Degree Of Arterial Hypertension Research Articles

PP.18.07] RELATIONSHIP OF ELASTIC VASCULAR WALL PROPERTIES, RENAL FUNCTION AND INFLAMMATORY BIOCHEMICAL MARKERS IN HYPERTENSIVE PATIENTS WITH METABOLIC DISORDERS

Objective: To study the elastic properties of vascular wall, 24-hour blood pressure (BP) profile, parameters of renal function, biochemical parameters and their relationship with metabolic disorders in patients with arterial hypertension (AH) and metabolic disorders (abdominal obesity and dyslipidemia). Design and method: 130 patients (mean age 47.20 ± 9.6 years) were divided into 2 groups. The main group (group 1) included 77 subjects with AH degree I-III and MD (mass body index (MBI) 34.5 ± 3.9 kg/m2) and the control group (group 2) contained 53 subjects with AH without MD. The parameters of 24-hour BP monitoring, sphygmography, renal function (microalbuminuria, creatinine and estimation glomerular filtration rate (eGFR) using MDRD formule), parameters of the lipid profile, inflammatory markers – homocysteine, C-reactive protein (hs-CRP) and fibrinogen were estimated. Results: In group 1 there was registered significant increase in mean 24-hour and daytime systolic BP (SBP), time and square indices, in night time SBP and diastolic BP variability (p < 0.001); in sphygmography indices (cardio-ankle vascular index (CAVI), pulse wave velocity (PVW) and anklebrachial index (ABI) (p < 0.01); in parameters of renal function - microalbuminuria and eGFR (p < 0.001); in biochemical parameters - total cholesterol, fibrinogen (p < 0.016) and hs-CRP level (p = 0.04) compared to group 2. In group 1 correlation analysis revealed a positive correlation between microalbuminuria and PWV-R (p = 0.039), creatinine and R-ABI (p = 0.007), eGFR and L-ABI (p = 0.05), hs-CRP and CAVI and between fibrinogen and eGFR (p < 0.05). Besides, regression analysis method in patients with AH degree I revealed a positive relationship of creatinine with PWV-L (R2 = 0.14, p = 0.03), in patients with AH degree II - creatinine with CAVI and MBI (R2 = 0.451, p = 0.004 and p = 0.012). Conclusions: The relationship between elastic parameters of vascular wall, inflammatory markers, parameters of renal function and MBI has a pathogenetic basis for the progression of hypertension and impaired function of the target organ.

PP.16.14] THE INTERRELATION OF BLOOD PRESSURE VARIABILITY, ENDOTHELIAL FUNCTION AND C-REACTIVE PROTEIN IN PATIENTS WITH ARTERIAL HYPERTENSION AND CORONARY ARTERY DISEASE

Objective: To study the relationship of blood pressure variability (BPV) with parameters of vasomotor endothelial function and C-reactive protein (hsCRP) in patients with arterial hypertension (AH) combined with coronary artery disease (CAD). Design and method: A total of 80 patients with AH degree II-III and CAD were examined. 24-hour monitoring of blood pressure, endothelial dependent vasodilatation (EDV) and endothelium independent vasodilatation (EIV), level of hsCRP were evaluated. Results: In general, in the studied group of patients with BPV the statutory indicators did not exceed, however, the selection of patients with increased BPV showed that they constitute almost half of the observed sample (48.7%). Patients with increased BPV differed from patients with normal BPV by higher values of hsCRP (2.98 ± 0.71 vs 1.56 ± 0.33 mg/l, respectively), body mass index (33.91 ± 1.61 vs 29.49 ± 1.05 kg/m2), less pronounced response to the introduction of nitroglycerin in the evaluation EIV (13.23 ± 1.79 vs 17.70 ± 0.77%, p < 0.05). Correlations identified the relationship between systolic BPV day and EDV (r = −0.44, p = 0.012); hsCRP (r = 0.31, p = 0.008); systolic BPV night and EIV (r = −0.50, p = 0.003); diastolic BPV and EIV (r = −0.43, p = 0.013). The logistic regression analysis revealed that patients with depletion of EIV were 1.2 times more likely to have increased BPV OR 1,223 [95% CI 1,012–1,478; p = 0,037]. In patients with increased systolic BPV higher levels of hsCRP were observed 1.6 times more frequently OR 1.576 [95% CI 1.014–2.451; p = 0.043]. Conclusions: Relation of BPV with indicators of vasomotor endothelial function and a marker of the inflammatory response of the vascular wall that could indicate a pathogenetic relationship of the parameters, which, in turn, determine the development of adverse events in patients with AH and CAD was detected.

Clinical efficacy and cardioprotective capabilities of olmesartan and lercanidipine in the form of monotherapy and with their combined use in patients with arterial hypertension 1-2 degree

The aim of the study was to evaluate the clinical efficacy and cardioprotective effects of olmesartan and lercanidipine in the form of monotherapy and combined use in patients with arterial hypertension (AH) 1-2 degree and the presence of target organ damage in the form of left ventricular hypertrophy (LVH) and microalbuminuria UIA). Materials and methods. 90 patients with AH of 1-2 degree were examined and presence of LVH according to echocardiography (EchoCG) data, middle age 50.3±4.3 years, 42 of them men and 48 women, with AH of 1st degree - 44 (48.9%) people, with AH of the 2nd degree - 46 (51.1%) people. The mean duration of hypertension was 6.8±1.5 years. Methods included daily monitoring of blood pressure (cardiovascular system): CardioTens (Meditech, Hungary), transthoracic EchoCG: Voluson 730 Expert (General Electric, USA). One of the inclusion criteria was the presence of LVH according to EchoCG data: more than 95 g/m2 in women and more than 115 g/m2 in men. Depending on the initial degree of hypertension patients were divided into 3 groups. Patients with the 1st degree of AH were randomized to olmesartan monotherapy with 10-40 mg/day (group 1) and lercanidipine 10-20 mg/day (group 2), with grade 2 AH included in the combination therapy group Studied drugs (3rd group). Doses of drugs were titrated until the target blood pressure levels were reached. Initially and after 6 months of therapy, the results of SMAD, EchoCG were evaluated, the quality of life of patients was assessed using the visual-analogue scale "Health thermometer". The statistical analysis was carried out using the program Statistica 7.0. Results of the study. The degree of significant decrease in blood pressure in comparison with the baseline values and the corrective effect on the daily profile of blood pressure were comparable in the monotherapy groups with olmesartan and lercanidipine. In the group of combined use of target drugs of target levels, blood pressure was achieved in a larger percentage of cases than in the monotherapy groups. A reliable cardioprotective effect of olmesartan and lercanidipine was revealed both in monotherapy and in combination in patients with AH of 1-2 degree with LVH and MAU, manifested by a decrease in LV mass index (LVMI). The greatest cardioprotective effect in LVH regression was achieved in the combination therapy group. Conclusion. Olmesartan and lercanidipine when used in monotherapy have a cardioprotective effect in the form of a reliable and comparable decrease in LVMI, and their use in combination has a more pronounced effect on LVH regression.

Mechanisms of development of chronic cerebral ischemia in arterial hypertension

To study a relationship of arterial hypertension (AH) severity with the cerebral blood flow and structural changes in the brain matter, processes of lipid peroxidation and antioxidant defense, parameters of homeostasis, indicators of endothelial dysfunction and apoptosis. A complex study of 84 patients with AH, aged from 43 to 64 years, was carried out. The severity of atherosclerotic damage increased with the increasing of the AH degree. There were the sings of cerebral atrophy, changes in the white matter of brain hemispheres accompanied by the increase of oxidative stress and insufficient antioxidant activity, appearance of procoagulation shifts in the homeostasis system, along with the moderate activity of fibrinolysis, increase in the level of proinflammatory cytokines and markers of apoptosis, endothelin-1, decrease in nitrogen oxide concentration.

ОПТИМІЗАЦІЯ ЛІКУВАННЯ ДІАСТОЛІЧНОЇ СЕРЦЕВОЇ НЕДОСТАТНОСТІ У ПАЦІЄНТІВ ІЗ ГІПЕРТОНІЧНОЮ ХВОРОБОЮ В УМОВАХ КОМОРБІДНОСТІ З ГІПЕРУРИКЕМІЄЮ

У пацієнтів із гіпертонічноюхворобою (ГХ) з нормо- та гіперурикемією ми провели дослідження впливу комбінованої антигіпертензивної терапії з включенням ІаПФ лізиноприлу або ара ІІ вальсартану на діастолічну дисфункцію лівого шлуночка (ДДлш). було обстежено 137 пацієнтів із Гх ІІ стадії з 2–3 ступенями АГ: 74 хворих були з безсимптомною гіперурикемією (ГУЕ) (основна група) та 63 – з нормальними показниками рівня сечової кислоти (СК) (група порівняння). було встановлено пряму кореляцію між показником ДДЛШЕ/Е’ та рівнем сечової кислоти (СК), що свідчить про те, що у пацієнтів із аГ коморбідність із ГУе частішепоєднується із порушенням діастолічної функції лш. При цьому рівень сК при псевдонормальному типі ДДЛШ був вищим, ніж при релаксаційному типі у групі контролю здорових осіб. Через 6 місяців у групі вальсартану було виявлено більш значне поліпшення ДДЛШ як в групі з нормо-, так і згіперурикемією. Порівнюючи динаміку СК після проведеного лікування, було виявлено, що вона достовірно знижувалась у групі пацієнтів, які приймали вальсартан, порівняно з групою лізиноприлу, в якій не було виявлено достовірної різниці рівня СК у динаміці лікування.

Hereditary features of plasma concentrations of endothelin-1 in men with hypertension and chronic heart failure

Objective. To improve diagnosis of the severity of essential hypertension in men by determining the plasma levels of ET-1 in patients with different ET-1 gene variants.Materials and methods. We examined 191 men aged 40–60 years old, who live in Podillia region in Ukraine. Among them 79 men from control group, 62 men with uncomplicated essential hypertension (EH) with left ventricular hypertrophy (LVH) and 50 men with EH and chronic heart failure (CHF) II-III functional classes by NYHA. We used clinical, biochemical, instrumental and mathematical methods of investigation, polymerase chain reaction and enzyme immunoassay.Results. In both healthy men and patients with EH Lys/Lys genotype and the Lys allele of the ET-1 gene dominates. It was found that any inherited variant of the ET-1 gene was not associated with the risk of developing EH and CHF on its background. In patients with EH the peptide level was significantly higher than in the control group and the highest concentration of ET-1 was in patients with EH and CHF. In men from the control group, patients with uncomplicated EH with LVH and EH with CHF – carriers of genotype Lys/Lys – plasma concentration of ET-1 was significantly lower than in owners of the Asn allele. In carriers of Lys/Lys genotype the highest level of the peptide in plasma is determined in patients with EH complicated by CHF. In owners of the Asn allele concentration of ET-1 in men with EH was significantly higher than in control subjects, but the difference between patients with EH was not found. In men with uncomplicated EH with LVH, who are carriers of Lys/Lys genotype the 2d degree of arterial hypertension (AH) is significantly more common, and in carriers of the Asn allele the 3d degree of AH. In patients with EH and CHF carriage of the Asn allele is associated with 3d degree of AH.Conclusions. Lys/Lys genotype and the Lys allele of the ET-1 gene dominate among control group and patients with EH. The carriers of the Asn allele of the ET-1 gene have significantly higher plasma levels of the aforementioned peptide among the control group and in the patients with EH. The Asn allele is associated with 3d degree of AH. The ET-1 boundary levels were estimated, that can be used for screening of large contingents of people for early diagnosis of EH and CHF.

PP.21.10] INFLAMMATORY BIOCHEMICAL MARKERS AND FUNCTIONAL PARAMETERS OF ARTERIAL WALL IN HYPERTENSIVE PATIENTS WITH METABOLIC DISORDERS

Objective: To study inflammatory biochemical markers, functional parameters of vessel wall, 24-h blood pressure (BP) profile and their correlation with metabolic disorders in patients with arterial hypertension (AH) and abdominal obesity (AO). Design and method: 248 patients were divided into 2 groups: the main group (group 1) included 168 subjects (mean age 44.36 ± 1.52 years) with AH degree I-III and AO (mass body index (MBI) 32.4 ± 4.1 kg/m2) and the control group (group 2) - 80 subjects (mean age 42.27 ± 0.85 years) without metabolic disorders. The parameters of sphygmography; 24-hour BP monitoring; inflammatory markers – homocysteine, high-sensitivity C-reactive protein (hs-CRP), TNF-alpha, fibrinogen and ceruloplasmin and lipid parameters, diene conjugates, malonic dialdehyde (MDA), catalaze were estimated. Results: In group 1 there was registered significant increase in sphygmography indices (cardio-ankle vascular index (CAVI), pulse wave velocity (PVW) and ankle-brachial index (ABI) and in BP monitoring - mean 24-h and daytime systolic BP, time and square indices, in nighttime systolic BP and diastolic BP variability. In biochemical parameters significant increase in inflammatory markers - homocysteine, hs-CRP level and in total cholesterol, low-density lipoprotein cholesterol, triglyceride level and high-density lipoprotein cholesterol was detected compared to group 2. Besides in group 1 positive correlation between parameters of sphygmography with inflammatory and lipid markers (CAVI and homocysteine, triglyceride; PVW and fibrinogen; ABI and LDL cholesterol, MDA, hs-CRP, ceruloplasmin); with MBI, 24-h BP, age and sex of patients was found. Conclusions: Biochemical markers of inflammation along with the parameters of lipid profile may be associated with vascular remodeling in patients with AH and AO.

Dynamics of Biochemical Markers of Endothelial Dysfunction in Patients With Arterial Hypertension

Arterial hypertension (AH) occupies the first place among causes of atrial fibrillation (AF) in general population. AF in patients with AH substantially elevates risk of cardiovascular complications. Endothelial dysfunction (ED) in patients with AH at appearance of AF might have great prognostic value for stratification of risk of thromboembolic complications. We studied biochemical markers of ED in patients with AH and various forms of AF. Collagen binding activity of the von Willebrand factor (vWF) in patients with permanent AF was significantly higher than in patients without heart rhythm disturbances and did not depend on degree of AH. We revealed dependence of moderate strength between frequency of AF paroxysms during a year and collagen binding activity of vWF in patients with persistent AF. Blood plasma concentration of endothelin increased with increase of degree of AH both in patients with AF and in those without heart rhythm disturbances and did not depend on form of arrhythmia.

Features of cardiac remodeling in patients with hypertension of different ethnic groups

Objective. To study the features of different types of left ventricles (LV) geometry in patients with essential hypertension (EH) of different ethnic groups. Materials and methods. We examined 180 patients, residents of the Sakhalin Region, with 1-3 degree arterial hypertension, including 88 patients of Korean ethnicity aged from 45 to 63 years (mean age - 59.2±0.86 years) and 92 patients of Slavic ethnicity in age from 43 to 64 years (mean age - 58.2±0.93 years). LV structural and functional characteristics were studied by means of echocardiography with Doppler analysis on the ultrasonic system Acuson X300 (HP, USA). Results. The results of assessment of different types of LV geometry revealed the following differences: prevalence of the LV concentric remodeling was higher in patients with EH of Korean ethnicity (21.5% versus 13% among the Slavs, p=0.04). Conclusion. The study of the structural characteristics of left ventricular in patients with hypertension, residents of the Sakhalin Region, revealed that concentric remodeling and concentric left ventricular hypertrophy are the main types of LV geometry in hypertensive patients of both ethnic groups. However, concentric LV remodeling was more often detected in patients with hypertension of Korean ethnicity.

GENDER AND AGE CHARACTERISTIC OF THE BLOOD LIPID SPECTRUM IN PATIENTS SUFFERING FROM DIABETIC NEPHROPATHY WITH ARTERIAL HYPERTENSION

Studying the factors of diabetic nephropathy (DN) progression is a vital problem of the present timeThe aim of the research. To study age and gender specific features of the blood lipid imbalance of the patients suffering from diabetic nephropathy with the presence of arterial hypertensionMaterial and methods. Age and gender peculiarities o the lipid imbalance in the blood of the patients suffering from nephropathy stage IY with availability of arterial hypertension which arose against a background of diabetes type 2 have been studied.The results of the research and their discussion. Evidence of the lipid imbalance in the patients under study has been found to depend upon not only the stage of renal chronic disease and arterial hypertension degree, but age and gender of the patients.Conclusions. Significant gender distinctions of the lipid imbalance in patients with DN stage IY against a background of RChD stage I-II and AH stage II with its prevalence in women were revealed. Lipid imbalance is more evident in patients with DN stage IY against a background of RChD stage I-II with AH stage II of old age, manifesting by a significant increase of LPLD level. A reliable increase of the level of GChL, LPLD, TG and a significant decrease of LPLD in patients with DN stage IY against a background of RChD stage II with AH stage II in comparison with corresponding indices of the patients with DN stage IY against a background of RChD stage I with AH stage I.

Correction particularities of left ventrical diastolic dysfunction in patients with essential arterial hypertension with hyperuricemia

The effect of the combined antihypertensive treatment with lisinopril or valsartan on the left ventricle diastolic dysfunction (LVDD) was compared in hypertensive patients depending on the uric acid level. 118 patients with the second stage and 2 and 3 degrees of arterial hypertension (AH) were observed, 69 patients among them had concomitant symptom-free hyperuricemia (basic group) and 49 had normal uric acid (UA) blood level (comparing group). The direct correlation between the LVDD index E/E’ and UA level was determined, which proves the more often association of hyperuricemia and left ventricle diastolic function disturbances in hypertensive patients. In the same time, the UA level in patients with pseudonormal type of LVDD was higher than in patients with relaxation type. In valsartan group after the 6 months treatment the more significant improvement of the LVDD was determined in both normo- and hyperuricemia patients. The effect of valsartan on the decreasing of hyperuricemia level was found to be more marked than that of lisinopril.

Platelet Activity in Patients With Third Degree Arterial Hypertension and Metabolic Syndrome

Platelet Activity in Patients With Third Degree Arterial Hypertension and Metabolic Syndrome

Особенности ремоделирования сердца у пациентов с гипертонической болезнью разных этнических групп

Objective. To study the features of different types of left ventricles (LV) geometry in patients with essential hypertension (EH) of different ethnic groups. Materials and methods. We examined 180 patients, residents of the Sakhalin Region, with 1-3 degree arterial hypertension, including 88 patients of Korean ethnicity aged from 45 to 63 years (mean age - 59.2±0.86 years) and 92 patients of Slavic ethnicity in age from 43 to 64 years (mean age - 58.2±0.93 years). LV structural and functional characteristics were studied by means of echocardiography with Doppler analysis on the ultrasonic system Acuson X300 (HP, USA). Results. The results of assessment of different types of LV geometry revealed the following differences: prevalence of the LV concentric remodeling was higher in patients with EH of Korean ethnicity (21.5% versus 13% among the Slavs, p=0.04). Conclusion. The study of the structural characteristics of left ventricular in patients with hypertension, residents of the Sakhalin Region, revealed that concentric remodeling and concentric left ventricular hypertrophy are the main types of LV geometry in hypertensive patients of both ethnic groups. However, concentric LV remodeling was more often detected in patients with hypertension of Korean ethnicity.

The state of the hemomicrocirculation system and predictive capacity of parameters characterizing it in patients with hypertensive nephropathy

Today the diagnostics of microcirculatory disorders in patients with hypertensive nephropathy (HN) is an extremely important issue. Aim. To evaluate the functional state of hemomicrocirculatory (HMC) system and to analyze predictive capacity of parameters characterizing it in patients with essential hypertension (EH) of II stage accompanied with manifestations of nephropathy. Methods and results. 155 patients were examined including two main groups of patients with stage II EH of second (n=31) and third (n=31) degree of arterial hypertension (AH) with early signs of nephropathy as well as three comparison groups including patients with essential hypertension stage II of the second (n=31) and third (n=31) degree of hypertension with preserved renal function, and practically healthy individuals (n=31). Albumin/creatinine ratio in urine greater that 30 mg/g was taken as the marker of kidney disorder. The function of HMC system was evaluated by means of laser Doppler flowmetry. It was found that it is typical for patients with HN to show the reduction in tissue perfusion, variability of peripheral blood flow, apparent dysfunctional disorders of the microvascular endothelium, significant neurogenic and myogenic tonus increase. The significant loss of elastic properties of microvessels and pronounced signs of stagnation of blood in the postcapillary segment of microvasculature were also noted. Patients with HN accompanied with the sharp reduction of normocirculatory microcirculation hemodynamic type (HTM) showed increase in the cases of spastic and stagnant-stasis HTM. Conclusions. Among the analyzed parameters which characterize HMC system, A max E and A max C appeared to be the most qualitative predictors of the HN in hypertensive patients and had a joint predictive potential.

The first results of an international clinical trial VICTORY:the efficacy and safety of antihypertensive valsartan monotherapy and the fixed combination of valsartan and hydrochlorothiazide usingdifferent dosage regimens in patients with 1-2 degree arterial hypertension

On behalf of the group of russian researchers. The aim of the VICTORY study was to estimate the efficacy and safety of valsartan monotherapy using different dose regimes (Valsacor® 80, 160, 320 mg) and its fixed combination with hydrochlorothiazide (HCTZ) using different dosage regimens [Valsacor® H160 (valsartan 160 mg + HCTZ12.5 mg), Valsacor® H320 (valsartan 320 mg + HCTZ 12.5 mg) Valsacor® HD320 (valsartan 320 mg + HCTZ 25 mg)] in reaching the target level of blood pressure (BP) in patients with 1-2 degree arterial hypertension (AH).Materials and methods. There are 130 patients with 1-2 degree AH were enrolled in the open international multicenter prospective randomized study from 7 cities in 8 Russian Clinical Centers in Russia. The starting dose of valsartan depended upon the previous antihypertensive treatment: for previously untreated patients - 80 mg (Valsacor® 80 mg, KRKA, Slovenia) with randomization into 4 parallel groups (n=108) for the patients receiving antihypertensive therapy during the screening, after washout 7-day period of Valsacor® 160 mg application with randomization into 8 parallel groups (n=22). Besides the dynamics of clinical BP, we evaluated the impact of therapy on pulse ware velocity, erectile function (in men) and the quality of life. Results. The clinical BP in 130 patients with AH with age of 55.6±11.5 years (65% women) at the moment of inclusion into the study was 157.6/95.1 mm Hg. The BP was reduced to 140.9/85.3 mm Hg on the 4-week of valsartan 80 or 160 mg application. Valsartan titration or the combination of valsartan and HCTZ on the 8-week helped to reduce BP to 135.2/83.5 mm Hg. The 16-week treatment showed the BP reduced to 129.2/79.4 mm Hg. ( p

Первые результаты международного клинического исследования VICTORY: эффективность и безопасность антигипертензивной монотерапии валсартаном и его фиксированной комбинации с гидрохлоротиазидом в разных дозовых режимах у пациентов с артериальной гипертонией 1–2-й степени

On behalf of the group of russian researchers. The aim of the VICTORY study was to estimate the efficacy and safety of valsartan monotherapy using different dose regimes (Valsacor® 80, 160, 320 mg) and its fixed combination with hydrochlorothiazide (HCTZ) using different dosage regimens [Valsacor® H160 (valsartan 160 mg + HCTZ12.5 mg), Valsacor® H320 (valsartan 320 mg + HCTZ 12.5 mg) Valsacor® HD320 (valsartan 320 mg + HCTZ 25 mg)] in reaching the target level of blood pressure (BP) in patients with 1-2 degree arterial hypertension (AH).Materials and methods. There are 130 patients with 1-2 degree AH were enrolled in the open international multicenter prospective randomized study from 7 cities in 8 Russian Clinical Centers in Russia. The starting dose of valsartan depended upon the previous antihypertensive treatment: for previously untreated patients - 80 mg (Valsacor® 80 mg, KRKA, Slovenia) with randomization into 4 parallel groups (n=108) for the patients receiving antihypertensive therapy during the screening, after washout 7-day period of Valsacor® 160 mg application with randomization into 8 parallel groups (n=22). Besides the dynamics of clinical BP, we evaluated the impact of therapy on pulse ware velocity, erectile function (in men) and the quality of life. Results. The clinical BP in 130 patients with AH with age of 55.6±11.5 years (65% women) at the moment of inclusion into the study was 157.6/95.1 mm Hg. The BP was reduced to 140.9/85.3 mm Hg on the 4-week of valsartan 80 or 160 mg application. Valsartan titration or the combination of valsartan and HCTZ on the 8-week helped to reduce BP to 135.2/83.5 mm Hg. The 16-week treatment showed the BP reduced to 129.2/79.4 mm Hg. ( p <0.000001). The therapy was statistically significant reducing the level of heart rate and did not affect aortic augmentation index and the condition of erectile function. The percentage of patients who had the departure from normal blood glucose levels, creatinine and potassium, did not increase since the beginning of the study till the 16-week of treatment. Adverse effects were observed in 9.2% of patients, the connection with the drugs was assessed as improbable and in one case as possible, the severity - was moderate or slight.Conclusions:Valsartan monotherapy and the combination of valsartan and HCTZ significantly reduce the systolic BP and diastolic BP to normal levels in patients with 1-2 degree arterial hypertension.As a result of valsartan therapy and the combination with HCTZ the target BP values were achieved at 91% of all patients involved in the study.Valsartan monotherapy and the combination of valsartan and HCTZ led to heart rate reduction and did not affect aortic augmentation index.Therapeutic effect was very good in 89.1% of the patients and good - in 7.0%.The overall clinical efficiency was measured as extremely high in 73.4% of patients, very high - in 15.6% and high - in 6.3%.On assessing the impact of the therapy on the quality of life of patients we noted that 78.7% of patients were in good health, and in 18.1% of cases the treatment did not worsen the general well-being of the patient.

Нейро-вегетативный статус и суточный профиль артериального давления у пациентов с артериальной гипертензией

The aim of research is study peculiar properties of vegetative status and 24 hours&amp;#180; arterial pressure profile in inefficient antihypertensive therapy patients. It was examined 180 patients in age from 42 to 65 with diagnosis I-III degree of arterial hypertension on classification RSOC; volunteers without arterial hypertension and sporadic rise of pressure has been integrated into research (n=36). Clinical and biochemical monitoring realized to the whole of examines in accordance with standards on diagnostic of arterial hypertension. 24 hours&amp;#180; profile arterial pressure will be done in conformity with guideline national joint committee on cure of arterial hypertension JNK VI, WHO/ISH. Determination predominant autonomic balance carried out from system for integrated vegetative status, by its results patients were divided into subgroups. Then the patients were separated into subgroups by predominant autonomic balance with a glance degree and phase of arterial hypertension; modification key indicator of 24 hours&amp;#180; arterial pressure profile in subgroups was investigated. It has been found experimentally that type of predominant autonomic balance varies with the phase, by not with degree of arterial hypertension. Inefficient antihypertensive therapy patients have more high frequency and variability of cardiac rhythm, which combine with insufficient degree decrease of cardiac rhythm at night; more high value of systolic, diastolic, sphygmic and medium pressure comparison with control group. Complex hemodynamic rates (DP, maxIMP) and also bodymass index in inefficient antihypertensive therapy patients exceed the same in efficient treatment cluster.

The functional state of microcirculatory vessels in patients with arterial hypertension I-II degree with different degrees of cardiovascular risk

Aim: to evaluate the main parameters of the microcirculatory blood flow and to determine its reserve capacity in patients with arterial hypertension (AH) and different degrees of cardiovascular risk (CVR).Subjects and methods. We examined 64 subjects aged 47-58 years, of which 27 were healthy volunteers and 37 patients with 1st and 2nd degree arterial hypertension, with medium, high and very high CVR (the antihypertensive therapy was cancelled for 2 weeks before the study). In all subjects laser Doppler flowmetry (LDF) with studing initial perfusion parameters, 2 constrictor and 3 dilatator tests waky perfomed. To assess the status of the tone-shaping «active» and «passive» parts of microcirculatory modulation, analysis of the amplitude and frequency spectrum of LDF- grams was carried out.Results. A significant increase in the rate of «base perfusion» in all hypertensive groups compared with the control group was found. The amplitude of respiratory oscillations was one-third higher in high and very high CVR groups in comparison with the control, the amplitude of the myogenic and neurogenic oscillations were maximal and reached significant values in very high CVR group. A reduction in constrictor response in hypertensive patients with middle and high CVR and its increase in the very high CVR group was shown during constrictor functional tests. The power of perfusion increase was reduced in response to all kinds of dilatator stimulus in hypertensive patients group.Conclusion. The findings indicate a progressive increase in the level of «base perfusion», worsening of venous congestion symptoms in hypertensive patients with the progression in CVR severity. High and very high CVR patients showed a reduction in myogenic tone of microvessels when compared with those with normotension. Dilatator functional tests showed a tendency to lower capillary blood flow reserve in hypertensive patients compared with the control group.

PHARMACOECONOMIC ANALYSIS OF ANTIHYPERTENSIVE DRUG COMBINATIONS USE

Aim. To pursue pharmacoeconomic analysis of two drug combinations of ACE inhibitor (enalapril) and diuretic. Material and methods. Patients with arterial hypertension degree 2 and diabetes mellitus type 2 without ischemic heart disease (n=56) were included into the study. Blood pressure (BP) dynamics and cost/effectiveness ratio were evaluated. Results. In group A (fixed combination of original enalapril/hydrochlorothiazide) 61% of patients achieved target BP level with initial dose, and the rest 39% of patients – with double dose. In group B (non-fixed combination of generic enalapril/indapamide) 60% of patients achieved the target BP with initial dose of drugs, 33% - with double dose of ACE inhibitor, and 7% - with additional amlodipine administration. In patients of group A systolic BP (SBP) reduction was 45.82±1.23 mm Hg by the 12th week vs. 40.0±0.81 mm Hg in patients of group B; diastolic BP (DBP) reduction was 22.47±1.05 mm Hg and 18.76±0.70 mm Hg, respectively, by the 12th week of treatment. In the first month of treatment costs of target BP achievement was 298.62 rubles per patient in group A, and 299.50 rubles – in group B; by the 12th week of treatment – 629.45 and 631.22 rubles, respectively. Costs of SBP and DBP reduction by 1 mm Hg during 12 weeks of therapy were 13 and 27 rubles per patient, respectively, in group A, and 16 and 34 rubles per patient, respectively, in group B. Conclusion. The original fixed combination (enalapril+hydrochlorothiazide) proved to be more clinically effective and more cost effective in the treatment of hypertensive patients in comparison with the non-fixed combination of generic drugs (enalapril+indapamide).

Age-related changes in the brain of obese Zucker rat:Morphological and immunochemical analysis.

Metabolic syndrome (MetS) is defined as a combination of glucose intolerance, arterial hypertension, dyslipidemia and obesity with insulin resistance as the main cause of these imbalances. In general, obesity increases the risk of vascular diseases. Both cardiovascular and cerebrovascular disorders are often linked to impaired cognitive functions. A relationship between metabolic disease and mild cognitive impairment, and/or vascular dementia was hypothesized. The obese Zucker rat (OZR), represents a model of obesity and type 2 diabetes exhibiting a moderate degree of arterial hypertension. OZRs are characterized by the simultaneous occurrence of hyperglycaemia, hyperinsulinaemia and hyperlipidaemia. This study has investigated brain microanatomy of OZRs compared with their nonobese cohort lean Zucker rats (LZRs) to assess possible relationships between MetS and brain damage. Male OZRs and LZRs of 12, 16 and 20 weeks of age were used. Body weight, blood pressure and blood chemistry parameters were checked every two weeks and before killing. The brain was dissected out and processed for immunochemical and immunohistochemical analysis of nerve cells identified by neuronal specific nuclear protein (NeuN) and axons identified by neurofilament (NF) immunohistochemistry. Glial-fibrillary acid protein (GFAP) immunoreactive astrocytes were also investigated. OZRs of different ages, were characterized by a high body weight, an increase of systolic pressure, glycemia, triglycerides and cholesterol levels in comparison with LZRs. An age-dependent increase of these parameters was observed in OZRs. A decrease of brain/body weight ratio was found in OZRs. In frontal cortex and hippocampus, morphological and immunochemical analysis revealed a decrease of NeuN immunoreactive neurons not related to apoptosis in older OZRs group compared to age matched LZRs. In OZRs a decrease of NF immunoreaction and an increase of GFAP immunoreactive astrocytes was observed compared to LZRs These findings suggest that OZRs, used for investigating mechanisms and pathophysiology of obesity and type 2 diabetes, may also represent a model for assessing the influence of MetS on brain.