Vol 15, No 2 (2018)

Articles
The influence of antyhypertensive therapy of valsartan and fixed combination with hydrochlorothiazide use on pulse-wave velocity and central arterial pressure in patients with arterial hypertension of 1-2 grades in international VICTORY clinical trial
Chazova I.E., Martynyuk T.V., Accetto R., Sirenko Y.N., Vincelj J., Widimsky J., Barbič-Žagar B., Arhipov M.V., Grinshtein Y.I., Ostroumova O.D., Galjavich A.S., Rotar O.P., Haisheva L.A., Nedogoda S.V.
Abstract
Objective - to explore influence of valsartan monotherapy use and its use in combination with hydrochlorothiazide (HCTZ) on pulse-wave velocity (PWV) and central arterial pressure (CAP) in patients with arterial hypertension (AH) of 1-2 grades in international VICTORY clinical trial. Materials and methods. The international multicenter prospective randomized clinical study VICTORY that lasted for 16 weeks included patients with 1-2 grades AH. In patients who previously received antihypertensive therapy a 7 days washout period was carried out. All patients started their therapy with 80 mg valsartan (Valsacor®, KRKA, Slovenia); in Russia the starter dose of Valsacor®, KRKA was 160 mg in previously treated patients that did not influence the study results. If after 4 weeks of treatment BP was more than 140/90 mm hg (more than 130/80 mm hg in high risk patients or in diabetes mellitus patients) the dose of valsartan was increased to 160 mg (320 mg in Russia) or diuretic in fixed combination with valsartan was added (160 mg valsartan/12.5 mg HCTZ): Valsacor® H 160 (KRKA, Slovenia). If target BP after 8 weeks of treatment was not reached valsartan dose was increased to 320 mg or fixed combination of valsartan and diuretic (160 mg/12.5 mg) was used. If target BP after 12 weeks of treatment was not reached - valsartan and diuretic 320 mg/12.5 mg were used. PWV and CAP (SphygmoCor®, AtCorMedical) were assessed at baseline and after 16 weeks of treatment. The primary endpoints were assessment of the impact of studied medications on aortic stiffness, aortic augmentation index and comparison of absolute medians of reached central and peripheral BP reduction with baseline value. Results. Of 365 patients included in the study 74 were included in PWV and CAP study subgroup. Valsartan and its combination with HCTZ were effective in CBP reduction. The mean absolute reduction of central systolic and diastolic BP after 16 weeks of treatment was 19.7±12.9 mm hg and 13.9±8.5 mm hg, respectively (р<0.0001). PWV at 16 weeks was statistically significant (p<0.0001). The mean aortic augmentation index value did not change significantly (p=0.855). Conclusions. In VICTORY study valsartan use for 16 weeks as monotherapy (Valsacor®) and in combination with HCTZ (Valsacor®H) resulted in aortic stiffness reduction in patients with 1-2 grades AH, that may lead to patients' prognosis improvement and risk of cardiovascular events reduction.
Systemic Hypertension. 2018;15(2):6-13
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Possibilities of treatment of patients with resistant arterial hypertension
Shugushev Z.K., Maximkin D.A., Ryumina A.S.
Abstract
The literature review provides an analysis of various modern invasive methods of treatment of patients with resistant arterial hypertension. Future of the method is sketched, as well as their efficacy and safety.
Systemic Hypertension. 2018;15(2):14-22
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Improving blood pressure control, organoprotection and metabolic disorders correction in patients with hypertension switching from diuretic-based combinations to fixed combination lisinopril + amlodipine + rosuvastatin
Nedogoda S.V., Chumachek E.V., Ledyaeva A.A., Tsoma V.V., Salasyuk A.S., Smirnova V.O., Khripaeva V.Y., Palashkin R.V., Popova E.A.
Abstract
The aim of the study was to assess the possibility of fixed combination Lisinopril + amlodipine + rozuvastatin to improve arterial elesticity in patients with hypertension and high pulse wave velocity, despite previous diuretic-based combination antihypertensive therapy. Materials and methods. In an open, observational study duration of 24 weeks was included 60 patients on previous diuretic-based combination antihypertensive therapy. All participants underwent 24-hour blood pressure monitoring, applanation tonometry (augmentation index and central blood pressure), pulse wave velocity measurement, laboratory tests (lipid profile, fasting glucose, insulin resistance index - NOMA), leptin, high-sensitivity C-reactive protein before and after the switching to a fixed combination of lisinopril + amlodipine + rosuvastatin. Results. According to measurements of office blood pressure switching of patients on double combinations based on diuretics to a fixed combination of lisinopril + amlodipine + rosuvastatin, a further decrease in systolic blood pressure (SBP) by 13.7% and diastolic BP (DBP) by 18.8% was observed. According to the ABPM, the decline in the average daily SBP was 15.8%, DBP - 22.5%, average SBP - 16.2%, DBP - 19.8%. The combination of lisinopril + amlodipine + rosuvastatin reduced PWV by 15.9%, augmentation index by 13.5%, central SBP by 8.4% (p<0.01 compared to baseline for all). The fixed combination of lisinopril + amlodipine + rosuvastatin resulted in a 41.1% decrease in LDL, 32.3% in triglycerides, and a 11.3% increase in HDL (p<0.01 for all). The use of a fixed combination of lisinopril + amlodipine + rosuvastatin provided a reliable decrease in the level of insulin resistance, hsSRB and leptin. Conclusions. The fixed combination of lisinopril + amlodipine + rosuvastatin provides better control of blood pressure, improved vascular elasticity (augmentation index, PWV, central BP), and also improves lipid and carbohydrate metabolism, reduces inflammation and leptin resistance in patients initially receiving double combined antihypertensive therapy, based on diuretics. The maximum positive effect is observed in the group of patients initially receiving HCTZ-based therapy.
Systemic Hypertension. 2018;15(2):24-31
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State of the art for diagnosis and treatment of orthostatic hypotension
Aksenova A.V., Gorieva S.B., Rogoza A.N., Sivakova O.A., Esaulova T.E., Chazova I.E.
Abstract
This paper presents state of the art of the problem of diagnosis and treatment of orthostatic hypotension (OH). It focuses on the developed algorithms for diagnostics of classical orthostatic hypotension (COH), initial orthostatic hypotension (IOH) and delayed orthostatic hypotension (DOH). It describes the necessary methods for the differential diagnosis of the OH causes. Comparative analysis of the European Society of Cardiology and American College of Cardiology/American Heart Association/Society of Cardiac Rhythm was performed. The treatment options for different groups of patients with orthostatic hypotension are described.
Systemic Hypertension. 2018;15(2):32-42
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Arterial hypertension in patients with non-specific aortoarteritis
Chikhladze N.M.
Abstract
Non-specific aortoarteritis (Takayasu arteritis) is a rare disease, it is a chronic vasculitis that occurs with the defeat of the aorta and main arteries, the development of stenosis of the arteries and ischemia of the relevant organs. In most cases, symptomatic arterial hypertension develops. The article presents a modern view of the peculiarities of the course of arterial hypertension, considered methods of diagnosis and treatment of this disease.
Systemic Hypertension. 2018;15(2):43-48
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Blood pressure level and arterial stiffness parameters role in prediction of the antihypertensive therapy efficacy escape phenomenon
Mikhailova O.O., Elfimova E.M., Litvin A.Y., Rogoza A.N.
Abstract
The aim of the study was to evaluate blood pressure (BP) level and vessel wall stiffness parameters role in antihypertensive therapy (AHT) escape phenomena development on the background of primarily effective AHT use. Materials and methods. Data from 102 patients with arterial hypertension level 1-3, stage I-II were analyzed. All patients underwent individual AHT adjustment for 2-3 weeks (adjustment period). At the end of the adjustment period the therapy effectiveness was evaluated with clinical BP measurement (target BP values less than 140/90 mm hg) and 24-hour BP monitoring (target daily BP values less than 130/80 mm hg). The study included only those patients who reached target clinical and daily BP values on the background of 2-3 antihypertensive drugs use at the end of the adjustment period. At the beginning of the observation period after effective AHT was used carotid-femoral pulse wave velocity was evaluated with applanation tonometry. For the purpose of timely escape phenomena diagnosis clinical BP measurement and 24-hour BP monitoring were performed in 1, 3, and 6 months after the trial start in all patients. Results. After 6 months of observation patients were divided in 2 groups: group 1 included 34 patients with AHT escape phenomena, group 2 - 68 patients with stable, controlled AH. In group 1 on the background of effective AHT use at the beginning of observation higher levels of following measures were observed: clinical systolic BP - SBP (125.2±11.3 mm hg vs 119.7±11.7 mm hg, p=0.021), daily SBP (128.0±3.3 mm hg vs 121.2±7.4 mm hg, p=0.000), daily average SBP (131.6±4.9 mm hg vs 125.3±8.5 mm hg, р=0.000), night average SBP (120.4±8.5 mm hg vs 111.8±8.6 mm hg, р=0.000), daily pulse BP 50.2±4.8 mm hg vs 44.2±7.6 mm hg, p=0.000), daily mean brachial artery stiffness index - ASI (161.9±28.3 mm hg vs 142.2±24.5 mm p=0.000), carotid-femoral pulse wave velocity (11.6±2.5 m/s vs 10.5±2.3 m/s, p=0.029). In single-factor logistic regression models all these measures were shown to have predictive value in AHT escape phenomena development. According to multifactor logistic regression analysis that included carotid-femoral pulse wave velocity more than 10.8 m/s, daily mean ASI>137, daily SBP>124 mm hg, and daily pulse BP>46 mm hg, the only independent predictor on the background of effective AHT at the beginning of the observation was daily SBP>124 mm hg (odds ratio 19.1, 95% confidence interval 3.6-101.8; p=0.0004). Conclusion. BP level and artery stiffness index measured on the background of effective AHT at the beginning of the observation are predictors for escape phenomena development and can be used for effectiveness and required frequency of therapy management prognosis.
Systemic Hypertension. 2018;15(2):49-54
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Stroke prevention in patients with atrial fibrillation and comorbidities
Ostroumova O.D., Voevodina N.Y., Guseva T.F., Pavleeva E.E., Piksina G.F., Goloborodova I.V.
Abstract
In the article questions of prevention of stroke, including repeated ones, are considered. The choice of anticoagulant therapy is discussed in patients with atrial fibrillation and a number of concomitant diseases - coronary artery disease, diabetes mellitus, chronic kidney disease, chronic heart failure. The data of subanalyses of a randomized clinical trial of ARISTOTLE are presented, indicating a high profile of efficacy and safety of the new oral anticoagulant apixaban in these categories of patients.
Systemic Hypertension. 2018;15(2):55-59
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Hypertensive crisis as cerebrovascular disease risk factor
Kravchenko M.A., Andreeva O.S., Gnedovskaya E.V., Chechetkin A.O., Varakin Y.Y., Oshchepkova E.V., Piradov M.A.
Abstract
Objective. To assess main epidemiological indicators for hypertensive crises (HC) in the population of productive age and to study possible correlations of crisis associated arterial hypertension (AH) with clinical and instrumental phenomenon of chronic cerebrovascular diseases. Materials and methods. Data of several studies presented: cross-sectional studies of 726 people aged 35-64 and 415 people aged 40-59. Observational cohort study of 109 patients aged 57.4±5.8 with uncomplicated AH. For the detection of HC in anamnesis, there were used special criteria which widens standard HC definition for additional account of light and mild severity cases. Results. Overall AH prevalence was 45% (95% CI 41-51), in men - 48% (40.2-55.9), in women - 45% (38.4-51.6). History of HC in anamnesis was 11.8% (95% CI 9-15.2), in men 8.8% (5.4-14) and in women - 13.8% (10-18.7). Proportion of HC associated AH defined at the level of 25-30% of all AH cases. The most prevalence of HC associated AH was found in people with “high normal” (130-139/85-89) arterial pressure - 37%. Prevalence of the complaints on headaches, dizziness, poor memory and lower intellectual productivity was higher in people with HC. Chronic cerebrovascular disease was found 2-fold frequently in HC associated AH. But in generally analysis of possible correlations of HC with clinical and instrumental phenomenon of chronic cerebrovascular diseases didn’t revealed any statistically significant differences. Conclusion. HC burden for healthcare system is serious, because it is important risk factor for cerebrovascular diseases and associated with significant lowering of the quality of life. Prevalence of the HC cases with light and mild severity is underestimated. Despite that the study of the most prevalent forms of HC (rare, light and mild severity) didn’t find any associations with morphological or persistent clinical pathology, functional phenomenon were found statistically significant frequently.
Systemic Hypertension. 2018;15(2):60-64
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Endothelin receptor antagonist bosentan role in modern strategy for patients with pulmonary arterial hypertension treatment
Arkhipova O.A., Martynyuk T.V.
Abstract
At the present time evidential base on bosentan use comprises more randomized control trials results compared with other Lag-specific medications. Bosentan can be successfully used as monotherapy of in combination with medications of other groups in patients with idiopathic pulmonary hypertension (PH), pulmonary arterial hypertension (PAH) comorbid with connective tissue disease (PAH-CTD), HIV (PAH-HIV), congenital heart disorders (systemic-to-pulmonary shunts) - PAH-CHD, and also in PH treatment and for disease progression delay in patients with unimpaired functional class. It is the only Lag-specific medication approved for use in children and the only medication of this group included in the list of essential medicines. The articles presents literature review of clinical trials on bosentan and discusses indications, contradictions and side effects of its use.
Systemic Hypertension. 2018;15(2):66-71
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Nitrogen oxide biochemical pathway in pulmonary arterial hypertension therapy and REPLACE trial results
Shmalts A.A., Gorbachevsky S.V.
Abstract
Endogen nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) deficiency in pulmonary vessels walls plays essential role in pulmonary arterial hypertension (PAH) pathogenesis. Soluble guanylate cyclase stimulator riociguat and phosphodiesterase-5 (PDE5) inhibitor sildenafil increase cGMP content and have proven clinical efficacy in PAH treatment. The potentially beneficial mechanisms of riociguat mechanism of action include endogen NO independence in cGMP synthesis and its independence from other phosphodiesterase isoferments (other than PDE5). Clinical options, safety and effectiveness of iPDE5 - riociguat transition in patients with PAH were for the first time shown in non-controlled study RESPITE and the assessment is continued in randomized placebo-controlled trial REPLACE.
Systemic Hypertension. 2018;15(2):72-76
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Continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea syndrome and arterial hypertension: expert opinion
Litvin A.Y., Elfimova E.M., Chazova I.E.
Abstract
The combination of the obstructive sleep apnea (OSA) syndrome and arterial hypertension (AH) is a common problem affecting both the medical and social aspects of a patient's life. CPAP-therapy is the main treatment of sleep-discorded breathing. This paper focuses on up-to-date data on the relationship between OSA and AH and reviews studies evaluating the effect of CPAP-therapy on blood pressure, the risk of cardiovascular complications and the quality of life of patients.
Systemic Hypertension. 2018;15(2):77-78
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