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reported that lymphocytes in interaction with antigens enhance production of IL-ip and TNF-a by immunocompetent cells in the mechanisms of protecting reaction [3], while NO expression increases the percentage of LPA [20]. In pregnant women with a tendency to the development of HIP after 20-22 weeks of gestation we revealed a strong direct relationship between adhesion ability of lymphocytes, blood platelets and NO concentration (r=0.85; P<0.001). At the same time, a clear direct relationship between high percentage of LPA and DBP levels after 20-22 weeks of gestation was found (r=0.89; P<0.001). In the period of 7-10 weeks, this relationship was absent (r=0.18; P<0.005).
Thus, autoimmune processes in the endothelium of maternal blood vessels may be one of possible mechanisms of hypertensive disorders in pregnant women.
Conclusions.
1. In pregnant women at risk of hypertensive disorders, especially after 20-22 weeks of gestation and later, lymphocytes ability to platelets adhesion is rose, the concentrations of pro-inflammatory cytokines and NO level are increased.
2. The direct relationship between DBP high level with degree of LPA, CECs, NO, IL-I^ and TNF-a cytokines at gestation period of20-22 weeks indicates their importance in the pathogenesis of hypertensive disorders in pregnant women.
References:
1.
Gazieva I. A., Chistyakova G. N. Immunological aspects of the pathogenesis of placental insufficiency//Issues of obstetrics, gynaecology and perinatology. - 2009. - № 1. - P. 57-63.
Klimov V. A. The endothelium of feto-placentar complex in physiological and pathological pregnancies//Obstetrics and gynaecology. - 2008. - № 2. - P. 7-10.
Makarov O. V., Bogatyryev Yu. A., Osipova N. A. The value of autoantibodies in the pathogenesis of preeclampsia//Ob-stetrics and gynaecology. - 2012. - № 4/1. - P. 16-21.
Manukhina Ye. B., Dauni H. F., Mallet R. T., Malyshev I.Yu. Protective and damaging effects of periodic hypoxia: the role of nitric oxide//Bulletin of RAMS - 2007. - № 2. - P. 25-33.
Metelskaya V. A., Gumanova M. G. Screening-method for the determination of nitric oxide metabolites in blood se-
rum//Clinical laboratory diagnosis. - 2005. - № 6. - P. 15-18.
Ostanin A. A., Kustov S. M., Tyrinova T. V. et al. Indicators of immunity of pregnant at early forecast of the development of placental insufficiency//Obstetrics and gynaecology. - 2010. - № 1. - P. 33-38.
Petrishchev N. N., Vlasov T. D. Physiology and pathophysiology of endothelium/Endothelial dysfunction. The causes, mechanisms and pharmacological correction//edited by N. N. Petrishchev. - St. Petersburg: Publishing House of St. Petersburg State Medical University, 2003. - P. 4-38. In Russian.
Pinegin B. V., Karsonova M. I. Macrophages: properties and functions//Immunology [Immunologiya]. - 2009. - № 4. - P. 241-249. Sidorova I. S., Zarubenko N. B., Gurina O. I. Markers of endothelial dysfunction in preeclampsia//Russian Bulletin of obstetrics and gynaecology. - 2010. - № 5. - P. 24-26.
10. Shalina R. I., Konovalova V., Normantovich T. O., Lebedev Ye. V. Prediction of preeclampsia in the I trimester of pregnancy: myth or reality?//Issues of obstetrics, gynaecology and perinatology. - 2010. - № 4. - P. 82-87.
11. Vitkovskiy Y. A., Kuznik B. I., Solkov A. V. The phenomenon of lymphocyte-platelet rosetting//Immunology. - 1999. -№ 4. - P. 35-37.
2.
3.
4.
5.
6.
7.
9.
Mirzoulugbek Mirmakhmudovich Mirsaydullayev, Doctoral candidate of chair of therapy of faculty of improvement of doctors of the Andizhan State medical institute, Andijan State Medical Institute, Andijan, Uzbekistan.
E-mail: [email protected] Nematjon Solievich Mamasaliyev, doctor of medical sciences, professor, manager of chair of therapy of faculty of improvement of doctors of the Andizhan State medical institute Andijan State Medical Institute, Andijan, Uzbekistan. E-mail: [email protected]
Awareness about high blood pressure, care for own health and prevention of high blood pressure among HIV-positive population in Ferghana valley
Abstract: An epidemic research was organized and carried out, in which representative choice from HIV-positive people from Namangan and Ferghana regions at the age of from 20 to 50 and older with the amount of 341 people.
In studying HIV-positive people the following methods were used: survey, instrumental, biochemical, and immunologic. A special application form was used for detecting cardiovascular illnesses and high-blood pressure and their risk factors among HIV-positive people.
The low awareness of HIV-positive people about high-blood pressure was detected. In different age groups awareness level of researched population was detected in such degrees: at the age of 20-24 -47,5%, 25-29 -48,3%, 30-34 -52,1%, 35-39-56,4%, 40-44-59,0 (p<0,05), 45-49-60,0% (p<0,05), >50-70,0% (<0,05) and 20-5053,7%.
Awareness ofHIV-positive people about main risk factors turned out to be quite low in sequence: obesity — 50,7%, hypercholesterolemia — 29,3%, insufficient physical activeness-53,1%, smoking-57,7%, consuming alcohol-62,2%, stresses-33,4% and bad eating habits-51,3%.
Among HIV-positive people, a low level of responsibility for own health is found (10,7%), as well as a low level of preparedness for participating in preventive measures regarding high-blood pressure HBP (12,%). In 87,7% of the cases among HIV-positive people, there is insufficient awareness about the effectiveness of preventive measures regarding high-blood pressure, as well as the lack of confidence in ideas of preventive recommendations for preventing health problems and promoting a healthy life style.
Keywords: awareness, care for own health, prevention, HIV-positive peoples, high blood pressure, epidemio-logical research.
Introduction.
Currently cardiovascular diseases are the main problem in state, medical and public organizations in developed countries because of high illness rate, disabilities and mortality among population, epidemic researches showed that in most countries ofWestern Europe, North America, Australia, Japan, etc. the number of mortality and disabilities because of cardiovascular diseases have decreased due to prevention measures [1; 2], while in Russia and post-Soviet countries this number has been increasing in the last 10-15 years [3].
Atherosclerotic cardiovascular disease (CVD), a leading cause of morbidity and mortality in the general population, is an increasing concern for human immunodeficiency virus (HIV)-infected patients. HIV-infected individuals are exposed to accelerated vascular aging [4], and this issue has become even more relevant since antiretroviral therapy has impressively extended the life span of HIV-infected individuals [5; 6]. Hypertension is a treatable major established risk factor for CVD and a common condition in HIV infection, with a prevalence ranging 13%-36% [7; 8; 9; 10]. New-onset hypertension occurred with an incidence of 29.8 per 1,000 person-years in a recent report from Norway [11]. The suggestion that antiretroviral therapy and/or HIV infection may be associated with higher blood pressure (BP) has been repeatedly raised [12; 13; 14]. More important, recent data suggest that both elevated and borderline high BP are associated with a substantially greater relative risk of acute myocar-dial infarction in HIV-positive compared with HIV-negative subjects [15]. Thus, identifying and appropriately managing hypertension is a clinically relevant issue in HIV-infected patients.
The awareness of people on arterial hypertension in Uzbekistan remains low.
In recent years "caring for own health and prevention from high blood pressure (HBP)" is becoming one of the crucial epidemic indicators, showing peculiarities of popula-
tion tendencies [16; 17]. However, such researches among HIV-positive population, especially in Uzbekistan hasn't been conducted.
Research Aim. Studying awareness about high blood pressure, care for own health and preventing high-blood pressure among HIV-positive people of Ferghana valley in Uzbekistan.
Material and methods.
On the basis of the list of HIV-positive people in Namangan and Ferghana regional centers struggling AIDS a representative choice list was formed for an epidemic research, qualified by gender and age with the method of overall picking. The total number of researched group was 341 people.
In studying HIV-positive people the following methods were used: survey, instrumental, biochemical and im-munologic, was used special application form for detecting cardiovascular illnesses and High-blood pressure and their risk factors (RF) among HIV-positive people. Moreover the application form of first study of patient's condition and HIV stage, which contains the following: 1) verifying HIV diagnosis and if possible, finding out when the patient was infected; 2) detailed, personal, family and medical case history; 3) physical examination; 4) laboratory and other researches; 5) inspecting specialist, if necessary; 6) detecting clinical and im-munologic stage of the illness.
All the examining was done by the personnel knowing epidemic methods in cardiology: Blood pressure was recorded using of mercury sphygmomanometer. The participants were seated quietly for at least 5 minutes in rest prior to BP measurement. Two BP readings we taken for each individual at an interval of 5 minutes and the average was considered as the final BP for that individual. For classification of systemic hypertension, the Joint National Committee 7 (JNC VII) criterion was used. Those who had Systolic Blood Pressure (SBP) > 140 and or Diastolic Blood Pressure (DBP) > 90 mmHg were diagnosed to have hypertension.
Results.
The low awareness of HIV-positive people about HBP was detected (table 1). So in different age groups awareness level of researched population was detected in such degrees: at the age of20-24-47,5%, 25-29-48,3%, 30-34-52,1%, 3539-56,4%, 40-44-59,0 (p<0,05), 45-49-60,0% (p<0,05), >50 -70,0% (<0,05) and 20-50-53,7%.
It should be stated that with the age awareness of HIVpositive people drops significantly — from 47,5% to 70,0% or by 22,5%, that's to say 1,5 times (<0,05).
Received results of ours differ from the ones of other researchers' with noticeable variability [18; 19].
Consequently, it will be urgent according reorganizations in the structure of medical aid among HIV-positive people with special and important accent to the ways of giving information about AH to this contingent of population.
Table 1. - Awareness HIV-positive people among Ferghana valley population about high blood pressure
Age groups, years The number of the examined Awareness about HBP
ABS %
20-24 (I) 40 19 47,5
25-29 (II) 89 43 48,3
30-34 (III) 73 38 52,1
35-39 (IV) 55 31 56,4
40-44 (V) 39 23 59,0
45-49 (VI) 25 15 60,0
Older than 50 (VII) 20 14 70,0
20-50 341
t-criteria based statistics (p) < 0,05 V-I, VI-I, VII-I
< 0,01 -
< 0,001 -
While studying awareness of HIV-positive people about same picture that is to say that awareness about risk factors risk factors of AH depending on the age also was seen the was quite low (table 2).
Table 2. - Awareness of HIV-positive people of Ferghana valley about HBP risk factors (abs./%-accord)
Age years
20-24 25-29 30-34 35-39 40-44 45-49 > 50 <20-50 P
AH risk factors n-40 n-89 n-73 n-55 n=39 n=25 n=20 n=341
n/% (1) n/% (2) n/% (3) n/% (4) n/% (5) n/% (6) n/% (7) n/% <0,05 <0,01 <0,001
Obesity 19/47,5 45/50,6 37/50,6 28/50,9 20/51,3 13/52,0 11/55,0 173/50,7 7-1 - -
High CL in blood 7/17,5 25/28,0 21/28,8 17/30,9 13/33,3, 9/36,0 8/40,0 100/29,3 3-1 4-1 5-1 6-1 7-1 -
IPA 20/50,0 47/52,8 38/52,1 29/52,7 21/53,8 14/56,0 12/60,0 181/53,1 7-1 - -
Smoking 22/55,0 50/56,2 42/57,5 32/58,1 23/58,9 15/60,0 13/65,0 197/57,7 7-1 - -
CA 25/62,5 53/59,6 45/61,6 34/61,8 25/64,1 16/64,0 14/70,0 212/62,2 7-2 - -
Stresses 12/30,0 28/31,5 24/32,9 19/34,5 14/35,9 9/36,0 8/40,0 114/33,4 7-1 - -
Bad eating habits 18/45,0 44/49,4 37/50,6 29/52,7 21/53,8 14/56,0 12/60,0 175/51,3 6-1 7-1 - -
As we can see from Table 2, awareness of HIV-positive insufficient physical activeness (IPA) — 53,1%, smoking — people about main risk factors turned out to be quite low in 57,7%, consuming alcohol (CA) — 62,2%, stresses — 33,4% sequence: obesity — 50,7%, hypercholesterolemia — 29,3%, and bad eating habits — 51,3%.
At the time of filling the application in anthropometry was made: weighing the body was carried out in medical scales with the accuracy of up to 0,1 kg., the height was measured on the ruler with the accuracy of up to 0,5 sm. ECG was done in 12 sections with evaluation in accordance with Minnesota code position.
Immunologic examinations were done with the help of medical specialists from laboratories of regional centre of struggling against AIDS. The strategy 3 was used (one testing with 2 confirming results)/WHO, UNAIDS and SDS, 2001/.
Statistical management of received results were made with appliance of t-criteria of Student and by using Excel-2007 software. While comparing intensive indicators were used X-square criteria (X 2), criteria of Pearson and Kolmogorov-Smirnov, as well as proportional risk of Cox.
Depending on the age awareness of HIV-positive people about main RF increases in such frequencies: about obesity — from 47,5% (at the age up to 40), up to 55,0% (at >50), that is 1,5 times or 7,5% (<0,05); about hypercholesterolemia — from 17,5% to 40% or 2,5 times, that is 22,5% (<0,01); about insufficient physical activeness — from 50,0% to 60,0% or 10% (<0,05); about smoking — from 55,0% to 65,0% or 10% (<0,05); about consuming alcohol — from 59,6% to 70% or 10,4% (<0,05); about stresses — from 30,0% to 40% or 10% (<0,05) and about bad eating habits — from 45,0% (at the age of up to 25) to 60,0% (at the age of > 50) or 15,0% (<0,05).
The maximum awareness of HIV-positive people was detected regarding smoking, insufficient physical activeness, consuming alcohol, irregular eating and obesity. Thus, HIV-
Table 3. - Attitude of HIV-positive people to
positive people, prefer more significant RF of AH (obesity, irregular eating, IPA, smoking, and drinking alcohol), leaving behind other factors (hypercholesterolemia and stresses).
It seems that in various mass media the increase of information in this aspect and arranged measures of different structures among HIV-positive people are needed.
Other researches also showed such opinions and suggest that measures for preventing HBP, cardiovascular diseases and chronic non infectious diseases should begin from raising awareness on this problem [20; 21; 22].
Analyses of results show that for HIV-positive people 4 levels of answers are common. (table. 3): good health — 6,1%, satisfactory — 40,6% (<0.01), bad-48,7% and excellent — 4,6%.
their health (results of epidemic research)
Answer levels of examined HIV-positive people Expanding of health indicators
abs %
Good health (l) 20 6,1
Satisfactory health (2) 138 40,6
Bad health (3) 167 48,7
Excellent health (4) 16 4,6
P <0,05 2-1, 2-4, 3-1, 3-4
<0,01
<0,001
Table 4 presents the results of our analyses, dedicated people in different age groups. to studying expanding of health indicators of HIV-positive
Table 4. - Attitude of HIV-positive people to their health in various age groups (abs%-accord.)
HIV-positive people's opinion Age groups, years P
Up to 24 n=40 25-29 n=89 30-34 n=73 35-39 n=55 40-44 n=39 45-49 n=25 >50 n=89 20-50 n=89 <0,05 <0,01 <0,001
n (%) n (%) n (%) n (%) n (%) n (%) n (%) n (%)
Good health 7 (17,5) 6 (6,7) 4 (5,4) 2 (3,6) 1 (2,6) 0,0 0,0 20 (6,1) 3-5 1-2 2-5 1-6 1-7 1-5 1-4
Satisfactory health 30 (75,0) 40 (60,6) 42 (57,6) 18 (32,7) 5 (12,8) 2 (8,0) 1 (5,0) 138 (40,6) 1-3 1-4 1-7 1-6 1-5
Bad health 34 (85,8) 46 (51,7) 47 (64,3) 19 (34,5) 8 (20,5) 7 (28,0) 6 (30,0) 167 (48,7) 1-2 1-3 1-4 1-5 1-6
Excellent health 6 (15,0) 5 (5,6) 3 (4,1) 1 (1,8) 1 (2,6) 0,0 0,0 16 () 2-5 1-3 1-2 1-7 1-6 1-5 1-4
As we can see from the given data for HIV-positive people 4 levels of answers are common in various age groups: good health — 17,5% (at the age of up to 24), 6,7% (25-29), 5,4% (30-34) 3,6% (35-39), 2,6% (40-44) and 0,0% (>45); satisfactory health — 75,0% (<24 years), 51,7% (25-29), 64,3% (30-34), 34,5% (35-39), 20,5% (40-44), 28,0% (45-49) and 30,0% (>50) and excellent
health — 15,0%, 5,6%, 4,1%, 1,8%, 2,6% and 0,0% — accordingly.
Consequently, on their age the best attitude towards own health is among HIV-positive people in the group of up to 24 and 25-34 years.
The next task was studying attitude to preventing measures related to HBP.
Table 5. - IV-positive people's attitude to preventing recommendations about HBP
№ HIV-positive peoples opinions said Relation of HIV-positive people and population (n=341)
Abs. %
1. Very positive 42 12,3
2. Partially yes, may take part 101 29,6
3. Never involved in preventing 162 47,5
4. No, not useful 23 6,7
5. Cannot answer 13 3,8
According to the results of our research (Table.5), 12,3% of HIV-positive people showed their opinion to preventing measures regarding HBP answering 12,3% — "Very positive", 29,6% — "Partially, possible to participate", 47,5% — "Never participated in preventing", 6,7% — "No, not useful" and 3,8% — "Cannot answer". On the whole, 87,7% HIV-positive people have insufficient awareness about effectiveness of preventing measures regarding AH. Perhaps, this situation must gain attention of both researchers and practitioners.
Conclusion. 1. Screening method of early diagnosis, detecting and correction of HBP and its risk factors may be
widely used in making regional and large-scale researches on detecting real needs for preventing measures regarding HBP among HIV-positive people.
2. Among HIV-positive people low level of responsibility for own health is stated (10,7%) and low level of preparedness for participating in preventive measures regarding HBP (12,%). In 87,7% of cases among HIV-positive people there is insufficient awareness about effectiveness of preventing measures regarding HBP and lack of confidence in ideas of preventive recommendations about preventing health problems and healthy life style.
References:
1. Primatesta P., Brookes M., Poulter N. R. Improved hypertension management and control. Results from the health survey for England 1998//Hypertension. 2001. № 38. 827-32 p.
2. The JNS 7 Report. The seventh report of the joint National Committee on Prevention, Evaluation, Detection and Treatment of High Blood Pressure//JAMA. 2003. № 289 (19). 2560-72 p.
3. Konstantinov V. V., Zhukovsky G. S., Timofeyeva T. N., et al. Prevalence of an arterial hypertension and its communication with mortality and risk factors at men in the cities of various regions//Cardiology. 2001. № 4. 39-42 p (In Russian).
4. De Socio G. V., Ricci E., Parruti G., Maggi P., Madeddu G., Quirino T., Bonfanti P. Chronological and biological age in HIV infection//Journal of Infection. 2010. № 61. 428-430 p.
5. Palella FJ. Jr., Delaney K. M., Moorman A. C., Loveless M. O., Fuhrer J., Satten G. A., Aschman D.J., Holmberg S. D. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators//New England Journal of Medicine. 1998. № 338. 853-860 p.
6. Capetti, A., Landonio S., Meraviglia P., Di Biagio A., Lo Caputo S., Sterrantino G., Ammassari A., Menzaghi B., Franzetti M., De Socio G. V., Pellicano G., Mazzotta E., Soria A., Meschiari M., Trezzi M., Sasset L., Celesia B. M., Zucchi P., Melzi S., Ricci E., Rizzardini G. 96 week followup of HIV-infected patients in rescue with raltegravir plus optimized backbone regimens: a multicentre Italian experience//PLoS One. 2012. № 7, e39222.
7. Bergersen B. M., Sandvik L., Dunlop O., Birkeland K., Bruun J. N. Prevalence of hypertension in HIV-positive patients on highly active antiretroviral therapy (HAART) compared with HAART-naive and HIV-negative controls: results from a Norwegian study of 721 patients//European Journal of Clinical Microbiology and Infectious Diseases. 2003. № 22. 731-736 p.
8. Gazzaruso C., Bruno R., Garzaniti A., Giordanetti S., Fratino P., Sacchi P., Filice G. Hypertension among HIV patients: prevalence and relationships to insulin resistance and metabolic syndrome//J Hypertens. 2003. № 21. 1377-1382.
9. Jerico C., Knobel H., Montero M., Sorli M. L., Guelar A., Gimeno J. L., Saballs P., Lopez-Colomes J. L., Pedro-Botet J. Hypertension in HIVinfected patients: prevalence and related factors//Am J Hypertens. 2005. № 18. 1396-1401 p.
10. Baekken M., Os I., Sandvik L., Oektedalen O. Hypertension in an urban HIV-positive population compared with the general population: influence of combination antiretroviral therapy//J Hypertens. 2008. № 26. 2126-2133 p.
11. Manner I. W., Baekken M., Oektedalen O., Os I. Hypertension and antihypertensive treatment in HIV-infected individuals. A longitudinal cohort study//Blood Press. 2012. № 21. 311-319 p.
12. Crane H. M., Van Rompaey S. E., Kitahata M. M. Antiretroviral medications associated with elevated blood pressure among patients receiving highly active antiretroviral therapy//AIDS. 2006. № 20. 1019-1026 p.
13. Wilson S. L., Scullard G., Fidler S. J., Weber J. N., Poulter N. R. Effects of HIV status and antiretroviral therapy on blood pressure//HIV Med. 2009. № 10. 388-394 p.
14. De Socio G. V., Bonfanti P., Martinelli C., Ricci E., Pucci G., Marinoni M., Vitiello P., Menzaghi B., Rizzardini G., Schil-laci G. Negative influence of HIV infection on day-night blood pressure variability//J Acquir Immune Defic Syndr. 2010. № 55. 356-360 p.
