Effects Of Antihypertensive Therapy Research Articles

INSUFFICIENT CONTROL OF OUT-OF-OFFICE BLOOD PRESSURE: THE PROBLEM OF MASKED UNCONTROLLED HYPERTENSION: review

Despite significant advances in the diagnosis and treatment of arterial hypertension (AH), the problem of insufficient blood pressure (BP) control in hypertensive patients is quite acute. According to current guidelines, the effectiveness of antihypertensive therapy is mainly assessed by reaching the target levels of office BP, while masked uncontrolled hypertension (MUCH), which is diagnosed on the basis of insufficient control of out-of-office BP, increases the risk of cardiovascular events. Patients with insufficient out-of-office BP control have an increased risk of cardiovascular events compared to patients with both office and out-of-office BP control, therefore MUCH requires timely diagnosis and correction. This mini-review summarizes the understanding of the nature of MUCH. A particular attention is paid to risk factors and ways of influencing the out-of-office BP control. The article also assessed the important contribution of ABPM to the control of out-of-office BP and to determining the overall risk of MUCH.

Depression as a potential factor for the ineffectiveness of hypertension control in post-COVID-19 patients

Objective: improving the effectiveness of hypertension control in patients after COVID-19 with manifestations of depression. Materials and methods: the study included 48 patients with hypertension who had suffered a coronavirus infection. The criterion for inclusion in the study was effective control of blood pressure when using two-component antihypertensive therapy before the development of coronavirus disease and its absence when using the same therapy at the time of inclusion in the study. To identify the symptoms of depression, a study was conducted using the Beck Depression questionnaire. Group A consisted of patients with arterial hypertension with manifestations of depression and group B-patients with arterial hypertension without symptoms of depression. In both groups, a combination of a renin-angiotensin-aldosterone system blocker, a diuretic and a calcium channel blocker were used. The observation was carried out for 4 weeks, the dynamics of blood pressure and its daily parameters, manifestations of depression were evaluated. Results: the presence of symptoms of depression was detected in 39.5% of patients. At the time of inclusion in the study, office blood pressure exceeded the target level in all patients, there was an insufficient decrease in systolic and diastolic blood pressure during the day and at night, an increase in most indicators of blood pressure variability. The use of three-component therapy made it possible to achieve the target blood pressure level in 93.1% of patients without symptoms of depression. In the group of patients with depression, only 21.0% of patients reached the target blood pressure level. The analysis of daily blood pressure indicators showed a decrease in the effectiveness of antihypertensive therapy in the group of patients with depression. All daily blood pressure indicators were statistically significantly higher than in group B. Conclusion: in patients who have suffered a coronavirus infection, it is necessary to identify depression as a possible factor of ineffective control of arterial hypertension and a decrease in adherence to the recommended therapy.

Exploring the role of pharmacists in improving blood pressure control among hypertensive patients at the workplace

Several hours of productivity are lost due to improper management of hypertension. Poor adherence and inadequate care due to weak healthcare systems contribute to the lack of effectiveness of anti-hypertensive therapy. Pharmaceutical care plays a vital role in achieving treatment goals for patients with chronic conditions such as hypertension. This study sought to ascertain the effectiveness of pharmaceutical care services provided at the workplace on adherence and blood pressure control among staff with hypertension. This was a prospective pre-post study conducted at the Kwame Nkrumah University of Science and Technology from September 2019 to September 2020. Staff with confirmed diagnosis of hypertension were offered individualized pharmaceutical care every month for six months. Outcome measures were changes in blood pressure measurement, adherence and the number of pharmaceutical care issues identified and resolved. Forty-three university staff participated in this study. Reductions in mean systolic and diastolic blood pressure and difference in mean adherence scores were statistically significant after 6 months of follow up (p ≤ 0.00). A medical diagnosis of diabetes (p ≤ 0.044) and Body Mass Index (p ≤ 0.038) were associated with control of hypertension. Adherence to medications improved after the follow up period. Participants and pharmacists involved in the study expressed satisfaction with the program's impact. Pharmaceutical care at the workplace can improve medication adherence and blood pressure control among hypertensive patients. Blood pressure control was also better among individuals with normal Body Mass Index or a medical history of diabetes.

Эффективность антигипертензивной терапии в коррекции когнитивных нарушений у пациентов с гипертонической болезнью

Данные о способности антигипертензивной терапии снижать риск развития новых случаев когнитивных нарушений (КН) противоречивы. Поэтому целью исследования было оценить влияние антигипертензивной терапии на динамику когнитивных функций у пациентов с гипертонической болезнью (ГБ). В исследование включено 90 пациентов с ГБ I–II стадии, 2–3-й степени (средний возраст пациентов составил 49,66 ± 8,74 года). Всем пациентам проведены клинико-анамнестические обследования, использованы лабораторные и инструментальные методы исследования. Для изучения когнитивных функций применялись нейропсихологические тесты: GPCOG, MMSE, таблицы Шульте. Среди обследованных КП обнаружены у 36 пациентов (40 %). Для лечения в качестве антигипертензивной терапии была использована комбинация ингибитора ангиотензинпревращающего фермента или блокатора рецепторов ангиотензина + блокатор кальциевых каналов. На фоне антигипертензивной терапии отмечалось не только снижение и нормализация артериального давления, но и улучшение когнитивных функций. В частности, в 61,29 % случаев пациенты набрали достоверно больше баллов при повторном тестировании MMSE (p = 0,003) и GPCOG (p = 0,01), почти все пациенты (96,77 %) затратили достоверно меньше времени на выполнение заданий по таблицам Шульте (p = 0,0001). Общая сумма баллов по шкале MMSE выросла на 3,66 % (p = 0,003), суммарный балл по шкале GPCOG увеличился на 22,24 % (p = 0,01), а при контрольном выполнении теста Шульте пациенты потратили на 14,39 % меньше времени по сравнению с исходными результатами (p = 0,0001).

Abstract P131: RISK FACTORS AND WAYS OF INFLUENCING MASKED UNCONTROLLED HYPERTENSION

Purpose: to establish risk factors of masked uncontrolled hypertension (MUCH) and clarify how fixed combinations can affect blood pressure (BP) control. Methods: We examined 70 patients with hypertension. The initial assessment of the effectiveness of antihypertensive therapy was carried out 3 months after its appointment. Of the 70 patients, 63 were able to reach essential office BP reduction point (these patients were additionally scheduled for ABPM). Results: Among 63 patients in whom hypertension was controlled according to office BP data, 58.7% had insufficient BP control according to ABPM data. Among patients with insufficient control of out-of-office BP, there were significantly more patients with circadian rhythm disorders (p=0.000). An assessment of possible factors for the development of MUCH showed that elderly age occurred in 78.4%, male sex - in 59.5%, smoking - in 70.3%, stress - in 78.4%, various sleep disorders - in 45.9%, diabetes mellitus (DM) - in 56.8%, obesity - in 67.6%, insulin resistance (IR) - in 73%, chronic kidney disease (CKD) - in 35.1% patients with MUCH. Analysis of patient therapy showed that out of 37 patients with MUCH, 7 patients received monotherapy, 9 patients - free dual combinations, and 21 patients - fixed dual combinations. For patients with MUCH, antihypertensive therapy was strengthened: patients who had previously received monotherapy or free combinations were transferred to double fixed combinations (both drugs acted for 24 hours), and those patients who received double fixed combinations were transferred to triple fixed combinations. Evaluation of therapy after 3 months showed that of 37 patients with initially established MUCH, complete BP control was achieved in 86.5% (in the remaining 13.5%, despite sufficient office BP control, MUCH was maintained according to ABPM data). Conclusions: In inadequate control of out-of-office BP, disturbances of the circadian rhythm are more common than with complete BP control. MUCH is associated with such risk factors as elderly age, male gender, smoking, stress, sleep disturbances, DM, obesity, IR, and CKD. Strengthening antihypertensive therapy contributed to the achievement of both office and out-of-office BP in 86.5% of patients with previously established MUCH.

Fixed combination of ramipril and indapamide in patients with hypertension and non-alcoholic fatty liver disease: focus on the large arteries

Objective.To assess the effect of antihypertensive therapy with ramipril and indapamide on the elasticity of the vascular wall of the large arteries in relation to insulin resistance and chronic low-intensity inflammation in patients with hypertension (HTN) and non-alcoholic fatty liver disease (NAFLD).Design and methods.An open prospective controlled study was conducted: 30 patients with HTN stage I–II in combination with NAFLD (Fatty Liver Index (FLI) > 60) at the age of 45–65 years were included. Washout period was scheduled 5–7 days before the baseline examination, followed by the prescription of one of the fixed combinations of ramipril (2,5/5 mg/day) and indapamide (0,625/1,25 mg), depending on the required dosage (Konsilar-D 24 VERTEX AO, Russia) and were given recommendations on lifestyle changes and weight loss. A clinical examination was carried out, indicators of daily blood pressure (BP) monitoring and central aortic pressure (CAP), pulse wave velocity (PWV), lipid and carbohydrate metabolism, chronic low-intensity inflammation and the severity of insulin resistance before and after treatment were analyzed.Results.After 24-week therapy with a fixed combination of ramipril and indapamide at an average dosage of 4,04 ± 1,24 and 1,01 ± 0,31 mg, respectively, 100% of patients with HTN and NAFLD achieved target BP levels. According to 24-hour BP monitoring data, a significant decrease in systolic BP (SBP) and diastolic BP (DBP) was observed, both in the daytime (Δ12 mm Hg, р = 0,0001; Δ5,5 mm Hg, р = 0,0019, respectively), and at night (Δ13,5 mm Hg, р = 0,0006; Δ5,5 mm Hg, р = 0,0054, respectively). In addition, there was a significant decrease in CAP in the daytime (SBPao p = 0,0011, DBPao p = 0,0022) and night hours (SBPao p = 0,0015, DBPao p = 0,00124), and a statistically significant decrease in augmentation index (day p = 0,0460, night p = 0,0182). When evaluating clinical data and bioimpedance measurements, a decrease in waist circumference (p = 0,0000), hip circumference (p = 0,0001), the proportion of subcutaneous (p = 0,0134) and visceral (p = 0,0019) fat was found, which may indicate a decrease in the severity of visceral obesity. Also, during treatment, there is a decrease in the severity of insulin resistance (and the concentration of tumor necrosis factor alpha (TNF-α) (p < 0,0001) and CRP (p = 0,0002) in blood plasma. Finally, fixed combination of ramipril and indapamide led to a significant decrease in vascular stiffness (p = 0,0166) and a decrease in the proportion of patients with PWV paradoxical test (p = 0,0320). Correlation analysis showed that increased stiffness of the large arteries in patients with HTN and NAFLD is closely related to insulin resistance and lipid metabolism. At the same time, after 24-week therapy by a fixed combination of ramipril and indapamide, a decrease in the vascular stiffness in patients with HTN and NAFLD significantly correlated with the TNF-α concentration.Conclusions.A 24-week therapy by the fixed combination of ramipril and indapamide iin patients with HTN and NAFLD is associated with the persistent decrease in BP and CAP, both during the day and at night. There was a decrease in the vascular rigidity in muscular arteries. The treatment and recommendations for changing the lifestyle are associated with the decrease in the severity of abdominal obesity and insulin resistance, as well as the decrease in the severity of low-intensity systemic inflammation in patients with HTN and NAFLD, and a significant correlation was established between a decrease in TNF-α and an increase in the vascular elasticity of muscle and elastic type arteries.

Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF.

Renal denervation in hypertension patients: Proceedings from an expert consensus roundtable cosponsored by SCAI and NKF.

Azilsartan medoxomil: opportunities and prospects in diabetes mellitus

Current data on the prevalence of hypertension and diabetes mellitus (DM) are presented. Concomitant DM complicates the course of cardiac diseases, affecting the effectiveness of antihypertensive therapy. Along with high blood pressure, lipid and carbohydrate metabolism parameters should be corrected. Nephroprotection is also important in these patients. These goals are achievable due to the pleiotropic effects of some drugs. The analytical paper reviews the pleiotropic organoprotective effects of the antihypertensive drug azilsartan medoxomil. The data on its antihypertensive efficacy versus other angiotensin II receptor blockers are presented. In addition, the results of clinical trials in patients with various components of the metabolic syndrome (obesity, dyslipidemia, hyperglycemia) and DM are described.

Masked uncontrolled hypertension: risk factors and ways of influence

According to the current Guidelines, the effectiveness of antihypertensive therapy is assessed mainly by achieving target levels of office blood pressure (BP). However, masked uncontrolled hypertension (MUCH) increases the risk of cardiovascular events, therefore deserves timely diagnosis and correction.
 Objective — to establish the prevalence and risk factors of MUCH and to clarify how the use of fixed combinations can affect the control of office and out‑of‑office BP.
 Materials and methods. We examined 70 patients with arterial hypertension (AH) of 1 — 2 degrees. The initial assessment of the effectiveness of antihypertensive therapy was carried out 3 months after its appointment. Of the 70 patients initially enrolled in the study, 63 were able to reach essential office BP reduction point (< 140/90 mm Hg, according to 2020 ISH Guidelines). Patients who reached essential point of office BP reduction were additionally provided 24 hour ambulatory BP monitoring (ABPM) to detect possible MUCH.
 Results. It was found that among 63 patients in whom AH was controlled according to office BP data, 37 patients (58.7 %) had insufficient hypertension control according to ABPM data (they had MUCH). An assessment of possible factors for the development of MUCH showed that elderly age occurred in 29 (78.4 %) patients with MUCH, male sex — in 22 (59.5 %) patients, smoking — in 26 (70.3 %) patients, stress — in 29 (78.4 %) patients, various sleep disorders — in 17 (45.9 %) patients, diabetes mellitus (DM) — in 21 (56.8 %) patients, obesity — in 25 (67.6 %) patients, insulin resistance (IR) — in 27 (73 %) patients, chronic kidney disease (CKD) — in 13 (35.1 %) patients. Analysis of patient therapy showed that out of 37 patients with MUCH, 7 patients received monotherapy, 9 patients received free dual combinations (ACE inhibitor/sartan + calcium antagonist/diuretic), and 21 patients received fixed dual combinations. In accordance with 2018 ESC/ESH Guidelines, antihypertensive therapy was strengthened for patients with MUCH: those patients who had previously received monotherapy or free combinations were transferred to double fixed combinations (ACE inhibitors/sartans + calcium antagonist/diuretic), in which both drugs acted for 24 hours, and those patients with MUCH who received double fixed combinations were transferred to triple fixed combinations. Evaluation of antihypertensive therapy after 3 months showed that of 37 patients with initially established MUCH, complete BP control was achieved in 32 (86.5 %) patients (in the remaining 5 patients, despite sufficient control of office BP, MUCH was maintained according to ABPM data).
 Conclusions. In inadequate control of out‑of‑office BP, various disturbances of the circadian rhythm (with a predominance of the non‑dipper rhythm) are more common than with complete BP control. MUCH is associated with such risk factors as elderly age, male gender, smoking, stress, sleep disturbances, DM, obesity, IR, and CKD. Strengthening antihypertensive therapy contributed to the achievement of both office and out‑of‑office BP in 86.5 % of patients with previously established MUCH.

Assessment of the effectiveness of antihypertensive therapy in the early post-stroke period of ischemic stroke based on indicators of arterial stiffness

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Globally, stroke is the second leading cause of death, leading to a reduction in life expectancy and disability of patients. It seems important to study and introduce into practical health care both new approaches to stroke prevention and measures aimed at full recovery in the post-stroke period. Purpose To assess the antihypertensive therapy (AHT) in patients with arterial hypertension (AH) in the early post-stroke period of ischemic stroke (IS), based on indicators of arterial stiffness. Methods The study included 180 patients with hypertension (mean age 64 years) in the acute period of ischemic stroke (IS). Inclusion criteria in this trial: AH, age over 40 years, time from the onset of stroke no more than 48 hours. Arterial stiffness was assessed by an oscillometric method with an assessment of the 24-hour reflected wave transit time (RWTT), aortic augmentation index (AIxao)), arterial stiffness index (ASI), and pulse wave velocity (PWV). The indicators were assessed at the time of admission, at the time of discharge from the hospital (14-21 days) and 2 months after discharge. We determined endothelin-1 (ET-1) levels by ELISA at admission and 2 months after discharge. Retrospectively, patients were divided into 5 groups depending on the prescribed AHT: group 1 (48 patients) - ACEIs/ARBs, thiazide-like diuretics (TLDs), group 2 (46 people) - ACEIs/ARBs, nondihydropyridine calcium antagonists (ACs) and beta-blockers (BBs), group 3 (39 people) - ACEIs/ARBs and ACs, group 4 (26 patients) - ACEIs/ARBs and BBs, group 5 (21 people) - ACEIs/ARBs, TLDs and BBs. Results AHT showed a positive trend in terms of arterial stiffness in all 5 groups. Compared with the baseline values, the significant decrease in PWV (12.4 ± 1.7m/s vs 10.9 ± 1.8m/s, p < 0.01), AIxao (39.8 ± 6.3% vs 36.8 ± 5,2%, p < 0.001), ASI (167.9(127.0;174.5) vs 158.8(115.0;168.7)), p < 0.05), increased RWTT (98.0 ± 9.8ms vs 105.3 ± 7.5ms) in group 2 of patients were found. After 2 months, when comparing indicators between groups the significant decrease in PWV to 9.1(8.7; 11.6)m/s, p < 0.01), AIxao to 31.7(29.8;41.9)%, p < 0.01, an increase in RWTT to 107.7(102.4; 110.2)ms, p < 0.01 in the group of patients taking ACEIs/ARBs, ACs and BBs were detected. After 2 months after discharge, a significant decrease of ET-1 was also observed in group 2 (5.8 ± 2.2ng/ml vs 4.2 ± 1.8ng/ml). The combination of ACEs/ARBs and BBs showed the least effectiveness in reducing arterial stiffness. Conclusions The combination of ACEIs/ARBs, ACs and BBs showed the greatest efficiency in reducing the stiffness in patients with hypertension in the early post-stroke period of IS. It seems important for the functional recovery of patients in the post-stroke period to use the drug therapy aimed not only at lowering blood pressure, but also favorably affecting the arterial stiffness.

Non-steroidal anti-inflammatory drugs and arterial hypertension: drug interaction-adjusted management of patients

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common drugs in clinical practice and account for 5–10% of all drugs prescribed each year. However, the use of this group of drugs is associated with the risk of a wide range of side effects, most of which are cardiovascular complications. In addition, NSAIDs interact with other drugs, for example, their effect on antihypertensive therapy has recently been recognized as particularly important. Improvement of not only efficacy, but also safety is another important principle of rational pharmacotherapy. Adverse drug reactions (ADR) can very often result from underlying genetic factors of the human body. In this regard, a personalized approach suggesting the prescription of drugs according to the individual characteristics of patients is especially important. In such cases, pharmacogenetic testing is the most promising method that identifies the genetic factors of patients and allows to predict patients’ responses to specific drugs. This applies especially to a large range of drugs metabolised via the cytochrome P450 system in the liver. Results from numerous studies show that the effect of P450 family gene polymorphism determines the individual sensitivity to antihypertensive drugs, as it is these isozymes that are involved in the metabolism of drugs used to treat arterial hypertension (AH). In particular, the cytochrome (CYP) 450 isoenzyme is one of the basic enzymes involved in the biotransformation of losartan, an angiotensin receptor antagonist. Therefore, the CYP2C9 gene polymorphism largely determines the pharmacological response to NSAIDs and affects the effectiveness of antihypertensive therapy due to the change in the drug metabolism, as well as the structure and function of the receptors, on which they have an effect.

THE ROLE OF ANGIOTENSIN II RECEPTOR BLOCKERS IN THE FUNCTION AND MORPHOLOGY OF PLATELETS IN HYPERTENSIVE PATIENTS

Objective: Activation of platelet angiotensin receptors could potentially contribute to further progression of thrombotic events in hypertension. The aim of our study was to investigate the effect of antihypertensive therapy with ARBs on platelet function and morphology in a population of untreated hypertensive patients. Design and method: 120 untreated hypertensive patients(mean age 51 years; office blood pressure: 153/87 ± 7.3 mmHg, 55% males; 56% smokers)were divided into groups based on ARBs treatment (group 1) or no (group 2) and were prospectively followed up. Group 1 was further classified into 2 subgroups with subgroup 1 (n = 50) receiving Olmesartan and subgroup 2(n = 50)receiving Candesartan. Platelet function was assessed at baseline and at 40 days by means of a PFA-100 analyzer using epinephrine (EPI) and ADP. Time to aperture occlusion, closure time (CT),was recorded in seconds. Additionally, clotting times, mean platelet volume (MPV), vWf:Ag and fibrinogen levels were assessed. Results: At baseline, platelet activity was determined(PFA CTEPI, PFA CTADP)with no statistically significant differences between groups. At reassessment, changes in both CT- PFAEPI and CT-PFAADP were found between groups(group 1: CT-PFAEPI = 138.9 ± 22.3 sec, group 2: CT-PFAEPI = 104.9 ± 22.9 sec, group 1: CT-PFAADP = 85.5 ± 18.6 sec and group 2: CT-PFAADP = 81.5 ± 11.9 sec). However, after checking the significance of these changes (δ)it was found that only CT-PFAEPI change (δ) difference between treatment groups reached statistical significance(group 2 vs subgroup 1: δCT-PFAEPI21.8 [95% CI (2.17 – 41.4)],p = 0,025, group 2 vs subgroup 2: δCT-PFAEPI20.7 [95% CI (1.09 – 40.3)], p = 0.035, subgroup 1 vs subgroup 2: δCT-PFAEPI 1.08[95% CI (-15.3 – 17.4)], p = NS). During follow-up, treatment with ARBs was associated with significant lowering of fibrinogen (from 341.7 ± 62.2 to 316.3 ± 61.8 mg/dl, p < 0.001),MPV levels (from 10.4 ± 0.91 to 8.8 ± 0.9fL, p < 0.001) and vWf:Ag (from 103.2 ± 6.7 to 93.8 ± 7.1)with no corresponding reductions in group 2. After multivariate analysis,CT-PFAEPI changes(δ)were significantly correlated only with ARBs(p < 0.001),irrespectively of specific drug. Conclusions: The present study indicates that treatment with ARBs contributes to downregulation of platelet activity in hypertension, suggesting that it could offer additional cardiovascular benefit in hypertensive patients.

Expert consensus. Effect of antihypertensive therapy on cognitive functions

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

Aspects of efficacy, safety and adherence to antihypertensive therapy with single pill combinations of valsartan, amlodipine and hydrochlorothiazide (Vamloset® and Co-Vamloset) in patients with 2 and 3 grade of arterial hypertension in the Russian clinical study VICTORY II

Aim. To assess the efficacy and safety of Vamloset (amlodipine/valsartan 5/80, 5/160, 10/160 mg) and Co-Vamloset (amlodipine/valsartan/hydrochlorothiazide 10/160/12.5, 10/160/25 mg) in achieving the target levels of blood pressure (BP) in patients with stage 23 arterial hypertension (AH). The article discusses indicators affecting adherence to antihypertensive therapy (AHT).
 Material and methods. The VICTORY II Russian study in 8 clinical centers of the Russian Federation included 103 patients over 18 years of age with stage 23 essential AH (who havent been previously treated and have office systolic BP160 mm Hg and/or diastolic BP100 mm Hg or who havent reached the target office blood pressure with mono- or double AHT). The Full Analysis Set (FAS) for efficacy analysis included 99 patients, a FAS population with the restoration of data missed using Last Observation Carried Forward. The SF-36 questionnaire for assessing the quality of life, the effect on erectile function in men, the convenience of current therapy from the point of view of patients were analyzed after 16 weeks of treatment. The Per Protocol (PP) population included 80 patients completing the study without major protocol deviations to assess the primary parameters of efficacy. All patients with stage 2 hypertension were prescribed Vamloset (amlodipine/valsartan 5/80 mg), with stage 3 hypertension amlodipine/valsartan 5/160 mg. Dose titration of Vamloset and Co-Vamloset (LLC Krka-RUS) was carried out every 4 weeks according to the AHT schemes.
 Results. The studys active phase included 100 patients aged 59.510.9 years (women 59%) with AH duration of 83.48.4 months; 83% of patients received AHT prior inclusion in the study. In the PP population, 16 week- AHT with Vamloset or Co-Vamloset allowed reaching the target BP in 90.0% of patients (95% confidence interval [CI] 81.295.6). Overall clinical efficacy was achieved in 98.8% of patients (95% CI 93.2100.0). All treatment regimens were characterized by high patient compliance. In the total group, 50% of patients rated their AHT as more convenient than they had previously used; of them, in the stage 2 AH group 47.8%, in the stage 3 AH group 53.3%. Metabolic neutrality with regard to at least one indicator was observed in 100% of patients, with regard to 6 indicators in 43.9% [33.9; 54.9]. For all 98 patients included in the analysis, changes in all SF-36 scales, except for physical functioning (p=0.339), were statistically significant (p0.05). The effect of AHT on erectile function was rated as positive in 51.3% of men. Good tolerance data are consistent with the established drug safety profile.
 Conclusion. In the VICTORY II study, high antihypertensive efficacy and an improvement in a set of indicators of optimal adherence to AHT by Vamloset and Co-Vamloset within 16 weeks were proved in patients with stage 23 AH. Patients high rating for quality improvement in the quality of life, safety of therapy and ease of use ensured optimal compliance of Vamloset and Co-Vamloset therapy throughout the study.

Hypertension and COVID-19: Ongoing Controversies.

Coronavirus disease 2019 (COVID-19) has become a worldwide pandemic responsible for millions of deaths around the world. Hypertension has been identified as one of the most common comorbidities and risk factors for severity and adverse outcome in these patients. Recent investigations have raised the question whether hypertension represents a predictor of outcome in COVID-19 patients independently of other common comorbidities such as diabetes, obesity, other cardiovascular diseases, chronic kidney, liver, and pulmonary diseases. However, the impact of chronic and newly diagnosed hypertension in COVID-19 patients has been insufficiently investigated. The same is true for the relationship between blood pressure levels and outcomes in COVID-19 patients. It seems that the long discussion about the impact of angiotensin-converting enzyme inhibitors (ACEI) and blockers of angiotensin I receptors (ARB) on severity and outcome in COVID-19 is approaching an end because the large number of original studies and meta-analyses discarded the initial findings about higher prevalence of ACEI/ARB use in patients with unfavorable outcomes. Nevertheless, there are many controversies in the relationship between hypertension and COVID-19. The aim of this review article is to provide a clinical overview of the currently available evidence regarding the predictive value of hypertension, the effect of blood pressure levels, the impact of previously known and newly diagnosed hypertension, and the effect of antihypertensive therapy on the severity and outcomes in COVID-19 patients.

Polymorphism of genes-candidates of renin-angiotensin-aldosteronovy system (ACE, AGT, AGTR1) and effectiveness of treatment of arterial hypertension. Results of research in Mountain Shoria

Aim. To study the dependence of the effectiveness of antihypertensive therapy on the polymorphic variants of candidate genes of the RAAS (ACE, AGT, AGTR1) in patients with hypertension (АH) of the population of Mountain Shoria.
 Materials and methods. In the conditions of the expeditions from 2013 to 2017, the population of Mountain Shoria was surveyed. Included 1409 people 18 years and older. Blood pressure monitoring was carried out as a result of office measurement, according to the standard recommendations of National Guidelines of the Russian Society of Cardiology/the Russian Medical Society on Arterial Hypertension (2010). As a result of the survey, patients with AH were identified for further observation (597 people) who need medical antihypertensive treatment. Repeat screening was conducted in a year. The criterion for inclusion in prospective observation of patients with hypertension was: regular intake of prescribed medication. 253 respondents were surveyed: indigenous (156 people) and non-indigenous (97 people) nationality. All patients underwent a standard examination, including the collection of complaints and anamnesis, an assessment of objective status, laboratory and instrumental studies. Polymorphisms of genes ACE (I/D, rs 4340), AGT (c.803T C, rs699), AGTR1 (A1166C, rs5186) were tested using polymerase chain reaction.
 Results. Dynamic observation of patients with hypertension found that in the cohort of Shors the target level of blood pressure reached the owners of heterozygous I/D and minor D/D genotypes of the ACE gene, carriers of T/C and C/C genotypes of the AGT gene and the homozygous genotype A/A of the AGTR1 gene. In the non-indigenous nationality cohort, only carriers of the D/D genotype of the ACE gene.
 Conclusion. National differences were identified with respect to the sensitivity of the pharmacological response to treatment, which once again proves the important role of taking into account the ethnic factor in the choice of drug.

Gender-based differences in the effectiveness of antihypertensive therapy with losartan compared with enalapril

Objective: Today there is a limited number of gender-based characteristics of the enalapril and losartanadministration in order to correct blood pressure in patients with arterial hypertension.The aim ofthe study was to compare the effectiveness of enalapril and losartan for blood pressure correcting inpatients with arterial hypertension (AH), depending on gender.
 Materials and methods: The studywas carried out in 2019 at Military Hospital 175 in Ho Chi Minh city, Vietnam. To achieve this goal,100 people were included in the study (50 females in the menopause and 50 males) with grade I-IIarterial hypertension aged 50 to 60 years. Patients with hypertension were divided into the followinggroups: group 1A – 25 males, who received enalapril 20 mg/d and 12.5 mg/d hydrochlorothiazideonce per day as antihypertensive therapy; group 1B – 25 males, who received losartan 50 mg/d andhydrochlorothiazide 12.5 mg/d once per day; group 2A – 25 females, who received enalapril 20 mg/dand hydrochlorothiazide 12.5 mg/d once per day; group 2B – 25 females, who received losartan 50mg/d and hydrochlorothiazide 12.5 mg/d once per day. The follow-up was 12 weeks.
 Results anddiscussion: The study showed that antihypertensive therapy with losartan is more effective in femalescompared with enalapril, as evidenced by a significant SBP decrease by 21.1% (p<0.05) at the endof treatment with losartan in females versus 18.6% (p<0.05) when using enalapril with the presenceof a statistically significant intergroup difference in the indicator (p<0.05).
 Conclusion: Our resultsindicate the presence of a gender difference in the antihypertensive effect of losartan and enalapril.
 Bangladesh Journal of Medical Science Vol.20(2) 2021 p.348-355

Antihypertensive therapy features in multimorbid outpatients

Objective. To assess the characteristics of antihypertensive therapy (AHT) in outpatient patients in relation to comorbidities and multimorbidity level. Design and methods. A cross-sectional study included 140 patients with diagnosed hypertension (HTN). We performed a standardized complaints and medical history registration, questionnaire survey, anthropometry, office blood pressure (BP) assessment. Based on Charlson index the patients were divided into 2 groups: group 1 with moderate multimorbidity (≤ 4 points), group 2 with high multimorbidity level (≥ 5 points). The data are presented as median and proportions with bi-directional 95 % confidence interval. Results. In the sampling of 100 (64,3 71,4 78,6 %) women and 40 (21,4 28,6 35,7 %) men median age was 65 68 70, median Charlson index was 4 5 5. Group with moderate multimorbidity included 63 patients. High multimorbidity group included 77 subjects. HTN degree did not differ between the groups. Subjects from group 2 had higher level of cardiovascular risk (χ2 = 17,2, df = 2, p = 0,00018) and were more likely to have a history of HTN-associated clinical conditions (χ2 = 27,1, df = 2, p = 0,00000). By the time of examination, AHT was started in 137 (95,097,9 100,0%) patients. Monotherapy was ongoing in 20 cases (8,814,3 20,4%), combined AHT was prescribed to 117 (79,6 85,4 91,2 %) persons: 50 (21,2 36,5 43,8 %) patients received 2 drugs, 67 (40,9 48,9 56,9 %) patients received ≥ drugs. Number of antihypertensive drugs was higher in patients of group 2 than in group 1 (χ2 = 6,7, df = 2, p = 0,036). Drug number was not associated with HTN degree (χ2 = 3,8, df = 4, p = 0,44). Patients from group 2 were more likely to take β1-blockers (p = 0,027) and moxonidine (p = 0,042). Non-steroid anti-inflammatory drugs (NSAIDs) reduced the frequency of achieving the target BP level in patients treated by angiotensin converting enzyme inhibitors (p = 0,002). The frequency of achieving target BP was 42,9 50,7 58,6 %, it was independent of the number of prescribed drugs (p = 0,07) and did not differ in the groups of moderate and high multimorbidity (p = 0,87). Conclusions. Multimorbid patients require combined antihypertensive drugs to control hypertension. Multimorbidity level, comorbidities and drug-to-drug interactions should be taken into account during individualized HTN management. NSAID significantly affect the effectiveness of antihypertensive therapy.

Effects of angiotensin ii receptor blockers on cognitive functions in patients diagnosed with dementia undergoing anti-dementia therapy

Background and Aims: Literature regarding effects of antihypertensive therapy on cognition is infused by controversy. Our objective was to examine the effects of angiotensin II receptor blockers(ARBs) as associated with specific anti-dementia medication on cognitive functioning: memory(MMSE, Clock-Drawing-Test), functionality(ADL, IADL), behavior disorders(NPI-Q: Neuropsychiatric-Inventory-Questionnaire) and global deterioration(GDS-Test/Reisberg) in time.

Antihypertensive Pharmacotherapy in Correcting the Indicators of Innate Immunity in Patients with Essential Arterial Hypertension

Introduction: The study of indicators of innate immunity in patients with arterial hypertension in clinical trials makes it necessary to correct them in order to reduce vascular inflammation in arterial hypertension to prevent damage to target organs and development of cardiovascular complications. The aim of the study was to assess the effectiveness of antihypertensive therapy to correct indicators of innate immunity in patients with essential arterial hypertension.
 Materials and methods: Patients with essential arterial hypertension (EAH) (II stage, 3rd degree) were divided into 3 groups: the 1st group included the patients with hypertrophy of the left ventricular myocardium; the 2nd group included the patients with atherosclerotic vascular lesions; the 3rd group included the patients with chronic kidney disease. As an initial antihypertensive pharmacotherapy, all the patients with essential arterial hypertension were prescribed perindo­pril (5–10 mg/day) and amlodipine (5–10 mg/day).
 Results and discussion: Changes in innate immunity indices in patients with essential arterial hypertension (II stage, 3rd degree) are differentiated depending on the affected target organ. The antihypertensive pharmacotherapy with perin­dopril and amlodipine in patients with essential arterial hypertension has various corrective effects on impaired innate immunity, depending on the nature of target organ damage. Regardless of target organ damage, ноу antihypertensive therapy with perindopril and amlodipine does not affect the reduced functional and increased metabolic activities of peripheral blood neutrophils.
 Conclusion: The results obtained dictate the need for further clinical studies of other classes of antihypertensive drugs and their combinations in the correction of innate immunity indices in order to effectively prevent the progression of target organ damage.
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