[Plasma Renin Activity and Potential of Indapamide Retard to Improve Control of Hypertension].

PURPOSE: to study plasma renin activity (PRA) as a predictor of antihypertensive response to addition of diuretic to combination of angiotensin- converting enzyme inhibitor (ACEI) and calcium antagonist (CA). MATERIAL AND METHODS: The study included 72 patients (39% men, mean age 62.0 ± 8.3 years) with uncontrolled despite use of ACEI and CA arterial hypertension (AH) without overt associated clinical conditions (AH criteria of national guidelines, 2010). After 4 weeks of therapy with ACE inhibitor (quadropril 6 mg/day) and CA (felodipine 5 mg/day) in all patients who did not reach target level of blood pressure (BP) (clinical BP≥140/90 mm Hg, daytime BP according to ambulatory BP monitoring [ABPM] >135/85 mm Hg) indapamide retard (1.5 mg/day) was added to combination therapy for 6 months. Examination included measurement of baseline and on treatment PRA and repetitive ABPM. RESULTS: More pronounced antihypertensive response was observed in the group of patients with volume dependent AH. Baseline BP was 156.6 ± 14.1/86.7 ± 1.5 and 151.9 ± 17.1/78.0 ± 7.8 mm Hg, on treatment level of clinical BP - 126.2 ± 10.6/72.5 ± 11.6 and 132.2 ± 9.1/71.9 ± 7.2 mm Hg (p<0.05) in patients with volume dependent and renin dependent AH, respectively. Target clinical BP was achieved in 95 and 80% of patients, respectively (χ2= 10.3; p<0.05). According to ABPM both daytime and nighttime on treatment BP was lower in the group of patients with volume dependent AH (130.0 ± 11.0/74.1 ± 9.9 vs. 136.5 ± 7.3/78.8 ± 8.2 mm Hg, p<0.05; and 127.9 ± 15.8/71 ± 13.5 vs. 132.6 ± 13.0/74.5 ± 10.2 mm Hg, p<0.05). CONCLUSION: PRA is an independent predictor of antihypertensive response to addition of a diuretic to combination therapy with ACEI and CA.

[Visit-to-visit blood pressure variability: clinical and prognostic significance].

The phenomenon of variability of blood pressure (BP) was studied for a long time, but recently it has received increased attention, with the focus shifted from short-term BP variability, estimated at daily monitoring for clinical blood pressure variability from visit to visit, which can be regarded as one of the indicators quality control of blood pressure with prolonged treatment. In light of the recent years of clinical data from visit to visit BP variability seems a promising new target for antihypertensive therapy.

[The state of carotid arteries in young men with arterial hypertension].

PURPOSE: To study elastic properties of carotid arteries in young men with arterial hypertension (AH). MATERIAL AND METHODS: We examined men aged 18-25 years (mean 21.1+/-0.14 years): 36 with normal blood pressure (BP), 123 with stable and 51 with unstable AH. Parameters studied comprised intima-media thickness (IMT) of carotid arteries, their M-mode measured maximal systolic and minimal diastolic diameters (Ds and Dd), stiffness of common carotid artery (CCA) wall determined on the basis of analysis of elasticity and distensibility coefficients (CC and DC), Peterson's and Young's modules of elasticity (Ep and E), and index of flow deformation (CS). RESULTS: Compared with young men with normal BP and unstable AH patients with stable AH had abnormal elastic properties of CCA and increased IMT. CONCLUSIONS: Stable AH in young men is associated with signs of remodeling of CCA walls and increase of their rigidity.

[Efficacy of fixed combination amlodipine/valsartan in hospitalized patients with hypertensive disease].

Efficacy and tolerability of fixed amlodipine/valsartan combination was studied in 86 patients with hypertensive disease hospitalized in departments of general internal medicine or cardiology. All patients had indications for antihypertensive therapy and were randomized either to fixed combination amlodipine/valsartan (n=43) or to therapy which corresponded to the hospital formulary (n=43). Correction of antihypertensive therapy was performed by treating physician at daily rounds. Self-control of blood pressure (BP) was performed by patients with the use of UA767PC apparatus. Results of BP self-control were compared with clinical measurements in order to detect concealed inefficacy of treatment. Results. Rate of achievement of target BP with fixed combination amlodipine/valsartan (93%) was comparable with that on traditional therapy (90%). But the use of fixed combination amlodipine/valsartan compared with traditional therapy was associated with lower clinical and self measured BP, quicker achievement of target BP (5.8+/-2.3 and 9.2+/-1.8 days, respectively, p<0.05), lesser number of antihypertensive drugs (2.5+/-0.6 and 3.0+/-0.9 days, respectively), lower rate of concealed inefficacy of treatment (12 and 31%, respectively, p<0.05). Conclusions. We have demonstrated appropriateness of inhospital administration of fixed amlodipine/valsartan combination as an approach allowing to achieve target BP in shorter time, with the use of fewer antihypertensive drugs, and diminishing concealed inefficacy of treatment.

[Achievements and problems of modern trials of antihypertensive drugs].

Most important value of lowering of substantially elevated arterial pressure (AP) for improvement of outcomes in patients with arterial hypertension (AH) was convincingly confirmed by large truly placebo controlled randomized clinical trials (RCT) with the use of mainly diuretics, and/or beta-adrenoblockers in the 60-80ths. Later comparative RCT confirmed equal antihypertensive efficacy of 5 main drug classes relative to AP level in brachial artery. In this review we discuss merit of auxiliary class-specific properties of antihypertensive agents potentially affecting prognosis besides AP lowering. We also discuss problems related to decline of significance of quantitative criteria of AH and consideration of AP level in general context of cardiovascular risk; problems of external validity of RCT; extrapolation of RCT results obtained in patients with complicated AH and very high cardiovascular risk on young patients with uncomplicated AH; significance of hard and surrogate end points.

[Echocardiographic assessment of myocardial fibrosis in young men with arterial hypertension and different types of left ventricular remodeling].

In order to study structural functional characteristics of myocardium including parameters of myocardial fibrosis according echocardiography data in men with various levels of arterial pressure (AP) we examined 215 men aged 18-25 (mean 21.1+/-0,1) years with history of elevated AP at casual measurement. AP phenotype (normotension, stable arterial hypertension [AH], unstable AH) was determined on the basis of multiple measurements of clinical AP and 24 hour AP monitoring. At echocardiography we assessed presence of left ventricular (LV) hypertrophy (LVH), type of LV geometry, proportionality of LV myocardial mass (LVMM), diastolic function. Myocardial fibrosis was assessed by pixel density distribution range (PDDR) with the use of analysis of reflected signal. There were no manifestations of LV remodeling in subjects with normal AP. Concentric LV remodeling was found in 27.5 and 60.5% of patients with unstable and stable AH, respectively. Concentric LVH was found only in patients with stable AH (4.8%). Disproportionally high LVMM was found in 16.1% of subjects with stable AH. In a combined group with concentric LV remodeling and LVH rate of disproportionally high LVMM was 20.8%. We noted significant (p<0.001) increase of PDDR in stable AH (181.4+/-2.2) compared with PDDR in normal AP (164.6+/-4.6) and unstable AH (160.1+/-2.7). In stable I degree AH PDDR (177.3+/-2.2) was insignificantly lower than in II degree AH (185.7+/-3.9). PDDR in concentric LV remodeling was 180.5+/-2.3, in concentric LVH- 166.8+/-13.2, in normal LV geometry - 168.4+/-2.5. PDDR in disproportionally high LVMM was higher than in proportional LVMM. Independent interrelationship was found between PDDR and body mass index (r=0.17; p=0.03), duration of AH (r=0.17; p=0.03), isovolumic relaxation time (r= 0.15; p=0.04). In young men LV remodeling can be detected at the stage of unstable AH. In stable AH degree of myocardial fibrosis was associated with higher AP level, concentric LV geometry, disproportionally high LVMM, lowering of diastolic function.

[Characteristics of central pulse wave in young men with various phenotypes of arterial pressure].

In this work we compared parameters of central arterial pressure (AP) on the basis of analysis of pulse wave in young men in dependence of AP phenotype determined by repetitive clinical measurements and 24 hour AP monitoring (24HAPM). Comparison of characteristics of central pulse wave was carried out in 12 men with normal AP, 36 men with arterial hypertension (AH) according to clinical measurements and 24HAPM, and 17 men with white coat hypertension (WCH). Mean age was 21.0+/-2.1 years. Differences in levels of pulse pressure (PP) between groups with AH were revealed only at the level of the aorta. Studied patients with normal AP and 24HAPM did not differ by such characteristics as index of increment and reflected wave appearance time. Studied patients with AH confirmed by 24HAPM were characterized by significantly greater augmentation of central PP (100.0+/-12.6% vs 96.6+/-11.8% in persons with normal AP and 95.6+/-15.0% with WCH, p<0.05), earlier appearance of reflected wave (149.2+/-18.9 ms vs 160.6+/-16.2 and 160.3+/-28.6 ms, respectively, p<0.05), high rate of pulse wave propagation (8.6+/-1.2 m/s vs 7.2+/-1.2 and 7.0+/-1.7 m/s). Amplification was similar in three groups. The data obtained has shown that in men aged 18-25 years presence of AH, confirmed by 24HAPM) is associated with elevation of central systolic AP and PP and higher values of markers of both rigidity of the aorta and remodeling of peripheral vascular bed.

[Phenotypes of arterial pressure in young men].

AIM: To study with the use of repetitive clinical measurements and 24-hour arterial pressure (AP) monitoring phenotypes of AP in young men aged 18-25 years with history of elevation of AP at accidental determination. MATERIAL AND METHODS: We examined 194 young men (mean age 21.1+/-2.1 years) because of detection of elevated AP at casual measurements. Clinical AP was assessed at repetitive determinations in sitting position at the same time on 5 consecutive days. 24-hour AP monitoring (24-HAPM) was carried out according to standard method. Classification of AP level and phenotype was made in accordance with recommendations of European Society of Arterial Hypertension (AH) (2007). RESULTS: Optimal clinical AP was found in 13 (6.7%), normal AP - in 20 (10.3%), high normal AP - in 24 (12,4%), stable AH - in 107 (55.2%) young men. Eighty one persons (41.8%) had I, 20 (10.3%) - II, and 6 (3.1%) - III degree AH. Among studied patients with stable elevation of clinical AP rate of isolated systolic AH (ISAH) was 65.4%, systole-diastolic AH - 6.1%, isolated diastolic AH - 8.4%. Comparison of levels of clinical AP and 24-HAPM showed that 34 young men (17.5%) had white coat hypertension, 73 (37.6%) - had true AH, 13 (6.7%) - concealed AH. The level of clinical SAP turned out to be the sole predictor of concealed AH. Among examined persons 40 (20.6%) had 1, 57 (29.4%) - 2, 34 (17.5%) - 3 or more additional risk factors. Sixty one subjects (31.4%) had metabolic syndrome. No association was established between number of risk factors, presence of metabolic syndrome, and AP phenotype. Left ventricular hypertrophy was revealed in 24.4% of patients with true AH and in 15.2% - with concealed AH. CONCLUSION: Dominating type of AH in young men is ISAH. The data obtained evidence for importance of 24-HAPM for establishment of AP phenotype in young men with normal and high normal clinical AP.

[Essential hypertension, dementia, and antihypertensive therapy in geriatric patients].

The review summarizes the current views on the pathogenesis of dementia and the significance of blood pressure levels for its development. The present status of the prevention of cognitive disorders and dementia is detailed in the use of antihypertensive therapy: there are the data of prospective cohort studies of the impact of antihypertensive therapy on the risk of dementia, the results of placebo-controlled studies in the groups of elderly and senile patients with a history of cerebrovascular complications, and the data of meta-analyses of studies. As for cognitive function, the effects of different classes of the currently available antihypertensive agents, such as diuretics, calcium antagonists, angiotensin-converting enzyme inhibitors, and angiotensin II type 1 receptor antagonists, are analyzed.

[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.