Vol 12, No 3 (2015)


Experts of RMSAH opinion: the fixed combination of azilsartan medoxomil and chlortalidone is broadening options of the combined therapyin patients with arterial hypertension

Chazova I.E., Karpov Y.A., Chukaeva I.I., Kislyak O.A., Zhernakova Y.V., Martynuk T.V., Litvin A.Y.


Как показывают фармакоэпидемиологические исследования, роль комбинированной терапии в лечении АГ становится все более важной и все больше врачей отдают предпочтение фиксированным комбинациям АГП для лечения АГ. Это связано с тем, что фиксированные комбинации не только позволяют повысить эффективность антигипертензивной терапии, но и улучшают приверженность.Учитывая, что проблема контроля АД у пациентов с АГ по-прежнему остается актуальной, новые фиксированные комбинации АГП могут представлять интерес для врачей.
Systemic Hypertension. 2015;12(3):6-10
pages 6-10 views

The results of the pharmacoepidemiological study PIFAGOR IV concerning arterial hypertension (AH patients survey)

Leonova M.V., Belousov Y.B., Shteinberg L.L., Alimova E.E., Smirnova E.P., Belousov D.Y.


Group of researchers analytical group of PIFAGOR IV study The aim is to study the next step of pharmacoepidemiology of arterial hypertension (AH) in Russia to evaluate the structure and frequency of different classes of antihypertensive drugs (AHD) usage in clinical practice.Material and methods. The prospective pharmacoepidemiological multicenter study (PIFAGOR IV). We interrogated AH patients using special prepared questionnaires. The collection of questionnaires took place from February to July, 2013. The study included 2533 valid questionnaires from 52 cities and towns of Russia.Results. 80% of the patients regularly take AHD; 32.8% of patients receive monotherapy, 38.6% receive two AHD combinations, 28.4% - 3 or more AHD combinations. The average number of AHD was 2.02 per patient. The structure of AHD consisted of 5 recommended classes: ACE inhibitors (27.8%), -adrenergic receptor blocking agents (21.7%), diuretics (15.7%), calcium antagonists (11.3%) and angiotensin II receptor blockers (10.7%), fixed combination - 10.8%. Additional proportion of classes: central-acting agents - 2.3% and b-adrenoceptor blocking agents - 0.1%. Among the ACE inhibitors the main share had 3 drugs: enalapril (33.6%), perindopril (16%), and lisinopril (13%). In b-blockers class the main share had 2 drugs - bisoprolol (64.4%), and usual form of release and modified release dosage form of metoprolol (the total share 21,4%). Indapamide of standard and retard form took the first place in the structure of diuretics (the total share 75%). In calcium antagonists class the main share had amlodipine (55.8%). The main drug in ARBs II was losartan (55.4%). Central-acting agent class was consisted of moxonidine (66%), methyldopa (17%) and clonidine (5%). For about 76% of cases were presented by combinations containing diuretics and 24% - by combinations containing calcium antagonists among the fixed combinations. The proportion of original drugs in the structure of AHD was 38.3%. The average BP level in patients was 140.4/86.4 mm Hg and the blood pressure targets were determined in 50.2% of cases. A high degree of compliance according to the Morisky-Green test indicated in 32%, low compliance - in 49% of cases.Conclusions. We noted the reduction of ACE inhibitors proportion and increase of ARBs II proportion, increase of fixed combinations in the structure of AHD. However, we noticed the decrease of the treatment efficacy in patients with AH using average BP level and achievement of the target BP, as well as the average number of AHD.
Systemic Hypertension. 2015;12(3):11-18
pages 11-18 views

The prevalence of renal dysfunction in arterial hypertension (in the framework of the ESSE-RF study)

Oshchepkova E.V., Dolgusheva I.A., Zhernakova I.V., Chazova I.E., Shal'nova S.A., Iarovaia E.B., Rotar' O.P., Konradi A.O., Boitsov S.A.


Objective. To study the prevalence of renal dysfunction, its relation with arterial hypertension and metabolic risk factors.Materials and methods. Data from the ESSE-RF study from 10 regions of the Russian Federation are presented. Renal dysfunction was assessed on the basis of the calculation of glomerular filtration rate (GFR). GFR calculation was conducted on the Chronic Kidney Disease Epidemiology Collaboration (GFR-EPI).Results. The study reveals a high prevalence of GFR decline in the population studied (76.8% in women and 23.2% in men). More unfavorable situation was found among the patients with hypertensionand in patients with hypertension and impaired glucose metabolism or diabetes mellitus, in which the prevalence of decrease GFR was higher than in patients without hypertension and without impaired glucose metabolism or diabetes mellitus.Conclusion. Prevalence of renal dysfunction among the Russian population is defined. Associations of reduction in glomerular filtration rate with cardiometabolic risk factors are revealed.
Systemic Hypertension. 2015;12(3):19-24
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Fixed dose combinations for the treatment arterial hypertension: the real way to improve control

Morozova T.E., Andreev S.S.


Insufficient control of blood pressure levels of the essential hypertension in Russia (less than 30% for women, less than 20% for men) was proven by epidemiology trials. This article is a review of the present opportunities to increase efficacy of treating hypertension by application of combined anti-hypertensive therapy and the advantages of fixed dose combinations (FDC). The authors scientifically prove the importance of using the combination, including angiotensin I-converting enzyme perindopril arginine and the long-half time dihydropyridine calcium channel blocker amlodipine in various clinical cases. Also the article summarizes the research of real clinical practice proving the high efficiency and safety of perindopril arginine /amlodipine FDC.
Systemic Hypertension. 2015;12(3):25-29
pages 25-29 views

Dependence of the efficiency of the initial state of fosinopril structure common carotid arteries, intravascular blood flow and central hemodynamics at patients with arterial hypertension

Melnikova L.V., Bartosh L.F., Grechishkina O.A.


Aim. To study changes in structural and functional features of the common carotid arteries and central hemodynamic parameters under the influence of fosinopril at hypertensive patients depending on achieving target blood pressure.Material and methods. The study included 116 patients with essential hypertension. All patients underwent a general clinical study, an ultrasound scan of the common carotid arteries (CCA ) with the assessment of the structure and intravascular blood flow, and echocardiography with the definition of the parameters of central hemodynamic and intravascular, ambulatory blood pressure monitoring (ABPM) before the study and after 24 weeks of antihypertensive therapy angiotensin - converting enzyme fosinopril. Two groups of patients: the first group consisted of 74 people with the achievement of the targets of blood pressure (BP), the second 42 people who have not been achieved target BP levels.Results. In the first group there was a statistically significant decrease in the proportion of peripheral resistance, increased systolic index, distensibility coefficient of the common carotid arteries peak flow velocity. In the second group specific peripheral resistance was significantly increased, the thickness of the intima-media increased, decreased peak flow velocity.Conclusion. Effectiveness depends on fosinopril initial state total peripheral resistance, cardiac output, structural and functional features elastic arteries.
Systemic Hypertension. 2015;12(3):30-33
pages 30-33 views

Gender differences renin-angiotensin-aldosterone system and its relation to humoral factors in patients with arterial hypertension

Dadashova G.M.


Aim. Explore gender characteristics of the renin-angiotensin-aldosterone system (RAAS), to assess the state of the RAAS relationship with the level of female sex hormones, aldosterone, plasma renin activity in patients with arterial hypertension (AH) in postmenopausal women.Materials and methods. The study included 35 patients with hypertension 1-3-th degree, the average age 56.8±6.9 years. The control group included 21 healthy people with a normal body mass index (BMI). Each of these groups was divided into subgroups by gender: group IA included healthy men (n=10), group IB - healthy women (n=11), group IIA - men with hypertension (n=17), group IIB - Women with hypertension (n=18). Evaluation was carried out with a hormonal status determining levels of estradiol, testosterone, aldosterone, plasma renin activity in the serum.Results. Aldosterone concentration in group IIB was 169.8±109.9 pg/ml and was significantly higher (p<0.05) than in the group IIA 98.1±47.4 pg/ml. In women with hypertension was observed in more than two-fold increase in renin than men with hypertension (3.8±2.2 vs 1.5±1.3). Statistically significant differences in hormonal profile manifested in the form of a lower concentration of testosterone in the group IB compared to the group IA (0.2±1.08 vs 6.8±2.7), p<0,05. In the group of patients with hypertension (group IIB) was detected with a high concentration of testosterone (9.5 times) when compared with a control group of women (group IB).Conclusion. Hypertensive patients were found gender differences in the state of the RAAS with a higher concentration of aldosterone and renin in postmenopausal women than in men of comparable groups. Testosterone levels in women with hypertension was significantly higher than the values in comparison with the control group of women.
Systemic Hypertension. 2015;12(3):34-38
pages 34-38 views

Radiofrequency denervation of renal arteries. Myth or reality?

Grigin V.A., Danilov N.M., Matchin Y.G., Chazova I.E.


Resistant hypertension is an urgent problem in modern cardiology, leading to myocardial infarction, stroke, and, as a consequence, early disability of patients. The emergence of such a method as radiofrequency denervation of the renal arteries in the complex antihypertensive therapy can expect to achieve control of blood pressure and thus reduce the risk of cardiovascular complications. This article presents the current state of the use of this method in clinical practice.
Systemic Hypertension. 2015;12(3):39-44
pages 39-44 views

Treatment of hypertension in overweight patients

Kukes V.G., Anikin G.S., Andreevskaya E.M., Ashurkova E.A.


The aim of the treatment of hypertension in patients with overweight is not only normalization of blood pressure, but also improvement of endothelial function, reduction of insulin resistance and lipid metabolism. Some of the drugs with a broad therapeutic spectrum and huge evidential base, - I1-imidazoline-receptor agonists can be applied in both monotherapy and as a part of the combined therapy in overweight patients.
Systemic Hypertension. 2015;12(3):46-49
pages 46-49 views

The first Russian experience of sildenafil application in patients with idiopathic pulmonary hypertension

Dadacheva Z.K., Belevskaya A.A., Saidova M.A., Danilov N.M., Martyniuk T.V., Chazova I.E.


Over the last decade, the interest in the treatment of idiopathic pulmonary hypertension (IPAH) has greatly increased because of the development and implementation of innovative therapeutic approaches. One of the modern drug groups for the treatment of pulmonary arterial hypertension are phosphodiesterase type 5 inhibitors (PDE5), which can cause pulmonary vasodilation via a NO-dependent mechanism.The aim of the research was to study the efficacy and safety of sildenafil treatment in patients with IPAH received 16-week course and to study sildenafil impact on clinical, hemodynamic and functional status.Material and methods: 20 patients with IPAH (mean age 40.9±11.5 years) functional class (FC) II-IV (WHO), who were receiving standard therapy (anticoagulants, diuretics, glycosides, calcium antagonists), were prescribed sildenafil 20 mg three times a day for 16 weeks. Initially, and after 16 weeks of treatment we studied FC, and the results of the six-minute walk test (6MWT), transthoracic echocardiography (ECHO), right heart catheterization (RHC) and laboratory tests to determine the safety of the therapy were carried out, as well.Results: the group of patients had 6MWT distance of 344±116 m at the beginning of the study. For about 90% of the patients suffered from dizziness, 75% - from the pain in the heart, 65% of the patients had edema and 35% - hepatomegaly. The patients suffered from severe pulmonary hypertension according to the functional and hemodynamic status. The estimated pulmonary artery systolic pressure (PASP) according to ECHO results was 89.6±22 mm Hg. According to the data from RHC we noted the elevation of mean pulmonary arterial pressure (mPAP) to 56.3±19 mm Hg, of pulmonary vascular resistance (PVR) to 1218±709 dyne/sec x per x cm-5 and the decrease in cardiac output (CO) - 3.4±0.8 l/min/m2.There were slight increasing in 6MWT distance (+23 m, p>0.05) and a statistically significant improvement in clinical status in comparison with the initial data: dizziness - 71%, heart pain - 38%, edema and hepatomegaly were observed in 15% and 14% (p<0.05) of the cases, respectively, during 4 weeks of therapy. ECHO showed statistically significant reduction of estimated PASP - 83±14 mm Hg (p<0.05). We noted a statistically significant increase in 6MWT distance +112 towards 16 week of treatment in comparison with the initial data (p<0.05). We noted a statistically significant reduction of PASP (from 89.6±23.1 mm Hg to 75.2±14 mm Hg, p<0.05), according to the data from ECHO. At the end of 16 weeks of sildenafil treatment all patients demonstrated no edema and hepatomegaly; dizziness was diagnosed only in 26% of the cases (p<0.05), heart pain - in 10%. Sildenafil treatment demonstrated statistically significant dynamics of key hemodynamic characteristics using RHC - mPAP (-9,3 mm Hg), PVR (235 dyne/sec x per x cm-5), CO (-0.4 l/min/m2).On the background of sildenafil therapy the patients had following side effects: palpitations - 3 patients (15%), hot flashes - 2 patients (10%), headache - 1 patient (5%), systemic hypotension - 3 patients (15%). All mentioned side effects occurred within the first 2-3 days of therapy and were minor and did not cause dose correction.Conclusions. The application of sildenafil in dose of 60 mg per day in patients with IPAH within 16 weeks had resulted in a significant increase in 6MWT, improvement of FC and hemodynamic parameters according to the data from ECHO and RHC. Therapy characterized by a good tolerance and accompanied by no clinically significant side-effects.
Systemic Hypertension. 2015;12(3):50-55
pages 50-55 views

Pathogenetic treatment of chronic heart failure: the role of torasemide

Perepech N.B.


The article discusses the torasemide pharmacokinetic characteristics which are favourably different from furosemide characteristics. We paid attention to the fact that torasemide had anti-aldosteronic and antifibrotic effects; all these characteristics were alien to other diuretics nature. The results of clinical studies showed torasemide ability to prevent the development and reverse myocardial fibrosis. Taking into account modern representations concerning the pathogenesis of chronic heart failure, in particular the role of diastolic dysfunction in developing haemodynamic compromise, we substantiated torasemide application as a part of complex pharmacotherapy of chronic heart failure in patients with elevated left ventricular filling pressure before the appearance of clinical manifestations of stagnation.
Systemic Hypertension. 2015;12(3):56-62
pages 56-62 views

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