COMPARATIVE ANALYSIS OF ARTERIAL HYPERTENSION TREATMENT IN MEN AND WOMEN BASED ON THE RESULTS OF ACCORD STUDY (ACRIDILOLE IN COMBINATION THERAPY IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY OR TYPE 2 DIABETES)

Aim. To compare the efficacy and safety of carvedilol in men and women with mild to moderate arterial hypertension, associated with obesity and/or compensated diabetes type 2. Material and methods. Hypertensive patients (n=592, 176 men and 416 women) with obesity and/or diabetes were involved into randomized comparative open-label study in parallel groups. Patients were randomized into two groups. Patients of group A (n=291: 90 men and 201 women) kept on to receive previous antihypertensive drugs except beta-blockers which were withdrawn and replaced with carvedilol (Acridilole®, PLC “Akrikhin”, Russia). Patients of control group (n=301: 86 men and 215 women) kept on to receive only previous antihypertensive drugs. Efficacy of antihypertensive therapy was assessed at every 2-week visits during 24-week observation. Biochemical parameters of glucose and lipid metabolism, 12-lead ECG were evaluated at baseline and at the end of the study. Target blood pressure (BP) achievement and safety was assessed in 24 weeks of treatment. Results. Women had more severe metabolic abnormalities compared with men. By the 24th week of treatment significant reduction in systolic BP , diastolic BP , and heart rate was found in the both groups of patients regardless of gender , intergroup differences were significant (p<0,05). By the end of the study target BP level was achieved in 96.3% of men and 96,8% of women in group A and 85.9% and 88.8%, respectively , in the control group (p<0,001). The number of hospital admissions decreased in 4.8 times in men (p<0.0001) and 12 times - in women (p<0.05) in group A, and in 2.7 and 3.3 times, respectively , — in the control group (p<0.0001). Mild to moderate side effects were observed in 32 patients: 19 and 13 patients in group A and control group, respectively (p=0.58). Adverse event rate was not distinguished significantly between men and women. Conclusion: The results show comparable high efficacy and safety of carvedilol in hypertensive men and women with concomitant diseases and high metabolic and cardiovascular risk

THE STUDY OF ANAMNESTIC FACTORS AND THEIR ROLE IN ESTIMATION OF SHORT-TERM (IN-HOSPITAL) PROGNOSIS IN PATIENTS UNDERWENT BRAIN STROKE OR TRANSIENT ISCHEMIC ATTACK, BY THE DATA FROM LIS-2 REGISTRY

Aim. To assess the role of anamnestic factors in estimation of the shortest-term (in-hospital) prognosis in patients after stroke. Material and methods. We included all patients during the period 01.01.2009 to 31.12.2011 (n=960), who were diagnosed the stroke ot TIA inMHILyubertsyDistrictHospital№2.Results. Into the registry LIS-2 included 960 patients. During hospitalization 207 patients died, in-hospital mortality was 21,6%. Mortality increased with the age, and the age became an independent death risk factor in hospital (p=0,037). Hemoorhagic stroke increased the risk of death 6,95 times, and consciousness disorders — 2-5 times (depending on the level of disorder), CHF signs— by 3,14 times, and AF— 1,86 times. These values were evaluated as independent anamnestic risk factors of the in-hospital death.Conclusion. The data from LIS-2 registry demonstrates analogy with the data from other stroke registries in RF. In-hospital mortality in LIS-2 was 2-3 times higher comparing to the registries of other countries. Factors influenced in-hospital mortality were age, type of the stroke, level of consciousness at admission, CHF and cardiac rhythm disorders as AF

INFLUENCE OF PATIENTS’ PREHOSPITAL ATTENDANCE AT OUTPATIENT CLINICS ON LONG-TERM OUTCOMES OF ACUTE CORONARY SYNDROME: LIS-3 STUDY

Aim. To assess influence of patients’ prehospital attendance at outpatient clinics on long-term outcomes of acute coronary syndrome (ACS).Material and methods. Patients (n=397) hospitalized with ACS (01.11.2013-31.07.2015) were included. 19.4% of patients died in hospital (77/397).-According to their rate of attendance at outpatient clinics all survived patients (n=320) were divided into 3 groups: committed to visiting outpatient-clinics (n=139), partially committed (n=103) and not committed (n=78). Follow-up period was 14-35 months (88.44% follow-up rate). During-follow-up period 12.5% of patients died (40/320). All-cause mortality and recurrent cardiovascular diseases (nonfatal myocardial infarction and stroke,-unstable angina) were defined as the primary endpoint. Prognostic significance of separate factors and their combinations were assessed by their influence on the primary endpoint.Results. Clinical severity of course of the disease was assessed regarding all factors that had influence on the primary endpoint. By their degree of influence on the primary endpoint each factor was given a certain score. According to the sum of all scores patients were divided into 2 groups: patients with less (n=205) and more (n=78) severe clinical course of the disease. Risk of development of primary endpoint was higher in patients with more severe clinical course of the disease (relative risk 3.997; 95% confidence interval 2.199-7.267; p <0.0001) regardless of patients’ attendance at outpatient-clinics (p>0.05).Conclusion. Patients’ prehospital attendance at outpatient clinics did not affect long-term outcomes of acute coronary syndrome. Patients with more-severe clinical course of the disease were more likely to develop adverse outcomes during the follow-up regardless of their prehospital attendance at outpatient clinics

THERAPEUTIC EQUIVALENCE OF ORIGINAL CLOPIDOGREL (PLAVIX) AND ITS GENERIC (EGITROMB). RESULTS OF COMPARATIVE RANDOMIZED CROSS-OVER BLIND STUDY

Aim. To study therapeutic equivalence (efficacy, safety and tolerability) of original clopidogrel (Plavix) and its generic (Egitromb) in patients of high cardiovascular risk. Material and methods. Thirty one patients with coronary heart disease and indications for clopidogrel therapy were involved into the randomized cross-over blind study. Half of the patients received original clopidogrel (75 mg daily) during the first 2 weeks and then they received generic clopidogrel in the same dose during next 2 weeks. Another half of the patients received the drugs in reverse order. Antiplatelet activity of Plavix and Egitromb was estimated by effects on ADP-induced platelet aggregation initially and after 2 weeks of treatment with each drug. Study blinding was provided by the following approach: doctors of cardiology clinic performed clinical monitoring and drug distribution; coded blood samples for platelet aggregation assessment were studied in independent laboratory of thrombosis; statistical data analysis was performed by biostatistics expert in other research center. Results. 2-week therapy with each drug led to a significant decrease of ADP-induced platelet aggregation which remained low after switching from original drug to generic and vice versa. Aggregation dynamics did not depend on the first administered drug. There were no significant differences between aggregation changes as a result of treatment with original or generic drug. No one adverse event was observed in association with both drugs therapy. Conclusion. Generic drug Egitromb (Egis, Hungary) and original clopidogrel Plavix (Sanofi-Aventis, France) have equivalent antiplatelet effect

IMPACT OF ATRIAL FIBRILLATION ON THE NEAR AND LONG-TERM PROGNOSIS OF LIFE AFTER ACUTE MYOCARDIAL INFARCTION. THE DATA OF THE LIS-1 STUDY (LYUBERTSY MORTALITY STUDY OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION)

Aim. To study the effect of atrial fibrillation (AF) that existed before the myocardial infarction (MI), on near and long-term mortality in patients with acute MI.Material and methods. The data of LIS register (Lyubertsy study on mortality rate in patients after MI), that included all patients hospitalized for acute MI (n=1133) during the period from 1 January 2005 to 31 December 2007, were used to solve the aim of the study.Results. AF was recorded in 88 patients (7.8%), and the frequency of AF significantly increased with age. 22 patients with a history of AF (25%) died in hospital, and mortality in this group of patients was significantly higher than this in the whole group of patients (15.2%; p=0.025). However, these differences were not statistically significant when adjusted for age and gender (OR=1.25; 95% CI 0.77-2.04; p=0.37). 66 people from 961 patients, who were discharged from the hospital, had the AF before acute MI. Relative risk of death in patients with AF in this group (adjusted for age and sex) was significantly higher than this in patients without AF (OR=1.91; 95% CI 1.18-3.11; p=0.005). Conclusion. AF diagnosed in patients with acute MI at admission did not influence significantly hospital mortality. However, pre-existing AF increases significantly the risk of death in patients survived acute period of MI

HEALTHCARE RESOURCES UTILIZATION AND TEMPORARY DISABILITY IN POPULATION AGED 50-64 ACCORDING TO THE EPIDEMIOLOGICAL ESSE-RF STUDY

Aim. To analyze health care resource utilization and temporary disability in people of pre-retirement age in the Russian population.Material and methods. The analysis was carried out on the basis of the ESSE-RF study materials (13 regions of the RF). Standard epidemiological survey methods and evaluation criteria were used. The analysis included results of a survey of the ESSE-RF study participants about health care resource utilization and temporary disability (TD) during 12 months before the survey. The following characteristics were ascertained: a number and reasons of outpatient visits for medical assistance, hospital admissions (including duration of in-hospital treatment), emergency calls and temporary disability (a number of days and cases), their mean number per one study participant, mean number of cases and days of TD per 100 working participants, associations with social-demographic parameters, risk factors, chronic non-communicable diseases, stress and anxiety levels by the Hospital Anxiety and Depression Scale (HADS).Results. A total of 8334 people aged 50-64 years were examined: men – 2784 (33%) and women – 5550 (67%). A share of the hospitalized (at least one time) was 11% in the age group of 50-54 years, 12% – in the age group of 55-59 years and by the age of 60-64 this indicator increased to 15%. 20% of the participants at least one time were admitted to hospital and/or called an ambulance. A share of people who had utilized health care resources at least one time was increasing with age. Unemployed people were hospitalized more frequently than employed ones. Number of chronic non-communicable diseases correlated with the probability of hospitalization and/or emergency call. Categories 2 and 3 of disability, presence of diabetes mellitus, ischemic heart disease and hypertension were statistically significantly associated with the probability of hospitalization and/or emergency call. Smoking did not increase the probability of hospitalization and/or emergency call in comparison with absence of this risk factor, at that, people who had given up smoking were 1.3 times more likely to be hospitalized than non-smokers. People with low and moderate alcohol consumption were hospitalized and called an ambulance significantly less often than those who abstained from alcohol. Clinically significant anxiety increased the probability of hospital admission and/or emergency call as compared to people without this factor by the HADS. Subclinical and clinically significant anxiety, mean and high levels of stress were associated with the probability of hospitalization and/or emergency call. Number of TD days turned out to be rather low - 0.3 day per 1 working man and 0.4 day - per 1 working woman, this index did not significantly differ with age.Conclusion. So, pre-retirement age (50-64 years) is characterized by increase in health care resource utilization due to health state worsening. At the same time significant share of people of this age (40%) did not seek medical help. These 40% of pre-retirement age people can be possible reserve for health state improvement by means of their active involvement in preventive activity of primary health care system (the study had been conducted before the preventive medical examination program starting)

ОПТИМИЗАЦИЯ СОСТАВА КРЕМНИСТОЙ ЛАТУНИ ЛЦ16К4 С ЦЕЛЬЮ ПОВЫШЕНИЯ ЕЕ ЖИДКОТЕКУЧЕСТИ ПРИ ПОЛУЧЕНИИ ХУДОЖЕСТВЕННОГО ЛИТЬЯ

LC16K4 silicon brass is widely used in ornamental casting because of its good processing characteristics, beautiful golden color and the possibility to apply various decorative coatings. The paper studies the possibility to increase fluidity of LC16K4 silicon brass by varying its chemical composition according to GOST 17711-93. A vacuum suction method used for fluidity measurement revealed that this parameter changes when adding 0,1 wt.% of the alloying element (Zn, Si, Al) and that measurements show high repeatability. The experimental data were subjected to regression analysis. The effect of zinc and silicon on the silicon brass fluidity was quantitatively assessed, and an adequate mathematical model was built with a response surface of the fluidity function. The optimum melt overheating temperature was found that ensures the highest alloy fluidity with a minimum zinc loss. The results of this study may be useful in ornamental and industrial casting of LC16K4 silicon brass, as well as in other metallurgy and foundry areas. Кремнистая латунь марки ЛЦ16К4 нашла широкое применение в художественном литье за счет высоких технологических свойств, красивого золотого цвета и возможности нанесения различных декоративных покрытий. В работе проведено исследование возможности увеличения ее жидкотекучести путем варьирования химического состава в рамках ГОСТ 17711-93. Для измерения жидкотекучести был использован метод вакуумного всасывания, который выявил изменения этого показателя при добавлении от 0,1 мас.% легирующего элемента (Zn, Si, Al), а также показал высокую сходимость результатов. Экспериментальные данные подвергались регрессионному анализу. Была получена количественная оценка степени влияния цинка и кремния на жидкотекучесть кремнистой латуни, построена адекватная математическая модель и поверхность отклика функции жидкотекучести. Определена оптимальная температура перегрева, обеспечивающая максимальное значение жидкотекучести сплава при минимальном угаре цинка. Результаты данной работы могут быть применимы при получении художественного и промышленного литья из кремнистой латуни ЛЦ16К4, а также в других областях металлургии и литейного производства.

Факторы риска, ассоциированные с развитием недифференцированной дисплазии соединительной ткани

Development of the undifferentiated connective tissue dysplasia (UCTD) is influenced by various adverse factors to the fetus during intrauterine growth. There is not a clear linkage to the contribution of the separate factors to the development of the UCTD.Aims of the study are to determine the risk factors associated with the development of the UCTD of the adolescents and to appreciate the predictive value of the examined factors related to UCTD to form the dispensary groups of the children with UCTD.Materials and methods. During the first stage of the study there was an examination of 110 adolescents at the age of 10–14 years old, the UCTD presence was established according to the scale proposed by T.I. Kadurina and V.N. Gorbunova (2009). During the second stage the data of the prenatal casework and maternity hospital records attached to the out-patient medical records were examined to detect the specialties of the antenatal life course. During the third stage 2 groups were formed: with the presence of UCTD (n = 81) and without UCTD (n = 29). The mother groups were formed accordingly with the adolescents groups.Results. The pregnancy of the mothers of the adolescents with UCTD proceeded against the anemia, threatening miscarriage, chronic fetal hypoxia, chronic fetoplacental insufficiency, toxicosis, gestosis, and concomitant chronic conditions (thyroid, kidneys, digestive apparatus, aspiration pathology) more common than the pregnancy of the mothers of the adolescents without UCTD. The binary logistic regression method allowed the predictors of the UCTD’s formation to be determined, there were: toxicosis during the gestation course (OR = 10.9; CI 95% 2.94–40.49), anemia of pregnancy (OR = 8.6; CI 95%: 2.42–30.81), gestosis (OR = 6.53; CI 95%: 1.27–33.71), chronic fetal hypoxia (OR = 4.4; CI 95%: 1.09–17.83) and pre-existing chronic conditions of the mothers (OR = 3.6; CI 95%: 0.86–15.48). Different factor combination enhances the likelihood of the delivery of a child with UCTD more than 6.5-fold: chronic conditions of the mothers and chronic fetal hypoxia (OR = 6.8; CI 95%: 1.95–48.57); anemia of pregnancy and chronic fetal hypoxia (OR = 7.2; CI 95%: 1.01–50.99), and toxicosis (OR = 10.4; CI 95%: 1.48–72.82).Conclusion. The risk factors associated to the development of UCTD in adolescents are: toxicosis during the gestation course, anemia of pregnancy, gestosis, chronic fetal hypoxia and pre-existing chronic conditions of the mothers. The use of the equation of the binary logistic regression allows the prediction of the possibility of the development of UCTD in adolescents at the level of 80.9% and to form the dispensary groups of children in order to prevent the development of dysplastic-dependent pathologyРазвитию недифференцированной дисплазии соединительной ткани (НДСТ) способствует влияние разнообразных неблагоприятных факторов на плод в период его внутриутробного развития, при этом нет однозначного представления о вкладе отдельных факторов в развитие НДСТ.Цель исследования. Установить факторы риска, ассоциированные с развитием НДСТ в подростковом возрасте, и оценить предиктивное значение исследуемых факторов в отношении НДСТ для возможности формирования диспансерных групп детей с НДСТ.Материалы и методы. На I этапе исследования был проведен осмотр 110 подростков в возрасте 10–14 лет, наличие НДСТ устанавливали по шкале, предложенной Т.И. Кадуриной, В.Н. Горбуновой (2009). На II этапе для выявления особенностей течения антенатального периода изучали сведения дородовых патронажей и выписок из роддомов, прикрепленных к амбулаторным картам. На III этапе апостериорно были сформированы две группы: с наличием НДСТ (n = 81) и без НДСТ (n = 29). Группы матерей были сформированы соответственно группам подростков.Результаты. У матерей группы подростков с НДСТ чаще, чем без НДСТ беременность протекала на фоне анемии, угрозы прерывания беременности, хронической гипоксии плода, хронической фетоплацентарной недостаточности, токсикоза, гестоза, сопутствующих хронических заболеваний (болезней щитовидной железы, почек, органов пищеварения, дыхания). С помощью метода бинарной логистической регрессии предикторами формирования НДСТ были установлены: течение беременности на фоне токсикоза (ОШ = 10,9; ДИ 95% 2,94–40,49), анемии беременной (ОШ = 8,6; ДИ 95% 2,42–30,81), гестоза (ОШ = 6,53; ДИ 95% 1,27–33,71), хронической гипоксии плода (ОШ = 4,4; ДИ: 95% 1,09–17,83) и наличия хронических заболеваний у матери (ОШ = 3,6; ДИ 95% 0,86–15,48). Сочетание факторов в различных комбинациях увеличивает вероятность рождения ребенка с НДСТ более, чем в 6,5 раз: хронические заболевания у матери с хронической гипоксией плода (ОШ = 6,8; ДИ 95% 1,95–48,57); анемия беременной с хронической гипоксией плода (ОШ = 7,2; ДИ 95% 1,01–50,99), с токсикозом (ОШ = 10,4; ДИ 95% 1,48–72,82).Заключение. Факторами риска, ассоциированными с развитием НДСТ в подростковом возрасте, являются: течение беременности на фоне токсикоза, анемии беременной, гестоз, хроническая гипоксия плода и наличие хронических заболеваний у матери. Использование уравнения бинарной логистической регрессии позволяет с вероятностью 80,9% прогнозировать развитие НДСТ у ребенка в подростковом возрасте и сформировать диспансерные группы детей для профилактики развития диспластикозависимой патологии.

Метаболический синдром и его компоненты как критерии оценки эффективности лечения гипертонической болезни

Purpose of the study was to evaluate the effectiveness of complex treatment of essential hypertension based on the definition of risk of development, frequency and severity of metabolic syndrome (MS) and its components before and after treatment in male patients of the therapeutic clinic.Materials and methods. The study included 123 patients hospitalized with a main diagnosis of hypertension. In addition to the main examination, anthropometric, instrumental and hormonal-biochemical examination was additionally carried out. A point assessment of deviation degree and additional components of MS from reference was defined. In accordance with the received sum of points each patient was assigned a specific stratification category in relation to MS: lack of risk of development, existence of low, moderate or high risk of development and also light, medium or heavy severity of MS. Repeated examination was carried out in 14 days from initiation of treatment. The effectiveness of treatment was estimated as significant improvement, improvement, without change, deterioration, or significant deterioration depending on change of sum of points.Results. Before the start of treatment, 22.8% of the examined patients had a moderate or high risk of developing MS, and 77.2% had MS of varying degrees of severity. After 14 days the number of patients with MS decreased by 14.6%, and the number of patients with risk of its development increased to 37.4%. In 14 days the number of patients with MS decreased by 14.6%, and the number of patients with risk of his development increased to 37.4%. Among all components of the MS, the greatest number of cases of improvement was noted for hypertension. Significant improvement from the carried-out therapy was revealed in 17.9%, improvement in 39.0%, lack of changes in 37.4% and deterioration in 5.7% of patients.Conclusion. The employment of the method of Point assessment of degree of risk development and severity of MS, as a cluster of risk factors for the development of cardiovascular diseases, in patients with essential hypertension allowed the estimation of efficiency of the carried-out therapy and the individualization of a treatment regimen.Цель исследования. Оценить эффективность комплексной терапии гипертонической болезни у пациентов мужского пола терапевтической клиники на основании определения риска развития, частоты встречаемости и тяжести метаболического синдрома (МС) и его компонентов до и после лечения.Материалы и методы. Обследовали 123 пациента с основным диагнозом «гипертоническая болезнь». Дополнительно к основному проводили антропометрическое, инструментальное и гормонально-биохимическое обследования. Выполняли балльную оценку степени отклонения основных и дополнительных компонентов МС от референсных значений. В соответствии с полученной суммой баллов у каждого пациента определяли конкретную стратификационную категорию по отношению к МС: отсутствие риска развития, наличие незначительного, умеренного или высокого риска развития, а также легкой, средней или тяжелой степени тяжести МС. Повторное обследование выполняли через 14 дней от начала лечения. Эффективность лечения оценивали как значимое улучшение, улучшение, без изменений, ухудшение или значимое ухудшение в зависимости от изменения суммы баллов.Результаты. До начала лечения 22,8% обследованных пациентов имели умеренный и высокий риски развития МС, а 77,2% – непосредственно МС различной степени тяжести. Через 14 дней количество пациентов с МС снизилось на 14,6%, а количество пациентов с риском его развития увеличилось до 37,4%. Из всех компонентов МС наибольшее количество случаев улучшения было отмечено по артериальной гипертензии. Значимое улучшение от проводимой терапии было выявлено у 17,9%, улучшение – у 39,0%, отсутствие изменений – 37,4% и ухудшение – у 5,7% пациентов.Заключение. Применение методики балльной оценки степени риска развития и тяжести МС как кластера факторов риска развития сердечно-сосудистых заболеваний у пациентов с гипертонической болезнью позволило оценить эффективность проводимой терапии и индивидуализировать схемы лечения

CONCOMITANT CARDIOVASCULAR DISEASES AND ANTIHYPERTENSIVE TREATMENT IN OUTPATIENT PRACTICE (BY THE RECVASA REGISTRY DATA)

Aim. To study a pattern of concomitant cardiovascular diseases (CVDs) and to estimate particularities and quality of medical antihypertensive therapy in hypertensive patients in real outpatient practice with a help of the Registry in Ryazan region.Material and methods. A total of 3690 patients with hypertension, ischemic heart disease, chronic heart failure and atrial fibrillation, who had attended general practitioners and cardiologists of 3 outpatient clinics in Ryazan city, were enrolled in the outpatient Registry of cardiovascular diseases (RECVASA). The diagnosis of hypertension was recorded in 3648 of 3690 (98.9%) outpatient charts, 28.1% of the subjects were men and 71.9% - women.Results. A total of 2907 (79.7%) of 3648 patients had combination of hypertension with other CVDs. Combination of 3-4 cardiovascular diagnoses was registered in 63.8% of the cases. 11.5% and 9.5% of the patients had a history of myocardial infarction and cerebral stroke, respectively. Diagnosis of hypertension was verified in 448 of 450 randomized hypertensive patients (99.6%). The incidence of prescription of one and two antihypertensive drugs (AHDs) was 25% and 39%, respectively, of 3 AHDs – 21%, 4 and more – 2%. AHDs were not prescribed in 13% of hypertensive patients. The mean number of prescribed AHDs was 1.73. The mean incidence rate of target blood pressure achievement was 26.1%. We have noted insufficient ACE inhibitors/angiotensin receptor blockers (ARB) and beta-blockers prescription in different concomitant CVDs. Patients with 3-4 cardiovascular diagnoses were more often prescribed combined antihypertensive treatment. Prescription of ACE inhibitors/ARB, beta-blockers and thiazide diuretics combination was preferable in 74.1% of the cases, when taking into account absolute and relative contraindications for betablockers use – in 64.0%. 15.2% of the hypertensive patients used reimbursed drugs for CVDs at the moment of the Registry enrollment as compared with 39.2% in previous years (p<0.05).Conclusion. The RECVASA study data allowed revealing high incidence of concomitant CVDs in hypertensive patients, insufficient use of combined antihypertensive treatment, including AHDs with proved favorable influence on prognosis. Achievement of concordance of medical treatment to national and international guidelines, taking into account concomitant CVDs, and optimization of patients’ coverage with reimbursed drugs are the main reserves for antihypertensive treatment quality improvement