Vol 10, No 1 (2013)

Articles
The diagnosis and treatment of patients with arterial hypertension and chronic obstructive inflammatory pulmonary diseases (Guidelines of the Russian Medical Society on Arterial Hypertension and the Russian Respiratory Society)
Chazova I.E., Chuchalin A.G., Zykov K.A., Ratova L.G.
Abstract
Systemic Hypertension. 2013;10(1):5-34
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Angiotensin-converting enzyme inhibitors or sartans in patients at high risk for cardiovascular events: a wrong question or an undesirable answer
Gilyarevsky S.R., Orlov V.A., Kuzmina I.M., Golshmid M.V.
Abstract
The paper discusses current views on the role of using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers to prevent severe cardiovascular events. It gives both respective documentary information and experts’ opinions. The possible causes of clinical inertness defining deviations in the tactics of using drugs that suppress the activity of the renin-angiotensin system are considered.
Systemic Hypertension. 2013;10(1):35-38
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Evaluation of the antihypertensive efficacy and safety of moxonidine in the treatment of uncomplicated hypertensive crisis
Tereshchenko S.N., Gaponova N.I., Abdrakhmanov V.R.
Abstract
Aim. To evaluate the clinical efficacy and safety of the selective imidazoline I1-receptor agonist moxonidine versus the angiotensin-converting enzyme inhibitor captopril in patients with uncomplicated hypertensive crisis (UHC). Subjects and methods. Two hundred and twenty-five patients (125 women, 100 men) aged 56,2±14,4 years with UHC were examined. The patients were randomized to a group of once-daily 0.4 mg moxonidine orally (n=113) and a group of once-daily 25 mg captopril (n=112). Dynamic measurements of blood pressure (BP) and heart rate, electrocardiogram recording, and determinations of blood creatinine, potassium, and glucose levels were made along with general clinical examination. The efficacy indices in patients were time to the onset of antihypertensive action, degree of BP lowering, and duration of antihypertensive effect. duration. 24-hour BP monitoring was used to evaluate the efficacy of the drugs compared. The time course of changes in the parameters was analyzed for 12 hours. Results. Both groups achieved an antihypertensive effect as a significant reduction in systolic and diastolic BP 30 and 60 min after therapy initiation, respectively; at the same time BP decreases did not exceed 25% of the baseline levels. Moxonidine was found to be more effective mainly in the duration of its antihypertensive effect with a steady BP decline throughout the follow-up. There was evidence that moxonidine exerted a positive metabolic effect, particularly in significantly reducing blood creatinine levels. In the moxonidine group, the patients with above satisfactory efficacy were 26,9% significantly more and those with above satisfactory tolerance were 18,8% more. Conclusion. The findings suggest that moxonidine versus captopril is highly effective and well tolerated in patients with UHC. The drug may be successfully used to treat UHC, starting in the prehospital period, especially in patients with concomitant diseases (diabetes mellitus, metabolic syndrome, chronic renal failure).
Systemic Hypertension. 2013;10(1):40-47
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Hypertension treatment: Is there a place for b-adrenoblockers?
Minushkina L.O.
Abstract
The paper considers whether b-adrenoblockers may be used in the therapy of hypertension. It views in more detail the specific features of nebivolol, a third-generation highly selective b-adrenoblocker that has properties of acting on endothelial function and stimulating NO synthesis. The possible mechanism for the angioprotective activity of the drug is described. There is evidence for its antihypertensive efficacy. The effect of nebivolol on target organs in hypertension, its metabolic effects, and the possibilities of using the drug in patients with comorbidities are considered.
Systemic Hypertension. 2013;10(1):48-51
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Comparative characterizations of patients with hypertensive disease in the mid-1980s and in the 2010s (the patients’ portraits in the context of factor analysis)
Zakharova E.G., Fursov A.N., Potekhin N.P.
Abstract
Aim: to study the clinical characteristics of patients with hypertensive disease (HD) in the first decade of the 21st century versus the mid-1980s, by using multivariate statistical methods for the further optimization of therapeutic and diagnostic guidelines. Materials and methods. 234 case histories of patients with HD in the periods 1985 to 1987 (Group 1) and 2010–2012 (Group 2) were analyzed. Factor analysis of 110 signs identified 7 factors or leading symptom complexes. Results. Comparison of HD patients’ portraits in the mid-1980s and the first decade of the 21st century may lead to a number of main conclusions: firstly, HD has undergone certain alternations in the past quarter of a century, which is associated with changes in both the socioeconomic characteristics of society and those in approaches to therapy and with the advent of novel groups of antihypertensive drugs; secondly, the emergence of drugs with a proven nephroprotective effect (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) resulted in the reduced negative impact of BP on renal functions. Thus, three of the seven factors in Group 1 are directly related to the renal function of patients with HD while Group 2 shows only one factor of systemic and intraglomerular hypertension; thirdly, metabolic disturbances assume great importance in the characterization of Group 2 patients. Metabolic syndrome is typical of them; fourthly, for the patients of the early 21st century, of particular significance is tobacco smoking that is not only a risk factor of cardiovascular diseases in general, but also a factor influencing of the diurnal BP variation that promotes the formation of its particularly unfavorable variants – a night peaker, and finally fifthly, the patients of the early 21st century are characterized by a greater adherence to systemic antihypertensive therapy, which positively affects primarily on the course of the disease, by preventing target organ damage. Conclusion. The findings make it possible to optimize therapeutic and diagnostic efforts in patients with HD and to make more goal-oriented secondary prevention of complications.
Systemic Hypertension. 2013;10(1):52-57
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Real and potential benefits of third-generation calcium antagonists
Kirichenko A.A.
Abstract
The paper considers the specific features of the pharmacokinetics of third-generation dihydropyridines (membrane-controlled pharmacokinetics). Comparative trials have shown their longer action and high efficacy, which are highly competitive with those of major groups of antihypertensive drugs. Lercanidipine proved to have the nephroprotective activity comparable with that of angiotensin-converting enzyme (ACE) inhibitors. They have been demonstrated to have a better tolerance and safety than second-generation calcium antagonists.
Systemic Hypertension. 2013;10(1):57-61
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Priorities for choosing diuretics in the treatment of hypertensive disease: Evidence-based medicine, recommendation documents, and real clinical practice
Kompaniets O.G., Averin E.E.
Abstract
Reorganization of the drug supply is one of the most important parts of the Russian health care reform. Pharmacoepidemiology is one of the sections of clinical pharmacology, the study of the results of the application and effects of drugs in large groups. The aim of the study was the analysis of pharmacoepidemiological and validity purpose diuretic therapy in patients with hypertension and chronic heart failure in clinical practice. A comparative analysis of retrospective pharmacoepidemiological diuretic in the hospital according to the sources of primary medical records for 2010-2012. - Continuous sampling histories hospital regional center and district hospitals in Krasnodar Krai (435 patients). The results of our study showed an active and relevant guidance documents use of diuretics doctors practical medicine. There have been no use of diuretics is the testimony and in the presence of contraindications, revealed no excess doses and irrational combinations. Can be considered a positive increase in the activity of torasemide destination due to the impact of the drug on the prognosis of the disease, which can be realized through antialdosterone effect and influence on depozitsiyu collagen. Analysis of contemporary domestic and foreign recommendations GB and CHF, as well as evidence-based data suggests that the use of diuretics is a stable long-term trends in the pharmacotherapy of cardiac disease, so you need to continue to assess the quality of the clinical use of pharmacological agents, to raise awareness doctors about clinical situations with the need to connect with spironolactone and acetazolamide, as well as a new indication and especially the appointment of torasemide in patients with chronic heart failure, hypertension, as reflected in clinical guidelines and "standards of primary health care workers in essential hypertension (hypertension) "Health Ministry.
Systemic Hypertension. 2013;10(1):62-65
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Antihypertensive efficacy of a fixed full-dose perindopril A-indapamide combination in patients with grades 2–3 arterial hypertension
Glukhova T.V., Solgalova S.A., Alferov V.V.
Abstract
Aim: to study the antihypertensive efficacy of a fixed full-dose perindopril arginine-indapamide combination in patients with grades 2–3 arterial hypertension (AH) who do not receive antihypertensive therapy or those who do not achieve blood pressure (BP) control with other antihypertensive drugs. Subjects and methods. The trial enrolled 30 patients: 20 (66,6%) males and 10 (33,3%) females aged 30 to 60 years (mean age 50,5±7,1 years). Grades 2 and 3 AH was recorded in 28 (93,3%) and 2 (6,6%) patients, respectively. According to office measurements, the baseline BP (systolic BP (SBP)/diastolic BP (DBP) averaged 169±13,3/100,3±6,9 mm Hg in the group. Before included into the trial, 25 (83,4%) patients had taken antihypertensive agents, of them 10 (40%) and 2 (5%) examinees had combination therapy and fixed-dose combinations, respectively. Results. During therapy with a fixed-dosed combination of perindopril arginine 10 mg and indapamide 2,5 mg, there was generally a trend for SBP and DPB to lower at week 2 of therapy and there was a significant reduction in SBP by 42,4±11,2 mm Hg and in DBP by 20,1±9,3 mm Hg by the end of month 3. The goal BP (lower than 140/90 mm Hg) was achieved in 96,6% of the patients. Conclusion. The fixed full-dose perindopril arginine-indapamide combination allows therapeutic efficiency to be enhanced in grades 2–3 AH patients having no target BP values.
Systemic Hypertension. 2013;10(1):66-69
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Effect of adrenalectomy on the condition of the myocardium and arteries in hypertensive patient with primary hyperaldosteronism
Valieva Z.S., Chikhladze N.M., Sakhnova T.A., Blinova E.V., Panteleev I.V., Tripoten M.I., Balakhonova T.V., Chazova I.E.
Abstract
In the last years several studies demonstrated the important role of aldosterone not only in the development of arterial hypertension bur also in the development of cardiovascular complications. Growing investigations have recognized the important role of aldosterone in the development of left ventricular hypertrophy, the myocardial fibrosis and changes in the wall of the carotid arteries. This article provides a clinical case of hypertensive patient with primary hyperaldosteronism. The dynamics of blood pressure, the state of Renin-Angiotensin-Aldosterone System, left ventricular myocardium and carotid arteries were analized in the preoperative period, and in one year follow-up after the successful removal of the aldosteroma
Systemic Hypertension. 2013;10(1):70-75
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Effect of the fixed-dose combination Ekvator on blood pressure level and cognitive functions in elderly patients with arterial hypertension
Ostroumova O.D., Pervichko E.I.
Abstract
The paper gives the data of the authors’ trial of the effect of the fixed-dose combination antihypertensive drug lisinopril + amlodipine on blood pressure level and cognitive functions in 25 elderly patients with grades 1–2 arterial hypertension. The test drug has a high antihypertensive efficacy, as shown by both routine blood pressure measurements and 24-hour monitoring data. The findings suggest that the fixed-dose combination antihypertensive drug lisinopril + amlodipine improves a number of parameters characterizing cognitive functions
Systemic Hypertension. 2013;10(1):76-79
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The new widely discussed clinically significant aspects influence of β-blockers
Arutyunov G.P.
Abstract
The use of b-blockers is of particular interest now. There are the pros and cons of prescribing these drugs. Thus, a considerable body of the papers that cast doubt on the role of b-blockers in elderly patients with arterial hypertension (AH) in preventing chronic heart failure and enhancing exercise endurance in patients with AH has been published since 2006–2008. However, the Russian guidelines have retained indications for the use of b-blockers that are indispensable drugs in the treatment of AH with high comorbidity. The paper analyzes the most studied b-blockers
Systemic Hypertension. 2013;10(1):80-87
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Left ventricular hypertrophy and renin-angiotensin-aldosterone system: AT1-receptor blockers are in the focus
Barsukov A.V., Glukhovskoy D.V., Talantseva M.S., Bagaeva Z.V., Pronina E.V., Zobnina M.P., Sveklina T.S., Korovin A.E.
Abstract
Left ventricular hypertrophy (LVH) is one of the cardio-vascular continuum components, determining the prognosis of patient with essential hypertension (EH). Pathogenesis of LVH has a multifactor character. Important role in development of cardiomyocites hypertrophy, Intracardiac fibrosis, left ventricle cavity dilation belongs to renin-angiotensin-aldosteron system (RAAS). Pharmacologic blockade of RAAS composes the basis of therapy, directed to LVH regress. Application of Telmisartan is considered high-reasonable approach to treatment of EH-patient with LVH.
Systemic Hypertension. 2013;10(1):88-96
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