ARTERIAL HYPERTENSION AND DIABETES MELLITUS: A QUEST FOR OPTIMAL TREATMENT — AN EXPERIENCE OF PERINDOPRIL A/AMLODIPINE USAGE

The article highlightes some data on the prevalence of arterial hypertension with diabetes mellitus. A review is provided on the modern consensus data about antihypertensive therapy selection for this combination of diseases. The main groups of drugs are mentioned that are mostly in use for this pathology. Also some new data on the net meta-analyses is highlighted, that are done by the novel Multiple Treatments Meta-analysis (MTM) technology, having Bayesian method in its bases. This method allows to use the results of non-direct comparative clinical trials for direct comparison of different drugs and regimens. It is argued that there are benefits in use a combination of ACE inhibitor and calcium channel blocker, and then fixed dose combination of Prestans (“Les Laboratories Servier”, France) prescription is recommended for arterial hypertension with diabetes treatment

Hemodynamics at different levels of salt intake in patients with hypertrophic cardiomyopathy of different age groups

Aim. To assess the relationship between the level of salt (NaCl) consumption and clinical and hemodynamic parameters in patients with hypertrophic cardiomyopathy (HCM) of different age groups.Material and methods. We examined 57 patients with HCM (mean age, 59,2±16,2 years). The patients were divided into groups according to the World Health Organization (WHO): I — young age (≤44 years old) — 12,4% of patients; II — middle (45-59 years old) — 37,2%; III — elderly (60–74 years old) — 36%; IV — senile (≥75 years old old) — 14,4%. The clinical status of patients was assessed, during which special attention was paid to syncope not related to cardiac arrhythmias. NaCl intake was assessed by the 24-hour urine sodium (Na+) level.Results. In the general cohort, in Na+ level <50 mmol/day, the lowest left ventricular stroke volume (LVSV) index was observed, which were associated with syncope (r=-0,9, p=0,03). With the urinary sodium level of 50-70 mmol/day, an increase in LVSV index was observed and the absence of syncope. At Na+ level more than 70 mmol/day, no increase in LVSV index was observed. In this regard, a predictive model was created, as a result of which it was found that with an increase in Na+ consumption by 1 mmol/day, an increase in LVSV index by 0,3 ml/m2 should be expected. There were no significant differences in the effect of NaCl intake on the studied parameters in patients with HCM of different ages. At the same time, low NaCl intake in elderly patients was associated with syncope.Conclusion. Minimal values of Na+ intake (<50 mmol/day or NaCl 3 g/day) were found, which are unfavorable for patients with HCM due to the risk syncope. The 24-hour urine sodium level to maintain a hemodynamically safe level of LVSV index in patients with HCM should be more than 70 mmol/day (NaCl 4,1 g/day). Monitoring of Na+ consumption level is especially important in elderly people with HCM

Right heart condition in patients with COVID-19 pneumonia

Aim. To assess right heart condition in patients with coronavirus disease 2019 (COVID-19) pneumonia.Material and methods. One hundred and five patients with COVID-19 pneumonia were divided into 3 groups depending on the involvement of lung parenchyma: group I — 0-25%, II — 25-50%, III — 50-75%. The clinical status of patients was assessed using the NEWS2 and SHOKS-COVID scales. A complete blood count and biochemical blood tests were performed to determine the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and troponin I. Echocardiography was performed to assess the right heart structural, hemodynamic and functional parameters.Results. In patients with COVID-19 pneumonia, with an increase in lung parenchyma involvement, the intensity of systemic inflammatory response increased: C-reactive protein, group I — (4 [1,9; 35] mg/l), in III — (70,5 [33; 144] mg/l) (pI-III=0,012); myocardial stress marker level increased: NT-proBNP, group I — 77 [48; 150] ng/l, group III — 165 [100; 287] ng/l (pI-III=0,047). The dependence of NT-proBNP on C-reactive protein level was revealed (r=0,335, p=0,03). Intergroup comparison did not reveal significant differences between the main right heart functional parameters: TAPSE, Tei index (PW and TDI), FAC of the right ventricle (RV) (p>0,05). However, differences in the tricuspid annular peaks were found as follows: group I — 0,14 [0,12; 0,14] m/s, group II — 0,14 [0,12; 0,15] m/s, group III — 0,16 [0,14; 0,17] m/s (pI-II=0,012, pI-III=0,014) and RV global longitudinal strain: group I — 19,63±7,72%, group III — 27,4±5,93% (pI-III=0,014). The relationship between the RV global longitudinal strain and SHOKS-COVID score was confirmed (r=0,381; p=0,024).Conclusion. Patients with COVID-19 pneumonia showed no signs of right heart dysfunction. The development of RV hyperfunction was noted. Most likely, this is a compensatory mechanism in response to acute RV afterload. NT-proBNP increase under conditions of an inflammatory response may indicate myocardial stress. The results obtained allow to expand our understanding of the right heart condition in patients with COVID-19 pneumonia

Структура и свойства тонких пленок титаната-цирконата бария и титаната-станната бария для сверхвысокочастотных применений

Structural and radio frequency (RF) dielectric properties of thin films of ferroelectric solid solutions BaZrxTi1-xO3 and BaSnxTi1-xO3 obtained by RF magnetron sputtering of ceramic targets on Pt/ r-cut of Al2O3 sapphire substrate are investigated. A high tunability of thin layers and low values of dielectric loss acceptable for microwave application have been revealed.Исследованы структурные и высокочастотные диэлектрические свойства тонких пленок сегнетоэлектрических твердых растворов и выращенных методом высокочастотного магнетронного распыления керамических мишеней на подложке Выявлена высокая управляемость диэлектрической проницаемости тонких слоев под действием приложенного электрического поля при приемлемых для сверхвысокочастотных применений диэлектрических потерях

2020 Clinical practice guidelines for Myocarditis in adults

Russian Society of Cardiology (RSC)With the participation: Eurasian Association of Therapists (EUAT), Society of Specialists in Heart Failure (OSSN), Russian Scientific Medical Society of Therapists (RNMOT), Russian Society of Pathologists, Russian Society of Radiologists and Radiologists (RSR)Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federatio

Сравнительный анализ применения тоцилизумаба при тяжелых COVID-19-ассоциированных пневмониях у пациентов разных возрастных групп

According to accumulated clinical data, one of the causes of severe damage to lung epithelial cells associated with SARS-CoV-2 (2019-nCoV) is an acute, timely underestimated "cytokine storm" (cytokine cascade, hypercytokinaemia) with characteristic signs of an expressed hyper-inflammatory syndrome with subsequent polyorganic failure. The study presents the results of the analysis of the effectiveness of tocilizumab therapy (TCZ) in patients (n = 181) of different age groups with developed pneumonia caused by SARS-CoV-2. The aim of the study was to evaluate the effectiveness of TCZ therapy in patients of different age groups with developed pneumonia in the frame of COVID-19. Methods. Patients (n = 181) with community-acquired pneumonia caused by coronavirus SARS-CoV-2 are included in a one-center, non-randomized, prospective study to evaluate the effectiveness of TCZ therapy conducted at the State Public Health Institution "City Clinical Hospital No.52" of the Moscow City Health Department. Patients were divided into 3 age subgroups – up to 50 years, 50–70 years and over 70 years. Patients with community-acquired SARS-CoV-2-induced pneumonia receiving non-invasive oxygen support and patients who had artificial lung ventilation (ALV) were given a single dose of 400 mg of TCZ in addition to basic therapy. Results. There are no significant differences between age groups in the severity of pneumonia according to the data of the computed tomography (CT), however, a more severe condition and a higher mortality rate (p < 0.001) were reliably observed in patients over 70 age compared to the other age groups. After TCZ treatment in patients of each age group, the severity of the condition assessed on the National Early Warning Score (NEWS2) has been significantly reduced compared to the baseline. Conclusion. According to the data of the pilot study the efficacy and safety of TCZ in patients of all presented age groups with COVID-associated pulmonary tissue lesion and signs of "cytokine storm" was demonstrated. At the same time, patients up to 50 years after the therapy of TCZ managed to achieve greater clinical efficiency compared to patients in other groups. According to the severity of the state and laboratory criteria, the lowest clinical efficacy of TCZ therapy was observed in patients over 70 years of age; as a consequence, the highest mortality rate was observed in the same group. At the same time, the TCZ therapy has not had a positive impact on the change of laboratory values and the severity of the disease in case of unfavorable outcome. Согласно накопленным клиническим данным, одной из причин тяжелых повреждений клеток эпителия легких, ассоциированных с SARS-CoV-2 (2019-nCoV), является острый, вовремя недооцененный синдром «цитокинового шторма» (цитокиновый каскад, гиперцитокинемия) с характерными признаками выраженного гипервоспалительного синдрома с последующей полиорганной недоста - точностью. В работе представлены результаты анализа эффективности терапии тоцилизумабом (ТЦЗ) у пациентов (n = 181) разных возрастных групп с развившейся пневмонией в рамках COVID-19. Целью исследования явилась оценка эффективности терапии ТЦЗ у пациентов разных возрастных групп с развившейся пневмонией, вызванной SARS-CoV-2. Материалы и методы. В одноцентровом нерандомизированном проспективном исследовании оценки эффективности терапии ТЦЗ, проведенном на базе Государственного бюд жетного учреждения здравоохранения «Городская клиническая больница № 52» Департамента здравоохранения города Мос - квы, приняли участие пациенты (n = 181) с внебольничной пневмонией, вызванной коронавирусом SARS-CoV-2. Больные были распределены в 3 возрастные подгруппы: до 50 лет, 50–70 лет, старше 70 лет. Пациентам с внебольничной пневмонией, вызванной SARS-CoV-2, получающим неинвазивную кислородную поддержку, и больным, у которых проводилась искусственная вентиляция легких (ИВЛ), в до полнение к основной терапии назначен ТЦЗ однократно в дозе 400 мг. Результаты. Достоверных различий между возрастными группами по тяжести пневмонии по данным компьютерной томографии (КТ) не выявлено, однако отмечено достоверно более тяжелое состояние и более высокий уровень смертности (p < 0,001) у больных старше 70 лет по сравнению с остальными возрастными группами. После терапии ТЦЗ у больных каждой из возрастных групп тяжесть состояния, оцененная по шкале National Early Warning Score (NEWS2), достоверно снизилась по сравнению с исходными показателями. Заключение. По данным пилотного исследования продемонстрирована эффективность и безопасность применения ТЦЗ у пациентов всех представленных возрастных групп с COVID-ассоциированным повреждением легочной ткани и признаками «цитокинового шторма». При этом у пациентов до 50 лет после терапии ТЦЗ удалось добиться бόльшей клинической эффективности по сравнению с больными остальных групп. По степени тяжести состояния и лабораторным критериям самая низкая клиническая эффективность терапии ТЦЗ отмечена у пациентов старше 70 лет; как следствие, в этой же группе отмечен самый высокий уровень смертности. При этом в случае неблагоприятного исхода терапия ТЦЗ не оказывала положительного влияния на изменение лабораторных показателей и степень тяжести заболевания.

SALT INTAKE, ARTERIAL HYPERTENSION, AND CARDIOVASCULAR RISK. PART I

This review is focussed on the link between salt intake and the risk of cardiovascular disease. The results of international multi-centre, randomized, prospective, clinical and epidemiological studies from late 20th and early 21st century are analysed. It is demonstrated that salt intake differs across international populations, and that the amount of salt consumed is directly linked to the risk of arterial hypertension (AH) development. In addition, increased salt intake is associated with elevated AH risk and increased cardiovascular mortality rates even at relatively low levels of blood pressure

THE DECREASE OF SODIUM CHLORIDE CONSUMPTION. EFFICACY OF PREVENTIVE STRATEGY. PART V

The article concerns the review of different approaches to reduce table salt consumption by human beings. The levels for harmless consumption are reviewed those were recommended in terms of target organ damage prevention. The guidelines for salt consumption consuming regulation are presented, that are in use in various world countries. The foundations for personal, social aEnd state policy for practical implication of these guidelines are provided. The predicted outcomes for the realization of the policy in relation to decrease of general and cardiovascular mortality and also correction of arterial hypertension are given. The article can be in the field of interest of physicians — internists of broader profile, cardiologists, health managers

SALT INTAKE, ARTERIAL HYPERTENSION, AND CARDIOVASCULAR RISK. PART II

The paper is focused on salt intake reduction and the subsequent cardiovascular risk reduction. The results of international, multi-centre randomised prospective clinical studies are analysed, summarizing the evidence obtained in the second half of the 20th century and the early 21st century. It has been demonstrated that decreased salt intake results in blood pressure reduction among both healthy people and patients with arterial hypertension. It is also associated with cardiovascular risk reduction and lower levels of all-cause and cardiovascular mortality. The potential risk of adverse effects is relatively small and should not prevent salt intake reduction. The evidence-based recommendations on salt intake are presented

Differentiated approach to the treatment of hypertensive crisis

Recent years have seen a revision of the traditional therapeutic approaches to many pathological conditions, which came as a result of the emergence of new data on the mechanisms of disease flow, original medicines and evidence-based clinical studies. Changes have affected many branches of medicine, including emergency