The use of different threshold values can significantly influence the assessment of prevalence of LVH in hypertension. The "mild" criteria, to our opinion, can overestimate the prevalence of structural LV remodelling, while implementation of sex-specific criteria for the definition of LVH increases the sensitivity of the method. In any way, eccentric LVH is as common for hypertension as a concentric LVH, the proportion of the latter increasing with age and more frequently observed in males. Concomitant obesity, in particular abdominal, significantly increases LVH prevalence.

eft ventricular hypertrophy (LVH) is generally believed to be an independent risk factor in hypertension, 1-5 and the possibility and beneficial effect of reversing LVH during antihypertensive treatment have been well documented in clinical studies. [6][7][8][9][10] However, little is known about the evolution of left ventricular (LV) geometry in untreated subjects, because of the difficulties of long-term follow-up for humans and the ethical problems of organising a prospective study of untreated patients.There are 4 patterns of LV geometry in hypertension, classified according to the LV mass (LVM) index and relative wall thickness (RWT), 11 and it is now well established that the LV geometry pattern is closely related to LV function and the patient's prognosis. 12,13 Thus, concentric LVH is associated with a higher risk of cardiac arrhythmias, and even sudden death, 12 and the literature is replete with evidence that concentric LVH strongly predicts the development of heart failure. 13,14 In addition, the evidence is accumulating that eccentric LVH is frequently observed in the early stages of hypertension, 15-17 but little is known whether the geometry patterns are necessary consequent stages in the development of the hypertensive heart from normal geometry through LVH to LV dilatation and heart failure, or if every pattern is genetically and/or hemodynamically predisposed. Finally, the natural history of the transition from 1 pattern to another is still unknown, as are the changes in the geometry patterns during antihypertensive therapy.The present study investigated the changes in LVM, diastolic function, and geometry in hypertensive patients in a prospective 5-year follow-up in concordance with an evaluation of the regularity and effectiveness of treatment. Methods PatientsHypertensive patients older than 18 years from one of the city districts of St Petersburg who were in the patient database of the outpatient clinic, were screened for the study. Because no other option for outpatient care is available in this area, the vast majority of patients with essential hypertension are seen in the selected healthcare center. Patients were recruited for the study during their annual check-up from 1995 to 1998. The selection criteria were: (1) previously established diagnosis of essential hypertension (=1 year) based on the standard criteria (3 consecutive measurements of blood pressure (BP) in the right brachial artery while seated: >140 mmHg for systolic BP and/or >90 mmHg for diastolic BP); (2) Background Left ventricular hypertrophy (LVH), as well as the geometry pattern of the left ventricle, is believed to be an independent risk factor for hypertension. The present study investigated the changes in left ventricular mass, diastolic function and geometry in hypertensive patients in a prospective 5-year follow-up in conjunction with an evaluation of the regularity and effectiveness of treatment. Methods and ResultsOne hundred hypertensive patients older than 18 years were examined according to the study protocol...

This study confirms the antianginal and anti-ischemic efficacy of single dose and long-term treatment with trimetazidine. Treatment with trimetazidine was well tolerated.

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Aim. As a clinical part of the Russian multi-centre randomised study, to assess the clinical benefits and safety of adding Trimetazidine MB to the standard treatment scheme in patients with stable angina (SA), in order to optimise their ambulatory therapy and improve their compliance. Material and methods. The study included 981 patients with Functional Class (FC) II-III SA and various concomitant diseases and syndromes, such as chronic heart failure (CHF), Type 2 diabetes mellitus (DM-2), or chronic obstructive pulmonary disease (COPD) in smokers. All participants were divided into two groups: Group I (n=838) received standard therapy plus trimetazidine MB (70 mg/d, twice a day), while Group II (n=143) received standard therapy only. The treatment and follow-up phases lasted for 12 months. Results. In Group I, the weekly number of angina attacks decreased by 42 % from the baseline at one month (р<0,0001), and by 70 % at 12 months (р<0,0001). The number of nitroglycerin (NTG) tablets taken decreased, respectively, by 41 % (р<0,0001) and 68 % (р<0,0001). In Group II, the decrease in angina attack number and NTG tablet number was significant only at 6 months and was less pronounced than in Group I. Therefore, in Group I, the number of patients with FC I increased by 7 times, while the number of FC III patients decreased by 1,8 times. No marked FC dynamics was observed in Group II. In Group I, left ventricular ejection fraction (LVEF) increased by 2,4 % (р<0,001), while interventricular septum and LV posterior wall thickness decreased, respectively, by 4,2 % (р<0,01) and 3,5 % (р<0,01). These parameters, however, did not change substantially in Group II patients. At 12 months, the number of patients hospitalised due to clinical decompensation, or becoming disable, was twice as high in Group II as in Group I. Conclusion. The Russian “PERSPECTIVE” Study results demonstrated high clinical effectiveness and safety ofTrimetazidineMB therapy, combined with standard treatment, in SA patients with CHF, DM-2, and COPD. Therefore, metabolic therapy could be more widely used in the real-world clinical settings.

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