Vol 18, No 3 (2021)

Expert opinion

Management of patients with arterial hypertension and atrial fibrillation

Chazova I.E., Golitsyn S.P., Zhernakova J.V., Zheleznova E.A., Kropacheva E.S., Mironov N.I., Kostiukevich M.V., Laiovich L.I., Utsumueva M.D., Iuricheva I.A., Litvin A.Y., Elfimova E.M., Rogoza A.N., Panchenko E.P.

Abstract

Arterial hypertension (AH) is a leading risk factor for cardiovascular disease as well as it is the most common, independent and potentially reversible risk factor for atrial fibrillation (AF). AH contributes to the occurrence and maintenance of AF due to hemodynamic disorders, alterations in cardiomyocyte electrophysiological properties and structural remodeling in the atria. AF, which is also associated with an increased risk of cardiovascular events, is the most common arrhythmia. AH and AF often coexist, and their prevalence increases with age. This consensus provides the key features of the management of patients with these nosological units. The pathogenesis, risk stratification, and features of the selection of antihypertensive, antiarrhythmic and antithrombotic therapy are described in detail.

Systemic Hypertension. 2021;18(3):105-128
pages 105-128 views

Original Article

Efficacy and safety of azilsartan medoxomil in various doses in patients with metabolic disorders

Perepech N.B., Chazova I.E., Zhernakova J.V.

Abstract

Background. Obesity is an independent risk factor of the cardiovascular complications in patients with arterial hypertension (HTN). It can directly contribute to an increase in blood pressure (BP). Thus, the treatment of patients with HTN and obesity becomes a complex clinical problem, which requires new highly effective antihypertensive drugs.

Aim. To assess the effectiveness and safety of novel angiotensin II receptor blocker azilsartan medoxomil (AZL-M) as monotherapy and in free combinations with diuretics and/or calcium antagonists in obese or overweight patients with HTN in real clinical practice.

Materials and methods. An international multicenter observational non-interventional prospective study of the efficacy and safety of AZL-M in patients with hypertension and overweight or obesity was performed in the Russian Federation and the Republic of Kazakhstan. Patients took the drug for 6 months in accordance with the approved local instructions for use. All examinations were performed in accordance with routine clinical practice on the basis of a physician’s decision.

Results. In patients prescribed AZL-M as monotherapy (without dosage changes during the study) a significant decrease in systolic and diastolic blood pressure (systolic BP and diastolic BP, respectively) was observed (p<0.001, compared to baseline); the average decrease in systolic BP and diastolic BP was 30.50±12.67 and 14.47±8.65 mmHg, respectively (n=865). Target BP (140/90 mmHg or 140/85 mmHg in patients with diabetes mellitus) was achieved in 112 (94.12%), 547 (92.24%) and 135 (88.24%) of patients who were prescribed AZL-M at doses of 20, 40, or 80 mg/day, correspondingly. In patients receiving AZL-M in combination with a diuretic or calcium antagonist, the rate of achievement of ad blood pressure targets was 78.8–87.5% and 81.3–85.5%, respectively, and the frequency of response to therapy was 68.8–92.9% and 81.3–93.9%, respectively. During the entire observation period, 43 adverse events (AEs) were recorded, the most common of which were arterial hypotension (14 cases). All AEs associated with the study drug were of mild or moderate intensity.

Conclusion. AEs administered as monotherapy and as part of combination therapy provided a statistically and clinically significant decrease in BP and a high frequency of target BP achievement in patients with HTN and metabolic disorders associated with overweight or obesity. Given the high efficacy and good tolerance of the drug, AEs can be considered as the drug of choice for the treatment of HTN in patients with overweight or obesity.

Systemic Hypertension. 2021;18(3):130-139
pages 130-139 views

Clinical features and course of arterial hypertension in patients with its various forms

Denisova A.R., Esaulova T.E., Solntseva T.D., Sivakova O.A., Chazova I.E.

Abstract

Aim. To study the main risk factors, clinical, laboratory and instrumental data, concomitant cardiovascular diseases (CVD) and associated clinical conditions in patients with controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension based on retrospective analysis.

Materials and methods. The study included 455 patients with hypertension. All patients were divided into 7 groups. The group of controlled hypertension included 240 patients (52.75%), controlled resistant hypertension – 61 (13.4%), uncontrolled hypertension – 10 (2.2%), uncontrolled resistant hypertension – 53 (11.65%), refractory hypertension – 63 (13.8%), probably resistant hypertension – 15 (3.3%), probably refractory hypertension – 13 (2.9%). Anamnesis (assessment of the duration and age of the onset of arterial hypertension, assessment of the presence of CVD), risk factors for the development of hypertension (obesity, dyslipidemia, impaired glucose tolerance and fasting glycemia, hyperuricemia, family history of CVD, early menopause in women; heart rate >80 beats/min, smoking), laboratory parameters (creatinine, glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, uric acid) and instrumental methods of examination (ECG, echocardiography, clinic mean 24h BP, Holter monitoring, duplex BCA scanning) were assessed in all groups of patients based on the analysis of the medical history.

Results. In this article we presented the results of a comparative analysis of patients with controlled hypertension, uncontrolled resistant hypertension, refractory and probably refractory hypertension. Patients with refractory hypertension were significantly more young, non-smokers and females compared with patients with uncontrolled resistant hypertension and controlled hypertension. Patients with refractory hypertension had greater prevalence of left ventricular hypertrophy according to ECG and echocardiography (p<0.05). Fundus lesions were found exclusively in patients with uncontrolled hypertension, 55% of cases were found in the group of refractory hypertension (p<0.05). There were no significant differences in the presence of BCA atherosclerosis between the groups. Patients with refractory hypertension were significantly more likely to have heart failure, a history of stroke and transient ischemic attack compared with patients from the group of controlled hypertension (p<0.05). There was no significant difference in the presence of chronic kidney disease, type 2 diabetes mellitus, coronary heart disease, atrial fibrillation between the groups.

Conclusion. Patients with refractory hypertension are significantly more likely to have target organ damage and concomitant cardiovascular, cerebrovascular diseases than patients with controlled hypertension.

Systemic Hypertension. 2021;18(3):140-146
pages 140-146 views

Renal artery denervation in patients with resistant arterial hypertension: clinical and organ-protective effect

Gapon L.I., Mikova E.V., Krinochkin D.V., Savelyeva N.Y., Zherzhova A.Y., Aleksandrovich E.L.

Abstract

Aim. To assess the clinical efficacy of renal artery denervation (RAD) in treatment of patients with resistant arterial hypertension (RAH) compared to patients taking drug therapy (DT) at long-term follow-up and the possibility of RAD impact on target organs (heart, kidneys).

Materials and methods. 80 RAH patients were examined (mean age 54.30±10.19 years). Patients were divided in two groups: the basic group was comprised of 40 RAH patients taking antihypertensive DT, who underwent RAD (gr. 1) and comparison group was composed of 40 RAH patients taking only antihypertensive DT (gr. 2). Gender and age differences between groups were statistically insignificant (p>0.05). Mean duration of AH was 18.63±8.96 years. The follow-up was carried out during one year.

Results. In RAD group there was confirmed decrease not only in the office, but also in the average day-time and night-time blood pressure (BP), changes were more significant in systolic BP (SBP) indicators: the overall daytime ΔSBP was 17.36±9.31 mmHg (p<0.001), the average day-time ΔSBP was 17.18±10.53 mmHg (p<0.001), the average night-time ΔSBP was 19.22±10.76 mmHg (p<0.001). At the same time, in DT group changes in values of overall, maximum, minimum, average day-time and average night-time SBP and diastolic BP were not statistically significant in 12 months. RAD in RAH was accompanied by decrease in left ventricular hypertrophy with initial hypertrophy (p<0.05), decrease in microalbuminuria (p<0.05), decrease in velocity in segmental (p<0.05) and interlobar renal arteries (p<0.01).

Conclusion. RAD in patients with RAH had not only antihypertensive effect but also positive effect on target organs of AH (heart, kidneys).

Systemic Hypertension. 2021;18(3):153-160
pages 153-160 views

Review

Evaluation of heart rate variability in patients with different forms of pulmonary hypertension

Qurbonbekova N.K., Kasparova A.M., Kozhemyakina E.S., Sobolev A.V., Martynyuk T.V.

Abstract

Pulmonary hypertension (PH) is a severe pathology of the cardiovascular system with extremely poor prognosis, if unreated. Early diagnosis of PH is difficult, due to the absence pathognomonic symptoms, and at the initial stage the disease may be asymptomatic. An increase in pulmonary vascular resistance and pressure in the pulmonary artery cause severe dysfunction of the right ventricle, which affects the functional status of patients. The assessment of heart rate variability (HRV) parameters is used to predict the increased risk of sudden death in various diseases of the cardiovascular system and the functional status of the body. HRV is mainly regulated by the sympathetic and parasympathetic divisions of the autonomic nervous system. It is noted that pulmonary arterial hypertension is associated with increasing of sympathetic activity. The review, based on the analysis of the pathophysiological mechanisms of pulmonary arterial hypertension and chronic thromboembolic PH, presents the results of studies assessing the time and spectral parameters of HRV in patients with PH of various etiologies.

Systemic Hypertension. 2021;18(3):147-152
pages 147-152 views

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