Vol 16, No 4 (2019)

Articles
Consensus on patients with hyperuricemia and high cardiovascular risk treatment
Chazova I.E., Zhernakova J.V., Kisliak O.A., Nedogoda S.V., Podzolkov V.I., Oshchepkova E.V., Medvedeva I.V., Mironova O.I., Blinova N.V.
Abstract
Substantial amount of epidemiologic studies showed that hyperuricemia is highly associated with cardiovascular disorders, chronic renal disease, and diabetes mellitus development risk. This fact shows necessity of increased focus on uric acid level in serum not only in relation to rheumatic disorders but also in relation to cardiovascular and renal risk. European Society of Cardiology and Russian Arterial Hypertension Society experts included tests on uric acid level serum concentration in routine tests for hypertensive patients. Important steps in increase of hyperuricemia control in clinical practice are increase of awareness as a risk factor of cardiovascular disorders, development of risk management algorithm for patients with hyperuricemia and high cardiovascular risk, and increase of treatment adherence. Decrease of uric acid level in serum achieved after treatment with urate decreasing therapy mostly with xanthine oxidase inhibitor is associated with improvement of blood pressure control and decrease of cardiovascular adverse events frequency.
Systemic Hypertension. 2019;16(4):8-21
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The nature of the course of arterial hypertension in low-renin hyperaldosteronism
Chikhladze N.M.
Abstract
The review examines the nature of the course of arterial hypertension (AH) in case of tumor and hyperplastic changes in the adrenal cortex, leading to the development of low-renin hyperaldosteronism. The severity and nature of the course of AH were analyzed, it was shown that in most cases high stable hypertension develops, and resistance to multidrug antihypertensive therapy is observed. Attention is drawn to the features of the course of AH: options for hypertensive crisis, as well as cases of a moderately elevated and even normal level of blood pressure. Possible pathogenetic mechanisms that determine the characteristics of the course of AH are considered. Based on the results of the studies, including our own data, the importance of analyzing the individual characteristics of the course of the disease in order to select preferable methods of treatment and reduce the risk of undiagnosed aldosteromas is substantiated.
Systemic Hypertension. 2019;16(4):22-26
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Long-term outcomes after percutaneous transluminal pulmonary angioplasty for chronic thromboembolic pulmonary hypertension
Karabasheva M.B., Danilov N.M., Sagaidak O.V., Matchin Y.G., Chazova I.E.
Abstract
Introduction. Chronic thromboembolic pulmonary hypertension is a precapillary form of pulmonary hypertension that develops due to thrombotic mass obstruction of the pulmonary arteries. Balloon pulmonary angioplasty (BPA) is a new, alternative treatment method for inoperable chronic thromboembolic pulmonary hypertension (CTEPH), which demonstrated good hemodynamic and clinical effects. In this article we studied the long-term outcomes results after BPA. Material and methods. The study included 22 patients with inoperable CTEPH who were treated by BPA 6 (5; 8) interventions per patient. The results of the procedure were evaluated 2 months and 18 (12; 18) months after the last BPA. Results. A significant decrease in all important hemodynamic parameters was noted. There no difference between the date immediately after the operation and the long term period. However, the division of patients into groups with and without disease progression allow us to identify factors affecting the effectiveness of BPA (weight, the number of BPA procedures per patient, the total number of treated segmental arteries, the presence of coronary heart disease and chronic obstructive pulmonary disease, not the appointment of a concomitant pathogenetic pulmonary arterial hypertension (PAH) therapy. Conclusion. BPA is an effective method of treating patients with inoperable CTEPH, which demonstrates a good, sustainable long-term result. Patients with classical type 4 pulmonary hypertension receiving PAH-specific therapy are best responders to BPA.
Systemic Hypertension. 2019;16(4):27-32
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Role of fixed combinations in modern treatment of arterial hypertension: new or well overlooked old?
Adasheva T.V., Samorukova E.I., Zadionchenko V.S., Laricheva K.A.
Abstract
The article discusses therapeutic tactics changes and arterial hypertension (AH) treatment algorithms stated in latest European Society of Hypertension and European Society of Cardiology guidelines (ESH/ESC 2018). Causes of therapeutic strategies ineffectiveness are analyzed: therapeutical persistency, insufficient use of combined therapy, treatment adherence problems, and “complexity” of therapeutic strategies used. Stages of combined AH therapy history and treatment with fixed combinations renaissance in the 1990s are described. Special attention is given to triple-component fixed combination for AH treatment. Therapeutic strategy of rapid change to triple-component antihypertensive therapy in case of double-component schemes non-effectiveness is explained. The latest expert consensus, mataanalyses, and studies explaining fundamental principles of AH control increase in population are presented. Mechanisms of AH treatment adherence increase are analyzed. Results of the latest study of amlodipine/indapamide/perindopril fixed combination use effectiveness, safety, and treatment adherence are analyzed independently.
Systemic Hypertension. 2019;16(4):33-37
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Uncontrolled arterial hypertension in patients with breast cancer and the risk of developing cardiotoxicity with anthracycline-containing chemotherapy
Oshchepkova E.V., Avalyan A.A., Rogoza A.N., Gorieva S.B., Saidova M.A., Chazova I.E.
Abstract
Aim. To study of the role of the effectiveness of blood pressure control according to the daily monitoring of blood pressure in patients with triple negative breast cancer with arterial hypertension at risk of developing cardiotoxicity with anthracycline-containing chemotherapy. Materials and methods. The study included 99 breast cancer patients (mean age 48 years [36; 63]) who received chemotherapy including anthracyclines, taxanes and platinum -based agent. Before chemotherapy, patients underwent 24-hour blood pressure monitoring, which revealed masked uncontrolled hypertension. Before and after chemotherapy, echocardiography was performed, including speckle tracking echocardiography in a two-dimensional mode, and the concentration of biomarkers (highly sensitive troponin T and NT-proBNP) was also determined. Patients with breast cancer with masked uncontrolled hypertension (n=12) were the main group of the study, and patients with controlled hypertension (n=17) and patients with normotension (n=70) were the comparison group. Results. After chemotherapy in patients with uncontrolled hypertension, a large degree of decrease in global longitudinal strain (GLS) was recorded, a high incidence of subclinical cardiotoxicity, assessed by the diagnostic criterion of GLS; a larger increase in the volume of the drug and a higher degree of increase in highly sensitive troponin T. In patients with uncontrolled hypertension who received a higher total dose of doxorubicin, the degree of decrease in GLS was statistically significantly greater than in patients with controlled hypertension. Conclusion. Uncontrolled hypertension in patients with breast cancer is unfavorable in terms of the risk of developing subclinical and clinical cardiotoxicity, especially when using high doses of anthracycline. The method of daily monitoring of blood pressure should be used in patients with breast cancer both to detect masked hypertension and to assess the achievement of the target level of blood pressure before anthracycline-containing chemotherapy.
Systemic Hypertension. 2019;16(4):38-44
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Risk factors for falls in patients with arterial hypertension
Khovasova N.O., Naumov A.V., Tkacheva O.N., Moroz V.I.
Abstract
Falls are a serious multi-factorial problem faced by the elderly persons which is associated with serious complications, loss of functional autonomy, disability and death. One of the common comorbidities among the elderly persons is arterial hypertension (AH) which increases the risk of falls. Aim. To study the risk factors for falls among patients with AH. Materials and methods. Examined 155 patients of geriatric department with the presence of at least one fall in the last year: 133 (85.8%) women (75,29±8.31 years) and 22 (14.2%) men (79,14±4.64 years). Risk of falls and risk factors of falls were assessed in patients with AH. Results. 148 (95.5%) patients had AH. The most common risk factors for hypertension in the elderly were atherosclerosis and decreased physical activity. Target organ lesions of varying severity were observed in all patients. In 25.7% of cases, BP figures outside the target values were noted. 18 (12.2%) patients received hypotensive therapy irregularly. On avera-ge, at admission, patients received of 2.06±0.63 anti-hypertensive drug. The frequency of falls in patients with hypertension made up 2.59±2.2, two or more falls happened in 91 persons (61.5%). According to the self-assessment risk of falls scale 131 (88.5%) patients had a high risk of falls. A high risk of falling in hospital (on the Morse scale) was identified in 63 (42.6%) patients. The most common risk factors for falls in patients with AH were previous falls in anamnesis, sensory de-ficit, imbalance, osteoarthritis. The CGA results demonstrate that patients with hypertension with blood pressure below the target values in comparison with the target and even high numbers of blood pressure have a higher prevalence of frailty, worse indicators of functional status, higher incidence and high risk of falls on the Morse scale. Conclusion. The most common risk factors for falls among patients with AH are previous falls in anamnesis, sensory deficit, imbalance, osteoarthritis. For patients with hypertension, low blood pressure is a predictor of high risk of falls and a worse prognosis. When blood pressure is below the target, there is a higher prevalence of frailty and worse indicators of functional status, which is a poor prognostic sign for the elderly.
Systemic Hypertension. 2019;16(4):45-51
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Target blood pressure levels in patients with arterial hypertension and frailty
Ostroumova O.D., Cherniaeva M.S., Morozov A.P.
Abstract
Arterial hypertension (AH) is an important public health problem worldwide. The high prevalence of hypertension can partially be explained by an increase in blood pressure (BP) with age and a rapid increase in the elderly population (over 65 years old). Despite the effect of age on BP, evidence of target blood pressure values for its control in patients of older age groups with AH is limited, especially if they have frailty. There are data from a number of studies that reveal a relationship between lower BP levels and all-cause mortality in patients with AH in older age groups. In clinical practice, decisions regarding BP targets are especially difficult in elderly people with frailty who often do not meet the criteria for inclusion in randomized controlled trials and for this group of elderly people the clinical recommendations of leading communities do not give a specific answer about the target BP level. The evidence base regarding the target BP values in the treatment of AH in patients of older age groups with frailty presented in this review is not numerous, but its analysis suggests the advantages of higher BP numbers, with maximum systolic BP values of 165 mm Hg and diastolic BP of 90 mm Hg, while lower BP levels may be unsafe in terms of increasing the risk of adverse cardiovascular events and mortality from both cardiovascular causes and all causes. Polymorbidity in combination with polypharmacy and an increased risk of adverse events require a patient-oriented individual approach to the appointment of antihypertensive therapy. For a final decision on the management tactics of patients with AH and frailty, large, specially designed randomized clinical trials are needed.
Systemic Hypertension. 2019;16(4):52-60
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Heart rate variability in women with essential hypertension under exposure of regular moderate physical training
Smolyakov Y.N., Kuznik B.I., Guseva E.S., Davydov S.O.
Abstract
The task of the study was to elucidate the effect of moderate exercise on heart rate variability (HRV) in women who regularly take kinesitherapy courses. Materials and methods. Studies were conducted on 72 women with essential hypertension (EH), divided into 2 subgroups: first (EH-1) included 37 women suffering from stage II EH and under medical therapy, the second (EH-2) consisted of patients who underwent along with medication treatment, regular courses of kinesitherapy. To evaluate the characteristics of HRV, a photoplethysmography method was used. The following indicators were used: SDRR is the standard deviation of all cardiointervals, RMSSD is the square root of the average sum of squares of cardiointerval differences, LF - is the oscillation power in the low frequency range, due to the activity of the sympathetic section, HF - is the power in the high frequency range, associated with respiratory movements and caused by vagal activity, LF/HF - is the power ratio, reflecting sympathetic balance, CVI - nonlinear parasympathetic index, CSI - nonlinear sympathetic index. Results. It was established that the average heart rate in women of both groups is approximately the same, while all other indicators (with the exception of LF/HF and CSI) were significantly higher in patients EH-2 group. In patients EH-2 group, there is a significantly larger value of SDRR, RMSSD, LF, HF. In the frequency analysis, no increase in the total power of cardiointerval oscillations and autonomic balance (LF/HF) was detected. A pronounced increase in the nonlinear parasympathetic index (CVI) has been shown, while the sympathetic index (CSI) remained unchanged. Conclusion. Regular use of kinesitherapy courses helps to increase the tone of the parasympathetic division of the autonomic nervous system, which is significantly depressed in EH.
Systemic Hypertension. 2019;16(4):61-64
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Radiofrequency denervation of the renal arteries in patients with resistant arterial hypertension: 3 years of observation experience
Savelyeva N.Y., Zherzhova A.Y., Mikova E.V., Gapon L.I., Kolunin G.V., Krinochkin D.V.
Abstract
Objective. To evaluate the efficiency of radiofrequency denervation of the renal arteries in patients with resi-stant arterial hypertension during a three-year follow-up. Materials and methods. The study involved 40 patients with resistant arterial hypertension aged 27 to 70 years (mean age 54.91±9.77 years) while receiving three or more antihypertensive drugs (including diuretic) in optimal doses. The conditions for inclusion in the study were considered resistant arterial hypertension with blood pressure (BP)>160/100 mm Hg, intact kidney function - glomerular filtration rate (MDRD)>45 ml/min - and the absence of secondary hypertension. All patients had sympatic radiofrequency denervation of renal arteries; its efficiency later was estimated according to the clinical measurement and ambulatory blood pressure monitoring (ABPM). Results. The level of office BP reliably differed initially and after 3 years: DSBP -34.48±6.44 mm Hg (p=0.001), DDBP - 22.29 mm Hg (p=0.001). According to ABPM results, reliable dynamics of systolic blood pressure was not observed. The data of DBP at night were significantly lower after 36 months; DDBP was -5.37±9.77 mm Hg. Conclusions. A marked decrease in the data of office SBP and DBP was observed, which proves the long-term efficiency of radiofrequency denervation of the renal arteries in patients with resistant hypertension. Accor-ding to ABPM results after 36 months, a significant decrease was registered among the DBP indicators at night and daytime.
Systemic Hypertension. 2019;16(4):65-69
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New approaches to the analysis of daily variability of sinus rhythm in assessing the antihypertensive effect of various drugs
Sobolev A.V., Talabanov P.G., Ryabykina G.V., Kozhemyakina E.S., Oshchepkova E.V.
Abstract
Aim. Identify in patients with arterial hypertension (AH) the peculiarities of the effect of various classes of antihypertensive drugs on the daily variability of sinus rhythm (HRV). Material and methods. We examined 29 patients with grade 1-2 degree essential AH aged 32 to 60 years (16 men and 13 women) using bifunctional monitoring of ECG and blood pressure before and after treatment with bisoprolol, amlodipine, lisinopril and a combination consisting of lisinopril and amlodipine. We evaluated the hypotensive effect of the drugs associated with the distribution of heart rate during the day and the amount of HRV corresponding to different ranges of heart rate. Results. In cases where the antihypertensive effect (AE) of bisoprolol was expressed, the initial HRV values in the heart rate ranges close to 75 beats/min were significantly greater than in the absence of effect. After treatment, in the presence of AE of bisoprolol, a significant decrease in HRV parameters was observed in these heart rate ranges. AE of amlodipine was associated with an initially high heart rate concentration in the ranges close to 75 beats/min. The efficacy of lisinopril and the combination of lisinopril with amlodipine was associated with an initially high heart rate concentration in the range 69-83 beats/min and its decrease during the treatment. Conclusion. With a random set of patients and a random choice of drugs for the treatment of AH, the presence and absence of an antihypertensive effect was accompanied by statistically significant differences in the initial values and in the dynamics of HRV parameters.
Systemic Hypertension. 2019;16(4):70-79
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Vascular wall status and its link with perivascular adipose tissue and other fat depots in young patients with abdominal obesity
Zheleznova E.A., Zhernakova J.V., Pogorelova O.A., Tripoten M.I., Blinova N.V., Shariya M.A., Azimova M.O., Gorieva S.B., Maslov A.V., Balakhonova T.V., Chazova I.E.
Abstract
Aim. To evaluate the common carotid artery (CCA) intima-media complex thickness (IMT) and the presence of atherosclerotic plaques (ASP) in young people with abdominal obesity who don’t have metabolic syndrome and those who have it, as well as a link between fat depots (perivascular, visceral, subcutaneous, epicardial) and CCA IMT. Materials and methods. The study included 145 people aged 18-45 years. They were divided into 3 groups: group 1 (n=18) - healthy volunteers (control group), group 2 (n=48) - patients with abdominal obesity and no more than one additional risk factor (metabolically healthy) and group 3 (n=79) - patients with metabolic syndrome. In persons included in the study the following parameters were measured: the height, weight, body mass index, waist circumference, fasting blood glucose, glucose tolerance, uric acid, lipid profile, insulin and the insulin resistance index (HOMA-IR). They also were given a 24-hour blood pressure monitoring, and an evaluation of CCA IMT, a presence of ASP in the carotid arteries and a maximum degree of internal carotid stenosis was performed using the duplex scan of brachiocephalic arteries. Computed tomography (Aquilion One Vision Edition, Toshiba, Japan) with determining subcutaneous, visceral, perivascular, epicardial fat was performed, and the ratio of subcutaneous to visceral fat was calculated. Results. Significant differences in mean CCA IMT were revealed only between persons of group 1 and group 3 (p=0.025), while the median of IMT were within normal ranges (group 1: 0.49 [0.46; 0.56]; group 2: 0.53 [0.49; 0.59]; group 3: 0.56 [0.52; 0.62]). Significant differences in a distribution of individuals with increased IMT between groups were also not revealed. However, the proportion of individuals with ASP was significantly higher in group 2 compared with group 1 (p<0.001) and in group 3 compared with group 2 (p<0.001), as well as the presence of maximum stenosis in the carotid artery. Direct correlation between CCA IMT and periaortic (r=0.440; p=0.000), epicardial (r=0.329; p<0.001) and visceral (r=0.326; p<0.001) fat depots, as well as the inverse correlation with a ratio subcutaneous fat/visceral fat (r=-0.241; p=0.005) were revealed. In addition, there were correlations between CCA IMT and body mass index, waist circumference, lipid profile and 24-hour blood pressure monitoring parameters, that once again confirms a close pathogenetic link between obesity, disorders of lipid metabolism and vascular wall status.
Systemic Hypertension. 2019;16(4):80-86
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