Clinical features and course of arterial hypertension in patients with its various forms

Aim. To study the main risk factors, clinical, laboratory and instrumental data, concomitant cardiovascular diseases (CVD) and associated clinical conditions in patients with controlled and uncontrolled hypertension, controlled resistant and uncontrolled resistant hypertension, refractory hypertension, and probably resistant and probably refractory hypertension based on retrospective analysis. Materials and methods. The study included 455 patients with hypertension. All patients were divided into 7 groups. The group of controlled hypertension included 240 patients (52.75%), controlled resistant hypertension 61 (13.4%), uncontrolled hypertension 10 (2.2%), uncontrolled resistant hypertension 53 (11.65%), refractory hypertension 63 (13.8%), probably resistant hypertension 15 (3.3%), probably refractory hypertension 13 (2.9%). Anamnesis (assessment of the duration and age of the onset of arterial hypertension, assessment of the presence of CVD), risk factors for the development of hypertension (obesity, dyslipidemia, impaired glucose tolerance and fasting glycemia, hyperuricemia, family history of CVD, early menopause in women; heart rate 80 beats/min, smoking), laboratory parameters (creatinine, glucose, total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, uric acid) and instrumental methods of examination (ECG, echocardiography, clinic mean 24h BP, Holter monitoring, duplex BCA scanning) were assessed in all groups of patients based on the analysis of the medical history. Results. In this article we presented the results of a comparative analysis of patients with controlled hypertension, uncontrolled resistant hypertension, refractory and probably refractory hypertension. Patients with refractory hypertension were significantly more young, non-smokers and females compared with patients with uncontrolled resistant hypertension and controlled hypertension. Patients with refractory hypertension had greater prevalence of left ventricular hypertrophy according to ECG and echocardiography (p0.05). Fundus lesions were found exclusively in patients with uncontrolled hypertension, 55% of cases were found in the group of refractory hypertension (p0.05). There were no significant differences in the presence of BCA atherosclerosis between the groups. Patients with refractory hypertension were significantly more likely to have heart failure, a history of stroke and transient ischemic attack compared with patients from the group of controlled hypertension (p0.05). There was no significant difference in the presence of chronic kidney disease, type 2 diabetes mellitus, coronary heart disease, atrial fibrillation between the groups. Conclusion. Patients with refractory hypertension are significantly more likely to have target organ damage and concomitant cardiovascular, cerebrovascular diseases than patients with controlled hypertension.

Evaluation of heart rate variability in patients with different forms of pulmonary hypertension

Pulmonary hypertension (PH) is a severe pathology of the cardiovascular system with extremely poor prognosis, if unreated. Early diagnosis of PH is difficult, due to the absence pathognomonic symptoms, and at the initial stage the disease may be asymptomatic. An increase in pulmonary vascular resistance and pressure in the pulmonary artery cause severe dysfunction of the right ventricle, which affects the functional status of patients. The assessment of heart rate variability (HRV) parameters is used to predict the increased risk of sudden death in various diseases of the cardiovascular system and the functional status of the body. HRV is mainly regulated by the sympathetic and parasympathetic divisions of the autonomic nervous system. It is noted that pulmonary arterial hypertension is associated with increasing of sympathetic activity. The review, based on the analysis of the pathophysiological mechanisms of pulmonary arterial hypertension and chronic thromboembolic PH, presents the results of studies assessing the time and spectral parameters of HRV in patients with PH of various etiologies.

Renal artery denervation in patients with resistant arterial hypertension: clinical and organ-protective effect

Aim. To assess the clinical efficacy of renal artery denervation (RAD) in treatment of patients with resistant arterial hypertension (RAH) compared to patients taking drug therapy (DT) at long-term follow-up and the possibility of RAD impact on target organs (heart, kidneys). Materials and methods. 80 RAH patients were examined (mean age 54.3010.19 years). Patients were divided in two groups: the basic group was comprised of 40 RAH patients taking antihypertensive DT, who underwent RAD (gr. 1) and comparison group was composed of 40 RAH patients taking only antihypertensive DT (gr. 2). Gender and age differences between groups were statistically insignificant (p0.05). Mean duration of AH was 18.638.96 years. The follow-up was carried out during one year. Results. In RAD group there was confirmed decrease not only in the office, but also in the average day-time and night-time blood pressure (BP), changes were more significant in systolic BP (SBP) indicators: the overall daytime SBP was 17.369.31 mmHg (p0.001), the average day-time SBP was 17.1810.53 mmHg (p0.001), the average night-time SBP was 19.2210.76 mmHg (p0.001). At the same time, in DT group changes in values of overall, maximum, minimum, average day-time and average night-time SBP and diastolic BP were not statistically significant in 12 months. RAD in RAH was accompanied by decrease in left ventricular hypertrophy with initial hypertrophy (p0.05), decrease in microalbuminuria (p0.05), decrease in velocity in segmental (p0.05) and interlobar renal arteries (p0.01). Conclusion. RAD in patients with RAH had not only antihypertensive effect but also positive effect on target organs of AH (heart, kidneys).

Management of patients with arterial hypertension and atrial fibrillation

Arterial hypertension (AH) is a leading risk factor for cardiovascular disease as well as it is the most common, independent and potentially reversible risk factor for atrial fibrillation (AF). AH contributes to the occurrence and maintenance of AF due to hemodynamic disorders, alterations in cardiomyocyte electrophysiological properties and structural remodeling in the atria. AF, which is also associated with an increased risk of cardiovascular events, is the most common arrhythmia. AH and AF often coexist, and their prevalence increases with age. This consensus provides the key features of the management of patients with these nosological units. The pathogenesis, risk stratification, and features of the selection of antihypertensive, antiarrhythmic and antithrombotic therapy are described in detail.

Efficacy and safety of azilsartan medoxomil in various doses in patients with metabolic disorders

Background. Obesity is an independent risk factor of the cardiovascular complications in patients with arterial hypertension (HTN). It can directly contribute to an increase in blood pressure (BP). Thus, the treatment of patients with HTN and obesity becomes a complex clinical problem, which requires new highly effective antihypertensive drugs. Aim. To assess the effectiveness and safety of novel angiotensin II receptor blocker azilsartan medoxomil (AZL-M) as monotherapy and in free combinations with diuretics and/or calcium antagonists in obese or overweight patients with HTN in real clinical practice. Materials and methods. An international multicenter observational non-interventional prospective study of the efficacy and safety of AZL-M in patients with hypertension and overweight or obesity was performed in the Russian Federation and the Republic of Kazakhstan. Patients took the drug for 6 months in accordance with the approved local instructions for use. All examinations were performed in accordance with routine clinical practice on the basis of a physicians decision. Results. In patients prescribed AZL-M as monotherapy (without dosage changes during the study) a significant decrease in systolic and diastolic blood pressure (systolic BP and diastolic BP, respectively) was observed (p0.001, compared to baseline); the average decrease in systolic BP and diastolic BP was 30.5012.67 and 14.478.65 mmHg, respectively (n=865). Target BP (140/90 mmHg or 140/85 mmHg in patients with diabetes mellitus) was achieved in 112 (94.12%), 547 (92.24%) and 135 (88.24%) of patients who were prescribed AZL-M at doses of 20, 40, or 80 mg/day, correspondingly. In patients receiving AZL-M in combination with a diuretic or calcium antagonist, the rate of achievement of ad blood pressure targets was 78.887.5% and 81.385.5%, respectively, and the frequency of response to therapy was 68.892.9% and 81.393.9%, respectively. During the entire observation period, 43 adverse events (AEs) were recorded, the most common of which were arterial hypotension (14 cases). All AEs associated with the study drug were of mild or moderate intensity. Conclusion. AEs administered as monotherapy and as part of combination therapy provided a statistically and clinically significant decrease in BP and a high frequency of target BP achievement in patients with HTN and metabolic disorders associated with overweight or obesity. Given the high efficacy and good tolerance of the drug, AEs can be considered as the drug of choice for the treatment of HTN in patients with overweight or obesity.

Drug therapy of arterial hypertension: assessment of the physicians’ basic knowledge. Final results of the PHYSTARH project

Background. Arterial hypertension is a multifactorial disease accompanied by an increase in systolic and/or diastolic blood pressure above the established values. Uncontrolled blood pressure can cause various complications, which will lead to either disability or death of the patient. Aim. To assess the compliance of the level of doctors knowledge with current clinical guidelines in the treatment of arterial hypertension. Materials and methods. Within the framework of the PHYSTARH multicenter study, we presented the results of an anonymous prospective survey to assess the level of physicians knowledge and pharmacotherapeutic preferences in the treatment of arterial hypertension. Results. The study involved 425 physicians from 9 regions of Russia: Belgorod, Voronezh, Lipetsk, Chelyabinsk, Moscow, Krasnodar Territory, Primorye Territory, the Republic of Adygea and Tatarstan. In the course of the analysis, we revealed an insufficiently high level of the respondents knowledge in the treatment of arterial hypertension. Less than half of the respondents chose the indication of combination therapy as a therapeutic intervention in which the effectiveness of lowering blood pressure increases about 5 times more than when the dose of the original drug is doubled; correctly indicated the pharmacological group for the proposed drug (methyldopa), determined the indication for the use of aspirin in patients with hypertension, selected the optimal antihypertensive therapy for the proposed clinical situations, indicated absolutely contraindicated antihypertensive drugs in pregnancy and chronic obstructive pulmonary disease. Conclusion. The need for additional educational activities among physicians was established to improve the quality of knowledge on the basic aspects of hypertension, because a significant number of key questions on this topic cause difficulties for respondents.

Consensus of experts from the Russian Medical Society of Arterial Hypertension. Arterial hypertension and erectile dysfunction

Sexual health is an essential part of overall health, and an active and healthy sex life is an important aspect of a good quality of life. Cardiovascular diseases and sexual health disorders have common risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, obesity and smoking) and common pathogenesis (endothelial dysfunction, inflammation and atherosclerosis). All this led to speculations about the pathophysiology and treatment options for sexual dysfunctions. The use of phosphodiesterase type 5 inhibitors has revolutionized the treatment of erectile dysfunction (ED) in men. This article focuses on ED and its relationship with hypertension. This document was created by experts from the Russian Medical Society of Arterial Hypertension with the participation of a member of the European Society of Hypertension Working Group on Sexual Dysfunction and Arterial Hypertension. In recent years, the expert group was very active in educating hypertension specialists and related specialties physicians about ED via numerous lectures at national and international congresses. It has been noted that ED precedes the development of coronary heart disease. The artery diameter hypothesis has been proposed as a possible explanation for this observation. Clinical manifestations of atherosclerotic lesions and/or endothelial dysfunction of the penile arteries may precede those in larger arteries. Patients with hypertension who receive antihypertensive drugs are more likely to suffer from sexual dysfunctions compared to untreated patients. The occurrence of ED appears to be related to the undesirable effects of antihypertensive drugs on the penile tissues. There is information about various effects of antihypertensive drugs on erectile function.

Prevalence of risk factors for arterial hypertension among draft age youth

Background. The currently observed diseases of the circulatory system getting younger, the increase in the incidence of arterial hypertension (AH) and the high mortality rate of men of working age in Russia are elements of one of the main medical and social problems. The identification of risk factors (RF) for the development of hypertension in young patients and the identification of the groups with the highest risk of cardiovascular events in their future adult life is aimed at preventing hypertension, early treatment initiation, increasing life expectancy and reducing mortality. Aim. To study the prevalence of the main modifiable RF associated with arterial hypertension among draft age youth. Materials and methods. The identification of RF, their qualitative, quantitative description, assessment and comparative analysis among men with normal and high blood pressure (BP) of varying degrees. Results. In the control group without hypertension, 37.1% of the subjects did not have any RF; 48.6% of the surveyed each had one RF; 14.3% were persons with two RFs. There were no people identified with three or more RFs. In the study group with AH, 27.0% of patients did not have any RF; 37.4% of patients had one RF; 22.6% of patients with two RFs; 9.5% of patients with three RFs and 2.6% of patients had four RFs. The occurrence of each RF in the control group without hypertension and in the study group with hypertension as a whole is presented as follows respectively: overweight/obesity 37.1 and 59.1%; smoking 34.3 and 38.3%; alcohol abuse 0 and 2.6%; physical inactivity 8.4 and 12.2%; hypercholesterolemia 2.9 and 20.9%; hypertriglyceridemia 5.7 and 16.5%; hyperglycemia 5.7 and 5.2%. Conclusion. RF is widespread in young men, regardless of BP level. More than 60% of draft age youth without hypertension have at least one RF. Among all modifiable RFs, the highest frequency of occurrence is associated with increased weight and smoking. Overweight or obesity is always found in individuals with two or more RFs. Among men with hypertension, people with obesity, low physical activity and impaired lipid metabolism are more common than among men without hypertension. Risk assessment in draft age youth presents certain difficulties. Identification and assessment of risk factors will make it possible to develop an individual program for their modification, prevention of the development of hypertension and detection of the disease in the early stages.

Comparative characteristics of indicators of peripheral arterial and central aortic pressure, remodeling of the left ventricular myocardium in salt-sensitive and salt-resistant patients with arterial hypertension

Background. Changes in the vascular wall, in particular, an increase in its stiffness and an increase in pressure in the aorta, as well as hypertrophy of the left ventricular myocardium are factors that determine a poor prognosis in patients with arterial hypertension. At the same time, the peculiarities of changes in arterial stiffness indices and left ventricular myocardial remodeling in patients with different sensitivity to salt loading have not been adequately studied. Aim. To conduct a comparative analysis of the values of peripheral blood pressure and central aortic pressure, indicators of left ventricular myocardial remodeling in salt-sensitive and salt-resistant patients with arterial hypertension. Materials and methods. The study involved 180 patients with arterial hypertension: 96 men and 84 women. The median age was 59 years. Salt sensitivity test was performed according to V.I. Kharchenko. All patients underwent 24-hour blood pressure monitoring, echocardiography. Indicators of peripheral arterial pressure and central aortic pressure, remodeling of the left ventricular myocardium were determined. Results. According to the results of the test V.I. Kharchenko, 88 patients were classified as salt-sensitive, 92 as salt-resistant. After a salt sensitivity test in salt-sensitive patients, the main indicators of peripheral blood pressure and central aortic pressure exceeded those in salt-resistant patients in the daytime, at night, and throughout the day as a whole. In the group of salt-sensitive individuals, statistically more significant negative changes in echocardiographic parameters were recorded; a significant number of salt-sensitive patients were diagnosed with prognostically unfavorable variants of left ventricular myocardial remodeling. Conclusion. In salt-sensitive patients with arterial hypertension, compared with salt-resistant patients, there are higher values of both peripheral blood pressure and central aortic pressure, more significant negative changes in echocardiographic parameters with the formation of concentric hypertrophy and eccentric remodeling of the left ventricular myocardium. It can be assumed that the assessment of salt sensitivity makes it possible to verify patients with the most unfavorable changes in parameters of ambulatory blood pressure monitoring and significant remodeling of the left ventricular myocardium. This approach can be used to individualize pharmacotherapy in patients with arterial hypertension and increase its effectiveness.

Expert consensus. Effect of antihypertensive therapy on cognitive functions

Arterial hypertension (AH) is the major modifiable risk factor for cognitive impairment (CI), including dementia, CI in cerebrovascular and neurodegenerative diseases, including Alzheimers disease. By 2050, the number of people with dementia will approximately 3 times increase due to the aging population and limited opportunities for drug prevention and treatment of severe CI. In connection with the above, it seems necessary to create an expert consensus, which would summarize the evidence-based medicine data available to date on the effect of antihypertensive therapy (AHT) on cognitive function (CF). In the expert consensus, the data of prospective randomized clinical trials, observational and population studies, meta-analyzes on the effect of AHT on the risk of dementia and CI progression, including certain CF, were summarized and analyzed. The consensus considers the effect of antihypertensive drugs (AHD) on various cognitive domains. Literature data give evidence that AHT reduces the risk for dementia, including vascular dementia, reduces the risk of for dementia in Alzheimers disease, as well as reduces the risk and can prevent the progression of non-dementia CI. The effect of AHT on various CF has been little studied. Most meta-analyzes did not reveal the benefits of any class of AHD; however, one study demonstrated the advantage of angiotensin receptor blockers, while another study diuretics. The consensus emphasizes that, given the high incidence of AH in the general population, AHT may be one of the most effective ways to prevent CI or delay CI progression. The effect of different classes of AHD on CF requires further study. It is necessary to conduct a larger number of well-designed randomized clinical trials that would assess the state of executive functions in patients with AH.