Репозиторий Университета

© 2018, Media Sphera Publishing Group. All rights reserved. Essential arterial hypertension (AH) is one of the main risk factors for the development of cognitive impairment and dementia. Cognitive decline is an early sign of brain damage as a target organ of hypertension, it occurs even in patients with uncomplicated hypertension with minimal duration of disease. Cognitive impairment progresses with increasing age and hypertension duration, as well as in non-controlled AH. In patients with hypertension, the prevalence of emotional disorders — anxiety and depression is also high. In addition to antihypertensive therapy, hypertensive patients need correction of concomitant cognitive and emotional disorders. Rat-gopantenic acid simultaneously corrects both emotional and cognitive impairment, and has a good tolerability profile as well. An analysis of the evidence base of rac-gopantenic acid showed its high efficacy in the treatment of mental disorders and good tolerability along with a positive effect on somatic disorders and results of antihypertensive therapy. Taken together, they enhance adherence to treatment and, consequently, reduce the cardiovascular risk.

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. A method for simultaneous determination of metoprolol and bisoprolol in human blood serum by HPLC-MS/MS was developed and validated. The analytical ranges of the method were 5 – 250 ng/mL and 1 – 250 ng/mL for metoprolol and bisoprolol, respectively. The suitability of the developed for therapeutic drug monitoring during treatment for arterial hypertension and other cardiovascular diseases was demonstrated. In particular, the proposed method could identify patients at high risk for developing adverse effects and help to monitor a switch between metoprolol and bisoprolol while changing the pharmacotherapy regime.

© 2018, Silicea-Poligraf. All rights reserved. The current population is characterized by a high prevalence of risk factors for the development of chronic kidney disease: hypertension, diabetes, obesity, metabolic syndrome, physical inactivity, smoking. The development of severe complications and a close connection with potentially fatal cardiovascular disorders make this disease a socially and economically significant problem. Treatment of chronic kidney disease in advanced stages belong to nephrologist duties. However, the success of preventive interventions depends on the time of their onset, which makes it relevant to identify the disease. The use of nephroprotective approaches by physicians of different specialties (general practitioners, cardiologists, gerontologists, nephrologists, endocrinologists) can significantly improve the prognosis of both those at risk of developing renal dysfunction and the existing disease. The review presents data on the clinical and laboratory efficacy of angiotensin-renin blocker use, as well as the combination of angiotensin II receptor blockers with calcium antagonists. Using the combination of the angiotensin II receptor blocker irbesartan and amlodipine as an example, we demonstrated the possibilities of nephroprotective therapy in patients with renal dysfunction.

© 2018 Cardiovascular Therapy and Prevention. The article discusses the role of telmisartan in the treatment of arterial hypertension in patients with metabolic syndrome. Telmisartan is second-generation type 1 angiotensin II receptor blocker, which has unique pleiotropic effects due to partial affinity for receptors that activate the proliferation of subtype γ peroxisomes (PPARγ) located in adipose tissue. The interrelation of metaflamation, a specific chronic inflammatory process with pathogenetic mechanisms of development of cardiovascular diseases, including arterial hypertension, is also described in study. The role of the adiponectin peptide is considered, which synthesis is stimulated by partial PPARγ receptor agonists (as mentioned above - telmisartan). It has a positive effect on fat and carbohydrate metabolism, as well as cardioprotective properties. The conclusion contains the results of numerous randomized studies and meta-analyzes confirming the high efficacy of telmisartan in the treatment of arterial hypertension in patients with morbid obesity.

© 2018 Cardiovascular Therapy and Prevention. Modern appropriate treatment of hypertension involves the use of combination antihypertensive therapy. According to updated version of European Society of Cardiology 2018 guidelines, renin-angiotensinaldosterone system blockers must be used as first-line drugs, including in combination with hydrochlorothiazide. This article presents the algorithms for the management of patients with uncomplicated and asymptomatic (with target lesions) arterial hypertension. It also described the management of patients with concomitant cardiovascular, cerebrovascular, renal pathology and diabetes mellitus, and use of fixed combination of candesartan and hydrochlorothiazide. The article presents research data that confirmed not only the high antihypertensive efficacy of this combination, but also demonstrated its neutral metabolic profile, organ-protective effects, the ability to use in patients with chronic kidney disease, chronic heart failure, prior stroke, as well as high tolerability and treatment adherence.

© Russian Journal of Cardiology. Renin-angiotensin-aldosterone axis activation is an important mechanism of hypertension and its cardiovascular and renal complications. Angiotensin receptor blockers are considered among the first-choice antihypertensive drugs in Russia, European countries, and the USA. In addition to antihypertensive action, these drugs positively influence several components of the cardiovascular continuum and can be used for individualized management of high cardiovascular risk patients. The paper discusses the benefits of angiotensin receptor blockers use in patients with cardiovascular comorbidities. The paper includes a clinical case scenario revealing antihypertensive efficacy of telmisartan as an initial agent in a patient with high risk of cardiovascular events.

© 2018 by the authors; licensee Modestum Ltd., UK. Objective: The problem of drug interactions is increasingly important today because they may induce serious adverse events as well as interfere with efficacy of pharmacotherapy. Combinations of drugs are most often prescribed to patients presenting with comorbid pathology. The incidence of a combination of arterial hypertension (AH) and acid-dependent diseases (ADDs) varies widely ranging from 11.6 to 50%. One of combinations of drugs prescribed to such patients is a combination of calcium channel blocker amlodipine and proton pump inhibitor omeprazole. The latter in the human body undergoes biotransformation mediated at the level of cytochrome P450 by isoenzymes CYP2C19 and CYP3A4. Amlodipine is a substrate of the isoenzyme CYP3A4, which increases the probability of the development of interaction between these drugs. The purpose of our study was to investigate antihypertensive efficacy of amlodipine in patients suffering from arterial hypertension combined with acid-dependent diseases and additionally taking omeprazole. Method: Study included a total of 150 patients with AH and ADD. Antihypertensive therapy was evaluated by means of office measuring of arterial pressure (AP) and circadian monitoring of AP (CMAP). The followed-up patients with AH and ADD were divided into 2 groups. Group One was composed of hypertensive patients undergoing pharmacotherapy with 10 mg amlodipine, whose condition required due to exacerbation of ADD administration of omeprazole at a dose of 20 mg for a period from 3 to 4 weeks. Group Two comprised hypertensive patients receiving antihypertensive therapy consisting of 10 mg amlodipine, who were found to have remission of acid-dependent diseases, with no additional medication taken. Results: The obtained findings demonstrated that one of the commonly used drug combinations in treatment of patients with AH and ADD in ambulatory conditions was a combination of omeprazole and amlodipine, accounting for 7.1%. The results of office measurement of arterial pressure (AP) 2 weeks after initiating pharmacotherapy with omeprazole in patients with AH and ADD demonstrated that the patients receiving omeprazole in addition to antihypertensive therapy were found to have a statistically significant decrease in systolic arterial pressure (SAP) and statistically significantly more pronounced dynamics of a decrease in diastolic arterial pressure (SAP) (p<0.05) compared with those not receiving therapy with omeprazole. Also, in the group of patients taking omeprazole, the findings of circadian monitoring of blood pressure (CMAP) showed a statistically significant decrease in average circadian SAP, average circadian DAP, mean value of daytime SAP and mean value of nighttime SAP (p<0.05). Conclusion: The obtained findings demonstrated that simultaneous prescription of amlodipine and omeprazole to patients with concomitant pathology, i.e., AH and ADD, turned out to enhance the antihypertensive affect of amlodipine, which probably resulted from substrate competition of amlodipine and omeprazole at the level isoenzyme CYP 3A4 of cytochrome P450.

© 2018 by the authors; licensee Modestum Ltd., UK. Objective: A considerable proportion of the population due to both economic reasons and traditions appear to be experiencing chronic deficit in micronutrients, which may be deteriorated on the background of drug therapy being performed. The purpose of our study was to optimize pharmacotherapy of patients with first-ever prescribed diuretic-containing combined therapy for arterial hypertension (AH) by means of adding a vitamin-mineral complex. Method: To determine B-group vitamins (thiamine, riboflavin, pyridoxine) in blood plasma by means of high-performance liquid chromatography (HPLC) and, on achieving the target values of arterial pressure (AP), to analyse the patients’ quality of life by means of such neuropsychological tests as the General Health Questionnaire – 36 (GHQ-36) and WAM (wellbeing, activity, mood) questionnaire. Results: The group of patients receiving antihypertensive therapy alone demonstrated a decrease in blood plasma thiamine, riboflavin and pyridoxine from 34.5±4.2 to 25.4±3.2 ng/ml (p<0.05), from 11.3±1.5 to 7.8±1.1 ng/ml (p<0.05) and from 13.4±1.5 to 9.1±1.3 ng ng/ml, respectively. In patients receiving the vitamin-mineral complex additionally to drug therapy of AH, no significant alterations in the content of micronutrients in blood plasma were revealed. We noted more pronounced dynamics in the scores by the GHQ-36 and a more pronounced increase in the patients’ activity by the WAM test, amounting to 28,9 Δ % and 15.51 Δ %, respectively (p<0.05). Conclusion: Supplementing antihypertensive pharmacotherapy with a vitamin-mineral complex makes it possible not only to maintain the level of micronutrients at the level of the physiological requirements but to improve the patients’ quality of life as assessed by neuropsychological scales.

© 2018 by the authors; licensee Modestum Ltd., UK. Objective: Cognitive impairments (CIs) appear to be commonly encountered in patients with arterial hypertension (AH). Hence, our study was aimed at examining the frequency of cognitive impairments (CIs) in the physician’s outpatient practice, as well as at determining clinical and instrumental peculiarities of the course of AH in patients with and without CIs. Method: We carried out comprehensive examination of three hundred and fifty 50-to-80-year-old hypertensive patients followed up in the setting of a polyclinic and tested by means of neuropsychological scales (MMSE, Mini-Cog test, Montreal Cognitive Assessment Scale, Hospital Anxiety and Depression Scale), duplex scanning of extracranial vessels, and magnetic resonance tomography (MRT) of the brain. Results: The findings of neuropsychological testing demonstrated the presence of CIs in 83.5% of hypertensive patients, with CIs reaching the level of dementia in 16.9% and being combined with depressive symptoms in 40.3%. Hypertensive patients with CIs as compared with those without CIs were found to have more pronounced lesions to white matter of the brain: periventricular (71.1%) and/or subcortical (15.8%) leukoaraiosis. Subcortical leukoaraiosis of the frontal lobes of the brain was associated with an elevated level of systolic arterial pressure (SAP). It was confirmed that impaired circadian rhythm of AP with stable persistence of nocturnal hypertension resulted in the most pronounced structural and morphological damage of the brain. Conclusion: High incidence of CIs in hypertensive patients has been confirmed. Structural and morphological impairments of strategically important regions of the brain (subcortical leukoaraiosis of the frontal lobes) in hypertensive patients with CIs were associated with elevated SAP.

© 2018 Izdatel'stvo Meditsina. All rights reserved. The right drug at the right dose administered to a patient in time is the goal which all medical specialists aim at when prescribing medicines to patients. Pregnancy is a condition when the principle of personalized pharmacotherapy is especially relevant. Due to the developing fetus and the occurring changes in the maternal organism, the selection of drug therapy during pregnancy is especially difficult for a clinician. This issue is tightly intertwined with clinical pharmacogenetics since the genetic code of a woman that determines the activity of the liver cytochrome, the fetus-placental barrier, and renal clearance contributes to the peculiarities of the drug metabolism during pregnancy. Additional data provides the opportunities to form therapeutic models and to determine the ways of personifying pharmacotherapy in pregnancy. The purpose of this review is to summarize the available data on the pharmacogenetics of antihypertensive drugs used during pregnancy.

© 2018 Media Sphera Publishing Group. All rights reserved. Pharmacotherapy of resistant arterial hypertension represents a serious problem, because today there are no clear algorithms of action in this clinical situation. The review discusses the key works in which the authors propose a solution to this problem. The variants of a differentiated approach to treatment based on hemodynamic type, plasma renin activity, as well as a number of empirical strategies, including the predominant use of mineralocorticoid receptor antagonists, are discussed.

© 2018 Dynasty Publishing House. All rights reserved. Post-partum depression arises following pregnancy and childbirth, it is a severe disorder threatening the wellbeing of both mother and baby. In the affected families, there is a higher risk of the child's impaired emotional, social and cognitive development. Post-partum depression is one of the most common complications of the postnatal period. The disease prevalence varies from 6.5 to 12.9% and more in countries with low and middle levels of income and life. We analysed 62 Russian and worldwide literature sources published in the PubMed, Google Scholar databases and in Russian medical periodicals over the period 2002-2017 on this theme, we also translated the original Edinburgh Postnatal Depression Scale. This systematic review presents current ideas of the causes of postpartum depressions, methods of treatment and prevention.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article discusses various mechanisms of developmentt and progression of arterial hypertension in young and middle aged adults. It emphasizes the predominant role of hypersympathicotonia in the development of the disease in this category of patients. Various mechanisms are considered, by means of which the increase of activity of the sympathetic nervous system leads to elevation of arterial pressure and potentiates early damage of target organs, first of all, damage of the heart. The data of numerous studies demonstrating pronounced cardioprotective effects of a highly selective representative of the class of β-blockers bisoprolol in young and middle aged hypertensive patients are presented.

© 2018 Media Sphera Publishing Group.All right reserved. Objective. This study aimed to assess the cognitive functions and cerebral blood flow measured with arterial spin labeling (ASL) and their possible correlations with vascular age in untreated middle-aged patients with grade 1-2 essential arterial hypertension (EAH). Methods. We examined 73 subjects aged 40-59 years (33 with EAH and 40 healthy volunteers [controls]). Neuropsychological assessment included Montreal Cognitive Assessment (MoCA), Trail Making test (part A and part B), Stroop Color and Word Test, verbal fluency test (phonemic verbal fluency and semantic verbal fluency), 10-item word list learning task. All subjects underwent brain MRI. MRI protocol included ASL. Vascular age was calculated by two techniques-using Framingham Heart Study risk tables and SCORE project scales. Results. Patients with EAH had lower performance on phonemic verbal fluency test and lower mean MoCA score (29.2±1.4 vs. 28.1±1.7 points) compared to controls (13.4±3.2, p=0.002; 29.2±1.4, p=0.001, respectively). White matter hyperintensities (WMH) were present in 7.5 % controls and in 51.5 % EAH patients (p=0.0002). Cerebral blood flow (CBF) in EAH patients was lower in both right (39.1±5.6 vs. 45.8±3.2 ml/100 g/min) and left frontal lobes of the brain (39.2±6.2 45.2±3.6 ml/100 g/min, respectively) compared to controls (p<0.001). EAH patients without WMH had lower CBF compared to controls (right frontal lobe: 39.5±5.1 ml/100 g/min, p=0.0002; left frontal lobe: 38.9±4.3 ml/100 g/min, p=0.00002). In EAH patients vascular age (57.7±7.4 and 64.6±11.0 years as measured by SCORE project scales and Framingham Heart Study risk tables, respectively) was significantly (p<0.001) greater than chronological one (50.2±6.2 years) and was significantly (p<0.001) higher than the corresponding values in the control group. Correlation analysis revealed negative significant associations between vascular age and MoCA score, phonemic verbal fluency test score and CBF. Conclusions. Treatment-naive middle-aged patients with uncomplicated grade 1-2 EAH compared to normotensive controls have lower mean scores in phonemic fluency test and MoCA, lower CBF, even in the absence of WMH, which correlates with vascular age, particularly with the value calculated by Framingham Heart Study risk tables. Early vascular ageing is important factor of brain impairment in hypertension in middle-aged patients even at early stages of EAH.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article deals with the modern tactics of pulmonary hypertension therapy, used in case of unsatisfactory clinical response to previous therapy. All classes of pathogenetic therapy of pulmonary hypertension are presented, as well as modern views on the risk stratification of annual mortality of patients. Switching to a more effective drug both within one group of pathogenetic PAHtherapy, and to drugs of other classes is discussed. The latest classification of pulmonary hypertension (Nice, 2018) is presented.

© 2018, Springer Science+Business Media, LLC, part of Springer Nature.  We presented the results of our study of chronostructure of BP, HR, electrolyte excretion, and locomotor activity under conditions of “free-run rhythm” (light deprivation). In adult male Wistar-Kyoto (normotensive) and SHR (spontaneously hypertensive) rats, BP, biopotentials of the heart (ECG), and locomotor activity were recorded over 24 h by telemetric monitoring and the rate of excretion of electrolytes (Na + , K + , Ca 2+ , and Mg 2+ ) during the nighttime and daytime hours was measured. It was found that under free-run rhythm, 24-h profiles of BP, HR, excretory function of the kidneys, and locomotor activity underwent more considerable changes in normotensive Wistar-Kyoto rats in comparison with hypertensive SHR rats. However, hypertensive rats demonstrated pronounced changes in rhythmic characteristics of HR, which can restrict adaptation reserves of the cardiovascular system.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Aim. Assessment of the markers levels of endothelial dysfunction (ED): stable metabolites of nitric oxide (NOx), endothelin-1 (E1), homocysteine (HC), von Willebrand factor (vWF) and tissue plasminogen activator (tPA) in blood plasma of smoker and nonsmoker patients with arterial hypertension (AH) of low and moderate risk, not taking antihypertension therapy regularly. Material and methods. Totally, 124 AH patients included, 45 males and 79 females, mean age 51,4±6,5 y. O., mean AH duration 7,9±7,3 y. Controls included 35 healthy volunteers (20 males, 15 females). Concentration of NOx in plasma was measured with spectrophotometry, and of vWF, HC, E1 and tPA-with immune enzyme assay. Results. To evaluate the relation of smoking and ED markers levels, AH patients and controls were selected to subgroups according to smoking status: smoker (35,5%) and non-smoker (64,5%) AH patients; smoker (38%) and non-smoker (62%) controls. In smoker AH patients comparing to non-smoking there were significantly higher concentrations of NOx-48,2±18,8 mcM/L and 40,3±21,2 mcM/L, respectively (p<0,05), E1-1,2±0,16 and 0,6±0,2 fM/L, resp. (p<0,05), HC-25,7±6,04 and 16,2±6,5 mcM/L, resp. (p<0,05), vWF-1,39±0,7 and 1,1±0,6 mg/dL, resp (p<0,05) and tPA-13,05±6,2 and 8,5±6,2 mcM/L, resp. (p<0,05). There was correlation in the AH group, of NOx concentration and smoking (r=0,46, p<0,05), and tobacco smoking duration (r=0,83, p<0,05). Also, there were positive correlations of HC and smoking (r=0,4, p<0,05). In control group smokers had higher HC-20,7±5,3 and 17,2±4,7 mcM/L, resp. (p<0,05), vWF-1,3±0,8 and 0,8±0,6 mg/dL, resp. (p<0,05) and tPA-11,1±6,5 and 6,6±5,2 mcM/L, resp. (p<0,05). There were no significant changes in NOx and E1. Conclusion. In smokers of both AH and control groups the levels of HC, vWF and tPA were significantly higher in comparison with nonsmokers. In smoker AH patients the mean concentrations of NOx and E1 are higher than in non-smoker patients. Levels of ED are related with not only the fact of smoking itself (p<0,05), but smoking duration (p<0,05).

© 2018 by the authors; licensee Modestum Ltd., UK. Objective: Arterial hypertension (AH) is one of the most common and socially significant diseases worldwide. Despite years of experience gained in studying hypertension, the problems concerning selection of antihypertensive therapy with pleiotropic organ-protecting effects are still of current importance. The purpose of the study was to assess therapeutic efficacy and pleiotropic organ-protective capability of third-generation calcium antagonist lercanidipine in patients with stage 2-3 hypertension. Method: Our study enrolled a total of ninety-two 31-to-84-year-old patients. Of these, 72 patients diagnosed as having stage 2 or 3 AH composed the Study Group and 20 apparently healthy subjects were included into the Control Group. At baseline and after 6 months, all patients of the Study Group underwent examinations consisting in measuring biochemical parameters [total cholesterol (TCH), triglycerides (TG), low-density lipoprotein cholesterol (LDL CH), uric acid, urea, creatinine, glucose], 24-hour ambulatory BP monitoring, echocardiography (EchoCG) in order to assess the dimensions and volume of the cardiac chambers, thickness of the left ventricular posterior wall (LVPW) and left-ventricular myocardium mass index (LVMMI), studying microalbuminuria (MAU), a known marker of endothelial dysfunction and early renal lesion; assessing the state of the vascular wall by the ankle-brachial index (ABI) and pulse pressure (PP). Antihypertensive therapy consisted in lercanidipine alone taken at a dose of 10-20 mg/day, failure to thereby achieve the target BP level was followed by additionally prescribing an angiotensin converting enzyme (ACE) inhibitor, enalapril, given at a dose of 5-20 mg twice daily. Results: All patients by the end of the study achieved the target level of AP (p<0.05), also demonstrating significantly improved (p<0.01) parameters of endothelial dysfunction and an early marker of renal damage (MAU), indices of elastic properties of the vascular wall ABI (p<0.05) and PP (p=0.01). Significantly positive dynamics was observed for the following parameters: decreased creatinine concentration (p<0.001), increased GFR (p<0.001), decreased levels of TCH (p<0.01) and LDL CH (p<0.001). Conclusion: Lercanidipine therapy of patients with stage 2-3 AH proved highly efficient, well tolerated, metabolically neutral with pleiotropic organ-protecting properties in the form of improved condition of the vascular wall, correction of endothelial dysfunction, nephroprotective action.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Vitamin D deficiency is widespread worldwide and present in about 30-50% of population. In most cases, this problem is associated with musculoskeletal system pathology: Rickets in children, and osteomalacia or osteoporosis in adults. However, in recent years, convincing data was obtained on the links between Vitamin D deficiency and cardiovascular pathology. Low Vitamin D levels in humans are associated with the unfavorable cardiovascular risk factors, such as arterial hypertension (AH), diabetes mellitus, and dyslipidemia, which are the predictors of the severe cardiovascular diseases, including strokes and infarctions. It has been demonstrated that Vitamin D has a strong vasoptotective effect via endothelial dysfunction improvement, prevents blood vessels and myocardium remodeling, improves blood pressure parameters, reduces the risk of development of left ventricular hypertrophy, slows down fibrosis, reduces the risk of atherosclerosis, reduces insulin resistance, and also affects inflammation and immunity. This article provides data of Russian and foreign studies demonstrating the effect of Vitamin D deficiency on the development of atherosclerosis, AH, heart rhythm disorder and progression of chronic heart failure.

© 2018 Media Sphera Publishing Group. All rights reserved. At present, compelling evidence has been obtained that combined therapy of pulmonary arterial hypertension (PAH) with specific drugs can significantly slow progression of PAH. Therefore, in current guidelines combination therapy is already considered as standard treatment for a significant proportion of patients with moderately severe and severe forms of PAH. However, the quality of life and long-term prognosis of patients receiving combination therapy, should be the object of further research. The future research is absolutely necessary to identify the most optimal strategy of treatment of patients with PAH, such as initial combination therapy or rapid sequential combination therapy, double or triple combinations as well as exploring new signaling pathways PAH, which can become targets for new specific drugs PAH.