Vol 12, No 4 (2015)

As a result of investigation of the children the dysfunction of endothelium at high normal arterial pressure is the cause of the hemodynamic disturbances of children, equal of the arterial hypertension. As a result the children with high normal arterial pressure are the groups of the risk for arterial hypertension wich need the complex of correction of theses disturbances, early diagnostics of the arterial hypertension and its profylaxis. AT high level risk factors and vasoconstrictive properties at children with high normal arterial pressure the more high frequency of headache, the heart pain, both pains and the episodes of high normal pressure.

The research objective was in studying and evaluating the indicators of longitudinal deformation of the left ventricle and the left atrium in persons with arterial hypertension (AH), and also in persons with risk factors, but without AH, workers of railway transport.Materials and methods. The workers of railway transport under research are: 45 patients with AH, 35 people with risk factors, but without AH and 20 healthy volunteers. All the people under research were exposed the transthoracal echocardiography on ultrasonic Philips iE 33 system (Holland) including two-dimensional impulsive wave tissue Doppler echocardiography.Results. The decrease of a systolic velocity of a fibrous ring of the mitral valve in the region of septal and lateral segments in both groups is observed in comparison with the control. In studied groups deterioration of a diastolic function and significant decline of indicators of global longitudinal deformation of a left ventricle and the left atrium in comparison to healthy people are also registered. Depression of segmental deformation of a left ventricle in both groups has a chaotic character. The more the index of mass of a myocardium of a left ventricle, the lower indicators of global deformation are; the more the index of volume of the left atrium, the lower indicators of deformation of the left atrium are.Conclusion. Depression of diastolic and segmental systolic functions of a left ventricle of workers of railway transport is registered both with AH and without AH, but with risk factors that are reflected in indicators of longitudinal deformation of a left ventricle and a left atrium.

Purpose of study - evaluate the effectiveness of combined antihypertensive treatmentthat includes direct renin inhibitor in salt-sensitive and salt-resistant patients with refractory hypertension (RHT).Methods and materials. The study included 192 patients with RHT. Based on the results of the V.I.Kharchenko test and a variation of combined antihypertensive therapy, all patients were randomized into groups: group 1 - salt-sensitive patients treated with an ACE inhibitor (ACEI), dihydropyridine calcium antagonist (CA), thiazide diuretic (TD) and direct renin inhibitor aliskiren (subgroup 1A) or b-blocker - BB (subgroup 1B); group 2 - salt-resistant patients treated with ACE inhibitors, dihydropyridine CA, TD and aliskiren (subgroup 2A) or BB (subgroup 2B). In the absence of achieving target BP after 6 weeks from the start of observation, patients started receiving five-component treatment: ACE inhibitor, CA, TD, BB and aliskiren. Initially and after 48 weeks of observation, all patients underwent ambulatory blood pressure monitoring (ABPM).Results. In the group of salt-sensitive patients treatment including aliskiren contributed to achievement of target values of BP in 43.3%, and with pre- scription of BB - in 54.3% of patients. In both groups there was a significant improvement in most of the parameters of ABPM, more pronounced when using BB. Normalization of circadian BP profile was registered significantly more often ( p <0.05) when using the BB than aliskiren treatment. In patients with salt resistance target BP level when using treatment that included aliskiren was recorded in 70.4% of cases, with prescription of BB - in 50% of patients. The use of aliskiren in these patients provided significantly greater improvement in the main indicators of ABPM and more frequent normalization of circadian BP profile than the therapy that included BB. Five-component treatment including aliskiren proved to be more effective in salt-resistant patients in both, frequency of reaching target BP and the dynamics of the main indicators of ABPM.Conclusion. In salt-sensitive patients the combination including BB as part of four-component treatment provided significant cumulative antihyper- tensive effect. In patients with salt resistance more effective was the use of aliskiren in comparison with the BB. The use of five-component treatment had certain advantages in salt-resistant patients.

The article discusses the factors that determine the choice of antihypertensive drugs, especially blockers of receptors of angiotensin and thiazide diuretics. The data about the peculiarities of azilsartan medoxomil, it differs from other sartans. Among the main properties of azilsartan medoxomil, which may determine his choice for the treatment of patients with arterial hypertension, is called the significant strength of the binding of blockers of receptors of angiotensin to AT1 receptor and its duration of action, as well as special properties that improve tissue sensitivity to insulin. Discussed the feasibility of establishing fixed combinations azilsartan medoxomil with thiazide diuretics chlorthalidone.

The precordial region. Pain in the chest in these patients is associated with relative coronary insufficiency due to low cardiac output, a relatively weak development of coronary collaterals on the background of hypertrophy of the wall of the right ventricle or reflex constriction of the coronary arteries due to distension of the pulmonary artery (viscero-visceral reflex), lowest saturation of blood oxygen at an advanced stage, as well as compression of the left main coronary artery dilutionin the pulmonary artery trunk. Many of them in electrocardiography revealed changes similar to ischemic. The purpose of this study was to identify signs of myocardial ischemia in patients with pulmonary arterial hypertension and evaluate the relationship of pain with the presence of ischemic changes according to 12 channel Holter ECG monitoring, and synchronized single photon emission computed tomography myocardial alone and in combination with load tests.

Aim. To study the effectiveness of long-term physical training of moderate intensity in patients with arterial hypertension working age who have suffered acute myocardial infarction in the framework of the Russian randomized trial.Materials and methods. The study included 206 patients with arterial hypertension after acute myocardial infarction (not earlier than 3 weeks from the event). Patients were randomized into 2 groups: basic group 102 and control 104. All patients received standard medical therapy. In the main group used physical training in a mode of medium intensity (50-60% power during a load test) 3 times a week for 1 year. The effectiveness of the intervention was assessed by clinical data and results of instrumental and laboratory analysis.Results. After a year of physical training in patients with arterial hypertension after acute myocardial infarction, there was a significant increase in physical performance by increasing the load duration (38%; p <0.001) and total volume of performed physical work (89.7 per cent; p <0,001) on the background of decreasing load magnitude a double of the work (8.2%); p <0.01. This was accompanied by a significant increase in ejection fraction of the left ventricle by 7.6% ( p <0.001) and stroke volume of the heart by 5.1% ( p <0.01). In the control group was not noted positive developments, in contrast, showed a significant increase in the left atrium (4.3%, p <0.05) on the absence of dynamics of indicators of physical performance. Under the effect of physical training decreased blood pressure levels: systolic blood pressure -3.1% ( p <0.05) and diastolic blood pressure by 3.5% ( p <0.001) against the increase in the group natrenirovavshit patients (3.1%; p <0.05; and 3.4%; p <0.05 respectively). Physical exercise exerted anti-ischemic effect, which is manifested in the reduction of episodes of myocardial ischemia, including silent, and of angina attacks and consumption of nitroglycerin unlike patients of the control group. The trained patients showed a significant decrease in the primary endpoint of 50% ( p <0.05) and disability days (by 43.2%; p <0.05) against the control group.Conclusion. Long-term (one year) of physical exercise of moderate intensity in patients with arterial hypertension complicated by acute myocardial infarction, conducted on III outpatient phase of cardiac rehabilitation provides a stable course of the disease, reduce the risk of cardiovascular complications, improve the patient's quality of life and are safe in the vast majority.