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Aim of the study was to evaluate in a prospective cohort study the relationship between the severity of the white coat effect (WHE) in patients with hypertension, who treated with regular antihypertensive therapy, and the composite endpoint, several prognostic indicators, in a routine clinical practice.Material and Methods. We analyzed the data of a prospective cohort study, which included 125 patients with hypertension who received regular antihypertensive therapy. The study consisted of three visits (baseline, 6 and 12 months) and an outcome data collection period (30.1±7.6 months of follow-up after the third visit). This study included three visits every 3 months: 1 visit – screening, ambulatory blood pressure monitoring (ABPM) session, Echo; 2 – assessment of the patient’s status and the therapy effectiveness; 3- assessment of the patient’s status, ABPM session, Echo (the total number of ABPM was 239, Echo - 240). The primary composite endpoint included death for any reason angina pectoris, transient ischemic attack, development of chronic heart failure, arterial revascularization, frequent ventricular extrasystoles, atrial fibrillation, secondary - deterioration of the cardiovascular diseases course and tertiary endpoint – deterioration of the arterial hypertension, concomitant diseases course.Results. The study involved 125 patients: 28 men (22%), 97 women (78%), mean age was 62.6±0.8 years, duration of hypertension 11.6±0.8 years, height 163.6±0.7 cm, body weight 83.1±1.4 kg. The baseline mean daytime systolic BP (SBP) was 125.1±9.8 and diastolic (DBP) – 76.1±7.0 mm Hg, age was 62.8±9.0 years, the WCE level for SBP was 16.5±1.4, for DBP 10.9±0.7 mm Hg. We identified a positive correlation between tertiary composite endpoint data and WCE: for systolic WCE (SWCE) (F = 4.7, p

Aim. To study the predictors of adverse events in hypertensive (HTN) patients, including those with chronic respiratory diseases (CRDs).Material and methods. Regression analysis evaluated clinical and anamnestic data and blood pressure (BP) in outpatients with stage II-III HTN (n=156): 49 patients had asthma, 20 — chronic obstructive pulmonary disease; age — 63,4±8,8 years, women — 72,4%, followup duration 29,3±8,0 months. The outcomes included in the composite primary endpoint (EP) were registered in 32 patients (death, major cardiovascular events and complications), while the secondary EPs were registered in 57 patients (hospitalizations, emergency calls, temporary disability due to cardiovascular disease/CRD, hypertensive crisis, exacerbation of CRD, pneumonia, respiratory failure), and tertiary EP — in 76 (other significant diseases/conditions, including increased blood pressure without hypertensive crisis, requiring correction of regular therapy).Results. Predictors of primary EPs were the decrease level of nocturnal diastolic BP (DBP) (β=-5,335, p=0,026), nocturnal DBP variability (β=1,796, p=0,007), blood leukocyte level (β=0,241, p=0,039); secondary EPs — systolic blood pressure ≥170 mm Hg in history (β=1,305-1,641, p=0,037-0,017), statin use (β=-0,997, p=0,037), CRD (β=0,734, p=0,023), blood platelet level (β=-0,008, p=0,022); tertiary EPs — only CRD (β=1,082, p

The most common cardiovascular disease (CVD) and risk factor for the main causes of death is hypertension (HTN), the prevalence of which in Russia is 44%. The combination of HTN and chronic respiratory diseases (CRDs) can lead to mutual influence and worsen the prognosis.Aim. To study long-term outcomes in HTN patients with CRDs under outpatient monitoring in primary health care.Material and methods. This prospective observational study of hypertensive outpatients (n=156, age, 63,4±8,8 years, men, 27,6%) was carried out, of which 49 had asthma, 20 — chronic obstructive pulmonary disease (n=69; group with CRD). The composite primary endpoint included death, myocardial infarction, cerebral stroke, transient ischemic attack, arterial revascularization, angina pectoris, peripheral arterial disease (>50% stenosis), heart failure, atrial fibrillation, and ventricular premature beats >30 h. There were following secondary endpoints: hypertensive crisis, hospitalization, emergency call and temporary disability due to cardiovascular diseases, asthma, chronic obstructive pulmonary disease, pneumonia, chronic respiratory failure. In addition, the following tertiary endpoints were analyzed: increased blood pressure (BP) without a hypertensive crisis, which required correction of HTN therapy, deterioration in CRD course (an increase in the ACQ-5 or CAT total score without exacerbation), acute bronchitis, other acute diseases and exacerbations of chronic ones, which required hospitalizations, new clinically significant chronic diseases not included in the primary and secondary endpoints.Results. The follow-up period was 29±8 months. The groups did not differ in relation to prevalence of primary endpoints. The frequency of secondary and tertiary endpoints was higher in the CRD group due to "respiratory" events and episodes of BP destabilization requiring correction of HTN therapy (p

The seasonal blood pressure variability (BPV) is known to demonstrate a typical winter peak. Recently, more attention is paid to the opposite situation: the summer BP levels being higher than those in winter. This phenomenon is called inverse BPV. The present article summarizes recent data on this topic. The data of the HOMED-BP project, as well as the results of the original prospective study in 770 hypertensive patients from two Russian Federation regions (mean follow-up duration 6.4 years), were used. According to the preliminary knowledge, the prevalence of inverse BPV in hypertensive patients is relatively high (15-25%). This phenomenon is more typical for treated patients, particularly for those on combination therapy, and is associated with beta-blocker intake. Higher duration of hypertension and higher levels of some risk factors (smoking) characterize the patients with inverse BPV. According to the HOMED-BP data, patients with inverse BPV had the highest overall cardiovascular risk (hazard ratio in comparison with the reference group of “minimal” “normal” BPV was 3.07; p=0.004). In summary, inverse BPV is a potentially unfavorable BP phenotype. However, its reproducibility and prospective value deserve further investigation. The absolute magnitude of seasonal BPV in these patients, calculated using different BP measurement methods, warrants special attention.

Aim. To study the main relationships of the white coat effect (WCE) levels in patients with arterial hypertension (AH) with bronchial asthma (BA) who treated with AH and BA drugs in routine clinical practice.Material and Methods. We analyzed the prospective cohort study data of AH patients, some of them had BA without exacerbation. We have formed two groups of patients:1 - control group, patients with AH without BA, the second - with AH + BA. The study consisted of three visits (first visit, 6 months and 12 months visits) and data collection period (30.1±7.6 months of follow-up). The following procedures were performed at the first and 12 month visits: clinical blood pressure (BP) measurements (sitting and standing), 24-hour monitoring ambulatory (ABPM), spirometry, clinical and biochemical blood tests, BA control questionnaires (ACQ) and quality of life (QL) questionnaire (GWBQ), at the second visit clinical BP measurement was performed and, if necessary, the drug dose was corrected.Results. The study included 125 patients, 28 men, 97 women. The first group of AH patients without BA included 85 people, the second (AH + BA) - 40. In AH patients without BA with ischemic heart disease, arterial revascularization, regular alcohol intake and smoking we identified the association with the lower WCE levels. In AH+BA patients with diabetes mellitus, gastrointestinal diseases, higher education was identified WCE decrease. In AH patients without asthma we found inverse relationships WCE levels with respiratory function parameters, the nighttime BP decrease, heart rate and the difference between standing and sitting BP levels, and correlations with the EchoCG variables (the left ventricular hypertrophy (LVH) indices), with age, AH duration and body mass index (BMI). In patients with AH + BA we found inverse correlations between WCE levels and some EchoCG variables, the difference between standing and sitting BP levels, and correlations with body weight, BMI.Conclusion. Thereby, in AH patients without BA with ischemic heart disease, revascularization, regular alcohol intake, smoking we identified the association with the lower WCE levels. This patients WCE indices had inverse correlations with height, respiratory function parameters, the BP nighttime decrease, the difference between standing and sitting BP levels and direct relationships with EchoCG variables of LVH, age, AH duration and BMI. In AH + BA patients with diabetes, gastrointestinal diseases, higher education we found relationships with lesser WCE manifestation. WCE levels in this group had inverse correlations with some EchoCG indicators, the standing and sitting BP difference and direct relations with weight and BMI.

Diagnosis of the blood pressure (BP) phenotype is the most important indication for its ambulatory measurement because BP phenotype is associated with cardiovascular complications and death. The study of BP phenotypes is important for patients with hypertension (HT) and comorbidity, including asthma and chronic obstructive pulmonary disease (COPD). The combination of HT with these lower airway diseases (LAD) leads to the mutual influence of pathologies creates difficulties in the drugs choice and may affect BP phenotype in HT patients.Aim. To compare in the prospective investigation various characteristics of BP phenotype in HT patients considering LAD (asthma or COPD).Material and methods. The prospective cohort study of ambulatory patients with HT (n=156) was carried out. The part of these patients had asthma or COPD (n=69). The clinical measurements and 24-hour BP monitoring, spirometry, clinical and biochemical blood tests, standard examination were performed, initially and after 12 months. BP phenotype were determined by the ratio of clinical BP and ambulatory BP considering their threshold values. Standard statistical methods and multivariate analysis were used.Results. Patients with LAD had 2 times more often prognostically unfavorable phenotypes: ineffective antihypertensive therapy (AHT) 37.3% vs 15.7% and masked AHT inefficiency 7.5% vs 4.5%; white coat HT on treatment (WCH) and effective AHT were less common(29.9% vs 42.7%; 25.5% vs 37.1%, respectively, p 148 mm Hg (b=2.733, p=0.040), LAD (b=1.015, p=0.011), serum total cholesterol (b=0.350, p=0.043), degree of nighttime diastolic BP decrease (for 13.1-18.0% b=-2.130, p=0.004; for 18.1-24.0% b=-2.509, p=0.001). The factors associated with masked AHT inefficiency in comparison to effective AHT were heart rate in orthostasis >87 beats/min(b=3,512, p=0.006) and SBP in orthostasis 141-148 mm Hg (b=3.405, p=0.004).Conclusion. The prevalence of prognostically unfavorable BP phenotypes (ineffective AHT and masked AHT inefficiency) is two times higher in HT patients with LAD. The first is associated with LAD presence, sex, and serum cholesterol; both phenotypes interrelated with hemodynamic parameters including degree of nighttime diastolic BP decrease. We found no association between AHT and LAD therapy with the BP phenotypes in this study. However, larger works in this area are required, including analysis of outcomes in long-term prospective studies.

Aim. To study the seasonal indicators of quality of life and control of bronchial asthma in hypertensive patients with bronchial asthma, observed by a cardiologist of the state outpatient institution.Material and methods. Data from a prospective cohort study of hypertensive patients, some of which had bronchial asthma without exacerbation, were analyzed. Patients who were observed by a cardiologist at a state outpatient clinic took part in the study. There were other concomitant diseases that occurred in the participants, in addition to hypertension and bronchial asthma. Two groups of patients were formed: the control group (n=85) included patients with hypertension only, the main group (n=40) included hypertension and bronchial asthma. Patients had 3 visits: initial one, and after 6 and 12 months and then data on outcomes (30.1Ѓ}7.6 months of follow-up) were collected. The first and third visits included clinical measurements of blood pressure (BP), 24-hour BP monitoring, spirometry, clinical and biochemical blood tests, a standard survey, survey with questionnaires evaluating the control of bronchial asthma (Asthma Control Questionnaire; ACQ) and the patients quality of life (General Well-Being Questionnaire; GWBQ). The second visit included clinical BP and ACQ and GWBQ questionnaires. A comparison of the average indicators from the total number of observations carried out in winter, spring, summer and autumn periods has been performed.Results. Hypertensive patients with/without bronchial asthma (n=125; 28 men, 97 women, average age 62.6Ѓ}8.8 years, duration of hypertension – 11.6Ѓ}8.6, duration of bronchial asthma – 9.3Ѓ}11.9 years) took part in the study. Outpatient BP levels throughout the study period were maintained at target values in both groups. It was shown that seasonal BP levels do not differ in the compared groups, except for winter indicators: winter daytime systolic BP levels were higher in the main group (p=0.03). Seasonal fluctuations in BP were not detected in the control group, however, they were present in the patients of the main group: winter daytime levels of diastolic BP and average daily levels of diastolic BP and systolic BP were higher than summer ones, and winter daytime systolic BP values (p1.5), in summer and autumn – partially controlled (total score ≤1.5). During the analysis of various factors associated with the combined primary endpoint (death, transient ischemic attack, angina pectoris, cardiac arrhythmias, arterial revascularization), relationships with quality of life indicators were revealed: negative connections – with indicators characterizing positive psychological health, mood at visit, positive correlations – with psychological abilities.Conclusion: Seasonal fluctuations in ambulatory BP levels were not found in the control group and were found in the main group. The quality of life indicators for patients of the main group were significantly worse than in the control group for all components in all seasons. The control of asthma changed in different seasons in accordance with the ACQ total score: uncontrolled bronchial asthma occurred in winter and spring, partially controlled – in summer and autumn. Correlations of the combined primary endpoint with quality of life indicators were found after analyzing various factors.

On February 25, 2021, an expert round table was held, which considered the problem of interdisciplinary discussion of a coronavirus disease 2019 (COVID-19) and the development of joint actions for management of patients with chronic noncommunicable diseases during a pandemic.

In hypertensive patients, blood pressure variability (BPV) and comorbidity are associated with prognosis. However, there have been no complex prospective studies of BPV in patients with hypertension and chronic lower airway diseases (CLAD). Aim. To investigate specific features of different BPV types and their prognostic value in hypertensive patients with and without CLAD in a prospective study. Material and methods. This prospective cohort study included hypertensive patients, approximately half of whom had asthma or chronic obstructive pulmonary disease (COPD). Clinic blood pressure (BP) measurements, ambulatory and home BP monitoring (ABPM, HBPM), spirometry, clinical blood analysis and blood chemistry, and a standard questionnaire and physical examination were performed at baseline and 12 months later. Clinical BP measurements and HBPM were also repeated 6 months after the baseline visit. At 12 months from the last study visit, we collected the information about cardiovascular complications and deaths. Statistical methods included ANOVA and survival analysis. The BPV indices were calculated as SD for different time periods, ARV (average real variability), and VIM (variation independent of mean). The inter-group comparisons were adjusted for age and sex. The assessment of intra-visit and long-term BPV was based on clinical BP measurement. The assessment of 24-hour BPV and mid-term BPV was based on ABPM and HBPM, respectively. Results. The BPV levels, assessed by ABPM and HBPM, were higher in patients with CLAD. There were no long-term BPV differences between two groups, in according to clinical BP data. Higher levels of daytime BPV were associated with orthostatic systolic BP, baseline forced expiratory volume in 1 second (FEV1), and glomerular filtration rate (GFR). An increase in nighttime BPV was associated with COPD, serum creatinine, FEV1 after β2-agonist inhalation, and GFR. In the CLAD group, the cumulative survival was lower, while the total risk was higher. The following endpoint predictors were identified: supraventricular arrhythmias, SD of nighttime diastolic BP, blood leukocyte count and nocturnal BP fall (Wald Chi-Square 14.780- 4.257; p

Background. Seasonal variability of cardiovascular morbidity and mortality emphasizes the need for the development of new preventive approaches. One of them could be early diagnostics of the unfavorable blood pressure (BP) phenotypes.Aim. To evaluate markers of the masked uncontrolled hypertension (MUH) phenotype in winter and summer in ambulatory treated hypertensive patients.Material and methods. We selected patients from the database (n=477; Ivanovo and Saratov residents) according to the following criteria: regular antihypertensive treatment (AHT), clinical BP

Background. The seasonal variability of blood pressure (BP) and cardiovascular morbidity and mortality motivates researchers to search for the new approaches of the antihypertensive treatment (AHT) efficacy assessment, including the analysis of interrelation between clinic and ambulatory BP, i.e. BP phenotypes.Aim. To evaluate the prevalence of BP phenotypes in treated hypertensive outpatients both in winter and summer.Material and methods. Hypertensive patients under regular AHT with available data of clinic BP and 24-hour BP monitoring both in winter and summer seasons (n=477) were selected from a outpatient database with clinic BP 60%) in this region. In contrast, the cohort of relatively older patients with longer hypertension history examined in a relatively warmer region revealed significantly higher rate of masked uncontrolled hypertension in summer (50.2%) while prevalence of all other phenotypes – in winter.

Aim. To compare influence of amlodipine and spirapril on ambulatory blood pressure profile, including antihypertensive effect smoothness in patients with arterial hypertension (HT).Methods. 39 patients (aged 53,7±10,0 y.o.) with HT were included in the open, randomized, cross-over study, 30 patients completed study. The duration of every therapies was 4 weeks, initial control period and wash-out period between therapies lasted 1 week. The initial daily dose of amlodipine was 5 mg, standard dose of spirapril (6 mg/daily) was not changed during the trial. After 1-2 weeks of treatment amlodipine dose was increased up to 10 mg/daily as well as dihydrochlorothiazide was added, if necessary. Ambulatory blood pressure monitoring (ABPM) was performed initially and at the end of both therapies.Results. Both drugs demonstrated good antihypertensive effect according to ABPM data. Decrease of systolic/diastolic blood pressure was 11,2±1,8/7,6±1,2 mm Hg in amlodipine therapy and 10,0±1,8/7,1±1,2 in spirapril therapy (pConclusion. Amlodipine has prominent as well as smooth antihypertensive effect, that gives it advantages in the long-term antihypertensive therapy.

Aim. To assess the prevalence of masked inefficacy of arterial hypertension treatment (AH MTI) and its predictors in various clinical groups and for various blood pressure (BP) control strategies, in order to evaluate the true effectiveness of antihypertensive therapy (AHT). Material and methods. AHT effectiveness was assessed in two groups of the patients with Stage I-II AH (n=219 and n=39), by comparing the ratios of clinical (cl) to ambulatory (a) BP parameters. AH MTI was defined as elevated aBP and target clBP levels during AHT. The potential predictors of AH MTI included gender, age, body mass index (BMI), anamnestic data, frequency of the clinical visits to measure BP, quality of life (QoL) parameters (GWBQ questionnaire), circadian BP profile, orthostatic BP, and ECG signs of left ventricular hypertrophy (LVH). Results. AH MTI prevalence in Groups I and II was 11,0-15,7 % and 22,6-58,1 %, respectively, depending on the definition used. The groups were significantly different in terms of age, BMI, and QoL questionnaire III and VI domains. According to the regression analysis results, in Group I AH MTI was associated with QoL questionnaire II, V, and VI domains, baseline parameters of 24-hour BP monitoring, 24-hour systolic BP (SBP) variability, minimal daytime levels of mean BP, and metoprolol and atenolol therapy. In Group II, AH MTI was predicted by age, BMI, previously administered AHT, alcohol consumption, orthostatic SBP levels, Sokolow-Lyon index, Cornell voltage and Cornell product, Gubner index, and QoL questionnaire I, IV, and VI domains. Conclusion. AH MTI prevalence is associated with some baseline characteristics of the patients and the character of AHT. Due to regression to the mean, AH MTI prevalence could increase substantially when clBP parameters are measured more often.

Aim: To investigate the effects of an ACE inhibitor spirapril (S) on office and ambulatory blood pressure (BP) levels, quality of life (QoL) and psychological status (PS) in patients with Stage 1–2 arterial hypertension (AH). Material and methods: This open, randomised cross-over study (4 weeks of spirapril therapy, 4 weeks of amlodipine (A) therapy) included 39 patients with Stage 1–2 AH, aged 53,7±10,0 years; mean AH duration was 11,8±9,5 years. After 7-day wash-out period, S (6 mg) or A (5 mg) were administered; if necessary, A dose was increased to 10 mg; S dose was constant. At baseline and in the end of each treatment phase, 24-hour BP monitoring (BPM), personality traits (Multiphasic Personality Inventory) and QoL (General Well-Being Questionnaire by Marburg University) assessment were performed. No only average levels of office and ambulatory BP, but also the masked hypertension effect (MHE), as an equivalent of masked AH treatment ineffectiveness (MTI), were assessed. MHE was evaluated based on the difference between daytime ambulatory and office BP levels. Results: Both medications were effective in achieving target levels of office and ambulatory AH. MHT value was +1,3±2,0/+0,3±1,3 and +3,6±2,0/+0,3±1,3 mm Hg for S and A treatment, respectively (р

Aim. To compare spirapril and amlodipine effects on circadian blood pressure (BP) profile, quality of life (QoL), and psychological status (PS) in patients with arterial hypertension (AH).Material and methods. This open, randomized, comparative crossover study (spirapril and amlodipine courses lasting for 4 weeks each) included 24 patients with Stage I-II AH (mean age 54,2 10,5 years; mean AH duration 12,3 10,2 years). After 7 days of no antihypertensive therapy, the participants were randomly assigned either spirapril (6 mg/d) or amlodipine (5 mg/d). In case of inadequate effectiveness, hydrochlorothiazide (25 mg) was added and/or amlodipine dose was increased to 10 mg/d; spirapril dose was unchanged. Twenty-four BP monitoring (BPM), PS and QoL assessment (MMPI, Marburg University Questionnaire) were performed. Statistical analysis was performed in SAS 6.12.Results. Mean BP level was achieved for both medications; individual target BP levels were achieved in 17 patients receiving spirapril and 18 participants receiving amlodipine. No significant difference was observed for main 24-hour BPM parameters. Spirapril was more effective in reducing nighttime BP. Effect uniformity was similar for both agents: systolic/diastolic BP smoothness index was 0,55/0,45 (р 0,05) for spirapril and 0,65/0,56 (р 0,05) for amlodipine. Both medications did not affect QoL or PS in AH patients. Spirapril also improved socialisation, self-control, optimism, and general energy level.Conclusion. Spirapril is a highly effective antihypertensive medication, improving not only circadian BP profile, but also PS parameters among AH patients.

Report on activity of editorial board of “Rational Pharmacot herapy in Cardiology” in 2014.