Cardiovascular Therapy and Prevention, 2017, 16(1)
INDIVIDUAL PREVENTION OF CARDIOVASCULAR DISEASES. THE POSITION OF EUROPEAN CARDIOVASCULAR SOCIETIES
Oganov R. G., Maslennikova G. Ya.
National Research Center for Preventive Medicine of the Ministry of Health. Moscow, Russia
Cardiovascular Therapy and Prevention, 2017; 16(1): 4–7
Position agreement of the experts
ARTERIAL HYPERTENSION MANAGEMENT IN PATIENTS AGED OLDER THAN 80 YEARS AND PATIENTS WITH THE SENILE ASTHENIA
A position agreement of the experts of Russian association of gerontologists and geriatricians, Gerontological society of Russian Academy of Sciences, Russian medical society for arterial hypertension
Cardiovascular Therapy and Prevention, 2017; 16(1): 8–21
CLINICAL VALUE OF THE PARAMETERS OF LOCAL AND REGIONAL VASCULAR RIGIDITY, WAYS FOR PHARMACOLOGICAL CORRECTION
Oleynikov V. E., Moiseeva I. Ya., Melnikova E. A., Tomashevskaya Yu. A., Avdeeva I. V.
FSBEI HE “Penza State University” of the Ministry of Education, Medical Institute. Penza, Russia
Aim. To study the influence of age on the parameters of local vascular rigidity in healthy persons, and to assess correlations of carotid arteries rigidity in coronary heart disease (CHD) patients with arterial hypertension (AH) of 1-2 grades with assessment of vasoprotective effect of a sartan — antagonist of angiotensin II receptors (AAR).
Material and methods. With an aim to study age and cardiovascular pathology influence on the parameters of local rigidity, 44 healthy persons included and 20 patients with AH of 1-2 grades comorbid with proven CHD. Local carotid stiffness was assessed by ultrasound examination of carotid arteries, My Lab 90 device with the technology of radiofrequency analysis of vessel wall condition — echo tracking. Also, the influence was analyzed, of 24-week therapy by one of sartans on structural and functional characteristics of carotid arteries.
Results. Comparison of the results of local stiffness in healthy group showed the local pulse wave velocity (PWV) in the range from 5,9±0,7 m/s in those 30-39 year old to 6,6±1,1 m/s in normotonics >50 y. o., there were significant differences in those >50 y. o. comparing with participants <40 y. o. Analogical changes were shown for the stiffness index β. Together with normalized office blood pressure (BP), AAR treatment was followed by a decrease of local pressure in carotid arteries, and decrease of carotid PWV from 9,9 (9,1; 11,5) m/s to 8,3 (6,6; 8,6) m/s with regression by 17% (p<0,05). Positive influence of AAR on structural and functional properties of carotid arteries confirms the significant growth of the coefficient by 3,3% (p<0,05), and decrease of stiffness indexes α & β by 19,4% (р<0,05) and 19,9% (p<0,01), respectively.
Conclusion. Parameters of local stiffness significantly correlated with anthropometric parameters, duration of AH, systolic and diastolic BP in patients with cardiovascular comorbidity. Therapy with sartan followed by not only normalization of BP, but improved the parameters of local arterial rigidity.
Key words: arterial stiffness, echo tracking, arterial hypertension.
Cardiovascular Therapy and Prevention, 2017; 16(1): 22–26
THE SPECIFICS OF HYPERTENSION PREVALENCE IN TYUMENSKAYA REGION AND ITS TREATMENT EFFICACY AMONG INHABITANTS OF 25-64 YEAR OLD
Efanov A. Yu.1,2, Storojok М. А .1, Sholomov I. F.1,2, Medvedeva I. V. 1,2, Shalaev S. V.1
1 Tyumen State Medical University of the Ministry of Health. Tyumen; 2Scientific-Practical Medical Center. Tyumen, Russia
Aim. To study prevalence of arterial hypertension (AH), mean values of systolic (SBP) and diastolic (DBP) levels of blood pressure, awareness of patients on this, antihypertension drugs (AD) intake and treatment efficacy among inhabitants of Tyumen Region, age 25-64 year old.
Material and methods. A cohort of Tyumen Region inhabitants, 25-64 y. o., investigated under the framework of multicenter observational study ESSE-RF. Number of participants — 1762, of those men 34,4% (n=607), women 65,6% (n=1155), mean age 48,9±11,4 y. o.
Results. In Tyumen Region the prevalence of AH was 48,9%, which is 4,9% higher than general population in ESSE-RF (by 9 regions). The same high pressure was found in general population of men and women, however statistically significantly predominated in men aged <55 y. o. The prevalence of AH increased with age — from 17,1% in group 25-34 y. o. to 70,6% in group 55-64 y. o., significantly more frequently registered in rural inhabitants — 58,1% vs 46,8% (р<0,05) and those with lower educational level — 57,4% vs 47,9% (p<0,05). The specifics of Tyumen Region was low level of awareness about having AH. In difference with the general ESSE-RF selection, with this value 73,1%, awareness on their AH in Tyumen Region was 57,6%. Naturally, this value was higher in women — 60,5% vs 50,6% (р=0,03), city inhabitants — 59,3% vs 51,7% (p<0,05) and persons with middlelevel or higher education — 58,4% vs 47,9% (p<0,05). Not high was the portion of those regularly taking AD — 39,5%, of those effectively treated 39,1%. Women with AH significantly more commonly took AD — 43,9% vs 23,0%, and were doing this more effectively — 43,2% vs 24,3% (р<0,01). Efficacy of AD was higher among those with higher education — 44,7% vs 35,9% (р<0,01), decreased with the age and did not relate on the type of settlement. Of the specifics of Tyumen Region was not high portion of those with AH reached target values of BP — 15,4% vs 22,7% in general population of ESSE-RF. This value did not have significant differences depending on the age and type of settlement, but was significantly higher among women in the age group >35 y. o., citizens, as rurals. Correlation of effective BP control with educational level was found only in male population. Among hypertensive males with middle and higher education, BP control was significantly better comparing to AH patients with low educational level.
Conclusion. The results determined the aims of prevention work with AH taking the specifics of this factor prevalence in Tyumen Region.
Key words: arterial hypertension, prevalence, risk factors, treatment efficacy, awareness.
Cardiovascular Therapy and Prevention, 2017; 16(1): 27–33
PERSON-CENTERED INTERVIEW AS A TOOL FOR CLINICAL WORK IN MYOCARDIAL INFARCTION SETTING
Taratukhin E. O.1, Kudinova М. А.2, Shaydyuk О. Yu.1, Golovkina А. L.2, Vaslyaeva S. N.2
1 N. I. Pirogov Russian National Research Medical University (RNRMU). Moscow; 2SBHI City Clinical Hospital № 15 n. a. Filatov O. M. Moscow, Russia
The issue of non-communcable diseases risk factors is one of the main in global targets of healthcare. However the key point in this direction is still a patient-clinician communication that demands high level of understanding and empathy. A useful tool for clinical work might be person-centered interview.
Aim. To evaluate epistemological role of person-centered interview and to define its place in cardiological care for acute myocardial infarction patients (MI).
Material and methods. The study is done in qualitative methodology: in-depth semistructured interview. Totally, 216 consequent MI patients screened. After inclusion criteria assessment (economically active males with first MI, none severe comorbidities and no anamnesis of coronary heart disease) and study procedures, 14 interviews included into analysis by phenomenological descriptive with the elements of interpretation, method.
Results. A range of non-expressed experiences revealed of the living through of the disease state in this group of patients: serious life change, borderline of life “before” and “after”; anxiety and fear of sudden death and repeat of the event; discourage and confusion; puzzlement; disorientation in symptoms, misunderstanding; loss of perspective for better in life; stigmatization; self-image changes; feelings of guilt and resentment; somatic markers; specifics of social stress.
Conclusion. Person-centered interview as a method of dialogue, implemented to the work of clinician, makes it to reveal the nonexpressed but very important sides of the disease course. In the experiencing of males with first MI, economically active, there is a range of issues requiring specific work. Addressing to the phenomenal of patients might be a higher level position in the work with life style determined non-communicable diseases.
Key words: patient-centred medicine, in-depth interview, phenomenological analysis, risk factors, personalized medicine.
Cardiovascular Therapy and Prevention, 2017; 16(1): 34–39
THE RESULTS OF DELAYED ENDOVASCULAR INTERVENTION IN ST ELEVATION ACUTE MYOCARDIAL INFARCTION DUE TO THROMBOTIC OCCLUSION OF CORONARY ARTERY
Azarov A. V.1,2, Semitko S. P.2, Glezer М. G.3, Akhramovich R. V.1, Maloroev А . I.1, Melnichenko I. S.1, Atarov G. Yu. 1, Lebedev А . V.1
1 SBHI MR “Mytischi City Clinical Hospital”. Moscow Region; 2 N. I. Pirogov Russian National Research Medical University (RNRMU). Moscow; 3I. M. Sechenov First Moscow State Medical University of the Ministry of Health. Moscow, Russia
Aim. To study clinical results and safety of delayed vs urgent stenting with application of modern antithrombotic drugs in massive coronary thrombosis in patients with ST-elevation acute myocardial infarction (STEMI).
Material and methods. Totally, 28 STEMI patients included, age 52 (25-77) y. o., of those males 80% (n=23), who, during January 2014 to February 2016, in first 6-12 hours from the onset of the disease, received endovascular treatment with purpose to recover adequate blood flow without urgent stent implanting into infarct-related artery. Minimal invasive strategy with the aim to recover antegrade blood flow up to TIMI 2-3 was done for 14 (50%) patients. In all patients, after restoring of the antegrade flow, there was thrombus, visualized in artery lumen, with TIMI thrombus grade score (TTG) ≥3. Another criteria of efficacy was resolving of ST elevation by ≥50%. As antiplatelet support during the intervention all patients received the combination of IIb/IIIa blockers (eptifibatide) and 600 mg clopidogrel or 180 mg ticagrelor. Second coronary arteriography (CAG) was done in up to 5 days.
Results. By 4,0±1,0 day, blood flow TIMI 2-3 in infarction-related artery was secure in 100% patients; there was marked decrease of the grade of target stenosis in infarction-related artery from 77,8±10,2% to 50,5±19,5%; decrease by its length from 21,5±8,5 to 15,5±5,5 mm; increase of the reference diameter of artery from 3,1±0,8 to 3,5±0,75 mm, and thrombosis bride by TTG — from 3,9 to 0,9. By the data from CAG, stenting of the target segment was done in 8 (29%) patients, and in 3 (10%) stenting done based on the data from intravascular ultrasound. In 17 (61%) patients the infarction-related stenosis was non-significant. In the group of delayed stenting there was no cases of no/slow-reflow development. At hospital stage of management, there were no cardiovascular events in the observation group.
Conclusion. In patients with massive thrombosis of infarction-related artery (TTG ≥3) and restored antegrade coronary flow TIMI 2-3, the delayed stenting is a safe and effective strategy of treatment at hospital stage.
Key words: acute myocardial infarction with ST segment elevation, percutaneous coronary intervention, coronary stenting.
Cardiovascular Therapy and Prevention, 2017; 16(1): 40–45
ASSESSMENT OF THE EFFICACY OF CATHETER ISOLATION OF PULMONARY VEINS OSTIA FOR TREATMENT OF PAROXYSMAL ATRIAL FIBRILLATION WITH ANTIARRHYTHMIC THERAPY IN EARLY POST-SURGERY PERIOD (THE PRUF STUDY)
Tarasov A. V., Davtyan K. V., Martsevich S. Yu., Shatakhtsyan V. S.
National Research Center for Preventive Medicine of the Ministry of Health. Moscow, Russia
Aim. To address the complex approach to observation and medication therapy with assessment of efficacy and safety of monotherapy by antiarrhythmic drugs (AAD): propafenon, sotalol, verapamil in comparison with non-AAD controls, for prevention of recurrent atrial tachiarrhytmias in early and later post-operation time of catheter isolation of pulmonary veins ostia.
Material and methods. Randomized by “envelope” method, and by the design of the study, 243 patinets included, 142 (58,44%) males and 101 (41,56%) females, age 25-79 y. o. (mean — 56,09±10,14 y. o.) with anamnesis of 4,48±2,6 years, and selected to 4 similar groups: 1 gr. (n=61) prescribed AAD by Vaughan Williams class 4 — verapamil retard 240 mg/day, 2 gr. (n=62) — AAD class 1С — propafenon 450 mg/day, 3 group (n=60) — AAD class 3 — sotalol 160 mg/day, and 4 control group (n=60) — non-AAD. Follow-up lasted from 365 days (±10 days). Study methods: patient diary, ECG, Holter ECG, and half of the patients underwent implanting of subcutaneous monitor Reveal® (Medtronic).
Results. Total efficacy of ostium isolation after one procedure was 66,6% (n=162, 95% confidence interval (CI) 61-72%), 67,2% (n=123, 95% CI 60-74%) at the background of antiarrhythmic therapy, and 65% (n=39, 95% CI 52-76) non-AAD (р=0,75). In 81 (33,4%) patients AAD was non-effective, of whom 62 (25,5%) were operated second time. After two procedures, total efficacy reached 88,5% (n=215, 95% CI 84-92%), with AAD — 88,55% (n=183, 95% CI 83-92%) and non-AAD — 88,33% (n=53, 95% CI 78-94%) (р=0,83). There were differences in groups during early post-operation period by the number of medicational and electrical cardioversions, as by the number of hospitalizations related to arrhythmia. Mean number of hospitalizations in 3 months was 0,654±0,74 cases. In group 1 it was 0,684±0,73 vs controls non-AAD — 0,894±0,88 (р=0,178), group 2 (propafenon) — 0,447±0,57 vs controls — 0,894±0,88 (р=0,0016) and in group 3 (sotalol) — 0,592±0,67 vs controls — 0,894±0,88, resp. (р=0,044).
Conclusion. AAD in post-operation therapy of catheter isolation of pulmonary veins ostia does not influence the outcomes of invasive treatment after one or two operations, however influences clinical course of post-operation period, decreasing the number of medication and electrical cardioversions and significantly decreasing the number of hospitalizations related to cardiac arrhythmias.
Key words: atrial fibrillation, radiofrequency ablation of pulmonary veins ostia, early post-operation period, verapamil, propafenon, sotalol, PRUF study.
Cardiovascular Therapy and Prevention, 2017; 16(1): 46–53
AGE-RELATED CHANGES IN HEART RATE VARIABILITY AND THEIR RELATION WITH LEUCOCYTE TELOMERE LENGTH
Streltsova L.I.1, Tkacheva О.N.1,2, Plokhova Е . V.1,2, Akasheva D. U.1, Strajesko I. D. 1, Dudinskaya Е . N.1,2, Boytsov S. А.1
1 National Research Center for Preventive Medicine of the Ministry of Health, Moscow; 2Russian Center for Gerontology. Moscow, Russia
Aim. To assess the relation of age-depended changes in heart rate variability (HRV) with telomere length. With the age, even with no cardiovascular diseases (CVD), there is a decline of HRV which is an indicator of vegetative system condition. The probable mechanism for age-related decrease in HRV might be cellular ageing. One of the markers of cellular ageing is telomere length regarded as a marker of biological age.
Material and methods. Totally, 229 persons of age 23-91 y. o. included, with no clinical signs of cardiovascular diseases. All participants underwent the HRV analysis by the data of Holter ECG monitoring and of short ECG recordings supine and upright position by 5 minutes. Telomere length was assessed in leucocytes on genomic desoxyribonucleic acid (DNA) with plymeraze chain reaction real time. The participants were selected to two groups: <60 y. o. and ≥60 y. o. Comparative analysis was done, of the parameters studied, in two age groups, correlational analysis of telomere length with HRV, linear regression analysis and multiple regression.
Results. In the group of the older, telomere length was higher than in the younger — 9,90±0,47 units vs 9,65±0,43 units (p<0,001) with close correlation of telomere length with the age (r=-0,32, p<0,05). By the data of linear regression, telomere length is closely related with the mean value of standard deviations of all selected RR intervals for every 5 minutes of 24-hour recording (SDANN), with the power of high-frequency spectrum (HF), relation of lower- and high-frequency waves (L/H) (β=0,36, p=0,006; β=0,39, p=0,004; β=-0,32, р=0,02, resp.). In older persons, in the group of shorter telomeres there were significantly lower values of mean standard deviations for all selected R-R-intervals (SDNN) (111 (94; 126) ms vs 122 (112; 122) ms), mean-square differences between the duratons of the next sinus intervals RR (RMSSD) R-R (RMSSD) — 16 (11; 22) ms vs 22 (17; 25) ms), power of the very low frequency spectrum components (VLF) — 1176 (718; 1453) ms 2 vs 1476 (850; 1763) ms2) by the data from Holter ECG, than in the group of longer telomeres (p<0,05). Differences by the shorter recordings supine and upright were not significant.
Conclusion. Telomere length is related to the age-relevant HRV changes. Telomere length might be an early predictor of the ageassociated weakening of autonomous regulation of heart functioning and reflect real biological age of vegetative nervous system irrelevant to other cardiovascular risk factors.
Key words: age, heart rate variability, ageing, telomeres.
Cardiovascular Therapy and Prevention, 2017; 16(1): 54–60
EFFECTIVENESS OF 12-WEEK OUTPATIENT PHYSICAL REHABILITATION OF PATIENTS AFTER NON-ST-ELEVATION ACUTE CORONARY SYNDROME WITH PERCUTANEOUS CORONARY INTERVENTION ON INFARCTION-RELEVANT ARTERY
Volodina К. А.1,2, Linchak R. М.1, Achkasov Е. Е.2, Alaeva Е. N.1, Tkhay N. V.1, Bulgakova О. V.1
1 National Research Center for Preventive Medicine of the Ministry of Health. Moscow; 2I. M. Sechenov First Moscow State Medical University of the Ministry of Health. Moscow, Russia
Aim. To assess the efficacy of physical cardiorehabilitation in patients with acute coronary syndrome non-ST-elevation (NSTEACS) and percutaneous coronary intervention (PCI) on infarction-relevant artery.
Material and methods. To the prospective study, 35 patients included — mean age 57,9±9,7 y. o.; 78% males, 22% females after NSTEACS with urgent PCI on symptom-dependent artery and noncomplicated post-surgery period. Time of inclusion into the study was 2-8 weeks after ACS onset. At 1 and 12 weeks of cardiorehabilitation programs there was functional (echocardiography, electrocardiography, exercise testing) and laboratory diagnostics (lipids and chemistry). For 12 weeks the participants visited 3 times per weeks the standard cardorehabilitation trainings.
Results. After the cardiorehabilitation course, in patients we found decreae of total cholesterol from 4,4±1,4 to 3,9±1,1 (р=0,02); low density lipoproteides level from 2,6±1,1 to 2,1±0,7 (р=0,002); significant increase of high density lipoproteides from 0,9±0,3 to 1,2±0,4 min (р<0,001) and left ventricle ejection fraction from 55±8,3% to 60,6±8,2% (p<0,001). Significant decrease of the resting heartrate (HR) from 72,9±10,3 bpm to 67,9±6 bpm (р=0,04); mean time of the HR recovery from 4,1±1,2 min to 3,8±1 min (р=0,03) and blood pressure from 4,2±1,1 min to 3,8±1 min (р=0,013) after exercise testing;
significant increase of exercise tolerance to physical exertion from 4,0±1,5 МЕТ to 5,0±1,7 МЕТ (p<0,001) and time of test from 5,0±1,9 min to 6,7±2 min (p<0,001).
Concusion. 12-week program of cardiorehabilitation leads to significant normalization of carbohydrate and lipid metabolisms, helps to increase exercise tolerance and significantly recovers the hemodynamical parameters of circulation.
Key words: acute coronary syndrome, exercises, rehabilitation, functional diagnostics, laboratory diagnostics.
Cardiovascular Therapy and Prevention, 2017; 16(1): 61–66
Pharmacotherapy of cardiovascular diseases
STUDY OF PATIENTS ADHERENCE TO TREATMENT IN METABOLIC SYNDROME, WITH THE NOVEL COMBINATION ANTIHYPERTENSION COMPOUND OF RAMIPRIL AND AMLODIPINE BY THE DATA OF OBSERVATIONAL STUDY GRANAT-1
Martsevich S. Yu., Lukina Yu. V., Kutishenko N. P., Voronina V. P., Dmitrieva N. A., Zakharova A. V., Lerman O. V., Garganeeva A. A., Gomova T. A., Drozdetsky S. I., Chesnikova O. I. on behalf of the trial workgroup GRANAT-1#
National Research Center for Preventive Medicine of the Ministry of Health. Moscow, Russia
Aim. To study some aspects of antihypertension therapy (AHT) adherence in patients with arterial hypertension (AH) and metabolic syndrome (MS) by an example of fixed combination of ramipril and amlodipine, under the framework of GRANAT-1 trial (Observational Program for Patients with Arterial Hypertension and Metabolic Syndrome).
Material and methods. Totally, 101 patient included, having had confirmed AH and MS. All participants completed the study. All patients consented to participate, had been recommended the combination drug AHT — fixed combination of ramipril and amlodipine (Egipres) in various dosages selected by clinician in routine assessment. Every patient was invited to clinic for 4 visits during 5 months with interval 1-2-2 months (visits 1-4). For assessment of the general adherence to clinician
recommendations (CR) during the first and final visits, all patients filled the Moriskos-Green test (MG) including 4 questions. In all visits, patients were assessed BP level, heart rate, and during visits 2-4 there was adverse events evaluation (AE). Also, the real adherence was evaluated by the intake of Egipres, and activeness of clinicians towards the achievement of target BP levels in participants.
Results. The recommended AHT started taking 95 patients, by the end Egipres was being taken by 92 participants, 9 of them took other AHT. 90 patients achieved target BP (81 taking Egipres). Effect of the prescribed at visit 1 AHT in most patients appeared by 1 month (visit 2): in every third patient the target BP was reached, and mean systolic BP decreased by 17,2 mmHg and diastolic BP by 7,7 mmHg (visit 2), and 31,0 mmHg and 16,1 mmHg, resp. — by visit 4. Totally, 3 AE registered, probably amlodipine-related. A significant improvement of total adherence was found: if at the beginning of study, by MG test only 22 (21,8%) adhered, by the end — 70 (69%) of patients. In three cases there was lack of clinician activity to help achieve target BP.
Conclusion. Single-time usage of the fixed combination of amlodipine and ramipril, its high efficacy and safety with regular visiting of physician help to increase general adherence of patients to treatment.
Key words: arterial hypertension, metabolic syndrome, antihypertension therapy, rational fixed combination, treatment adherence.
Cardiovascular Therapy and Prevention, 2017; 16(1): 67–73
EFFICACY OF AZILSARTAN MEDOXOMIL ON THE DAILY PROFILE OF PERIPHERAL AND CENTRAL ARTERIAL PRESSURE AND ARTERIAL STIFFNESS IN HYPERTENSIVES WITH TYPE 2 DIABETES
Troitskaya E. A., Starostina E. S., Kobalava Zh. D.
Peoples’ Friendship University of Russia. Moscow, Russia
Comorbidity of diabetes mellitus (DM) with arterial hypertension (AH) leads to four-time increase of cardiovascular risk (CVR). Achievement of target blood pressure (BP) is one of the main strategies of cardiovascular complications prevention in DM patients. Efficacy of azilsartan medoxomil is higher than of other drugs from the group.
Aim. To study changes in peripheral and central BP daily profile and parameters of arterial stiffness in replacement of RAAS blocker as a part of two component antihypertension therapy (AHT) by 40 mg azilsartan medoxomil for patients with AH and type 2 DM, with dose titration to 80 mg if target BP not reached.
Material and methods. Thirty AH+DM2 patients not having target BP<140/85 mmHg on two component AHT (53% females, mean age 60,4±7,6 y. o., 40% smokers). Replacement of RAAS blocker by
azilsartan medoxomil 40 mg with dose increase to 80 mg in 6 weeks if BP <140/85 mmHg not achieved. Folow-up lasted for 12 weeks. 24-hour profile of peripheral and central BP and parameters of arterial stiffness were assessed with BPLab Vasotens (JSC “Piotr Telegin”). The results were statistically significant in p<0,05.
Results. In 12 weeks of therapy, 25 patients (83%) reached the target peripheral BP<140/85 mmHg. The increase of azilsartan medoxomil at week 6 was needed in 11 (37%) patients. In 12 weeks there was significant decrease in clinical peripheral and central BP (from 160±16/89±9 mmHg to 125±7/73±6 mmHg and from 144±11/84±4 mmHg to 115±9/67±5 mmHg, respectively), decrease of the mean daily peripheral BP by 22/9 mmHg, central by 18/13 mmHg, mean nocturnal BP by 24/9 mmHg and 19/10 mmHg, respectively. There was significant decrease of daily and night variability of SBP (from 15±4 to 10±3 mmHg and from 11±3 to 8±2 mmHg, resp.), decrease of PWV (from 10,2±2,3 to 9,5±2,2 m/s) and augmentation index (from 24,6±8,6 to 13±7,0%), р<0,05 for all differences. There were no significant changes in PP amplification. Improvement of 24-hour BP (ABPM) led to increase of the dippers portion: improvement of SI SBP at azilsartan medoxomil was found in 53% cases. There was decrease of the level of morning SBP raise: from 34±13 mmHg to 25±10 mmHg (р<0,05). The drug demonstrated metabolic neutrality and good tolerability.
Conclusion. Replacement of RAAS by azilsartan medoxomil in AH and DM2 patients taking bicomponent AHT leads to achievement of target clinical BP in 83% of patients, normalization of 24-hour profiles of peripheral and central BP and improvement of parameters of arterial stiffness in most patients. Azilsartan medoxomil therapy tolerated good and is metabolically neutral.
Key words: azilsartan medoxomil, arterial hypertension, diabetes type 2, central arterial pressure, ambulatory blood pressure profile, ambulatory blood pressure monitoring, arterial stiffness.
Cardiovascular Therapy and Prevention, 2017; 16(1): 74–81
EFFICACY OF MULTIDISCIPLINARY MANAGEMENT OF PULMONARY HYPERTENSION
Gaisin I.R.1, Richkova L.V.2, Gazimzyanova А.S.2, Larina О.N.2, Maximov N.I.1, Galimova А.А.2, Gureeva V.N.2, Pomosov S.А.2, Shirobokova Е.G.2, Ponomareva А.А .2, Nikolaeva N.B.2, Shilina L.V.2, Ivanova L.V.2, Zhuykova M.Yu.2, Maximov N.N.2, Bogdanova I. V.2, Chechetova N. N. 2 ,Timonin D. V.2
1 FSBEI HE “Izhevsk State Medical Academy”. Izhevsk; 2BHI RU “Republic Clinical-Diagnostical Center of the Ministry of Health of Udmurtskaya Republic”. Izhevsk, Russia
Aim. To assess the efficacy of regional system of multidisciplinary care in pulmonary hypertension (PH).
Material and methods. In a single-center, pro- and retrospective cohort study, 2001-2015, the epidemiological characteristics and yearly mortality from PH were assessed in the created in late 1990s multiple system of PH management in the Udmurt Republic. According to the specific drug therapy tactics, there were three periods of observation: in 2001-2005 PH patients received, by indication calcium channel blockers and supportive therapy; in 2006-2010 sildenafil was added; from 2011 pulmonary arterial hypertension (PAH) patients also received bosentan, ambrisentan, and in chronic thromboembolic PH — inhaled iloprost.
Rеsults. In the cardiology and rheumatology clinic of the Udmurt Republic, a multidisciplinary system of PH management was shaped, with three-stage individualized care of patients, beginning from newborn period (1st stage — pre-hospital, 2nd — hospital, 3rd — rehabilitation). Within the first 5 years of follow-up, mortality of PH patients was 15-12% per year, from 2006 to 2010 — 10-7,5% per year, in 2011-2015 — 5,6–3,8% (р2015-2001=0,008).
Conclusion. Interprofessional approach to PH patients care in the circumstances of regional center and therapy by PAH-specific drugs significantly increased survival rate of patients.
Key words: pulmonary hypertension, multidisciplinary management, bosentan, sildenafil, riociguat, macitentan, selexipag.
Cardiovascular Therapy and Prevention, 2017; 16(1): 82–90
Opinion on a problem
TREATMENT ADHERENCE: MODERN VIEW ON A WELL KNOWN ISSUE
Lukina Yu. V., Kutishenko N. P., Martsevich S. Yu.
National Research Center for Preventive Medicine of the Ministry of Health. Moscow, Russia
The treatment adherence problem is one of the most significant for medicine and society. The article focuses on the main aspects of the adherence problem: modern view on terminology of this issue, various factors classification influencing adherence, diagnostics of adherence. A review is presented of the ways to improve adherence, that are provided by modern science to apply into clinical practice. The necessity confirmed, to consider the issues related to adherence, with obligatory taking the quality of such therapy, as only high quality treatment can be, being adhered, successful in the main goals: improvement of prognosis of the diseae and life, improvement of patients life quality.
Key words: adherence, compliance, multifactority, treatment quality.
Cardiovascular Therapy and Prevention, 2017; 16(1): 91–95
ON THE RELATION OF STROKE AND AIR POLLUTION WITH PARTICULATE MATTER. PREVENTION ACTIONS
Kolpakova A. F.
FSBSI Institute of Computational Technologies SR RAS. Novosibirsk, Russia
The article focuses on the contemporary view on the relation of air pollution by particulate matter (PM) with morbidity and mortality from the brain stroke. The results of studies are reviewed, on the long- and shortterm influence of PM pollution on cardiovascular system depending on their size, origin, chemistry, concentration in the air, as the ways for stroke prevention.
Key words: air pollution, particulate matter, stroke, stroke prevention.
Cardiovascular Therapy and Prevention, 2017; 16(1): 96–99
NON-COMPACTION MYOCARDIUM OF THE LEFT VENTRICLE: SECONDARY PREVENTION OF THROMBOEMBOLISM
Myasnikov R. P.1, Kulikova О. V.1, Kharlap М. S.1, Koretsky S. N.1, Andreenko Е. Yu.1, Mershina Е. А.2, Sinitsin V. Е.2, Boytsov S. А.1
1 National Research Center for Preventive Medicine of the Ministry of Health. Moscow; 2FSAI “Treatment-Rehabilitation Center” of the Ministry of Health. Moscow, Russia
Main clinical specifics of the non-compaction myocardium of left ventricle (NCM) are heart failure, arrhythmias and thromboembolism. Severe trabecularity and deep intertrabecular spaces might be the origin of blood congestion and formation of clots inside the left ventricle (LV). The article focuses on the recent aspects of anticoagulation in NCM, and presents clinical case of man 54 year old with NCM diagnosis, admitted with symptoms of severe heart failure and multiple clots in LV, complicated with repeat systemic embolism. Later, after patient’s voluntarily decrease of treatment, repeat thrombosis of the LV developed, with embolism in the left brachial and in popliteal arteries. All patients with NCM, as a secondary prevention of thromboembolism, a permanent anticoagulation is indicated. Also, as a primary prevention, anticoagulation is needed for NCM patients who need thromboembolism risk factors, such as atrial fibrillation and systolic dysfunction of the LV.
Key words: non-compaction myocardium of the left ventricle, cardiomyopathies, heart failure, left ventricle thrombosis, thromboembolism.
Cardiovascular Therapy and Prevention, 2017; 16(1): 100–104
X Anniversary international conference preventive cardiology 2017
Cardiovascular Therapy and Prevention, 2017; 16(1): 105-106