Рабочая группа по диабету, предиабету и сердечно-сосудистым заболеваниям европейского общества кардиологов (ESC) в сотрудничестве с европейской ассоциацией по изучению диабета (EASD).

The 2008 European Society of Cardiology/European Society of Hypertension guidelines recommend the first-line prescription of two antihypertensive drugs in single-pill combinations (SPCs), also known as fixed-dose combinations, for the treatment of most patients with hypertension. This recommendation is based on a large amount of data, which shows that first-line treatment with SPCs supports reaching blood pressure targets rapidly and reducing cardiovascular outcome risk while keeping the therapeutic strategies as simple as possible and fostering adherence and persistence. As this approach constitutes a big shift from the stepped-care approaches that have been dominant for many years, practicing physicians have expressed concerns about using SPCs as first-line agents. In this review, we will discuss the barriers to the uptake of this recommendation. We will also offer suggestions to reduce the impact of these barriers and address specific concerns that have been raised.

AimCardiovascular risk factors are also risk factors for cognitive impairment. They have cumulative effect in target organ damage. The precise correlation between cardiovascular risk factors and cognitive impairment, as well as assessing the extent to which they may affect cognitive functioning, is difficult to ascertain in everyday clinical practice. Quick, specific, and sensitive neuropsychological tests may be useful in screening for, and the prophylaxis of, target organ damage in hypertensive patients.MethodsWe gathered full anamnesis, performed physical examination, laboratory screening and echocardiography. These variables were observed at office and home for all patients, For half of the patients, 24-hour ambulatory blood pressure monitoring and neuropsychological testing using Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE), Geriatric Depression Scale, and the 4-instrumental activities of daily living scale were undertaken.ResultsFor a period of 2 years, 931 patients were included after applying the inclusion and exclusion criteria. The mean age was 65.90±10.00 years. Two hundred and sixty three patients (85 [32.32%] males and 178 [67.68%] females) were reevaluated after a mean follow-up period of 12 months (6–20 months). The mean results of MoCA and MMSE were significantly lower (p<0.05) in the group of patients with poorly controlled blood pressure and cardiovascular risk factors. There was mild to intermediate negative correlation between Systematic Coronary Risk Evaluation (SCORE) and the neuropsychological tests’ results.ConclusionCardiovascular risk factors play an important role for the development of cognitive impairment in the eastern European population because of their high frequency and interaction. The use of easily applicable neuropsychological tests in everyday clinical practice of specialties other than neurology may help in stratifying the risk for development and progression of mild cognitive impairment in this high-risk group.

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