HYPERTENSION IN POSTMENOPAUSAL WOMEN: POSSIBILITIES OF COMBINATION THERAPY

Objective – to study the efficacy and safety of Tenoten in the combination therapy of hypertension in early postmenopausal women.Subjects and methods. The study enrolled 60 early postmenopausal women with grade I–II hypertension. A study group included 30 women who took Tenoten during antihypertensive therapy (AHT); a control group comprised 30 women who received AHT only.Results. Tenoten could achieve additional improvement of 24-hour blood pressure (BP) monitoring data in the postmenopausal hypertensive women. Tenoten was found to have a positive effect on general health, activity, and mood and to alleviate the symptoms of autonomic dysfunction and anxiety.Conclusion. Tenoten that is able to alleviate the manifestations of anxiety and autonomic dysfunction, to exert a positive effect on bloodpressure values, and to improves health, mood, and social activity should be used in addition to AGT.</p

Factors associated with parasympathetic activation following exercise in patients with rheumatoid arthritis: a cross-sectional study

Background Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD) with poor parasympathetic function being implicated as an underlying factor. Factors related to parasympathetic function, commonly assessed by heart rate recovery (HRR) following maximal exercise, are currently not known in RA. We aimed to explore the association between HRR with CVD risk factors, inflammatory markers, and wellbeing in patients with RA. Methods Ninety-six RA patients (54.4 ± 12.6 years, 68 % women) completed a treadmill exercise test, during which heart rate (HR) was monitored. HRR1 and HRR2 were defined as the absolute change from HR peak to HRR 1 min post HR peak and 2 min post HR peak, respectively. Cardiorespiratory fitness, CVD risk factors, and serological markers of inflammation were measured in all patients. The Framingham Risk Score (FRS) was used as an assessment of global risk for CVD events, and wellbeing was assessed by questionnaires. Results Mean HRR1 and HRR2 were 29.1 ± 13.2 bpm and 46.4 ± 15.3 bpm, respectively. CVD risk factors as well as most inflammatory markers and measures of wellbeing were inversely correlated with HRR1 and HRR2. Multivariate regression analyses revealed that 27.9 % of the variance in HRR1 and 37.9 % of the variance in HRR2 was explained collectively by CVD risk factors, measures of inflammation, and wellbeing (p = 0.009, p = 0.001 respectively), however no individual measure was independently associated with HRR1 or HRR2. Conclusion Parasympathetic activation was associated with overall CVD risk, arthritis-related burden and wellbeing in patients with RA

CLINICAL SIGNIFICANCE OF HEART RATE VARIABILITY INDEXES DERIVED FROM 5-MINUTE AND 24-HOUR ECG RECORDINGS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Aim. To estimate heart rate variability (HRV) from 5-min and 24-h electrocardiogram (ECG) recordings in female patients with rheumatoid arthritis (RA) and patients of control group, to analyze association between HRV indexes and cardiovascular risk factors and RA-related clinical characteristics.Material and Methods. 90 female patients with RA and 30 healthy subjects matching for age were included in the study. The baseline evaluation included a physical examination, assessment of the cardiovascular risk factors and RA clinical characteristics, laboratory tests, 5-min and 24-hour ECG recordings. We analyzed the time-domain (SDNN, rMSSD, pNN50), frequency-domain (LF, HF, LF/HF ratio) and nonlinear indexes (SD1, SD2, SD21) of HRV from 5-min ECG recording and the time-domain (SDNN, rMSSD, pNN50) indexes from 24-h ECG recordings.Results. Patients with RA had lower HRV in comparison with control subjects (p&lt;0,05). We got the following results for 5-min ECG recordings: time-domain (SDNN, rMSSD, pNN50), frequency-domain (LF, HF) and nonlinear indexes (SD1, SD2) negatively correlated with erythrocyte sedimentation rate (ESR) (р&lt;0,05). All parameters of HRV (except for pNN50) strongly negatively correlated with disease activity score (DAS28). LF and HF levels depended on age. The analysis of 24-h ECG recordings showed negative correlation of timedomain indexes (SDNN, rMSSD, pNN50) with DAS28 and ESR.Conclusion. Reduced HRV is associated with inflammation activity in patient with RA. Low level of HRV and high RA activity are unfavorable cardiovascular factors

NEW MARKERS FOR CARDIOVASCULAR RISK: FROM STUDIES TO CLINICAL GUIDELINES

New markers for cardiovascular disease (CVD) risk are the subject of an intensive discussion in the scientific literature. The biomarkers (newlipid parameters, inflammatory markers) and signs of subclinical atherosclerosis are candidates to be included in models to assess the cumulative risk of CVD. The paper considers the basic studies dealing with new markers of CVD risk and their place in current clinical recommendations.</p

RHEUMATOID ARTHRITIS AND CARDIOVASCULAR RISK: PERSPECTIVES OF TREATMENT WITH STATINS

The cardiovascular risk factors in patients with rheumatoid arthritis (RA) are reviewed. The perspectives of treatments with statins in RA are given. Results of clinical trials on statin effects on the inflammatory disease activity and endothelial function in patients with RA are summarized.</p

INFLUENCE OF MENOPAUSE ON BLOOD PRESSURE DIPPING IN WOMEN WITH METABOLIC SYNDROME: A CASE-CONTROL STUDY

Aim. To study if menopause influences the blood pressure (BP) decrease level during nighttime in women with metabolic syndrome.Methods. 84 women with metabolic syndrome are examined, from them 52 are in postmenopause (average age is 56 [SD 5] years) and 32 are in premenopause (average age is 44 [5] years). Anthropomorphic measurements were made, levels of office BP and heart rate were assessed, ambulatory BP monitoring was carried out, lipids and glucose of blood serum were studied.Results. Clinical parameters, characterizing metabolic syndrome, didn’t vary between the groups. Number of patients with insufficient decrease of BP in postmenopausal women didn’t differ significantly from the number of such women in premenopausal period (for systolic BP: 64% versus 52%, p=0,288; for diastolic BP: 34% versus 42%, p=0,469). Nevertheless, when evaluating the level of systolic BP decrease during nighttime as continuous variable, significant differences between groups are revealed (M±SEM [95% CI]: 4.4±1.5% [1.4-7.3] in postmenopausal women versus 11.3±1.7% [7.9-14.8] in premenopausal women, p=0,011).Conclusion. Postmenopause associates with insufficient systolic BP decrease during nighttime in women with metabolic syndrome

INFLUENCE OF MENOPAUSE ON BLOOD PRESSURE DIPPING IN WOMEN WITH METABOLIC SYNDROME: A CASE-CONTROL STUDY

Aim. To study if menopause influences the blood pressure (BP) decrease level during nighttime in women with metabolic syndrome.Methods. 84 women with metabolic syndrome are examined, from them 52 are in postmenopause (average age is 56 [SD 5] years) and 32 are in premenopause (average age is 44 [5] years). Anthropomorphic measurements were made, levels of office BP and heart rate were assessed, ambulatory BP monitoring was carried out, lipids and glucose of blood serum were studied.Results. Clinical parameters, characterizing metabolic syndrome, didn’t vary between the groups. Number of patients with insufficient decrease of BP in postmenopausal women didn’t differ significantly from the number of such women in premenopausal period (for systolic BP: 64% versus 52%, p=0,288; for diastolic BP: 34% versus 42%, p=0,469). Nevertheless, when evaluating the level of systolic BP decrease during nighttime as continuous variable, significant differences between groups are revealed (M±SEM [95% CI]: 4.4±1.5% [1.4-7.3] in postmenopausal women versus 11.3±1.7% [7.9-14.8] in premenopausal women, p=0,011).Conclusion. Postmenopause associates with insufficient systolic BP decrease during nighttime in women with metabolic syndrome.</p

GUIDELINES ON ARTERIAL HYPERTENSION MANAGEMENT OF THE EUROPEAN SOCIETY OF CARDIOLOGY AND EUROPEAN SOCIETY OF HYPERTENSION 2018: WHAT’S NEW?

The article considers the key points of the new 2018 guidelines of the European Society of Cardiology and European Society of Hypertension on management and treatment of patients with arterial hypertension (AH). The guidelines widen the possibilities for ambulatory monitoring of blood pressure (BP) and at-home measurement of BP in diagnosis of AH, especially for detection of hidden (“masked”) hypertension and white-coat hypertension. New target ranges for BP depending on age and concomitant pathology are established. For most patients, BP &lt;140 mm Hg (primary target) is accepted, for patients under 65 years if therapy is well-tolerated BP &lt;130 mm Hg should be achieved. Selection of treatment for elderly patients shouldn’t be based on chronological age but on biological age taking into account evaluation of senile asthenia, self-maintenance and therapy tolerability. For starting selection of drugs for AH, in most patients two-component therapy (one pill drug) is preferable. The latest guidelines contain simplified algorithms for management of patients with AH. It is shown that in most patients, a preference should be made for combinations of renin-angiotensin-aldosterone system blocker (inhibitors of angiotensin-converting enzyme or angiotensin II receptor blockers) with a slow calcium channels blocker and/or thiazide/thiazide-like diuretic. Beta-blockers should be prescribed only for specific clinical cases. Special emphasis is made on evaluation of patient’s treatment adherence as the main reason for insufficient BP control, as well as on increased role of nurses and pharmacists in education, monitoring, and support of patients with AH being an important part of general strategy of BP control