[Apolipoprotein B100 as a risk factor of acute coronary syndrome and this risk factor effect on arterial hypertension in patients with ischemic heart disease].

AIM: To clarify correlations between an elevated concentration of apolipoprotein B100 (apoB) in blood plasma and risk of acute coronary syndrome (ACS); to study apoB level in hypertensive patients and its correlation with ischemic heart disease (IHD) risk in these patients. MATERIAL AND METHODS: Lipid serum spectrum (cholesterol, triglycerides (TG), lipoprotein a (Lpa) and apoB was studied in 456 patients with ACS by NYHA criteria, 119 patients with chronic IHD and 86 patients free of cardiovascular diseases (controls). All 575 patients with IHD were divided into those with and without hypertension (426 and 149 patients, respectively). RESULTS: Lpa was significantly higher in patients with ACS; apoB was higher in ACS and chronic IHD patients. ApoB was higher in IHD normotensive patients than in controls and higher in IHD hypertensive patients than in IHD normotensive patients and in the control group. Lpa in IHD hypertensive patients was significantly higher (p < 0.045) than in the controls as well as TG (p < 0.05). By the other parameters the groups did not differ. CONCLUSION: The blood plasma level of apoB higher than 130 mg/dl is an independent and significant risk factor of ACS in IHD patients especially at the age under 60. The level of apoB over 115 mg/dl is a significant risk factor of IHD. The significance of this lipid factor rises in concomitant hypertension.

[Comparative morpho-functional assessment of the impact produced by prolonged infusions of prostaglandins E and F on the course of genetically preconditioned arterial hypertension]. / Sravnitel'naia morfofunktsional'naia otsenka vliianiia prolongirovannykh infuzii prostaglandinov E i F na techenie geneticheski obuslovlennoi arterial'noi gipertonii.

The administration of prolonged intravenous infusions of prostaglandins is defined; the method provided for specifying a long-term impact produced by prostaglandins on a nature of the course of genetically preconditioned arterial hypertension (AHT) in rats. Infusions of PGE-2 bring about a prolonged and stable reduction of mean arterial presser (AP) by 10% versus its original value; they intensify 2-fold the depressor baroreflectory regulation and stimulate the urinary excretion of endogenous renal PGF-2 alpha; besides, they contribute to a better blood supply to organs, i.e. an increased perfusion of the cortical and medullary layers of the kidneys and of the brain substances; and dilatation of the intramural branches of the coronary arteries, due to which the AP becomes milder. Infusions of PGF-2 alpha contribute to a prolonged and stable elevation of mean AP by 12% versus the original value; they inhibit the depressor baroreflectory regulation and intensify the pressor baroreflectory regulation; they, additionally, induce the urinary excretion of endogenous renal PGF-2 alpha and correct the lesions in the blood supply to organs, i.e. pathological microcirculation, anemia and spasm of the renal parenchyma, ischemic foci in the myocardium, spastic contraction of small cerebral arteries, edema and destructive changes (of the local necrosis variation) in the cerebral substance microvessels concomitant with a commencing diapedetic hemorrhages. Finally, all above listed lesions are signs of the malignant AP course.

[Rheumatic manifestations of Takayasu's disease]. / "Revmaticheskoe proiavleniia" bolezni Takaiasu.

Rheumatic manifestations of nonspecific aortic arteritis are described with a special focus on analysis of early symptoms of the disease.

[Morning rise of systolic blood pressure (by 24-hour ambulatory monitoring) and platelet aggregability in essential hypertension patients]. / Utrennii pod''em arterial'nogo davleniia (po dannym sutochnogo monitorirovaniia) i aggregatsiia trombotsitov u bol'nykh gipertonicheskoi bolezn'iu.

AIM: To investigate the relationship between platelet aggregability (PA) and parameters of blood pressure (BP) in patients with essential hypertension (EH). MATERIALS AND METHODS: We analyzed 24-h BP recordings (SL-90207, 15-min day and 30 min night time intervals) of 47 hospitalized males with mild to moderate EH (mean age 48 +/- 1 years) to assess the following parameters: mean 24-h, awake (Aw) and nighttime (N) systolic (S) and diastolic (D) BP. We assessed the morning rise (MR) of BP using the new index: a relative morning rise of systolic BP-RMRSBP--(max value of SBP from 6 am to 12 am/mean asleep SBP) x 100%. The kinetics of mean aggregate size (MAS) changes was studied with aggregation analyzer model (230LA Biola Ltd., Russia). The following parameters were used for estimation of platelet aggregability: a relative increase in MAS 2 min after beginning of sample stirring--for spontaneous aggregation (SPA) and the maximum increase in the light transmission for 0.5 microM ADP-induced aggregation (ADPI-PA). The patients were divided into two groups according to the median value of RMRSBP: group 1 (n = 25, RMRSBP < 121%) and group 2 (n = 22, RMRSBP > 121%). The differences in estimated parameters were tested by Student two tailed t-tests and presented by M +/- SE. P < 0.05 was considered statistically significant. RESULTS: No significant differences have been found between the groups by mean age, body mass index, duration of arterial hypertension, mean 24-h, awake DBP and SBP. Statistically significant differences have been found between groups by SPA, ADPI-PA, night SBP, night DBP, RMRSBP, RMRDBP. In group 2 there was a correlation between RMRSBP and SPA, but not in group 1. CONCLUSIONS: The morning rise of systolic BP is associated with an increase of ADP-induced and spontaneous platelet aggregability in the patients with mild to moderate essential hypertension and apparently that association is more pronounced at high values of morning BP (more than 20% from mean nocturnal values of SBP).

[Blood flow in affected major arteries of head in hypertensive patients]. / Sostoianie krovotoka v patologicheski izmenennykh magistral'nykh arteriiakh golovy u bol'nykh gipertonicheskoi bolezn'iu.

AIM: To assess blood flow in intracranial internal carotid and vertebral arteries in patients with essential hypertension (EH) and hemodynamically insignificant atherosclerotic lesions and deformities of major arteries of the head (MAH). MATERIALS AND METHODS: The blood flow was assessed in 55 untreated patients (mean age 53 +/- 1 years) with mild, moderate or severe hypertension. 20 healthy patients served control. Duplex scanning was performed using ACUSON unit. RESULTS: Total blood flow (Q) in hypertensive subjects appeared significantly subnormal. It was less in patients with hemodynamically insignificant atherosclerotic stenosis and flexures of the carotid and vertebral arteries than in patients with affection of the carotid arteries only. Q in MAH was lower in smokers than in non-smokers.

[Features of dopaminergic system function in menopausal females with arterial hypertension]. / Osobennosti funktsional'nogo sostoianiia dofaminergicheskoi sistemy u zhenshchin s arterial'noi gipertoniei klimaktericheskogo perioda.

AIM: Assessment of dopaminergic activity by changes in urine excretion of dopamine, arterial hypertension, blood prolactine, 24-h diuresis and natriuresis in response to a single (2.5 mg) and 7-day (daily dose 5 mg) administration of parlodel in patients with essential hypertension (EH) in menopausal and reproductive age having different serum levels of estrogens. MATERIALS AND METHODS: The indices of 52 hypertensive menopausal women and of 18 women at reproductive age of whom 8 had hypothalamic syndrome were followed up. RESULTS: A single dose parlodel (bromocriptine) in the dose 2.5 mg 2 hours after its administration caused a significant fall in arterial pressure, rise in 24-h diuresis in hypertensive menopausal women (p < 0.01). Parlodel given in a daily dose 5 mg for 7 days in menopausal hypertensive women lowered a significant fall in arterial pressure, blood concentrations of aldosteron, prolactin, aroused dopamine and urinary sodium excretion (p < 0.01). Similar were the changes in hypertensive women at reproductive age with hypothalamic syndrome (n = 8). In such women free of hypothalamic impairment the changes did not occur (n = 10). A significant positive correlation was found between serum levels of prolactine and estradiol in all the hypertensive women in menopause. CONCLUSION: Deficiency of dopaminergic activity in menopause is induced by hypoestrogenemia correlating with serum levels of prolactin. This deficiency was identified in hypertensive menopausal women by the results of acute and prolonged tests with dopamine mimetic--parlodel.

[Activity of chymotrypsin-like proteinases in patients with ischemic heart disease, arterial hypertension and nonspecific aortic arteritis]. / Aktivnost' khimotripsinopodobnykh proteinaz u bol'nykh ishemicheskoi bolezn'iu serdtsa, arterial'nymi gipertoniiami i nespetsificheskim aortoarteritom.

AIM: To analyze activity of chymotrypsin-like plasma proteinases (CTP) in patients with various cardiovascular diseases. MATERIAL AND METHODS: CTP activity was studied in 82 patients with various cardiovascular diseases: 13 coronary heart disease patients with normal arterial pressure, 49 patients with essential hypertension (EH) and secondary arterial hypertension, 20 patients with nonspecific aortic arteritis. 28 donors served control. RESULTS: CTP activity in plasma of patients with EH rose 4 times compared to donors. If EH patients had concurrent diseases (CHD, chronic pyelonephritis, atherosclerosis of extracranial arteries), CTP activity may increase by 30-300%. In patients with nonspecific aortic arteritis CTP activity in blood plasma is 17.5 times higher than in donors. CONCLUSION: High CTP activity in cardiovascular patients may be explained by chymase and cathepsin G release into blood flow indicating activation of alternative to ACE pathway of angiotensin II production or the presence of the inflammatory process.

[Left ventricular myocardial structure and function in patients with primary aldosteronism]. / Struktunoe i funktsional'noe sostoianie miokarda levogo zheludochka u bol'nykh s pervichnym al'dosteronizmom.

AIM: To study severity of left ventricular hypertrophy (LVH) and left ventricular function in patients with primary aldosteronism (PA) in comparison with hyperaldosteronemia and preoperative arterial hypertension, to follow the dynamics of these parameters early and late after surgical removal of aldosteroma. MATERIALS AND METHODS: Concentration of aldosterone (AC), plasma renin activity (PRA) were measured in 28 PA patients aged 26-58 years before removal of aldosteroma and 1 month, 1 year and 2-5 years after the surgical treatment. Myocardial status was assessed by echocardiography, Doppler echocardiography. 30 healthy subjects aged 25-55 years served control. RESULTS: All the PA patients showed initial or moderate LVH. Index of left ventricular myocardial mass was influenced at the first regression step by primarily diastolic pressure, at the second step--by basal PRA. The diastolic function was affected. One month after unilateral adrenalectomy PRA level and arterial pressure decreased but regression of LVH was noted only 1 year and later after the surgery. Diastolic function improved 1 year after the operation but without normalization within 2-5-year follow-up. CONCLUSION: The lack of a complete normalization of diastolic function of the left ventricle late after the surgery despite regression of LVH and preoperative correlation of the isometric relaxation time with PRA level may be caused by fibrous changes in the myocardium and by hyperaldosteronemia effects.

Systolic Hypertension in Europe (Syst-Eur) trial phase 2: objectives, protocol, and initial progress. Systolic Hypertension in Europe Investigators.

The Systolic Hypertension in Europe (Syst-Eur) trial proved that blood pressure (BP) lowering therapy starting with nitrendipine reduces the risk of cardiovascular complications in older (> or = 60 years) patients with isolated systolic hypertension (systolic BP > or = 160 mm Hg and diastolic BP < 95 mm Hg). After the completion of the Syst-Eur trial on 14 February 1997, 3506 consenting patients (93.0% of those eligible) were enrolled in phase 2 of the Syst-Eur trial. This open follow-up study aims to confirm the safety of long-term antihypertensive therapy based on a dihydropyridine. To lower the sitting systolic BP below 150 mm Hg (target BP), the first-line agent nitrendipine (10-40 mg/day) may be associated with enalapril (5-20 mg/day), hydrochlorothiazide (12.5-25 mg/day), both add-on study drugs, or if required any other antihypertensive agent. On 1 November 1998, 3248 patients were still being followed, 86 patients had proceeded to non-supervised follow-up, and 43 had died. The median follow-up in Syst-Eur 2 was 14.3 months. At the last available visit, systolic/diastolic BP in the patients formerly randomised to placebo (n = 1682) or active treatment (n = 1824), had decreased by 13.2/5.2 mm Hg and by 4.6/1.6 mm Hg, respectively, so that the between-group BP difference was 1.7 mm Hg systolic (95% Ci: 0.8 to 2.6 mm Hg; P < 0.001) and 0.9 mm Hg diastolic (95% Cl: 0.4 to 1.5 mm mm Hg; P < 0.001). At the beginning of Syst-Eur 2, the goal BP was reached by 25.4% and 50.6% of the former placebo and active-treatment groups; at the last visit these proportions were 55.9% and 63.1%, respectively. At that moment, 45.9% of the patients were on monotherapy with nitrendipine, 29.3% took nitrendipine in combination with other study drugs. Until the end of 2001, BP control of the Syst-Eur 2 patients will be further improved. Cardiovascular complications and adverse events, such as cancer or gastro-intestinal bleeding, will be monitored and validated by blinded experts.

[Lipanor treatment of atherogenic hyperlipoproteinemia]. / Lipanor pri lechenii bol'nykh s aterogennymi giperlipoproteinemiiami.

AIM: The study of the hypolipidemic efficiency, safety and tolerance of ciprofibrate (lipanor) in therapy of atherogenic hyperlipoproteinemia. MATERIALS AND METHODS: The trial included 14 hypertensive postmenopausal females, 14 patients with diabetes mellitus type II, 14 males with coronary heart disease and primary hyperlipoproteinemia (total cholesterol > 6.5 mmol/l, triglycerides < 4.5 mmol/l under low-cholesterol diet). Lipanor was given for 12 weeks in a daily single dose 100 mg in the morning. Lipids and other biochemical indices were measured in a fasting state after 1 and 3 months of lipanor treatment. RESULTS: After 1 month of lipanor treatment there was a 22-30%, 24-49% decrease in the level of low-density lipoprotein cholesterol, triglycerides, respectively. High-density lipoprotein cholesterol increased by 16%. The hypolipidemic effect of lipanor persisted for 3 months during which triglycerides continued to fall (up to 38.5%). Lipanor was well tolerated, only one patient with diabetes mellitus had hyperactivity of creatine phosphokinase manifesting with clinical symptoms (the drug was discontinued). 3 patients developed mild side effects. Alkaline phosphatase activity inhibited in all the groups by 25-41%. CONCLUSION: Lipanor is a highly effective, safe hypolipidemic drug with good tolerance. It can be recommended for correction of atherogenic hyperlipoproteinemia in patients at high risk of atherosclerosis progression.

[Extracorporeal circulation methods in the treatment of nonspecific aortic arteritis]. / Lechenie bol'nykh nespetsificheskim aortoarteriitom s pomoshch'iu metodov ékstrakorporal'nogo krovoobrashcheniia.

AIM: Development of a protocol of multiple-modality treatment of patients with nonspecific aortoarteritis (NAA) making use of plasmapheresis and specific plasma adsorption of proteinases. MATERIALS AND METHODS: Six patients with NAA aged 15 to 58 years were examined using ultrasonic dopplerography, magnetic imaging, and angiography of the large vessels. Red cell sedimentation rate was assessed, cathepsin G activity, antitryptic activity, and content of C-reactive protein in the blood measured. Drug therapy was supplemented by repeated sessions of plasmapheresis and specific plasma adsorption on immotin. RESULTS: After sessions of plasmapheresis (n = 17) and plasma adsorption (n = 13), increased cathepsin G activity dropped by at least 30% (in 3 patients it normalized), the content of C-reactive protein decreased in the presence of normal antitryptic activity (in patients with decreased activity it normalized and in those with increased values a tendency to normalization was observed). Red cell sedimentation rate decreased, particularly so 1 and 2 months after treatment; the patients felt better. CONCLUSION: Multiple-modality treatment of NAA patients making use of plasmapheresis and plasma adsorption decreases the activity of the inflammatory process.

Randomised double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators.

BACKGROUND: Isolated systolic hypertension occurs in about 15% of people aged 60 years or older. In 1989, the European Working Party on High Blood Pressure in the Elderly investigated whether active treatment could reduce cardiovascular complications of isolated systolic hypertension. Fatal and non-fatal stroke combined was the primary endpoint. METHODS: All patients (> 60 years) were initially started on masked placebo. At three run-in visits 1 month apart, their average sitting systolic blood pressure was 160-219 mm Hg with a diastolic blood pressure lower than 95 mm Hg. After stratification for centre, sex, and previous cardiovascular complications, 4695 patients were randomly assigned to nitrendipine 10-40 mg daily, with the possible addition of enalapril 5-20 mg daily and hydrochlorothiazide 12.5-25.0 mg daily, or matching placebos. Patients withdrawing from double-blind treatment were still followed up. We compared occurrence of major endpoints by intention to treat. FINDINGS: At a median of 2 years' follow-up, sitting systolic and diastolic blood pressures had fallen by 13 mm Hg and 2 mm Hg in the placebo group (n = 2297) and by 23 mm Hg and 7 mm Hg in the active treatment group (n = 2398). The between-group differences were systolic 10.1 mm Hg (95% CI 8.8-11.4) and diastolic, 4.5 mm Hg (3.9-5.1). Active treatment reduced the total rate of stroke from 13.7 to 7.9 endpoints per 1000 patient-years (42% reduction; p = 0.003). Non-fatal stroke decreased by 44% (p = 0.007). In the active treatment group, all fatal and non-fatal cardiac endpoints, including sudden death, declined by 26% (p = 0.03). Non-fatal cardiac endpoints decreased by 33% (p = 0.03) and all fatal and non-fatal cardiovascular endpoints by 31% (p < 0.001). Cardiovascular mortality was slightly lower on active treatment (-27%, p = 0.07), but all-cause mortality was not influenced (-14%; p = 0.22). INTERPRETATION: Among elderly patients with isolated systolic hypertension, antihypertensive drug treatment starting with nitrendipine reduces the rate of cardiovascular complications. Treatment of 1000 patients for 5 years with this type of regimen may prevent 29 strokes or 53 major cardiovascular endpoints.

[The effect of different factors on cardiac rhythm variability in patients with arterial hypertension]. / Vliianie razlichnykh faktorov na variabel'nost' ritma serdtsa u bol'nykh arterial'noi gipertoniei.

The purpose of this study was to evaluate the influence of different factors, among them left ventricular hypertrophy (LVH) on long-term heart rate variability (HRV) in patients with hypertension. 38 patients with arterial hypertension of different genesis were included in the study. Ischemia was excluded in all the patients by the data of clinical and instrumental methods of investigation. LVH data obtained from HRV of 20 healthy subjects was used as control. HRV was evaluated by estimating variations for short intervals of a rhythmogram (VSI). A HRV decrease did not depend on sex, but essentially depended on patients'a age, disease duration and the form of hypertension. A marked tendency leading to the rate variability decrease was observed only in moderate LVH. In cases of original LVH variability data did not differ from those in patients without signs of LVH. Low or marginal HRV was more often observed in patients with essential hypertension and in those with hypertension of endocrine genesis. As far as renal hypertension is concerned low variability was less frequent. There were a lot of factors which affect the change of HRV. The more significant of them were the patients' age, hypertension genesis and form of hypertension. Factors leading to the rate variability decrease were the following age above 40, endocrine or essential hypertension and moderate form of hypertension.

[Drug methods of preventing stroke in cardiovascular diseases (a lecture)]. / Medikamentoznye metody profilaktiki insul'ta pri serdechno-sosudistykh zabolevaniiakh (lektsiia).

Basing on the results of numerous investigations it is possible to single out 4 main directions in prevention of acute failure of cerebral circulation (AFCC) in cardiovascular diseases: stroke prevention in hypertensive subjects, prevention of cardioembolic stroke in patients with cardiac arrhythmia, prevention of recurrent AFCC episodes in patients with transitory ischemic attacks and minor stroke, prevention of the stroke by inhibition of progression of carotid atherosclerosis. The best population effect in stroke prevention belongs to active detection and adequate treatment of AH because AH is involved in development of the majority of the mechanisms underlying both hemorrhagic and ischemic stroke.

[Magnetic resonance tomography and magnetic resonance phlebography in studies of the brain in patients with severe arterial hypertension]. / Magnitno-rezonansnaia tomografiia i magnitno-rezonansnaia flebografiia v issledovaniiakh golovnogo mozga u bol'nykh tiazheloi arterial'noi gipertoniei.

MR tomography of the brain, MR angiography of extra- and intracranial arteries and veins, duplex scanning of the extracranial arteries and veins were performed according to the technique spin-echo, by the technique 2D, 3D time-to-flight (unit "Magnetom 63 SP", 1.5 T), Acuson 128 technique, respectively, in 21 patients with high and malignant blood hypertension (BH) and 11 healthy controls. In BH patients magnetic resonance has detected signs of hypertensive encephalopathy: dilation of the liquor-conduction system, small hyperintensive foci in the white substance, zones of periventricular hyperintensity. MR angiograms visualized flexures of the extracranial arteries. MR phlebograms were characterized: 1) reduction of or absence of the signal from the blood flow along the cross, sigmoid sinus and internal jugular vein of the hemisphere associated with enlargement of the contralateral structures; 2) lowering of the signal intensity from the blood flow along the upper sagittal sinus; 3) dilation of the emission veins and superficial cerebral veins. These abnormalities should be considered in the treatment of BH.