[Effect of the presence of a drug in the list of supplementary drug provision on compliance to its administration by outpatients with arterial hypertension].

Aim of the study was to investigate relationship between the presence of a drug in the list of supplementary drug provision (SDP) and compliance to its consumption by outpatients with arterial hypertension as well as determination of the place of SDP in a row of other factors affecting compliance to treatment. Methods. Patients (men and women) older than 18 years with initial level of office systolic arterial pressure (AP) 140-179 mm Hg and diastolic AP up to 100 mm Hg who visited regional internist. The study was conducted at the base of 82 Moscow polyclinics with participation of 185 physicians and 5474 patients. In all patients besides general clinical examination with office AP measurement calculation of body mass index and assessment of risk factors and concomitant therapy were carried out. All patients assessed themselves their self feeling with the use of visual-analog scale (VAS). Compliance of patients to antihypertensive therapy was evaluated with the help of the Moriski - Green test. Fact of continuous use of antihypertensive drugs received by patients within framework of the SDP system was necessarily obligatory. For final analysis 4816 ambulatory cards were selected. Results. Portion of patients with low compliance to therapy was greatly than that of patients with high compliance to therapy (61.1 vs. 38.9%, respectively, p=0.00001). Inclusion into analysis of additional factor (presence of CHD) reduced contribution of SDP to compliance to 25%, but it remained as before significant (p<0.0007). However addition to these factors of other parameters such as presence of diabetes mellitus or tonometer at home completely leveled effect of SDP on compliance to therapy (p<0.12). Conclusion. Presence of drugs in the SDP list significantly elevates compliance to therapy. However SDP does not appear the only independent predictor of high compliance. If SDP is considered together with other determining factors (presence of concomitant IHD and diabete, readiness to spend money for tonometer) its role as independent factor of high compliance is diminished and loses significance.

[The efficacy and safety of the combination of ß-blocker bisoprolol and if inhibitor I(f) ivabradine in patients with stable angina and chronic obstructive pulmonary disease].

The study was aimed to assess the efficacy and safety of treating coronary heart disease (CHD) patients complicated with COPD using the combination of tolerable doses of -blocker bisoprolol and inhibitor If-channel ivabradine, compared with bisoprolol alone. A total of 50 patients were included (88% men, mean age 62.8+/-7.2 years) with stable angina and clinical signs of bronchoobstruction (84% with COPD and 16% with bronchial asthma in remission phase). At the study start, all patients received bisoprolol, the dose of which was titrated until the clinical signs of intolerance (most common - bronchoobstruction) appeared or worsened. Average dose of bisoprolol at the time of forced titration stop was 6.3+/-2.2 mg/day, mean heart rate (HR) decreased from 82.1+/-8.4 to 72.2+/-8.5 bpm. Then, the patients were randomized into two groups: patients of the first group (n=25) continued to take bisoprolol in tolerable dose, and patients of the second group were added ivabradine (5-15 mg, mean dose 10.7+/- 3.1 mg/day). In contrast to the bisoprolol alone, combination therapy resulted in further decrease of HR to an average of 62.6+/-4.1 bpm over 6 month of follow-up. This was associated with additional decrease of the number of angina attacks (by 4.68+/-4.40 per week vs. 2.48+/-4.70, <0.05), nitrates consumption (by 206.0+/-153.6 mg/week vs. 95.6+/-134.2 mg/week, <0.01) and score of negative components of quality of life (by 5.16+/-3.3 vs. 2.24+/-4.5, <0.05), compared with the first group, respectively. In combination therapy group there was also the decrease of the inhaled broncholytics consumption (from 2.88+/-3.23 to 1.88+/-2.65 per week, <0.05), that was not evident in the first group. Average number of hospitalizations per 1 patient decreased over 6 months of follow-up, compared to the same period before the trial, in both groups, but more prominently in the combination therapy group (-0.31+/-0.55 vs. -0.56+/-0.76, accordingly, <0.1). Therefore, in the treatment of patients with CHD, stable angina and concomitant bronchoobsrtuctive manifestations, if not possible to administer -blockers in the adequate HR-reducing dose, the addition of ivabradine to the treatment could be the treatment of choice. The combination of tolerable doses of bisoprolol and ivabradine is s afe and allows to achieve adequate HR decrease. This is a ssociated with maximal antianginal effect, decrease in the need for broncholytic therapy, improvement of the quality of life and decrease of the number of hospitalizations, compared with the treatment with bisoprolol alone.

[Optimization of use of beta-adrenoblockers in the treatment of chronic heart failure in the outpatient setting].

AIM: to evaluate of the effectiveness of switching from beta-adrenoblockers (BAB) non-included into the guidelines for the management of chronic heart failure (CHF) to nebivolol and bisoprolol for outpatients. SUBJECTS AND METHODS: The study included 67 patients with stable Functional Classes (FC) II and II CHF who received the standard therapy and BAB non-included into the guidelines for the management of CHF. The patients were randomized to the groups taking bisoprolol (n = 35) or nebivolol (n = 32) in doses of 1.25 to 10 mg/day. Before and 6 months after therapy, the investigators assessed the patient's clinical status and quality of life (QL), performed a six-minute walk test and echography, and determined the blood level of the N-terminal fragment of brain natriuretic peptide prohormone (NT-proBNP). RESULTS: The switching to bisoprolol and nebivolol was followed by a significant clinical improvement, a larger covered distance, and better QL. Left ventricular ejection fraction was increased along with a reduction in mean FC CHF. There were no significant changes in NT-proBNP in the total patient group, but it was significantly decreased in the subgroup of those with the baseline high level of the peptide. CONCLUSION: The switching of patients with stable CHF from therapy with BAB not included into the guidelines for the management of CHF to nebivolol or bisoprolol yields positive results and improves left ventricular systolic function (which is attended by the reduction in NT-proBNP levels) and may be recommended for treatment in the outpatient setting.

[Clinical and vascular effects of ACE inhibitor enalapril in combination with thiaside-like diuretic indapamide in hypertensive outpatients. Results of the multicenter trial POEMA].

AIM: To evaluate efficacy and safety of a 6-month treatment of 237 patients with arterial hypertension (AH) of degree 1-3 with ACE inhibitor enalapril (mean dose 21.9 +/- 9.0 mg/day), 49.4% of which received adjuvant indapamide (2.5 mg/day), to study effects of this therapy on rigidity of the major arteries by dynamics of pulse wave velocity (PWV) and US rigidity index beta (RIB). MATERIAL AND METHODS: The study included only patients with initially elevated PWV which was detected in 266 (53%) of 501 examinees. RESULTS: Lowering of systolic and diastolic blood pressure (BP) was 16.8 and 14.0% to treatment month 3 and, in addition, 1.6 and 1. 7% to month 6, respectively (p < 0.001). Target BP (< or = 140/90 mm Hg) was achieved in 82.7% patients. During the trial 3 (1.2%) patients withdrew because of severe cough. Slowdown of PWV measured by brachiomalleolar (PWVbm) and carotid-femoral (PWVcf) methods was equal in the course of the trial and made up 2.45 and 6.1% to treatment month 3 (p < or = 0.05 for both) and additional 3.25 and 7.4% to month 6 (p < 0.001 for both), respectively. High PWV normalized completely in 42.6% patients. After 6 months of the trial US RIB decreased by 30.5% (p < or = 0.001). The correlation analysis detected a significant correlation between SAP fall and PWV decrease only during the first 3 months of therapy (r = 0.402, p = 0.005). In month 3-6 the correlation became insignificant (r = 0.28, p = 0.055). CONCLUSION: Combination of enalapril and indapamide is effective and safe in outpatients with arterial hypertension of the first-third degree and baseline high rigidity of the vascular wall. This treatment reduces PWV and rigidity of the major arteries associated with BP lowering (in the treatment month 1-3) and a vasoprotective effect of the drugs.

Efficacy of relaxation techniques in hypertensive patients.

We examined 117 outpatients (20- to 45-year-old men) with mild essential hypertension before treatment, after the main treatment course (6 weeks), and at 12-month follow-up. The patients were randomized into two major groups: (a) a treatment group that received autogenic training (23 patients), biofeedback (24 patients), or breathing-relaxation training (23 patients) and (b) a control group that consisted of 24 patients who did not receive any intervention and 23 patients who were treated with a "psychological placebo." Clinical, psychological, and psychophysiological data from all patients who were offered relaxation therapy were analyzed. By the end of follow-up, and compared to the control group, the treatment group demonstrated a significant reduction in systolic and diastolic blood pressures, peripheral vascular resistance, and hypertensive response to emotional stress, and an improvement in psychological adaptation, quality of life, and capacity for work. Comparative analysis of the efficacy of different relaxation methods revealed that biofeedback and breathing-relaxation training resulted in the greatest reduction in blood pressure. The antihypertensive effect of relaxation therapy correlated positively with pretreatment blood pressure levels and negatively with the duration of illness and certain psychological features.

The hypertensive heart: pathogenesis, variants, and prognostic value.

We examine the heart's involvement in arterial hypertension, reporting on several studies of hypertensive patients showing that left ventricular myocardial mass is a significant prognostic indicator of essential hypertension and that left ventricular hypertrophy (LVH) correlates with an induced increase in Ca2+ concentration in platelets. We also consider the LVH variant of asymmetric hypertrophy and the role of the hypertensive heart in coronary insufficiency, and we speculate on the significance of the degree of LVH and asymmetric hypertrophy as risk factors for predicting cardiac complications of essential hypertension.

[Nature of the reaction of blood plasma steroid hormones in hypertension to various types of stimulation]. / O kharaktere reaktsii steroidnykh gormonov plazmy krovi u bol'nykh gipertonicheskoi bolezn'iu na razlichnye vidy stimuliatsii.

Fifteen healthy persons and 31 patients with essential hypertension whose ages ranged from 18 to 45 were examined. The basal level of three steroid hormones (progesterone, aldosterone, and cortisol) in blood plasma and their level after loading (walking, furosemid and rest, furosemid and walking) were studied by the radioimmune method. It is shown that in comparison with healthy individuals, patients with essential hypertension are marked by a change in the ratio of the pressor (aldosterone, cortisol) to the depressor (progesterone) hormones in blood plasma during loading. In different types of loading, no direct correlation was found, on the whole, between the degree of the reactions of aldosterone and renin in healthy individuals and in patients with essential hypertension.

[Role of steroid hormones in the etiology and clinical course of hypertension]. / Uchastie steroidnykh gormonov v patogeneze i klinicheskom techenii gipertonicheskoi bolezni.

Examination was conducted of 33 healthy persons and 85 individuals suffering from hypertensive disease (stage IB, 52 patients and stage IIB, 33 patients) from 18 to 45 years of age. The basal level of three steroid hormones (progesterone, aldosterone, hydrocortisone) was studied by the radio-immune method. It was established that stabilization of arterial pressure is attended by an increase in the aldosterone/progresterone and aldosterone/hydrocortisone ratios. During one stage of the disease the basal level of steroid hormones varied within different limits, particularly in labile hypertension. The interconnection of blood plasma steroid hormone level and the age, duration of the disease, aggravation by hereditary factors, level of arterial pressure and daily and basal natriuresis was revealed.

[The effectiveness of psychorelaxation therapy in patients with hypertension]. / Effektivnost' psikhorelaksatsionnoi terapii u bol'nykh gipertonicheskoi bolezn'iu.

A study of 117 patients with labile essential hypertension before as well as 6 weeks and 12 months after psychorelaxation treatment (PRT), making use of autogenous training, biological feedback or respiratory relaxation training techniques (the main group), and the control patients, exposed to no psychological effects and those on the so-called psychological placebo, demonstrated a significantly greater fall of systolic and diastolic arterial blood pressure, total peripheral resistance and hypertensive response to emotional stress, as well as better psychological adaptation, quality of life and working capacity in the main-group patients, as compared to the controls, by the end of the study.

[Effect of salt on the functional state of the renin-angiotensin-aldosterone system in healthy persons and hypertensives]. / Vliianie soli na funktsional'noe sostoianie renin-angiotenzin-al'dosteronovoi sistemy u zdorovykh i bol'nykh gipertonicheskoi bolezn'iu.

A total of 16 normal subjects and 30 patients with IB (labile hypertension) and IIB (stable hypertension) stages of essential hypertension during excessive salt intake as well as 13 normal persons and 43 patients at the labile and stable stages of essential hypertension on usual salt diet were examined. Renin activity, plasma aldosterone and cortisol levels were studied using radioimmunoassay in the basal conditions and 1 and 5 hours later after intravenous administration of 5% saline solution (3,6-3,8 mu mole of sodium (1 kg body mass). It was demonstrated that the prolonged excessive intake of sodium hydrochloride resulted in the alteration of the functional state of the renin-angiotensin-aldosterone system even in the normal persons. The above alterations are characterized by the loss of the adequate response of the renin-angiotensin system and the adrenal cortex to the increased sodium concentration, and extracellular fluid volume in the body, as well as by the separation of the functions of these two humoral systems.

[Low renin variant of hypertension: functional relations of the renin-aldosterone pressor system]. / Nizkoreninovaia forma gipertonicheskoi bolezni: osobennosti funktsional'nykh sootnoshenii pressornoi sistemy renin-al'dosteron.

Renin-aldosterone function was studied in 23 patients with low-renin essential hypertension (LREH) under resting and stimulated conditions. Patients were selected on the basis of differential diagnostic tests of renin-angiotensin stimulation and inhibition as well as roentgeno-radiologic findings in order to rule out adrenal lesions. The results were compared with those of patients with primary aldosteronism and with essential hypertension where renin activity can be stimulated under similar sodium balance conditions. Intravenous or prolonged furosemide administration was shown to be the test of choice for the diagnosis of renin suppression. The renin-aldosterone system of LREH patients featured subnormal renin activity and normal aldosterone levels in baseline conditions, and the lack of renin stimulation together with limited aldosterone stimulation following functional tests. The analysis of changes in diuresis, natriuresis and the pattern of Na/K coefficient points to a great diuretic and natriuretic effect of furosemide in patients with LREH.

[The vasodilator minoxidil in the treatment of hypertension]. / Vazodilatator minoksidil v lechenii gipertonicheskoi bolezni.

A new vasodilating agent, minoxidil, was used in 17 patients with essential hypertension that had not responded sufficiently to combined treatment with 3 or 4 conventional hypotensive agents. After minoxidil was added, mean arterial BP dropped by 50 +/- 2.4 mmHg, the effect persisting for 3-4 months. Discontinuation of minoxidil after a short-term administration of 20 +/- 3.8 mg daily was accompanied with a BP rise eventually reaching baseline values, while gradual replacement with nifedipine after daily doses of minoxidil had been reduced smoothly over 3 or 4 weeks allowed to maintain mean arterial BP about 34 +/- 1.8 mm Hg below the baseline. The use of minoxidil in combination with beta-blockers and diuretics for 6 weeks resulted in a significant increase of left-ventricular myocardial weight, while cardiac contractility and pump function remained intact, as evidenced by electrocardiography. After 3 weeks of treatment, peripheral vascular resistance diminished in the forearm owing to reduced arterial and arteriolar tone, yet no reverse development of the vascular-wall adaptive structural changes could be seen at venous occlusion plethysmography.

[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.

[Long-term dispensary observation of patients with so-called low-renin forms of arterial hypertension]. / Dlitel'noe dispansernoe nabliudenie bol'nykh s tak nazyvaemymi nizkoreninovymi formami arterial'noi gipertonii.

The authors provided an analysis of the results of 3-year follow-up and therapy of 32 patients with hypertension developing with blood renin low activity. A prolonged, statistically significant decrease in the AP level with the improvement of the patients' subjective status was noted in continuous adequate hypotensive therapy. The most severe clinical course was observed in the group of patients with unresected adrenal adenoma. During treatment of patients with primary aldosteronism with spironolactone one should pay attention to the presence of some concomitant diseases (mastopathy, myoma of the uterus) because this drug may turn their course unfavorably, thus making the treatment of patients with adrenal pathology difficult.

[Use of various non-pharmacological methods in the treatment of patients in the early stages of arterial hypertension]. / Primenenie nekotorykh nemedikamentoznykh metodov dlia lecheniia bol'nykh s rannimi stadiiami gipertonicheskoi bolezni.

Patients with labile hypertension received various kinds of nonmedicinal therapy: psychological intervention (40 patients), acupuncture (25 patients), physical training (11 patients). Chemotherapy was provided to 38 patients. A significant antihypertensive effect was achieved with the use of the nonmedicinal therapeutic methods. Their efficacy was comparable with that of chemotherapy.

[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.

[Comparative effectiveness of the combined outpatient-hospital and outpatient treatments of hypertension patients with high and stable arterial pressure indices]. / Sravnitel'naia éffektivnost' kompleksnogo ambulatorno-statsionarnogo i ambulatornogo lecheniia bol'nykh gipertonicheskoi bolezn'iu, protekaiushchei s vysokimi i stoikimi urovniami arterial'nogo davleniia.

The paper is concerned with an analysis of the effectiveness of the outpatient and hospital stages in the treatment of patients with essential hypertension with stable and high AP indices. The absence of significant changes in the time course of AP, the number and nature of complications and the number of days of temporary disability was shown in 197 patients treated in the groups of outpatient and outpatient-hospital therapy.

[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.

[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.

[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.