Analysis of the course of arterial hypertension in patients with venous system pathology

Objective: to study the features of arterial hypertension in patients with pathology of the venous system.

Materials and methods: the study consisted of 2 stages. Stage 1 included 410 patients with arterial hypertension. The presence of signs of connective tissue dysplasia was initially identified, and the patients’ height and weight were measured to calculate their body mass index (BMI, kg/m2). Using ultrasound diagnostics, the patients’ renal venous blood flow, heart and kidney conditions were examined, and the levels of creatinine, glucose, uric acid, and serum lipid profiles were measured. In the presence of renal venous blood flow disorders in the examined patient, in addition to standard antihypertensive therapy, diosmin was prescribed at a dose of 600.0 mg once a day for 1 month, twice a year every 6 months, followed by dynamic monitoring of blood pressure and creatinine control status for 2 years. Based on the data obtained, the patients were divided into two groups: group 1 (n=291) (patients with AH+bilateral renal venous blood flow disorders) and group 2 (n=119) (patients with AH+normal.

Results: in patients with hypertension, bilateral renal venous blood flow disorders were 2.4 times more common than normal renal blood flow (p0.001) and were more often associated with such manifestations of DST as mitral valve prolapse (11.9 times, p0.001), nephroptosis (24.8 times, p0.001), varicose veins extremities (23.3 times, p0.001), hemorrhoids (10.6% vs 0%, p0.001), chronic venous insufficiency (26.5% vs 0%, p0.001), varicocele (6.0 times, p=0.05). In addition, when comparing the body mass index between the groups, significant differences were obtained: the proportion of people with a BMI of 18.6–24.9 was 8 times higher among group 1 patients (43.3% vs 5.3%, p 0.001). In patients with hypertension and bilateral renal venous blood flow disorders, it was found that 30% of the examined patients had signs of varicose veins of the lower extremities, as well as chronic venous insufficiency, which were familial in nature (these conditions were found in parents, grandparents). In addition, patients with hypertension and bilateral renal venous blood flow disorder in 100% of cases noted a crisis course of hypertension associated with alcohol consumption (including low-alcohol drinks), as well as episodes of physical inactivity. The additional administration of diosmin to standard antihypertensive therapy in patients with hypertension and bilateral renal venous blood flow disorder made it possible to slow down the progression of a decrease in glomerular filtration rate.

Conclusion: thus, it can be concluded that the presence in patients with hypertension of conditions such as mitral valve prolapse, nephroptosis, varicose veins of the lower extremities, varicose veins of the spermatic cord and distal rectum, chronic venous insufficiency, as well as BMI values corresponding to the norm, may be a predictor of the presence of impaired renal venous blood flow. Patients with arterial hypertension and impaired renal venous blood flow have characteristic features of the clinical course of hypertension (family history of venous pathology), lifestyle stratification (alcohol consumption, physical inactivity), provoking a crisis course. Additional administration of drugs to antihypertensive therapy in this category of patients that affect the state of the venous system pathogenetically rationally and may slow down the rate of decrease in glomerular filtration rate.

1. Balanova Yu.A., Drapkina O.M., Kutsenko V.A., Imaeva A.E., Kontsevaya A.V., Maksimov S.A. et al. Hypertension in the Russian population during the COVID-19 pandemic: sex differences in prevalence, treatment and its effectiveness. Data from the ESSE-RF3 study. Cardiovascular Therapy and Prevention. 2023;22(8S):3785. (In Russ.) doi: 10.15829/1728-8800-2023-3785. EDN: YRUNUX

2. Franklin SS, Lopez VA, Wong ND, Mitchell GF, Larson MG, Vasan RS, et al. Single versus combined blood pressure components and risk for cardiovascular disease: the Framingham Heart Study. Circulation. 2009;119(2):243-250. doi: 10.1161/CIRCULATIONAHA.108.797936

3. 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension: Erratum. J Hypertens. 2019;37(2):456. Erratum for: J Hypertens. 2018;36(12):2284-2309. doi: 10.1097/HJH.0000000000002026

4. Chazova I.E., Zhernakova Yu.V. Diagnosis and treatment of arterial hypertension [Guidelines]. Systemic Hypertension. 2019;16(1):6-31. (In Russ.) doi: 10.26442/2075082X.2019.1.190179

5. Kobalava Zh.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., Arutyunov G.P., Baranova E.I., et al. 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

6. Okorokova T.O., Kryuchkova O.N. Logistic regression model for predicting failure of dual antihypertensive therapy: a prospective comparative non-randomized clinical trial. Kuban Scientific Medical Bulletin. 2023;30(5):54-63. (In Russ.) doi: 10.25207/1608-6228-2023-30-5-54-63

7. Vereschagina G.N., Lisichenko O.V. Cardiovascular syndrome at systemic connective tissue dysplasia in young men. Medical news of North Caucasus. 2008;(2):64-67. (In Russ.) eLIBRARY ID: 15287252 EDN MWNUUH

8. Eliseeva L.N., Zhdamarova O.I. Dopplerographic parameters of arterial and venous blood flow in the kidneys in hypertensive patients. Russian Medical News. 2013;18(3):63-69. (In Russ.) eLIBRARY ID: 20220588 EDN: RAMRDF

9. Prochaska JH, Arnold N, Falcke A, Kopp S, Schulz A, Buch G, et al. Chronic venous insufficiency, cardiovascular disease, and mortality: a population study. Eur Heart J. 2021;42(40):4157-4165. doi: 10.1093/eurheartj/ehab495

10. Zheng Y, Zhang R, Shi W, Li L, Liu H, Chen Z, et al. Metabolism and pharmacological activities of the natural health-benefiting compound diosmin. Food Funct. 2020;11(10):8472-8492. doi: 10.1039/d0fo01598a

11. Serra R, Ielapi N, Bitonti A, Candido S, Fregola S, Gallo A, et al. Efficacy of a Low-Dose Diosmin Therapy on Improving Symptoms and Quality of Life in Patients with Chronic Venous Disease: Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2021;13(3):999. doi: 10.3390/nu13030999

12. El-Fawal R, El Fayoumi HM, Mahmoud MF. Diosmin and crocin alleviate nephropathy in metabolic syndrome rat model: Effect on oxidative stress and low grade inflammation. Biomed Pharmacother. 2018;102:930-937. doi: 10.1016/j.biopha.2018.03.162

13. Zhdamarova O.I., Eliseeva L.N., Urban P.I. Additional effects of diosmin in the treatment of arterial hypertension in patients with impaired renal venous blood flow. South Russian Journal of Therapeutic Practice. 2022;3(2):63-70. (In Russ.) doi: 10.21886/2712-8156-2022-3-2-63-70

14. Eklöf B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J. Vasc. Surg. 2004;40(6):1248–1252. doi: 10.1024/0301-1526.34.3.157

15. Shanaev I.N. Modern views on the development of varicose and post-thrombotic diseases. Kuban Scientific Medical Bulletin. 2020;27(1):105-125. (In Russ.) doi: 10.25207/1608-6228-2020-27-1-105-125

16. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. 2015;28(1):1-39.e14. doi: 10.1016/j.echo.2014.10.003

17. Fuster V, ed. The AHA Guidelines and Scientific Statements Handbook. 2008. doi: 10.1002/9781444303476

18. Krasnova T.V. The importance of Dopplerographic methods in the diagnosis of hemodynamic disorders in nephroptosis. Ultrasound diagnostics. 1999;(4):29-38. (In Russ.)