Abstract Objective. To evaluate the 24‑h profile of brachial and aortic blood pressure (BP) in patients with rheumatoid arthritis (RA) compared to the controls and to investigate the associations of the abnormalities.

Design and methods. The cross-sectional study included 85 patients with RA (males 22,4 %, aged 59,7 ± 14,3 years, hypertension (HTN) in 65 %, mean DAS‑28 (C‑reactive protein, CRP) 3,7 ± 1,1) and control group (40 patients matched by gender, age and risk factors). Office brachial BP was measured with a validated oscillometric device, 24-hour ambulatory blood pressure monitoring (ABPM) by BPLab Vasotens, arterial stiffness and aortic BP by applanation tonometry. Cardiovascular (CV) risk was calculated as mSCORE (EULAR recommended modified version). P < 0,05 was considered significant.

Results. The rate of BP control was 58 % in RA and 67 % in the control group (p = 0,48). Patients with RA and HTN compared to matched controls had higher levels of brachial and aortic office, mean daytime, nighttime and 24‑h systolic BP (SBP), patients with RA without HTN showed higher brachial night SBP (113 ± 10 vs 105 ± 9 mmHg, р = 0,02). All patients with RA had higher rate of masked HTN (28,2 % vs 7,5 %, p = 0,009), night SBP and DBP elevation (56,5 % vs 17,5 %, p < 0,001; 26,7 % vs 0 %, p = 0,02, in the group without HTN, respectively), isolated nocturnal HTN (30,6 % vs 5 %, p = 0,001) and non-dipping (83,5 % vs 62,5 %, p = 0,02). Univariate analysis revealed significant associations of night brachial SBP with age (r = 0,5), office SBP (r = 0,6) and diastolic BP (DBP) (r = 0,3), carotid-femoral (cf) pulse wave velocity (PWV) (r = 0,5) and mSCORE (r = 0,5); non-dipping pattern was associated with age (r = 0,22) and night brachial and aortic DBP (r = 0,36 and 0,35, respectively), р < 0,05 for trend. Multivariate analysis confirmed independent associations of night brachial SBP with cfPWV (β = 0,43, p = 0,009) and non-dipping with night brachial DBP (β = 0,57, p = 0,007). Non-dippers with elevated night SBP had the highest levels of cfPWV, CRP and mSCORE compared to dippers and non-dippers with normal night SBP.

Conclusions. High incidence of night SBP elevation does not depend on the history of HTN and is associated with cfPWV increase. Non-dipping state correlates with elevation of night brachial DBP. Combination of non-dipping state with night HTN is associated with arterial stiffness and higher CV risk. Inflammation might mediate these associations.

XXI century emphasized humanity to embrace the digital era after a reality of Third and Fourth Industrial Revolutions, nowadays dictating new terms of social networking. It is expected that information and communication technologies integrated with value-based medicine will significantly impact healthcare delivery to tremendous number of patients with socially important noncommunicable diseases. Cardiovascular illnesses comprise the greatest part of such pathologies. Hypertension (HTN) being the most prevalent cardiovascular disease is also the key modifiable cardiovascular risk factor yet seems to be an attractive target for both value-based concept and telehealth interventions. Present review addresses up-to-date science on telehealth, sets out the main well-known, but yet unsolved challenges in management of HTN along with the new approaches involving telemedicine programs, digital health outlooks. The main barriers of telehealth implementation are also considered along with the possible solutions.

Elevated blood pressure (BP) is an important risk factor not only for cardiovascular morbidity and mortality, but also for cognitive decline and loss of autonomy in later life. Randomized clinical trials (RCTs) in populations of older patients living at home with low comorbidity and preserved autonomy showed benefits of decreasing the elevated BP in patients older than 80 years. Older patients with frailty, loss of autonomy and other geriatric problems were systematically excluded from the RCTs. Observational studies in these groups of patients showed an increase in morbidity and mortality at a lower level of BP during antihypertensive therapy. Obviously, in very elderly patients a universal strategy for the BP lowering cannot be applied due to the significant heterogeneity of their functional status. In this review geriatric approach based on assessment of the functional status of the elderly patient, the presence of frailty and degree of loss of autonomy as a basis for decision-making process regarding the antihypertensive therapy is discussed.

Several recent large studies, most of which were performed in Denmark, have revealed a link between hydrochlorothiazide use and the risk of non-melanoma skin cancer. Photosensitizing properties of hydrochlorothiazide, inherent in many antihypertensive drugs, are considered a key pathophysiological mechanism underlying this association. The results of these studies prompted an update to the recommendations of the European Medical Agency for the safety of hydrochlorothiazide. However, to date there have been no convincing evidence of causality of this association. The accumulation of data on usage of hydrochlorothiazide, the most widely used diuretic worldwide, made the discussion of this association possible despite the low prevalence of skin cancer. At the same time, the retrospective design of these studies should be considered, as well as limited sample and lack of adjustment for important confounders. Therefore, the results obtained in these studies must be interpreted with extreme caution to prevent the decrease in hypertension control due to reduced compliance with treatment, unjustified withdrawal or replacement of hydrochlorothiazide, including its fixed combinations, with other thiazide or thiazide-like diuretics, which also have photosensitizing action.

Numerous studies have demonstrated the negative prognostic value of tachycardia, both in the general population and in specific subgroups, including patients with coronary artery disease (CAD), arterial hypertension (HTN) and heart failure with preserved ejection fraction (HFpEF). In the latest edition of the European guidlines for the treatment of HTN the level of heart rate (HR) exceeding 80 beats per minute is highlighted as a separate independent predictor of adverse outcomes. However, the feasibility of pharmacological reduction of HR in patients with sinus rhythm is unclear. Unlike patients with reduced ejection fraction, in whom the positive effects of HR reduction are well established, the data on the effect of pharmacological HR reduction on the prognosis of patients with HTN, CAD and/or HFpEF are not so unambiguous. Some adverse effects of pharmacological correction of HR in such patients, which may be caused by a change in the aortic pressure waveform with its increase in late systole in the presence of left ventricular diastolic dysfunction, are discussed. The reviewed data underline the complexity of the problem of clinical and prognostic significance of increased HR and its correction in patients with HTN, stable CAD and/or HFpEF.

Objective. The aim of the study was a comparative assessment of urine NGAL (neutrophil gelatinase associated lipocalin) and KIM‑1 (kidney injury molecule‑1) as biomarkers of early detection of tubulointerstitial renal damage in patients with arterial hypertension (HTN) without concomitant diabetes mellitus and kidney disease.

Design and methods. The study involved 52 patients of both sexes (17 man and 35 women, mean age 60,2 ± 6,54 years) hospitalized for aggravation of HTN 1–3 degrees, which were divided into 3 groups with glomerular filtration rate (GFR) > 90 ml/min/1,73 m ² (n = 21), 60–90 ml/min/1,73 m ² (n = 19) and < 60 ml/min/1,73 m ² (n = 12). In a separate group, patients with albuminuria in the range 10–29 mg/g urine creatinine were isolated. The comparison group consisted of 15 normotensive individuals (6 men and 9 women, mean age 49,8 ± 9,68 years) with no obvious signs of renal, cardiovascular or other diseases. All patients and controls underwent examination, and albumin, NGAL (Human NGAL ELISA kit) and KIM‑1 (Human KIM‑1 Immunoassay ELISA) levels were assessed in the first morning urine portion.

Results. In the group of patients with GFR 67,7 ± 4,92 ml/min/1,73 m ² (mildly reduced kidney function) and in the group of patients with GFR 55,8 ± 4,44 ml/min/1,73 m ² (renal dysfunction) urine NGAL level increased by 3,43 (р < 0,05) and 3,92 times (р < 0,05), respectively, as compared with the control group. The urine concentration of KIM‑1 increased by 2,06 times (р < 0,05) was observed only in patients with renal dysfunction. Based on the ROC analysis AUC for the urine NGAL level in patients with mildly reduced kidney function is 0,78 (95 % confidence interval, 95 %CI: 0,70–0,86; p < 0,001), specificity — 89,6 %, sensitivity — 66,7 %. Similar indicators for KIM‑1 are 0,72 (95 % CI: 0,64–0,80; p < 0,001), specificity — 85,3 %, sensitivity — 16,7 %. In the group of patients with mildly reduced kidney function the urine level of NGAL correlated with the HTN severity (r = 0,8944, р < 0,001) and its duration (r = 0,8953, р < 0,001).

Conclusions. Urine NGAL as compared with KIM‑1 is a more sensitive biomarker, which indicates tubulointerstitial injury in HTN patients without diabetes mellitus and kidney diseases in the early stage of impairment renal function.

Objective. The aim was to assess the role of the aortic pulse wave velocity (PWVao) as additional predictor of hypertension (HTN) development in men with obesity.

Design and methods. 526 men without HTN (according to ambulatory blood pressure monitoring (ABPM) without therapy) (age 45,1 ± 5,0 years) with abdominal obesity (waist circumference > 94 cm) and SCORE < 5 %, without cardiovascular diseases and diabetes mellitus were examined. The diagnostic tests included the lipid and glucose profiles, creatinine, albuminuria evaluation, echocardiography, carotid ultrasound, bifunctional ABPM (portable recorder BPLab®) with average daily PWVao assessment. Patients with subclinical carotid atherosclerosis (n = 98) were excluded from the follow-up. Follow-up examination including ABPM was conducted on average after 46,3 ± 5,1 months.

Results. Data of 406 subjects were available for analysis. HTN defined as average daily BP ≥ 130/80 mm Hg was found in 157 patients (38,7 %). The mathematical model included the following parameters: age, body mass index, mean daily systolic BP and mean daily PWVao. Among these predictors a PWVao was characterized by the highest standardized regression coefficient (0,461, p < 0,001). The area under the ROC-curve was 0,945 (95 % confidence interval 0,920–0,971, р < 0,001). At the selected cut-off point of PWVao 7,7 m/s the sensitivity and specificity of the model were 85,4 % and 96,8 %, respectively.

Conclusions. The mathematical model for assessing the probability of HTN development in patients with obesity which includes the PWVao is characterized by a high overall percentage of correct classifications with comparability with actual data. Bifunctional ABPM with the PWVao evaluation in patients with obesity is the preferred method for additional prognostic assessment.

Background. The renin-angiotensin-aldosterone system (RAAS) plays a key role in target organ damage in arterial hypertension (HTN), initiating the development of left ventricular hypertrophy (LVH), as well as the heart and vascular wall fibrosis and remodeling. In addition, one of the mechanisms of the cardiovascular disease progression is the angiotensin II-induced inflammation.

Objective. To study the changes in renin, aldosterone and high-sensitive C‑reactive protein (CRP) levels two years after sympathetic renal denervation (RDN), to compare these changes with antihypertensive efficacy of the intervention and LVH regression.

Design and methods. We included 77 patients with drug-resistant hypertension in the absence of contraindications to renal denervation. All patients underwent renal radiofrequency ablation. The active renin, aldosterone and a high-sensitive CRP concentrations assessment, 24‑hour blood pressure (BP) measurement and echocardiography were performed before, at 6 months, one and two years after the intervention.

Results. There was a gradual decrease in CRP levels (the difference was significant after 6 months), aldosterone (significant two years after surgical treatment), and active renin (the difference was the most pronounced after one year). At all follow-up assessments, plasma renin activity correlated with left ventricular mass. At the same time, there were no significant differences between responders and non-responders.

Conclusions. RDN leads to a RAAS activity attenuation, manifested by the decrease in both renin and aldosterone and CRP, probably due to angiotensin II proinflammatory effects reduction. Given these effects are long-term, correlate with LVH degree and unrelated to the BP lowering, a direct cardioprotective effect of renal denervation should be considered.

Background. Orthostatic hypotension is a significant risk factor of falling in older adults. To diagnose the orthostatic hypotension an orthostatic test is used with assessment of heart rate (HR) response, systolic (SBP) and diastolic blood pressure (DBP) at the 3rd minute after the rise. However, according to studies, measurement of SBP and DBP at the 1st minute after rising can be more sensitive to detect older adults at risk of falling than at 3rd minute.

Objective. The purpose of this study was to evaluate the role of changes in SBP, DBP and HR at the 1st, 2nd and 3rd minutes when performing an orthostatic test for identification of the elderly at high-risk of falls.

Design and methods. This cross-sectional study included 100 adults aged 59+. Among them women comprise 56 % (n = 56). The following procedures were performed: the orthostatic test, anthropometry, medical history, assessment of drug treatment, depression evaluation, dementia and the degree of autonomy decline.

Results. HR response at the 1st minute after the transition from horizontal to vertical position is more significant factor of falls risk than SBP and DBP changes during performing of orthostatic test. Absence of HR increasing during the transition from horizontal to vertical position associates with 10‑fold of risk falls among older adults: odds ratio 95 % confidence interval (OR 95 % CI) 10,5 (2,9–37,8). This association remained significant even after adjusting for age, gender, β-blockers use and comorbidity.

Conclusion. Absence of HR increasing during the transition from horizontal to vertical position is a high sensitive marker of detecting older adults with polymorbidity in patients with the high risk of falls.