Female and Male Phenotypes of Iron Deficiency in CHF. Additional analysis of the «The Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (J-CHF-RF)¼ study.

Aim    To evaluate the incidence of iron deficiency (ID) in men and women with chronic heart failure (CHF) and to compare clinical and functional indexes in patient with and without ID depending on the gender.Material and methods    An additional analysis of the study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)" was performed. The study included 498 (198 women, 300 men) patients with CHF, in whom, in addition to iron metabolism, the quality of life and exercise tolerance (ET) were studied. 97 % of patients were enrolled during their stay in a hospital. ID was defined in consistency with the European Society of Cardiology (ESC) Guidelines. Also, and additional analysis was performed according to ID criteria validated by the morphological picture of the bone marrow.Results    ID was detected in 174 (87.9 %) women and 239 (79.8 %) men (p=0.028) according to the ESC criteria, and in 154 (77.8 %) women and 217 (72.3 %) men (p=0.208) according to the criteria validated by the morphological picture of the bone marrow. Men with ID were older and had more severe CHF. They more frequently had HF functional class (FC) III and IV (63.4 % vs. 43.3 % in men without ID); higher concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and lower ET. HF FC III increased the probability of ID presence 3.4 times (p=0.02) and the probability of HF FC IV 13.7 times (p=0.003). This clinical picture was characteristic of men when either method of determining ID was used. In women, ID was not associated with more severe CHF.Conclusion    Based on the presented analysis, it is possible to characterize the male and female ID phenotypes. The male ID phenotype is associated with more severe CHF, low ET, and poor quality of life. In females of the study cohort, ID was not associated with either the severity of CHF or with ET.

[Iron deficiency in Russia heart failure patients. Observational cross-sectional multicenter study].

Aim    To evaluate the prevalence of iron deficiency (ID) in Russian patients with heart failure (HF).Material and methods    Iron metabolism variables were studied in 498 (198 women, 300 men) patients with HF. Data were evaluated at admission for HF (97 %) or during an outpatient visit (3 %). ID was determined according to the European Society of Cardiology Guidelines.Results    83.1 % of patients had ID; only 43.5 % of patients with ID had anemia. Patients with ID were older: 70.0 [63.0;79.0] vs. 66.0 years [57.0;75.2] (p=0.009). The number of patients with ID increased in parallel with the increase in HF functional class (FC). Among patients with ID, fewer people were past or current alcohol users (p=0.002), and a greater number of patients had atrial fibrillation (60.1 vs. 45.2 %, p=0.016). A multiple logistic regression showed that more severe HF (HF FC) was associated with a higher incidence of ID detection, whereas past alcohol use was associated with less pronounced ID. An increase in N-terminal pro-brain natriuretic peptide (NT-proBNP) by 100 pg/ml was associated with an increased likelihood of ID (odds ratio, 1.006, 95 % confidence interval: 1.002-1.011, p=0.0152).Conclusion    The incidence rate of HF patients is high in the Russian Federation (83.1 %). Only 43.5 % of these patients had anemia. The prevalence of ID in the study population increased with increases in HF FC and NT-proBNP.

Cardioprotective potential of chronopharmacotherapy in patients with arterial hypertension who had a transient ischemic attack.

Aim    Analysis of the cardioprotective effectivity of chronopharmacotherapy in patients with arterial hypertension (AH) after transient ischemic attack (TIA).Material and methods    174 patients with AH and TIA were evaluated. All patients were randomized to three groups based on the dosing schedule of chronopharmacotherapy: group 1 (n=59), patients receiving indapamide retard 1.5 mg and valsartan 160 mg, both in the morning; group 2 (n=58), indapamide retard 1.5 mg in the morning and valsartan 160 mg in the evening; group 3 (n=57), indapamide retard 1.5 mg in the morning and valsartan 80 mg in the morning and evening. Echocardiography (EchoCG) (ALOKA SSD 2500, Japan) was performed for all patients at baseline and at 12 months of the treatment. Statistical analysis of results was performed with the Statistica 12.0 (StatSoftInc, USA) software.Results    Before the treatment, EchoCG parameters did not significantly differ between the patient groups. After 12 months of the treatment, positive changes in the end-systolic dimension (ESD), interventricular septal thickness (IVST), thickness of the left ventricular posterior wall (TLVPW), LV myocardial mass (LVMM), LVMM index (LVMMI), ejection fraction (EF), ratio of transmitral early peak flow velocity and late filling flow velocity (E/A), and isovolumetric velocity relaxation time (IVRT) were more pronounced in the group of sartan evening dosing (group 2) than in the group of sartan single morning dosing (group 1) (p<0.05). In group 3, the changes in ESD, IVST, TLVPW, LVMM, LVMMI, EF, E/A ratio, deceleration time (DT) of LV, and IVRT were significantly greater than those in group 1, whereas the dynamics of ESD, IVST, TLVPW, LVMM, LVMMI, E/A ratio, and DT were better in group 3 than in group 2 (p<0.05). In addition, a significantly greater number of patients with normalized LV geometry was registered in group 3 compared to groups 1 and 2 (p<0.05). The number of patients with normal LV diastolic function after the treatment was also significantly greater in group 3 than in group 1 (p<0.05) and comparable with group 2.Conclusion    The morning dosing of indapamide retard and the b.i.d. dosing of valsartan provided more pronounced beneficial changes in major EcoCG indexes and improvement of LV geometry and diastolic function than the sartan single dosing only in the morning or evening in combination with the diuretic.

Gender Differences in Vascular Stiffness Indicators and Daily Blood Pressure Profile in Patients with Arterial Hypertension and Depressive Disorders.

Aim      To study gender-related characteristics of vascular wall stiffness (VWS), central blood pressure (CBP), and BP diurnal profile in patients with arterial hypertension (AH) and depression.Material and methods  This prospective, noninterventional study enrolled 161 patients, including 98 patients with AH and depression (50 (51 %) men and 48 (49 %) women) and 63 patients with AH without depression (32 (50.8 %) men and 31 (49.2 %) women. The 24-h BP monitoring (24-h BPM) with a BPLab Vasotens hardware system was performed for all patients. The following indexes were evaluated: mean diurnal, mean daytime, and mean nighttime systolic and diastolic BP (SBP and DBP); daytime and nighttime SBP and DBP time index; SBP and DBP variability; and suite of metrics characterizing VWS and CBP. Depression was diagnosed with the Hospital Anxiety and Depression Scale (HADS) and the Zung Self-Rating Depression Scale. Statistical analyses were performed using the STATISTICA 12 software.Results In the patient group with AH and depression, practically all indexes of 24-h BPM were higher for men than for women (р<0.05). Most 24-h BPM parameters did not differ in groups of men and women without depression. Independent of gender, 24-h BPM parameters were significantly higher in patients with both AH and depression than in AH patients without depression. Adverse changes in major indexes of VWS and CBP, were more pronounced in men than in women with AH and depression (р<0.05). Adverse changes in most VWS and CBP indexes were more statistically significant for men with AH and depression than for men without depression.Conclusion      The presence of depression in men and women with AH was associated with significant pathological changes in both BP diurnal profile and CBP and VWS parameters. Furthermore, adverse changes in indexes were more pronounced for men with depression than for women. The study results should be taken into account in administration of antihypertensive and psychocorrective drug therapy to personalize the treatment and provide not only optimization of diurnal BP profile but also vasoprotection.

[Antihypertensive and Vasoprotective Effects of Combined Pharmacotherapy in Patients with Arterial Hypertension and Prediabetes].

Aim To evaluate effects of different types of combination drug therapy on indexes of 24-h blood pressure monitoring (24-h BPM), arterial stiffness, and central aortic pressure (CAP) in patients with arterial hypertension (AH) and prediabetes.Materials and methods The study included 120 patients with AH and prediabetes. After randomization using envelopes, three treatment groups were formed: group 1, patients receiving perindopril, indapamide SR, and metformin (n=40); group 2, patients receiving perindopril, moxonidin, and metformin (n=40); and group 3, patients receiving perindopril, indapamide SR, and amlodipine (n=40). 24-h BPM, determination of arterial stiffness, and measurement of CAP were performed for all patients.Results After 24 weeks of treatment, patients of all groups showed statistically significant improvements of most indexes of 24-h BPM, arterial stiffness, and CAP. In groups 2 and 3, the treatment was associated with significantly more pronounced beneficial changes in 24-BPM, arterial stiffness, and CAP compared to group 1. Antihypertensive and vasoprotective effects of the perindopril+moxonidin+metformin and perindopril+indopamide SR+amlodipine combinations were comparable.Conclusion The observed statistically significant antihypertensive and vasoprotective effects of the perindopril+moxonidin+metformin combination along with its known positive metabolic effect allow recommendation of this combination therapy to patients with AH and prediabetes as an effective strategy for BP control.

Antihypertensive and vasoprotective effectiveness of the chronopharmacotherapy in patients with arterial hypertension after acute cerebrovascular accident.

AIM: To evaluate the effectiveness of combined antihypertensive chronopharmacotherapy and estimate the daily blood pressure profle (BP) parameters, such as: stiffness of the vascular wall and central aortic pressure in patients with arterial hypertension (AH) who underwent transient ischemic atack (TIA) or ischemic stroke (IS). MATERIALS AND METHODS: 235 patients with hypertension who underwent acute cerebrovascular accident were examined. Tere were 116 patients with TIA and 119 with IS. All patients were randomized in 4 groups according to regimen of antihypertensive drugs combination. Te 1st group (n = 59) included patients with AH, who underwent TIA and received indapamide retard 1.5 mg and valsartan 160 mg in the morning regiment of drug therapy. Te 2nd group (n = 57) included patients with AH, who underwent TIA and received indapamide retard 1.5 mg in the morning and valsartan 80 mg twice a day (morning and evening). Te 3rd group (n = 47) included patients with AH, who underwent IS and received indapamide retard 1.5 mg and valsartan at a dose of 160 mg in the morning. Te 4th group (n = 56) included patients with AH, who underwent IS and received indapamide retard 1.5 mg in the morning and valsartan 80 mg twice a day (morning and evening). Ambulatory blood pressure monitoring (ABPM), central aortic pressure (CAP) measurement and vessel wall stiffness values were evaluated before treatment and afer 12 months of therapy. RESULTS: Before the start of combined antihypertensive chronopharmacotherapy, most of the parameters for ABPM, vessel wall stiffness values and CAP in groups 1 and 2, 3 and 4 were comparable. Achievement of the target level of BP afer 8 weeks of treatment, was signifcantly more ofen in groups with a double sartan therapy (group 2 and group 4) in compare with its single time application only in the morning hours (group 1 and group 3) (p<0.05). Statistically signifcant positive dynamics of the main values of the daily profle of blood pressure, stiffness of the vascular wall and central aortic pressure (p <0,05) were registered in all groups. However, more pronounced decline of main parameters of ABPM, stiffness of the vascular wall and central aortic pressure values were noted in group with double use sartan therapy in compare with single time sartan therapy in the morning time. (p <0.05). Signifcant positive dynamics of the main values of the ABPM, stiffness of the vascular wall and CAP were registered in patients who underwent IS and received double application sartan therapy (4th group) in compare with patients with TIA (2nd group) (p = 0.02). CONCLUSION: Double use sartan therapy, combined with a thiazide diuretics in patients, who underwent IS or TIA more ofen promotes to get target values of blood pressure, improve the main values of the ABPM, stiffness of the vascular wall and CAP in compare with single time sartan therapy in the morning time.

[Effectiveness of chronopharmacotherapy in salt-sensitive and salt-resistant patients with chronic heart failure and preserved ejection fraction].

The aim of the study was to evaluate the influence of chronopharmacotherapy on the indices of the structural and functional state of the left ventricular myocardium in patients with arterial hypertension (AH), type 2 diabetes mellitus and heart failure with preserved ejection fraction (HFpEF) considering of salt-sensitivity. MATERIALS AND METHODS: Included 130 patients with uncontrolled AH, type 2 diabetes and HFpEF (81 women and 49 men), median age - 59 (38-72) years. Patients were divided into 2 groups: saltsensitive (group 1) and salt-resistant (group 2), and then randomized to 2 subgroups depending on the treatment option: morning ramipril and indapamide retard, in the evening amlodipine (subgroup 1A and 2A) or in the evening ramipril, in the morning indapamide-retard and amlodipine (subgroup 1B and 2B). Initially and after 24 weeks of antihypertensive therapy, an echocardiographic study was carried out with an assessment of the main indicators of the structural and functional state of the left ventricular (LV) myocardium, a 6-minute walk test for determining the functional state of patients. RESULTS: After 24 weeks in all subgroups there was a reliable positive dynamics of echocardiographic indicators. In the group of salt-sensitive patients, the reception of the angiotensin converting enzyme inhibitor (ACE inhibitor) in the evening and thiazide diuretic (TD) + calcium antagonists (AC) in the morning provided a signifcantly more signifcant reduction in the majority of LV myocardial remodeling parameters compared with the administration of ACE inhibitor + TD in the morning and AK in the evening. In the case of salt-resistant patients, comparable positive changes in echocardiographic indicators were noted against the background of both dosing regimens during the day. Against the background of the treatment, irrespective of the salt sensitivity and dosing regimen, an unreliable and comparable increase in the distance of the 6-minute walk test was recorded during the day. CONCLUSION: In salt-sensitive patients with AH, type 2 diabetes and HFpEF, the use of ACE inhibitor before bedtime provided signifcantly more signifcant regression of the parameters of the structural and functional state of LV myocardium compared with the morning reception. In the group of salt-resistant patients, the efcacy of both dosing regimens during the day was comparable.

[Efficiency of triple antihypertensive therapy in patients with uncontrolled hypertension and depressive disorders]. / Éffektivnost' trekhkomponentnoi antigipertenzivnoi terapii u patsientov s nekontroliruemoi arterial'noi gipertoniei i depressivnymi rasstroistvami.

AIM: To evaluate the efficiency of triple antihypertensive therapy in patients with uncontrolled hypertension and depressive disorders (DD). MATERIAL AND METHODS: 153 patients with uncontrolled hypertension were examined, of whom 82 patients were diagnosed with mild and moderate DD. A combination of perindopril 10 mg/day, indapamide SR 1.5 mg/day, and amlodipine at an initial dose of 5 mg/day was given to patients with hypertension and DD. After 4 weeks of treatment, if target blood pressure (BP) levels could not be achieved, the dose of amlodipine was increased up to 10 mg/day. General clinical examination and 24-hour BP monitoring (BPM) were performed in all the patients at baseline and in the patients with DD also after 24 weeks of therapy. The traditional measures of the diurnal BP profile, as well as the parameters characterizing arterial stiffness and central aortic pressure (CAP) were estimated. RESULTS: After 8 weeks of therapy, target BP levels were recorded in 63 (76.8%) patients. After 24 weeks of treatment, the hypertensive patients with DD showed significant positive changes in all the investigated 24-hour BPM parameters and normalization of the diurnal BP profile in 65.1% of cases. During the treatment, there were significant decreases in pulse wave velocity, brachial arterial and aortic augmentation indices, aortic systolic and diastolic pressures, and mean aortic BP and an increase in the velocity of the reflected wave. CONCLUSION: Triple therapy, including perindopril, indapamide SR, and amlodipine, contributed to the achievement of target BP levels in the majority of hypertensive patients with DD, with significant positive changes in all 24-hour BPM parameters, optimization of the diurnal BP profile in most patients, clinically significant improvement of the parameters that characterize arterial stiffness and CAP.

[The Effectiveness of Combination Antihypertensive Therapy in Women With Hypothyroidism and the Metabolic Syndrome].

PURPOSE OF THE STUDY: Evaluating the effectiveness of the various options of combination antihypertensive therapy (AHT) in women with arterial hypertension (AH) and metabolic syndrome (MS) and hypothyroidism. MATERIAL AND METHODS: The study included 163 women with hypertension, metabolic syndrome, and hypothyroidism, the median age of 53.5 (48-60) years; in 73 (44.8%) women were diagnosed with subclinical hypothyroidism (SH), 90 (55.2%) - overt hypothyroidism (OH). Patients with both SH and OH, depending on the source of the heart rate (HR) was appointed as one of the following combination of AHT. If heart rate <75 beats/min, patients (n=100) received a combination of the dihydropyridine calcium antagonist (AA) amlodipine 5 mg/day, and angiotensin receptor blockers II (ARB) losartan 50 mg/day, with heart rate >75 beats/min (n=63) - a combination of amlodipine 5 mg/day and imidazoline receptor agonist (IRA) moxonidine 200 micrograms/day. The failure to achieve target blood pressure (BP) after 4 weeks of dose drugs doubled with subsequent evaluation of the effectiveness even after 4 weeks. At baseline and after 6 months of therapy, all patients underwent daily blood pressure monitoring (DBPM). RESULTS: At 8 weeks, the use of a combination of AA+ARB target BP level was registered in 26 (59%) of 44 women with SH and 34 (60.7%) of the 56 - OH. In the group of women who took the AA+IRA, after 8 weeks of the target blood pressure was observed in 24 (82.8%) of 29 patients with SH and 28 (82.4%) of 34 - to OH. Register the target blood pressure was observed significantly more frequently (p<0,05) when using a combination of AA+IRA compared with AA+ARBs as with SH and OH. As a result of the combination of DBPM AA and ARBs in patients with SH and OG provided a significant reduction in average daily, daytime and nighttime systolic and diastolic blood pressure (SBP and DBP), the time index of SBP and DBP during the day and night hours. The therapy of AA and IRA regardless of the severity of hypothyroidism, there was a significant improvement in all indicators DBPM: average daily, daytime and nighttime SBP and DBP, time index and variability in SBP and DBP during the day and at night. Furthermore, as in the SH and OH significantly more pronounced positive changes most DBPM parameters were recorded using IRA in combination with AA compared with a combination AA+ARB. Significant increase in the number of women with optimal BP daily profile "dipper" observed only when using amlodipine and moxonidine. CONCLUSION: In women with hypertension, hypothyroidism and MS, regardless of the severity of decline of thyroid function and combination of the dihydropyridine AA IRA had an advantage over the AA combination with ARBs, since most patients provided achieving target blood pressure and clinically significant positive impact on BPM indicators. The results can be used in selecting the optimal AHT in patients with hypertension, MS, and the manifest subclinical hypothyroidism.

[Hronotherapy Aspects of Efficiency Azilsartan Medoxomil in Combination Therapy in Patients With Hypertension and Metabolic Syndrome].

OBJECTIVE: Determination of the effectiveness and safety of different dosing regimens during the day (in the morning or at bedtime) combination therapy including azilsartan medoxomil in patients with essential hypertension and metabolic syndrome (MS). DESIGN AND METHODS: The study included 60 patients with uncontrolled hypertension and MS (age median - 59 (54-65) years). Patients were randomized in two groups: group 1 (n=30) received azilsartan medoxomil 40 mg/day, and indapamide retard 1,5 mg/day in the morning; group 2 (n=30)- azilsartan medoxomoil 40 mg at bedtime and indapamide retard 1,5 mg in the morning. All patients at baseline, and after 4 and 12weeks assessed levels of office blood pressure (BP), heart rate (HR); at baseline and after 12 weeks was conducted ambulatory BPmonitoring (ABPM). Evaluated the main indicators of circadian blood pressure profile, as well as the central aortic pressure (CAP) and the rigidity of the vascular wall: systolic, diastolic, and mean arterial pressure in the aorta, aortic augmentation index, pulse wave velocity in the aorta, the augmentation index. Study results were processed using the program Statistica 6.1 by methods nonparametric statistics. RESULTS: Regardless of the regimen used azilsartan destination as part of combination therapy after 4 weeks showed a significant (p<0.05) reduction in SBP and DBP. After 12 weeks of observation target blood pressure was recorded 27 (90%) patients of group 1 and 29 (96.7%)- group2. As a result of ABPM after 12 weeks of treatment in both groups showed a statistically significant (p<0.05) improvement in all parameters investigated. However, positive changes such indicators as an index time of hypertension in the day and night hours, SBP, DBP, and BP variability during the night, the morning rise of systolic as well as the speed of morning rise in SBP and DBP were more pronounced in the appointment azilsartan medoxomil at bedtime compared to morning reception. The use of both treatment regimens provided significant (p<0.05) increase frequency registration profile dippear and reduction - non-dipper. Importantly, irrespective of the time of taking the drugs in both groups occurred significant (p <0.05), and a comparable improvement in rigidity and CAP vascular wall. CONCLUSION: When combined with essential hypertension and MS azilsartana use of combination drug therapy provided achievement of the target values of blood pressure in the majority of patients, a significant improvement in the main indicators of ABPM, CAP, and the rigidity of the vascular wall, as well as the normalization of daily profile of blood pressure in the majority of patients, regardless of dosing regimen during the day. However, the combination of indapamide retard morning - azilsartan medoxomil at bedtime accompanied by a significantly greater positive changes most ABPM parameters, especially at night.

[Effectiveness of Dispersible Forms of Perindipril in Patients With Uncontrolled Arterial Hypertension in Clinical Practice].

AIM: The study was aimed at evaluating the efficacy and usability of a dispersible form of perindopril in patients with arterial hypertension (HT) in clinical practice. MATERIALS AND METHODS: The study enrolled 52 patients with newly diagnosed or uncontrolled HT of grade 1-2. The baseline assessment consisted of physical examination, instrumental and laboratory tests, including electrocardiography, clinical and biochemical blood tests, measurement of daily albuminuria, and estimation of glomerular filtration rate (GFR). The assessment was repeated at 12 weeks of treatment. The patients were asked to complete questionnaires at the first visit, in order to determine the potential need for administration of dispersible tablets, and at the last visit, to evaluate the convenience of their use. Depending on the baseline blood pressure (BP) and the risk for cardiovascular events, patients were treated with perindopril dispersible form 10 mg/daily in monotherapy, or with combination of perindopril 10 mg/daily in the dispersible form and indapamide retard 1.5 mg/daily. The interim assessments of the treatment efficacy and safety were carried out at 2 and 4 weeks, and the final assessment was performed at 12 weeks from inclusion. RESULTS: The target BP was achieved in 22 (42.3%) patients at 2 weeks, 35 (67.3%) patients at 4 weeks, and 50 (96.2%) patients at 12 weeks of treatment. The reductions in systolic and diastolic BP, assessed by office BP measurements and BP self-control, as well as reduction in heart rate became significant (<0.001) as earlier as after 2 weeks of treatment, and this trend continued up to 12 weeks. In addition, the treatment was associated with by a significant reduction in daily albuminuria, serum creatinine, and increase in GFR. According to the survey data, 71.4% of patients preferred dispersible form of perindopril to the ordinary one, considering it as more convenient, effective and applicable in various everyday situations. CONCLUSION: In patients with HT, the dispersible form of perindopril in monotherapy and in combination with a diuretic provides a rapid and substantial BP reduction, as well as the achievement of target BP values in the majority of cases. In addition, such a treatment is associated with a significant positive effect on the heart rate, as well as on the renal function. Treatment with a soluble form of perindopril is well tolerated by patients and is estimated by them as a convenient and effective one.