Vol 15, No 1 (2018)

Articles
Clinical manual for diagnosis, prevention and treatment of cardiovascular complications of cancer therapy. Parts VI-VII
Chazova I.Y., Tyulyandin S.A., Vitsenia M.V., Panchenko E.P., Fedotkina Y.A., Poltavskaya M.G., Gilyarov M.Y., Martynyuk T.V., Ovchinnikov A.G., Stenina M.B., Trophimova O.P., Ageev F.T.
Abstract
Advances in treatment have led to improved survival of patients with cancer but have also resulted in untoward side effects associated with treatment. Cardiovascular diseases are one of the most frequent of these side effects. Myocardial dysfunction and heart failure, myocardial ischaemia, arrhythmias, arterial hypertension, thromboembolic disease and other cardiovascular complications can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. This manual discusses concepts for timely diagnosis, intervention, and surveillance of patients treated with cardiotoxic cancer therapies. In this part оf manual we discuss the diagnostic, prevention and treatment aspects of cancer therapy-related thromboembolism and complications of radiotherapy.
Systemic Hypertension. 2018;15(1):6-20
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The place of intervention methods of treatment of patients with resistant hypertension in clinical practice
Agaeva R.A., Danilov N.M., Sagaydak O.V., Chazova I.E.
Abstract
Every year scientific interest in studying of interventional methods of treatment of resistant hypertension steadily increases. Row of high technology device are created for performance of such procedures as well as techniques of their management are also developed. Non-pharmacological ways of treatment are described in this article, which are widely used in clinical practice: baroreflex activation therapy, radiofrequency renal denervation, and central iliac arteriovenous anastomosis.
Systemic Hypertension. 2018;15(1):21-22
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Fixed combination of amlodipine and lisinopril effectiveness in hypertensive smokers
Ostroumova O.D., Kochetkov A.I.
Abstract
Objective. To conduct a comparative analysis of blood pressure (BP) profile characteristics in middle-aged (45-65 years) patients with stage 1-2 hypertension not associated with comorbid cardiovascular disease depending on smoking status; to estimate the influence of fixed combination of amlodipine and lisinopril (FC A/L) use on these characteristics. Materials and methods. At the first stage of the study 60 untreated patients (31 men, 29 women, mean age 53.6±0.8 years) with stage 1-2 hypertension were divided in two groups according to smoking status. The smoking group included 11 men and 11 women with mean age 53.4±1.2 years, non-smoking group - 20 men and 18 women with mean age 53.7±1.0 years. Ambulatory blood pressure monitoring (ABPM) (monitor MDP-НС-02с, DMS) and BP measurement based on Korotkov sound technique as well as transthoracic echocardiography were performed in all patients. At the second stage a subgroup of 30 untreated patients (16 men, mean age 52.7±1.11 years, 40% smokers [12 patients]) was formed. Patients received FC A/L (Ekvator®) with starting dose 5 mg/10 mg titrated every 14 days until target BP lower than 140/90 mm Hg was reached. The therapy was continued for 12 weeks, after that ABPM was performed again. Results. In smokers and non-smokers with hypertension no significant differences in BP levels in office BP measurement and ABPM were observed. At the second stage all 30 patients receiving FC A/L reached target office BP levels. In subgroups of smokers and non-smokers with hypertension significant office systolic BP (p<0.001 in both groups), diastolic BP (p<0.001 in both groups), and pulse BP (p<0.05 and р<0.001, respectively) reduction was observed on FC A/L treatment. There were no significant differences in office BP dynamics between subgroups. At the end of follow-up a significant decrease of systolic BP within 24 hours (p<0.001 in both groups), diastolic BP within 24 hours (p<0.001 in both groups), and pulse BP within 24 hours (р<0.01 and p<0.001, respectively) was observed. A significant decrease of day systolic and diastolic BP (p<0.001 for both parameters in both groups) and also pulse BP (p<0.01 and p<0.001, respectively) was observed in both groups of patients. A significant decrease of night systolic BP (p<0.001 in both groups), diastolic BP (p<0.01 and p<0.001, respectively), and pulse BP (p<0.01 in both groups) was observed in smokers and non-smokers. There were no significant differences between the groups in systolic, diastolic, and pulse BP dynamics according to ABPM. There was a significant reduction in systolic day BP variability (p<0.01 and p<0.05, respectively) and diastolic night BP variability (p<0.001 и p<0.05, respectively) in smokers and non-smokers on FC A/L therapy. In hypertensive smokers a significant reduction of diastolic day BP variability was also observed (p<0.05). Conclusions. Smoking does not influence a 24 hours BP profile in patients aged 45-65 years with stage 1-2 hypertension. The FC A/L use in these patients has antihypertensive effect regardless of smoking status.
Systemic Hypertension. 2018;15(1):23-31
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Immune alterations and endothelial dysfunction in patients with hand-arm vibration syndrome comorbid with hypertension
Babanov S.A., Baraeva R.A., Budash D.S., Baykova A.G.
Abstract
A complete physical examination of 145 patients with various forms of hand-arm vibration syndrome (HAVS) and 30 patients of control group was performed in order to solve the aims and objectives of the research. The HAVS forms included 1st stage HAVS associated with local vibration, 2nd stage HAVS associated with local vibration, 2nd stage HAVS associated with local vibration comorbid with hypertension, 1st stage HAVS associated with general vibration, 2nd stage HAVS associated with general vibration, 2nd stage HAVS associated with general vibration comorbid with hypertension. It was observed that endothelial dysfunction in HAVS, especially when comorbid with hypertension, is accompanied by immune alterations such as humoral immunity factors and cytokines imbalance and is characterized by pro-inflammatory cytokine levels increase (IL -1β, IL -8, TNF-α) and anti-inflammatory cytokine level decrease (IL-4) from exposure to production vibration regardless of its type especially when comorbid with hypertension. It is proven that in isolated HAVS associated with local or general vibration, especially when comorbid with hypertension, endothelial dysfunction is characterized by increase of endothelin-1 serum level and growth factors such as transforming growth factor β1 (TGF-β1) and vascular endothelial growth factor А (VEGF-A) increase. Increase of endothelin-1 serum level in patients with HAVS is associated with hemostatic alterations such as platelet-derived growth factor ВВ (PDGF-BB), fibronectin, and Willebrand factor increase.
Systemic Hypertension. 2018;15(1):32-37
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The problem of broncho-obstructive syndrome early detection in cardiological patients. Review of specialized respiratory questionnaires and their use in patients with comorbid cardiovascular and broncho-obstructive pathologies
Klimova A.A., Ambatello L.G., Smolyakova E.V., Nistor S.Y., Zykov K.A., Chazova I.E.
Abstract
The management of patients with cardiovascular pathology and comorbid obstructive pulmonary diseases seems to be an urgent problem against the background of their widespread prevalence among the adult population. According to the latest recommendations of GOLD 2017, it is not possible to diagnose COPD and to select options for pharmacotherapy without assessing the symptoms. Evaluation of symptoms in patients with cardiorespiratory pathology is a key element in the diagnosis of both respiratory and cardiovascular deseases. It is important to conduct differential diagnosis of both nosologies for reliable evaluation of the results of standardized respiratory questionnaires. Many respiratory questionnaires have been developed now; some of them have been validated and recommended for use in clinical practice in patients with COPD and asthma. However, their sensitivity and specificity are different, these questionnaires can`t be used interchangeably. In some cases, a decrease in the informative value of standardized respiratory questionnaires was revealed in patients with comorbid cardiovascular and obstructive pulmonary diseases. There are extremely few scientific works, that assess the same aspects of this problem. In connection with this, the development of specialized questionnaires for patients with comorbid cardiovascular and obstructive pulmonary pathology is relevant.
Systemic Hypertension. 2018;15(1):38-44
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Pulmonary hypertension: reasonable selection of specific therapy
Karoli N.A., Sazhnova S.I., Rebrov A.P.
Abstract
Pulmonary hypertension is characterized with persistent increase in pulmonary vascular resistance leading to progressive worsening of right ventricular failure and death. The basis for pulmonary arterial hypertension is structural changes in pulmonary arteries and arterioles caused by endothelial dysfunction. Endothelin-1 is the main pathogenic trigger of pulmonary hypertension and potential target for therapeutic exposure. The efficacy of endothelin receptor antagonists is proved in various preclinical and clinical studies. In patients with pulmonary arterial hypertension, the efficacy of dual and selective endothelin receptor antagonists is comparable despite the varied activity against various receptors. Bosentan is the most widely used pulmonary vasodilator which improves exercise tolerance and decelerates disease progression.
Systemic Hypertension. 2018;15(1):45-50
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Organoprotective properties of therapy by fixed combination of perindoprile and amlodipine in patients with arterial hypertension and diabetes mellitus type 2
Statsenko M.E., Turkina S.V., Titarenko M.N.
Abstract
Actuality: the contribution of changes in central aortic pressure (CAP) to target organ damage and the effect of a fixed combination of perindopril with arnolate with amlodipine besylate on these parameters in patients with arterial hypertension (AH) and type 2 diabetes (DM) has not been studied. Objective: to reveal the relationship between the main indicators of CAP and the damage of target organs (vessels, kidneys and heart) in patients with AH and type 2 diabetes; assess the organoprotective properties of a 12-week therapy with a fixed combination of perindopril arginate with amlodipine besylate in this category of patients. Materials and methods: 30 patients with AH stage III and DM at the age of 45 to 65 years were examined. The indicators of CAP were determined by Vasotens 24 software (“Petr Telegin” LLC, Russia). The structural and functional state of the myocardium was assessed echocardiographically with a Doppler sensor. The pulse wave velocity (PWV) was measured with Polyspectr 8/E apparatus (Neurosoft, Russia). To evaluate the kidney function, the glomerular filtration rate (GFR) was calculated, and albumin excretion in the urine was determined. A fixed combination of perindopril arginine / amlodipine besylate was administered for 12 weeks. Results: 12-week therapy was accompanied by the achievement of target values of blood pressure in 100% of patients, a decrease in office systolic and diastolic blood pressure. There was a significant improvement in indicators of CAP, which was accompanied by a statistically significant decrease in PWV in vessels of the elastic and muscular type, an improvement in the functional state of the kidneys: a decrease in the level of the albumin/creatinine ratio of urine, an increase in rGFR, by a significant decrease in the left ventricular myocardium index. Conclusion: admission of a fixed combination of perindopril and amlodipine in patients with AH in combination with type 2 diabetes for 12 weeks is accompanied by reliable cardio, nephroprotective and endotheliotropic effects, statistically significantly reduces systolic and diastolic CAP, augmentation index in daytime and night hours, leads to a significant reduction of rigidity of the main arteries.
Systemic Hypertension. 2018;15(1):51-55
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The prevalence of diabetes mellitus in population of hypertensive patients according to ESSE RF study results
Zhernakova Y.V., Chazova I.E., Oshchepkova E.V., Shalnova S.A., Konradi A.O., Rotar O.P., Yarovaya E.B., Shlyahto E.V., Boitsov S.A.
Abstract
The prevalence of type 2 diabetes mellitus (DM) is progressively increasing nowadays, as well as of other diseases associated with obesity. Though the detectability of new DM cases is still low. The present study deals with type 2 DM prevalence assessment in Russian population and in hypertensive patients. Objective. To assess type 2 DM prevalence, including undiagnosed DM, in general population and in population of hypertensive patients according to ESSE RF (Cardiovascular disease epidemiology in Russian Federation regions) study results. Materials and methods. A random population sampling of men and women aged 25-64 years in 10 cities in Russia (n=16 936) was performed. Results. The prevalence of DM accounted for 5.2%, newly diagnosed (undiagnosed) DM was found in 3.5% respondents. Among hypertensive patients the prevalence of DM was higher and accounted for 8.6%. In 5.2% of the respondents the fasting glucose level was higher than 7 mmol/L with no DM in past medical history. The prevalence of DM in general population accounted for 8.6% and in hypertensive patients - 13.8%.
Systemic Hypertension. 2018;15(1):56-62
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Prevalence, awareness and adherence to treatment of arterial hypertension: myths and reality
Krivoshapova K.E., Tsygankova D.P., Barbarash O.L.
Abstract
This review analyzes and summarizes the results of major epidemiological studies aimed at assessing the prevalence of arterial hypertension, one of the most significant cardiovascular risk factors according to the socioeconomic factors (the ESSE study, the PURE study). Comparative characteristics of both the prevalence of arterial hypertension and the level of awareness among the population about the presence of arterial hypertension, adherence to treatment and control of blood pressure among residents of countries with different socio-economic levels are given. We concluded that despite the implementation of preventive measures, the gap between the diagnosis of arterial hypertension, the subsequent control of blood pressure and adherence to treatment in most countries remains rather large. This indicates the need for a more thorough analysis of possible causes and the development of new preventive measures.
Systemic Hypertension. 2018;15(1):63-67
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