Репозиторий Университета

© 2018 Media Sphera Publishing Group. All rights reserved. In this article we present problems of prognostic value of day-by-day blood pressure (BP) variability, its role in development and progression of damage of target organs in arterial hypertension, and impact on risk of cardiovascular, cerebral-vascular complications, and mortality. We also discuss methodological aspects of assessment of day-by-day BP variability. The article contains literature data on effects of antihypertensive therapy on variability of home BP, and consideration of evidence base of possibilities of the fixed amlo-dipine/perindopril combination for lowering day-by-day BP variability.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study cognitive functions, anxiety and depression levels, 24-hour blood pressure (BP) profile, cerebral blood flow (CBF) perfusion in treatment-naive middle-aged patients with uncomplicated essential arterial hypertension (EAH) depending on the white matter hyperintensities (WMH) burden. Material and methods. Forty-one hypertensive patients (mean age 46.2±4.6 years) and 41 healthy volunteers (mean age 50.3±6.7 years) were enrolled to the study. All subjects underwent brain MRI (MAGNETOM Skyra 3.0T, T1, T2 FSE, T2 FLAIR, T1 MPRAGE, ASL), Montreal cognitive assessment (MoCA), 10-word learning task, verbal fluency test, trail making test, Stroop color and word test, anxiety and depression assessment with Hamilton rating scales, 24-hour blood pressure monitoring (ABPM). Results. WMH were found in 22 (53.7%) hypertensive patients and in 3 (7.3%) healthy volunteers (p=0.0002). Hypertensive patients had the significantly lower CBF compared to controls (p<0.001). Conclusion. WMH were identified in treatment-naive middle-aged patients with uncomplicated mild to moderate EAH. There was an association between WMH and lower CBF in the cortical plate of frontal lobes, SBP variability and worse cognition. Cerebral hypoperfusion can cause cognitive impairment even in the earliest stages of EAH, which increases due to emotional disorders.

© 2018, Media Sphera Publishing Group. All rights reserved. This article presents a review of Russian and foreign literature about the impact of arterial hypertension (AH) on the risk of cognitive impairment and dementia. Large studies have demonstrated the effect of blood pressure (BP) on the risk of vascular dementia and Alzheimer’s disease (AD) in elderly and oldest old people as well as a role of antihypertensive therapy. There is evidence of a negative effect of hypertension in middle age on cognitive functions in late-life. Observational studies as a whole have shown the positive effect of antihypertensive therapy on the prevention of cognitive function and dementia. However, there are a number of limitations that dictate the need for further research on this issue. The importance of the interdisciplinary approach to treatment of cognitive impairment by cardiologists and/or therapists, together with neurologists, as well as complex treatment regimens, including correction of risk factors and neuroprotective therapy, is highlighted.

© 2018 Media Sphera Publishing Group.All Rights Reserved. The article presents data of domestic and foreign authors on the relationship between occupational factors and arterial hypertension. The role of latent arterial hypertension, its frequency in the population, the lesion of the target organs and the prognosis in comparison with normotensive individuals, arterial hypertension of the "white coat" and stable arterial hypertension have been analyzed. Arterial hypertension in the workplace is a form of latent arterial hypertension. The authors review the influence of harmful production factors (physical, chemical), as well as psychosocial stress on the risk of developing arterial hypertension.The risk of developing hypertension in specified groups of workers has been analyzed separately. The place of production-related diseases in modern occupational pathology in the Russian Federation. A wider implementation of measures aimed at early diagnosis and prevention of arterial hypertension in workers is proposed.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Aim. To evaluate the presence and the severity of the complaints (headache, dizziness, memory loss, concentration of attention, sleep disturbances, decreased mood, increased anxiety), the state of cognitive functions, emotional status and quality of night sleep in treatmentnaïve middle-aged patients with mild to moderate EAH compared to healthy volunteers of the same age. Materials and methods. 103 treatment-naïve patients with EAH aged 40-59 years at the enrollment, who met the inclusion/exclusion criteria and provided written informed consent (46 men, mean age 53.6±0.8 years) and 50 healthy volunteers (17 men, mean age 51.5±1.0 years) with normal blood pressure (BP) level - control group - were enrolled to the study. Mean EAH duration was 2.9±5.7 years. Cognitive assessment included Montreal cognitive assessment, 10-words learning task, verbal fluency test, TMT, Stroop color and word test. Anxiety and depression were evaluated via Hamilton rating scales (HARS and HDRS). 24-hours ambulatory BP monitoring (ABPM) was performed according to European guidelines. Results. 70% of patients with EAH complained of memory disturbance, 68% - lack of attention, 22% - sleep disturbances, 12% - dizziness, 9% - headache. It took statistically significant more time for patients with EAH to perform on TMT B (p<0.05), they had significantly higher TMT B - TMT A difference score (p<0.01) and lower mean MoCA score (p<0.05). Patients with EAH had significantly higher mean score in Hamilton anxiety (2.1±3.7) and depression (1.1±2.4) rating scales compared to controls (0.3±0.9 points, p<0.01 and 0.1±0.5 points, p<0.001, respectively). Patients with EAH who complained of sleep disturbances had low sleep quality (8.7±2.8 points). Among patients with EAH who complained about headaches 66.6% had episodic migraine and chronic tension type headache (33.4%). Those patients had a substantial impact of headache on life and daily living according to HIT-6 (mean score - 57.5±6.1). Only 2 patients out of 12 with complains about dizziness had benign paroxysmal positional vertigo and Ménière's disease. Conclusion. Complaints about memory dysfunction, lack of attention, sleep disturbances, less common - dizziness and headaches, are most typical in patients with EAH on the early stages of the disease. They differ from healthy volunteers of the same age by having cognitive impairment and higher anxiety and depression scores. Patients with EAH who complained about sleep disturbances had low sleep quality. Headache in patients with EAH was due to episodic migraine and tension type headache which had a negative impact on life and daily living.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Cardiovascular diseases remain leading cause of high mortality in diabetes patients. The article is focused on the influence of diabetes on cardiovascular risks. The prevalence presented, as the significance of the main and additional risk factors of cardiovascular diseases in the development of macrovascular complications in diabetes. In the context of influence on cardiovascular risks, modern glucose lowering drugs are considered, the safety and efficacy properties. Advantages of dapagliflozin underscored, the novel oral drug of new generation, with safe and prominent antidiabetic effect and ability to correct the main factors of cardiovascular risk (obesity, hypertension).

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Aim. To evaluate the prevalence of arterial hypertension (AH) in heart transplant recipients, and its influence on the risk of adverse events, as the efficacy and safety of antihypertension medications (AHM). Material and methods. To the study, were consequently included all heart transplant recipients operated in the Shumakov Centre during the years 2013 to 2016 and survived 90 days after orthotopic heart transplantation. Results. Totally, 353 recipients included, with AH or AHM intake in anamnesis in 62 (17,6%). Within 90 days post surgery, AH that demanded for medication therapy was found in 151 (42,8%) patients. In posttransplant AH patients there were the following specific parameters in preoperational period: higher body mass index - 25,7±4,1 vs 24,9±4,4 (р=0,026), blood creatinine concentration - 100,6±62,6 vs 68,8±4,8 (р<0,001), donor heart posterior wall thickness - 11,9±0,8 vs 11,3±0,7 (р=0,034), creatinine concentration in 3 month after operation - 131,7±101,6 vs 94,1±46,5 (p<0,001). There was relation revealed, of AH development risk with anamnesis of AH and renal failure, as a necessity for renal replacement therapy within 30 days post surgery and episodes of acute antibody-mediated reaction on transplant. In the recipients taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ACEi/ARB) before operation, the survival rate free from adverse events was better than in those taking calcium channel blockers (CCB) (plog-rank=0,042). Conclusion. The results of the study point on high prevalence of AH in heart recipients. Presence of AH in anamnesis, renal failure, episodes of humoral, but not cellular, reaction to the transplant, and donor heart hypertrophy do significantly increase the probability of AH development after transplantation. Comparison revealed significant benefit of ACEi/ ARB versus CCB as antihypertension medications in either monotherapy or in combination with diuretics.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Aim. Assessment of the dynamics of arterial hypertension (AH), coronary heart disease (CHD), postinfarction cardiosclerosis (PICS), stroke, cardiovascular risk factors prevalence by visit, during 6 years in the inhabitants of rural areas. Assessment of the impact of prevention events on the revealing rate of cardiovascular diseases. Material and methods. In the years 2015-17, a retrospective analysis was done, of the database on 2202 adults (≥18 y.o.) in Mokshinskaya rural outpatient facility. Of those 970 (44,1%) males and 1232 (55,9%) females. Study object - the reports for 2011-2016. For statistics, the IBM SPSS 21.0 was used, together with WinPEPI 10.49. Precise Fisher test applied and chi-square by Pearson. Statistics borderline set to 5%. Results. In 2016г the prevalence of AH - 9,54% (of all adult population), CHD - 2,00%, PICS - 0,59%, stroke - 0,27%. Prevalence increase by: AH - 32,5%, diabetes - 30,6%, obesity - 52,4%. There was tendency to decline of all CHD cases number: from 3039,8 by 100 thousand persons to 1998,2 by 100 thsd. PICS values did not change significantly. Cardiovascular mortality in the studied population was slightly higher - 7,3 promille in 2016, than cardiovascular mortality by Rosstat data - 6,2 promille and correlates strongly negatively with prevention events that have been performed. Conclusion. During a 6 year period there is significant increase of AH, diabetes, obesity prevalence that correlates significantly with prevention events. Nevertheless, the data on 2016 remains below mean statistics for entire country, except on obesity. Increase of the number of obesity persons by 52,4% is a serious medical and social problem of the studied population. It is a risk factor sreiously influencing cardiovascular morbidity and mortality.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Aim. To analyze the specifics of comorbidity forming and age-related correlations of the risk factors (RF) distribution in arterial hypertension (AH) patients living in rural areas. Material and methods. In 2015-2017 a retrospective analysis of 2500 patients database was done at two general practitioners offices in Konakovsky District of Tverskaya Oblast. Of those, 350 were selected (14%) at the age 44-53 (164 males, 186 females) among the charts containing most complete data on the dispanserization. Additionally, surveying of the group was done for more detailed retrospective analysis of comorbidity and RF existence during lifetime of 25-35 years. Results. In the structure of comorbidity AH predominates, which has been diagnosed in 50,86%of patients; mostly it is diagnosed at the age 44-53 (81,06%). After AH, 2nd place is held by dorsopathies (24%), 3rd - gastrointestinal disorders (12%). For chronic pulmonary obstructive disease and cerebrovascular disease - it is less than 3%. 96,1%of men with AH are smokers at the age 18 to 53 y. o. By the age 53, in 40,26%of men and 36,63%of women there is bodyweight increase; and raised cholesterol - in 48,05%and 22,77%, respectively. Conclusion. In rural areas inhabitants, the formation of comorbidity is ongoing mostly at age 44-53 y. o. Of the specifics of comorbidity in these patients, there is often combination of AH with dorsopathies, and quite rare - with chronic obstructive lung disease or cerebrovascular diseases. The observed at the age 34-43 "diagnostic gap" points on the necessity for attention to this exact age strata with the aim of ontime diagnostics and early stages of diseases reveal. The structure of RF during the lifetime is not homogenic and is the highest at the age of comorbidity forming (except smoking and professional harms). All the considered RF are more prominent in men than in women.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. The article is focused on the issues of clinical efficacy of telmisartan - angiotensin II type 1 receptor blocker from the perspective of its influence on cardiovascular risk in systemic hypertension patients. The results presented, of a variety of studies, witnessing potent antihypertensive and protective properties of telmisartan. The opportunities described, for usage of the drug in high risk patients, its efficacy in cardio- and nephroprotection. Special attention is paid for an exclusive property of telmisartan to be an agonist of PPAR γ-receptors, hence to correct glucose and lipid metabolism in patients with metabolic syndrome and diabetes.

© 2018 Russian Transplant Society. All Rights Reserved. Lung transplantation (LT) for idiopathic pulmonary arterial hypertension (IPAH) now is the only radical treatment of this disease. Aim: to analyze own experience of performing LT in patients with IPAH. Materials and methods. 8 adult IPAH patients, who underwent LT between 2014 and october 2018, were included. In 7 of 8 patients undergoing bilateral lung transplantation on intraoperative venoarterial extracorporeal membrane oxygenation (VA ECMO) with prolongation into the postoperative period. Results. VA ECMO support was prolonged into postoperative period 6 and 7 days respectively in 2 (25,0%) patients and 3 days in 6 (75,0%) patients. Hospital mortality in IPAH patients was 1. Conclusions. Own experience demonstrates that LT is an effective method of treatment in patients with IPAH. Hospital, 1- and 3-year survival rates for the patient collective were 87.5, 75.0 and 75.0% respectively.

© 2018, Silicea-Poligraf. All rights reserved. The review is focused on clinical significance of the left ventricle hypertrophy (LVH) — presentation of heart lesion as a target organ for systemic hypertension (SH). Various LVH development mechanisms are presented, and special attention is paid to sympathic nervous system and β-adrenoreceptors in pathogenesis. Fundamental methods of diagnostics are described for LVH, in comparison. The pathology is classified from the perspective of recent guidelines on echocardiographic diagnostics. Epidemiology provided. Taken current evidence, the prognostic role of LVH is described as a factor increasing the risk of fatal and non-fatal cardiovascular, cerebrovascular and renal complications in SH patients. Trials data presented that points on LVH regression with highly selective β1-blocker bisoprolol treatment. Pathophysiology of LVH regression is discussed for β1-blocker treatment.

© 2018 Stolichnaya Izdatelskaya Kompaniya. In the article, with regard to current clinical recommendations, the place of combined antihypertensive therapy, especially triple drugs regimens, is considered in the treatment of patients with arterial hypertension. Special focus is given to the body of evidence for the efficacy of valsartan and amlodipine, as the reference drug of angiotensin II receptor blockers and calcium channel blockers, respectively. Not only their high antihypertensive properties are demonstrated, but also a favorable effect on target-organ protection and prognosis is described. In particular, the possibilities of valsartan in reducing the severity of left ventricular hypertrophy and microalbuminuria are described, and its unique properties in the class of sartans that allow the use of this drug in patients with ischemic heart disease and chronic heart failure are emphasized. Data on the antiatherosclerotic effects of amlodipine and its proven ability to reduce cardiovascular risk are presented. Current data are presented about their use in a fixed-dose combination with hydrochlorothiazide, including real clinical practice settings. The evidence base of high clinical efficacy, safety and metabolic neutrality of the triple combination of antihypertensive drugs valsartan, amlodipine and hydrochorothiazide is presented. The issues of increasing adherence of patients to treatment when prescribing fixed-dose combinations are considered. An algorithm for the selection of antihypertensive drugs in the form of monotherapy and combination therapy of two or three drugs depending on the clinical situation (the presence of certain target-organs damages and associated clinical conditions, primarily ischemic heart disease, atherosclerosis of carotid arteries and chronic heart failure) and the severity of the additional risk of cardiovascular complications..

© 2018 Ima-Press Publishing House. All rights reserved. The paper analyzes the concepts of personality profiles and demonstrates the possibility of applying this approach to comparatively assessing the psychological characteristics of patients with essential arterial hypertension (EAH). It sets forth the fundamentals of the concepts by F. Alexander, H.F. Dunbar, M. Friedman, and R. Rosenman, which emphasize the importance of emotional, personal, and behavioral factors for the etiology and pathogenesis of EAH and analyzes in detail the psychological study of the characteristics of the so-called type D (distressed) personality that is characterized by a combination of the predominance of negative emotions, social isolation, and inability to regulate these factors. The authors present the results of their own empirical study of personal characteristics (through the Cattel's 16 personality factors questionnaire) in patients with office hypertension (OH) versus those with classical EAH and healthy individuals. OH patients are shown to be significantly less sociable, less emotionally stable, more overwrought and shy, and more prone to self-control and feelings of guilt. The experimental psychological study (by simulating of emotional stress and by using the modified variant of the procedure developed by S. Rosenzweig to examine frustration reactions) has revealed that the patients with OH tend to experience the most intense negative sthenic emotions and they significantly more frequently resort to repression of these emotions. The findings prove that the EAH group is e heterogeneous and confirm the assumption that OH patients show negative affectivity and lower social activity.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article describes the definition of dementia, its diagnostic criteria, classification. Differences in the pathogenesis and clinical manifestations of different types of dementia are considered. The issues of interrelation of arterial hypertension and the risk of development of cognitive disorders and dementia in old and very old people are discussed in detail. Data on the effect of antihypertensive drugs of different groups on the risk of dementia and the state of cognitive functions are presented. The evidence base of dihydropyridine calcium antagonist amlodipine and thiazide-like diuretic indapamide-retard is discussed with respect to the prevention of dementia and cognitive decline and their beneficial effect on cognitive function in patients with arterial hypertension.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. The article is focused on a broad evidence of antihypertension efficacy of perindopril and bisoprolol. The issues considered, of the drugs usage in patients with arterial hypertension, ischemic heart disease and chronic heart failure according to the international and local clinical guidelines. Special attention is paid for the influence of perindopril and bisoprolol on prognosis - the risk of cardiovascular complications from the evidence based medicine perspective. The data provided on a novel unique combination of these medications, and the benefits are accounted, as the mechanism of complimentary interaction; the results of randomized trials, clinical trials provided, that point on the high potential of this sort of combinational treatment.

© 2018 Russian Association of Endocrinologists. All rights reserved. The presented paper is a third revision of the clinical recommendations for the treatment of morbid obesity in adults. Morbid obesity is a condition with body mass index (BMI) ≥40 kg / m2 or a BMI ≥35 kg / m2 in the presence of serious complications associated with obesity. The recommendations provide data on the prevalence of obesity, its etiology and pathogenesis, as well as on associated complications. The necessary methods for laboratory and instrumental diagnosis of obesity are described in detail. In this revision of the recommendations, the staging of prescribing conservative and surgical methods for the treatment of obesity are determined. For the first time, a group of patients with obesity and type 2 diabetes mellitus is selected, in whom metabolic surgery allows a long-term improvement in the control of glycemia or remission of diabetes mellitus.