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1.
Artigo em Russo | MEDLINE | ID: mdl-31851178

RESUMO

There is a growing interest to the problem of drug-induced epileptic seizures (ES) due to their relatively high prevalence, poor prognosis, a large number of different drugs associated with the development of drug-induced ES, and low awareness among general practitioners. Drug-induced ES are most often associated with the use of antidepressants, antipsychotics, antiepileptic drugs (overdose or as a result of discontinuation), antibiotics, immunosuppressants and immunomodulators, antitumor agents, analgesics, central nervous system stimulators, anesthetics etc. The prevalence of drug-induced ES varies with different drugs. It is estimated that about 6.1% of the first occurring ES are drug-induced. Risk factors for drug-induced ES include a history of epilepsy or ES, cancer, blood-brain barrier dysfunction, several concomitant neurological diseases, mental disorders, childhood, old and very old age, fever, impaired liver metabolism in patients with liver diseases, impaired drug excretion in patients with kidney diseases, polypharmacy, pharmacokinetic properties of the drugs themselves, allowing them to penetrate the blood-brain barrier in the central nervous system (lipophilicity, transport and communication with blood plasma proteins), drug concentration in blood serum, method and frequency of drug administration, single and daily doses of drugs. No clinical guidelines for the management of patients with drug-induced ES are available. It is recommended to identify patients at risk: elderly patients, patients with impaired liver and kidney function and patients receiving drugs that can cause ES and/or lower the seizure threshold. Benzodiazepines are the first-line treatment in drug-induced status epilepticus, barbiturates and propofol are the second-line treatment. The general principles for the prevention of drug-induced ES include careful selection of the optimal dose of drugs that can cause ES, especially in patients with impaired liver and/or kidney function, monitoring of several parameters in blood serum (for example, liver enzymes, electrolytes, glucose etc.), monitoring of the blood plasma concentration of certain drugs, avoiding the simultaneous administration of several drugs that stimulate the central nervous system, and a rapid discontinuation of such drugs.


Assuntos
Epilepsia , Convulsões , Idoso , Anticonvulsivantes/efeitos adversos , Antidepressivos/efeitos adversos , Antipsicóticos/efeitos adversos , Criança , Humanos , Prevalência , Fatores de Risco , Convulsões/induzido quimicamente
2.
Kardiologiia ; 59(11): 56-65, 2019 Dec 11.
Artigo em Russo | MEDLINE | ID: mdl-31849300

RESUMO

Blood pressure variability (BPV) is the fluctuations of blood pressure over a certain period of time under the influence of various factors. The issue of increased BPV is of particular clinical importance due to high predictive value of this parameter as a risk factor for fatal and non-fatal cardiovascular, cerebrovascular and renal events. It is proved that in the BPV increasing, the key role is played by impairments in arterial baroreflexes, which, in turn, are mediated by increased vascular stiffness, impact of angiotensin II and the sympathetic nervous system, endothelial dysfunction, nitric oxide deficiency and aging, including the vascular aging. Antihypertensive drugs that targeting largest amount of pathophysiological mechanisms in BPV increasing have a most advantages in correcting excessive pressure fluctuations. In this regard such drugs are perindopril and amlodipine, which can eliminate almost the entire spectrum of increased BPV causes and, therefore, optimally reduce the cardiovascular risk.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão , Pressão Sanguínea , Determinação da Pressão Arterial , Humanos , Hipertensão/tratamento farmacológico
3.
Artigo em Russo | MEDLINE | ID: mdl-31626183

RESUMO

According to modern concepts, sleep disorders are considered as a common geriatric syndrome, which also emphasizes their polyfactorial genesis. One of the important factors inducing sleep disorders is the intake of various drugs, which becomes especially significant with the problems of polymorbidity and polypharmacy occurring in older age groups. The article provides a classification of drug-induced sleep disorders, which presents a wide range of conditions associated with a disturbance of the sleep-wake cycle. The authors present the frequency of insomnia associated with taking drugs from different pharmacological groups according to the literature, and consider mechanisms of insomnia development due to the effect on various receptors and neurotransmitter systems, as well as data on their effect on sleep structure. The article presents risk factors for drug-induced insomnia and discusses preventive measures and management of patients.

4.
Vestn Otorinolaringol ; 84(4): 72-80, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31579063

RESUMO

The ability of drugs to have an ototoxic effect has been studied for a long time, however, the true prevalence of this undesirable phenomenon is unknown, which is due to the use of various audiological protocols, a wide range of reactions to drugs in different ethnic groups, and most importantly, the lack of caution with regard to otological symptoms due to their reversibility or lack of immediate threat to life. Drug-induced ototoxicity is a functional disorder of the inner ear (cochlea and/or vestibular apparatus) or eighth pair of cranial nerves. Pharmacotherapy, associated with the development of ototoxic drug reactions, may remain undervalued for a long time, often until irreversible hearing impairment is formed. The most frequently prescribed drugs that cause ototoxic phenomena include anticancer drugs, antibacterial drugs of the aminoglycoside group, loop diuretics, calcium channel blockers, non-steroidal anti-inflammatory drugs, antimalarial drugs, salicylates, etc. Monitoring the degree of hearing impairment before and during therapy is important in preventing the development of drug-induced ototoxicity and makes it possible to consider alternative treatment regimens in a timely manner. It is in this connection that the role of participation in the appointment of rational pharmacotherapy to patients with a potential risk of developing otological phenomena of a clinical pharmacologist and audiologist undoubtedly increases.


Assuntos
Surdez , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Perda Auditiva , Aminoglicosídeos/efeitos adversos , Antibacterianos/efeitos adversos , Surdez/induzido quimicamente , Orelha Interna/efeitos dos fármacos , Perda Auditiva/induzido quimicamente , Humanos
5.
Artigo em Russo | MEDLINE | ID: mdl-31464299

RESUMO

Drug-induced delirium is an urgent challenge of modern healthcare, especially in elderly patients, due to the widespread prevalence, associated complications, longer hospitalization period, higher mortality rate. The exact pathogenesis of delirium is unknown, however, a number of studies suggest that it is based on neurotransmitter dysfunction. Thus, drugs that affect the metabolism of these neurotransmitters can lead to the onset of delirium. The Delirium Drug Scale (DDS) and the Anticholinergic Burden scale (ACB) are used to assess the risk of delirium. For patients with an increased risk of delirium, it is recommended to avoid prescribing benzodiazepines, use with caution opiates, dihydropyridines and antagonists of H1-histamine receptors. Non-pharmacological methods are recommended as a first-line treatment of delirium (behavioral approaches, placing the patient in specially equipped delirious rooms, etc.). If non-pharmacological methods have shown to be ineffective or the patient's behavior represents a danger to the life and health of himself and / or others, it is possible to administer antipsychotic drugs.


Assuntos
Antipsicóticos , Benzodiazepinas , Antagonistas Colinérgicos , Delírio , Idoso , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Antagonistas Colinérgicos/efeitos adversos , Delírio/induzido quimicamente , Hospitalização , Humanos
6.
Artigo em Russo | MEDLINE | ID: mdl-31317906

RESUMO

The review deals with the problem of polypragmasia and associated adverse drug reactions, which is very relevant for the elderly and senile age. Based on the frequent unjustified prescription of antipsychotic drugs in clinical practice and the serious consequences associated with it, especially in elderly people with cognitive impairment, the aim of this review was to analyze the current literature and an evidence base for antipsychotic therapy optimization in elderly. One of the most effective way to decrease drug-associated harm is deprescribing, the planned process of decreasing dose, discontinuation of drug or switching to another one aimed to improve quality of life of the patient. The article describes different types of deprescribing, presents the results of the analysis of literature on deprescribing of antipsychotics in long-term use in elderly patients with dementia. Central to this is the analysis of a systematic review of Cochrane E. Van Leeuwen and co-authors (2018), the leading research in the evidence base of deprescribing. Based on the available literature, the authors make the conclusion about the safety of deprescribing of antipsychotic drugs. The effect of abrupt discontinuation of treatment with antipsychotic drugs was evaluated in available literature. Most of the evidence relates only to residents of nursing homes or to patients in long-term psychogeriatric or geriatric wards (in-patient treatment). However, the evidence base of deprescribing of antipsychotic drugs is small, many studies have methodological limitations, the initial characteristics of the patients included in the study are extremely heterogeneous, methodologies for diagnosing and determining the severity of dementia, types and dosages of antipsychotic drugs, duration of observation periods differed greatly. Attention is drawn to the short duration of observation periods. All of the above dictates the need for specially planned randomized clinical trials, the results of which will develop detailed algorithms for deprescribing antipsychotics.


Assuntos
Antipsicóticos , Demência , Desprescrições , Idoso , Antipsicóticos/uso terapêutico , Demência/tratamento farmacológico , Humanos , Pacientes , Qualidade de Vida , Revisão Sistemática como Assunto
7.
Kardiologiia ; 59(3): 18-26, 2019 Apr 12.
Artigo em Russo | MEDLINE | ID: mdl-30990137

RESUMO

OBJECTIVE: to investigate the impact of indapamide / perindopril single-pill combination (I / P SPC) on arterial stiffness parameters, blood pressure (BP) level and BP variability (BPV) in middle-aged patients with stage II grade 1-2 essential arterial hypertension (EAH). Materials and methods. We retrospectively formed a group of patients with stage II grade 1-2 EAH who had not previously received regular antihypertensive therapy (AHT) (n=52, mean age 52.9±6.0 years). All patients were treated with I / P SPC and all of them achieved target office BP level (less than 140 / 90 mm Hg). After 12 weeks of follow-up (from the time of reaching the target BP) assessment of AHT effectiveness (general clinical data, ambulatory blood pressure monitoring [ABPM], volume sphygmography, echocardiography), and vascular stiffness evaluation were performed. RESULTS: At the end of follow-up office systolic BP (SBP), diastolic BP (DBP), pulse BP, day-time, night-time and 24­hour SBP and DBP significantly (p<0.001 for all) decreased. According to the ABPM data day-time, nighttime, and 24­hour systolic BPV significantly decreased (p=0.029, p=0.006 and p<0.001, respectively); day-time and 24­hour diastolic BPV also significantly decreased (p=0.001 and p<0.001, respectively). Day-night standard deviation (SDdn) significantly decreased too (p=0.002 and p<0.001, respectively). Volumetric sphygmography showed significant decrease of right cardio-ankle vascular index (CAVI) (from 8.20±1.29 to 7.58±1.44, p=0.001) and of left CAVI (from 8.13±1.40 to 7.46±1.43, p<0.001), as well as reduction of the number o f patients with a right- and / or left-CAVI >9.0 (from 32.7 to 11.5 %, p=0.018). According to assessment of arterial stiffness using the Vasotens24 software package, the arterial stiffness index (ASI) significantly (p<0.001) decreased from 153.5±29.9 to 138.3±20.0 (by -9.2±13.1 %). Transthoracic echocardiography data demonstrated significant decrease (p<0.001) in effective arterial elastance (from 1.82±0.43 to 1.58±0.36 mm Hg; by -11.85±16.29 %) and significant (p<0.001) increase in the arterial compliance - from 1.27±0.34 to 1.54±0.38 mm Hg / ml (+26.95±38.06 %). CONCLUSION: In AHT naive patients 40-65 years old with stage II grade 1-2 EAH therapy with I / P SPC provided effective 24­hour BP control, reduced BPV and improved arterial stiffness parameters.


Assuntos
Hipertensão , Indapamida/uso terapêutico , Perindopril/uso terapêutico , Anti-Hipertensivos , Arginina , Pressão Sanguínea , Monitorização Ambulatorial da Pressão Arterial , Humanos , Hipertensão/tratamento farmacológico , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
8.
Artigo em Russo | MEDLINE | ID: mdl-30874535

RESUMO

This review summarizes and systematizes currently available literature on antipsychotics as one of the most frequently prescribed group of psychotropic drugs. Based on published data from clinical studies and meta-analyzes, the authors consider unwanted adverse reactions in patients taking antipsychotic medications. Mechanisms of development of undesirable drug reactions are discussed. Special attention is paid to those adverse reactions of antipsychotics that most often occur in old and very old age (increased risk of adverse cardiovascular and cerebrovascular events, sudden death, prolonged QTc interval, falls, fractures, orthostatic hypotension, extrapyramidal disorders, pneumonia, urinary tract infections, etc.).


Assuntos
Antipsicóticos/uso terapêutico , Acidentes por Quedas , Idoso , Humanos , Psicotrópicos
9.
Zh Nevrol Psikhiatr Im S S Korsakova ; 118(10): 115-121, 2018.
Artigo em Russo | MEDLINE | ID: mdl-30499507

RESUMO

Essential arterial hypertension (AH) is one of the main risk factors for the development of cognitive impairment and dementia. Cognitive decline is an early sign of brain damage as a target organ of hypertension, it occurs even in patients with uncomplicated hypertension with minimal duration of disease. Cognitive impairment progresses with increasing age and hypertension duration, as well as in non-controlled AH. In patients with hypertension, the prevalence of emotional disorders - anxiety and depression is also high. In addition to antihypertensive therapy, hypertensive patients need correction of concomitant cognitive and emotional disorders. Rat-gopantenic acid simultaneously corrects both emotional and cognitive impairment, and has a good tolerability profile as well. An analysis of the evidence base of rac-gopantenic acid showed its high efficacy in the treatment of mental disorders and good tolerability along with a positive effect on somatic disorders and results of antihypertensive therapy. Taken together, they enhance adherence to treatment and, consequently, reduce the cardiovascular risk.


Assuntos
Transtornos Cognitivos , Transtorno Depressivo , Hipertensão , Anti-Hipertensivos , Ansiedade/complicações , Ansiedade/tratamento farmacológico , Cognição , Transtornos Cognitivos/complicações , Transtornos Cognitivos/tratamento farmacológico , Transtorno Depressivo/complicações , Transtorno Depressivo/tratamento farmacológico , Humanos , Hipertensão/complicações , Ácido Pantotênico/análogos & derivados , Ácido Pantotênico/uso terapêutico , Ácido gama-Aminobutírico/análogos & derivados , Ácido gama-Aminobutírico/uso terapêutico
10.
Kardiologiia ; (10): 71-79, 2018 Oct.
Artigo em Russo | MEDLINE | ID: mdl-30359218

RESUMO

The article describes the definition of dementia, its diagnostic criteria, classification. Differences in the pathogenesis and clinical manifestations of different types of dementia are considered. The issues of interrelation of arterial hypertension and the risk of development of cognitive disorders and dementia in old and very old people are discussed in detail. Data on the effect of antihypertensive drugs of different groups on the risk of dementia and the state of cognitive functions are presented. The evidence base of dihydropyridine calcium antagonist amlodipine and thiazide-like diuretic indapamide-retard is discussed with respect to the prevention of dementia and cognitive decline and their beneficial effect on cognitive function in patients with arterial hypertension.


Assuntos
Demência , Hipertensão , Indapamida , Anti-Hipertensivos , Pressão Sanguínea , Cognição , Humanos
11.
Kardiologiia ; 58(9): 76-88, 2018 09.
Artigo em Russo | MEDLINE | ID: mdl-30295203

RESUMO

This article presents an overview of data of Russian and foreign literature on possible associations between cognitive impairment and atrial fibrillation (AF). It includes modern classification of cognitive impairment, mechanisms of the effect of AF on cognitive functions and development of dementia, recommendations for the prevention of cognitive impairment in patients with AF. Special attention is paid to the assessment of cognitive status, and safe anticoagulant therapy, which is a priority in the prevention of cognitive impairment in patients with AF. Analysis of literature showed greater efficacy and safety of drugs from the group of Non-vitamin K Antagonist Oral Anticoagulants (NOAC), rivaroxaban in particular, in comparison with warfarin. Drugs from the NOAC group can be recommended for prevention stroke, cognitive impairment and dementia in elderly patients with AF.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/prevenção & controle , Demência/etiologia , Demência/prevenção & controle , Rivaroxabana/uso terapêutico , Varfarina/uso terapêutico , Administração Oral , Idoso , Anticoagulantes/administração & dosagem , Fibrilação Atrial/fisiopatologia , Cognição , Disfunção Cognitiva/fisiopatologia , Demência/fisiopatologia , Humanos , Fatores de Risco , Rivaroxabana/administração & dosagem , Federação Russa , Varfarina/administração & dosagem
12.
Artigo em Russo | MEDLINE | ID: mdl-30335083

RESUMO

This article presents a review of Russian and foreign literature about the impact of arterial hypertension (AH) on the risk of cognitive impairment and dementia. Large studies have demonstrated the effect of blood pressure (BP) on the risk of vascular dementia and Alzheimer's disease (AD) in elderly and oldest old people as well as a role of antihypertensive therapy. There is evidence of a negative effect of hypertension in middle age on cognitive functions in late-life. Observational studies as a whole have shown the positive effect of antihypertensive therapy on the prevention of cognitive function and dementia. However, there are a number of limitations that dictate the need for further research on this issue. The importance of the interdisciplinary approach to treatment of cognitive impairment by cardiologists and/or therapists, together with neurologists, as well as complex treatment regimens, including correction of risk factors and neuroprotective therapy, is highlighted.


Assuntos
Doença de Alzheimer , Transtornos Cognitivos , Demência Vascular , Hipertensão , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Anti-Hipertensivos/uso terapêutico , Cardiologistas , Cognição , Transtornos Cognitivos/complicações , Demência Vascular/complicações , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Fatores de Risco , Federação Russa
13.
Artigo em Russo | MEDLINE | ID: mdl-30251974

RESUMO

AIM: To study cognitive functions, anxiety and depression levels, 24-hour blood pressure (BP) profile, cerebral blood flow (CBF) perfusion in treatment-naive middle-aged patients with uncomplicated essential arterial hypertension (EAH) depending on the white matter hyperintensities (WMH) burden. MATERIAL AND METHODS: Forty-one hypertensive patients (mean age 46.2±4.6 years) and 41 healthy volunteers (mean age 50.3±6.7 years) were enrolled to the study. All subjects underwent brain MRI (MAGNETOM Skyra 3.0T, T1, T2 FSE, T2 FLAIR, T1 MPRAGE, ASL), Montreal cognitive assessment (MoCa), 10-word learning task, verbal fluency test, trail making test, Stroop color and word test, anxiety and depression assessment with Hamilton rating scales, 24-hour blood pressure monitoring (ABPM). RESULTS: WMH were found in 22 (53.7%) hypertensive patients and in 3 (7.3%) healthy volunteers (p=0.0002). Hypertensive patients had the significantly lower CBF compared to controls (p<0.001). CONCLUSION: WMH were identified in treatment-naive middle-aged patients with uncomplicated mild to moderate EAH. There was an association between WMH and lower CBF in the cortical plate of frontal lobes, SBP variability and worse cognition. Cerebral hypoperfusion can cause cognitive impairment even in the earliest stages of EAH, which increases due to emotional disorders.


Assuntos
Disfunção Cognitiva , Hipertensão , Adulto , Encéfalo/diagnóstico por imagem , Estudos de Casos e Controles , Circulação Cerebrovascular , Cognição , Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico por imagem , Humanos , Hipertensão/complicações , Imagem por Ressonância Magnética , Pessoa de Meia-Idade
14.
Kardiologiia ; (8): 82-88, 2018 Aug.
Artigo em Russo | MEDLINE | ID: mdl-30131046

RESUMO

In this article we present problems of prognostic value of day-by-day blood pressure (BP) variability, its role in development and progression of damage of target organs in arterial hypertension, and impact on risk of cardiovascular, cerebral-vascular complications, and mortality. We also discuss methodological aspects of assessment of day-by-day BP variability. The article contains literature data on effects of antihypertensive therapy on variability of home BP, and consideration of evidence base of possibilities of the fixed amlodipine/perindopril combination for lowering day-by-day BP variability.


Assuntos
Hipertensão , Anlodipino , Anti-Hipertensivos , Pressão Sanguínea , Combinação de Medicamentos , Humanos , Perindopril , Prognóstico
15.
Kardiologiia ; (5): 23-31, 2018 May.
Artigo em Russo | MEDLINE | ID: mdl-29870321

RESUMO

OBJECTIVE: This study aimed to assess the cognitive functions and cerebral blood flow measured with arterial spin labeling (ASL) and their possible correlations with vascular age in untreated middle-aged patients with grade 1-2 essential arterial hypertension (EAH). METHODS: We examined 73 subjects aged 40-59 years (33 with EAH and 40 healthy volunteers [controls]). Neuropsychological assessment included Montreal Cognitive Assessment (MoCA), Trail Making test (part A and part B), Stroop Color and Word Test, verbal fluency test (phonemic verbal fluency and semantic verbal fluency), 10­item word list learning task. All subjects underwent brain MRI. MRI protocol included ASL. Vascular age was calculated by two techniques - using Framingham Heart Study risk tables and SCORE project scales. RESULTS: Patients with EAH had lower performance on phonemic verbal fluency test and lower mean MoCA score (29.2±1.4 vs. 28.1±1.7 points) compared to controls (13.4±3.2, р=0.002; 29.2±1.4, p=0.001, respectively). White matter hyperintensities (WMH) were present in 7.5 % controls and in 51.5 % EAH patients (р=0.0002). Cerebral blood flow (CBF) in EAH patients was lower in both right (39.1±5.6 vs. 45.8±3.2 ml / 100 g / min) and left frontal lobes of the brain (39.2±6.2 и 45.2±3.6 ml / 100 g / min, respectively) compared to controls (р.


Assuntos
Encéfalo , Cognição , Adulto , Circulação Cerebrovascular , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Marcadores de Spin
16.
Kardiologiia ; (3): 63-72, 2018 Mar.
Artigo em Russo | MEDLINE | ID: mdl-29782273

RESUMO

The article discusses various mechanisms of developmentt and progression of arterial hypertension in young and middle aged adults. It emphasizes the predominant role of hypersympathicotonia in the development of the disease in this category of patients. Various mechanisms are considered, by means of which the increase of activity of the sympathetic nervous system leads to elevation of arterial pressure and potentiates early damage of target organs, first of all, damage of the heart. The data of numerous studies demonstrating pronounced cardioprotective effects of a highly selective representative of the class of ß-blockers bisoprolol in young and middle aged hypertensive patients are presented.


Assuntos
Bisoprolol/uso terapêutico , Hipertensão Essencial/tratamento farmacológico , Antagonistas Adrenérgicos beta , Humanos , Pessoa de Meia-Idade , Sistema Nervoso Simpático
17.
Kardiologiia ; 58(11): 72-81, 2018 Nov 24.
Artigo em Russo | MEDLINE | ID: mdl-30625080

RESUMO

In the review, the clinical significance of increased myocardial stiffness and strain impairment in the settings of arterial hypertension is considered. The mechanisms of increasing myocardial stiffness as a part of hypertensive heart disease are presented. Particular attention is paid to the role of the sympathetic nervous system activation as one of the triggers that induce the connective tissue alteration of cardiac interstitium. The possibilities of echocardiography in the early noninvasive detection of myocardial strain abnormalities are discussed. New ultrasound parameters for describing stiffness properties of the heart are presented. From the evidence-based medicine point of view, the prognostic significance of increasing myocardial stiffness as a risk factor of the adverse cardiovascular events, as well as the possibility of its management with different antihypertensive drugs, is considered. Finally, there are presented clinical trials data, indicating high potential of the highly selective ^1-adrenoblocker bisoprolol for of correction myocardial stiffness and strain impairment.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão , Rigidez Vascular , Ecocardiografia , Humanos , Hipertensão/tratamento farmacológico , Miocárdio , Sistema Nervoso Simpático
18.
Ter Arkh ; 90(9): 15-26, 2018 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-30701730

RESUMO

AIM: To evaluate the presence and the severity of the complaints (headache, dizziness, memory loss, concentration of attention, sleep disturbances, decreased mood, increased anxiety), the state of cognitive functions, emotional status and quality of night sleep in treatment-naïve middle-aged patients with mild to moderate EAH compared to healthy volunteers of the same age. MATERIALS AND METHODS: 103 treatment-naïve patients with EAH aged 40-59 years at the enrollment, who met the inclusion/exclusion criteria and provided written informed consent (46 men, mean age 53.6±0.8 years) and 50 healthy volunteers (17 men, mean age 51.5±1.0 years) with normal blood pressure (BP) level - control group - were enrolled to the study. Mean EAH duration was 2.9±5.7 years. Cognitive assessment included Montreal cognitive assessment, 10-words learning task, verbal fluency test, TMT, Stroop color and word test. Anxiety and depression were evaluated via Hamilton rating scales (HARS and HDRS). 24-hours ambulatory BP monitoring (ABPM) was performed according to European guidelines. RESULTS: 70% of patients with EAH complained of memory disturbance, 68% - lack of attention, 22% - sleep disturbances, 12% - dizziness, 9% - headache. It took statistically significant more time for patients with EAH to perform on TMT B (p<0.05), they had significantly higher TMT B - TMT A difference score (p<0.01) and lower mean MoCA score (p<0.05). Patients with EAH had significantly higher mean score in Hamilton anxiety (2.1±3.7) and depression (1.1±2.4) rating scales compared to controls (0.3±0.9 points, p<0.01 and 0.1±0.5 points, p<0.001, respectively). Patients with EAH who complained of sleep disturbances had low sleep quality (8.7±2.8 points). Among patients with EAH who complained about headaches 66.6% had episodic migraine and chronic tension type headache (33.4%). Those patients had a substantial impact of headache on life and daily living according to HIT-6 (mean score - 57.5±6.1). Only 2 patients out of 12 with complains about dizziness had benign paroxysmal positional vertigo and Ménière's disease. CONCLUSION: Complaints about memory dysfunction, lack of attention, sleep disturbances, less common - dizziness and headaches, are most typical in patients with EAH on the early stages of the disease. They differ from healthy volunteers of the same age by having cognitive impairment and higher anxiety and depression scores. Patients with EAH who complained about sleep disturbances had low sleep quality. Headache in patients with EAH was due to episodic migraine and tension type headache which had a negative impact on life and daily living.


Assuntos
Ansiedade , Depressão , Hipertensão Essencial , Cefaleia/etiologia , Transtornos do Sono-Vigília , Adulto , Ansiedade/diagnóstico , Ansiedade/fisiopatologia , Monitorização Ambulatorial da Pressão Arterial/métodos , Cognição/fisiologia , Depressão/diagnóstico , Depressão/fisiopatologia , Tontura/etiologia , Hipertensão Essencial/diagnóstico , Hipertensão Essencial/fisiopatologia , Hipertensão Essencial/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Transtornos do Sono-Vigília/diagnóstico , Transtornos do Sono-Vigília/etiologia , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
19.
Ter Arkh ; 90(9): 123-132, 2018 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-30701746

RESUMO

The review presents a modern view on stress as a risk factor for the development of arterial hypertension (AH). A variety pathogenic mechanisms responsible for increase of blood pressure during stress exposure are described in detail. The importance of the sympathetic activation as a key link in the development of stress-induced AH and initiation of a cascade of pathophysiological reactions that realize their adverse effects at the level of the whole organism is underlined. Particular attention is paid to worksite AH as a variant of stress-induced hypertension due to its wide prevalence and association with an increased risk of cardiovascular complications, primarily myocardial infarction and stroke. Epidemiological data and results of recent metanalysis are presented, indicating the high significance of job strain as a risk factor for adverse cardiovascular events. The actual psychological stress reduction programs are described. Possibilities of using ß-blockers in patients with stress-induced hypertension as drugs affecting the central pathogenetic trigger of this disease are considered. The advantages of using bisoprolol as a highly selective ß-blocker are considered taking into account the available body of evidence for its effectiveness in patients with worksite AH, as well as its metabolic neutrality and target-organ protective properties.


Assuntos
Antagonistas Adrenérgicos beta/farmacologia , Hipertensão , Estresse Ocupacional/fisiopatologia , Local de Trabalho/psicologia , Ciências Biocomportamentais , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/psicologia , Estresse Ocupacional/prevenção & controle , Estresse Psicológico/fisiopatologia , Sistema Nervoso Simpático/efeitos dos fármacos , Sistema Nervoso Simpático/fisiopatologia
20.
Kardiologiia ; 57(11): 68-75, 2017 Nov.
Artigo em Russo | MEDLINE | ID: mdl-29276920

RESUMO

The article is devoted to the modern state of the problem of blood pressure variability (BPV). Along with discussion of classification and methods of diagnosis it contains data on prognostic value of visit-to-visit BPV. We have also reviewed effect on BPV of various regimens of antihypertensive therapy and presented evidence base supporting ability of amlodipine/perindopril fixed dose combination to lower visit-to-visit BPV.


Assuntos
Hipertensão , Anlodipino , Anti-Hipertensivos , Pressão Sanguínea , Determinação da Pressão Arterial , Combinação de Medicamentos , Humanos , Perindopril
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