[Epidemiology of Arterial Hypertension in Russian Federation - Importance of Choice of Criteria of Diagnosis]

Office blood pressure: overcoming the problems of diagnosis and control of arterial hypertension treatment

Some national guidelines since 2017 considered the most common method for diagnosing and controlling hypertension (HTN) (office blood pressure (OBP) measurement) as screening only. Automated OBP (AOBP) measurement claims to be a unique method by obtaining a standardized result, even in primary health care. AOBP improves the reliability of data by reducing the influence of various errors on result. However, although the level of AOBP is on average lower than similar OBP in clinical and research practice and is comparable to the mean 24-hour BP monitoring, at present, all international guidelines emphasize the mandatory use of ambulatory BP measurements for diagnostic purposes. Whether the results of AOBP and the reference level ≥130/80 mm Hg are equivalent with the same OBP level, the use of which is associated with an increase in the prevalence of hypertension and insufficient control of antihypertensive therapy, is a question for research. Compared with conventional OBP, the use of AOBP in conjunction with outpatient measurement leads to a reduction in the proportion and timing of initiation of treatment in patients with masked HTN, whose cardiovascular risk is similar to that of patients with stable HTN. However, the widespread implementation of AOBP is hindered by the high cost and lack of accumulated data. The review analyzes in detail the limitations and advantages of various types of BP measurement, as well as the potential of using AOBP in modern clinical and research practice.

 

Parallel Reaction Monitoring Mode for Atenolol Quantification in Dried Plasma Spots by Liquid Chromatography Coupled with High-Resolution Mass Spectrometry

In this study, we reported a rapid, sensitive, robust, and validated method for atenolol quantification in dried plasma spots (DPS) by liquid chromatography with high-resolution mass spectrometry (LC-HRMS) using parallel reaction monitoring mode (PRM). Aliquots of 25 µL human plasma were placed onto Whatman 903 Cards and air-dried. Disks (3.2 mm internal diameter) were punched, and a 100 µL working internal standard solution was added to each sample and then incubated on a shaker for 15 min at 40 °C, followed by rapid centrifugation (10,000× g, 10 s). The supernatant was transferred into 300 µL vials for subsequent LC–HRMS analysis. After chromatographic separation, atenolol and the internal standard were quantified in positive-ion parallel reaction monitoring mode by detection of all target product ions at 10 ppm tolerances. The total time of the analysis was 5 min. The calibration curve was linear in the range of 5–1000 ng/mL with interday and intraday precision levels and biases of <14.4%, and recovery was 62.9–81.0%. The atenolol in DPS was stable for ≥30 days at 25 and 4 °C. This fully validated method is selective and suitable for atenolol quantitation in DPS using LC–HRMS.

Risk Factors of In-Hospital Mortality in Non-Specialized Tertiary Center Repurposed for Medical Care to COVID-19 Patients in Russia

The purpose of our study is to investigate the risk factors of in-hospital mortality among patients who were admitted in an emergency setting to a non-specialized tertiary center during the first peak of coronavirus disease in Moscow in 2020. The Federal Center of Brain and Neurotechnologies of the Federal Medical and Biological Agency of Russia was repurposed for medical care for COVID-19 patients from 6th of April to 16th of June 2020 and admitted the patients who were transported by an ambulance with severe disease. In our study, we analyzed the data of 635 hospitalized patients aged 59.1 ± 15.1 years. The data included epidemiologic and demographic characteristics, laboratory, echocardiographic and radiographic findings, comorbidities, and complications of the COVID-19, developed during the hospital stay. Results of our study support previous reports that risk factors of mortality among hospitalized patients are older age, male gender (OR 1.91, 95% CI 1.03–3.52), previous myocardial infarction (OR 3.15, 95% CI 1.47–6.73), previous acute cerebrovascular event (stroke, OR = 3.78, 95% CI 1.44–9.92), known oncological disease (OR = 3.39, 95% CI 1.39–8.26), and alcohol abuse (OR 6.98, 95% CI 1.62–30.13). According to the data collected, high body mass index and smoking did not influence the clinical outcome. Arterial hypertension was found to be protective against in-hospital mortality in patients with coronavirus pneumonia in the older age group. The neutrophil-to-lymphocyte ratio showed a significant increase in those patients who died during the hospitalization, and the borderline was found to be 2.5. CT pattern of “crazy paving” was more prevalent in those patients who died since their first CT scan, and it was a 4-fold increase in the risk of death in case of aortic and coronal calcinosis (4.22, 95% CI 2.13–8.40). Results largely support data from other studies and emphasize that some factors play a major role in patients’ stratification and medical care provided to them.

Association of HLA Class I Genotypes With Severity of Coronavirus Disease-19

Human leukocyte antigen (HLA) class I molecules play a crucial role in the development of a specific immune response to viral infections by presenting viral peptides at the cell surface where they will be further recognized by T cells. In the present manuscript, we explored whether HLA class I genotypes can be associated with the critical course of Coronavirus Disease-19 by searching possible connections between genotypes of deceased patients and their age at death. HLA-A, HLA-B, and HLA-C genotypes of n = 111 deceased patients with COVID-19 (Moscow, Russia) and n = 428 volunteers were identified with next-generation sequencing. Deceased patients were split into two groups according to age at the time of death: n = 26 adult patients aged below 60 and n = 85 elderly patients over 60. With the use of HLA class I genotypes, we developed a risk score (RS) which was associated with the ability to present severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) peptides by the HLA class I molecule set of an individual. The resulting RS was significantly higher in the group of deceased adults compared to elderly adults [p = 0.00348, area under the receiver operating characteristic curve (AUC ROC = 0.68)]. In particular, presence of HLA-A*01:01 allele was associated with high risk, while HLA-A*02:01 and HLA-A*03:01 mainly contributed to low risk. The analysis of patients with homozygosity strongly highlighted these results: homozygosity by HLA-A*01:01 accompanied early deaths, while only one HLA-A*02:01 homozygote died before 60 years of age. Application of the constructed RS model to an independent Spanish patients cohort (n = 45) revealed that the score was also associated with the severity of the disease. The obtained results suggest the important role of HLA class I peptide presentation in the development of a specific immune response to COVID-19.

Assessment of cardiometabolic risk factors in various phenotypes of masked hypertension

Aim. To assess the relationship of cardiometabolic risk factors in patients with various phenotypes of masked hypertension (MH).

Material and methods. The study included 207 men with a median age of 34,6 years [32,3; 36,3] being systematically stressed. All examined patients had normal clinical blood pressure (BP), and there was no history of its increase. We conducted 24-hour ambulatory blood pressure monitoring (ABPM), carotid duplex scan with determination of the intima- media thickness (IMT). The levels of total cholesterol (TC), low (LDLC) and high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) were determined. Body mass index, visceral adiposity index, lipid accumulation product index and waist-to-height ratio were calculated. We performed clustering of ABPM data, calculated the odds ratio of association between cardiometabolic risk factors and certain MH phenotypes.

Results. MH was diagnosed in 142 (68,6%) patients examined, divided into 3 clusters: systolic-diastolic — SDMH (50,7%), isolated systolic — ISMH (27,5%) and isolated diastolic — IDMH (21,8%). Impaired lipid metabolism, visceral adiposity, IMT increase and atherosclerotic plaques were more often recorded in patients with SDMH and IDMH. The levels of TC, LDL-C and IMT were highest in individuals with IDMH. Odds ratio analysis indicated significant associations of SDMH and IDMH phenotypes with indicators of visceral adiposity, IMT, TG, TC, LDL-C and TG/HDL-Cl.

Conclusion. Clustering of ABPM data in individuals with MH and comparing related phenotypes with cardiometabolic risk factors complements their clinical and functional characteristics and can be a useful tool for improving customized prevention and therapy programs.

How to Choose the Optimal Single-Pill Combination of the First-Line Antihypertensive Drugs? The Benefits of Amlodipine and Telmisartan Combination

In patients with arterial hypertension (AH), an extremely important measure of the effectiveness of antihypertensive drugs (AHD) is not only a direct decrease in blood pressure (BP), but also its stable control throughout the 24 hours, preventing excessive morning surge and increased BP variability, which in turn are recognized cardiovascular risk factors. Currently, in the vast majority of hypertensive patients, the main antihypertensive therapy approach is using single-pill combinations (SPC) of AHD. Among the first-line combinations for a wide range of patients with AH and no special clinical conditions is amlodipine/telmisartan SPC. Distinctive features of these drugs, on the one hand, are unique pharmacological properties, consisting in an ultra-long antihypertensive effects, superior to other AHD in their classes; and on the other hand, there is an large body of evidence from numerous clinical trials confirming their high antihypertensive and target-organ protective potential as well as excellent capabilities in cardiovascular risk reduction. To assess the AHD effectiveness extent, several parameters have been proposed, of which the most rational and useful is the smoothness index, calculated using the ambulatory blood pressure monitoring data. Smoothness index describes both the degree of BP reduction and its distribution during the monitoring period. This index inversely associates with the changes in BP variability, and has predictive value in relation to the hypertension-mediated organ damage regression during different antihypertensive regimens. Amlodipine/telmisartan SPC has also been studied in many trials, including comparative ones with other AHD. In these works its direct powerful antihypertensive effect and a pronounced beneficial impact on the smoothness index have been proved, demonstrating stable BP control throughout the 24 hours (especially in the most dangerous morning hours), and also a decrease in BP variability. Therefore, amlodipine/telmisartan SPC can effectively reduce cardiovascular risk and improve prognosis in patients with AH.