Vol 9, No 4 (2012)

Diuretics have been long used to treat arterial hypertension; however, the use of loop diuretics has been limited by cases of chronic kidney and heart failure. The loop diuretic torasemide is now administered in subdiuretic doses (2,5–5 mg) to treat arterial hypertension; it is well tolerated, metabolically neutral, and, due to its antialdosterone effect, fails to cause hypokalemia.

The paper discusses the aspects of using b-adrenoblockers in the treatment of patients with arterial hypertension (AH). It discusses the reasons why United Kingdom experts have excluded b-adrenoblockers from the list of first-line antihypertensive drugs. The place of b-adrenoblockers is defined among other antihypertensive agents according to the European and Russian guidelines for the management of hypertensive patients. The authors show indications for the use of different b-adrenoblockers in patients with AH and underline the need for an individual approach to choosing a b-adrenoblocker and the expediency of administering long-acting cardioselective drugs as agents having an optimal combination of their efficacy and safety.

Among patients with hypertension and with a combination of hypertension and diabetes mellitus the majority does not reach target values of arterial pressure levels. There is a number of lacks in ambulatory antihypertensive therapy and adherence to it. The considerable number of patients continues to accept therapy irregularly, the choice of antihypertensive drugs and their combinations is not always adequate, non – medicamentous actions don’t realize by all patients. At the same time the powerful negative contribution is associated with low adherence of patients to spent antihypertensive therapy.

The use of technical means, home automatic tonometers in particular, is one of the possible ways of enhancing therapy compliance. Aim: to evaluate the impact of the availability of an automatic tonometer on patient adherence to antihypertensive therapy and its efficiency. Subjects and methods. The investigation included 60 patients aged 45–75 years with grades 1–2 arterial hypertension. The patients were randomized to tonometer Group «OMRON» that was given an OMRON automatic tonometer and control Group that was not given the latter. Compliance-increasing methods, such as giving losartan free of charge, a self-control diary, and written recommendations, were used in all the study participants. General clinical examination, office blood pressure (BP) measurement, biochemical blood testing, and questioning using the hospital anxiety and depression scale (HADS), Morisky-Green test, and a visual analogue scale (VAS) were employed to assess quality of life. Results. Both groups achieved a reduction in systolic and diastolic blood pressures (SBP and DBP). The quality of life was improved only in Group «OMRON» (VAS scores increased from 64,8 to 73,6; p=0,01). At visit 1 (at week 3), the patients in both groups showed an equally high level of compliance. At visit 2 (at week 12) the compliance in Group «OMRON» increased up to 96,4% whereas that in Group «Control» decreased to 81,3% (a 15,1% difference; p<0,001). There was a positive correlation between the degree of a change in quality of life (VAS) and compliance (r=0,37; p=0,02). Subgroup 3 included the patients who had not got an automatic tonometer before the investigation (16 and 10 patients from Groups «OMRON» and «Control», respectively). In the subgroup, SBP lowering was achieved only in the participants from Group «OMRON» at visit 2. The degree of DBP reductions was also greater in Group «OMRON» (∆DBP, 9,6 versus 6,6 mm Hg; р=0,05). Conclusion. The availability of an automatic tonometer enhances adherence to antihypertensive therapy in the patients and it is associated with their better quality of life. In the patients who had not got an automatic tonometer before the investigation, its giving increased the efficiency of antihypertensive therapy.

Objective: in our study, iloprost was used as a drug for acute tests in patients with pulmonary arterial hypertension (PAH). Design and Method. We included 7 pts with pulmonary arterial hypertension (PAH): 5 females and 2 males, average age 32,0±12,0 years. All patients underwent right heart catheterization including acute tests with both nitric oxide and Iloprost. In addition to hemodynamic changes the intravascular ultrasound (IVUS) parameters were analyzed. We used parameters such as: intima-media thickness, the pulsatility index (PI), the outer and inner diameter of the vessel, the area of the vascular wall. Results. Compared with the action of nitric oxide, the degree of reduction of medium pulmonary arterial pressure (mPAP) after Iloprost was 17,2±5 and 25,37±9 mm Hg respectively, and pulmonary vascular resistance (PVR) 251,4±120 and 276±129 dynes×c×cm-5 respectively (p<0,05). In addition, the hypotensive effect of inhaled iloprost developed rapidly. More pronounced response to Iloprost was also confirmed by the data of IVUS: intima–media thickness decreased to 1,18±0,07 mm after leading NO and to 1,01±1,12 mm after iloprost inhalation (p<0,05), and the PI was 25±21,4 after using NO and 45,7±38 after iloprost (p<0,05). Conclusions: our research suggests that iloprost has advantages, not only as a drug for a long pathogenesis therapy, but as a vasodilator for acute pharmacological tests.

Objectives: the aim is to estimate the share of people with AH among the Tubalars and nonindigenous inhabitants of the Altai Republic taking into account a sex, an ethnic origin and to analyze genetic predisposition to the diseases of АВ0, Rh, MN, P, Kell blood group systems. Materials and methods. There was clinico-epidemiologic survey of the Altai Republic population (sample of 935 people, 663 people of them are Tubalars, 272 people are nonindigenous) aged from 18 till 88 years. Arterial hypertension was diagnosed according to criteria of WHO/MOAG of 1999. The study of genetic markers was carried out according to the standard methodology, blood group systems were defined: ABO, «full» Rhesus factor, MN, P, Kell. The sample size of different systems made from 301 to 425 people. The force of association between studied markers and the disease was judged according to the criterion of relative risk. Results. 38,6% Tubalars and 40,8% nonindigenous population were diagnosed with arterial hypertension. The share of people with Rh(+) blood group is larger among Tubalars (94,6%) in comparison with nonindigenous representatives (87,4%; p<0,05). The full Rhesus factor CCDee and CcDEe phenotypes were registered more often among Tubalars, and the ccDee, CcDee, ccDEe, Ccddee phenotypes – among nonindigenous ethnic group. The MM phenotype was brought out more often among people of indigenous nationality (64,5% against 43,7%), whereas the MN and NN phenotypes – among people of nonindigenous nationality (40,4% against 28,5% and 15,9% against 7,0%; p<0,05). There were established the risk of development of AH for people with Rh(-) blood group among Tubalars, positive associative connection with AH disease for the people having the MN phenotype and resistance of people with Rh(+) blood group and the NN phenotype. Conclusion. The share of people with AH in the Altai Republic do not differ from the average rates in Russia (37,9% among men, 40,0% among women). There were brought out ethnic differences in blood group distribution of Rhesus and MN systems.

В 2012 г. отметил юбилей Сергей Николаевич Наконечников – доктор медицинских наук, ученый секретарь ФГБУ Российский кардиологический научно-производственный комплекс Минздрава РФ, профессор кафедры скорой медицинской помощи ФДПО МГМСУ, руководитель отдела новых медицинских информационных технологий, генеральный директор Российского медицинского общества по артериальной гипертонии, вице-президент благотворительного фонда «Артериальная гипертония», генеральный секретарь Евразийской ассоциации кардиологов.