Vol 16, No 3 (2019)

Articles
Target levels of blood pressure in the elderly and very old patients with chronic kidney disease without frailty
Ostroumova O.D., Cherniaeva M.S.
Abstract
Currently, people has been paying special attention to the problem of arterial hypertension (AH) in patients of the elderly and very old patients. The expected benefits from the treatment of AH compared to the potential harm in this age group of patients are increasingly being questioned, since they often have disturbed the mechanisms that maintain homeostasis and vital organ perfusion, especially pronounced in “frailty“ elderly and very old patients. Existing randomized clinical trials have shown that antihypertensive therapy in patients of elderly and very old significantly reduces cardiovascular morbidity, as well as cardiovascular mortality and all-cause mortality, however, the target blood pressure (BP) values are still debatable. A number of comorbidities also affect the determination of target levels of BP reduction. For example, AH is a major risk factor for its development and progression for chronic kidney disease (CKD). Therefore, it is important to understand the strategy of treating patients of elderly and very old with concomitant CKD. This article presents a review of the literature on target BP values in elderly and very old patients without frailty with diabetic and non-diabetic CKD. We reviewed data from large studies and meta-analyzes, assessing the relationship of more intensive compared with less intensive control of BP with a reduced risk of major cardiovascular events, mortality or changes in glomerular filtration rate. During the analysis of the literature, it was shown that the studies are extremely controversial: along with the benefits obtained in some of them from lowering BP of less than 130 mm Hg in terms of reducing mortality, cardiovascular risk and rates of progression of CKD, other studies have obtained results indicating not only the absence of these advantages, but also a clear advantage of higher target BP figures. Thus, there is a need for large, specially designed randomized clinical trials devoted to this issue.
Systemic Hypertension. 2019;16(3):6-12
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Features of arterial hypertension patients with discrepancies in vectorcardiographic and echocardiographic conclusions about the presence of left ventricular hypertrophy [Original Article]
Blinova E.V., Sakhnova T.A., Chaykovskaya O.Y., Saidova M.A., Ryabykina G.V.
Abstract
Aim. To determine the features of patients with arterial hypertension (AH) with a discrepancy of electrocardiographic, including vectorcardiographic (VCG) and echocardiographic conclusions about the presence of left ventricular hypertrophy (LVH). Materials and methods. 140 patients with AH were examined (mean age 59.8±12.0 years, 33.6% of men). The Sokolov- Lyon criterion, the Cornell product, the sum of the amplitudes of the R wave in lead X and the S wave in lead Z of the synthesized vectorcardiogram (RX+SZ) and the amplitude of the maximal QRS vector (MQRS) were analyzed. Left ventriclular myocardial mass (LVMM) was calculated using the ASE formula, LVMM/height2.7 more than 44 g/m2.7 in women and more than 48 g/m2.7 in men was considered a criterion for LVH.Results. In patients with AH, pathological RX+SZ and MQRS values were significantly more frequent compared with the Sokolov-Lyon criterion and the Cornell product. Pathological values of RX+SZ and MQRS were met both in patients with an increased and with a normal indexed LVMM. Patients with "true-positive" VCG findings compared with "false-negative" had significantly larger values of the relative wall thickness, LVMM and indexed LVMM. Patients with “false positive” VCG findings compared with “true-negative” were more likely to have left ventricular diastolic dysfunction (90% and 68%, respectively). Patients with the presence of VCG criteria for LVH, both with normal and with an increased indexed LVMM, were characterized by higher values of systolic blood pressure and higher values of the QRS duration. Conclusion. In patients with arterial hypertension, pathological values of vectorcardiographic indices were significantly more frequent compared with the Sokolov-Lyon criterion and the Cornell product. VCG indices allowed to separate groups of patients with the presence and absence of diastolic dysfunction of the left ventricle, as well as groups of patients with normal and elevated values of systolic blood pressure.
Systemic Hypertension. 2019;16(3):13-18
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Age-sex, ethnic and genetic peculiarities of high normal arterial blood pressure in residents of Mountain Shoria
Mulerova T.A., Gruzdeva O.V., Maksimov V.N., Ogarkov M.I.
Abstract
Aim. To study the prevalence of a high normal arterial blood pressure (HNABP) depending on the age-sex and ethnic characteristics of the population of Mountain Shoria and its association with the cardiovascular risk factors and genetic markers. Materials and methods. We performed a cross-sectional study of the compactly settled population in the isolated areas of Mountain Shoria (Orton and Ust-Kabyrza villages) and in urban-type settlement Sheregesh. The sample of the Shor population was 901 subjects (284 men and 617 women). As the comparison group, we examined 508 non-indigenous (newly arrived) subjects (153 men and 355 women) in the indicated villages. All the respondents underwent a general clinical laboratory and instrumental examination. Polymorphisms of genes ACE (I/D, rs 4340), АGT (c.803T>C, rs699), AGTR1 (А1166С, rs5186), ADRB1 (с.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs 28365031), MTHFR (c.677С>Т, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a) were tested using polymerase chain reaction. Results. The factors associated with HNABP are analyzed in the present research. In the group of the Shors the following conditions were associated with this pathology: obesity (OR 2.03), its abdominal type (OR 1.98), genotype I/D of АСЕ gene (OR 1.80) and genotype А/С of AGTR1 gene (OR 2.03); in the non-indigenous ethnic group - obesity (OR 2.39), abdominal obesity (OR 3.17) and genotype D/D of АСЕ gene (OR 3.43). In the Shor patients with HNABP the prevalence of left ventricular myocardial hypertrophy (28.1%) and albuminuria (17.3%) appeared to be higher as compared to the non-indigenous subjects - 17.2%, (р=0.047) and 5.1% (р=0.049), respectively. Conclusion. The present study demonstrated a high prevalence of HNABP in the population of Mountain Shoria depending on ethnicity. Therefore, such patients require monitoring for an early detection of the increased blood pressure, control of risk factors, preventive examinations and dispensary observation.
Systemic Hypertension. 2019;16(3):19-23
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Regulatory adaptive status in determining the effectiveness of lisinopril and fosinopril in patients with chronic heart failure with preserved left ventricular ejection fraction
Nedvetskaia S.N., Shubitidze I.Z., Tregubov V.G., Pokrovskiy V.M.
Abstract
Aim. To determine effectiveness of combination therapy with lisinopril and fosinopril in patients with chronic heart failure (CHF) with preserved left ventricular ejection fraction (LV EF), considering its impact on the regulatory and adaptive capabilities organism. Materials and methods. 80 patients were examined with CHF II functional class with preserved systolic function of the left ventricle (left ventricular ejection fraction ≥50%) (classification of the New York Heart Association) in the presence of hypertension disease (HD) III stage and/or ischemic heart disease (IHD). Randomly divided into two equal groups. In the first group was appointed for treatment with lisinopril (the average dose was 14.0±3.8 mg/day), in the second group - fosinopril (the average dose - 14.7±4.2 mg/day). All patients were prescribed nebivolol (7.1±2.2 mg/day and 6.8±2.1 mg/day). Depending on the concomitant pathology were appointed acetylsalicylic acid in the intestinal shell (100 mg/day, n=9 and 100 mg/day, n=10) and atorvastatin (15.3±4.9 mg/day, n=15 and 16.5±4.8 mg/day, n=17). Initially and after six months later of combined pharmacotherapy studied: a quantitative assessment of regulatory and adaptive capabilities of the organism, echocardiography, treadmill test, six-minute walk test, determination in blood plasma of the N-terminal precursor of the natriuretic brain peptide level, all-day monitoring of blood electrocardiograms and pressure. The quality of life was also assessed using a questionnaire. Results. Both treatment regimens of patients equally improved the structural and functional parameters of the heart, reduced neurohumoral activity, optimized heart rate and pulse. In this case, treatment with fosinopril is more pronounced positively regulatory-adaptive capacity and tolerance to physical load, and also there was an improvement in the quality of life. Conclusion. In patients with CHF with preserved LV EF, in the presence of HD and/or IHD combined pharmacotherapy with fosinopril in comparison with lisinopril probably is preferable due to the more pronounced increase in regulatory and adaptive capabilities.
Systemic Hypertension. 2019;16(3):24-28
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Clinical, functional and hemodynamic profile of patients with Eisenmenger syndrome in comparison with the group of idiopathic pulmonary hypertension, features of starting specific therapy choice
Gratsianskaya S.E., Valieva Z.S., Zorin A.V., Martynyuk T.V.
Abstract
Aim. To conduct a comprehensive analysis of the clinical, functional, hemodynamic profile of patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) and Eisenmenger syndrome, as compared with the group of idiopathic pulmonary hypertension (IPAH) according to the Russian Registry, and also to study the features of drug therapy. Materials and methods. The study involved 20 patients with PAH-CHD and Eisenmenger syndrome and 20 patients with IPAH over 18 years old. All patients had been entered in the Russian registry (NCT03707561). A comparative analysis of clinical, functional, hemodynamic parameters was held. The diagnosis was established in accordance with the algorithm proposed in the Russian guidelines the diagnosis and treatment of PH (2016). Results. In this study, 20 patients with PAH-CHD (16 women and 4 men) and Eisenmenger syndrome and 20 patients with IPAH (18 women and 2 men) were analyzed. Patients were comparable in age and sex. The time from the onset of symptoms to the final diagnosis in the PAH-CHD group was significantly longer: on average, it took three years to establish the diagnosis, whereas in patients with IPAH, on average, after 10.5 months, the correct diagnosis was made (p=0,0006). In the group of patients with Eisenmenger syndrome, there was a significant decrease in SpO2 both at rest and under exertion and averaged 86.5±9.7% at rest and 70±12.3% after exercise (p=0,0002). Conclusions. Patients with Eisenmenger syndrome compared with the IPAH group are characterized by a longer duration of symptoms until the diagnosis, and lower oxygen saturation. When estimating the parameters of pressure in the pulmonary artery (sPAP, dPAP, mPAP), according to the data of right heart catheterization and echo, significantly higher values of pressure in the pulmonary artery and lower values of SpO2 were detected.
Systemic Hypertension. 2019;16(3):29-35
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The possibilities of angiotensin receptor blocker azilsartan medoxomil and its combination with chlortalidone in cardiovascular risk decrease in patients with obesity, metabolic syndrome and diabetes mellitus
Zhernakova J.V., Chazova I.E., Blinova N.V.
Abstract
Angiotensin receptor blockers (ARBs) are with increasing frequency used in arterial hypertension treatment, this class of medications is especially important in treatment of patients with obesity, metabolic syndrome and diabetes mellitus. Although not all the ARBs are the therapy of first choice in these patients. The special requirements are imposed upon antihypertensive mediations for patients with arterial hypertension and metabolic disorders such as high antihypertensive activity, maximum duration of action, possibility of increase of peripheral tissues sensitivity to insulin and, subsequently, metabolic profile. Besides, these patients require the use of combined therapy already at the treatment start. There are very few ARBs combinations with thiazide diuretics that exhibit these properties. The present review discusses possibilities of new ARB azilsartan medoxomil (Edarbi®) and its combination with chlortalidone (Edarbi® Clo) in decrease of cardiovascular risk in patients with obesity, metabolic syndrome and diabetes mellitus.
Systemic Hypertension. 2019;16(3):36-42
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Experience of the management of patients with pulmonary hypertension in the Republic of Karelia
Ryabkov V.A., Vezikova N.N., Malygin A.N., Novozhilova N.V., Merenkov V.V.
Abstract
Pulmonary hypertension (PH) is a common and frequent condition in the practice of a physician according to the results of echocardiography, and no longer can cause difficulties in determining the genesis, as well as further management of tactics. PH can be not only a complication of a severe heart failure or chronic lung diseases, but also be a manifestation of much more rare forms of diseases: pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH). Timely diagnosis of PH and the correct interpretation of its origin with the contemporary treatment options can improve the quality of life and prognosis for previously severe PAH, as well as talk about the potential curability of some patients with CTEPH. The article describes the approaches adopted in the region to treat patients with PH, including the steps of diagnosis both: outpatient and in-patient hospital. The experience of interaction between the experts of the Almazov National Medical Research center and the specialists of the Baranov Republic Hospital on the problems of diagnostics and treatment of patients with PAH and CTEPH is presented. The purpose of the publication is to demonstrate the possibilities of examination and treatment of patients with PH in the Republic of Karelia.
Systemic Hypertension. 2019;16(3):43-52
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Gender characteristics of obstructive sleep apnea syndrome clinical manifestations and patients' quality of life
Khachatryan N.T., Elfimova E.M., Mikhailova O.O., Litvin A.Y., Chazova I.E.
Abstract
Obstructive sleep apnea - is a socially significant disease that leads to an increased risk of developing cardiovascular complications and dramatically worsens the patient's quality of life. For a long time, the disease was considered exclusively male, however, the results of recent epidemiological studies reflect a decrease in the difference of the incidence between men and women. These changes are due to a more targeted study of the manifestations and clinical course of the disease, as well as new approaches in the diagnosis of obstructive sleep apnea syndrome. The review is focused on the analysis of recent data on gender differences in the prevalence, pathophysiology of obstructive sleep apnea, diagnostic approaches and clinical manifestation of the disease. It also considers the impact of gender on the quality of life and sleep. The obtained results can help better explain the mechanisms of gender differences, as well as form new trends in the development of clinical trials.
Systemic Hypertension. 2019;16(3):53-57
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