Vol 11, No 4 (2014)

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.

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.

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.

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.

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.

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.

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.

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.