Psychological Continuum of Elderly Patients Suffering from Arterial Hypertension with Metabolic Syndrome, Against the Background of Chronotherapy with a Fixed Combination of Amlodipine, Lisinopril and Rosuvastatin.

Aim        To study the psychological continuum in elderly patients with arterial hypertension associated with metabolic syndrome during the chronotherapy with a fixed combination (FC) of amlodipine, lisinopril, and rosuvastatin.Material and methods        In the inpatient conditions, 63 patients aged 60-74 years with arterial hypertension associated with metabolic syndrome were treated with chronotherapy with a FC of amlodipine, lisinopril, and rosuvastatin (5 / 10 / 10 mg/day in the evening). These patients composed the main group. The control group (58 patients aged 60-74 years with arterial hypertension associated with metabolic syndrome) was treated with the FC of amlodipine, lisinopril, and rosuvastatin at the same dose of 5 / 10 / 10 mg/day in the morning.Results   At one year, the disorders of psychological continuum were significantly decreased with the chronotherapy (evening dosing) with the antihypertensive FC of amlodipine, lisinopril, and rosuvastatin compared to the traditional treatment (morning dosing) at the same dose of 5 / 10 / 10 mg/day in both groups. With the chronotherapeutic approach, the dynamic of cognitive disorders in patients aged 60-74 years with arterial hypertension associated with metabolic syndrome was characterized by a significant increase in the Mini-Mental-State-Examination scale score from 17.8±0.3 at baseline to 23.5±0.4 with the evening dosing (р<0.001) vs. the increase from 16.9±0.3 to 20.4±0.4 (р<0.001) with the morning dosing. The situational anxiety score decreased from 40.0±2.2 to 30.6±1.8 (р<0.05) and from 40.8±2.5 to 33.5±1.9  (р<0.05), and the trait anxiety score decreased from 48.8±2.0 to 26.4±1.9 (р<0.001) and from 44.9±1.9 to 30.7±1.7  (р<0.01) with the evening and morning dosing, respectively. Depressive disorders slightly decreased with the chronotherapy by 14.1 % vs. 7.7 % with the traditional regimen; nevertheless, they were consistent with depressive spectrum disorders in both groups.Conclusion            The study results showed a higher effectiveness of the chronotherapeutic treatment compared to the traditional treatment with FC of amlodipine, lisinopril, and rosuvastatin in arterial hypertension with metabolic syndrome.

[The effect of antihypertensive chronotherapy on indicators of the daily blood pressure profile in elderly patients with arterial hypertension with a history of myocardial infarction.]

Traditional treatment regimens for patients with hypertension are not always effective and need to be improved based on the principles of chronobiology. The purpose of this work is to analyze the effect of preventive chronotherapy with amlodipine, lisinopril, and rosuvastatin on daily blood pressure monitoring. In 62 patients with a history of myocardial infarction and hypertension at the age of 60-74, a fixed combination of amlodipine, lisinopril and rosuvastatin at a dose of 5/10/10 mg 2 hours before reaching maximum systolic blood pressure (preventive chronotherapy), in 63 patients with similar diseases and age, this drug is taken at a dose of 5/10/10mg in the evening, and in 58 people - in the morning (traditional treatment). Daily monitoring of blood pressure before and 6 months after treatment was performed by the «SpacelabsMedical¼ device (USA) with the calculation of generally accepted indicators. The greatest effectiveness of preventive chronotherapy in comparison with other treatment options for achieving the target blood pressure level, reducing the time indices and the variability of systolic blood pressure has been established, which allows us to recommend this fixed combination in geriatric practice.

[Cardio-cerebral hemodynamics and the prostanoid system in patients with the initial stages of essential hypertension]. / Sostoianie kardiotserebral'noi gemodinamiki i sistemy prostanoidov u bol'nykh s nachal'nymi stadiiami éssentsial'noi gipertenzii.

There is an interrelationship between the central and cerebral hemodynamics in those young adults who are in the incipient stages of their essential hypertension. Prostanoids have their part in formation of types of central hemodynamics and origination of its integration with cerebral bloodflow during the course of the illness.

[Plasma and cellular factors of atherogenesis and the prostanoid system at the early stages of arterial hypertension]. / Plazmennye i kletochnye faktory aterogeneza i sistema prostanoidov na rannikh stadiiakh arteria'lnoi gipertonii.

In young patients with borderline arterial hypertension and, to a greater extent, with Stage 1 hypertensive disease (HD), changes were found in the proatherogenic plasma lipid and apoprotein composition, which were manifested as higher levels of total cholesterol, triglycerides, low and very low density lipoprotein cholesterols along with increased apolipoprotein B and apolipoprotein B:apolipoprotein AI ratio. The prostacyclin-thromboxane system in borderline arterial hypertension was in an activated state by retaining the physiological ratio of its components. The patients with Stage I HD exhibited a considerable increase in thromboxane activity, which determined the system's imbalance towards its predominance. In Stage I HD, the thrombocytic link of hemostasis was characterized by enhanced platelet aggregability mediated by the imbalance of the prostacyclin-thromboxane system in the direction of thromboxane.

[Thrombocytic hemostasis and the prostaglandin system at early stages of arterial hypertension]. / Trombotsitarnyi gemostaz i sistema prostanoidov na rannikh stadiiakh arterial'noi gipertonii.

In young patients with borderline arterial hypertension the system of pressor and depressor prostaglandins (PG) is activated with maintenance of their physiological proportion. In patients with I stage essential hypertension a considerable rise in the level of PGF2 alpha and thromboxane determines the system imbalance in the direction of the predominance of pressor components. The platelet hemostatic link in I stage essential hypertension is characterized by an increase in platelet aggregation activity which is mediated by the imbalance of the prostacyclin-thromboxane system in the direction to thromboxane.