MACHINE LEARNING FOR PREDICTING THE OUTCOMES AND RISKS OF CARDIOVASCULAR DISEASES IN PATIENTS WITH HYPERTENSION: RESULTS OF ESSE-RF IN THE PRIMORSKY KRAI

Nevzorova V. A.¹, Plekhova N. G.¹, Priseko L. G. ¹, Chernenko I. N.¹, Bogdanov D. Yu.², Mokshina M. V. ¹, Kulakova N. V.¹

Abstract

Aim. To assess the prospects of using artificial intelligence technologies in predicting the outcomes and risks of cardiovascular diseases (CVD) in patients with hypertension (HTN).

Material and methods. A software application was created for data mining from respondent profiles in a semi-automatic mode; libraries with data preprocessing were analyzed. We analyzed the main and additional parameters (35) of CVD risk factors in 2131 people as a part of ESSE-RF study (2014-2019). To create a forecasting model, a high-level language Python 2.7 was used using object-oriented programming and exception handling with multithreading support. Using randomization, learning (n=488) and test (n=245) samples were formed, which included data from patients with an established diagnosis of HTN.

Results. The prevalence of HTN among subjects was 34,39%. There were following significant factors for predicting CVD: anthropometric parameters, smoking, bio chemical profile (total cholesterol, ApoA, ApoB, glucose, D-dimer, C-reactive protein). As a result of a 5-year follow-up, CVD was found in 235 people (32,06%) with HTN and 187 people (13,38%) without HTN; mortality rates were 1,27% in subjects with HTN and 1,12% — without HTN. The absolute mortality risk among participants with HTN (0,037) was significantly higher (p<0,05) than in patients without HTN (0,017). To create a neural network (NN), the basic Sequential model from the Keras library was used. During machine learning, 26 variables important for the CVD development were used as input and 9 neurons — as output, which corresponded to the number of established cardiovascular events. The created NN had a predictive value of up to 97,9%, which exceeded the SCORE value (34,9%).

Conclusion. The data obtained indicate the importance of risk factor phenotyping using anthropometric markers and biochemical profile for determining their significance in the top 20 predictors of CVD. The Python-based machine learning provides CVD prediction according to standard risk assessments.

Key words: cardiovascular risk factors, hypertension, artificial intelligence.

Relationships and Activities: the study was supported by the grant of Russian Foundation for Basic Research (№ 19-29-01077).

¹Pacific State Medical University, Vladivostok; ²Vladivostok Clinical Hospital № 1, Vladivostok, Russia.

Nevzorova V. A. ORCID: 0000-0002-0117-0349, Plekhova N. G. ORCID: 0000-0002-8701-7213, Priseko L. G. ORCID: 0000-0002-3946-2064, Chernenko I. N. ORCID: 0000-0001-5261-810X, Bogdanov D. Yu. ORCID: 0000-0002-8388-5566, Mokshina M. V. ORCID: 0000-0003-3663-1560, Kulakova N. V. ORCID: 0000-0001-6473-5653.

Received: 13.02.2020

Revision Received: 21.02.2020

Accepted: 12.03.2020

For citation: Nevzorova V. A., Plekhova N. G., Priseko L. G., Chernenko I. N., Bogdanov D. Yu., Mokshina M. V., Kulakova N. V. Machine learning for predicting the outcomes and risks of cardiovascular diseases in patients with hypertension: results of ESSE-RF in the Primorsky Krai. Russian Journal of Cardiology . 2020;25(3):3751. (In Russ.) doi:10.15829/1560-4071-2020-3-3751

ASSESSMENT OF GLOMERULAR AND TUBULOINTERSTITIAL APPARATUS STATE DEPENDING ON THE LEVEL OF THE NATRIURETIC PEPTIDE IN HYPERTENSION PATIENTS

Chernyavina A. I.

Abstract

Aim. To assess the state of the glomerular and tubulointerstitial apparatus depending on the level of the N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with hypertension (HTN).

Material and methods. The study included 119 patients with stage I-II HTN (target organ damage classification). We determined the cystatin C level, glomerular filtration rate (GFF) using the CKD-EPI equation, neutrophil gelatinase‐associated lipocalin (NGAL) and NT-proBNP levels; echocardiography and sphygmoplethysmography was performed. In the first analysis, patients were divided into two groups depending on the NT-proBNP level. Group 1 (n=32) consisted of patients with NTproBNP level >125 pg/ml, group 2 (n=87) — with NT-proBNP level <125 pg/ml. Empirically, the NT-proBNP cutoff point (75 pg/ml) was found to assess the role of cystatin C. The first group included 41 patients with NT-proBNP level >75 pg/ml, the second group — 78 patients with NT-proBNP level <75 pg/ml.

Results. In the group 1 (NT-proBNP >125 pg/ml) the NGAL concentration was significantly higher than in the group 2: 2,50 [1,90;2,85] vs 1,30 [0,9;2,0] ng/ml, respectively (p=0,022). Patients in the groups did not significantly differ in the cystatin C levels and GFR (p=0,099 and p=0,090, respectively). When dividing patients according to the NT-proBNP cutoff point (75 pg/ml), the following data were obtained. The concentration of cystatin C in the first group with NT-proBNP >75 pg/ml was 1041,50 [995,00;1185,00] vs 964,30 [801,00;1090,00] ng/ml in the second group (p=0,034). Patients in the groups significantly differed in GFR (p=0,027). A correlation analysis revealed a moderate, direct relationship of NT-proBNP with cystatin C (r=0,32; p<0,005) and NGAL levels (r=0,36; p<0,05), as well as a moderate, inverse relationship with GFR (r=-0,35; p<0,005).

Conclusion. NT-proBNP determination can be used as an integrative risk stratification tool for glomerular and tubulointerstitial injury in HTN patients.

Key words: natriuretic peptide, glomerular and tubulointerstitial apparatus.

Relationships and Activities: not.

E. A. Wagner Perm State Medical University, Perm, Russia.

Chernyavina A. I. ORCID: 0000-0002-0051-6694.

Received: 09.01.2020

Revision Received: 19.01.2020

Accepted: 19.01.2020

For citation: Chernyavina A. I. Assessment of glomerular and tubulointerstitial apparatus state depending on the level of the natriuretic peptide in hypertension patients. Russian Journal of Cardiology. 2020;25(3):3712. (In Russ.) doi:10.15829/1560-4071-2020-3-3712

CLINICAL OUTCOMES IN HYPERTENSION PATIENTS AFTER CORONARY STENTING DUE TO EXERTIONAL ANGINA

Akhtereyev R. N.¹, Galyavich A. S.², Baleeva L. V. ², Galeeva Z. M.²

Abstract

Aim. To study clinical outcomes in hypertension patients after coronary stenting due to exertional angina.

Material and methods. The study included 214 patients with class 3 stable angina and hypertension. All patients underwent coronary angiography followed by elective stenting. Clinical outcomes were assessed on average after 44 months of outpatient follow-up.

Results. During the follow-up period, 43% of patients retained class III angina; the decrease in systolic (SBP) and diastolic blood pressure (DBP) was 18- and 14-mm Hg, respectively. There were 35 cases of myocardial infarction (MI) in this category of subjects. We revealed that 57% of patients had a progression of angina: from class III to class IV; the decrease in SBP and DBP was 10- and 18-mm Hg, respectively. There were 110 cases of MI and 10 cases of acute cerebrovascular accident in these patients.

Conclusion. Inadequate control of SBP in patients after stenting due to stable exertional angina leads to a greater number of complications, mainly myocardial infarction.

Key words: hypertension, exertional angina, systolic blood pressure, myocardial infarction.

Relationships and Activities: not.

¹City Clinical Hospital № 7, Kazan; ²Kazan State Medical University, Kazan, Russia.

Akhtereyev R. N. ORCID: 0000-0002-1904-8632, Galyavich A. S. ORCID: 0000-0002-4510-6197, Baleeva L. V. ORCID: 0000-0002-7974-5894, Galeeva Z. M. ORCID: 0000-0002-9580-3695.

Received: 02.02.2020

Revision Received: 09.02.2020

Accepted: 17.02.2020

For citation: Akhtereyev R. N., Galyavich A. S., Baleeva L. V., Galeeva Z. M. Clinical outcomes in hypertension patients after coronary stenting due to exertional angina. Russian Journal of Cardiology. 2020;25(3):3736. (In Russ.) doi:10.15829/1560-4071-2020-3-3736

COMORBIDITY OF HYPERTENSION AND CHRONIC VENOUS DISEASE IN MEN

Baev V. M.¹, Vagapov T. F.², Shmeleva S. A. ¹

Abstract

Aim. To study the clinical manifestations and characteristics of lower extremity chronic venous disorders (CVD) in working-age men with hypertension (HTN).

Material and methods. The study included 74 men with HTN at the age of 30-50 years and 41 men without HTN. HTN duration and regularity of antihypertensive medication intake were studied. We analyzed complaints and objective signs associated with CVD, their severity, structural and functional parameters of superficial, deep and perforator veins of the lower extremities using the triplex ultrasound. The prevalence and severity of cardiovascular risk factors among patients with HTN and CVD and patients with HTN and without CVD were analyzed.

Results. Men aged 30-50 with HTN showed a high prevalence of complaints (68%) associated with CVD: evening heaviness and fullness in the legs; pain decrease at rest; a combination of pain, spasm and swelling in long-time standing. Objective signs of CVD were recorded in 83,8% of men with HTN (most often — telangiectasia (38%) and swelling (24%)). Men with HTN were diagnosed with more severe manifestations of CVD than men without HTN. In patients with HTN, episodic pain and evening perimalleolar swelling were 1,8 and 4 times more likely, respectively, than in men without HTN. The presence of CVD and HTN was not associated with cardiovascular risk factors. HTN in men was characterized by a large-diameter veins, pathological reflux, vein tortuosity, the presence of thrombotic masses and postthrombotic lesions. In patients with HTN, along with an increased blood flow velocity in the deep and perforator veins of the lower leg, a low velocity in the deep femoral veins was observed. This is the evidence of venous insufficiency even at rest. Orthostasis in men with HTN increased the frequency of reflux in superficial veins by 2-4 times, which proves latent venous insufficiency.

Conclusion. HTN is characterized by an increase in the frequency and severity of symptoms and signs of CVD, which indicates their comorbidity.

Key words: men, comorbidity, hypertension, chronic vein disorders.

Relationships and Activities: not.

¹E.A. Wagner Perm State Medical University, Perm; ²The Medical Unit of the Ministry of Internal Affairs of Russia in the Perm Krai, Perm, Russia.

Baev V. M. ORCID: 0000-0001-9283-8094, Vagapov T. F. ORCID: 0000-0003-2849-4236, Shmeleva S. A. ORCID: 0000-0001-8274-0480.

Received: 13.04.2019

Revision Received: 28.05.2019

Accepted: 24.06.2019

For citation: Baev V. M., Vagapov T. F., Shmeleva S. A. Comorbidity of hypertension and chronic venous disease in men. Russian Journal of Cardiology . 2020;25(3):3258. (In Russ.) doi:10.15829/1560-4071-2020-3-3258

EARLY STRUCTURAL AND FUNCTIONAL LEFT VENTRICULAR DISORDERS IN YOUNG PATIENTS WITH HYPERTENSION: A ROLE OF INSULIN RESISTANCE

Shavarova E. K.¹, Kobalava J. D.¹, Yezhova N. E. ¹, Khomova I. A.¹, Bazdyreva E. I.²

Abstract

Cardiac remodeling refers to factors that increase the risk of cardiovascular events in patients with hypertension (HTN). Changes in myocardial structure and function can be caused not only by hemodynamic causes, but also a number of metabolic disorders.

Aim. To analyze the associations of insulin resistance and left ventricular (LV) remodeling in a cohort of young patients with untreated uncomplicated hypertension and high normal blood pressure (BP).

Material and methods. The presented cohort cross-sectional study included 105 subjects. We analyzed clinical, demographic and anthropometric characteristics, performed a biochemical panel (creatinine, potassium, lipid profile, glucose, insulin, uric acid) with the estimation of insulin resistance scores (HOMA-IR, METs-IR, TyG), a glycosylated hemoglobin test. Urine albumin-to-creatinine ratio was determined. Office and 24-hour ambulatory BP measurement and two-dimensional speckletracking echocardiography were performed in all patients.

Results. The median age was 23 years (men — 85%); 51% of participants were overweight or obese, 39% had dyslipidemia, 21% — insulin resistance. Signs of LV remodeling were observed in 38 (40%) subjects: 32 (34%) — concentric remodeling, 5 (5%) — concentric LV hypertrophy (LVH), 1 (1%) — eccentric LVH. Defects of LV systolic global longitudinal strain (GLS) were observed in 44 (47%) young patients with HTN and preHTN. Stepwise multivariate regression analysis revealed that the TyG index was an independent predictor of LV GLS defects (b=0,38, p=0,001).

Conclusion. In a cohort of young patients with HTN and high normal blood pressure, there is a high prevalence of insulin resistance, metabolic disorders, and early signs of LV remodeling and subclinical systolic dysfunction. The TyG index, available for estimation by routine biochemical tests, is an independent factor affecting the LV GLS.

Key words: hypertension, young patients, prehypertension, insulin resistance, left ventricular hypertrophy, left ventricular strain, left ventricular systolic global longitudinal strain, two-dimensional speckle-tracking echocardiography.

Relationships and Activities: not.

¹Peoples’ Friendship University of Russia, Moscow; ²V.V. Vinogradov City Clinical Hospital, Moscow, Russia.

Shavarova E. K. ORCID: 0000-0002-9503-9236, Kobalava J. D. ORCID: 0000-0003-1126-4282, Yezhova N. E. ORCID: 0000-0003-4382-1397, Khomova I. A. ORCID: 0000-0002-8121-9965, Bazdyreva E. I. ORCID: 0000-0002-5937-3042.

Received: 01.03.2020

Revision Received: 09.03.2020

Accepted: 13.03.2020

For citation: Shavarova E. K., Kobalava J. D., Yezhova N. E., Khomova I. A., Bazdyreva E. I. Early structural and functional left ventricular disorders in young patients with hypertension: a role of insulin resistance. Russian Journal of Cardiology . 2020;25(3):3774. (In Russ.) doi:10.15829/1560-4071-2020-3-3774

ATRIAL FIBRILLATION AND CHA ₂DS₂VASC SCORE OF 1 — IS THERE A PROBLEM IN CLINICAL PRACTICE?

Baranova E. I.^1,2, Pavlova V. A.², Ionin V. A. ^1,2, Petrishcheva E. Yu.¹, Bliznyuk O. I.², Zaslavskaya E. L. ², Ma I.¹, Skuridin D. S.¹, Shlyakhto E. V. ^1,2

Abstract

Aim. To study the incidence of nonvalvular atrial fibrillation (AF) in patients with a CHA ₂DS₂VASc score of 1 in actual clinical practice, to determine the major and minor risk factors of thromboembolism and the frequency of oral anticoagulant therapy in these patients.

Material and methods. We performed a retrospective analysis of 6575 medical records of patients hospitalized for five years in a therapeutic inpatient unit. To determine the stroke risk, major and minor modifying factors were assessed.

Results. Of 1160 patients with nonvalvular AF, 93 (8,0%) patients had a CHA ₂DS₂VASc score of 1: hypertension (87,1%), heart failure (4,3%), vascular diseases (4,3%), diabetes (2,15%) and age 65-74 years (2,2%); minor modifying factors were as follows: left atrial (LA) dilatation (81,7%), obesity (40,9%), persistent/permanent AF (37,6%), proteinuria (26,9%), chronic kidney disease (3,2%). A combination of minor risk factors was observed in 61,3%, the most common of which were obesity, LA dilatation, persistent/permanent AF. Anticoagulants were prescribed to 72% of patients with a CHA ₂DS₂VASc score of 1.

Conclusion. In actual clinical practice, patients with nonvalvular AF with a CHA ₂DS₂VASc score of 1 are often found. The most common risk factors for stroke in these patients are hypertension, persistent or permanent AF, LA dilatation, and obesity. The use of anticoagulant therapy in these patients does not contradict current guidelines. However, further prospective follow-up is necessary to determine the effectiveness and safety of this therapy.

Key words: atrial fibrillation, hypertension, CHA₂DS₂VASc score of 1, anticoagulants.

Relationships and Activities: the study was supported by a grant from the Russian cience Foundation (№ 17-75-30052).

¹Almazov National Medical Research Center, St. Petersburg; ²First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russia.

Baranova E. I. ORCID: 0000-0002-8788-0076, Pavlova V. A. ORCID: 0000-0002-8479-0331, Ionin V. A. ORCID: 0000-0001-7293-1144, Petrishcheva E. Yu. ORCID: 0000-0002-6429-2941, Bliznyuk O. I. ORCID: 0000-0002-1017-4966, Zaslavskaya E. L. ORCID: 0000-0002-1209-7765, Ma I. ORCID: 0000-0002-2339-4263, Skuridin D. S. ORCID: 0000-0002-1541-9248, Shlyakhto E. V. ORCID: 0000-0003-2929-0980.

Received: 04.02.2020

Revision Received: 25.02.2020

Accepted: 12.03.2020

For citation: Baranova E. I., Pavlova V. A., Ionin V. A., Petrishcheva E. Yu., Bliznyuk O. I., Zaslavskaya E. L., Ma I., Skuridin D. S., Shlyakhto E. V. Atrial fibrillation and CHA2DS2VASc score of 1 — is there a problem in clinical practice? Russian Journal of Cardiology. 2020;25(3):3738. (In Russ.) doi:10.15829/1560-4071-2020-3-3738

METHODS OF DIAGNOSTICS

BLOOD PRESSURE PHENOTYPES IN YOUNG PATIENTS WITH TYPE 1 DIABETES

Kobalava J. D., Stavtseva Yu. V., Troitskaya E. A., Safarova A. F., Petrosyan A. E.

Abstract

Aim. To study phenotypes of clinic and 24-hour ambulatory blood pressure (BP), to determine their associations with arterial stiffness parameters, and to assess global cardiovascular risk (CVR) in young patients with type 1 diabetes (T1D).

Material and methods. The presented cross-sectional single-center study included 81 T1D patients without a history of hypertension (HTN) and other cardiovascular diseases (CVD) (men — 39%; median age — 27 years; median duration of T1D — 6 years). All participants underwent a routine clinical and laboratory testing, measurement of clinic and 24-hour ambulatory BP (BPLab Vasotens), assessment of central BP and arterial stiffness parameters using applanation tonometry technique. BP phenotypes were analyzed with diagnostic criteria for HTN by ESC/ESH 2018 guidelines. CVR was assessed using the SCORE 10-year risk calculator (ESC 2019). The differences were considered significant at p<0,05.

Results. The prevalence of true HTN was 6,2%, masked HTN — 38,3%. Isolated nocturnal HTN was revealed in 30,7% of patients with clinic BP <140/90 mm Hg. The subgroup with masked HTN was dominated by patients with normal clinic BP (58,1%) and in most cases was characterized by isolated diastolic BP increase (64,5%). Masked HTN was associated with a higher carotid-femoral pulse wave velocity (PWV) (median — 7,2 versus 6,3 m/s, p=0,002). The most common profiles of nocturnal BP decrease were non-dipper (63.9%) and night-picker (16.6%). High and very high CVR was recorded in 87,7% of patients.

Conclusion. Hypertension occurs in 44,5% of young patients with type 1 diabetes and is characterized by a high prevalence of masked isolated nocturnal HTN and non-dipping. Masked HTN is associated with a higher carotid-femoral PWV. High and very high 10-year CVR was recorded in 87,7% of patients.

Key words: type 1 diabetes, 24-hour ambulatory blood pressure monitoring, masked hypertension, arterial stiffness, cardiovascular risk.

Relationships and Activities: not.

Peoples’ Friendship University of Russia, Moscow, Russia.

Kobalava J. D. ORCID: 0000-0003-1126-4282, Stavtseva Yu. V. ORCID: 0000-0001-9323-4444, Troitskaya E. A. ORCID: 0000-0003-1756-7583, Safarova A. F. ORCID: 0000-0003-2412-5986, Petrosyan A. E. ORCID: 0000-0002-2112-864X.

Received: 29.01.2020

Revision Received: 16.02.2020

Accepted: 11.03.2020

For citation: Kobalava J. D., Stavtseva Yu. V., Troitskaya E. A., Safarova A. F., Petrosyan A. E. Blood pressure phenotypes in young patients with type 1 diabetes. Russian Journal of Cardiology. 2020;25(3):3729. (In Russ.) doi:10.15829/1560-4071-2020-3-3729

PHENOTYPING OF MASKED HYPERTENSION BASED ON THE CLUSTERING OF 24-HOUR BLOOD PRESSURE MONITORING DATA

Geltser B. I.¹, Shakhgeldyan K. I.^1,2, Kotelnikov V. N. ¹, Vetrova O. O.¹, Orlova-Ilyinskaya V. V. ¹, Karpov R. S.³

Abstract

Aim. Phenotyping of masked hypertension (MH) based on clustering of 24-hour ambulatory blood pressure monitoring (ABPM) results data and comparing it with indicators of target organ damage.

Material and methods. We retrospectively analyzed medical records of 207 men with a median age of 34,6 years and normal office blood pressure (BP), who were systematically exposed to occupational stressors and were undergoing a routine in-patient examination. All patients underwent ABPM, echocardiography, carotid ultrasound, glomerular filtration rate estimation. The clustering of ABPM data was carried out using the Kohonen self-organizing neural networks and K-means algorithm. Data processing was performed in the R programming language using the RStudio environment.

Results. MH was diagnosed in 142 (68,6%) patients which were divided into 3 clusters according to 4 criteria factors of ABPM: systolic-diastolic (SDMH) — 50,7%, isolated systolic (ISMH) — 27,5% and isolated diastolic (IDMH) — 21,8%. Majority (51,4%) of patients with SDMH were characterized by a relatively balanced distribution of episodes of increased systolic and diastolic BP during the day, and other ratios were much less common. In patients with ISMH, hypertension prevailed in the daylight, and in IDMР — nighttime. Individual clusters differed significantly in terms of the 24-hour BP profile and signs of target organ damage. Various types of cardiac remodeling were recorded in 24 (17%) patients with MH, 16 (66,7%) of which belonged to the SDMH phenotype. Intima-media thickening >0,9 mm occurred in 40% of patients with IDMH, in 30% — SDMH and only 9% — ISMH. At the same time, the majority of patients with glomerular hyperfiltration was recorded in patients with ISMH (20,5%), and with hypofiltration — IDMH (29%) and SDMH (23,6%).

Conclusion. Modern technologies of clustering increase the effectiveness of risk stratification for patients with MH, and contribute to the personification of preventive and therapeutic programs.

Key words: masked hypertension, clustering, target organs.

Relationships and Activities: the study was partially supported by the Russian Federal Property Fund (project № 18-29-03131).

¹Far Eastern Federal University, School of Biomedicine, Vladivostok; ²Vladivostok State University of Economics and Service, School of Information Technologies, Vladivostok; ³Tomsk National Research Medical Center, Cardiology Research Institute, Tomsk, Russia.

Geltser B. I. ORCID: 0000-0002-9250-557X, Shakhgeldyan K. I. ORCID: 0000-0002-4539-685X, Kotelnikov V. N. ORCID: 0000-0001-5830-1322, Vetrova O. O. ORCID: 0000-0001-5483-2927, Orlova-Ilyinskaya V. V. ORCID: 0000-0002-9667-6149, Karpov R. S. ORCID: 0000-0002-7011-4316.

Received: 24.04.2019

Revision Received: 28.05.2019

Accepted: 24.06.2019

For citation: Geltser B. I., Shakhgeldyan K. I., Kotelnikov V. N., Vetrova O. O., Orlova-Ilyinskaya V. V., Karpov R. S. Phenotyping of masked hypertension based on the clustering of 24-hour blood pressure monitoring data. Russian Journal of Cardiology. 2020;25(3):3286. (In Russ.) doi:10.15829/1560-4071-2020-3-3286

BLOOD CELLS AND THEIR EFFECT ON THE LIPID PROFILE IN WOMEN WITH ESSENTIAL HYPERTENSION

Kuznik B. I.^1,2, Guseva E. S.², Davydov S. O. ^1,2, Smolyakov Yu. N.^1,2, Roitman E. V.³, Tsybikov N. N. ¹

Abstract

Aim. To find out the relationship of particular blood cells (BC) and their ratios with lipid metabolism in patients with essential hypertension (EH), with (EH-1) and without kinesiotherapy (EH-2).

Material and methods. The study included 30 healthy women (control group) and 72 women with EH, which were divided into 2 groups: group 1 (EH-1) — 37 women with stage II (target organ damage classification) hypertension who receive antihypertensive therapy; group 2 (EH-2) — 35 women who underwent antihypertensive therapy and kinesiotherapy (3-4 courses for 2-3 years).

Results. Correlation analysis revealed that the studied relationships in healthy women, EH-1 and EH-2 women can be either direct or inverse. In healthy women, we observed negative association of monocytes (MON) with atherogenic index (AI), a positive association of basophils (BAS) with high density lipoproteins (HDL) and its negative association with low density lipoproteins (LDL), very low density lipoproteins (VLDL) and AI and red blood cells/platelets (RBC/PLT ratio) with HDL. Negative associations of lymphocytes (LYM)/BAS ratio with triglyceride (TG) and eosinophils (EOS)/BAS ratio with LDL were also detected. Patients with EH-1 had a direct relationship between LYM/EOS ratio and TG. In patients with EH-2, a negative relationship was found between PLT and HDL, MON and HDL, neutrophils (NEU)/MON ratio and TAG, and a positive — between white blood cells (WBC), NEU, MON and AI, LYM and TAG, MON and TAG, as well as AI.

Conclusion. The obtained data indicate that all BC and their ratios in women with/without EH and with/without kinesiotherapy affect the lipid metabolism.

Key words: hypertension, blood cells, lipids, kinesiotherapy, correlations.

Relationships and Activities: not.

¹Chita State Medical Academy, Chita; ²Innovation Clinic Academy of Health, Chita; ³Pirogov Russian National Research Medical University, Moscow, Russia.

Kuznik B. I. ORCID: 0000-0002-2502-9411, Guseva E. S. ORCID: 0000-0001-6212-6571, Davydov S. O. ORCID: 0000-0001-6690-7391, Smolyakov Yu. N. ORCID: 0000-0001-7920-7642, Roitman E. V. ORCID: 0000-0002-3015-9317, Tsybikov N. N. ORCID: 0000-0002-0975-2351.

Received: 27.05.2019

Revision Received: 03.07.2019

Accepted: 07.09.2019

For citation: Kuznik B. I., Guseva E. S., Davydov S. O., Smolyakov Yu. N., Roitman E. V., Tsybikov N. N. Blood cells and their effect on the lipid profile in women with essential hypertension. Russian Journal of Cardiology. 2020;25(3):3349. (In Russ.)

doi:10.15829/1560-4071-2020-3-3349

NEURAL NETWORK ANALYSIS OF MORTALITY RISK PREDICTORS IN PATIENTS AFTER ACUTE CORONARY SYNDROME

Shvets D. A.¹, Karasev A. Yu.¹, Smolyakov M. V. ², Povetkin S. V.³, Vishnevsky V. I.⁴

Abstract

Aim. To study the possibilities of neural network analysis of clinical and instrumental data to predict the mortality risk in patients after acute coronary syndrome (ACS).

Material and methods. The study involved 400 patients after ACS which who observed for 62 months. The criterion for the complicated course of coronary artery disease (CAD) is the cardiovascular death. Group 1 consisted of 310 patients with uncomplicated course of CAD; group 2 — 90 patients with complicated course of CAD. To predict mortality risk, the machine learning method and neural network analysis was used. Machine learning was carried out with the inclusion of clinical, laboratory and instrumental (electrocardiography, echocardiography) parameters (49 in total). To solve the classification problems, two types of neural network architectures were used: Multilayer Perceptron (MLP) and Convolutional Neural Networks (CNN). The ratio in the examples for learning and validation was 340/60. The method of learning with a teacher was used on the available data in which the outcomes were known, and the neural network parameters were adjusted so as to minimize the error.

Results. The following factors made the highest contribution to the mortality risk after ACS: age; history of MI and acute cerebrovascular accident; atrial fibrillation, class 2-3 heart failure; no history of percutaneous coronary intervention; stage 3 chronic kidney disease; reduced left ventricle ejection fraction. Most of the deaths occurred in the 2nd and 4th years of follow-up, which may be due to the low effectiveness of secondary prevention of CAD. CNN architecture had higher accuracy (sensitivity — 68%; specificity — 84%; area under curve=0,74). An advantage of CNN is its ability to analyze patterns over time using recurrent neural networks.

Conclusion. Neural network analysis of clinical, laboratory and instrumental data allows configuring network parameters for mortality risk prediction. CNN predicts 5-year mortality risk after ACS with a sensitivity of 68% and a specificity of 84%.

Key words: neural network, machine learning, acute coronary syndrome, mortality.

Relationships and activities: not.

¹Orel Regional Clinical Hospital, Orel; ²OOO ActivBusinesConsult, Orel; ³Kursk State Medical University, Kursk; ⁴I.S. Turgenev Orel State University, Orel, Russia.

Shvets D. A. ORCID: 0000-0002-1551-9767, Karasev A. Yu. ORCID: 0000-0002-8334-0988, Smolyakov M. V. ORCID: 0000-0001-6059-7126, Povetkin S. V. ORCID: 0000-0002-1302-9326, Vishnevsky V. I. ORCID: 0000-0002-3004-9687.

Received: 03.12.2019

Revision Received: 17.12.2019

Accepted: 22.12.2019

For citation: Shvets D. A., Karasev A. Yu., Smolyakov M. V., Povetkin S. V., Vishnevsky V. I. Neural network analysis of mortality risk predictors in patients after acute coronary syndrome. Russian Journal of Cardiology . 2020;25(3):3645. (In Russ.)

doi:10.15829/1560-4071-2020-3-3645

CLINIC AND PHARMACOTHERAPY

THE EFFECTS OF THE COMBINATION OF ANGIOTENSIN-CONVERTING ENZYME INHIBITOR AND DIURETIC ON THE LOWER LIMB VENOUS CIRCULATION IN MEN WITH HYPERTENSION AND CHRONIC VENOUS DISORDERS

Letyagina S. V.¹, Baev V. M.², Shmeleva S. A. ², Agafonova T. Yu.²

Abstract

Aim. To study the effects of angiotensin converting enzyme (ACE) inhibitor and diuretic combination on the lower limb venous circulation in men with hypertension (HTN) and chronic venous disorders (CVD).

Material and methods. The study included 37 men with uncontrolled hypertension at the age of 46 (40-49) years, which were divided into two groups: 20 patients with objective signs of CVD (CEAP criteria) and 17 patients without CVD. During hospitalization, all participants received antihypertensive therapy with a combination of ACE inhibitor (8 mg) and diuretic (1,5 mg). Vein Doppler ultrasound at rest was performed on the day of hospitalization and after 14 days. The diameter and the area of vein lumen, flow velocity and peripheral venous pressure (PVP) were recorded. Mann-Whitney and Wilcoxon tests were used for statistical analysis.

Results. Initially, patients with CVD had higher values of PBP (by 26%), diameter and area of the vein lumen (53%) and flow velocity (by 14%) than in patients without CVD. As a result of therapy, in the group of patients with HTN and without CVD, systolic (SBP) and diastolic blood pressure (DBP) decreased to the target levels, PVP decreased by 13%, vein diameter increased by 27%, blood flow velocity decreased by 15%. Therapy in patients with CVD led to the normalization of SBP, DBP, and a decrease in PVP and flow velocity by 31% and 33%, respectively. No significant changes in the diameter and cross-sectional area of lower limb veins were noted.

Conclusion. The obtained data showed that 14-day antihypertensive therapy with ACE inhibitor and diuretic in patients with HTN and CVD, unlike patients with HTN and without CVD, did not led to vein dilation, but was associated with flow velocity and PVP decrease. By therapy’s end, most of venous hemodynamic parameters, including PVP, were identical in the studied groups.

Key words: hypertension, chronic venous disorders, antihypertensive therapy, vein.

Relationships and Activities: not.

¹The Medical Unit of the Ministry of Internal Affairs of Russia in the Perm Krai, Perm; ²E.A. Wagner Perm State medical University, Perm, Russia.

Letyagina S. V. ORCID: 0000-0002-1635-7149, Baev V. M. ORCID: 0000-0001-9283-8094, Shmeleva S. A. ORCID: 0000-0001-8274-0480, Agafonova T. Yu. ORCID: 0000-0001-9935-0040.

Received: 05.10.2019

Revision Received: 10.11.2019

Accepted: 11.11.2019

For citation: Letyagina S. V., Baev V. M., Shmeleva S. A., Agafonova T. Yu. The effects of the combination of angiotensin-converting enzyme inhibitor and diuretic on the lower limb venous circulation in men with hypertension and chronic venous disorders. Russian Journal of Cardiology. 2020;25(3):3545. (In Russ.) doi:10.15829/1560-4071-2020-3-3545

GENETICS IN CARDIOLOGY

THE RELATIONSHIP OF GENE POLYMORPHISM WITH THE HEART FAILURE RISK IN PATIENTS WITH HYPERTENSION AND HIGH ADHERENCE TO TREATMENT

Koziolova N. A., Chernyavina A. I.

Abstract

Aim. To determine the heart failure (HF) risk in patients with hypertension (HTN) and high adherence to treatment, depending on the blood concentration of the N-terminal pro-brain natriuretic peptide (NT-proBNP) and gene polymorphism.

Material and methods. The study included 232 patients with HTN without a verified diagnosis of HF. The mean age was 46,13±8,21 years. Patients were evaluated for genotypes by following markers: AGT Thr174Met rs4762, GNB3 C825T rs5443, MTHFR C677T rs1801133, MTRR Ile22Met rs1801394, ApoE Cys130Arg rs 429358, PPARα G/C rs425377. We also assessed ejection fraction, diastolic function and left ventricular mass index by echocardiography and determined NT-proBNP blood levels. Patients were divided into two groups depending on the NT-proBNP concentration. The group 1 consisted of 64 (27,6%) patients with NT-proBNP >125 pg/ml, the group 2 — 168 (72,4%) patients with NT-proBNP <125 pg/ml.

Results. Among patients with NT-proBNP >125 pg/ml, the most significant was the C/T genotype of MTHFR C677T polymorphism (rs1801133), 95% confidence interval (CI) for the odds ratio (OR) and relative risk (RR) of HF was 4,82 and 3,29, respectively (95% CI for OR=2,24-10,60; for OR=1,80-6,39). The A/G and G/G genotypes of the MTRR Ile22Met polymorphism (rs1801394) were statistically significant. The probability of HF with the A/G genotype of the MTRR gene increased by more than 2 times (OR=2,32, 95% CI=1,15-4,64), and the OR of its development was 1,77 (95% CI=1,11-2,69). The probability of HF with the G/G genotype increased more than 3 times (OR=3,65, 95% CI=1,37-9,76), and the OR of its development was 2,20 (95% CI=1,25-3,27). Correlation analysis revealed a direct relationship between the NTproBNP levels and polymorphism of the MTHFR (r=0,47; p<0,005) and MTRR (r=0,33; p<0,05) genes.

Conclusion. In patients with HTN and high adherence to treatment, the HF risk with an Nt-proBNP >125 pg/ml depends on genetic determinism. Candidate genes for the HF in HTN patients with high adherence to treatment are the genotypes C/T of MTHFR C677T polymorphism (rs1801133), and A/G and G/G of MTRR Ile22Met polymorphism (rs1801394).

Key words: gene polymorphism, hypertension, natriuretic peptides.

Relationships and Activities: not.

E. A. Wagner Perm State Medical University, Perm, Russia.

Koziolova N. A. ORCID: 0000-0001-7003-5186, Chernyavina A. I. ORCID: 0000-0002-0051-6694.

Received: 11.01.2020

Revision Received: 20.01.2020

Accepted: 11.03.2020

For citation: Koziolova N. A., Chernyavina A. I. The relationship of gene polymorphism with the heart failure risk in patients with hypertension and high adherence to treatment. Russian Journal of Cardiology. 2020;25(3):3708. (In Russ.) doi:10.15829/1560-4071-2020-3-3708

EXPERT CONSENSUS

MODERN ANTIHYPERTENSIVE THERAPY: THE EFFECTIVENESS OF A UNIQUE RUSSIAN FIXED-DOSE COMBINATION OF RAMIPRIL AND INDAPAMIDE

Konradi A. O., Nedogoda S. V., Nedoshivin A. O., Ratova L. G., Libis R. A. on behalf of the working group

Working group: Arutyunov G. P., Borovkova N. Yu., Galyavich A. S., Grinshtein Yu. I., Duplyakov D. V., Kashtalap V. V., Lopatin Yu. M., Lyamina N. P., Malchikova S. V., Mikhin V. P., Nechaeva G. I., Ostroumova O. D., Ripp T. M., Chumakova G. A., Shaposhnik I. I., Yakusevich V. V.

Key words: hypertension, fixed-dose combination, ramipril, indapamide.

Relationships and Activities: not.

Konradi A. O. ORCID: 0000-0001-8169-7812, ResearcherID: P-1547-2014, Nedogoda S. V. ORCID: 0000-0001-5981-1754, Nedoshivin A. O. ORCID: 0000-0001-8892-6411, Ratova L. G. ORCID: 0000-0002-3109-034X, ResearcherID: U-7767-2017, Libis R. A. ORCID: 0000-0003-0130-990X, ResearcherID: O-9193-2015, Arutyunov G. P. ORCID: 0000-0002-6645-2515, ResearcherID: K-9721-2018, Borovkova N. Yu. ORCID: 0000-0001-7581-4138, Galyavich A. S. ORCID: 0000-0002-4510-6197, ResearcherID: L-6327-2015, Grinshtein Yu. I. ORCID: 0000-0002-4621-1618, ResearcherID: M-4091-2014, Duplyakov D. V. ORCID: 0000-0002-6453-2976, ResearcherID: O-5547-2014, Kashtalap V. V. ORCID: 0000-0003-3729-616X, ResearcherID: N-1491-2016, Lopatin Yu. M. ORCID: 0000-0002-6453-2976, ResearcherID: N-9262-2015, Lyamina N. P. ORCID: 0000-0001-6939-3234, ResearcherID: M-4547-2014, Malchikova S. V. ORCID: 0000-0002-2209-9457, Mikhin V. P. ORCID: 0000-0002-5398-9727, ResearcherID: G-4776-2013, Nechaeva G. I. ORCID: 0000-0002-2255-128Х, ResearcherID: Е-9250-2014, Ostroumova O. D. ORCID: 0000-0002-0795-8225, Ripp T. M. ORCID: 0000-0001-5898-0361, ResearcherID: P-6586-2015, Chumakova G. A. ORCID: 0000-0002-2810-6531, ResearcherID: L-5677-2015, Shaposhnik I. I. ORCID: 0000-0002-7731-7730, ResearcherID: P-2221-2015, Yakusevich V. V. ORCID: 0000-0003-2667-5893, ResearcherID: D-1950-2018.

Received: 11.03.2020

Revision Received: 16.03.2020

Accepted: 17.03.2020

For citation: Konradi A. O., Nedogoda S. V., Nedoshivin A. O., Ratova L. G., Libis R. A., Arutyunov G. P., Borovkova N. Yu., Galyavich A. S., Grinshtein Yu. I., Duplyakov D. V., Kashtalap V. V., Lopatin Yu. M., Lyamina N. P., Malchikova S. V., Mikhin V. P., Nechaeva G. I., Ostroumova O. D., Ripp T. M., Chumakova G. A., Shaposhnik I. I., Yakusevich V. V. Modern antihypertensive therapy: the effectiveness of a unique Russian fixed-dose combination of ramipril and indapamide. Russian Journal of Cardiology. 2020;25(3):3782. (In Russ.) doi:10.15829/1560-4071-2020-3-3782

CLINICAL AND RESEARCH MEDICINE

MAY MEASUREMENT MONTH 2019: ADHERENCE TO TREATMENT AND HYPERTENSION CONTROL IN RUSSIA

Rotar O. P.^1,24, Tolkunova K. M.¹, Solntsev V. N. ¹, Erina A. M.¹, Boyarinova M. A.¹, Alieva A. S. ¹, Moguchaya E. V.¹, Kolesova E. P.¹, Pavlyuk E. I. ¹, Posnenkova O. M.², Abrosimova O. V.³, Drapkina O. M. ⁴, Shepel R. N.⁴, Ivanova E. S.⁴, Zhamalov L. M. ⁴, Ivanova M. I.⁵, Evdokimov D. S.⁵, Boldueva S. A. ⁵, Yakunchenko T. I.⁶, Mevsha O. V.⁶, Petrova M. N. ⁷, Pokoeva Z. A.⁸, Kalinkina T. V.⁸, Statsenko M. E. ⁹, Derevyanchenko M. V.⁹, Lopatin Yu. M.⁹, Petrova M. M. ¹⁰, Kaskaeva D. S.¹⁰, Chernova A. A.¹⁰, Nikulina S. Yu. ¹⁰, Kaplieva O. V.¹¹, Mikhaylichenko A. O.¹¹, Latkin O. E. ¹¹, Smirnova E. A.¹², Kholodkova Yu. A.¹³, Mikhin V. P. ¹⁴, Novokreshchennyh O. G.¹⁵, Dolya E. M.¹⁶, Gaffarov N. S. ¹⁶, Yevsevieva M. E.¹⁷, Fursova E. N.¹⁷, Italintseva E. V. ¹⁷, Sergeeva O. V.¹⁷, Makeeva E. R.¹⁸, Nurtdinova I. I. ¹⁹, Tagirova L. M.¹⁹, Bukharova E. K.²⁰, Ripp T. M. ²⁰, Mordovin V. F.²⁰, Kochergina A. M.^21,22, Leonova V. O. ²², Okunev I. M.²¹, Sharapova Yu. A.²³, Tanicheva A. A. ¹, Konradi A. O.¹, Shlyakhto E. V.¹

Abstract

The International Society of Hypertension and the World Hypertension League initiated a blood pressure screening study called May Measurement Month 2019 (MMM19) to improve the detection of elevated blood pressure (BP) and to assess BP control in patients with hypertension (HTN).

Aim. To assess adherence to treatment of the hypertensive population according to MMM19 campaign in Russia.

Material and methods. During May 2019, 5394 people from 21 regions of Russia took part in the screening. Participation was voluntary and did not imply gender restrictions; all subjects were over 18 years of age. During the screening, BP was measured three times using electronic and mechanical sphygmomanometers, as well as a questionnaire on the diabetes, history of cardiovascular events, smoking, and alcohol consumption was filled. Information was also collected on the date of last BP check and the administration of statins, acetylsalicylic acid and antihypertensive drugs. Data on height and body weight was obtained from respondents.

Results. The analysis included data from 5274 participants aged 18 to 96 years (men — 1834 (34,8%)). Median age was 25 years, quartiles — 20 and 49 years. According to MMM19 data, the proportion of HTN patients in the Russian population was 31,9%, and with the exception of participants under 25 years old — 51,5%. Patients with HTN over 25 years old take antihypertensive therapy in 73,6%; 38,6% are characterized by irregular drug intake. Only 11,8% of men and 17,2% of women reach the target blood pressure <130/80 mm Hg. Only 20-30% of patients who used 4-5 antihypertensives reached the target BP level.

Conclusion. According to MMM19 in Russia, only a third of high-risk patients measured BP over the past 12 months. There is also low adherence to antihypertensive therapy and inadequate control of HTN. Patients with HTN and a history of cardiovascular events are more likely to take antihypertensives regularly.

Key words: screening, hypertension, blood pressure, adherence, awareness.

Relationships and Activities: not.

¹Almazov National Medical Research Center, St. Petersburg; ²V.I. Razumovsky Saratov State Medical University, Saratov; ³Saratov State Technical University, Saratov; ⁴National Medical Research Center for Therapy and Preventive Medicine, Moscow; ⁵I.I. Mechnikov North-Western State Medical University, St. Petersburg; ⁶Belgorod National Research University, Belgorod; ⁷North-Eastern Federal University, Yakutia; ⁸Chita State Medical Academy, Chita; ⁹Volgograd State Medical University, Volgograd; ¹⁰V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk; ¹¹Far-Eastern State Medical University, Khabarovsk; ¹²I.P. Pavlov Ryazan State Medical University, Ryazan; ¹³Ryazan Regional Clinical Cardiology Dispensary, Ryazan; ¹⁴Kursk State Medical University Kursk; ¹⁵N.A. Semashko Republican Clinical Hospital, Ulan-Ude, Republic of Buryatia; ¹⁶V.I. Vernadsky Crimean Federal University, S. I. Georgievsky Medical Academy, Simferopol, Republic of Crimea; ¹⁷Stavropol State Medical University, Stavropol; ¹⁸City Clinical Hospital № 1, Ulyanovsk; ¹⁹Ulyanovsk State University, Ulyanovsk; ²⁰Tomsk National Research Medical Center, Tomsk; ²¹Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; ²²Kemerovo State Medical University, Kemerovo; ²³N. N. Burdenko Voronezh State Medical University, Voronezh; ²⁴ITMO University, St. Petersburg, Russia.

Rotar O. P. ORCID: 0000-0002-5530-9772, ResearcherID: A-3670-2014, Tolkunova K. M. ORCID: 0000-0002-2083-0947, ResearcherID: ААВ-4484-2020, Solntsev V. N. ORCID: 0000-0002-2066-6542, ResearcherID: H-2707-2013, Erina A. M. ORCID: 0000-0003-0648-3421, ResearcherID: AAH-1857-2019, Boyarinova M. A. ORCID: 0000-0002-5601-0668, ResearcherID: AAH-2738-2019, Alieva A. S. ORCID: 0000-0002-9845-331X, ResearcherID: AAH-2371-2019, Moguchaya E. V. ORCID: 0000-0003-0838-5390, ResearcherID: AAH-3802-2019, Kolesova E. P. ORCID: 0000-0002-1073-3844, ResearcherID: AAH-2492-2019, Pavlyuk E. I. ORCID: 0000-0002-0108-5996, ResearcherID: AA-5267-2020, Posnenkova O. M. ORCID: 0000-0001-5311-005X, ResearcherID: B-5627-2015, Abrosimova O. V. ORCID: 0000-0002-0754-8373, ResearcherID: AAB-7688-2020, Drapkina O. M. ORCID: 0000-0002-4453-8430, ResearcherID: G-8443-2016, Shepel R. N. ORCID: 0000-0002-8984-9056, ResearcherID: G-8380-2016, Ivanova E. S. ORCID: 0000-0001-5379-7170, ResearcherID: AAB-2701-2020, Zhamalov L. M. ORCID: 0000-0003-2349-9791, ResearcherID: AAB-2836-2020, Ivanova M. I. ORCID: 0000-0002-3438-9742, ResearcherID: ААВ-3258-2020, Evdokimov D. S. ORCID: 0000-0002-3107-1691, ResearcherID: ААВ-3172-2020, Boldueva S. A. ORCID: 0000-0002-1898-084X, ResearcherID: AAH-3862-2019, Yakunchenko T. I. ORCID: 0000-0002-4031-6267, ResearcherID: AAB-5612-2020, Mevsha O. V. ORCID: 0000-0001-7238-7302, ResearcherID: AAB-5315-2020, Petrova M. N. ORCID: 0000-0001-5443-5905, ResearcherID: F-8712-2014, Pokoeva Z. A. ORCID: 0000-0002-8712-0237, ResearcherID: AAB-6519-2020, Kalinkina T. V. ORCID: 0000-0002-0575-2530, ResearcherID: AAB-5276-2020, Statsenko M. E. ORCID: 0000-0002-3306-0312, ResearcherID: P-2769-2015, Derevyanchenko M. V. ORCID: 0000-0002-6232-4583, ResearcherID: A-1859-2016, Lopatin Yu. M. ORCID: 0000-0003-1943-1137, ResearcherID: B-2804-2017, Petrova M. M. ORCID: 0000-0002-8493-0058, ResearcherID: L-5623-2014, Kaskaeva D. S. ORCID: 0000-0002-0794-2530, ResearcherID: S-8106-2016, Chernova A. A. ORCID: 0000-0003-2977-1792, ResearcherID: F-3814-2016, Nikulina S. Yu. ORCID: 000-0002-6968-7627, ResearcherID: N-7054-2014, Kaplieva O. V. ORCID: 0000-0002-3074-6706, ResearcherID: AAB-3552-2020, Mikhaylichenko A. O. ORCID: 0000-0002-6202-533X, ResearcherID: AAB-3549-2020, Latkin O. E. ORCID: 0000-0003-3778-5254, ResearcherID: AAB-3559-2020, Smirnova E. A. ORCID: 0000-0003-0334-6237, ResearcherID: Y-1235-2018, Kholodkova Yu. A. ORCID: 0000-0001-8774-4608, ResearcherID: AAB-6614-2020, Mikhin V. P. ORCID: 0000-0002-5398-9727, ResearcherID: G-4776-2013, Novokreshchennyh O. G. ORCID: 0000-0002-9592-7559, ResearcherID: AAB-3682-2020, Dolya E. M. ORCID: 0000-0002-0766-3144, ResearcherID: AAB-5326-2020, Gaffarov N. S. ORCID: 0000-0002-0665-6874, ResearcherID: AAB-3299-2020, Yevsevieva M. E. ORCID: 0000-0001-9579-252X, ResearcherID: U-4053-2017, Fursova E. N. ORCID: 0000-0001-8636-0987, ResearcherID: AAB-5018-2020, Italintseva E. V. ORCID: 0000-0002-3988-3432, ResearcherID: S-1125-2016, Sergeeva O. V. ORCID: 0000-0002-5273-5194, ResearcherID: AAB-6298-2020, Makeeva E. R. ORCID: 0000-0002-8524-1094, ResearcherID: AAB-4811-2020, Nurtdinova I. I. ORCID: 0000-0002-3473-725X, ResearcherID: AAB-5017-2020, Tagirova L. M. ORCID: 0000-0002-9286-2577, ResearcherID: ААВ-4904-2020, Bukharova E. K. ORCID: 0000-0001-8798-1531, ResearcherID: ААВ-4737-2020, Ripp T. M. ORCID: 0000-0001-5898-0361, ResearcherID: P-6586-2015, Mordovin V. F. ORCID: 0000-0002-2238-4573, ResearcherID: F-8913-2017, Kochergina A. M. ORCID: 0000-0003-3998-7028, ResearcherID: I-6495-2017, Leonova V. O. ORCID: 0000-0001-7608-4499, ResearcherID: AAB-3574-2020, Okunev I. M. ORCID: 0000-0001-9619-3123, ResearcherID: AAB-3572-2020, Sharapova Yu. A. ORCID: 0000-0002-4269-2143, ResearcherID: AAB-5935-2020, Tanicheva A. A. ORCID: 0000-0001-9375-3340, ResearcherID: AAC-5213-2020, Konradi A. O. ORCID: 0000-0001-8169-7812, ResearcherID: P-1547-2014, Shlyakhto E. V. ORCID: 0000-0003-2929-0980, ResearcherID: A-6939-2014.

Received: 04.02.2020

Revision Received: 05.03.2020

Accepted: 16.03.2020

For citation: Rotar O. P., Tolkunova K. M., Solntsev V. N., Erina A. M., Boyarinova M. A., Alieva A. S., Moguchaya E. V., Kolesova E. P., Pavlyuk E. I., Posnenkova O. M., Abrosimova O. V., Drapkina O. M., Shepel R. N., Ivanova E. S., Zhamalov L. M., Ivanova M. I., Evdokimov D. S., Boldueva S. A., Yakunchenko T. I., Mevsha O. V., Petrova M. N., Pokoeva Z. A., Kalinkina T. V., Statsenko M. E., Derevyanchenko M. V., Lopatin Yu. M., Petrova M. M., Kaskaeva D. S., Chernova A. A., Nikulina S. Yu., Kaplieva O. V., Mikhaylichenko A. O., Latkin O. E., Smirnova E. A., Kholodkova Yu. A., Mikhin V. P., Novokreshchennyh O. G., Dolya E. M., Gaffarov N. S., Yevsevieva M. E., Fursova E. N., Italintseva E. V., Sergeeva O. V., Make eva E. R., Nurtdinova I. I., Tagirova L. M., Bukharova E. K., Ripp T. M., Mordovin V. F., Kochergina A. M., Leonova V. O., Okunev I. M., Sharapova Yu. A., Tanicheva A. A., Konradi A. O., Shlyakhto E. V. May Measurement Month 2019: adherence to treatment and hypertension control in Russia. Russian Journal of Cardiology . 2020;25(3):3745. (In Russ.) doi:10.15829/1560-4071-2020-3-3745

HYPERTENSION SPECIFIC PATIENT-REPORTED OUTCOME MEASURE. PART III: VALIDATION, RESPONSIVENESS AND RELIABILITY ASSESSMENT

Ionov M. V. ^1,2, Zvartau N. E.^1,2, Dubinina E. A.^3,4, Khromov-Borisov N. N. ¹, Tregubenko I. A.^3,5, Konradi A. O. ^1,2

Abstract

Aim. Health-related quality of life in patients with arterial hypertension (HTN) is still determined by only generic patient-reported outcome measures (PROMs), although disease-specific ones are more reliable and highly valid. Previously, we reported the results of development and item-selection process of the new Russian HTN-specific PROM. The purpose of this last stage was to confirm validity, reliability, responsiveness and sensitivity of the scale and to present its final version.

Material and methods. Analysis was done using data from a mass survey of patients with Grades 1-3 HTN (n=359, aged 25 to 91 y. o.) and healthy volunteers (n=48, aged 23 to 65 y.o), 407 returned questionnaires. We conducted two exploratory factor analyses (EFA) with the intermediate version of the PROM (80 questions, 20 of them HTN-specific). The Cattel’s scree test was used to select the optimal number of factors. After removing the items with a low factor loadings, a confirmatory factor analysis (CFA) was performed to assess the model’s fitindexes adequacy. The core indexes to be measured were SRMR, RMSEA, CFI. Finally, the PROM’s reliability (Cronbach’s α and McDonald’s ω) and criterion validity (responsiveness) were evaluated.

Results. Both EFA with oblique and varimax rotation showed 35 questions have factor loadings ≥0,5 and assigned to one of 5 factors. The basic structure of the PROM was retained for further CFA. Most of indices of fit measured met the requirements: SRMR was 0,08, RMSEA was 0,07 (90% CI (0,07-0,08)) and CFI was 0,08, which confirms the construct validity. Both Cronbach’s α and MacDonald’s ω of each of the domains were ≥0,80 and the whole scale was 0,89 confirming satisfactory reliability. Scores of the questionnaire were positively correlated with the severity of HTN (p<0,001 for Grades 1-3 HTN) and between HTN and non-HTN patients (p=0,01 and 0,04 in psychologic and social domains respectively).

Conclusion. Sequentially addressing of exploratory and confirmatory factor analyses and assessment of reliability and responsiveness allowed to form the final version of the patient-reported outcome measure for arterial hypertension. The new Russian-language questionnaire is a useful and feasible tool for routine practice and clinical trials.

Key words: hypertension, patient-reported outcome measures, health-related quality of life, questionnaire design, exploratory factor analysis, confirmatory factor analysis, reliability, responsiveness.

Relationships and Activities: the study was supported by a grant of Russian scientific Foundation (project No. 17-15-01177).

¹Almazov National Medical Research Centre, St. Petersburg; ²St. Petersburg national research University of information technologies, mechanics and optics (ITMO University), St. Petersburg; ³A. I. Herzen Russian state pedagogical University, St. Petersburg; ⁴V. M. Bekhterev National medical research center of psychiatry and neurology, St. Petersburg; ⁵I. P. Pavlov First St. Petersburg state medical University of the Ministry of Healthcare of Russia, St. Petersburg, Russia.

Ionov M. V. ORCID: 0000-0002-3664-5383, Zvartau N. E. ORCID: 0000-0001-6533-5950, Dubinina E. A. ORCID: 0000-0003-1740-6659, Khromov-Borisov N. N. ORCID: 0000-0001-6435-7218, Tregubenko I. A. ORCID: 0000-0002-8836-5084, Konradi A. O. ORCID: 0000-0001-8169-7812.

Received: 20.07.2019

Revision Received: 17.09.2019

Accepted: 24.09.2019

For citation: Ionov M. V., Zvartau N. E., Dubinina E. A., Khromov-Borisov N. N., Tregubenko I. A., Konradi A. O. Hypertension specific patient-reported outcome measure. Part III: validation, responsiveness and reliability assessment. Russian Journal of Cardiology. 2020;25(3):3438. (In Russ.) doi:10.15829/1560-4071-2019-3438

Information on previous publications:

Ionov M. V., Zvartau N. E., Dubinina E. A., Konradi A. O. Arterial hypertension specific patient-reported outcome measure. Part I: development and primary evaluation. Russian Journal of Cardiology. 2019;(6):54-60. (In Russ.) doi:10.15829/1560-4071-2019-6-54-60

Ionov M. V., Zvartau N. E., Dubinina E. A., Khromov-Borisov N. N., Konradi A. O. Hypertension specific patient-reported outcome measure. Part II: validation survey and item selection process. Russian Journal of Cardiology. 2019;(7):40-46. (In Russ.) doi:10.15829/1560-4071-2019-7-40-46

LITERATURE REVIEW

PSYCHOSOMATIC RELATIONSHIPS IN PATIENTS WITH HYPERTENSION

Larionov P. M.

Abstract

The article discusses the psychological and somatic factors associated with hypertension (HTN) and the characteristics of psychovegetative relationships in HTN from the perspective of a systemic concept of mental adaptation and maladaptation.

Emotional and personality traits of individuals with HTN (behavior, anxiety, alexithymia, neurotic traits and cognitive emotion regulation) were identified and their change under the disease effect was noted. Some aspects of adaptation to the disease, adherence to treatment and changes of life quality in people with HTN are noted. Research data were critically analyzed and new lines of searching for psychosomatic factors associated with HTN were suggested. It was proposed to shift the focus from an isolated study of personality traits, and focus on the study of psychovegetative relationships in HTN, in particular, the relationship of emotion regulation (ER) with the cardiovascular response to stress. Due to the association of ER with blood pressure changes and the opportunity to improve ER through psychological aid, and therefore, treat HTN, this approach deserves further consideration as a part of cooperation between medical workers and psychologists.

Key words: hypertension, psychosomatic relationships, psychosomatic factors, emotional and personal traits, emotion regulation.

Relationships and Activities: not.

Kazimierz Wielki University, Bydgoszcz, Poland.

Larionov P. M. ORCID: 0000-0002-4911-3984.

Received: 23.12.2019

Revision Received: 19.01.2020

Accepted: 20.01.2020

For citation: Larionov P. M. Psychosomatic relationships in patients with hypertension.

Russian Journal of Cardiology. 2020;25(3): 3683. (In Russ.)

doi:10.15829/1560-4071-2020-3-3683

CLINICAL GUIDELINES

GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF CIRCULATORY DISEASES IN THE CONTEXT OF THE COVID-19 PANDEMIC#

Authors/Task Force Members: Shlyakho E. V., Konradi A. O., Arutyunov G. P., Arutyunov A. G., Bautin A. E., Boytsov S. A., Villevalde S. V., Grigoryeva N. Yu., Duplyakov D. V., Zvartau N. E., Koziolova N. A., Lebedev D. S., Malchikova S. V., Medvedeva E. A., Mikhailov E. N., Moiseeva O. M., Orlova Ya. A., Pavlova T. V., Pevsner D. V., Petrova M. M., Rebrov A. P., Sitnikova M. Yu., Solovyova A. E., Tarlovskaya E. I., Trukshina M. A., Fedotov P. A., Fomin I. V., Khripun A. V., Chesnikova A. I., Shaposhnik I. I., Yavelov I. S., Yakovlev A. N.

Document Reviewers: Belenkov Yu. N., Galyavich A. S., Nedoshivin A. O., Abdullaev A. A., Barbarash O. L., Vasyuk Yu. A., Gabinsky Ya. L., Glezer M. G., Golukhova E. Z., Karpov R. S., Karpov Yu. A., Kobalava Zh. D., Libis R. A., Lopatin Yu. M., Matskeplishvili S. T., Nedogoda S. V., Pogosova N. V., Pozdnyakov Yu. M., Popov S. V., Chumakova G. A., Shalnova S. A., Yakushin S. S.

#This guidelines is current as of 01.04.2020. Follow the information updates on the website of the Russian Society of Cardiology www.scardio.ru

Key words: COVID-19, cardiovascular diseases, prevention, acute coronary syndrome.

Relationships and Activities: not.

Shlyakho E. V. ORCID: 0000-0003-2929-0980, Konradi A. O.* ORCID: 0000-0001-8169-7812, ResearcherID: P-1547-2014, Arutyunov G. P. ORCID: 0000-0002-6645-2515, Arutyunov A. G. ORCID: 0000-0003-1180-3549, Bautin A. E. ORCID: 0000- 0001-5031-7637, Boytsov S. A. ORCID: 0000-0001-6998-8406, Villevalde S. V. ORCID: 0000-0001-7652-2962, Grigoryeva N. Yu. ORCID: 0000-0001-6795-7884, Duplyakov D. V. ORCID: 0000-0002-6453-2976, ResearcherID: O-5547-2014, Zvartau N. E. ORCID: 0000-0001-6533-5950, Koziolova N. A. ORCID: 0000-0001-7003-5186, Lebedev D. S. ORCID: 0000-0002-2334-1663, Malchikova S. V. ORCID: 0000-0002-2209-9457, Medvedeva E. A. ORCID: 0000-0002-5130-5192, Mikhailov E. N. ORCID: 0000-0002-6553-9141, Moiseeva O. M. ORCID: 0000-0002-7817-3847, Orlova Ya. A. ORCID: 0000-0002-8160-5612, Pavlova T. V. ORCID: 0000-0003-3301-1577, Pevsner D. V. ORCID: 0000-0002-5290-0065, Petrova M. M. ORCID: 0000-0002-8493-0058, Rebrov A. P. ORCID: 0000-0002-3463-7734, Sitnikova M. Yu. ORCID: 0000-0002-0139-5177, Solovyova A. E. ORCID: 0000-0002-0013-0660, Tarlovskaya E. I. ORCID: 0000-0002-9659-7010, Trushkina M. A. ORCID: 0000-0003-3597-6794, Fedotov P. A. ORCID: 0000-0002-7452-1971, Fomin I. V. ORCID: 0000-0003-0258-5279, Khripun A. V. ORCID: 0000-0001-6765-2837, Chesnikova A. I. ORCID: 0000-0002-9323-592X, Shaposhnik I. I. ORCID: 0000-0002-7731-7730, Yavelov I. S. ORCID: 0000-0003-2816-1183, Yakovlev A. N. ORCID: 0000-0001-5656-3978.

Received: 23.03.2020

Revision Received: 30.03.2020

Accepted: 31.03.2020

For citation: Shlyakho E. V., Konradi A. O., Arutyunov G. P., Arutyunov A. G., Bautin A. E., Boytsov S. A., Villevalde S. V., Grigoryeva N. Yu., Duplyakov D. V., Zvartau N. E., Koziolova N. A., Lebedev D. S., Malchikova S. V., Medvedeva E. A., Mikhailov E. N., Moiseeva O. M., Orlova Ya. A., Pavlova T. V., Pevsner D. V., Petrova M. M., Rebrov A. P., Sitnikova M. Yu., Solovyova A. E., Tarlovskaya E. I., Trukshina M. A., Fedotov P. A., Fomin I. V., Khripun A. V., Chesnikova A. I., Shaposhnik I. I., Yavelov I. S., Yakovlev A. N. Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic. Russian Journal of Cardiology. 2020;25(3):3801. (In Russ.) doi:10.15829/1560-4071-2020-3-3801

ARTERIAL HYPERTENSION IN ADULTS. CLINICAL GUIDELINES 2020

Russian Society of Cardiology

Presidium of the Working group: Kobalava Zh. D., Konradi A. O., Nedogoda S. V., Shlyakhto E. V.

Members of the Working group: Arutyunov G. P., Baranova E. I., Barbarash O. L., Boitsov S. A., Vavilova T. V., Villevalde S. V., Galyavich A. S., Glezer M. G., Grineva E. N., Grinstein Yu. I., Drapkina O. M., Zhernakova Yu. V., Zvartau N. E., Kislyak O. A., Koziolova N. A., Kosmacheva E. D., Kotovskaya Yu. V., Libis R. A., Lopatin Yu. M., Nebiridze D. V., Nedoshivin A. O., Ostroumova O. D., Oschepkova E. V., Ratova L. G., Skibitsky V. V., Tkacheva O. N., Chazova I. E., Chesnikova A. I., Chumakova G. A., Shalnova S. A., Shestakova M. V., Yakushin S. S., Yanishevsky S. N.

Key words: arterial hypertension, adults, guidelines.

For citation: Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786. (In Russ.)

doi:10.15829/1560-4071-2020-3-3786

7 апреля 2020 г.

Russian Journal of Cardiology 2020, 25 (3)

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