Vol 13, No 2 (2016)

Articles
Diuretics in combination antihypertensive therapy: focus on forecast
Chazova I.E., Martyniuk T.V.
Abstract
In the modern therapy of arterial hypertension (AH) along with thiazide diuretics b-blockers, calcium antagonists, angiotensin converting enzyme inhibitors and angiotensin receptor blockers are considered for initial and maintenance of antihypertensive therapy in the form of mono - or combination therapy. Five of these classes of drugs have comparable antihypertensive effectiveness and proven impact on prognosis in accordance with the results of randomized controlled clinical trials. The most widely used in clinical practice for the treatment of patients with AH received thiazide diuretics. The most powerful evidence base among the diuretics in regards to the effect on prognosis is chlortalidone. The article presents data from a randomized, placebo-controlled and comparative studies сhlortalidone and hydrochlorothiazide in AH. It is shown that diuretics are the most effective component of combination therapy. The application of a new fixed combination сhlortalidone in combination with azilsartan medoxomil in our country will improve opportunities for effective treatment of this category of patients.
Systemic Hypertension. 2016;13(2):6-10
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The major arteries and skin microcirculatory vessels status and antihypertensive therapy effect on them in hypertensive patients with high and very high cardiovascular risk
Mordvinova E.V., Oshchepkova E.V., Fedorovich A.A., Zairova A.R., Pogorelova O.A., Tripoten M.I., Rogoza A.N.
Abstract
Aim: to assess the state of the large blood vessels and skin microcirculatory vessels and the effects of angiotensin II receptor blockers (ARB) on them in hypertensive patients with high and very high cardiovascular risk (CVR). Subjects and methods. We examined 59 hypertensive patients aged 35-60 years, of which 29 high CVR subjects and 30 very high CVR (without antihypertensive therapy within 2 weeks prior to the study). In all subjects the evaluation of target organ damage, laser Doppler flowmetry (LDF) with initial perfusion parameters registration and amplitude-frequency spectrum of LDF-grams analysis, registration of central blood pressure, local stiffness parameters and photoplethysmography (PTMG) were performed. The second study was carried out after 2 weeks of antihypertensive treatment with ARB. Results. A significant increase in endothelial rhythm amplitude and coefficient of variation in very high risk hypertensive patients in comparison with a group of high-risk patients was found. In the group of very high-risk hypertensive patients central arterial pressure, augmentation index and local stiffness values were higher (n/a), the rate of carotid arteries extensibility was significantly reduced. There was a significant large vessels impairment in very high risk group according PTMG data. Target blood pressure level achieved in up to 80% of patients after 2 weeks treatment. During the re-examination a statistically significant improvement in the large arteries was found, LDF parameters also improved, but significant values was not reached. Conclusion. The findings suggest that with increasing degree of CVR in patients with hypertension there is a progressive deterioration of both large vessels and microcirculation state. After short-term antihypertensive therapy the function of large vessels improve in very high risk hypertensive patients, but the state of the microvasculature not changes significantly.
Systemic Hypertension. 2016;13(2):11-16
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Vascular stiffness in patients with arterial hypertension: possible antihypertensive therapy
Ostroumova O.D., Kochetkov A.I., Lopukhina M.V.
Abstract
The article discusses the factors that increase the arterial stiffness: the blood pressure, atherosclerosis, smoking, diabetes, age. Given evidence that pulse wave velocity and a number of other indicators that reflect the state of the vascular wall, are markers for increased risk of cardiovascular complications and mortality. The influence of antihypertensive drugs of different groups on the stiffness of the vascular wall, with particular attention paid to the effects of drugs from group of diuretics. We discuss possible mechanisms of the influence of indapamide retard on the elastic properties of vessels. It is emphasized that the influence on the stiffness of the arteries of different antigipertenzivny medicines, even belong to the same class, is different, due to differences in pharmacokinetic properties.
Systemic Hypertension. 2016;13(2):17-23
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Assessment of efficiency and safety of application of the reproduced drug of Mertenil® according to MSCT-coronary angiography
Malov A.A., Feiskhanova L.I.
Abstract
In article possibility of an assessment of efficiency of therapy by the reproduced drug Mertenil of production of JSC Gideon Richter (Hungary) appointed for the purpose of primary prevention of the cardiovascular diseases. Increase of level of lipoproteid of the low density is one of the most powerful risk factors of death. Today therapy of a statin is carried out both for secondary and for primary prevention of cardiovascular diseases. For an assessment of dynamics of atherosclerotic processat patients with the diagnosis: CHD hypercholesterolemia without visual verification of defeat of the proximal coronary course possibility of use of a multispiral computer tomography of coronary arteries with calculation of a coronary calcic index is considered.
Systemic Hypertension. 2016;13(2):24-27
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Features of cardiac remodeling in patients with hypertension of different ethnic groups
Abramov E.A., Nevzorova V.A., Repina N.I.
Abstract
Objective. To study the features of different types of left ventricles (LV) geometry in patients with essential hypertension (EH) of different ethnic groups. Materials and methods. We examined 180 patients, residents of the Sakhalin Region, with 1-3 degree arterial hypertension, including 88 patients of Korean ethnicity aged from 45 to 63 years (mean age - 59.2±0.86 years) and 92 patients of Slavic ethnicity in age from 43 to 64 years (mean age - 58.2±0.93 years). LV structural and functional characteristics were studied by means of echocardiography with Doppler analysis on the ultrasonic system Acuson X300 (HP, USA). Results. The results of assessment of different types of LV geometry revealed the following differences: prevalence of the LV concentric remodeling was higher in patients with EH of Korean ethnicity (21.5% versus 13% among the Slavs, p=0.04). Conclusion. The study of the structural characteristics of left ventricular in patients with hypertension, residents of the Sakhalin Region, revealed that concentric remodeling and concentric left ventricular hypertrophy are the main types of LV geometry in hypertensive patients of both ethnic groups. However, concentric LV remodeling was more often detected in patients with hypertension of Korean ethnicity.
Systemic Hypertension. 2016;13(2):28-32
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Prognostic factors of cardiovascular complications during the heatwave of 2010 (cohort observational study)
Smirnova M.D., Fofanova T.V., Ageev F.T.
Abstract
Aim of the study was to identify prognostic factors of hypertensive crisis during the heatwave of 2010. Materials and methods: observational cohort study involving 754 patients with moderate/low, high/very high risk and patients with CAD. Medical documentation and questionnaires was used. Selectively (344 pers.) were done sphygmography Visits were conducted in april - may and september - october 2010. Results: The frequency of cardiovascular complications increased during heat waves than in the september - october 2010. There were more hypertensive crises, unscheduled visits to the doctor and arrhythmia during the heat wave than after the heat. CAD [OR 1.8 (1.1-2.8)], a history of stroke [OR 3,4 (1.0-11.4)], intake of nitrates [OR 3.1 (1.1-9.1)] and discontinuation of antihypertensive medications [OR 2.7 (1.4-5.1)] proved to be predictors of hypertensive crisis during heat wave. Independent predictors had a history of stroke [OR 5.3 (1.1-25.1)] and the discontinuation of antihypertensive medications [OR 2.5 (1.2-4.9)]. Conclusion: CAD, intake of nitrates, history of stroke and discontinuation of antihypertensive medications proved to be predictors of hypertensive crisis during heat wave. Independent predictors had a history of stroke and the discontinuation of antihypertensive medications.
Systemic Hypertension. 2016;13(2):33-36
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Chronotherapy’s opportunities of a fixed combination of perindopril 10 mg/indapamide 2.5 mg in patients with a lack of night reduction in blood pressure
Aksenova A.V., Elfimova E.M., Litvin A.Y., Chazova I.E.
Abstract
Currently, adequate reduction of blood pressure (BP) during the night in patients with arterial hypertension remains important problem. To study chronotherapy’s opportunities to achieve better BP control by a single dose of antihypertensive drugs while maintaining high compliance. Aim. To evaluate the efficacy, tolerability, safety of various prescription regimes of fixed combination: perindopril 10 mg and indapamide 2.5 mg in patients with insufficient degree of BP reduction at night. Design and methods. The study included 30 patients (20 men and 10 women, 56±9.3 years, body mass index 30.5±5.3 kg/m2, the duration of arterial hypertension - 7.1±5.8 years), on ineffective dual antihypertensive therapy (BP>140/90 mm Hg). Initially, ambulatory BP monitoring (ABPM) and blood tests were performed. Then, previous therapy was terminated and fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) was administered. Patients were randomized into two groups: morning and evening regimens of therapy. After 8 weeks of treatment ABPM and blood tests were repeated. Statistical analysis was done after further separation of patients into groups with sufficient (dippers) and insufficient (non-dippers) degree of BP reduction at night. Results. In the group of "non-dippers" average ambulatory systolic BP (SBP) during wakefulness declined from 149.4±11.7 mm Hg to 129.8±10.6 mmHg (p<0.01), the average ambulatory diastolic BP (DBP) during wakefulness - from 94.7±12.3 mm Hg to 78.3±8.6 mm Hg (ns), ambulatory SBP during sleep - from 146.6±16.1 mm Hg to 121.8±15.7 mm Hg (p<0.01), ambulatory DBP during sleep - from 86.2±9.2 mm Hg to 70.3±6.5 mm Hg (p<0.01). The reduction of nighttime SBP increased from 1.9±5.8% to 6.2±9.3% (p<0.05), the reduction of nighttime DBP from 6.2±3.9% to 9.6±8.2% (ns). ABPM measurements of "non-dipper" sub-groups, who received treatment in the evening or in the morning after 2 months had no significant difference, except the variability of DBP during wakefulness (p<0.05). We didn’t observe statistically significant difference in terms of the nighttime BP reduction. However, nighttime BP reduction was higher in the evening dosing group: SBP - 4.1±11.1% (morning group), 7.8±7.9% (evening group) and DBP - 8.9±11.0 (morning group) and 10.2±5.5 (evening group). Blood tests were in the normal range during the whole study. Conclusion. A fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) is effective and safe in patients with both normal and with insufficient degree of reduction in BP at night. Prescription of medication in the evening in non-dipper patients can have the added benefit on the BP profile. Further research is needed.
Systemic Hypertension. 2016;13(2):37-45
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Strategy of medical treatment of pulmonary arterial hypertension in the current international recommendations
Martyniuk T.V., Chazova I.E.
Abstract
Significant progress in the treatment of pulmonary arterial hypertension (PAH), in recent years, is associated with the introduction into clinical practice of a number of drugs pathogenetic action, can cause vasodilation and reverse remodeling of pulmonary vessels. Recently PAH-specific therapy was replenished with new drugs. This review is created as a result of the analysis of modern American recommendations CHEST and recommendations of the European society of cardiology and the European respiratory society (ESC/ERS) in order to provide all professionals involved in the maintenance of the PAH, data on the main approaches to the pharmacotherapy and the optimal choice of pharmacological treatment methods.
Systemic Hypertension. 2016;13(2):46-64
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Demographic and clinical differences between idiopathic and scleroderma-related pulmonary arterial hypertension: Russian National Registry analysis
Yudkina N.N., Valeeva E.G., Taran I.N., Nikolaeva E.V., Paramonov V.M., Kurmukov I.A., Valieva Z.S., Arkhipova O.A., Martynyuk T.V., Volkov A.V., Nasonov E.L., Chazova I.E.
Abstract
Pulmonary arterial hypertension associated with systemic sclerosis (SSc-PAH) and idiopathic pulmonary arterial hypertension (IPAH) belong to group I in the clinical classification of PH, but there is evidence for significant differences in their survival due to current therapy. Objective: the objective of this report is to compare pts with (SSc-PAH) and (IPAH) based on data of Russian National Registry. Patients and methods: in the study we included 52 pts with IPAH and 50 with SSc-PAH. There were no differences in functional class (FC). Diagnosis was based on RHC. Results. At the moment of diagnosis average age of patients with SSc-PAH was 15 year higher (p<0.0001). 6MWD was somewhat more in IPAH group. Borg index was higher in SSc-APAH (4.2±2.1 vs 3.3±1.5); p<0.049. The degree of heart failure (HF) and respiratory failure (RF) did not differ. Dyspnea was the most common among the first symptoms (94% in SSc-PAH and 73% in IPAH). Syncope were observed only in IPAH. In both the diagnosis was verified quite late (in SSc-PAH group in 33 (13; 56.5mts), IPAH - in 30.5 (13.3; 76.3mts). Signs of HF were detected in both groups with equal frequency (76% and 65% respectively). Advanced stage of PAH including symptoms of HF were detected with equal frequency. Only ECHO revealed pericardial effusion more frequently in pts with SSc-PAH (56% vs 35%, p<0.05). Also they had more frequently weight lost (14% vs 2%, p<0.05). Hemodynamics estimation revealed significant haemodynamic differences: sRVP (73.4±19.1 mm Hg) and mPAP (49.1±11.5 mm Hg) in SSc-PAH were significantly lower, than in IPAH (85.9±25.6 mm Hg and 57.5±15.3 mm Hg). dRVP and mRVP were significantly higher in SSc (7.02±5.59 and 28.5±12.7 mm Hg), compared to 0.95±7.6 and 11.7±6.0 mm Hg respectively. Whereas CO values were equal, the average PVR was higher in IPAH (13.2 vs 10.6 WU, р<0.005). RAP levels were equal at both groups. FVC was within normal limits in groups, but DLCO was lower in SSc-PAH group (46.9±13.5% vs 68.5±12.8%). Hb in SSc-APAH group was significantly lower (136±22 g/l vs 149±19 g/l), erythrocyte count was almost same is both groups (4.9±0.6 and 5.1±0.7×1012/l). C-reactive protein in patients with SSc-PAH was higher (9.4±15.1 vs 1.1±1.0 mg/l); p<0.001. Significant decrease in survival during the second and third years of observation was revealed in SSc-PAH group. Difference in 5 years survival between the two groups was 15%, difference was close to statistically significant (p=0.06). Conclusion: although general clinical appearance of patients with SSc-APAH and IPAH looks similar, there are significant differences in hemodynamic indexes and laboratory signs between the two groups. This factor leads to difference in progress and outcome of the disease.
Systemic Hypertension. 2016;13(2):65-72
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"Grey zone" of vasoreactivity during acute vasodilator testing in patients with pulmonary hypertension
Sagaydak O.V., Danilov N.M., Matchin Y.G., Martynyuk T.V., Chazova I.E.
Abstract
Aim - to analyze functional status and hemodynamic changes in patients who demonstrate vasoreactivity but doesn’t reach the criteria of "positive respond" ("grey zone") and to compare this data with "responders" and "true non-responders". Material and methods. We enrolled 159 patients with pulmonary hypertension. Right heart catheterization with acute vasodilator testing was performed in all cases. Depending on hemodynamic respond during acute vasoreactivity testing patients were divided in to three groups: "responders", "true non-responders" and patients in the "grey zone". The following parameters were analyzed in all included patients: basic clinical parameters, hemodynamic changes, right ventricle size, right atrium area, 6-minute walking test distance and time to clinical worsening. Results. In our study it was shown that patients of "grey zone" had several clinical and hemodynamic parameters that differ significantly from patients "responders" and "true non-responders". Patients in the "grey zone" also have the longest time to clinical worsening.
Systemic Hypertension. 2016;13(2):73-76
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Nephroprotective in patients with metabolic syndrome: approaches to the appointment of antihypertensive drugs
Ostroumova O.D., Zykova A.A., Maksimov M.L.
Abstract
In the article shows the questions of prevalence, diagnosis and prognostic significance of renal damage in metabolic syndrome. Discusses the pathogenetic mechanisms of development and progression of chronic kidney disease in individuals with obesity. Approaches to selection of antihypertensive drugs, advantages and limitations of the major classes of antihypertensive drugs in the treatment of metabolic syndrome, arterial hypertension combined with renal disease.
Systemic Hypertension. 2016;13(2):77-83
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Calcium antagonists in pharmacotherapy in patients with concomitant cardiac pathology: priorities of the recommendations in clinical practice
Kompaniets O.G., Linchak R.M., Ketova G.G.
Abstract
The article discusses the problem of using calcium antagonists in clinical practice. Physicians' judgments in prescribing calcium antagonists showed its compliance with current guidelines for the treatment of hypertension. Emphasizes the feasibility of dihydropyridine calcium antagonists as efficacy and safety tools in patients with combination of arterial hypertension, stable angina and chronic heart failure. The article discusses the results of clinical efficacy studies of felodipine in a combined cardiac pathology with cognitive impairment.
Systemic Hypertension. 2016;13(2):84-87
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Evaluating of the effectiveness and safety of the reproduced selective β1-blocker without intrinsic sympathomimetic activity Bidop® in patients with hypertrophic cardiomyopathy
Feiskhanova L.I., Malov A.A.
Abstract
The article assesses the effectiveness of therapy generics Bidop® production of Gedeon Richter (Hungary), designated to improve diastolic function, and treatment of heart failureof patients with hypertrophic cardiomyopathy with predominant hypertrophy of the interventricular septum and symmetrical concentric shape in the absence of obstruction of outflow tract of the left ventricle (LV). The effect of the presence of zones of intramyocardial fibrosis hypertrophied LV departments identified through MRI delayed contrast, to the process of active relaxation.
Systemic Hypertension. 2016;13(2):88-90
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