[Problems of insufficient control of target blood pressure levels in the outpatient practice].

AIM: Assessment of the frequency of reaching the target level of blood pressure (BP) and the factors affecting it in outpatients with arterial hypertension (AH). MATERIALS AND METHODS: An open, one-stage, comparative study involving 64 patients with hypertension and 47 without hypertension at the age of 40 to 59 years. All patients underwent physical examination, assessment of cardiovascular risk (CVR), 24-hour blood pressure monitoring (ABPM), echocardiography (ECHOCG), color duplex scanning of brachiocephalic arteries. RESULTS: Patients with hypertension and comparison groups were comparable in age, sex, smoking, history of myocardial infarction. 1st degree of hypertension was present in 26.6%, 2nd in 40.6%, 3rd in 12.5% of patients. Obesity was detected in 24.3% of patients and all patients with obesity had AH. The SCORE score in individuals with hypertension was 4.94.5; in the comparison group, 2.32.6 (p0.001). Non-stenosing atherosclerosis was present in 54.8% and 88%, p=0.020, and atherosclerotic plaque in the vascular lumen was present in 45.3% and 12% of patients with and without hypertension, respectively (p0.001). 68.8% were constantly treated, and the target BP was reached in 31.3% of patients with hypertension. Male gender (OR 1.68; 95% CI 1.6828.49; p=0.007), obesity (OR 4.78; 95% CI 1.1420.29; p=0.033), concomitant pathology (OR 3.09; 95% CI 1.029.37; p=0.046) were negative, and dyslipidemia (OR 0.10; 95% CI 0.010.84; p=0.033) was positive, affecting the achievement of the target level of blood pressure. CONCLUSION: The target level of blood pressure was achieved in 31.3% of outpatients with hypertension, mainly in women. Among patients who did not reach the target level of blood pressure, men, individuals with high SSR and obesity predominated. Concomitant pathology and obesity are negative, and dyslipidemia was positively associated with the achievement of the target level of blood pressure, which must be taken into account when developing measures for prevention and treatment.

[Approaches to the Diagnosis and Treatment of Arterial Hypertension in the Light of European Recommendations].

In this review we present analysis the European recommendations on hypertension - what's new and what has changed in the tactics of managing patients with arterial hypertension (AH). We compared recommendations on hypertension of the European Society of Cardiology (ESC) and the European Society of hypertension (ESH) 2018 with European recommendations of previous years. In the updated version of guidelines, it is still recommended to determine AH as blood pressure (BP) ≥140 and / or ≥90 mm Hg; to subdivide BP levels into optimal, normal, and high normal, to classify severity of AH as 3 degrees, and to distinguish separately its isolated systolic form. Values for out-of-office BP remained unchanged, but recommendations emerged concerning wider use of ambulatory BP monitoring and self-measurement of BP. For initial therapy, it was recommended to use two drugs combinations preferably as single pill combinations. An increase of the role of nurses and pharmacists in teaching, supporting patients and controlling hypertension has been noted. This can improve the achievement of target BP and, as a result, reduce the cardiovascular risk. New European recommendations highlight the modern aspects of classification and diagnosis of AH, main stages of screening, and algorithm of drug treatment of AH.

[Duodenogastric reflux and gastric pathology in the elderly patients].

OBJECTIVE: To determine the frequency of duodenogastric reflux (DGR), and to assess the changes in the gastric mucosa in the presence of bile reflux. MATERIALS AND METHODS: Our study includes the results of 1371 gastroduodenoscopies carried out in 2008, for patients between 65 and 92 years old, the study includes both kind of patients who were admitted to hospital and those who were investigated on an outpatient basis. The main group includes 695 patients with various level of DGR severity, and the control group consists of 676 patients without DGR. RESULTS: DGR was diagnosed in 14.8% more in women. In case of the presence of DGR we have found changes in the antrum mucosa as congestion, and minor erosion, hyperplasia, metaplasia of gastric and esophageal mucosa, and stomach polyps. And we have not noticed such changes when DGR was absent. We have found that the high frequency of antral hyperplasia is correlated to the DGR severity. CONCLUSION: DGR is diagnosed in more than 10% of patients who undergo gastroduodenoscopy. DGR is an indicator of conditions often associated with various morphological changes in gastric mucosa; therefore this finding has to be taken in consideration in the further investigations and management of such patients.

[Use of prazosin in patients with hypertension]. / Primenenie prazozina u bol'nykh gipertonicheskoi bolezn'iu.

Clinical trials of the alpha-adreno-blocker prazosin (Pratsiol as produced by "Orion", Finland) were carried out in 42 patients with essential hypertension, stages 2-3 by WHO classification, and 3 patients with nephrogenic hypertension. Daily doses of the drug varied between 3 and 20 mg. Good hypotensive effect was noted in 51% of patients whose cardiac index had not originally exceeded 4.5 r/min/m2 and showed no basic rise under the effect of treatment, total peripheral resistance was never below 1200 din X sec X cm-5, and heart rate kept below 80 beats per minute. In cases of higher cardiac index and heart rate values, prazosin had little or no effect. A daily dose of 8-10 mg may be considered an optimum regimen. Sinus tachycardia was the most common of side-effects. The drug was particularly effective where hypertension was combined with bradycardia.

[The optimization of the captopril treatment of patients with stage-II hypertension at polyclinics]. / Optimizatsiia lecheniia bol'nykh gipertonicheskoi bolezn'iu II stadii v poliklinicheskikh usloviiakh.

To optimize captopril therapy of patients suffering from stage II essential hypertension under ambulant conditions, use was made of an acute medicamentous test with that drug. The long-term systematic therapy (for a year) was provided to 50 patients with positive results of the test. The long-term systematic captopril therapy in individually selected doses led to a decrease and stabilization of blood pressure, minimized subjective disease manifestations and improved hemodynamic characteristics. The application of the drug in moderate doses prevented the development of side effects that might require drug discontinuance.

[The therapeutic and prophylactic use of Olicard-Retard under outpatient polyclinical conditions in stenocardia patients]. / Lechebno-profilakticheskoe primenenie v ambulatorno-poliklinicheskikh usloviiakh olikarda-retard u bol'nykh so stenokardiei.

Olicard-Retard, isosorbide-5-mononitrate drug, has been tried in a single daily dose 40 mg in 60 outpatients with angina pectoris. The drug reduced the frequency of anginal attacks and nitroglycerine intake in most of the patients. The antianginal properties were combined with anti-ischemic effects as shown by echocardiography. Side effects (head ache) were mild. Olicard-Retard proved effective in angina of effort both in monotherapy and combined treatment.

[The use of the cephalosporin antibiotic Zinnat under polyclinic conditions in treating patients with bronchopulmonary infections]. / Primenenie tsefalosporinovogo antibiotika zinnata v poliklinicheskikh usloviiakh pri lechenii bol'nykh s bronkholegochnymi infektsiiami.

The cephalosporin antibiotic zinnat was given to 171 outpatients with bronchopulmonary infections. Pneumonia patients received 500 mg, patients with acute bronchitis or exacerbation of chronic bronchitis 250 mg twice a day. The recovery was registered in 97.7, 98.8 and 91.8% of patients, respectively. The drug proved effective, low-toxic, convenient in use. Wide-spectrum action, significant activity against both gram-positive and gram-negative pathogens make zinnat a promising drug for outpatient treatment of bronchopulmonary infections.