The influence of antyhypertensive therapy of valsartan and fixed combination with hydrochlorothiazide use on pulse-wave velocity and central arterial pressure in patients with arterial hypertension of 1-2 grades in international VICTORY clinical trial

Objective - to explore influence of valsartan monotherapy use and its use in combination with hydrochlorothiazide (HCTZ) on pulse-wave velocity (PWV) and central arterial pressure (CAP) in patients with arterial hypertension (AH) of 1-2 grades in international VICTORY clinical trial. Materials and methods. The international multicenter prospective randomized clinical study VICTORY that lasted for 16 weeks included patients with 1-2 grades AH. In patients who previously received antihypertensive therapy a 7 days washout period was carried out. All patients started their therapy with 80 mg valsartan (Valsacor®, KRKA, Slovenia); in Russia the starter dose of Valsacor®, KRKA was 160 mg in previously treated patients that did not influence the study results. If after 4 weeks of treatment BP was more than 140/90 mm hg (more than 130/80 mm hg in high risk patients or in diabetes mellitus patients) the dose of valsartan was increased to 160 mg (320 mg in Russia) or diuretic in fixed combination with valsartan was added (160 mg valsartan/12.5 mg HCTZ): Valsacor® H 160 (KRKA, Slovenia). If target BP after 8 weeks of treatment was not reached valsartan dose was increased to 320 mg or fixed combination of valsartan and diuretic (160 mg/12.5 mg) was used. If target BP after 12 weeks of treatment was not reached - valsartan and diuretic 320 mg/12.5 mg were used. PWV and CAP (SphygmoCor®, AtCorMedical) were assessed at baseline and after 16 weeks of treatment. The primary endpoints were assessment of the impact of studied medications on aortic stiffness, aortic augmentation index and comparison of absolute medians of reached central and peripheral BP reduction with baseline value. Results. Of 365 patients included in the study 74 were included in PWV and CAP study subgroup. Valsartan and its combination with HCTZ were effective in CBP reduction. The mean absolute reduction of central systolic and diastolic BP after 16 weeks of treatment was 19.7±12.9 mm hg and 13.9±8.5 mm hg, respectively (

2020 Clinical practice guidelines for Pulmonary hypertension, including chronic thromboembolic pulmonary hypertension

Russian Society of Cardiology (RSC)With the participation: Association of Cardiovascular Surgeons of Russia, Russian Respiratory Society, Federation of Anesthesiologists and Resuscitators, Association of Rheumatologists of Russia, National Congress of Radiation Diagnosticians

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

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

Effect of selective β-blockers on spirometry in a 4 hour bronchial provocation test in patients with bronchoobstructive pathology

Administration of β-blockers in patients with cardiovascular pathology combined with obstructive bronchial or pulmonary disease (bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD)) is associated with a risk of bronchospasm in a number of patients. No test has been developed so far to identify such patients. We recommend to carry out a 4-hour bronchial provocation test with a small dose of beta 1 selective β-blocker bisoprolol. The study included 31 patients with BA and COPD with concomitant cardiovascular disease requiring administration of β-blockers. Results of six consecutive spirometry tests, which continued for 4 hours to assess the effect of bisoprolol on airway function, are demonstrated. The maximum reduction in FEV1 after administration of the β-blocker was identified. Spirometry test results were compared in patients with BA and COPD

Comparative effectiveness of fixed combinations of various ramipril and hydrochlorothiazide doses

Aim. To assess effectiveness and tolerability of combined antihypertensive therapy with various doses of an ACE inhibitor ramipril and hydrochlorothiazide (HCT) in patients with Stage 1-2 arterial hypertension (AH). Material and methods. In 3 clinical centres of Moscow City, 70 patients (50 % men, 50 % women; mean age 59±13,5 years) were randomised into 2 groups: Group I (n=27), receiving ramipril (5 mg) and HCT (25 mg); and Group II (n=32), receiving ramipril (10 mg) and HCT (12,5 mg). After 4 weeks of therapy, patients not achieving target blood pressure (BP) levels were administered ramipril in the dose of 10 mg and HCT in the dose of 25 mg. Therefore, the further 16-week follow-up was focused on 3 groups: Group I (n=18), receiving ramipril 5 mg and HCT 25 mg; Group II (n=19), receiving ramipril 10 mg and HCT 12,5 mg; and Group III (n=22), receiving ramipril 10 mg and HCT 25 mg. Treatment effectiveness was assessed by clinical BP levels after 4, 12 and 20 weeks. At baseline and in the end of the study, 24-hour BP monitoring (BPM), blood and urine biochemical assays were performed. Results. After 20 weeks of the therapy, clinical BP levels were reduced by -18,9±8,2/-10,8±7,5 mm Hg in patients receiving ramipril 5 mg and HCT 25 mg (p<0,001). In participants receiving ramipril 10 mg and HCT 12,5 mg, clinical BP levels decreased by -20,3±9,7/-11,6±6,0 mm Hg (p<0,001). The therapy with ramipril 10 mg and HCT 25 mg was associated with a reduction in clinical BP by -23,4±9,8/-10,6±7,8 mm Hg (p<0,001). According to 24-hour BPM data after 20 weeks of the treatment, mean circadian BP levels were reduced by -9,9±7,9/- 5,9±7,0 mm Hg (p<0,01) in Group I, by -15,8±13,2/-9,5±6,8 mm Hg (p<0,001) in Group II, and by -20,6±14,7/- 10,8±10,8 mm Hg (p<0,001) in Group III, respectively. Conclusion. In total, 92 % of the patients achieved target BP levels: 100 % in Group I, 100 % in Group II, and 86 % in Group III. Good and excellent therapy tolerability was observed in 96 %. Among patients with microalbuminuria at baseline, 41 % demonstrated its normalisation

ADVANTAGES OF FIX COMBINATION THERAPY FOR REACHING BLOOD PRESSURE TARGET LEVELS IN PATIENTS WITH ARTERIAL HYPERTENSION (RESULTS OF CLIP-ACCORD PROGRAM)

Information letter of Russian Medical Society of Arterial Hypertension.</p