Vol 12, No 1 (2015)

Articles
Radiofrequency renal arteries denervation: waiting for reply
Grigin V.A., Danilov N.M., Matchin Y.G., Shelkova G.V., Chazova I.E.
Abstract
Systemic Hypertension. 2015;12(1):8-9
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The role of beta-blockers in the treatment of arterial hypertension: what do we know today
Zhernakova Y.V., Chazova I.E.
Abstract
Beta adrenergic receptor blocking agentsare one of the multi-function classes of the drugs, prescribing to treatvarious cardio-vascular diseases, and at the same time, this class have been mostly discussing for several years due to the number of publications with the critical comments and rule this class of drugs out from priority groups for the treatment of arterial hypertension (AH), as, for example, it took place in the United Kingdom and the United States. However, national guidelines for the diagnosis and treatment of arterial hypertension (AH), as well as the guidelines from the European Society of Hyper- tension keep the same position on the β-blockers, including them on equal ground with list of 5 major classes of antihypertensive drugs to treat AH.
Systemic Hypertension. 2015;12(1):10-18
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The efficacy offixed combination of bisoprolol and amlodipine in patients with arterial hypertension, ischemic heart disease and metabolic syndrome
Skibickiy V.V., Fendrikova A.V., Skibickiy A.V., Syrotenko D.V.
Abstract
The aim of the studyis to evaluate the efficacy of the fixed combination of beta adrenergic receptor blocking agents (β-AB) bisoprolol and dihydropyridine calcium channel inhibitor (CCI) amlodipine in patients with uncontrolled arterial hypertension (AH), stableischemic heart disease (IHD) and metabolic syndrome (MS) in actual clinical practice.Material and methods. The study enrolled 61 patients with uncontrolled AH, stable IHD and MS in the open prospective randomized study. The patients were randomized into 2 groups, using opaque and sealed envelopes. Patients in group 1 (n =30) had been receiving angiotensin-converting enzyme inhibitor (ACE inhibitor or ACE-i) - ramipril in dose of 10 mg/day (Hartil, Egis), fixed combination of bisoprolol and amlodipine (Concor AM, Takeda) in different doses. Patients in group 2 (control, n=31) should have been treated at the discretion of the doctor, necessarily the treatment should have included the free combination of ACE inhibitors, generic b-AB and dihydropyridine CCI. Initially, and after 12 weeks of treatment we conducted 24-hour ambulatory blood pressure monitoring (APBM) with the assessment of key indicators of 24-hour blood pressure monitoring results, the parameters of the blood vessel hardness and central blood pressure. The Statistical analyses of the results were carried out using the software package Statistica 6.1 (StatSoft Inc., United States).Results. After 12 weeks of therapy, the target level of BP was - 96,7% in the 1st group and 87,1% in the 2nd group of patients. The application of Concor AM was accompanied by significant improvements of the indicators of APBM and of the blood vessel hardness and central blood pressure characteristics. In addition, the usage of Concor AM provides the normalization of 24-hour ambulatory blood pressure monitoring results in 73% of patients. In the control group we determined the positive, but less significant changes in the indicators of APBM and rarer normalization of 24-hour ambulatory blood pressure monitoring results than in the group of patients, administrating Concor AM.Conclusion. In patients with AH, IHD and MS the administration of Concor AM is provided a significant antihypertensive and vasoprotective effects, which are more effective by the side of using free combination of β-AB and dihydropyridine CCI.
Systemic Hypertension. 2015;12(1):26-31
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The rise of cardiac biomarkers due to planned PCI and 1-year prognosis in patients with stable coronary artery disease and arterial hypertension
Mironova O.Y.
Abstract
Aim. The aim of our study was to assess the prevalence of myocardial infarction (MI) type 4a and myocardial damage due to planned percutaneous interventions (PCI) in patients with stable coronary artery disease (CAD) and arterial hypertension (AH).Material and methods. 281 patients were screened before the enrollment in our study. 183 patients with stable CAD were included in our study whose levels of cardiac troponin I and CK-MB (creatine kinase-MB fraction) were studied after PCI. We divided patients into the groups according to their levels of cardiac troponin I after PCI and CK-MB (group 1 - no elevation; 2 - elevation 1-3 upper limits of normal - ULN; III - more than 3 ULN).167 patients had AH. In case of detected rise of CK-MB and/or troponin echocardiography and cardiac magnetic resonance imaging (MRI) were performed. Results. The prevalence of MI type 4a was 10,8% and periprocedural myocardial damage - 16,2% respectively. After performing the discriminant analysis we sought to build a prognostic model and calculate the formula of periprocedural myocardial damage probability: 0,871 × gender (male = 0; female = 1)+0,516 × angina pectoris functional class + 0,022 × age (years) - 0,011 × (estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease - MDRD formula) + 0,27 × number of diseased coronary arteries ≥2,731.Conclusion. Women with low EGFR (MDRD), mutivessel disease and angina pectoris class 3-4 (NYHA) have the highest risk of MI type 4a. The most difficult localization for PCI is circumflex artery.
Systemic Hypertension. 2015;12(1):32-36
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Effects of amlodipine and atorvastatin on endothelial vasoactive mediators in patients with metabolic syndrome
Blinova N.V., Masenko V.P., Chazova I.E.
Abstract
Aims: to study the effects of the amlodipine and atorvastatin on the blood levels of vasoactive mediators in patients with metabolic syndrome (MS). Design and methods. There were included 60 patients with MS, hypertension and dyslipidemia who were randomized into three treatment groups: monotherapy with amlodipine, atorvastatin monotherapy and a combination therapy with amlodipine and atorvastatin. Office blood pressure, 24-hour ambulatory blood pressure monitoring, measurements of the NO metabolite levels, endothelin-1, thromboxane B2 (TxB2) and 6-keto-prostaglandin F1α (6-keto-PGF1α) were performed at baseline and after 24 weeks of the therapy.Results. Amlodipine and atorvastatin in monotherapy or in a combination were associated with the significant improvement of certain studied parameters. Amlodipine treatment significantly decreased TxB2 and 6-keto-PGF1α levels. There was a significant reduction of TxB2, 6-keto-PGF1a levels and increase of NO metabolite in atorvastatin group. Treatment with combination of amlodipine and atorvastatin was characterized by significant decrease of TxB2 and endothelin-1 and increase of NO metabolite.Conclusion. Amlodipine and atorvastatin treatment showed positive effects on the levels of vasoactive mediators thereby leading to the improvementof endothelial function in patients with MS.
Systemic Hypertension. 2015;12(1):37-42
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Functional state of kidneys and arterial hypertension among indigenous and nonindigenous residents of Mountain Shoria
Ogarkov M.Y., Filimonov E.S., Mulerova T.A., Kuzmina A.A.
Abstract
Goal: to investigate the interrelation between arterial hypertension and functional state of kidneys among indigenous and nonindigenous Mountain Shoria residents.Material and methods. 370 Mountain Shoria residents (consisting of 113 men and 257 women) were examined. All examinees were 51,07±1,46 and 52,93±0,96 years old on average. The level of blood creatinine was determined by all examinees. Its clearance was calculated according to the Cockcroft-Gault formula in order to determine the glomerular filtration rate. The calculated values were matched with the average square of the body surface (approximately 1,73 square meters). The whole statistical processing was carried out with the help of the Statistica 6.1 programme, significant differences were accepted at p <0,05.Results. 188 people with arterial hypertension were found out among the examined Mountain Shoria residents (this number amounts to 50,81%). The average blood pressure value and the frequency of arterial hypertension among the examinees with renal dysfunction were higher, than among the residents with normal renal function. It was also found out, that the significant reduction of the glomerular filtration rate was typical for the Mountain Shoria residents with arterial hypertension. At the same time the rise in the average level of blood creatinine was noticed only among the women with arterial hypertension. Conclusion. The amount of examinees with the glomerular filtration rate less than 60 ml/min/1,73 sq.m. among the indigenous residents was found to be determinately less than those among the nonindigenous ones, namely 3,65% against 10,67%, by p =0,0082. The amount of examinees with the glomerular filtration rate was proved to be much higher by the patients with arterial hypertension than by the persons with normal blood pressure (11,17% against 2,75%, by p =0,0015). It has been scientifically proved that the average level of blood creatinine by the male examinees was higher, than by the female examinees, and the average value of the glomerular filtration rate was independant upon the sex. The average creatinine level was lower among the indigenous residents than that of the nonindigenous, and the average value of glomerular filtration rate was found out to be higher only by the female indigenous residents.
Systemic Hypertension. 2015;12(1):43-46
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Medical and social risk factors for arterial hypertension in coal miners
Indukaeva E.V., Makarov S.A., Ogarkov M.Y.
Abstract
The risk of cardiovascular complications increases steadily with increases in arterial pressure and is significantly intensified in the presence of other risk factors for cardiovascular disease (smoking, sedentary lifestyle, alcohol abuse, stress, dyslipidemia, metabolic syndrome, diabetes mellitus). It reduces the quality of life, which is especially important for people, engaged in heavy physical labor. The most common medical and social risk factors for cardiovascular disease and hypertension in coal miners are the following: overweight and obesity, bad habits and lack of education. The further study of the prevalence pattern of risk factors for cardiovascular disease in coal miners is required to develop, implement and evaluate the efficiency of preventive measures towards reducing cardiovascular risk factors.
Systemic Hypertension. 2015;12(1):47-51
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Patients with arterial hypertension associated with metabolic disorders: characteristics and therapeutic approach
Zhernakova Y.V., Sharipova G.H., Chazova I.E.
Abstract
Arterial hypertension (AH) is associated with metabolic disorders in approximately 80% of cases. There is a pandemic of so-called new risk factors, such as insulin resistance and association with systemic type of hyperinsulinemia, abdominal obesity, hyperinsulinemia and a special type of dislipidemy, nowadays. Patients with AH associated with such metabolic disorders are at a higher risk of developing cardiovascular disease and diabetes. However, it is very difficult to achieve the target level of blood pressure in this category of patients. Usually, these patients should be treated using combination therapy at the beginning of the treatment. Drugs, which possess good antihypertensive effect, as well as an additional positive influence on metabolic parameters, for instance I2-imidazoline receptor agonists, can be used as the drugs of choice in combination with ACE inhibitorsor angiotensin II receptor blockersin this category of patients.
Systemic Hypertension. 2015;12(1):52-57
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The meaning of hypertensive therapy choice in the correction of cerebral affection: from mild cognitive impairment to dementia
Shishkova V.N.
Abstract
Disorders and neuropathy are the leading cause of disability. Their partof total morbidity and disability is increasing due to the global growth of vascular diseases of the brain: the acute and the chronic disorders of cerebral circulation. The clinical characteristics of chronic disorders of cerebral circulation have been forming gradually, and include the development of cognitive impairments, up to dementia. The base for their development can serve thelong-term cardiovascular diseases (CVD). The problem of cognitive impairments in patients with CVD, particularly with arterial hypertension (AH), is a leading one, taking into consideration the fact that these disorders are continuing to grow in the population. There is a real possibility to impact on the cognitive functions condition in patients with AH, using traditional antihypertensive drugs such assartans to achieve the target blood pressure levels. However, there is the additional benefit of special drugs in this group, such as Micardis and Twynsta, in the correction of cognitive function disorders.
Systemic Hypertension. 2015;12(1):58-64
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Safety of beta-agonists with different duration of action in patients with arterial hypertension and broncho-obstructive diseases
Dolgusheva Y.A., Agapova O.Y., Zykov K.A., Chazova I.E.
Abstract
Objective. To examine the safety of beta-agonists (BA) with different duration of action in patients with arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) or bronchial asthma (BA).Materials and methods: 40 patients (22 - male, 18 - female) with AH and COPD and AH and asthma aged 18 years were enrolled and examined initially. At the next three month, patients were treated with 3 types of BA: at the 1st month - with salbutamol (SABA), at the 2nd - with formoterol (LABA), at the 3rd - with indacaterol (ULABA). Initially, after one week and at the end of each month blood pressure (BP) and heart rate (HR) on the visit, oxygen saturation of peripheral blood, computer spirometry, serum potassium in blood, electrocardiogram, were evaluate. Initially, after one week and at the end of three month of treatment with SABA, LABA and ULABA all patients underwent holter monitoring and ambulatory blood pressure 24-monitoring.Results. Baseline, 1-month, 2-month, 3-month BP and HR levels on the visit were similar among all patients ( p =NS). At the end of the 3rd month of treatment with BA different duration of action in patients with AH and COPD daily average systolic BP (SBP) was lowered than initially ( p <0,05), daily average diastolic BP (DBP) during treatment ULABA lower compared to DBP during treatment SABA ( p <0,05) and during treatment LABA for weeks ( p <0,05). On the contrary in patients with AH and asthma daily average SBP became increased than initially ( p <0,05), nightly average SBP during treatment SABA and ULABA for weeks higher compared to nightly average SBP initially. Treatment with BA caused significant serum potassium change in blood in both group. In patients with AH and asthma three patients had hypokalemia.Conclusion. Treatment with BA in patients with AH and bronchoobstructive diseases accompanied by significantly changes BP and significantly decreased levels of serum potassium in the blood in both group. Our results suggested the need for a different treatment of patients with AH and COPD or asthma.
Systemic Hypertension. 2015;12(1):65-69
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The association of arterial hypertension and ischemic heart disease is the main problem in modern cardiology practice
Ostroumova O.D., Dudaev V.A., Fomina V.M.
Abstract
This article deals with the epidemiological datashowing higher frequency of arterial hypertension (AH) in patients with ischemic heart disease (IHD). We discussed the basic characteristics of modern domestic and foreign recommendations for treating patients with combination of AH and IHD. We showed the target of blood pressure (BP) in this category of patients. This article deals with the priority groups of antihypertensive drugs, which have the advantages in the combination usage in patients with association of these diseases. We fixed special attention to the problem of BP variability (BPV) as a new risk factor for the development of coronary complications in patients with AH. We showed the possibility of fixed combination of perindopril and amlodipine in reducing interand intervisit BPV in patients with AH and IHD in actual clinical practice.
Systemic Hypertension. 2015;12(1):70-75
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Central and humoral mechanisms for arterial hypertension in women
Podzolkov V.I., Bragina A.E., Rodionova J.N., Koloda J.A.
Abstract
The article discusses various mechanisms of arterial hypertension (AH) development in postmenopausal women. It includes literature data on the sexual hormones, namely estrogen and progesterone deficit and androgen overproduction, influence on the blood pressure level and metabolic disorder. Special focus is on the role of renin-angiotensin-aldosterone system in AH pathogenesis. Separate paragraph is focused on the role autonomous nervous system dysfunction and disorders of biogenic amines metabolism in the vascular and autonomic disorders in climacteric syndrome, as well as the contribution of the humoral shifts typical for central obesity, such as hyperinsulinemia, and hyperleptinemia.
Systemic Hypertension. 2015;12(1):76-82
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Treatment with perindopril in patients with arterial hypertension: improving compliance
Anikin G.S., Minina E.S., Andreevskaya E.M.
Abstract
The problem of the compliance is relevant in the treatment of patients with arterial hypertension. The review presents the data to identify mechanisms for improving the compliance in the context of one of the most studied drugs, such as - perindopril. We have indicated the aspects of perindopril monotherapy, as well as in combination with indapamide and amlodipine. We have showed the advantages of fixed combinations. The individual aspect of the easy medicine administration isdispersion form of the drug. This article shows the advantages of usage PrestariumR ORO - innovative form of perindopril, mouth dissolving tablets.
Systemic Hypertension. 2015;12(1):83-86
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