[Sartans in the treatment of arterial hypertension: focus on telmisartan and azilsartan. A review].

The activity of the renin-angiotensin-aldosterone system is one of the main pathogenetic mechanisms underlying cardiovascular diseases at all stages of the cardiovascular continuum. This article discusses the role of telmisartan and azilsartan as the most powerful sartans in modern cardiology. Azilsartan and especially telmisartan have a significant organoprotection and are superior to other antihypertensive drugs in terms of lowering blood pressure. However, the effect of azilsartan on hard endpoints has not been studied while the efficacy of telmisartan on hard endpoints has been evaluated in plenty clinical trials including 3 large randomized clinical trials with several thousand patients. The article also presents calculations showing the better cost-effectiveness of telmisartan compared to azilsartan.

[The impact of psychological resilience, as a component of intrinsic capacity, on the risk of developing atrial fibrillation.]

The authors conducted a cross-sectional epidemiological study of a random sample of community-based older adults aged 65 years and older (n=611) to assess the impact of psychological resilience on the risk of developing atrial fibrillation (AF). To assess the degree of psychological resilience, the Sense of Coherence Scale (SOC) with 47 and more points was used. The prevalence of AF was 30,1% (n=184). Participants who scored 47 or more on the SOC, after adjusting for all confounders, had a 42,9% lower risk of AF. Thus, psychological resilience is one of the protective factors that reduce the risk of AF in older adults. The use of SOC with a cut-off point of less than 47 allow to identify older adults at risk of AF.

[The National Consensus statement on the management of adult patients with non-alcoholic fatty liver disease and main comorbidities].

The National Consensus was prepared with the participation of the National Medical Association for the Study of the Multimorbidity, Russian Scientific Liver Society, Russian Association of Endocrinologists, Russian Association of Gerontologists and Geriatricians, National Society for Preventive Cardiology, Professional Foundation for the Promotion of Medicine Fund PROFMEDFORUM. The aim of the multidisciplinary consensus is a detailed analysis of the course of non-alcoholic fatty liver disease (NAFLD) and the main associated conditions. The definition of NAFLD is given, its prevalence is described, methods for diagnosing its components such as steatosis, inflammation and fibrosis are described. The association of NAFLD with a number of cardio-metabolic diseases (arterial hypertension, atherosclerosis, thrombotic complications, type 2 diabetes mellitus, obesity, dyslipidemia, etc.), chronic kidney disease and the risk of developing hepatocellular cancer were analyzed. The review of non-drug methods of treatment of NAFLD and modern opportunities of pharmacotherapy are presented. The possibilities of new molecules in the treatment of NAFLD are considered: agonists of nuclear receptors, antagonists of pro-inflammatory molecules, etc. The positive properties and disadvantages of currently used drugs (vitamin E, thiazolidinediones, etc.) are described. Special attention is paid to the multi-target ursodeoxycholic acid molecule in the complex treatment of NAFLD as a multifactorial disease. Its anti-inflammatory, anti-oxidant and cytoprotective properties, the ability to reduce steatosis an independent risk factor for the development of cardiovascular pathology, reduce inflammation and hepatic fibrosis through the modulation of autophagy are considered. The ability of ursodeoxycholic acid to influence glucose and lipid homeostasis and to have an anticarcinogenic effect has been demonstrated. The Consensus statement has advanced provisions for practitioners to optimize the diagnosis and treatment of NAFLD and related common pathogenetic links of cardio-metabolic diseases.

[The prevalence of anemia and its associations with other geriatric syndromes in subjects over 65 years old: data of Russian epidemiological study EVKALIPT].

BACKGROUND: A low hemoglobin level in older adults impairs cognitive ability and functional status and associates with risk of falls and fractures, sarcopenia, malnutrition, depression, frailty, and decreased autonomy. Epidemiological data on the anemia prevalence in the geriatric population in our country is not available. AIM: To assess the prevalence of anemia and analyze its associations with geriatric syndromes (GS) in subjects aged 65 years. MATERIALS AND METHODS: 4308 subjects (30% of men) aged 65107 years, living in 11 regions of the Russian Federation, were examined and divided into age groups (6574 years, 7584 years and 85 years). All the participants underwent a comprehensive geriatric assessment and determined hemoglobin level. RESULTS: The anemia prevalence in older adults was 23.9%. It has been shown that with an increase in age per 1 year, the risk of anemia detection increases by 4%. The incidence of anemia was higher in males than females (28.1% versus 22.1%; p0.001). In most cases, anemia was mild. The results of a comprehensive geriatric assessment show that patients with anemia had lower hand grip force, Barthel Index, the sum of points on Lawton instrumental activities of daily living scale, Mini Nutritional Assessment scale, the Mini-Cog test and higher the sum of points on the Geriatric Depression Scale (GDS-15) and the Age Is No Barrier scale. Patients with anemia were more likely to use hearing aids, absorbent underwear, and assistive devices during movement. Patients with anemia had a higher incidence of all GS, except for orthostatic hypotension and chronic pain syndrome. The presence of GS is associated with an increased risk of anemia by 1.33.4 times. CONCLUSION: EVKALIPT study obtained domestic data on the prevalence of anemia in older patients and examined its associations with other GS.

[Epithelial protective therapy in comorbid diseases. Practical Guidelines for Physicians].

This document was produced with the support of the National Medical Association for the Study of Comorbidities (NASС). In 2021 the first multidisciplinary National Consensus on the pathophysiological and clinical aspects of Increased Epithelial Permeability Syndrome was published. The proposed guidelines are developed on the basis of this Consensus, by the same team of experts. Twenty-eight Practical Guidelines for Physicians statements were adopted by the Expert Council using the "delphic" method. Such main groups of epithelial protective drugs as proton pump inhibitors, bismuth drugs and probiotics are discussed in these Guidelines from the positions of evidence-based medicine. The clinical and pharmacological characteristics of such a universal epithelial protector as rebamipide, acting at the preepithelial, epithelial and subepithelial levels, throughout gastrointestinal tract, are presented in detail.

[Healthy life expectancy of people over age 65: results of the Russian epidemiological study EVCALIPT.]

Population health is an important indicator of the general well-being of the population, and it has it's practical significance, as it determines the costs of providing care, social and medical assistance for the elderly. The study presents an assessment of healthy life expectancy indicators of people over age 65 based on the results of the Russian epidemiological study EVCALIPT and a comparison of this results with data from other surveys in Russia and European countries.

[Influence of risk factors for cardiovascular diseases, history of cardiovascular diseases, and structural and functional state of the heart on 3-year survival in persons 95 years and older.]

In recent years, more and more works have appeared that with age, classic risk factors that negatively affect the prognosis (cardiovascular diseases) lose their influence on life expectancy. The study aimed to assess the influence of cardiovascular diseases and their risk factors and structural and functional characteristics of the heart on three-year survival in people 95 years and older. The study involved 69 patients 95 years and older (98±1,9 years), 61 (88,4%) were women. After 36 months, data were obtained on the participants' status of life: 25 (36,2%) were alive, and 44 (63,8%) died. Based on the regression analysis results, it was determined that risk factors and history of cardiovascular diseases were not associated with 3-year survival. With a 3-year follow-up, the risk of death increases three times with a decrease in diastolic blood pressure less than 75 mm/Hg, 7,8 times with a decrease in left ventricular ejection fraction below 62%, and 4,9 times with an increase in the end-diastolic size of the right ventricle by more than 2,9 cm.

[The prevalence of osteoarthritis and its association with geriatric syndromes in people over 65: data from the Russian epidemiological study EVKALIPT].

BACKGROUND: Osteoarthritis (OA) in elderly and senile patients is not only common, but also one of the main diseases affecting the duration of active life, its quality, the appearance of addictions and loss of autonomy. Data on the relationship between OA and geriatric syndromes (GS) in our country are extremely scarce. AIM: To estimate the prevalence of OA and to analyze its associations with HS in persons aged 65 years. MATERIALS AND METHODS: The study included 4308 people (30% of men) aged 65 to 107 years, living in 11 regions of Russia. The patients were divided into 2 groups: with OA (n=2464) and without OA (n=1821). All patients underwent a comprehensive geriatric assessment. RESULTS: The prevalence of OA was 57.6%. With age, the frequency of OA increased significantly. According to the results of a comprehensive geriatric assessment, patients with OA had lower walking speed, the sum of points on the Bartel, Lawton scales and a short battery of physical functioning tests and higher the sum of points on the geriatric scale of depression and the age is not a hindrance scale. Patients with OA rated the quality of life and health status lower and higher the intensity of pain syndrome. Patients with OA were more likely to use any assistive device, with the exception of a wheelchair. In patients with OA, the most common HS were chronic pain syndrome (92%), senile asthenia syndrome (64%), basic (66%) and instrumental (56%) dependence in everyday life, cognitive impairment (62%), probable depression (51%) and urinary incontinence (50%). Univariate regression analysis showed that OA is associated with a 1.23.0-fold increase in the risk of a number of GS and a 28% decrease in the risk of malnutrition. CONCLUSION: OA is widespread in the elderly population. The presence of OA is associated with a number of GS associated with loss of autonomy.

[Lipid-Lowering Therapy for Primary Cardiovascular Prevention in Older Adults. Consensus Statement of the Russian Association of Gerontologists and Geriatricians, National Society on Atherosclerosis, Russian Society of Cardiology, Association of Clinical Pharmacologists].

 Completed randomized clinical studies did not have a sufficient statistical power for demonstrating clearly the efficacy of lipid-lowering therapy for primary prevention in patients aged 75 years and older and did not evaluate the effect of lipid-lowering therapy on development and course of key geriatric syndromes. Age-related alterations of skeletal muscles, cognitive decline, senile asthenia, comorbidities, polypragmasy, potential changes in drug pharmacokinetics and pharmacodynamics, and impaired renal function may adversely affect the benefit to harm ratio of statins in older patients. Key questions for administration of a lipid-lowering therapy for primary prevention in patients aged 75 years and older are: 1. Does the relationship between increased low-density lipoprotein cholesterol (LDL CS) and death rate persist? 2. Does a benefit from decreasing the level of LDL CS persist? 3. Is the lipid-lowering therapy safe? 4. What scales for risk stratification and determining indications for lipid-lowering therapy should be used?

[New possibilities of using moxonidin for blood pressure control in female patients with osteopenia].

OBJECTIVE: To assess the effect of moxonidine on bone metabolism and bone mineral density (BMD) in postmenopausal patients with arterial hypertension (AH) and osteopenia. MATERIALS AND METHODS: A randomized, open, clinical trial included 114 postmenopausal patients with AH. All participants were evaluated bone metabolism), BMD, telomerase activity (TA). Randomization was carried out into 2 groups (moxonidine and bisoprolol therapy) using simple envelopes. After 12 months of therapy, a dynamic examination was performed. RESULTS: Both groups showed a positive effect of both moxonidine and bisoprolol on hypertension during treatment both as monotherapy and in the group of patients receiving combined antihypertensive therapy: a decrease in SBP and DBP in the 1st group was 13.6% and 12.8% respectively, and in the 2nd group - 13.7% and 15% respectively, while achieving normal values. In most patients of group 1, normalization of body weight was noted in comparison with group 2 (23.4% and 17.4%, respectively, p = 0.043), delta of body weight in the moxonidine group was -1.89%. The increase in the processes of bone formation in the form of increased markers of OC and Osteoprotegerin and a statistically signifcant increase in TA in patients receiving moxonidine were revealed, while in women who took bisoprolol there were no dynamic changes in bone metabolism rates, there was a tendency for a decrease in BMD and a signifcant decrease in AT. CONCLUSIONS: Te detected pleiotropic effect of moxonidine on bone metabolism and replicative cell aging processes will reduce the risk of development or progression of osteopenia and osteoporosis in postmenopausal women with AH.

[Social, Demographic and Behavioral Factors and Their Impact on 5-year Survival in Subjects Aged Over 75 Years in Moscow Population].

OBJECTIVE: to study the impact of social, demographic and behavioral factors on 5-year survival rate in persons older than 75 years living in Moscow and the Moscow region. MATERIALS AND METHODS: We included in this prospective observational study 283 patients (25% men, age 75-98, mean 86.8±4.3 years) after stay at the Russian gerontological clinical research center. To study social and behavioral factors we recorded anthropometric parameters and used questionnaires. Duration of follow-up was 5 years. Endpoint was death from any cause. RESULTS: One hundred five patients (37.1%) died during the follow-up (median 3.8 years). Survival analysis using the Kaplan-Meier method revealed a number of parameters that affected 5-year survival: age, defcient and excessive body weight, consumption of less than 1 liter of water per day, start of the night sleep after midnight, nightime sleep duration ≥10 h, level of physical activity and history of blood donation. At multivariate analysis adjusted for age and sex the following factors were independently associated with death during follow-up: weight defciency (hazard ratio [HR] 7.36, 95% confdence interval [CI] 2.15-25.26, p=0.001), second degree obesity (HR 0.47, 95% CI 0.25-0.87, p=0.016), start of night sleep after midnight (HR 2.53, 95% CI 1.32-4.85, p=0.005), nightime sleep duration ≥10 h (HR 3.89, 95% CI 1.77-8.59, p=0.001), and history of blood donation (HR 0.24, 95% CI 0.09-0.62, p=0.003). CONCLUSION: In people older than 75 years late sleep initiation and long duration of night sleep, and weight loss increase the risk of death in the next 5 by years, 2.5, 3.9 and 7.4 times, respectively, while overweight and history of blood donation are associated with 53% and 76% reduction of the risk of death.

[Indapamide SR/Amlodipine Fixed Dose Combination: Novel Approach to Effective Control of Systolic Arterial Pressure].

Effective control of arterial pressure (AP) is achieved only in ⅓ of patients with arterial hypertension. It is especially difficult to achieve control of systolic (S) AP in elderly patients in whom SAP is the strongest prognostic factor of cardiovascular complications. Thiazide and thiazide-like diuretics and calcium antagonists are effective for lowering of elevated SAP and pulse (P) AP including aortic PAP elevation of which is associated with high stiffness of arterial wall and is typical for elderly people. Combination of a thiazide diuretic and a calcium antagonist has been recommended by modern guidelines on arterial hypertension (AH) management but until recently it has not found wide application because of absence of a fixed preparation. Evidence base of indapamide-retard and amlodipine use in AH, their profiles of efficacy and safety are such that their combination can become an alternative variant for treatment of patients with AH. Appearance of a fixed indapamide-retard/amlodipine combination opens new perspectives of effective therapy of AH with high SAP and PAP in elderly and other patients with high stiffness of arterial wall.

[Isolated Systolic Hypertension in Different Ages].

Hypertension is the leading risk-factor for cardiovascular disease and death from them. Traditionally, the problem of isolated systolic hypertension is associated with old age in mind the natural dynamics of systolic and diastolic blood pressure throughout life. Isolated systolic hypertension is the most common type of hypertension in elderly men as well as young adults. The pathophysiology of this condition in different age periods have fundamental differences. The adverse prognostic significance of isolated systolic hypertension in the elderly, and the need for its non-drug and drug treatment are well documented. Accumulating epidemiological evidence on the adverse prognostic significance of isolated systolic hypertension. People young and middle-aged isolated systolic hypertension heterogeneous and may be a consequence of excessive pulse pressure amplification from the aorta to the peripheral arteries and the manifestation of an accelerated aging. Evaluation of central blood pressure and arterial stiffness in young may help identify premature vascular aging.

Treating hypertension by rational use of diuretics: results of the Russian ARGUS-2 Study.

OBJECTIVE: Insufficient use of diuretics in combination antihypertensive therapy is a main cause of poor blood pressure (BP) control in Russia. The objective of the ARGUS-2 study was to demonstrate that a rational use of a thiazide-like diuretic, indapamide sustained release (SR), alone or in combination, improves BP control in patients with arterial hypertension difficult to control due to isolated systolic hypertension (ISH), diabetes mellitus (DM), chronic nephropathy, or metabolic syndrome. METHODS: The open-label, non-comparative, 3-month study without preliminary washout included 1438 hypertensive patients (mean age: 57.3 +/- 10.7 years, mean BP: 158.8 +/- 14.2/93.4 +/- 10.0 mmHg), with difficult-to-control arterial hypertension and who had never been treated with diuretics previously. Throughout the study, patients received indapamide SR 1.5 mg OD. BP control was defined as <140/90 mmHg for all patients and <130/80 mmHg for those with diabetes mellitus or chronic nephropathy. RESULTS: Indapamide SR was given as initiation monotherapy to 13.7% of the patients, as substitutive monotherapy to 6.8% of the patients uncontrolled by a previous monotherapy, as additive therapy to 31.9% of the patients uncontrolled by previous monotherapy, and as additive therapy to 47.6% uncontrolled by previous combination therapy without a diuretic. Among included patients 75.7% received also an ACE inhibitor or an angiotensin II receptors blocker, 43.9% a calcium channel blocker, and 32.8% a beta-blocker. In 3 months after indapamide SR administration, average BP level decreased to 131.8 +/- 9.7/80.5 +/- 6.9 mmHg and 84.5% of the study population achieved BP control. BP was controlled in 91.9% of patients with ISH (n = 477), 74.8% of those with diabetes (n = 214), 75.6% of those with chronic nephropathy (n = 82), and 85.1% of patients with metabolic syndrome (n = 745). No case of hypokalemia was reported. CONCLUSION: The study demonstrates the value of including the thiazide-like diuretic indapamide SR in a combined antihypertensive regimen to control BP in hypertensive patients with added cardiovascular risk factors whose hypertension is difficult to treat. Methodological limitations of this study are its open-label design and the possibility of a change in concomitant antihypertensive treatment during the study.