Aim. To investigate the antihypertensive effectiveness of a fixed perindopril/ amlodipine combination (Prestans) and its effects on the visit-to-visit variability of blood pressure levels and quality of life (QoL) among in-patients with uncontrolled arterial hypertension (AH). Material and methods. The study included 35 patients (15 men and 20 women; mean age 50,4±8,9 years) who were hospitalised due to uncontrolled AH. The previously administered ineffective antihypertensive therapy was cancelled and replaced by Prestans (5/5, 10/5, 5/10, or 10/10 mg/day, subject to AH severity). The in-hospital monitoring lasted for 14 days and included daily assessment of office, systolic and diastolic BP (sBP, dBP), mean and pulse BP, intra-visit and visitto-visit BP variability, and QoL (sF-36 questionnaire). Results. All hospitalised patients had stage III AH, including 31,4% with degree 2 AH and 68,6% with degree 3 AH. during the in-hospital course of Prestans treatment, the levels of sBP and dBP decreased from 184,2±14,6 to 142,1±13,8 mm Hg (p<0,05) and from 104,6±7,2 to 84,3±5,7 mm Hg (p<0,05), respectively. Mean and pulse BP levels also reduced significantly. The intra-visit variability of office sBP significantly decreased from day 1 (5,07±0,9 mm Hg) to day 14 (1,5±0,1 mm Hg; p<0.05). The visit-to-visit sBP variability also decreased, from 11,6±2,5 to 2,1±1,2 mm Hg, respectively (p<0,01). At baseline, the patients demonstrated a substantial reduction in both physical and mental health QoL parameters. The treatment was associated with a significant improvement in the psychological health domain (emotional and social functioning). Conclusion. In patients with uncontrolled AH, the in-hospital treatment with Prestans resulted in a mean reduction of sBP/dBP levels by 38,4/19,6 mm Hg, a significant decrease in mean and pulse BP levels, and achievement of target BP levels in 82.9% of the patients as early as at day 14 of the treatment. The amlodipine/perindopril treatment was also associated with reduced intra-visit and visit-to-visit BP variability, as well as with improved BP control, emotional status, and QoL. Russ J Cardiol 2014, 4 (108): 75-81Key words: perindopril/amlodipine, visit-to-visit variability, quality of life.
Background:Similarities in risk factors, initial stages, progression and final stage of both atherosclerotic cardiovascular disease (ACVD) and chronic kidney disease (CKD) allowed formulating a concept of cardiorenal continuum.1ACVD and CKD remain the main causes of mortality in rheumatoid arthritis (RA) patients.2,3Objectives:To evaluate the effects of rituximab (RTM) therapy on cardiorenal continuum of RA patients.Methods:Biologics-naïve RA patients (n=92; age 49.5±9.9) were followed up for 72 months after commencing and continuing RTM therapy (1–10 standard courses) compared with 50 control RA patients (age 49.2±9.8). All control and 63% of RTM patients received methotrexate or leflunomide.Results:There were no baseline differences between two groups – Table. At year 6, RTM patients have fewer incidences of hypertension, anxiety/depression, atherosclerosis and diastolic dysfunction than controls. RTM decreased prevalence of albuminuria and CKD.Table.Cardiorenal continuum of rheumatoid arthritis patients (%)FeaturesRituximab groupControl grouppRTM–C1 year n=923 years n=476 years n=311 yearn=503 years n=266 years n=16Risk factorsHypertension52.238.325.8p6–1=0.02250.038.550.0p6=0.032Dyslipidaemia44.636.238.748.046.250.0>0.05Pre-diabetes41.336.241.944.034.656.3>0.05Metabolic syndrome12.06.43.210.07.712.5>0.05Diabetes mellitus3.2002.000>0.05Anxiety/depression78.341.5p3–1=0.00535.3p6–1<0.00176.073.168.8p3=0.009p6=0.008Initial stages (asymptomatic organ damage)Atherosclerosis34.821.312.9p6–1=0.04536.034.637.5p6=0.02Left ventricular hypertrophy8.74.308.07.70>0.05Diastolic dysfunction57.638.322.6p6–1=0.01856.050.056.3p6=0.04Albuminuria19.600p6–1=0.03812.006.3>0.05Kidney impairment6.52.106.000>0.05ProgressionAngina6.5004.000>0.05Chronic kidney disease26.18.59.7p6–1=0.04212.000>0.05End stageMyocardial infarction000000>0.05Stroke000000>0.05Heart failure4.400000>0.05Acute/chronic renal failure000000>0.05Death000000>0.05There were no significant differences in frequencies of other risk factors, signs of organ damage and cases of established heart, cerebrovascular and renal diseases/complications.Conclusion:RTM may be effective in delay of the movement of RA patients on cardiorenal continuum. The clinical implications of RTM for cardiorenal correlations in RA patients need to be confirmed in large-scale clinical outcome trials.References:[1]Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm.Am J Kidney Dis2000;35(4, Suppl. 1):117–31.[2]Avina-Zubieta JA, Choi HK, Sadatsafarvi M,et al.Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies.Arthritis Rheum2008;59:1690–7.[3]Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis.Best Pract Res Clin Rheumatol2011;25:469–83.Disclosure of Interests:Ilshat Gaisin Speakers bureau: Boehringer Ingelheim, KRKA, Berlin-Chemie Menarini, Sanofi, Larisa Ivanova Speakers bureau: Bayer, Novartis, KRKA, Nikolay Maximov Speakers bureau: Pfizer, KRKA, Rosa Valeeva: None declared, Dilara Yurk: None declared, Anastasia Vedekhina: None declared, Nuriya Garaeva: None declared, Irina Sabelnikova: None declared
BackgroundSimilarities in risk factors, initial stages, progression and final stage of both atherosclerotic cardiovascular disease (CVD) and chronic kidney disease (CKD) allowed formulating a concept of cardiorenal continuum.1 CVD and CKD remain the main causes of mortality in rheumatoid arthritis (RA) patients.2,3ObjectivesWe aimed to evaluate the effects of rituximab biologic therapy on cardiorenal continuum of RA patients.MethodsBiologics-naïve RA patients (n=50; age 55.1±10.3) were followed up for 72 months after commencing and continuing rituximab therapy (1–10 standard courses) compared with 30 control RA patients (age 53.2±9.8).ResultsAt year 6, rituximab patients have fewer incidences of hypertension, anxiety/depression, atherosclerosis and diastolic dysfunction than control patients (Table).Table 1.Cardiorenal continuum features of rheumatoid arthritis patients (%)FeaturesRituximab groupControl groupPR-C 1 year, n=503 years, n=476 years, n=311 year, n=303 years, n=266 years, n=16 Risk factorsHypertension50.038.325.840.038.550.0p6=0.032p6–1=0.028Dyslipidaemia44.036.238.740.046.250.0>0.05Pre-diabetes52.036.241.933.334.656.3>0.05Metabolic syndrome12.06.43.210.07.712.5>0.05Diabetes mellitus4.000000>0.05Anxiety/depression83.241.535.380.073.168.8p3=0.009p3–1=0.006p6–1<0.001p6=0.008Initial stagesAtherosclerosis32.021.312.940.034.637.5p6=0.02p6–1=0.048Left ventricular hypertrophy8.04.306.77.70>0.05Diastolic dysfunction48.038.322.646.750.056.3p6=0.04p6–1=0.022Albuminuria8.000006.3>0.05Kidney impairment6.02.1013.300>0.05ProgressionAngina6.0003.300>0.05Chronic kidney disease16.08.59.713.400>0.05End stageMyocardial infarction/stroke000000>0.05Heart failure2.000000>0.05Acute/chronic renal failure000000>0.05Death0012.9000>0.05There were no significant differences in frequencies of other risk factors, signs of asymptomatic multiorgan damage and cases of established heart, cerebrovascular and renal diseases/complications.ConclusionsRituximab may be effective in delay of the movement of RA patients on cardiorenal continuum. The clinical implications of rituximab for cardiorenal correlations in RA patients need to be confirmed in large-scale clinical outcome trials.References Sarnak MJ, Levey AS. Cardiovascular disease and chronic renal disease: a new paradigm. Am J Kidney Dis 2000;35(4, Suppl. 1):117–31.Avina-Zubieta JA, Choi HK, Sadatsafarvi M, et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 2008;59:1690–7.Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis. Best Pract Res Clin Rheumatol 2011;25:469–83. Disclosure of InterestNone declared
Introduction. Patients with obstructive sleep apnea syndrome (OSA) may have features of acute ST-segment elevation myocardial infarction (STEMI). We assumed that the previous OSA due to acute and chronic hypoxia has a “protective” effect on myocardial damage in STEMI. To assess the damage to the myocardium, we selected the index of local contractility disorders (ILCD), and used the oxygen desaturation index (ODI) to assess OSA’s severity.Aim. To study the relationship between myocardial damage and the severity of OSA in STEMI after percutaneous coronary intervention (PCI).Material and Methods. We examined 130 patients with first-time STEMI after PCI on the infarct-associated coronary artery. Examination and treatment of patients were performed based on current procedures and standards of medical care and clinical recommendations. All patients were monitored for pulse oximetry during nighttime sleep within one week after hospitalization. The patients were divided into two groups: group A (n=59, ODI 0-5/hour, STEMI without OSA) and group B (n=71, ODI >5/ hour, STEMI with OSA).Results. Regression analysis showed that the elements of myocardium’s structural remodeling, the severity of OSA, and some biochemical indicators are included in the same indicator system and are associated with ILCD. The “left ventricular ejection fraction” (“LVEF”) indicator, estimated using the J.S. Simpson method, had the largest contribution to the ILCD in both groups of patients, while the “ID” indicator backfired on ILCD only in the group of STEMI with OAS. Thus, OSA contributed to less damage to the left ventricular myocardium in STEMI.
Background:Raynaud’s phenomenon (RP) secondary to rheumatic diseases (RD) can progress to irreversible tissue damage with digital ulceration, scarring and, rarely, gangrene requiring amputation1. Current medical treatments for RP are far from ideal: they are often either ineffective and/or poorly tolerated, thus a significant proportion of patients discontinue drug therapy2.Objectives:To determine RP expression levels and to evaluate the long-term efficacy of iloprost and alprostadil in RP patients with RD.Methods:Indicated therapy with intravenous iloprost (n=10), alprostadil (n=17) or their combinations (n=13) was carried out for three years in patients with secondary RP in RD. Frequency of Raynaud’s attacks, digital ulcers (DU) formation and pain intensity on visual analogue scale (VAS) were evaluated. A control group included 30 patients with RP in RD who did not receive prostanoid therapy. By factor analysis method a generalized index of RP expression was identified, on the basis of which levels of RP expression were determined.Results:“RP expression” scale, revealed as an indicator of RP generalized manifestation, was an average value of two subscales: (1) consisted of 4 indices “DU”, “digital pitting scars”, “phalange amputation” and “frequency of Raynaud’s attack”, (2) included 3 indicators: “intensity of pain”, “duration of illness”, “whitening of fingers”. Correlation of subscales showed their reliability (r=0.294, p=0.053). RP final expression (severity) was 1.51±0.86. A low level of RP expression had values below 0.65, a high level – over 2.37. At baseline, the high level of RP severity was defined in 16 (22.9%) patients, medium – in 43 (61.4%), low – in 11 (15.7%).RP treatment with iloprost was effective in the healing of DU in 100% of patients and led to decrease of RP expression generalized index from 2.25 [1; 3] to 1.75 [1; 2] (p=0.012). Alprostadil therapy reduced pain intensity on VAS (p<0.05) and numbness during Raynaud’s attacks (p<0.01) and decreased RP expression from 1 [1; 2] to 1 [0.5; 1.5] (p=0.038). Patients on prostanoids combination had new DU and amputations; pain intensity reduced by 47% (p<0.05), RP expression generalized indicator did not change.Conclusion:Based on RP clinical manifestations in RD patients, a generalized index of RP expression was identified and levels of RP severity were determined. Treatment with iloprost or alprostadil has significant effects on reducing the clinical manifestations of RP with a corresponding decrease in its severity. Iloprost is indicated in patients with medium and high levels of RP expression index, alprostadil – with medium and low index and non-effectiveness of calcium channel blockers.References:[1]Hughes M, Herrick AL. Digital ulcers in systemic sclerosis.Rheumatology (Oxford) 2017;56 (1):14–25.[2]Kowal-Bielecka O, Fransen J, Avouac J et al. Update of EULAR recommendation for the treatment of systemic sclerosis.Ann Rheum Dis2017;76(8):1327–39.Acknowledgments:Professor LP. Anan’evaDisclosure of Interests:Ilshat Gaisin Speakers bureau: Boehringer Ingelheim, KRKA, Berlin-Chemie Menarini, Sanofi, Zukhra Bagautdinova: None declared, Marianna Glavatskikh: None declared, Nikolay Maximov Speakers bureau: Pfizer, KRKA, Rosa Valeeva: None declared, Oxana Desinova: None declared, Rushana Shayakhmetova: None declared
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