Target Blood Pressure Levels Research Articles

Achievement of target blood pressure in patients with arterial hypertension on the background of antihypertensive therapy in real clinical practice

Aim. To evaluate the features of pharmacotherapy in achieving different levels of target blood pressure (BP) in patients with arterial hypertension (AH) with the absence or presence of comorbid diseases in real outpatient practice.Material and methods. At the open multicenter observational study, outpatient physicians filled original patient questionnaires, which reflected the demographic data of patients, the presence of comorbid diseases and conditions prescribed antihypertensive drugs and achieved during treatment with their use levels of systolic (SBP) and diastolic (DBP) blood pressure (BP), body mass index (BMI), creatinine and blood glucose levels, as well as information about smoking. The obtained data were stratified into groups depending by the level of blood pressure achieved in patients during the therapy, as well as depending on the existing comorbid diseases. Estimated rate of prescription of antihypertensive agents, the number of components of therapy, the number assigned to tableted dosage forms (tablets). We also evaluated the frequency assignments of fixed combinations (FC). Results. The study included data from 2073 patients. They were divided into six groups according to the level of BP achieved. The groups were comparable by demographic and anthropometric characteristics, as well as in gender representation. In patients of the first group on the background of therapy were achieved the lowest values of blood pressure — 120­129/<80 mm Hg. art. They were less likely than other groups to detect comorbid diseases, less frequently prescribed thiazide/thiazide­like diuretics (TD), and FC were prescribed in 33,8%. In patients of the second group the blood pressure level was 130­139/<80 mm Hg. art., the duration of hypertension was the smallest, they were most often prescribed angiotensin II receptor blockers (ARBS) and so on, and the share of FC was the maximum among the compared groups — 42,3%. In the third group, the blood pressure level was 120­139/80­89 mm Hg. St. These patients are most often prescribed angiotensin converting enzyme inhibitors (ACEi), but rarely angiotensin receptors blockers (ARB), frequency assignments of FC — 37,8%. The level of blood pressure in patients of the fourth group who did not achieved the target value of SBP (≥140 mm Hg), in the fifth group — the target value of DBP (>90 mm Hg), and in the sixth group — the target values of SBP (≥140/>90 mm Hg. art.). Their share in the total sample was 19,9%, 4,1%, and 41,2%, respectively. Patients from these groups were more likely to have comorbid diseases, they were more often prescribed four or more components of therapy. BP level <130/<80 mm Hg in patients with type 2 diabetes mellitus (DM 2) was achieved in 4,2%, in patients with coronary heart disease (CHD) in 8,3%. In these groups, a high frequency of beta­blockers (BB) was noted. Patients with chronic kidney disease (CKD) had blood pressure levels of 130139/<80 mm Hg was 7,9%. Among patients with stroke/transient ischemic attack (TIA) blood pressure 120­129/<80 mm Hg was achieved in 2%. In the general sample of patients, one component of antihypertensive therapy was prescribed in 5,8%, two — in 48,3%, three — in 34,7%, four or more — in 11,2%.Conclusion. Target blood pressure <140/90 mm Hg was achieved at 34,8%, and the level of blood pressure <130/80 mm Hg — only at 11,5% of patients. In these patients, comorbid diseases were less often observed, from hypotensive drugs, ACEI, BB or TD were most often used, the predominant appointment of twocomponent antihypertensive therapy was noted, which was most often presented in the form of two tablets. In patients with comorbid diseases revealed a very low proportion of achieving the target level of blood pressure: with DM 2 — 4,2%, with CKD — 7,9%, with IHD — 8,3%, with stroke/TIA — 2%. Among the patients of the whole sample, two­ and three­component antihypertensive therapy was most often prescribed (48,3% and 34,7%, respectively). A greater number of antihypertensive components were prescribed to patients with several comorbid diseases, and, consequently, with a more severe course of hypertension.

Unresolved Problems in the Treatment of Arterial Hypertension and What to Do

The emergence of numerous combinations of antihypertensive drugs in recent years creates a problem of choice for the doctor due to the lack of classification decisions in this area of hypertension.The objective: effectiveness study of the antihypertensive combination of enalapril and indapamide (Enzix duo and Enzix duo forte, manufacturer of Hemofarm AD, Serbia) was studied in patients with high cardiovascular risk of grade II with concomitant coronary heart disease or diabetes.Material and methods. Surveyed 28 patients randomized into 2 groups depending on the severity of the disease. To check the progress of the disease, a complex of surveys was conducted – the dynamics of clinical status, echocardiography, BP monitoring and questionnaires were studied using the 36-Hem Short-Form Health Survey (SF-36) classic questionnaire for self-assessment of quality of life.Results. The integrated assessment of the effectiveness of the applied treatment algorithm allowed us to establish a positive dynamics of the clinical condition of the patients, the achievement of the target blood pressure level in all studied patients (after adjusting the drug dose), a statistically significant decrease in the LVMH index and average BP monitoring values.Conclusions. The results of the study have shown that the drug combination therapy Enzix duo forte can successfully treat patients with any degree of hypertension, including patients with malignant forms, coronary heart disease, diabetes.

How to reach the target blood pressure level according to the 2018 European recommendations? Reserve possibilities of phytomolecules

The article highlights the prevalence of arterial hypertension (AH). Attention is paid to the classification of hypertension and target blood pressure (BP). The classification of hypertension according to the level of blood pressure, the presence of cardiovascular risk factors, target organ damage and / or the presence of associated diseases helps to optimize individual treatment. Correction of treatment is also carried out depending on the initial level of blood pressure and comorbid pathology. Attention is focused on the need for the appointment in many cases, immediately combined antihypertensive therapy. Such drugs, in addition to many well-known tableted drugs, are also drugs of plant origin. On the example of the herbal preparation Neocardil, from the standpoint of evidence, the place of flavonoids in the treatment of patients with hypertension is considered.

Global Impact of the 2017 American College of Cardiology/American Heart Association Hypertension Guidelines.

Global Impact of the 2017 American College of Cardiology/American Heart Association Hypertension Guidelines.

Arterial Hypertension in Older Adults in the Light of New European Guidelines 2018

The tendency of aging of the population and, together with it, the increase in the prevalence of arterial hypertension (HT) determines the need to study the peculiarities of treatment of HT in patients of elderly and senile age. In this regard, in the new Guidelines of the European Society of Cardiology for diagnosis and treatment of HT (2018), the authors identified groups of elderly patients (aged 65-79 years) and very elderly patients (aged ≥80 years), blood pressure (BP) levels for the initiation of antihypertensive therapy and target BP levels, and recommended the main principles of antihypertensive therapy. The new recommendations of the ESH/ESC in 2018 also presented the characteristics of HT management in elderly patients. The necessity of mandatory detection of senile asthenia in elderly patients and determination of the degree of their independence from outside help is emphasized. In all elderly patients, especially in very elderly or fragile patients, it is recommended to evaluate the presence or development of orthostatic hypotension during treatment, as well as actively to detect episodes of hypotension using the 24-hour BP monitoring. For antihypertensive therapy in elderly patients, the same five classes of antihypertensive drugs and their combination are recommended. It is emphasized that if it is not required for the treatment of concomitant diseases, loop diuretics and alpha-blockers should be avoided because their use is associated with an increased risk of falls. It is recommended to investigate the level of serum creatinine more often to evaluate the kidney function and to detect a possible decrease in the glomerular filtration rate because of a decrease in BP and perfusion of the kidneys. The target BP levels indicated in the Guidelines are: systolic BP values 130-139 mm Hg and diastolic BP 70-80 mm Hg. In the Guidelines it is emphasized that elderly patients need careful monitoring of any adverse side effects of antihypertensive drugs.

The Potential of the Volumetric Sphygmography for the Diagnosis of Impaired Arterial Stiffness in Patients with Uncomplicated Arterial Hypertension and Its Possibilities for Evaluation of the Antihypertensive Therapy Effectiveness

Aim . To investigate arterial stiffness parameters in middle-aged patients with stage II grade 1-2 essential arterial hypertension (HT) and evaluate their changes after treatment with single pill combinations (SPC) of antihypertensive drugs. Methods . At the first phase of the study, according to the medical records data, a group of untreated patients with stage II grade 1-2 HT (n=100, 47 men, mean age 51.9±6.5 years), and a group of healthy controls with normal blood pressure (BP) (n=86; 28 men; mean age 48.8±5.8 years) were formed. The analysis of arterial stiffness was performed by the volumetric sphygmography technique using VaSera VS-1500N device (Fukuda Denshi Co., Ltd, Japan). All the subjects underwent ambulatory BP monitoring (BPLab, BP2005-01.04.00.2540, Petr Telegin, Russia) as well as a routine BP measurement by the Korotkov method. At the second stage of the study, a group of HT patients (n=90) was formed according to the medical history data. These patients thanks to antihypertensive treatment with SPC (perindopril arginine/indapamide or valsartan/amlodipine) achieved the target BP level (<140/90 mm Hg) according to routine measurements and they were assessed in terms of therapy efficacy (general clinical data, SMAD, volume sphygmography) 12 weeks after the target BP level was reached. Results . At the first phase of the study, in HT patients cardio-ankle vascular index (CAVI), both on the left (7.9±1.3) and right side (8.1±1.3), as well as the right-side augmentation index (1.22±0.31%) were significantly higher (p=0.006, p=0.003, p=0.047, respectively) compared to the controls (7.5±0.9, 7.6±0.9, 1.13±0.28%, respectively). At the second phase of the study, after SPC treatment the CAVI significantly decreased both on the left- (up to 7.36±1.37, p=0.02) and right-side (up to 7.46±1.44, p=0.02). Conclusions . In untreated 40-65 years-old patients with stage II grade 1-2 HT arterial stiffness assessed by volumetric sphygmography is significantly higher compared with sex-matched healthy individuals. 12-week therapy with SPCs improves the elastic properties of the major arteries, reducing the CAVI value.

Endothelial function of vessels in patients with chronic kidney disease combined with subclinical hypothyroidism under the influence of combined antihypertensive therapy.

The aim of the study: to evaluate the endothelial function of the vessels under the influence of combined antihypertensive therapy (valsartan 160 mg / amlodipine 5 mg vs valsartan 160 mg / hydrochlorothiazide 12,5 mg) in patients with CKD and subclinical hypothyroidism. 80 patients with CKD I-II stages and AH 1 and 2 degrees were examined. According to TSH level patients were divided into 2 groups. Than patients with SH were separated into 2 subgroups: 1a – patients that received valsartan 160mg/ amlodipine 5 mg and 1b - patients that received valsartan 160mg/ hydrochlorothiazide 12,5 mg). More often violation of brachial artery flow-mediated dilation was found among the main group. The use of two-component antihypertensive therapy based on valsartan 160 mg and amlodipine 5 mg or valsartan 160 mg and hydrochlorothiazide 12,5 mg ensured the achievement of target blood pressure levels in 83,3% and 84% of patients, respectively. The more significant improvement of brachial artery flow-mediated dilation was observed in patients that received fixed combination valsartan 160 mg/amlodipine 5 mg.

Target blood pressure level in older patients with hypertension

Target blood pressure level in older patients with hypertension

CONTROL OF GLYCEMIA AND CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH TYPE 2 DIABETES IN PRIMARY CARE IN MONTENEGRO

Some observational studies have shown that only a small number of diabetic patients achieve optimum control of glycaemia and cardiovascular risk factors. The aim of this study was to analyze whether patients with type 2 diabetes mellitus treated in primary care achieve adequate control of glycemic levels and cardiovascular risk factors. This was a retrospective, record-based, cross-sectional study that included eligible patients from 35 to 90 years old with type 2 diabetes mellitus treated in Primary Health Care Center in Podgorica. We investigated electronic records of 531 diabetic patients. The observed prevalence of type 2 diabetes mellitus among individuals between ages 35 and 90 years, was 11,84 %. Half of the patients were female. The mean age was 65,88±9,86 years. The mean value of HbA1c was 7,56±1,71. Fifty-nine percents of patients achieved optimal levels of HbA1c ≤ 7 %. Also, more than half of patients achieved target levels of blood pressure while 27.9% achieved LDL ≤ 2.6 mmol/L. Fifty percent of patients were non-smokers and 45.1 % were obese. Among patients on primary prevention only 5.7 % had met all target levels while on secondary prevention that number was even smaller 3.7 %. Our study showed that control of HbA1c and blood pressure was similar to other studies but reaching target levels of LDL was challenging for our patients. Further analysis are needed in order to discover the reasons for poor control of certain CVRF and to develop strategies for its optimal management.

A Randomised Trial of Intensive versus Standard Blood-Pressure Control in Patients with a History of Stroke: The RESPECT Study

A Randomised Trial of Intensive versus Standard Blood-Pressure Control in Patients with a History of Stroke: The RESPECT Study

Abstract P346: Impact of the Changing Guidelines in the Classification of Patients: Insights from a Real Life mHealth Digital Registry

Background: The recent updated AHA/ACC guidelines have spiked academic discussions on the changing prevalence of hypertensive subjects with the new thresholds. Aim: To determine the changes in classification (hypertensive or not) on a real life and spontaneous mHealth digital registry, via mobile App and website. Population and Methods: 7956 consecutive subjects (71% males; 53±11 years old) subscribed, spontaneously, a real-time BP -recording, - interpretation and -trend evaluation service (via smartphone-Health App and website platforms). Thru the digital platforms, each BP value, after consistency-checks, feeds a proprietary algorithm providing both individual BP value interpretation in comparison to the previous BP history, and BP trend and fluctuations assessments. These latter are fed back to users on their smartphone and computer screens instantly. The service complies with the most strict data privacy, safety and security requirements. Results: We collected 176432 BP measurements, overall. BP were optimal according to the AHA-ACC guidelines values (&lt;=120/80mmHg) were in 29% of instances, while either only the systolic or the diastolic BP values were optimal in 53% of instances. Conversely, according to the most commonly used normal thresholds of BP &lt;=130/85mmHg 63% of both systolic and diastolic BP values were normal, while either only the systolic or the diastolic BP values were optimal in 39% of instances. Conclusion: In a population of subjects, who subscribed a digital remote BP monitoring and evaluation service because they are so aware of the need of controlling their BP, the change of guidelines threshold for optimal and event reducing BP doubles the impact of non-controlled BP. This registry highlights the wide gaps still existing in achieving target blood pressure levels in real-life subjects, even in the most aware hypertensive subjects.

What factors do influence arterial hypertension control in Russia

In the work, the results presented, gathered in the multicenter study ESSE-RF, and characterizing factors associated with insufficient control of blood pressure (BP) in arterial hypertension (AH) patients. Aim. Evaluation of the factors associated with insufficient BP control in Russian males and females age 25-64 y. o., with AH, by the ESSE-RF data. Material and methods . Representative selections were assessed of 13 regions of Russia, males (n=5563) and females (n=9737) 25-64 y. o., investigated in 2012-2013 y. Systematic stratified multistage random selection was applied. Response about 80%. All participants were surveyed with a standard questionnaire (demography, anamnesis, wealth). Mean values were calculated (M±m), quintiles and ranges. Methods of analytical statistics were applied: dispersion-co variation, logistic regression, odds ratio. Results . Two groups were revealed, with raised BP, that differ basically. Group one, those with BP higher than 140/90 mm Hg, not taking antihypertensive medication, and group two — those who take medications, but do not reach target BP. Group one consists of men almost 2 times more, with risk factors, but no cardiovascular diseases in anamnesis. Only the heart rate (HR) and alcohol overconsumption significantly positively correlate with the treatment absence in men — OR=1,49 (p<0,001) and OR=1,47 (p<0,0001), respectively, as in women — OR=1,41 (p<0,003) and OR=1,62 (p<0,0001). Group two is characterized by higher level of the risk factors, and complete model of logistic regression has revealed positive associations of high HR, general obesity, high triglycerides and glucose with ineffective treatment in males; in females — high HR, general obesity. Conclusion. It is necessary to apply various approaches to increase the number of persons with controlled BP. Broad informing on healthy lifestyle, incl. target BP levels in those who do not visit physician office. Screening in AH is necessary, esp. for antihypertensive medication intake control.

THE ROLE OF GROUP EDUCATIONAL PROGRAMS IN MODIFICATION OF THE CARDIOVASCULAR RISK MAIN FACTORS

Aim – to study the influence of Healthy Schools "Healthy Lifestyle Basis" education on modifying of cardiovascular risk main factors. Materials and methods. 57 patients with cardiovascular diseases were examined. General clinical examination, anthropometric examinations (body weight, height, body mass index, and body composition), blood pressure measurement, and cholesterol determination, as well as its fractions in blood, were carried out before and after training course. The educational cycle included 9 lessons. Results. It was found that Healthy Schools education contributes to better both systolic and diastolic blood pressure monitoring. Thus, initially target blood pressure levels (&lt;140/90 mmHg for patients without diabetes mellitus and &lt;140/85 mmHg in case of diabetes) were observed in 49 % of patients, at the end of the training cycle – in 67 %. At the same time, the patients’ anthropometric parameters (BMI, fat and muscle tissue content, visceral fat) as well as cholesterol and its atherogenic serum fractions, did not change significantly. The patients’ education did not affect motivation level for their lifestyle improvement. So the number of patients consuming less than5 grams of table salt per day and over400 grams of vegetables and fruit did not change significantly. The level of physical activity between the examined patients did not change. Conclusion. The training course “Healthy Schools: Healthy Lifestyle Basis" contributes to improvement of blood pressure level monitoring, but does not significantly affect behavioral risk factors and does not lead to improvement of lipid metabolism monitoring in patients with cardiovascular disease. It is necessary to search for new more effective preventive care models for patients with high cardiovascular risk.

The effectiveness of the replacement of the generic blockers of the renin-angiotensin-aldosterone system by perindopril arginine in patients with uncontrolled blood pressure: the results of the regional program “DIFFERENCE”

Taking into account the widespread use of generic drugs and insufficient rate of achieving the target blood pressure (BP), a regional program “DIFFERENCE” was initiated. The purpose of this study was to assess the chance of increasing the effectiveness of antihypertensive therapy (AHT) by replacing generic perindopril and receptor blockers to angiotensin II (BRA) by the original perindopril and generic indapamide by the original one.Design and methods. The study included 330 hypertensive patients (47,3% males; the average age of men is 53,5 ± 8,5 years, women — 54,2 ± 10,2 years, p &gt; 0,05). The mean systolic BP was 149,5 ± 5,3 mm Hg, average diastolic BP — 96,4 ± 4,9 mm Hg; 1st HTN degree was achieved in 49,1% patients, 2nd — in 41,2%; 3rd degree remained in 9,7%. Monotherapy of HTN was prescribed in 79,4% patients.Results. After the transfer from the generic perindopril to the original drug (± transfer from the generic indapamide to the original one) within 4 weeks no other changes of AHT were introduced. During these 4 weeks, the average systolic BP decreased to 139,1 ± 5,1 mm Hg, diastolic blood pressure declined to 88,2 ± 5,8 mm Hg, which allowed to achieve the target BP in 37,0% patients (p &lt; 0,01). On the Month 1 visit, taking into account indications, the frequency of combined AHT increased to 76,4%, on the Month 3 visit — to 88,2%, exceeding the original one by 4,3 times (p &lt; 0,01). On the Month 3 visit the average systolic BP was 136,5 mm Hg, diastolic BP — 85,9 mm Hg, the target BP level was achieved in 53,9% cases (p &lt; 0,01). By the study completion, the most often combination included perindopril with diuretic or calcium antagonist.Conclusions. The study “DIFFERENCE” demonstrated the effectiveness of the replacement of generic perindopril and BRA by the original perindopril combined, if necessary, with the replacement of generic indapamide by the original one in patients wth uncontrolled HTN. To date, the combined AHT has not been assigned frequently enough, which is also the reason for the insufficient efficiency. The most common were the combinations of perindopril with diuretic or calcium antagonist.

Quality of Blood Pressure Control in General Practice Using Ambulatory Blood Pressure Monitoring - a Retrospective Monocentric Cross-Sectional Study

The diagnosis and therapy of arterial hypertension is a continuous challenge in general practice. The aim of this study is to analyze the nature and effectiveness of blood pressure control in patients with known arterial hypertension in a primary care practice using office- (OBPM) and ambulatory (ABPM) blood pressure measurement. 283 patients (90 % of all regularly treated patients having hypertension) were retrospectively examined for the achievement of the target blood pressure values in ABPM and OBPM in the past 1 to 2 years. Target blood pressure levels were in line with current ESH recommendations (officeblood pressure < 140/90 mmHg, mean 24-h ABPM < 130/80 mmHg). The OBPM of all patients (age: 68 ± 12.7, 48 % women) was 132 ± 11.8/80 ± 4.2 mmHg, the 24-h ABPM was 128 ± 10.7/74 ± 7.9 mmHg. An isolated office hypertension had 11.3 %, a masked hypertension 21.9 %. Only 33.9 % had physiological dipping behavior (49.1 % non-dipper, 13.8 % reverse dipper and 3.2 % extreme dipper). The blood pressure control rate (reaching the target blood pressure) was 67.8 % in the OBPM and 57.2 % in the 24-h ABPM. 23.0 % were treated with monotherapy, 37.5 % with dual combination, 19.8 % with a triple combination and 14.5 % with > 3 antihypertensives. 83.9 % of all had RAS blockers. The OBPM target was achieved in 75.0 % under a triple and 71.7 % under dual combination. The 24-hour ABPM target was mostly achieved in patients requiring only monotherapy (66.2 %) or dual therapy (60.4 %); others < 60 %. In the family practice examined, the treatment control of patients with arterial hypertension was mostly guideline-based and better than described in the literature. The parallel and consistent implementation of ABPM in addition to OBPM as well as the high prescription rate of RAS blockers and recommended combination therapies might be the key for this result.

Pharmacoeconomic analysis of the use of ramipril and candesartan in patients with arterial hypertension

Arterial hypertension (AH) is the most common cardiovascular disease in the world and is the cause of disability of the population of the developed countries of the world. A feature of hypertension pharmacotherapy is a lifelong intake of medications. Indicators of economic evaluation of the effectiveness of different methods of treatment contribute to the selection of pharmacotherapy, which will provide the patient with the highest effectiveness of treatment, taking into account the financial capabilities of a particular patient. The main objectives of antihypertensive therapy is to achieve the target level of blood pressure (BP), the protection of target organs and a positive impact on risk factors for cardiovascular complications. The cost-effectiveness method makes it possible to compare costs with the same therapeutic effectiveness, which was the purpose of our study.Materials and methods. 100 protocols of medical cards of inpatients were studied. Two groups of patients were isolated: the first group for the treatment of AH received candesartan, and the second group – ramipril. The parameters were taken into account: achievement of target blood pressure, as well as possible complications of drug therapy - hypotension, cough, angioedema. To assess the cost of treatment against the background of the use of ramipril and candesartan, a cost-effectiveness pharmaco-economic analysis was carried out.Results of the study. Using the cost-effectiveness method, an analysis of ramipril and candesartan was carried out. The minimum, average and maximum costs of a single, daily, and course dose were calculated and the cost of BP normalization was calculated. The data obtained by us indicate a lower cost of treatment with ramipril. Analysis of the effectiveness of the drugs showed that ramipril is more effective in achieving the target blood pressure, but the percentage of side effects among which heart failure and cough were significantly higher. The data obtained indicate a high therapeutic efficacy of candesartan and ramipril, which allows us to draw conclusions:Conclusions. The most effective in achieving target BP was ramipril than candesartan. Analysis of the efficacy of drugs has established that ramipril has side effects and causes cough and heart failure, and candesartan can cause angioedema and hypotension. In analyzing the direct costs of treating hypertension, based on current standards of medical care for patients with AH, it was found that the least expensive is the treatment with ramipril. The analysis cost-effectiveness, showed that ramipril possesses the greatest pharmaco-economic advantage

COMPARATIVE EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY IN PREGNANT WOMEN WITH GESTATIONAL AND CHRONIC ARTERIAL HYPERTENSION

Objective: The aim of this study was to analyze the efficacy of antihypertensive therapy in pregnant women with mild to moderate Gestational Hypertension (GH) and Chronic Arterial Hypertension (CAH) to achieve target blood pressure (BP). Design and method: The retrospective analysis of management of mild to moderate hypertension during pregnancy of 100 women with GH and 100 women with CAH was conducted. The regimes of drug therapy and their effectiveness were analyzed. The criterion of the efficacy of antihypertensive therapy was target office BP level less than 150–100 mm Hg in accordance with the National Guidelines. Office BP levels were registered twice a month during pregnancy. Results: The average age of women with CAH and GH was 34,0 ± 6,2 and 31,8 ± 5,1 years old relatively. To achieve target BP, regular antihypertensive therapy was required in 84% of pregnant women with CAH and 68% women with GH. In all cases methyldopa was administered, less often it was a combination with amlodipine. To control BP in 61% of pregnant women with GH was sufficiently lower doses of 250–750 mg daily methyldopa. But women with CAH needed large doses of 1000–2000 mg daily methyldopa (46% vs 29% of GH, p < 0,05) or its combination with amlodipine 5–10 mg daily (16% vs 8% of GH). Target BP levels were achieved in 90% of CAH and 96% of GH. There were no significant differences in maternal and fetal outcomes. Nevertheless, the incidence of preeclampsia with GH was slightly higher than with CAH (10% vs 6%, p > 0,05). In all cases of preeclampsia, low doses of methyldopa 250–500 mg or episodic use were needed to control BP during the previous period of pregnancy. Conclusions: Target BP levels were achieved by the monotherapy of methyldopa in most pregnant women with mild to moderate CAH and GH. Pregnant women with CAH needed large doses of methyldopa in comparison with GH. Despite effective therapy, the incidence of preeclampsia with GH was higher than with CAH. It is not quite clear the value of blood pressure control in the development of complications in pregnant women with mild to moderate hypertension.

POSSIBILITY OF IMPROVING THE QUALITY OF DIAGNOSIS AND TREATMENT OF HYPERTENSION AND DYSLIPIDEMIA BY PHYSICIANS EDUCATION

Objective: To study the possibility of improving the educational level of primary health care physicians (cardiologists and internists) of Kursk city (Russia) aimed at improving the quality of diagnosis and treatment of hypertension and dyslipidemia in the short and long term. Design and method: The educational project (EP) covered all primary care physicians and cardiologists of Kursk (n = 144). During 1 year several seminars were held for physicians by the experts of national guidelines on hypertension and dyslipidemia. The criteria for the efficacy of EP was the achievement of target levels of blood pressure (BP) and total cholesterol, as well as positive changes of physicians actions on the diagnosis and treatment of hypertension and dyslipidemia. For this reason physician records from 300 randomly selected ambulatory cards was analysed before the start of the EP and following 1 and 3 years. Results: Following 3 years after the EP, the frequency of achieving target BP was 39.6% (n = 119), which is significantly higher than before the project – 31,6%(n = 95), p < 0.05, but lower than 1 year after the EP - 51% (n = 153), p < 0,01). The frequency of achievement of the target level of total cholesterol after 3 years was 38.3% (n = 115), significantly higher than before the start of the project 9,3%(p < 0.01), and differs a little from the figures obtained after 1 year- 43,3% (n = 130), p 0,05. There were the improvement of situation with the investigations aimed at revealing of target organ damages. So, after 3 years, heart ultrasound has appointed 24.7% (n = 74) of doctors, significantly higher than before the start of the EP (p < 0.001), but lower than 1 year after the EP (p < 0.05). Impressive increase of investigations to reveal microalbuminuria was found - after 3 years −32,7% (n = 98), which is significantly higher than before the project (p < 0.001) and after 1 year (p < 0.001). Conclusions: EP demonstrated not only short, but long-term efficacy. However, given a decline in several important variables of efficacy of education it should be done on systematic basis.

IMPROVING AN EFFICIENCY OF RESISTANT HYPERTENSION TREATMENT WITH FIXED DOSE COMBINATION OF 3-COMPONENTS ANTIHYPERTENSIVE MEDICATION

Objective: Improving an efficiency of resistant hypertension treatment with fixed dose combination of 3-components antihypertensive medicationDesign and method: 180pts with the preliminary diagnosis of RAH,which was confirmed by24-h ambulatory blood pressure monitoring(ABPM),were included in the study. All pts received an average of4.1 ± 0.3 antihypertensive drugs, mainly in free combinations. After ABPM pts were started treatment with 3-component fixed dose combination (FDC) of antihypertensive drugs:the FDC of perindopril10 mg/indapamide2.5 mg/amlodipine10mg(108pts)or the FDC of valsartan320 mg/hydrochlorothiazide25 mg/amlodipine10mg(72pts). The adherence to the treatment was evaluated by the Morisky-Green test (MGT) at the initial examination and after 3 months of treatment with the FDC of antihypertensive drugs. Results: The average level of office systolic BP (SBP) and diastolic BP (DBP)was158.1 ± 1.2 and 91.03 ± 0.9mmHg respectively. After 3 months of treatment with 3-components FDC, according the results of office and ambulatory BP measurements,RAH was confirmed at 78pts and 102pts achieved the target blood pressure level (these pts were classified as pts with controlled arterial hypertension (CAH)). RAH pts were older than CAHpts:52.4 ± 1.2vs49.8 ± 1.6years (p = 0.02). Both groups were dominate by men-60.5%among RAH pts and62.6% among CAH pts. But initial BP levels (office and ambulatory)were higher in RAH group (tab.1). In the CAH group the office SBP decreased by 21%,DBP-by19.5%,the average daytimeSBP and DBP by15.2 and14% respectively,the average nighttime SBP and DBP by16.7 and16.4% respectively. In the RAH group BP lowering was smaller:the office SBP decreased by13.2%,DBP - by9%,the average daytime SBP and DBP by10.3and8.7% respectively,the average nighttime SBP and DBP by11.1and10.2% respectively. All pointed changes of BP were significant (p < 0.001)(tab.1). The results of the Morisky-Green tests show that treatment with FDC of antihypertensive drug leaded to improvement of the adherence to therapy. The initial Morisky-Green rate,which was assessed retrospectively,at RAH pts was1.3 ± 0.1points and at CAH pts1.4 ± 0.1 (p > 0.05),after 3-months of treatment with 3-components FDC it elevated to 2.5 ± 0.2 and 2.6 ± 0.2 points, respectively, in both groups (p < 0.005). Conclusions: Thereby, administration of 3-components FDC (RAAS blocker/diuretic/calcium channel blocker)improves the adherence to treatment, which can probably ameliorate the efficacy of antihypertensive treatment. Perhaps,the use of 3-component FDC in patients with a diagnosis of RAH could help to achieve the effective BP control and reduce the necessity of adding the 4-th antihypertensive drug for achieving of goal BP.

Computational technology of daily blood pressure monitoring results comparison in patients with arterial hypertension

The evaluation of treatment effectiveness and further patient with arterial hypertension (AH) monitoring require the target level of arterial pressure achievement and its control by means of daily monitoring of blood pressure (DMBP).Purpose of the work involves development, software implementation and practical approval of computational technology in order to compare the results of patient’s two daily monitoring of blood pressure (DМBP).Material and methods. The open controlled study included 10 patients with AH at the third stage in long term after a cerebral stroke. Patients were treated according to the regulatory basis. DBPM was conducted using device АВРМ-01 (Meditech, Hungary) twice (before the treatment and after 1 year).Results comparison of the first and repeated DMBP was carried out by means of proposed computational technology and its own software ArtHyper in which the technology was implemented. The technology is based on the comparison of DMBP indices distribution functions using the two-sample Kolmogorov test and the Wilcoxon test.Results. The proposed technology work was demonstrated in terms of two patients. The target level of arterial pressure was achieved only for the first patient. The majority of DMAT indices distribution for this patient did not change in a year, in other words, the blood pressure and heart rate remained stable due to the treatment. The level of PBP slightly decreased, but in this case it was a positive factor. The second patient didn’t follow the complete course of treatment and didn’t achieve the target level of blood pressure. His levels of diastolic blood pressure and heart rate increased.Conclusions. The computational technology of two patient’s DMBP results comparison was developed. Its practical testing was carried out on real data and demonstrated the effectiveness of technology to detect changes in the second results monitoring and the possibility of its application for the evaluation of rehabilitation and treatment efficiency in patients with arterial hypertension.