Ремоделирование миокарда относится к факторам, повышающим риск сердечно-сосудистых событий у лиц с артериальной гипертонией (АГ). Структурно-функциональные изменения миокарда могут быть следствием не только отчетливого влияния гемодинамических причин, но и ряда метаболических нарушений. Цель. Анализ ассоциаций инсулинорезистентности и ремоделирования левого желудочка (ЛЖ) в когорте молодых пациентов с нелеченой неосложненной АГ и высоким нормальным артериальным давлением (АД). Материал и методы. В когортное поперечное исследование включено 105 человек, у которых проанализированы клинико-демографические, антропометрические характеристики, выполнены биохимический анализ крови (креатинин, калий, липидный спектр, глюкоза, инсулин, мочевая кислота) с расчетом индексов инсулинорезистентности (HOMA-IR, METs-IR, TyG), анализ крови на гликированный гемоглобин, определяли соотношение альбумина/креатинина в разовой порции мочи. Всем обследованным измеряли офисное АД, выполняли суточное мониторирование АД, эхокардиографию с технологией 2D-спекл трекинг. Результаты. Медиана возраста составила 23 года, 85% мужчин. Избыточную массу тела или ожирение имели 51%, 39% -дислипидемию, 21% -инсулинорезистентность. Признаки ремоделирования ЛЖ наблюдались у 38 (40%) обследованных, из них у 32 (34%) -концентрическое ремоделирование, у 5 (5%) -концентрическая гипертрофия ЛЖ (ГЛЖ), у 1 (1%) -эксцентрическая ГЛЖ, нарушение глобального продольного систолического стрейна ЛЖ у 44 (47%) лиц молодого возраста с АГ и предгипертонией. При ступенчатом многофакторном регрессионном анализе независимым предиктором нарушения глобальной продольной деформации ЛЖ оказался индекс TyG (b=0,38, p=0,001). Заключение. В когорте молодых лиц с АГ и высоким нормальным АД отмечается высокая частота как инсулинорезистентности, метаболических нарушений, так и ранних признаков ремоделирования ЛЖ и субклинического снижения его систолической функции. Индекс TyG, доступный для расчета на основании рутинного биохимического обследования, является независимым фактором, влияющим на глобальную продольную деформацию ЛЖ.Ключевые слова: артериальная гипертония, молодые, предгипертония, инсулинорезистентность, гипертрофия левого желудочка, нарушение деформации левого желудочка, глобальный продольный систолический стрейн левого желудочка, 2D-спекл трекинг эхокардиография. Отношения и деятельность: нет.

Objective: Triglyceride-glucose (TyG) index is a marker of insulin resistance (IR) which has previously appeared to be a promising predictor of hypertension (HTN), coronary artery calcification and non-alcoholic fatty liver disease. However, the interrelation between TyG index and subclinical left ventricular systolic dysfunction has never been studied. Design and method: We evaluated anthropometric and metabolic characteristics, clinical blood pressure and performed 24-hours ambulatory blood pressure monitoring (ABPM) and echocardiography including two-dimensional speckle tracking in 94 young treatment-naive hypertensives (age 23 [21;25] years, 85,1% males, body mass index (BMI) 25,88 ± 4,78 kg/m2) free of diabetes mellitus. Most patients (67%) had masked HTN and diagnosis was stated with ABPM. IR was estimated with HOMA-IR and TyG index which was calculated as ln[fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. All patients were divided in two subgroups according to LV GLS median, e.g. with GLS of -20,05 or less and > -20,05. Then we compared main clinical variables including obesity and metabolic characteristics and blood pressure levels in derived subgroups. We used Student's t-test and Mann-Whitney U-test to compare variables with normal and non-normal distribution, respectively. To investigate the relationship between IR indices and GLS we performed simple and multiple linear regression analysis. Results: The subgroups were comparable in age, sex and race composition; there was also no significant difference in BMI, waist circumference (WC), waist-to-hip ratio (WHR), WC to height ratio. Insulin and HOMA-IR values were identical. The groups were significantly different in triglycerides levels (0,86 ± 0,31 vs 1,32 ± 0,79 mmol/L for GLS < -20,05 and > -20,05, respectively, p < 0,001) and TyG index (8,05 ± 0,39 vs 8,44 ± 0,55, respectively, p < 0,05). 24-hours SBP and DBP were higher in group with worse GLS: 131,2 ± 11,4 vs 139,3 ± 16,7 mm Hg and 77 [73;85,5] mm Hg, respectively, with p < 0,05 for both. In simple linear regression TyG index was a significant predictor of GLS value with beta = 0,407 (p < 0,001). After addition of age, sex, WHR and office DBP into the model TyG index remained independently associated with GLS with beta = 0,253 (p < 0,05). Conclusions: In young hypertensives TyG index is an independent predictor of GLS impairment.

Objective: Hypertension (HTN) and target organ damage rate in young subjects is underestimated in clinical practice according to latest population studies and treatment strategy of HTN is not well defined due to minor and controversial data of clinical studies. As a part of cohort study of HTN detection and evaluation in young population we investigated renal function in untreated hypertensive subjects with primary diagnosed essential hypertension. Design and method: We performed office BP evaluation and ambulatory blood pressure monitoring with oscillometric cuff-based device in 102 young subjects with untreated essential hypertension defined with ESH criteria of HTN according to office and ambulatory blood pressure monitoring (age 26.2 ± 7.7 (M ± SD) years, 88.3% male, office SBP 134.7 ± 15.8 mm Hg, office DBP 73.2 ± 12.4 mm Hg). Serum creatinine and albumin/creatinine ratio in urine were measured. GFR was calculated with CKD-EPI. For comparison of variables in quartiles of blood pressure we used one-way ANOVA for parametric ones and Kruskal-Wallis test – for non-parametric variables. Results: We compared glomerular filtration rate (GFR) and albumin/creatinine ratio (ACR) in quartiles of office and 24 h systolic and diastolic blood pressure. Significant difference in GFR was registered in office SBP quartiles: GFR in 1st and 4th quartiles was 105,1 ± 21,7 vs 90,3 ± 14 ml/min/1,73m2, with F 4.035, P value 0,0097 while there was no any significant difference of ACR levels according to office BP levels. ACR was significantly different in quartiles of mean nighttime DBP: ACR median in 1st quartile – 4 [0,75; 5,0] vs 8 [3,0; 29,0] in last quartile, P value 0,0056 with no significant difference for daytime DBP and daytime and nighttime SBP. Significant correlation between mean nighttime DBP and ACR was observed: r 0,243, P value 0,023. R for office SBP and GFR was (-0,325) with P value 0,002. Conclusions: In young untreated hypertensive subjects elevation of office SBP is associated with GFR decline while ACR has association with nighttime DBP elevation.

Objective: Magensium deficeincy is known as a risk factor for cardiovascular disease. However, the data on it's role in arterial stiffness developement is controversial. Our aim was to investigate the association of serum magnesium levels with arterial stiffness in young hypertensive patients. Design and method: We included 94 adults 18–45 years old with masked and sustained hypertension verified with 24-hours ambulatory blood pressure monitoring (ABPM). None of them were on blood pressure (BP) lowering treatment. We performed routine clinical investigation including anthropometry, biochemical blood assay, office BP measurement and ABPM. Atrerial stiffness was estimated with applanation tonometry and cardio-ankle vascular index (CAVI) measurement. To investigate the relationship between serum magnesium concentration and other variables we used Spearman's rank correlation coefficient. Results: Median age was 23[21–25] years, 79% were males, median body mass index - 24.9 [22.3;28.7]. Median serum magnesium level was 0,9 [0,84;0,94]. No significant associations were found for magnesium concentration and BP characteristics, neigher office, nor 24-hours. Pulse wave velocity was reversely associated with serum magensium level: (-0,184), p = 0,013. Magnesium concentration had also reverse significant correlation with CAVI (-0,300), p < 0,001. These findings were independent of blood pressure levels, body mass index and insulin resistance. Conclusions: Serum magnesium concentration is reversely associated with pulse wave velocity and cardio-ankle vascular index in young patients with hypertension.

Objective: While ESC define individuals with systolic blood pressure of 130–140 mm Hg or diastolic blood pressure of 80–89 mm Hg as normotensive, AHA classify them as hypertensive. Already sophisticated, clinical decision making in young hypertensives becomes really tricky, especially in patients of gray zone. Design and method: We recruited 127 adults 18–45 years old with BP 130/80 mm Hg or higher registered during check-up. All of them had never taken any BP-lowering medication. In all those out-patients we performed routine medical examination, including repeated measurements of office BP, 24-hours ambulatory BP monitoring, anthropometry, blood and urine tests and echocardiography. The participants were divided into 3 subgroups: normotensives (with SBP < 130 and/or DBP < 80mmHg, n = 64), hypertensives (SBP 140 mm Hg and/or DBP 90 mm Hg, n = 25), and intermediate group (SBP 130–139 and/or DBP 80–89 mmHg, n = 38). Results: Median age was 23[21–25] years; 81,1% were males, 90,6% were Caucasians. The subgroups were comparable in age and BMI. Patients had different glomerular filtration rate (GFR): 105,85[102,64;121,79] vs 103,02[91,61;109,73] vs 96,85[84,50;104,85] ml/min/1.73 m2 for normotensive (group I), intermediate (group II) and hypertensive (group III) patients respectively, p = 0,001. We observed difference in left ventricular mass index (LVMI): 80,32[68,34;87,06] vs 87,06[78,87;99,98] vs 92,31[85,15;107,55] g/m2 in groups I, II and III, respectively, p < 0,001. In pairwise comparison of LVMI we observed significant difference between I and II groups (p = 0,002) and I and III (p < 0,001). LV concentric remodeling was more prevalent in hypertensive patients (52%) than in normotensive (20%) or patients with intermediate BP (46%), p = 0,004. Incidence of LV hypertrophy didn’t significantly differ in groups: 3,6% vs 6,5% vs 12%, for I, II and III, respectively, p = 0,352. E/A ratio was 1,68[1,38;1,86] vs 1,55[1,3;1,9] vs 1,86[1,48;2,22] for I, II and III, respectively, p = 0,044. In the pairwise comparison the difference in E/A between normotensive and patients with intermediate level of BP was significant: p = 0,016. Conclusions: Rate and severity of abnormal LV geometry and function and GFR decline is higher in young patients with high normal BP than in those with normal and optimal BP.