Vol 15, No 3 (2018)

Articles
Guidelines for diagnostics and treatment of hypertension 2018 - European experts’opinion [Guidelines]
Chazova I.E., Zhernakova Y.V.
Abstract
Hypertension is one of the most common diseases in the world. That is why guidelines fordiagnostics and treatment of hypertension attract great attention of medical specialists ofvarious fields. A new version of guidelines on hypertension jointly developed by cliniciansof the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) was presented at the European Meeting on Hypertension and Cardiovascular Protectionplenary meeting in Barcelona on June 8th 2018. After guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA) were published in November 2017 it became one of the most anticipated events. The full text will be published on August 25th 2018 in parallel with an official presentation during the ESC Congress in Munich. Yet we already are able to estimate the degree of European experts and their American colleagues’ concurrence.
Systemic Hypertension. 2018;15(3):6-10
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Resistant and refractory arterial hypertension: similarities and differences, new approaches to diagnosis and treatment
Aksenova A.V., Esaulova T.E., Sivakova O.A., Chazova I.E.
Abstract
Refractory hypertension is a novel phenotype of antihypertensive treatment failure. The terms "refractory hypertension" and "resistant hypertension" were considered interchangeable for a long time and related to difficult-to-treat hypertension. Recently, the term "refractory hypertension" refers to a very small group of patients who do not really reach the target blood pressure for maximum antihypertensive therapy. In this review we discuss similarities and contrasts definition, prevalence, patient characteristics, risk factors, and possible underlying etiologies of refractory and resistant hypertension.
Systemic Hypertension. 2018;15(3):11-13
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Physical inactivity as a risk factor for cardiovascular morbidity and mortality
Krivoshapova K.E., Tsygankova D.P., Barbarash O.L.
Abstract
The review discusses the results of various clinical studies assessing the impact of physical activity on the cardiovascular system and provides the evidence suggesting that physical inactivity along with psychosocial factors, i.e. smoking, excessive alcohol consumption, unhealthy diet, obesity, arterial hypertension, diabetes, is one of the most significant risk factors leading to the development of cardiovascular disease. The comparative assessment of the indicators of cardiovascular morbidity and mortality adjusted to the level of physical activity and gender in the countries with different socioeconomic development is presented. Thus, there is a need to increase adherence to the recommended levels of physical activity in order to reduce cardiovascular morbidity, overall and cardiovascular mortality in the countries with different income levels.
Systemic Hypertension. 2018;15(3):14-20
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Gender differences efficiency of various dosage regimes of antihypertensive agents by patients with arterial hypertension and coronary heart disease
Skibitsky V.V., Gorodetskaya E.V., Kudryashov E.A., Fendrikova A.V., Skibitsky A.V.
Abstract
Aim - to assess the effect of different dosing regimens for combined antihypertensive therapy with the use of ACE inhibitor zofenopril or angiotensin II receptor blocker valsartan on the blood pressure (BP) profile in men and women with arterial hypertension (AH) and stable coronary heart disease (CHD). Materials and methods. 198 patients (98 men and 100 women) with AH and stable CHD (stable angina of II functional class) were examined. In men and women, the effectiveness of 3 variants of antihypertensive therapy was evaluated: a combination of metoprolol succinate/hydrochlorothiazide + zofenopril or valsartan 160 mg once or valsartan 80 mg 2 times/day. Initially and 24 weeks later, 24-hour BP monitoring was performed. Results. Among men, BP<140/90 mm Hg was more often achieved with zofenopril than valsartan 1 time/day (90.9% vs 61.8%; p<0.05). The achievement of BP<140/90 mm Hg in women was noted more often with a double appointment of valsartan than zofenopril (91.7% vs 70.3%; p<0.05). On therapy that included valsartan 1 time/day, BP<140/90 mm Hg was more often achieved in women than in men (87.1% vs 61.8% respectively; p<0.05). In the groups re-ceiving valsartan 2 times/day, the number of women and men who reached the BP<140/90 mm Hg was comparable (91.7% vs 81.8% respectively; p>0.05). Regardless of the administration of zofenopril or valsartan, positive changes in the diurnal profiles of BP were observed in all patients. In valsartan therapy, the number of female with a dipper profile increased and decreased with the profile of the non-dipper, and among men, the number of patients with a dipper profile increased only with zofenopril and valsartan 2 times/day. Conclusions. There were revealed gender differences in the changes of results of 24-hour BP monitoring against the background of antihypertensive therapy with various blockers of the renin-angiotensin-aldosterone system in patients with AH and CHD.
Systemic Hypertension. 2018;15(3):21-26
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Influence of allure polymorphism distribution of arterial hypertensions gene-candidates jointly with cardiovascular risk factors on change of thickness of intima-media complex among patients with higher arterial pressure living in Mountain Shoriya
Mulerova T.A., Maksimov S.A., Chigisova A.N., Ogarkov M.Y.
Abstract
Objective - to evaluate the association of genetic markers and cardiovascular risk factors with thickening of the intima-media complex among patients with arterial hypertension in the indigenous and non-indigenous population of Mountain Shoriya. Material and methods. The population of Mountain Shoriya in the number of 1409 people was surveyed by a single method (901 people are of indigenous nationality, Shorians, 508 people are non-indigenous 90% of them are Caucasians). Shors are a small Turkic-speaking people. Lipid blood spectrum, fasting plasma glucose, Quetelet index, waist circumference, genetic markers [ACE (I/D, rs4340), AGT (c.803T>C, rs699), AGTR1 (A1166C, rs5186), ADRB1 (p.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c.677C>T, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a)]. Carotid ultrasound was performed. Hypertension was diagnosed according to the National Guidelines of the Russian Society of Cardiology/the Russian Medical Society on Arterial Hypertension (2010). The study included 226 Shorians and 124 non-indigenous people with arterial hypertension and an increased thickness of the intima-media complex. The control group consisted of individuals with high blood pressure without atherosclerosis of carotid arteries (81 and 66 people, respectively). Results. It was revealed that such risk factors as gender and age are significantly associated with the thickness of the intima-media complex in the shorthand cohort (OR 1.93; 95% CI 1.03-3.62 and OR 20.01; 95% CI 4.79-83.65) and age - in the cohort of representatives of non-indigenous nationality (OR 3.20; 95% CI 1.39-7.36). An important role in the formation of atherosclerosis of carotid arteries in patients with arterial hypertension has a duration of the course of the disease in both ethnic groups, respectively - OR 2.78; 95% CI (1.45-5.33) and OR 4.22; 95% CI (1.97-9.01). A significantly smaller contribution is made by the genetic component: the rs699 polymorphism of the AGT gene, as in the Shorts (OR 3.51; 95% CI 1.10-11.25), and in non-indigenous residents (OR 4.90; 95% CI 1.15-20.92) and polymorphism rs1801133 of the MTHFR gene only in persons of indigenous nationality (OR 10.80; 95% CI 2.35-49.70). Conclusion. Timely establishment of risk factors for subclinical atherosclerosis in hypertension and their correction depending on the national trait will help prevent the progression of the process, reverse it, and reduce the risk of complications, premature disability and mortality.
Systemic Hypertension. 2018;15(3):27-31
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The progression of carotid vascular remodeling risk factors in patients with arterial hypertension
Pavlova O.S., Korobko I.Y., Nechesova T.A., Liventseva M.M., Zatoloka N.V., Kovsh E.V., Ogurtsova S.E., Mrochek A.G.
Abstract
Objective. To determine the clinical and genetic risk factors for the development and progression of carotid vascular remodeling according to the prospective observation after five years in patients with essential arterial hypertension (AH). Material and methods. The repeat clinical and instrumental examination with assessment of concomitant cardiovascular risk factors (obesity, smoking, alcohol consumption, physical activity level, hyperglycemia, hypercholesterolemia, signs of depression) was performed in 78 patients with AH. The ultrasound examination of carotid arteries included evaluation of intima-media complex thickness (IMT) and the presence of atherosclerotic plaques. The polymorphism of the genes of the renin-angiotensin-aldosterone system analyzed by polymerase chain reaction and polymorphism of restriction fragment lengths. Results. Progression of vascular remodeling was observed in 26 patients (33.3%) according to the results of carotid arteries examination after 5 years. Age (r=0.53; p=0.001), degree of AH (r=0.43; p=0.0001), level of office systolic blood pressure (r=0.295; p=0.0090), presence of the mutant C allele polymorphism A1166C of the angiotensin II type 1 receptor gene - AGTR1 (r=0.387; p=0.0001), blood glucose (r=0.30; p=0.010), waist circumference (r=0.258; p=0.023) were associated with an increase IMT common carotid artery (CCA) in patients with AH. The multiple linear regression analysis identified independent factors influencing on the IMT CCA - age (b=0.62; p=0.01), males (b=0.321; p=0.01) and the mutant C allele carrier polymorphism A1166C of AGTR1 gene (b=0.312; p=0.01). Conclusions. The progression of carotid vascular remodeling risk factors in patients with AH were age, male gender and polymorphism of A1166C gene AGTR1.
Systemic Hypertension. 2018;15(3):32-38
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Obesity as a predictor for cardiovascular disease development: role of localized fat depot
Azimova M.O., Blinova N.V., Zhernakova Y.V., Chazova I.E.
Abstract
At present a steady increase of obesity prevalence is observed all over the world. It is known that specifically visceral obesity is associated with high risk of cardiovascular disease and their complications development, but the available verification methods do not determine the real visceral adipose tissue volume accurately. The importance of localized fat depot as a risk factor for cardiovascular diseases and as an early marker of target organs damage in obese patients is discussed in the review. An alternative method of epicardial adipose tissue thickness determined with the use of echocardiography used as waist circumference analogue for a more precise evaluation of visceral obesity in everyday practice is reviewed.
Systemic Hypertension. 2018;15(3):39-43
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Features of diurnal blood pressure profile, arterial stiffness and left ventricular structure and function in patients with arterial hypertension, prediabetes and type 2 diabetes mellitus
Fendrikova A.V., Gutova S.R., Skibitsky V.V., Skibitsky A.V.
Abstract
Aim. Analysis of features of diurnal blood pressure profile (DBPP), arterial stiffness and left ventricular (LV) structure and function in patients with arterial hypertension (AH) and impaired glucose metabolism. Materials and methods. The study included 220 patients with AH: 30 - without impaired glucose metabolism, 160 with prediabetes, and 30 patients with type 2 diabetes mellitus (DM). Prediabetes were determined by the results of an oral glucose tolerance test. 24-hour blood pressure monitoring were conducted, the main parameters of arterial stiffness and central aortic pressure (CAP) were examined using the BPLab Vasotens complex of OOO "Petr Telegin" (Russia). Echocardiography using a tissue doppler was performed on a Siemens ACUSON X 300 ultrasound device (Korea). Results. It was established that in patients with AH and impaired glucose metabolism the main parameters of DBPP, arterial stiffness, CAP and LV structure and function were comparable. In patients with AH and prediabetes were recorded increased levels of systolic and pulsatile blood pressure in the brachial artery and aorta, high mean aortic pressure within 24 hours, the level of diastolic blood pressure in the brachial artery and aorta during the night, morning rise of systolic blood pressure speed, "pressure load" mainly at night, than in patients with isolated AH. The pathological type of the "non-dipper" curve was detected 2.5 times more often in patients with type 2 DM and prediabetes than in patients with AH without impaired glucose metabolism. In patients with AH and prediabetes the pulse wave velocity, the augmentation index in the brachial artery and aorta characterizing the stiffness of the vessel wall and LV structure and function was significantly higher than in patients without impaired glucose metabolism. Concentric LV hypertrophy was registered 3.3 times more often than in patients without impaired glucose metabolism, and LV diastolic dysfunction with violation of its relaxation was revealed in 100% of cases. Conclusion. In patients with AH and prediabetes, the pathological changes in the parameters of DBPP, arterial stiffness and LV structure and function were comparable with those with AH and type 2 DM, and were more pronounced than in patients without impaired glucose metabolism.
Systemic Hypertension. 2018;15(3):44-49
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