V. Denesiuk

National Pirogov Memorial Medical University, Vinnytsya

Introduction. It is generally accepted, that activation of renin-angiotensin-aldosterone system is the first step in the development of hypertension, subsequently leading to the formation of atherosclerotic lesions in blood vessels of heart, brain, kidneys, aorta, and further alteration of peripheral vessels. Some time after the onset of hypertension, left ventricle hypertension develops, inducing various forms of coronary heart disease, strokes, etc. Currently the above circumstances turned to be a global problem of cardiology and medicine. However,  data on diagnostic criteria and the evaluation of these combined diseases prognostic predictors are far from complete.

The aim of the study. To reflect achievements of modern cardiology in the investigation of criteria predicting complications in the blood circulatory system.

Materials and methods. A review of 51 articles is supplemented with author`s own results.

Results. It is estimated that arterial hypertension induce hypertrophy of the left ventricle with further cardiac remodeling, which contributes to myocardial infarction, strokes, and cardiac arrhythmias. In patients with coronary heart disease combined with hypertension, structural reorganization of myocardium is supplemented with remodeling of cardiac conducting system resulting with ventricular extrasystoles, atrial fibrillation, etc. Predictors of acute left ventricular failure and chronic heart failure have been published in the literature. Due to our observations, coronary heart disease in patients with hypertension correlates with disturbances in central hemodynamics, decreased contractile function of the left ventricle, changes in blood supply of different pulmonary zones, significant disturbances in tissue metabolism, these pathological signs leading to the development of chronic heart failure, arrhythmias and heart blockage, disorders of cerebral blood circulation.

Conclusion. The obtained results make it possible the identification of diagnostic criteria and predictors of various circulatory complications in patients with the diagnosed coronary heart disease combined with hypertension. However, more observations are needed to get new insight into the pathogenic mechanisms of complications development, further specification of their predictors and creating more effective methods of their prevention.

References

1. Amosova KM, Bezrodny AB, Andreev YeV, Prudkiy IV, Kudlai VD, Zaporozhets OB et al. Comparative assessment of heart rhythm variability in patients who suffered a Q-myocardial infarction, with reduced and preserved systolic function of the left ventricle in the dynamics of treatment with the inclusion of β-adrenoblockers. Heart and Vessels. 2008;3(23):66-74. (Ukrainian).
2. Babii LМ, Stroganova NP, Sawitskii SYu, Khomenko YuO. Early and remote cardiac remodeling in post-infarction patients depending on localization of the infarction. Ukrainian Journal of Cardiology. 2016;5:24-32. (Russian).
3. Barska OV. Cardiovascular events and late remodeling of the heart and 84 vessels after an acute coronary syndrome and increasing the effectiveness of preventive treatment. Vinnitsa. 2022; 216 р. (Ukrainian).
4. Belovol AN, Knyazkova II. Heart failure: diagnosis and monitoring during therapy. Heart Failure. 2012;1:24-39. (Russian).
5. Bilovol OM, Kravchun PP. Assessment of signs and options of post-infarction remodeling in patients with post-infarction cardiosclerosis. Ukrainian Therapeutical 2015;1(44):37-40. (Ukrainian).
6. Holovach IYu. Hypertrophy of the left ventricle and arterial hypertension: new pathogenetic and therapeutic concepts. News of Medicine and Pharmacy. 2013;9(460):3-5. (Russian).
7. Dedov DV, Ivanov VP, Elgardt IA. The influence of electromechanical remodeling of the heart on the development of atrial fibrillation in patients with coronary heart disease and arterial hypertension. Russian Journal of Cardiology. 2011;13-17. (Russian).
8. Denesyuk VI. Ischemic heart disease in combination with hypertension. Vinnitsa; 1995. 392 p. (Russian).
9. Denesyuk VI, Serkova VK. Diseases of the heart and blood vessels, resistant to treatment. A practical guide for physicians. Vinnitsa: Logos; 1998. 200 p. (Russian).
10. Denesyuk VI. Diseases of the heart and blood vessels in combination with the pathology of other organs and systems. Vinnitsa; 2002. 352 p. (Russian).
11. Denesyuk VI, Serkova VK, Malaya LT. Angina. Achievements, problems, prospects. Vinnitsa; Kharkiv: DP DKF; 512 p. (Russian).
12. Denesyuk OV, Denesiuk VI. The effect of complex therapy on the parameters of left ventricular remodeling and the prevention of cardiovascular events after unstable angina in combination with arterial hypertension. Pathologia. 2019;16(2):270-275. (Ukrainian).
13. Denesyuk OV. The effect of standard complex two-year therapy on the achievement of the target level of blood pressure and the regression of degrees in patients after a myocardial infarction with comorbid arterial hypertension. Likars’ka sprava. 2015;7-8:22-28. (Ukrainian).
14. Denesyuk VI, Moroz VM, Denesyuk OV. Arrhythmias and heart blocks. 30-year scientific and practical experience of studying heart rhythm disorders taking into account the recommendations of evidence-based medicine. Kyiv: Center DZK; 2017. 559 p. (Ukrainian).
15. Dynnyk OB, Havrylenko TI, Zalevsky VN. Apoptosis of cardiomyocytes, cytokines and remodeling of the myocardium against the background of the development of chronic heart failure. Likars’ka sprava. 2005;5-6:3-9. (Russian).
16. Iskanderov BG, Rakhmatullova AF. Dynamics of structural, functional and electrophysiological parameters of the heart in patients with paroxysmal atrial fibrillation after coronary artery bypass grafting in combination with radiofrequency ablation of the pulmonary veins. Russian Journal of Cardiology. 2014;12(116):19-25. (Russian).
17. Karetnikova VN, Belenkova YuA, Zykov VM et al. Glycemic level as a marker of prognosis in patients with ST-segment elevation myocardial infarction. Cardiology. 2012;1:26-31. (Russian).
18. Kobalava ZhD, Kotovskaya YuV, Safarova AF et al. Echocardiographic assessment of myocardial fibrosis in young men with arterial hypertension and different types of left ventricular remodeling. Cardiology. 2011;2:34-39. (Russian).
19. Kovalenko VM, Nesukai OG, Dolzhenko MM et al. Preventive cardiology: Implementation of international organizations in Ukraine. Kyiv: Morion; 2015. 102 p. (Ukrainian).
20. Koziolova NA, Shatunova IM. Clinical significance of left ventricular hypertrophy in arterial hypertension. Cardiology. 2015;8:62-67. (Russian).
21. Korol ST-segment elevation acute coronary syndrome and predictors of in-hospital mortality. Ukrainian Therapeutical Journal. 2016;2(49):77-80. (Ukrainian).
22. Kravchun PP. Changes in the diastolic function of the left ventricular myocardium in patients with post-infarction cardiosclerosis and arterial hypertension depending on the degree of obesity. Medicine of Emergency Conditions. 2014;6(61):158-160. (Ukrainian).
23. Mazur VV, Mazur ES, Poon ChB. Features of postinfarction remodeling of the left ventricle of the heart in patients with arterial hypertension. Cardiology. 2004;7:53-56. (Russian).
24. Malysheva OV, Sveriullina ZM, Shalaev SV. Prognostic value of various models of a certain level of coronary risk in patients with acute myocardial infarction without persistent ST segment elevations. Cardiology. 2012;4:4-9. (Russian).
25. Matova EA, Pavlenko SV, Svishchenko EP et al. Ten-year dynamics of indicators of diastolic dysfunction of the left ventricle in patients with hypertension. Ukrainian Journal of Cardiology. 2011;6:53-58. (Russian).
26. Oryshchyn ND, Ivaniv YuA. Predictors of ischemic mitral insufficiency in patients with left ventricular diastolic dysfunction after myocardial infarction of different localization. Ukrainian Journal of Cardiology. 2017;6:38-49. (Ukrainian).
27. Radchenko GD, Sirenko YuM. Hypertrophy of the left ventricle: determination of assessment methods, possibilities of regression. Arterial Hypertension. 2010;4(12):82-90. (Ukrainian).
28. Radchenko GD, Sirenko YuM. Left ventricular hypertrophy, its regression and prognosis in patients treated in a specialized department (Results of a retrospective 5-year study). Ukrainian Journal of Cardiology. 2007;1:54-62. (Ukrainian).
29. Sychov OS, Romanova EN, Getman TV, Srybna OV. Evaluation of the efficacy and safety of the Kapikor drug in patients with heart rhythm disturbances against CAD. Arhythmology. 2018;3(27):18-25. (Russian).
30. Tashchuk VK, Polyanska OS, Gulag OI, Gingulyak OM. Neurohumoral impact of arterial hypertension and chronic disease on hostrial myocardial infarction: pathogenetic interactions between heart remodeling and vicarious aldosterone antagonists. Arterial Hypertension. 2015;3(41):61- (Ukrainian).
31. Chernyavskaya TK. Angiotensin-converting enzyme inhibitors in real practice: inequality of equals. 2013;5:55-59. (Russian).
32. Yakovlev VV, Golofeevsky VYu, Sotnikov AV. Risk factors for the development of recurrent myocardial infarction in young and middle-aged men. Terapevticheskii Arkhiv. 2010;9:13-17. (Russian).
33. Agabiti-Rosei E, Porteri E, Rizzoni D. Arterial stiffness, hypertension, and rational use of nebivolol. Vasc Health Risk Manag. 2009;5(1):353-360.
34. Amigoni M, Meris A, Thune JJ. Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function. Eur Heart J. 2007;28(3):326-333.
35. Barbiri A, Barsi F, Mantovani F. Left ventricular hypertrophy reclassification and death: application of the Recommendation of the American Society of Echocardiography. European Association of Echocardiography. Eur Heart J. Cardiovac Imaging. 2012;13(1):109-117.
36. Barbiri A, Barsi F, Mantovani F. Prognostic impact of left ventricular mass seventy according to the classification proposed by the American Society of Echocardiography. European Association of Echocardiography. J Am Soc Echocardiogram. 2011;24(12):1383-1391.
37. Camm AJ, Kirchhof P, Lip GYH et al. ESC Guidelines for the management of atrial fibrillation (2010 Version). Eur Heart J. 2010;6:6-61.
38. Cohen A, Chauvel C. The best of 2001. Echocardiography. Arch Mal Coeur Vaiss. 2002;95 Spec No 1(5 Spec 1):21-28.
39. DahlöfB, GosseP, GuéretP, DubourgO, de SimoneG, SchmiederR et al. Perindopril/indapamide combination more effective than enalapril in reducing blood pressure and left ventricular mass: the PICXEL study. J Hypertens. 2005;23(11):2063-2070.
40. De las Fuentes L, Soto PF, Cupps BP, Pasque MK, Herrero P, Gropler RJ et al. Hypertensive hypertrophy is associated with abnormal myocardial fatty aci and myocardial efficiency. J Nucl Cardiol. 2006;13(3):369-377.
41. EagleKA, LimMJ, DabbousOH, PieperKS, GoldbergRJ, Van de WerfF et al. For the GRACE Investigators. A validated prediction model for all forms of acute coronary syndrome: estimating the rick of 6 – month postdis – charge death in an international registry. J Am Med Assoc. 2004;291(22):2727-2733.
42. Gerdts E, Oikarinen L, Palmieri V, Otterstad JE, Wachtell K, Boman K et al. Correlates of left ventricular hypertrophy: the Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study. 2002;39(1):739-743.
43. Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischaemic mitral regurgitation: long – term outcome and prognostic implication with quantitative Doppler assessment. Circulation. 2001;103(13):1759-1764.
44. Gupta N, Karki P, Sharma S, Shrestha N, Acharya P et al. Effect of hemodynamic and metabolic predictors on echocardiographic left ventricular mass in non-diadetic hypertensive patients. Kathmandu Univ Med J (KUMJ). 2010;8(30):172.
45. Hickey MS, Smith LR, Muhlbaier LH, Harrell FE, Reves JG, Hinohara T et al. Current prognosis of ischemic mitral regurgitation: implications for future management. Circulation. 1988;78(3 Pt 2):I51-I59.
46. Kosiborod M, Inzucchi SE, Krumholz HM, Xiao L, Jones PG, Fiske S et al. Glucometers in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk. Circulation. 2008;117(8):1018-1027.
47. Kuppahally S, Akoum N, Burgon N, Badger TJ, Kholmovski EG, Vijayakumar S et al. Left atrial starain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodelling detected by delayed – enhancement MRI. Circ Cardiovasc Imaging. 2010;3(3):231-239.
48. Pfeffer MA, Braunwald E. Ventricular remodelling after myocardial infarction. Experimental observation and clinical implication. Circulation. 1990;81(4):1169-1172.
49. Pfeffer MA, Lamas GA, Woughan DE, Parisi AF, Braunwald E. Effect of captopril on progressive ventricular dilatation after anterior myocardial infarction. New Engl J Med. 1988;319(2):80-86.
50. Schillaci G, Verdecchia P, Porcellati C, Cuccurullo O, Cosco C, Perticone F. Continuous relation between left ventricular mass and cardiovascular risk in essential hypertension. Hypertension. 2000;35(2):580-586.
51. White HD, Norris RM, Brown MA, Brandt PW, Whitlock RM, Wild CJ. Left ventricular end – systolic volume as the major determination of survival after myocardial infarction. 1987;76(1):44-51.