[Subclinical markers of liver damage in patients with arterial hypertension and obesity].

AIM: To investigate the possibility of preclinical detection of liver damage in patients with hypertension and obesity. MATERIALS AND METHODS: The study included 168 patients with hypertension aged 30 to 60 years. All patients underwent general clinical and laboratory-instrumental examination, including ultrasound of the abdominal organs with Doppler assessment of blood flow and determination of markers such as ALT, AST, TG, lipid profile indicators at inclusion, after a month, three months and nine months. RESULTS: Depending on the presence of obesity, all patients with hypertension were divided into two groups. Obese patients had a statistically significant increase in office blood pressure, FSI, the ratio of TG and LDL-C to HDL-C, a more significant higher average levels of glucose, TG and ALT levels, as well as impaired hepatic blood flow according to ultrasound. CONCLUSION: Indicators of FSI, ALT/AST ratio, ratio of TG and LDL-С to HDL-C as well as assessment of hepatic blood flow indicators can be used for early diagnosis of nonalcoholic fatty liver disease, as they predict liver steatosis.

[Obesity in metabolic syndrome, as well as kidney dysfunction]. / Ozhirenie pri metabolicheskom sindrome i pochechnaia disfunktsiia.

The presence of metabolic syndrome (MS) in a patient allows him to be assigned to a group at high risk for atherosclerosis, cardiovascular events, coronary heart disease, and type 2 diabetes mellitus. In addition, MS negatively affects not only the heart and vessels, but also kidney function, which leads to chronic kidney disease (CKD). MS is pathogenetically associated with CKD and is an independent prognostic factor of the development of the latter, namely, the involvement of the kidney frequently determines prognosis and quality of life in these patients. The paper gives a modern view on the concept of MS and CKD and considers its main diagnostic criteria, etiology, and pathogenesis. The study of the relationships between MS and CKD may suggest that the high prevalence of kidney dysfunction in the general population is largely determined by metabolic nephropathies, including obesity-related nephropathy. The identification of risk factors and poor prognostic markers in this category of patients seems to be extremely important for the early diagnosis of the disease and their timely elimination is one of the main approaches to the comprehensive prevention of CKD in these patients.

[Renin inhibitors--new direction in the treatment of arterial hypertension].

The paper covers current problems in the treatment of arterial hypertension. Renin is an important and promising therapeutic target. The direct renin inhibitor aliskiren (Rasilez) is a promising current effective antihypertensive agent that has cardio- and nephroprotective effects. The paper considers a number of clinical studies that have proven the antihypertensive effect of aliskiren and revealed its benefits versus other drugs recommended for blood pressure lowering. It is assumed that this agent may be used in combinations with angiotensin-converting enzyme inhibitors, thiazide or thiazide-like diuretics, and calcium antagonists. Moreover, aliskiren neutralizes the effect of feedback in the compensatory increase in the activity of plasma renin.

[Comparative trial of efficacy of trimethasidine MB and 3-(2,2,2-trimethylhydrasine) propionate dihydrate in chronic heart failure].

AIM: To study efficacy of the myocardial cytoprotector trimethasidine MB and metabolic drug 3-(2,2,2-trimethylhydrasine) propionate dihydrate (3-TMHP) in the treatment of chronic cardiac failure (CCF). MATERIAL AND METHODS: Sixty-five patients with CCF after myocardial infarction (> 6 months) with left ventricular ejection fraction (LV EF) <40% were randomized into 3 groups: group 1 (n=28) received basic therapy plus trimethasidine in a daily dose 70 mg; group 2 (n=25)--basic therapy plus 3-TMHP in a daily dose 1000 mg; control group (n=12) received basic therapy with ACE inhibitors, beta-blockers and diuretics. Before and after 6-month treatment all the patients have undergone stress echocardiography with dobutamine. Perfusion and myocardial metabolism were determined in 34 patients with single photon emission computed tomography of the myocardium (SPECT) with 99m-Tc-technetril and positron-emission tomography of the myocardium (PET) with F-18-fluorodesoxyglucose. RESULTS: Groups 1 and 2 significantly reduced functional class of CCF and prolonged the distance of a 6-min walk. Significant improvement of life quality was observed only in the treatment with trimethasidine. According to PET, treatment with trimethasidine MB and 3-TMHP has an anti-ischemic action manifesting with a significant attenuation of glucose hypermetabolism in the ischemic segment to normal values. However, significant improvement of systolic thickening in hybernated segments by SPECT as well as a significant rise of LV EF were recorded only in the treatment with trimethasidine MB. Stress echocardiography with dobutamine had high specificity (85.7%) but low sensitivity (50.4%) in detection of hybernated myocardium. CONCLUSION: Trimethasidine MB (preductal MB) has advantages over 3-TMHP, so it is preferable in ischemic CHF.

[Modern antidepressants in complex management of patients with hypertension and concomitant affective disorders]. / Sovremennye antidepressanty v kompleksnom lechenii bol'nykh s arterial'noi gipertenziei s soputstvuiushchimi affektivnymi rasstroistvami.

According to results of multiple studies depression and anxiety are found in more than 50% of patients with hypertension. Presence of affective disorders elevates risk of progression of hypertension. That is why complex therapy comprising antihypertensive drugs from various groups and antidepressants takes on higher and higher significance. Modern antidepressants produce no substantial cardiotoxic effects. Combination of an antihypertensive drug (angiotensin converting enzyme inhibitor captopril or beta-adrenoblocker metoprolol) with an antidepressant affects favorably clinical course of hypertension, 24-hour blood pressure profile, characteristics of intracardiac hemodynamics, structural and geometric left ventricular parameters, allows to achieve sufficient antihypertensive effect with acceptable tolerability.