Vol 11, No 4 (2014)


First results of the Russian database of international prospective observational registry variability of blood pressure in patients with hypertension

Ostroumova O.D.


The article presents the results of an analysis of the Russian part of the international registry of variability in blood pressure. It is shown that in a real clinical practice antihypertensive therapy reduces inter-visit variability of systolic and diastolic blood pressure. It has been found that the fixed combination of perindopril arginine / amlodipine has antihypertensive effect and its impact on the variability of systolic blood pressure exceeds that for other modes of antihypertensive therapy. Revealed patterns are characteristic also for subgroups of patients with a combination of hypertension and coronary heart disease, hypertension and diabetes.
Systemic Hypertension. 2014;11(4):9-16
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Dynamics of arterial hypertension and its impact on mortality in the Russian population

Balanova Y.A., Shalnova S.A., Deyev A.D., Konstantinov V.V., Kapustina A.V.


Aim. To assess impact of hypertension status in Muscovites cohort aged 35-64 examined twice for 20-years period on all cause mortality. Material and methods. Population based cohorts consists of 2029 Muscovites (1046 men and 983 women) observed twice during 21,8 years period. The same protocol was used with response rate - 65%. Participants defined as hypertensives if their SBP was ≥140 mm Hg, and/or their DBP was ≥90 mm Hg, and/or they reported current use of antihypertensive medications. Effective treatment - the proportion of those with SBP<140 mm Hg and DBP<90 mm Hg among those treated.The first survey participants were divided into the four groups by blood pressure levels and arterial hypertension treatment: First - normal blood pressure, second - treated and controlled hypertensives, third - hypertensives never treated, and fourth - treated but not achieved target BP level. Mortality follow up after second screening was 3,7 years, 154 deaths were observed.Proportional hazard (Cox) regression was applied for linking all cause mortality with groups of hypertension status controlling on sex, age and survey. First - used as a reference group.Results. During the observation period mean SBP has increased among males by 17,6 mm Hg (p<0,0001) and among females by 8 mm Hg (p<0,0001). Mean DBP has decreased significantly among both sexes, (p<0,0001). The dramatically increase in the prevalence of hypertension (from 42,0 to 76,2% in males; from 41,8 to 72,9% in females; р<0,0001) was found.The frequency of adherence to antihypertensive medications without achieving target value has increased (from 3 to 33,2% in males and from 7,4 to 33,1% in females; p<0,0001). The frequency of effective treatment has increase (males: from 0,9 to 14,8%, females: from 3,1 to 23,7%; p<0,0001). After adjustment for sex, age at the first screening, and second hypertension status the effective treated subjects presented a similar all cause mortality risk (risk ratio - RR 0,618 with 95% confidence interval - CI 0,084-4,527) as those with normal blood pressure. Hypertensives who didn’t take medication presented RR 1,564 (1,107-2,208). Those without control of hypertension had RR 1,728 (0,79-3,78).Conclusion. The natural history of hypertension in our country demonstrates its dramatic increase with age. Keeping in mind the progression of the aging process, we expect the increase number of persons suffering from hypertension. To reduce the risk of death in hypertensives it is necessary to steadily improve adherence to treatment and thus increase the number of effective treatment of patients.
Systemic Hypertension. 2014;11(4):17-21
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Methods of sympathetic activity evaluation in patients with systemic refractory hypertension

Grigin V.A., Danilov N.M., Sagaydak O.V., Shelkova G.V., Chazova I.Y.


Despite the availability of modern medicines for treating the majority of cardiovascular diseases, the existence of such severe diseases as refractory arterial hypertension and pulmonary hypertension, has brought us to the development of the pathogenetic invasive method of such conditions treatment. Identification of potential responses at the stage of patients selection will help us to see in details the pathogenesis and development of this nosology, to determine the predictors of the efficacy of alternative methods of treatment sand to develop the protocol for these situations. From there, the article discusses various methods of activity evaluation of the sympathetic part of the vegetative nervous systemas the mainsector of pathogenesis of systemic hypertension development.
Systemic Hypertension. 2014;11(4):21-26
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Role of the Pulse Oximetry in the cardiologist's practice‌‌

Aksenova A.V., Yelfimova Y.M., Galitsin P.V., Goriyeva S.B., Bugayev T.D., Mikhailova O.O., Litvin A.Y., Rogoza A.N., Chazova I.Y.


The study had two phases: the first phase of exploring the possibility of a computer pulse oximetry as a screening method for the diagnosis of respiratory disorders during sleep in patients with cardiac profile in steady-state conditions, the second - a screening study of prevalence of obstructive sleep apnea in the same category of patients. In a comparative study of two methods: cardiorespiratory monitoring (4 channels, held monitoring device «Kardiotekhnika-07», «Incart», Russian, and computer pulse oximetry device PulseOx 7500, SPO medical, Israel) included 70 patients (70% men and 30% of women), mean age 55,5±11,2 years. The sensitivity of the computed pulse oximetry in detecting disorders of breathing during sleep (number of episodes of more than 5 per hour, reducing the saturation of more than 3%) was 94,4%; specificity - 79,2%; positive predictive value - 91,1%; negative - 86,4%; accuracy - 87,7%. In a screening study included every fifth patient entering the Russian Cardiology Research and Production Complex MH of the Russian Federation. Patients of the departments of cardiovascular surgery, emergency cardiology department of chronic heart failure, patients with respiratory diseases COPD, asthma were excluded. Statistical analysis included 206 patients. Median age was 68,4±13,7 years, BMI - 32,9±5,5 kg/m2, 43,6% of men and 56,3% of women. From 5 to 15 events per hour was observed in 31,1% of patients, from 15 to 30 events/h - 31,1% and more than 30 events per hour - 23,9%. Thus, respiratory disorders of varying severity were in 77,4% randomly sampled in the study patients.
Systemic Hypertension. 2014;11(4):26-30
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Modernization of hypertension treatment in the Yaroslavl region: interim results of the yearly comprehensive program for modernization of the regional healthcare system

Mozheyko M.E., Eregin S.Y., Vigdorchik A.V., Klimovskaia I.M., Riahi F., Hughes D.


Goalofthestudy. This project comparedblood pressure (BP)-related endpointsin two cross-sectional surveys of hypertensive patients visiting public outpatient healthcare facilities in the Yaroslavl Region of Russia before and after initiation of a comprehensive healthcare system modernization program for hypertension leaded by Department of Health and Pharmacy of Yaroslavl Region.Materials and methods. Hypertension treatment modernization program included making hypertension diagnostics and treatment a priority by setting up a Steering Committee to coordinateand evaluatethe program progression; introduction of hypertension diagnostics and treatment protocol and standards region-wide via an intensive educational program for healthcare professionals; conduction of public education campaign increasingcommunity engagement and hypertension therapyadherence. Two cross-sectional surveys, one at baseline and the other13 monthsafterprograminitiation, were conducted to monitor the evolution of hypertension management. Surveys evaluated BP control rate as a primary measure and mean BP levels and distribution, cardiovascular risk factors, and associated conditions, heart rate levels, and antihypertensive therapy as a secondary measures.Results. Surveys were conducted in 2011 (baseline) and 2012 (1,794 and 2,992 patients respectively) across 38 Regional clinics. BP control levels (<140/90) improved significantly over baseline (16,8% vs 23,0%) reflecting a 37% relative improvement (p<0,0001), as did mean BP (from 151/90 to 147/88; р<0,0001) and the proportion of patients with severe uncontrolled hypertension (systolic BP≥180 mm Hg) was reduced from 9,7% to 6,4% (p<0,0001).Conclusions. Implementing a guidelines-based comprehensive health systems improvement programvia medical and patient education programs resulted in introduction of more optimal therapy approaches and improved patient BP control across Yaroslavl region.
Systemic Hypertension. 2014;11(4):30-36
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The prevalence of carotid atherosclerosis in spontaneous populations in Tomsk

Zhernakova Y.V., Kaveshnikov V.S., Serebriakova V.N., Trubacheva I.A., Oshepkova Y.V., Balahonova T.V., Karpov R.S., Chazova I.Y.


Modern data on the prevalence of carotid atherosclerosis (CAS) in the general population are very limited both in Russia and abroad. In this study we investigated the prevalence of CAS using screening ultrasound examination in a random sample of spontaneous population aged 25-64 years in urbanized city of Western Siberia as part of a multicenter observational study ESSE-RF (epidemiology of cardiovascular diseases in different regions of the Russian Federation).The CAS prevalence was 36,4% in males and 24,4% in women in the examined population. We determined large variation of atherosclerotic plaques prevalence, depending on the age and gender. The CAS prevalence in creased more intense in males up to 50 years and in women 50 up to 59 years. Men were twice as likely to had been diagnosed CAS than women. The prevalence of CAS associated with amount of narrowing less than 25 and 50% or more in the examined population was 68,5%, and less than 1%, respectively. According to the results of the study we shouldpay great attention to the processes, leading to intensive development of CAS in the population aged 35-44 years, especially in men. The development of effective approaches to the control of modifiable risk factors for cardiovascular diseases in this age group could be a very appropriate measure for preventing the rapid development of the CAS in the population.
Systemic Hypertension. 2014;11(4):37-42
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The state of the vascular wall in adult population of Tomsk in the framework of the project ESSAY RF

Rogoza A.N., Kaveshnikov V.S., Trubacheva I.A., Serebriakova V.N., Zairova A.R., Zhernakova Y.V., Oshepkova Y.V., Karpov R.S., Chazova I.Y.


The article presents the results of study of arterial stiffness, ankle-brachial index and pulse pressure in adult population of Tomsk in the framework of the project ESSAY RF (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation). 1379 men and women of 24-64 y.o. were studied by using volumetric sphygmography (VaSera VS-1500, Fukuda Denshi, Japan).The optimal values of CAVI (cardio-ankle vascular index), as a marker of arterial stiffness, were considered in group of relatively healthy persons in russian population. CAVI values in whole studied population were analyzed in comparison with data of other researchers and in association with CVD and CVD risk factors.
Systemic Hypertension. 2014;11(4):42-48
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Local rigidity of the walls of the carotid artery at the site of formation of atherosclerotic plaques in patients with arterial hypertension

Vakhovskaya T.V., Tripoten M.I., Pogorelova O.A., Balakhonova T.V., Loukianov M.M., Boytsov S.A.


Aim: To study the local elastic properties of the arterial wall at the site of atherosclerotic plaque and adjacent areas «healthy» wall of the common carotid artery in patients with arterial hypertension (AH).Materials and methods. The study included 25 patients (3 men, 22 women) with AH 1-2 grad in combination with moderate carotid atherosclerosis and lipid metabolism disorders. All patients underwent conventional ultrasound duplex scanning of the carotid arteries to determine the severity of atherosclerotic carotid arteries and the structure of atherosclerotic plaque. Determination of parameters of the local rigidity - the elasticity of the arterial wall and the atherosclerotic plaque, was carried out on the ultrasound system ALOKA a7. Was scanned and the surroundingarea atherosclerotic plaque sections of the arterial wall in the B/M mode using echo-tracking method.Results. A significant increase in the hardness of the arterial wall in atherosclerotic plaque as in the adventitia and its surface, as compared with the adjacent «healthy» wall of the carotid artery. Atherosclerotic plaque base has significantly greater rigidity and less flexibility than its surface. Conclusion. The formation of atheroma by the action of arterial pulse pressure develops heterogeneity elastic properties carotid wall not only along the artery, but in the atherosclerotic plaque (between its base and the surface). This indicates of different mobility plots artery and plaque and can lead to the formation of the mechanical instability of atherosclerotic plaque in patients with hypertension.
Systemic Hypertension. 2014;11(4):49-52
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Dispersible Prestarium A tablets in the treatment of patients with arterial hypertension

Malchikova S.V., Tarlovskaya Y.I.


The research represents data on dispersing dosage form of Coversyl adherence and efficacy in real clinical practice.
Systemic Hypertension. 2014;11(4):52-54
pages 52-54 views

Peculiarity of medical management of patients with arterial hypertension after liver transplantation

Kosmacheva Y.D., Babich A.E.


The article analyzes information of the prevalence, causes and mechanisms of development of hypertension in patients after liver transplantation. The authors integrate data from domestic and foreign literature about priorities of choice of antihypertensive drugs and possible changes in patterns of immunosuppressive drug therapy to reduce the risk of onset and progression of cardiovascular disease in patients who were underwent orthotopic liver transplantation.
Systemic Hypertension. 2014;11(4):55-57
pages 55-57 views

The treatment options of the new angiotensin II receptor blocker - azilsartan medoxomil in the therapy of hypertension in patients with metabolic disorders

Zhernakov Y.V., Chazova I.Y.


One of the key pathogenic mechanisms of the arterial hypertension (AH) development in patients with metabolic syndrome is the activation of the renin-angiotensin-aldosterone system (RAAS). According to these advantages we need to use drugs inhibiting the RAAS in the treatment of AH patients. This article demonstrates the information about the new Angiotensin II receptor blocker (azilsartan) application in AH patients with metabolic disorders. There are several studies showing the high antihypertensive efficiency of azilsartan as compared with other antihypertensive drug classes in patients with obesity and metabolic disorders. According to the pilot studies, azilsartan has additional positive metabolic effects: increases tissue sensitivity to insulin and reduces body fat mass.
Systemic Hypertension. 2014;11(4):58-61
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The development of a screening questionnaire to improve the early detection of pulmonary arterial hypertension

Valieva Z.S., Valeeva E.G., Glukhova S.I., Martynyuk T.V., Chazova I.E.


Objective: development of a questionnaire for the early detection of pulmonary arterial hypertension (PAH), and its further introduction for a broad routine medical practice.Were identified clinical symptoms, allowing differentiate various forms of the disease (IPAH and PAH-CHD), because these forms of PAH most frequent in cardiology practice.Material and methods. The questionnaire includes 6 sections: clinical symptoms, physical examination, anamnestic information, diseases associated with pulmonary hypertension; signs of PAH according to electrocardiography, chest radiography, echocardiography. All sections of the questionnaire filled by physician. Was held a retrospective analysis of the clinical symptoms, physical examination, anamnestic information, methods of instrumental examination of 70 patients with IPAH in comparison with 29 patients with PAH-CHD and the control group - 48 patients with arterial hypertension (AH).Results. The leading complaints in patients with PAH are dyspnea (99%), palpitations (58%), fatigue (59%), syncope (21%), dry cough (28%), peripheral edema (38%). The physical signs of PAH include an accentuated pulmonary component of second heart sound (93%), cyanosis (40%). Most often, the development of pulmonary hypertension precipitated by stress, pregnancy, acute respiratory infections.Conclusion. According to the results we concluded that the developed questionnaire may be offered for wide use in routine clinical practice and recommended not only for screening patients with IPAH, but also with PAH-CHD.
Systemic Hypertension. 2014;11(4):62-67
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Arterial hypertension and brain damage. New targets of therapy

Yanishevskiy S.N., Mirnaya D.A., Andreyev R.V.


Objective: to assess the feasibility of ARBs to reduce hypoperfusion of the brain that develops in patients with arterial hypertension of 1-2 degrees. Material and methods. A study of changes in the ultrasonic Doppler index (RI resistivity index and pulsatility index PI) and the structure of neurological symptoms in patients with arterial hypertension of 1-2 degrees (n=86) due to 53-week olmesartan medoxomil reception (Cardosal®). Results. Patients with arterial hypertension of 1-2 degrees have diagnosed diffuse neurological symptoms and mild cognitive impairment. Doppler ultrasound revealed an increase in peripheral resistance index in the internal carotid and middle cerebral arteries, compared with patients without hypertension. Through 53 weeks therapy of olmesartan medoxomil (Cardosal®) observed a statistically significant decrease in peripheral vascular resistance (p<0,05), a decrease in the occurrence of neurological symptoms and regression of mild cognitive impairment.Conclusion. The use of olmesartan medoxomil (Cardosal®) as an antihypertensive drug can stop the development brain’s perfusion disorders and initiate reverse remodeling of the vascular wall.
Systemic Hypertension. 2014;11(4):68-70
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Topical questions of beta-blockers application in clinical practice

Nebieridze D.V.


The present review shows the modern view on the possibilities of beta-blockers application in different clinical situations. The class of beta-blockers is a heterogeneous group in terms of clinical usage. The recent critical comments by some researchers on beta-blocker therapy should not misguide the practitioners, who always need to ask themselves the question: what kind of clinical situations and specific beta-blockers are discussed. Some beta-blockers, especially non-selective ones, could demonstrate negative effects and are contraindicated in specific clinical situations (metabolic disorders, COPD, peripheral arterial disease). Modern super-selective beta-blockers such as Betaloc ZOK did not have these negative effect sand could be widely used in clinical practice, even in patients with metabolic syndrome, DM-2 and COPD.Another problem associated with the application of beta-blockers is not frequent prescription or usage of beta-blockers in subthreshold dose.
Systemic Hypertension. 2014;11(4):71-74
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Perindopril - angiotensin-converting enzyme inhibitor is approved for usage

Napalkov D.A.


In the form of the literature review we shows the concept of the treatment of high-risk hypertensive patients, who have been taking ACE inhibitors which application is the most advanced approach from the perspective of evidence-based cardiology. One of the most studied drugs is perindopril. The article deals with the data on the special properties of perindopril molecules, as well as on the possibilities of using perindopril and indapamide combination, as well as on usage of indapamide and amlodipine for the realization of protective mechanism. At the conclusion of the article we offered the differentiated approach to the usage of different drugs containing perindopril for different indications.
Systemic Hypertension. 2014;11(4):75-78
pages 75-78 views

The application of torasemide in patients with arterial hypertension: evidence-based and practical approaches

Gilyarevsky S.R., Kuzmina I.M., Golshmid M.V.


The article deals with therole of diuretics in treatment of patients suffering from arterial hypertension (AH). We showed evidence-based results of diuretic therapy. We discussed the loop diuretic indications in treatment patients with AH, as well as the possible role of torasemide application in AH patients in certain clinical cases.
Systemic Hypertension. 2014;11(4):79-83
pages 79-83 views

Once again about the clinical efficacy and safety of sartans

Minina Y.S., Khadzhieva B.R.


Sartans are safety and effective class of anti-hypertensives nowadays. Sartans are the most effective inpatients suffering from arterial hypertension. Their efficiency is determined by the association of Angiotensin II type 1 receptor. Candesartan and azilsartan are themost powerful and approved angiotensin receptor blockers. Candesartan in comparison with azilsartan has wide proposed spectrum of clinical use. Azilsartan is indicated for the treatment of arterial hypertension. In terms of efficiency and safety we showed these sartans.
Systemic Hypertension. 2014;11(4):84-86
pages 84-86 views

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