Vol 17, No 1 (2020)
- Year: 2020
- Articles: 4
- URL: https://journals.eco-vector.com/2075-082X/issue/view/1937
Guidelines
7-45
Original Article
Radiofrequency renal denervation with mono-electrode and multi-electrode device for treatment in patient with uncontrolled hypertension: results of a 6-month follow-up
Abstract
Aim. To study the efficacy and safety of radiofrequency renal denervation with mono-electrode and multi-electrode devices in patients with uncontrolled arterial hypertension during а 6-month follow-up period.
Materials and methods. The study included 52 patients with uncontrolled arterial hypertension, while receiving multicomponent antihypertensive therapy, including diuretic. Patients underwent radiofrequency renal denervation with a mono-electrode (group A; n=27) and multi-electrode devices (group B; n=25). The effectiveness of the procedure was study according to office blood pressure (BP) and ambulatory blood pressure monitoring (ABPM).
Results. In group A and B, according to office BP after 6 months, there decreased in SBP/DBP by 32/14 and 30/10 mmHg (р=0.00001/р=0.00001 and p=0.00001/0.0004) respectively. According to ABPM, in group A there was a decrease in the average daily SBP and DBP by 7 and 4 mmHg (р=0.01 and р=0.03) respectively. According to ABPM, after 6 months in group B, there was a decrease in the average daily SBP and DBP by 12 and 6 mmHg (р=0.0003 and р=0.0007) respectively.
Conclusions. The results confirm the safety and effectiveness of radiofrequency renal denervation. RDN of the distal branches of the renal arteries leads to a greater hypotensive effect.
46-50
Results of pulmonary thromboendarterectomy depending on different levels of pulmonary vascular resistance and angiographic index of the pulmonary artery lesion
Abstract
Objective. Pulmonary endarterectomy is a first-choice treatment for patients with chronic thromboembolic pulmonary hypertension. Data describing the results of the operation with different levels of pulmonary vascular resistance (PVR) depending on the spread and percentage of pulmonary artery disease are not declared in the world literature. The aim of our study is to evaluate and compare the hospital results of the operation in patients with different levels of pulmonary vascular resistance, depending on the CT-angiographic index of the pulmonary artery lesion.
Materials and methods. A retro-prospective study was conducted, which included 52 patients. All patients were divided into 2 groups, depending on the levels of pulmonary vascular resistance (PVR): group 1 included 31 patients with PVR<1000 dyne×s/cm5, group 2 – 21 patients with PVR>1000 dyne×s/cm5. Data of the preoperative right heart catheterization in groups 1 and 2, respectively: mean pulmonary artery pressure (mPAP) – 44.4±8.3 and 56.9±9.6 mm Hg, pulmonary artery wedge pressure – 7.3±2.4 and 6±1.5 mm. Hg, cardiac output (CO) – 3.9±0.9 and 3.2±0.6 l/min, cardiac index (CI) – 2±0.5 and 1.6±0.4 l/min/m2, PVR – 767±174 and 1272.6±186.4 dyn×sec/cm5. The operation was carried out bilaterally according to a standard protocol with cardiopulmonary bypass, deep hypothermia and circulatory arrest.
Results. Data of the right heart catheterization on the first day after the operation in first and second groups, respectively: mPAP – 28.5±6.3 and 35.78±4.2 mm Hg, PVR – 253.39±85.5 and 333.9±101.9 dyne×s/cm5, CO – 5.37±0.9 and 5, 2±1.1 l/min, CI – 2.69±0.39 and 2.6±0.4 l/min/m2. There was a significant decrease of pulmonary hypertension (p<0.05) in the early postoperative period, in both groups. However, a detailed analysis of the obtained data revealed that in patients with pulmonary vascular resistance of more than 1000 dyne×s/cm5 with a pulmonary artery lesion index of less than 50%, a significant course of the early postoperative period along the combined endpoint was observed. The intensive care unit stay was 4 days in average in both groups. The need for a tracheostomy for the prolongation of artificial ventilation of the lungs was in 2 and 1 cases in first and second groups, respectively. In the first group, there were 5 cases of transient neurological disorders, which regressed at the time of discharge. Two patients in the second group died.
Conclusion. Despite the varying levels of baseline PVR, a significant improvement in hemodynamic parameters is observed in the early postoperative period, although patients in group 2 were less proven to normalization of pulmonary hemodynamics. However, a detailed comparative analysis revealed that the most severe category of patients are patients with PVR>1000 dyne×s/cm5, with pulmonary artery lesion index of less than 50%. Thus, the calculation of the CT-angiographic index of pulmonary artery diseases an additional diagnostic method to rate the risks of surgery, especially in patients with a high level of preoperative pulmonary hypertension
62-68
Review
Evidence base regarding target levels of arterial pressure in patients after a stroke: focus on a geriatric population
Abstract
Arterial hypertension (AH) is a very significant and most common risk factor for stroke, and lowering blood pressure (BP) is the most effective action to prevent stroke in patients with AH. This article provides an overview of existing randomized clinical trials (RCTs) and meta-analyzes to study the optimal target BP levels in patients with AH and cerebral events with a history of focusing on the geriatric population. As a result of the analysis of literature data, we obtained contradictory results: RCTs showed the benefits of lower target BP, in only two of them the target level of systolic BP (SBP) was less than 130 mm Hg, and the average age of patients included in the RCTs varied from 60 to 68 years, the number of patients older than 75 years was insignificant, and some studies excluded patients older than 85 years. Several subanalyses analyzed by RCTs found a J-shaped relationship between BP levels achieved and the risk of adverse cardiovascular events. One of them showed that with a decrease in BP below the SBP – 120 mm Hg and DBP – 65 mm Hg higher BP was associated with a lower risk of cardiovascular events. Another one showed that the risk of re-stroke and the risk of subsequent adverse events was statistically significantly higher in patients with an average level of SBP below 120 mm Hg than in patients with a level of SBP of 130–139 mm Hg. The meta-analysis published in the Cochrane database did not show significant advantages of lowering BP<130/85 mm Hg versus standard lowering BP<140–160/90–100 mm Hg, while another meta-analysis revealed some advantages of a more intense decrease in BP for the prevention of re-stroke. Existing studies did not take into account the heterogeneity of the geriatric population and did not include patients with fraility and multimorbidity patients, and did not take into account the type of stroke to develop a differentiated approach to the tactics of lowering BP in patients of all age groups. Therefore, in relation to the recommended ESC/ESH experts in 2018, target BP levels of 120–129/70–79 mm Hg (aged 18–65 years) and 130–139/70–79 mmHg (aged ≥65 years) for patients with AH and a history of cerebral events, there are still some doubts about the benefits of lower target BP values for the prevention of re-stroke and other cardiovascular events for the entire population of geriatric patients, especially patients older than 75, so specially designed randomized controlled trials are needed.
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Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 83917 от 12.09.2022 г.