Ambulatory 24-hour blood pressure (BP) monitoring (24-h BPM) occupies its right place as one of the greatest advances in cardiology. By paying a well-deserved tribute to the evident advantages of this technique, is the question of whether this expensive labor-intensive method that is burdensome for a patient and provides very much information is optimally used in clinical practice and whether we always consider the findings critically rightful? Many cross-sectional and longitudinal studies have demonstrated that ambulatory BP is closer correlated with target organ lesions than clinical BP and it is of greater prognostic value for the development of cardiovascular complications. By interpreting the data of these studies, it should be remembered that while on the subject of clinical BP, we mean the mean value of less than 10 measurements of BP over a short period of time while 24-h BPM provides information on several tens of BP measurements. There is evidence for the fact that only patients with a good reproducibility of 24-h BPM exhibit a closer correlation of the latter with lesion to target organs than that with clinical BP. Most patients with arterial hypertension may be followed up with repeated clinical measurements of BP or its self-control. But 24-h BPM is the method of choice in assessing patients with wide variations in clinical and domestic BP, the symptoms of hypotension, sporadic hypertension, unexplained target organ lesions. 24-h BPM preserves its leading role in evaluating the antihypertensive efficacy of novel drugs under the conditions of clinical studies.

The study was undertaken to examine the impact of long-term therapy with enapril alone and in its fixed combination with hydrochlorothiazide (renitec/co-renitec, MSD) on the time course of changes in central, peripheral, and renal hemodynamic parameters and on the status of cardiopulmonary reflex in patients with hypertensive disease. The study included 35 patients with Stages I-II arterial hypertension. Therapy with renitec/co-renitec was performed for 6 months, starting with its dose of 10 mg, followed by titration up to 40 mg and switching to a combined therapy. A decrease in blood pressure in the groups of patients receiving therapy with enalapril alone and in combination with hydrochlorothiazide was found to be associa ted mainly with diminished peripheral vascular resistance, which was followed by a higher volume blood flow rate in the forearm-and a better sensitivity of the cardiopulmonary baroreflex. Moreover, long-term use of enalapril both alone and in combination with thiazide diuretic was attended by improved renal hemodynamics.

Studies were conducted in 58 patients (33 males and 25 females) aged 36 to 59 years who had arterial hypertension. 24-hour blood pressure (BP) monitoring and brain magnetic resonance imaging were performed in all the patients before and 5 years after the studies. Focal cerebral white matter lesions (FCWML) that had been absent before was found to appear in 15 (25%) patients; FCWML showed no changes in 12 (21%) patients. There was an increase in the number of FCWML in 17 (30%). The patients in whom FCWML appeared had significantly higher baseline values of BP and its time indices and, on repeated examination, they had only significantly higher time indices of BP. The findings suggest that arterial hypertension is a factor that enhances the likelihood of GCWML and that the use of 24-hour BP monitoring permits identification of a group of patients having a high risk for their appearance.

Twenty-one patients with coronary heart disease, functional classes I-II angina pectoris concurrent with moderate arterial hypertension were examined. Magnesium preparations were studied for their effect on blood pressure values, ECG parameters, and exercise tolerance during a bicycle ergometric test, as well as serum lipid profile and some membranous ion-transporting systems in the red blood cells. Exogenous magnesium was not found to have any effect on blood pressure. The administration of magnesium preparations promotes a decrease in urinary excretion of magnesium and an increase in its intracellular concentration, positively affects its homeostasis and the metabolism of other elements related to the development of vascular abnormalities.

The study has evaluated the impact of 26-week therapy with Rilmenidine, 1-2 mg daily, versus atenolol, 50-100 mg daily, on the parameters of 24-hour blood pressure monitoring, on the results of lipid phenotyping and oral glucose test in 37 patients with mild and moderate arterial hypertension (Stage II) during the randomized study. The antihypertensive effects of the drugs were comparable with a more significant decrease in heart rate in the atenolol group. At the same time, Rilmenidine showed good effects on the parameters of lipid metabolism and on the results of oral glucose tests as compared with atenolol whereas therapy with the latter resulted in deterioration of the blood lipid spectrum.

The purpose of the work was to examine the influence of modifiable and unmodifiable factors on the recording of late ventricular potentials (LVP) in patients with arterial hypertension (AH). Ahundred and ten patients with AH, including 58 males and 52 females, aged 23 to 73 years (mean 53,7±9,68 years). Late potentials were detected in 38 (34,5%) patients with AH, including 23 (39,6%) males and 15 (28,8%) females. There was significantly a more frequent recording of LVP in patients with impaired 24-hour blood pressure (BP) variability. At the same time, LVP was most frequently recorded in patients with an over-dipper diurnal BP variability (47,7%), as well as in those with dipper by systolic BP and over-dipper by diastolic BP (50%). There was a relationship of the frequency of LVP recording to the degree of AH. LVP was more frequently recorded in patients with AH and left ventricular dilatation and in the eccentric type of left ventricular hypertrophy (49,3%).

Aim. To study the impact of combined therapy with the angiotensin-converting enzyme inhibitor enap and the calcium antagonist corinfar SR on the values of blood pressure (BP) and the content of lipid peroxidation products in patients with.arterial hypertension (AH). Subjects and methods. Twenty-eight patients with Stage I-IIAH were treated with a combination of enap and corinfar SR for 6 weeks in the outpatient setting. The time course of changes in BP and the serum levels of dienic conjugates and malonic dialdehyde were determined. Results. The effective therapy with a combination of enap and corinfar SR was possible in 83% of the patients. Systolic and diastolic BPs decreased by 24 and 21% and they were 135,1±8,3 and 84,1±4,3 mm Hg, respectively. The content of dienic conjugates and malonic dialdehyde reduced by 10 and 9%, respectively. Conclusion. In addition to a steady-state BP decrease, 6-week combined therapy with enap and corinfar SR inhibits the serum activity of intermediate lipid peroxidation products.

The clinical significance of heart rate variability and Q-T interval duration during 24-hour bifunctional monitoring of ECG and blood pressure (BP) was studied in 81 patients aged 22-58 years (mean 41,40±0,72 years) who had Stages I-III essential hypertension (EH). A comparison group included 20 healthy individuals. Temporary and spectral methods were used to assess the parameters of heart rate variability; 24-hour Q-Tand O-Tk intervals, as well as echocardiographic data were analyzed. Patients with Stages I-III EH were ascertained to have a progressive decrease in diurnal heart rate variability along with a reduction in the total power of the spectrum, in the power of low-frequency constituents, and in their ratio. EH progression was found to be associated with an increase in the duration of the Q-T interval, its corrected values during daylight hours and with the degree of heart rate variability without circadian changes. The degree of autonomous cardiac control was statistically significantly related to heart rate variability and a risk for ventricular repolarization disorders.

Calcium antagonists (CA) are the group of drugs the main property of which are the ability to inhibit calcium influx through the so-called slow calcium channels. According to chemical structure, CA are divided into dihydropyridines (nifedipine, amlodipine, felodipine) and nondihydropyridines (verapamil and diltiazem). CA are also divided into first generation agents (conventional tablets) and second generation agents (long acting agents), the last are not only more convenient bat also more safe drugs. The data of large randomised trials confirm that CA have favorable effect on life prognosis during their regular administration to patients with arterial hypertension, this effect of CA is similar to that of other antihypertensive drugs (AHD). However, CA may be superior to other AHD in preventing stroke and inferior to other AHD in preventing myocardial infarction and congestive heart failure.

The study was undertaken to examine the metabolism and blood levels of major adrenal and gonadal androgens and the relationship between the levels of insulin and major steroid hormones in males with untreated arterial hypertension (AH). A hundred and twenty-five patients with AH and 15 healthy males matched by age who made up a control group. The males with AH had low levels of free testosterone, dihydroepiandrosterone sulfate and high concentrations of insulin as compared with the control group. The values of gonadotropic hormones, estradiol and cortisol did not differ in the comparable groups. There was a negative correlation between the levels of free testosterone, dihydroepiandrosterone sulfate, and insulin in patients with AH.

Background: The Vaisartan Antihypertensive Longterm Use evaluation (Value) study compares cardiovascular outcomes in 15,314 eligible patients from 31 countries randomized to valsartan or amlodipine-based treatment. Methods: The blood pressure (BP) trends are analyzed in 13,449 of value study patients who had baseline BP and 24 months BP and treatment data. Results: In a cohort of 12,570 patients, baseline 24 and 30 months BP, but 30 months treatment data, were available. Of 13,449 patients, 92% (n= 12,398) received antihypertensive therapy at baseline, the baseline BPwas 153,5/86,9 mm Hg in treated compared to 168,1,8/95,3 mm Hg in 1051 untreated patients. After 6 months both groups had indistinguishable BP values. At 12 months the BP decreased to 141,2/82,9 mm Hg (p<0,0001 for systolic BP and diastolic BP versus baseline), at 24 months to 139,1/80 mm Hg (p<0,0001 v 12 months), and to 138/79 mm Hg at 30 months (p<0,0001 v 24 months). The systolic BP control (<140 mm Hg) at 30 months increased from 21,9% at baseline to 62,2%, the diastolic BP (<90 mm Hg) from 54,2% to 90,2% and the combined control (<140 and <90 mm Hg) from 18,9% to 60,5%. At 24 months 85,8% of patients were on protocol drugs: monotherapy = 39,7%, added hydrochlorothiazide = 26,6%, add-on drugs = 15,1%, and protocol drugs in nonstandsrd doses = 4,3%. Conclusions: The achieved BP control exceeds values reported in most published large-scale trials, the Value study is executed in regular clinical settings and 92% of the patients received antihypertensive drugs at baseline. When an explicit BP goal is set, and a treatment algorithm is provided, the physicians can achieve better control rates than in their regular practice. AmJ Hypertens 2003; 16: 544-48®2003 American Journal of Hypertension, Ltd.

The functional condition of endothelium is investigated at 51 eldedy patients with arterial hypertension II-III of a stage during 3 monthly treatments by indapamid retard. Endothelial vasodilatation function and thickness of a complex intima - media were evaluated with ultrasonic duplex scanning of arteries. It has been revealed reduced endothelium-dependent vasodilatation and structural remodeling of peripheral arteries in elderly hypertensives. Alongside with high antihypertensive activity, indapamid retard positively influenced on structural and functional characteristics of humeral arteries.