Study the features of the course of uncontrolled arterial hypertension in Aral Sea region
Authors: Shukurova D , Ataniyazov K H A , Khamidullaeva G A , Yusupova K H F , Abdullaeva G J , Masharipov S H M , Mashkurova Z T 
Published: October 2021

Abstract

Aral Sea disappearance is a well-known ecological disaster. An arid, sharply continental climate, high mineralization, pollution and a shortage of drinking water in Aral Sea region harm human health. The aim of this work was to study the features of the course of uncontrolled arterial hypertension (AH) in this ecologically unfavorable region.
Material and research methods. Surveyed 132 patients hospitalized in the Aral branch of the republican emergency center with hypertensive crisis, uncomplicated form. The average age of patients was 57.2±11.6 years, and 80 (60.6%) were women and 52 were men (39.4%). The duration of hypertension was 8.85±3.4 years. Before study, 41 (31%) patients did not take antihypertensive drugs, 79 (59%) patients were on monotherapy (62% RAAS-blockers, 19% beta-blockers, 19% calcium antagonists) and 10 (7.5%) patients took double combined AGT. Only two patients were on triple combined AGT: RAAS blocker+AK+BAB. Patients characterized by a high cardiovascular risk, on 40 patients diagnosed CHD, 11 patients were suffered myocardial infarction, the consequences of stroke in 8 patients. All patients underwent office measurement of blood pressure, ultrasound of the brachiocephalic arteries, echocardiography, biochemical blood tests, and albumin urinary excretion. The Henken test was performed to determine the salt taste sensitivity. The low threshold of salt taste sensitivity corresponded to the concentration of NaCl less than 0.16%, an average is 0.16%, and high is more than 0.32%.

Results
Before treatment, SPB was 200.8±22.6 mm Hg, DPB 105.4±7.62 mm Hg, heart rate 79.86±11.54 beats/min. The body mass index (BMI) was 30.2±4.78 kg/m2. All patients have left ventricular hypertrophy (LVH), the indexed mass of the LV myocardium was 171.62±30.9 g/m2. Intima-media thickness of the common carotid artery was 1.24±0.16 mm. Albumin urinary excretion (AUE) averaged 221.0±130.2 mg/day, while norm albuminuria were detected in four patients (3%), microalbuminuria (MAU) in 89 patients (67.4%), and proteinuria in 39 patients (29.6%). Hanken's test showed the presence of a high threshold for taste sensitivity in almost all patients, amounting to 0.51±0.17% NaCl concentration.

Conclusion
Patients with uncontrolled hypertension and uncomplicated hypertensive crisis living in the Aral Sea region are characterized by low adherence to treatment, the presence of target organ damage, a high threshold for taste sensitivity to table salt, and the severity of daily urinary albumin excretion, in 67.4% of cases with MAU and 29.6% cases of proteinuria. These findings characterize the presence of nephrosclerosis in patients with uncontrolled hypertension. Our results once again point the necessity to early detection of hypertensive patients and the appointment of combined antihypertensive therapy on the part of primary care.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): other