Vol 10, No 2 (2013)

Articles
Combined pharmacotherapy for arterial hypertension: a view through the 2013 clinical practice guidelines
Rodionov A.V.
Abstract
The paper considers major changes in approaches to treating arterial hypertension in the context of the 2013 clinical guidelines on hypertension of the European Society of Cardiology/European Society of Arterial Hypertension. Prominence is given to a differentiated approach to combined pharmacotherapy, including the use of a fixed-dose lercanidipine/enalapril combination.
Systemic Hypertension. 2013;10(2):5-8
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Torasemide: additional benefits for postmenopausal women with arterial hypertension
Tkacheva O.N., Runikhina N.K., Sharashkina N.V.
Abstract
Effective and safe diuretic torasemide has additional effects of renin-angiotensin-aldosterone system blockage. Torasemide can be used as monotherapy or combined with other antihypertensives. In low doses torasemide produces pronounced antihypertensive effect without augmentation of excretion of potassium and water with urine. Long-term administration of torasemide was not associated with significant effects on lipid, purine, carbohydrate, or electrolyte metabolism parameters. Torasemide particularly effective in postmenopausal women, as these women are more likely formed low-renin hypertension. Therefore, torasemide can be used more widely in modern clinical practice.
Systemic Hypertension. 2013;10(2):9-13
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Sartans in the treatment of high-risk hypertension: the abilities of candesartan
Morozova T.E.
Abstract
This paper presents an overview of the literature on the treatment of arterial hypertension drugs that block the renin-angiotensin-aldosterone system (RAAS) – angiotensin receptor blockers ΙΙ (ARB), whose action is based on inhibition of the RAAS at the AII receptor. ARB candesartan (atakand), along with a strong long-term antihypertensive effect has organoprotective (causes regression of LVH has nephroprotection) antidiabetogennym effect, prevents the development of stroke. Clinical experience suggests candesartan, high efficiency and a good range of security among different categories of hypertensive patients with concomitant pathology, chronic heart failure, diabetes, obesity.
Systemic Hypertension. 2013;10(2):13-18
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Factors influencing compliance with lifestyle modification in an organized population
Alekseeva T.S., Ogarkov M.Y., Skripchenko A.E., Yankin M.Y.
Abstract
Objective: to identify the factors influencing compliance with lifestyle modification for the primary and secondary prevention of arterial hypertension (AH) in an organized population. Subjects and methods. The investigation enrolled 435 subjects (339 men and 96 women). The mean age of shop workers was 43 (range 33 to 49) years. The investigation program consisted of filling out a questionnaire containing sociodemographic characteristics, anthropometric data, information on the presence of bad habits and AH. Blood pressure, total blood cholesterol, and cardiovascular risk were determined in all the subjects included in the investigation. After examination, they were all recommended to observe healthy lifestyle and to modify risk factors, if any. The investigators implemented systematic prophylactic measures. Interim assessments of results were made during annual prophylactic examinations. Results. Education and age were factors that influence compliance with lifestyle modification. Compliance was found to increase with age. Assessment of the importance of education level for compliance with medications to prevent AH demonstrated that the subjects with lower (secondary) education were less compliant. At the same time, our investigation revealed no significant impact of an occupational factor on compliance. There was simultaneously a trend suggesting that the women were more compliant with nondrug therapy; however, the differences failed to achieve the level of statistical significance. Conclusion. Education and age were factors that influence compliance with lifestyle modification. At the same time, our investigation did not reveal any gender differences or any significant influence of an occupational factor on compliance.
Systemic Hypertension. 2013;10(2):19-22
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The place of Indapamide retard in the treatment of patients with left ventricular dysfunction and preserved systolic function in the presence of arterial hypertension
Tereshchenko S.N., Zhirov I.V.
Abstract
The issue of blood pressure levels is practically very important in patients with chronic heart failure (CHF). As is known, combination therapy for the latter implies the use of several groups of hemodynamically relevant agents; diuretics are an important component of CHF therapy. However, diuretics are the most unstudied medications in the treatment of patients with CHF in the context of evidence-based medicine. On the one hand, their efficacy and necessity for the treatment of patients with cardiac decompensation are beyond question and, on the other, even if you want, placebo-controlled trials using diuretics look difficult to perform.
Systemic Hypertension. 2013;10(2):23-26
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Effect of angiotensin II receptor antagonists on left ventricular hypertrophy, vascular elasticity, and lipid and carbohydrate metabolic parameters in metabolic syndrome
Nedogoda S.V., Salasyuk A.S., Chalyabi T.A., Barykina I.N., Pocheptsov D.A., Ledyaeva A.A., Tsoma V.V., Chumachek E.V.
Abstract
Aim: to evaluate the antihypertensive efficacy and effects of telmisartan and losartan on metabolic parameters in patients with arterial hypertension and metabolic syndrome. Subjects and methods. A blind randomized, controlled, parallel group comparative (telmisartan versus losartan for 24 weeks) trial enrolled 60 patients with arterial hypertension and metabolic syndrome. Results. Significant differences were found in favor of telmisartan in antihypertensive activity, cardio-, angio-, and nephroprotection and ability to improve lipid and carbohydrate metabolic parameters. Only did telmisartan reduce the manifestations of insulin resistance and hyperleptinemia in patients with hypertension and obesity. Therapy with telmisartan versus losartan exerted a pronounced positive effect on anthropometric parameters and fat deposition rate. The drugs were found to be well tolerated and to cause no adverse reactions in both groups.
Systemic Hypertension. 2013;10(2):27-33
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Use of diuretics in hypertensive patients with metabolic disturbances
Zhernakova Y.V., Chazova I.E.
Abstract
The multicenter research MERSY (Moxonidine Efficacy on blood pressure Reduction revealed in a metabolic SYndrome population) finished in 2008 was devoted to an assessment of long-term safety and efficiency of agonist I2-imidazolin receptors – moxonidine in patients with arterial hypertension and metabolic syndrome (in the general group and in advance defined subgroup of patients in a postmenopause). In 2013 final international results of the research MERSY which showed high antihypertensive activity of moxonidine, and also its positive influence on metabolic parameters and mass of a body were published.
Systemic Hypertension. 2013;10(2):34-40
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Additional possibilities of antihypertensive therapy for metabolic syndrome
Kislyak O.A., Pokhilchenko M.V.
Abstract
Metabolic syndrome (MS) is a clinical and laboratory symptom complex that encompasses abdominal obesity, carbohydrate and fat metabolic disturbances, arterial hypertension (AH), and target organ involvement. The drugs of first choice in the management of patients with AH and MS are renin-angiotensin-aldosterone system (RAAS) inhibitors, angiotensin receptor blockers (ARB) in particular, when combined with calcium antagonists (CA), which have been proven to be metabolically neutral and able to reduce the risk of type 2 diabetes mellitus. A fixed-dose combination of the ARB losartan and the CA amlodipine has additional capabilities to affect the components of MS due to higher adiponectin and lower uric acid levels.
Systemic Hypertension. 2013;10(2):41-46
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Subclinical vessel lesion in normotensive patients with abdominal obesity: focus on arterial stiffness
Druzhilov M.A., Otmakhov V.V., Beteleva Y.E., Korneva V.A., Kuznetsova T.Y.
Abstract
Aim: assessment of arterial stiffness (AS) in patients with abdominal obesity (AO) without arterial hypertension and low cardio-vascular risk (CVR), the analysis of AS correlation with the markers of target organ remodeling, determination of threshold values AS, combined with a high probability target organ damage. Subjects and methods. 95 normotensive patients with AO were examined (mean age 44,9±5,1 years, 72 men) by following methods: lipid and glucose level, carotid artery ultrasound with intima/media thickness estimation, echocardiography, 24-hour monitoring of blood pressure (BP) with arterial stiffness assessment, obtained by the portable recorder BPLab. Results. Subclinical arterial lesion was revealed in 37,9%, mean pulse wave velocity (PWV) was 7,6±0,6 m/s, maximum PWV – 10 m/s. PWV and central BP in aorta were higher in patients with subclinical carotid atherosclerosis (8,0±0,5 m/s vs 7,5±0,6 m/s, р<0,05), diastolic dysfunction (8,0±0,7 m/s vs 7,5±0,6 m/s, р<0,05), microalbuminuria (8,2±0,5 m/s vs 7,5±0,6 m/s, р<0,05). PWV≥8,3 m/s and average daily systolic BP in aorta ≥111 mm Hg correlated with subclinical target organ damage. Conclusion. The study of AS using a bifunctional 24-hour monitoring of BP may be a potentially simple and reproducible method for assessing the probability of the presence of subclinical atherosclerosis and high CVR, requiring no extra cost.
Systemic Hypertension. 2013;10(2):46-52
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Efficacy of irbesartan in arterial hypertension and metabolic syndrome
Ostroumova O.D., Zykova A.A., Polosova T.A., Bondarets O.V.
Abstract
The paper gives the data of Russian guidelines for the diagnosis and approaches to treating metabolic syndrome. It considers the choice of antihypertensive drugs in the treatment of hypertensive patients with metabolic syndrome. The benefits of angiotensin II receptor blockers are shown. The results of a number of trials evaluating the efficacy and safety of irbesartan used to manage arterial hypertension in metabolic syndrome are analyzed.
Systemic Hypertension. 2013;10(2):53-56
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Legochnaya arterial'naya gipertenziya: na puti ot ratsional'noy diagnostiki k vyboru effektivnoy lekarstvennoy terapii
Chazova I.E., Martynyuk T.V.
Abstract
Pulmonary arterial hypertension (PAH) is a clinical condition characterized by precapillary pulmonary hypertension (PH) in the absence of other causes leading to an increase of blood pressure in the pulmonary artery (PA), such as lung diseases, chronic PA thromboembolism, etc., including rare diseases. The Fourth World Symposium on PH in 2008 proposed new diagnostic criteria for PAH: a resting mean PA pressure ≥25 mm Hg with a normal PA wedge pressure ≤15 mmHg. PAH is the first category of PH involving different nosological entities with similar clinical manifestations, morphological patterns, and hemodynamic disorders. The key component in the pathogenesis of PAH is endothelial dysfunction with imbalance between vasodilators and vasoconstrictors and activation of the blood coagulation system, giving rise to pulmonary vascular remodeling and enhanced pulmonary vascular resistance. The detection of potential targets for therapeutic exposure and a considerable number of randomized trials using the pathogenic therapeutic agents led to the introduction of medicines that affect three potential targets: 1) deficiency of prostacyclin that replenishes its analogues (prostanoids); 2) that of nitric oxide, the vasodilator effect of which is associated with the elevated level of cyclic guanosine monophosphate, which substantially improved treatment possibilities in patients with PAH. The PACES trial of the efficacy of sildenafil in combination with intravenous epoprostenol is an example of effective specific combination therapy for PAH.
Systemic Hypertension. 2013;10(2):57-69
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Do spirometry for patients with cardiovascular diseases?
Nazarov B.M., Zykov K.A., Ratova L.G., Agapova O.Y., Dolgusheva Y.A., Chazova I.E.
Abstract
In recent decades cardiovascular (CVD) and COPD diseases are widespread around the world, leading to a high prevalence of patients with comorbidity, especially arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD) and/or bronchial asthma (BA). The growing number of patients with this comorbidity is due to increased hypertension, COPD, and asthma comorbidities, with the increase of the geriatric population of patients with these pathologies. Epidemiological studies have shown that the deterioration of lung function is as strong a predictor of cardiovascular mortality, as well as major cardiovascular risk factors. However, spirometry in patients with CVD is carried out infrequently. Inadequate spirometric diagnostics of COPD and asthma, especially in patients with cardiovascular disease, affects the clinical course of both diseases, leading to inappropriate treatment and poor prognosis for the patient. The need for extensive screening spirometry in all patients with CVD is not proven. Thera are no spirometry reference values in patients with CVD, which makes it almost impossible to use these parameters in stratification of CV risk. This dictates the need for further research to clarify the relationship between the severity and characteristics of the various CVD and spirometric parameters.
Systemic Hypertension. 2013;10(2):69-74
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A modern phylogenetic theory of pathology, pathogenesis of essential arterial hypertension and universal algorhythm of damage to the target organs
Titov V.N.
Abstract
Separate regulation of 2 arterial beds – phylogenetically early muscle arterioles (millions of local peristaltic pumps) and phylogenetically late proximal region, heart and elastic arteries – is the basis for the phenomenon that their non-coordination formed at different stages of phylogenesis manifests itself in functional disorders in paracrine cell communities. There is a small number of means to produce any effect on the paracrine cell community function at the level of the organism. Metabolic disorders in these communities can be normalized via the biological reaction of arterial pressure (AP). Pathogenesis of essential arterial hypertension is based on in vivo disorders of the biological functions of homeostasis, exotrophy, endoecology and adaptation. In essential hypertension, primary disorders form at the paracrine cell community level in the distal area of arterial bed, but not in the target organs. Only later, after compensatory activation of the biological reaction of AP and formation of discrepancy between regulations at the organism and paracrine cells communities, the process secondarily involves the target organs: kidneys, lungs and brains which have autonomous hemodynamics systems. The heart is the fourth target organ in essential hypertension. The pathogenesis of essential hypertension is based on phylogenetic discrepancy between metabolism regulation at the levels of the entire body and paracrine cell communities.
Systemic Hypertension. 2013;10(2):75-82
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Mnenie ekspertov Rossiyskogo meditsinskogo obshchestva po arterial'noy gipertonii: znachenie fiksirovannykh kombinatsiy v uluchshenii kontrolya arterial'nogo davleniya
- -.
Abstract
До настоящего времени артериальная гипертензия (АГ) остается одной из главных проблем здравоохранения. Такая ситуация связана как с большим распространением АГ, так и с тем обстоятельством, что это состояние является одним из главных факторов риска сердечно-сосудистых заболеваний [1]. По данным федеральной целевой программы «Профилактика и лечение артериальной гипертензии в Российской Федерации», в 2009 г. распространенность АГ среди населения России составила 40,8% [2]. Из этого числа 86,3% знали о наличии у них этого заболевания. При этом антигипертензивные препараты (АГП) принимали 69,5% пациентов с АГ, из них только у 27,3% получаемое лечение было эффективно. Хотя этот показатель повысился по сравнению с 2003–2004 гг. (когда он составлял 24,9%), у большинства пациентов контроль артериального давления (АД) до сих пор остается неудовлетворительным
Systemic Hypertension. 2013;10(2):83-84
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