Objective To identify the early predictors of a self-reported persistence of long COVID syndrome (LCS) at 12 months after hospitalisation and to propose the prognostic model of its development.Design A combined cross-sectional and prospective observational study.Setting A tertiary care hospital.Participants 221 patients hospitalised for COVID-19 who have undergone comprehensive clinical, sonographic and survey-based evaluation predischarge and at 1 month with subsequent 12-month follow-up. The final cohort included 166 patients who had completed the final visit at 12 months.Main outcome measure A self-reported persistence of LCS at 12 months after discharge.Results Self-reported LCS was detected in 76% of participants at 3 months and in 43% at 12 months after discharge. Patients who reported incomplete recovery at 1 year were characterised by a higher burden of comorbidities (Charlson index of 0.69±0.96 vs 0.31±0.51, p=0.001) and residual pulmonary consolidations (1.56±1.78 vs 0.98±1.56, p=0.034), worse blood pressure (BP) control (systolic BP of 138.1±16.2 vs 132.2±15.8 mm Hg, p=0.041), renal (estimated glomerular filtration rate of 59.5±14.7 vs 69.8±20.7 mL/min/1.73 m2, p=0.007) and endothelial function (flow-mediated dilation of the brachial artery of 10.4±5.4 vs 12.4±5.6%, p=0.048), higher in-hospital levels of liver enzymes (alanine aminotransferase (ALT) of 76.3±60.8 vs 46.3±25.3 IU/L, p=0.002) and erythrocyte sedimentation rate (ESR) (34.3±12.1 vs 28.3±12.6 mm/h, p=0.008), slightly higher indices of ventricular longitudinal function (left ventricular (LV) global longitudinal strain (GLS) of 18.0±2.4 vs 17.0±2.3%, p=0011) and higher levels of Hospital Anxiety and Depression Scale anxiety (7.3±4.2 vs 5.6±3.8, p=0.011) and depression scores (6.4±3.9 vs 4.9±4.3, p=0.022) and EFTER-COVID study physical symptoms score (12.3±3.8 vs 9.2±4.2, p<0.001). At 1 month postdischarge, the persisting differences included marginally higher LV GLS, mitral E/e’ ratio and significantly higher levels of both resting and exertional physical symptoms versus patients who reported complete recovery. Logistic regression and machine learning-based binary classification models have been developed to predict the persistence of LCS symptoms at 12 months after discharge.Conclusions Compared with post-COVID-19 patients who have completely recovered by 12 months after hospital discharge, those who have subsequently developed ‘very long’ COVID were characterised by a variety of more pronounced residual predischarge abnormalities that had mostly subsided by 1 month, except for steady differences in the physical symptoms levels. A simple artificial neural networks-based binary classification model using peak ESR, creatinine, ALT and weight loss during the acute phase, predischarge 6-minute walk distance and complex survey-based symptoms assessment as inputs has shown a 92% accuracy with an area under receiver-operator characteristic curve 0.931 in prediction of LCS symptoms persistence at 12 months.

BackgroundLong COVID syndrome (LCS) represents a significant global health challenge due to its wide-ranging physical and cognitive symptoms that persist beyond 12 months in a substantial proportion of individuals recovering from SARS-CoV-2 infection. Developing tools for predicting long-term LCS persistence can improve patient management and resource allocation.ObjectiveTo evaluate the natural dynamics of symptoms over 12 months following hospitalization for COVID-19 and to establish the utility of survey-based symptoms assessment for predicting LCS at one year.MethodsThis prospective observational study included 166 hospitalized COVID-19 survivors who were evaluated pre-discharge and followed up at 1, 3, and 12 months. Assessments included surveys including physical and mental symptom scales (e.g., EFTER-COVID, SBQ-LC, PCFS, MRC Dyspnea, CAT, CCQ, and HADS) and machine learning modeling to predict LCS persistence at 12 months.ResultsLCS symptoms were reported by 76% of patients at three months and 43% at 12 months. Physical symptom scores, particularly EFTER-COVID and PCFS, consistently differentiated LCS and LCS-free cohorts. CAT outperformed other respiratory scales in its discriminatory ability, while HADS subscales showed limited predictive value. Younger patients (<40 years) demonstrated faster recovery, whereas older patients (>60 years) exhibited persistent symptoms across respiratory and cognitive domains. A machine learning model combining EFTER-COVID, SBQ-LC, CAT, and MRC Dyspnea scores achieved 91% predictive accuracy for LCS persistence at 12 months.ConclusionComprehensive survey-based symptoms assessment at three months post-discharge provides a practical and cost-effective tool for prediction of the long COVID persistence at 12 months, supporting targeted rehabilitation strategies.

Objective: To study the prognostic value of survey-based respiratory, physical, emotional, and cognitive symptoms assessment in hypertensive patients hospitalized for COVID-19 in prediction of symptoms persistence at 3 months after discharge. Design and method: 88 hospitalized patients with COVID-19 and a history of hypertension (mean age 57.8+-11.8 years, 53% female) underwent a comprehensive survey-based symptoms assessment 1-2 days prior to discharge that included MRC Dyspnea scale, CAT and CCQ questionnaires, HADS, the physical symptoms subscale of the EFTER-COVID questionnaire, and the Memory, Thinking, and Communication subscale of the SBQ-LC questionnaire. Marginal effects in logistic regression analysis were used to gauge the predictive value of resulting scores and separate symptoms. 500 SANN-based classification models were subsequently trained for various combinations of significant predictors, with an automatic ranging of obtained models by their predictive accuracy. Results: 77% of participants have reported an incomplete ecovery at 3 month after hospital discharge. In the order of decreasing predictive value for persistence of symptoms, significant (p < 0,05) risk factors included EFTER-COVID physical symptoms score (Somers’ D-statistic = 0,63), HADS depression subscale (D = 0,58), SBQ-LC Memory, Thinking, and Communication score (D = 0,52), MRC dyspnea class (D = 0,45), and CAT score (D = 0,30); among the specific symptoms, significant predictors included dyspnea (D = 0,42), dizziness (D = 0,38), muscles and joints pain (D = 0,38), and difficulties in remembering things (D = 0,40). Out of the derived machine-learning based classification models, the optimal performance was observed for the one using gender, pre-discharge MRC dyspnea class, and summary scores on EFTER-COVID physical symptoms and SBQ-LC Memory, Thinking, and Communication subscales. The model exhibited a 100% predictive acccuracy in classifying the pre-specified test/validation subset of the study group into those who would subsequently report persistence of symptoms or complete recovery. Conclusions: Survey-based pre-discharge assessment of symptoms in hypertensive patients hospitalized for acute COVID-19 yields a high prognostic value. The combination of gender and survey-based measures of dyspnea, physical and cognitive symptoms may be used in this setting to predict the persistence of symptoms at 3 months after hospital discharge.

long COVID-19 syndrome causes sustained limitations in activity and work capacity in a significant proportion of convalescents, the risk of which is higher among patients who required hospitalization. Phenotyping of COVID-19 survivors based on the most common comorbidities’ role in shaping the risks of the acute phase endpoints and development of post-covid syndrome can be used to improve the efficacy of predicting the course of the disease. To study the associations of hypertension (HT) with the clinical features of acute COVID-19 in hospitalized patients, severity of residual functional disorders and pulmonary affection by the time of discharge. Material and methods. 221 hospitalized patients with COVID-19 (age 53,4 ± 13,6 years, 53% female) were examined 1-2 days before discharge. The study protocol included interview and analysis of medical documentation to retrospectively extract the anamnestic data and clinical features of the acute phase; lung ultrasound, reactive hyperemia test of the brachial artery, and a 6-minute walk test. Results. The most frequently identified comorbidities in the study cohort were HT, obesity, and type 2 diabetes, which were present in 40%, 38%, and 10% of participants, respectively. Hypertensive patients were older (57,8 ± 11,8 vs 50,7 ± 13,9 years, р < 0,001), had higher BMI (31,7 ± 5,3 vs 31,7 ± 5,3 кг/м2, р < 0,001), higher prevalence of obesity (59% vs 25%, p < 0,001) and type 2 diabetes (21% vs 2%, p < 0,001) compared to normotensive participants, but were characterized by comparable laboratory indices, parameters of pulmonary parenchyma affection (by CT scan and lung ultrasound), endothelial function, SpO2 levels during the acute phase of the disease and by the time of discharge, as well as age- and anthropometric parameters-adjusted 6-minute walk distance (67,4 ± 10,5 % vs 69,5 ± 13,6 %, p > 0,05). Hypertensive patients hospitalized for COVID-19 were characterized by older age, higher prevalence of obesity and type 2 diabetes compared to normotensive participants but did not differ in their laboratory profile (including markers of systemic inflammation, prothrombotic activation, renal function, and liver damage), levels of pulmonary affection by CT and lung ultrasound, and endothelium-dependent vasodilatation in a reactive hyperemia test of the brachial artery. The observed decrease in the 6-minute walk distance in patients with HT was explained by differences in age and anthropometric parameters.

Objective: The accuracy of prediction of Long COVID-19 development is currently suboptimal. Phenotyping a general post-COVID-19 population based on simple clinical and anamnestic criteria may be used to address this problem. The purpose of this study was to identify the early predictors of Long COVID-19 syndrome at 3 months after discharge in hospitalized patients with a history of hypertension (HT). Design and method: 221 hospitalized patients with COVID-19 (mean age 53.4+-13.6 years, 53% female, 40% with a history of hypertension) underwent comprehensive transthoracic echocardiography and a 6-minute walk test (6MWT) 1-2 days prior to discharge and after 1 month. A combination of logistic regression analysis and unsupervised machine learning was used to derive predictive models of self-assessed Long COVID-19 at 3 months after discharge (166 patients who have completed all visits comprised the final cohort). Results: Self-assessed Long COVID-19 at 3 months was detected in 50 (77%) of hypertensive and 74 (73%) of normotensive participants, p = 0,597. In the general cohort, a modest performance of 83% was observed in the validation subset for the derived pre-discharge predictors-based ML classification model, which only constituted to re-classification of 1/3 of otherwise false-positive cases compared to the assumption of 100% prevalence of Long COVID, with a total net reclassification improvement (NRI) of 8%. Phenotyping the general cohort based on the presence of hypertensive anamnesis significantly improved the predictive accuracy for the HT-positive subgroup: 100% accuracy was observed in the validation subset with an NRI of 23% vs baseline assumption, Chi-square test P < 0,001 vs the general cohort model confusion matrix. The derived models used sex, MRC dyspnea class, Charlson comorbidity index, and either (1) pre-discharge systolic BP and mitral E to left ventricular global longitudinal strain ratio, or (2) peak D-dimer, pre-discharge 6-minute walk distance, and peak capillary oxygen desaturation during the 6MWT. Conclusions: History of hypertension can be used as a phenotyping criterion to improve the accuracy of Long COVID-19 prediction among hospitalized patients: the derived ML-based classification models yielded a 100% predictive accuracy in the pre-specified validation subset of hypertensive patients hospitalized for acute COVID-19.

Background:Long COVID syndrome has emerged as a new global healthcare challenge, with impaired physical performance being a prominent debilitating factor. Cardiopulmonary rehabilitation is a mainstay of management of symptomatic post-COVID patients, and optimization of candidate selection might allow for more effective use of available resources.Methods:In order to study the natural dynamics and to identify predictors of physical functional recovery following hospitalization for COVID-19, 6 min walk test was performed pre-discharge in 176 patients (40% hypertensive, 53% female, mean age 53.2 ± 13.5 years) with re-evaluation at 1 month.Results:Six min walk distance and the reached percent of predicted distance (6MWD%) were suboptimal at both visits-396 ± 71 m (68.7 ± 12.4%) pre-discharge and 466 ± 65 m (81.8 ± 13.6%) at 1 month. Associated changes included significant oxygen desaturation (2.9 ± 2.5 and 2.3 ± 2.2%, respectively) and insufficient increment of heart rate during the test (24.9 ± 17.5 and 28.2 ± 12.0 bpm) that resulted in low reached percent of individual maximum heart rate (61.1 ± 8.1 and 64.3 ± 8.2%). Automatic clusterization of the study cohort by the 6MWD% changes has allowed to identify the subgroup of patients with poor "low base-low increment" trajectory of spontaneous post-discharge recovery that were characterized by younger age (38.2 ± 11.0 vs. 54.9 ± 12.1, p < 0.001) but more extensive pulmonary involvement by CT (43.7 ± 8.8 vs. 29.6 ± 19.4%, p = 0.029) and higher peak ESR values (36.5 ± 9.7 vs. 25.6 ± 12.8, p < 0.001). Predictors of poor recovery in multivariate logistic regression analysis included age, peak ESR, eGFR, percentage of pulmonary involvement by CT, need for in-hospital oxygen supplementation, SpO2 and mMRC dyspnea score pre-discharge, and history of hypertension.Conclusion:COVID-19 survivors were characterized by decreased physical performance pre-discharge as assessed by the 6 min walk test and did not completely restore their functional status after 1 month of spontaneous recovery, with signs of altered blood oxygenation and dysautonomia contributing to the observed changes. Patients with poor "low base-low increment" trajectory of post-discharge recovery were characterized by younger age but more extensive pulmonary involvement and higher peak ESR values. Poor post-discharge recovery in the study cohort was predictable by the means of machine learning-based classification model that used age, history of hypertension, need for oxygen supplementation, and ESR as inputs.

Objective: To study the impact of hypertension on the formation of structural and functional cardiac changes during hospitalization for COVID-19 and the dynamics of detected changes in the early post-discharge period. Design and method: 212 hospitalized COVID-19 patients (mean age 53.4+-13.6 years, 53% female) underwent comprehensive transthoracic echocardiographic examination and the 6-minute walk test at the baseline 1-2 days prior to discharge and after 31 days of follow-up, being compared to 88 matched controls. Results: COVID-19 patients had increased absolute (10.1 ± 1.5 vs 9.1 ± 0.9 mm, p < 0.001) and relative LV walls thickness (0.45 ± 0, 07 vs 0.39 ± 0.04, p < 0.001), LV myocardial mass index (38.1 ± 8.9 vs 33.9 ± 5.8 g/m 2 .7, p < 0.001) and left atrial volume index (28.6 ± 6.6 vs 25.1 ± 4.9 ml/m 2 , p < 0.001), as well as decrease in LV global longitudinal strain (-17.5 ± 2.4 vs -18.6 ± 2, 2%, p < 0.001) and diastolic filling parameters (e’ 9.2 ± 2.2 vs 11.3 ± 2.6 cm/s, p < 0.001; E/e’ 7.5 ± 1.8 vs 6.8 ± 1.7, p = 0.002). The observed changes were more pronounced in the cohort of hypertensive participants, but also persisted among normotensive patients, resulting in a high prevalence of concentric LV geometry (78% and 43%, respectively, p < 0.001 between groups and vs control), predominantly grade I diastolic dysfunction (51% and 25%, p < 0.001 between groups and vs control), and abnormal values of global longitudinal strain (32% and 19%, p = 0.027 between groups, p < 0.001 vs control), all of which persisted throughout 1-month follow-up. The increase in the % of predicted 6-minute walk distance was 11.2 ± 7.5 in hypertensives vs 12.8 ± 7.6 in non-hypertensive participants, p > 0.05. Conclusions: Hospitalised COVID-19 patients at the pre-discharge period were characterized by the high prevalence of LV concentric geometry and diastolic dysfunction, as well as the minor decrease of its longitudinal contractility, which were more pronounced in the presence of concomitant hypertension and did not improve during 1 month of follow-up.

BackgroundPost-COVID-19 syndrome (PCS) has been increasingly recognized as an emerging problem: 50% of patients report ongoing symptoms 1 year after acute infection, with most typical manifestations (fatigue, dyspnea, psychiatric and neurological symptoms) having potentially debilitating effect. Early identification of high-risk candidates for PCS development would facilitate the optimal use of resources directed to rehabilitation of COVID-19 convalescents.ObjectiveTo study the in-hospital clinical characteristics of COVID-19 survivors presenting with self-reported PCS at 3 months and to identify the early predictors of its development.Methods221 hospitalized COVID-19 patients underwent symptoms assessment, 6-min walk test, and echocardiography pre-discharge and at 1 month; presence of PCS was assessed 3 months after discharge. Unsupervised machine learning was used to build a SANN-based binary classification model of PCS development.ResultsPCS at 3 months has been detected in 75% patients. Higher symptoms level in the PCS group was not associated with worse physical functional recovery or significant echocardiographic changes. Despite identification of a set of pre-discharge predictors, inclusion of parameters obtained at 1 month proved necessary to obtain a high accuracy model of PCS development, with inputs list including age, sex, in-hospital levels of CRP, eGFR and need for oxygen supplementation, and level of post-exertional symptoms at 1 month after discharge (fatigue and dyspnea in 6MWT and MRC Dyspnea score).ConclusionHospitalized COVID-19 survivors at 3 months were characterized by 75% prevalence of PCS, the development of which could be predicted with an 89% accuracy using the derived neural network-based classification model.

BackgroundImpaired physical functional status is one of the typical long-term sequelae of COVID-19 infection that significantly affects the quality of life and work capacity. Minor changes in cardiac structure and function that are unable to cause the manifestation of overt heart failure may remain undetected in COVID-19 convalescents, at the same time potentially contributing to the persistence of symptoms and development of long COVID syndrome.PurposeTo study the typical features and short-term dynamics of cardiac remodeling and possible signs of cardiac dysfunction following hospitalization for COVID-19.MethodsThis is a combined cross-sectional and longitudinal cohort study in which 176 hospitalized patients (93 female and 83 male, mean age 53.4 ± 13.6 years) with COVID-19 infection underwent comprehensive transthoracic echocardiography pre-discharge (22.6 ± 7.1 days from the onset of symptoms) with repeated evaluation after 1 month. The control group included 88 age-, sex-, height- and weight-matched healthy individuals, with a subset of those (n = 53) matched to the subset of non-hypertensive study participants (n = 106).ResultsConcentric left ventricular geometry was revealed in 59% of participants, including 43% of non-hypertensive subjects; predominantly Grade I diastolic dysfunction was found in 35 and 25% of patients, respectively. Other findings were naturally following from described phenotype of the left venticle and included a mild increase in the absolute and relative wall thickness (0.45 ± 0.07 vs. 0.39 ± 0.04, p < 0.001), worsening of diastolic indices (e’ velocity 9.2 ± 2.2 vs. 11.3 ± 2.6 cm/s, p < 0.001, E/e’ ratio 7.5 ± 1.8 vs. 6.8 ± 1.7, p = 0.002) and global longitudinal strain (17.5 ± 2.4 vs. 18.6 ± 2.2, p < 0.001). No significant improvement was found on re-evaluation at 1 month.ConclusionsHospitalized patients recovering from COVID-19 were characterized by a high prevalence of left ventricular concentric remodeling, predominantly Grade I diastolic dysfunction, and a mild decrease in the longitudinal systolic function. These changes were less frequent but still prevalent in the non-hypertensive subgroup and largely persisted throughout the 1-month follow-up.

Objective: To study the impact of hypertension on the dynamics of physical, emotional and cognitive symptoms during the 12-months follow-up after hospitalization for COVID-19. Design and method: 212 patients hospitalized for COVID-19 (50% hypertensive, 53% female, mean age 53,4±13,6 years) underwent comprehensive questionnaire survey evaluating physical (CAT, CCQ and mMRC dyspnea scales for respiratory and EFTER-COVID for other related symptoms), emotional (HADS) and cognitive well-being (Memory, Thinking and Communication subscale of SBQ-LC questionnaire, MTC-SBQ-LC) that was performed pre-discharge and repeated after 1, 3, and 12 months. Results: Despite being older (57,8±11,8 vs 50,7±13,9, p<0,001) and having higher BMI (31,7±5,3 vs 27,4±4,4 kg/m 2 , p<0,001), hypertensive patrticipants had similar baseline summary scores of symptoms severity but slightly higher mMRC dyspnea score (2,7±1,1 vs 2,3±1,1, p = 0,023), and no significant difference in trends of summary scores have been detected by ANOVA (see graphic abstract). Non-hypertensive subjects had worse baseline limitation of everyday activity, cough and sputum production by respective CAT and CCQ sections that were characterized by better dynamics during follow-up. The residual level of respiratory-related symptoms at 12 months was higher in hypertensive cohort (CAT score 8,1±5,1 vs 5,8±5,0, p = 0,003, CCQ score 7,5±6,1 vs 4,5±5,1, p<0,001, mMRC dyspnea score 1,57±0,63 vs 1,27±0,54, p<0,001), most likely due to more frequent concomitant obesity and diastolic dysfunction. The most striking data was obtained in the MTC-SBQ-LC: yonger and healthier non-hypertensive participants displayed similar trends of most cognitive symptoms to the hypertensive cohort, but had persistently worse brain fog, difficulties in understanding others’ speech, planning, concentrating, and word-finding, that resulted in significantly higher summary score at 12 months after discharge (1,71±2,36 vs 0,96±1,30, p = 0,010). No differences were detected in anxiety and depression levels as assessed by HADS. Conclusions: Hypertensive patients that had been hospitalized for COVID-19 displayed similar trends of resolving physical, emotional and cognitive symptoms throughout the 12-month follow-up but had higher levels of residual respiratory-related symptoms and dyspnoea compared to the non-hypertensive participants, whereas the latter were characterized by significantly higher level of cognitive dysfunction as assessed by the dedicated SBQ-LC subscale.

Objective: To study the relation of hypertensive status and systolic blood pressure (SBP) pre-discharge values to the dynamics of functional re-conditioning as assessed by 6-minute walk distance during the 1-month follow-up after hospitalization for COVID-19. Design and method: 6-minute walk distance (6MWD) was assessed pre-discharge in 176 patients hospitalized for COVID-19 (40% hypertensive, 47% male, mean age 53,2 ± 13,5 years) using the 20 m walkway and an extended protocol that included monitoring of peripheral pulse and capillary blood oxygen saturation (SpO2) every 30 seconds via bluetooth-connected pulse oximeter. The repeated evaluation was performed after 1 month of follow-up. Results: Hypertensive participants were characterised by older age (57,8±11,8 vs 50,7±13,9, p < 0,001), higher weight and body mass index (31,7±5,3 vs 27,4±4,4 kg/m 2 , p < 0,001). As a result, 6MWD in them was shorter (378±57 vs 418±75 m, p = 0,001) but no difference in reached percent of predicted distance (6MWD%) was detected (63,0±8,5 vs 63,2±11,1 %, p = 0,939). The described relation persisted at 1 month, with no difference in absolute (72±43 vs 68±43 m, p = 0,324) and percentage gain of 6MWD (12,8±6,6 vs 11,2±7,5 %, p = 0,266) between groups. Multiple regression analysis has allowed to build the model that accounted for 94% of variability in the 6MWD% gain between visits (85% for dedicated hypertensive cohort model). After adjustment for age, sex, height, weight, Remdesivir treatment, minimal SpO2 levels during acute COVID-19, changes of SpO2 and pulse rate throughout the 6MWT, SBP remained a potent independent predictor of 6MWD% gain, with 10 mmHg higher values at baseline evaluation being associated with 21,5% lesser 6MWD% gain in hypertensive subjects and 8,2% lesser – in normotensives. Conclusions: Hypertensive status did not have an impact on 6MWD% in pre-discharge COVID-19 patients. Moderate-to-high quality multiple regression models have demonstrated an independent role of SBP, demographic and anthropometric data, changes of SpO2 and pulse rate throughout the 6MWT in prediction of 6MWD% gain during 1 month after discharge, both in hypertensive and normotensive patients.

Cardiovascular pathology is one of the frequent comorbidities in patients with chronic obstructive pulmonary disease, due to both genetic predisposition and common risk factors (smoking, senile age, male gender, sedentary lifestyle, obesity). The article shows that development of endothelial dysfunction is one of the earliest phases of pathogenesis in this setting. Endothelial dysfunction mechanisms are defined and characterized, including an imbalance of vasoconstricting and vasodilating agents with the emergence of "vicious circles" that violate hemo-vascular homeostasis. The role of nitric oxide, endothelin-1, intercellular adhesion molecule-1 (ICAM-1) in the development of endothelial dysfunction in COPD patients is discussed.The article defines the concept of oxidative stress, the most potent oxidants and mechanisms of their damaging effect arebeing listed. A particular attention is paid to 8-isoprostane as a golden standard in assessment of oxidative stress in patients with COPD.

Hypertension in its origin is a heterogeneous and multisystemic disease. Evaluation of oxidative stress activity based on the level of 8-iso-PgF2α, proinflammatory activity based on tumour necrosis factor-α, its type I soluble receptor, and C-reactive protein levels is relevant for further understanding of pathogenesis of hypertension and improvement of the early diagnostics of heart failure. 186 hypertensive patients were observed during a 2-months course of treatment, aged 30 to 65 years. Serum levels of 8-iso-PgF2α (n = 34), tumour necrosis factor-α and its type I soluble receptor were determined by ELISA before and after course of treatment. C-reactive protein level was determined by biochemical method. The control group included 16 clinically healthy individuals, aged 27 to 55 years. Hypertensive patients enrolled into the study were randomized into three groups that received different protocols of combined anti-hypertensive therapy: I clinical group – а combination of bisoprolol and indapamid, II – а combination of lacidipine and candesartan, III – а combination of fosinopril sodium and hydrochlorothiazide. On the background of combined antihypertensive therapy, we observed favourable dynamics of 8-iso-PgF2α, tumour necrosis factor-α and its type I soluble receptor, and C-reactive protein levels. Taking into account the insignificance of the correlations revealed, a one-factor dispersion analysis was applied which allowed us to determine the influence of the grade and duration of hypertension on the dynamics of the studied parameters. It has been found that the grade of hypertension is related to an increase in TNF-α and 8-iso-PgF2α serum levels, but not in TNF-α type I soluble receptor, and the duration of hypertension is related to an increase in C-reactive protein, TNF-α and its type I soluble receptor levels, with no relation to the level of 8-iso-PgF2α. Thus, oxidative stress possibly promotes the activation of potentially damaging immune mechanisms mediated by proinflammatory cytokines, nonspecific inflammation and drives the further progression of lesions in the target organs.

SUBCLINICAL CARDIAC DAMAGE IN CARDIOPULMONARY POLYMORBIDITY. (review). Part 1. Ashcheulova T., Ambrosova T., Kochubiei O., Honchar O., Sytina I. Hypertension and chronic obstructive pulmonary disease are one of the frequent comorbid conditions in internal medicine and are subject to meaningful cooperation among physicians, cardiologists, and pulmonologists. A combination of chronic obstructive pulmonary disease and hypertension presents certain diagnostic and therapeutic challenges. These conditions share common risk factors, similar clinical presentations and some common parts of pathogenesis. The problem of association between chronic obstructive pulmonary disease and hypertension may be currently discusses both as a simple combination of various clinical entities, and as chronic obstructive pulmonary disease resulting in development of factors contributing to hypertension. One way or another, either a simple combination, or a mutually aggravating syndrome, but we state there is a cardiorespiratory continuum where chronic obstructive pulmonary disease acts as a valid component of hypertension development, and vice versa. Thus, it seems to be relevant to study peculiarities of the structural and functional status of the cardiovascular system and microcirculation, systemic remodeling mechanisms, endothelial dysfunction and inflammation in presence of chronic obstructive pulmonary disease -associated hypertension. Problems of additional cardiovascular risk marker development, treatment efficiency assessment remain topical. Use of electrocardiography and echocardiography with dopplerometry has been an important diagnostic principle of subclinical cardiovascular damage in presence of hypertension and chronic obstructive pulmonary disease comorbidity. Non-invasive imaging methods play a central part in diagnostics of subclinical target organ damage. Wide implementation thereof is based on high diagnostic accuracy, common availability, safety and relatively low price. Key words: hypertension, chronic obstructive pulmonary disease, comorbidity, electrocardiography, echocardiography with dopplerometry Резюме. СУБКЛІНІЧНЕ УРАЖЕННЯ СЕРЦЯ ПРИ КАРДІОПУЛЬМОНАЛЬНІЙ ПОЛІМОРБІДНОСТІ (огляд). Частина 1. Ащеулова Т.В., Амбросова Т.М., Кочубєй О.А., Гончарь О.В., Ситіна І.В. Артеріальна гіпертензія і хронічне обструктивне захворювання легень - одне з частих коморбідних станів в клініці внутрішніх хвороб і є предметом конструктивної взаємодії терапевтів, кардіологів, пульмонологів. Поєднання хронічного обструктивного захворювання легень і артеріальної гіпертензії являє певні труднощі для діагностики і лікування. Ці захворювання мають загальні фактори ризику, схожі клінічні прояви і спільність деяких ланок патогенезу. Таким чином, представляється актуальним дослідження особливостей структурно-функціонального стану серцево-судинної системи і мікроциркуляції, вивчення системних механізмів ремоделювання, ендотеліальної дисфункції та запалення при артеріальній гіпертензії в поєднанні з хронічним обструктивним захворюванням легень. Залишаються актуальними питання розробки додаткових маркерів серцево-судинного ризику, оцінки ефективності проведеного лікування. В останні роки важливими принципами діагностики субклінічного ураження серця і судин при коморбідності хронічного обструктивного захворювання легень і артеріальної гіпертензії є використання електрокардіографії та ехокардіографії з доплерометрією. Неінвазивні методи візуалізації відіграють центральну роль в діагностиці субклінічного ураження органів-мішеней. Їх широке застосування обумовлено високою діагностичної точністю, повсюдною поширеністю, безпекою і відносно низькою вартістю. Ключові слова. Артеріальна гіпертензія, хронічне обструктивне захворювання легень, коморбідность, електрокардіографія, ехокардіографія з доплерометрією. Резюме. СУБКЛИНИЧЕСКОЕ ПОРАЖЕНИЕ СЕРДЦА ПРИ КАРДИОПУЛЬМОНАЛЬНОЙ ПОЛИМОРБИДНОСТИ (обзор). Часть 1. Ащеулова Т.В., Амбросова Т.Н., Кочубей О.А., Гончарь А.В., Сытина И.В. Артериальная гипертензия и хроническое обструктивное заболевание легких - одно из частых коморбидных состояний в клинике внутренних болезней и являются предметом конструктивного взаимодействия терапевтов, кардиологов, пульмонологов. Сочетание хронического обструктивного заболевания легких и артериальной гипертензии представляет определенные трудности для диагностики и лечения. Эти заболевания имеют общие факторы риска, схожие клинические проявления и общность некоторых звеньев патогенеза. Таким образом, представляется актуальным исследование особенностей структурно-функционального состояния сердечно-сосудистой системы и микроциркуляции, изучение системных механизмов ремоделирования, эндотелиальной дисфункции и воспаления при артериальной гипертензии в сочетании с хроническим обструктивным заболеванием легких. Остаются актуальными вопросы разработки дополнительных маркеров сердечно-сосудистого риска, оценки эффективности проводимого лечения. В последние годы важными принципами диагностики субклинического поражения сердца и сосудов при коморбидности хронического обструктивного заболевания легких и артериальной гипертензии является использование электрокардиографии и эхокардиографии с допплерометрией. Неинвазивные методы визуализации играют центральную роль в диагностике субклинического поражения органов-мишеней. Их широкое применение обусловлено высокой диагностической точностью, повсеместной распространенностью, безопасностью и относительно низкой стоимостью. Ключевые слова. Артериальная гипертензия, хроническое обструктивное заболевание легких, коморбидность, электрокардиография, эхокардиография с допплерометрией.

INTRODUCTION:Obesity is becoming one of the leading risk factors of coronary heart disease, hypertension, cerebrovascular disease. Despite the presence of a large number of antihypertensive agents and scientific substantiation of antihypertensive treatment principles it would be wrong to assume that the problem is completely solved. Development of endothelial dysfunction is one of the key pathogenic mechanisms in hypertension. This process is proven to have contributed by immune inflammation activation which is mediated by pro-inflammatory cytokines and oxidative stress. AIMS:To investigate the additional benefits of the combined antihypertensive therapy with lacidipine and candesartan on the basis of studying their antioxidant properties, impact on endothelial function and pro-inflammatory cytokines activity in hypertensive patients with overweight and obesity. METHODS:A combination of a calcium channel blocker and angiotensin receptor blocker (lacidipine 2 mg, 4 mg, and candesartan 4mg, 8mg, 16mg) was prescribed to 30 patients with essential hypertension of grades 1-3, 30 to 65 years old (mean age - 54.7 ± 5.8 years), who previously have not been receiving regular antihypertensive therapy. RESULTS:During the course of combined antihypertensive therapy with lacidipine and candesartan, a significant reduction in i-NOS activity, TNF-α to its type I soluble receptor ratio (TNF- α/sTNF-αRI), and oxidative stress marker - 8-iso-PgF2α has been observed. Activity of e-NOS, levels of SOD and catalase, in contrast, have increased by the end of observation period. CONCLUSION:The improvement of endothelial function due to lower level of oxidative stress and a significant decrease of immune activation has been observed in hypertensive patients with overweight and obesity under the influence of combined antihypertensive therapy with lacidipine and candesartan.