[Salt consumption and arterial hypertension: are there reasons to change point of view?].

The review presents modern data on interrelationships between sodium consumption, blood pressure level, and risk of cardiovascular complications. Phenomenon of salt sensitivity and methods of its detection are described. Results of epidemiological and interventional studies are used as a basis for formulation of populational strategy of limitation of sodium consumption. Possibilities of antihypertensive therapy with natriuretic effect are also presented.

[Statins in primary prophylaxis of cardiovascular diseases].

The review summarises data on statins efficacy in primary prophylaxis of cardiovascular complications. Main results of the JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) trial are analysed in detail. Its role in possible changes in current recommendations on prophylaxis and treatment of atherosclerosis is shown. Statins are considered as drugs essential in the strategy of improvement of life quality.

[Cistatin C as a novel marker of renal function impairement and cardiovascular risk].

Impairment of renal function beginning from subclinical stages is independent risk factor of development of cardiovascular diseases and cardiovascular death. Cystatin C is considered in recent years as an alternative marker of functional state of the kidney and risk of development of cardiovascular diseases. Cystatin C is a protease inhibiting protein with low molecular mass which is characterized by free glomerular filtration and is not subjected to tubular secretion. Formulas are elaborated for calculation glomerular filtration rate basing on cystatin C level. In this review we consider potential advantages of cystatin C for assessment of early impairment of renal function. We also present data on interrelation between cystatin C, metabolic parameters, and markers of target organs damage, on prognostic value of cystatin C in various populations of patients.

[Independent diagnostic value of microalbuminuria and calculated glomerular filtration rate in patients with arterial hypertension for detection of subclinical renal involvement].

In 734 patients with arterial hypertension without established diseases of cardiovascular system (including 158 patients with diabetes mellitus) we compared various methods of assessment of functional state of the kidney (microalbuminuria, creatinine, calculation of creatinine clearance and glomerular filtration rate) for detection of subclinical renal involvement and assessment of cardiovascular risk. We showed that determination of microalbuminuria and calculation of glomerular filtration rate (MDRD equation) had independent and mutual complementary diagnostic value, and allowed to identify patients with pathogenetically different renal lesions, reflected proteinuric and nonpoteinuric mechanisms of progression of nephropathy in arterial hypertension with and without diabetes mellitus.

[The role of adiponectin in development and progression of cardiovascular diseases].

Arterial hypertension, insulin resistance, diabetes mellitus are associated with obesity. However exact mechanisms of this association have not been determined yet. Biologically active substances produced by adipose tissue participate in pathogenesis of cardiovascular diseases and complications. In this review we present data on the role of adiponectin -- adipocytokine with unique antiatherogenic, antiinflammatory, and insulin sensitizing properties. Hypoadiponectinemia is considered to be potentially modifiable cardiovascular risk factor and novel therapeutic target. Therapy with PPAR gamma agonists, blockers of renin-angiotensin and sympathetic nervous systems is associated with elevation of concentration of adiponectin.

[Disproportionately high left ventricular myocardial mass in patients with arterial hypertension].

BACKGROUND: Increase of myocardial mass of left ventricle (MMLV) to a greater extent than required by hemodynamic load by elevated arterial pressure (AP) is reflected in concepts of " disproportionately " high (DH) MMLV and resistant to antihypertensive treatment LV hypertrophy (LVH). AIM: To study in patients with arterial hypertension (AH) frequency of DH MMLV and factors associated with it. MATERIAL AND METHODS: Patients (n=170, 70 men, age 57.6+/-5.9 years) with previously untreated or irregularly treated uncontrollable AH. Proportionality of MMLV was assessed by coefficient of disproportionality (CD) defined as ratio of actual to expected MMLV. RESULTS: DH MMLV was found in 140 patients (82.4%). Frequency of ECHOCG LVH among patients with DH MMLV was 49.3%. There were no cases of LVH among patients with proportional MMLV. Frequency of LVH depended on severity of disproportionality of MMLV elevation and was 18.9% at CD 128-155.9% and 82.2% at CD 184%. Patients with DH MMLV were characterized by greater body mass index, higher rate of disturbances of carbohydrate and lipid metabolism. Patients with DH MMLV without compared with those with LVH were characterized by significantly higher rate of concentric variant of LV geometry (66.2 vs 40.6%, p<0.05) and diastolic dysfunction (57.7 vs 36.2%, p<0.05), lower values of parameters of systolic LV function and higher rate of combination of concentric remodelling and diastolic LV dysfunction. CONCLUSION: DH MMLV is frequent among patients with previously untreated or irregularly treated uncontrollable AH. Calculation of disproportionality of MMLV allows to give additional characteristic of morphofunctional state of the myocardium in patients with AH. DH MMLV is associated with complex of subclinical structurally-functional disturbances of the myocardium and unfavourable changes of carbohydrate and lipid metabolism.

[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.

[Problems of a physician-patient interaction and control of arterial hypertension in Russia. Main results of scientific-practical program ARGUS-2].

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.

[Is patient education a factor elevating efficacy of arterial hypertension control?].

Unsatisfactory control of arterial hypertension is to a great extent determined by low compliance of patients to treatment, which can be caused by insufficient information about the disease and lack of proper motivation. Special methods were elaborated for elevation of level of awareness of patients - from one-time physician's advice and delivery of printed material up to a group training in a framework of programs with scheduled duration, volume, and succession of presentation. In this paper we present a review of publications devoted to the problem of patient\'s education, analysis of their efficacy in relation of improvement of control of disease, feasibility of application in various categories of patients with arterial hypertension. Most effective appears to be complex approach combining education of both patients and physicians, reminders to patients about visits and taking of medicines, special drug packaging, social support and cooperation from the side of the family.

[Significance of various methods of assessment of functional state for cardiovascular risk stratification].

Arterial hypertension (AH) combined with diabetes mellitus accelerates development of damage of the kidney. Elevation of serum creatinine level, lowering of creatinine clearance or calculated glomerular filtration rate (GFR), microalbuminuria are independent prognostic factors of cardiovascular morbidity and mortality. Unfavorable outcomes of impaired renal function can be prevented or delayed with the help of appropriate interventions at early stages. There is an urgency to search for methods allowing to reveal in patients with cardiovascular diseases impairment of renal function at preclinical stages. In all patients with AH estimation of GFR using MDRD equation or creatinine clearance using Cockcroft-Gault formula as well as measurement of urinary protein excretion are necessary. The given article presents review of available literature data devoted to the problem of contemporary methods of early preclinical detection of renal damage.

[Non-hemodynamic effects of calcium channel blocker nifedipine: effects on functional activity of blood cells and endothelium].

AIM: To compare efficacy of long-acting nifedipin (cordipin-XL) and beta-blocker atenolol (tenormin) in hypertensive patients; to assess efficacy of antihypertensive treatment on functional activity of blood and endothelial cells, remodeling of the myocardium and vessels. MATERIAL AND METHODS: A total of 35 patients with essential hypertension stage II entered the trial. Eighteen of them received cordipin-XL, 17--tenormin. RESULTS: Contrary to tenormin, cordipin-XL significantly improved blood rheology, reduced functional activity of leukocytes, concentration of Willebrand factor and intercellular adhesive molecules in blood plasm. Positive hemodynamic and non-hemodynamic effects of cordipin-XL were accompanied with reversion of left ventricular hypertrophy. CONCLUSION: Non-hemodynamic effects of cordipin-XL associated with improvement of endothelial function and blood rheological properties seem to have an independent role in prophylaxis of cardiovascular complications.

[Rheological properties of blood and endothelial function in patients with hypertensive disease]. / Reologicheskie svoistva krovi i funktsiia éndoteliia u bol'nykh gipertonicheskoi bolezn'iu.

Patients with hypertension are characterized by elevated platelet and erythrocytes aggregation and presence of relationship between rigidity of red blood cells and myocardial mass index. They also have increased number of leukocytes in peripheral blood, enhanced adhesive ability of neutrophils, increased representation of integrin receptors on lymphocytes and monocytes, and expression of Fas-receptors. These features evidence for augmented functional activity of leukocytes in hypertensive disease. Changes of rheological parameters of blood occur before impairment of vasomotor endothelial function. Augmentation of viscous properties of blood and functional activity of leukocytes aggravates hemodynamic disturbances in hypertension and can facilitate myocardial and vascular remodeling.