State of the art for diagnosis and treatment of orthostatic hypotension

This paper presents state of the art of the problem of diagnosis and treatment of orthostatic hypotension (OH). It focuses on the developed algorithms for diagnostics of classical orthostatic hypotension (COH), initial orthostatic hypotension (IOH) and delayed orthostatic hypotension (DOH). It describes the necessary methods for the differential diagnosis of the OH causes. Comparative analysis of the European Society of Cardiology and American College of Cardiology/American Heart Association/Society of Cardiac Rhythm was performed. The treatment options for different groups of patients with orthostatic hypotension are described

MAGNETIC RESONANCE TOMOGRAPHY IN SLEEP APNEA SYNDROME DIAGNOSTICS

Aim. To study the specifics of soft tissues surrounding upper airways (STSUA) structure using magnetic resonance tomography (MRI) in patients with obesity and obstructive sleep apnea syndrome (OSAS). Material and methods. Totally 40 men studied with the mean age 44,7±9,6 y. Of those 20 had obesity of I-II grade — with body mass index (BMI) 35,1±3,4 кг/м2 and severe OSAS (apnea-hypopnea index — AHI — was 53,4±15,7). Controls consisted of 20 persons without obesity — BMI 23,8±1,3 kg/m2 . Assessment of upper airways was performed on Philips Achieva 3.0T tomograph. We measured the volumes of soft palate (VSP), tongue (VT), lateral pharyngeal walls (VLPW) and the squares of maximum upper airways narrowing (SMUAN) at retropharyngeal (RP) and retroglossal (RG) levels. Results. In obese patients with OSAS we found higher values of TV — 70,5±12,4 vs 45,0±5,7 cm3 , VSP — 7,5±1,7 vs 3,5±0,7 cm3 , VLPW at the level of RP — 11,7±4,1 vs 3,2±0,8 cm3 , VLPW at the level of RG — 10,4±2,8vs 3,1±8,4 cm3 and lower values of SMUAN at the level of RP — 6,3±3,5 vs 14,0±3,8 cm2 , as RG — 19,3±7,5 vs 27,0±5,0 mm2 . All differences were statistically significant (p<0,001). Conclusion. MRI can be successfully applied for the evaluation of STSUA parameters of upper airways openness

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