Chronic thromboembolic pulmonary hypertension: current diagnostic and treatment options: A review

The article reviews current approaches to diagnosing and treating chronic thromboembolic pulmonary hypertension (CTEPH). The definition of the CTEPH is given, and its main risk factors are described. It is shown that the modern algorithm of diagnostic search includes four stages; the examination methods used at each stage are characterized. The most rational approach to CTEPH therapy is provided; the possibilities and limitations of pulmonary endarterectomy, transluminal balloon angioplasty of the pulmonary arteries, and specific therapy of pulmonary hypertension in such patients are described. The clinical presentation and treatment of CTEPH according to the Russian Pulmonary Hypertension Registry are reviewed

Obstructive sleep apnea syndrome and cardiovascular risk factors in the antihypertensive therapy “escape” phenomenon

Aim. To assess the role of obstructive sleep apnea and other cardiovascular (CV) risk factors in the development of the antihypertensive therapy (AHT) efficacy escape phenomenon in patients with arterial hypertension (AH). Materials and methods. The data of 75 patients with AH stage III, grades 13 were proceeded. All patients included in the study underwent night respiratory monitoring. After AHT prescription, blood pressure (BP) was monitored by three measurement methods (office, daily monitoring and self-control of blood pressure) initially, in 1, 3 and 6 months after the inclusion in order to confirm the initial therapy efficacy and to identify or exclude the escape phenomenon. Results. In 36.0% of patients, the escape phenomenon was diagnosed in 1 or 3 months of observation. When comparing the group with the escape phenomenon, an initially higher level of systolic BP was revealed according to office measurements, 24-hour monitoring and self-control BP monitoring (134.04.7 mmHg vs 126.08.5 mmHg; 129.02.3 mmHg vs 121.07.7 mmHg; 131.08.2 mmHg vs 121.56.2 mmHg resp.; р0,05). There were no differences in sleep apnea and CV risk factors between the groups. However in patients with a minimal SpO285% during sleep, there were a higher levels of office systolic BP both before the AHT prescription, and during its use (157.610.4 mmHg vs 152.48.1 mmHg resp., р0,05; 132.06.8 vs 127.18.9 mmHg resp.; р0,05), and mean 24-hour systolic BP (125.75.9 vs 121.68.2 mmHg resp.; р0,05) compared with patients with a minimum SpO285%. Conclusion. The higher BP level in patients with lover nocturnal hypoxemia does not allow us to exclude the delayed negative impact of obstructive sleep apnea, especially severe, on the BP profile in case of initially successful AH control

Sleep duration and cardiovascular risk: results of the large-scale epidemiology study ESSE-RF

Background. The recent data suggest that sleep disorders are associated with cardiovascular diseases. We assessedthe relation between self-reported sleep duration and cardiovascular and metabolic disorders in the large-scale epidemiological study. Material and methods. The ESSE-RF is a population-based cross-sectional study involving 22,258 participants aged 25–64 years from 13 regions of the Russian Federation. In 2012–2014, all subjects underwent a structured interview including questions about average daily sleep duration, lifestyle, complaints and diseases. The current analyses considered the associations with the following disorders: obesity, hypertension, coronary artery disease, myocardial infarction, stroke (cerebral thrombosis or hemorrhage) and diabetes mellitus. Results. Altogether 20,359 respondents were included in the final analysis. The mean self-reported sleep duration was 7.0 h per night: 23.3% participants reported sleeping less than 6 h while 4.5% subjects slept more than 9 h. We found both short and long sleep duration to be associated with self-reported cardiovascular diseases. The association was independent of age, sex, body mass index, blood pressure, lipids and glucose levels. The multivariable odds were higher for obesity in short-sleepers compared to those sleeping 7–8 h. In the meanwhile, the association was U-shaped for coronary artery disease. A J-shaped relation was found for myocardial infarction. No relation was found for hypertension, diabetes mellitus or stroke. Conclusions. Differences in sleep duration may have health consequences given associations between short and long sleep duration and cardiometabolic outcomes

A pilot study to determine the relationship of changes in the characteristics of β1- and β2-adrenoreceptors against the background of the use of β2-agonists with clinically significant parameters in patients with cardiovascular pathology

Background: Comorbid cardiovascular and bronchoobstructive diseases worsens disease course and prognosis and causes difficulties in therapy. Effectiveness 2-agonists (cornerstone of bronchoobstructive pathology treatment) depends on -adrenoreceptors state. Therefore, a detailed study of the functional state of beta-adrenoreceptors is necessary. Aim: to evaluate the relationship of changes in the characteristics of 1- and 2-adrenoreceptors, against the background of the use of 2-agonists in patients with cardiovascular and bronchoobstructive diseases with clinically significant parameters. Methods: In the pilot single-center prospective study during 2.5 years 45 patients (15 with cardiovascular and 30 with bronchoobstructive diseases) were included. Anamnestic data and complaints were collected and laboratory and instrumental studies were performed. Modified radioligand analysis on blood T-lymphocytes using radiolabeled Cyanopindolol and unlabeled selective ligands (ICI 118551, CGP 20712) before and after salbutamol and formoterol was performed and the binding activity of 1- and 2-adrenoreceptors was determined. Results: The correlation analysis between clinically significant parameters and changes in the specific binding index of 1- and 2-adrenoreceptors confirmed its clinical relevance. In test with beta-agonists in cardiovascular and bronchoobstructive diseases patients, an increase in the specific binding index of 1-adrenoreceptors is associated with clinical, laboratory and instrumental parameters of a favorable course of the disease, and an increase in the specific binding index of 2-adrenoreceptors is associated with negative. In the cardiovascular group without bronchoobstructive diseases with salbutamol an increase in the specific binding index of 1-adrenoreceptors was associated with parameters of unfavorable disease course, while an increase in the specific binding index of 2-adrenoreceptors did not have a clear associative relationship with clinical characteristics. Conclusions: The association of changes in the specific binding index of 1- and 2-adrenoreceptors in patients with cardiovascular and bronchoobstructive diseases with clinically significant parameters during acute tests with short- and long-acting 2-agonists was revealed, which in the future may provide an opportunity to identify patients with an unfavorable course of the disease

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Aspects of efficacy, safety and adherence to antihypertensive therapy with single pill combinations of valsartan, amlodipine and hydrochlorothiazide (Vamloset® and Co-Vamloset) in patients with 2 and 3 grade of arterial hypertension in the Russian clinical study VICTORY II

Aim. To assess the efficacy and safety of Vamloset® (amlodipine/valsartan 5/80, 5/160, 10/160 mg) and Co-Vamloset (amlodipine/valsartan/hydrochlorothiazide 10/160/12.5, 10/160/25 mg) in achieving the target levels of blood pressure (BP) in patients with stage 2–3 arterial hypertension (AH). The article discusses indicators affecting adherence to antihypertensive therapy (AHT). Material and methods. The VICTORY II Russian study in 8 clinical centers of the Russian Federation included 103 patients over 18 years of age with stage 2–3 essential AH (who haven’t been previously treated and have office systolic BP≥160 mm Hg and/or diastolic BP≥100 mm Hg or who haven’t reached the target office blood pressure with mono- or double AHT). The Full Analysis Set (FAS) for efficacy analysis included 99 patients, a FAS population with the restoration of data missed using Last Observation Carried Forward. The SF-36 questionnaire for assessing the quality of life, the effect on erectile function in men, the convenience of current therapy from the point of view of patients were analyzed after 16 weeks of treatment. The Per Protocol (PP) population included 80 patients completing the study without major protocol deviations to assess the primary parameters of efficacy. All patients with stage 2 hypertension were prescribed Vamloset® (amlodipine/valsartan 5/80 mg), with stage 3 hypertension – amlodipine/valsartan 5/160 mg. Dose titration of Vamloset® and Co-Vamloset (LLC «Krka-RUS») was carried out every 4 weeks according to the AHT schemes. Results. The study’s active phase included 100 patients aged 59.5±10.9 years (women 59%) with AH duration of 83.4±8.4 months; 83% of patients received AHT prior inclusion in the study. In the PP population, 16 week- AHT with Vamloset® or Co-Vamloset allowed reaching the target BP in 90.0% of patients (95% confidence interval [CI] 81.2–95.6). Overall clinical efficacy was achieved in 98.8% of patients (95% CI 93.2–100.0). All treatment regimens were characterized by high patient compliance. In the total group, 50% of patients rated their AHT as more convenient than they had previously used; of them, in the stage 2 AH group – 47.8%, in the stage 3 AH group – 53.3%. Metabolic neutrality with regard to at least one indicator was observed in 100% of patients, with regard to 6 indicators – in 43.9% [33.9; 54.9]. For all 98 patients included in the analysis, changes in all SF-36 scales, except for physical functioning (p=0.339), were statistically significant (

COVID-19: a patient with cardiovascular disease at high risk

The COVID-19 pandemic that has swept the planet has posed many questions for doctors around the world, including the tactics of managing patients with cardiovascular disease, both infected and self-isolated. A symposium held with the support of the Merck company was devoted to this problem: "COVID-19: a patient with cardiovascular pathology at a particular risk"

Russian Medical Society for Arterial Hypertension Expert Consensus: Hypertension and COVID-19

The novel coronavirus infection (COVID-19) caused by the b-coronavirus SARS-CoV-2, and leads to acute respiratory distress-syndrome, has affected more than nineteen million people worldwide, resulting in 0.7 million deaths as of August 2020. The fact that the virus uses angiotensin-converting enzyme 2 as a receptor for entering the target cell, and the high prevalence of hypertension and other cardiovascular diseases among patients with COVID-19, have caused serious discussions on the management of such patients. This consensus of experts from the Russian Medical Society for Arterial Hypertension analyzed the existing data on the relationship between COVID-19 and hypertension, the pathophysiological aspects of the penetration of the virus into target cells and the use of renin-angiotensin-aldosterone system inhibitors in patients with hypertension and COVID-19