Features of the clinics and treatment of patients with obesity and hypertension (according to the National register of arterial hypertension)


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Abstract

The purpose of this study lied in the examination of the clinical characteristics and assessment of the quality of treatment for patients with arterial hypertension (AH) with obesity according to the National Registry of the AH. Materials and methods. The frequency of obesity in a sample of patients with AH, observed in 2010-2016. in polyclinics and cardiological dispensaries for cardiovascular diseases (CVD), was 38.3%, of which the incidence of severe obesity (grade III) was 8%. Women account for the majority of obese AH patients (72%). Results. The study revealed the burden of AH patients with obesity in the following risk factors for CVD: dyslipidemia, hyperglycemia and a history of early cardiovascular disease. Relatively often in patients with hypertension with obesity, there were lesions of target organs (hypertrophy of the left ventricle, chronic kidney disease of the third stage), CVD [ischemic heart disease (CHD), chronic heart failure (CHF) II-IV functional class NYHA] and diabetes mellitus type 2 These data indicate that patients with AH obesity refers to a high and very high cardiovascular risk. The conclusion. Conducted antihypertensive and hypolipidemic therapy (statins) in patients with AH obesity was not optimal, only 30% of patients achieved the target level of BP and 23.6% - the target level of total cholesterol.

About the authors

E V Oshchepkova

Myasnikov Research Institute of Clinical Cardiology. FSBI "National medical research center of Cardiology" of the Ministry of Health of Russia

д.м.н., проф., руководитель лаб. мониторинга программ по снижению смертности от сердечно-сосудистых заболеваний Moscow, Russia

N V Lazareva

Myasnikov Research Institute of Clinical Cardiology. FSBI "National medical research center of Cardiology" of the Ministry of Health of Russia

Email: n.lazareva@list.ru
к.м.н., с.н.с. лаб. мониторинга программ по снижению смертности от сердечно-сосудистых заболеваний, ORCID: orcid.org/0000-0002-3253-0669 Moscow, Russia

I E Chazova

Myasnikov Research Institute of Clinical Cardiology. FSBI "National medical research center of Cardiology" of the Ministry of Health of Russia

д.м.н., проф., акад. РАН, директор Института клинической кардиологии им. А.Л. Мясникова; ORCID: orcid.org/0000-0002-9822-4357 Moscow, Russia

References

  1. Heart disease and Stroke statistics - 2016 update: a report from the American Heart Association. Circulation. 2016; 133.
  2. Клинические рекомендации «Диагностика и лечение артериальной гипертонии». Рабочая группа по подготовке текста: Чазова И.Е., Ощепкова Е.В., Жернакова Ю.В. Кардиологический вестник. 2015;1:5-30
  3. ESH/ESC Guidelines for the management of arterial hypertension. J Hypertens. 2013;31(7):1281-357.
  4. WHO. Obesity and overweight. Fact sheet N 311. Updated January 2015. Available at: http://www.who.int/mediacentre/factsheets/ fs311/en/. Checked by 10.08.2016.
  5. Gino Seravallea, Guido Grassi. Obesity and hypertension. J Pharmacological Research. 2017;122:1-7.
  6. Чазова И.Е., Жернакова Ю.В., Ощепкова Е.В. и др. Распространенность факторов риска сердечно - сосудистых заболеваний в российской популяции больных артериальной гипертонией. Кардиология. 2014;10:4-12
  7. Kannel W.B, Brand N, et al. The relation of adiposity to blood pressure and development of hypertension. The Framingam study. Amer Intern Med. 1967;67:48-59.
  8. Tanamas S.K, Wong E, Backholer K, Abdullah A, Wolfe R, Barendregt J, Peeters A. Duration of obesity and incident hypertension in adults from the Framingham Heart Study. J Hypertens. 2015 Mar;33(3):542-5.
  9. Stamler J, Rose G, Stamler R. INTERSALT study finding. Public health and medical care implications. Hypertension. 1989;14(5):570-7.
  10. Landsberg L. Book chapter. Hypertension: A Companion to Braunwald`s Heart Disease (Third Edition). Obesity. 2018: 328-334.
  11. Hall J.E. The kidney, hypertension and obesity. Hypertension. 2003; 41(3):625-33.
  12. Poirier P, Giles T.D, Bray G.A, et al. American Heart Association; Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2006;113:898-918.
  13. Alpert M.A. Obesity cardiomyopathy; pathophysiology and evolution of the clinical syndrome. Amer J Med Sci. 2001;321:225-36.
  14. Aneja A, El-Atat F, Mc-Farlane S.I, Sowers J.R. Hypertension and obesity. Recent Progr Horm Res. 2004;59:169-205.
  15. Engeli S, Sharma A.M. The renin - angiotensin system and natriuretic peptides in obesity - associated hypertension. J Mol Med. 2001;79:21-9.
  16. Lafontan M, Moro C, Sengenes C, et al. An unsuspected metabolic role for atrial natriuretic peptides: the control of lipolysis, lipid mobilization, and systemic non esterified fatty acids levels in humans. Arterioscler Thromb Vasc Biol. 2005;25:2032-42.
  17. Jensen M.D. Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab. 2008 Nov;93(11 Suppl 1):S57-63.
  18. Grassi G, Seravalle G, et al. Sympathetic activation in obese normotensive subjects. J Hypertension. 1995;25:560-3.
  19. Seravalle G, Grassi G. Sympathetic nervous system, hypertension, obesity, and metabolic syndrome. High Blood Press. Cardiovasc Prev. 2016; 23:175-9.
  20. Meyers M.R, Gokce N. Endothelial dysfunction in obesity: etiological role in atherosclerosis. Curr Opin Endocrinol Diabetes Obes. 2007;14:365-9.
  21. Ощепкова Е.В., Лазарева Н.В., Чазова И.Е. Оценка качества обследования больных артериальной гипертонией в первичном звене здравоохранения (по данным российского Регистра артериальной гипертонии). Системные гипертензии. 2017;2:29-34
  22. Рекомендации по ведению больных АГ с метаболическими нарушениями. Российское медицинское общество по артериальной гипертонии. Москва, 2013 г.
  23. Национальные рекомендации «Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению». Рабочая группа по подготовке текста: Смирнов А.В., Шилов Е.М. и др. Нефрология. 2012;16(1):89-115.
  24. US Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 2010.
  25. Catapano A, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. European Heart J. 2016;37(39):2999-3058.
  26. Aurigemma G.P, de Simone G.D, et al. Cardiac Remodeling in Obesity. Circ Cardiovasc Imaging. 2013;6:142-52.
  27. Cuspidi C, Sala C, Negri F, et al. Prevalence of left - ventricular hypertrophy in hypertension: an updated review of echocardiographic studies. J Hum Hypertens. 2012;26(6):343-9.
  28. Салтыкова М.М., Ощепкова Е.В., Атауллаханова Д.М., Лазарева Н.В., Бобохонова А.С., Рогоза А.Н. Электрокардиографическая диагностика гипертрофии миокарда левого желудочка у пациентов с артериальной гипертензией. Терапевтический архив. 2006; 78(12):40-5.
  29. Muiesan M.L, Salvetti M, et al. Obesity and ECG left ventricular hypertrophy. J Hypertension. 2017 Jan;35(1):162-9.
  30. Messerli F.H, Williams B, et al. Essential hypertension. Lancet. 2007;18; 370(9587):591-603.
  31. Hall M.E, Carmo J.M, et al. Obesity, hypertension and chronic kidney disease. Intern J Nephrology and Renovascular Disease. 2014 Feb 18;7:75-88.
  32. Travers K, Martin A, et al. Burden and management of chronic kidney disease in Japan: systematic review of literatureю. Intern J Nephrol and Renovascular Disease. 2013;6:1-13.
  33. Landsberg L, Aronne L.J, et al. Obesity - related hypertension: pathogenesis, cardiovascular risk, and treatment - a position paper of the Obesity Society and the American Society of Hypertension. Obesity. 2013;21:8-24.
  34. De Marco V.G, Aror An R, et al. The pathophysiology of hypertension in patients with obesity. Nat Rev Endocrinol. 2014:10(6):364-76.
  35. Wang Y, Wang Q.J. The prevalence of prehypertension and hypertensionamong US adults according to the new Joint National Committee guidelines. Arch Intern Med. 2004;164:2126-34.
  36. Wezel U, et al. Treatment of arterial hypertension in obese patients. Semin Nephol. 2013 Jan;33(1):66-74.
  37. Чазова И.Е., Данилов Н.М., Литвин А.Ю. Рефрактерная артериальная гипертония: Монография. М.: Атмосфера, 2014. 256 с.
  38. Ощепкова Е.В. Глава в монографии: Чазова И.Е., Данилов Н.М., Литвин А.Ю. Рефрактерная артериальная гипертония: Монография. М.: Атмосфера, 2014:10-16.
  39. De Souza F, Muхfeldt E, et al. Essicacy of spironolactone therapy in patients with true resistant hypertension. Hypertension. 2010;55:147-15.
  40. Engbaek M, Hjerrild M, et al. The effect of low - dose spironolactone on resistant hypertension. J AM Soc Hypertens. 2010;4:290-4.

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