Vol 18, No 2 (2021)

Expert opinion

Consensus of experts from the Russian Medical Society of Arterial Hypertension. Arterial hypertension and erectile dysfunction

Alekseeva T.A., Litvin A.Y., Elfimova E.M., Mikhailova O.O., Larina V.N., Shpot E.V., Podzolkov V.I., Chazova I.E.

Abstract

Sexual health is an essential part of overall health, and an active and healthy sex life is an important aspect of a good quality of life. Cardiovascular diseases and sexual health disorders have common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity and smoking) and common pathogenesis (endothelial dysfunction, inflammation and atherosclerosis). All this led to speculations about the pathophysiology and treatment options for sexual dysfunctions. The use of phosphodiesterase type 5 inhibitors has revolutionized the treatment of erectile dysfunction (ED) in men. This article focuses on ED and its relationship with hypertension. This document was created by experts from the Russian Medical Society of Arterial Hypertension with the participation of a member of the European Society of Hypertension Working Group on Sexual Dysfunction and Arterial Hypertension. In recent years, the expert group was very active in educating hypertension specialists and related specialties physicians about ED via numerous lectures at national and international congresses. It has been noted that ED precedes the development of coronary heart disease. The artery diameter hypothesis has been proposed as a possible explanation for this observation. Clinical manifestations of atherosclerotic lesions and/or endothelial dysfunction of the penile arteries may precede those in larger arteries. Patients with hypertension who receive antihypertensive drugs are more likely to suffer from sexual dysfunctions compared to untreated patients. The occurrence of ED appears to be related to the undesirable effects of antihypertensive drugs on the penile tissues. There is information about various effects of antihypertensive drugs on erectile function.

Systemic Hypertension. 2021;18(2):69-79
pages 69-79 views

Original Article

Drug therapy of arterial hypertension: assessment of the physicians’ basic knowledge. Final results of the PHYSTARH project

Bontsevich R.A., Vovk Y.R., Gavrilova A.A., Kirichenko A.A., Krotkova I.F., Kosmacheva E.D., Kompaniets O.G., Prozorova G.G., Nevzorova V.A., Martynenko I.M., Ketova G.G., Barysheva V.O., Maksimov M.L., Osipova O.A.

Abstract

Background. Arterial hypertension is a multifactorial disease accompanied by an increase in systolic and/or diastolic blood pressure above the established values. Uncontrolled blood pressure can cause various complications, which will lead to either disability or death of the patient.

Aim. To assess the compliance of the level of doctors’ knowledge with current clinical guidelines in the treatment of arterial hypertension.

Materials and methods. Within the framework of the PHYSTARH multicenter study, we presented the results of an anonymous prospective survey to assess the level of physicians’ knowledge and pharmacotherapeutic preferences in the treatment of arterial hypertension.

Results. The study involved 425 physicians from 9 regions of Russia: Belgorod, Voronezh, Lipetsk, Chelyabinsk, Moscow, Krasnodar Territory, Primorye Territory, the Republic of Adygea and Tatarstan. In the course of the analysis, we revealed an insufficiently high level of the respondents’ knowledge in the treatment of arterial hypertension. Less than half of the respondents chose the indication of combination therapy as a therapeutic intervention in which the effectiveness of lowering blood pressure increases about 5 times more than when the dose of the original drug is doubled; correctly indicated the pharmacological group for the proposed drug (methyldopa), determined the indication for the use of aspirin in patients with hypertension, selected the optimal antihypertensive therapy for the proposed clinical situations, indicated absolutely contraindicated antihypertensive drugs in pregnancy and chronic obstructive pulmonary disease.

Conclusion. The need for additional educational activities among physicians was established to improve the quality of knowledge on the basic aspects of hypertension, because a significant number of key questions on this topic cause difficulties for respondents.

Systemic Hypertension. 2021;18(2):80-87
pages 80-87 views

Prevalence of risk factors for arterial hypertension among draft age youth

Uvarovskaia B.V., Mel’nik M.V., Kniazeva S.A.

Abstract

Background. The currently observed diseases of the circulatory system “getting younger”, the increase in the incidence of arterial hypertension (AH) and the high mortality rate of men of working age in Russia are elements of one of the main medical and social problems. The identification of risk factors (RF) for the development of hypertension in young patients and the identification of the groups with the highest risk of cardiovascular events in their future adult life is aimed at preventing hypertension, early treatment initiation, increasing life expectancy and reducing mortality.

Aim. To study the prevalence of the main modifiable RF associated with arterial hypertension among draft age youth.

Materials and methods. The identification of RF, their qualitative, quantitative description, assessment and comparative analysis among men with normal and high blood pressure (BP) of varying degrees.

Results. In the control group without hypertension, 37.1% of the subjects did not have any RF; 48.6% of the surveyed each had one RF; 14.3% were persons with two RFs. There were no people identified with three or more RFs. In the study group with AH, 27.0% of patients did not have any RF; 37.4% of patients had one RF; 22.6% of patients with two RFs; 9.5% of patients with three RFs and 2.6% of patients had four RFs. The occurrence of each RF in the control group without hypertension and in the study group with hypertension as a whole is presented as follows respectively: overweight/obesity 37.1 and 59.1%; smoking 34.3 and 38.3%; alcohol abuse 0 and 2.6%; physical inactivity 8.4 and 12.2%; hypercholesterolemia 2.9 and 20.9%; hypertriglyceridemia 5.7 and 16.5%; hyperglycemia 5.7 and 5.2%.

Conclusion. RF is widespread in young men, regardless of BP level. More than 60% of draft age youth without hypertension have at least one RF. Among all modifiable RFs, the highest frequency of occurrence is associated with increased weight and smoking. Overweight or obesity is always found in individuals with two or more RFs. Among men with hypertension, people with obesity, low physical activity and impaired lipid metabolism are more common than among men without hypertension. Risk assessment in draft age youth presents certain difficulties. Identification and assessment of risk factors will make it possible to develop an individual program for their modification, prevention of the development of hypertension and detection of the disease in the early stages.

Systemic Hypertension. 2021;18(2):88-93
pages 88-93 views

Comparative characteristics of indicators of peripheral arterial and central aortic pressure, remodeling of the left ventricular myocardium in salt-sensitive and salt-resistant patients with arterial hypertension

Skibitskiy V.V., Vasil'ev V.Y., Fendrikova A.V., Pyatakov S.N.

Abstract

Background. Changes in the vascular wall, in particular, an increase in its stiffness and an increase in pressure in the aorta, as well as hypertrophy of the left ventricular myocardium are factors that determine a poor prognosis in patients with arterial hypertension. At the same time, the peculiarities of changes in arterial stiffness indices and left ventricular myocardial remodeling in patients with different sensitivity to salt loading have not been adequately studied.

Aim. To conduct a comparative analysis of the values of peripheral blood pressure and central aortic pressure, indicators of left ventricular myocardial remodeling in salt-sensitive and salt-resistant patients with arterial hypertension.

Materials and methods. The study involved 180 patients with arterial hypertension: 96 men and 84 women. The median age was 59 years. Salt sensitivity test was performed according to V.I. Kharchenko. All patients underwent 24-hour blood pressure monitoring, echocardiography. Indicators of peripheral arterial pressure and central aortic pressure, remodeling of the left ventricular myocardium were determined.

Results. According to the results of the test V.I. Kharchenko, 88 patients were classified as salt-sensitive, 92 – as salt-resistant. After a salt sensitivity test in salt-sensitive patients, the main indicators of peripheral blood pressure and central aortic pressure exceeded those in salt-resistant patients in the daytime, at night, and throughout the day as a whole. In the group of salt-sensitive individuals, statistically more significant negative changes in echocardiographic parameters were recorded; a significant number of salt-sensitive patients were diagnosed with prognostically unfavorable variants of left ventricular myocardial remodeling.

Conclusion. In salt-sensitive patients with arterial hypertension, compared with salt-resistant patients, there are higher values of both peripheral blood pressure and central aortic pressure, more significant negative changes in echocardiographic parameters with the formation of concentric hypertrophy and eccentric remodeling of the left ventricular myocardium. It can be assumed that the assessment of salt sensitivity makes it possible to verify patients with the most unfavorable changes in parameters of ambulatory blood pressure monitoring and significant remodeling of the left ventricular myocardium. This approach can be used to individualize pharmacotherapy in patients with arterial hypertension and increase its effectiveness.

Systemic Hypertension. 2021;18(2):94-100
pages 94-100 views

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