[Effect of the presence of a drug in the list of supplementary drug provision on compliance to its administration by outpatients with arterial hypertension].

Aim of the study was to investigate relationship between the presence of a drug in the list of supplementary drug provision (SDP) and compliance to its consumption by outpatients with arterial hypertension as well as determination of the place of SDP in a row of other factors affecting compliance to treatment. Methods. Patients (men and women) older than 18 years with initial level of office systolic arterial pressure (AP) 140-179 mm Hg and diastolic AP up to 100 mm Hg who visited regional internist. The study was conducted at the base of 82 Moscow polyclinics with participation of 185 physicians and 5474 patients. In all patients besides general clinical examination with office AP measurement calculation of body mass index and assessment of risk factors and concomitant therapy were carried out. All patients assessed themselves their self feeling with the use of visual-analog scale (VAS). Compliance of patients to antihypertensive therapy was evaluated with the help of the Moriski - Green test. Fact of continuous use of antihypertensive drugs received by patients within framework of the SDP system was necessarily obligatory. For final analysis 4816 ambulatory cards were selected. Results. Portion of patients with low compliance to therapy was greatly than that of patients with high compliance to therapy (61.1 vs. 38.9%, respectively, p=0.00001). Inclusion into analysis of additional factor (presence of CHD) reduced contribution of SDP to compliance to 25%, but it remained as before significant (p<0.0007). However addition to these factors of other parameters such as presence of diabetes mellitus or tonometer at home completely leveled effect of SDP on compliance to therapy (p<0.12). Conclusion. Presence of drugs in the SDP list significantly elevates compliance to therapy. However SDP does not appear the only independent predictor of high compliance. If SDP is considered together with other determining factors (presence of concomitant IHD and diabete, readiness to spend money for tonometer) its role as independent factor of high compliance is diminished and loses significance.

[The efficacy and safety of the combination of ß-blocker bisoprolol and if inhibitor I(f) ivabradine in patients with stable angina and chronic obstructive pulmonary disease].

The study was aimed to assess the efficacy and safety of treating coronary heart disease (CHD) patients complicated with COPD using the combination of tolerable doses of -blocker bisoprolol and inhibitor If-channel ivabradine, compared with bisoprolol alone. A total of 50 patients were included (88% men, mean age 62.8+/-7.2 years) with stable angina and clinical signs of bronchoobstruction (84% with COPD and 16% with bronchial asthma in remission phase). At the study start, all patients received bisoprolol, the dose of which was titrated until the clinical signs of intolerance (most common - bronchoobstruction) appeared or worsened. Average dose of bisoprolol at the time of forced titration stop was 6.3+/-2.2 mg/day, mean heart rate (HR) decreased from 82.1+/-8.4 to 72.2+/-8.5 bpm. Then, the patients were randomized into two groups: patients of the first group (n=25) continued to take bisoprolol in tolerable dose, and patients of the second group were added ivabradine (5-15 mg, mean dose 10.7+/- 3.1 mg/day). In contrast to the bisoprolol alone, combination therapy resulted in further decrease of HR to an average of 62.6+/-4.1 bpm over 6 month of follow-up. This was associated with additional decrease of the number of angina attacks (by 4.68+/-4.40 per week vs. 2.48+/-4.70, <0.05), nitrates consumption (by 206.0+/-153.6 mg/week vs. 95.6+/-134.2 mg/week, <0.01) and score of negative components of quality of life (by 5.16+/-3.3 vs. 2.24+/-4.5, <0.05), compared with the first group, respectively. In combination therapy group there was also the decrease of the inhaled broncholytics consumption (from 2.88+/-3.23 to 1.88+/-2.65 per week, <0.05), that was not evident in the first group. Average number of hospitalizations per 1 patient decreased over 6 months of follow-up, compared to the same period before the trial, in both groups, but more prominently in the combination therapy group (-0.31+/-0.55 vs. -0.56+/-0.76, accordingly, <0.1). Therefore, in the treatment of patients with CHD, stable angina and concomitant bronchoobsrtuctive manifestations, if not possible to administer -blockers in the adequate HR-reducing dose, the addition of ivabradine to the treatment could be the treatment of choice. The combination of tolerable doses of bisoprolol and ivabradine is s afe and allows to achieve adequate HR decrease. This is a ssociated with maximal antianginal effect, decrease in the need for broncholytic therapy, improvement of the quality of life and decrease of the number of hospitalizations, compared with the treatment with bisoprolol alone.

[Optimization of use of beta-adrenoblockers in the treatment of chronic heart failure in the outpatient setting].

AIM: to evaluate of the effectiveness of switching from beta-adrenoblockers (BAB) non-included into the guidelines for the management of chronic heart failure (CHF) to nebivolol and bisoprolol for outpatients. SUBJECTS AND METHODS: The study included 67 patients with stable Functional Classes (FC) II and II CHF who received the standard therapy and BAB non-included into the guidelines for the management of CHF. The patients were randomized to the groups taking bisoprolol (n = 35) or nebivolol (n = 32) in doses of 1.25 to 10 mg/day. Before and 6 months after therapy, the investigators assessed the patient's clinical status and quality of life (QL), performed a six-minute walk test and echography, and determined the blood level of the N-terminal fragment of brain natriuretic peptide prohormone (NT-proBNP). RESULTS: The switching to bisoprolol and nebivolol was followed by a significant clinical improvement, a larger covered distance, and better QL. Left ventricular ejection fraction was increased along with a reduction in mean FC CHF. There were no significant changes in NT-proBNP in the total patient group, but it was significantly decreased in the subgroup of those with the baseline high level of the peptide. CONCLUSION: The switching of patients with stable CHF from therapy with BAB not included into the guidelines for the management of CHF to nebivolol or bisoprolol yields positive results and improves left ventricular systolic function (which is attended by the reduction in NT-proBNP levels) and may be recommended for treatment in the outpatient setting.

[Clinical and vascular effects of ACE inhibitor enalapril in combination with thiaside-like diuretic indapamide in hypertensive outpatients. Results of the multicenter trial POEMA].

AIM: To evaluate efficacy and safety of a 6-month treatment of 237 patients with arterial hypertension (AH) of degree 1-3 with ACE inhibitor enalapril (mean dose 21.9 +/- 9.0 mg/day), 49.4% of which received adjuvant indapamide (2.5 mg/day), to study effects of this therapy on rigidity of the major arteries by dynamics of pulse wave velocity (PWV) and US rigidity index beta (RIB). MATERIAL AND METHODS: The study included only patients with initially elevated PWV which was detected in 266 (53%) of 501 examinees. RESULTS: Lowering of systolic and diastolic blood pressure (BP) was 16.8 and 14.0% to treatment month 3 and, in addition, 1.6 and 1. 7% to month 6, respectively (p < 0.001). Target BP (< or = 140/90 mm Hg) was achieved in 82.7% patients. During the trial 3 (1.2%) patients withdrew because of severe cough. Slowdown of PWV measured by brachiomalleolar (PWVbm) and carotid-femoral (PWVcf) methods was equal in the course of the trial and made up 2.45 and 6.1% to treatment month 3 (p < or = 0.05 for both) and additional 3.25 and 7.4% to month 6 (p < 0.001 for both), respectively. High PWV normalized completely in 42.6% patients. After 6 months of the trial US RIB decreased by 30.5% (p < or = 0.001). The correlation analysis detected a significant correlation between SAP fall and PWV decrease only during the first 3 months of therapy (r = 0.402, p = 0.005). In month 3-6 the correlation became insignificant (r = 0.28, p = 0.055). CONCLUSION: Combination of enalapril and indapamide is effective and safe in outpatients with arterial hypertension of the first-third degree and baseline high rigidity of the vascular wall. This treatment reduces PWV and rigidity of the major arteries associated with BP lowering (in the treatment month 1-3) and a vasoprotective effect of the drugs.

Characterization of B virus glycoprotein antibodies induced by DNA immunization.

Genes encoding glycoproteins gB, gC, gD, gE, and gG of herpes B virus (species Cercopithecine herpesvirus 1) were cloned into mammalian expression vector pcDNA3.1/V5-His. Abilities of the plasmid constructs to express recombinant glycoproteins were confirmed by Western blot analysis of transfected CHO-K1 and COS-7 cells. Antibody production was induced in rabbits by intramuscular injections with the expression constructs at four-weekly intervals. Antibodies to gB were detected after the second DNA inoculation, while it took an additional plasmid injection to induce responses to gC, gD and gE. The gG plasmid failed to stimulate antibody production. Antisera ELISA titers varied greatly depending on the gene, with gB inducing highest (21,000) and gE inducing lowest (60) antibody titer. The induced antibodies were predominantly conformation-dependent. The gB, gC, and gD antisera contained HSV cross-neutralizing antibodies, but only gB antisera contained B virus neutralizing antibodies. The gB antisera cross-reacted with HSV antigens in Western blot, ELISA, dot-blot, plaque immunostaining and immunoprecipitation assays, whereas gD and gC antisera were mostly B virus-specific. Thus, polyclonal antibodies to B virus glycoproteins can be generated by DNA immunization and used as diagnostic and research reagents.

[Long-term ambulatory follow-up of hypertension patients with low renin activity in blood]. / Dlitel'noe ambulatornoe nabliudenie za bol'nymi arterial'noi gipertoniei s nizkoi aktivnost'iu renina v krovi.

AIM: To characterize a clinical course of arterial hypertension in patients with low activity of blood renin. MATERIAL AND METHODS: 44 hypertensive patients with low activity of blood renin participated in the trial. They were divided into three groups consisting of 18, 14 and 12 patients (group 1, 2 and 3 with adrenal adenoma, adrenal hyperplasia and hypertension, respectively). RESULTS: Baseline hypertension was higher in group 1. The clinical picture did not differ much between the groups. Long-term follow-up has revealed that mean arterial pressure tended to lowering in groups 1 and 2 while in group 3 it tended to rise. Incidence of arrhythmia increased thrice though myasthenia became less frequent. CONCLUSION: Group 1 patients had a more severe clinical course of hypertension with high lethality and many associated diseases. To achieve a clinical effect, they had to take higher doses of antihypertensive drugs.

[Characteristics of patients with arterial hypertension in Moscow (as exemplified by a municipal cardiological center)]. / Kharakteristika bol'nykh arterial'noi gipertoniei v Moskve (na primere gorodskogo kardiologicheskogo dispansera).

AIM: To characterize hypertensive patients, residents of Moscow, treated at Moscow Municipal Cardiological Center (MMCC) in 1999. MATERIAL AND METHODS: A total of 1056 case histories of patients with the diagnosis of arterial hypertension or essential hypertension, directed to MMCC in 1999, were analyzed. The files were processed using specially developed standard methods. RESULTS: Patients with stage III essential hypertension aged over 60 years are most often treated at MMCC. Patients with more severe left-ventricular hypertrophy more often have cardiovascular complications. CONCLUSION: High incidence of cardiovascular complications indicates that the treatment of patients in an outpatient setting is poor.

[Treatment of patients with arterial hypertension in Moscow]. / Osobennosti lecheniia bol'nykh arterial'noi gipertoniei v Moskve.

AIM: To analyze treatment for arterial hypertension in Moscow. MATERIAL AND METHODS: 1056 case histories of hypertensive patients referred to Moscow city cardiological hospital in 1999 were analysed. The analysis covered the following issues: frequency of use of antihypertensive drugs depending on the disease stage; adequacy of the doses; changes in the treatment due to the presence of hypertrophy of the left ventricular myocardium, cardiac failure, vascular complications, diabetes mellitus. RESULTS: Treatment of hypertension was not adequate in many patients. Often, inadequate decisions were made on the drugs doses, course regimens, monotherapy. CONCLUSION: Insufficiently effective treatment of arterial hypertension can result in aggravation of the disease and frequent complications.

[Efficacy of moxonidine, an imidazoline receptor agonist, in patients with essential hypertension]. / Opyt primeneniia agonista imidazolinovykh retseptorov moksonidina u bol'nykh gipertonicheskoi bolezn'iu (sobstvennoe nabliudenie).

AIM: Study of zint (moxonidine), a hypotensive drug with the central mechanism of action. MATERIALS AND METHODS: The hemodynamics and platelet functional activity were assessed in 30 patients with essential hypertension treated by zint in a daily dose of 0.4 mg, taken in the morning, for 3 months. RESULTS: By the end of treatment the systolic arterial pressure decreased by 23 +/- 4 mm Hg, diastolic by 15 +/- mm Hg, mean pressure by 17 +/- 2 mm Hg, and heart rate by 5 +/- 4 str/min. Echography showed that myocardial hypertrophy decreased but negligibly. An evident decrease of ADP-induced platelet aggregation was observed. CONCLUSION: Zint therapy may be a most physiological method of arterial hypertension control.

[Immunologic indicators in vaccinated mice with Machupo virus infection]. / Immunologicheskie pokazateli u vaktsinirovannykh myshei pri myshei pri zarazhenii virusom Machupo.

The parameters of nonspecific immunity (interferon, interleukin-1, tumor necrosis factor, and natural killers) changed in immune BALB/c mice after challenge with Machupo virus in doses of 1000 and 5000 PFU. After challenge with 1000 PFU the activity of the above parameters increased during the first three days and no cases of animal death occurred. After challenge with 5000 PFU the maximal values of interferon, interleukin-1, tumor necrosis factor, and natural killers were observed on days 5-7, the animals dying at the height of these values. Hence, the formation of specific humoral and cell-mediated immune response in BALB/c mice immunized with inactivated Machupo virus does not protect the animals from infection with the homologous virus in a dose of 5000 PFU. High mediator activity of nonspecific immunity factors on days 5-7 after infection augments the disease course and leads to earlier death of vaccinated animals in comparison with the same dose of the virus in nonimmune mice.

[The treatment of hypertension patients with Estulic]. / Lechenie bol'nykh gipertonicheskoo bolezn'iu éstulikom.

Estulic, a hypotensive drug of a central mechanism of action, has been tried for effect on hemodynamics, coronary circulation and platelet functional activity in 30 patients with essential hypertension. The findings at tonometry, echoCG, treadmill exercise, platelet aggregation were indicative of a fall in both diastolic and systolic pressure associated with decreased platelet aggregation.

[Study of the immunobiological properties of parotitis viral strains]. / Izuchenie immunobiologichekikh svoistv shtammov virusa parotita.

The possibility of using different strains of parotitis virus (Enders, L-3, Jeryl-Leen) as antigens for enzyme immunoassay (EIA) to titer antibodies in human and animal blood sera is analyzed. Methods for preparation and purification of antigen on the basis of the said parotitis virus strains have been developed. Conditions of EIA were optimized. The sensitivity and specificity of EIA and hemagglutination inhibition test were compared.

[The immunity indices of BALB/c mice immunized with an inactivated antigen of the Machupo virus]. / Pokazateli immuniteta u myshei linii BALB/c, immunizirovannykh inaktivirovannym antigenom virusa Machupo.

The paper presents the data characterizing parameters of specific and nonspecific immunity in BALB/c mice immunized with gamma-ray-inactivated Machupo virus antigen or its formalinized antigen. The gamma-ray inactivated preparation was shown to be more immunogenic for BALB/c mice. A certain relationship between the time course of activity of nonspecific immunity factors in the immunized animals and the protective activity of the preparation under study was also noted. The decisive role of the T-cell part of the immune system was demonstrated in the resistance of this model animal to Machupo virus infection.

[The immunity indices in the infection of mice of different strains with the Machupo virus]. / Pokazateli immuniteta pri zarazhenii myshei razlichnykh linii virusom Machupo.

The pathomorphological patterns and the activity of serum interferon, interleukin-1, tumor necrosis factor, natural killers, and proliferative activity of lymphocytes were studied in BALB/c and C57B1/6 mice intracerebrally infected with Machupo virus. The BALB/c mice showed 100% lethality at 8-9 days after inoculation while C57B1/6 mice were found nonsusceptible to Machupo virus inoculation by this route. The pathomorphological findings at the peak of clinical manifestations in BALB/c mice revealed no organ whose functional deficiency could lead to the death of the animals. Investigations of nonspecific immunity parameters revealed a direct dependence between their high activity and susceptibility of the animals to Machupo virus infection. It is assumed that the endogenous shock due to the high activity of immune response mediators is the cause of death in Machupo virus infection.

[The effectiveness of psychorelaxation therapy in patients with hypertension]. / Effektivnost' psikhorelaksatsionnoi terapii u bol'nykh gipertonicheskoi bolezn'iu.

A study of 117 patients with labile essential hypertension before as well as 6 weeks and 12 months after psychorelaxation treatment (PRT), making use of autogenous training, biological feedback or respiratory relaxation training techniques (the main group), and the control patients, exposed to no psychological effects and those on the so-called psychological placebo, demonstrated a significantly greater fall of systolic and diastolic arterial blood pressure, total peripheral resistance and hypertensive response to emotional stress, as well as better psychological adaptation, quality of life and working capacity in the main-group patients, as compared to the controls, by the end of the study.

Efficacy of relaxation techniques in hypertensive patients.

We examined 117 outpatients (20- to 45-year-old men) with mild essential hypertension before treatment, after the main treatment course (6 weeks), and at 12-month follow-up. The patients were randomized into two major groups: (a) a treatment group that received autogenic training (23 patients), biofeedback (24 patients), or breathing-relaxation training (23 patients) and (b) a control group that consisted of 24 patients who did not receive any intervention and 23 patients who were treated with a "psychological placebo." Clinical, psychological, and psychophysiological data from all patients who were offered relaxation therapy were analyzed. By the end of follow-up, and compared to the control group, the treatment group demonstrated a significant reduction in systolic and diastolic blood pressures, peripheral vascular resistance, and hypertensive response to emotional stress, and an improvement in psychological adaptation, quality of life, and capacity for work. Comparative analysis of the efficacy of different relaxation methods revealed that biofeedback and breathing-relaxation training resulted in the greatest reduction in blood pressure. The antihypertensive effect of relaxation therapy correlated positively with pretreatment blood pressure levels and negatively with the duration of illness and certain psychological features.

[Use of various non-pharmacological methods in the treatment of patients in the early stages of arterial hypertension]. / Primenenie nekotorykh nemedikamentoznykh metodov dlia lecheniia bol'nykh s rannimi stadiiami gipertonicheskoi bolezni.

Patients with labile hypertension received various kinds of nonmedicinal therapy: psychological intervention (40 patients), acupuncture (25 patients), physical training (11 patients). Chemotherapy was provided to 38 patients. A significant antihypertensive effect was achieved with the use of the nonmedicinal therapeutic methods. Their efficacy was comparable with that of chemotherapy.

The hypertensive heart: pathogenesis, variants, and prognostic value.

We examine the heart's involvement in arterial hypertension, reporting on several studies of hypertensive patients showing that left ventricular myocardial mass is a significant prognostic indicator of essential hypertension and that left ventricular hypertrophy (LVH) correlates with an induced increase in Ca2+ concentration in platelets. We also consider the LVH variant of asymmetric hypertrophy and the role of the hypertensive heart in coronary insufficiency, and we speculate on the significance of the degree of LVH and asymmetric hypertrophy as risk factors for predicting cardiac complications of essential hypertension.