Vol 14, No 1 (2017)

Articles
Cardiovascular risk factors in people with high normal blood pressure in Russian population (based on data obtained in ESSE-RF epidemiological study)
Efremova Y.E., Oshchepkova E.V., Zhernakova Y.V., Chazova I.E., Iarovaia E.B., Shalnova S.A., Rotar O.P., Konradi A.O., Shliakhto E.V., Boitsov S.A.
Abstract
Introduction. High normal blood pressure (HNBP) is reported to result in arterial hypertension (AH), especially when associated with various risk factors. Still only few studies on HNBP prevalence in Russian population have been carried out. Objective. To study the prevalence of HNBP and its association with age, gender, and traditional cardiovascular risk factors (CVRFs) in adult population of 12 regions of Russia. The study is based on data obtained in ESSE-RF (Epidemiology of Cardiovascular Diseases in Different Regions of Russian Federation) study. Materials and methods. The analysis of data obtained in ESSE-RF study, which included 21 887 patients aged 25-64 years, was performed. The group of patients not taking antihypertensive and/or statin therapy (n=12 897, 41 % male, 59% female) was selected for the analysis. The patients were divided into 3 groups according to blood pressure (BP) levels. The first group included 7095 patients with normal BP, the second group included 2415 patients with HNBP (130-139/85-89 mmHg), the third - 3387 patients with AH. A detailed analysis of CVRFs was performed, including family history, obesity, diabetes mellitus (DM), ischemic heart disease (IHD), low density lipoprotein (LDL) and cholesterol levels, and glucose level. Results. The prevalence of HNBP was 19% (22% in male population, 16% in female). The prevalence rates were higher in younger age male groups (< 45 years); in female groups the prevalence rates correlated with age. The patients with HNBP had more CVRFs than ones with normal BP. According to multivariant analysis, HNBP was associated with obesity with odds ratio (OR) from 1.32, (95% confidence interval [CI]), to 1.7 (95% CI); gender with OR from 1.54 (95% CI) to 3.89 (95% CI); high LDL and cholesterol levels, and high glucose levels. No direct relation between HNBP and positive family history, DM or IHD was found. Conclusion: The study demonstrates that HNBP is a relevant issue in Russia that requires further research. It also illustrates the necessity of targeting the individuals with HNBP in order to control CVRFs.
Systemic Hypertension. 2017;14(1):6-11
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Treatment of patients with high cardiovascular risk: a modern view on combined therapy
Blankova Z.N., Aslanian N.S., Smolianinova N.G., Ageev F.T.
Abstract
Introduction. Lack of efficacy of treatment with several medications in patients with arterial hypertension (AH) and high cardiovascular disease (CVD) risk is often explained by low compliance to treatment. Using combined therapy (CT) is one of the ways to increase compliance. Objective. To evaluate the influence of CT consisting of amlodipine, lisinopril and rosuvastatin on arterial elastance and serum fibrosis marker levels in patients with high CVD risk. Materials and methods. The study included 66 patients (mean age 66.5 years, 5% male, 95% female) with atherosclerosis of the brachiocephalic arteries. Serum levels of cholesterol and low density lipoprotein (LDL); brachial and central blood pressure (BP); brachial-ankle and carotid-femoral pulse wave velocity (baPWV and cfPWV, respectively); and augmentation index (AI) were determined initially and after 6 months of CT. Results. Against the background of CT statistically significant reduction of levels of LDL from 4.1 (3.6; 4.7) to 2.2 (1.8; 2.5) mmol/L (p<0.01); systolic and diastolic brachial BP from 127 (116; 144) to 122 (115; 132) mm Hg (p<0.01) and from 79 (72; 89) to 75 (70; 83) mm Hg (p<0.01), respectively; systolic and diastolic central BP from 125 (112; 139) to 120 (110; 124) mm Hg (p<0.01) and from 80 (75; 87) to 76 (70; 81) mm Hg (p<0.01), respectively; baPWV from 13.6 (12.5; 15.9) to 12.9 (11.8; 14.2) m/s (p<0.01); cfPWV from 11 (9; 12.2) to 9,4 (8.4; 10.2) m/s (p<0.01); and AI from 31 (25; 35) to 26 (21; 32) (p<0,05) was observed. Conclusion. CT consisting of amlodipine, lisinopril and rosuvastatin resulted in BP and LDL target level achievement and arterial stiffness reduction in patients with AH and high CVD risk. Further research is also necessary to more thoroughly assess efficacy of CT.
Systemic Hypertension. 2017;14(1):12-16
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Comprehensive assessment of cardiovascular risk factors of arterial hypertension in indigenous and non-indigenous inhabitants of Mountain Shoria
Mulerova T.A., Maksimov S.A., Ogarkov M.Y.
Abstract
Purpose: a comprehensive assessment of risk factors and a population risk of arterial hypertension (AH), which is conditioned by them, among indigenous and non-indigenous population of Mountain Shoria. Materials and methods. We conducted a clinical and epidemiological study of the population who live compactly in the areas of Mountain Shoria (Orton and Ust-Kabyrza villages) and in the urban-type village (Sheregesh). These regions of middle mountains are situated in the south of Western Siberia. We examined 1178 inhabitants of the indicated villages by a continuous method, the sampling consisted of adult population (18 years and older). For the estimation of the population risk of AH, conditioned by cardiovascular risk factors, we calculated a load by these factors, consisting of the ratio of the prevalence of these factors in the studied subpopulations to the prevalence in the entire cohort. Results. Among the studied risk factors the greatest contribution to the prevalence of AH in the entire sample has the abdominal obesity - 100 c.u., obesity - 77 c.u., elevated low-density lipoprotein cholesterol - 73 c.u., carbohydrate metabolism disorders - 59 c.u., elevated indicator of total cholesterol - 56 c.u., lack of physical activity - 54 c.u., dyslipidemia - 53 c.u. The contribution of the other risk factor is fewer, in the range from 1 to 27 c.u. The total value of the load with risk factors in the entire sample is 556 c.u. The minimum values of additional risk of AH in all age groups are registered in Shor men, the maximum values - in women of non-indigenous ethnic group. The direction of changes with age of additional risk of AH in gender groups are different: in men - a slight increase in each successive age group, in women - a pronounced increase of load in 40-64 years followed by a slight increase in the senior age group. Conclusion. The conducted study indicates the differences of population risk of AH associated with cardiovascular risk factors in the ethnic cohorts of Mountain Shoria.
Systemic Hypertension. 2017;14(1):17-22
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Arterial hypertension treatment changes in Yaroslavl region: results obtained after 4 years of complex program of regional healthcare system’s improvement implementation
Mozheyko M.E., Vigdorchik A.V., Eregin S.Y., Danilenko N.V., Klimovskaya I.M., Ramanathan K., Hughes D.
Abstract
Program’s aim. Cardiovascular morbidity and mortality rates in Russia are among the highest in Europe. The aim of this work was to implement a complex healthcare system improvement program in Russia’s Yaroslavl region, dedicated to increasing arterial hypertension treatment efficacy and prevent complications of arterial hypertension. Materials and methods. The program was developed by a group of healthcare professionals of the Department of Healthcare and Pharmacy of Yaroslavl region together with Novartis Pharma Company’s technical advice within the framework of a private-public partnership. The program consisted of several actions aiming to raise the healthcare system’s attention to hypertension. Achievement of target blood pressure (BP) control by every patient seen by physicians of the Yaroslavl region healthcare system became the main goal and leading criteria for assessing hypertension treatment efficacy. Additionally, significant effort was put into patient education on self-control of BP levels and importance of achieving target BP levels in accordance with Russian national clinical guidelines and on adherence to treatment. Within 4 years, program efficacy was evaluated and reinforced by conducting annual cross-sectional questionnaire-based epidemiological studies. Analysis was performed in a representative sample of patients that evaluated BP control level, mean BP levels, systolic BP level distribution by grades, as well as cardiovascular risk factors and concomitant diseases presence and current antihypertensive therapy. In addition, analysis of official statistics on disease incidence and drug sales databases were performed. Results. From 2011 to 2014 BP control level increased significantly: 17% of patients had BP<140/90 mm Hg in 2011, 23% in 2012, 32% in 2013 and 33% in 2014. In the same time mean BP level reduced from 151/90 to 145/86 mm Hg and share of patients with systolic BP≥180 mm Hg decreased from 10% to 5%. Stroke incidence declined by 20% (from 4,6 to 3,7 per 1000 adult population in 2011 and 2014 respectively) and antihypertensive drug utilization increased by 16% (2014 vs. 2011). Conclusion. A healthcare system improvement program aiming to increase hypertension treatment efficacy resulted in significant improvement in BP control level and substantial decrease in stroke incidence. Continuous improvement is necessary to increase BP control level further resulting in reduction of cardio-vascular mortality and morbidity in the region. Nationwide system for hypertension drug provision could be an instrument of further improvement.
Systemic Hypertension. 2017;14(1):23-29
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Mitral insufficiency: systematization, conservative and surgical treatment
Cherepanova E.V., Gurevich M.A.
Abstract
The article concerns mechanisms, clinical features, diagnostics, possible complications and treatment of mitral insufficiency. Much attention is given to modern diagnostic methods, principles for case management and indications for surgical treatment.
Systemic Hypertension. 2017;14(1):30-36
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The effect of antihypertensive therapy and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea syndrome in association with arterial hypertension
Elfimova E.M., Rvacheva A.V., Tripoten M.I., Pogorelova O.V., Balakhonova T.V., Zykov K.A., Litvin A.Y.
Abstract
Objective. To evaluate the effect of antihypertensive therapy (AHT) and CPAP therapy on inflammatory and endothelial dysfunction markers levels in patients with severe obstructive sleep apnea (OSA) syndrome in association with arterial hypertension (AH). Materials and methods. The study included 43 male patients with severe OSA syndrome (Apnea-Hypopnea Index 52.4 [46.1; 58.6]) and AH (systolic blood pressure 144.0 [142.0; 156.0] mm Hg, diastolic blood pressure 90.9 [88.3; 93.5] mm Hg). Treatment with angiotensin-converting enzyme inhibitors, calcium antagonists, and thiazide-like diuretics was performed till target BP level measured with Korotkoff method was achieved. The patients who had reached target BP level (BP≤140/90 mm Hg) were randomized into two groups: group 1 included 23 patients who continued taking the AHT, group 2 included 22 patients who continued taking the AHT to which CPAP therapy was added. Peripheral blood lymphocyte immunophenotyping, cytokine panel test (IL-1β, IL-6, tumor necrosis factor a, IL-2Ra, sCD40L), adhesion molecule analysis (ICAM-1, VCAM-1), thromboxane B2, 6-keto-prostaglandin F1 alpha (6-keto-PGF1a), and endothelin-1 levels in blood serum were evaluated at admission, after target BP level achievement (2nd visit) and after 3 months of AHT or AHT+CPAP therapy (3rd visit). Flow-mediated dilation of brachial artery was assessed using reactive hyperemia test by D.Celermajer. Results. Against the background of combined AHT the target BP level was achieved by 95% of patients. After target BP level achievement a significant decrease of IL-1β -0.16 [-0.5; 0], p=0.000 level and number of CD50+ cells (lymphocytes with inter-cellular adhesion molecule ICAM-3) from 2158.5 [1884.7; 2432.3] to 1949.6 [1740.9; 2158.3], p=0.050 were observed in patients with severe OSA associated with AH. There were no significant changes in vascular endothelial function observed in patients taking only AHT. Significant decrease of fibrinogen (-0.3 [-0.4; -0.1], p=0.002) and homocystein (-2.03 [-3.8; -0.2], p=0.03) levels was observed in patients taking both AHT and CPAP therapy. Conclusion. The combination of AHT and CPAP therapy in patients with severe OSA and AH not only allows reaching the target BP level but also leads to inflammatory and endothelial dysfunction markers levels decrease.
Systemic Hypertension. 2017;14(1):37-40
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Balloon angioplasty as an alternative to thromboendarterectomy for proximal pulmonary artery obstruction in a patient with chronic thromboembolic pulmonary hypertension: a case report
Danilov N.M., Matchin Y.G., Iarovoi S.Y., Demchenkova A.Y., Chazova I.E.
Abstract
Thromboendarterectomy is undoubtedly the most widely used method in chronic thromboembolic hypertension treatment. Although surgical treatment is highly effective, it is often associated with high risk of complications. One of the main reasons for impossibility of surgery performance is distal pulmonary artery obstruction. In this case medical therapy or staged balloon angioplasty is considered the treatment of choice. This case report discusses if pulmonary artery angioplasty can be used in patients with proximal pulmonary artery obstruction.
Systemic Hypertension. 2017;14(1):41-44
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Fixed combination of highly selective β-adrenoblocker bisoprolol and calcium antagonist amlodipine (Concor® AM) for arterial hypertension treatment in metabolic disorder patients
Zhernakova Y.V., Martyniuk T.V., Arkhipova O.A., Azimova M.O., Rogoza A.N., Chazova I.E.
Abstract
Introduction. Combination therapy is widely used in treatment of patients with arterial hypertension (AH) of high and very high cardiovascular risk. Fixed combinations (FC) of medications are preferable and it is important to develop new effective and safe ones. Organ-protective effects are also significant. Objective. To study antihypertensive effectiveness of new FC of highly selective β-adrenoblocker bisoprolol and calcium antagonist amlodipine (Concor® AM), its influence on cardiometabolic risk factors and target lesions in metabolic disorder patients with AH of stages 1 or 2. Materials and methods. The study included 30 patients (13 male, 17 female, mean age 47.20±0.22 years) with AH of stages 1 or 2 and metabolic syndrome (MS). All patients underwent clinical assessment of blood pressure (BP); levels of serum cholesterol (SCL), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride, creatinine, and glucose in oral glucose tolerance test; 24-hour blood pressure monitoring; central systolic blood pressure (CSBP); carotid-femoral pulse wave velocity (cfPWV), and intima-media complex thickness which were determined initially and after 6 months of therapy with FC. Results. The target level of BP was reached by 88% patients after treatment with Concor® AM. Significant deceleration of heart rate (from 74.95±2.20 to 68.81±1.13 bpm) and CSBP (from 151.7 to 132.6 mm Hg) were observed. Treatment with Concor® AM led to artery stiffness decrease evaluated by cfPWV decrease (from 14.21±0.45 to 12.1±0.23 m/s, p≤0.05). Conclusion. FC of highly selective β-adrenoblocker bisoprolol and calcium antagonist amlodipine (Concor® AM) was shown effective for AH treatment in patients with MS. Future research is recommended to investigate the effectiveness of FC therapy in a larger cohort of patients.
Systemic Hypertension. 2017;14(1):45-50
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Angiotensin receptor blocker telmisartan: efficacy, safety and relevance of clinical application
Maksimov M.L., Dralova O.V.
Abstract
Angiotensin receptor blocker telmisartan is a modern and effective antihypertensive drug which has advantages in comparison with other drugs of the group of angiotensin receptor blockers. Long half-life retains its effect is significant more than 24 hours, which is especially important for blood pressure control in the dangerous morning hours. Telmisartan is excreted by the kidneys less than 2%, making its use safe in patients with renal pathology. High antihypertensive efficacy combined with its excellent tolerability. Telmisartan has the greatest affinity to PPARg-receptors, which is especially important when selecting antihypertensive therapy in patients with arterial hypertension and metabolic disorders, insulin resistance, metabolic disorders. A considerable number of studies showing the effectiveness of treatment with telmisartan in patients with cardiovascular disease, diabetes, metabolic syndrome, nephropathy. The article presents the results of a study of therapeutic equivalence of generic drug is telmisartan, which showed a high bioequivalence to original brand-name formulation and was according to the indications: hypertension and decrease cardiovascular morbidity and mortality in patients aged 55 years and older with a high risk of cardiovascular disease. The results of our observations show comparable antihypertensive efficacy of the original and generic products and well tolerated by the results of questioning of patients.
Systemic Hypertension. 2017;14(1):51-57
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Chronic kidney disease and cardiovascular events: a focus on central blood pressure
Murkamilov I.T., Aitbaev K.A., Sabirov I.S., Fomin V.V., Yusupov F.A.
Abstract
The purpose of the review - to present the literature on the role of central arterial pressure (CAP) and arterial stiffness progression cardio-vascular complications (CVC) and renal dysfunction in patients with chronic kidney disease (CKD). The main provisions. In this review we discuss the pathogenetic questions damaging effect of increasing CAP and arterial stiffness on the vascular wall, the development of arteriosclerosis, atherosclerosis and destabilization of atherosclerotic plaque in the blood vessels of the kidneys. All this is the direct cause of the CVC and renal dysfunction in CKD.
Systemic Hypertension. 2017;14(1):58-60
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Dihydropyridine calcium antagonists: conscious choice
Ostroumova O.D., Vikentev V.V., Abrosimov A.G., Smoliarchuk E.A.
Abstract
This article contains information concerning the aspects of pharmacokinetics and pharmacodynamics of dihydropyridine calcium antagonists. The authors have discussed the evidence-based amlodipine treatment of arterial hypertension, ischemic heart disease and chronic heart failure. The authors present the comparison of the efficacy, safety and application characteristics of the different dihydropyridine calcium antagonists that can be used in specific clinical cases.
Systemic Hypertension. 2017;14(1):61-68
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