Vol 9, No 4 (2012)

Articles
Diurnal blood pressure variability as a risk factor for complications of arterial hypertension
Ostroumova O.D., Reznikova K.U.
Abstract
The paper gives the definition of blood pressure variability and lists its types. It considers the value of diurnal blood pressure variability as an independent risk factor of stroke and myocardial infarction in arterial hypertension. The authors present the data of their study of the effect of a fixed-dose combination of amlodipine and lisinopril on diurnal blood pressure levels and variability.
Systemic Hypertension. 2012;9(4):5-10
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Diuretics in arterial hypertension: a focus on torasemide
Baryshnikova G.A., Stepanova I.I.
Abstract
Diuretics have been long used to treat arterial hypertension; however, the use of loop diuretics has been limited by cases of chronic kidney and heart failure. The loop diuretic torasemide is now administered in subdiuretic doses (2,5–5 mg) to treat arterial hypertension; it is well tolerated, metabolically neutral, and, due to its antialdosterone effect, fails to cause hypokalemia.
Systemic Hypertension. 2012;9(4):11-16
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The abilities of losartan in angioprotection in hypertensive patients with hyperuricemia
Nedogoda S.V., Ledyaeva A.A., Chumachok E.V., Tsoma V.V., Salasyuk A.S.
Abstract
Aim: to evaluate the ability of the angiotensin II receptor blocker losartan (Lorista, KPKA) to reduce the level of uric acid and to correct the parameters of vascular wall elasticity in patients with arterial hypertension, hyperuricemia, and gout. Subjects and methods. An open-label, randomized, controlled, parallel group comparative (losartan versus conventional therapy with other antihypertensive drugs for 24 weeks) trial enrolled 40 patients with arterial hypertension, hyperuricemia, and gout. Results. No significant differences were found between the groups of losartan (Lorista) and conventional therapy with other antihypertensive drugs groups in their antihypertensive activity. At the same time the losartan group showed a considerably more decrease in uric acid levels than did the conventional group (34,7% versus 7,8% in the group of therapy with other antihypertensive drugs (p<0,05), with no differences being detected in the degree of daily uric acid excretion. In addition, losartan (Lorista) monotherapy promoted the better elasticity of both muscular and elastic vessels to a greater extent than therapy with other antihypertensive drugs, which appeared as a reduction in carotid-femoral pulse wave velocity (PWV) by 14,2 and 6,4% (p<0,05) and carotid-radial PWV by 15,7 and 8,3% (p<0,05). The parameters of the elasticity of cushioning vessels (augmentation index and central aortic pressure) and intima-media thickness improved only during losartan therapy.
Systemic Hypertension. 2012;9(4):16-21
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B-ADRENOBLOCKERS IN THERAPY FOR ARTERIAL HYPERTENSION: ON THE WAY TO REASONABLE COMPROMISE
Perepech N.B., Shurygina V.D.
Abstract
The paper discusses the aspects of using b-adrenoblockers in the treatment of patients with arterial hypertension (AH). It discusses the reasons why United Kingdom experts have excluded b-adrenoblockers from the list of first-line antihypertensive drugs. The place of b-adrenoblockers is defined among other antihypertensive agents according to the European and Russian guidelines for the management of hypertensive patients. The authors show indications for the use of different b-adrenoblockers in patients with AH and underline the need for an individual approach to choosing a b-adrenoblocker and the expediency of administering long-acting cardioselective drugs as agents having an optimal combination of their efficacy and safety.
Systemic Hypertension. 2012;9(4):22-27
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Organ-protective effect of fixed-dose combination antihypertensive therapy with eprosartan and hydrochlorothiazide for subclinical and clinical target organ damage in hypertensive patients
Koziolova N.A., Bushmakina A.V., Kovalevskaya N.A., Shatunova I.M.
Abstract
Aim: to evaluate the efficiency of starting fixed-dose combination therapy with eprosartan and hydrochlorothiazide on the clinical and subclinical parameters of target organ damage in patients with hypertensive disease (HD) irrespective of baseline blood pressure (BP) and cardiovascular risk. Subjects and methods. The study consisted of two parallel substudies. Substudy 1 that screened 3536 workers from industrial enterprises identified 395 (13%) hypertensive patients. Among them, there were 50 (12,7%) untreated patients with HD who had three-component target organ damages: left ventricular hypertrophy, hypertensive nephropathy, peripheral artery lesion. Sixty (15,2%) untreated patients with Stage 1 HD without clinical signs of organ changes were recorded among the same cohort in Substudy 2. In both substudies, Group 1 received a fixed-dose combination of eprosartan mesylate 600 mg once daily and hydrochlorothiazide 12,5 once daily regardless of baseline BP at the onset of the study. Group 2 had monotherapy with enalapril and/or its combination with hydrochlorothiazide depending on the degree of BP elevation and the group of a cardiovascular risk. Results. Starting fixed-dose combination antihypertensive therapy (eprosartan + hydrochlorothiazide) irrespective of baseline BP and cardiovascular risk versus monotherapy with enalapril and/or its free combination with hydrochlorothiazide, which was used in terms of BP level and cardiovascular risk ensured a more significant regression of both clinical and subclinical target organ damages during 6-month therapy according to the changes in left ventricular mass (LVM), LVM index, and tissue inhibitor of type 1 matrix metalloproteinases, microalbuminuria and glomerular filtration rate, intima-media complex thickness during carotid Doppler ultrasound study, and pulse wave velocity in different segments, as evidenced by volumetric sphygmoplethysmography. Conclusions. The use of a fixed-dose combination of eprosartan and hydrochlorothiazide in untreated patients of able-bodied age regardless of baseline BP and cardiovascular risk ensures the regression of target organ damages and the prevention of their development in the absence of organ changes.
Systemic Hypertension. 2012;9(4):28-34
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Analysis of antihypertensive therapy and its adherence in hypertensive patients with and without concomitant diabetes mellitus
Sergeyeva V.A.
Abstract
Among patients with hypertension and with a combination of hypertension and diabetes mellitus the majority does not reach target values of arterial pressure levels. There is a number of lacks in ambulatory antihypertensive therapy and adherence to it. The considerable number of patients continues to accept therapy irregularly, the choice of antihypertensive drugs and their combinations is not always adequate, non – medicamentous actions don’t realize by all patients. At the same time the powerful negative contribution is associated with low adherence of patients to spent antihypertensive therapy.
Systemic Hypertension. 2012;9(4):35-39
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The capacities of automated oscillometric blood pressure measuring devices in patients with atrial fibrillation
Rogoza A.N., Goriyeva S.B.
Abstract
Beat-to-beat variability of blood pressure (BP) hampers its exact measurements in patients with arrhythmias, which can give rise to diagnostic inaccuracies and accordingly wrong treatment. Aim: to assess whether BP measurement might be exact in patients with permanent atrial fibrillation when using the latest generation of high-accuracy oscillometric devices. Subjects and methods. The developed design was used to examine 15 patients and to make 44 comparisons of BP measurements. The inclusion criteria were permanent atrial fibrillation and evidence for hypertension. Results. BP levels measured by an objective auscultatory method (OAM), a traditional auscultatory method (TAM), and OMRON M6 device were compared. Considerable (more than 10 mm Hg) differences were found in the recordings taken by OAM and OMRON M6 during 6 (14%) systolic BP (SBP) and 4 (9%) diastolic BP (DBP) measurements. However, substantial differences were concurrently revealed in those obtained by the two auscultatory methods TAM and OAM in 3 (7%) and 4 (9%) measurements of SBP and DPB, respectively; which appears to be related to the general problems of BP measurements in arrhythmias. Conclusion. The conducted pilot study has generally confirmed that the up-to-date high-grade oscillometric tonometers (such as an OMRON 6) may be used to measure SBP and DBP levels in the presence of atrial fibrillation.
Systemic Hypertension. 2012;9(4):40-43
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The availability of a home tonometer as a factor that increases therapy compliance in outpatients with arterial hypertension
Smirnova M.D., Tsygareishvili E.V., Ageyev F.T., Svirida O.N., Kuzmina A.E., Fofanova T.V.
Abstract
The use of technical means, home automatic tonometers in particular, is one of the possible ways of enhancing therapy compliance. Aim: to evaluate the impact of the availability of an automatic tonometer on patient adherence to antihypertensive therapy and its efficiency. Subjects and methods. The investigation included 60 patients aged 45–75 years with grades 1–2 arterial hypertension. The patients were randomized to tonometer Group «OMRON» that was given an OMRON automatic tonometer and control Group that was not given the latter. Compliance-increasing methods, such as giving losartan free of charge, a self-control diary, and written recommendations, were used in all the study participants. General clinical examination, office blood pressure (BP) measurement, biochemical blood testing, and questioning using the hospital anxiety and depression scale (HADS), Morisky-Green test, and a visual analogue scale (VAS) were employed to assess quality of life. Results. Both groups achieved a reduction in systolic and diastolic blood pressures (SBP and DBP). The quality of life was improved only in Group «OMRON» (VAS scores increased from 64,8 to 73,6; p=0,01). At visit 1 (at week 3), the patients in both groups showed an equally high level of compliance. At visit 2 (at week 12) the compliance in Group «OMRON» increased up to 96,4% whereas that in Group «Control» decreased to 81,3% (a 15,1% difference; p<0,001). There was a positive correlation between the degree of a change in quality of life (VAS) and compliance (r=0,37; p=0,02). Subgroup 3 included the patients who had not got an automatic tonometer before the investigation (16 and 10 patients from Groups «OMRON» and «Control», respectively). In the subgroup, SBP lowering was achieved only in the participants from Group «OMRON» at visit 2. The degree of DBP reductions was also greater in Group «OMRON» (∆DBP, 9,6 versus 6,6 mm Hg; р=0,05). Conclusion. The availability of an automatic tonometer enhances adherence to antihypertensive therapy in the patients and it is associated with their better quality of life. In the patients who had not got an automatic tonometer before the investigation, its giving increased the efficiency of antihypertensive therapy.
Systemic Hypertension. 2012;9(4):44-49
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Stress-induced arterial hypertension – clinical features and treatment options
Ratova L.G., Chazova I.E.
Abstract
Aim: to evaluate the characteristics of 24-h blood pressure (BP) profile, prevalence of target organ damage in patients (pts) with stress-induced arterial hypertension (AH) and efficacy of the fluoxetine therapy. Materials and methods. The study included 23 pts with stress-induced AH, which diagnosis is confirmed on the ambulatory blood pressure monitoring in the working day (44% males and 56% females, mean age 38,9±5 years, body mass index 28,2±4,0 kg/m2). The regular antihypertensive therapies were not accepted by any patient. Initially clinical BP (BP clin.) level was 144,6±5,5/91,7±6,4 (136–156/80–100) mm Hg, heart rate (HR) 70,2±10,4 (50–88) bpm. All patients were given recommendations of lifestyle modification, and 20 patients started taking fluoxetin. Results. The 26,1% of pts have 1–2 risk factors (RF) and 73,9% have three or more RF. Target organ damage was found in 65% of pts. The presence of established cardiovascular disease were absent. BP during working hours was significantly higher than in the free time (∆BP 14,7±5,3/10,9±4,3 mm Hg, p<0,001). At night, the BP level was normal. After 3 months of fluoxetin 10–20 mg/day treatment BP clin. was reduced by -15,2±7,7/11,0±7,8 mm Hg (p<0,001). HR was not significantly changed. According to 24-h BP, daytime and nighttime BP significantly decreased too, but maximum BP reduction was in the work hours. The fluoxetin therapy was well tolerated. Conclusion. Stress-induced AH is characterized by a significant increase blood pressure in work hours compared with free time and night hours, and often accompanied by the target organ damage. The treatment of Fluoxetin reduces blood pressure, but doesn’t reduce tachycardia, which is common in these patients during office hours.
Systemic Hypertension. 2012;9(4):50-53
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Iloprost for acute tests in patients with pulmonary arterial hypertension
Belyatko E.A., Danilov N.M., Matchin Y.G., Martynyuk T.V., Chazova I.E.
Abstract
Objective: in our study, iloprost was used as a drug for acute tests in patients with pulmonary arterial hypertension (PAH). Design and Method. We included 7 pts with pulmonary arterial hypertension (PAH): 5 females and 2 males, average age 32,0±12,0 years. All patients underwent right heart catheterization including acute tests with both nitric oxide and Iloprost. In addition to hemodynamic changes the intravascular ultrasound (IVUS) parameters were analyzed. We used parameters such as: intima-media thickness, the pulsatility index (PI), the outer and inner diameter of the vessel, the area of the vascular wall. Results. Compared with the action of nitric oxide, the degree of reduction of medium pulmonary arterial pressure (mPAP) after Iloprost was 17,2±5 and 25,37±9 mm Hg respectively, and pulmonary vascular resistance (PVR) 251,4±120 and 276±129 dynes×c×cm-5 respectively (p<0,05). In addition, the hypotensive effect of inhaled iloprost developed rapidly. More pronounced response to Iloprost was also confirmed by the data of IVUS: intima–media thickness decreased to 1,18±0,07 mm after leading NO and to 1,01±1,12 mm after iloprost inhalation (p<0,05), and the PI was 25±21,4 after using NO and 45,7±38 after iloprost (p<0,05). Conclusions: our research suggests that iloprost has advantages, not only as a drug for a long pathogenesis therapy, but as a vasodilator for acute pharmacological tests.
Systemic Hypertension. 2012;9(4):54-57
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Electrical and viscoelastic parameters of erythrocytes in patients with different degrees of arterial hypertension
Gromov A.A., Kruchinina M.V., Rabko A.V., Baum V.A., Generalov V.M.
Abstract
We investigated the electrical and viscoelastic parameters of red blood cells in patients with hypertension of 1 and 2 degree. We marked the increase of variations in the characteristics of red blood cells with an increase in the degree of hypertension. We identified the correlations of erythrocytes parameters with biochemical indicators reflecting hyperlipidemia, microalbuminuria and the presence of inflammation. It was noted that the velocity of red blood cells to the electrodes, the dipole moment can be the markers of initial stages of endothelial dysfunction. It was suggested that the decrease of deformability, surface charge of red blood cells are the important pathogenetic factors in the progression of hypertension, therefore, requires additional emphasis in the treatment of this disease.
Systemic Hypertension. 2012;9(4):59-64
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Analysis of associations between genetic markers of erythrocytes of ав0, Rh, mn, P, kell blood group systems and arterial hypertension at the Altai Republic population
Ogargov M.U., Mulerova T.A., Filimonov S.N., Luzina F.A., Onishchenko E.G.
Abstract
Objectives: the aim is to estimate the share of people with AH among the Tubalars and nonindigenous inhabitants of the Altai Republic taking into account a sex, an ethnic origin and to analyze genetic predisposition to the diseases of АВ0, Rh, MN, P, Kell blood group systems. Materials and methods. There was clinico-epidemiologic survey of the Altai Republic population (sample of 935 people, 663 people of them are Tubalars, 272 people are nonindigenous) aged from 18 till 88 years. Arterial hypertension was diagnosed according to criteria of WHO/MOAG of 1999. The study of genetic markers was carried out according to the standard methodology, blood group systems were defined: ABO, «full» Rhesus factor, MN, P, Kell. The sample size of different systems made from 301 to 425 people. The force of association between studied markers and the disease was judged according to the criterion of relative risk. Results. 38,6% Tubalars and 40,8% nonindigenous population were diagnosed with arterial hypertension. The share of people with Rh(+) blood group is larger among Tubalars (94,6%) in comparison with nonindigenous representatives (87,4%; p<0,05). The full Rhesus factor CCDee and CcDEe phenotypes were registered more often among Tubalars, and the ccDee, CcDee, ccDEe, Ccddee phenotypes – among nonindigenous ethnic group. The MM phenotype was brought out more often among people of indigenous nationality (64,5% against 43,7%), whereas the MN and NN phenotypes – among people of nonindigenous nationality (40,4% against 28,5% and 15,9% against 7,0%; p<0,05). There were established the risk of development of AH for people with Rh(-) blood group among Tubalars, positive associative connection with AH disease for the people having the MN phenotype and resistance of people with Rh(+) blood group and the NN phenotype. Conclusion. The share of people with AH in the Altai Republic do not differ from the average rates in Russia (37,9% among men, 40,0% among women). There were brought out ethnic differences in blood group distribution of Rhesus and MN systems.
Systemic Hypertension. 2012;9(4):65-68
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The 2012 hypertension summer school in Dublin (Ireland)
Blinova N.V., Elfimova E.M.
Abstract
Annual Hypertension Summer School 2012, organized by the European Society of Hypertension, was held in Dublin (Ireland). The following topics on epidemiology, pathophysiology, diagnostics and treatment of arterial hypertension were covered during the school. Particular attention was given to the target organ damage, as well as to the peculiarities of management and treatment of arterial hypertension in various groups of patients.
Systemic Hypertension. 2012;9(4):69-70
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On the occasion of the birthday of Sergey N.Nakonechnikov
- -.
Abstract
В 2012 г. отметил юбилей Сергей Николаевич Наконечников – доктор медицинских наук, ученый секретарь ФГБУ Российский кардиологический научно-производственный комплекс Минздрава РФ, профессор кафедры скорой медицинской помощи ФДПО МГМСУ, руководитель отдела новых медицинских информационных технологий, генеральный директор Российского медицинского общества по артериальной гипертонии, вице-президент благотворительного фонда «Артериальная гипертония», генеральный секретарь Евразийской ассоциации кардиологов.
Systemic Hypertension. 2012;9(4):70
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