[The agreed experts' position of the Eurasian Association of Therapists on tactics of management of patients with comorbid pathology infected with SARS-Cov-2].

The agreement of experts of the Eurasian Association of Therapists (EAT) discusses pathogenesis and treatment of COVID-19. Modern data on the characteristics of cardiovascular, kidney, respiratory damage in SARS-infected CoV-2 are presented. The tactics of managing patients initially having cardiovascular diseases, diabetes mellitus, chronic obstructive pulmonary disease, bronchial asthma, chronic kidney disease are discussed in detail. The article presents data on drug interaction of drugs.

[Variants of remodeling of left ventricular myocardium in patients with arterial hypertension and disturbances of carbohydrate metabolism].

AIM: to study special characteristics of left ventricular (LV) myocardial remodeling in patients with arterial hypertension (AH) and disturbances of carbohydrate metabolism. MATERIAL AND METHODS: We examined 241 patients with 1-2 degree AH and comparable age and sex: 100 patients had type 2 diabetes mellitus (DM) (group 1), 41 had impaired glucose tolerance (IGT) (group 2), 100 patient had normal glucose tolerance (group 3). Examination included anthropometric and laboratory studies, echocardiography. RESULTS: Concentric LV hypertrophy was found in 34, 14.6 and 6% of patients in groups 1, 2, and 3, respectively. There were no significant differences between groups by other variants of myocardial remodeling. Disturbances of LV diastolic function were more frequent in groups 1 (89%) and 2 (82.9%) compared with group 3 (57%). CONCLUSION: Concentric LV hypertrophy was more frequent in patients with AH and type 2 DM.

[The degree of alexithymia in type 2 diabetes mellitus patients and its association with medical and demographic parameters].

AIM: To study the degree of alexithymia (an inability to understand and to express emotions verbally) and its relationship to medical and demographic parameters in patients with type 2 diabetes mellitus (DM) versus control group individuals. SUBJECTS AND METHODS: 265 patients with type 2 DM and 65 gender- and age-matched control individuals were examined. The degree of alexithymia was rated by the 26-item Toronto Alexithymia Scale (TAS-26). Survey, anthropometry, and laboratory tests were made. RESULTS: Carbohydrate metabolism was decompensated in the majority of the patients with DM; its complications were detected in most cases. The patients with type 2 DM compared with the controls had higher alexithymia levels; significant alexithymia was more frequently recorded (47.2% versus 21.5%; p < 0.001). In patients with type 2 DM, the degree of alexithymia correlated positively with depression and DM complications (with depression in the control group) and negatively with higher education and compensated carbohydrate metabolism. CONCLUSION: Higher alexithymia in the patients with type 2 DM was associated with decompensated carbohydrate metabolism and the presence of complications.

[Eating behavior in patients with diabetes mellitus].

AIM: To study the specific features of eating behavior (EB) in patients with diabetes mellitus (DM). SUBJECTS AND METHODS: One hundred and seventy-eight patients, including 128 with type 2 DM and 50 with type 1 DM, were examined. Questionnaire survey, general clinical, and laboratory studies were conducted. RESULTS: The patient groups did not differ in educational level and gender. In the patients with type 1 DM, the duration of the disease was longer and the incidence of complications was higher than in those with type 2 DM. Carbohydrate metabolism was decompensated in the majority of the patients with types 1 and 2 DM. A higher normative score if only by one of the disordered EB (DEB) scales (according to the DEBQ), was found in 68 and 78.9% with type 1 and type 2 DM, respectively. The patients with type 2 DM were more frequently ascertained to have restrictive EB. The patients with type 2 DM and restrictive EB were more aware of the disease, more often checked blood glucose levels themselves, and were better compensated. The proportion of patients with external and emotiogenic EB did not differ between the groups, the latter type was registered less frequently. CONCLUSION: Disordered EBs were detected in many patients with DM. The found features of EB may be taken into account while teaching the patients.

[Frequency and specific features of depressive disorders in patients with type 2 diabetes mellitus].

The aim of the work was to study the frequency of depressive conditions and their specific features in 200 patients with type 2 diabetes mellitus with reference to their quality of life. The patients were subjected to clinical and laboratory examination and interviewed to elucidate their awareness of the disease. The CES-D depression scale and SF-36 questionnaire were used for the purpose. Signs of depression were revealed in 43.5% of the patients. Occurrence of depression positively correlated with diabetic complications and negatively with patients' awareness and quality of life (especially its psychic component). The physical component deteriorated in patients with diabetic complications. The study showed high frequency of depression in DM2 patients and its negative influence on the physical and psychic component of their quality of life.

[Antihypertensive treatment compliance and obstacles to its improvement. Results of Russian program ARGUS-2].

AIM: To study barriers made by the patients for adequate treatment of arterial hypertension. MATERIAL AND METHODS: The ARGUS-2 trial was made in 15 centers of 13 cities of Russia. Anonymous questionnaire survey covered 1298 patients (796 outpatients and 502 inpatients). The patients answered the following questions: 1) what are basic problems of life with hypertension; 2) compliance with intake of antihypertensive drugs; 3) causes of missed intakes of the drugs; 4) opposition to intake of drugs by the patients. Questioning procedure was preset by the trial protocol. RESULTS: Only 37.4% (38.9% outpatients, 34.6% inpatients) were the treatment adopters. Drug intake was missed most frequently because offorgetting. The problems of life with hypertension were differently interpreted by patients and physicians: for the latter main problems were financial and routine while AH complications were on the 6-7 place. The latter were of primary importance for the patients while financial problems took place 4-6 Barriers to regular intake for the patients were poor self-control and unawareness about side effects of the drugs. CONCLUSION: Complience of the patient can be improved only by complex approach: improvement of education, higher motivation, active involvement of patients into the treatment process, better contacts between the physician and the patient.

[Problems of a physician-patient interaction and control of arterial hypertension in Russia. Main results of scientific-practical program ARGUS-2].

OBJECTIVE: To study the problems of physician-patient cooperation, patient- and physician related barrieres to target blood pressure (BP) achievement and to demonstrate improvement of BP control with indapamide SR 1.5 mg, when given to patients remaining uncontrolled while receiving antihypertensive therapy without thiazide diuretics (TD). METHODS: The trial Improvement of Arterial Hypertension Control in High-Risk Hypertensive Patients (ARGUS-2) run in 15 Russian centres during the year 2006. Retrospective analysis of medical notes of 684 outpatients and 575 inpatients with arterial hypertension. Validated questionnaires were used for interview of 373 physicians and 1298 patients. The study of Arifon retard efficacy was carried out in 1438 outpatients with difficult-to-control hypertension. RESULTS: BP was above the goal level in 97.1% pts at the first analyzed visit to an outpatient department. Antihypertensive therapy was unchanged in 20.5% cases, the drug dose was increased in 46,6%, additional medication was administered in 36,8%. In 30.8% pts antihypertensive agent was substituted by another class drug. At the last analyzed visit target BP was found in 24.4% pts. BP control was poorer in pts with BP goal <130/80 mmHg (20.1%) than in those with higher target BP (25.9%). Achievement of BP goal was associated with combination therapy, higher rate of TD administration and with more frequent visits to physician. During hospitalization target BP <140/<90 mmHg was achieved in 87.1%,<130/<80 mmHg in. 76.2%. Arifon retard administration resulted in target BO achievement in 84.5% patients. Physicians percept low adherence to antihypertensive treatment, lack of patients knowledge about risk related to arterial hypertension, economical problems as main barriers to improvement of arterial hypertension management. Patients considered economical problems related to antihypertensive treatment more much less important than physicians did. CONCLUSION: The study results suggest the importance of therapeutic inertia overcome to improve arterial hypertension management in Russia. Low rate of multiple combination therapy and TD prescription are important features of therapeutic inertia. Polar perception of problems related to arterial hypertension by physicians and patients should be considered as influencing factors for educational programs development.