Objective. To assess the polypharmacy and the appropriateness of prescribed drugs according to the STOPP/START criteria of elderly patients with type 2 diabetes mellitus (T2DM) аnd essential arterial hypertension (HTN) at the endocrinology department of a multidisciplinary hospital.

Design and methods. Medical records of 260 patients ≥ 65 years old (65-93 years old, average age — 75,2 ± 6,8 years, 219 women) with T2DM and HTN admitted to the endocrinology department of the multidisciplinary hospital (Moscow, Russia) were analyzed according to the “STOPP/START” criteria.

Results. Five and more medications (polypharmacy) were simultaneously prescribed in 211 people (81,2 %). We identified that potentially not recommended (which should be avoided in certain cases) drugs were prescribed to 58 patients (22,3 %). At the same time 178 patients (65,4 %) did not get prescription for the recommended medications. The most frequent identified STOPP criteria included: 1) glibenclamide or chlorpropamide or glimepiride in patients with T2DM (29,5 %); 2) loop diuretics in the absence of clinical signs of heart failure (17,9 %); 3) glibenclamide in T2DM (15,4 %). The most frequent START criteria included: 1) statin therapy in patients with the documented history of coronary, cerebral or peripheral vascular disease, where the patient’s functional status remains independent for daily activities and life expectancy is more than 5 years (30,5 %); 2) aspirin with the documented history of atherosclerotic coronary disease in patients with sinus rhythm (16,3 %); 3) clopidogrel with a documented history of cerebral or peripheral vascular disease (15,1 %).

Conclusions. According to our data, in patients aged 65 years and older with T2DM and HTN, polypharmacy occurs in more than 80 % of cases. In patients ≥ 65 years old with T2DM potentially not recommended drugs are often administrated, while recommended medications are not prescribed. Our findings demonstrate the need for optimization of pharmacotherapy in elderly and senile patients with T2DM and HTN.

The review presents basic information about the processes of replicative cellular and vascular aging. Special attention is paid to the problem of hypertension and insulin resistance. The mechanisms of the onset of insulin resistance and hypertension, their role in the development of major age-related vascular changes, the transformation of vascular aging into disease, and their contribution to life expectancy are discussed. Possible ways of influencing these processes are considered.

Objective. To study the influence of blood pressure (BP) on 5-year survival in the middle and late old age subjects living in Moscow and the Moscow region.

Design and methods. Two hundred and sixty-three patients (24 % of men) aged 75-98 (mean age 87) years after programmed stay at the Russian gerontology clinical research center were included in the prospective observational study. We analyzed values of systolic, diastolic and pulse BP at admission to hospital and at discharge, and their dynamics during hospitalization in all patients and separately in age subgroups of 75-89 and ≥ 90 years. The follow-up period was 5 years. Endpoint included death from any cause.

Results. During the follow-up period (median 3,82 years), 94 (35,7 %) patients died. Degree of BP decrease during hospitalization had no impact on survival in the very old patients. Only BP at hospitalization (reflecting the long existing “habitual” BP level) had prognostic value. In patients over 75 years, systolic BP (SBP) at hospitalization < 140 mm Hg was associated with increased 5-year total mortality risk by 54 % (relative risk (RR) 1,54; 95 % confidence interval (CI) 1,02-2,33; p = 0,041), and the highest mortality rate was in patients with SBP < 110 mm Hg. Kaplan-Meier analysis did not show association between the BP level and 5-year survival in patients aged 75-89 years. In long-living subgroup, 5-year mortality risk was higher in patients with SBP < 140 mm Hg and pulse BP (PBP) < 55 mm Hg, however, according to the multivariate analysis, PBP level was an independent predictor of 5-year total mortality (RR 2,63; 95 % CI 1,28-5,40; p = 0,009). In long-livers, the highest mortality rate was in patients with SBP < 110 mm Hg and/or PBP < 40 mm Hg.

Conclusions. In patients over 75 years, low SBP is associated with increased 5-year total mortality risk on 54 %, and in long-livers subgroup, low PBP increases mortality risk by 2,6 times. Diastolic BP has no prognostic value.

Background. Cognitive impairment and dementia are the symptoms of brain damage in hypertension (HTN), which impair quality of life and autonomy, in particular, in elderly patients. However, the influence of various drugs on the cognitive functions remains unclear.

Objective. To assess the effect of anticholinergic drugs on cognitive functions in hypertensive patients aged 80 years and older.

Design and methods. We consistently included 74 patients (77 % women) aged 80 years and older (median age 86 [82-89] years) with essential HTN stage I—III, who were admitted to the Department of Internal Diseases at the multidisciplinary hospital. Inclusion criteria were the following: patients with essential HTN stage I—III of both sexes; 2) age at the time of inclusion in the study — 80 years and older; regular antihypertensive therapy. The main non-inclusion criteria were the following: 1) age less than 80 years; myocardial infarction during the previous 3 months; mental illness, dependence on drugs or alcohol; acute cerebrovascular events during previous 6 months; non-compliance with the study protocol. Each patient underwent the assessment of cognitive status, depression, comprehensive geriatric evaluation. Medical records were studied. When medications were administered, the prescribed anticholinergic (AH) drugs were assessed by the scale of anticholinergic Cognitive Burden (ACB). The following scales and tests were used to evaluate cognitive functions: Mini-mental State Examination (MMSE), Montreal-Cognitive Assessment (MoCA), the Boston naming test (Boston Naming Test (BNT), Category fluency tests, subtest Wechsler Adult Intelligence Scale (WAIS-IV), Digit symbol substitution test (DSST), Word List Test (WLT), Alzheimer’s Disease Assesment Scale — Cognitive (ADAS-cog). Symptoms of depression were assessed using a shortened version of the geriatric Depression Scale (GDS 15).

Results. Based on the AH burden (the ACB scale), the patients were divided into 2 groups: 1^st group included patients who do not take drugs with AH burden (n = 25, 33,8 %), 2^nd group included patients taking drugs with AH burden (n = 49, 66,2 %). Patients who took drugs with AH burden showed a more pronounced decrease in cognitive functions: MMSE (lower overall score: 21 [18—23] and 22,5 [20—26] points, respectively, p = 0.04), number of recognizable images on the Boston test (lower number of the images: 27 [25— 30] and 30 [28—31], respectively, p = 0.014), and the cognitive adas-cog subscale (higher score, 16,7 [12—19,3] and 12,7 [11—14,6], respectively, p = 0.03).

Conclusion. In HTN patients aged 80 years and older, therapy with AH burden is associated with the more profound decrease in cognitive functions.

Background. Arterial stiffness is an independent prognostic factor for cardiovascular events and target organ damage related to hypertension.

Objective. To determine the rate of age-related increase of cardio-ankle vascular index (CAVI) and to investigate the association between CAVI and cardiovascular events in older adults.

Design and methods. This cross-sectional study was conducted on 200 older adults aged 60+ in Bashkortostan and St Petersburg. The following parameters were assessed: arterial stiffness (CAVI assessed by Vascular Screening System VaSera VS-1500), anthropometry, medical history and laboratory tests (glucose, lipids).

Results. The CAVI is nonlinearly associated with age. In Bashkortostan, it was determined using the following equation: Mean ± SD (women) = (7,5454 + 0,01426 × age + 0,000002445 × age³) ± (-11,8225 + 0,3681 x age — 0,002621 × age²); Mean ± SD (men) = (12,1277-0,06924 × age + 0,000006745 × age³) ± (12,52380,2833 × age + 0,001730 × age²). The equation was validated in St Petersburg. CAVI was a higher predicting score in patients with a history of stroke than in those without a history of stroke. An increase in CAVI by 1 unit was associated with the 1,5-fold higher probability of a stroke in history, even after adjusting for age, gender and multimorbidity [odds ratio (95 % confidence interval) = 1,66 (1,16-2.38)].

Conclusion. We determined the rate of CAVI score increase with age. We developed and validated a new equation to predict CAVI in older adults in different age. We defined the values of CAVI score associated with the history of stroke in adults aged 60 years and older.

Objective. To conduct a comprehensive study of comorbidity, medications and to assess the possibilities of deprescribing in hypertensive patients older than 60 years.

Design and methods. The study was registered as an observational program “Arterial hypertension: the main clinical and pharmacological determinants in patients over 60 years” and was conducted within the period from June to August 2018. In total, 460 patients (201/43,7 % — men, the age — 76,72 ± 8,1 years) with hypertension (HTN) were included sequentially.

Results. The main complaints were: headaches (n = 393/85,4 %), decreased memory, attention (305/66,3 %), dizziness (286/62,2 %), back pain (215/46,7 %), joint pain (206/44,8 %), sleep disorders (183/39,8 %), heartburn (179/38,9 %), epigastric pain (154/33,5 %), constipation (147/31,9 %). The main diagnosed pathologies included: ischemic heart disease (332/72,2 %), chronic brain ischemia/dyscirculatory encephalopathy (305/66,3 %), spinal osteoarthrosis (293/63,7 %), chronic gastritis (198/43 %), varicose veins of the lower limbs (136/29,6 %), diabetes mellitus (121/26,3 %), cataract (96/20,9 %). The following medications were taken by the patients: antihypoxants/nootropics/neuroprotectors (302/65,7 %), diuretics (251/54,6 %), angiotensinconverting enzyme (ACE) inhibitors (273/59,4 %), β -blockers (203/44,1 %), non-steroidal anti-inflammatory drugs (NSAIDs) (179/38,9 %), sartans (147/32 %), calcium antagonists (120/26,1 %), proton pump inhibitors (117/25,4 %), statins (111/24,1 %). Among patients, 176 (38,3 %) subjects stopped taking the antihypertensive drugs on their own, they were not informed by the doctor about the possibilities of reducing the dose of antihypertensive drugs and deprescribing technology.

Conclusions. Our data demonstrate the multimorbidity of the population of hypertensive patients over 60 years of age, receiving a wide range of drugs and the need for a comprehensive discussion of the deprescribing approach.

Objective. Cross-sectional study of lipid metabolism regulation and coronary angiographic data parameters in men admitted to the hospital due to acute coronary syndrome (ACS).

Design and methods. The presence of hypertension (HTN) combined with several related biological risk factors of chronic non-infectious diseases were assessed. We included 98 men with ACS (73 patients with myocardial infarction and 25 subjects with unstable angina). All patients underwent an urgent coronary angiography. We assessed the presence of risk factors of chronic non-infectious diseases (CNID), such as HTN, abdominal obesity, dyslipidemia and hyperglycemia. Plasma levels of leptin and adiponectin were evaluated.

Results. HTN was diagnosed in 81 % men with ACS. Among patients with three or more CNID risk factors, HTN is found in 100 %. The highest leptin level (12 [7,3-19,0] ng/ml) was found in patients with both HTN and abdominal obesity, compared to those with isolated HTN (2,2 [0,7-4,3] ng/ml; p = 0,0) or abdominal obesity (7,3 [7,1-8,4] ng/ml; p = 0,022). In patients with both HTN and dyslipidemia, adiponectin level is lower (21,5 [10,6-35,3] μg/ml) than in those with HTN alone (40,5 [12,8-71,6] μg/ml; p = 0,026). Also, in patients with combination of HTN and dyslipidemia, the coronary artery stenosis is significantly more pronounced (99,5 [90-100] %) than in those with HTN alone (70 [45-95] %; p = 0,004). In subjects with all three risk factors leptin levels (18,1 [9,5-26,4] ng/ml), the ratio leptin/adiponectin (0,7 [0,2-1,2] U) and the level of coronary artery stenosis (100 [86,2-100] %) are higher than in individuals with < 3 risk factors (4,2 [1,1-8,4] ng/ml; p = 0,0; 0,2 [0,03-0,5] U; p = 0,001 and 90 [60-100] %, respectively). Subjects with three or more risk factors of CNID show more frequently increased leptin level (n = 34; 81 %) (odds ratio (OR) = 6,4 95 % confidence interval (95 % CI) [2,3; 17,3]) and acute coronary artery stenosis (n = 40; 83 %) (OR = 2,7 CI 95 % [1,0; 7,2]). In contrast, those with less than three CNID risk factors have lower rate of increased leptin and coronary stenosis (n = 16; 40 %; p < 0,01 and n = 28; 65 %; p = 0,046, respectively).

Results. In our study, HTN appeared to be the most common biological risk factor in men with ACS. Thus, when more than 3 risk factors are present, HTN seems to be an essential one. In addition, the presence of three or more biological risk factors is associated with increased leptin levels and acute coronary artery stenosis.

Objective. To estimate changes in medication adherence in patients treated with fixed-dose combination of amlodipine / indapamide / perindopril arginine included in DOKAZATEL’STVO observational study.

Design and methods. Effects of the fixed-dose combination of amlodipine / indapamide / perindopril arginine on medication adherence were assessed in 1554 patients who filled in the questionnaire at baseline and at the last visit. Primary outcomes of the study included the change in the office and ambulatory (home blood pressure (BP) monitoring) systolic and diastolic BP from baseline to 3 months and rate of the achievement of target BP < 140/90 mmHg after 3-month treatment. Adherence was assessed by special questionnaire.

Results. The fixed-dose combination of amlodipine / indapamide / perindopril arginine resulted in the decrease in systolic BP by 39.5 mmHg and diastolic BP by 18.8 mmHg after 3 months. Target office BP < 140/90 mmHg was achieved in 87 %. High adherence at baseline was observed in 7,1 % patients, after 3 months of treatment — in 38,3 % (p < 0,001). Mean adherence score increased from 2,9 ± 1,6 to 5,0 ± 1,1 (p < 0,001). Study drug intake was associated with increase in motivation and awareness from 38 % to 95,4 % and from 19,8 % to 67,3 %, respectively (p < 0,001 for trend).

Conclusions. The administration of the fixed-dose combination of amlodipine / indapamide / perindopril arginine was associated with well tolerated BP decrease and significant increase in medication adherence and motivation even in the absence of specific targeted interventions.

Objective. To study the efficacy and tolerability of a fixed combination of bisoprolol and perindopril in the treatment of hypertensive patients after revascularization for acute coronary syndrome (ACS) at the third (outpatient) stage of cardiological rehabilitation.

Design and methods. In total, 1004 patients who underwent coronary artery stenting due to ACS were followed-up by cardiologists after discharge from the vascular departments of hospitals in Omsk. Their data were analyzed after 6 months (lipids, blood pressure (BP), total mortality, hospitalization rate). Among them, 91 patients were not included in the physical cardiological rehabilitation program due to the non-target values of BP and heart rate (HR). All of them took free combinations of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors. They were offered to change a free combination to a fixed one including bisoprolol and perindopril in individual doses (5/5, or 5/10, or 10/10 mg). We estimated the office BP, HR at three time points: at the start of therapy (1st visit, V1), after 4 weeks (V2) and after 12 weeks (V3). The BP variability and patients’ adherence to treatment were also assessed.

Results. After 4 weeks of treatment by the fixed combination of bisoprolol and perindopril, BP and HR decreased: 92,0 % achieved target BP levels, while target HR was achieved in 95,4 %. At V3, after dose titration, target BP and heart rate were achieved in all patients. After 12 weeks of treatment, the variability of systolic BP (SBP) and diastolic BP (DBP) was normalized in 80,4 % and 88,1 %, respectively (p < 0,001). Individual target HR in patients with heart failure symptoms and/or angina pectoris was not achieved in 91,3 % respondents at V1, in 18,5 % at V2, in 4,6 % at V3. At V2, 50 people (54,9 %) were considered eligible for the individual physical rehabilitation. At V3, additional 38 (41,7 %) patients were re-evaluated as eligible for the physical rehabilitation program. Patients demonstrated improved adherence to treatment: from V1 to V2 the compliance increased up to 73,0 % (p < 0,01), at V3 — up to 78,0 % (p < 0,001). We assessed the intention to continue the treatment, the answers were the following: “I don’t know” — 2,4 %, “perhaps” — 40,7 %, “definitely” — 56,7 %.

Conclusions. Our study demonstrate the need for a wider implementation of the fixed combination of bisoprolol and perindopril in management of hypertensive patients after ACS.

Objective. To evaluate the effect of combinations azilsartan medoxomil / chlorthalidone (Az-M/Chl) vs. perindopril / indapamide (Pr / Yn) regarding the modification of the daily blood pressure profile (BP) and augmentation index level in hypertensive patients (hypertension 2^nd degree, HTN), the blood pressure profile “nondipper” or “night-peaker” and type 2 diabetes mellitus (DM).

Design and methods. The study included 51 HTN (mean age 73 ± 11,7 years) patients (25 patients in the group Az-M / Chl and 26 patients in the group Pr / Yn, the groups were comparable by the main clinical parameters) with blood pressure profile “non-dipper” or “night-peaker”, DM (compensation stage). All patients have been receiving stable but ineffective antihypertensive therapy for at least 3 months before inclusion. The level of salt consumption was defined by the questionnaire “Charlton: SaltScreener”. Ambulatory 24-hour blood pressure monitoring (ABPM) was performed using BPLab® device (software Vasotens, Russia) which enables analysis of central hemodynamics. Statistica 10.0 software and software R using readxl, psych, ggplot2, ggpubr, gridExtra packages were used for statistical data processing.

Results. Twenty-seven (53 %) patients reported consumption of more than 6 g of salt per day: 14 (56 %) patients in the Az-M / Chl group, and 13 (50 %) patients in the Pr / Yn group. Mean daily BP was 161,2 / 102 ± 8,77 / 9,31 mm Hg in the Az-M / Chl group, and 158,3 / 96,7 ± 10,4 / 7,21 mm Hg in the group Pr / In (p > 0,05); mean daily systolic BP (MAP) was 161,2/102,0 ± 8,8 / 9,3 mm Hg and 158,3 / 96,7 ± 10,4 / 7,2 mm Hg, respectively (p > 0,05); aortic augmentation index — 4,88 ± 15,9 % and 2,7 ± 10,9 %, respectively (p > 0,05). At randomization (baseline), the non-dipping BP profile was found in 86,3 % (n = 44) patients, and the night-peaker profile — in 13,7      % (n = 7) patients. At the final visit, all patients achieved target BP level; mean daily systolic BP was 130,2 ± 8,8 and 139,9 ± 8,2 mm Hg in the Az-M/Chl and Pr / In groups, respectively (W = 140, p-value = 0.000497). The Az-M / Chl group demonstrated a more significant reduction in arterial stiffness. In addition, in the AZ-M / Chl group, 18 (72 %) patients showed change to a dipping BP profile, while only 5 (19 %) patients demonstrated the change in the Pr / Yin group.

Conclusion. The combination of azilsartan medoxomil/chlorthalidone showed a more significant compared with the combination of perindopril/indapamide: (1) a decrease in mean blood pressure per day; (2) the effect on the modification of the daily profile of blood pressure; (3) alteration of GI in aorta.