Arterial hypertension: modern advances in metabolomics

Early diagnosis and effective pharmacotherapy of arterial hypertension are urgent problems, a significant contribution to the solution of which can be made by metabolomics. The etiology of hypertension remains unknown for the majority of patients with high blood pressure; the diagnosis for 90% is defined as essential (primary) hypertension. This population is characterized by disturbance of the metabolic pathways of lipids, glucose, biogenic amines and amino acids, which may manifest with hyperlipidemia, hyperglycemia, and insulin resistance with the possible subsequent development of type II diabetes mellitus. The study of the metabolomic signature can provide a clue to the identification of biomarkers of hypertension and contribute to the effective development of preclinical diagnosis and identification of risk groups, as well as a more complete understanding of the etiological and pathogenetic mechanisms of increased blood pressure. Published studies indicate the existence of metabolome characteristic of hypertensive patients, distinguishing them from normotensive subjects. The most typical are changes involving amino acids, polyunsaturated fatty acids, carnitines, phosphatidylcholines, and acylglycerols.The variability of the response to antihypertensive therapy does not allow achieving effective control of blood pressure in a significant proportion of patients. The peculiarities of changes in the metabolome under the use of various pharmacological groups can be used to identify metabolite markers of the response to the main classes of antihypertensive drugs, as well as markers of the development of side effects of drug therapy. Thus, individualization of the pharmacotherapeutic approach based on pharmacometabolomics can significantly increase the efficacy and safety of antihypertensive therapy.This review aims to study the main groups of metabolites identified in published trials as predictors of the development of hypertension, as well as metabolite markers of response to antihypertensive therapy.

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The effectiveness of combination antihypertensive therapy in patients with arterial hypertension and additional risk factors: obesity and obstructive sleep apnea syndrome

Terapevticheskii arkhiv ◽

10.26442/00403660.2018.12.000005 ◽

2018 ◽

Vol 90 (12) ◽

pp. 28-33 ◽

Cited By ~ 1

Author(s):

E M Elfimova ◽

A Yu Litvin ◽

I E Chazova

Keyword(s):

Blood Pressure ◽

Sleep Apnea ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Fixed Combination ◽

Blood Pressure Monitoring ◽

Target Blood Pressure ◽

Effective Control ◽

Pressure Monitoring ◽

Male Patients

Aim. To study the effectiveness of a fixed combination of perindopril and amlodipine, with the subsequent addition of indapamide-retard in male patients with arterial hypertension (AH), obesity and severe sleep apnea (OSAS). Materials and methods. The study included 43 male patients in whom antihypertensive therapy titration was performed to achieve target blood pressure values with a fixed combination of calcium antagonist amlodipine (10 mg) and an angiotensin-converting inhibitor perindopril (5-10 mg) and indapamide-retard. At baseline and after 4-6 weeks, the effectiveness of antihypertensive therapy was monitored according to clinical measurements and ambulatory blood pressure monitoring (ABPM). An assessment of the carotid-femoral pulse wave velocity (cfPWV), aortic PWV (aoPWV), and ankle-brachial PWV (abPWV) was performed. Results and discussion. Target blood pressure values (according to clinical blood pressure, 24-hour blood pressure monitoring) during therapy with amlodipine 10 mg and perindopril 10 mg reached 65% of patients and another 30% reached target blood pressure when adding indapamide-retard 1.5 mg, that is - 95% of all patients included in the study. Upon reaching the target blood pressure values, a significant decrease in cfPWV, aoPWV and abPWV was observed. Conclusion. The fixed combination of perindopril arginine and amplodipine, with the addition of indapamide retard in male patients with hypertension 1st degree in the presence of obesity and severe OSAS allows to reach effective control of blood pressure and improve the elastic properties of large arteries, which can lead to a favorable organoprotective effect in this category of patients.

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EPOCHA-AH 1998–2017. Dynamics of prevalence, awareness of arterial hypertension, treatment coverage, and effective control of blood pressure in the European part of the Russian Federation

Kardiologiia ◽

10.18087/cardio.2445 ◽

2019 ◽

Vol 59 (1S) ◽

pp. 34-42 ◽

Cited By ~ 9

Author(s):

Yu. V. Badin ◽

I. V. Fomin ◽

Yu. N. Belenkov ◽

V. Yu. Mareev ◽

F. T. Ageev ◽

...

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Russian Federation ◽

Representative Sample ◽

Antihypertensive Drugs ◽

Pilot Project ◽

European Part ◽

Effective Control ◽

Treatment Coverage ◽

The Russian Federation

Aim.To perform a repeated epidemiological study of a representative sample in the European part of the Russian Federation in 2017 and to compare the dynamics of arterial hypertension (AH) prevalence with the eﬀectiveness of blood pressure (BP) control in the population compared to 1998, 2002, and 2007.Materials and methods.A representative sample of the European part of the Russian Federation was created in 2002 and re-examined in 2007 and 2017. In 1998, a pilot project was performed for examining a representative sample for the Nizhniy Novgorod region.Results.During 19 years of follow-up, the AH prevalence increased from 35.5 to 43.3%. Te awareness and treatment coverage reached 76.9 and 79.3%, respectively, in 2017. Achievement of the target BP with a single measurement also increased among patients receiving antihypertensive medication from 14.3 to 34.9%. For the treatment of AH, medium-acting antihypertensive drugs are used, ofen at suboptimal doses.Conclusion.Epidemiological indices of awareness, treatment coverage, and number of eﬀectively managed patients with AH have improved. However, the AH prevalence has increased by 7.8% for 19 years, which indicates inefciency of the primary prevention of this disease.

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The optimal combination of Lysinopril and Amlodipine for the treatment of patients with hypertension

International Professional Journal Medicine ◽

10.31082/1728-452x-2020-211-212-1-2-31-39 ◽

2020 ◽

Vol 1-2 (211-212) ◽

pp. 31-39

Author(s):

Gulnara Junusbekova ◽

◽

Meiramgul Tundybayeva ◽

Tatyana Leonovich ◽

Manshuk Yeshniyazova ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Risk ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Cardiovascular Complications ◽

Antihypertensive Activity ◽

Daily Monitoring ◽

Very High

Arterial hypertension (AH) remains one of the most common diseases in the world. Reducing cardiovascular risk of mortality from cardiovascular complications is a priority in the treatment of hypertension. Targets of hypertension therapy is to achieve SBP/DBP <140/80 mm Hg. article, regardless of cardiovascular risk and comorbidity. The choice of antihypertensive therapy depends on blood pressure levels, the presence or absence of concomitant diseases, lesion of target organs. Effective and long-lasting control of AH proved by the use of combinations of antihypertensive drugs, including antagonists and ACE inhibitors. The purpose of the study. Evaluation of clinical efficacy and safety of fixed combination antihypertensive therapy using lisinopril combined with amlodipine in patients with hypertension. Material and methods. The study included 30 respondents from essential hypertension II-III degree (ESH/ESC, 2018) aged 35 to 75 years. Patients were treated with the schema a (lisinopril 10 mg, amlodipine 5 mg) and scheme b (lisinopril 20 mg, amlodipine 10 mg) fixed combination therapy with the drug VivaCor® once in the morning. The period of observation was 3 months. At the time of inclusion and at the end of the study all respondents was performed echocardiography, daily monitoring of blood pressure, evaluation of laboratory and instrumental methods of research. Results and discussion. The combination of lisinopril with amlodipine has a fairly high antihypertensive activity, provides a significant cardioprotective effect and is an integral part of antihypertensive therapy in the long-term strategy of administering patients with high hypertensive / very high total cardiovascular risk. Conclusions: 1. The use of a fixed combination of lisinopril and amlodipine in patients with hypertension instead of free or other two-component combinations leads to its target level within 3 months of therapy. 2. Taking a fixed combination of lisinopril and amlodipine is effective and safe. 3. Therapy using the combined drug VivaCor® in patients with high / very high risk of hypertension prevents further pathological remodeling of the heart. 4. The combination of amlodipine and lisinopril is metabolically neutral and well tolerated by patients. Keywords: arterial hypertension, lisinopril, amlodipine, VivaCor.

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Elderly Patient with Hypertension in General Practice: Clinical Features and Antihypertensive Therapy

Family Medicine ◽

10.30841/2307-5112.1.2021.231938 ◽

2021 ◽

pp. 61-66

Author(s):

Viacheslav Zhdan ◽

Yevdokiia Kitura ◽

Maryna Babanina ◽

Oksana Kitura ◽

Maksym Tkachenko

Keyword(s):

Blood Pressure ◽

Elderly Patients ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

High Frequency ◽

Antihypertensive Drugs ◽

White Coat Hypertension ◽

Aged Patients ◽

Increased Risk ◽

Treatment Of Hypertension

The prevalence of arterial hypertension (AH) increases with age: among people over 60 years old this index is more than 2 times higher in the general population, 2/3 of people over 65 years old suffer from hypertension. Among patients 65–89 years old with hypertension, 2/3 patients have isolated systolic hypertension (ISAG). Features of hypertension in the elderly patients are: lability of blood pressure (BP), increasing frequency of pseudohypertension, high frequency of «white coat hypertension», decreased sensitivity of pressor factors for antihypertensive drugs, high frequency of resistant to treatment of hypertension. The new recommendations of the European Society of Cardiology for the diagnosis and treatment of hypertension emphasize 2 groups of elderly patients: 65–79 years old and ≥80 years old, which described the epidemiological features, the prevalence of risk factors for cardiovascular events, blood pressure levels for antihypertensive therapy and target blood pressure, and the recommended principles of drug therapy that are different from young and middle-aged patients. For most patients, fixed combinations are indicated as starting AGT, but monotherapy is recommended for the treatment of hypertension in very elderly patients (over 80 years old) and elderly patients over 65 years old with senile asthenia. The decreasing of blood pressure should be gradual, taking into consideration the increased risk of orthostatic reactions at this age. European and American experts recommend os first-line drugs low doses of thiazide diuretics and calcium channel antagonists (mainly dihydropyridine), which are especially indicated in isolated systolic arterial hypertension to effectively reduce the frequency of cardiovascular complications in the treatment of elderly patients with hypertension.

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Arterial hypertension in ophthalmic surgical patients

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2021-1-186-191 ◽

2021 ◽

pp. 186-191

Author(s):

L.V. Pavlyushchenko ◽

◽

E.E. Filimonova ◽

M.A. Esina ◽

◽

...

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Clinical Symptoms ◽

Antihypertensive Drugs ◽

High Stress ◽

Cardiovascular Complications ◽

Surgical Patients ◽

Uncontrolled Hypertension ◽

Standard Dosage

Purpose. Analysis of the frequency and structure of arterial hypertension (AH) among ophthalmic surgical patients, assessment of the adequacy of prescribed antihypertensive therapy. Material and methods. Clinical material is presented by 157 patients with hypertension. Its structure was assessed. Its structure was assessed according to the stage, the degree of increase in the level of blood pressure (BP) and the category of cardiovascular risk. We analyzed the proportion of cases of uncontrolled hypertension, including those with a sudden pronounced individually significant increase in blood pressure without affecting target organs. Results. The prevalence of patients was stage III hypertension (62.4%), grade 3 hypertension (53.5%), with a very high and high risk of cardiovascular complications (73.2 and 20.4%, respectively). 93.6% of patients received antihypertensive therapy, but only 57.1% of them, mostly women (69.1%), regularly took medications and monitored their blood pressure. With a sudden pronounced individually significant increase in blood pressure, we used oral antihypertensive drugs – captopril and nifedipine, which made it possible to achieve a decrease in blood pressure and relief of clinical symptoms in all cases. Conclusion. 33.1% of patients had no hypertension control at the time of hospitalization. The proportion of patients with a sudden pronounced individually significant increase in blood pressure was 12.7%. Typical reasons for loss of control over hypertension were interruptions in taking antihypertensive drugs and high stress levels before surgery. The use of standard dosage captopril and nifedipine was effective in all cases. Key words: arterial hypertension, sudden pronounced individually significant increase in blood pressure, antihypertensive therapy.

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RESISTANT ARTERIAL HYPERTENSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: PREVALENCE, PROGNOSTIC SIGNIFICANCE, REASONS AND APPROACHES TO ANTIHYPERTENSIVE THERAPY

Nephrology (Saint-Petersburg) ◽

10.24884/1561-6274-2019-23-1-37-44 ◽

2019 ◽

Vol 23 (1) ◽

pp. 37-44 ◽

Cited By ~ 1

Author(s):

O. B. Kuzmin ◽

V. V. Zhezha ◽

L. N. Landar ◽

O. A. Salova

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Drug Therapy ◽

Kidney Disease ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Resistant Hypertension ◽

Antihypertensive Drugs ◽

Refractory Hypertension ◽

Hypertensive Patients

Arterial hypertension (AH) resistant to drug therapy is the phenotype of uncontrolled AH, in which patients receiving at least 3 antihypertensive drugs, including a diuretic, maintain blood pressure above the target level. Initially, the term refractory hypertension was also used to refer to resistant hypertension. Recently, however, refractory hypertension has been isolated into a separate phenotype of difficult to treat hypertension, which is defined as insufficient control of target blood pressure, despite the use of at least 5 different mechanisms of antihypertensive drugs, including long-acting diuretic and antagonist of mineralcorticoid receptors. Resistant hypertension is detected in 10–15 % of all hypertensive patients receiving drug therapy, and is often found in patients with chronic kidney disease. Hypertension can be a cause and/or consequence of kidney damage and is typical of most patients with chronic kidney disease. The lack of control of target blood pressure in a significant proportion of hypertensive patients with CKD who receive at least 3 antihypertensive drugs of different mechanisms of action indicates a lack of effectiveness of antihypertensive therapy, which not only accelerates the loss of renal function, but also significantly worsens the prognosis, contributing to such people risk of cardiovascular and renal complications. The review presents data on the prevalence, prognostic value of resistant hypertension in patients with chronic kidney disease, features of its formation and approaches to increasing the effectiveness of antihypertensive therapy in this patient population.

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Antihypertensive efficacy of a fixed full-dose perindopril A-indapamide combination in patients with grades 2–3 arterial hypertension

Systemic Hypertension ◽

10.26442/sg28953 ◽

2013 ◽

Vol 10 (1) ◽

pp. 66-69

Author(s):

T V Glukhova ◽

S A Solgalova ◽

V V Alferov

Keyword(s):

Blood Pressure ◽

Combination Therapy ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Antihypertensive Drugs ◽

Antihypertensive Agents ◽

Antihypertensive Efficacy ◽

Fixed Dose ◽

Full Dose ◽

Achieve Blood Pressure

Aim: to study the antihypertensive efficacy of a fixed full-dose perindopril arginine-indapamide combination in patients with grades 2–3 arterial hypertension (AH) who do not receive antihypertensive therapy or those who do not achieve blood pressure (BP) control with other antihypertensive drugs. Subjects and methods. The trial enrolled 30 patients: 20 (66,6%) males and 10 (33,3%) females aged 30 to 60 years (mean age 50,5±7,1 years). Grades 2 and 3 AH was recorded in 28 (93,3%) and 2 (6,6%) patients, respectively. According to office measurements, the baseline BP (systolic BP (SBP)/diastolic BP (DBP) averaged 169±13,3/100,3±6,9 mm Hg in the group. Before included into the trial, 25 (83,4%) patients had taken antihypertensive agents, of them 10 (40%) and 2 (5%) examinees had combination therapy and fixed-dose combinations, respectively. Results. During therapy with a fixed-dosed combination of perindopril arginine 10 mg and indapamide 2,5 mg, there was generally a trend for SBP and DPB to lower at week 2 of therapy and there was a significant reduction in SBP by 42,4±11,2 mm Hg and in DBP by 20,1±9,3 mm Hg by the end of month 3. The goal BP (lower than 140/90 mm Hg) was achieved in 96,6% of the patients. Conclusion. The fixed full-dose perindopril arginine-indapamide combination allows therapeutic efficiency to be enhanced in grades 2–3 AH patients having no target BP values.

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Perspektivy klinicheskogo primeneniyanovoy fiksirovannoy kombinatsii -preparata Ko-Eksforzh v lecheniiarterial'noy gipertonii

Cardiosomatics ◽

10.26442/cs44978 ◽

2011 ◽

Vol 2 (1) ◽

pp. 64-71

Author(s):

Marina Gennad'evna Bubnova

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Treatment Compliance ◽

Efficacy And Safety ◽

High Efficacy

Summary. This review is concerned with improving of blood pressure (BP) control in patients with arterial hypertension (AH). The reasons for the low treatment compliance and combined antihypertensive therapy benefits are analyzed. Data for futility of an extended use of antihypertensive drugs (AHD) fixed combinations are given. Studies demonstrating high efficacy and safety of a new triple fixed combination of amlodipine, valsartan and hydrochlorothiazide (HCT) are presented as well. Patients with hypertension, which should more actively use this combination of drugs, are signified.

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Doctors’ Adherence to the Guidelines on the Diagnostics and Treatment of Arterial Hypertension

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2019-15-4-502-509 ◽

2019 ◽

Vol 15 (4) ◽

pp. 502-509

Author(s):

N. B. Perepech ◽

V. D. Shurygina ◽

A. V. Tregubov

Keyword(s):

Blood Pressure ◽

Risk Stratification ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Clinical Guidelines ◽

Antihypertensive Drugs ◽

Blood Pressure Level ◽

Cardiovascular Complications ◽

Target Blood Pressure ◽

Fixed Dose

Aim. Examination of knowledge of the basic provisions of clinical guidelines for the management of patients with arterial hypertension and finding out the readiness of doctors for the practical application of updated recommendationsMaterial and methods. Anonymous questionnaires of 306 doctors served as material for the study. The questionnaire consisted of two parts. The introductory part included questions that allow to find out the specialty, work experience, gender, age, and whether the respondent has cardiovascular risk factors. The main part of the questionnaire included 16 questions regarding provisions of the guidelines on the diagnosis and treatment of arterial hypertension in force at the time of the survey (2017/2018 academic year). Statistical processing of the results was carried out using the Microsoft Excel 2010 software package. Differences were regarded as significant at p<0.05.Results. The findings suggest that both therapists and cardiologists do not give due importance to the risk stratification of cardiovascular complications in patients with arterial hypertension and are not sufficiently aware of the possibilities and limitations of the use of combinations of antihypertensive drugs. Therapists worse than cardiologists know the main points of the clinical guidelines for the management of patients with arterial hypertension (target blood pressure levels during treatment [64.6% vs 87.7%, p<0.001], indications for combination antihypertensive therapy starting, the possibility of fixed dose combinations using [52.3% vs 83.9%, p<0.001]). A significant part of physicians (both cardiologists and therapists) adequately assess the antihypertensive treatment effectiveness, not enough frequent achievement of the target blood pressure level in their patients and is willing to provide more strict control of blood pressure.Conclusion. The results of the survey indicate the need of the active education of doctors in the management of patients with arterial hypertension. The most attention should be paid to the training of therapists and general practitioners on the cardiovascular complications risk stratification, the using of the antihypertensive drugs combinations use and methods to increase patient adherence to antihypertensive therapy.

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The comparative effects of different fixed combinations of antihypertensive drugs in patients with arterial hypertension and hypothyroidism

Ukrainian Journal of Cardiology ◽

10.31928/1608-635x-2020.4.3544 ◽

2020 ◽

Vol 27 (4) ◽

pp. 35-44

Author(s):

V. I. Tseluyko ◽

D. A. Korchagina

Keyword(s):

Blood Pressure ◽

Arterial Hypertension ◽

Antihypertensive Therapy ◽

Fixed Combination ◽

Antihypertensive Drugs ◽

Blood Pressure Monitoring ◽

Myocardial Mass ◽

Pressure Monitoring ◽

Heart Remodeling ◽

Group 2

The aim – to assess the effects of different fixed double combinations of antihypertensive drugs and analyze their impact on heart remodeling in patients with arterial hypertension and hypothyroidism. Materials and methods. The study included 50 patients with hypertension and hypertension, which were divided into 2 groups by the method of blind envelopes of 25 people each. Patients in group 1 were assigned a fixed combination of perindopril with indapamide, patients in group 2 were assigned a fixed combination of perindopril with amlodipine. The groups were statistically compared by age, duration of hormonal substitution therapy, duration of hypertension, level of office SBP, DBP at inclusion in the study. In terms of body mass index, the study groups were comparable, but the number of obese patients was higher in group 2 (p=0.05). Observation of patients lasted 12 months.Results and discussion. The studied fixed combinations of antihypertensive drugs, namely perindopril with indapamide and perindopril with amlodipine provide a reduction in blood pressure in patients with hypertension with concomitant hypothyroidism according to the results of ambulatory blood pressure monitoring. Control of blood pressure in patients with arterial hypertension and concomitant hypothyroidism during a year of antihypertensive therapy provides a reduction in the severity of heart remodeling, the nature and extent of which depends on both the presence of obesity and the choice of a fixed combination of antihypertensive drugs.Conclusions. The results showed that in patients with AН and hypothyroidism achievement of euthyroid state contributes to BP reduction, but requires further administration of antihypertensive therapy. We studied fixed combinations of antihypertensive drugs, namely perindopril with indapamide and perindopril with amlodipine in patients with AG and associated hypothyroidism provide reliable blood pressure reduction according to the results of outpatient blood pressure monitoring (р<0.05). The fixed combination of perindopril with amlodipine compared with the fixed combination of perindopril with indapamide provides a significantly more significant effect on the regression of left ventricular myocardial hypertrophy, namely, a decrease in myocardial mass index by a degree of 2.7 in patients with obesity (р<0,01) myocardial mass index by body surface area in patients without obesity (p=0.06).

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