Vol 11, No 1 (2014)

Articles
Hypertension treatment features in perimenopausal women
Zhernakova Y.V., Chazova I.E.
Abstract
Major causes of disability among women are chronic heart failure, developed on arterial hypertension (AH) and cerebral stroke. However, the prevalence of AH among postmenopausal women is significantly higher than for men. Women are more likely to develop AH with metabolic disorders, including metabolic syndrome. Therefore, the drugs of choice to treat AH in women in perimenopauseare ACE inhibitors and Angiotensin II Receptor Blocker. If necessary, combination antihypertensive treatment drugs of choice are agonistsimidazoline receptors, such as moxonidine. The use of this category of patients havemoxonidine action justified by the features of the pharmacological action of this drug (decrease in sympathetic hyperactivity), high efficiency, antihypertensive as well as additional positive effects on body weight and metabolic parameters.
Systemic Hypertension. 2014;11(1):5-10
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The value of blood pressure variability in clinical practice. Opportunities of amlodipine in reducing blood pressure variability (based on the Russian program «VARIATIONS»)
Ostroumova O.D., Bondarets O.V., Guseva T.F.
Abstract
The article discusses the importance of different types of variability in blood pressure (BP) as an independent risk factor for stroke and myocardial infarction in patients with arterial hypertension. The results of the Russian observation program (1500 patients) on the impact of amlodipine show BP variability in real clinical practice. According to the results, amlodipine 5-10 mg after 2 weeks of treatment significantly reduces the variability of systolic and diastolic blood pressure in both sexes. His influence on the short-term variability in diastolic blood pressure is dose-dependent.
Systemic Hypertension. 2014;11(1):11-16
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Aldosterone synthase gene polymorphism in patients with hypertension combined ischemic heart disease with in various left ventricular mass
Yahontov D.A., Derisheva D.A., Gulyaeva L.F.
Abstract
Study purpose - assessment of the relationship of levels of aldosterone and natriuretic peptide plasma aldosterone synthase gene polymorphism variants in patients with coronary heart disease (CHD) in combination with arterial hypertension (AH) at different left ventricular mass.Materials and methods. The study involved 63 male with hypertension and CHD; there were 32 men with signs of left ventricular hypertrophy (LVH) and 31 men with coronary artery disease with hypertension with a normal index of left ventricular mass. Evaluated the concentrations of aldosterone and plasma natriuretic peptide (NUP) in the relationship with characteristic of aldosterone synthase gene polymorphism.Results. It is established that the genotype CYP11В2 T/С of is associated with increased levels of aldosterone and signs of left ventricular hypertrophy. The level of LVC in the signs of LVH group was 2,1 fold higher than in patients without LVH. For patients with evidence of left ventricular hypertrophy is characterized by: the genotype of CYP11В2 T/C (62,5% of cases), the identification of the T allele (1,3 times more likely than patients without evidence of LVH) and more rarely than with normal index of left ventricular mass occurs variant CYP11В2 T/Т and more rarely prevalent allele C. Conclusion. In patients with coronary artery disease and hypertension, it is reasonable to implement in practice population genetic analysis to assess the probability the formation of left ventricular hypertrophy in the early stages of the disease.
Systemic Hypertension. 2014;11(1):16-20
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Practical aspects of fixed combinations in the treatment of hypertension
Ogarkov M.Y., Baranova M.N., Skripchenko A.E.
Abstract
Hypertension is a leading cause of heart attacks and strokes. Reaching target blood pressure (BP) in hypertension is the main condition optimization outlook for cardiovascular morbidity and mortality. To solve this problem in a substantial portion of patients, who are in need of antihypertensive drugs, wherein 70-80% of the target blood pressure can be achieved using a combination therapy. Fixed combinations of antihypertensive drugs increase treatment compliance and provide better organ protection. The new fixed combination of highly selective β-blocker bisoprolol and the calcium antagonist amlodipine can achieve target BP levels in 82,5% of patients with a minimum frequency of side effects.
Systemic Hypertension. 2014;11(1):22-25
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Candesartan in treating hypertension
Minushkina L.O.
Abstract
Candesartan is a selective angiotensin II receptor blocker type 1. The distinctive features of its pharmacokinetics and pharmacodynamics are long duration of antihypertensive action, high selectivity and good bioavailability. In the treatment of hypertension, candesartan can effectively prevent morning rise in blood pressure. For preparation peculiar cerebro-and cardioprotective effects, the ability to reduce the risk of new cases of diabetes. The drug is effective in the treatment of nephropathy different genesis, including in patients with a marked reduction in renal function. Metabolic neutrality, the ability to prevent the development of micro-and macroangiopathy can recommend this angiotensin receptor blocker in the treatment of diabetic patients. Favorable profile of the pharmacokinetic properties of an advantage in efficacy of candesartan in comparison with other drugs of the same group.
Systemic Hypertension. 2014;11(1):25-29
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Rational therapy of hypertension with concomitant ischemic heart disease
Chukaeva I.I., Orlova N.V., Soloveva M.V.
Abstract
Hypertension is one of the most common cardiovascular diseases, that causes the disability and mortality. Recommendations of the European Society of Hypertension and the European Society of Cardiologyin 2013 identified new approaches of antihypertensive therapy. For the control of blood pressure is recommended five major groups of drugs. Numerous multicenter studies confirm the high efficiency of angiotensin converting enzyme inhibitors (perindopril) and calcium antagonists (amlodipine). Drugs have proven marked hypotensive and cardioprotective effects. Prestarium fixed combination with a calcium antagonist such as amlodipine (Prestancia) due to the synergistic effect allows for greater efficiency and can be recommended in the treatment of combined pathology of hypertension and coronary heart disease.
Systemic Hypertension. 2014;11(1):29-33
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Place of angiotensin receptor blockers in antihypertensive therapy
Martynov A.I., Urlaeva I.V., Akatova E.V., Nikolin O.P.
Abstract
The arterial hypertension takes the basic place among the cardiovascular diseases which are a principal cause of death and invalidity. For today the basic group for treatment of an arterial hypertensia remain angiotensin-converting enzyme inhibitors (ACEi). However, according to numerous researches, angiotensin II receptor inhibitors by the efficiency are equal with ACEi, but have the best profile of shipping and provide higher adherence to therapy. One of highly effective, well studied, with considerable demonstrative base of preparations irbesartan.
Systemic Hypertension. 2014;11(1):34-39
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Risk of target organ damage in patients with arterial hypertension and various numbers of metabolic syndrome components
Zhernakova Y.V., Sharipova G.K., Chazova I.E.
Abstract
The metabolic syndrome is one of most socially significant and strategic problems of clinical medicine. It is known that metabolic syndrome promotes earlier and more expressed target organ damage in patients with arterial hypertension. However, correlation of the number of metabolic syndrome components with target organ damage, selection of metabolic syndrome components, influencing expressiveness on target organ damage, are studied insufficiently. In this study it is determined that with the elevating number of the metabolic syndrome components, the frequency and expressiveness of heart, kidney and vessel damage, accompanied by the increased risk of development of cardiovascular complications, increase in patients with the maximum number of the metabolic syndrome components. Moreover, it is revealed that the relative risk of simultaneous damage of heart, kidneys and vessels in patients with arterial hypertension and metabolic syndrome, apart from high blood pressure and abdominal obesity is associated with the increase of fasting glucose level.
Systemic Hypertension. 2014;11(1):40-44
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Place of arterial hypertension in brain lesion development - from minor cognitive disorders to dementia
Shishkova V.N.
Abstract
He problem of cognitive impairment in patients with somatic diseases today occupies a leading position, as it represents one of the most widespread manifestations of organic brain damage. The role of arterial hypertension(AH) in the formation of cognitive impairment (CI) has been shown in large epidemiological studies. CI detected in 73% of patients of both middle and senior age with hypertension duration of more than 5 years. Early detection of potentially treatable cognitive disorders is one of the most important tasks of the modern practitioner, cardiologist, endocrinologist, family doctor, as the patients in the early stages of CI constitute the majority of people seeking help. In today's world, primary care physicians' actions are often crucial in the prediction of dementia, since the detection of early forms of non-dementia CI and timely and adequate treatment of cardiovascular disease, especially hypertension, is often enough for the severity of the CI patients was significantly decreased, and dementia never came.
Systemic Hypertension. 2014;11(1):45-51
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New trends in the treatment of hypertension in 2013: the renaissance of pulse pressure
Ostroumova O.D., Galeeva N.Y.
Abstract
The article examines the published data on the prognostic value of a high pulse pressure. Given is the position of European experts on the role of pulse pressure as a marker of target lesions limited hypertension.The possibilities of antihypertensive therapy in reducing the pulse pressure are also discussed.
Systemic Hypertension. 2014;11(1):52-56
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Β-blockers: the lack of taskimplementation or the unwillingness of doctors in the russian federation to optimize the treatment?
Fomin I.V., Polyakov D.S.
Abstract
The purpose of the study. The achievedheart rate of 50-60 beats per minute in patients after acute myocardial infarction, and up to50-70 beats per minute for patients with stable angina is considered effective. Assuming that in Russia low doses of β-blockers are often used, thequestion was raised: «How common tachycardia can bein patients with coronary heart disease (CHD) and chronic heart failure (CHF), and whether there are strategic approaches to achieving the targets in heart rate in these patients in real clinical practice and are β-blockers often used in patients for whom this group of drugs is the basic one?»Materials and Methods. Work carried out in the framework of the Russian epidemiological study of a representative sample of the European partof the Russian Federation. All patients with CHF and coronary artery disease were divided into two subgroups: heart rate reducers not receiving medicines and receiving at least one heart rate reducing drug (a β-blocker, calcium channel 1 and 3rd type (AK) blockers, glycosides).Results and discussion. In a representative sample of the program in healthy individuals (without clinical manifestations of coronary arterydisease) tachycardia was diagnosed in 7,1% of cases. Almost all respondents without CHD (87,3%) had normal heart rate from 61 to 80 beats per minute. Number of respondents without CHD with heart rate of 70 to 79 bpm. per min. (54,1%) turned out to be significantly less than that of patients with rhythm in any form of coronary artery disease (p<0,001).In a population of patients with CHF a clinical symptom of tachycardia was established in 73,5% of patients.Analysis of the prescribed β-blockers therapy in patients with CHF showed that in 54% of cases the use of beta-blockers did not result in effectivecontrol of the rhythm in patients with CHF. β-Blockers recommended for the treatment of CHF were used only 36,2% of patients.Conclusions. Early intravenous β-blockers (drug Betalok) use before percutaneous coronary intervention reduces infarct size and increases leftventricular ejection fraction in patients with myocardial infarction of ST segment elevation. Answering the question posed in the title, you can say: doctors are not ready to take an active position in prescribing and achievingthe target doses of β-blockers. This situation immediately generates the lack of task implementation in terms of optimization of therapy and reduces the risk of cardiovascular mortality in coronary artery disease and heart failure.
Systemic Hypertension. 2014;11(1):56-63
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The telmisartan and amlodipine combination in the treatment of hypertension
Shehyan G.G., Yalymov A.A., Schikota A.M., Zadionchenko V.S., Varentsov S.I.
Abstract
The following review assesses socially significant disease - hypertension (AH) - and the problem of finding an effective antihypertensive therapy. Twynsta® drug (manufacturer Boehringer Ingelheim Pharma) - modern combined antihypertensive drug, which not only provides effective blood pressure control, but also due to the protective effect has been proved for all target organs improves the life expectancy of patients with hypertension. The clinical studies show that combination of telmisartan and amlodipine provides additional benefits in the treatment of patients with metabolic syndrome (by improving the carbohydrate and lipid metabolism), patients with impaired renal function (by inducing the regression of proteinuria), as well as left ventricular hypertrophy (by causing regression of the latter). The recently completed studies have shown that telmisartan acts as a selective PPAR-receptor modulator.In the present review it is shown that Twynsta® represents modern combined antihypertensive drugs and has a clinically proven favorable efficacy and safety profile.
Systemic Hypertension. 2014;11(1):64-72
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Optimization of drug therapy of coronary heart disease and arterial hypertension: choice angiotensin-converting enzyme inhibitors
Trukhan D.I., Tarasova L.V.
Abstract
Important problem for the cardiologist and the first contact a doctor (therapist and general practitioner) is to optimize the therapeutic and preventive aspects of drug therapy in patients with coronary heart disease and arterial hypertension. The article considers the question of choice of ACE inhibitor from the standpoint of rational pharmacotherapy and evidence-based medicine.
Systemic Hypertension. 2014;11(1):73-77
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Experience of treating hypertension in an outpatient setting: a clinical case
Agafonov A.N., Khozyainova N.Y., Petruschenkova O.V.
Abstract
Presents a case of treating hypertension stage II, 2 nd degree, risk 3 (high) in a patient of 54 years on an outpatient basis. For antihypertensive therapy was chosen fixed combination of quinapril 20 mg + hydrochlorothiazide 12.5 mg (Akkuzid) 1 times a day. Assigned therapy has several solutions to achieve the urgent tasks: to reach target blood pressure (BP) during the entire two weeks, to maintain the target blood pressure level throughout the observation period (24 weeks) to achieve regression of left ventricular hypertrophy. Effectiveness of prescribed therapy served as the main reason for high patient complains of treatment.
Systemic Hypertension. 2014;11(1):78-81
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