Vol 13, No 4 (2016)

Articles
Effect of renal denervation on the arterial stiffness and central hemodynamics in patients with resistant hypertension
Shchelkova G.V., Zairova A.R., Danilov N.M., Rogoza A.N., Chazova I.E.
Abstract
Aim: to evaluate the effect of renal denervation (RDN) on the stiffness of the aorta and major arteries, central blood pressure and index augmentation in patients with resistant hypertension. Material and methods. We included 20 patients with systolic blood pressure 178 [170; 180] mm Hg and diastolic blood pressure 100 [94; 100] mm Hg on 5.1±0.7 antihypertensive drugs with diuretic, who underwent bilateral RDN. Blood pressure (BP) was studied before intervention, at 7 days and 6 months after RDN by tree methods: office BP, 24-hour ambulatory blood pressure (ABPM) and aortic BP with applanation tonometry a. radialis (SphygmoCor). All patients were divided into two groups by ABPM in 6 months after RDN: responders (decrease of mean ABPM≥5 mm Hg) and non-responders (decrease of mean ABPM<5 mm Hg). Arterial stiffness parameters were measured with carotid-femoral pulse wave velocity (PWVcf), cardio-ankle vascular index (CAVI) and index augmentation (AIx). Result. RDN significantly decrease office BP in a majority of patients with resistant hypertension, but significantly improved central aortic pressure and arterial stiffness only in responders to RDN.
Systemic Hypertension. 2016;13(4):7-12
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Radiofrequency renal arteries denervation: effectively and safely
Grigin V.A., Danilov N.M., Matchin Y.G., Chazova I.E.
Abstract
Objective. To determine the possibility of radio frequency denervation of the renal arteries (RDN) in the treatment of patients with refractory essential hypertension (GRA). Materials and methods. The study included 57 patients with a diagnosis of the guide RAG. According to the results of surveys conducted by RDA was performed of 25 patients diagnosed with essential RAG. Within 12 months after the procedure was carried out monitoring of clinical blood pressure (BP), BP monitoring (ABPM), and laboratory evaluation of renal function and renal artery ultrasound. Statistical analysis was performed using Statistica 6.1 program, significant differences were recognized when p<0.05. Results. Within 12 months after the RDN with the group there was a significant decrease in blood pressure (p<0.01) according to the data of the clinical measurements, and the results of ABPM. There were no complications in the place of performance of radio-frequency effects or violation of renal excretory function has been reported. According to the results of the analysis, predictors of effectiveness RDN not identified. Conclusion. Radiofrequency denervation of the renal arteries is a safe and effective non-drug methods in complex treatment of refractory essential hypertension.
Systemic Hypertension. 2016;13(4):13-18
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A fixed combination of amlodipine and losartan: effectiveness and safety in abnormal weather conditions in patients with arterial hypertension
Ageev F.T., Smirnova M.D., Fofanova T.V., Blankova Z.N., Vitsenya M.V., Tsybulskaya T.V., Neverova E.F., Samsonova N.S.
Abstract
Actuality. The effect of drugs on adaptation to abnormal temperatures is one of the most important questions put to practical medicine by the heat waves of recent years. One of the controversial issues - safety of use during the heat wave of calcium channel blockers (ACC) and blockers of receptors for angiotensin II (ARBS). The goal is to evaluate the efficacy and security of treatment of patients with arterial hypertension (AH) during the heat wave of a fixed combination of ARBS+ACC (Lortenza, KRKA). Materials and methods. Included 26 patients with hypertension 1 and 2 degrees from 42 to 81 years. All patients underwent measurement of office blood pressure, electrocardiography, body sphygmography with the determination of the pulse wave velocity and selectively CAVI, biochemical analysis of blood, estimation of osmolarity of blood, questionnaire: visual analogue scale, a questionnaire for patients exposed to heat, the test of adherence to treatment Moriscos-Green. Estimated diaries of self-control of blood pressure. The inclusion visit took place in spring 2016, 1st visit was in May - June 2016, 2nd - during heat waves, 3rd - September - October 2016. Results. The observed decrease in systolic blood pressure and diastolic blood pressure (p=0.000) to the target values, preserved for the whole period of observation. According to the diaries of self-control of blood pressure controlled blood pressure 81% of patients. During a heat wave, this value decreased to 58%, in autumn - to 63%. The 3rd visit achieved a reduction in heart rate at -6.0 (-11.1; and 2.8) beats/min; p=0.007. A noticeable decrease of the pulse wave velocity from 15.2±3.4 to 14.4 V±3.0 m/s; p=0.01 and CAVI in of-2.1 (to -2.9; -0.65); p=0.01; the decline in uric acid level c of 415.3 to 346.2 mmol/l (p=0.04) and creatinine on the 2nd visit compared to baseline (p=0.02). Electrolyte shifts and increasing the osmolarity of the blood during heat waves have not been identified. There is a growing commitment therapy (p=0.04) and quality of life to 20.0 (7.4; 23.3); p=0.000 by visual analogue scale. Conclusion. Fixed combination of losartan and amlodipine (Lorenza) is an effective, safe and may be recommended for patients receiving AG in the hottest period.
Systemic Hypertension. 2016;13(4):19-25
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The application of ivabradine in the management of ischaemic heart disease
Gurevich M.A., Kuzmenko N.A.
Abstract
Ischemic heart disease is not only serious disorder with special clinical characteristics and generally requiring multidisciplinary approach, but also a social and economic problem now. Heart rate control is one of the main therapeutic principles that should be applied in patients with ischemic heart disease. In practice there are always cases when β-blockers for reducing heart rate should not be used because of contraindications in patients (for example, disorders of carbohydrate and lipid metabolism). Ivabradine can be an alternative in this situation due to selective and specific inhibition of the If-channels current across the cardiac pacemaker, characterized by negative chronotropism without negative inotropic effect and without affecting atrioventricular conduction and blood pressure. Ivabradine therapy is generally well tolerated and increases adherence commitment of patients to treatment. Raenom® (Gedeon Richter, Hungary) is generic ivabradine of good-quality.
Systemic Hypertension. 2016;13(4):26-29
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Regulatory adaptive status in determining the effectiveness of nebivololum and sotalolum in patients with hypertensive disease and paroxysmal atrial fibrillation
Eremina M.A., Tregubov V.G., Pokrovsky V.M.
Abstract
Aim: compare the effectiveness of treatment with nebivololum or sotalolum in patients with hypertensive disease (HD) and paroxysmal atral fibrillation (AF) taking into account quantitative evaluation of the regulatory adaptive status (RAS). Materials and methods. 50 patients with HD of stages II-III and paroxysmal AF took part in the research, they were randomized into two groups for treatment with nebivololum (5.6±1.6 mg/day n=25) or sotalolum (157.0±38.3 mg/day, n=25). As part of combination therapy, patients were administered lisinoprilum (14.3±3.7 mg/day and 14.4±3.9 mg/day), when required alsoatorvastatinum (18.8±4.4 mg/day, n=11 and 16.0±5.1 mg/day, n=12), acetylsalicylic acid (91.2±14.1 mg/day, n=11and 92.1±16.8 mg/day, n=11), respectively. Initially and 6 months after therapy, the following was done: quantitative assessment of RAS (by cardio-respiratory synchronism test), echocardiography, triplex scanning of brachiocephalic arteries, treadmill test, six-minute walk test, all-day monitoring of blood pressure and electrocardiogram, subjective assessment of quality of life. Results. Both drug regimens comparably improved structural and functional condition of the heart, controlled arterial hypertension, effectively suppressed paroxysms of AF, improved the quality of life. At the same time, the use of nebivololum increased the RAS and increased exercise tolerance, to a lesser degree than the use of sotalolum. Conclusion. In patients with HD of stages II-III and paroxysmal AF the use of nebivololum as part of combination therapy may be preferable to sotalolum due to its positive impact on the RAS.
Systemic Hypertension. 2016;13(4):30-35
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The effect of combined antihypertensive therapy on arterial wall rigidity in male patients with hypertension, obesity and obstructive sleep apnea
Elfimova E.M., Zairova A.R., Andrievskaya M.V., Bogieva R.M., Rogoza A.N., Litvin A.Y.
Abstract
Goal: to study the effectiveness of combination antihypertensive therapy (AHT) and its influence on the indices characterizing the arterial stiffness of various types in patients with arterial hypertension (AH) in combination with obesity and severe obstructive sleep apnea (OSA). Material and methods. The study included 27 male patients with hypertension [143.0 (142.0; 150.0)/91.0 (85.3; 94.8) mm Hg. century], obesity [body mass index of 33.8 (32.0; 37.2) kg/m2] and OSA was severe [the index of apnea/hypopnea - AHI - 46.8 (33.3; 63.4) events per hour] who underwent AHT titration to achieve target values of blood pressure (BP), a fixed combination of the calcium antagonist amlodipine (10 mg) and the angiotensin-converting enzyme inhibitor perindopril (5-10 mg). At baseline and after 4-6 weeks when reaching target blood pressure was assessed pulse wave velocity (PWV) using different instrumental techniques. Carotid-femoral PWV (CFSP) was determined by applanation tonometry (SphygmoСor AtCor, Australia), aortic PWV - ultrasonic technique in the descending aorta (thoracic spine), the ankle-brachial PWV - using volumetric sphygmography (VaseraVS-1000 Fukuda Dens, Japan). Results. The target pressure (according to clinical blood pressure, daily monitoring blood pressure) on the background of amlodipine 10 mg and perindopril 5 mg was 58% patients and 42% of patients reached the target level of blood pressure against the background amlodipine 10 mg and perindopril 10 mg. On a background of 4-6 weeks of admission AHT 33.8% increase in the number of patients with a normal circadian profile of blood pressure - «dipper». Upon reaching the target blood pressure revealed a significant decrease CFSP, ankle-brachial PWV and aortic PWV 11.4, 11.0 and 15.4%, respectively. Conclusion. A fixed combination of perindopril arginine and amlodipine in patients with arterial hypertension of the 1st degree in the presence of obesity and OSA allows achieving a good level of BP control, to improve the performance of the daily profile and to improve the elastic properties of large arteries, which has a beneficial protective effect in these patients.
Systemic Hypertension. 2016;13(4):36-40
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Coagulation markers in patients with obstructive sleep apnea syndrome and effects of continuous positive airway pressure
Bugaev T.D., Elfimova E.M., Ageeva N.V., Dobrovolskiy A.B., Litvin A.Y.
Abstract
The aim of our study is to determine association between obstructive sleep apnea (OSA) syndrome and levels of blood coagulation markers and evaluate possible effects of continuous positive airway pressure (CPAP) therapy. Materials and methods. We included 74 middle-aged (mean age 48 [40; 55] years) male patients with arterial hypertension (AH) of average duration 8 [5; 10] years without antiplatelet, anticoagulant therapy and diabetes mellitus. All patients underwent sleep breathing study. According to the severity of OSA, patients were divided into 2 groups: 40 patients with severe OSA - apnea/hypopnea index - AHI 50.2 (37.8; 75.2) and control group with 34 patients with mild or no OSA - AHI 4.8 (2.6; 7.8). In all patients were analyzed markers of hemostasis system and parameters of whole blood viscosity; 34 patients with severe OSA underwent 3-4 nights of effective CPAP therapy (with achievement AHI<5) with evaluation of the above analysis at baseline and in the end of therapy. Results. We found a significant increase of fibrinogen, plasminogen activator inhibitor-1 (PAI-1), plasmin-a2-antiplasmin complex (PAP), tissue plasminogen activator/plasminogen activator inhibitor-1 complex (tPA-PAI-1), whole blood viscosity at low shear rates and erythrocytes aggregation index in the group with severe OSA compared with controls. After short-term (3-4 nights) CPAP therapy significantly decreased all parameters of whole blood viscosity with achieved normal levels of hematocrit, but markers of hemostasis system showed no significant difference. Conclusion: the coagulation status of blood is elevated in severe OSA patients (with AH and obessity). Short-term CPAP therapy can improve parameters of whole blood viscosity with achieved normal values of hematocrit. These results suggest that even few nights of CPAP therapy may reduce cardiovascular risk in OSA, in part through improving of whole blood viscosity.
Systemic Hypertension. 2016;13(4):41-46
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The choice of antihypertensive therapy in correction of cognitive impairments and prevention of dementia: possibilities of valsartan and fixed-dose combination of valsartan and hydrochlorothiazide
Ostroumova O.D., Garelik I.A., Karavashkina E.A.
Abstract
This article discusses the definition, classification and pathogenetic mechanisms of cognitive functions in arterial hypertension. The authors discuss the capabilities of the different classes of antihypertensive drugs in correction of cognitive impairments and prevention of dementia. The authors also discuss the advantages of the angiotensin II receptor blockers in prevention of dementia and in their potential mechanisms of cerebral protection. The article describes in detail the possibilities of valsartan in correction of cognitive impairments associated with arterial hypertension, the advantages of valsartan in comparison with calcium antagonists and its unique neuroprotective mechanisms. We show our own results of the study concerning fixed-dose combination of valsartan and hydrochlorothiazide, and find out that this combination has high antihypertensive and cerebral protection (capacity to improve cognitive function) and effectiveness.
Systemic Hypertension. 2016;13(4):47-55
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The control of blood pressure level as the prevention of cognitive impairment
Melnik M.V., Afonicheva I.I., Kazyulin A.A.
Abstract
Today the prevalence of cognitive impairment is a large scale. At the end of the pathological process partial or complete, social, professional and common maladjustment and disability comes. One of the main factors of progression of cognitive impairment is a decrease in adherence to the therapy, forming a vicious circle of the underlying disease and its complications. In the article we examine the prevalence, pathogenesis and classification of cognitive impairment of patients with arterial hypertension, memory impairment, analyze the relationship of high blood pressure numbers. The use of modern antihypertensive drugs, with adequate control of blood pressure reduces the risk of development and progression of cognitive impairment. To this end, successfully it can be used calcium channel blocker lercanidipine third generation, which has high anti-hypertensive activity, cerebroprotective function, causing regression of cognitive disorders, enhancing the quality of life of patients. Nowadays there is a small number of studies investigating the effect of calcium channel blockers on cognitive function, that led to the study of this issue.
Systemic Hypertension. 2016;13(4):56-59
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The patients of high cardiovascular risk of healthy: unrecognized metabolic syndrome
Blinova N.V., Zhernakova Y.V., Chazova I.E., Oshchepkova E.V.
Abstract
Aims: to study the target organ damage in patients with metabolic syndrome (MS) and arterial hypertension (AH) 1 degree. Design and methods. We included 20 healthy volunteers and 60 patients with MS, AH 1 degree and dyslipidemia. Office blood pressure, 24-hour ambulatory blood pressure monitoring, measurements of the endothelial vasoactive mediators, carotid ultrasonography and echocardiography had performed at baseline. Results. The majority of patients with MS and AH 1 degree had metabolic abnormalities; the levels of vasoactive mediators were higher in comparison with control group; 30% of patients had signs of atherosclerotic process in carotid arteries; 40% of patients had left ventricular hypertrophy. Conclusion: the results showed high prevalence of target organ damage in patients with MS and AH 1 degree.
Systemic Hypertension. 2016;13(4):60-65
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