Vol 14, No 2 (2017)


Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)

Marwick T.H., Gillebert T.C., Aurigemma G., Chirinos J., Derumeaux G., Galderisi M., Gottdiener J., Haluska B., Ofili E., Segers P., Senior R., Tapp R.J., Zamorano J.L., Khadzegova A.B., Matskeplishvili S.T., Krikunov P.V.


Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.
Systemic Hypertension. 2017;14(2):6-28
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Quality assessment of examination of patients with arterial hypertension in primary health care (according to the Russian arterial hypertension register data)

Oshchepkova E.V., Lazareva N.V., Chazova I.E.


Objective: to assess the quality of examination of patients with arterial hypertension in primary health care. Materials and methods. The study was carried out with the Arterial Hypertension Register method (a software with remote access, medical data inputs were made from medical records of patients with AH). The study included a selection of 29 126 patients with AH under care in primary health care in 22 regions of Russia in 2010-2014. 35% were males, females were older by 3.7 years (60.9±12.5 years and 64.6±12.0 years respectively, p<0.05). Results. 1 stage AH was observed in 43% of patients; 2 stage - in 12%; 3 stage - in 3%. BP<140/90 mm Hg was registered in 38% of patients. 80% of patients were under antihypertensive therapy. 4% of patients with AH lacked BP data in their medical records. Analysis of examinations of patients with AH showed that 63% of patients had data on family medical history of cardiovascular diseases in their medical cards; 78.1% - data on smoking status; 45% - on alcohol consumption; 83.8% - on physical activity level; 26.4% - on waist circumference; 46.5% - on height and bodyweight. Total cholesterol was identified in 86.4%, HDL cholesterol - in 25.5%, triglycerids - in 38.6%, glucose - in 85.3% and creatinine in 58.7% of patients with AH. ECG examination was done on 100% of patients, echo-cardiography - on 28.9%, duplex screening of brachiocephalic arteries - on 1% of patients with AH.Chronic heart failure (44.4%), coronary artery disease (45.6%) and Q-wave myocardial infarction in anamnesis (20.5%) were statistically more frequently observed in males. In females CHF was observed in 35.2% of patients, CAD - in 26.7% and Q-wave MI in anamnesis - in 5.5% of pts. II type diabetes mellitus was observed in 12.1% of males and in 17.8% of females with AH. Conclusion. The Register method study on a selection of patients with AH under care in primary health care in 2010-2014 shows that their examination with regard to medical history taking, cardiovascular risk factors and target organ damage assessment in patients with AH is nonoptimal. Further efforts are needed to educate physician primary care physician, family doctors and cardiologists on the methods of diagnostics and treatment of patients with AH according to the Russian guidelines on AH.
Systemic Hypertension. 2017;14(2):29-34
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Achievement of the main goals of therapy by using of a triple fixed combination of amlodipine, indapamide and perindopril (Co-Dalneva®) in patients with arterial hypertension

Chukaeva I.I., Spiryakina Y.G., Glibko K.V., Orlov D.A., Bayramova A.S., Logunova I.Y.


Introduction. Combined antihypertensive therapy is indicated in 94% of patients with hypertension. Fixed combinations are preferable to use as they have a high profile of effectiveness, safety, more convenient to use and significantly increase the adherence. Objective. To evaluate the effectiveness of triple fixed combination of amlodipine/indapamide/perindopril for the control of blood pressure in patients who did not achieve the target blood pressure level in the previous combined therapy. Materials and methods. The study included 44 patients with hypertension of high and very high risk of cardiovascular complications (mean age - 58.59±10.57 years, 17 men, 27 women). Blood pressure levels, quality of life, anxiety and depression levels, adherence, biochemical indices, levels of inflammation markers (CRP, IL-6, IL-10) and endothelial dysfunction (sVCAM-1, VEGF) were assessed in all patients at baseline and after 6 months of amlodipine/indapamide/perindopril therapy. Results. Against the backdrop of the treatment, all patients reached the target level of blood pressure (BP), pulse BP decreased by 30.3 mm Hg. (p<0.001), all quality of life indicators improved: significant changes (p<0.05) in physical functioning (from 58.1±27.7 to 71.3±20.5%), role-physical functioning (from 54.7±41.2 to 85.5±31.5%), role-emotional (from 53.3±46.0 to 77.3±40.1%), vitality (from 53,4±16.9 to 63.2±14.5%). The anxiety levels (from 5.9±2.8 to 3.5±2.6) and depression (from 5.9±2.5 to 3.7±2.1) significantly decreased. Adherence increased to a high level (from 3.4±1.8 to 6.5±1.0 points, p<0.01). There were no reliable dynamics of biochemical parameters and markers of inflammation. The level of sVCAM-1 decreased (from 1063.5±442.4 to 898.67±433.5 ng/ml, p<0.001). There were no cases of orthostatic hypotension. Conclusion. Therapy with a triple fixed combination of perindopril/indapamide/amlodipine (Ko-Dalneva®) achieves the target blood pressure level with a significant reduction in pulse BP, increases adherence and quality of life, reduces anxiety and depression with good tolerability and metabolic neutrality, and improves the vascular endothelial state, significantly lowering sVCAM-1.
Systemic Hypertension. 2017;14(2):36-40
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Clinical efficacy of sympathetic denervation of renal arteries in patients with resistant arterial hypertension as part of annual prospective follow-up

Gapon L.I., Mikova E.V., Savelyeva N.Y., Kolunin G.V., Zherzhova A.Y.


Objective. To study the clinical efficacy of sympathetic denervation of the renal arteries (RDN RA) in patients with resistant arterial hypertension (AH). Materials and methods. The study included 34 patients with resistant AH aged 27 to 70 years. Criteria for inclusion in the research: a resistant course of AH with a level of arterial pressure (BP) >160/100 mm Hg. Art. (With a diuretic) at optimal doses, the preserved renal function (glomerular filtration rate >45 ml/min) and the absence of a secondary form of AH, written informed consent. Results. RDN PA contributed to statistically significant A decrease in both office and average daily SBP and DBP, a clinical hypotensive effect was observed in men and women, however, in the night hours there was a more significant decrease in SBP in women. Conclusions. A prospective one-year observation confirmed a long-term Efficiency RDN RA in the treatment of patients with refractory hypertension.
Systemic Hypertension. 2017;14(2):41-44
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Advantages azilsartan medoxomil in patients with arterial hypertension: how to make a choice and to optimize antihypertensive therapy?

Martynyuk T.V., Chazova I.E.


Azilsartan medoxomil is a drug from class of angiotensin II receptor antagonist (sartans), have a antihypertensive effect and excellent tolerability profile. In comparison with other drugs (candesartan, olmesartan, ramipril, chlorthalidone, valsartan) according to comparative studies and meta-analyses azilsartan medoxomil demonstrated high antihypertensive efficacy, in terms of 24-hour BP control, which allows to recommend its purpose in patients of hypertension 1-2 degrees. This is due to the ability of the drug not only safely reduce AD during day and night hours, but also to normalize the circadian profile. Pleiotropic effects of azilsartan medoxomil in the form of increased sensitivity of receptors to insulin, a positive effect on glucose metabolism, improved endothelial function allow us to consider its purpose in patients with carbohydrate metabolism disorders, overweight, obesity, and metabolic syndrome. The drug is indicated for as patients who have not previously received antihypertensive therapy and if previous treatment with other RAAS blockers did not lead to reliable achievement of target BP levels. High efficiency and safety of azilsartan medoxomil can provide better patient adherence to long term therapy and achieve optimal results of therapy.
Systemic Hypertension. 2017;14(2):45-50
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The effect of combined therapy on the properties of the vessel wall in patients at high risk of cardiovascular complications

Blankova Z.N., Aslanyan N.S.


Introduction. The evaluation of therapy effectiveness in patients at high risk of cardiovascular complications includes the evaluation of target organs condition. A complex approach means follow-up control of laboratory and instrumental data. Materials and methods. The study included 113 patients with hypertension and nonstenotic atherosclerosis of brachiocephalic arteries. All the patients received antihypertensive therapy and some received hypolipidemic drugs. Cholesterol and low density lipoproteins (LDL) levels, brachial and central blood pressure (BP), brachial-ankle and carotid-femoral pulse wave velocity (baPWV and cfPWV, respectively), augmentation index (AI) of fibrosis markers (C-terminal telopeptide from collagen I (CITP) and C-terminal terminal propeptide of pro-collagen I (PINP) were assessed at baseline, after 6 months and 12 months of treatment with fixed combination of amlodipine, lisinopril and rosuvastatin. Results. The conducted therapy was followed by lowering the LDL levels from 3.9 (3.1; 4.6) to 2 (1.8; 2.3) mmol/L (p<0.01), brachial systolic and diastolic BP levels from 127 (116; 139) to 123 (115; 131) mm Hg (p<0.01) and from 79 (72; 89) to 75 (70; 83) mm Hg (p<0.01) respectively, central systolic and diastolic BP levels from 126 (112; 137) to 120 (110; 124) mm Hg (p<0.01) and from 80 (75; 87) to 76 (70; 81) mm Hg (p<0.01) respectively; by decreasing arterial stiffness: baPWV from 13.6 (12.5; 15.9) to 12.9 (11.8; 14.3) m/s (p<0.01) and cfPWV from 11 (9; 12.2) to 9.4 (8.4; 10.2) m/s (p<0.01), AI decreased from 31 (25; 35) to 26 (21; 32); p<0.05. The arterial stiffness index calculated without BP levels (cardio-ankle vascular index) decreased from 7.2 (6.6; 8.3) to 7.0 (6.6; 7.9) m/s (p<0.05). Treatment with Ekvamer® resulted in PINP levels decreasing from 49.8 (33; 67) to 35 (21; 52) mg/dL (p<0.05) and CITP - from 0.44 (0.24-0.6) to 0.3 (0.18-0.46) mg/dL (p<0.05). No difference between initial and final PINP/CITP levels was observed. The dynamics of PINP levels was associated with aortal stiffness dynamics, cfPWV (r=0.5; p<0.05). Conclusion. Treatment with fixed combination of amlodipine, lisinopril and rosuvastatin resulted in reaching target levels of LDL, brachial and central BP, and arterial stiffness decrease in patients at high risk of cardiovascular complications. The cfPWV dynamics was inter-related with collagen synthesis marker PINP levels.
Systemic Hypertension. 2017;14(2):51-55
pages 51-55 views

Quality of life in patients with idiopathic pulmonary hypertension: the first experience of trimetazidine

Kuznetsova E.G., Glukhova S.I., Martynyuk T.V., Nakonechnikov S.N., Chazova I.E.


Objective - to estimate the quality of life with therapy of trimetazidine in patients with idiopathic pulmonary hypertension, I-III functional class. Material and methods. In this study we included 29 patients (27 women and 2 men) aged 41.9±10 years. All patients had a common complain of angina-like symptoms. The patients were divided into 2 groups. The first group consisted of 11 patients (1 men and 10 women) who were additionally prescribed trimetazidine 35 mg twice daily for 24 weeks. The second group included 18 patients (1 men and 17 women) who continued to receive standard and specific therapy. At baseline and after 24 weeks all patients were examination, which included: laboratory (general and biochemical blood tests, D-dimer), clinical and instrumental examinations (electrocardiography, echocardiography, chest radiography, scintigraphy, a 6-min walking test, spirometry). We are take into consideration: age, sex, functional class (World Health Organization), complaints, tolerance, a 6-min walking test, Holter electrocardiogram in 12 lead, SF-36 questionnaire. Results. We analyzed the questionnaire SF-36 quality of life compared to before and after treatment trimetazidine: improvement in general health (p<0.02), physical role functioning (p<0.02), improvement index bodily pain (p<0.01), Vitality (p<0.02), mental health (p<0.01). Our study showed that the SF-36 questionnaire reliably describes the patient's physical, social and mental condition. Conclusion. Trimetazidine therapy improves quality of life in patients with idiopathic pulmonary hypertension, complaining of chest pain.
Systemic Hypertension. 2017;14(2):57-64
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A new fixed combination of perindopril, indapamide and amlodipine. "Three in one" is the way to improve the results of arterial hypertension treatment

Temnikova E.A.


The management of patients with arterial hypertension is a difficult problem even if use the modern antihypertensive drugs. The reasons of the inadequate control to arterial pressure level during the treatment are different. The application fixed combinations of antihypertensive drugs improves the results of therapy, weigh with separate pathogenetic mechanisms of blood pressure increasing and the counterregulatory effects of the treatment each components of the combination. The use of fixed combinations significantly increases patient adherence to treatment. A new fixed triple combination of perindopril, indapamide, amlodipine expands therapeutic options for the treatment arterial hypertension. The effectiveness of the use of each of the components and their combination is proved in large international studies.
Systemic Hypertension. 2017;14(2):65-68
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Prevalence of hypertension in military age males according to physical evaluation results

Melnik M.V., Uvarovskaya B.V., Makson I.P., Ivanov A.A.


Introduction. The social and medical implication of cardiovascular diseases is determined by their frequency, early disability and high mortality they cause. High mortality of working age men is one of the primary state problems in Russia. The greatest concern is caused by negative changes in health status of men aged 18-27 years who determine the military potential and thus the safety of the country. The defects of public health services and medical support of young men affect the primary criterion of system of preparing citizens to military service effectiveness - fitness for service status. Every 5th young man liable for military service is send to health care facilities for follow-up examination. Also every 4-5th from those on military service discharges from the Armed Forces of the Russian Federation early as improperly called up for military service for medical reasons. Among the reasons for early discharge of military personnel cardiovascular diseases rank first. Objective. To determine prevalence of hypertension as cardiovascular risk factor in military aged male according to physical evaluation results. Materials and methods. An analysis of statistical data provided by State-owned Federal State Institution “The Main Center of Military Medical Examination of the Ministry of Defense of Russian Federation” in the Western Military District in 2011-2016 year and data on results of military-medical examination of recruited men in military registration and enlistment office of Izmaylovo district of Eastern Administrative Okrug in Moscow in 2011-2016 year was conducted. Results. In the Western Military District cardiovascular diseases amounted to 26‰ in 2011, 22.3‰ in 2012, 19.5‰ in 2013, 32‰ in 2014, 32‰ in 2015, and 27‰ in 2016 year. The percentage of newly diagnosed hypertension did not exceed 13.8‰, with its maximum in 2011 year and tendency to decrease through analyzed 6 years (11.4, 10.0, 10.0, 9.0, 7.0‰ respectively). All in all a decrease of total number of young men was observed in Moscow in the last 4 years, from 2011 to 2014. More than 58% military aged male committed to military registration and enlistment office of Izmaylovo district in Moscow have signs of various diseases and are not suitable for military service for health reasons. According to data on disease distribution in the abovementioned district, cardiovascular diseases took the second place and accounted for 12.6% in 2011 year. In the following 2012, 2013, and 2014 years the prevalence of cardiovascular diseases decreased to 8.9, 8.1, and 7.3%, respectively, so they took the 5th place. However, in 2015 and 2016 years cardiovascular diseases were again among the top three, giving way to musculoskeletal and nervous system disorders. Conclusion. Detection of hypertension on initial stages of the disease and differential diagnostics with other diseases with similar clinical symptoms is a crucial task and providing high quality medical support of military men is essential for high military effectiveness of the Armed Forces of the Russian Federation
Systemic Hypertension. 2017;14(2):69-74
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Clinical-pharmacological priorities in the election of blockators of the renin-angiotenzine system and diuretics in patients with uncompleted hypertension

Ponomareva A.I., Ketova G.G., Kompaniets O.G.


The article discusses the problem of using ACE inhibitors and diuretics in arterial hypertension. Analysis of the position of doctors when prescribing ACE inhibitors and diuretics showed its compliance with current national guidelines for the treatment of hypertension. Physicians use more adequate criteria for antihypertensive drugs usage. There were no non-rational use of diuretics in combination, regardless of indications and contraindications. If there are indications for the use of a diuretic and a preparation of ACE inhibitors, you have to make greater use of fixed combinations of drugs. The article discusses the results of clinical efficacy studies of perindopril and indapamide in clinical practice. Noliprel® forte is an effective antihypertensive medication, not only reducing BP, but also organoprotective aim and good tolerability in wide range of patients with arterial hypertension.
Systemic Hypertension. 2017;14(2):75-79
pages 75-79 views

The results of the international clinical study VICTORY: efficacy and safety of antihypertensive monotherapy with valsartan (Valsacor®) and its fixed combination with hydrochlorothiazide (Valsacor® H) in routine clinical practice in patients with grade 1 and grade 2 hypertension

Chazova I.E., Martynyuk T.V., Accetto R., Sirenko Y., Vincelj J., JWidimsky J., Barbič-Žagar B., Arhipov M.V., Grinshtein Y.I., Ostroumova O.D., Galjavich A.S., Rotar' O.P., Haisheva L.A., Nedogoda S.V.


Objective. The VICTORY study aimed to evaluate effectiveness and safety of monotherapy with valsartan (Valsacor®) and its fixed combination with hydrochlorothiazide (Valsacor® H) in clinical practice in patients with stage 1 and stage 2 hypertension. Materials and methods. In the prospective, randomized, open-label, international multicentre study involved 356 patients with grade 1 and grade 2 hypertension from 5 countries, including 130 patients from Russia. In Russia the study was conducted in 7 cities, in 8 clinical centers. The patients, who were receiving antihypertensive therapy at the moment of screening, underwent a 7 days wash-out period. The starter dose of valsartan (Valsacor®, KRKA, Slovenia) was 80 mg (except for Russia where 160 mg of Valsacor® were given at the first visit, what did not influence the study results). After 4 weeks of treatment in case of blood pressure (BP) >140/90 or 130/80 mm Hg the dose was increased to 160 mg (in Russia - to 320 mg) or combined therapy with Valsacor® H (KRKA, Slovenia) was prescribed. In 4 weeks the dose of valsartan was increased to 320 or 160/12.5 mg in case of previous dose insufficiency. If target BP levels were not reached in the next 4 weeks, the dose was increased to 320/12.5 mg. The primary endpoints included evaluation of antihypertensive effect of valsartan and its fixed combination with hydrochlorothiazide on BP levels; evaluation of the drugs’ influence on aortal stiffness; comparison of absolute average means of achieved decrease in central and peripheral BP compared with baseline; evaluation of the impact on aortic augmentation index. The secondary endpoints included comparison of primary endpoints when using mono and combined therapy; evaluation and comparison of the effect on erectile function in men by questionnaires at baseline and after 16 weeks of treatment; evaluation of adverse events frequency. Results. Data on 365 patients - 196 (54.0%) female and 169 (46.0%) male aged 54.6±12.0 years were analyzed. Mean initial value of systolic (SBP) and diastolic BP (DBP) were 156.6±8.9 and 95.6±6.0 mm Hg, respectively and 130.1±8.2 and 80.9±5.8 mm Hg, respectively after 16 weeks of treatment. The mean absolute decrease of SBP and DBP was 26.6±10.4 and 14.8±7.6 mm Hg. The decrease of SBP and DBP was statistically significant in all treatment periods (p<0,0001). The mean absolute decrease of central SBP and DBP at the 5th visit was 19.7±12.9 and 13.9±8.5 mm Hg, respectively (p<0.0001). When compared, the mean values of SBP and DBP between groups of mono and combined therapy were statistically significant (p<0.0001). 90,6% of patients reached the target BP levels: 98% in those who received monotherapy with valsartan and 84% in those who received combination of valsartan and hydrochlorothiazide. The mean absolute increase of erectile function score was 0.84±2.45 (p<0.0001). There were no differences in erectile function score dynamics in the two groups of patients. 92.8% of patients did not experience adverse effects and adverse events associated with the medication. There were no cases of severe adverse events in the study. The most frequent adverse effects were headache (1.9%), dizziness (1.6%), and weakness (1.6%). Conclusion. The study demonstrated high effectiveness and good tolerability of valsartan and its fixed combination with hydrochlorothiazide (Valsacor®, Valsacor® H) in patients with stage 1 and stage 2 hypertension. 1. Valsartan in monotherapy (Valsacor®) and in combination with hydrochlorothiazide (Valsacor® H) lowers the SBP and DBP levels to reference levels. 2. At the 16th week of treatment 90.6% reached target BP levels: 98% in the valsartan monotherapy group and 84% in the combination therapy with valsartan and hydrochlorothiazide group. 3. The medications Valsacor® and Valsacor® H have good tolerability: 92.8% of the patients did not experience any adverse effects. 7.1% of patients had at least 1 adverse effect but none of them experienced any severe adverse events. 4. The therapeutic effect was estimated as good and very good in 96.9% of patients. 5. The overall clinical effectiveness was estimated as excellent, very good and good in 95.3% of patients. 6. Most of the patients receiving Valsacor® and Valsacor® H noted an increase in life quality. 7. Treatment with Valsacor® and Valsacor® H resulted in increase of erectile function in male patients with stage 1 and stage 2 hypertension.
Systemic Hypertension. 2017;14(2):80-89
pages 80-89 views

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