Vol 11, No 2 (2014)

Articles
Study of the relationship social and psychological characteristics of hypertensive patients, the frequency of medical emergencies and adherence of patients to treatment
Chumakova E.A., Gaponova N.I.
Abstract
The aim of the study was to investigate the relationship of psychological and social characteristics of patients with hypertension often seek emergency medical help with their adherence to treatment.Material and methods. Outpatient were examined 300 patients with hypertension (100 men and 200 women) from 35 years and older (mean age 72,1±12,8 years). Duration of hypertension ranged from 4 to 36 years old. We excluded patients with symptomatic arterial hypertension. Using questionnaires, revealed frequency of calls ambulance, the extent to which medical recommendations and regularity of antihypertensive drugs by patients. Also completed questionnaires Spielberg- Hanin for the assessment of emotional status.Results. The study showed that more frequent calls in general are more common in women than men, single patients, compared to unmarried as well as retirees compared to active patients. The proportion of women callers ambulance at least 1 time per year was 29% and was significantly (p<0,05) lower than that of men - 58%. Analysis of the dependence of regularity medication (drugs) on the level of personal anxiety patients showed significant differences that are typical for patients with different levels of trait anxiety.Conclusion. The findings suggest that the regularity of patients antihypertensive drugs and the extent to which medical advice is largely due to psychological characteristics examined patients.
Systemic Hypertension. 2014;11(2):5-8
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A differentiated approach to the primary prevention of cardiovascular disease
Napalkov D.A.
Abstract
The review of literature shows the modern analysis of medical approaches for cardiovascular disease primary prevention. We have been discussing the necessity of antiaggregant and statin therapy in such cases and also studding new results of involving antihypertensivetherapy (calcium antagonist - amlodipine) to prevent stroke and heart attack.
Systemic Hypertension. 2014;11(2):9-12
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National questionnaire of treatment compliance:testing and application in outpatient practice
Fofanova T.V., Ageev F.T., Smirnova M.D., Svirida O.N., Kuzmina A.E., Thostov A.S., Nelyubina A.S.
Abstract
Objective. The aim is to test national questionnaire of treatment compliance of patients with arterial hypertension in the outpatient setting. Materials and methods. The study enrolled 60 patients with stages 1 and 2 arterial hypertension at the age of 45-75 years. We made general clinical examination, measurement of office blood pressure (BP) and biochemical blood assay, run questionnaire survey (hospital anxiety and depression scale (HADS), Morisky-Green test (4-item Medication Adherence Report Scale - MARS), national questionnaire of treatment compliance, assessment of quality of life using Visual Analogue Scale (VAS), calculated the number of pills taken by the patient, issuance and the analysis of returned diaries for self-monitoring. Total sampling was accounted for 43 patients.Results. National enquirer demonstrates statistically significant correlation of results compared to the results of treatment compliance, using Morisky-Green test, and compared to the index commitment based on the total number of pills taken by the patient from the blisters which had been prescribed by the doctor.
Systemic Hypertension. 2014;11(2):13-16
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Efficacy and safety of amlodipine and perindopril (Prestance) fixed combination in patients with arterial hypertension during the summer heat
Chazova I.E., Ageev F.T., Smirnova M.D., Ageeva N.V., Fofanova T.V., Svirida O.N., Mikhailov G.V., Levin A.M., Revich B.A.
Abstract
Relevance. Impact of the drugs on adaptation to the heat wave of abnormal temperature has been one of the most important practical medicine questions in recent years. One of the points at issue is safety calcium channel antagonists and ACE inhibitors treatment during abnormal heat. The aim of the study is to investigate the efficacy and safety of perindopril arginine (drug Prestance - Servier Industries, Ltd.) and amlodipine fixed combination in arterial hypertension (AH) patients during the summer heat and the summer heat influence on the adaptation mechanisms to abnormally high temperatures.Materials and methods. The study enrolled 165 patients with stages 1 and 2 AH: 69 patients with average risk and 91 patients with high andvery-highrisk of cardiovascular complications. There were 69 men and 96 women in the study, living in Moscow city, in the Moscow and in the Ivanovo Regions. All patients were measuring office BP, biochemical blood assay and hematocrit and were running questionnaire survey: visual analogue scale (VAS), Morisky-Green test and questionnaire for the patients who were exposed to heat. Pulse ware velocity was measured in 30 patients. The first visit was done in the first half of June 2013, the second visit - during the heat (July 2013), the third one in September 2013. Results. In the course of the study systolic (SBP) and diastolic BP (DBP) were reduced (р<0,00001) and the SBP and DBP target level reached 73,9% (41,9% - durig the second visit). We observed the increase of VAS and Morisky-Green test scores from 2,24±1,43 (Ме 2,0) to 3,26±0,91 (the 2ed visit) and to 3,49±0,91 (Ме 4,0) (3ed visit), hyperkalemia (р=0,0056), hyponatremia (р=0,00042), hypocreatinemia (р=0,018), hypocholesterolemia (р<0,00001), hypotrigliceridemia (р=0,027), hypoglucosemia (р=0,0035). We noted pulse ware velocity and hematocrit reduction (the 3ed visit). Conclusion. Therapy of Prestance was effective, safe and well tolerated by AH patients during the summer heat without any sings of hypotension and electrolyte imbalance which were attributed to bodyheat. Improvement of adaptive response in the human body was associated with effective arterial elastance and reduction in blood viscosity.
Systemic Hypertension. 2014;11(2):17-22
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Effects of loop diureticswith differenthalf-elimination times on natriuresis changes in hypertensive patients with different blood pressure profile
Arutyunov G.P., Dragunov D.O., Sokolova A.V.
Abstract
The aim is to study the interaction of natriuresis curves with 24-h blood pressure (BP) profile, as well as to study the effect of diuretic therapy on natriuresis changes and on the BP profile.Materials and methods. From the group of patients who participated in the study on the types of natriuretic curves we selected patients (n=56) with signs of deterioration of chronic heart failure (CHF) and who should be prescribed diuretic therapy. Patients received torasemide SR or IR. Results. It was demonstrated that type of natriuresis curves and blood pressure (BP) profile could be changed. Deterioration of natriuresis more oftener and earlier were observed in torasemide IR group compared with torasemide SR group of patients (p<0,05).The type of natriuresis curve is associated with increasing of Tamm-Horsfall protein (THP) level, switching from one to another type of curveand duration of GB. It was shown that long-lasting hypertension (GB) was associated with high level of angiotensin II (AII). The likelihood of changes in 3ed curve to 2ed one is 83,93% (ОR 11,667); the likelihood ofchanges in 2ed curve to 1st one - 92,86% (ОR 120,00). The main predictors of BP profile could cause side effects were over use of salt (ОR 1,4), long-lasting GB (ОR 3,5), the type of natriuresis curves (OR 3,4). The likelihood of daily BP non-dipper or night-peaker profile to be changed is 83,3% (OR 21,00).Conclusion. The significant impairment of sodium excretion and increasing THP excretion are the markers of progressive renal tubulointerstitial fibrosis in the patients with modified natriuresis. The activity of AII is increasing and BP profile is changing and all these changes prove the necessity for monitoring natriuresis.
Systemic Hypertension. 2014;11(2):23-28
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The functional state of microcirculatory vessels in patients with arterial hypertension I-II degree with different degrees of cardiovascular risk
Mordvinova E.V., Oschepkova E.V., Fedorovich A.A., Rogoza A.N.
Abstract
Aim: to evaluate the main parameters of the microcirculatory blood flow and to determine its reserve capacity in patients with arterial hypertension (AH) and different degrees of cardiovascular risk (CVR).Subjects and methods. We examined 64 subjects aged 47-58 years, of which 27 were healthy volunteers and 37 patients with 1st and 2nd degree arterial hypertension, with medium, high and very high CVR (the antihypertensive therapy was cancelled for 2 weeks before the study). In all subjects laser Doppler flowmetry (LDF) with studing initial perfusion parameters, 2 constrictor and 3 dilatator tests waky perfomed. To assess the status of the tone-shaping «active» and «passive» parts of microcirculatory modulation, analysis of the amplitude and frequency spectrum of LDF- grams was carried out.Results. A significant increase in the rate of «base perfusion» in all hypertensive groups compared with the control group was found. The amplitude of respiratory oscillations was one-third higher in high and very high CVR groups in comparison with the control, the amplitude of the myogenic and neurogenic oscillations were maximal and reached significant values in very high CVR group. A reduction in constrictor response in hypertensive patients with middle and high CVR and its increase in the very high CVR group was shown during constrictor functional tests. The power of perfusion increase was reduced in response to all kinds of dilatator stimulus in hypertensive patients group.Conclusion. The findings indicate a progressive increase in the level of «base perfusion», worsening of venous congestion symptoms in hypertensive patients with the progression in CVR severity. High and very high CVR patients showed a reduction in myogenic tone of microvessels when compared with those with normotension. Dilatator functional tests showed a tendency to lower capillary blood flow reserve in hypertensive patients compared with the control group.
Systemic Hypertension. 2014;11(2):29-35
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Recommendations on treatment strategies in hypertensivepatientswithmetabolic disorders
Zhernakova Y.V., Chazova I.E.
Abstract
In 2013 experts of The Russian Medical Society on Arterial Hypertension (RMSAH) had prepared recommendations about management of patients with arterial hypertension (AH) and metabolic disorders (such as obesity, carbohydrate and lipid metabolism, hyperuricemia) and which chapters about diagnosis and correction were expanded, compared to the previous RMSAH recommendations. We also added a chapter about management of patients with AH and type 2 diabetes (T2D). Treatment and diagnosis algorithms of metabolic syndrome (MS) and T2D, discussed in these recommendations, will help us early identify and correct these disorders and will reduce cardiovascular events in patients with AH, even mortality one.
Systemic Hypertension. 2014;11(2):36-42
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Efficacy and safety of Mertenil (rosuvastatin) 40 mg in patients with familial hypercholesterolemia
Zubareva M.Y., Malyshev P.P., Rozhkova T.A., Kuharchuk V.V.
Abstract
Familial hypercholesterolemia (FH) is an inherited disease that results in high levels of total cholesterol, causing the risk of early ischemic heart disease (IHD). Rosuvastatin is the high-potency hypolipidemic agent of HMG-CoA reductase inhibitors which is approved for clinical use.The goal of our research is to study efficacy, safety Mertenil (rosuvastatin) acceptability of maximal course dose of 40 mg in patients with phenotypic FH. Materials and methods. The 16-week open study was prospective. The study included 40 men and women at the age of 18 years and older with phenotypic FH. 18 patients had the Arg3500Gln mutation in APOB100 gene. Men accounted for 40% of total number of patients. The average age of patients was 55,9 years and average LDL cholesterol (LDL-c) level was 7,2 (1,2) mmol/l. Patients did not accept statins before the inclusion in this study (for a period no less than 3 months).Results. Rosuvastatin40 mg monotherapy 16 weeks study contributed to decrease LDL-c by 50% (p<0,001) and ApoB-100 by 45,1% (p<0,001), TG by 20,1% (p<0,01). Aspartate aminotransferase, alanintransferase and creatinekinase activity were not statistically significant from the base values and were not exceed 1,5 superior normal limit after 16-weeks study. Through 16 weeks of therapy the identified reduction of hsCRP and uric acid were observed (p<0,05). Side-effects were not observed throughout the period of treatment.Conclusion. Therapy of Mertenil (rosuvastatin) 40 mgis available and effective in treatment of heterozygous FH.
Systemic Hypertension. 2014;11(2):42-47
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The mechanisms of developmentcardiovascular disease and type 2 diabetes: the role of insulin resistance, hyperinsulinemia and hypoadiponektinemia. Treatment and management
Shishkova V.N.
Abstract
In the current paradigm, the primary insulin resistance plays a central role in the development of not only diabetes but also associated with cardiovascular complications, such as arterial hypertension, arteriosclerosis, heart failure, atrial fibrillation. Defense mechanism involves the secretion of adiponectin from adipoctyes and thus helps to block the development of these diseases. Modern antihypertensive treatment options of angiotensin-receptor blocker telmisartan show that, telmisartan can be used in patients with arterial hypertension because of improving insulin resistance and increasing adiponectin levels.
Systemic Hypertension. 2014;11(2):48-53
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Chronic obstructive pulmonary disease combined with arterial hypertension: efficacy and safety ofthesustained-release indapamide (Arifon® retard)
Ovcharenko S.I., Nersesyan Z.N., Morozova T.E.
Abstract
There is a problem of medicamental correction of arterial hypertension (AH) in patients with chronic obstructive lung disease (COLD), because number of drugs for the treatment of AH is limited in patients with bronchoobstractive diseases.The study shows that prolonged-release indapamide complex therapy is efficiency and safety (Arifon® retard) in patients with COLD associated with AH. The results demonstrate Arifon retard have positive effect on the AH: normalization of daily blood pressure (BP) profile and improvement of24-hour ambulatory blood pressure monitoring levels.At the same time it is shown that administration of Arifon retard does not affect the pulmonary ventilation rates (the results of the spirometry) and does not increase the lung hyperinflation (according to the results of Body plethysmography), and is not associated with hypokalaemia. The results of the study demonstrate that Arifon® retard can be used for safe correction of BP in patients with COLD associated with AH.
Systemic Hypertension. 2014;11(2):54-58
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The effectiveness of zofenopril in patients with cardiovascular disease
Kukes V.G., Anikin G.S.
Abstract
Hyperactivity of the renin-angiotensin-aldosterone system plays an important role in the pathogenesis of any cardiovascular disease. Angiotensin - converting enzyme inhibitors are the main drugs among many medicines influencing the activity of the renin-angiotensin-aldosterone system, and these inhibitors have a wide range of beneficial effects. The presence of the sulfhydryl group in a molecule of angiotensin-converting enzyme inhibitor (zofenopril) determines the number of unique properties of this drug. Recent results have been showing the effectiveness of treatment in case of combined cardiovascular disease. This article presents the results of the studies showing the efficacy and safety of zofenopril.
Systemic Hypertension. 2014;11(2):59-62
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The benefits of candesartan usage in the treatment of arterial hypertension
Ostroumova O.D., Bondarets O.V., Guseva T.F.
Abstract
The article deals with the characteristics of angiotensin-II receptor antagonist pharmacokinetics. We have shown the differential characteristic of pharmacokinetics and pharmacodynamics of candesartan. The results demonstrate the clinical efficacy of candesartan in treatment of arterial hypertension (AH) and inreducing the risk of complications.
Systemic Hypertension. 2014;11(2):62-66
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The problem of determining the efficiency of treatmentin the era of evidence-based medicine: international and domestic experience
Gilyarevsky S.R.
Abstract
This article deals with the modern approach to the choice of effective drugs, such as angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, in preventing cardiovascular complications. We discuss evidential considerations of the drugs administration and the detection principles, concerning effective therapy in special clinical situations. The present paper deals with the results not only of the randomized trials but with the results from recent observational studies being reflective of real practice in the application of antihypertensive drug.
Systemic Hypertension. 2014;11(2):67-71
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