Objective: To check, in a group of hypertensive patients the association between blood flow-related parameters of hemodynamics in middle cerebral artery (MCA) and systolic (SBP), diastolic (DBP) blood pressure and duration of hypertension (HT-time) and age.Design and Methods: The study was cross-sectional. Transcranial Doppler (TCD) examination was performed bilaterally. The MCAs were insonated through transtemporal window, and pulsatility (PI), resistance (RI) indexes and mean cerebral blood flow velocity (CBFV) were calculated. Blood pressures were measured conventionally in accordance with current guidelines.Results: Mean AE SD age of 96 patients was 58.7 AE 11.9 years. The group comprised 52.1% men, 18.9% smokers, 8.3% took nitrates (which in exploratory analyses were the only class of medications influencing PI and RI). Mean AE SD SBP/DBP was 142.6 AE 19.5/91.9 AE 12.6 mm Hg, mean PI was 0.97 AE 0.21, RI 0.59 AE 0.06 and CBFV 0.58 AE 0.17 m/s. The duration of hypertension averaged 9.5 AE 8.6 years. In multiple regression models adjusted for sex, age, smoking and use of nitrates, with SBP, DBP and HT-time forced into one model, neither duration of hypertension (p = 0.58) nor level of SBP(p = 0.60) or DBP (p = 0.58) were associated with CBFV. However, SBP (â = 0.003, p = 0.02), DBP (â = -0.007, p = 0.002), and HT-time (â = 0.006, p = 0.004) were significantly associated with PI. In similar analyses SBP (â = 0.0009, p = 0.03), DBP (â = -0.002, p = 0.004), and HT-time (â = 0.002, p = 0.006) were significantly associated with RI. After adjustment for the confounders listed above, HT-time independently explained 8.6% of variation in RI and 9.2% of variation in PI. When SBP or DBP were introduced separately, the percentage of variance in PI or RI explained by HT-time increased to over 11%. ABI Ã has decreased from 1,179-1,067(p,0015).Conclusion: Exercise training programs can improve some of the hemodynamic parameters: SBP, MBP, and HR. Physical training, part of the cardiovascular rehabilitation plays an important role in decreasing MBPS. The parameters that describe arterial stiffness: AASI and PP can also be improved. Rehabilitation programs are also a safe and effective method for reducing cardiovascular risk in hypertensive patients, expressed in our study through ABI.

Aim. To assess the efficacy and safety of Vamloset (amlodipine/valsartan 5/80, 5/160, 10/160 mg) and Co-Vamloset (amlodipine/valsartan/hydrochlorothiazide 10/160/12.5, 10/160/25 mg) in achieving the target levels of blood pressure (BP) in patients with stage 23 arterial hypertension (AH). The article discusses indicators affecting adherence to antihypertensive therapy (AHT). Material and methods. The VICTORY II Russian study in 8 clinical centers of the Russian Federation included 103 patients over 18 years of age with stage 23 essential AH (who havent been previously treated and have office systolic BP160 mm Hg and/or diastolic BP100 mm Hg or who havent reached the target office blood pressure with mono- or double AHT). The Full Analysis Set (FAS) for efficacy analysis included 99 patients, a FAS population with the restoration of data missed using Last Observation Carried Forward. The SF-36 questionnaire for assessing the quality of life, the effect on erectile function in men, the convenience of current therapy from the point of view of patients were analyzed after 16 weeks of treatment. The Per Protocol (PP) population included 80 patients completing the study without major protocol deviations to assess the primary parameters of efficacy. All patients with stage 2 hypertension were prescribed Vamloset (amlodipine/valsartan 5/80 mg), with stage 3 hypertension amlodipine/valsartan 5/160 mg. Dose titration of Vamloset and Co-Vamloset (LLC Krka-RUS) was carried out every 4 weeks according to the AHT schemes. Results. The studys active phase included 100 patients aged 59.510.9 years (women 59%) with AH duration of 83.48.4 months; 83% of patients received AHT prior inclusion in the study. In the PP population, 16 week- AHT with Vamloset or Co-Vamloset allowed reaching the target BP in 90.0% of patients (95% confidence interval [CI] 81.295.6). Overall clinical efficacy was achieved in 98.8% of patients (95% CI 93.2100.0). All treatment regimens were characterized by high patient compliance. In the total group, 50% of patients rated their AHT as more convenient than they had previously used; of them, in the stage 2 AH group 47.8%, in the stage 3 AH group 53.3%. Metabolic neutrality with regard to at least one indicator was observed in 100% of patients, with regard to 6 indicators in 43.9% [33.9; 54.9]. For all 98 patients included in the analysis, changes in all SF-36 scales, except for physical functioning (p=0.339), were statistically significant (p0.05). The effect of AHT on erectile function was rated as positive in 51.3% of men. Good tolerance data are consistent with the established drug safety profile. Conclusion. In the VICTORY II study, high antihypertensive efficacy and an improvement in a set of indicators of optimal adherence to AHT by Vamloset and Co-Vamloset within 16 weeks were proved in patients with stage 23 AH. Patients high rating for quality improvement in the quality of life, safety of therapy and ease of use ensured optimal compliance of Vamloset and Co-Vamloset therapy throughout the study.

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Aim.Assessment of Vamloset and Co-Vamloset effects on blood pressure target levels and indicators associated with organ protection: albuminuria; elasticity of arteries and central aortic pressure (CAP); endothelial function; tumor necrosis factor-a, interleukin (IL) IL-6 and IL-10, vascular cell adhesion molecule 1 and vascular endothelial growth factor (VEGF-A). Materials and methods.The Russian multicenter open-label prospective clinical study VICTORY II which was conducted in 8 clinical centers included 103 patients 18 years with grade 23 essential arterial hypertension (AH), who were previously untreated office systolic blood pressure (SBP) 160mmHg and/or office diastolic blood pressure (DBP) 100 mm Hg or have not reached the target office blood pressure with mono- or dual therapy. The active phase of the study included 100 patients; the per-protocol (PP) population 80 patients completing the study without major protocol deviations. Patients were not randomized. The target office BP for patients without diabetes were: SBP139 mm Hg, DBP89 mm Hg; for patients with diabetes: SBP139 mm Hg, DBP84 mm Hg. All patients with grade 2 hypertension (group 1) were administrated Vamloset (amlodipine/valsartan, 5/80mg), with grade 3 hypertension Vamloset (amlodipin/valsartan, 5/160 mg). Up-titration of the dose of amlodipine/valsartan to 5/160 mg and 10/160 mg, the administration of Co-Vamloset (amlodipine/valsartan/hydrochlorothiazide) in doses of 10/160/12.5 mg, 10/160/25 mg (LLC KRKA-RUS) was carried out every 4 weeks according to the prescribed schemes. In the total group, the effect of studied therapy on the level of albumin in the urine was assessed. Before starting treatment and after 16 weeks of treatment, 40 patients in the subgroup with additional examinations underwent daily monitoring of blood pressure, assessment of pulse wave velocity and augmentation index; CAP; levels of tumor necrosis factor-, IL-6 and IL-10, vascular cell adhesion molecule 1and VEGF-A. Results.The active phase of the study included 100 patients aged 59.510.9 years (59% of women) with a duration of AH 83.48.4 months. 83% of patients received prior antihypertensive therapy by the time of enrollment in the study. The treatment duration for all patients was 15.9 weeks. After 16 weeks, therapy with Vamloset and Co-Vamloset provided an optimal decrease in BP: 90% of patients with grade 23 AH in the PP population reached the target level of office BP, the mean change in SBP / DBP was -32.2/-16.0 mm Hg. According to the data of daily monitoring of BP in the subgroup with additional examinations, the target levels of average daily SBP/DBP were reached in 52.9/67.6% of patients, respectively. Along with reliable control of blood pressure, additional organ protection with studied antihypertensive drugs after 16 weeks of therapy was shown by assessment data: albuminuria in 58.8% of patients with an initially elevated level of albuminuria (n=17), a positive effect of the studied therapy on the level of albumin in the urine was determined, augmentation index improvement in 57.1% of patients in the study group, CAP improvement in 73% of patients in the study group; positive dynamics of endothelial damage markers (IL-6, IL-10, VEGF-A) was achieved. The data on the good tolerability of AHT corresponded to the previously established safety profile of these drugs. Conclusion.In the VICTORY II clinical study in patients with grade 23 hypertension, along with high antihypertensive efficacy, a spectrum of organoprotective effects of Vamloset and Co-Vamloset on aortic stiffness with improved augmentation index and CAP, markers of endothelial damage (IL-6, IL-10, VEGF-A), the severity of albuminuria was shown.

hypertension. Among patients with TRHT, patients with the increased RRI were characterized by older age (52,2 ± 4,9 vs.47,3 ± 10,6 ys, p < 0,05), higher body mass index (32,8 ± 6,0 vs. 29,7 ± 4,5 kg/m2, p < 0,05), as well as lower 24 h, daytime and nighttime diastolic blood pressure values (77,8 ± 6,1 vs. 85,8 ± 12,9 mmHg, p < 0,01; 80,6 ± 7,7 vs. 89,8 ± 13,0 mmHg, p < 0,05; 72,1 ± 4,9 vs. 78,2 ± 12,3 mmHg, p < 0,01, respectively) as compared to patients with RRI < 0,7. The both groups did not differ in respect of renal function. Conclusions:Our study showed that the patients with TRHT were characterized by higher RRI values as compared to the subjects with well-controlled HT.Objective: No consensus has been established which is the best fourth-line agent in patients with RHT. We previously demonstrated that bioimpedance-guided reduction of extracellular volumen with intensification of diuretic therapy can control BP in patients with RHT. To assess the effect of intensifying diuretic treatment with a loop diuretic (furosemide) or an aldosterone antagonist (spironolactone) on control of BP in patients with RHT.Design and method: Study population comprised 30 patients with RHT (mean of 4.1 ± 0.9 antihypertensive drugs/patient) who were divided into 2 treatment arms according to clinical criteria. Fifteen patients received furosemide 40 mg/day and 15 patients spironolactone 25 mg/day in combination with habitual medication. Ambulatory BP monitoring was performed baseline, 3 months, and 6 months.Results: Baseline BP was 162 ± 8/90 ± 6 mmHg, 70%men, age 63.3 ± 9.1 years, and 56.1% diabetic. Baseline glomerular filtration rate (eGFR-CKD-EPI) was 55.8 ± 16.5 mL/min/1.73m 2 . No significant differences were found between groups at baseline in age, gender, % diabetics, eGFR, BP, number of antihypertensive drugs, or aldosterone levels. At 6 months, systolic BP decreased 24 ± 9.2 mmHg (from 163.6 ± 8.6 to 139.6 ± 8.1 mmHg) in spironolactone group, compared with 13.8 ± 2.8 mmHg (from 162 ± 7.9 to 148 ± 6.4 mmHg) in furosemide group(p < 0.01). Diastolic BP fell 11 ± 8.1 mmHg in spironolactone group compared with 5.2 ± 2.2 mmHg in furosemide group (p < 0.01). Forty percent of patients in spironolactone group reached the BP target (<140/90 mmHg) at 6 months compared with only 13% in furosemide arm. No significant changes in eGFR in any group during follow up. A significant reduction in urinary albumin creatinine ratio (from 173 ± 268 to 14 ± 24 mg/g, p < 0.01) was observed in spironolactone group at 6 months, but not in furosemide group. Multiple regression analysis showed that only treatment with spironolactone was associated with control of BP < 140/90 mmHg at 6 months. No severe adverse events were recorded. Mild hyperkalemia was observed in 2 patients on spironolactone.Conclusions: Spironolactone is more effective than furosemide for control of BP in RHT patients, with positive added effect on albuminuria. Spironolactone is safe in patients with mild kidney impairment, although serum potassium should be closely monitored, ...