[Creation of registers as one of the mechanisms for improving medical care for patients with chronic heart failure. Problem state].

The annual mortality of patients with clinically pronounced symptoms of chronic heart failure in the Russian Federation reaches 26-29%, i.e., from 880 to 986 thousand patients with heart failure die in the country in one year, which is comparable to the population of a large city. Providing care for patients with heart failure places a heavy burden on the country's health care system, making a significant contribution to mortality rates, hospitalization rates, including readmissions, which in turn requires considerable costs. The article presents an overview of registry studies that are devoted to assessing the effectiveness of diagnostics, the completeness of examinations, as well as the adequacy of ongoing drug treatment.

[Clinical characteristics and quality assessment of the treatment of patients with chronic heart failure with diabetes mellitus].

AIM: A study of the clinical and instrumental characteristics and quality of treatment of patients with chronic heart failure (CHF) with diabetes mellitus. MATERIALS AND METHODS: The study was conducted by using the CHF register method, which is a computer program with remote access, which allows on-line data collection on patients who have been examined and treated in primary care and in hospitals. The study included 8272 patients with CHF IIIV FC (functional class) (New York Heart Association NYHA); among them 62% of patients were treated in hospital. RESULTS: The study showed that the frequency of diabetes was 21%. The main causes of CHF in diabetic patients are coronary artery disease, myocardial infarction (in anamnesis) and hypertension. These patients are more often diagnosed with III and IV CHF FC according to (NYHA) and retained LV (left ventricular) ejection fraction. The reduced ejection fraction was observed in 6.8% of cases, and the frequency of the intermediate LV was significantly higher than among patients with CHF and with diabetes and accounted for 18.9%. At patients with CHF with diabetes in comparison with patients with CHF without diabetes, atherosclerosis of the peripheral arteries, stroke (in anamnesis) and chronic kidney disease of stage III and IV were significantly more common. CONCLUSION: Under the treatment, patients with CHF with diabetes have higher levels of SBP (systolic blood pressure), lipids and glucose in the blood plasma, indicating a lack of quality of treatment and, accordingly, the doctors are not optimally performing the clinical guidelines on treating this category of patients.

Arterial hypertension and chronic obstructive pulmonary disease: clinical characteristics and treatment efficasy (according to the national register of arterial hypertension).

AIM: The objective of the research is studying of demographic and clinical profile as well as treatment effectiveness of patients with AH and COPD based on National Register of Arterial Hypertension. MATERIALS AND METHODS: Among the analyzed selection, consisted of 32 571 patients with AH, who were followed up in the primary medical care, at the average age of 64±7 years old (there were 64% women of them), 5.4% patients with AH had COPD. The analysis of cardiovascular and cerebrovascular diseases frequency as well as treatment effectiveness was made. RESULTS: According to National Register of Arterial Hypertension, cardiovascular [coronary heart disease, Q myocardial infarction, chronic heart failure (CHF), peripheral artery atherosclerosis] and cerebrovascular (stroke/transitory ischemic attack) diseases are accurately more often diagnosed at patients with AH and COPD. CONCLUSION: Male sex and age are the strongest independent factor, contributing into the risk of development of cardiovascular diseases at these patients. COPD considerably increases the risk of CHF development. The conducted analysis has shown that treatment, prescribed to patients with AH and COPD meets modern recommendations.

Features of the clinics and treatment of patients with obesity and hypertension (according to the National register of arterial hypertension).

AIM: The purpose of this study lied in the examination of the clinical characteristics and assessment of the quality of treatment for patients with arterial hypertension (AH) with obesity according to the National Registry of the AH. MATERIALS AND METHODS: The frequency of obesity in a sample of patients with AH, observed in 2010-2016. in polyclinics and cardiological dispensaries for cardiovascular diseases (CVD), was 38.3%, of which the incidence of severe obesity (grade III) was 8%. Women account for the majority of obese AH patients (72%). RESULTS: The study revealed the burden of AH patients with obesity in the following risk factors for CVD: dyslipidemia, hyperglycemia and a history of early cardiovascular disease. Relatively often in patients with hypertension with obesity, there were lesions of target organs (hypertrophy of the left ventricle, chronic kidney disease of the third stage), CVD [ischemic heart disease (CHD), chronic heart failure (CHF) II-IV functional class NYHA] and diabetes mellitus type 2 These data indicate that patients with AH obesity refers to a high and very high cardiovascular risk. CONCLUSION: Conducted antihypertensive and hypolipidemic therapy (statins) in patients with AH obesity was not optimal, only 30% of patients achieved the target level of BP and 23.6% - the target level of total cholesterol.

[The First Results of the Russian Register of Chronic Heart Failure].

We present in this paper first results of the Russian registry of chronic heart failure (CHF) as well as comparative analysis of available registries and a number of randomized controlled trials and meta-analyses on CHF.

[Creation of a Russian Federation's register for assessing the physician adherence to the guidelines for the diagnosis and treatment of chronic heart failure].

The paper reviews existing chronic heart failure (CHF) registers, a number of randomized trials, and meta-analyses on CHF. It provides a rationale for the need to create a CHF register in the Russian Federation, which will be able to assess the physician adherence to the guidelines for the guidelines for and the quality of medical care.

[Painless myocardial ischemia in patient with extensive constrictive atherosclerosis of coronary arteries].

We describe in this article a clinical case of a patient with arterial hypertension, painless myocardial ischemia and extensive constrictive atherosclerosis of coronary arteries. Coronary heart disease (painless ischemia) was suspected basing on results of transesophageal electrostimulation coupled with stress echocardiography and was confirmed by coronary angiography. This description is followed by discussion of possibilities of different instrumental methods in diagnostics of painless ischemia, classification of painless ischemia, treatment, and prognosis.

[Indices of static and dynamic components of pressure load (assessed by 24-hour blood pressure monitoring) and the state of renal function in patients with essential hypertension].

Aim of this study was to evaluate possible relationship between parameters of blood pressure (BP) profile and glomerular filtration rate in patients (pts) with I-II stage essential hypertension (EH). Material and methods. We studied 120 pts (97 men), aged 23-65 (50,2+/-0,6) years with I (n=98) and II (n=22) stage EH. In BP profile (SL-90207) we calculated 24-hour, daytime, nighttime values of systolic, diastolic, pulse pressures (SBP, DBP, PP), time load (TL), variability and nocturnal fall (NF) of BP. The state of renal function was assessed by measurement of glomerular filtration rate (GFR) calculated by the Cockcroft formula. Results. After nonlinear statistical analysis by Gauss-Newton all patients were divided into three groups according to GFR tertiles. Significant differences were found between these groups by 24-hour, nighttime and daytime values of SBP and DBP. Values of SBP were the lowest in group II. In group II lowest values of PP were also observed, but statistically significant differences were found only in nocturnal PP values between groups II and III. There were no significant differences between groups by TL and NF of BP. In group Ill (high GFR) variability of daytime values of SBP and DBF were significantly higher. Univariate correlation analysis showed statistically significant negative relationship between GFR and nocturnal PP in patients with lowest level of GFR. Positive correlations between nocturnal values of PP and GFR in groups II and III were also observed. Conclusion. These results indicated the presence of strong relationship between high values of nocturnal PP and decreasing of glomerular filtration rate in patients with EH and thus confirmed significance of "constant" and "dynamic" components of pressure load as a marker of impairment of renal function.

[Effect of sex on informative power of various electrocardiographical criteria of left ventricular hypertrophy in patients with excessive body mass].

Aim of the study was to analyze dependence of various voltage parameters of QRS complex on increase of left ventricular myocardial mass (LVMM) in samples of men and women with excessive body mass or obesity. We included data from 223 patients with excessive body mass and diagnosis of stage I - II arterial hypertension. ECG was registered in 12 standard leads. Left ventricular hypertrophy (LVH) was certified if according to echoCG data LVMM exceeded 125 g/m2 in men and 110 g/m2 in women. Depending on sex and presence of LVH all patients were divided into 4 groups: M1 (men with LVH, n=74), M2 (men without LVH, n=74), W1 (women with LVH, n=55), anb W2 (women without LVH, n=20). We analyzed amplitudes of all waves of the QRS complex as well as Sokolow-Lyons voltage parameters and the Cornell index. The following intergroup differences were most significant: between groups M1 and M2 - in amplitudes of S waves in chest leads V3, V4; between groups W1 and W2 - in amplitudes of R-waves in limb leads I and aVL, and amplitudes of S-waves in lead III. Increases of the Cornell voltage index were observed both in men and women with LVH. The following criteria had greatest sensitivity at 95% specificity: in men - SV4 > 1,1 mV (34%) and RaVL+SV3 > 2,3 mV (32%); in women - RaVL > 0,8 mV (56%) and RI+SIII > 1,5 mV (56%). Informative power of electrocardiographical diagnosis of LVH can be augmented by the use of different voltage criteria in groups of men and women. In men most informative are chest leads (SV1 - V3, RaVL) while in women - limb leads (RI, RaVL, and SIII). The use of combination parameters RaVL+SV3 > 2,3 mV (in men) and RI+SIII > 1,5 mV (in women) allows to augment sensitivity with unchanged specificity. In patients with excessive body mass voltage the Sokolow-Lyons criterion is not informative. Most significant component of the Cornell voltage criterion in groups of men with excessive body mass is amplitude of SV3, in groups of women - amplitude of RaVL.

[Effects of garlic allicor tablets on lipid metabolism and risk of fatal cardiovascular complications in patients with atherogenic dyslipoproteinemia].

The aim of investigation was to assess an effect of allicor at a lipid metabolism and a free radical oxidation of blood lipids, anthropometic values, and arterial blood pressure at patients with atherogenic dislipoproteidemy. 112 patients (47 men and 65 women) 40 to 60 years of age were examined. 56 patients had ischemic heart disease and/or equal disorders. Another 56 patients were free of any signs of atherosclerosis, but had one or more risk factor of cardiovascular pathology. Six month therapy using allicor results in moderate hypolipidemic and antioxidative effect. A dosage of 600 mg per day decreases individual ten-year chance of fatal cardiovascular complications at patients with clinical signs of atherosclerosis, whereas at patients who have no signs of atherosclerosis the complications are decreased with dosage of 300 mg per day.

[The problem of indexation of left ventricular myocardial mass by body size in obese patients].

AIM: To assess efficacy of different ECG-criteria of left ventricular myocardial hypertrophy (LVH) in hypertensive patients as regards body mass (obesity). MATERIAL AND METHOD: Data on 100 patients (42 males and 58 females, age 19-79 years) with diagnosis of hypertension of the first-second degree were analysed. ECG was registered in 12 leads. LVH was determined by ECG by the following criteria: Sokolov-Lion (S-L): Sv1+Rv5(v6) > 35 mm; Cornell voltage (Crn-V): R avL+Sv3 > 28 mm (> 20 mm for women); Cornell product (Crn-P). According to the body mass the patients were divided into 3 groups: with normal weight, overweight and obesity. Crn = P criterion was most sensitive in all the three groups. RESULTS: In the groups sensitivity of ECG criteria depends on several factors: on the method of indexation and on the gender and body mass index. CONCLUSION: Informative value of ECG criteria of LVH depends on the method of indexation and on the amount of the excessive body mass.

[Electrocardiographic diagnosis of hypertrophy of the left ventricular myocardium in patients with arterial hypertension and overweight].

AIM: To study efficacy of different ECG criteria of hypertrophy of left ventricular myocardium (LVH) in hypertensive patients with reference to overweight and obesity. MATERIAL AND METHODS: The authors analyse data on 100 patients (42 males and 58 females) aged 19-79 with diagnosis of arterial hypertension stage I-II. ECG was conducted in 12 leads. LVH by ECG was determined according to the following criteria: Sokolov-Lyon (S-L): Sv1+Rv5(v6) > 35 mm; Cornell voltage (Crn V): R avL +Sv3 > 28 mm (> 20 mm for females; Cornell product (Crn P): (RavL+Sv3)xQRSduration > 2440 mm x ms (for females RavL+Sv3 amplitudes + 0.6 mm). To verify L VH by echoCG, the authors used threshold values of left ventricular myocardium mass index (LVMMI) 125 g/m(2) for males and 110 g/m(2) for females. LVMMI was calculated by two methods: LVMM to body surface area (BSA) 2) LVMM to BSA of an ideal figure of a relevant height. Depending on the BMI all the patients were divided into 3 groups: with normal weight (BMI under 25 kg/m2), with overweight (BMI between 25 and 30 kg/m(2)), with obesity (BMI over 30 kg/m(2)). RESULTS: Sensitivity of the criterion Crn-P was the highest. The S-L criterion had the least sensitivity (under 10%) in groups with overweight by more than 25 kg/m(2). In these groups sensitivity of all ECG criteria of L VH depends on some factors: on indexation of LVH by body size, gender and overweight. S-L criterion sensitivity is higher in subgroups of males irrespective of overweight and obesity. CONCLUSION: Informative value of LVH ECG criteria depends on the method of LVMM indexation by body size, overweight and gender of the patients.

[New approaches to diagnosis of left ventricular hypertrophy by dipolar electrocardiography].

AIM: To show possibilities of dipolar electrocardiography (DECG) in diagnosis of left ventricular hypertrophy (LVH). MATERIAL AND METHODS: We made DECG in 151 healthy subjects and 158 hypertensive patients. To characterize DECG quantitatively, we used the integral activation duration index (IADI) calculated as a weighted sum of the areas with different duration of activation, module of the maximal vector QRS, QRSxIADI (IADIM). RESULTS: In patients with left ventricular myocardial mass index (LVMMI) under 150 g/m2, sensitivity of DECG was 38-49%, in the index over 150 g/m2 sensitivity reached 38-75%, specificity 89-98% compared to healthy examinees and 72-82% compared to hypertensive patients without LVH. The IADIM parameter correlates directly (moderate correlation) with duration of QRS complex and LVMMI. CONCLUSION: Possibilities of using parameters IADI and IADIM for assessment of electrophysiological myocardial remodeling and their correlation with other methods need further investigations.

[Methodological approaches to estimation of morning urge of arterial pressure in essential hypertensives]. / Metodicheskie podkhody k otsenke utrennego po"ema arterial'nogo davleniia u bol'nykh gipertonicheskoi bolezn'iu.

AIM: To estimate the time intervals of a morning arterial pressure urge (MAPU) and MAPU characteristics in patients with essential hypertension (EH). MATERIAL AND METHODS: The study enrolled 70 patients (50 male and 20 female) with EH of the first (n = 41) and second (n = 20) degrees aged 34-65 years (mean age 50.4 +/- 0.9 years). The control group consisted of 9 healthy men. Morning dynamics of arterial pressure (AP) and heart rate (HR) was studied basing on the data of 24-h AP monitoring (Spacelabs-90207, USA). RESULTS: Dynamics of AP from nocturnal to diurnal patterns in both hypertensive and normotensive subjects falls into 3 phases: a premorning urge (from 4-5 a.m. to waking up) with a characteristic slow rise in AP and HR; a morning urge (from waking up for 4-5 hours) with a characteristic forced AP and HR rise); a diurnal urge (from 11 a.m. to 13-14 p.m.) with characteristic slowing down of AP and HR rise. Patients with EH of the first and second degree vs normotensive subjects had unfavourable changes in morning dynamics of AP and HR: a significant progressive growth of maximal systolic and diastolic pressure proportional to mean circadian AP levels; a rise of morning hours index of AP which characterizes amplitude-speed features of AP and HR. CONCLUSION: To characterize MAPU most completely it is recommended to estimate the following parameters: wave index (to assess AP conversion from one level to another), mean rate of AP change per hour (to prevent influence of random factors on the rate of MAPU); relative maximal values of AP (to estimate maximal AP values in morning hours and nocturnal mean AP).

[Morning rise of systolic blood pressure (by 24-hour ambulatory monitoring) and platelet aggregability in essential hypertension patients]. / Utrennii pod''em arterial'nogo davleniia (po dannym sutochnogo monitorirovaniia) i aggregatsiia trombotsitov u bol'nykh gipertonicheskoi bolezn'iu.

AIM: To investigate the relationship between platelet aggregability (PA) and parameters of blood pressure (BP) in patients with essential hypertension (EH). MATERIALS AND METHODS: We analyzed 24-h BP recordings (SL-90207, 15-min day and 30 min night time intervals) of 47 hospitalized males with mild to moderate EH (mean age 48 +/- 1 years) to assess the following parameters: mean 24-h, awake (Aw) and nighttime (N) systolic (S) and diastolic (D) BP. We assessed the morning rise (MR) of BP using the new index: a relative morning rise of systolic BP-RMRSBP--(max value of SBP from 6 am to 12 am/mean asleep SBP) x 100%. The kinetics of mean aggregate size (MAS) changes was studied with aggregation analyzer model (230LA Biola Ltd., Russia). The following parameters were used for estimation of platelet aggregability: a relative increase in MAS 2 min after beginning of sample stirring--for spontaneous aggregation (SPA) and the maximum increase in the light transmission for 0.5 microM ADP-induced aggregation (ADPI-PA). The patients were divided into two groups according to the median value of RMRSBP: group 1 (n = 25, RMRSBP < 121%) and group 2 (n = 22, RMRSBP > 121%). The differences in estimated parameters were tested by Student two tailed t-tests and presented by M +/- SE. P < 0.05 was considered statistically significant. RESULTS: No significant differences have been found between the groups by mean age, body mass index, duration of arterial hypertension, mean 24-h, awake DBP and SBP. Statistically significant differences have been found between groups by SPA, ADPI-PA, night SBP, night DBP, RMRSBP, RMRDBP. In group 2 there was a correlation between RMRSBP and SPA, but not in group 1. CONCLUSIONS: The morning rise of systolic BP is associated with an increase of ADP-induced and spontaneous platelet aggregability in the patients with mild to moderate essential hypertension and apparently that association is more pronounced at high values of morning BP (more than 20% from mean nocturnal values of SBP).