ARTERIAL HYPERTENSION AS A RISK FACTOR OF ISCHEMIC HEART DISEASE DESTABILIZATION (FRAGMENT OF RACSMI‑UZ STUDY)

Background. Registries are the most accurate tool for assessing the status of real clinical practice. The registries help to identify deficiencies in the management of patients, to determine the most optimal ways to improve the quality of treatment. In 2015, the Republican Specialized Center of Cardiology organized and initiated the Registry of acute coronary syndrome (ACS) and acute myocardial infarction (AMI) in one of the districts of Tashkent city (RACSMI-Uz Registry). In the present work, which is a fragment of the RACSMI-Uz study, the main clinical and laboratory characteristics of patients with ACS/AMI were collected and analyzed, depending on the presence or absence of arterial hypertension (HTN). Design and methods. We analyzed the registry database of 432 patients who survived ACS/AMI. Results. In HTN patients survived after ACS/AMI, such accompanying pathologies as 1–2 stage obesity, myocardial infarction in past, type 2 diabetes mellitus, etc. were registered more often and the rate of stenotic (> 50 %) narrowing of the coronary arteries was greater. The heart rate > 80 beats/min was 1,5-times greater among HTN patients than among non-HTN subjects. Lipid metabolism in patients after ACS/AMI with concomitant HTN was characterized by hypertriglyceridemia and relatively safe low values of total cholesterol level. Compliance with medications was 2 times higher in HTN patients with ACS/AMI than among those without HTN.

registry, acute coronary syndrome, acute myocardial infarction, arterial hypertension, risk factor

1. Маколкин В. И. Артериальная гипертензия и ишемическая болезнь сердца: фармакотерапия с позиций патогенетической взаимосвязи. http://www.medlinks.ru/article.php?sid=19609. [Makolkin VI. Arterial hypertension and coronary heart disease: pharmacotherapy with a positional pathogenetic relationship. http://www.medlinks.ru/article.php?sid=19609. In Russian].

2. Мясников А. Л. Гипертоническая болезнь и атеросклероз. М.: Медицина, 1965. [Myasnikov AL. Essential hypertension and atherosclerosis. M.: Medicine, 1965. In Russian].

3. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH et al. Systolic hypertension in Europe (SystEur) Trial Investigators. Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. Lancet. 1997;350(9080):757–764.

4. MacMahon S, Rodberg A. The effect of antihypertensive treatment on vascular disease: reappraisal of the evidence in 1994. J Vasc Med Biol. 1993;4:265–271.

5. Kannel WB. Labile hypertension: a faulty concept? The Framingham study. Kannel WB, Sorlie P, Gordon T. Circulation. 1980;61(6):1183–1187.

6. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality. Lancet. 2002;360 (9349):1903–1913.

7. Vasan RS, Larson MG, Leip EP, Evans JC, O’Donnell CJ, Kannel WB et al. Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med. 2001;345(18):1291– 1297.

8. Содномова Л. Б. Фактическое состояние проблемы острого коронарного синдрома. Бюллетень ВСНЦ СО РАМН. 2010;3(73):143–145. [Sodnomova LB. The state of the art of acute coronary syndrome. Bulletin VSSC of the Russian Academy of Medical Science. 2010;3(73):143–145. In Russian].

9. Эрлих А. Д., Грацианский Н. А. Независимый регистр острых коронарных синдромов Рекорд. Характеристика больных и лечение до выписки из стационара. Атеротромбоз. 2009;1(2):105–119. [Erlich AD, Gratsiansky NA. Independent registry of acute coronary syndromes Record. Characteristics of patients and treatment before discharge from the hospital. Atherothrombosis. 2009;1(2):105–119. In Russian].

10. Kannel WB, LeBauer EJ, Dawber TR, McNamara PM. Relation of body weight to developement of coronary heart disease. The Framingham Study. Circulation. 1967;35(4):734–744.

11. Reunanen A, Karjalainen J, Ristola P, Heliövaara M, Knekt P, Aromaa A. Heart rate and mortality. J Intern Med. 2000;247 (2):231–9.

12. Dyer AR, Persky V, Stamler J, Paul O, Shekelle RB, Berkson DM et al. Heart rate as a prognostic factor for coronary heart disease and mortality findings in three Chicago epidemiological studies. Am J Epidemiol. 1980;112(6):736–49.

13. Filipovski J, Ducimetiere P, Safar ME. Prognostic significance of exercise: blood pressure and heart rate in middleaged men. Hypertension. 1992;20(3):333–9.

14. Greenland P, Daviglus ML, Dyer AR, Liu K, Huang CF, Goldberger JJ et al. Resting heart rate is a risk factor for cardiovascular and noncardiovascular mortality. Am J Epidemiol. 1999; 149(9):853–62.

15. Jouven X, Desnos M, Guerot C, Ducimetière P. Predicting sudden death in the population: the Paris Prospective Study 1. Circulation. 1999;99(15):1978–83.

16. Кобалава Ж. Д., Шаварова Е. К. Частота сердечных сокращений у больных артериальной гипертонией: возможный маркер повышенного риска или самостоятельная терапевтическая мишень? Системные гипертензии. 2015;12(2):13–18. [Kobalava ZhD, Shavarova EK. Heart rate in patients with arterial hypertension: a possible marker of increased risk or an independent therapeutic target? Systemic Hypertension. 2015;12(2):13–18. In Russian].

17. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. The Heart Outcomes Prevention Evaluation Study Investigators (2000). Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342(3):145–153.

18. Осадчук М. А. Оптимизация терапии больных пожилого возраста с артериальной гипертензией в сочетании с избыточной массой тела, гиперхолестеринемией и стабильной стенокардией II функционального класса. МЕДПРОСВИТА [Электронный ресурс]. URL: http://www.ns03.ru/index.php/research/item/63. [Osadchuk MA. Optimization of therapy of elderly patients with hypertension combined with overweight, hypercholesterolemia and stable angina of functional class II. MEDPROSVITA [Electronic Source]. URL: http://www. ns03.ru/index.php/research/item/63. In Russian].