[Systemic and local stiffness of the arteries in young patients with arterial hypertension].

UNLABELLED: The aim of the work was to study characteristics of systemic and local arterial stiffness in young patients with arterial hypertension (AH) suffering this condition in the childhood or adulthood and to relate them to risk factors of cardiovascular complications. Materials and methods. 54 patients aged 18-35 (mean 25.3 +/- 3.4) years with AH. 37 of them had AH since 18 year and 27 ones starting from the childhood or adulthood Control group included 26 healthy volunteers aged 25.8 +/- 3.7 year. The carotid-femoral pulse wave propagation rate (PWPR) was measured by applanation tonometry with a SphygmoCor apparatus. Parameters of carotid stiffness of CCA were studied by the echo-tracking method using Aloka ProSound a7 device. Results. Patients with AH and without it in the childhood or adulthood showed higher PWPR values than controls (7.1 +/- 1.2 and 7.5 +/- 1.4 vs. 6.3 +/- 1.0 m/s respectively) Ep and AC values were higher in patients who did not have AH in the childhood or adulthood: right Ep 89 +/- 24.4 and 68.7 +/- 18.4 kPa, AC 0.9 +/- 0.2 and 1.1 +/- 0.1 mm2/kPa respectively; left Ep 86.1 +/- 20.3 and 71/4 +/- 16 kP AC 0.9 +/- 0.2 and 1.1 +/- 0.1 mm2/kPA (p < 0.05). In the patients with AH since the childhood or adulthood with concomitant metabolic syndrome (MS) the PWPR values and carotid artery stiffness were higher than in the absence of MS (p < 0.05). CONCLUSION: Young patients with AH showed carotid-femoral PWPR compared with control regardless of AH in the childhood or adulthood Parameters of local carotid stiffness were increased only in patients having no AH in the childhood or adulthood Patients with AH since the childhood or adulthood with concomitant MS had higher carotid stiffness and carotid-femoral PWPR than in the absence of MS

[Comparison of morphological features of carotid arteries atherosclerotic plaques with clinical-instrumental data in symptomatic and asymptomatic patients with severe carotid atherosclerosis].

A complex histomorphometric and clinical-instrumental analysis of atherosclerotic lesions of the carotid arteries obtained during carotid endarterectomies (CEE) of patients with hemodynamically significant stenoses was conducted. Two groups of patients were compared: symptomatic, which earlier underwent cerebral vascular accident (CVA) or transitory ischemic attacks (TIA), and asymptomatic ones with no complications of the disease. Statistical analysis of clinical and laboratory data showed no significant differences between two groups except for the level of lipoprotein(a) [Lp(a)] in the blood plasma, which was higher (p<0.05) in asymptomatic patients compared with symptomatic ones. Statistical analysis of carotid arteries ultrasound duplex scanning (USDS) in the preoperative period did not reveal significant differences in the degree of maximum vessels stenosis between the compared groups of patients. Surface defects of atherosclerotic plaques (ASP) were shown to be significantly more common (p<0.05) in the group of symptomatic patients compared with asymptomatic ones. According to histological analysis 88% of extracted ASP was unstable in symptomatic patients and 77% of ASP - in asymptomatic patients. This may indicate high risk of CVA/TIA in both groups of patients. Statistical evaluation of magnetic resonance tomography (MRT) and USDS techniques in comparison with abilities of the most reliable histological analysis showed that both non-invasive diagnostic methods are highly sensitive in detecting unstable ASP, though MRT showed higher level of specificity compared with USDS.

[Arterial stiffness and blood levels of glycation end-products in patients with arterial hypertension and carotid atherosclerosis].

Combination of arterial hypertension (AH) and carotid atherosclerosis significantly increases the risk of cardiovascular complications. Arterial stiffness is believed to be a key risk factor of the development of such complications. This paper described peculiarities of this condition, methods for its assessment in patients with AH and carotid atherosclerosis, and importance of characteristics of regional and local stiffness for estimation of cardiovascular risks. The role of glycation end-products in damaging arterial walls and triggering pathogenetic mechanisms of atherosclerosis is discussed.

[Effectiveness and safety of losartan and its combination with amlodipine in therapy of arterial hypertension].

AIM: To estimate effectiveness and safety of losartan and its combination with amlodipine in therapy of arterial hypertension. MATERIALS AND METHODS: The study based at 6 clinical centres was conducted in two stages. All 160 patients with grade I-II AH (103 women and 57 men aged 54 ± 12 yr) participated in stage 1 of the study and patients of centre No 1 (n = 100) in stage 2. Losartan was used at a dose of 50-100 mg/24 h for 8 weeks (stage 1) and thereafter from week 9 to 26 (stage 2) in combination with amlodipine (5-10 mg/24 hr) if the desired AP level (< 140/90 mmHg) was not achieved. The following parameters were measured: systolic and diastolic AP (SAP and DAP) (office measurement and 24-hr monitoring), pulse wave propagation rate (PWPR), left ventricle mass index (LVMI), thickness of intima-media complex (IMT), blood biochemistry, tolerability of therapy and its side effects. RESULTS: Losartan alone decreased SAP and DAP from 150 ± 11/91 ± 7 to 132 ± 12/81 ± 8 mm Hg (office measurement) and from 144 ± 10/86 ± 9 to 128 ± 12/76 ± 10 mm Hg (24-hr monitoring); heart rate decreased fom 74 ± 8 to 70 ± 8/min (p < 0.05). SAP and DAP in 66 patients who completed stage 2 was 122 ± 6/73 ± 6 mm Hg or significantly lower than before therapy (147 ± 9/87 ± 9) (p < 0.001). Mean daily decrease of SAP and DAP according to 24-hr monitoring decreased from 144 ± 10 to 128 ± 12 and from 86 ± 9 to 76 ± 10 mm Hg respectively (p < 0.001). The target AP value was reached in 73% of the cases (99 out of 136 patients) after stage 1 and in 95% cases (63 out of 66) after stage 2. The values of LVMI (105 ± 23 and 98 ± 26 g/m2), PWPR from 16 ± 2.1 to 13 ± 3.5 m/s (p < 0.05), IMT (0.76 ± 0.16 and 0.80 ± 42 mm), and microalbuminuria (11.0 ± 1.7 and 8.6 ± 0.7 mg/24 hr) before and after completion of stage 2 were not significantly different in 66 patients (p > 0.05). Biochemical parameters of blood did not appreciably change. The safety profiles of both drugs were on the whole positive. Deaths and adverse reactions were absent barring clinically insignificant side effects in 28 of the 160 patients (17.5%). CONCLUSION: Losartan and amlodipine are effective and safe agents for AH therapy.

[Possibilities of instrumental methods of diagnosis of unstable atherosclerotic plaques of carotid arteries].

Today there exists a wide variety of laboratory and instrumental methods aimed at diagnosing an unstable carotid aortosclerotic plaque. Assessment of the laboratory indices is not sufficiently effective since it does not allow of revealing the fact of the formation of an unstable plague at early stages and to determine its localization. The instrumental methods employed (ultrasonographic study, magnetic resonance imaging, multiplanar computed tomography, positron emission tomography) were focussed on detecting pathomorphological markers of instability - thickness of the fibrous coating, structural plaques, the presence of erosions, ulcerations, haemorrhages, calcifications, lipid nucleus, activity of the cellular processes inside the plaque. The revealed signs promote early diagnosis of unstable atherosclerotic plaque with the determination of its localization. Nevertheless, they do not provide evidence about the danger of its rupture, whereas the overwhelming majority of acute vascular catastrophes including acute impairments of cerebral circulation is directly associated with arterial thrombosis resulting from rupture of the atherosclerotic plaque. Therefore, search for new methods aimed at prediction of complications of the atherosclerotic plaque which would be employed in routine clinical practice still remain urgently important today. The most promising is the study of the state of the atherosclerotic plaques of carotid arteries for prediction of acute impairment of cerebral circulation.

[Increased arterial stiffness is a significant but not obligatory factor of arterial hypertension in persons over 60 years of age].

AIM: To ascertain whether high arterial rigidity is obligatory in arterial hypertension (AH) and the presence of AH is obligatory in patients with rigid arteries. MATERIAL AND METHODS: Volume sphygmography (VS) was made in 153 patients aged 60-86 years: 96 patients with untreated AH of degree 1-3 (40 males aged 71.0 +/- 7.6 years) and 57 normotensive subjects without cardiovascular symptoms (31 males aged 66.6 +/- 6.2 years). VS measured ankle-shoulder velocity of the pulse wave (PWVas) and cardiac-ankle vascular index (CAVI). PWVas > M+STD and CAVI > M+2STD (STD is deviation from mean value) were considered above normal for the age. RESULTS: Hypertensive patients had significantly higher arterial rigidity than normotensives (PWVas 178 +/- 3.0 and 15.6 +/- 2.3 m/s, respectively, p = 0.00001); CAVI--9.7 +/- 2.1 and 8.6 +/- 1.1, respectively, p = 0.0003). Arterial rigidity in hypertensive patients occurred significantly more frequently than in normotensive subjects: by PWVas in 46 and 25% cases (p = 0.01), by CAVI--in 41 and 5% cases (p < 0.0001), respectively. It is essential that arterial rigidity was not increased in 54% hypertensive patients by PWVas and in 75% by CAVI. CONCLUSION: PWVas and CAVI were higher in elderly hypertensives than in elderly normotensives but elevated arterial rigidity was not obligatory in hypertensives while 25% elderly normotensives had it. Thus, elevated arterial rigidity is an essential but not obligatory mechanism of AH development in the elderly.

[Effectiveness of synthetic opioid peptide dalargin in acute myocardial infarction]. / Effektivnost' sinteticheskogo opioidnogo peptida dalargina pri ostrom infarkte miokarda.

The synthetic opioid peptide dalargin was examined for its potency in 86 patients with primary transmural myocardial infarction. The agent was shown to contribute to a decrease in initially elevated plasma cortisol levels and an increase in beta-endorphine and leucine-enkephaline concentrations. Myocardial contractility became normal by reducing the hyperfunction of its intact segments. This was evidenced by antistressor effects of the drug. However, no substantial effect was found on the clinical course of the disease, evolution of myocardial infarction, plasma CPK MB. The left ventricular contractility showed severe depression.

[Effect of mexidol on oxidative stress in cerebral variant of hypertensive crisis]. / Vliianie meksidola na sostoianie okislitel'nogo stressa u bol'nykh gipertonicheskoi bolezn'iu, oslozhnennoi gipertonicheskim krizom po tserebral'nomu variantu.

Parameters of oxidative stress were studied in 44 patients with grade II-III essential hypertension and cerebral variant of hypertensive crisis. All patients received antihypertensive treatment. Mexidol was administered intravenously (300 mg o.d.) for 7 days starting with the second day of a hypertensive crisis. Control group consisted of 27 patients who were not treated with mexidol. The level of lipid peroxidation products and parameters of antioxidative system were used for assessment of the state of oxidative stress. Significant increases of the coefficient of oxidative stress were registered at all study points in patients who were not treated with mexidol. Treatment with antioxidant mexidol was associated with decreased coefficient of oxidative stress throughout the whole study period (up to 14-th day).

[The pathogenesis of heart rupture in myocardial infarct]. / O patogeneze razryva serdtsa pri infarkte miokarda.

Examination of 166 patients with primary transmural myocardial infarction (MI) of the anterior site has shown that the blood of MI patients (n = 34) complicated by cardiorrhexis manifests the maximal increase of the stress reaction components, lipid peroxidation products and an appreciable lowering of the content of adaptogens. It is emphasized that the development of the maladaptation syndrome underlies the pathogenesis of cardiorrhexis during MI as the result of the failure of the compensatory-adaptive potentialities of the body in response to the excessive stress reaction. It has been discovered that the high rise of the ST segment on the ECG and pronounced arterial hypoxemia are informative indicators mirroring the high probability of cardiorrhexis occurrence in MI patients. A scheme of cardiorrhexis pathogenesis in MI patients is offered.

[Efficacy of cytoprotective agent Mexicor in urgent cardiology]. / éffektivnost' tsitoprotektora Meksikora v neotlozhnoi kardiologii.

AIM: To study efficacy of cytoprotector mexicor in patients with unstable angina (UA), acute myocardial infarction (MI), hypertensive crises (HC) in combined therapy with conventional drugs. MATERIAL AND METHODS: An open randomized study included 338 patients with acute forms of ischemic heart disease (IHD) and arterial hypertension running with crises. Combined therapy of 20 patients with UA, 90 patients with MI and 43 patients with HC (study groups) was supplemented with mexicor in a dose 6-9 mg/kg/day. The control matched patients (20, 86 and 79 patients, respectively) received conventional treatment alone. The effects of the treatments were assessed by ultrasound investigation of the heart in M-, B- and Doppler modes, by ECG and arterial pressure 24-h monitoring, by activity of lipid peroxidation (LPO). RESULTS: Adjuvant therapy of urgent cardiological conditions with mexicor diminished oxidant stress, left ventricular dysfunction. In MI patients mexicor promoted reduction of the akinesia zones, recovery of disturbed segmentary contractility. In UA patients mexicor contributed to more pronounced decrease in the frequency, duration and severity of myocardial ischemia, enhanced stabilization of angina. In HC patients mexicor promoted earlier normalization of a 24-h AP profile and variability of cardiac rhythm, recurrence rate of HC decreased 2-fold. CONCLUSION: The addition of mexicor to conventional therapy of UA, MI, HC improves clinical course of these diseases, reduces oxidant stress, accelerates recovery of cardiac contractility and left ventricular diastolic function, normalization of central hemodynamics.