Vol 14, No 3 (2017)


Clinical Manual for Diagnosis, Prevention and Treatment of Cardiovascular Complications of Cancer Therapy. Part I

Chazova I.Y., Tyulyandin S.A., Vitsenia M.V., Ovchinnikov A.G., Poltavskaya M.G., Gilyarov M.Y., Martynyuk T.V., Panchenko E.P., Fedotkina Y.A., Stenina M.B., Trophimova O.P., Ageev F.T.


Advances in treatment have led to improved survival of patients with cancer but have also resulted in untoward side effects associated with treatment. Cardiovascular diseases are one of the most frequent of these side effects. Myocardial dysfunction and heart failure, myocardial ischaemia, arrhythmias, arterial hypertension, thromboembolic disease and other cardiovascular complications can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. This manual discusses concepts for timely diagnosis, intervention, and surveillance of patients treated with cardiotoxic cancer therapies. In this first part оf manual we discuss the diagnostic, prevention and treatment aspects of cancer therapy-related cardiac dysfunction and heart failure.
Systemic Hypertension. 2017;14(3):6-20
pages 6-20 views

Markers of early cardiotoxicity in patients with breast cancer undergoing chemotherapy depending on blood pressure level

Avalyan A.A., Kirillova M.Y., Shitov V.N., Oshchepkova Y.V., Saidova M.A., Stenina M.B., Chazova I.Y.


Objective. To study the possibility of the 2D Speckle Tracking Imaging in early detection of cardiotoxicity in patients with triple negative breast cancer and arterial hypertension (AH) during anthracycline-containing chemotherapy. Materials and methods. 70 women (mean age 48.6±13.3 years) with triple negative breast cancer were enrolled. All patients underwent chemotherapy, including anthracycline, taxan, platinum-based agent. Echocardiography, including 2D Speckle Tracking Imaging, was performed on Vivid-E 9 ultrasound machine before and after 8 weeks of chemotherapy. Left ventricular ejection fraction (LVEF) (the biplane Simpson`s method) and global longitudinal strain (GLS) (mean normal GLS of -22.1±1.8 for women) were analysed. Patients were divided into two groups: group 1 - with AH (n=18) and group 2 - with normal blood pressure (n=52). Results. Before chemotherapy in group 1 GLS was lower than normal value (-19.1±2.8% vs -22.1±1.8%; p<0.05) and lower than in the group 2 (-19.1±2.8% vs -20.0±2.8%; p>0.05). After chemotherapy in all patients GLS decrease was observed from -20.0±2.8% to -18.5±2.9% (p<0.05) and in group 1 from -19.1±2.8% to -16.4±3.8% (р<0.05), group 2 from -20.0±2.8% to -19.2±2.4% (p<0.05). However LVEF remained within normal values. The values of GLS decreased by more than 15% in 12 (17%) of all the patients. Conclusions. Apparently, GLS is the one of most sensitive early marker of chemotherapy - induced cardiotoxicity compared with the LVEF.
Systemic Hypertension. 2017;14(3):21-27
pages 21-27 views

The new angiotensin II receptor blocker Edarbi® as part of the pathogenetic treatment of arterial hypertension in patients with metabolic disorders

Chazova I.Y., Zhernakova Y.V., Blinova N.V., Rogoza A.N.


Relevance. Recently, the proportion of angiotensin receptor blockers has significantly increased among prescribed antihypertensive drugs. High organoprotective properties, additional metabolic effects and tolerability comparable to placebo make them the drugs of choice, especially in patients with stage 1 and stage 2 hypertension having low adherence to antihypertensive therapy, but already burdened by additional metabolic risk factors. Purpose of the study - study of the antihypertensive efficacy of the angiotensin receptor blocker azilsartan medoxomil (Edarbi®), its effect on cardiometabolic risk factors and damage of target organs in patients with stage 2 hypertension. Materials and methods. The study included 32 patients (mean age 47.32±8.4 years), 19 men and 13 women with stage 2 hypertension. All patients were evaluated for clinical blood pressure (BP), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, creatinine, glucose level in a carbohydrate tolerance test, 24-hour blood pressure monitoring, central aortic systolic pressure, сarotid-femoral pulse wave velocity and intima-media thickness was determined initially and after 6 months of therapy. Results. During taking Edarbi® 82% of patients with stage 1 and stage 2 hypertension and metabolic syndrome reached the target level of BP, which was accompanied by a significant improvement in diastolic function of the left ventricle in 56% of patients. Already in the first 6 months the treatment reduced arterial stiffness and improved metabolic control
Systemic Hypertension. 2017;14(3):28-35
pages 28-35 views

Beta-blockers, and real clinical practice in Russia: the gap between the understanding of the doses of beta-blockers and subsequent prognosis in patients with cardiovascular disease

Fomin I.V., Polyakov D.S.


Presents an analysis of the reception beta-blockers in three epidemiological studies sections of the EPOKhA. Respondents in each slice (2002, 2007, 2017) were stratified into 5 subgroups: only suffering from hypertension - AH (subgroup AH), patients with stable angina pectoris, but in history and clinically has no evidence of acute myocardial infarction (AMI) and chronic heart failure (subgroup of coronary heart disease); after myocardial infarction, but do not have clinical manifestations of chronic heart failure (subgroup myocardial infarction); patients with acute myocardial infarction formed for any reason, but with no previous history of AMI (subgroup chronic heart failure), and patients with clinical manifestations of chronic heart failure after suffering AMI in anamnesis (subgroup myocardial infarction + chronic heart failure). During 15 years in the Russian Federation the frequency of administration of beta-blockers increased from 20% in the section of cardiovascular pathology to 30%. The most sensitive to the use of beta-blockers were patients with a history of AMI and chronic heart failure. Prolonged beta-blockers have been used at the population level only in 2007, but the frequency with any cardiovascular pathology does not exceed the 50% threshold, and the achievement of goals (control heart rate) does not exceed 10% of the level at any pathology. This dependence is associated with low-dose beta-blockers. In any case, the dose of beta-blockers did not exceed 50% of recommended that can be a separate cause of cardiovascular mortality at the population level in Russia.
Systemic Hypertension. 2017;14(3):36-41
pages 36-41 views

Clinical and genetic factors determining target lesions of patients with arterial hypertension among Mountain Shoria population

Mulerova T.A.


Objective. To establish associations between clinical and genetic risk factors and target lesions (heart, blood vessels, kidneys) of patients with arterial hypertension (AH) among the population of Mountain Shoria, depending on ethnicity. Matherials and methods. A clinical and epidemiological study of compactly living population in the remote areas of the Mountain Shoria was carried out. This middle altitude region is located in the south of Western Siberia. 1409 people were examined (901 representatives of the indigenous ethnic group - the Shors, 508 representatives of the non-indigenous ethnic group - 90% of them being Caucasian). The diagnosis of AH was set in accordance with the recommendations of the Society of Cardiology of the Russian Federation / Medical Society of the Russian Federation on the Problem of Arterial Hypertension, 2010. Assessment of the structural and functional state of the cardiac muscle and duplex scanning of brachiocephalic arteries among the patients with AH was made by echocardiography. A photometric method was used to examine the urinary albumin concentration level. The polymorphisms of the genes ACE (I/D, rs4340), АGT (c.803T>C, rs699), AGTR1 (А1166С, rs5186), ADRB1 (с.145A>G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (c.677С>Т, Ala222Val, rs1801133) and NOS3 (VNTR, 4b/4a) were tested by the PCR method. Results. Among the members of the indigenous ethnic group left ventricle hypertrophy (LVH) correlated with the AG progression features (extent and duration), smoking, genotypes I/D of the ACE gene among men and T/T and C/T of the MTHFR gene; increased intima-media complex thickness (IMT) correlated with the AG progression features (duration), male sex, age, genotypes T/C of the AGT gene and C/T of the MTHFR gene; high level of albuminuria (AU) correlated with the AG progression features (extent and duration), lipid disorders (hypoalphacholesterolemia, hypertriglyceridemia, hyperbetacholesterolemia), genotypes D/D and I/D of the ACE gene, D/D of the ADRA2B gene and the C/T of the MTHFR gene among 18-64-year-olds. Genotype T/C of the AGT gene had a protective effect on LVH, genotypes G/G and A/G of the ADRB1 gene had protective effects on IMT and AU levels. In the nonindigenous ethnic group LVH correlated with the AG progression features (duration), hypertriglyceridemia, abdominal obesity, genotypes D/D of the ACE gene, 4b/4a and 4a/4a of the NOS3 gene; increased IMT correlated with the AG progression features (duration), age and genotypes T/C and C/C of the AGT gene; AU high level correlated with the AG progression features (extent and duration), obesity, abdominal including, genotypes C/C of the AGTR1 gene, D/D of the ADRA2B gene and T/T of the MTHFR gene. Genotype I/D of the ADRA2B gene had protective effect on IMT. Conclusion. The study demonstrated the importance of the ethnogenetic mechanisms in the multifactorial pathology development. The problem requires further research, also identification of people with AH and target lesions is needed for monitoring during the prophylactic medical examination of the population.
Systemic Hypertension. 2017;14(3):42-50
pages 42-50 views

The influence of Losartanum and Amlodipinum fixed combination use on cardiovascular complications risk factors seasonal variability in patients with arterial hypertension

Smirnova M.D., Fofanova T.V., Ageev F.T., Blankova Z.N., Vicenia M.V., Barinova I.V.


Rationale: The influence of drugs on adaptation to high temperatures and seasonal variability of cardiovascular disease factors is one of the most important issues of treatment raised during re-cent heat waves. The safety of calcium channel blockers (CCBs) and angiotensin II receptor blockers (ARBs) use during heat waves is quite controversial. Aim: To assess the seasonal variability of hemodynamic parameters, vessel wall stiffness, lipid, carbohydrate and electrolyte metabolism in patients with arterial hypertension (AH) and to as-sess safety and effectiveness of fixed combination of Losartanum and Amlodipinum (Lortenza® KRKA) use according to one-year follow-up results. Materials and methods. The study included 26 patients with stage 1 and 2 AH aged from 42 to 81 years. Office blood pressure measurement, electrocardiography, volumetric sphygmography (pulse-wave velocity, cardio-ankle vascular index), serum chemistry, blood osmolarity tests were performed. Visual Analog Scale (VAS), Heat Questionnaries and self-control diaries were also assessed. The baseline visit took place in spring of 2016, the first visit - in May-June 2016, the second - during the heat wave, the third - in September-October 2016, the fourth - in January-February 2017, and the fifth - in April-May 2017. Results. The treatment resulted in systolic and diastolic blood pressure decrease (р=0.000) to target value which persisted during the follow-up period. According to the self-control diaries 81% of patients did really control BP. During the heat wave only 58% of patients succeeded in BP control, in autumn - 63%, in winter and spring - 81% and 86%, respectively. By the third visit the heart rate decreased on -6.0 (-11.1; -2.8) beats per minute, p=0.007. The decrease in pulse-wave velocity from 15.2±3.4 m/s to 13.6±2.7 m/s, p=0.01 and CAVI on -2.1 (-2.9; -0.65), p=0.01 was observed on the third visit. Decrease in uric acid level (р<0.05), was also noted and persisted during the follow-up period. Seasonal variability of total cholesterol and low-density lipoprotein cholesterol was observed only after the third visit. Increase of advanced gly-cation endproducts levels at winter was also observed. No electrolyte imbalance or blood osmo-larity increases were observed. The quality of life improved according to VAS results. Most of complications (8 cases) developed during the heat wave (р<0.05 compared with other periods). Conclusion. The use of fixed combination of Losartanum and Amlodipinum (Lortenza®) is effec-tive and safe so it can be recommended to patients with AH to be used in heat waves periods.
Systemic Hypertension. 2017;14(3):51-57
pages 51-57 views

Survival of patients with pulmonary arterial hypertension during therapy PAH-specific drugs

Platonov D.Y., Tsareva N.A., Avdeev S.N.


Pulmonary arterial hypertension (PAH) is a life threatening syndrome, which is characterized by a progressive increase in pulmonary vascular resistance (PVR), medium pulmonary artery pressure and functional disorders and morphological changes of pulmonary arteries. Despite the relative abundance of PAH-specific drugs, the choice of a suitable agent for the treatment of a particular patient remains challenging. One of the most important parameters measured in clinical studies is patient survival or, in some cases, mortality. Survival or mortality as secondary or components of the primary endpoint one way or another has been studied in clinical trials of drugs for the treatment of PAH. For tablets drugs for the treatment of some forms of PAH (sildenafil, riociguat, bosentan, macitentan, ambrisentan) currently available data studies, which studied the survival.
Systemic Hypertension. 2017;14(3):58-64
pages 58-64 views

Dynamics of clinico-psychological characteristics in patients with obstructive sleep apnea syndrome and arterial hypertension after one month of the use of CPAP therapy

Konovalova K.I., Elfimova E.M., Mikhailova O.O., Fedorova V.I., Litvin A.Y.


Objective. To determine the dynamics of the clinical and psychological characteristics on the background of 1 month of CPAP therapy in patients with obstructive sleep apnea syndrome (OSA) and arterial hypertension (AH), both adherent and non-adherent to the treatment. Methods. The study included 180 patients with OSA and AH. Upon enrollment, anthropometric data, the results of polysomnography and cardiorespiratory studies, Beck depression scale, Spielberger personal and situational anxiety scale, Epworth daytime sleepiness scale, Pittsburgh sleep quality questionnaire and Quality of Life (WHO QOL-100) questionnaire were analysed. Out of 40 patients undergoing CPAP therapy, 30 patients were adherent to the treatment within a month. The adherence criterion was considered to be the usage of the CPAP device more than 4 hours per night, more than 5 days a week. In this article, the dynamics of the questionnaire scales is given only for those who were adherent to CPAP therapy. Results. Patients with OSA and AH adherent to CPAP therapy showed a statistically significant reduction in daytime sleepiness and depression, as well as improved quality of sleep and quality of life in the physical domain within 1 month of using CPAP therapy. Conclusion. Even short-term use of CPAP therapy in patients with OSA and AH leads to a reduction in daytime sleepiness and depression, improved quality of sleep and quality of life in the physical domain.
Systemic Hypertension. 2017;14(3):65-71
pages 65-71 views

The efficacy and safety of torasemid in the treatment of arterial hypertension in different clinical situations

Ostroumova O.D., Piksina G.F., Smolyarchuk E.A., Pavleeva E.E., Bondarets O.V.


The article considers issues of efficiency and safety of the use of torasemid, a loop diuretic, with the additional property of antagonist of the mineralocorticoid receptor in the treatment of arterial hypertension in different groups of patients.
Systemic Hypertension. 2017;14(3):72-78
pages 72-78 views

Interaction of antihypertensive drugs and rosuvastatin: focus on safety, efficiency and prospects

Luchinina E.V., Kompaniets O.G., Kizhvatova N.V.


Arterial hypertension and dyslipidemia is a very frequent comorbid condition. Arterial hypertension and dyslipidemia are combined in 40-70% of patients. The statins is the basic drug in primary and secondary prevention of cardiovascular disease and in the reduction of cardiovascular complications. We`ve attempted to summarize some data about the statins and interaction of antihypertensive drugs. Rosuvastatin is a medicine that provides an intensive reduction of low-density lipoproteins, does not require dose adjustment when applied in conjunction with antihypertensive drugs. The absence of inhibition and activation of rosuvastatin cytochrome P450 provides a low risk of negative interactions in the clinical situations of induced polypharmacy. Every clinician is to remember that it`s crucial to take into account some adverse reactions combining the statins with drugs of other pharmacological groups.
Systemic Hypertension. 2017;14(3):79-83
pages 79-83 views

Calcineurin inhibitors and arterial hypertension in recipients of solid organs

Kosmacheva E.D., Martirosyan S.M., Lepshokova M.K., Babich A.E.


Arterial hypertension is an established risk factor for cardiovascular complications. Since the introduction of calcineurin inhibitors (CNI), аrterial hypertension is observed in 50-80% of transplanted patients. Arterial hypertension and transplantation are closely linked, and its association may promote impaired graft and overall survival. We summarize the main mechanisms involved in the genesis of CNI-induced hypertension as follows: impaired renal function with the sodium retaining, endothelial dysfunction, renin-angiotensin-aldosterone system and sympathetic activation, production of vasoconstrictor substances, activation the renal Na+/Cl--cotransporter. Attention is focused on the dose-dependent increase in arterial pressure and the need for further study of the intensity of the pro-hypertensive effect of various calcineurin inhibitors.
Systemic Hypertension. 2017;14(3):84-86
pages 84-86 views

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