Vol 11, No 3 (2014)

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.

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.

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).

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.

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.

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.

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.

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.

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.