Solution of this issue could improve risk groups determination for preventive procedures

ARTERIAL STIFFNESS AND CARDIOVASCULAR RISK FACTORS IN YOUNG MEN (41-44 YEARS)

Aim. To study the relationship of individual cardiovascular risk factors with arterial stiffness and subclinical atherosclerosis in young men.Material and methods. The study is part of a 32-year prospective cohort monitoring of males, beginning with childhood (11-12 years). The study-included 303 (30.1%) representatives of the initial population sample aged 41-44 who underwent an outpatient examination at the State Research-Center for Preventive Medicine in 2015-2016. The examination included a survey by a standard questionnaire, measurement of anthropometric parameters, blood pressure (BP), pulse counting. Biochemical assays were carried out according to standard laboratory procedures. Applanation tonometry-was used to measure stiffness of the arterial wall. Intima-media thickness (IMT) and subclinical atherosclerosis signs were determined in both left and right carotid arteries by ultrasound scanning.Results. Arterial stiffness and central pressure were significantly higher in the group with hypertension (HT). Risk of HT development depended on HT-presence in mother and did not depend on HT in father. HT was associated with obesity (79.4% vs 44.3%; p<0.001), especially of abdominal type and elevated triglycerides (1.3±0.9 vs 1.8±1.1 mmol/l; p<0.05), this indirectly reflected nutritional disorder and development of metabolic syndrome. The analysis of arterial stiffness parameters showed positive correlation with mean systolic (r=0.256) and diastolic (r=0.228) BP in the brachial artery and also with heart rate (r=0.133). A statistically significant positive correlation of central pressure in the aorta and pulse BP with indices of arterial-stiffness was noted. When comparing arterial stiffness and duplex scans, a correlation of mean IMT with the augmentation index (r=0.131) and augmentation BP (r=0.125) was obtained, but no correlation between IMT and pulse wave velocity was found. Correlation of vascular rigidity with total cholesterol level was also noted (r=0.121).Conclusion. The arterial stiffness was closely related to HT and already developed in early stages, in a fairly young age. Arterial stiffness in men was not associated with dyslipidemia and diabetes presence. Interrelation of arterial stiffness and degree of early atherosclerotic vascular lesions was ambiguous

Lipid profile stability and prognostic value in adolescents: 22-year prospective study

Aim. To prospectively assess dynamics, stability, and prognostic value of blood lipid profile (LP) in adolescents, for identifying early coronary heart disease prevention approaches. Material and methods. This prospective study included 347 boys and 332 girls. During 22-year follow-up, six clinical examinations were performed (at the age of 13-14, 15-16, 19-20, 21-22, 26 and 34-35 years). Examination program included measuring levels of total cholesterol (TCH), high-density lipoprotein CH (HDL-CH), and triglycerides (TG), body weight (BW) and height (BH), subscapular, abdominal, and triceps skin fold thickness (SST, AST, and TST), pubescence assessment. Results. Gender differences in LP, especially in pubescence, could not be completely explained. Increased LP atherogenity and dyslipidemia (DLP) rates in young males were associated with increased BW and fat tissue percentage. Mildly increased and normal TCH, HDL-CH, low-density lipoprotein CH (LDL-CH) in pubescent boys and girls were equally stable and not associated with increased risk of atherogenic DLP in adult age. In pubescent adolescents, TCH predicted its level in 34-35 year-olds only in combination with physical development parameters. Overweight in pubescent boys was an independent predictor of future hypercholesterolemia in adult age. Conclusion.The observed age LP dynamics points to the need for early preventive measures in risk groups and general population, starting in pre-pubertal or early pubertal periods

Long-term controlled antihypertensive therapy in Chernobyl liquidators, its effectiveness and benefits

Aim. To compare effectiveness of controlled antihypertenive therapy (AHT) and standard outpatient care among Chernobyl male liquidators (ML) with mild to moderate arterial hypertension (AH). Material and methods. This 12-month, open, comparative randomized study included 81 ML aged 37-70, with mild to moderate AH. The main group consisted of 42 patients, the control group – of 39; mean age 52.2±1.3 and 51.5±1.1 years, mean AH duration 10±1 and 9.6±1 years, respectively. In main group, patients received an ACE inhibitor spirapril, combined with hypothiazide (12.5-25 mg/d), and atenolol (12.5-100 mg/d), if necessary. In control group, AHT and its correction were performed by outpatient physicians. Medical history collection, physical examination, anthropometry, blood pressure (BP) measurement (three times), and electrocardiograpy were performed. Results. During one-year controlled AHT, comparing to standard outpatient care, more effective decrease in systolic and diastolic BP was achieved. Antihypertensive effect was registered in 78.6% and 38.0% of the main and control group patients, respectively. At the end of the study, most participants from the main group ((78.6%) received combined therapy (2 or more drugs); in control group, this number was only 17.2%. Conclusion. The results of the study demonstrated high effectiveness and benefits of long-term controlled AHT, comparing to standard outpatient care