[Use of nebivolol in patients with mild and moderate hypertension]. / Primenenie nebidvolola u bol'nykh miagkoi i umerennoi gipertonicheskoi bolezn'iu.

AIM: To evaluate the effectiveness and safety of the beta-adrenoblocker nebivolol in patients with mild and moderate essential hypertension. MATERIAL AND METHODS: The trial enrolled 20 patients. 11 of them had mild and 9 moderate arterial hypertension (mean age 47.1 +/- 9.52 years, hypertension history 6.98 +/- 2.75 years). 2-5 days after discontinuation of hypotensive drugs the examination was made including blood count, ECG, echocardiography, 24-h AP monitoring. It was repeated on days 56-60 of nebivolol therapy. Arterial pressure and heart rate were measured at the start of the treatment and 1, 3, 5 and 8 weeks later. RESULTS: Nebivolol treatment significantly reduced systolic arterial pressure in 30% and diastolic arterial pressure in 50% patients, heart rate decreased on the treatment day 7-10. On the treatment day 56-60 systolic and diastolic pressure lowered significantly in 53.3% and 66.7% patients, respectively. The analysis of changes in echocardiographic evidence found no significant shifts in volume and linear parameters. Nebivolol was well tolerated by 85% patients. Side effects included head ache, cardialgia, dizziness, weakness and nausea. CONCLUSION: Nebivolol (nebilet) is an effective hypotensive drug with mild side effects. Further studies on nebivolol effects on myocardial mass are needed.

[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.

[Five-year activity of new departments of emergency cardiological care with cardiac resuscitation units in Moscow]. / Itogi piatiletnego opyta raboty vnov' sozdannykh otdelenii neotlozhnoi kardiologii s blokom kardioreanimatsii v Moskve.

AIM: To analyse results of treatment in new cardiological critical care units in Moscow (62 beds). MATERIAL AND METHODS: Five years reports presented in 1993-1999 to Moscow Public Health Committee. RESULTS: The activity of the new cardiological units proved efficient: cardiovascular lethality reduced by 20%; quality of diagnosis and treatment improved; bed turnover increased. CONCLUSION: A new system of medical care for critical cardiological patients is recommended for introduction as basic form of organization of urgent cardiological inpatient care in Moscow.

[Platelet aggregation in patients with hypertrophic cardiomyopathy]. / Sostoianie agregatsii trombotsitov u bol'nykh s gipertroficheskoi kardiomiopatiei.

AIM: To examine correlation between platelet aggregation and the degree of left ventricular hypertrophy (LVH) in patients with hypertrophic cardiomyopathy (HC). MATERIAL AND METHODS: Routine clinical examination, ECG, echo-CG, measurement of platelet aggregation, routine biochemical blood tests were made in 45 HC males and 15 healthy controls. RESULTS: HC patients were characterized with high induced and spontaneous platelet aggregation which increased with left ventricular myocardial mass. In LVH, platelets were especially sensitive to the aggregation inductor U-46619, thromboxane A2 analogue. CONCLUSION: It is demonstrated that there is a positive correlation between platelet aggregation and the degree of LVH in HC patients.

[Platelet aggregation in patients with various forms of left ventricular hypertrophy and its changes at long-term follow-up and treatment]. / Aggregatsiia trombotsitov u bol'nykh s razlichnymi formami gipertrofii levogo zheludochka i ee dinamika pri dlitel'nom nabliudenii i lechenii.

AIM: To study platelet aggregation (PA) in patients with left ventricular hypertrophy (LVH) in essential hypertension (EH) and hypertrophic cardiomyopathy (HTCM), and to assess aspirin treatment effects. MATERIAL AND METHODS: A general clinical examination, echocardiography, 24-h monitoring of ECG and arterial pressure, bicycle exercise, test for platelet aggregation, routine blood biochemical tests were performed in 30 males with EH and LVH, 30 males with HTCM and 10 healthy controls. RESULTS: It was found that the patients had high platelet sensitivity to aggregation inductors as well as high spontaneous aggregation. LVH severity correlated positively with activation of spontaneous and induced platelet aggregation. This dependence is unrelated to arterial pressure or the disease duration. Patients with episodes of silent myocardial ischemia had a more pronounced rise in spontaneous and induced platelet aggregation than those without silent ischemia. A long-term administration of aspirin significantly lowered spontaneous and induced platelet aggregation, depression of ST segment. The above changes occurred both in HTCM and in hypertensive patients with LVH. CONCLUSION: Platelet aggregation correlates with severity of LVH and episodes of silent myocardial ischemia both in patients with hypertension, LVH and HTCM.

[Myocardial hypertrophy and coronary insufficiency as a cause of arrhythmia in patients with hypertension]. / Gipertrofiia miokarda i koronarnaia nedostatochnost' kak prichina narusheniia ritma u bol'nykh gipertonicheskoi bolezn'iu.

AIM: To elucidate contribution of left ventricular hypertrophy (LVH) vs myocardial ischemia to rhythmic disorders in patients with essential hypertension (EH) and LVH. MATERIALS AND METHODS: Echocardiography, coronarography, treadmill test, 24-h ECG monitoring were included in examination of 69, 69, 68 and 63 patients, respectively. All of them had EH stage II and LVH. The comparison was made between the groups composed by LVH degree and by the presence or absence of coronary artery atherosclerosis (CAA). RESULTS: Subjective arrhythmia was recorded in 27% of the examinees, while objective one was registered by 24-h monitoring and treadmill test in 85.7 and 42.6% of the patients, respectively. Ventricular arrhythmia in EH stage II patients with LVH is associated for the most part with coronary insufficiency, often in the presence of atherosclerosis of the coronary artery. High-grade ventricular extrasystoles by B. Lown and M. Wolf and LVH degree were related. CONCLUSION: An essential role in the onset of supraventricular arrhythmia (SVA) in EH stage 2 patients with LVH belongs to the size of the left atrium and LVH degree. SVA is related to left ventricular myocardial ischemia.

[Late ventricular potentials in left ventricular hypertrophy in patients with stage-II hypertension]. / Otdalennye potentsialy zheludochkov pri gipertrofii levogo zheludochka u bol'nykh gipertonicheskoi bolezn'iu II stadii.

AIM: To evaluate diagnostic significance of high-resolution ECG in patients with blood hypertension (BH) stage II with left ventricular hypertrophy (LVH) in the presence or absence of angiographically verified atherosclerosis of the coronary arteries. MATERIALS AND METHODS: ECG (registration of late ventricular potentials by M. Simson and R. Haberl), echo-CG and coronaroventriculography were performed in 63 males with BH stage II. RESULTS: Late ventricular potentials (LVP) were detected according to M. Simson in 6.3% of the examinees, while according to R. Haberl in none of them. Duration of filtered complex QRS was normal in all the patients. LVP characteristics were not significantly different in the presence or absence of coronary atherosclerosis. Severe and moderate LVH patients differed significantly by duration of low-amplitude high-frequency signals. An inverse correlation existed between duration of low-amplitude signals in the end of filtered complex QRS and parameters of echo-CG. CONCLUSION: LVP registration both by M. Simson and R. Haberl failed to provide additional information on substrate of the arrhythmia in hypertension stage II patients with LVH free of clinical symptoms of tachyarrhythmia. However, there is an inverse correlation between duration of low-amplitude signals in the end of filtered complex QRS and thickness of interventricular septum, asymmetry index, left ventricular myocardial mass.

[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.

[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.

[Comparative analysis of the parameters of left ventricular systolic and diastolic functions in patients with hypertension and patients with hypertrophic cardiomyopathy]. / Sravnitel'nyi analiz parametrov sistolicheskoi i diastolicheskoi funktsii levogo zheludocjka u bol'nykh gipertonicheskoi bolezn'iu i bol'nykh gipertroficheskoi kardiomiopatiei.

17 patients with essential hypertension and asymmetric, 12 ones with concentric left ventricular (LV) hypertrophy and 13 patients with asymmetric hypertrophic cardiomyopathy (HCM) were examined by M-mode and Doppler echocardiography. There were significant changes of LV diastolic volumes, mitral flow velocities and phase duration in all groups of patients compared to healthy subjects. Nevertheless, the hypertensive groups had noninvolved LV systolic function. The HCM group had impaired LV systolic function because of a decline in pump capacity of hypertrophic myocardium resultant from diminution of its cavity.

[Anomalous chordae tendineae]. / Ob anomal'nykh khordakh serdtsa.

ECG of 322 patients with various cardiovascular diseases allowed the conclusion on the occurrence of anomalous chordae of the heart in 21.7% of cases. The chordae had no effect on the disease diagnosis, running, hemodynamics, left ventricular myocardial mass.

[The functional characteristics of the thrombocytes in patients with hypertension and "silent" myocardial ischemia]. / Funktsional'nye kharakteristiki trombotsitov u bol'nykh gipertonicheskoi bolezn'iu i s "nemoi" ishemiei miokarda.

Functional platelet characteristics were studied in hypertensive subjects having episodes of silent myocardial ischemia. A total of 36 patients with essential hypertension (EH) stage II (WHO criteria, 1979) underwent echocardiography and 24-h ECG monitoring. Platelet aggregation induced by adenosine diphosphate was assessed by laser aggregation analyzer. It is demonstrated that platelet aggregation in EH patients with silent ischemia was increased 5-fold as compared to healthy subjects and 2-fold versus EH patients without ischemia. No significant differences existed between the two groups by such parameters as systolic or diastolic pressure and left ventricular myocardial mass. An involvement of elevated platelet aggregation can be suggested in the genesis of coronary insufficiency in EH associated with episodes of silent myocardial ischemia.

[Atrial disorders of the heart rhythm in hypertension]. / Predserdnye narusheniia ritma serdtsa pri gipertonicheskoi bolezni.

A total of 57 males with stage-II hypertensive disease were studied to diagnose latent atrial disturbances of cardiac rhythm. Holter monitoring showed that latent atrial arrhythmias were diagnosed in 82.4% of patients. There was a significant correlation between the incidence of atrial arrhythmias and the left atrial dimension defined at echocardiography. A dilatation of the left atrium of greater than 4.0 cm serves a factor that predisposes to frequent atrial extrasystoles and atrial tachycardias. The electrical instability of a dilated left atrium was evidenced by diagnostic transesophageal cardiac pacing which readily induced persistent paroxysms of atrial fibrillations in patients with enlarged left atrium. The simultaneous use of Holter monitoring and diagnostic transesophageal cardiac pacing in the outpatient setting enhances their diagnostic value in detecting latent atrial arrhythmias in patients with hypertensive disease.

[The risk assessment for a fatal outcome in patients with stable angina based on the data from a long-term prospective observation (a comparison of the 5-year survival prognosis with the data at the 6th to 12th years of the observation)]. / Otsenka riska letal'nogo iskhoda u bol'nykh so stabil'noi stenokardiei po dannym dlitel'nogo prospektivnogo nabliudeniia (sopostavlenie 5-letnego prognoza vyzhivaemosti s dannymi na 6--12-m godu nabliudeniia).

A rule has been developed to predict coronary death in 377 patients with coronary heart disease and stable angina due to coronary stenotic atherosclerosis. Gravimetric values of various clinical signs, resting ECG changes, and bicycle ergometric testing have been obtained by a computer. A decisive rule has been also derived. According to the values of prognostic indices I1 and I2, groups of low, moderate, and high risks for fatal outcomes for 5 years have been identified and the patient's survival during a subsequent follow-up of 6 to 12 years has been assessed. The developed scheme of prognosis permits its use in practice.

[A method for determining individual nifedipine sensitivity in treating hypertension patients]. / Metod opredeleniia individual'noi chuvstvitel'nosti k nifedipinu pri lechenii bol'nykh gipertonicheskoi bolezn'iu.

Nifedipine antihypertensive effect was evaluated in 20 patients with essential hypertension. It was found to depend on pretreatment values of ADP-induced platelet aggregation response. The latter was studied with a new method of laser measurements of the aggregate radius sizes.