Vol 11, No 3 (2014)


The results of the open observational, international, multicenter, prospective program to assess the efficacy, safety and tolerability of the first direct renin inhibitor RasilezR (aliskiren) in patients with arterial hypertension in ‘real-life’ clinical practice settings (DRIve)

Chazova I.Y.


Rasilez® (aliskiren) is the first drug from direct renin inhibitors class (DRI), which is used to treat arterial hypertension. The first aim of the «DRIve» program (Open observational, international, multicenter, prospective study to assess the efficacy, safety and tolerability of the first direct renin inhibitor Rasilez® (aliskiren) in patients with arterial hypertension in a real life setting) is to collect information about the efficacy, safety and tolerability of Rasilez (aliskiren) in monotherapy or in combination with other drugs in a real life setting for 6 months of therapy. Secondary aims were to analyze the patient acceptance of therapy and additional factors determining the outcome of Rasilez treatment. The program had been holding out from October 2009 until July 2011 in 17 cities of Russia.
Systemic Hypertension. 2014;11(3):5-6
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Education and self-education of the patients is an important step towards increasing patients acceptance of therapy

Chazova I.Y., Ageev F.T., Fofanova T.V., Chikhladze N.M., Kuznetsova M.B., Smirnova M.D., Ostrogorskaya V.A., Geraschenko Y.S.


The blood pressure level control and the long-term administration of anti-hypertensive agents are of high priority and play key role in treatment of patients with hypertension in the outpatient setting. This paper analyzes the short-term and long-term results of the education of patients with AH in a patient's School, and the effectiveness of the education concerning acceptance of therapy among these category of patients.Aim. To analyze received knowledge of the patients with arterial hypertension associated with LVH at patient's School compared to the control group and the study of the degree of patients acceptance of therapy and quality of life of both group of patients during the study.Material and methods. We underwent 13 cycles of education (course of education lessons with duration of 6 weeks, lessons 1 time per week). Topics and the duration of lessons (90 minutes), as well as the number of patients enrolled in the groups (8-10 people), corresponding to norms approved by the Ministry of Health of the Russian Federation. We educated 128 patients with AH (there were 66 patients with AH with out association with LVH and 27 patients, associated with LVH). The control group consisted of 65 patients with AH who had refused toattend patient's School for various reasons (41 patients without association with LVH and 24-associated with LVH).The Groups of patients educated/failed the education were matched by sex, age, duration of AH, BMI, levels of SBP and DBP. Instrumental and laboratory studies (general clinical examination, ECG, biochemical analysis of blood) were underwent before the treatment, at the end of the education cycle and in 24-months of outpatient treatment.Results. Patients who had been educated at the patient's School showed the statistically significant reduction of the BP level. In the end of School the systolic BP was 139,3±7,4 mm Hg and the diastolic BP - 86,2±5,4 mm Hg (p=0,0001). Patients in the control group also showed statistically significant reduction of BP during last visit, however, the degree of BP reduction in this group was statistically significant lower. The target BP was observed in 79% in the first group of patients and 54% in the second group of patients (p=0,003). Dynamics of the quality of life, estimated by the visual analog scale (VAS) was statistically significant higher in the group of patients, attending School (p=0,001). Acceptance of therapy among patients who had been visiting the School, significantly increased, but the statistically significant changes in acceptance of therapy in the second group of patients were not observed. Questioning and examination of the patients one year later, showed that in the group of patients who had received one cycle of education in the School, the BP level remained statistically significant below the basal value (SBP 142,3±5,7 and DBP 88,5±4,3 mm Hg, p<0,05). Quality of life and acceptance of therapy in this group did not have statistically significant negative dynamics and remained at a high level (VAS: 75,7±3,2% (3,1±0,9 points (p=0,05)). Patients in the control group noticed growth of BP level (SBP 154,7±8,2 mm Hg and DBP 90,5±4,3 mm Hg) and impairment of quality of life (VAS 62,3±4,9% p=0,03). Morisky-Green test showed an initially low level (1,9±0,2 points).Conclusion. The results show the high efficacy of the patient education at School among patients with AH, including the patients with AH and LVH.
Systemic Hypertension. 2014;11(3):7-10
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Psychosomatic Aspects of Low Adherence to Antihypertensive Therapy in Patients with Arterial Hypertension

Fofanova T.V., Ageyev F.T., Kadushina E.B., Drobizhev M.Y., Smirnova M.D., Kuzmina A.E.


Aim. To evaluate psychosomatic aspects of adherence to antihypertensive therapy (AHT) in patients with arterial hypertension and its relationships with comorbid somatic disturbances.Subjects and methods. A total of 161 patients with arterial hypertension with duration of more than 12 months (19 women, 42 men) aged 53,4±11,4 years were included in the study. All studied patients were followed up in the outpatient department of the Cardiology Research Institutenamed after A.L.Miasnikov, Russian Cardiology Research and Production Complex, Ministry of Health of the Russian Federation, and were consented for the psychiatric examination. To evaluate the patient adherence to AHT the following questionnaires and scales have been used: original Complaint Questionnaire designed by the authors for patients with arterial hypertension, USK, USK-B, ORB, GOTD, and patient self-reported Morisky-Green medication adherence scale. Consistent with data of patient case histories and responses to questionnaires, studied subjects were classified into two groups of adherence levels to AHT: Group I - 30 (19%) subjects; 17 women/13 men; mean age 52,9±11,7 years - included patients with high adherence to AHT, who started medication right after being diagnosed for arterial hypertension, and were treated regularly. Group II - 131 (81%) subjects; 102 women/29 men; mean age 53,1±11,8 years - included patients with low adherence to AHT, with postponed initiation of AHT after the diagnosis, and irregular or absent treatment.Results and conclusions. Patients comprising Group I with high adherence to AHT were characterized by short duration of arterial hypertension, crisis-type of its onset followed by panic attacks; concomitant disorders (ischemic heart disease, arrhythmias, ulcer disease, thyroid gland abnormalities), high anxiety level, panic attacks, anxiety and phobic paroxysms, subclinical depressions (dysthymia, cyclothymia), anxiodepressivesituational adaptation reactions, and nozogenic (adaptive) anxiodepressive reactions (hypernozognosia). Patients comprising Group II with low adherence to AHT were characterized by more severe affective symptoms (depressive and maniacal phases of bipolar affective disorder and recurrent depressions) and different variants of pathocharacterologic personality development.
Systemic Hypertension. 2014;11(3):11-16
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The impact of fixed combination of amlodipine and perindopril (drug Prestance)on the mechanisms of heat adaptation in patients with arterial hypertension

Ageev F.T., Smirnova M.D., Fofanova T.V., Svirida O.N., Mikhailov G.D., Revich B.A.


Relevance. The impact of the drugs on adaptation to the heat wave of abnormal temperature has been one of the most important practical medicine questions, concerning heat waves, recent years. One of the points at issue is safety administration of calcium channel antagonists and ACE inhibitors during abnormal heat.Aim of the study is to assess the efficacy and safety of the fixed combination of perindopril arginine (drug Prestance, Servier Industries, Ltd.)/amlodipine in patients with arterial hypertension (AH) during the summer heat and the summer heat influence on the mechanisms of heat adaptation to abnormally high temperature.Material and methods: The study enrolled 165 patients with stages 1-2 AH: 69 patients with average risk and 91 patients with high/very high risk of cardiovascular complications. There were 69 men and 96 women in the study, living in Moscow city, in the Moscow and in the Ivanovo Regions. All patients were measuring office BP, undergoing biochemical analysis of blood, running questionnaire survey: visual analogue scale (VAS), questionnaire for the patients who were exposed to heat, the level of products reacting with the 2-thiobarbituric acid (malonyldialdehyde, MDA) and activity of superoxide dismutase (SOD) using standard test-kits and the pulse ware velocity (PWV) was measured in 30 patients. The first visit was in the first half of June 2013, the second visit - during the heat (July 2013) and the third one in September 2013.Results: In the course of the study SBP (systolic BP) and DBP (diastolic BP) were reduced (р<0,00001), target level of SBP and DBP reached 73,9% (41,9% - the second visit).We observed the increase of VAS scores, hyperkalemia (р=0,0056), hyponatremia (р=0,00042), hypocreatinemia (р=0,018), hypocholesterolemia (р<0,00001), hypotrigliceridemia (р=0,027), hypoglucosemia (р=0,0035). We were observing the reduction of PWV and of the characteristics of oxidative stress (MDA, р<0,0001 and MDA/ SOD, р<0.001) during the peak of the heat, during the 3ed visit. Conclusion: Prestance therapy during the summer heat showed efficacy and safety and was well tolerated by AH patients without any signs of hypotension and electrolyte imbalance which were attributed to body heat. The improvement of adaptive human body response was associated with effective arterial elastance and reduction of oxidative stress.
Systemic Hypertension. 2014;11(3):16-21
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Why occurrence of arterial hypertension with age becomes frequent?

Poseliugina O.B., Poseliugina E.B., Al-Galban N.


Research objective: to study a table salt (PS) role in arterial hypertension (AH) increase with age.Material and methods. Examined 583 patients essential hypertension 1-2-th degree aged 25 to 59 years and 350 practically healthy persons - monitoring group. They investigated the threshold taste sensitivity to the PS (TTSPS) was determined daily urinary excretion of sodium ions with urine with the subsequent recalculation on the programme of the substation, which was received by the person with food in grams on the eve of research.Results. It appeared that in increase of AG accruing with age plays an undoubted role increase in consumption of PS. Thus the increase in consumption of PS is carried out involuntarily and is connected with decrease in sensitivity of the flavoring analyzer to Na. It, in turn, can be caused both age involution of the flavoring analyzer, and decrease in its sensitivity in connection with big consumption of PS.Conclusion. With age at sick AG of action for restriction of consumption of PS have to amplify only. It is possible to believe that at advanced and senile age in treatment of sick AG diuretics start playing rather big role.
Systemic Hypertension. 2014;11(3):22-24
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Angiotensin II receptor blockers in the treatment of arterial hypertension in patients with concomitant pathology: focus on candesartan

Trukhan D.I.


The results of numerous foreign and russian researches allow us to consider Candesartan as an important component of an effective therapy for patients with arterial hypertension, including the elderly, as well as with concomitant chronic heart failure, diabetes mellitus and other disorders in practice cardiologist and doctor of first contact (the therapist and general practitioner).
Systemic Hypertension. 2014;11(3):24-29
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Modern opportunities of monotherapy in patients with arterial hypertension associated with comorbid disorders

Gorokhovskaya G.N., Yun V.L.


This article examines the modern approach to the treatment of arterial hypertension as one of the most important medical and social problems in the developed world, characterised by a high prevalence high risk of cardiovascular complications and occurrence along with comorbid diseases.
Systemic Hypertension. 2014;11(3):29-33
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Possibilities ARB II (sartans) in hypertensive patients

Morozova T.E., Andrushchishina T.B., Gontarenko S.V.


The article presents an overview of the literature on the choice of pharmacotherapy of arterial hypertension (AH). Among antihypertensive drugs occupy an important place ARBs II (BRA), a heterogeneous group of drugs whose representatives have significant intercompany differences. This article focuses on the properties and effects of olmesartan, that distinguish it from other ARBs. Along with a strong long-term antihypertensive effect of olmesartan has organoprotective (regression of LVH, nephroprotection etc.). Olmesartan clinical experience indicates a high efficiency and a good range of security among different categories of patients with hypertension.
Systemic Hypertension. 2014;11(3):33-38
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Comparative evaluation of zofenopril. Are the characteristics of angiotensin I converting enzyme inhibitors important for the practice?

Kirichenko A.A.


The article provides an overview of the main comparative studies of antihypertensive efficacy and cardioprotective characteristics of zofenopril. We showed the information about the benefits of the drugs with higher tissue bioavailability preventing left ventricular hypertrophy and increasing its stiffness, because number of drugs possessing antiatherosclerotic and antiischaemic effects. The results of the studies, revealing the characteristics of action of these drugs class, will extend the capabilities of medical practitioners in the treatment of patients suffering from AH after acute myocardial infarction, associated with angina.
Systemic Hypertension. 2014;11(3):39-43
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The combination therapy in arterial hypertension: opportunities of the fixed combination of irbesartan andhydrochlorothiazide(Koaprovel’)

Ostroumova O.D., Guseva T.F., Bondarets O.V.


The article deals with the various aspects of the combinationtherapyin arterial hypertension. We showed the complementary effects and benefits of the combination of angiotensin II receptor antagonistsand diuretics; also we described clinical caseswhere thiscombination therapy is forpriority use. In detail we analysed the literature data on the efficacy and safety of combination of irbesartan and hydrochlorothiazide, including long-term use.
Systemic Hypertension. 2014;11(3):43-48
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Pharmacoepidemiological study of recommendations of diuretics for the treatment of hypertension in the outpatient setting

Ponomareva A.I., Kompaniets O.G., Linchak R.M., Nemirovskaya M.M., Strokan M.V., Babich A.E.


The aim of the study is pharmacoepidemiologicalanalysis of the structureandreasonability of diuretic therapy in patients with hypertensive disease (HD)in ‘real-life’ clinical practicesettings.Materialandmethods:we underwentthe retrospectivepharmacoepidemiologicalcomparative analysisof the structureofdiuretic therapyreviewingoutpatient cardsfrom 2011 to 2014.We extracted data from outpatientcardsin outpatient department of Krasnodar Territoryusingcontinuous sampling method(421 patients)with the subsequent assessmentin accordance withmodern guidance materials. Results. In comparison with the regional study historic resultsthe administrationoftorsemidehad significantly increasedin patients withHD andnoncomplicatedchronic cardiac failure(12%).The priority drugs for the administrationamong diuretics werehydrochlorothiazide (24%)and indapamide (20%),spironolactone (20%).The ACE inhibitoror sartanusing in fixed combination with diuretic was recommended in 20% of out- patient cards.Structure ofdiuretic distribution in group of patients with HD, associated withCHF(II-IVfunctional class)had showedthe efficiencyof spironolactonein26%,of hydrochlorothiazide - 15%,torsemide - 13%,indapamide - 7%;the combination of spironolactoneandtorsemidewas receivedby 14% of patients,the combination of spironolactoneandhydrochlorothiazide - 6%,spironolactoneand furosemide - 1%,in 4% of outpatient cardswe noticed the triple combination of monocomponentdiuretic.Conclusion. We did not find unreasonable administration of diuretic therapy combination out ofindication and in the presence of contradictions.The prescription of modern long-termdiuretics associated with lower risk of side-effects developing will improve efficiencyand safetyof pharmacotherapy.It is very important to use fixed drugs combinationin case of administration the diuretic and agentsofrenin angiotensin system inhibitors.The volume and prescription reasonability analysis ofdiuretic therapy in patients withHDin ‘real-life’ clinical practicesettingshas shown compliance with modernnational guidance materials for the HD and CHF treatment.
Systemic Hypertension. 2014;11(3):48-52
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Phylogentic theory of pathology. Common phylogenetic features in the pathogenesis of essential arterial hyperntesion and insulin resistance syndrome

Titov V.N.


Our phylogenetic theory of pathology (algorrhythm of a disease development) is based on 1) a theory of biological functions and biological reactions in vivo; 2) regulation of biological functions, reactions, and metabolic processes at three phylogenetically different levels: а) autocrine (cell level); b) paracrine (in paracrine-regulated cell communities) and c) total organism level; 3) conceptions on formation of physiological and aphysiological processes («civilization» diseases) at various stages of phylogenesis. Universal pathogenesis of essential arterial hypertension and insulin resistance syndrome is based on functional discrepancy between phylogenetically early regulatory mechanisms at the level of paracrine cell communities and phylogenetically late regulation at the organism level. Pathogenic factors of this discrepancy are impaired biological functions of homeostasis, trophology, endoecology and adaptation. An increase in the content of unesterified fatty acids in the intercellular medium results from activation of lipolysis in paracrine community cells which cannot inhibit phylogenetically late insulin, but not in insulin-dependent adipocytes. The formation of pathogenesis of each metabolic pandemia occurs dynamically at different stages of phylogenesis.
Systemic Hypertension. 2014;11(3):53-60
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Effect of sildenafil on clinical evidence and hemodynamic parameters in patients with pulmonary arterial hypertension, associated withsystemic rheumaticdiseases

Volkov A.V., Udkina N.N., Kurmukov I.A., Nikolaeva Y.A., Nasonov Y.L.


Timeliness of the topic: Pulmonary arterial hypertension(PAH), associated with systemic rheumaticdiseases(SRD),in particular with diffuse scleroderma, is a progressive disorder characterized by adverse outcomeespecially in lack of adequate treatment. Sildenafil 20 mg relaxes blood vessels and shows antiproliferative effect in patients with SRD.The aim of this paperis to study efficiency and safety of sildenafil in patients with PAH, associated with systemic rheumatic diseases.Material and methods:we have been monitoring the 16-week therapyin 14 patients with PAH, associatedwith systemic scleroderma (12 patients) and systemic lupus erythematosus (2 patients). The efficiency was assessed by the dynamics of clinico-laboratorial indices, central hemodynamics were evaluated using the right heart catheterization before the study and after 16 weeks of treatment.Results:We marked thatthe walkeddistancehad been increased by 31 meterinsix-minute walking testduring the therapy;we also saw the improvement of thefunctional classin 29% of patients.The significant improvement achieved in evaluating the hemodynamic parameters.A significant reduction of mean pulmonary arterial pressure was determined from 50.4 ± 9.2 mm Hg to 40.7 ± 10.2 mm. (p = 0.002), the pulmonary vascular resistance fell from 9.5 ± 5.9 to 6.4 ± 3.7 Wood units(p = 0.05),as well assome of the other indicators decreased.Right atrial pressurefell from8.3 ± 5.5 mm Hg. to 6.5 ± 3.1 mm Hg,we noticedthe stabilizationof left ventricle systolic function indices, thus,cardiac indexin all 14 patients,participatingin our study,had not been undergoingsignificant changes (3.1 ± 0.9 l/min/m2at the beginning of the study and 3.1 ± 0.7 l/min/m 2after 16 weeks of the therapy).The risk level, using scale register REVEAL, significantly decreased frommoderate high (9.0 ± 2.0)to medium (8.2 ± 1.9), (p = 0.04).There were no serious adverse events during the 16-week treatment using sildenafil. Three patients showed predisposition to hypotension, but, the blood pressuredecreased within the normal rangesin total group. Skin changes characterized bydermahemia ("blush") were observed in 4 patients and did not significantly impact on the general well-being of patients.Conclusion: Thus, Sildenafil 20 mgshowedefficiency and safety and could be used in treatment patients with PAH, associated with SRD.
Systemic Hypertension. 2014;11(3):61-66
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Beta-adrenergic blocking agent in cardiovascular disease: focus on metoprolol

Baryshnikov G.A., Stepanova I.I., Kudryavtseva N.A.


This article presents the data on the therapeutic efficacy ofbeta-adrenergic blocking agentsin ischemic heart disease, chronic heart failure (CHF), arterial hypertension. We analyzed the basic pharmacological mechanism of action of these drugs class. The comparison of pharmacodynamic and pharmacokinetic characteristics of metoprolol succinate retard with other beta-adrenoreceptor-blocking agents showed metoprolol succinate advantage over the short-term drugs for treatment of CHF. According to the results of randomised clinical trialswe determined high therapeutic efficacy and safety of metoprolol succinate retard.
Systemic Hypertension. 2014;11(3):68-74
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Perindopril is angiotensin-converting enzyme inhibitor in treatment patients with arterial hypertension

Martynov A.I., Urlaeva I.V., Akatova Y.V., Nikolin O.P.


According to the 2013 ESH guidelines, it is possible to use any group of known antihypertensive drugs in the treatment of arterial hypertension. But we often have been using different combinations of drugs. In this situation, using drugs combination in fixed dosage increases patients acceptance of therapy and makes treatment easier. According to the results of the numerous studies, perindopril statistically significant reduces total and cardiovascular mortality and the incidence of myocardial infarction. The combination of perindopril and calcium antagonist makes the drug more effective.
Systemic Hypertension. 2014;11(3):74-80
pages 74-80 views

Pleiotropic features of dihydropyridine calcium channel antagonists

Anikin G.S.


It is hard to imagine modern medicine without safe drugs (D). Often, adverse drug reactions (ADR) are the reason for drug with drawal, which is quite effective as a whole. The main dihydropyridine calcium channel antagonists (DCCA) ADR are the edema of shin and tachycardia, causing this drug with drawal. Lercanidipine is aquite new member of this class; it is a highly lipophilic compound, which blocking the influx of calcium ions through L-type calcium channels, by maintaining the high intramembrane concentration. This review provides the data on the efficacy and safety of lercanidipine and its pleiotropic features.
Systemic Hypertension. 2014;11(3):81-83
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Nebivolol for treatment patients with arterial hypertension

Mikheeva O.M., Komisarenko I.A.


Beta-adrenergic blocking agent is included in the group of primary agentsfor treatment of patients with AH. In the pathogenesis of AH,one of the main causes leading to raisingthe blood pressure isendothelial dysfunction.Correction ofendothelial dysfunctionis AH treatment strategic aim.Nebivololis a cardioselectivethird-generationvasodilatingβ-adrenergic blocking agent, which is in addition toβ-adrenergic blocking effect, can alsoincrease endogenousproduction of NOin the endothelial cellsdue to the decreasing of oxidative degradation. As a result,nebivololprovides positivehemodynamic effects on patients with AH, decreasingperipheral resistanceandblood pressure.
Systemic Hypertension. 2014;11(3):83-87
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The role of the vegetative part of sympathetic nervous system in development of cardiovascular complications in patients with arterial hypertension: pharmacological aspects

Gilyarevsky S.R.


Recently, we have determined new interest in studying the role of sympathetic part of autonomic division of nervous system (SANS) in the pathogenesis of arterial hypertension (AH), as well as in studying the role of agents, suppressing the activity of SANS, using for AH treatment, including the usage of antihypertensive agents and non-pharmacological methods. This article discusses the changes of autonomic regulation of the cardiovascular system in patients with AH. The role of these changes in the development of the functional and structured changes of the heart and systemic vessels can be observing during long-standing AH and will lead to the development of adverse clinical outcomes. We have been showing received data, associated with the impact of non-medicated and pharmacological approaches to the autonomic regulation of the cardiovascular system.
Systemic Hypertension. 2014;11(3):88-94
pages 88-94 views

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