[Antihypertensive treatment compliance and obstacles to its improvement. Results of Russian program ARGUS-2].

AIM: To study barriers made by the patients for adequate treatment of arterial hypertension. MATERIAL AND METHODS: The ARGUS-2 trial was made in 15 centers of 13 cities of Russia. Anonymous questionnaire survey covered 1298 patients (796 outpatients and 502 inpatients). The patients answered the following questions: 1) what are basic problems of life with hypertension; 2) compliance with intake of antihypertensive drugs; 3) causes of missed intakes of the drugs; 4) opposition to intake of drugs by the patients. Questioning procedure was preset by the trial protocol. RESULTS: Only 37.4% (38.9% outpatients, 34.6% inpatients) were the treatment adopters. Drug intake was missed most frequently because offorgetting. The problems of life with hypertension were differently interpreted by patients and physicians: for the latter main problems were financial and routine while AH complications were on the 6-7 place. The latter were of primary importance for the patients while financial problems took place 4-6 Barriers to regular intake for the patients were poor self-control and unawareness about side effects of the drugs. CONCLUSION: Complience of the patient can be improved only by complex approach: improvement of education, higher motivation, active involvement of patients into the treatment process, better contacts between the physician and the patient.

[Alcohol-induced arterial hypertension and genetic polymorphism of alcohol-metabolizing enzymes].

AIM: To study arterial pressure (AP) and heart rate (HR) in patients suffering from alcohol withdrawal syndrome (AWS) with relation to genetic polymorphism of alcohol dehydrogenase-2 (ADG2) and aldehyde dehydrogenase-2 (AlDG2). MATERIAL AND METHODS: AP and HR were analysed for 36 alcoholics (83 hospitalizations, including repeated ones) with genotypes ADG2 and AIDG2 at admission to and discharge from narcological hospital. RESULTS: ADG2 genotypes distribution was the following: ADG2-1/1--61.1% (n = 22); ADG2-1/2--36.1% (n = 13); ADG2-2/2--2.8% 9n = 1). All the patients had a genotype AIDG2-1/1. A hypertensive reaction occurred in 75.9% inpatients with AWS. At admission, patients with genotype ADG2-1/1 had significantly higher systolic AP and HR vs those with allele ADG2-2: 146.6 +/- 17.0 mmHg against 141.2 +/- 14.9 mmHg, 95.6 +/- 13.9 b/min vs 88.5 +/- 12.2 b/min, respectively. In homozygous genotype ADG2-1/1 AP and HR were higher than in heterozygotes: SAP 152.3 +/- 12.9 mm Hg vs 145.2 +/- 16.2 mm Hg, pulse pressure 57.2 +/- 11.9 vs 50.0 +/- 15.1 mm Hg, HR 96.8 +/- 13.4 b/min vs 87.7 +/- 12.0 b/min. The groups had similar mean diastolic pressure. At discharge, AWS standard therapy resulted in a significant lowering of AP and HR in the study group. Mean values of the parameters in groups with different genotypes did not differe at discharge. CONCLUSION: Population of alcoholics from the Moscow Region had allele polymorphism ADG2. Genetic polymorphism AlDG2 is not typical for this group. Hypertensive reaction was registered in the majority of alcoholics in AWS. Higher systolic, pulse pressure and heart rate were significantly higher in the AWS group with genotype ADG2-1/1. Controlled alcohol withdrawal entails a significant reduction of AP and HR.

[Clinical and demographic characteristics of various types of arterial hypertension in elderly patients (based on results of Russian scientific-practical program ARGUS]. / Kliniko-demograficheskie kharacteristiki razlichnykh variantov arterial'noi gipertonii u pozhilykh patsientov (po rezul'tatam Rossiiskoi nauchno-prakticheskoi programmy ARGUS).

AIM: It is the fragment of the trial aimed at the study of demographic indices and components of cardiovascular risk in patients over 55 with known and newly diagnosed arterial hypertension (AH) by referral to outpatient clinic depending on AH type. MATERIAL AND METHODS: For a week, 140 therapists from 14 regions of the Russian Federation measured AP in all persons aged 55 and older visiting outpatient clinics. A total of 5582 persons were examined. 3847 of them were already diagnosed to have hypertension. Primary diagnosis of hypertension was made in 5.7 examinees out of 2442. RESULTS: Patients with previous diagnosis of hypertension vs those with primary diagnosis had significantly greater index of body mass, had more often overweight, obesity and diabetes mellitus. Isolated systolic AH was encountered in 56% of all the primary cases. High and very high risk to develop cardiovascular complications was encountered in 59.9% of primary patients and 85.8% of those previously diagnosed. CONCLUSION: Patients aged 55 and older with newly diagnosed isolated systolic AH had the following most common factors of risk of cardiovascular complications: overweight, obesity, smoking, dyslipidemia, diabetes mellitus. In treated patients these risk factors are: overweight, obesity, dyslipidemia, diabetes mellitus, smoking.

[Polymorphism of vascular angiotensin II receptor gene and cardiovascular disorders]. / Polimorfizm gena sosudistogo retseptora angiotenzina II i serdechno-sosudistye zabolevaniia.

AIM: To study polymorphism of the gene of vascular angiotensin II receptor. MATERIALS AND METHODS: Polymorphism that consists in variability of adenine (A) and cytosine (C) residues at position 1166 of the gene for vascular angiotensin II receptor (AT1R) was analyzed in a Moscow population (n = 98) and three groups of affected patients with myocardial infarction (n = 32, MI), left ventricular hypertrophy (LVH, n = 38) and essential hypertension (EH, n = 178). Polymorphic region of the AT1R gene was amplified using the polymerase chain reaction (PCR) and genomic DNAs from human whole blood as template. PCR products were electrophoresied in a gel after digestion with BstDEI restriction nuclease. Significance of differences in distribution of both allele and genotype frequencies at the population sample and in affected patients were estimated via exact Fisher's test. RESULTS: A significant decrease in the frequency of the A genotype was detected in all the three affected groups compared to healthy controls. Besides, the frequency of the A allele was significantly decreased in EH group with a corresponding increase in the frequency of both the AC genotype and the C allele. CONCLUSION: The A1166C polymorphism of the AT1R gene is associated with EH, MI and LVH in a Moscow population. The association is stronger with EH. The A allele and the AA genotype protect against development of disorders at early onset while the other genotypes and the C-allele are risk factors. A protective role of the AA genotype is more significant than predisposition action of the CC homozygote.

[Changes in blood pressure 24 hour monitoring data and quality of life in patients with systolic hypertension treated with arifon]. / Dinamika pokazatelei sutochnogo monitorirovaniia arterial'nogo davlenia i kachestva zhizni u bol'nykh sistolicheskoi gipertoniei pri monoterapii arifonom.

AIM: The study of quality of life and 24-h monitoring blood pressure data in elderly patients with isolated systolic hypertension (SH) on arifon monotherapy. MATERIALS AND METHODS: 22 patients over 65 (mean age 69.8 +/- 1.3 years) suffering from SH entered the open trial. 24-h monitoring of blood pressure was performed at least 2 weeks after discontinuation of the previous antihypertensive treatment and after 4 weeks of arifon monotherapy (2.5 mg once a day). Quality of life was evaluated according to the standard SIP questionnaire. RESULTS: Arifon 4-week treatment resulted in a significant fall of systolic pressure for 24 hours, day and night (by 16.2, 13.7 and 17.4%, respectively; p < 0.001). Variability of blood pressure did not change much. 24-h index for systolic and diastolic blood pressure increased 2-fold and by 46%, respectively. Moreover, the rate of the systolic pressure growth in the morning hours decreased by 36.7% (p < 0.05). Psychosomatic status by SIP questionnaire changed for the best. CONCLUSION: Arifon is an effective treatment of SH and improves quality of life.

[Change of circadian pattern of arterial pressure in patients with congestive heart failure treated with perindopril, an inhibitor of angiotensin-converting enzyme (ACE)]. / Izmenenie sutochnogo profilia arterial'nogo davleniia u bol'nykh s zastoinoi serdechnoi nedostatochost'iu pri terapii ingibitorom angiotenzinprevrashchaiushchego fermenta perindoprilom.

The 24-h profile of blood pressure (BP) was studied in 28 patients (21 males and 7 females) with congenital heart failure (CHF) of NYHA class II-III (ejection fraction < 45%). The patients were 46 to 76 years of age and had postinfarction cardiosclerosis. They had not received ACE inhibitors before. Two groups were formed basing on the presence of hypertension. Perindopril was administered in a single daily dose of 2 mg or higher if demanded to reduce symptoms of CHF and/or to normalize BP. The treatment continued for 3 months. The 24-h BP profile was assessed using portable device SpaceLabs 90207 (USA). In CHF patients with hypertension perindopril significantly lowered mean 24-h, day and night BP and its loads, reestablished two-phase circadian rhythm of AP and corrected BP variability. In CHF patients free of hypertension significant changes of the profile were not registered. It is evident that unwanted changes in the BP 24-h profile due to perindopril were absent in CHF normotensives.