Target Blood Pressure Values Research Articles

Short-term training of family medicine teams on cardiovascular risk assessment and management: Effects on practice and outcomes

Background/Aim: The prevention of cardiovascular risk factors and cardiovascular disease management contributes to the cardiovascular mortality reduction. The effects of these activities have been measured by quality indicators. The aim of this study was to determine the effects of family medicine team training workshop and implementation of clinical guidelines on the cardiovascular risk factors and diseases management in primary health care in the Republic of Srpska/Bosnia and Herzegovina. Methods: The "CardioVascular Risk Assessment and Management" study included a sample of 373 teams from 41 primary health care centres trained to provide adequate services and to compare the quality of cardiovascular risk management before and after the training workshop and implementation of clinical guidelines. The comparison was based on nine project defined performance indicators related to hypertension, type 2 diabetes mellitus, hyperlipidaemia, tobacco smoking and obesity. Results: Significant improvements were observed in six indicators after the training workshop and implementation of guidelines. Target values for blood pressure and HbA1c were achieved in over 80 % of patients (82.12 ± 15.81 vs 84.49 ± 12.71 and 84.49 ± 12.71 vs 85.49 ± 24.55; before and after the training workshop, respectively), while the target values for LDL cholesterol were achieved in 54.98 % ± 20.33 before and 57.64 % ± 16.66 after the training workshop. The number of teams that had less than 20 % of recorded data significantly decreased after the training workshop and guidelines implementation, and adequate recording of all indicators was improved. Conclusion: The training workshop of family medicine teams and implementation of clinical guidelines resulted in significant quality improvement of cardiovascular diseases management in primary health care.

Glycated Hemoglobin and Blood Pressure Levels in Adults With Type 2 Diabetes: How Many Patients Are on Target?

ObjectivesAchieving glycated hemoglobin (A1C) and blood pressure targets is an important strategy for preventing chronic vascular complications in diabetes. Our aim in this study was to determine the proportion of type 2 diabetes patients who meet the recommended A1C and arterial blood pressure targets and to identify the determinants of failure to do so. MethodsA cross-sectional study was conducted in an outpatient endocrine clinic at a university hospital. The A1C goal was 7% in general and 8% for patients with advanced chronic complications. Regarding blood pressure, the overall expected target was 140/90 mmHg. ResultsA total of 602 type 2 diabetes patients were analyzed: 62% were female, 14% self-reported as black, mean age was 63±11 years, mean diabetes duration was 17±9 years and median A1C was 8.0% (interquartile range, 7.0% to 9.5%). Macrovascular disease was present in 33% of the patients, diabetic retinopathy in 47%, peripheral neuropathy in 43% and diabetic kidney disease in 56%. Regarding metabolic control, 403 (67%) patients were not at the adjusted target A1C level, and being female, black, young and an insulin user were the main determinants of poor glycemic control. Regarding blood pressure, 348 (58%) patients were not at the recommended targets, and a more advanced age was the main associated factor. ConclusionsBecause more than half of type 2 diabetes outpatients do not meet the recommended A1C and blood pressure target values, there is a major call to overcome the therapeutic inertia and target treatment of patients on an individual basis.

Descriptive Cross-Sectional Study on Knowledge, Awareness, and Adherence to Medication among Hypertensive Patients at a Tertiary Care Centre in Colombo District, Sri Lanka

Objective This study was aimed to assess the patient's knowledge and awareness about hypertension and adherence to antihypertensive medication among hypertensive patients. Methods The descriptive cross-sectional study was conducted in three medical clinics of Colombo South Teaching hospital, Kalubowila, Sri Lanka, from April 2019 to September 2019. Total of 384 hypertensive patients were recruited by systematic randomized controlled sampling and interviewed with validated questionnaires to assess their knowledge about hypertension and adherence to antihypertensive medication. Data were analyzed using SPSS (version 21) analytical package, and the chi-squared test was performed. Results The total sample consisted of 384 hypertensive patients with a mean age of 59.32 (±12.34SD). This included 180 (46.9%) males and 204 (53.1%) females. The male : female ratio was approximately 9 : 10. Most of patients were with primary and ordinary educational status (65.9%), normal body mass index (54.9%), mild elevation of LDL cholesterol (76.3%), and coexistent ischemic heart disease (39.6%). The knowledge about hypertension among majority of patients was reasonable. However, they were unaware about normal values of blood pressure (69%, 95% of CI 1.92–2.09) and diagnostic values of hypertension (90.1%, 95% of CI 2.26–2.40). Moreover, they were unaware of their blood pressure values at time of diagnosis (75.3%, 95% of CI 2.09–2.25), at recent clinic visit (71.3%, 95% of CI 2.0-2.17), and target level (81.8%, 95% of CI 2.25-2.41). Most patients had adequate knowledge about the risk factors and complications of hypertension and were aware of their target organ damage (70.3%). Most patients believed that medication alone is not sufficient to control blood pressure (41.7%, 95% of CI 1.40-1.51) and adequate control of their blood pressure reduces complications (68.2%, 95% of CI 1.37-1.51). Most of the patients (71.8%) had reasonable good drug compliance. The forgetfulness was commonly attributed for nonadherence (69%, 95% of CI 1.26-1.36). Conclusions The knowledge about hypertension among majority of patients was reasonable. But, they were unaware about their disease status and their diagnosis, target, and recent blood pressure values. Most of patients had adequate knowledge about the risk factors and complications of hypertension. However, they were unaware about their target organ damage due to hypertension. The drug compliance was reasonable among them. The forgetfulness was common reason for nonadherence. Therefore, healthcare professionals should implement individualized educational programmes to increase the awareness of disease status, appropriate blood pressure levels, and adherence of treatment to improve the outcome of patients.

Risk Factors Associated with Structural Progression in Normal-Tension Glaucoma: Intraocular Pressure, Systemic Blood Pressure, and Myopia.

PurposeTo determine risk factors associated with structural progression in medically treated normal-tension glaucoma (NTG).MethodsThis retrospective cohort study included 166 NTG patients (average age, 56.5 years; average mean deviation, −4.2 dB). The structural progression endpoint was determined by optical coherence tomography; significant thickness differences in the peripapillary retinal nerve fiber layer (RNFL) or macular ganglion cell inner plexiform layer (GCIPL) that exceeded baseline test-retest variability were identified with event-based guided-progression analysis. Intraocular pressure and systemic blood pressure (BP) were measured at each visit throughout the follow-up period, and the risk for progression was evaluated with Cox regression. Myopic disc features and antihypertensives were also analyzed. Tree analysis was used to determine the cutoff values and elucidate influential risk factors.ResultsStructural progression, defined as progressive peripapillary RNFL or macular GCIPL thinning, was identified in 62 eyes. Occurrence of disc hemorrhages, presence of diabetes, and lower minimum systolic BP were associated with progression (hazard ratio [HR]: 2.116, P = 0.005; HR: 1.998, P = 0.031; HR: 0.968, P = 0.005; respectively). The cutoff value derived from the tree analysis of minimum systolic BP was 108 mm Hg. The tree analysis revealed systolic and diastolic BP to be the most influential risk factors for progressive peripapillary RFNL thinning and progressive macular GCIPL thinning, respectively.ConclusionsLow BP measured during follow-up correlated with structural progression in medically treated NTG eyes, indicating that the evaluation of hypotension is required during the management of NTG patients. The tree analysis identified BP target values that may help prevent glaucoma progression.

Pregnancy hypertension diagnosis and care in COVID-19 era and beyond.

Pregnancy hypertension diagnosis and care in COVID-19 era and beyond.

Hypertensive Disorders in Pregnancy and its Diagnosis and Treatment

While motherhood may be a positive and enjoyable experience, many ladies are experiencing suffering, illness, and death. During pregnancy, at delivery, or post-partum around 15% of pregnant women are expected to develop life-threatening complications and among these Hypertensive Disorders of Pregnancy (HDP) are significant contributors and sufferings [1]. Hypertension term is used to describe high Blood Pressure (BP). Hypertension in pregnancy is defined as: “Systolic blood pressure greater than or adequate to 140 mmHg and/or diastolic blood pressure greater than or adequate to 90 mmHg which usually confirmed within four hours apart measurement”. Pre-existing hypertension, Gestational Hypertension (GH), Pre-eclampsia (PE)/eclampsia, and superimposed hypertension are the spectrum of conditions that encompass hypertension disorder in pregnancy. The range in which these conditions occur is from a mild increase in blood pressure at term with no additional signs or symptoms to severe complications with potential for significant maternal, fetal, and neonatal harm. A significant number of women die every year from pregnancy-related causes globally. Hypertensive disorders in pregnancy cause approximately 12% of maternal deaths. This is the reason why hypertension complications are among the main public health issues worldwide. Hypertensive disorders in pregnancy vary in different populations. This problem is generally more common in developing countries compared to developed countries [2]. A reduction in salt intake and weight loss are of proven benefit in non-pregnant hypertensive patients. There is currently no evidence that instituting an exercise program during pregnancy is effective in preventing preeclampsia in at risk individuals, although in an animal model some benefit has been seen. Similarly, no evidence that instituting a weight loss program in pregnancy can prevent preeclampsia. Pharmacologic therapy during pregnancy may prevent progression to severe hypertension and maternal complications while improving fetal maturity by permitting prolongation of pregnancy. In pregnancy, methyldopa is one of the medications with the longest track record. No increased incidence of general health problems or cognitive problems was found from a study on children born to women treated with methyldopa during pregnancy. Methyldopa can have many side effects, including sedation and impaired sleep patterns as it acts centrally by decreasing sympathetic tone. Methyldopa may cause mild elevations of liver enzymes, which can lead to diagnostic confusion with HELLP syndrome. Methyldopa is not a potent BP lowering agent, it is relatively safe. It can be combined with other anti-hypertensives, such as a diuretic to achieve target blood pressure values. Beta-blockers are generally well-tolerated and these are safe in pregnancy. One of the favored therapies for hypertension disorders in pregnancy is labetalol. Labetalol is a non-selective beta-blocker that antagonizes both beta and alpha-1 receptors. Diuretics are the most commonly used medication. A woman can be continued on diuretic medication during pregnancy if she is on a diuretic before pregnancy. But, except for spironolactone, which may have fetal anti-androgen effects [4].

New approaches to managing patients with high total risk (review of year 2019 recommendations)

Cardiovascular disease is the leading cause of death worldwide. The current recommendations of the European Society of Cardiology (ESC) – 2019 are based on the results of large multicenter clinical trials that have proven the effectiveness of more stringent approaches to the management of patients with high cardiovascular risk. New regimens of drug therapy, the definition of new target values for blood pressure, blood lipid levels and the correction of hyperglycemia, the prevention of thromboembolic complications, are aimed at reducing the risk of cardiovascular events and mortality from cardiovascular diseases. The article discusses recommendations of the European Society of Cardiology – 2019 on the management of patients with chronic coronary disease, with lipid metabolism disorders, and diabetes mellitus.

Evidence base regarding target levels of arterial pressure in patients after a stroke: focus on a geriatric population

Arterial hypertension (AH) is a very significant and most common risk factor for stroke, and lowering blood pressure (BP) is the most effective action to prevent stroke in patients with AH. This article provides an overview of existing randomized clinical trials (RCTs) and meta-analyzes to study the optimal target BP levels in patients with AH and cerebral events with a history of focusing on the geriatric population. As a result of the analysis of literature data, we obtained contradictory results: RCTs showed the benefits of lower target BP, in only two of them the target level of systolic BP (SBP) was less than 130 mm Hg, and the average age of patients included in the RCTs varied from 60 to 68 years, the number of patients older than 75 years was insignificant, and some studies excluded patients older than 85 years. Several subanalyses analyzed by RCTs found a J-shaped relationship between BP levels achieved and the risk of adverse cardiovascular events. One of them showed that with a decrease in BP below the SBP 120 mm Hg and DBP 65 mm Hg higher BP was associated with a lower risk of cardiovascular events. Another one showed that the risk of re-stroke and the risk of subsequent adverse events was statistically significantly higher in patients with an average level of SBP below 120 mm Hg than in patients with a level of SBP of 130139 mm Hg. The meta-analysis published in the Cochrane database did not show significant advantages of lowering BP130/85 mm Hg versus standard lowering BP140160/90100 mm Hg, while another meta-analysis revealed some advantages of a more intense decrease in BP for the prevention of re-stroke. Existing studies did not take into account the heterogeneity of the geriatric population and did not include patients with fraility and multimorbidity patients, and did not take into account the type of stroke to develop a differentiated approach to the tactics of lowering BP in patients of all age groups. Therefore, in relation to the recommended ESC/ESH experts in 2018, target BP levels of 120129/7079 mm Hg (aged 1865 years) and 130139/7079 mmHg (aged 65 years) for patients with AH and a history of cerebral events, there are still some doubts about the benefits of lower target BP values for the prevention of re-stroke and other cardiovascular events for the entire population of geriatric patients, especially patients older than 75, so specially designed randomized controlled trials are needed.

Target levels of blood pressure in patients with arterial hypertension and coronary heart disease

High blood pressure (BP) is a leading risk factor for premature death and one of the important risk factors for coronary heart disease (CHD). A significant increase in risk is observed starting from the level of systolic BP of about 140 mm Hg. Tactics of antihypertensive therapy in patients with co-existent hypertension (HTN) and CHD are reviewed in the European and Russian recommendations for HTN. In spite of this, some uncertainty remains regarding the optimal target BP level in patients with HTN and clinically manifest CHD mainly due to the lack of convincing evidence arising from large and specially designed randomized clinical trials (RCTs) dedicated to this issue. Some observational studies, meta-analysis, special analysis of subgroups of patients with HTN and CHD from the large RCTs, showed a J-shaped relation between the achieved BP and an increased cardiovascular risk. Our paper reviews up-to-date literature in relation to the target BP level in patients with HTN and CHD, including patients with high cardiovascular risk and patients undergoing revascularization. We review data from large studies and meta-analysis, evaluating the impact of more intensive vs. less intensive control of BP on the risk of major cardiovascular events or mortality. The analysis of the literature confirmed a lack of evidence of benefits of lower target BP values in senile patients with co-existent HTN and CHD, thus indicating the need for well-planned RCTs.

Current guidelines and controversies in the diagnosis and therapy of hypertension in the elderly and very elderly — a review of international recommendations

According to the World Health Organization (WHO) arterial hypertension remains the most important cause of death in the world. Due to ageing of the population and the proven importance of high blood pressure in older age, various expert groups dealing with hypertension worldwide have dedicated more and more separate recommendations to elderly (65–79 years of age) and very elderly patients ( > 80 years of age). The subject of this work is to present and compare current guidelines for the diagnosis and treatment of hypertension developed for this demographic segment. Due to the global significance in shaping the views on hypertension, the following Englishlanguage guidelines have been used for comparative analyses in this work: 2017 ACC/AHA Guideline, 2018 ESC//ESH Guidelines, Hypertension Canada’s 2018 Guidelines, 2019 Hypertension in adults: diagnosis and management by National Institute for Health and Care Excellence (NICE), 2016 Guideline for the diagnosis and management of hypertension in adults by National Heart Foundation of Australia. The comparisons have been made based on of blood pressure criteria, the threshold values for drug treatment initiation and the blood pressure target values. In summary, hypertension guidelines for the elderly and very elderly differ significantly, although similar trends in their recommendations are evident.

To whom recommend intensive treatment for hypertension?

Arterial hypertension is the main identifiable cardiovascular risk factor, and although the benefit of blood pressure reduction is universally acknowledged, the scientific community has long been divided over the therapeutic blood pressure targets to be reached, also considering the estimated overall cardiovascular risk and the presence of individual risk factors and associated comorbidities. During the last few years, numerous clinical studies and meta-analyses, in particular, the SPRINT study, have been published, demonstrating the advantages of an intensive antihypertensive treatment, over a target blood pressure value (<140/90 mmHg), in the reduction of major cardiovascular events, myocardial infarction, stroke, heart failure, and all-causes cardiovascular mortality. Stemming from these results the major International Guidelines revisited the therapeutic objectives, recommending blood pressure value <130/80 mmHg for the vast majority of hypertensive patients until the age of 65 and suggesting a reduction of the target also in the elderly. Numerous studies and meta-analyses demonstrated that the reduction of the risk of coronary or cerebral events, and of all-causes cardiovascular mortality, is independent from the baseline value of blood pressure and the individual estimated risk. It has been also demonstrated that an early institution of antihypertensive treatment is associated with a faster realization of the recommended targets, and consequent significant benefits in terms of reduction of the incidence of myocardial infarction, heart failure, and major cardiovascular events, particularly when blood pressure control is achieved during the first 6 months of treatment, and even better during first 3 months. Other studies outlined that combination therapy with two or more drugs, mainly in a single pill configuration, are superior in reaching the recommended therapeutic targets. This is the reason why this strategy is strongly supported by the European Society of Cardiology/European Society of Hypertension (ESC/ESH) 2018 Guidelines, specifically the use of renin–angiotensin–aldosterone system inhibitors [angiotensin-converting enzyme (ACE) inhibitors and Sartans], in combination with calcium antagonist and/or thiazide diuretics, with the option to add antagonist of mineralcorticoid receptors, when an adequate blood pressure control has not been reached, or other classes of drugs, such as beta-blockers, when specific clinical indications are present, first and foremost ischaemic cardiomyopathy or heart failure. The newly proposed therapeutic goals are particularly important in high-risk patients, such as patients with previous cardiovascular events, diabetes mellitus, renal insufficiency, and patients older than 65 years of age.

Deprescribing Antihypertensive Drugs in Patients of Older Age Groups

Arterial hypertension (AH) is one of the most common diseases in the elderly. It has been proven that lowering blood pressure (BP) is effective in preventing stroke and cardiovascular complications in patients even at the age of ≥80 years. On the other hand, there is evidence that a significant decrease in BP can be harmful to older people and may lead to a higher risk of overall mortality. Therefore, existing guidelines for the treatment of AH determine specific approaches for managing patients of older age groups, where the target BP levels are determined not only by age and concomitant diseases, but also by the presence of frailty. Moreover, there is a need to monitor the dynamics of frailty indicators (social, functional, cognitive and mental status of the patient), since their deterioration may require changes in the tactics of antihypertensive therapy (dose reduction, drug withdrawal or replacement) and changes in target BP levels. In this regard, in recent years, the possibility/necessity of a planned and controlled process of dose reduction, drug withdrawal or replacement, if this drug can be harmful and/or does not bring benefits (deprescribing), has attracted attention. This article is a review of current literature, which presents the design and main characteristics of randomized clinical trials (RCTs) and systematic reviews on the deprescribing of antihypertensive drugs in elderly patients with AH and frailty. An analysis of these studies showed the benefits of deprescribing of antihypertensive drugs for elderly patients with frailty, which avoids potential harm to their health, improves the quality of life and reduces the economic cost of treatment. Therefore, deprescribing of antihypertensive drugs can be used as an additional tool to achieve the necessary target BP values in patients of an older age group. However, for the development of deprescribing of antihypertensive drugs schemes and its introduction into clinical practice, the results of large specially planned RCTs are needed to study this issue.

EFFECT OF THERAPY WITH A FIXED COMBINATION OF PERINDOPRIL AND AMLODIPINE ON VASCULAR AGE AND 5-YEAR RISK OF CARDIOVASCULAR COMPLICATIONS IN PATIENTS WITH ARTERIAL HYPERTENSION AND MILLITUS DIABETES TYPE 2

In recent years, the concept of cardiovascular risk factors, one of which is the process of vascular aging, has been of great interest. 30 patients with stage 2-3 of arterial hypertension and type 2 diabetes mellitus aged 45 to 65 years were included, including 23 women and 7 men. Patients after the washout period a fixed combination of perindopril with amlodipine (the original drug Prestans, AO Servier) in the form of tablets (perindopril arginine / amlodipine bezilat) were prescribed for 12 weeks, 1 time per day. Vascular age and 5-year risk of developing cardiovascular complications were calculated on the calculator app for smartphones ADVANTAGE AGE (Les laboratories Servier version 2, 2015). After 12-week therapy with a fixed combination of perindopril and amlodipine, the achievement of target blood pressure values was noted in 100 % of patients. The average passport age of the patients included in the study was (61,9 ± 4,4) [45; 65] years. In assessment vascular age, there was a statistically significant initial increase in vascular age above the passport age - (69,3 ± 8,5) [55; 89] years. 46,7 % of patients have an average risk of developing cardiovascular complications and 53,3 % of patients have a high risk of cardiovascular accidents. After 12 weeks of therapy with arginine perindopril and amlodipine bezilate, there was a significant decrease of vascular age to 63,1 ± 5,6 [51; 73] years, a decrease in the percentage of patients with high risk of cardiovascular complications to 23,4 % (p &lt; 0,05), due to patients with average risk (53,3 %, at p &lt; 0,05), and the appearance of patients (3,3 %) with a low risk of cardiovascular accidents within 5 years. In patients with arterial hypertension and diabetes millitus type 2, vascular age significantly increases in comparison with the passport age. The use of a fixed combination of perindopril arginine / amlodipine bezilate for 12 weeks in this category of patients significantly reduces the vascular age of patients and reduces the frequency of detection of patients with high and medium risk of cardiovascular accidents.

Как повысить эффективность комбинированной терапии артериальной гипертензии у больных с сопутствующей хронической обструктивной болезнью легких?

Aim: to conduct a comparative assessment of the hypotensive effect, as well as the effect on endothelial function, oxidative stress, and pulmonary artery pressure of chlorthalidone and hydrochlorothiazide as part of combined antihypertensive therapy in patients with arterial hypertension (AH) in combination with chronic obstructive pulmonary disease (COPD).Patients and Methods: the prospective study included 66 patients divided into two groups. As the main antihypertensive therapy, group 1 was prescribed with a combination of azilsartan medoxomil 40 mg and chlortalidone 12.5 mg as a fixed combination of Edarbi® CLO. Group 2 received a free combination of azilsartan medoxomil 40 mg (Edarbi®) and hydrochlorothiazide 12.5 mg. All patients underwent 24-hour blood pressure monitoring: (ABPM), echodopplercardiography, endothelium-dependent vasodilation, lipid peroxidation (LPO), nitric oxide metabolites, and endothelin-1 levels at baseline and after 6 months of treatment. Results: target blood pressure values (&lt;130/80 mm Hg) were achieved in 91% of patients in group 1, and 51.5% in group 2 after 1 month of the study. After 6 months of treatment, all patients in both groups reached the target BP values, but in group 2, the dose of hydrochlorothiazide had to be increased to 25 mg. According to the ABPM data, after 6 months of treatment, group 1 showed a decrease in the morning surge in SBP by 7.0±2.1% and DBP by 10±7.3%. There was also an increase in the number of patients with the daily profile of «dipper» type to 78.8%. In group 2, there was a decrease in the morning surge in SBP by 6.3±5.9% and DBP by 4.8±4.6% after 6 months of treatment. There was an increase in the number of patients with the daily profile of «dipper» type to 36.4%. After 6 months of treatment, there was more pronounced improvement in laboratory parameters of group 1 characterizing endothelial dysfunction and oxidative stress. Statistically significant results were obtained for conjugated trienes, NO2, S, Imax, and endothelin-1 when comparing groups 1 and 2.Conclusion: treatment of AH in patients with concomitant COPD in the form of a fixed combination of azilsartan medoxomil and chlorthalidone versus free combination of azilsartan medoxomil with hydrochlorothiazide has a more pronounced antihypertensive effect, positively affecting the daily BP profile, pulmonary artery pressure, endothelial function and lipid peroxidation processes after 6 months of treatment.KEYWORDS: arterial hypertension, chronic obstructive pulmonary disease, endothelial dysfunction, lipid peroxidation, azilsartan medoxomil, chlorthalidone.FOR CITATION: Grigorieva N.Yu., Samolyuk M.O., Sheshina T.V. et al. How to improve the effectiveness of combination therapy of arterial hypertension in patients with concomitant chronic obstructive pulmonary disease? Russian Medical Inquiry. 2020;4(7):418–424. DOI: 10.32364/2587-6821-2020-4-7-418-424.

Прогнозирование неблагоприятных сердечно-сосудистых событий в постинфарктном периоде с учетом приверженности лечению

Aim: to develop a graphic risk meter scale concerning major adverse cardiovascular events (MCVEs) during the 5-year post-infarction period, taking into account patients’ compliance to the treatment.Patients and Methods: the analyze was conducted on the data from a prospective five-year follow-up of patients (n=115) who experienced a myocardial infarction (MI) and were registered in the database of the Registry of Acute Myocardial Infarction (Tomsk). The following endpoints were analyzed: repeated MI, hospitalization for exacerbation of coronary heart disease, advanced chronic heart failure (CHF), and cardiac arrhythmias.Results: the study identified a set of factors that had a significant impact on the clinical course of the post-infarction period. CHF (diagnosed before the development of index MI) increased the chances of adverse course of post-infarction period in 9.5 times. The lack of achievement of systolic blood pressure target values increased the risk of cardiovascular complications in 5 times. The patients’ age of 75 years and older increased the possibility of an adverse postinfarction period course in 8.5 times. The predictor that favorably affected the post-infarction period course was an integral indicator equal to the product of the specific weight of vital drugs (in the general structure of prescriptions) and the treatment compliance degree. This indicator reduced the risk of MCVEs by 61% for each unit value, i.e. with the highest possible compliance to therapy that meets the recommendations; an adverse course risk of the post-infarction period decreased by 2.5 times.Conclusion: the results emphasize the importance of compliance with medical recommendations by patients who have experienced MI. The proposed graphic risk meter scale can be used to predict the development of adverse MCVEs during the 5-year post-infarction period. KEYWORDS: coronary heart disease, myocardial infarction, cardiovascular risk, treatment compliance, Morisky-Green test, disease prognosis.FOR CITATION: Kuzheleva E.A., Fedyunina V.A., Alexandrenko V.A. et al. Prediction of adverse cardiovascular events in the post-infarction period, taking into account treatment compliance. Russian Medical Inquiry. 2020;4(7):431–436. DOI: 10.32364/2587-6821-2020-4-7-431-436.

Evaluation of the antianginal effectiveness of trimetazidine in a new dosage form for a single dose, depending on the region of the Russian Federation. ODA trial results

Used database research ODA (Evaluation of the effectiveness and therapeutic response to Preductal OD 80 mg in everyday practical use for the treatment of stable angina), which was conducted in 56 cities of the Russian Federation. The analysis was carried out in the Central, North-West, Volga districts and regions united by the territorial principle - Southern + North Caucasian + Crimea + Sevastopol and Ural + Siberian + Far Eastern. By region, there were no differences in the ratio of men and women included in the observation, the number of smoking patients (about 15%), overweight (about 80% of patients), arterial hypertension (exceeding 85%),dyslipidemia (over 90%), and atrial fibrillation (met at each 8-10 included patient). The proportion of patients older than 65 years was greater in the Central, North-West and Ural regions. Unfavorable heredity in coronary artery disease is more common in the Southern, Central and Ural regions. More than 2/3 of the patients had low physical activity, and in the South - their number reached ¾ of all included in the observation. The largest number of patients with diabetes was in the Central and North-West regions (every fourth patient), in the Ural region every fifth. The lowest frequency of statin prescribing was in the Volga region. The smallest number of those receiving RAS inhibitors was in the North-West, Ural and South regions. Beta blockers took more than 80% of patients. Only 35% of patients had a target systolic blood pressure. The smallest proportion of people with target blood pressure values was in the NorthWest and South regions. Adding TMZ OD to therapy or replacing previous therapy with trimetazidine on TMZ OD in all regions resulted in a significant (p &lt;0.001) decrease in the incidence of angina attacks by as early as 1 month of therapy and the antianginal effect increased by the third month of treatment. By the third month of treatment, the average frequency of angina attacks was the lowest in the North-Western and Ural regions (significantly lower than even in the Central region) and remained higher only in the Volga region compared to the Central, North-Western and Ural regions. During follow-up, treatment compliance increased significantly in all regions. The fight against major risk factors remains insufficient and efforts should be made to change the situation in all regions of the Russian Federation. The inclusion of trimetazidine in therapy in the new TMZ OD dosage form allows to obtain a pronounced antianginal effect and increase adherence to therapy. Low adherence can be overcome by careful observation and closer contact between doctors and patients.

Target blood pressure levels in patients with arterial hypertension and frailty

Arterial hypertension (AH) is an important public health problem worldwide. The high prevalence of hypertension can partially be explained by an increase in blood pressure (BP) with age and a rapid increase in the elderly population (over 65 years old). Despite the effect of age on BP, evidence of target blood pressure values for its control in patients of older age groups with AH is limited, especially if they have frailty. There are data from a number of studies that reveal a relationship between lower BP levels and all-cause mortality in patients with AH in older age groups. In clinical practice, decisions regarding BP targets are especially difficult in elderly people with frailty who often do not meet the criteria for inclusion in randomized controlled trials and for this group of elderly people the clinical recommendations of leading communities do not give a specific answer about the target BP level. The evidence base regarding the target BP values in the treatment of AH in patients of older age groups with frailty presented in this review is not numerous, but its analysis suggests the advantages of higher BP numbers, with maximum systolic BP values of 165 mm Hg and diastolic BP of 90 mm Hg, while lower BP levels may be unsafe in terms of increasing the risk of adverse cardiovascular events and mortality from both cardiovascular causes and all causes. Polymorbidity in combination with polypharmacy and an increased risk of adverse events require a patient-oriented individual approach to the appointment of antihypertensive therapy. For a final decision on the management tactics of patients with AH and frailty, large, specially designed randomized clinical trials are needed.

Current features of management of comorbid patients with hypertension

The article presents an analysis of the current state of the problem of managing patients with arterial hypertension (AH) and various comorbid backgrounds. Also, it highlights the current guidelines (2018) for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Information on new target blood pressure (BP) values in the range of 120–130 mm Hg is emphasized for systolic blood pressure (SBP) and 70–80 mm Hg for the diastolic (DAD) one in the majority of patients with the exception of persons of 65 years and older, as well as patients with chronic kidney disease, who have been recommended to achieve a blood pressure of 130–139 mm Hg. Furthermore, his material presents the current views on the priority of combined (initially double, and triple in the case of failure), mainly fixed antihypertensive therapy, the choice of which requires the presence and nature of comorbid pathology.

Arterial hypertension in elderly and senile patients: clinical characteristics and treatment quality (according to the national register of arterial hypertension)

Introduction. The importance of studying treatment in older hypertensive patients is underlined by the tendency to aging of the population as a whole. During recent years, the approach to therapy of older patients changed. The guidelines on management of arterial hypertension recommend lower target blood pressure values and earlier start of the treatment.Aim. To study the quality of arterial hypertension treatment and clinical characteristics in older patients (≥65 years).Material and Methods. The Russian national registry of hypertension was conducted in 22 regions of the Russian Federation since 2012. It included 53 city primary health care centers and five cardiology clinics. The data were analyzed in two groups comprised of 65 to 79-year-old individuals and patients older than 80 years. Data on physical, instrumental, and laboratory examinations, as well as data regarding antihypertensive and lipid-lowering therapy and comorbidities, were analyzed.Results: Patients aged 65 to 79 years and those older than 80 years had coronary artery disease (42.7% and 55.5%), chronic heart failure (CHF) (46.8% and 55.7%), history of Q-wave myocardial infarction (MI) (6.4% and 5.9%), stroke (5.5% and 5.7%), atrial fibrillation/flutter (3.7% and 6.5%), chronic kidney disease (CKD) stage 3–5 (36.6% and 48.4%), and diabetes mellitus (19.4% and 13.4%). Following the guidelines on management of arterial hypertension 2013, the target values of systolic blood pressure were achieved in 30% of patients; target values of diastolic blood pressure were reached in 60% of patients. Decreases in systolic blood pressure lower than &lt;120 mmHg and in diastolic blood pressure lower than 70 mmHg were found in 3% of patients. In accordance with Guidelines 2018, target values of systolic blood pressure were achieved in 21–24% of patients; target values of diastolic blood pressure were achieved in 12–13% patients. Ambulatory 24-h blood pressure monitoring was performed only in 2.8% of 65–79-year-old patients and in 1.9% of patients older than 80 years. Data on antihypertensive therapy were absent in 13% of medical records of patients who had indications for it. Medical records of 20% of patients with history of Q-wave MI, CHF, diabetes mellitus, and CKD did not contain data on administration of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Administration of beta-blockers and mineralocorticoid receptor antagonists in patients with hypertension and chronic heart failure was insufficient. Achievement of target cholesterol levels was insufficient in both age groups.

The dynamics of blood pressure within 12 months after carotid artery stenting in patients with stenotic carotid lesions

Aim. To assess the dynamics of blood pressure (BP) and determine the predictors of the hypotensive effect after carotid artery stenting (CAS).Material and methods. The analysis included 99 patients who underwent CAS in a period of March 2014 and May 2016. Inclusion criteria: (1) the presence of 50% symptomatic or 70% asymptomatic stenosis of the carotid artery (according to NASCET criteria), (2) follow-up for at least 1 year, (3) measurement and recording of BP at four points: 24 hours before surgery, 1 hour, 24 hours and 12 months after surgery. Results. According to office measurement of BP, the average systolic/diastolic pressure was 117,11/60,75, 119,73/60,75, 134,75/70,48 mm Hg after 1 hour, one day and 12 months after the intervention, respectively. In comparison with the average numbers of BP before the intervention, 148,13/89,52 mm Hg there was a significantly significant decrease in BP levels after CAS (p&lt;0,01). According to the results of daily monitoring of blood pressure, a statistically important decrease in blood pressure was observed after 1 year of observation (p&lt;0,01) (136,52/76,84 compared with 145,91/87,63 before the intervention). Dissociated circle of Willis (odds ratio=10,37, 95% confidence interval, from 3,64 to 29,52; p&lt;0,001) and the occurrence of intraoperative hypotension (odds ratio =3,62, 95% confidence interval, from 1,16 to 11,28; p&lt;0,027) were predictors of a persistent decrease in BP after CAS. Conclusion. The obtained results indicated the need for more thorough conservative postoperative management, especially for patients with a dissociated circle of Willis. It is also necessary to achieve the target blood pressure values by individualized correction of antihypertensive therapy.