ИТОГИ РЕАЛИЗАЦИИ ФЕДЕРАЛЬНОЙ ЦЕЛЕВОЙ ПРОГРАММЫ ПО ПРОФИЛАКТИКЕ И ЛЕЧЕНИЮ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИИ В РОССИИ В 2002–2012 ГГ.

The analysis of measures efficiency for prevention by essential hypertension (EH) in Russian Federation within the space of 2002–2012 years was realized. Those measures were carrying out Federal (National) Project and primary activity of the medical and scientific institutions under the leadership Russian Cardiology Research and Production Complex. The basic result was decrease in cardiovascular disease death rate starting with 2004 year. The most pronounced significant changes were found in death rate from the cerebrovascular diseases. From 2003 to 2012, the annual cerebrovascular disease death rate decreased in 1,5 times (in 2003 — 339,9 by 100 thousands, to compare with 2012 — 224,1 by 100 thousands). Moreover, in 2012 the fatal stroke death rate was decreased on 114,8 thousands (to compare with 2004). Decrease of cardiovascular disease death rate is achieved from: early revealing of essential hypertension pts; development and introduction in practical public health of new methods of prevention («Schools of Health»), adequate diagnostic and treatment of essential hypertension patients; increase of an educational level by cardiology in polyclinics, also use by the government of special purposes for Cardiovascular disease death rate decrease.Проанализирована эффективность мероприятий по борьбе с артериальной гипертензией в Российской Федерации за период с 2002 по 2012 гг., проводимых в рамках Федеральной целевой программы и основной деятельности медицинских и научных организаций с организационно-методическим руководством Российского кардиологического научно-производственного комплекса как головного учреждения по профилю «Кардиология». Основным достижением явилось снижение смертности населения от болезней системы кровообращения, начиная с 2004 г. Наиболее выраженные позитивные изменения отмечены в смертности от цереброваскулярных болезней, уровень которой снизился в 1,5 раза с 339,9 случаев на 100 тыс. населения в 2003 г. до 224,1 в 2012 г., в т.ч. от фатальных инсультов (уменьшение на 114,8 тыс. случаев по сравнению с 2004 г.). Снижение смертности от болезней системы кровообращения достигнуто за счет: раннего выявления лиц с артериальной гипертензией; разработки и внедрения в практическое здравоохранение новых методов профилактики («Школы здоровья»), диагностики и лечения больных артериальной гипертензией; повышения образовательного уровня врачей первичного звена здравоохранения в области кардиологии, а также использования программно-целевого подхода государства в решении проблемы, направленного на достижение конечного результата — снижения смертности от болезней системы кровообращения.

COVID-19 and cardiovascular diseases [COVID-19 и сердечно-сосудистые заболевания]

First cases of new coronavirus infection were registered in December 2019. The COVID-19 outbreak was declared a global pandemic. COVID-19 is much more dangerous for people older than 65. It is well known that cardiovascular diseases are more affecting older patients as well. The potentially dangerous combination of the new infection and different cardiovascular diseases has become a crucial problem of cardiology in 2020. © 2020 Consilium Medikum. All rights reserved

The possibility of a new receptor blocker to angiotensin in improving control of hypertension. Non-intervention international multicenter observational prospective study of the use azilsartan medoxomil in patients with arterial hypertension and overweight

Currently, there is evidence of a rather low efficacy of antihypertensive therapy, especially in patients with obesity and metabolic disorders that indicate the need for the search of new highly effective antihypertensive agents that have additional features to prevent destruction of target organs and cardiovascular complications. On the Russian pharmaceutical market antihypertensive drugs presents receptor blocker to angiotensin – azilsartan medoxomil (Edarbi®). The article is published design of study of the effectiveness of azilsartan medoxomil in patients with arterial hypertension and overweight or obesity in daily clinical practice of the Russian Federation and the Republic of Kazakhstan

Advantages azilsartan medoxomil in patients with arterial hypertension: how to make a choice and to optimize antihypertensive therapy?

Azilsartan medoxomil is a drug from class of angiotensin II receptor antagonist (sartans), have a antihypertensive effect and excellent tolerability profile. In comparison with other drugs (candesartan, olmesartan, ramipril, chlorthalidone, valsartan) according to comparative studies and meta-analyses azilsartan medoxomil demonstrated high antihypertensive efficacy, in terms of 24-hour BP control, which allows to recommend its purpose in patients of hypertension 1–2 degrees. This is due to the ability of the drug not only safely reduce AD during day and night hours, but also to normalize the circadian profile. Pleiotropic effects of azilsartan medoxomil in the form of increased sensitivity of receptors to insulin, a positive effect on glucose metabolism, improved endothelial function allow us to consider its purpose in patients with carbohydrate metabolism disorders, overweight, obesity, and metabolic syndrome. The drug is indicated for as patients who have not previously received antihypertensive therapy and if previous treatment with other RAAS blockers did not lead to reliable achievement of target BP levels. High efficiency and safety of azilsartan medoxomil can provide better patient adherence to long term therapy and achieve optimal results of therapy

The results of the international clinical study VICTORY:efficacy and safety of antihypertensive monotherapy with valsartan (Valsacor®) and its fixed combination with hydrochlorothiazide(Valsacor® H)in routine clinical practice in patients with hypertens

Objective. The VICTORY study aimed to evaluate effectiveness and safety of monotherapy with valsartan (Valsacor®) and its fixed combination with hydrochlorothiazide (Valsacor® H) in clinical practice in patients with stage 1 and stage 2 hypertension. Materials and methods. In the prospective, randomized, open-label, international multicentre study involved 356 patients with grade 1 and grade 2 hypertension from 5 countries, including 130 patients from Russia. In Russia the study was conducted in 7 cities, in 8 clinical centers. The patients, who were receiving antihypertensive therapy at the moment of screening, underwent a 7 days wash-out period. The starter dose of valsartan (Valsacor®, KRKA, Slovenia) was 80 mg (except for Russia where 160 mg of Valsacor® were given at the first visit, what did not influence the study results). After 4 weeks of treatment in case of blood pressure (BP) >140/90 or 130/80 mm Hg the dose was increased to 160 mg (in Russia – to 320 mg) or combined therapy with Valsacor® H (KRKA, Slovenia) was prescribed. In 4 weeks the dose of valsartan was increased to 320 or 160/12.5 mg in case of previous dose insufficiency. If target BP levels were not reached in the next 4 weeks, the dose was increased to 320/12.5 mg. The primary endpoints included evaluation of antihypertensive effect of valsartan and its fixed combination with hydrochlorothiazide on BP levels; evaluation of the drugs’ influence on aortal stiffness; comparison of absolute average means of achieved decrease in central and peripheral BP compared with baseline; evaluation of the impact on aortic augmentation index. The secondary endpoints included comparison of primary endpoints when using mono and combined therapy; evaluation and comparison of the effect on erectile function in men by questionnaires at baseline and after 16 weeks of treatment; evaluation of adverse events frequency. Results. Data on 365 patients – 196 (54.0%) female and 169 (46.0%) male aged 54.6±12.0 years were analyzed. Mean initial value of systolic (SBP) and diastolic BP (DBP) were 156.6±8.9 and 95.6±6.0 mm Hg, respectively and 130.1±8.2 and 80.9±5.8 mm Hg, respectively after 16 weeks of treatment. The mean absolute decrease of SBP and DBP was 26.6±10.4 and 14.8±7.6 mm Hg. The decrease of SBP and DBP was statistically significant in all treatment periods (р<0,0001). The mean absolute decrease of central SBP and DBP at the 5th visit was 19.7±12.9 and 13.9±8.5 mm Hg, respectively (р<0.0001). When compared, the mean values of SBP and DBP between groups of mono and combined therapy were statistically significant (р<0.0001). 90,6% of patients reached the target BP levels: 98% in those who received monotherapy with valsartan and 84% in those who received combination of valsartan and hydrochlorothiazide. The mean absolute increase of erectile function score was 0.84±2.45 (p<0.0001). There were no differences in erectile function score dynamics in the two groups of patients. 92.8% of patients did not experience adverse effects and adverse events associated with the medication. There were no cases of severe adverse events in the study. The most frequent adverse effects were headache (1.9%), dizziness (1.6%), and weakness (1.6%). Conclusion. The study demonstrated high effectiveness and good tolerability of valsartan and its fixed combination with hydrochlorothiazide (Valsacor®, Valsacor® H) in patients with stage 1 and stage 2 hypertension. 1. Valsartan in monotherapy (Valsacor®) and in combination with hydrochlorothiazide (Valsacor® H) lowers the SBP and DBP levels to reference levels. 2. At the 16th week of treatment 90.6% reached target BP levels: 98% in the valsartan monotherapy group and 84% in the combination therapy with valsartan and hydrochlorothiazide group. 3. The medications Valsacor® and Valsacor® H have good tolerability: 92.8% of the patients did not experience any adverse effects. 7.1% of patients had at least 1 adverse effect but none of them experienced any severe adverse events. 4. The therapeutic effect was estimated as good and very good in 96.9% of patients. 5. The overall clinical effectiveness was estimated as excellent, very good and good in 95.3% of patients. 6. Most of the patients receiving Valsacor® and Valsacor® H noted an increase in life quality. 7. Treatment with Valsacor® and Valsacor® H resulted in increase of erectile function in male patients with stage 1 and stage 2 hypertension

Chronotherapy’s opportunities of a fixed combination of perindopril 10 mg/indapamide 2.5 mg in patients with a lack of night reduction in blood pressure

Currently, adequate reduction of blood pressure (BP) during the night in patients with arterial hypertension remains important problem. To study chronotherapy’s opportunities to achieve better BP control by a single dose of antihypertensive drugs while maintaining high compliance.  Aim. To evaluate the efficacy, tolerability, safety of various prescription regimes of fixed combination: perindopril 10 mg and indapamide 2.5 mg in patients with insufficient degree of BP reduction at night.  Design and methods. The study included 30 patients (20 men and 10 women, 56±9.3 years, body mass index 30.5±5.3 kg/m2, the duration of arterial hypertension – 7.1±5.8 years), on ineffective dual antihypertensive therapy (BP>140/90 mm Hg). Initially, ambulatory BP monitoring (ABPM) and blood tests were performed. Then, previous therapy was terminated and fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) was administered. Patients were randomized into two groups: morning and evening regimens of therapy. After 8 weeks of treatment ABPM and blood tests were repeated. Statistical analysis was done after further separation of patients into groups with sufficient (dippers) and insufficient (non-dippers) degree of BP reduction at night.  Results. In the group of "non-dippers" average ambulatory systolic BP (SBP) during wakefulness declined from 149.4±11.7 mm Hg to 129.8±10.6 mmHg (p<0.01), the average ambulatory diastolic BP (DBP) during wakefulness – from 94.7±12.3 mm Hg to 78.3±8.6 mm Hg (ns), ambulatory SBP during sleep – from 146.6±16.1 mm Hg to 121.8±15.7 mm Hg (p<0.01), ambulatory DBP during sleep – from 86.2±9.2 mm Hg to 70.3±6.5 mm Hg (p<0.01). The reduction of nighttime SBP increased from 1.9±5.8% to 6.2±9.3% (p<0.05), the reduction of nighttime DBP from 6.2±3.9% to 9.6±8.2% (ns). ABPM measurements of "non-dipper" sub-groups, who received treatment in the evening or in the morning after 2 months had no significant difference, except the variability of DBP during wakefulness (p<0.05). We didn’t observe statistically significant difference in terms of the nighttime BP reduction. However, nighttime BP reduction was higher in the evening dosing group: SBP – 4.1±11.1% (morning group), 7.8±7.9% (evening group) and DBP – 8.9±11.0 (morning group) and 10.2±5.5 (evening group). Blood tests were in the normal range during the whole study.  Conclusion. A fixed combination of perindopril 10 mg/indapamide 2.5 mg (Noliprel A Bi-forte) is effective and safe in patients with both normal and with insufficient degree of reduction in BP at night. Prescription of medication in the evening in non-dipper patients can have the added benefit on the BP profile. Further research is needed

Radiofrequency renal arteries denervation: effectively and safely

Objective. To determine the possibility of radio frequency denervation of the renal arteries (RDN) in the treatment of patients with refractory essential hypertension (GRA). Materials and methods. The study included 57 patients with a diagnosis of the guide RAG. According to the results of surveys conducted by RDA was performed of 25 patients diagnosed with essential RAG. Within 12 months after the procedure was carried out monitoring of clinical blood pressure (BP), BP monitoring (ABPM), and laboratory evaluation of renal function and renal artery ultrasound. Statistical analysis was performed using Statistica 6.1 program, significant differences were recognized when p<0.05. Results. Within 12 months after the RDN with the group there was a significant decrease in blood pressure (p<0.01) according to the data of the clinical measurements, and the results of ABPM. There were no complications in the place of performance of radio-frequency effects or violation of renal excretory function has been reported. According to the results of the analysis, predictors of effectiveness RDN not identified. Conclusion. Radiofrequency denervation of the renal arteries is a safe and effective non-drug methods in complex treatment of refractory essential hypertension

Fixed trandolapril and verapamil SR combination effectiveness in arterial hypertension patients

Aim. To study the effectiveness, rates of target blood pressure (BP) level achievement, and safety of a fixed-dose trandolapril and verapamil SR combination (Tarka) in patients with Stage I-II arterial hypertension (AH). Material and methods. The study initially included 100 AH patients; 7 dropped out, and 4 were excluded due to inclusion criteria violation. The study protocol was completed by 89 participants (36% men, 64% women), aged 27-74 years (mean age 56,6 10,8 years), with mean AH duration of 9,1 8 years. After 3-14-day wash-out period, clinical mean systolic BP (SBP clin.) level was 158,1 +/- 9,3/95,1 +/- 8,0 mm Hg, and heart rate (HR) level - 75,2 +/- 7,4 bpm. BP level corresponded to Stage I AH in 40,5% of the patients, and to Stage 11 AH - in 59,5%. Eighty five per cent of the participants received anti hypertensive medications, 17% had Type 2 diabetes mellitus (DM-2), 20% were smokers. Results. In all patients, Tarka therapy (2/180 mg/d) was associated with adequate BP reduction. Antihypertensive effect reached its maximum at Week 4 of the treatment. Twelve-week therapy resulted in significant decrease in BP clin., (Delta=-28,9 +/- 11,0/-18,4 +/- 8,1; p < 0,001) and HR (Delta=-6,0 +/- 6,6; p < 0,0001). Target SBP, DBP or SBP+DBP levels were achieved in 82%, 96%, and 80%, respectively. In DM-2 patients, target BP level was achieved in 71%. According to 24-hour BP monitoring data, after 12 weeks of treatment, BP was normalized in 68 participants: in 88% - for SBP, in 99% - for DBP, and in 88% - for both SBP and DBP. In all patients, the treatment was well tolerated; adverse effects (A-E) were registered in 9 individuals only. Conclusion. Good antihypertensive effectiveness of fixed trandolapril and verapamil combination facilitated target BP level achievement in 80% of the patients, with low AE rates. Therefore, the medication could be recommended at initial treatment stage

Fixed trandolapril and verapamil SR combination effectiveness in arterial hypertension patients

Aim. To study the effectiveness, rates of target blood pressure (BP) level achievement, and safety of a fixed-dose trandolapril and verapamil SR combination (Tarka) in patients with Stage I-II arterial hypertension (AH). Material and methods. The study initially included 100 AH patients; 7 dropped out, and 4 were excluded due to inclusion criteria violation. The study protocol was completed by 89 participants (36% men, 64% women), aged 27-74 years (mean age 56,6 10,8 years), with mean AH duration of 9,1 8 years. After 3-14-day wash-out period, clinical mean systolic BP (SBP clin.) level was 158,1 +/- 9,3/95,1 +/- 8,0 mm Hg, and heart rate (HR) level - 75,2 +/- 7,4 bpm. BP level corresponded to Stage I AH in 40,5% of the patients, and to Stage 11 AH - in 59,5%. Eighty five per cent of the participants received anti hypertensive medications, 17% had Type 2 diabetes mellitus (DM-2), 20% were smokers. Results. In all patients, Tarka therapy (2/180 mg/d) was associated with adequate BP reduction. Antihypertensive effect reached its maximum at Week 4 of the treatment. Twelve-week therapy resulted in significant decrease in BP clin., (Delta=-28,9 +/- 11,0/-18,4 +/- 8,1; p < 0,001) and HR (Delta=-6,0 +/- 6,6; p < 0,0001). Target SBP, DBP or SBP+DBP levels were achieved in 82%, 96%, and 80%, respectively. In DM-2 patients, target BP level was achieved in 71%. According to 24-hour BP monitoring data, after 12 weeks of treatment, BP was normalized in 68 participants: in 88% - for SBP, in 99% - for DBP, and in 88% - for both SBP and DBP. In all patients, the treatment was well tolerated; adverse effects (A-E) were registered in 9 individuals only. Conclusion. Good antihypertensive effectiveness of fixed trandolapril and verapamil combination facilitated target BP level achievement in 80% of the patients, with low AE rates. Therefore, the medication could be recommended at initial treatment stage