Vol 17, No 2 (2020)


Clinical guidelines on arterial hypertension diagnosis, treatment and prevention in children and adolescents

Aleksandrov A.A., Kisliak O.A., Leontyeva I.V.


Cardiovascular diseases (CVD) occupy a leading place in the structure of non-infectious pathology in adults and are the main cause of early disability and premature death in most economically developed countries. According to recent epidemiological studies, there has been a significant increase in both high normal blood pressure (BP) and arterial hypertension (AH) among children and adolescents. This applies to the greatest extent to adolescent children, while AH is detected from 4 to 22% of those surveyed, depending on the age of the surveyed and the selected criteria.

Systemic Hypertension. 2020;17(2):7-35
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Original Article

First results of Russian multicenter prospective clinical study VICTORY II: Vamloset® and Co-Vamloset effectiveness and safety in patients with stage 2 and 3 arterial hypertension

Chazova I.E., Martynyuk T.V., Rodnenkov V.O., Gorieva B.S., Rogoza A.N., Arkhipov M.V., Grinshtein Y.I., Ostroumova O.D., Galiavich A.S., Rotar’ O.P., Haisheva L.A., Kameneva T.R.



VICTORY II study objective. Evaluation of Vamloset and Co-Vamloset safety and effectiveness in reaching target blood pressure (BP) level in patients with stages 2–3 arterial hypertension (AH).

Materials and methods. Russian multicenter prospective clinical study conducted in 8 clinical centers in
6 cities in Russian Federation included 103 patients over 18 years of age with diagnosed essential hypertension of stages 2–3 (in accordance with 2013 European guidelines) who previously did not receive treatment (with office systolic BP – sBP≥160 mm Hg and/or office diastolic BP – dBP≥100 mmHg) or did not achieve target BP levels after receiving mono- or dual therapy. Office BP target levels comprised ≤139 mmHg for sBP and ≤89 mm Hg for dBP for patients without diabetes mellitus (DM), and ≤139 mm Hg for sBP and ≤84 mm Hg for dBP for patients with DM. All patients with stage 2 AH (group 1) were prescribed Vamloset® (amlodipine/valsartan, 5/80 mg), patients with stage 3 AH – Vamloset® ­(amlodipine/valsartan, 5/160 mg). Therapy correction Vamloset® (amlodipine/valsartan) in doses 5/160 mg, 10/160 mg and Co-Vamloset (amlodipine/valsartan/hydrochlorothiazide) in doses 10/160/12,5 mg, 10/160/25 mg (“КРКА-RUS”) was performed every 4 weeks according to provided schemes. At follow-up every 4 weeks the decision on necessity of antihypertensive treatment (AHT) correction were made by medical researcher in accordance with analysis of patients’ complaints, general condition and physical examination, results of office BP measurement, diary of BP self-control. In 40 patients in subgroup with additional assessment 24-hour BP monitoring, pulse wave velocity measurement, central BP evaluation, augmentation index calculation, and endothelium damage markers determination were performed.

Results. Active phase of the study included 100 patients aged 59.5±10.9 years (59% female) suffering from AH for 83.4±8.4 months. The patients received treatment with study medication (safety population). The protocol population (sampling Per Protocol) included 80 patients who completed the study without severe protocol violation. At the moment of study entrance 83% of patients received AHT. In all patients treatment duration comprised 15.9 weeks. In Per Protocol population target office BP level was achieved by 90.0% (95% confidence interval 81.2–95.6%) of the patients. Overall clinical effectiveness (extremely high, very high, high, and sufficient) was achieved in 98.8% [95% confidence interval 93.2–100%] of the patients. In group of patients with stage 2 AH target office BP level was achieved by 93.8% of patients, in group with stage 3 AH – by 84.4% of patients. Mean BP change in study group was -32.2 mm Hg for SBP and -16.0 mm Hg for DBP. Among patients with stage 2 AH target office BP level was achieved by 93.8% of patients, with mean BP change -30,7 mm Hg for SBP and -15.5 mm Hg for DBP. In patients with stage 3 AH target BP levels were achieved in 84.4% of patients with mean BP change -34,6 mm Hg for SBP and -16.7 mm Hg for DBP. After 16 weeks of treatment in Full Analysis Set population with recovery of missed measures using Last Observation Carried Forward 40.2% of patients reached target BP levels according to BP self-control results. Considering the limitations of results evaluation this practice requires further assessment, standardization, and improvement. According to 24-hour BP monitoring reaults after 16 weeks of treatment 26.5% of patients achieved target BP daily profile (for patients from subgroup with additional assessment in Full Analysis Set population with recovery of missed measures using Last Observation Carried Forward), that indicates additional influence of studied AHT on the prognosis of patients with stages 2–3 AH.

Conclusion. In clinical study VICTORY II Vamloset® and Co-Vamloset optimal effectiveness and safety in patients with stage 2 and 3 arterial hypertension were shown.

Systemic Hypertension. 2020;17(2):36-47
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Features of cerebral autoregulation and reactivity in patients with arterial hypertension in older age groups with orthostatic hypotensive reactions

Atyunina I.V., Oshchepkova E.V., Rogoza A.N.


Aim. To study the condition of cerebrovascular autoregulation and reactivity in different variants of orthostatic hypotensive reactions (OНR) in elderly patients with hypertension (АН).

Materials and methods. 50 patients with AH were examined (80% of women) aged 60 to 82 years (68.5±5.3). The duration of hypertension is from 2 to 43 years (16.8±11.6 years).The daily blood pressure profile was evaluated by the method of daily monitoring of blood pressure (BPLab, Russia). A study of OНR was carried out using an active orthostatic test (AOP) with continuous monitoring of cerebral blood flow (CBF) and with a minute measurement of blood pressure by the oscillometric method and continuous non-invasive measurement of SBP (systolic blood pressure) and DBP (diastolic blood pressure) in the finger artery (Task Force Monitor CNSystems Austria). The CBF velocity in the middle cerebral artery (SMA) was estimated using a transcranial sensor with a frequency of 2 MHz on an Angiodin-2K ultrasound machine (BIOSS company, Russia). In SMA, systolic (Vs), diastolic (Vd), average cerebral blood flow velocity – ACBF (Vm), pulsation index (Pi), and vascular resistance index (Ri) were recorded. The difference between the indicators was calculated initially and during AOP (in the first 30 seconds and for 3 minutes): ÄVm30s, %, ÄVm3m, %. Reactivity was assessed using a hypercapnic test (HCP) with breath holding. The relative change in the CBF indicators in the MCA was calculated by the formula: Kr = (Vm1–Vm2)¥100%/Vm1, where Kr is the reactivity coefficient, Vm1– ACBF at rest; Vm2 – ACBF during the test. Statistical analysis was performed using the non-parametric Mann–Whitney method using Statistica 6.0.

Results. In 17 (34%) patients with AH, OGR was detected. In 6 (12%) examined patients, initial OHR (IOH) was detected, in 6 (12%) classic OHR (COH), in 5 (10%) there was a combination of COH+IOH. According to the ABPM data, in patients with OHR compared with patients without OHR, there were no significant differences in the daily level of blood pressure (mmHg), SBP: 131.7±12.2 vs 131.3±13.8, p>0.05; DBP 74.3±11.8 vs 75.3±8.9, p>0.05). In AOP, patients with OHR significantly decreased Vm in orthostasis compared with patients without OHR, both in the first
30 seconds and at 3 minutes (Vm30s: 25.0±5.5 vs 30.4±4.7, p<0.05; Vm3m: 27.0±5.2 vs 31.2±4.7, p<0.05; ÄVm30s,%: 17.0±6.5 vs 8.3±4, 1, p<0.05; ÄVm3m,%: 11.7±6.3 vs 5.8±2.4, p<0.05). When performing HCТ between patients with OHR and without OHR, statistically significant differences in the indices Pi (0.79±0.08 vs 0.78±0.16, p>0.05) and Ri (0.51±0.09 vs 0.53±0.07, p>0.05) was not detected, however, in patients with OHR there is a tendency to a less pronounced increase in АCBF at the peak of HCT compared with patients without OHR (36.8±6.4 vs 40, 0±6.6, p=0.13). In patients with OHR, the cerebral reactivity coefficient was lower than in patients without OHR (13.4±3.9 vs 20.7±6.6, p<0.05).

Conclusions. In patients with AH of older age groups with OHR, a statistically significant decrease in ACBF in orthostasis was revealed. Patients with IOH showed a decrease in ACBF in the first seconds of orthostasis with its subsequent stabilization. Persons with COH have preserved the mechanisms of cerebral autoregulation in the first seconds of orthostasis, but with prolonged orthostatic load (3 minutes), the effectiveness of autoregulatory mechanisms decreases. OHR in patients with hypertension of older age groups is associated with a decrease in cerebral reactivity.

Systemic Hypertension. 2020;17(2):48-55
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The effect of adherence with long-term PAP therapy on the psycho-emotional state of patients with obstructive sleep apnea syndrome

Elfimova E.M., Mikhailova O.O., Khachatryan N.T., Starostin I.V., Litvin A.Y., Сhazova I.E.


Aim. To assess the impact of adherence and effectiveness of long-term positive airway pressure therapy (PAP-therapy) on the clinical and psychological characteristics of patients with obstructive sleep apnea syndrome.

Materials and methods. The study included 80 patients who were examined in the sleep apnea laboratory of the Myasnikov Institute of Clinical Cardiology of the National Medical Research Center for Cardiology and who have been on PAP-therapy for more than 12 months. The average age of the patients was 65.0 years [59.0; 71.0], body mass index – 35.0 kg/m2 [31.0; 38.0], sleep apnea-hypopnea index (AHI) – 39.5/h [31.0; 62.6]. The average duration of PAP therapy was 3.5 years [2.0; 6.0], while the minimum use was 1 year, the maximum – 15 years. In the sample of patients who came in person, the percentage of days using PAP-therapy was 87.5% [62.0; 98.0] and the average usage time – 6.3 hours [5.2; 7.3].

Results. On long-term PAP-therapy a persistent decrease in AHI was seen on average from 39.5/h [31.0; 62.6] to 2.7/h [1.2; 6.2], p=0,000. The criteria for good adherence to PAP-therapy (use> 4 hours/night, more than 70% of nights) were met by the percentage of days of use – by 67.5% of patients, the average time of use – by 87.5% of patients. Both criteria for good adherence to PAP-therapy was met by 64.8% of patients. With long-term PAP-therapy, 71.7% of patients met the criteria of effectiveness (AHI<5/h), AHI remained >5/h in 22.9% of patients and the average residual AHI was ≥10/h in 5.4% of patients. Correlation analysis showed associations between the PAP-therapy usage parameters and the severity of obstructive sleep apnea syndrome, and sleep quality: percentage of days of use and AHI (r=0.374, p=0.001), average time of use and PSQI (r=-0.438, p=0.000). Patients with a lower adherence to PAP-therapy (63.0% of days [22.0; 96.0] and 3.6 hours [2.4; 4.5] of use) did not differ in daytime sleepiness (ESS 5.0 ­points [2.0; 9.0] and 5.0 points [3.0; 8.0 ], p=0.891), but had a significantly lower quality of sleep (PSQI): 18.0 points [14.0; 20.0] versus 10.0 points [7.0; 18.0], p=0.004 compared with patients with high adherence to PAP-therapy (98.0% of the days [92.0; 99.0] and 7.9 hours [7.5; 8.2] of use).

Conclusions. Patients with the higher adherence to PAP-therapy had significantly better sleep quality. But even the use of PAP-therapy for less than 4 hours is associated with a decrease in daytime sleepiness severity.

Systemic Hypertension. 2020;17(2):56-60
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Pulmonary hypertension in patients with hemodynamically significant atherosclerotic lesion of a common carotid artery: new pathophysiological mechanisms of the disease

Markov M.A., Davydova M.P., Usachev D.U., Lukshin V.A., Balakhonova T.V., Rodnenkov O.V., Martynyuk T.V.


Background. Pulmonary hypertension (PH) is a severe pathology that often leads a patient to death or disability. Recently, the development of PH associated with activation of the sympathetic nervous system (SNS) has been of interest. Some results obtained in an acute experiment on rats showed that activation of the carotid bodies of one external carotid artery is a sufficient stimulus to increase the tone of pulmonary arteries. Obviously, this effect is mediated by the sympathetic nervous system. However, the long-term effects of unilateral hypoxia of the carotid bodies on the morphofunctional state of the pulmonary arteries are not described in the literature.

Aim. Effect assessment of common carotid artery bifurcation region ischemia due to the atherosclerotic process on the pulmonary arteries in patients.

Materials and methods. The retrospective study was conducted in the Burdenko Neurosurgical Center and in the National Medical Research Center for Cardiology. A total of 60 case histories were analyzed in detail. All patients underwent Duplex scanning of the brachiocephalic arteries, as well as transthoracic echocardiography. The study included patients with atherosclerotic plaque in the area of the common carotid artery bifurcation on either one side or both. Exclusion criteria consisted of diseases that lead to the development of PH. The relationship between the presence of hemodynamically significant atheroma and the development of PH was evaluated.

Results. Patients were divided into two groups – those with hemodynamically significant atherosclerotic plaque in the common carotid artery bifurcation region at least on one side (more than 75% of the vascular obstruction) and hemodynamically insignificant atheromas in the common carotid artery bifurcation region on one or both sides (less than 45%). Among patients from the first group, 52.8% of the patients had signs of PH. Among patients from the second group, only 16.7% of the patients had signs of PH. The difference in the frequency of PH occurrence between the two selected groups is statistically significant (p=0.005). There were no differences in red blood cells number, platelets number, glucose concentration and lipid composition of blood plasma.

Conclusion. Activation of SNS due to hemodynamically significant atherosclerotic plaque in the area of the bifurcation of the common carotid artery may be an independent mechanism for the development of PH.

Key words: pulmonary hypertension, carotid bodies, atherosclerotic plaque, sympathectomy of pulmonary arteries.

Systemic Hypertension. 2020;17(2):61-64
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Pulmonary hypertension or cardiology aerobatics

Chazova I.E., Martynyuk T.V., Danilov N.M.


Pulmonary hypertension (PH) is a group of diseases with a hemodynamic pattern of progressive increase in pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP), which leads to right ventricular dysfunction and the development of right ventricular heart failure.

Systemic Hypertension. 2020;17(2):66-68
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DOACs: life-changing technologies

Panchenko E.P., Shakhnovich R.M., Ageev F.T., Komarov A.L.


VIII Eurasian Congress of Cardiology. Overview of symposiums. DOACs: life-changing technologies. Systemic Hypertension

Systemic Hypertension. 2020;17(2):69-75
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COVID-19: a patient with cardiovascular disease at high risk

Chazova I.E., Zhernakova Y.V., Ostroumova O.D.


The COVID-19 pandemic that has swept the planet has posed many questions for doctors around the world, including the tactics of managing patients with cardiovascular disease, both infected and self-isolated. A symposium held with the support of the Merck company was devoted to this problem: "COVID-19: a patient with cardiovascular pathology at a particular risk".

Systemic Hypertension. 2020;17(2):76-83
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PAH: beyond the idiopathic form of disease

Martynyuk T.A., Shmalts A.A., Klimenko A.A.


VIII Eurasian Congress of Cardiology. Overview of symposiums. PAH: beyond the idiopathic form of disease. Systemic Hypertension.

Systemic Hypertension. 2020;17(2):84-90
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New opportunities for reducing cardiovascular risk in the Russian Federation

Ostroumova O.D., Sergienko I.V., Zhernakova Y.V.


VIII Eurasian Congress of Cardiology. Overview of symposiums. New opportunities for reducing cardiovascular risk in the Russian Federation. Systemic Hypertension

Systemic Hypertension. 2020;17(2):91-97
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