The aim – to study clinical characteristics of patients with arterial hypertension, symptoms of heart failure and preserved left ventricular (LV) ejection fraction (EF) depending on the value of E/e´ at rest and after submaximal exercise testing (SET). Material and methods. A prospective study involved 103 patients, average age 65.4±10.8 years, with clinical signs of heart failure, LV EF ≥ 50 % and signs of LV diastolic dysfunction. Echocardiography with tissue Doppler, SET, applanational tonometry were conducted. The level of NT-proBNP was studied. According to E/e´, patients were divided into 3 groups: E/e´ > 13 at rest (group І), E/e´ > 13 after SET (group ІІ), E/e´ < 13 after the SET (group ІІІ). Results. Group І included 64 (62.1 %), group ІІ – 24 (23.3 %), group ІІІ – 15 (14.5 %) patients. Patients were comparable regarding age, gender, frequency of earlier myocardial infarction and the average level of systolic blood pressure. Patients of group І, compared to those in groups ІІ and ІІІ, more often had atrial fibrillation, chronic kidney disease and anemia (all Р<0.01). Frequencies of diabetes mellitus and obesity in group ІІ were larger than in group ІІІ: 12 (50 %) and 4 (26.6 %); Р<0.05) and 15 (62.5 %) and 3 (20 %); Р<0.01), respectively. Severity of heart failure by NYHA was greatest in group І, less – in group ІІ and the smallest – in group ІІІ (all Р<0.01). Group ІІ, compared to group ІІІ, had worse exercise tolerance based on submaximal exercise test duration (7.2±1.7 and 8.6±1.9 minutes, Р<0.01) and power (50.0±19.9 and 68.3±22.0 W, Р<0.02), higher left atrial volume index (LAVI) 38.7±1.2 and 35.3±1.2 ml/m2 Р<0.05, left ventricular myocardial mass index (LVMI) 138.7±13.7 and 128.0±35.1 mg/m2 Р<0.05 and levels of NT-proBNP 422.8±93.8 and 134.3±53.5 pg/ml. Conclusions. Patients with E/e´ > 13 at rest differ from those with E/e´ increase after SET, by decrease of exercise tolerance and higher frequency of comorbidities. In patients with arterial hypertension, heart failure II–III classes NYHA and unchanged E/e´ at rest, its increase more than 13 after SET was noted in 61.5 % patients, and was associated less exercise load, greater frequency of obesity and type 2 diabetes, greater LVMI and LAVI and higher levels of NT-proBNP.

The aim —  to compare the effect of 6‑month treatment of patients with arterial hypertension (AH) of 1 — 2 degrees with angiotensin converting enzyme (ACE) or angiotensin II receptor blockers (ARB) in combination with a thiazide diuretic (indapamide) and dihydropyridine calcium channel blockers (CCB) in combination with a diuretic on indicators of brachial and central arterial pressure (AP), elastic properties of the arteries and the structural and functional state of the heart, depending on age.Materials and methods. The study included 320 patients (156 men and 164 women) aged from 35 to 80 years (mean age 62.8 ± 0.61 years) with uncomplicated AH of stage I — II, degree 1 — 2 (62.0 % and 38, 1 %, correspondingly). Depending on age, the patients were divided into two groups: < 65 years old (n = 157) and ≥ 65 years old (n = 163), the ratio of men and women was approximately 1 : 1. Using the method of blind envelopes patients of each group were randomized into 2 subgroups: subgroup «A» — that received therapy based on an ACE inhibitor (perindopril 5 — 10 mg) or ARB (olmesartan 20 — 40 mg), and subgroup «B» who received therapy based on CCB (lercanidipine 5 — 10 mg). Patients ≥ 65 years old, randomized to subgroup «B», began treatment with a fixed combination of indamapid 1.5 mg +amlodipine 5 mg (Arifam, Servier, France). If the target office brachial AP was not achieved (< 140/90 mm Hg), the dose of each of the studied antihypertensive drugs was increased to full therapeutic. If necessary, patients of subgroup «A» and patients aged < 65 years old of subgroups «B» were additionally given indapamide at a dose of 2.5 mg 1 time per day. Patients who were prescribed Arifam, if necessary, increased the dose to 1.5/10 mg. The patients underwent general clinical examination, measurement of brachial arterial pressure, pulse wave analysis and measurement of carotid‑femoral and carotid‑radial pulse wave velocity using applanation tonometry, Doppler echocardiography. The parameters of arterial wall stiffness (Ea), myocardial wall stiffness (Ees) of the left ventricle (LV), coefficient of ventricular‑arterial interaction (Еа/Еes) were calculated.Results and discussion. The study involved a total of 284 patients (145 men and 139 women), including those aged < 65 years in group «A» (41 men and 30 women), group «B» (37 men and 29 women), aged ≥ 65 years in group «A» (30 men and 30 women), and group «B» (37 men and 50 women). After 6 months of treatment, patients aged < 65 years in both subgroups reliably decreased brachial systolic, brachial diastolic, mean brachial AP, which was accompanied by a decrease in central systolic, central diastolic, central pulse, mean central AP, total peripheral vascular resistance (р < 0.01, р < 0.001). As a result of treatment, office brachial AP of 140/90 mm Hg was achieved in 69.0 % patients aged < 65 years in subgroup «A» and in 67.0 % patients of subgroup «B» (р > 0.05). In both subgroups of patients aged < 65 years, a decrease in pressure and augmentation index was observed, including that normalized by heart rate (HR) of 75 per 1 min (AP, АІх, АІх75), carotid‑femoral and carotid‑radial pulse wave velocity (all p < 0.01 and p < 0.001). There were no significant changes in the systolic and diastolic functions of the left ventricle, except for a decrease in the myocardial mass index (MMI) of the left ventricle in the group treated with a combination of CCB with indapamide by 7.1 % (p < 0.05) and e’ of the septum by 7.6 % (p < 0.05). In patients aged ≥ 65 years, the absolute decrease in central systolic AP in two subgroups was 23.20 ± 1.34 and 16.30 ± 1.94 mm Hg, respectively, (p < 0.01). The groups did not differ significantly in brachial pulse and central pulse BP (p > 0.05). In the group treated with Arifam, the baseline HR values correlated with AP (r = –0.357, p < 0.01), AІx (r = –0.274, p < 0.05), but not with AIx75, central systolic AP and mean central AP (p > 0.05). In patients aged ≥ 65 years, the antihypertensive effect of therapy with the combination of ACE inhibitor/ARB and indapamide was not accompanied by changes in MMI LV and indicators of LV systolic and diastolic function (all p > 0.05). In the group treated with Arifam there was a decrease in end‑diastolic and end‑systolic volumes (by 9.7 % (p < 0.05) and 10.8 % (p < 0.01)), an increase in LV ejection fraction by 3.6 % (p < 0.05), a decrease in MMI of LV by 12.5 % (p < 0.001), an increase in volume index of the left atrium by 11.0 % and E/E’ by 8.83 % (p < 0.05). In both subgroups of patients aged < 65 years, Ea and Еes decreased equally (p < 0.001). Against the background of antihypertensive therapy, the patients aged ≥ 65 years had a decrease in Ea, which was accompanied by a decrease in Ees in the group treated with ACE inhibitor/ARB and indapamide (p < 0.05), but Ea/Ees ratio did not change significantly in two age groups (p > 0.05).Conclusions. In spite of the same positive effect of 6‑month therapy with combinations of ACE inhibitors/ARB with indapamide and BPC with indapamide on brachial and central AP in older patients with hypertension of 1 — 2 degrees, the fixed combination of BPC amlodipine with indapamide (Arifam) had an advantage over the combination based on an ACE inhibitor (ARB) regarding the reduction of brachial, central, mean brachial and mean central AP, augmentation, pulse wave velocity, MMI of LV, left atrium volume index, E/e’ of LV, which was associated with an increase in heart rate (an average of 4.6 per 1 min).

The aim — to determine differences in the structure and function of the heart, arterial stiffness, resistive and pulsative loads and ventricular‑arterial connection in patients with arterial hypertension, confirmed heart failure (HF) and preserved ejection fraction, depending on age and gender.Materials and methods. The study included 115 patients (62 (53.9 %) men and 53 (46.1 %) women, average age — 67.3 ± 9.7 years) with a diagnosis of HF with preserved EF of IIA or IIB stage, II — III functional class according to NYHA, left ventricular (LV) ejection fraction (EF) ≥ 50 % and signs of LV diastolic dysfunction according to transthoracic echocardiography, who were divided into two groups by gender and two groups by age (≥ 65 years and < 65 years). All patients underwent general clinical examination, determination of the level of N‑terminal fragment of brain natriuretic peptide (NT‑proBNP), transthoracic echocardiography, applanation tonometry, test with 6‑minute walk. The frequency of comorbid conditions (non‑cardiac and cardiac) was analyzed.Results and discussion. When analyzing the frequency of cardiac comorbidity, we detected the same frequency of myocardial infarction (MI) and, in particular, Q‑MI in older and younger men, as well as in women (p < 0.05), with a lower incidence of MI in the anamnesis in women than in men in each age group (p < 0.05  — 0.01). The distance of the 6‑minute walk was smaller in the older age groups and in women than in men regardless of age (p < 0.05). A higher NT‑proBNP level was associated with older age and female gender (p < 0.05). Young women had a lower (p < 0.05) and older women had a higher (p < 0.05) incidence of obesity than men with the same frequency of diabetes in all 4 groups (p > 0.05). The glomerular filtration rate was lower in the elderly, and the frequency of anemia in these groups of patients was higher. In women of both age groups it was lower than in men (p < 0.05—0.01) with a correspondingly higher incidence of chronic kidney disease (p < 0.0—0.01). The expressiveness of LV hypertrophy in the mean value of the myocardial mass index of the LV was greater in old age, in women of both age groups it was less pronounced than in men (by 13.2 and 12.7 %, respectively, p < 0.05), and was associated with age deterioration of the diastolic function in women — a decrease in the mean e’ and DT (by 3.4 and 5.1 %, respectively, p < 0.05) and an increase in diastolic elastance (by 4.1 %, p < 0.05 compared with patients aged < 65 years). High values of diastolic elastance and left atrial volume index (by 4.2 and 10.0 %, p < 0.05) and a lower average level of DT (by 11.7 %, p < 0.05) in these patients confirmed a more pronounced diastolic dysfunction. The systolic pressure in the pulmonary artery was greater in women than in men, both at age < 65 years (by 20.5 %, p < 0.01) and ≥ 65 years (by 19.6 %, p < 0.01). The end‑diastolic LV volume index increased with age only in women (by 10.3 %, p < 0.05) and in both age groups it was smaller than in men (by 18.7 and 6.5 %, respectively, p < 0.05). This could be due to the greater severity of diastolic dysfunction in women, mostly young, as evidenced by their lower impact index (by 14.1 %, p < 0.05). A lesser frequency among women of cases of myocardial infarction could play a certain role. It was associated with greater EF in younger women compared with men (by 4.9 %, p < 0.05). In the absence of differences in brachial and central systolic blood pressure between all groups, the resistive load on the LV according to the mean brachial systolic blood pressure, systemic vascular resistance and Ea in women was higher than in men both at a young age (114.1 ± 9.1 and 94.7 ± 9.4; 1.8 ± 0.2 and 1.5 ± 0.4; 2.48 ± 0.91 and 1.97 ± 0.38, respectively, p < 0.05), and at an older age (106.2 ± 7.7 and 98.6 ± 10.9; 2.2 ± 0.5 and 1.6 ± 0.4; 2.14 ± 0.23 and 1.97 ± 0.39, respectively, p < 0.05), without significant age differences in mean brachial arterial pressure and Ea (p > 0.05) for both sexes. When assessing the pulse load, an increase in the augmentation index was detected, standardized to a heart rate of 75 per 1 min and a pulse wave velocity in older women, compared with older men (24.9 ± 4.3 and 22.4 ± 5.7; 13.04 ± 1.4 and 12.4 ± 1.9, respectively (p < 0.05).Conclusions. Among patients with hypertension and verified HF with preserved EF, in younger women compared with men there was a greater degree of diastolic dysfunction in terms of diastolic elastance, left atrial volume index, DT, an increase in systolic pressure in the pulmonary artery and NT‑proBNP level at the same frequency atrial fibrillation and body mass index. With a greater resistive load on the LV in terms of systemic vascular resistance and Ea, women patients with hypertension and heart failure with preserved EF had a higher pulse load (according to ascending augmentation index standardized to heart rate of 75 per 1 min and pulse wave velocity) than men with comparable central systolic blood pressure, regardless of age.

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