ObjectiveAccording to the European Society of Cardiology/European Society of Hypertension 2013 guidelines, evaluation of aortic blood pressure (BP) is needed in young with isolated systolic hypertension (ISH), but using special devices is not common, especially in Ukraine, where only a few centers have these devices. The purpose of our study was to identify the simple clinical predictors for differentiation (with or without elevated aortic systolic BP [SBP]) of the young with ISH without the need for further extensive work-up.Patients and methodsThe study included 44 young men (mean age: 32.2±1.3 years) with office SBP ≥140 mmHg and office diastolic BP (DBP) <90 mmHg (average: 153.4±2.1 mmHg and 83.4±1.7 mmHg, respectively). The following procedures were performed in all the subjects: body weight and height evaluation; measurement of office SBP, DBP, and heart rate; ambulatory BP monitoring; measurement of pulse wave velocity in arteries of elastic and muscle types and central SBP (cSBP); biochemical blood tests; electrocardiography; echocardiography; and carotid ultrasound investigations. Step-by-step multifactor regression analyses were used for finding the predictors of high cSBP.ResultsDepending on the cSBP level, all the patients were divided into two groups: first group (n=17), subjects with normal cSBP, and second group (n=27), subjects with elevated cSBP. Patients in the second group were significantly older, with less height and higher body mass index; they had significantly higher levels of office SBP and DBP. Characteristics of target organ damage were within normal limits in both groups and did not differ significantly. Only pulse wave velocity in arteries of elastic type was significantly higher in the second group. The independent predictors of increased cSBP were as follows: height ≤178 cm (β=7.038; P=0.05), body weight ≥91 kg (β=5.53, P=0.033), and the level of office DBP ≥80 mmHg (β=4.43; P=0.05). The presence of two or three of these factors increased the probability of high cSBP in more than ten times (β=10.6, P=0.001). The sensitivity and specificity were 92.6% and 88.2%, respectively.ConclusionThus, 38.6% of young with ISH had normal cSBP. Independent predictors of increased cSBP included height ≤178 cm, weight ≥91 kg, and the level of office DBP ≥80 mmHg. The presence of at least two of these factors indicated the need for starting the antihypertensive therapy in young with ISH. The presence of only one of these factors or none indicated the need for providing the central BP measurements in order to choose the further management strategy.

BackgroundThe aim of this study was to compare the antihypertensive efficacy of losartan 100 mg + hydrochlorothiazide (HCTZ) 25 mg versus bisoprolol 10 mg + HCTZ 25 mg and their influence on arterial stiffness and central blood pressure (BP).MethodsOf 60 patients with a mean BP of 173.3 ± 1.7/98.4 ± 1.2 mmHg, 59 were random-ized to losartan + HCTZ (n = 32) or bisoprolol + HCTZ (n = 27). Amlodipine was added if target BP was not achieved at 1 month, and doxazosin was added if target BP was not achieved after 3 months. Body mass index, office and 24-hour ambulatory BP, pulse wave velocity (carotid-femoral [PWVE] and radial [PWVM]), noninvasive central systolic BP, augmentation index (AIx), laboratory investigations, and electrocardiography were done at baseline and after 6 months of treatment.ResultsLosartan + HCTZ was as effective as bisoprolol + HCTZ, with target office BP achieved in 96.9% and 92.6% of patients and target 24-hour BP in 75% and 66.7% of patients, respectively, after 6 months. Effective treatment of BP led to significant lowering of central systolic BP, but this was decreased to a significantly (P < 0.05) greater extent by losartan + HCTZ (−23.0 ± 2.3 mmHg) than by bisoprolol + HCTZ (−15.4 ± 2.9 mmHg) despite equal lowering of brachial BP. Factors correlated with central systolic BP and its lowering differed between the treatment groups. Losartan + HCTZ did not alter arterial stiffness patterns significantly, but bisoprolol + HCTZ significantly increased AIx. We noted differences in ΔPWVE, ΔPWVM, and ΔAIx between the groups in favor of losartan + HCTZ. Decreased heart rate was associated with higher central systolic BP and AIx in the bisoprolol + HCTZ group, but was not associated with increased AIx in the losartan + HCTZ group.ConclusionAlthough both treatments decreased both office and 24-hour BP, losartan + HCTZ significantly decreased central systolic BP and had a more positive influence on pulse wave velocity, with a less negative effect of decreased heart rate on AIx and central systolic BP.

The Pulmonary Vascular Research Institute GoDeep meta-registry is a collaboration of pulmonary hypertension (PH) reference centers across the globe. Merging worldwide PH data in a central meta-registry to allow advanced analysis of the heterogeneity of PH and its groups/subgroups on a worldwide geographical, ethnical, and etiological landscape (ClinTrial. gov NCT05329714). Retrospective and prospective PH patient data (diagnosis based on catheterization; individuals with exclusion of PH are included as a comparator group) are mapped to a common clinical parameter set of more than 350 items, anonymized and electronically exported to a central server. Use and access is decided by the GoDeep steering board, where each center has one vote. As of April 2022, GoDeep comprised 15,742 individuals with 1.9 million data points from eight PH centers. Geographic distribution comprises 3990 enrollees (25%) from America and 11,752 (75%) from Europe. Eightynine perecent were diagnosed with PH and 11% were classified as not PH and provided a comparator group. The retrospective observation period is an average of 3.5 years (standard error of the mean 0.04), with 1159 PH patients followed for over 10 years. Pulmonary arterial hypertension represents the largest PH group (42.6%), followed by Group 2 (21.7%), Group 3 (17.3%), Group 4 (15.2%), and Group 5 (3.3%). The age distribution spans several decades, with patients 60 years or older comprising 60%. The majority of patients met an intermediate risk profile upon diagnosis. Data entry from a further six centers is ongoing, and negotiations with >10 centers worldwide have commenced. Using electronic interface-based automated retrospective and prospective data transfer, GoDeep aims to provide in-depth epidemiological and etiological understanding of PH and its various groups/subgroups on a global scale, offering insights for improved management.

Ишемическая болезнь сердца — вторая по распространенности после артериальной гипертензии сердечно-сосудистая патология в мире и Украине, а потому ведение пациентов с артериальной гипертензией и ишемической болезнью сердца — задача не только врача-кардиолога, но и врача-терапевта на любом из этапов оказания медицинской помощи. Симптоматическая терапия стабильной стенокардии, предусматривающая купирование и предупреждение приступов загрудинной боли (или эквивалентов стенокардии) у пациентов с ишемической болезнью сердца, остается актуальной стратегией в случаях, когда приступы стенокардии отмечаются на фоне оптимально подобранной терапии, проведение реваскуляризации невозможно, а дальнейшая титрация препаратов первого ряда осложняется из-за риска побочных эффектов. Ведущее место среди препаратов второй линии, имеющих противоишемический эффект и применяющихся с целью устранения приступов стенокардии, занимают нитраты короткого и пролонгированного действия, которые обеспечивают коронарную артериальную вазодилатацию благодаря действию активного компонента оксида азота. Чаще всего назначают пролонгированную форму изосорбида динитрата для профилактики приступов стенокардии. Удобный режим дозирования обеспечивает, с одной стороны, пролонгированный эффект, а с другой — помогает снизить риск развития толерантности к нитратам. Однако на практике можно наблюдать появление такого осложнения, как головная боль. С целью предупреждения этого довольно часто практический врач делает выбор в пользу молсидомина. Однако было доказано, что антиангинальная эффективность этого препарата значительно меньше, чем пролонгированных форм нитратов. В Украине молсидомин назначают не в той дозе, для которой был доказан антиангинальный эффект (16 мг), а в значительно более низкой. Было показано, что метаболит молсидомина линсидомин характеризуется значительной токсичностью, поэтому во многих странах мира от использования молсидомина отказались. Использование пролонгированных форм нитратов — наиболее оптимальная тактика.

The structure of prescriptions of cardiac drugs by the primary care physicians has remained unknown for a long time. We decided to use the data of the OZIRKA study, which aimed to investigate the effect of Ozalex (rosuvastatin) on lipid and cholesterol levels in patients with lipid metabolism disorders and hypercholesterolemia, and to assess the structure of prescriptions in real clinical practice, as well as the effectiveness of cardiovascular risk factors monitoring. We sincerely hope that the data we have obtained will optimize the treatment plan for primary care patients, improve their prognosis and survival, and provide the practitioner with evidence of the safety and efficacy of rosuvastatin that can be transferred to routine clinical practice.