Blood pressure (BP) level is an important determinant of micro- and macrovascular complication risk in patients with Type 2 diabetes mellitus (DM-2). One of the aims of ADVANCE Study was, therefore, to assess the effects of Fixed-dose perindopril and indapamide (Noliprel®) combination, added to standard therapy, on cardiovascular, renal and other complication risk in DM-2 individuals. The four-year study included 11140 DM-2 patients taking Noliprel ®/Noliprel® forte or placebo, together with previously administered standard treatment. Additional therapy with Noliprel® was associated with the reduction in systolic and diastolic BP levels – by 5,6 and 2,2 mm Hg, respectively. Relative risk of main micro - and macrovascular complications decreased by 9%, and the risks of cardiovascular death, all-cause death and renal complications – by 18%, 14%, and 21%, respectively.

Aim. To study the effectiveness, rates of target blood pressure (BP) level achievement, and safety of a fixed-dose trandolapril and verapamil SR combination (Tarka) in patients with Stage I-II arterial hypertension (AH).

Material and methods. The study initially included 100 AH patients; 7 dropped out, and 4 were excluded due to inclu- sion criteria violation. The study protocol was completed  by 89 participants (36% men, 64% women), aged 27-74 years (mean age 56,6±10,8 years), with mean AH duration of 9,1±8 years. After 3-14-day wash-out period, clinical mean systolic BP (SBP clin.) level was 158,1±9,3/95,1±8,0 mm Hg, and heart rate (HR) level – 75,2±7,4 bpm. BP level corresponded to Stage I AH in 40,5% of the patients, and to Stage II AH – in 59,5%. Eighty five per cent of the participants received antihypertensive medications, 17% had Type 2 diabetes mellitus (DM-2), 20% were smokers.

Results. In all patients, Tarka therapy (2/180 mg/d) was associated with adequate BP reduction. Antihypertensive effect reached its maximum at Week 4 of the treatment. Twelve-week therapy resulted in significant decrease in BP clin., (∆=-28,9±11,0/-18,4±8,1;  p<0,001) and HR (∆=-6,0±6,6;  p<0,0001). Target SBP, DBP or SBP+DBP levels were achieved in 82%, 96%, and 80%, respectively. In DM-2 patients, target BP level was achieved in 71%. According to 24-hour BP monitoring data, after 12 weeks of treatment, BP was normalized in 68 participants: in 88% – for SBP, in 99% – for DBP, and in 88% – for both SBP and DBP. In all patients, the treatment was well tolerated;  adverse effects (AE) were registered in 9 individuals only.

Conclusion. Good antihypertensive  effectiveness of fixed trandolapril and verapamil combination facilitated target BP level achievement in 80% of the patients, with low AE rates. Therefore, the medication could be recommended at initial treatment stage.

Aim. To assess the role of endogenous modulators of alpha- and beta-adrenoreceptors (AR) and M-cholinoreceptors (M-ChR), including their sensitizers (ESAAR, ESBAR) and blockers (EBAAR, EBBAR, EBMChR), as well as the role of endogenous myocyte contractility activator (EAMC) in arterial hypertension (AH) pathogenesis.

Material and methods. Alpha- and beta-adreno, M-cholinomodulating and myocyte-stimulating activity was assessed for five serum titrations (1:50, 1:100, 1:500, 1:103 and 1:104) in 206 AH-free women and men (n=42 and 44, respectively), Stage II AH patients (n=34 and 27), and Stage III AH participants (n=30 and 29, respectively). Serum activity was assessed using isolated frog heart (n=50), longitudinal strips of rat uterine horn (n=840) and circular strips of cow renal artery (n=549), measuring their contractive response to adrenalin (10-8-10-6 g/ml) and acetylcholine (10-6 g/ml), registered with “Myocytograph”.

Results. In AH-free, 40-55-year-old women and men, the serum demonstrated alpha- and beta-adrenosensitizing, M-cholinoblocking and myocyte-stimulating activity, as it contained ESAAR, ESBAR, EBMChR, and EAMC. In Stage II AH, alpha- and beta-adreno- or M-cholinomodulating activity did not change, but myocyte-stimulating activity increased, as the concentration of EAMC elevated. In Stage III AH, M-cholinoblocking, alpha- and beta-adrenosensitizing and myocyte-stimulating activity reduced, alpha- and beta-adrenoblocking activity increased, in parallel with the reduction in EBMChR, ESAAR, ESBAR, ESMC levels and the increase in EBAAR and EBBAR concentrations.

Conclusion. The changes in endogenous modulator levels decreased effectiveness of alpha- and beta-adrenergic influences on myocardium and vascular smooth myocytes. This, combined with increased EAMC concentration, could facilitate AH development.

Aim. To investigate structure and function of left ventriculum (LV) and brachial artery (BA) in arterial hypertension (AH) patients, according to blood levels of parathyroid hormone (PTH).

Material and methods. In total, 95 untreated patients with Stage I-III AH were examined. Blood PTH, total calcium levels, and 24-hour urine calcium excretion were measured. All participants underwent Doppler echocardiography, 24-hour blood pressure monitoring (BPM), and BA ultrasound. According to PTH levels, the patients were divided into three groups: Group I – 0-25 pg/ml, Group II – 26-50 pg/ml, and Group III – 51 pg/ml.

Results. LV hypertrophy prevalence in Group III was 80,6%, in Group I – 43,7%. In “dippers” (24-hour BPM data), PTH level and 24-hour urine calcium excretion were 1,5 times lower than in “non-dippers”. Comparing to Group I, Group III demonstrated significantly greater intima-media thickness (+17,8%) and linear blood flow

velocity (+19,7%), but lower BA diameter (417,3%) and endothelium-dependent vasodilatation (415,5%).

Conclusion. PTH levels correlated with prevalence and severity of LV and BA remodeling.

Aim. To assess the prevalence of arterial hypertension (AH) and comorbidity in women with climacteric syndrome (CS).

Material and methods. This cross-sectional study included 806 female Yekaterinburg citizens (median age 52 years). The prevalence of AH, coronary heart disease (CHD), chronic heart failure (CHF), history of stroke or myocardial infarction, as well as prevalence of pulmonary and gastro-intestinal pathology, osteoarthrosis, carbohydrate metabolism disturbances, and CS was investigated.

Results. AH was identified in 68% of the participants, including Stage I, II, and III AH in 30,3%, 26,1%, and 43,6%, respectively. AH was associated with increased rates of CHF, CHD, and long-term disability. In AH patients, clinical symptoms of chronic cholecystitis, carbohydrate metabolism disturbances, abdominal obesity (АО), and knee osteoarthrosis were more prevalent. There were no differences in the prevalence of acid-dependent gastric pathology, obstructive pulmonary disease, and depression. Severe CS was significantly more prevalent in AH patients.

Conclusion. In CS women, AH was highly prevalent, especially Stage III AH. AH was associated with increased rates of CHF, CHD, and long-term disability. High rates of АО, carbohydrate metabolism disorders, and osteoarthrosis could negatively affect AH and CHF treatment effectiveness.

Aim. To study psychological characteristics of arterial hypertension (AH) patients living in the Far North.

Material and methods. In total, 203 individuals were examined: 153 patients (59 males, mean age 42,12+7,01 years; 94 females, mean age 51,39+4,07 years) with verified AH, as well as 50 persons without cardiovascular pathology (19 males, mean age 43,44+10,17 years; 31 females, mean age 37,37+9,59 years). Personality type and affective parameters were assessed using interviews, personality scales, and questionnaires.

Results. The combination of hysteroid-hypochondriac and schizoid characteristics was a psychological AH marker in the Far North patients. Gender differences were related to affective sphere involvement in AH females. Behavioural traits in AH patients were characterized by problematic adaptation to changes in daily routine, low tolerance of unpredictable situations, pessimism, and exaggeration of expected threats.

Conclusion. AH clinical course is determined by borderline psychological disorders, which points to a need for complex treatment, including behavioral and relaxation methods.

Aim. To study the severity of cognitive dysfunction (CD) in patients with arterial hypertension (AH).

Material and methods. The study included 147 patients: 97 (66%) women and 50 (34%) men with AH of various stages. Patients age varied from 40 to 75 years (mean age 63,2+10,8 years). The participants were selected by stratified randomization method, according to inclusion and exclusion criteria. Various neuro-psychological tests were used in the study.

Results. In AH patients, CD prevalence and severity were positively associated with AH stage. Compared to controls, AH individuals were significantly different in terms of neuro-psychological test results, including changes in voluntary activity regulation, cognitive process neurodynamics, and dynamic disturbances of memory and space functions.

Conclusion. The study results provided new insights on CD prevalence and clinical manifestation in AH patients.

Aim. To evaluate neurodynamics parameters in young and middle-aged patients with arterial hypertension (AH).

Material and methods. In total, 41 men with AH (main group), aged 38-59 years, were examined. The control group included 15 healthy men (mean age 42,4+1,5 years). Interviewing, physical examination, and 24-hour blood pressure monitoring (BPM) were performed. Cognitive function was assessed with psycho-physiological program complex " Status PF", including neurodynamics tests (time of simple and complex visual-motor reactions - SVMR, CVMR).

Results. The results obtained verified cognitive dysfunction (CD) presence in young and middle-aged AH patients. At the same time, the interrelation between AH stage, AH duration and cognitive dysfunction type was U-shaped. The maximal CD was observed in individuals with AH duration <1 year or >10 years. Optimal cognitive function, possibly due to adaptation mechanisms, was detected in patients with AH duration of 5-10 years or in those aged 40-50 years. Inadequate BP decrease during nighttime was also associated with CD.

Conclusion. CD in AH was observed not only in elderly patients, but also in young and middle-aged persons with early AH stages. The changes in latent time of psycho-motor reactions could be regarded as the first manifestation of neurodynamics disturbances.

Aim. To study blood pressure (BP) levels in various vascular basins, as well as to investigate the role of aorta and large artery elasticity (stiffness) in arterial hypertension (AH) development.

Material and methods. In total, 447 normotensive people and 855 AH patients aged 17-90 years were examined. BP in upper and lower extremity basins and arterial stiffness for elastic and muscular type vessels were measured by volume sphygmography method (VaSera-1000, «Fukuda Denshi», Japan). In 218 participants, pulse wave (PW) contour analysis and central BP measurement were performed by applanation tonometry method (SphygmoCor, «AtCor Medical», Australia).

Results. Age BP dynamics for upper and lower extremity basins was similar in normotensives and AH patients. In calf arteries, comparing to brachial artery (BA), BP was more dependent on aorta and large artery stiffness, reflecting damping function of the latter. In BA, BP was more dependent on reflected waves (pressure augmentation) and PW amplification. Measuring lower extremity BP gives a chance to diagnose aorta stiffness-related AH earlier than traditional В A measurement of В P. The latter diagnoses AH only when elastic vessel stiffness increases enough.

Conclusion. Measuring BP in upper and lower extremity basins improves AH diagnostics and arteriosclerosis stage assessment.

Aim. To study losartan effectiveness and safety in patients with gout and arterial hypertension (AH).

Material and methods. In total, 30 patients not having goat attack were examined (mean age 49,8+10,5 years, disease duration - 6,5 (3,0;16) years). For 8 weeks, antihypertensive and uricosuric activity of losartan, as well as its adverse effects, were examined.

Results. Blood pressure normalized in 63% of the participants, serum uric acid level decreased by 9%, and uricosuria increased by 14%. No adverse effects or arthritic signs were registered.

Conclusion. Losartan could be recommended for treating AH in gout patients.

Aim. To study the effects of 16-week bisoprolol therapy on 24-hour blood pressure monitoring (BPM) data, carbohydrate and lipid metabolism, tissue insulin sensitivity, and cerebral perfusion (CB) in patients with mild to moderate arterial hypertension (AH) and metabolic syndrome (MS).

Material and methods. The study included 30 patients with I-II AH and MS receiving bisoprolol (5 mg/d). At baseline and after 3 months of the treatment, levels of total cholesterol (CH), high and low-density CH, triglycerides, fasting and postprandial glucose, and insulin were measured; 24-hour BPM and CP assessment were performed.

Results. Bisoprolol monotherapy was associated with substantial reduction in nighttime mean maximal and minimal systolic and diastolic BP, without significant changes in lipid profile, fasting and postprandial glycemia, or CP, comparing to baseline levels.

Conclusion. Due to its metabolically neutral effects, bisoprolol could be recommended in patients with carbohydrate and lipid metabolism disturbances.

Aim. To compare the effectiveness of alpha-glucosidase inhibitor acarbose (150 or 300 mg/d) and non-pharmaceutical lifestyle modification in controlling arterial hypertension (AH), carbohydrate and lipid metabolism, and body weight (BW) among patients with impaired glucose tolerance (IGT) and AH.

Material and methods. The study included 380 patients with Stage I-II AH, abdominal obesity (АО), and IGT. All participants were randomized into three equal groups: two groups receiving acarbose (150 or 300 mg/d) and a control group. At baseline and after 24 weeks of the treatment, anthropometry, carbohydrate and lipid metabolism parameters, as well as 24-hour blood pressure (BP) monitoring data were assessed.

Results. In participants receiving acarbose, BW reduction was twice as effective as in the controls. In all groups, the levels of fasting and especially postprandial glucose, total cholesterol (CH), and triglycerides were significantly reduced. Substantial reduction of low-density lipoprotein CH was observed only in those receiving 300 mg/d of acarbose, and high-density lipoprotein cholesterol level increased significantly only in patients receiving 150 mg/d ofacarbose. In both acarbose groups, systolic and diastolic BP(SBP, DBP) reduction was significantly greater than in the control group. Target fasting and postprandial glucose levels were achieved in most individuals receiving acarbose, in contrast to the controls. More than 80% of those from both acarbose groups achieved target SBP and DBP levels.

Conclusion. In patients with metabolic syndrome, acarbose therapy decreased BW, АО, ВР, fasting and postprandial glucose levels, at the same time improving lipid profile.

Aim. To investigate effectiveness and safety of ramipril therapy, with varying administration time, in patients with mild to moderate arterial hypertension (AH) and overweight (OW).

Material and methods. The patients were randomized into two groups: Group I (n=29) received ramipril (Hartil®, FGIS, Hungary) in the morning (5 mg/d, at 8-10 am) for 4 weeks; Group II(n=39) received the medication in the evening (5 mg/d, 9-11 pm). Four weeks later, in all patients not achieved target blood pressure (BP) levels (<140/90 mm Hg), ramipril dose was increased up to 10 mg/d. If target BP levels were not achieved after 8 weeks, hydrochlorothiazide (12,5 mg/d) was added. The total length of the study was 16 weeks.

Results. After 16 weeks of the treatment, BP levels were similar in both groups. According to office BP measurement results, systolic and diastolic BP (SBP, DBP) levels were significantly reduced in Groups I and II (p<0,05). According to 24-hour BP monitoring data, obtained after 8 and 16 weeks, mean SBP and DBP levels significantly decreased in Weeks 8 and 16 for Groups I and II, respectively. Day- and nighttime BP difference was similar in both groups.

Conclusion. Regardless of its administration time, ramipril effectively and safely reduced BP and microalbuminuria levels in patients with Stage I-II AH and OW.

Aim. To analyze ambulatory and hospital tactics of target blood pressure (BP) achievement.

Material and methods. In total, 60 ambulatory and 40 hospital case histories of AH patients were analyzed.

Results. Target BP levels were achieved in 6,7% of ambulatory patients. Even though 93,3% needed more aggressive antihypertensive therapy, only in 37%, some treatment optimization efforts were performed (dose increase and/or combined therapy prescription). Mean number of medications prescribed decreased during the control year. The rates of thiazide diuretics (tD) and calcium antagonists (CA) prescription were inadequately low. By the end of control year, target BP levels were achieved in 15% only. Therapy change rates in achievers and non-achievers varied from 0 to 14 (average one-year rate 3,8). Typically, achievers received АСГ inhibitor and tD combination. Main indication for hospitalization was uncontrolled AH (67,5%), due to irregular medication intake (64,9%). During hospitalization, target BP levels were achieved in 97,5% of the patients. Soon after admission, most hospitalized patients were administered three-agent combination therapy, including tD and АСГ inhibitors.

Conclusion. The possibility of achieving target BP in high and very high-risk AH patients was successfully proven. Real-world lapses in ambulatory management of this patient group, leading to inadequate AH control, were identified.

Aim. To study antihypertensive effectiveness and safety of amlodipine as monotherapy and in combination with carvedilol in patients with arterial hypertension (AH), taking into account total risk of cardiovascular events (CVT). Material and methods. The study included 210 AH patients: 36% males, 64% females; mean age - 57+10 years, AH duration - 10+9 years. After 3-10 "wash-out" days, clinical blood pressure (BPclin.) level was 158+11/96+7 mmHg, Stage I AH was observed in 49% of the participants, Stage II - in 51%. Moderate, high, or very high CVE risk was registered in 19%, 53%, and 28%, respectively.

Results. After 16 weeks of amlodipine treatment, as monotherapy and combined with carvedilol, BP clin. Was reduced by -27,7±11,7/-15,3±7,0 mm Hg (p<0,0001), heart rate (HR) – by 3,0±8,2 bpm (p=0,001). Among those receiving amlodipine monotherapy, target BP level was achieved in 75% of the patients, among those administered combined therapy – in 97%. In the control group, 16-week therapy was associated with BP clin. Reduction by -19,5±12,0/-10,2±7,2 mmHg (p<0,0001), HR – by 2,2±8,6 bpm (p<0,001); target BP level was achieved in 51% only. For high or very high CVE risk, target BP level was achieved significantly more often in the main group than in the group of non-standardized antihypertensive therapy – 97% vs 46% (p<0,001). CVE risk reduction was observed mostly in patients receiving amlodipine as monotherapy or combined with carvedilol.

Conclusion. Amlodipine treatment, as monotherapy or combined with carvedilol, not only reduced BP to target levels in most patients, but also improved long-term prognosis, due to CVE risk reduction. In patients with high or very high CVE risk, combined therapy is typically needed to achieve target BP levels.

Aim. To assess the consistency of blood pressure (BP) measurement terminology for Korotkoff method.

Material and methods. In total, 29 individuals, aged 22-85 years (mean age 63,3+2,8 years) were examined (9 healthy persons, 5 gastro-intestinal patients, 15 patients with arterial hypertension and coronary heart disease. Brachial artery (BA) was examined by Korotkoff method, using Riva-Rocci manometer, as well as by duplex scanning. Maximal (max) and minimal (min) blood flow velocity (V cm/s), vessel diameter, "live" cross-sectional area, volume blood output (Q cm3/s), and relative kinetic energy, or velocity intensity (hv) were measured.

Results. V and Q were 7 times greater for systole than diastole, for hv the difference was 47-fold. For BA, diastolic Q and blood flow hv were 3 and 5 times, respectively, lower than venous ones. Therefore, BP in diastole was no higher than 8-10 mm Hg, and diastolic BP (DBP) was inconsistent with last Korotkoff tone values. First and last Korotkoff tones are formed in systole, due to varying intensity of hemodynamic blow, true systolic BP (SBP) is lower than BP min by 15-20 mm Hg on manometer scale.

Conclusion. All Korotkoff BP parameters reflect varying intensity of systolic blood blow, and the last tone value is greater than SBP level by 15-20 mm Hg. DBP could not be measured by this method; consequently, "pulse BP" term is incorrect.

Comments on the article “Terminological aspects of blood pressure measurement” by G.G. Efremushkin

Obesity is one of the most prevalent diseases worldwide. Many epidemiological studies on the association between increased obesity prevalence and rising prevalence of other pathology have been performed. Obesity progression facilitates the development of cardiovascular disease (CVD), Type 2 diabetes mellitus, cholelithiasis, cancer, asthma, and musculo-skeletal pathology. CVD pathogenesis in obesity is complex. In obese patients, the incidence of arterial hypertension (AH), coronary heart disease (CHD), heart failure, hypercholesterolemia, blood rheology disorders and thromboembolism is increased.