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

THE IMPACT OF COMBINATION ANTIHYPERTENSION THERAPY ON THE MAIN PARAMETERS OF STRUCTURAL AND FUNCTIONAL CONDITION OF THE LEFT VENTRICLE MYOCARDIUM IN NON-CONTROLLED ARTERIAL HYPERTENSION WITH DEPRESSION SPECTRUM DISORDER

Aim. To evaluate the influence of antihypertension therapy that includes antidepressants, on the main parameters of structural and functional condition of the left ventricle (LV) myocardium in patients with non- controlled arterial hypertension (NCAH) and depression-spectrum disorder (DD).Material and methods. Totally 160 patients included, with NCAH and DD, median age 58 (53-64) y.o., who were administered combination therapy that included angiotensin-converting enzyme inhibitor perindopril 10 mg/day and diuretic indapamide SR 1,5 mg/day. The patients were randomized into 2 groups: to the 1st group we added escitalopram (Selectra, Abbott Laboratories) as antidepressant, 10 mg/ day; to the 2nd group — calcium channel antagonist (CA) amlodipine 5-10 mg/day. All patients at the baseline and in 6 months underwent ambulatory blood pressure monitoring (ABPM), echocardiography, DD diagnostics with the Tsung and HADS scores.Results. After 4 weeks of treatment the therapy that included antidepressant led to the decrease of BP to target levels in 52,6% of patients, in CA — in 24,4%, and in 24 weeks of treatment there was comparable number of target reached patients in both groups. Comparative analysis of cardioprotection action of combination antihypertension therapy showed that in the usage oif antidepressant, as in CA usage there was comparable regression of hypertrophy and diastolic function of LV myocardium. With the treatment, in the 1st group there was increase of patients with normal geometry of the LV by 54,7%, and in the 2nd group — by 52,4% (p<0,05). In the 1 and 2 groups we saw the increase of those with normalized diastolic LV function: to 68,8% and to 65,1%, respectively (p<0,05).Conclusion. Addition of escitalopram as part of combination therapy mediated a significant antihypertensive effect, a little overcoming the treatment with amlodipine addition. Usage of tetracomponent therapy in combination of HADS and DD led to significant and comparable regression of structural and functional changes of the LV myocardium, that can be utilized for optimization of arterial hypertension control in this category of patients

INFLUENCE OF COMBINATION ANTIHYPERTENSION THERAPY ON THE PARAMETERS OF VESSEL WALL RIGIDITY IN NON-CONTROLLED ARTERIAL HYPERTENSION PATIENTS WITH DEPRESSION

Aim. Assessment of combination of antihypertension therapy (CAT) including antidepressant, on the main parameters of ambulatory blood pressure monitoring (ABPM), vascular wall rigidity parameters and central aortic pressure in patients with non-controlled arterial hypertension (NCAH) and depression disorders (DD).Material and methods. Totally, 160 patients studied with NCAH and DD, whom CAT was prescribed, that included angiotensine converting enzyme inhibitor perindopril 10 mg/day and diuretic indapamide SR 1,5 mg/day. Patients were randomized to 2 groups: in 1 group, to the therapy antidepressant escitalopram (Es) was added 10 mg per day; in 2 group — calcium antagonist amlodipine 5-10 mg per day. At baseline and in 24 weeks all included patients underwent general clinical assessment, ABPM (hardware ABPM by LLC “Piotr Telegin” BPLab Vasotens, Russia) under circumstances of free exertion regimen, with measurements interval 25 min day and 50 minutes nighttime. The following was assessed: mean daily, daytime and nighttime systolic pressure (sBP), diastolic pressure (dBP), BP variability, time index of AH, level and speed of morning BP increase, circadian index, pulse BP. In addition, the mean daily parameters of vessel rigidity were evaluated: time of reflected wave spread, evaluative velocity of pulse wave in aorta, augmentation index (Alx, %); main central aortic pressure parameters were checked: sBP (sBPao, mmHg), dBP (dBPao, mmHg), mean pressure in aorta (BPaom, mmHg), augmentation index in aorta (Alxao, %). Questionnaires were completed by patients: anxiety and depression HADS, selfestimation of depression by Tsung, Spielberger anxiety, Vein vegetative changes, life quality questionnaire SF-36 and ABPM.Results. In 24 weeks of therapy the positive statistically significant dynamics of depression spectrum disorders was marked in Es group, but in the 2nd group, by the majority of parameters depression level remained high. Usage of antidepressant as a part of CAT led to significant decrease of anxiety and vegetative changes, but in “traditional” therapy group there was increase of anxiety and vegetative disorders remained. In 1st group of patients taking antidepressant there was more prominent and statistically significant comparing to control group improvement of life quality parameters by SF-36. CAT with Es led to decrease of BP to target levels in a half of patients in 4 weeks, but in controls, to reach target values, in 75,6% it was need to increase amlodipine dosage up to 10 mg daily. Comparison of dynamics of ABPM parameters in 24 weeks showed that in the 1st group there was significantly more prominent improvement of main ABPM parameters comparing to controls.Conclusion. Usage of Es in CAT led to significant improvement of psychoemotional and vegetative status of patients, decrease of the main symptoms of depression and anxiety, improvement of life quality parameters, more rapid target BP achievement and more significant improvement of main ABPM parameters, than therapy without antidepressant

MODERN OPPORTUNITIES FOR ANTIHYPERTENSION THERAPY: THE PLACE OF AZILSARTAN MEDOXOMIL

Modern approaches to antihypertension therapy suppose the usage of combination drugs, making significant positive influence on the values of systemic blood pressure (BP) in daily and nocturnal periods, optimization of 24-hour BP profile, achieved target BP in most of patients. Also, it is important to fulfill organ protection and vessel protection. To all these criteria does respond azilsartan medoxomil and its combination with chlorthalidone. The combination azilsartan/chlorthalidone shows serious antihypertension properties, including the patients with metabolic disorders, facilitates optimization of BP at night, decrease of vascular stiffness. Collection of positive properties of the combination makes it to apply broadly in real clinical practice to increase efficacy of hypertension patient’s management

FEATURES OF DIURNAL BLOOD PRESSURE PROFILE, ARTERIAL STIFFNESS AND CENTRAL AORTIC PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION AND PREDIABETES

Aim. To assess the features of diurnal blood pressure profile, arterial stiffness and central aortic pressure in patients with arterial hypertension (AH) and prediabetes.Materials and methods. The study included 118 patients with AH, 38 without prediabetes, 80 with prediabetes, 48 of them patients with impaired fasting glucose and 32 patients with impaired glucose tolerance. Prediabetes was determined by the results of an oral glucose tolerance test. All patients underwent 24-hour blood pressure monitoring the main parameters of arterial stiffness and central aortic pressure were determined using the BPLab Vasotens complex of OOO «Petr Telegin» (Russia).Results. The obtained data showed that in patients with hypertension and prediabetes there were recorded increased levels of systolic and pulsatile blood pressure in the brachial artery and aorta, a more pronounced "pressure load" was detected compared to patients without prediabetes. At night, the level of diastolic blood pressure in the brachial artery and aorta, the diastolic pressure time index was higher than in patients with AH without prediabetes. Pathological type of the "non-dipper" curve was detected 2.5 times more often in patients with AH and prediabetes. Moreover, the pulse wave velocity, the augmentation index in the brachial artery and aorta characterizing the stiffness of the vessel wall were significantly higher in hypertensive patients with prediabetes.Conclusion. Thereby, in patients with AH in combination with prediabetes, unlike patients without prediabetes, there were more pronounced changes in the parameters of the diurnal blood pressure profile, arterial stiffness and central aortic pressure including the pulse wave velocity, the augmentation index and pulsatile pressure which are known to be sensitive indicators of target organ damage and are associated with an increased risk of developing cardiovascular and cerebrovascular complications

ANTIHYPERTENSIVE EFFICACY OF CHRONOPHARMACOTHERAPEUTICAL APPROACH TO ARTERIAL HYPERTENSION IN POST TRANSIENT ISCHEMIC ATTACK PATIENTS

Aim. To assess antihypertensive efficacy of various 24-hour regimens of antihypertensive drugs prescription and the influence on 24-hour profile of blood pressure (BP) and aortic pressure, in systemic hypertension patients post transient ischemic attack.Material and methods. Totally, 174 patients were included, with grade 1-2 hypertension and previous non-effective treatment; who during the previous 4 weeks had transient ischemic attack. All patients were randomized to 3 groups according to the treatment variant: group 1 (n=59) — valsartan 160 mg and thiazide-like diuretic in the morning, group 2 (n=58) — thiazide-like diuretic in the morning and valsartan 160 mg at bedtime, group 3 (n=57) — thiazide-like diuretic in the morning and valsartan 80 mg b.i.d. (morning and bedtime). At baseline and in 12 months of therapy all patients underwent BP monitoring (ABPM) with assessment of mean 24 hour, daytime, nocturnal systolic BP (SBP) and diastolic BP (DBP), mean pulse pressure, time index of hypertension, SBP and DBP variability at daytime and at night, prominence and velocity of morning SBP and DBP raise, heart rate, central aortic pressure (CAP): SBP and DBP in aorta, variability of SBP and DBP in aorta, pulse BP in aorta, augmentation index in aorta, pulse pressure amplification, ejection period duration, efficacy index of subendocardial blood flow. Valsacor (KRKA, Slovenia) was included in the study as valsartan.Results. In 12 weeks of fixed combination therapy, the target levels of BP were registered: in group 1 — 43 patients (72,9%), group 2 — 48 (82,7%), group 3 — 55 (96,4%). Reached target BP was more common in b.i.d. intake of valsartan (group 3) comparing to group 1 (p=0,001) and group 2 (p=0,03). Statistically significant positive shifts of ABPM and CAP values were registered in all three regimens. However, in group 2 there was significantly more prominent decrease of the main parameters of ABPM and CAP, than in group 1. Valsartan two times daily (group 3) led to more prominent (p<0,05) improvement of ABPM and CAP value comparing to any variant of its once per day usage (group 1 and 2). In 12 months of treatment, there was a significant (p<0,05) increase in all groups of patients with normalized 24 hour BP profile (“dipper”): in group 1 — 28 (65%), group 2 — 37 (77%), group 3 — 48 (87%). Normalized 24 hour BP trend was registered more commonly in the group 3 patients comparing to those of groups 1 and 2. The differences in the number of “dipper” patients were significant between groups 3 and 1 (p=0,01).Conclusion. The study showed that b.i.d. or bedtime valsartan intake in combination with diuretic leads to more prominent improvement of the main ABPM and CAP parametes in comparison with the drug intake in the morning, in patients with transient ischemic attack. Two times daily intake of valsartan leads significantly (p<0,05) to normalization of 24 hour BP profile in most patients (87%) and more prominent improvement of the main ABPM, CAP values comparing to once per day morning or evening intake of the drug

THE IMPACT OF COMBINATION ANTIHYPERTENSION THERAPY ON THE MAIN PARAMETERS OF STRUCTURAL AND FUNCTIONAL CONDITION OF MYOCARDIUM OF THE LEFT VENTRICLE AND THICKNESS OF “INTIMA-MEDIA” COMPLEX RELATED TO THE PHENOMENON OF SALT-SENSITIVITY IN PATIENTS WITH REFRACTORY ARTERIAL HYPERTENSION

Aim. To assess the influence of combination of antihypertension therapy on the main structure-function myocardium condition of the left ventricle (LV), thickness of intima-media (IMT) in patients with refractory arterial hypertension depending on the phenomenon of salt-sensitivity.Material and methods. Totally, 192 patients included with RAH, that after assessment for salt-sensitivity were randomized to groups: 1st group — salt-sensitive patients, receiving inhibitor of angiotensinconverting enzyme (ACEi), dihydropiridine calcium antagonist (DCA), thiazide diuretic (TD) and direct renin inhibitor (DRI) aliskiren (subgroup 1A) or β-adrenoblocker (β-AB) (subgroup 1B); 2 group — salt-resistant patients, receiving ACEi, DCA, TD and aliskiren (subgroup 2A) or β-AB (subgroup 2B). At the baseline and in 48 weeks of treatment the echocardiographic study was performed.Results. Addition of DRI in 1A subgroup helped to reach target values of blood pressure (BP) in 43,3%, and in subgroup 2A — in 70,4% of patients. Usage of β-AB in subgroup 1B led to decrease of BP to target values in 54,3%, and in 2B subgroup — in 50% patients. Usage of DRI in salt-resistant patients helped significantly to regress the LV hypertrophy than in salt-sensitive. Increase of the number of persons with normalized geometry and diastolic function of the LV was comparable in both groups. Usage of β-AB in salt-sensitive and -resistant patients was followed by statistically more significant improvement of structural and functional condition of myocardium of the LV. Normalized geometry of the LV was registered significantly more commonly in slat-sensitive patients. The decrease of IMT was comparable at the background of the usage of both variants of therapy not depending from salt-sensitivity.Conclusion. Usage of DRI as combination therapy led to more significant in salt-resistant than in salt-sensitive patients, antihypertensive effect and LV hypertrophy regress. Prescription of β-AB was followed by BP decrease to target values in comparable number of patients in 1B and 2B subgroups, but had some advantages in hypertrophy regression and normalization of LV myocardium geometry in salt-sensitive patients comparing to salt-resistant

Left ventricular structure and function in chronic renal disease

Aim. To investigate left ventricular (LV) remodelling variants in patients with chronic renal disease.Material and methods. The study included 150 patients with primary renal parenchymal disease, various stages of chronic kidney failure (CKF), and secondary arterial hypertension (AH). General clinical examination, laboratory tests, and renal function assessment were performed. LV remodelling was assessed by echocardiography.Results. LV concentric and eccentric hypertrophy (LVCH and LVEH) were more prevalent in more advanced stages of CKF, and were often combined with rigid and pseudo-normal types of diastolic dysfunction. In patients on hemodialysis, LVEH was associated with restrictive and pseudo-normal types of diastolic dysfunction. In hemodialysis patients, the symptoms of chronic heart failure (CHF) were explained by systolic and diastolic dysfunction, while early CKF stages were associated with diastolic HF only.Conclusion. In chronic renal disease, structural and functional LV changes require active drug therapy, delaying the progression of myocardial remodelling and HF