The impact of war on the development and progression of arterial hypertension and cardiovascular disease: protocol of a prospective study among Ukrainian female refugees.

Background: Growing evidence supports the impact of psychological factors such as traumatic experiences and Post Traumatic Stress Disorder (PTSD) on the incidence of arterial hypertension (HTN) and cardiovascular diseases (CVD). The war in Ukraine is exposing million inhabitants to traumatic experiences and severe stress. Part of Ukrainians (mostly women and children) left the country to escape war. We report the protocol of a prospective study aiming at the assessment of the impact of war-induced stress on HTN and CVD in women Ukrainian refugees who moved to Poland. Methods and design: The study will be conducted in 3 stages. Stage 1 will assess the prevalence of HTN and PTSD among Ukrainian refugees and will estimate the impact of war-related trauma exposure on these parameters. Data on office blood pressure (BP) will be compared to data already collected in STEPS data 2019 and May Measurement Month 2021 in Ukraine, matched for age and sex. Stage 2 will involve subjects diagnosed with HTN and/or PTSD referred for management and follow-up of these conditions. Psychologic targeted therapies will be offered to subjects with confirmed PTSD, with a periodical reassessment of the severity of PTSD-associated symptoms and of its impact on HTN and cardiovascular health. Clinical history and characteristics will be compared among three groups: subjects with HTN and PTSD, with HTN without PTSD, with PTSD but without HTN. Stage 3 will involve a subgroup among those screened in Stage 1, with the objective of investigating the biological mechanisms underlying the relation between HTN and trauma exposure, identifying early signs of subclinical target organ damage in subjects with HTN with/without PTSD. Discussion: This study will test the hypothesis that trauma exposure and psychological stress contribute to BP elevation and progression of CVD in this population. It will provide new evidence on the effect of an integrated management, including psychological therapy, on BP and cardiovascular risk. Such approach may be further tested and extrapolated to other populations exposed to war and chronic violence, migrants and refugees around the world. Research Study Registration: number 2022/45/P/NZ5/02812.

State of integral remodeling parameters of target organs in patients with essential hypertension and obesity.

Arterial hypertension combined with obesity is a very common form of comorbid disease in most countries all over the world. The combination of these diseases is characterized by mutual burdening of remodelling processes in important target organs, what greatly increases the risk of cardiovascular complications and death. The mechanisms of injury progression to vital organs in essential hypertension (EH) and obesity have some common features. The most important risk factors of target organs damage are hemodynamic and neurohumoral: inflammatory, effectors of the renin- angiotensin-aldosterone system, insulin resistance and others. Polyethiologic remodelling, lack of knowledge concerning violations in structural and functional status of important target organs and mechanisms of the interactions of their progression with this comorbidity require further study of these issues. The objective of the study was the comparative study of the state of integral indicators of structural and functional state of the heart, blood vessels and liver in patients with EH second stage with normal body weight and with concomitant obesity I and II degrees. This study found that the presence of obesity I and II in patients with EH stage II is associated with the concentric type of left ventricular hypertrophy, saved by its ejection fraction and impaired diastolic filling processes. For the patients with EH in the early stages of obesity the following characteristics are quite typical: considerable increase of intima media thickness in the carotid arteries, increasing the stiffness in the main arteries and liver parenchyma, impaired of the functional state of endothelial.

[Structural and functional changes of heart and vessels in patients with essential hypertension and type 2 diabetes].

Comorbidity of essential hypertension and type 2 diabetes is a serious problem connected with early affection of target organs and further cardiovascular complications. Pathogenetic mechanisms, determining the progress of essential hypertension, insulin resistance and type 2 diabetes, mostly have mutual symptoms and lead to the progression of disease. Many investigators consider cardiovascular pathology to be disease which has free radical nature. Activation of free radical oxidative process and endothelial dysfunction are recognized one of the most important pathogenetic mechanisms of cardiovascular diseases. To investigate structural and functional changes of heart and vessels, state of the pro- and antioxidant status, levels of proinflammatory cytokines in patients with essential hypertension and type 2 diabetes we have examined 102 patients with essential hypertension stage II and type 2 diabetes in a moderate condition. After the investigation it was discovered that changes of cardiohemodynamics in patients with essential hypertension and type 2 diabetes are characterized by the following aspects: systolic function of left ventricle is conserved, concentric hypertrophy of left ventricle predominates and also there is diastolic dysfunction similar to disordered relaxation. Changes of blood vessel walls in the examined patients are shown by growing intima-media thickness and pulse wave velocity in carotid artery and aorta and also by dropping endothelium dependent vasodilation. The mentioned structural and functional changes in heart and magistral vessels go together with growing levels of cytokines, activation of pro-oxidant system with suppression of antioxidant system, what is shown by correlation connections of different intention and direction.