Arterial hypertension in adults. Clinical guidelines 2020

The Hi-receptor blocker Dimebon is shown to exhibit pronounced antiarrhythmic properties. Its activity and therapeutic action range (toxic/therapeutic ratio) exceed those of quinidine, ethmosine, isoptin, and bonnecor in several animal models of cardiac arrhythmia. The mechanism of its antiarrhythmic action is probably associated with blockade of sodium and particularly calcium channels, prolongation of the effective refractory period, and slowing of impulse traffic in the conduction system of the heart. Dimebon may be recommended for submission to clinical trials as an antiarrhythmic agent.Key Words: Dimebon; antihistamines; antiarrhythmics Dimebon [3,-(2-methyl-pyridyl-5)-ethyl-1,2,3,4-tetrahydro-7-carboline dihydrochloride] is a new Russian-made antihistamine blocking H 1 receptors [5]. The present study was undertaken to test Dimebon for antiarrhythmic activity in view of the evidence that the myocardium contains H 1 receptors and that certain antihistamines are capable of suppressing arrhythmias in experimental animals [4,10]. MATERIALS AND METHODSThe study used 205 male Wistar rats (body weight 0.18-0.22 kg), 48 random-bred rabbits (2.3-3.4 kg), 56 cats (2.6-3.2 kg) and 35 dogs (12-18 kg) of both sexes, as well as 16 and 36 preparations of isolated frog and guinea pig atria (trabeculae and auriculae), respectively.The acute toxicity (median lethal doses, LDs0 ) of Dimebon and other antiarrhythmic drugs tested for comparison was measured in rats.The effects of the drugs on electrocardiographic The ability of the drugs to exert antiarrhythmic activity in mixed atrial/ventricular arrhythmias was assessed using models of arrhythmias induced by aconitine [3], epinephrine [9], and calcium chloride [14] in rats, barium chloride [6] in rabbits, and strophanthin [1] in cats. The end-points used in these experiments were the median effective dose (EDs0), which eliminated arrhythmia in 50% of the test animals, and the LDs0/EDs0 ratio, which gives an indication of the therapeutic (antiarrhythmic) action range of the drug used. In addition, Dirnebon and two other drugs were also tested for effects on atrial [15] and ventricular [13] arrhythmias in dogs. The activity of the drugs in atrial arrhythmia was measured by the method of bio-0007-4888/95/0004-0362512.50 9Plenum Publishing Corporation

Aim. To assess antihypertensive efficacy of various 24-hour regimens of antihypertensive drugs prescription and the influence on 24-hour profile of blood pressure (BP) and aortic pressure, in systemic hypertension patients post transient ischemic attack. Артериальная гипертония Material and methods. Totally, 174 patients were included, with grade 1-2 hypertension and previous non-effective treatment; who during the previous 4 weeks had transient ischemic attack. All patients were randomized to 3 groups according to the treatment variant: group 1 (n=59)-valsartan 160 mg and thiazide-like diuretic in the morning, group 2 (n=58)-thiazide-like diuretic in the morning and valsartan 160 mg at bedtime, group 3 (n=57)-thiazide-like diuretic in the morning and valsartan 80 mg b. i.d. (morning and bedtime). At baseline and in 12 months of therapy all patients underwent BP monitoring (ABPM) with assessment of mean 24 hour, daytime, nocturnal systolic BP (SBP) and diastolic BP (DBP), mean pulse pressure, time index of hypertension, SBP and DBP variability at daytime and at night, prominence and velocity of morning SBP and DBP raise, heart rate, central aortic pressure (CAP): SBP and DBP in aorta, variability of SBP and DBP in aorta, pulse BP in aorta, augmentation index in aorta, pulse pressure amplification, ejection period duration, efficacy index of subendocardial blood flow. Valsacor (KRKA, Slovenia) was included in the study as valsartan. Results. In 12 weeks of fixed combination therapy, the target levels of BP were registered: in group 1-43 patients (72,9%), group 2-48 (82,7%), group 3-55 (96,4%). Reached target BP was more common in b. i.d. intake of valsartan (group 3) comparing to group 1 (p=0,001) and group 2 (p=0,03). Statistically significant positive shifts of ABPM and CAP values were registered in all three regimens. However, in group 2 there was significantly more prominent decrease of the main parameters of ABPM and CAP, than in group 1. Valsartan two times daily (group 3) led to more prominent (p<0,05) improvement of ABPM and CAP value comparing to any variant of its once per day usage (group 1 and 2). In 12 months of treatment, there was a significant (p<0,05) increase in all groups of patients with normalized 24 hour BP profile ("dipper"): in group 1-28 (65%), group 2-37 (77%), group 3-48 (87%). Normalized 24 hour BP trend was registered more commonly in the group 3 patients comparing to those of groups 1 and 2. The differences in the number of "dipper" patients were significant between groups 3 and 1 (p=0,01). Conclusion. The study showed that b. i.d. or bedtime valsartan intake in combination with diuretic leads to more prominent improvement of the main ABPM and CAP parametes in comparison with the drug intake in the morning, in patients with transient ischemic attack. Two times daily intake of valsartan leads significantly (p<0,05) to normalization of 24 hour BP profile in most patients (87%) and more prominent improvement of the main ABPM, CAP values comparing to once per day morning or evening intake...

Disclaimer РThe EAC/RNAS Guidelines represent the views of the EAC and RNAS, and were produced after careful consideration of the scientific and medical knowledge, and the evidence available at the time of their publication. The EAC and RNAS is not responsible in the event of any contradiction, discrepancy, and/or ambiguity between the EAC/RNAS Guidelines and any other official recommendations or guidelines issued by the relevant public health authorities, in particular in relation to good use of healthcare or therapeutic strategies. Health professionals are encouraged to take the EAC/RNAS Guidelines fully into account when exercising their clinical judgment, as well as in the determination and the implementation of preventive, diagnostic, or therapeutic medical strategies; however, the EAC/RNAS Guidelines do not override, in any way whatsoever, the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and, where appropriate and/or necessary, the patient’s caregiver. Nor do the EAC/RNAS Guidelines exempt health professionals from taking into full and careful consideration the relevant official updated recommendations or guidelines issued by the competent public health authorities, in order to manage each patient’s case in light of the scientifically accepted data pursuant to their respective ethical and professional obligations. It is also the health professional’s responsibility to verify the applicable rules and regulations relating to drugs and medical devices at the time of prescription.Members of the Working Group confirmed the lack of financial support / conflict of interest. In the event of a conflict of interest being reported, the member (s) of the Working Group was (were) excluded from the discussion of sections related to the area of conflict of interest.

Цель. Изучить и сравнить эффективность влияния комбинаций антигипертен-зивных препаратов с использованием различных режимов их дозирования в течение суток на показатели суточного профиля артериального давления (АД), центрального аортального давления (ЦАД) и жесткости сосудистой стенки у пациентов с артериальной гипертонией (АГ), перенесших ишемиче-ский инсульт (ИИ). Материал и методы. В исследование включены 177 пациентов с АГ, перенес-ших в ближайшие 4 нед. ИИ. Все пациенты рандомизированы в 3 группы в зависимости от режима назначения комбинаций антигипертензивных препа-ратов в течение суток. Исходно и через 12 мес. хронофармакотерапии всем больным проводилось суточное мониторирование АД (СМАД) с оценкой основных параметров СМАД, а также ЦАД и ригидности сосудистой стенки. Результаты. Через 8 нед. антигипертензивной терапии достижение целевого уровня (ЦУ) АД достоверно чаще отмечалось при двукратном приеме валсар-тана (3 группа) по сравнению с его однократным назначением только в утрен-ние (1 группа) или вечерние часы (2 группа) (p<0,05). Во всех группах реги-стрировались статистически значимые положительные изменения показате-лей СМАД, ЦАД и ригидности сосудистой стенки. В то же время во 2-й группе имело место достоверно (p<0,05) более значимое снижение основных показа-телей СМАД, ЦАД и жесткости сосудистой стенки, чем в 1-й группе пациентов. Двукратное применение сартана обеспечивало достоверно более выражен-ное (р<0,05) улучшение основных показателей СМАД, ЦАД и артериальной ригидности по сравнению с любым вариантом однократного его приема. Через 12 мес. хронофармакотерапии во всех группах отмечалось достоверное (p<0,05) увеличение количества пациентов с суточным профилем АД "dipper". Различия между группами по числу пациентов с профилем "dipper" и "nondipper" через 12 мес. лечения оказались достоверными между 3-й и 1-й (p=0,0004), 3-й и 2-й (p=0,04) группами в пользу третьей группы. Заключение. Таким образом, двукратный или только вечерний прием валсар-тана в комбинации с тиазидоподобным диуретиком утром способствовал более выраженному улучшению основных параметров СМАД, ЦАД и ригидно-сти сосудистой стенки по сравнению с применением препарата только в утренние часы. Двукратный прием валсартана отличался достоверно (p<0,05) более частым достижением ЦУ АД, способствовал нормализации суточного профиля АД у большинства пациентов и более выраженному улуч-шению основных показателей СМАД, ЦАД и сосудистой жесткости по сравне-нию с однократным приемом препарата в утренние или вечерние часы. АГ -артериальная гипертония, АГТ -антигипертензивная терапия, АД -артериальное давление, БРА -блокатор рецепторов ангиотензина II, ВУП -величина утреннего подъёма, ДАД -диастолическое артериальное давление, ДАДао -диастолическое артериальное давление в аорте, ИВ -индекс вре-мени, ИИ -ишемический инсульт, ПАД -пульсовое артериальное давление, ПАДао -пульсовое артериальное давление в аорте, РААС -ренин ангиотен-зин альдостероновая система, САД -систолическое артериальное давление, САДао -систолическое артериальное давление в аорте...