Improving blood pressure control, organoprotection and metabolic disorders correction in patients with hypertension switching from diuretic-based combinations to fixed combination lisinopril + amlodipine + rosuvastatin

The aim of the study was to assess the possibility of fixed combination Lisinopril + amlodipine + rozuvastatin to improve arterial elesticity in patients with hypertension and high pulse wave velocity, despite previous diuretic-based combination antihypertensive therapy. Materials and methods. In an open, observational study duration of 24 weeks was included 60 patients on previous diuretic-based combination antihypertensive therapy. All participants underwent 24-hour blood pressure monitoring, applanation tonometry (augmentation index and central blood pressure), pulse wave velocity measurement, laboratory tests (lipid profile, fasting glucose, insulin resistance index - NOMA), leptin, high-sensitivity C-reactive protein before and after the switching to a fixed combination of lisinopril + amlodipine + rosuvastatin. Results. According to measurements of office blood pressure switching of patients on double combinations based on diuretics to a fixed combination of lisinopril + amlodipine + rosuvastatin, a further decrease in systolic blood pressure (SBP) by 13.7% and diastolic BP (DBP) by 18.8% was observed. According to the ABPM, the decline in the average daily SBP was 15.8%, DBP - 22.5%, average SBP - 16.2%, DBP - 19.8%. The combination of lisinopril + amlodipine + rosuvastatin reduced PWV by 15.9%, augmentation index by 13.5%, central SBP by 8.4% (

Optimization of blood pressure control, organ protection and metabolic disorders using a fixed-dose combination of lisinopril+amlodipine+rosuvastatin in hypertensive patients after COVID-19

Aim. To evaluate the potential of a fixed-dose combination of lisinopril+amlodipine+rosuvastatin (Equamer®) in achieving additional vascular protection in patients with hypertension and high pulse wave velocity (PWV) after severe and very severe coronavirus disease 2019 (COVID-19), complicated by bilateral multisegmental viral pneumonia, with the use of biological therapy, who had not previously received combination antihypertensive therapy.Material and methods. This 12-week open-label observational study included 30 patients with or without antihypertensive therapy. The patients underwent 24-hour blood pressure monitoring, applanation tonometry (determination of the augmentation index (AI) and central blood pressure (CBP)), PWV measurement, blood laboratory tests (lipid profile, fasting glucose, C-reactive protein, complete blood count, ferritin, fibrinogen, D-dimer, alanine aminotransferase, aspartate aminotransferase, creatinine, uric acid) before and after switch to a fixed-dose combination of lisinopril+amlodipine+rosuvastatin.Results. At baseline, the patients had an increase in office blood pressure (BP) up to 152,6/89,1 mm Hg. After prescribing a fixed-dose combination of lisinopril+amlodipine+rosuvastatin, there was a decrease in systolic blood pressure (SBP) by 15,8% and diastolic blood pressure (DBP) by 12,2%. According to 24-hour blood pressure monitoring, the decrease in SBP was 15%, DBP — by 9%, PWV — by 23,8%, AI — by 9%, CBP — by 12,4% (p<0,05 for all compared to baseline values). Vascular age (VA) was initially increased to 41,9 years with a chronological age of 35,03 years. After the end of therapy, there was a significant decrease in VA to 36,5 years, low-density lipoproteins by 46,8%, triglycerides by 16,8% and an increase in high-density lipoproteins by 10,7% (p<0,05 for all compared to baseline values). In addition, the levels of C-reactive protein, fibrinogen, D-dimer, glucose, and uric acid significantly decreased.Conclusion. The fixed-dosed combination of lisinopril+amlodipine+rosuvastatin provides better blood pressure control, improved vascular elasticity parameters (AI, PWV, CBP, decrease in VA), and also improves lipid and carbohydrate metabolism, reduces inflammation in patients with hypertension and hyperlipidemia after severe COVID-19

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

Analysis of Early Patients Outcomes After Subarahnoid Hemorhage Depending of It`s Complications

Aim. The purpose of our article was to analyze all cases of non-traumatic SAH that have been treated at our clinic since January 2013 to December 2016 and determine the impact of the complications that can affect on the early patient`s outcome.Materials. Database included 127 patients with subarachnoid hemorrhage that were treated at the Regional Clinical Center for Neurosurgery and Neurology in Uzhgorod during 2013-2016. Extended analysis of the data was performed. The influence of various factors (intracerebral hematoma, symptomatic vasospasm, repeated rupture of aneurysm) on the early patient`s outcome was determined.Result. It was found that more than a half of the patients (70 people) experienced certain types of complications and only 41.7 % of patients had no complications at all.The most common complications were: intracerebral hematoma, intraventricular hemorrhage or their combination, as well as symptomatic vasospasm. According to our data, they were met with the same frequency of ~ 26-28 %. Rarely, occlusive hydrocephalus and re-rupture of the aneurysm occurred (7 % and 13 %). Mortality among patients with complications was 24 % - symptomatic vasospasm, 28 % - occlusive hydrocephalus, 17 % - intraventricular hemorrhage, 28 % - intracerebral hematoma, but in case of re-rupture of the aneurysm - up to 62.5 %. It is one of the most unfavourable factors for early outcome after SAH (p <0.001).Conclusions. Thus, according to our data, the most unfavourable SAH complication for early outcome is symptomatic cerebral vasospasm and repeated rupture of the aneurysm, slightly less - occlusive hydrocephalus and parenchymal hemorrhage. No significant influence of the presence of intraventricular haemorhage on the initial computed tomography after SAH was foun

Losartan therapy and hyperuricemia correction in patients with metabolic syndrome and arterial hypertension

Aim. To assess the potential of the angiotensin II receptor antagonist losartan for the correction of hyperuricemia (HU) in patients with arterial hypertension (AH) and metabolic syndrome (MS). Material and methods. This open, randomised, controlled comparative study in parallel groups included 60 AH patients with MS and HU. The patients received losartan or standard therapy for 12 weeks. Results. Throughout the follow-up period, no significant difference in antihypertensive effect was observed between the losartan and standard therapy groups. Losartan group patients demonstrated a more pronounced decrease in uric acid levels (-34,7 % vs. -7,8 % in the standard therapy group; p<0,05). In addition, losartan therapy, compared to the standard treatment, was associated with improved vascular elasticity, as manifested by the pulse wave velocity decrease (-27,8 % vs. -8,1 % for carotid-femoral index, and -30,2 % vs. -12,6 % for carotidradial index, respectively; both p<0,05)

Comparative effectiveness of original and generic losartan in patients with arterial hypertension

Aim. To compare clinical effectiveness and tolerability of original (Cozaar®) and generic (Lozap®) losartan in high and very high-risk patients with Stage I-II arterial hypertension (AH). Material and methods. This blind, randomized (envelope method), parallel study included 40 patients, 20 subjects in each group. After 14-day wash-out period, the participants were administered Cozaar® or Lozap® (50 mg/d; 1 tablet in the morning) for 3 months. Results. Cozaar® and Lozap® reduced systolic blood pressure (SBP) by 11,6% and 12,0% (р<0,05), respectively, diastolic BP (DBP) – by 8,3% and 8,2% (р<0,05), respectively (office measurement data). According to 24-hour BP monitoring data, T/P for SBP was 67,1% and 66,3% in Cozaar® and Lozap® groups, respectively (p<0,05). Both agents similarly reduced left ventricular posterior wall thickness, carotid-femoral and carotid-radial pulse wave rates – by 16,6%, 9,9%, 12,8% vs 16,6%, 10,1%, and 12,2%, respectively. Conclusion. Original and generic losartan medications were similar by antihypertensive activity and effects on surrogate end-points

COMPARATIVE EFFECTIVENESS OF FIXED-DOSE COMBINATIONS OF LISINOPRIL/AMLODIPINE AND ENALAPRIL/HYDROCHLOROTHIAZIDE

Aim. To compare clinical effectiveness and tolerability of the fixed-dose combinations of lisinopril/amlodipine (Ekvator) and enalapril/hydrochlorothiazide (Co-renitec) in high and very-high risk patients with Stage I–II arterial hypertension, whose blood pressure (BP) levels were not normalised during the preceding antihypertensive monotherapy.Material and methods. This blind, randomised (envelope method), parallel study included 27 patients in each group. For 6 months, participants received the first medication (1 tablet a day, in the morning). After the 14-day wash-out phase, they were switched to another medication and received either Ekvator (lisinopril 10 mg plus amlodipine 5 mg) or Co-renitec (enalapril 20 mg plus hydrochlorothiazide 12,5 mg).Results. After 6 months of the treatment, more than 78% of the patients receiving Ekvator achieved target BP levels, in contrast to the participants receiving Co-renitec. Moreover, the treatment with Ekvator was associated with a significant reduction in the myocardial thickness of the posterior left ventricular wall and the carotid-femoral pulse wave velocity, as well as with a significant improvement in lipid metabolism parameters.Conclusion. Ekvator was more effective than Co-renitec in terms of antihypertensive activity, left ventricular hypertrophy reduction, and arterial elasticity improvement, as well as trough/peak ratio improvement

Antihypertensive therapy in obesity

Obesity today is one of the most relevant interdisciplinary problems in healthcare and one of the key reasons for blood pressure increase. Thus, according to the Framingham Heart Study,78% of hypertension in men and 65% in women can be directly attributed to obesity [10]. Fat cells play an important role in the development of hypertension, i.e. they generate a variety of biologically active substances some of which have pressor and proinflammatory effects. Leptin is one of key substances which contributes to the increase of AP through the activation of the sympathetic nervous system and direct effect on kidneys (increased sodium reabsorption). Furthermore, obesity itself adversely affects the structure of renal tissue and increases the risk of progression of renal failure and hypertension. In addition, fatty tissue has its own renin-angiotensin system and may actively produce angiotensin

Treatment of arterial hypertension in metabolic syndrome in men with erectile dysfunction

Metabolic syndrome (MS) is a combination of hormonal, metabolic and clinical disorders, and one of the most studied subjects in the modern medicine. Today MS is considered to be a major risk factor for cardiovascular disease, disorders of carbohydrate metabolism and pathology of the reproductive system [6, 41]

Effectiveness of in insulin resistance correction and the adipokines level reduction in patients with arterial hypertension in comparison with other ARBs

Aim. To assess the possibility of azilsartan medoxomil to achieve target blood pressure (BP) (less than 130/80 mm Hg), to study angioprotective features and reduction of adipokines levels and inflammatory markers in patients with hypertension and previous therapy with other ARBs.Material and methods. In open observational study with 24 weeks follow-up were included 60 patients with previous therapy (losartan or valsartan or telmisartan).All patients underwent ambulatory BP monitoring, applanation tonometry (determination of the augmentation index and central BP), measurement of the pulse wave velocity, laboratory tests (lipid profile, uric acid, fasting glucose, Homeostasis Model Assessment, homocysteine, leptin, adiponectin, highly sensitive C-reactive protein, tumor necrosis factor alpha, interleukin-6).Results. Azilsartan provided the systolic BP (29,05%, 22,5% and 8,9%) and diastolic BP reduction 18,82%, 20,46% and 8,54% (p<0,05) in patients previously treated with losartan, valsartan or telmisartan, respectively. Central systolic BP (by 25,95%, 8,78%, 11,94%), central pulse BP (by 40%, 18,38% and 19,6%), augmentation index (by 28,87%, 20,69% and 14,29%) and pulse wave velocity (by 21,57%, 24,56% and 24,92%) were decreased (p<0,05). There were positive changes in leptin, C-reactive protein, IL-6, adiponectin levels in all patients with losartan, valsartan or telmisartan initial therapy (p<0,05).Conclusion. Azilsartan medoxomil has advantages in BP control, the arterial elasticity improving, reducing of insulin-resistance and inflammation