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"Arterial’naya Gipertenziya" ("Arterial Hypertension")

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Vol 17, No 3 (2011)
https://doi.org/10.18705/1607-419X-2011-17-3

ORIGINAL ARTICLES

203-208 805
Abstract
Cardiovascular diseases (CVD) are adverse outcomes in patients with morbid obesity. Visceral adipocytes secrete the bioactive substances - adipokines that could mediate CVD progression in obesity. At the same time the paradoxical effects of different adipokines could lead to better survival in obese patients with heart failure. Recent studies were focused on drugs that could influence cardioprotective adipokines, and the results of clinical research are controversial. The role of adipokines in CVD development and prevention seems to be a possible novel target for research and therapy.
209-215 759
Abstract
The review presents detailed analysis of antihypertensive effect moxonidine - II generation sympatholytic. Due to selective interaction with imidazoline I1-receptors moxonidine diminishes sympathetic activity causing decrease of peripheral vascular resistance. This leads to significant systolic and diastolic blood pressure reduction. The drug was shown to be effective and safe in both management of uncomplicated hypertensive crises and long-term treatment of arterial hypertension. Moxonidine benefits in treatment hypertensive patients with diabetes mellitus, metabolic syndrome, chronic obstructive pulmonary disease has been also proven. Moxonidine is well tolerated; its bioavailability after oral intake reaches 90 %. It produces neither hypotensive «first dose» nor rebound effects.
216-219 1986
Abstract
Prevention of cardiovascular complications as well as reduction of cardiovascular mortality rates, achievement of optimal blood pressure, correction of metabolic parameters and other risk factors are the main aims of antihypertensive treatment. Blood pressure control and increase of patients' adherence to treatment depend on the chosen drug. Combination therapy is the most effective in preventing target organ damage and cardiovascular complications in hypertensive patients. Better antihypertensive effect and decrease of side effects are beneficial features of rational antihypertensive combinations.
222-228 590
Abstract
Objeсtive. To assess the changes of vascular stiffness and central blood pressure in hypertensive patients on long-term antihypertensive therapy. Patients and methods. 84 subjects (56 women and 28 men) with hypertension and/or risk factors were screened. Mean age was 52,1 ± 10,6 years. Biochemistry (serum glucose and lipids), anthropometry, blood pressure (BP), arterial stiffness, central BP and ankle brachial index were assessed. Carotid ultrasound with estimation of intima-media thickness and echocardiography were performed. All patients were divided into 3 groups depending on the administered therapy: angiotensin converting enzyme (ACE) inhibitors (enalapril 5 mg, 52 subjects), beta-blockers (bisoprolol 5 mg, 22 subjects), calcium channel blockers (amlodipine 5 mg, 10 subjects). All parameters were assessed initially and after 3 and 12 months. To define age impact 2 subgroups were formed: 30-49 and 50-70 years old. Results. Arterial stiffness decreased after 3-month antihypertensive therapy, and no further changes were observed at long-term follow-up. The greatest decrease of the peripheral BP was observed in the group of ACE inhibitors, but central BP markedly decreased in calcium antagonists group. Patients over 50 years old had higher values of peripheral and central BP and subclinical target organ damage signs. Older patients showed better reversal of peripheral and central BP on antihypertensive therapy.
229-235 921
Abstract
To assess the carotid artery intima-media complex thickness (IMT) and vascular microinflammation in subjects with different level of blood pressure (BP). Design and methods. 194 subjects (mean age 42,1 ± 0,5 years) were divided into 5 groups according to the BP level (WHO classification, 2004). Following methods were performed: ultrasound examination of carotid arteries by means of Aloka 5000 with IMT measurement, lipid spectrum investigation, determination of the quantity of C-reactive protein (CRP) and serum levels of cytokines (TNFα, IL-1, IL-8, IL-4), as well as specific antibodies IgG to CMV, HCV-1, Cl. pneumoniae, H. рylori и β-streptococci (ASLO). Results. IMT is related to the level of systolic and diastolic BP in a different way. In the absence of vascular inflammation and low infection contamination level IMT is increased up to 0,9 mm in proportion to BP. In case of high contamination and in presence of vascular inflammation IMT is more than 0,9 mm. The vascular wall changes and inflammation level are almost identical in subjects with high normal BP and in hypertensive subjects.
236-239 568
Abstract
Background. Organoprotective features should be taken into account when antihypertensive therapy is administered. The infl uence of angiotensin converting enzyme inhibitor (ACEi) on intravascular blood fl ow is unknown. Design and methods. A total of 40 patients with essential hypertension stage I–II (mean age 48,1 ± 14,8 years) were included. All of them got fosinopril therapy for 27 weeks. Examination included: assessment of the common carotid artery diameter, intima-media complex thickness, distensibility coeffi cient, stiffness index, peak systolic velocity of the wall and the central layer of the blood fl ow in the common carotid artery and their relationship — the index of wall blood fl ow slowdown (IWBFS). Results. In addition to a distinct antihypertensive effect, fosinopril induces improvement of elastic properties of the vascular wall, reduces intima-media thickness and increases IWBFS. Conclusion. Fosinopril leads to the increase of IWBFS that may indicate the reduction of turbulent fl ow probability in the common carotid arteries and decreased risk of atherosclerosis.
240-245 1007
Abstract
To analyze the quality and perception of recommendations received by hypertensive patients during the visit to the clinic. Design and methods. We included 270 hypertensive patients (146 women, 124 men) who filled in the questionnaire after visiting their local physician. Results. On admission, patients received recommendations mostly in oral form (51 % males and 42 % females), 19% males and 27 % females got written prescriptions. 30 % of men and 31 % of women were informed both orally and in writing. According to the results of the survey 46 % of patients admitted that the recommendations are complete including the information about doses, quantity of antihypertensive drugs, and duration of treatment. However, more than half of patients (54 %) got only partial recommendations or were not informed at all, that can negatively impact the compliance to treatment. All patients evaluated recommendations by a special 5-level scale from «everything is clear» (5) to «nothing is clear» (1). Patients who got recommendations in combined form (both oral and written) demonstrated the highest level of compliance: 23 % of men and 27 % of women. Conclusions. Our study showed that to improve patients' adherence to treatment, the physician should correctly assess the goals of therapy and be persistent in achieving them. Prolonged motivation for treatment can be achieved only with an integrated approach, which includes education and training of both patients and their family members.
247-250 599
Abstract
To assess effectiveness of the fixed combination of perindopril and amlodipine (Prestans, Servier, France) in hypertensive patients. Design and methods. We examined 12 patients with 2-3 stage of arterial hypertension, average age was 56,3 ± 11,8 years. Biochemical blood tests, «office» blood pressure (BP) by Korotkov method and 24-hour BP monitoring were performed initially and after 4 weeks of Prestans (1 pill per day) therapy. Conclusion. Prestans decreased «office» systolic BP, systolic BP time index and level of morning diastolic BP elevation. Fixed combination of perindopril and amlodipine was shown to be metabolically neutral.
251-256 751
Abstract
Objective. To study personality characteristics and their gender differences in young patients with arterial hypertension verifi ed for the fi rst time, without major risk factors. Design and methods. 125 young patients with arterial hypertension verifi ed for the fi rst time (80 men and 45 women, mean age — 25,0 (20,0; 34,0) and 33,0 (31,0; 38,0) years, respectively) were included. Control group was formed by young healthy men and women (n = 125), mean age — 22,0 (19,0; 26,0) years. Personality characteristics were assessed by K. Leongard’s method. Indicators of anxiety were defi ned by C.D. Spilberger and J.L. Khanin’s method. K. Hek and H. Hess technique was used to assess neurotization level. Results. Changes of personality characteristics are primary in young patients with arterial hypertension verifi ed for the fi rst time and do not differ in men and women. Similar gender prevalence of anxiety-dysthymia pattern according to K. Leongard, and similar jet, personal anxiety and neurotization level are observed.
257-263 11202
Abstract
Framingham Heart Study identified left ventricular hypertrophy (LVH) as an independent risk factor for cardiovascular morbidity and mortality, including sudden cardiac death, and acute myocardial infarction. Thickened myocardial wall is also a source for heart rhythm disturbances. Objective. To estimate the rate of arrhythmias in hypertensive patients depending on left ventricular myocardial mass index (MMI). Design and methods. The study cohort included 107 hypertensive patients. The average age was 49,4 ± 10,9 years. Based on MMI value patients were divided into four groups. Ventricular arrhythmias were categorized according to Lown-Wolf classification. Results. The tendency to the increase of high gradation ventricular arrhythmias with the MMI augmentation was found out. There are significant differences of high gradation ventricular arrhythmias rate between the groups with different MMI values. There are positive correlations between LV MMI and the number of both ventricular and supraventricular arrhythmias per hour; between one-dimensional left atrium size and MMI (r = 0,53; p < 0,0001), left atrium volume and MMI (r = 0,32; p = 0,001); between one-dimensional left atrium size and isovolumetric ventricular relaxation time (IVRT) (r = 0,36; p < 0,001), as well as between MMI and IVRT (r = 0,43; p < 0,001). Conclusion. The frequency of threatening ventricular arrhythmias increases with MMI growth. MMI can be a prognostic factor of threatening ventricular arrhythmias in hypertensive patients with LVH.
264-268 1718
Abstract
To assess electromechanical features of dyssynchrony associated with complete left bundle branch block in hypertensive patients with coronary artery disease. Design and methods. 1st group included 38 subjects (16 males and 22 females, mean age - 53,0 ± 9,7 years) without cardiovascular diseases. 2nd group consisted of 24 patients (19 males and 5 females, mean age - 58,8 ± 8,9 years) who survived through myocardial infarction or coronary bypass surgery in past. Dyssynchrony was assessed at atrioventricular (AV), interventricular (IV) and intraventricular (VV) levels. Results and conclusion. Subjects from the 1st group showed lower volume of left ventricle (end-diastolic and end-systolic volumes), better contractility, and parameters of diastolic function (besides isovolumic relaxation time) did not differ between the groups. Dyssynchrony was comparable at AV and IV levels, but patients with verified coronary artery disease ahd significantly higher VV dyssynchrony (69,6 ± 18,9 vs. 59,7 ± 15,0 msec, р < 0,03). There was no correlation between QRS duration and dyssynchrony at any level. However, left ventricular hypertrophy correlated with dyssynchrony.
269-272 748
Abstract
To assess correlation between inflammatory markers and heart rhythm disturbances in patients with coronary artery disease (CAD) and arterial hypertension. Design and methods. We examined inflammation markers - tumor necrosis factor alpha (TNF) and C-reactive protein (CRP) - in 80 patients. Results. The level of inflammatory markers was higher in hypertensive patients with heart rhythm disturbances and CAD. Heart rhythm disturbances in hypertensive patients and in patients with CAD was associated with elevated inflammatory markers - TNF and CRP. In patients with CAD and arrhythmia CRP level was 12,41 ± 0,92 mg/l, and TNF was 10,58 ± 0,71 pg/ml. TNF level in hypertensive patients with heart rhythm disturbances was 5,4 ± 0,49 pg/ml, and CRP level was 10,4 ± 0,92 mg/l. CRP and TNF levels significantly differed compared to healthy people (CRP - 3,74 ± 0,58 mg/l, TNF - 2,27 ± 0,53 pg/ml, p < 0,005).
273-278 962
Abstract
Arterial hypertension contributes to the development of congestive heart failure (CHF). The efficiency of medications can vary between patients, thus, predictors of higher benefit are desired. Therefore, drug therapy of CHF requires more quick-response monitoring methods considering both cardiovascular remodeling and regulation and adaptation capabilities. For the estimation of regulatory-adaptive status (SAS) a cardio-respiratory synchronism (CRS) test considering two important functions, the cardiac and respiratory ones, is used. Objective. To assess efficiency of beta-blocker (BAB), Metoprolol Succinate, in hypertensive patients with CHF II functional class (FC) based on RAS effect estimation. Design and methods. 53 hypertensive patients with CHF of II FC (29 males and 24 females, mean age of 52,9 ± 2,3 years). CRS test, treadmill test with the measurement of maximum oxygen consumption during effort, echocardiography and NT-pro-brain natriuretic peptide testing were performed initially and after six months of sustained-release Metoprolol Succinate therapy (Betaloc ZOK, «AstraZeneca», Sweden, mean daily dose - 97,3 ± 9,5 mg/day). Results. Metoprolol Succinate did not affect either SAS, myocardial structure or exercise tolerance, moderately improved left ventricular diastolic function and reduced neurohumoral activation. Thus, BAB should not be always considered as the best therapy for hypertensive patients with CHF of II FC.
279-285 9000
Abstract
To assess the comparative effectiveness of antihypertensive therapy by an angiotensin receptor antagonist - Losartan or Candesartan - in patients with uncontrolled ambulatory arterial hypertension (AH). Design and methods. The study included 60 patients aged from 35 to 65 years divide into two groups. The first group included 31 hypertensive patients (15 men and 16 women, mean age 46,1 ± 9,9 years) receiving losartan. The second group was formed by 29 patients (12 men and 18 women, mean age 47,2 ± 9,8 years) with long-term hypertension receiving candesartan. Hypertension was diagnosed based on history and results of clinical and instrumental examination: blood tests, urinalysis, electrocardiogram, echocardiography, repeated 24-hour monitoring of blood pressure (BP) («BPLab» MnSDP-2) (at baseline and 4 weeks after drug administration). Results. Candesartan has significant benefits over losartan on the effect on circadian BP profile (reduction of the daily index of systolic BP by 5,8 and 4,8 % respectively, p < 0,05), reduction in the average values and variability of systolic BP (during the day by 38,0 and 27,1 % respectively, p < 0,05) and diastolic BP (daytime values by 25 and 18,3 %, p < 0,01, and at night - by 28,1 and 21,9 %, p < 0,05). Response to antihypertensive therapy was 90 % regarding systolic and 89 % - regarding diastolic BP change. Conclusion. Candesartan is not only more effective regarding the impact on the average values of BP, but also with regard to the variability of BP as a predictor of cardiovascular complications, which in turn might have a positive predictive value.


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ISSN 1607-419X (Print)
ISSN 2411-8524 (Online)