Changes in the dysfunction of the vascular endothelial on the background of long statin therapy in patients with arterial hypertension with high cardiovascular risk

Therapy ◽  
2021 ◽  
Vol 2_2021 ◽  
pp. 15-22
Author(s):  
Mikhin V.P. Mikhin ◽  
Vorotyntseva V.V. Vorotyntseva ◽  
Keyword(s):  
Cardiovascular Risk ◽  
Arterial Hypertension ◽  
Statin Therapy ◽  
Vascular Endothelial ◽  
High Cardiovascular Risk

scholarly journals Features and main problems of treating patients with high and very high cardiovascular risk with statins in real clinical practice (according to the data of the “PRIORITET” research)

2018 ◽  
Vol 17 (6) ◽  
pp. 52-60 ◽  
Author(s):  
S. Yu. Martsevich ◽  
Yu. V. Lukina ◽  
N. P. Kutishenko ◽  
N. A. Dmitrieva ◽  
T. A. Gomova ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cardiovascular Risk ◽  
Statin Therapy ◽  
Working Group ◽  
Target Level ◽  
High Cardiovascular Risk ◽  
Lipid Pattern ◽  
Very High ◽  
Real Clinical Practice ◽  
Group 1

Aim. To determine the features and main problems of statin therapy, as well as assess the possibility of achieving the target level of lipid pattern in patients with high and very high cardiovascular risk (CVR) in real clinical practice.Material and methods. The design of the “PRIORITET” observational program is an open observational study. Patients with high and very high CVR were divided into 3 groups in accordance with the initial data: (1) not taking statins, (2) taking statins, but not reaching the target low-density lipoprotein cholesterol (LDL-C) level, (3) taking statins with the achievement of the target LDL-C level, which is justified in replacing the statin inside the class — adverse effects (AE), high price, etc. Within 12 weeks 3 visits of patients to hospitals were carried out: baseline visit (B0), visit 1 month after the study initiation (B1) and visit 3 months after the study initiation (B3). The choice of atorvastatin or rosuvastatin was assessed by the doctors.Results. Groups 1, 2 and 3 included 112, 170 and 16 people, respectively. At B0, 145 (48,7%) patients were prescribed atorvastatin, and 153 (51,3%) — rosuvastatin. Three people dropped out of the study to B3, 295 patients completed the program. Lipid pattern of 285 patients were analyzed: 121 (41%) people (101 with very high CVR and 20 with high CVR) achieved the target LDL-C level, the remaining 164 (59%) patients (CVR — 156 and 8, respectively) — no. The most pronounced dynamics of LDL=C level was revealed in group 1, the differences between group 1 and groups 2 and 3 are highly statistically significant (p<0,0001). There were no differences in the frequency of reaching the target LDL-C level between patients taking atorvastatin or rosuvastatin. The target level of LDL-C (p=0,003) in the treatment of rosuvastatin in patients with high CVR was reached significantly more often than in patients with very high CVR. Also 3 non-serious AEs were reported. On average, in 9% of cases, reaching the target level of LDL-С during visits B1 and B3 was wrong interpreted by the attending physicians.Conclusion. The main problems of statin therapy in real clinical practice are the wrong interpretation of reaching the target level of LDL-C, inertness of doctors in titrating of statins doses and achieving the target level of lipid pattern. It may be the cause of reduced efficiency and deterioration of lipid-lowering therapy results in patients with high and very high CVR. The results of the “PRIORITET” study demonstrated the possibility of improving the practice of statins use and its accordance with clinical guidelines.Skibitsky V. V. on behalf of the working group of the “PRIORITET” researchWorking Group of the “PRIORITET” study: Voronina V. P. (Moscow), Zelenova T. I. (Moscow), Sladkova T.A. (Moscow), Alekseeva A. I. (Tula), Barabanova T. Yu. (Tula), Zotova A. S. (Tula), Kolomeitseva T. M. (Tula), Prikhod’ko T. N. (Tula), Pazelt E. A. (Nizhny Novgorod), Khramushev N. Yu. (Nizhny Novgorod), Skibitsky A. V. (Krasnodar), Alekseeva V. V. (Saratov), Lazareva E. V. (Saratov).

scholarly journals Modern Hypolipidemic Therapy in Patients with Arterial Hypertension with High Cardiovascular Risk Under Conditions of Long-Term Ambulatory Observation

2020 ◽  
Vol 12 (14) ◽  
pp. 68-72
Author(s):  
Ruziyeva Amira Asrorovna ◽  
Muradova Railya Rustamovna ◽  
Turaev Khikmatulla Negmatovich ◽  
Nuralieva Rano Matyakubovna
Keyword(s):  
Cardiovascular Risk ◽  
Arterial Hypertension ◽  
High Cardiovascular Risk

scholarly journals The use of angiotensin receptor blocker losartan in the combinational therapy of arterial hypertension

2009 ◽  
Vol 6 (4) ◽  
pp. 12-15
Author(s):  
N Sh Zagidullin ◽  
Sh Z Zagidullin
Keyword(s):  
Cardiovascular Risk ◽  
Combination Therapy ◽  
Arterial Hypertension ◽  
Resistant Hypertension ◽  
Angiotensin Receptor Blocker ◽  
High Efficiency ◽  
Combined Therapy ◽  
Angiotensin Receptor ◽  
High Cardiovascular Risk ◽  
Combinational Therapy

Blockade of renin-angiotensin systems is one problem in the treatment of arterial hypertension. Resistant hypertension and patients with high cardiovascular risk demand frequently use of combination therapy. The efficiency of combined therapy losartan plus hydrochlorothiazide at patients with arterial hypertension was studied in several large clinical multicentre randomized studies. It is proved high efficiency and safety of this combination therapy.

scholarly journals Clinical haracteristik and psychological profile of patients with arterial hypertension with high cardiovascular risk against the background of antihypertensive therapy with inhibitors of angiotensin converting enzyme (ACE)

2013 ◽  
Vol 4 (4) ◽  
pp. 36-39
Author(s):  
D. S Kaskayeva ◽  
M. M Petrova ◽  
V. V Kostina ◽  
A. A Evsyukov ◽  
E. A Tepper
Keyword(s):  
Cardiovascular Risk ◽  
Angiotensin Converting Enzyme ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Cardiovascular Complications ◽  
Psychological Profile ◽  
Converting Enzyme ◽  
High Cardiovascular Risk ◽  
Dynamic Observation ◽  
Comparative Aspect

The article in comparative aspect presents results of rating of psychological profile of 142 patients (all are men, average age 46,5±0,35 years) with arterial hypertension of stage I–III with high risk of cardiovascular complications having been studied after 6 months of dynamic observation against the background of conducted antihypertensive therapy with inhibitors of angiotensin converting enzyme (ACE).

scholarly journals Pharmacoeconomic Analysis of Therapy with Generic Statin Drugs in Patients with High and Very High Cardiovascular Risk (According to the Study PRIORITY)

2020 ◽  
Vol 16 (5) ◽  
pp. 693-698
Author(s):  
S. Yu. Martsevich ◽  
Yu. V. Lukina ◽  
N. P. Kutishenko
Keyword(s):  
Cardiovascular Risk ◽  
Cost Effectiveness ◽  
Statin Therapy ◽  
Pharmacoeconomic Analysis ◽  
Target Level ◽  
Cost Effectiveness Ratio ◽  
High Cardiovascular Risk ◽  
The Cost ◽  
Statin Drugs ◽  
Very High

Aim. To perform a pharmacoeconomical assessment of the use of generic statin drugs in patients with high and very high cardiovascular risk (CVR) in real clinical practice based on the data of the study PRIORITY.Material and methods. The PRIORITY study included 298 patients with high (29; 9.7%) and very high (269, 90.3%) CVR. All patients were recommended to take the reproduced drugs of atorvastatin and rosuvastatin in an individually prescribed dose. After 1 month (B1), if the target level of lowdensity lipoprotein cholesterol (LDL-C) was not reached, the statin dose was titrated. After 3 months of follow-up (B3), the hypolipidemic effect of statin therapy was evaluated. 295 people completed the study, 285 patients had the results of the lipid profile. To perform a pharmacoeconomic analysis and evaluate the “cost/effectiveness” ratio, we used the prices of generic statins in one of the online pharmacies. The effectiveness of statins was determined by the LDL-C reduction, as well as by the percentage of achieving the target LDL-C level.Results. At the first stage of the pharmacoeconomic analysis, the criterion for the effectiveness of 3-month lipid-lowering therapy was a decrease in LDL-C level by 1 mmol/l. The median and interquartile range of the ratio “cost/effectiveness” indicator for atorvastatin was 658.2 (431.5; 1257.1) RUB/mmol/l, and for rosuvastatin – 621.0 (390.7; 940.6) RUB/mmol/l (p=0.45). The results of a comparative assessment of the “cost/effectiveness” ratio (with the abovementioned effectiveness indicator) in subgroups of patients with high and very high CVR, with the achievement and nonachievement of the target level of LDL-C, adherent and non-adherent to statins, revealed the economic advantage of statins in groups of adherent patients (p=0.35), high-risk patients (p<0.0001) and individuals who reached the target level of LDL-C (p=0.002) when compared with the corresponding comparison groups. Despite the revealed high effectiveness of rosuvastatin at doses of 20-40 mg/day (assessed by the cost/effectiveness of achieving the target values of LDL-C for specific doses of statins), calculation of the “cost/effectiveness” ratio for each reproduced statin, in general, showed a higher economic effectiveness of atorvastatin.Conclusion. Pharmacoeconomic analysis of therapy with generic statin drugs, performed according to the data of the non-randomized uncontrolled study, allows to justify the economic efficiency and advantages of these drugs in various subgroups of patients who need statin therapy.

scholarly journals Pathogenetic role of cell-free circulating mitochondrial DNA in blood in the development of arterial hypertension

2021 ◽  
pp. 50-57
Author(s):  
С.А. Лепехова ◽  
Е.А. Трофимова ◽  
С.В. Кирильчик ◽  
В.В. Киреева ◽  
Ю.К. Усольцев ◽  
...  
Keyword(s):  
Mitochondrial Dna ◽  
Cardiovascular Risk ◽  
Arterial Hypertension ◽  
High Cardiovascular Risk ◽  
Pathogenetic Role ◽  
Quantitative Indicator ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
Very High

Изучение свободно циркулирующей митохондриальной ДНК (мтДНК) плазмы крови вызывает растущий интерес. Предполагается, что показатель мтДНК может быть перспективным клиническим биомаркёром оценки рисков течения заболеваний. Целью исследования явилась оценка взаимосвязи количественного показателя мтДНК со стадией заболевания и сердечно-сосудистым риском у пациентов с артериальной гипертензией (АГ). Методы. В исследовании участвовал 70 пациентов, которые были разделены на группу с АГ (n = 51) и контрольную группу практически здоровых пациентов (n = 19). Все пациенты подписали информированное согласие на обследование и обработку данных в рамках научного исследования. Проведена оценка демографических данных, длительности заболевания АГ, факторов риска, наследственности, уровня физической активности, антропометрических данных, лабораторное и инструментальное обследование. Оценка уровня мтДНК проведена методом количественной полимеразной цепной реакции. Использовали фрагмент мтДНК с праймерами FmtMinArc 5'-CTAAATAGCCCACACGTTCCC-3' и RmtMinArc 5'-AGAGCTCCCGTGAGTGGTTA-3'. Результаты. На основании проведенного исследования оценки взаимосвязи количественного показателя мтДНК в крови пациентов с АГ, выявлено, что независимо от стадии заболевания, достоверных различий в показателях уровня мтДНК не выявлено, однако отметим, что количество копий имело тенденцию к увеличению по сравнению с условно здоровыми пациентами. При анализе сердечно-сосудистого риска обнаружено, что количественный показатель мтДНК не зависит от стадии АГ. В то же время уровень мтДНК статистически значимо повышается у пациентов с АГ очень высокого сердечно-сосудистого риска по сравнению с условно здоровыми субъектами: Me (Q1; Q3) - 56731 (42531; 129375) копий/мл против 35156 (18325; 54956) копий/мл соответственно (p = 0,015). Заключение. Уровень мтДНК у пациентов с АГ может явиться маркёром сердечно-сосудистого риска. Учитывая ранее показанную патогенетическую роль уровня мтДНК при остром коронарном синдроме, следует продолжить анализ, чувствительность которого может быть повышена за счет включения количественных показателей содержания ядерной ДНК. Studying cell-free circulating mitochondrial DNA (mtDNA) in blood plasma induces growing interest. It is assumed that an indicator of mtDNA may appear a promising clinical biomarker for assessment of the risks in the course of diseases. The aim of this study was evaluating the relationship between the quantitative indicator of mtDNA in the blood of patients with arterial hypertension (AH) and the stage of the disease and the cardiovascular risk. Methods The study included 70 patients who were divided into a group with AH (n = 51) and a control group of apparently healthy patients (n = 19). All patients signed the informed consent for examination and the processing of personal data as a part of the study. Demographic data, duration of hypertension, risk factors, heredity, physical activity, anthropometric data, results of slaboratory and instrumental examinations were recorded. Concentration of mtDNA was measured by the quantitative polymerase chain reaction. A mtDNA fragment with primers FmtMinArc 5'-CTAAATAGCCCACACGTTCCC-3' and RmtMinArc 5'-AGAGCTCCCGTGAGTGGTTA-3' was used. Results. Studying the relationships between the quantitative indicator of mtDNA in the blood and AH showed that there were no significant differences in the indicators for the level of mtDNA regardless of the AH stage. However, we noted that the number of copies tended to increase in comparison with that in conventionally healthy patients. Analysis of the cardiovascular risk showed that the quantitative indicator of mtDNA did not depend on the stage of hypertension. At the same time, the level of mtDNA was significantly increased in very high cardiovascular risk patients with AH as compared to conventionally healthy subjects: Me (LQ; UQ), 56731.2 (42531.25; 129375.0) copies/ml vs. 35156.00 (18325.00; 54956.00) copies/ml, respectively (p = 0.015). Conclusion. The level of mtDNA in AH patients is a potential a marker for cardiovascular risk as shown by the increase in mtDNA in very high cardiovascular risk patients. Taking into account the previously demonstrated pathogenetic role of the level of mtDNA in acute coronary syndrome, the analysis should be continued. The analysis sensitivity can be increased by inclusion of quantitative indicators for the content of nuclear DNA.

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