Subject(s)
Amlodipine/administration & dosage , Blood Pressure/drug effects , Heart Rate/drug effects , Hypertension/drug therapy , Perindopril/administration & dosage , Adult , Aged , Aged, 80 and over , Ambulatory Care/statistics & numerical data , Blood Pressure Determination/standards , Dose-Response Relationship, Drug , Drug Combinations , Female , Humans , Hypertension/physiopathology , Male , Middle Aged , Russia , Young AdultSubject(s)
Amlodipine , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure/drug effects , Hypertension , Perindopril , Adult , Aged , Aged, 80 and over , Amlodipine/administration & dosage , Amlodipine/adverse effects , Antihypertensive Agents/administration & dosage , Antihypertensive Agents/adverse effects , Drug Combinations , Female , Humans , Hypertension/diagnosis , Hypertension/drug therapy , Male , Middle Aged , Perindopril/administration & dosage , Perindopril/adverse effects , Program Development , Treatment OutcomeABSTRACT
OBJECTIVE: To study the problems of physician-patient cooperation, patient- and physician related barrieres to target blood pressure (BP) achievement and to demonstrate improvement of BP control with indapamide SR 1.5 mg, when given to patients remaining uncontrolled while receiving antihypertensive therapy without thiazide diuretics (TD). METHODS: The trial Improvement of Arterial Hypertension Control in High-Risk Hypertensive Patients (ARGUS-2) run in 15 Russian centres during the year 2006. Retrospective analysis of medical notes of 684 outpatients and 575 inpatients with arterial hypertension. Validated questionnaires were used for interview of 373 physicians and 1298 patients. The study of Arifon retard efficacy was carried out in 1438 outpatients with difficult-to-control hypertension. RESULTS: BP was above the goal level in 97.1% pts at the first analyzed visit to an outpatient department. Antihypertensive therapy was unchanged in 20.5% cases, the drug dose was increased in 46,6%, additional medication was administered in 36,8%. In 30.8% pts antihypertensive agent was substituted by another class drug. At the last analyzed visit target BP was found in 24.4% pts. BP control was poorer in pts with BP goal <130/80 mmHg (20.1%) than in those with higher target BP (25.9%). Achievement of BP goal was associated with combination therapy, higher rate of TD administration and with more frequent visits to physician. During hospitalization target BP <140/<90 mmHg was achieved in 87.1%,<130/<80 mmHg in. 76.2%. Arifon retard administration resulted in target BO achievement in 84.5% patients. Physicians percept low adherence to antihypertensive treatment, lack of patients knowledge about risk related to arterial hypertension, economical problems as main barriers to improvement of arterial hypertension management. Patients considered economical problems related to antihypertensive treatment more much less important than physicians did. CONCLUSION: The study results suggest the importance of therapeutic inertia overcome to improve arterial hypertension management in Russia. Low rate of multiple combination therapy and TD prescription are important features of therapeutic inertia. Polar perception of problems related to arterial hypertension by physicians and patients should be considered as influencing factors for educational programs development.
Subject(s)
Antihypertensive Agents/therapeutic use , Diuretics/therapeutic use , Hypertension/drug therapy , Indapamide/therapeutic use , Physician-Patient Relations , Adult , Aged , Antihypertensive Agents/administration & dosage , Data Interpretation, Statistical , Delayed-Action Preparations , Diuretics/administration & dosage , Drug Therapy, Combination , Education , Female , Humans , Indapamide/administration & dosage , Interviews as Topic , Male , Middle Aged , Patient Compliance , Retrospective Studies , Risk Factors , Russia , Surveys and Questionnaires , Treatment OutcomeABSTRACT
The physicochemical conditions, composition of microbial communities, and the rates of anaerobic processes in the deep sandy horizons used as a repository for liquid radioactive wastes (LRW) at the Siberian Chemical Combine (Seversk, Tomsk oblast), were studied. Formation waters from the observation wells drilled into the production horizons of the radioactive waste disposal site were found to be inhabited by microorganisms of different physiological groups, including aerobic organotrophs, anaerobic fermentative, denitrifying, sulfate-reducing, and methanogenic bacteria. The density of microbial population, as determined by cultural methods, was low and usually did not exceed 10(4) cells/ml. Enrichment cultures of microorganisms producing gases (hydrogen, methane, carbon dioxide, and hydrogen sulfide) and capable of participation in the precipitation of metal sulfides were obtained from the waters of production horizons. The contemporary processes of sulfate reduction and methanogenesis were assayed; the rates of these terminal processes of organic matter destruction were found to be low. The denitrifying bacteria from the underground repository were capable of reducing the nitrates contained in the wastes, provided sources of energy and biogenic elements were available. Biosorption of radionuclides by the biomass of aerobic bacteria isolated from groundwater was demonstrated. The results obtained give us insight into the functional structure of the microbial community inhabiting the waters of repository production horizons. This study indicates that the numbers and activity of microbial cells are low both inside and outside the zone of radioactive waste dispersion, in spite of the long period of waste discharge.
