Background: A review of the literature showed that there are no studies on the course and outcomes of COVID-19 in patients with advanced HIV infection, so this study was conducted. Aims: Identification of predictors of adverse outcomes of COVID-19 in patients with HIV at the stage of secondary diseases in order to develop a predictive model of outcomes. This will help to simplify the decision-making on management of patients with COVID-19 and HIV infection at advanced stages. Materials and methods: This is a single-center study wich included 300 patients over 18 years of age with HIV infection at advanced stage of disease and moderate to severe COVID-19 requiring in-patient treatment. Results: Mortality rate was 27.3% (CI: 22.7% - 32.4%). Factors reflecting respiratory failure, immunodeficiency, decreased levels of protein, albumin, and increased levels of urea became unfavorable. A predictive model of adverse outcomes of COVID-19 in patients with advanced HIV infection has been obtained. Conclusions: A predictive model has been developed to help a practical healthcare doctor make a quick, informed decision on hospitalization of a patient in the intensive care unit and active therapeutic actions.

Лечение артериальной гипертензии (АГ), несмотря на большой выбор антигипертензивных препаратов, в настоящее время остается одной из актуальнейших проблем в современной кардиологии. Однако схемы, применяемые в реальной клинической практике, не всегда соответствуют существующим рекомендациям, в частности, Европейского общества по борьбе с гипертонией (European Society of Hypertension, ESH) и Европейского общества кардиологов (European Society of Cardiology, ESC). Так, пациенты с 2-3 степенью повышения артериального давления (АД) и высоким или очень высоким добавочным риском часто не получают требующуюся в данных клинических ситуациях комбинированную терапию. Согласно рекомендациям ESH и ESC, пациентам, имеющим АГ низкого/среднего риска развития сердечно-сосудистых осложнений (ССО) и смерти от них, возможно назначение монотерапии при достижении целевых значений АД [1]. Пациентам с высоким или очень высоким риском ССО и/или АГ 2-3-й степени сразу должна назначаться комбинация из двух препаратов. Если же целевые значения АД не достигаются, то применяется либо комбинация из двух препаратов в максимальных терапевтических дозах, либо производится смена комбинации препаратов, либо добавляются 3-й, 4-й и так далее антигипертензивный препарат [2, 3]. Комбинированная терапия также может быть назначена и пациентам, имеющим АГ с низким/средним риском развития ССО при недостижении целевых значений АД [3, 4].

Background. Current guidelines describe in detail the approaches to the management of patients with resistant hypertension, however, in real clinical settings the number of non-rational and ineffective combinations of antihypertensive drugs used remains high.Aim. To analyze the distribution of different combinations of antihypertensive drugs for the treatment of resistant hypertension and to estimate the proportion of non-rational combinations.Methods. The retrospective analysis includes 117 outpatients with resistant hypertension. Resistant hypertension was defined as blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes. Exclusion criteria was secondary hypertension. We defined rational combination as the standard combination (renin-angiotensin system [RAS] blocker + calcium-channel blocker [CCB] + diuretic) plus one of the group of reserve drugs (mineralocorticoid receptors antagonist [MRA], beta-blocker, alpha-blocker, agonist of imidazoline receptors [AIR]). Non-rational were considered combinations in which reserve drugs were used before the appointment of a triple combination of first-line drugs. Moreover, in a subgroup of non-rational therapy, situations were identified where such a combination was justified.Results. The proportion of rational combinations was 58.9%, reasonably non-rational - 15.5%, unreasonably non-rational - 25.6%. Unreasonably non-rational combinations are distributed as follows: non-appointment of CCB - 12%, non-appointment of RAS-blockers - 8%, non-appointment of diuretics - 6%, use of RAS-blockers for hyperkalemia - 6%, administration of MRA without non-potassium-sparing diuretics - 5%, double blockade of RAS - 3%, other combinations - 7%. In addition to first-line drugs, beta-blockers (93.2%), loop diuretics (22.2%), AIR (21.4) were the most prescribable, while the proportion of MRA is only 15.4% of the entire sample.Limitation: some patient's characteristics could be missed in case histories and some of the combinations could be falsely recognized as malpractice since the analysis was conducted retrospectively.Conclusion. The proportion of the non-rational combinations for the treatment of resistant hypertension is high. Among the drugs of the reserve, the frequent use of beta-blockers and moxonidine and the inadequate administration of spironolactone are noteworthy. The problem of treatment strategy choice remains relevant in real clinical practice.