Vol 15, No 2 (2018)

The literature review provides an analysis of various modern invasive methods of treatment of patients with resistant arterial hypertension. Future of the method is sketched, as well as their efficacy and safety.

This paper presents state of the art of the problem of diagnosis and treatment of orthostatic hypotension (OH). It focuses on the developed algorithms for diagnostics of classical orthostatic hypotension (COH), initial orthostatic hypotension (IOH) and delayed orthostatic hypotension (DOH). It describes the necessary methods for the differential diagnosis of the OH causes. Comparative analysis of the European Society of Cardiology and American College of Cardiology/American Heart Association/Society of Cardiac Rhythm was performed. The treatment options for different groups of patients with orthostatic hypotension are described.

The aim of the study was to evaluate blood pressure (BP) level and vessel wall stiffness parameters role in antihypertensive therapy (AHT) escape phenomena development on the background of primarily effective AHT use. Materials and methods. Data from 102 patients with arterial hypertension level 1-3, stage I-II were analyzed. All patients underwent individual AHT adjustment for 2-3 weeks (adjustment period). At the end of the adjustment period the therapy effectiveness was evaluated with clinical BP measurement (target BP values less than 140/90 mm hg) and 24-hour BP monitoring (target daily BP values less than 130/80 mm hg). The study included only those patients who reached target clinical and daily BP values on the background of 2-3 antihypertensive drugs use at the end of the adjustment period. At the beginning of the observation period after effective AHT was used carotid-femoral pulse wave velocity was evaluated with applanation tonometry. For the purpose of timely escape phenomena diagnosis clinical BP measurement and 24-hour BP monitoring were performed in 1, 3, and 6 months after the trial start in all patients. Results. After 6 months of observation patients were divided in 2 groups: group 1 included 34 patients with AHT escape phenomena, group 2 - 68 patients with stable, controlled AH. In group 1 on the background of effective AHT use at the beginning of observation higher levels of following measures were observed: clinical systolic BP - SBP (125.2±11.3 mm hg vs 119.7±11.7 mm hg, p=0.021), daily SBP (128.0±3.3 mm hg vs 121.2±7.4 mm hg, p=0.000), daily average SBP (131.6±4.9 mm hg vs 125.3±8.5 mm hg, р=0.000), night average SBP (120.4±8.5 mm hg vs 111.8±8.6 mm hg, р=0.000), daily pulse BP 50.2±4.8 mm hg vs 44.2±7.6 mm hg, p=0.000), daily mean brachial artery stiffness index - ASI (161.9±28.3 mm hg vs 142.2±24.5 mm p=0.000), carotid-femoral pulse wave velocity (11.6±2.5 m/s vs 10.5±2.3 m/s, p=0.029). In single-factor logistic regression models all these measures were shown to have predictive value in AHT escape phenomena development. According to multifactor logistic regression analysis that included carotid-femoral pulse wave velocity more than 10.8 m/s, daily mean ASI>137, daily SBP>124 mm hg, and daily pulse BP>46 mm hg, the only independent predictor on the background of effective AHT at the beginning of the observation was daily SBP>124 mm hg (odds ratio 19.1, 95% confidence interval 3.6-101.8; p=0.0004). Conclusion. BP level and artery stiffness index measured on the background of effective AHT at the beginning of the observation are predictors for escape phenomena development and can be used for effectiveness and required frequency of therapy management prognosis.

Objective. To assess main epidemiological indicators for hypertensive crises (HC) in the population of productive age and to study possible correlations of crisis associated arterial hypertension (AH) with clinical and instrumental phenomenon of chronic cerebrovascular diseases. Materials and methods. Data of several studies presented: cross-sectional studies of 726 people aged 35-64 and 415 people aged 40-59. Observational cohort study of 109 patients aged 57.4±5.8 with uncomplicated AH. For the detection of HC in anamnesis, there were used special criteria which widens standard HC definition for additional account of light and mild severity cases. Results. Overall AH prevalence was 45% (95% CI 41-51), in men - 48% (40.2-55.9), in women - 45% (38.4-51.6). History of HC in anamnesis was 11.8% (95% CI 9-15.2), in men 8.8% (5.4-14) and in women - 13.8% (10-18.7). Proportion of HC associated AH defined at the level of 25-30% of all AH cases. The most prevalence of HC associated AH was found in people with “high normal” (130-139/85-89) arterial pressure - 37%. Prevalence of the complaints on headaches, dizziness, poor memory and lower intellectual productivity was higher in people with HC. Chronic cerebrovascular disease was found 2-fold frequently in HC associated AH. But in generally analysis of possible correlations of HC with clinical and instrumental phenomenon of chronic cerebrovascular diseases didn’t revealed any statistically significant differences. Conclusion. HC burden for healthcare system is serious, because it is important risk factor for cerebrovascular diseases and associated with significant lowering of the quality of life. Prevalence of the HC cases with light and mild severity is underestimated. Despite that the study of the most prevalent forms of HC (rare, light and mild severity) didn’t find any associations with morphological or persistent clinical pathology, functional phenomenon were found statistically significant frequently.

Endogen nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) deficiency in pulmonary vessels walls plays essential role in pulmonary arterial hypertension (PAH) pathogenesis. Soluble guanylate cyclase stimulator riociguat and phosphodiesterase-5 (PDE5) inhibitor sildenafil increase cGMP content and have proven clinical efficacy in PAH treatment. The potentially beneficial mechanisms of riociguat mechanism of action include endogen NO independence in cGMP synthesis and its independence from other phosphodiesterase isoferments (other than PDE5). Clinical options, safety and effectiveness of iPDE5 - riociguat transition in patients with PAH were for the first time shown in non-controlled study RESPITE and the assessment is continued in randomized placebo-controlled trial REPLACE.