Ways to increase adherence to antihypertensive therapy

With a high prevalence in the Russian population and insufficient effectiveness of treatment, hypertension remains a poorly controlled cardiovascular risk factor, including due to the low compliance of patients. Noncompliance is due to a large number of factors, some of which were studied in post-hoc analysis of the Russian observational STIL’ and TRICOLOR studies. It demonstrated that fixed-dose combinations of antihypertensive drugs can make a significant contribution to solving such a complex problem as low compliance

Achievement of target resting heart rate on beta-blockers in patients with stable angina and hypertension (ATHENA in routine clinical practice in Russia

Objectives: The primary objective of this study was to establish the proportion of patients with stable angina and arterial hypertension on beta-blocker (BB) treatment reaching target resting heart rates (RHR) of 55-60 beats per min in clinical cardiology and general practice in Russia. Secondary objectives included the association between achievement of target RHR and mean BB doses, Seattle Angina Questionnaire (SAQ) scores and achievement of target blood pressure (BP) levels (systolic/diastolic BP <140/90mmHg). Research design and methods: ATHENA (AchievemenT of target resting HEart rate on beta-blockers in patients with stable angiNA and hypertension) was a non-interventional, cross-sectional, observational study conducted in 20 sites in Russia (NCT01321242). The study population comprised patients aged ≥18 years with stable angina (class I-III) and primary hypertension, on BB treatment for ≥2 months prior to enrollment. Results: Of 399 study participants, 62 (15.5%; 95% confidence interval [CI]: 0.121 to 0.195) achieved target RHR. Clinical characteristics associated with significant differences between subgroups achieving and not achieving target RHR were systolic BP (131.1 vs 138.2mmHg, P=0.006), diastolic BP (78.6 vs 83.5mmHg, P<0.001) and frequency of nitroglycerin administration (1.5% vs 3.0%, P=0.045). Most patients were taking bisoprolol (48.9%) and metoprolol (36.1%), with mean daily doses of 5.5mg and 73.7mg, respectively. Median SAQ scores were: 52.8 physical limitation, 50.0 angina stability, 60.0 angina frequency, 75.0 treatment satisfaction, 50.0 disease perception (quality of life) and 59.6 total score, with no significant differences between subgroups. Patients achieving target RHR were significantly more likely also to achieve target BP, compared with patients not achieving target RHR (72.6% vs 53.4%; P=0.005; odds ratio: 2.309; 95% CI: 1.270 to 4.197). Conclusion: In a Russian population with stable angina and hypertension on BB treatment, RHR control was suboptimal. ClinicalTrials.gov identifier: NCT01321242. © 2014 All rights reserved

CENTRALISED SURVEY ON THE UNDERTREATMENT OF THE HYPERCHOLESTEROLEMIA IN RUSSIA (CEPHEUS)

Aim. To assess the percentage of the patients who receive lipid-lowering drug therapy and achieve target levels of low-density lipoprotein cholesterol (LDL–CH), in accordance with the recommendations by the Russian Cardiology Society (RCS) and the 4th Joint European Task Force (4JETF).Material and methods. The CEPHEUS study is a multi-centre, cross-sectional observational study with the participation of Russian patients. The study participants received lipid-lowering therapy for at least 3 months (no dose modification for ≥6 weeks). The start-date and end-date of the study were Oct 22nd 2010 and Mar 22nd 2011, respectively. The cross-sectional data were collected during a single visit to the clinic.Results. The study included 1000 Russian patients. Overall, target LDL–CH levels were achieved in 34,5% (RCS criteria) and 48,2% (4JEFT criteria) of the patients who received lipid-lowering therapy in the routine clinical practice. The patients who were treated for secondary prevention of cardiovascular events (CVE) achieved target levels of LDL–CH more often than the patients treated for primary prevention: 38,2% vs. 27,0%, respectively, by the RCS criteria (odds ratio (OR) 1,67; 95% confidence interval (CI) 1,22–2,28; p=0,001) and 54,5% vs. 35,4%, respectively, by the 4JEFT criteria (OR 2,19; 95% CI 1,63–2,95; p&lt;0,001).Conclusion. Target levels of LDL–CH are achieved by &lt;50% of the Russian patients who receive lipid-lowering treatment. This percentage is even lower in patients receiving lipid-lowering treatment for primary CVE prevention

Arterial hypertension in women with climacteric syndrome

Due to high prevalence of arterial hypertension (AH) in postmenopausal women, this problem has received much attention recently. Hormonal changes in perimenopause cause neuroendocrine disturbances, facilitating AH development and determining some AH features. In peri- and postmenopausal women, AH often combines with climacteric complaints and menopausal metabolic syndrome, that should be taken into account in antihypertensive therapy choice. One of pathogenetically appropriate medication groups is imidazoline receptor agonists

Menopausal metabolic syndrome after hysterectomy

Aim. To study indapamide retard 1,5 mg effects in women with menopausal metabolic syndrome (MMS) after hysterectomy. Material and methods. The study involved 25 women (mean age 43.82±4.08 years), who underwent subtotal hysterectomy, with one or two ovaries intact, and suffered from Stage I-II arterial hypertension for 2-5 years. In all participants, 24-hour blood pressure (BP) monitoring, the assessment of central hemodynamics, plasma electrolytes and metabolites were performed. The treatment with indapamide retard 1,5 mg lasted for 16 weeks. Results. During the treatment, BP levels significantly decreased: for 24-hour systolic BP (SBP) - by 7.9%, for 24-hour diastolic BP (DBP) – by 9.5%; for daytime SBP and DBP – by 9,5% and 10.8%, respectively; for nighttime SBP and DBP – by 8.9% and 9.0%, respectively. Mostly due to positive dynamics in «overdipper» group, 24-hour BP profile had improved. Stroke and cardiac indices, total peripheral vascular resistance did decrease, with heart rate unchanged. Indapamide retard 1,5 mg did not significantly affect plasma levels of electrolytes, glucose, total cholesterol, uric acid, and immunoreactive insulin. Triglycerides and C-peptide levels declined by 24.68% and 41.59%, respectively. Conclusion. The study confirmed antihypertensive efficacy of indapamide retard 1,5 mg and its beneficial influence of central hemodynamics. Metabolic and electrolytic neutrality gives an opportunity to use indapamide for arterial hypertension management in MMS women