Effects Of Antihypertensive Therapy Research Articles

Prospects of using genetic testing to increase the effectiveness of antihypertensive therapy

Aim. To compare the effects of 3-month therapy with a fixed-dose combination of an angiotensin-converting enzyme inhibitor (perindopril) and a thiazide-like diuretic (indapamide) in genetically heterogeneous subgroups of patients with hypertension (HTN) for assessing the prospects of using genetic testing for choosing the antihypertensive treatment regimen. Material and methods. Forty-one patients with grade 1-2 HTN with insufficient effectiveness of previous antihypertensive therapy and 20 healthy individuals were examined to compare the prevalence of gene polymorphism in the Rostov Oblast. Patients with HTN underwent standard diagnostic tests, as well as a molecular genetic test to determine the most clinically significant polymorphic genes involved in the pathogenesis of HTN. Results. A relationship was found between the clinical and morphofunctional characteristics of HTN in patients with polymorphisms of AGT, AGTR2, CYP11B2, GNB3, and NOS3 -786 genes, of which 3 polymorphic genes (AGT, AGTR2, CYP11B2) encode the activity of the angiotensin-converting enzyme. The effectiveness of using a combination of renin-angiotensin-aldosterone system inhibitor agent with a thiazide-like diuretic as an initial antihypertensive therapy was evaluated. An analysis showed that fixed-dose combination of perindopril (10,0) and indapamide (2,5) (Noliprel A Bi-forte) in genetically heterogeneous subgroups of HTN patients displays a more pronounced antihypertensive and organ-protective effects in individuals with the mutant allele 704C of AGT T704C polymorphism. A significant decrease in blood pressure was demonstrated according to standard 24-hour monitoring (p<0,05). A significant decrease in the left ventricular mass index (p=0,0001), as well as a significant increase in the ratio of peak mitral flow velocity in early and late diastole (VE/VA) (p=0,0024) were showed. There was a positive effect of therapy on arterial stiffness parameters: a decrease of the pulse wave velocity (p=0,0035), vascular age (p=0,00002) and reflection index (Ri) (p=0,000001), compared with noncarriers of mutant allele 704C of AGT gene. Conclusion. The results obtained indicate the promise of using genetic approaches to develop a personalized drug treatment strategy for HTN patients in order to increase its effectiveness.

Врожденный иммунитет у больных эссенциальной артериальной гипертонией и эффективность антигипертензивной фармакотерапии

The purpose of the study was to assess the parameters of innate immunity in patients with essential arterial hypertension and to establish a relationship with the effectiveness of antihypertensive pharmacotherapy. Materials and methods. The study included 48 patients with essential arterial hypertension stage II, arterial hypertension 2 degree and hypertrophy of the left ventricular myocardium, which were divided into 2 groups: the first group (25 patients) - these are patients whose blood pressure reached the target values, and the second group (23 patients) are patients whose blood pressure did not reach the target values against the background of antihypertensive therapy (perindopril - 5 mg/day and amlodipine - 5 mg/day) (group 2). Indicators of 18 healthy donors were used as a comparison group (control group). Results. In patients with essential arterial hypertension of group 1, compared with the control group, the concentration of IL-1α, IL-6, IL-8, IL-10, IL-1 receptor antagonist, IL-2, C4- and C5a-components of the complement system and factor H is significantly higher and the level of C3 is lower-component of the complement system. In patients with essential arterial hypertension of group 2, more pronounced changes in the cytokine link of the immunity and the complement system were established before the start of antihypertensive therapy. After the antihypertensive therapy in patients with essential arterial hypertension of the 1st group in the blood plasma, the concentration of TNF, IL-1α, IL-8, IL-10, IL-1 receptor antagonist significantly decreased, but not to the values of the control group, and in patients of the 2nd group, the effectiveness of antihypertensive therapy in correcting parameters innate immunity was found to be less effective. Conclusion. Revealing the participation of innate immunity indicators in the formation of arterial hypertension opens up new possibilities for the pathogenetic therapy of this disease and developing measures to prevent or level the damage to target organs.

Barriers to effective outpatient hypertension treatment: a view of physicians and patients

Aim. To study the opinion of primary care physicians and hypertensive (HTN) outpatients with different compliance rate on factors preventing effective antihypertensive therapy (AHT).Material and methods. Primary care physicians and HTN outpatients were questioned. Questionnaires for physicians and patients included informative and survey parts, with a list of possible factors aggravated adherence to treatment. The assessment was carried out using visual analogue scale. The patient questionnaire also included questions about AHT and the eight-item Morisky Medication Adherence Scale (MMAS-8). The calculation was carried out with a 95% confidence interval (CI).Results. The survey involved 298 physicians and 517 patients. Among patients, about 1% had a high compliance rate, 34% — moderate, 65% — low. In all groups, AHT did not significantly differ and was characterized by a low frequency of prescribing fixeddose combinations (27,1%). According to physicians, the most significant and equivalent are the economic aspects of treatment — 7,9±2,1 (95% CI: 7,51-8,38), the need for lifestyle change — 7,9±2,4 (95% CI: 7,37-8,38) and, to a slightly lesser extent, psychological aspects 6,8±2,2 (95% CI: 5,43-6,43). The economic aspects of treatment and need for lifestyle change were also most significant factors according to patients with high (8,8±1,8 (95% CI: 7,23-10,37) and 8,4±1,7 (95% CI: 6,93-9,87), respectively) and low (95% CI: 6,4±3,0 (5,65-7,07) and 6,2±2,8 (95% CI: 5,5-6,82) respectively) compliance rates. For patients with moderate compliance rate, the most significant and almost equivalent factors were the need for lifestyle change — 5,6±3,3 (95% CI: 4,53- 6,71), the need for regular visits — 5,6±3,1 (95% CI: 4,53-6,58) and the need for selfmanagement — 5,6±2,8 (95% CI: 4,63-6,48).Conclusion. The results obtained make it possible to forecast the compliance rate of patients with HTN, and, therefore, direct more efforts to those with a low rate, thereby increasing the effectiveness of AHT.

Clinical profile and drug therapy of outpatients with arterial hypertension

Aim. To study clinical profile and antihypertensive treatment features in outpatients observed in ambulatory facilities.Material and methods. 140 arterial hypertension (AH) outpatients were examined, questioning and anthropometry were performed. Blood pressure (BP) was measured on both hands, then twice on the hand with larger value, the medium value was calculated. Tests results were obtained from outpatient cards.Results. The sampling included 100 (71.4%) females and 40 (28.6%) males. Median of systolic BP at first measurement was 140.0 mm Hg (130.0;150.0), mean value of three BP measurements was 138.0 mm Hg (127.0;150.0) (p&lt;0.001); median diastolic BP at first measurement was 83.0 mm Hg (80.0;90.0), mean BP value was 82.0 mm Hg (78.0;88.0) (p&lt;0.001). Grade 1 AH was identified in 11.4% of patients, Grade 2 – in 35.7%, Grade 3 in 52.9%. No target organ damage was found in 26.4% of AH patients, asymptomatic target organ damage was diagnosed in 26.4%, and 61.4% had associated clinical conditions. Cardiovascular event risk was assessed as moderate in 13.6%, high – in 24.3% and very high – in 62.1% of patients. Every third patient had myocardial hypertrophy signs; Cornell index was detected more often than Sokolov-Layon index (p=0.006). Chronic kidney disease was diagnosed in 65.1% of patients: 44.0% of them had stage C2, 13.8% – stage C3A, 6.5% – stage C3B, and 1.8% – stage C4. 97.9% of AH patients received antihypertensive treatment. Daily medication consumption was reported by 127 people, and 10 patients reported taking medication as needed. Monotherapy was prescribed in 14.3% of patients; combined treatment was performed in 83.6% people. BP target value was achieved in 59 patients (42.1%) at first measurement results and in 71 (50.7%) ones at calculated mean value (p=0.002). Indications for statin use were identified in 86.4% of patients. Statins were administered in 56.2% patients having indications and in 21.1% of subjects without indications (p=0.006). Indications for antiplatelet therapy use were identified in 56.4% of patients. Antiplatelet treatment was administered in 58.2% of patients with indications and in 23.0% of subjects without indications (p&lt;0.001).Conclusion. Glomerular filtration rate and left ventricular myocardial hypertrophy amplitude criteria calculation allow to diagnose subclinical target organ damage in outpatients at physician visit without additional costs. Compliance with the current antihypertensive therapy guidelines allows to achieve target BP in current practice. Compliance with the BP measuring rules allows to adequately assess the effectiveness of antihypertensive therapy. A significant proportion of AH outpatients have a very high cardiovascular risk, which requires lipid-lowering and antiplatelet therapy.

Pharmacotherapy for hypertension in Sub-Saharan Africa: a systematic review and network meta-analysis

BackgroundThe highest burden of hypertension is found in Sub-Saharan Africa (SSA) with a threefold greater mortality from stroke and other associated diseases. Ethnicity is known to influence the response to antihypertensives, especially in black populations living in North America and Europe. We sought to outline the impact of all commonly used pharmacological agents on both blood pressure reduction and cardiovascular morbidity and mortality in SSA.MethodsWe used similar criteria to previous large meta-analyses of blood pressure agents but restricted results to populations in SSA. Quality of evidence was assessed using a risk of bias tool. Network meta-analysis with random effects was used to compare the effects across interventions and meta-regression to explore participant heterogeneity.ResultsThirty-two studies of 2860 participants were identified. Most were small studies from single, urban centres. Compared with placebo, any pharmacotherapy lowered SBP/DBP by 8.51/8.04 mmHg, and calcium channel blockers (CCBs) were the most efficacious first-line agent with 18.46/11.6 mmHg reduction. Fewer studies assessing combination therapy were available, but there was a trend towards superiority for CCBs plus ACE inhibitors or diuretics compared to other combinations. No studies examined the effect of antihypertensive therapy on morbidity or mortality outcomes.ConclusionEvidence broadly supports current guidelines and provides a clear rationale for promoting CCBs as first-line agents and early initiation of combination therapy. However, there is a clear requirement for more evidence to provide a nuanced understanding of stroke and other cardiovascular disease prevention amongst diverse populations on the continent.Trial registrationPROSPERO, CRD42019122490. This review was registered in January 2019.

Sex differences in the efficacy of antihypertensive treatment in preventing cardiovascular outcomes and reducing blood pressure: protocol for a systematic review and meta-analysis

IntroductionHypertension is a leading cause of mortality worldwide and its prevalence is expected to rise over the next decade. Sex differences exist in the epidemiology and pathophysiology of hypertension. It...

DYNAMICS OF FUNCTIONAL STATE OF KIDNEYS IN PATIENTS WITH RESISTANT HYPERTENSION AND CHRONIC KIDNEY DISEASE ACCORDING TO LONG-TERM FOLLOW-UP

Resistant hypertension and chronic kidney disease are closely related from a pathogenetic and clinical point of view. To study the dynamics of functional state of kidneys and as well as to identify the predictors of its improvement, 117 patients with resistant hypertension were examined. Dynamic follow−up of patients included monitoring of antihypertensive therapy, blood pressure, biochemical and humoral parameters during 3, 6 and 36 months of treatment. The findings have shown that a significant long−term improvement in blood pressure control in the patients with chronic kidney disease improves their function and also has a nephroprotective effect in patients without any signs of renal damage. The established prognostic value of the higher initial creatinine content for the improvement of renal function in patients with resistant hypertension is stipulated with a positive effect of antihypertensive therapy on the glomerular filtration rate dynamics. The close association between improved renal function and lower baseline levels of interleukin 6 as well as an active renin in the blood may indicate a role for systemic inflammation and renin−angiotensin−aldosterone system activity in the renal dysfunction development. Prolonged improvement in blood pressure control in the patients with resistant hypertension without diabetes is associated with a stable level of urinary albumin excretion, whereas in patients with diabetes, an albuminuria increases over time. The study concluded that independent predictors of improved renal function in patients with resistant hypertension are higher baseline creatinine and lower glomerular filtration rate, lower concentrations of interleukin 6, active renin and plasma potassium. Key words: resistant arterial hypertension, chronic kidney disease, functional state of kidneys, antihypertensive therapy.

The Effect of Antihypertensive Therapy on Left Ventricular Longitudinal Strain: Missing Part of the Puzzle.

There is no consensus regarding the benefit of antihypertensive therapy on left ventricular structure and function. The most of studies investigated the effect of therapy on left ventricular hypertrophy, less studies were focused on left ventricular diastolic dysfunction and the minority on left ventricular mechanics. The majority of investigations showed positive effect of antihypertensive therapy on regression of left ventricular remodeling. Nevertheless, it is very difficult to distinguish the effect of antihypertensive medication from the effect of blood pressure reduction on left ventricular improvement. The other important issue in these studies is difficulty to distinguish the effect of left ventricular hypertrophy regression from the effect of antihypertensive medications on left ventricular diastolic function and mechanics. The novel findings suggest that the cascade of left ventricular remodeling in hypertensive heart disease begins with mechanical changes, continuous with diastolic dysfunction, and ends with left ventricular hypertrophy. This is very important paradigm because it enables early and timely diagnosis of subclinical left ventricular damage in hypertensive patients and should provide rapid detection of left ventricular function improvement during antihypertensive therapy.

Possibilities of antihypertensive therapy in correction of cognitive impairment in hypertensive patients

Data regarding possibilities of antihypertensive therapy to reduce a risk of the development of new cases of cognitive impairment are contradictory. So, the purpose of the study was to analyze the effect of antihypertensive therapy onto the dynamics of cognitive functions in hypertensive patients. We examined 90 patients with stage 1 and 2 hypertension, 2-3 degrees (middle age of patients was 49,66 ± 8,74 years). Clinical and anamnestic examination, laboratory and instrumental methods of examination were done to all patients. Neuropsychological tests, as GPCOG, MMSE, Schulte tables were used to study cognitive functions. Cognitive impairment were observed in 36 patients (40%). The combination of inhibitors of angiotensin-converting enzymes (іАCE) or angiotensin II receptor blockers (ARB) + calcium channel blocker (CCB) was used as antihypertensive therapy. While using this therapy not only the decrease and normalization of blood pressure but also improvement of cognitive functions were noticed. Particularly, in 61,29% cases patients gained obviously more points in the retesting MMSE(p=0,003) and GPCOG(p=0,01) and almost all patients (96,77%) needed less time to fulfill tasks by Schulte tables (p=0,0001). The total sum of points by MMSE scale increased by 3,66% (p=0,003), the total score by GPCOG scale increased by 22,24% (p=0,01), and in the control execution of Schulte test patients used less time by 14,39 % in comparison with initial results (p=0,0001).

Effectiveness of antihypertensive conservative-free therapy with fixed combination of bimatoprost and timolol (intermediate results)

The effects of antihypertensive therapy are often determined by patient compliance with the prescribed treatment plan. Acceptance of conservative-free forms of drugs leads to a decrease in the frequency and severity of side effects, reduces the need for the use of artificial tears, which lowers the cost of treatment for the patients. to evaluate the hypotensive effectiveness of a fixed combination of bimatoprost (0.03%) and timolol (0.5%), and its effect on the ocular surface in patients with newly diagnosed advanced glaucoma. The study was conducted during February-November 2018, and included 46 patients (76 eyes) with newly diagnosed POAG and healthy volunteers (control group). All patients underwent visometry, ICare rebound tonometry (Tiolat, Finland), elastometry with Maklakov tonometer (using 5 g, 10 g and 15 g loads), automated perimetry (AP) (Octopus-600, Haag-Streit diagnostics, Switzerland), optical coherence tomography (OCT) of the macular zone and optic nerve head, pachymetry (Spectralis OCT, Heidelberg Engineering, Germany). At the start of the study and one month after the start of treatment with the drug Ganfort (Allergan, USA), patients were examined to evaluate the state of their ocular surface: Norn's test, Schirmer's test, vital staining with lissamine green, and an OSDI questionnaire. At the start of treatment, administration of a fixed combination of bimatoprost and timolol led to a decrease in intraocular pressure by 7.9 (37.7%) mm Hg (V=271, p=5.496e-05) after 2 weeks of the use of Ganfort (Allergan, USA). During this period, the observation group did not exhibit statistically significant changes in the state of the ocular surface, which was comparable to the control group according to the data of the Norn's test, Schirmer's test, vital staining with lissamine green and the OSDI questionnaire (p>0.05). The use of a fixed combination of bimatoprost and timolol, while effectively reducing IOP, did not result in statistically significant changes in the ocular surface. Some improvement of both objective and subjective indicators of the state of ocular surface associated with the use of the Ganfort drug was noted in patients of the observation group.

EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY IN COMORBIDITY OF ARTERIAL HYPERTENSION AND OBESITY DEPENDING ON PHYSICAL ACTIVITY

In order to assess the effectiveness of antihypertensive therapy in comorbidity of hypertension and obesity, depending on physical activity of patients, a study was performed in 200 persons, They were prescribed with a diet therapy as non−drug treatment and an increased physical activity was recommended. The patients received a combination of an angiotensin converting enzyme inhibitor and a calcium antagonist. Primary blood pressure levels of the patients were evaluated 3 months after initiation of treatment: only 102 among 200 had reached the target levels in dual antihypertensive therapy, and the rest required an additional antihypertensive medication. As a result of the study, it has been found that physical activity positively affected the dynamics of cardiovascular remodeling, anthropometric and biochemical data as part of a comprehensive 6−month treatment of hypertensive patients with obesity (including dual antihypertensive therapy). With the similar drug treatment the patients with sufficient physical activity differed from those with low physical activity by the significantly lower body mass index, better dynamics of cardiovascular remodeling, higher levels of antiatherogenic lipoprotein, high inflammatory disease, and less pronounced adipokine imbalance. Key words: arterial hypertension, obesity, antihypertensive therapy, physical activity.

Antihypertensive treatment and depressive symptoms in Chinese middle-aged and older hypertensive adults: A population-based longitudinal study.

Hypertension is a risk factor for depressive disorders. Although the benefits of lowering blood pressure on the subsequent depressive disorders are supported by biological interpretation, the effect of antihypertensive therapies on depressive disorders is not clear. This study aimed to assess whether blood-pressure-lowering treatment have a protective effect on subsequent depressive symptoms in China. We used data from the nationally representative survey, including 2428 hypertensive participants free from depressive symptoms at baseline in 2011 to 2012. We assessed the depressive symptoms based on the 10-item Center for Epidemiological Studies Depression scale. We conducted Cox proportional hazards regression models to examine the effect of antihypertensive treatment on the incidence of depressive symptoms in 2011 to 2015. In the total sample, all the models resulted in nonsignificant results and an estimated 8% reduction in risk (95% CI, 0·76-1·12) in the model adjusted for all covariates for the antihypertensive treatment takers with blood pressure controlled. In the group of urban residents, the antihypertensive treatment takers with blood pressure controlled had lower odds (HR: 0.68; 95% CI, 0·49-0·96) of depressive disorders. The protective effect of the antihypertensive therapies might be relative to not only lowering blood pressure per se but also the management of hypertension. We proposed the early intervention to achieve the long-term protective effect of being antihypertensive and the supply of effective and collaborative care of hypertension and depression.

Uncontrolled Arterial Hypertension: Kidney, Neurohormonal Imbalance, and Approaches to Antihypertensive Drug Therapy

Resistant and refractory arterial hypertensions are two distinct clinical phenotypes of uncontrolled arterial hypertension (AH), which differ in their sensitivity to antihypertensive drug therapy. The review presents data obtained in clinical studies devoted to elucidating the involvement of disorders of neurohormonal status and renal function in the formation of resistant and refractory arterial hypertension, to and the development of new approaches to increasing the effectiveness of antihypertensive therapy in these patient's populations. The results of these studies have shown that in patients with uncontrolled arterial hypertension, despite prolonged intake ≥ 3 antihypertensive drugs with different mechanisms of action, including a diuretic, excess sodium reabsorption persists in the distal segments of nephron due to increased aldosterone activity and sympathetic nervous system hyperactivity. In this regard, special attention has been paid to the data of PATHWAY-2, PATHWAY-3 and ReHOT trials that in patients with resistant AH tested the clinical efficacy of spironolactone, amiloride, and antiadrenergic drugs bisoprolol, doxazosin and clonidine, suppressing activity of the sympathetic nervous system.

Diabetic Autonomic Cardiac Neuropathy and The Effectiveness of Anti-Hypertensive Therapy

Diabetic Autonomic Cardiac Neuropathy and The Effectiveness of Anti-Hypertensive Therapy

The experience of a comprehensive assessment of the effectiveness of antihypertensive therapy in clinical practice

Objective:to study the antihypertensive efficacy of a new dosage form of perindopril A — tablets dispersed in the oral cavity — in the group of patients with arterial hypertension (AH) on an outpatient basis.Material and methods:the study included 30 patients (mean age 53.8 ± 0.9 years) with the presence of arterial hypertension, diagnosed initially, or with no control of blood pressure at the background of previous antihypertensive therapy. All investigators were administered perindopril A in the form of a dispersible form in a dose of 10 mg in monotherapy or in combination with indapamide – in case of failure to achieve target blood pressure after 2 weeks of observation. The total duration of the study is 3 months.Results:by the end of the observation, the SBP / DBP decreased by 35.6 ± 2.3 / 16.5 ± 1.0 mm Hg. Correction of therapy with the addition of indapamide-retard was required in 6 (20%) patients. Effective antihypertensive therapy was accompanied by a significant decrease in daily (according to ICBP data), intravisit, and visit-to-visit variability of the SBP, which was 4.4 mm Hg in terms of standard deviation by the end of the observation. The use of a new dosage form of perindopril A was accompanied by a significant increase in adherence to therapy.Conclusion:the use of a new dosage form of perindopril A — tablets dispersed in the oral cavity — in monotherapy or in combination with indapamide-retard can improve the treatment of patients with hypertension who do not have target BP values.

Legacy Effect in the Treatment of Hypertension: Persistent Cardiovascular Protection after Conclusion of Randomized Clinical Trials in Hypertension.

Essential hypertension is the main determinant of cardiovascular morbidity and mortality worldwide. During the last decades, several antihypertensive drug therapies have been introduced and tested in clinical trials, both as monotherapies and combination therapies. The current recommended therapeutic approaches effectively reduce the lifetime risk of experiencing major cardiovascular outcomes and disabling comorbidities, such as myocardial infarction, stroke, and congestive heart failure. On the basis of multiple proofs, antihypertensive therapy is currently recommended for improving event-free survival rate and quality of life in different clinical settings and conditions. At the same time, other cardiovascular drugs, including novel lipid-lowering, anti-platelet, and anti-coagulation agents, have been made available and also contribute to reduce the incidence of atherothrombotic diseases. Beyond the beneficial aspects obtained by pharmacological treatment of major cardiovascular risk factors and comorbidities, including hypertension, several aspects remain to be defined. One major limitation linked to randomized, controlled clinical trials is represented by the relatively short duration of the studies, which usually ranges between 1 and 5years. Whether antihypertensive therapy should be maintained for a longer time (after 5years) and whether this is supported by sufficient evidence of a persisting benefit is supported by limited post-trial observations but mostly by findings derived from large clinical registries. The so-called legacy effect in the treatment of hypertension, in which patients who are treated with a given antihypertensive therapy may derive a long-term benefit after discontinuation of therapy, has been recently proposed on the basis of accumulating evidence and, in particular, on the availability of long-term post-trial observations in randomized controlled clinical trials. In this review, we discuss the evidence witnessing a legacy effect of antihypertensive therapy and whether this supports sufficiently lifetime drug treatment of hypertension.

Resistant arterial hypertension: clinical and pathogenetic peculiarities and predictors of therapy effectiveness

The aim – to evaluate the features of the target organs damage, neurohumoral and proinflammatory status and to determine the predictors of the effectiveness of antihypertensive therapy in patients with resistant arterial hypertension (RAH).Materials and methods. The study included 257 patients with apparent RAH. The secondary hypertension was revealed in 8.5 % of patients. After 3 months therapy with triple fixed-dose combination (FDC) of antihypertensive drugs in maximum tolerated doses, patients were distributed into two groups – true RAH (n=103) and patients with pseudo resistant AH (PRAH) (n=132). We performed the comparative analysis of clinical characteristics, target organ damage degree, features of neurohumoral (plasma concentration of aldosterone and active renin, 24 – hour urinary metanephrines) and proinflammatory (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor – α (TNF-α) in plasma) status among groups. The predictors of effectiveness of the 4th antihypertensive drug addition (spironolactone, eplerenone, nebivоlol, moxonidine) to triple FDC in patients with RAH were studied.Results and discussion. Higher levels of office and ambulatory blood pressure (BP), frequent (up to 14 %) disturbance of BP rhythm as night-peaker type, high BP morning surge are typical for RAH patients. 95 % of RAH patients had concentric left ventricular hypertrophy and 80 % – carotid atherosclerosis, a lower glomerular filtration rate and higher level of urinary albumin excretion rate (UAER). RAH patients had higher level of CRP – by 17.3 % (p=0.02), IL-6 – by 21.8 % (p=0.01), TNF-α – by 13 % (p=0.003) in comparison with PRAH patients. The predictors of spironolactone and eplerenone efficacy are plasma aldosterone concentration (β=0.653; p=0.002), aldosterone-renin ratio (β=0.542; p=0.003), UAE (β=–0.362; p=0.01) and the level of CRP (β=–0.315; p=0.03).Conclusions. Higher level of BP, target organ damage, more expressed activation of low – grade inflammation, sympathetic and renin-aldosterone-angiotensin systems activity are typical for RAH patients. The most effective drugs in addition to three – component FDC are MRA – spironolactone and eplerenone, which lead to the achievement of target BP at 48.5 % and 46.9 % (according to office and ambulatory testing) RAH patients. Nebivolol application contributed to BP normalization at 39.7 % and moxonidine – at 41.2 % RAH patients.

Peculiarities of left ventricular myocardial remodeling among pregnant women with chronic arterial hypertension complicated by preeclampsia

Objective: to evaluate the nature of LV myocardial remodeling among pregnant women with chronic arterial hypertension (CAH), complicated by preeclampsia (PE), and the effect of antihypertensive therapy start on the reversibility of cardiac changes. Materials and Methods : pregnant women with CAH (n = 376): group I - with isolated CAH (n = 172), group II - with the development of PE on its background. Depending on the time of antihypertensive therapy start: in the group with CAH - early (n = 58), delayed (n = 76), in the group with PE development on the CAH background - early (n = 114), delayed (n = 128). Clinical and statistical, echocardiography, tissue myocardial doppler echocardiography (TMDEchoCG). Results: the group of pregnant women with PE development on the CAH background was distinguished by large indicators of LV myocardium mass - by 15.5% in the second trimester of pregnancy, 12.1% - in the third one. The initial manifestations of diastolic dysfunction of the left ventricular (LV DD) were diagnosed according to the results of TMDEchoCG: among 28.9 % of pregnant women in the second trimester, 40.3% - in the third one. The frequency of abnormal LV remodeling on the CAH background was 76.3% in the II trimester, 85.4% in the III one, with an increase in LV hypertrophy of the concentric type by the III trimester from 28.2% to 38.6% . The absence of early antihypertensive therapy caused higher frequency of elevated (“> 128”) values of the disproportionality coefficient (DC): with PE development on the CAH background it increased by 1.3 times (60.9% vs 33.3%), with left ventricular hypertrophy (LVH) according to the concentric type - by 1.5 times in the second trimester (34.4% vs 18.8%) and by 2.5 times (59.4% vs 23.7%) - in the third one. The effectiveness of early CAH correction during pregnancy is proved by the lower occurrence of diastolic dysfunction (DD): in the second trimester 22.8% vs 38.3%, in the third one - 21.1% vs 61.7%. Conclusions: it is proved that the probability of LV myocardium damage development on the CAH background increases with the identification of a disproportionately high LV myocardium mass as a result of BP overload. The study of LV and DF geometry allows to clarify the degree of organ damage (myocardium) and the effectiveness of antihypertensive therapy. It is stated that in the absence of rational CAH correction, morphofunctional changes in the LV cardiac muscle progress with the course of pregnancy, to the greater extent - with PE complication.

The Vascular Wall State and Microcirculation Parameters in Patients with Controlled and Uncontrolled Arterial Hypertension

Aim. To study the rigidity of the vascular wall and microcirculation parameters in patients with uncontrolled (UCAH) and controlled arterial hypertension (CAH).Material and methods. 134 patients with essential hypertension were included, among them 88 (65.7%) patients with UCAH and 46 (34.3%) patients with CAH. Patients in both groups were similar by sex, age, duration of hypertension and some biochemical parameters. Patients had a study of the parameters of stiffness of the vascular wall, microcirculation parameters, as well as an evaluate of the plasma level of asymmetric dimethylarginine (ADMA).Results. Pulse wave velocity (PWV) did not differed between the UCAH and CAH, both in absolute values (1144 [1000-1290] vs 1138 [10281279] cm/sec; p=0.385) and in the frequency of exceeding the normal values (95% vs 92%; p=0.784). Microcirculation index (MI) in CAH was significantly higher than in the UCAH group: 30.55 [27.08-34.4] and 22.82 [18.62-26.05], respectively (p &lt;0.05). ADMA plasma concentration was significantly higher 0.69 [0.62-0.81] μmol/l in UCAH, than in the CAH group 0.62 [0.58-0.70] µmol/l (p &lt;0.05), that shows the presence of endothelial dysfunction. There were detected significant relation between MI and cognitive status.Conclusion. The results of our study indicate the presence of signs of endothelial dysfunction in patients with UCAH with changes in the stiffness of the vascular wall comparable with the CAH group. This may reflect the slower effect of antihypertensive therapy on the remodeling processes of large vessels in comparison with the microvasculature.

OCT angiography in a comprehensive assessment of hypotensive therapy effectiveness in patients with primary open-angle glaucoma

Degenerative changes in the retina of primary open-angle glaucoma (POAG) patients are developing as response to ischemia and chronic hypoxia accompanied by intolerant IOP. For this reason, the analysis of ocular blood flow changes in glaucoma monitoring, as well as the basic tests, should be considered an integral part of comprehensive examination of such patients.Thepurposeis to identify the most informative markers of the disease and to assess the effectiveness of its antihypertensive therapy by the fixed combination Dorzolamide / Timolol (Dorzopt Plus).Material and methods.34 patients aged 68.44 ± 4.26 years with an advanced POAG stage and sub- or decompensated IOP were examined. The examination included optical coherence tomography in the angiography mode.Results.A stable average reduction in IOP by 35.1 % (by 8.6 ± 0.7 mm Hg, p &lt; 0.05) as compared with the baseline was achieved. IOP normalization was accompanied by a stable increase in corneal hysteresis and perfusion pressure, a decrease in the average depth of the perimetric defect, and changes in chorioretinal blood flow.Conclusion.Changes in the choroid thickness and capillary density of the retinal peripapillary layer may be considered as the most informative biomarkers in the diagnosis of glaucoma and the evaluation of antihypertensive therapy effectiveness.