Vol 12, No 2 (2015)

Articles
Cardioncology: management of arterial hypertension in patients with cancer on chemotherapy
Chazova I.E., Oschepkova E.V., Kirillova M.Y., Sharipova G.C.
Abstract
Systemic Hypertension. 2015;12(2):6-7
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Comparison of the effectiveness of preparations containing moxonidine during emergency antihypertensive therapy
Ruksin V.V., Grishin O.V., Onuchin M.V.
Abstract
In 163 patients we compared the therapeutic efficacy and safety of a single sublingual original moxonidine (Fiziotenz, Abbott) and generic moxonidine (Tenzotran, Actavis Group) in the provision of emergency medical services in the case of high blood pressure. It was found that the original moxonidine (Fiziotenz) and generic moxonidine (Tenzotran) are effective to provide emergency medical services with an increase in blood pressure, especially in patients with hypersympathicotonia. At the same time, generic Tenzotran lowers blood pressure less and later than Fiziotenz, the original drug. Adverse effects after using both drugs were not expressed and rare.
Systemic Hypertension. 2015;12(2):8-12
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Heart rate in patients with arterial hypertension:a possible marker of high risk or independent therapeutic target?
Kobalava Z.D., Shavarova E.K.
Abstract
The article shows the data concerning the effect of lowering the heart rate (HR) in patients with arterial hypertension (AH), in case of cardiovascular risk reduction in this category of patients. In the routine practice, the high HR can be considered as a possible cardiovascular risk factor, but HR is not included in the basic risk calculators as part of primary prevention. The European AH experts advise to prescribe the drugs with the effect of lowering the heart rate in people with subjective poor tolerance to the tachycardia. The patients should be informed about the beneficial effects of the regular aerobic physical activity concerning the management of HR and BP. The Achieving target BP levels is remained the main priority in the management of patient with hypertensive disease.
Systemic Hypertension. 2015;12(2):13-18
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Autoregulation hemodynamics in pregnancies complicated by hypertensive disorders
Makarov R.A., Kinzhalova S.V., Davydova N.S.
Abstract
In the article the comparative analysis parametres of haemodynamics and features of autoregulation of haemodynamics in patients with uncomplicated pregnancy and pregnancy with hypertension is carried out.Complex investigation of central haemodynamics in 196 patients in the third trimester of pregnancy (65 - with physiologically proceeding pregnancy, 66 - with chronic arterial hypertensia, 65 patients with the pregnancy complicated by preeclampsia) by means of noninvasive bioimpedance technology with calculation of oscillatory activity and the spectral analysis of the three parametres of haemodynamics was carried.Authentic differences of parameters of central haemodynamics and the data of the spectral analysis between healthy pregnant women and pregnant women with hypertensive the disorders were received, the most expressed deviations are noted in preeclampsia.Considering compromised haemodynamics regulation in patients with preeclampsia the differentiated approach to therapy and choice of anesthesiological protection is required at operative delivery in this group of pregnant women.
Systemic Hypertension. 2015;12(2):19-23
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Effectiveness and safety of indapamide sustained-release in the treatment of post partial hypertension
Gaisin I.R., Iskchakova A.S., Shilina L.V., Maksimov N.I., Vavilkina Z.V., Sava N.P.
Abstract
Background. Hypertensive disorders in pregnancy have been recognized as an important risk factor for atherosclerotic CVD in women. Therefore, lifestyle modifications, regular blood pressure control, and control of metabolic factors are recommended after delivery, to avoid complications in subsequent pregnancies and to reduce maternal cardiovascular risk in the future. There are no uniform recommendations for the treatment of post partial hypertension (HT) yet.Methods. In a case-control, open-label 1-year study, 54 post-partum hypertensive women (aged 22-38 years; body mass index 26.7±3.8 kg/m2; 18 with previous pre-eclampsia, 18 pre-existing HT, 18 pre-existing HT plus superimposed pre-eclampsia) were studied. Nursing mothers (n=27) received adjusted-dose methyldopa (Egis) 500-2000 mg daily, 27 non-feeding women received indapamide SR (Servier) 1.5 mg daily. No significant differences observed between two groups at baseline.Results. After comprehensive follow-up, clinical blood pressure was not found to differ substantially between indapamide and methyldopa groups (124.8±3.2/83.2±2.1 mmHg vs 125.3±3.8/81.5±2.9 mmHg respectively; p =NS), but indapamide significantly better improved diurnal BP patterns. No maternal adverse effects were registered in both groups, except for sleepiness and bad mood in 18.5% of methyldopa patients. There was a significant difference in weight reduction, in favour of indapamide (-11.3 kg vs -2.7 kg; p =0.032), as well as in decrease of microalbuminuria (-189.2 mg/24 h vs -51.4 mg/24 h; p <0.001) and left ventricular mass index (-25.3 g/m2 vs -10.5 g/m2; p =0.021). No significant changes in lipid and glucose metabolism were found in both groups. Treatment with indapamide significantly improved endothelial function, non-invasively assessed by flow-mediated dilatation of the brachial artery using high-resolution ultrasound (+9.3% vs +2.9%; p =0.041). Moreover, indapamide demonstrated a good safety profile and led to high adherence to treatment. In the methyldopa group, no reduced milk production and offspring adverse effects were observed.Conclusions. The results provide support for indapamide SR as an effective and safe therapy of hypertension after delivery. Indapamide is superior to methyldopa in women with post partial hypertension.
Systemic Hypertension. 2015;12(2):24-28
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Fibromuscular dysplasia as the cause of malignant renovascular hypertension in a newborn
Albot V.V., Dolgikh V.V., Gvak G.V., Pogodina A.V.
Abstract
Fibromuscular dysplasia (FMD) is a non-atherosclerotic, non-inflammatory arteriopathy, which can affect arteries of any part of vascular system and is most commonly diagnosed in women between 20-60 years of age. We present the FMD case study of ischemic stroke in a 10-month-old child, manifested in the hospital. The application of diagnostic methods is not allowed to determine the cause of uncontrolled arterial hypertension development in patient during the life. Pathologic study revealed the generalized tubular fibromuscular vascular dysplasia affecting arterial vessels practically of all parts of vascular system and forming stenotic areas of both of the renal arteries, the arteries of the heart, brain, intestines, liver and spleen.Conclusion. FMD manifestation during the period of infancy is associated with severe course and poor prognosis. The improvement of the prognosis for this disease, obviously, can be achieved in case of the diagnosis the disease before the development of organ complications, what is required the monitoring of blood pressure level during the routine pediatric examinations in children of the first year of life, even in the absence of complaints.
Systemic Hypertension. 2015;12(2):29-32
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Efficacy and safety of different regimens of fixed combinationof perindopril 10 mg/indapamide 2.5 mg in patients with arterial hypertension
Elfimova E.M., Aksenova A.V., Litvin A.Y., Chazova I.E.
Abstract
Objective: The most common strategy to improve blood pressure (BP) control is improving compliance with once daily administration of antihypertensive therapy. Aim: To assess the efficacy, tolerability, safety of different regimes of prescription of combination of perindopril 10 mg and indapamide 2.5 mg.Design and methods. We included 31 patients (56±9.3 years, BMI 30.5±5.3 kg/m2, duration of arterial hypertension - 7.1±5.8 years), on two-component therapy (except combination of perindopril and indapamide) with BP>140/90 mmHg. At baseline ambulatory blood pressure monitoring (ABPM), blood tests were performed in 20 men and 10 women, then, patients were randomized into two groups: morning and evening regimes. Previous therapy was canceled and prescribed a combination of perindopril 10 mg and indapamide 2.5 mg. After 8 weeks of treatment, ABPM and blood tests were re-conducted. Results. Baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) in the whole group - 148.4±10.0/95.6±10.7 mm Hg. After 1 and 2 months of treatment Noliprel-A bi-forte SBP/DBP decreased to 131.4±8.4/86.6±5.7 mm Hg and to 133.4±11.2/84.5±8.8 mm Hg respectively. ( p <0.001 vs baseline). No additional antihypertensive drugs were added. The combination of perindopril 10 mg and indapamide 2.5 mg effectively reduces BP by ABPM data. There was no difference in terms of BP in morning and evening regime groups. Statistically significant changes in blood indices were not detected. Tolerability was assessed by The combination of perindopril 10 mg and indapamide 2.5 mg effectively reduces BP by ABPM data. There was no difference in terms of BP in morning and evening regime groups. Statistically significant changes in blood indices were not detected. Tolerability was assessed by patients as good to very good.Conclusion. The combination of 10 mg perindopril and indapamide 2.5 mg is effective in achieving and maintaining a "target" BP levels. The dosing regimen does not affect the efficacy and tolerability and does not cause additional adverse effects when administered in the evening.
Systemic Hypertension. 2015;12(2):33-37
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Ser49Gly polymorphic markers associations of ADRB1 gene and 4a/4b eNOS gene with hypertension and ischemic heart disease among the population of mountain shoria natives
Mulerova T.A., Rubtsova E.V., Kuz'mina A.A., Tatarnikova N.P., Maksimov V.N., Voevoda M.I., Ogarkov M.I.
Abstract
The purpose: to investigate the frequencies of genes ADRB1 and eNOS genotypes and alleles among the population of Mountain Shoria natives (Shors) and their associations with hypertension and ischemic heart disease.Material and methods. Clinical and epidemiological study of the indigenous population of remote Mountain Shoria areas was conducted. 221 people were observed by the continuous method; the sampling included the adult population (18 years and older). Mean age for observed people was 51.07±1.46 years for men, 52.93±0.96 years for women ( p =0.286). Blood pressure measurement was performed by the method of the WHO/ISH (1999). Epidemiological criteria for ischemic heart disease and left ventricular hypertrophy were used on the basis of ECG coding changes by the Minnesota code. Anthropometric data, blood lipid profile, C-reactive protein, 4a/4b polymorphism of eNOS gene, A/G polymorphism of ADRB1 gene were studied.Results. The frequencies of A/G polymorphism genotypes ADRB1 gene in a population of Shors were in Hardy-Weinberg equilibrium (AA - 47.0%, AG - 41.4%, GG - 11.6%). Genotypes of gene eNOS were as follows: 4b/4b - 80.8%, 4a/4b - 18.7%, 4a/4a - 0.5%. The relative risk of hypertension developing at homozygous for the allele A compared with homozygous for the allele G and heterozygous is higher for 1.6 times (95% CI 1.18-2.09, p =0.003). Accordingly, the relative risk of disease for the carriers of the G allele less than for the carriers of allele A and heterozygotes [RR 95% CI 0.35 (0.12-0.99), p =0.035]. The level of systolic blood pressure is higher at homozygotes AA (137.8±2.5 mm Hg) in comparison with homozygous GG (127.4±4.0 mm Hg). AA genotype carriers had an increased risk of ischemic heart disease in comparison with genotypes AG and GG. The analysis of associations for 4a/4b polymorphism eNOS gene with phenotypic traits among the indigenous ethnic group didn’t reveal any statistically significant patterns.Conclusion. The connection between A/G polymorphism of ADRB1 gene and risk factors of ischemic heart disease (with a help of C-reactive protein, atherogenic index).A allele of ADRB1 gene among the Shor population is associated with the risk of hypertension and ischemic heart disease.
Systemic Hypertension. 2015;12(2):38-42
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The hardness of the vessel wall in patients with arterial hypertension
Ostroumova O.D., Kochetkov A.I., Kopchenov I.I., Guseva T.F., Bondarec O.V.
Abstract
The article deals with the role of the hardness of the vessel wall in the pathogenesis of arterial hypertension and its complications and cardiovascular mortality. We discussed the factors increasing the hardness of the vessel wall, such as age, blood pressure level, atherosclerosis, smoking and diabetes mellitus. We showed the indicators reflecting the status of the vascular wall and which could play a role of markers of increased risk of cardiovascular complications. We reviewed the data concerning the improvement of the parameters of the hardness of the vessel wall under the influence of antihypertensive therapy using the angiotensin II type 1 receptor blocker - candesartan. We discussed the possible mechanisms of the candesartan influence on the elastic properties of the vessels. We stressed that the effect on the hardness of the arteries on using antihypertensive drugs, even within the same class, was different, which, apparently, was associated with the difference in the pharmacokinetic properties.
Systemic Hypertension. 2015;12(2):43-48
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Calcium channel blockers: more than 50 years on guard of health
Chazova I.E., Zhernakova Y.V.
Abstract
The class of drugs - calcium antagonists (CA), or calcium channel blockers (CCBs) is combined a quite heterogeneous drugs group possessing common vasodilatatory characteristics by disruption of the movement of calcium through the vascular smooth muscle cells and with different degree of impact on myocardium, the sinus node function, atrioventricular conduction, tonus of peripheral vessels and coronary blood flow. The existence of this class of drugs has become one of the great achievements in the field of pharmacology, at the end of the 20th century. Third Generation CCBs takes the special place in hypertensiology because of high bioavailability and tissue selectivity. Modern long-acting CA are widely used in case of arterial hypertension (AH), they can be used especially in patients with diabetes mellitus, peripheral artery disease, chronic obstructive pulmonary disease and bronchial asthma, ischemic heart disease and in elderly patients with systolic AH. These drugs show not only antihypertensive effect and organoprotective characteristics, but also can improve the prognosis in patients with high and very high cardiovascular risk.
Systemic Hypertension. 2015;12(2):49-56
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Influence of metabolic syndrome components on the level of nitric oxide stable metabolites in patients with essential hypertension
Podzolkov V.I., Bragina A.E., Bragina G.I., Murashko N.A.
Abstract
Objective. To investigate levels of the stable nitric oxide metabolites (NOx) in relation to different components of the metabolic syndrome (MS) in essential hypertension (EH).Methods. We examined 124 untreated patients with EH and 25 healthy volunteers with comparable age.Results. NOx levels were significantly higher in hypertensives (43.18±21, mol/l) then in controls (28.3±9.6 mol/l); p <0.05. In patients with hyperglycemia NOx concentration was significantly higher (46.5±23.9 mol/l) than in those without it (38.6±18, mol/l); р <0.05. NOx levels correlated with blood glucose levels (r=0.32, p <0.05). Obese hypertensives had lower NOx concentration than nonobese hypertensives (38.8±17.9 and 48.5±24.7mol/l accordingly; р <0.05). NOx levels correlated with the presence (r=-0.44, p <0.05) and degree of obesity (r=-0.3, p <0.05). NOx levels were significantly lower in patients with MS (31.6±11.3 and 47.05±20.7 mol/l accordingly; р <0.05). NOx levels decreased with the increase of the quantity of MS components ( р <0.05). NOx levels correlated with the amount of MS components (r=-0.38, p <0.05). Hypertensives with high leptin levels had lower NOx concentration (29±12.2 mol/l), compared to hypertensives with normal leptin levels (34.7±10.5 mol/l); p <0.05.Conclusion. Hypertension per se and hyperglycemia increase NOx levels, whereas MS and its essential signs like visceral obesity and high plasma leptin level decrease NOx levels.
Systemic Hypertension. 2015;12(2):57-61
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Possibilities of electrocardiographic and decartographic parametersin the diagnosis of right ventricular overload in patients with pulmonary arterial hypertension
Sakhnova T.A., Blinova E.V., Saidova M.A., Yurasova E.S., Arkhipova O.A., Martynyuk T.V., Trunov V.G., Aydu E.A., Chazova I.E.
Abstract
Aim: to study the possibilities of electrocardiographic and decartographic parameters to identify and assess the severity of overload of the right ventricle in pulmonary arterial hypertension (PAH) patients. Material and methods. Decartographic parameters of the activation duration and repolarization acceleration were studied in 120 patients with PAH and 120 healthy individuals compared to traditional ECG criteria of right ventricular hypertrophy. Moderate increase in systolic pulmonary artery pressure (SPAP) was determined as SPAP 30-50 mm Hg; severe as SPAP greater than 50 mm Hg. Results. The most informative decartographic indicators for the separation of the PAH group as a whole, and the subgroup with moderate increase in SPAP and normal group were the X and Z components of the repolarization acceleration vector and the index of activation duration, and for the separation of subgroups with moderate and severe increase in SPAP - Y component of the repolarization acceleration vector and index of activation duration. Decartographic parameters were more informative as compared with ECG criteria. Conclusion. In patients with PAH decartographic parameters can be useful for detecting the overload of the right ventricle and the assessment of its severity.
Systemic Hypertension. 2015;12(2):62-65
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Clinical case: combination therapy with iloprost and sildenafil in the treatment of idiopathic pulmonary hypertension
Zavyrylina I.N., Arkhipova O.A., Saidova M.A., Danylov N.M., Martynyuk T.V., Chazova I.E.
Abstract
Idiopathic pulmonary arterial hypertension is a rare disease with unknown etiology, characterized by progressive increase in pulmonary vessel resistance, right heart failure. Combined pathogenetic therapy using leads to depression of disease progression, repeated hospitalization, improvement in disease prognosis in patients with III-IV functional class (WHO).The patient with diagnosis of idiopathic pulmonary arterial hypertension, verified by right heart catheterization method, functional class III (WHO) was treated by anticoagulants, diuretics. There were observed the negative dynamic with right heart chambers dilation, appearing of heart failure signs during the treatment with phosphodiesterase type 5-inhibitor sildenafil. After adding an inhaled form of prostanoids-iloprost to sildenafil therapy there was achieved the significant improvement of the functional and hemodynamic status. Reduction in dyspnoea level, improvement in physical activity tolerance and disease prognosis were reached.
Systemic Hypertension. 2015;12(2):66-70
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The first results of an international clinical trial VICTORY:the efficacy and safety of antihypertensive valsartan monotherapy and the fixed combination of valsartan and hydrochlorothiazide usingdifferent dosage regimens in patients with 1-2 degree arterial hypertension
Chazova E.E., Martyniuk T.V.
Abstract
On behalf of the group of russian researchers. The aim of the VICTORY study was to estimate the efficacy and safety of valsartan monotherapy using different dose regimes (Valsacor® 80, 160, 320 mg) and its fixed combination with hydrochlorothiazide (HCTZ) using different dosage regimens [Valsacor® H160 (valsartan 160 mg + HCTZ12.5 mg), Valsacor® H320 (valsartan 320 mg + HCTZ 12.5 mg) Valsacor® HD320 (valsartan 320 mg + HCTZ 25 mg)] in reaching the target level of blood pressure (BP) in patients with 1-2 degree arterial hypertension (AH).Materials and methods. There are 130 patients with 1-2 degree AH were enrolled in the open international multicenter prospective randomized study from 7 cities in 8 Russian Clinical Centers in Russia. The starting dose of valsartan depended upon the previous antihypertensive treatment: for previously untreated patients - 80 mg (Valsacor® 80 mg, KRKA, Slovenia) with randomization into 4 parallel groups (n=108) for the patients receiving antihypertensive therapy during the screening, after washout 7-day period of Valsacor® 160 mg application with randomization into 8 parallel groups (n=22). Besides the dynamics of clinical BP, we evaluated the impact of therapy on pulse ware velocity, erectile function (in men) and the quality of life. Results. The clinical BP in 130 patients with AH with age of 55.6±11.5 years (65% women) at the moment of inclusion into the study was 157.6/95.1 mm Hg. The BP was reduced to 140.9/85.3 mm Hg on the 4-week of valsartan 80 or 160 mg application. Valsartan titration or the combination of valsartan and HCTZ on the 8-week helped to reduce BP to 135.2/83.5 mm Hg. The 16-week treatment showed the BP reduced to 129.2/79.4 mm Hg. ( p <0.000001). The therapy was statistically significant reducing the level of heart rate and did not affect aortic augmentation index and the condition of erectile function. The percentage of patients who had the departure from normal blood glucose levels, creatinine and potassium, did not increase since the beginning of the study till the 16-week of treatment. Adverse effects were observed in 9.2% of patients, the connection with the drugs was assessed as improbable and in one case as possible, the severity - was moderate or slight.Conclusions:Valsartan monotherapy and the combination of valsartan and HCTZ significantly reduce the systolic BP and diastolic BP to normal levels in patients with 1-2 degree arterial hypertension.As a result of valsartan therapy and the combination with HCTZ the target BP values were achieved at 91% of all patients involved in the study.Valsartan monotherapy and the combination of valsartan and HCTZ led to heart rate reduction and did not affect aortic augmentation index.Therapeutic effect was very good in 89.1% of the patients and good - in 7.0%.The overall clinical efficiency was measured as extremely high in 73.4% of patients, very high - in 15.6% and high - in 6.3%.On assessing the impact of the therapy on the quality of life of patients we noted that 78.7% of patients were in good health, and in 18.1% of cases the treatment did not worsen the general well-being of the patient.
Systemic Hypertension. 2015;12(2):71-82
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The recommendations review concerning the maintenance of patients with arterial hypertension: evidence and expert opinions
Samorodskaya I.V., Boitsov S.A.
Abstract
The article presents the comparison study of 4 English-language recommendations of professional communities during 2013 year concerning the methods used for formulating recommendations; blood pressure levels - BP (primary, threshold and target); the group of primary agents and the treatment regimens.Conclusions. Different methods for formulating recommendations and the use of expert opinions in the absence of the evidences can lead to certain differences in the recommendations. It is not enough being agreed upon the questions concerning the primary and target BP level in elderly patients, the use of b-blockers as the group of primary agents, nowadays and the recommendations show the different treatment regimens.
Systemic Hypertension. 2015;12(2):83-88
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Restriction of caloric intake is a key to prevention of vascular ageing
Orlova Y.A.
Abstract
Studies in recent decades suggest that slowing down the aging process is now real. We describe a number of physiological processes, which may affect the mortality and age-related deterioration of the functional state. One of the most studied impact is to limit caloric intake, which implies a decrease in daily caloric intake by 30-50% compared with an unlimited meal.Showing the effects of GST on the total risk of developing cardiovascular disease, different biomarkers of aging in people without obesity, blood pressure, and others.
Systemic Hypertension. 2015;12(2):89-95
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The correlation of the efficacy and safety of statins with the aim of primary and secondary prevention: myths and reality
Gilyarevsky S.R., Golshmid M.V., Kuzmina I.M.
Abstract
This article deals with the different aspects of statins acceptability. Special attention is paid to the most clinically significant and frequent side-effects of the statins application. In particular, we discuss in detail the problem of toxic effect of statins on muscles and the approaches of the optimum tactics of treatment in patients with the symptoms of muscles damage associated with the use of statins. We show the information concerning the safety use of modern statins, especially rosuvastatin.
Systemic Hypertension. 2015;12(2):96-102
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