Vol 6, No 4 (2009)


Topical problems in the clinical application of ƒ-adrenoblockers

Nebieridze D.V.


В публикации представлен современный взгляд на возможности различных ƒ-блокаторов в клинической ситуации. Класс ƒ-блокато- ров представляет неоднородную группу в плане возможностей клинического использования. Появляющаяся в последнее время кри- тика ƒ-блокаторов отдельными исследователями не должна вводить в заблуждение практического врача, который всегда должен задавать себе вопрос, о каких ƒ-блокаторах идет речь. Действительно, ряд ƒ-блокаторов, особенно неселективных, обладает отри- цательными эффектами и в ряде клинических ситуаций не может быть использован (метаболические нарушения, хроническая обструктивная болезнь легких (ХОБЛ), периферический атеросклероз). Вместе с тем современные суперселективные ƒ-блокаторы не обладают указанными отрицательными эффектами и могут широко использоваться в клинической практике, в том числе при метаболическом синдроме, сахарном диабете, ХОБЛ, периферическом атеросклерозе.
Systemic Hypertension. 2009;6(4):6-9
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Diuretics in treatment of patients with arterial hypertension

Chazova I.E., Ratova L.G.


Since all cardiovascular risk factors contribute to coronary artery disease in patients with arterial hypertension, they should all be considered in the management of this disease process. Thiazides diuretics when used at high doses, negatively impact lipid and glucose metabolism. These findings have resulted in decreased use of diuretics in favor of newer agents such as ACE inhibitors and calcium antagonists. However, recent data have demonstrated that when used at low doses (6.25 or 25 mg of hydrochlorothiazide), diuretics lack significant metabolic side effects while bringing about significant reductions in blood pressure. Thus, at these doses, hydrochlorothiazide is a useful drug in the treatment of hypertension, both as monotherapy and in combination therapy.
Systemic Hypertension. 2009;6(4):9-12
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The use of angiotensin receptor blocker losartan in the combinational therapy of arterial hypertension

Zagidullin N.S., Zagidullin S.Z.


Blockade of renin-angiotensin systems is one problem in the treatment of arterial hypertension. Resistant hypertension and patients with high cardiovascular risk demand frequently use of combination therapy. The efficiency of combined therapy losartan plus hydrochlorothiazide at patients with arterial hypertension was studied in several large clinical multicentre randomized studies. It is proved high efficiency and safety of this combination therapy.
Systemic Hypertension. 2009;6(4):12-15
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Amlodipine: its ability to reduce the risk of complications of arterial hypertension

Runikhina N.K., Tkacheva O.N.
Systemic Hypertension. 2009;6(4):15-19
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The modern treatment of cardiovascular diseases with b-blockers - focus on the nebivolol.

Evdokimova A.G., Ol'khin V.A., Evdokimov V.V., Zolotareva E.V., Khadzegova A.B.


Unlike first-line antihypertensives, nebivolol, a cardioselective b-blocker with vasodilatatory properties caused by its ability to modulate the activity of nitric oxide, positively affects prognosis in patients with arterial hypertension and chronic heart failure and shows metabolic neutrality. The clinical and pathogenetic studies demonstrating the benefits of nebivolol are discussed. Keywords: nebivolol, arterial hypertension, b-blockers.
Systemic Hypertension. 2009;6(4):20-25
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Three calcium antagonists: a place of everyone in treatment arterial hypertension (ALTERNATIVE study)

Chazova I.E., Ratova L.G.


In some regions of Russia, the prescription of different calcium antagonists by physicians was analyzed. This made it possible to assess their experience and knowledge and to direct ways to further improvements of the quality of care to patients with arterial hypertension. The present-day medical treatment of arterial hypertension in the Russian Federation is mainly determined by the recommendations made by the Russian Society of Hypertension and Russian Scientific Society of Cardiology 2008; however, the choice of a drug should be primarily based on a comprehensive assessment of risk factors available in a patient.
Systemic Hypertension. 2009;6(4):26-28
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Rationale for the use of sartans in patients with arterial hypertension

Stryuk R.I.


Angiotensin II (ATII) receptor antagonists, the drugs that affect the basic links of neuro-humoral regulation: the renin-angiotensin-aldosterone (RAAS) and sympathicoadrenal systems, have currently found wide use in clinical cardiology. By blocking the specific ATII receptors, the agents of this group contributes to systemic vasodilation, cell growth inhibition, including to the suppressed proliferation of endothelial and smooth muscle cells of the vascular wall, fibro-blasts, and to the inhibited cardiomyocytic hypertrophy. ATII receptor antagonists are referred to as first-line drugs used in the treatment of arterial hypertension (AH) in young patients in whom RAAS activity is generally increased, in that of diabetes mellitus since the drugs of this group are able to reduce the degree of microalbuminuria/proteinuria, and in the complex therapy for chronic heart failure (CHF). One of the representatives of this group is valsartan, a non-heterocyclic derivative, has a double elimination pathway (the liver and kidneys), a sustained 24-hour antihypertensive effect after single administration, which allows its once-daily dosing, by correcting systolic and diastolic blood pressure in more than 70% of patients. It should be emphasized that adjustment of the dose of valsartan is not required in moderately diminished hepatic or renal function. Valsartan failed to exert a negative effect on the level of glycemia and to cause changes in lipid profile and triglyceride levels. The long-term use of valsartan as mono-therapy for AH requires that the safety of treatment should not undergo additional laboratory monitoring. A multicenter, double-blind, placebo-controlled Val-HeFT trial covering 5010 pa-tients with CHF and a left ventricular ejection fraction (EF) of less than 40%, demonstrated that valsartan produced good clinical effects. Although overall mortality (one of the primary end points) was similar in the valsartan and placebo groups; another end point (reductions in the risk of mortality and morbidity) and the frequency of hospitalizations for increased symptoms of CHF was decreased in the valsartan group by 13.2 and 27.5%; respectively. In addition, valsar-tan was found to have a positive effect on a number of secondary end points: quality of life sig-nificantly improved, EF of the left ventricle rose, its dimensions decreased, and the degree of CHF symptoms was reduced, exercise tolerance increased, and the plasma levels of norepineph-rine, atrial natriuretic peptide, and aldosterone were decreased. The adverse reactions caused by ATII antagonists are seen rather rarely, which provides high patient compliance to some extent. The contraindications to the use of ATII antagonists are their hypersensitivity, arterial hypotension, hyperkalemia, dehydration, bilateral renal artery stenosis, pregnancy, childhood.
Systemic Hypertension. 2009;6(4):29-33
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Fleita is a Russian randomized, open-label, multicenter, comparative program for the evaluation of the efficacy and safety of the fixed combination drug Tarka (ABBOTT Laboratories, USA) versus optional sustained-release antihypertensive drugs in the treatment of patients with arterial hypertension and cognitive disorders (stepwise strategy)

Chazova I.E., Ostroumova O.D.


Lesion of the brain as a target organ in arterial hypertension (AH) is manifested not only by strokes, but also impaired cognitive functions. A number of foreign studies have revealed an independent association of death with cognitive impairment in elderly patients. However, the impact of AH on higher mental functions, including that in geriatric patients, has been little studied so far. The effect of antihypertensive drugs, including their fixed-dose combinations that are to be preferred in the pharmacotherapy of AH due to their high efficacy and safety, on cognitive functions also remains to be investigated. In this connection, the Russian FLEITA randomized, open-label, multicenter, comparative program for the evaluation of the efficacy and safety of the fixed-dose combination drug Tarka (ABBOTT Laboratories, USA) versus optional sustained-release antihypertensive drugs in the treatment of patients with arterial hypertension and cognitive disorders (stepwise strategy), its national coordinator being Professor I.E. Chazova, is being implemented under the aegis of the Russian Medical AH Society. The objective of the clinical FLEITA program is to study the clinical efficacy, tolerance, and safety of Tarka used in patients with AH and cognitive disorders. The paper also gives the task of the study, inclusion/exclusion criteria, and the design of the program.
Systemic Hypertension. 2009;6(4):34-34
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The improved form perindopril in treatment of arterial hypertension in various clinical situations (PREMIA)

Mychka V.B., Zhernakova Y.V., Chazova I.E.


The treatment of ACE inhibitors reduce risk of cardiovascular morbidity and mortality. The patients with grade 1-2 hypertension (n=2060) and at least one additional risk factors, subclinical organ damage, established CV or renal disease, diabetes mellitus or metabolic syndrome are recruited in this clinical study. The article presented of study design.
Systemic Hypertension. 2009;6(4):50-53
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Direct renin inhibitors aliskiren - possibilities correction cardiorenal syndrome

Chazova I.E., Fomin V.V.
Systemic Hypertension. 2009;6(4):53-58
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The condition of parameters of memory, attention and thinking at men of young age officers under the contractwith arterial hypertension.

Davidovich I.M., Afonaskov O.V., Staroverova Y.K.


Aim: to evaluate memory, attention and thinking functions indices in young hired military officers depending on their 24-hours blood pressure profiles. Materials and methods. The study was made in 49 patients with stage 1-2 arterial hypertension, aged 39,3±0,8, who did not take hypotensive medicines or took them occasionally. 24-hours blood pressure monitoring was performed with assessment of cognitive functions (memory, attention) depending on the stage, degree and duration of the disease. The control group included 12 men with no signs of arterial hypertension. Results. Comparing with the controls the memory, attention and thinking indices in hypertonic patients were found to be lower .even in those who had the first degree of hypertension and duration of the disease less than 5 years. The hypertonic patients showed lowering of attention and semantic memory scopes irrespective of duration of the disease. There was a negative correlation between monitored blood pressure data and memory, attention and thinking indices. Conclusions. Light cognitive dysfunctions can be found in young hired military officers with initial arterial hypertension but they are more typical for stage 2 of the disease
Systemic Hypertension. 2009;6(4):59-63
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Arterial hypertension in the elderly and higher mental functions. Possibilities of an-tihypertensive therapy withArifon retard in the prevention of dementia.

Ostroumova O.D., Korsakova N.K., Varako N.A.


Low-dose thiazide and thiazide-like diuretics (indapamide retard) are the drugs of choice in the treatment of elderly patients with arterial hypertension (AH), including isolated systolic AH (ISAH). The problem of treatment of AH in elderly patients is associated with that of vascular dementia. Despite the fact that AH is a major risk factor in the development and progression of dementia, its impact on higher mental functions in patients, including geriatric ones, has been little studied to the present day. The paper also gives the results of Syst-Eur and HYVET clinical trials. The results of the authors\' investigation are also presented. Twenty-six elderly patients (aged 60-74 years; mean age 65.2+5.9 years) with untreated or ineffectively treated grades 1-2 essential AH (mean disease duration 17.3+5.6 years) were examined; women were 84.6%; patients with ISAH and those with grade 1 AH were 70,8 and 84.6%, respectively. The patients were given the diuretic indapamide retard (Arifon retard, (Servier, France) in a dose of 1.5 once daily in the morning; the follow-up was 24 weeks. Physical examination, routine blood pressure (BP), 24-hour BP monitoring, and neuropsychological study, as described by A.R. Lu-ria, were conducted. Following 24-week treatment, there was a significant reduction in both di-urnal and nocturnal systolic and diastolic BP. After the performed treatment, there was a signifi-cant visual-logistic improvement (p<0,05) - the number of patients who had performed tests incorrectly decreased from 37 to 12%. During Arifon retard therapy, the volume of long-term auditive-verbal memory was significantly increased and the memorizing capacity also im-proved significantly. Therefore, antihypertensive monotherapy with Arifon retard significantly improved operative thinking and some parameters of memory in elderly patients with AH.
Systemic Hypertension. 2009;6(4):63-66
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Candesartan in the prevention of cardiovascular catastrophes: emphasis on the pre-vention of stroke

Drapkina O.M., Dikur O.N.


Arterial hypertension is one of the most important risk factors of acute cerebral circulatory disorders. Many clinical studies indicate that there are mechanisms that permit the prevention of stroke irrespective of a direct reduction in blood pressure. Antihypertensive agents affecting the renin-angiotensin-aldosterone system may have a cerebral protective effect beyond blood pres-sure lowering. The ability of angiotensin II receptor antagonists to prevent the development of stroke is associated with the fact that with the use of these agents, angiotensin II interacts with AT2-receptors, thereby improving the blood flow in the brain and enhancing the neuronal resis-tance to hypoxia. In this review, the focus is on the capacity of the angiotensin II receptor an-tagonist candesartan to prevent severe cerebrovascular events.
Systemic Hypertension. 2009;6(4):66-69
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Hypertension Summer School 19-25 September, 2009 - Smolenice, Slovakia

Aksenova A.V.


The 2009 European Society of Hypertension Summer School on Hypertension was organized by the Slovak Society of Hypertension in Smolenice (Slovakia). The summer school covered many aspects of hypertension, including parts of the epidemiology, pathophysiology, clinical presentation and clinical course, associated clinical conditions, and treatment. This report summarizes the key points. Hypertension is a systemic disease, involving many organs. Hypertension is highly prevalent, but not adequately treated. To choose the optimal therapeutic approach, stratification of total cardiovascular risk, including the assessment of target organ damage, is crucial. Antihypertensive treatment needs to be prompt and aggressive in those hypertensive subjects with high total cardiovascular risk.
Systemic Hypertension. 2009;6(4):70-84
pages 70-84 views

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