Pharmacotherapy Of Arterial Hypertension Research Articles

European guidelines for the treatment of arterial hypertension 2023: new trends

The treatment strategy for arterial hypertension is aimed at controlling blood pressure levels, as well as preventing serious cardiovascular complications and affecting the prognosis of the disease. Therefore, pharmacotherapy of arterial hypertension is given great importance as a guide to the treatment of patients in real practice. The new 2023 European Society Guidelines for the diagnosis and treatment of hypertension were developed after a thorough analysis of studies in the field of arterial hypertension, and were not limited to RCTs only, but also included realistic studies (observational, cohort, administrative databases). The 2023 Guidelines support the proven value of five major classes of antihypertensive drugs: thiazide/thiazide-like diuretics, ACEIs, ARBs, calcium antagonists, and β-blockers. New data from meta-analyses support the greater clinical relevance of RAS blockers, calcium channel blockers, and thiazide/thiazide-like diuretics in preventing hypertension-related outcomes, leading to their preferred use in the pharmacotherapy of arterial hypertension, including various combinations of drugs. A new trend in the pharmacotherapy of arterial hypertension has been the inclusion of β-blockers among the main antihypertensive drugs, including their preferred use for a number of clinical conditions. New classes of drugs, such as SGLT2 inhibitors and non-steroidal mineralocorticoid receptor antagonists, are cited as having BP-lowering effects and with strong evidence of reduced cardiovascular and renal outcomes in patients with type 2 diabetes and, in the case of SGLT2 inhibitors, in non-diabetic patients. The 2023 Guidelines significantly updated information on available combination strategies for the treatment of arterial hypertension, and added data on the effectiveness of fixed combinations, including quadropills and polypills.

Study of physicians’ preferences for pharmacotherapy of arterial hypertension in pregnant women (the PHYGEST study)

Introduction: Elevated blood pressure in a pregnant woman is associated with serious risks for the mother and fetus. Therefore, the issues of rational antihypertensive pharmacotherapy are always extremely relevant in the scientific community. Purpose of the Study: To determine the preferences of physicians in the issues of pharmacotherapy for pregnant women with arterial hypertension and evaluate the influence of specialists’ length of employment. Materials and Methods: A multicenter study (a pharmacoepidemiologic knowledge assessment) was conducted in 2018–2021 using an anonymous questionnaire with open-ended questions. This paper discusses 5 questions of the questionnaire. Results and Discussion: The preferences of practicing specialists (411 physicians from 8 regions of Russia) for the prescription of basic and additional drugs for the treatment and prevention of hypertension, the impact of the physicians’ length of employment, and the degree of compliance with current clinical guidelines were determined. Conclusions: Certain specific and not fully rational specialists’ preferences were revealed, which confirms the importance of attention to this problem and requires the introduction of additional educational and supervisory efforts in this direction, as well as the continuation of similar studies in the future.

The role of a clinical pharmacist in implementing modern guidelines for the pharmacotherapy of arterial hypertension

Aim. To study the possibilities of participation of a clinical pharmacist in complying with modern guidelines for antihypertensive pharmacotherapy using fixed combinations of drugs in the conditions of a pharmacy and determine the directions for improving the work of a clinical pharmacist to improve the quality of hypertension control.
 Materials and methods. The analysis of reports on the sale of antihypertensive drugs containing one active substance and fixed combinations of two or three active substances was carried out in a pharmacy at a healthcare institution.
 Results. Sales volumes of combined drugs prevailed over sales volumes of drugs that contained one active substance, and fixed combinations of two active substances prevailed over triple combinations. However, the frequency of selling two drugs of different groups as separate drugs was higher than the sale of drugs of two or three pharmacological groups as fixed combinations. At the same time, sales of fixed combinations prevailed for individual active substances among the angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. 
 Conclusions. Data on the sale of fixed combinations of two or three active substances in the pharmacy have demonstrated insufficient compliance with current guidelines for antihypertensive pharmacotherapy. One of the ways to improve compliance with modern guidelines for the use of fixed combinations is the active participation of the clinical pharmacist in the selection of drugs for a particular patient, actively interacting with the doctor. Thus, a clinical pharmacist can be an important link in the control of arterial hypertension and the implementation of modern guidelines for the pharmacotherapy of arterial hypertension.

Management Considerations for Pulmonary Arterial Hypertension Pharmacotherapy in the Intensive Care Unit.

Pulmonary arterial hypertension is a rare and progressive disease with significant morbidity and mortality risk. Several medications targeting three major disease pathways are approved for treatment. However, the management of pulmonary arterial hypertension pharmacotherapies in a patient admitted to an intensive care unit poses unique challenges. Factors such as intubation and altered mental status may prevent the continuation of home oral and/or inhaled therapy, and the progression of the disease may require escalation of therapy. This review will focus on practical management strategies for the continuation of home pulmonary arterial hypertension pharmacotherapy and escalation of therapy.

Physicians’ knowledge and preferences in tactics of management and rational pharmacotherapy of arterial hypertension in pregnant women (PHYGEST study)

Introduction: The issues of rational antihypertensive therapy in pregnant women are always extremely relevant, since high blood pressure in a pregnant woman is associated with serious risks for a mother and a fetus.
 The aim of the study: To determine the knowledge and preferences of physicians in the management of pregnant women with arterial hypertension.
 Materials and methods: A multicenter study was conducted in 2018–2021 using an anonymous questionnaire among 411 doctors from 8 regions of Russia.
 Results and discussion: The levels of knowledge and preferences of specialists in the issues of diagnosing and formulating a diagnosis of arterial hypertension and preeclampsia in pregnant women, prescribing basic and additional drugs for the treatment and prevention of hypertension were revealed, and the degree of compliance with the current clinical guidelines was assessed.
 Conclusion: Due to the insufficient level of knowledge of specialists, it is required to pay increased and special attention to this problem, strengthen control over compliance with clinical guidelines, and introduce it into postgraduate recommendations and continuing education programs.

Algorithm for the diagnosis and pharmacotherapy of arterial hypertension, chronic heart failure in patients with newly diagnosed tuberculosis and chronic obstructive pulmonary disease in the the intensive phase of tuberculosis chemotherapy

Chronic heart failure (CHF), arterial hypertension (AH), chronic obstructive pulmonary disease (COPD) worsen the prognosis for the cure of newly diagnosed pulmonary tuberculosis (TB), including due to an increase in negative symptoms and a deterioration in the quality of life of patients in the intensive phase of TB treatment. This requires the algorithmic diagnostic actions of a doctor for the subsequent appointment of rational pharmacotherapy with a proven best outcome in the treatment of TB.Objective. To develop an algorithm for the diagnosis and pharmacotherapy of patients with hypertension, CHF and COPD in the intensive phase of chemotherapy for newly diagnosed TB in terms of the best outcome of TB cure.Design and methods. An open, prospective, randomized comparative study included 135 patients who were admitted to a tuberculosis dispensary for the treatment of newly diagnosed TB. Depending on concomitant cardiac pathology, patients were divided into 2 groups: 76 patients with TB, COPD and AH; 59 patients with TB, COPD and CHF. In patients on the background of intensive chemotherapy for newly diagnosed TB, symptoms such as shortness of breath, tachycardia, and increased blood pressure (BP) were first detected or intensified. The selection of treatment regimens was carried out with an assessment of the best tolerability and effectiveness. Duration of follow-up was 6 months with an assessment of the outcomes of TB treatment in comparison with retrospective control (a similar group according to the inclusion and exclusion criteria treated in 2018).Results. During intensive chemotherapy of newly diagnosed TB, increasing symptoms were assessed and analyzed, indicating the appearance or exacerbation of comorbid pathology: AH, CHF and COPD. Based on the results of the study, an algorithm of doctor’s actions was developed for the differential diagnosis of cardiovascular (AH and CHF) and bronchopulmonary (COPD) pathologies with recommendations for prescribing a rational combination of drugs. In patients with TB, hypertension and COPD, the best effect was obtained in reducing the average daily systolic and diastolic BP during therapy with an angiotensin II receptor antagonist and a dihydropyridine calcium antagonist with satisfactory tolerability. For patients with TB, COPD and CHF, an angiotensin-converting enzyme inhibitor (if intolerant, an angiotensin II receptor antagonist) in combination with a mineralocorticoid receptor antagonist and titration of a beta-blocker with the addition of a myocardial cytoprotector to the above therapy showed an optimal effect on the severity of CHF symptoms. These treatment regimens for 3 months led to the achievement of target indicators for BP, heart rate, exercise tolerance in the test with a 6-minute walk, and improvement in echocardiography. Continuation of treatment up to 6 months showed a significant improvement in the outcomes of TB chemotherapy, expressed in an increase in the number of people who achieved cessation of bacterial excretion and closure of decay cavities, without increasing antibiotic therapy.Conclusions. Algorithm of doctor’s diagnostic actions and prescription of rational pharmacotherapy of AH, CHF and COPD in patients with newly diagnosed pulmonary TB leads not only to improved tolerability of TB therapy, but also to the outcomes of curing newly diagnosed TB without intensifying antibiotic therapy.

Pharmacoepidemiology of the administration of antihypertensive drugs by doctors in the Voronezh region in comparison with the results of the PYTHAGOR IV study

Background: To examine the pharmacoepidemiology of treatment for arterial hypertension (AH) in Russia, the PYTHAGOR study has been conducted since 2001, including PYTHAGOR III (20012002), PYTHAGOR III (2008), and PYTHAGOR IV (2013). Increasing the role of doctors of outpatient care in the pharmacotherapy of patients with AH creates prerequisites for conducting new pharmacoepidemiological studies.
 Aim: To investigate the structure of prescriptions of antihypertensive drugs (AHD) by outpatient doctors at the regional level in comparison with the results of PYTHAGOR IV pharmacoepidemiological study.
 Materials and methods: In 2018, a survey was conducted in the Voronezh region among 104 doctors, including 58 general practitioners (55.8%), 37 therapists (35.6%), and four cardiologists (3.8%). The average age of the doctors was 45.7 13.5 years, the accumulated period of work was 21.0 13.7 years, and the period of work in an outpatient clinic was 16.6 12.4 years.
 Results: In the structure of doctors pREFERENCES in selecting free combinations of AHD, doctors preferred angiotensin-converting enzyme inhibitors (iACE; 90.3%), but they were prescribed more rarely than that in PYTHAGOR IV study (93.8%). The remaining AHD groups were used by doctors of the VR more often than in the PYTHAGOR IV study: beta-adrenoblockers, 89.4% (PYTHAGOR IV, 73.1%); diuretics, 88.4% (73.2%); calcium antagonists (CА), 86.5% (67.3%); angiotensin II receptor blockers (ARB), 81.7% (62.1%); imidazoline receptor agonists, 57.6% (13.3%). In the selection of fixed combinations of AHD: iACE or ARB with a diuretic was used in 71.9% and 36.4%, respectively, and iACE with CA in 46.2%. In the PYTHAGOR IV study, these combinations were used more rarely, i.e., in 33.3%, 28.0%, and 24.1%, respectively.
 Conclusion: The data obtained indicate adherence of doctors to modern clinical guidelines for the pharmacotherapy of AH.

Arterial hypertension: modern advances in metabolomics

Early diagnosis and effective pharmacotherapy of arterial hypertension are urgent problems, a significant contribution to the solution of which can be made by metabolomics. The etiology of hypertension remains unknown for the majority of patients with high blood pressure; the diagnosis for 90% is defined as essential (primary) hypertension. This population is characterized by disturbance of the metabolic pathways of lipids, glucose, biogenic amines and amino acids, which may manifest with hyperlipidemia, hyperglycemia, and insulin resistance with the possible subsequent development of type II diabetes mellitus. The study of the metabolomic signature can provide a clue to the identification of biomarkers of hypertension and contribute to the effective development of preclinical diagnosis and identification of risk groups, as well as a more complete understanding of the etiological and pathogenetic mechanisms of increased blood pressure. Published studies indicate the existence of metabolome characteristic of hypertensive patients, distinguishing them from normotensive subjects. The most typical are changes involving amino acids, polyunsaturated fatty acids, carnitines, phosphatidylcholines, and acylglycerols.The variability of the response to antihypertensive therapy does not allow achieving effective control of blood pressure in a significant proportion of patients. The peculiarities of changes in the metabolome under the use of various pharmacological groups can be used to identify metabolite markers of the response to the main classes of antihypertensive drugs, as well as markers of the development of side effects of drug therapy. Thus, individualization of the pharmacotherapeutic approach based on pharmacometabolomics can significantly increase the efficacy and safety of antihypertensive therapy.This review aims to study the main groups of metabolites identified in published trials as predictors of the development of hypertension, as well as metabolite markers of response to antihypertensive therapy.

Рациональная фармакотерапия артериальной гипертензии в реальной клинической практике сквозь призму лекарственной безопасности и мультиморбидности

Рациональная фармакотерапия артериальной гипертензии в реальной клинической практике сквозь призму лекарственной безопасности и мультиморбидности

Cost Analysis of Health Examination Screening Program for Ischemic Heart Disease in Active-Duty Military Personnel in the Middle-Income Country.

Cardiovascular diseases, including ischemic heart disease, are the most common causes of morbidity and death in the world, including Serbia, as a middle-income European country. The aim of the study was to determine the costs of preventive examinations for ischemic heart disease in active-duty military personnel, as well as to assess whether this was justified from the point of view of the limited health resources allocated for the treatment of the Republic of Serbia population. This is a retrospective cost-preventive study which included 738 male active-duty military personnel, aged from 23 to 58. The costs of primary prevention of ischemic heart disease in this population were investigated. Out of 738 subjects examined, arterial hypertension was detected in 101 subjects (in 74 of them, arterial hypertension was registered for the first time, while 27 subjects were already subjected to pharmacotherapy for arterial hypertension). Average costs of all services during the periodic-health-examination screening program were €76.96 per subject. However, average costs of all services during the periodic-health-examination screening program for patients with newfound arterial hypertension and poorly regulated arterial hypertension were €767.54 per patient and €2,103.63 per patient, respectively. Since periodic-health-examination screening program in military personnel enabled not only discovery of patient with newfound arterial hypertension but also regular monitoring of those who are already on antihypertensive therapy, significant savings of €690.58 per patient and €2,026.67 per patient can be achieved, respectively. As financial resources for providing health care in Serbia, as a middle-income country, are limited, further efforts should be put on screening programs for ischemic heart disease due to possible significant savings.

ANALYSIS OF MEDICINAL PROVISION OF PATIENTS WITH ARTERIAL HYPERTENSION IN HOSPITAL CONDITIONS

The aim: The aim of the study was to study drug consumption in pharmacotherapy of arterial hypertension in a hospital setting. Materials and methods: In the course of work medical cards of patients of the Kyiv regional Cardiac Dispensary in the conditions of inpatient treatment were used. Methods such as: questionnaire, pharmacoeconomic, expert assessments were used. Results: One of the main issues of drug supply for the population, in particular for patients with arterial hypertension, is the study of the demand and consumption of drugs. The drugs used to treat hypertension belong to different pharmacotherapeutic groups and are used in the treatment of a number of other diseases. Recent years of development of the domestic pharmaceutical market are characterized by an increase in the number of these drugs. Conclusions: One of the main issues of drug supply for the population, in particular for patients with arterial hypertension, is the study of the demand and consumption of drugs. As a result of the study, an analysis of the range of drugs for the treatment of hypertension, a comparative study of the market of offers and prices for the treatment of hypertension was carried out.

Сравнительный анализ блокаторов рецепторов ангиотензина и ингибиторов ангиотензин-превращающего фермента в лечении артериальной гипертензии (обзор литературы)

Cardiovascular diseases are still one of the main causes of death and disability among the adult population, the search for optimal pharmacotherapy of arterial hypertension remains an urgent task. The renin-angiotensin-aldosterone system (RAAS) plays a direct role in the pathophysiology of arterial hypertension, being responsible for regulating fluid volume and maintaining water - salt balance. RAAS is also responsible for the processes of tissue growth and differentiation, apoptosis, and affects the synthesis of many neurohumoral factors. By increasing the activity of the RAAS angiotensin II contributes to vasoconstriction, increased secretion of aldosterone and the activity of the sympathetic nervous system, which in turn leads to the development and progression of hypertension. Angiotensin–II receptor blockers (ARBs) block the AT1 subtype receptors of the same name, which is accompanied by vasodilation, a decrease in the secretion of vasopressin and aldosterone. RAAS blockade is an effective modern reliable way to control blood pressure, as well as prevent related complications. angiotensin converting enzyme inhibitors and angiotensin receptor blockers have similar hypotensive effects and a high safety profile. Due to differences in the mechanism of action, when taking angiotensin receptor blockers, the frequency of undesirable side effects is recorded less, and, accordingly, adherence to treatment is greater. One of the modern angiotensin receptor blockers, olmesartan in various studies has demonstrated its superiority over angiotensin-converting enzyme inhibitors (ramipril and perindopril) in the treatment of arterial hypertension. Olmesartan has proven itself both in monotherapy and in combination with a dihydropyridine calcium channel blocker or a thiazide diuretic.

Monitoring Cardiovascular Medicine Prices as a Tool for Analyzing the Effectiveness of Government Intervetions to Ensure Access to Medicines at the Regional Level

Aim. The aim of our study was to continue a comparative analysis of availability and access to cardiovascular medicines in 2017 and 2018 in the city of Kazan according to the original WHO/HAI methodology to assess the effectiveness of government interventions to ensure access to medicines.Material and methods. We performed a comparative analysis of prices of cardiovascular medicines in 2017 and 2018 in Kazan using the World Health Organization and Health Action International (WHO/HAI) methodology, to assess medicines' availability and affordability to ensure their rational use. We studied availability and prices of 71 cardiovascular medicines in public and private pharmacies in the city of Kazan and analyzed procurement prices of these medicines in hospitals. Also we studied the affordability of medicines, as well as performed pharmacoeconomic cost-minimization analysis for arterial hypertension pharmacotherapy in 2018. For each name, we studied the prices for the original brand and its lowest-priced generic. We compared medicine prices with international reference, delivered by the Management Sciences for Health and by expressing them as median price ratio (MPR).Results. In the public sector, prices of generic medicines were at the level of reference prices with the indicators of MPR 1.14 [0.41-1.84] and 1.17 [0.49-2.21], in 2017 and 2018 respectively. In the private sector, prices of generics reduced 2 times in 2018 compared to 2017, with the decrease in MPR from 2.22 [1.12-3.91] to 1.25 [0.44-2.32], (p<0.05). In the public sector, the affordability indicators of generics were the same in the studied years (Me=0.24 in 2017 and Me=0.26 in 2018). However, in the private sector there was a 2.5 times reduction in the affordability of generics (reduction Me from 0.66 to 0.24, p<0.05) in 2018 compared to 2017. From 2017 to 2018 the affordability of original brands changed from 1.9 to 1.3 in the public sector and from 2.3 to 1.5 in the private sector, but this change was not statistically significant (p>0.05). In 2018, depending on the choice of the medicine the annual course of therapy of hypertension varied from 149 to 28835 rubles.Conclusions. In 2018, the prices of generic cardiovascular medicines, but not of originator brands, reached the level of reference prices in both the public and private sectors of Kazan. According to the WHO/HAI methodology, generic cardiovascular medicines became affordable. In the private sector, there was a reduction in the prices of generic medicines, but not of originator brands, with an improvement of affordability of generics in 2018 compared to 2017.

Nadciśnienie tętnicze po przeszczepieniu narządów unaczynionych

W ostatnich latach można zaobserwować dynamiczny rozwój transplantologii klinicznej. Dzięki udoskonaleniu technik chirurgicznych oraz wprowadzeniu bardziej skutecznych i bezpiecznych leków immunosupresyjnych rokowanie u chorych po przeszczepieniu narządów znacznie się poprawiło. Biorąc jednak pod uwagę rzadsze występowanie powikłań chirurgicznych oraz immunologicznych, a co za tym idzie — dłuższe przeżycie, obecnie to choroby układu krążenia są jedną z głównych przyczyn śmierci u tych chorych. Częstość występowania nadciśnienia tętniczego po przeszczepieniu narządów jest większa niż w populacji ogólnej. Ponadto w wielu badaniach wykazano, że u chorych po transplantacji narządów często nie występuje fizjologiczne obniżenie ciśnienia tętniczego w godzinach nocnych, co jest niekorzystnym czynnikiem rokowniczym. Niektóre leki immunosupresyjne stosowane po przeszczepieniu narządów unaczynionych mają właściwości hipertensynogenne. Niekorzystny mechanizm działania glukokortykosteroidów polega przede wszystkim na retencji sodu i wody. Hipertensynogenne właściwości inhibitorów kalcyneuryny wynikają z ich działania naczyniokurczącego. Efekt hipertensynogenny obu tych grup leków zależy od dawki. Drugą główną przyczyną nadciśnienia tętniczego u chorych po przeszczepieniu narządów unaczynionych, oprócz stosowania leków immunosupresyjnych, jest upośledzenie czynności nerek. Patogeneza nadciśnienia tętniczego u chorych po transplantacji nerki pozostaje złożona. Najczęściej wysokie wartości ciśnienia tętniczego wynikają z pogorszenia czynności przeszczepionej nerki. W diagnostyce różnicowej należy jednak uwzględnić również zaburzenia w obrębie nerek własnych i zaburzenia unaczynienia nerki przeszczepionej. W leczeniu nadciśnienia tętniczego po przeszczepieniu narządów unaczynionych w pierwszej kolejności należy wdrożyć postępowanie niefarmakologiczne — dietę, codzienną aktywność fizyczną, zmniejszenie masy ciała oraz zaprzestanie palenia papierosów. W farmakoterapii przeciwnadciśnieniowej można stosować leki ze wszystkich grup. Natomiast w farmakoterapii nadciśnienia tętniczego wywołanego inhibitorami kalcyneuryny należy preferować stosowanie dihydropirydynowych antagonistów wapnia (z wyjątkiem lerkanidipiny).

Фармакотерапия артериальной гипертонии у больных с хронической болезнью почек в реальной клинической практике

Фармакотерапия артериальной гипертонии у больных с хронической болезнью почек в реальной клинической практике

Фармакотерапия артериальной гипертонии у беременных: анализ результатов регистра беременных БЕРЕГ

Фармакотерапия артериальной гипертонии у беременных: анализ результатов регистра беременных БЕРЕГ

Efficacy and Safety of the Use of Pulmonary Arterial Hypertension Pharmacotherapy in Patients with Pulmonary Hypertension Secondary to Left Heart Disease: A Systematic Review.

Pulmonary hypertension (PH) is often caused by left heart disease (LHD) such as heart failure (HF) or valvular heart disease. Historically, few randomized controlled trials have evaluated the off-label use of medications for treating pulmonary arterial hypertension (PAH) in patients with PH-LHD. However, multiple randomized controlled trials have been published over the last decade that investigated their use in patients with PH-LHD. In addition, recent updates in the classification and definitions of PH have led to an improved recognition of PH-LHD phenotypes, notably combined post-capillary and pre-capillary PH and isolated post-capillary PH. In this systematic review, we show that PAH medications should not be recommended in two distinct HF populations: patients with HF without definitive PH diagnosis and patients with isolated post-capillary PH due to HF. In addition, the use of bosentan or macitentan is not recommended in patients with combined post-capillary and pre-capillary PH due to HF, but sildenafil may be considered to improve pulmonary hemodynamics and exercise capacity in patients with combined post-capillary and pre-capillary PH due to HF. Riociguat 2mg 3 times daily may also be considered to improve pulmonary hemodynamics in patients with combined post-capillary and pre-capillary PH due to heart failure with reduced ejection fraction but not heart failure with preserved ejection fraction. The postoperative use of sildenafil in the setting of PH after valvular heart disease intervention was evaluated. Limited clinical data and safety concern warrants caution with the postoperative use of sildenafil in patients with PH due to valvular heart disease. Despite recent advances in the understanding of PAH medications for patients with PH-LHD, uncertainty remains about their utility in distinct subgroups. Nonetheless, PAH pharmacotherapy should generally be avoided for most patients with PH-LHD.

Cardiovascular medicine prices as an indicator of access to medicines and their rational use

Aim. To perform a comparative analysis of cardiovascular medicine prices in 2011 and 2015 and to assess their availability and affordability as a basis for rational pharmacotherapy. Material and methods . We conducted a comparative analysis of prices for cardiovascular medicines in 2011 and 201 5 in Kazan using the World Health Organization and Health Action International (WHO/HAI) methodology, to assess medicines' availability and affordability to ensure their rational use. We studied availability and prices of 71 cardiovascular medicines in public and private pharmacies of the city of Kazan and analyzed procurement prices of these medicines in hospitals. Also we performed pharmacoeconomic cost-minimisation analysis for arterial hypertension pharmacotherapy in 2015. For each medicine, we analyzed the prices for the original brand drug and its lowest-priced generic. We compared medicine prices with international reference prices of 201 0 and 201 5, delivered by the Management Sciences for Health, by expressing them as median price ratio. Recording and analysis were performed using the standardized MS Excel WHO/HAI Workbook. Results . The prices of generic medicines, both in the public and private sectors, decreased relative to reference prices in 2015 compared to 2011. In 201 1 one third of the medicines were purchased as original brands and in 201 5 almost all medicines were procured as generics with a fourfold decrease in prices. In 201 5, depending on the choice of the medicine the annual course of monotherapy of hypertension varied from 208 to 281 05 rubles. Conclusion. Over the five years from 2011 to 2015, there was a general trend of price reduction for generic products relative to reference prices for cardiovascular medicines. But in order to provide rational pharmacotherapy, additional price studies and pharmacoeconomic analyzes are needed, taking into account the changing prices on the pharmaceutical market.

The Pharmacological Treatment of Arterial Hypertension in Frail, Older Patients—a Systematic Review

It is debated whether the treatment goals and decision-making algorithms for elderly patients with hypertension should be the same as those for younger patients. The American and European guidelines leave decisions about antihypertensive treatment in frail, institutionalized patients up to the treating physician. We therefore systematically searched the literature for publications on the phamacotherapy of arterial hypertension in frail patients. The MEDLINE, Embase, and Central databases were systematically searched for randomized, controlled trials (RCTs) and non-randomized studies, including observational studies, on the pharmacotherapy of arterial hypertension in elderly patients since the introduction of the concept of frailty, published over the period 1992-2017. Out of 19 282 citations for randomized, controlled trials and 5659 for non-randomized trials and observational studies, four RCTs and three observational studies were included in the further analysis. The included RCTs showed a trend to- wards a benefit from pharmacotherapy of hypertension in frail patients with respect to mortality, cardiovascular disease, functional status, and quality of life. On the other hand, some of the observational studies indicated a lower rate of falls and lower mortality among patients who received no antihypertensive treatment. In view of the conflicting findings of RCTs and non-randomized studies, the lower representation of frail subjects in RCTs, and the high risk of bias in non- randomized studies, the findings of the studies included in this review do not enable the formulation of any strictly evidence-based treatment recommendations. As a rule of thumb, the authors propose that a target systolic blood pressure of <150 mmHg should be aimed at in patients whose gait speed is less than 0.8 m/s, while a target range of 130-139 mmHg can be set for patients over age 80 who are no more than mildly frail.

Combined pharmacotherapy of arterial hypertension. Overview fixed combination antihypertensive drugs

Hypertension remains the cornerstone of the cardiovascular continuum. An increasing number of patients receive a combination antihypertensive therapy to achieve target blood pressure, expanding indications for combination therapy at the onset of treatment. Constantly growing market of fixed combinations (FC) of antihypertensive drugs. The article gives an overview of the FC, registered in the Russian Federation, discussed the clinical situation for the preferential destination of a FC. A more detailed analysis of FC comprising the angiotensin II receptor blocker and diuretics, in particular, discusses the benefits of FC comprising angiotensin II receptor blocker candesartan and hydrochlorothiazide.