Vol 12, No 4 (2015)

Articles
The role of risk factors and endothelium dysfunction in the pathogenesis of the high normal arterial preassure and clinical signs of the vegetative disturbances in children
Maksimovich N.A.
Abstract
As a result of investigation of the children the dysfunction of endothelium at high normal arterial pressure is the cause of the hemodynamic disturbances of children, equal of the arterial hypertension. As a result the children with high normal arterial pressure are the groups of the risk for arterial hypertension wich need the complex of correction of theses disturbances, early diagnostics of the arterial hypertension and its profylaxis. AT high level risk factors and vasoconstrictive properties at children with high normal arterial pressure the more high frequency of headache, the heart pain, both pains and the episodes of high normal pressure.
Systemic Hypertension. 2015;12(4):6-10
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Association of clinical and genetic factors with left ventricular hypertrophy in hypertension among the indigenous population Mountain Shoria
Mulerova T.A., Kuzmina A.A., Chigisova A.N., Voropaeva E.N., Maksimov V.N., Voevoda M.I., Ogarkov M.Y.
Abstract
Objective. To determine the association of clinical and genetic factors with the left ventricular hypertrophy among indigenous patients with hypertension living in Mountain Shoria.Design and methods. A clinical-epidemiological study of Mountain Shoria indigenous populations at isolated regions was undertaken. Continuous method surveyed 547 people, consisted of a sample of the adult population (18 years and older). Studied anthropometric data, lipid spectrum of the blood polymorphisms of genes ADRB1 (Ser49Gly, A/G, rs1801252) ADRA2B (I/D), ACE (I/D), eNOS (4a/4b) and MTHFR (C677T, Ala222Val, rs1801133) and their association with left ventricular hypertrophy.Results. The left ventricular hypertrophy in patients with hypertension was detected in 47.3% of the respondents. The odds ratio found among patients with hypertension duration of 5 years with the respondents hypertrophied myocardium 0.5 times lower (38.2%) than people without this disease of the heart - 61.8%, while among those with hypertension long history of more than 10 years, 4.1 times higher: 73.3% vs 26.7%. In a population of Shor hypercholesterolemia and giperbetaholesterinemiya associated with exaggerated myocardial damage. The percentage of smokers in a cohort of patients with hypertensive cardiac disease was (37.8%) and was higher by 2.0 times than in hypertensive patients without left ventricular hypertrophy (22.0%). With the relative risk of hypertension with myocardial damage in a population Shor associated gene ACE I allele. The odds ratio of hypertension to identify patients with cardiac respondents with heterozygous genotype AG ADRB1 gene was 3.0 times higher compared to the surveyed individuals with homozygous genotypes AA and GG.Conclusion. Among Shor risk of hypertension with left ventricular hypertrophy was influenced by factors: prolonged duration of the disease more than 10 years, smoking, hypercholesterolemia, giperbetaholesterinemiya. Installed Association II genotype of ACE gene and gene genotype AG ADRB1s development of left ventricular hypertrophy in patients with arterial hypertension in the population of Shor.
Systemic Hypertension. 2015;12(4):11-17
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Longitudinal deformation of the left ventricle and the left atrium in workers of railway transport with arterial hypertension
Marsalskaya O.A., Nikiforov V.S.
Abstract
The research objective was in studying and evaluating the indicators of longitudinal deformation of the left ventricle and the left atrium in persons with arterial hypertension (AH), and also in persons with risk factors, but without AH, workers of railway transport.Materials and methods. The workers of railway transport under research are: 45 patients with AH, 35 people with risk factors, but without AH and 20 healthy volunteers. All the people under research were exposed the transthoracal echocardiography on ultrasonic Philips iE 33 system (Holland) including two-dimensional impulsive wave tissue Doppler echocardiography.Results. The decrease of a systolic velocity of a fibrous ring of the mitral valve in the region of septal and lateral segments in both groups is observed in comparison with the control. In studied groups deterioration of a diastolic function and significant decline of indicators of global longitudinal deformation of a left ventricle and the left atrium in comparison to healthy people are also registered. Depression of segmental deformation of a left ventricle in both groups has a chaotic character. The more the index of mass of a myocardium of a left ventricle, the lower indicators of global deformation are; the more the index of volume of the left atrium, the lower indicators of deformation of the left atrium are.Conclusion. Depression of diastolic and segmental systolic functions of a left ventricle of workers of railway transport is registered both with AH and without AH, but with risk factors that are reflected in indicators of longitudinal deformation of a left ventricle and a left atrium.
Systemic Hypertension. 2015;12(4):18-22
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From the choice of antihypertensive drug to the choice of fixed combinations of antihypertensive drugs: a paradigm shift
Ostroumova O.D., Bondarets O.V., Kopchenov I.I., Guseva T.F.
Abstract
The article considers modern approaches to treatment of arterial hypertension. Emphasizes the need for combination antihypertensive therapy, mainly fixed combinations of antihypertensive drugs, patients with high and very high risk already at the start of treatment. Discusses the advantages of combinations of blockers of receptors of angiotensin II to diuretics and calcium antagonists, as well as clinical situations in which these combinations are a priority. Considered the evidence base, pharmacokinetics and clinical benefit of the representative of a class of blockers of receptors for angiotensin II and losartan.
Systemic Hypertension. 2015;12(4):23-29
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Effectiveness of combined antihypertensive treatment depending on the phenomenon of salt sensitivity in patients with refractory arterial hypertension
Skibitskiy V.V., Garkusha E.S., Fendrikova A.V.
Abstract
Purpose of study - evaluate the effectiveness of combined antihypertensive treatmentthat includes direct renin inhibitor in salt-sensitive and salt-resistant patients with refractory hypertension (RHT).Methods and materials. The study included 192 patients with RHT. Based on the results of the V.I.Kharchenko test and a variation of combined antihypertensive therapy, all patients were randomized into groups: group 1 - salt-sensitive patients treated with an ACE inhibitor (ACEI), dihydropyridine calcium antagonist (CA), thiazide diuretic (TD) and direct renin inhibitor aliskiren (subgroup 1A) or b-blocker - BB (subgroup 1B); group 2 - salt-resistant patients treated with ACE inhibitors, dihydropyridine CA, TD and aliskiren (subgroup 2A) or BB (subgroup 2B). In the absence of achieving target BP after 6 weeks from the start of observation, patients started receiving five-component treatment: ACE inhibitor, CA, TD, BB and aliskiren. Initially and after 48 weeks of observation, all patients underwent ambulatory blood pressure monitoring (ABPM).Results. In the group of salt-sensitive patients treatment including aliskiren contributed to achievement of target values of BP in 43.3%, and with pre- scription of BB - in 54.3% of patients. In both groups there was a significant improvement in most of the parameters of ABPM, more pronounced when using BB. Normalization of circadian BP profile was registered significantly more often ( p <0.05) when using the BB than aliskiren treatment. In patients with salt resistance target BP level when using treatment that included aliskiren was recorded in 70.4% of cases, with prescription of BB - in 50% of patients. The use of aliskiren in these patients provided significantly greater improvement in the main indicators of ABPM and more frequent normalization of circadian BP profile than the therapy that included BB. Five-component treatment including aliskiren proved to be more effective in salt-resistant patients in both, frequency of reaching target BP and the dynamics of the main indicators of ABPM.Conclusion. In salt-sensitive patients the combination including BB as part of four-component treatment provided significant cumulative antihyper- tensive effect. In patients with salt resistance more effective was the use of aliskiren in comparison with the BB. The use of five-component treatment had certain advantages in salt-resistant patients.
Systemic Hypertension. 2015;12(4):30-37
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Torasemid in the treatment of cardiovascular disease: the optimal use in conditions of comorbidity
Poteshkina N.G., Troshina A.A.
Abstract
The article reviews the current clinical data on the use of one of the modern pharmacological drugs torasemide (Diuver, Teva Pharmaceutical Industries Ltd., Israel) in the treatment of cardiovascular disease in conditions of comorbidity. Presents a comprehensive view of the problem identified and a reasoned approach to the choice of diuretic therapy with clinico-pathophysiological substantiation of the use of a loop diuretic torasemid. Conceptually formed of a number of provisions on the application of one of the modern diuretic drugs in therapeutic practice in patients with arterial hypertension and heart failure.
Systemic Hypertension. 2015;12(4):38-41
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«New» molecules composed of rational combinations of antihypertensive drugs: issues of choice
Kislyak O.A., Chervyakova Y.B.
Abstract
The article discusses the factors that determine the choice of antihypertensive drugs, especially blockers of receptors of angiotensin and thiazide diuretics. The data about the peculiarities of azilsartan medoxomil, it differs from other sartans. Among the main properties of azilsartan medoxomil, which may determine his choice for the treatment of patients with arterial hypertension, is called the significant strength of the binding of blockers of receptors of angiotensin to AT1 receptor and its duration of action, as well as special properties that improve tissue sensitivity to insulin. Discussed the feasibility of establishing fixed combinations azilsartan medoxomil with thiazide diuretics chlorthalidone.
Systemic Hypertension. 2015;12(4):42-45
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Using meldonium to improve adaptation of patients with hypertension and pre-diabetes to influence of heat
Smirnova M.D., Svirida O.N., Ageev F.T., Fofanova T.V., Vitsenya M.V., Mikhaylov G.V.
Abstract
Aim of the study was to evaluate the effect of meldonium the state of cardiovascular system and the quality of life of patients with arterial hypertension (AH) combined with pre-diabetes under the summer heat.Materials and methods. 45 hypertensive patients 51-76 years old with pre-diabetes. randomized to active management (M), which in addition to basic therapy received during the 3 summer months meldonium 1000 mg/day, and a control (C). Body mass index, office blood pressure, blood chemistry, HbA1c, pulse wave velocity (PWV), tissue glycation, visual analogue scale (VAS) were performed.Results. The trend to lower heart rate during the heat of the group M. In September, a trend increase in PWV (ΔPWV=1.7 m/s; p =0.056) in group C. Lipid and carbohydrate metabolism do not change. In both groups the trend to an increase in the level of sodium in the heat, in group M it remained until September. Increase sodium during heat greater in group M (Δ2.0 mmol/l vs 1,0 mmol/1); p =0.05. In group C, tendency to decrease VAS scores from 70 to 55 ( p =0.07) in group M trend to increase from 60 to 70 ( p =0.07), the differences between the groups were significant ( p =0.01). In group M trend continued in September.Conclusion. Meldonium can be used as an adaptogen in the period of summer heat in patients with hypertension in combination with pre-diabetes.
Systemic Hypertension. 2015;12(4):46-50
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Myocardial ischemia in patients with pulmonary arterial hypertension
Arkhipova O.A., Martyniuk T.V., Valeeva E.G., Ryabykina G.V., Samoylenko L.E., Sergienko V.B., Chazova I.E.
Abstract
The precordial region. Pain in the chest in these patients is associated with relative coronary insufficiency due to low cardiac output, a relatively weak development of coronary collaterals on the background of hypertrophy of the wall of the right ventricle or reflex constriction of the coronary arteries due to distension of the pulmonary artery (viscero-visceral reflex), lowest saturation of blood oxygen at an advanced stage, as well as compression of the left main coronary artery dilutionin the pulmonary artery trunk. Many of them in electrocardiography revealed changes similar to ischemic. The purpose of this study was to identify signs of myocardial ischemia in patients with pulmonary arterial hypertension and evaluate the relationship of pain with the presence of ischemic changes according to 12 channel Holter ECG monitoring, and synchronized single photon emission computed tomography myocardial alone and in combination with load tests.
Systemic Hypertension. 2015;12(4):52-56
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Comparison of vectorcardiographic parameters with structural-functional state of the right ventricle in patients with pulmonary hypertension
Blinova E.V., Sakhnova T.A., Saidova M.A., Loskutova A.S., Ryabykina G.V., Arkhipova O.A., Martynyuk T.V., Trunov V.G., Aidu E.A., Chazova I.E.
Abstract
Changes of the vectrocardiographic ventricular gradient (VG) in patients with pulmonary arterial hypertension (PAH) are indicative of right ventricular (RV) overload and may be used to assess its severity. The study aim was to evaluate interrelations between vectrocardiographic VG, spatial QRS-T angle and echocardiographic parameters of structural-functional state of the RV.The following parameters were assessed in 30 PAH patients: RV dimensions; tricuspid annular plane systolic excursion (TAPSE); RV fractional area change (FAC); RV peak systolic annular velocity (TDI-S’), and longitudinal strain (LS). VG and spatial QRS-T angle were calculated using the orthogonal leads derived from standard echocardiography.Spatial component VG-Y had moderate negative correlation with LS (r=-0.62; p <0.005); VG magnitude, VG-X and VG-Y had positive correlations with FAC (r from 0.50 to 0.65; p <0.005); VG magnitude and VG-Y had positive correlations with TDI-S’ (0.58 and 0.53; p <0.005); spatial QRS-T angle had negative correlation with TAPSE (r=-0.59; p <0.005), FAC (r=-0.66; p <0.005) and TDI-S’ (r=-0.67); p <0.005.In patients with severe PAH, VG and spatial QRS-T angle correlate not only with RV dimensions and pulmonary artery pressure, but with parameters of RV systolic function.
Systemic Hypertension. 2015;12(4):57-60
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Clinical effects of one-year physical training program in arterial hypertension patients of working age who have suffered acute myocardial infarction (Russian randomized controlled trial)
Aronov D.M., Bubnova M.G., Krasnitskiy V.B., Ioseliani D.G., Grinshteyn Y.I., Gulyaeva S.F., Efremushkin G.G., Lyamina N.P.
Abstract
Aim. To study the effectiveness of long-term physical training of moderate intensity in patients with arterial hypertension working age who have suffered acute myocardial infarction in the framework of the Russian randomized trial.Materials and methods. The study included 206 patients with arterial hypertension after acute myocardial infarction (not earlier than 3 weeks from the event). Patients were randomized into 2 groups: basic group 102 and control 104. All patients received standard medical therapy. In the main group used physical training in a mode of medium intensity (50-60% power during a load test) 3 times a week for 1 year. The effectiveness of the intervention was assessed by clinical data and results of instrumental and laboratory analysis.Results. After a year of physical training in patients with arterial hypertension after acute myocardial infarction, there was a significant increase in physical performance by increasing the load duration (38%; p <0.001) and total volume of performed physical work (89.7 per cent; p <0,001) on the background of decreasing load magnitude a double of the work (8.2%); p <0.01. This was accompanied by a significant increase in ejection fraction of the left ventricle by 7.6% ( p <0.001) and stroke volume of the heart by 5.1% ( p <0.01). In the control group was not noted positive developments, in contrast, showed a significant increase in the left atrium (4.3%, p <0.05) on the absence of dynamics of indicators of physical performance. Under the effect of physical training decreased blood pressure levels: systolic blood pressure -3.1% ( p <0.05) and diastolic blood pressure by 3.5% ( p <0.001) against the increase in the group natrenirovavshit patients (3.1%; p <0.05; and 3.4%; p <0.05 respectively). Physical exercise exerted anti-ischemic effect, which is manifested in the reduction of episodes of myocardial ischemia, including silent, and of angina attacks and consumption of nitroglycerin unlike patients of the control group. The trained patients showed a significant decrease in the primary endpoint of 50% ( p <0.05) and disability days (by 43.2%; p <0.05) against the control group.Conclusion. Long-term (one year) of physical exercise of moderate intensity in patients with arterial hypertension complicated by acute myocardial infarction, conducted on III outpatient phase of cardiac rehabilitation provides a stable course of the disease, reduce the risk of cardiovascular complications, improve the patient's quality of life and are safe in the vast majority.
Systemic Hypertension. 2015;12(4):61-68
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A modern view of the place of b-blockers in the treatmentof cardiovascular disease: the choice of drug within a class is crucial
Ostroumova O.D., Fomina V.M., Smolyarchuk E.A.
Abstract
In the article discusses questions of application of b-blockers (b-AB) for the treatment of arterial hypertension, coronary heart disease, chronic heart failure. The data from modern Russian and European recommendations about the place of b-AB in the treatment of cardiovascular diseases. Analyzed in detail the selection of b-AB inside the class from the standpoint of pharmacokinetics, selectivity, study in clinical studies. Data about efficiency and safety of application of metoprolol succinate for the treatment of arterial hypertension, coronary heart disease, chronic heart failure.
Systemic Hypertension. 2015;12(4):69-74
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