Пензенский государственный университет. 440026, Пенза, ул. Красная, 40 Цель. Изучить эффективность антигипертензивной терапии у пожилых пациентов в условиях исследовательской программы и амбулаторной практики посредством суточного мониторирования артериального давления (СМАД) и оценки офисного АД, а также проанализировать приверженность пациентов назначаемому лечению. Материал и методы. В группу наблюдения включены 75 пациентов с артериальной гипертензией 1-2 степени. Пациентов повторно вызывали спустя 4 года, проводили измерение офисного АД, СМАД, опрос по анкете Мориски-Грина, а также в ходе беседы просили дать оценку ряду основных факторов, которые могли повлиять на приверженность лечению. В зависимости от результатов заполнения анкеты Мориски-Грина больные были распределены на 2 когорты: комплаентных и некомплаентных. Результаты. Спустя 4 года контакт был установлен с 50 пациентами из 75. При анализе опросника Мориски-Грина выявлено, что только 10 пациентов (20%) являются комплаентными, у 13 пациентов (26%) был высок риск развития неприверженности. 26 пациентов (52%) забывали принимать препараты, 25 пациентов (50%) невнимательно относились ко времени приема лекарственных средств. 29 опрошенных (58%) не принимали препараты при хорошем самочувствии, 18 (36%)-если чувствовали себя плохо после приема лекарственных средств из-за резкого снижения АД. Заключение. Приверженность пациентов лечению по-прежнему остается одной из важнейших проблем терапии хронических заболеваний. Только 20% больных являлись очень высоко приверженными терапии, что вполне согласуется с данными других исследователей, полученными в российской популяции пожилых лиц с сердечнососудистой патологией. Ключевые слова: артериальная гипертензия, пациенты старше 60 лет, комплаенс, суточное мониторирование артериального давления.

Introduction. Among the priorities of the strategic development of the health care system there is the telemedicine technologies implementation. Material and methods. The project was developed in the Penza State University. For the economic justification of the remote BP monitoring, the project technological scheme has been prepared, the market capacity has been assessed and competition has been analyzed, the business model and financial model of the project have been developed, and risks have been evaluated. Results. The project is deployed at the base and with the participation of the budget medical institution. The patient is provided with a tonometer with built-in GSM or blutooth module. After the patient’s BP has been measured, the data in an encrypted format is transmitted to the remote monitoring center and stored in the cloud base. For each patient, the doctor sets target and individual thresholds for blood pressure. Intermediate monitoring of BP is carried out by paramedical personnel who, in case of deviations from reference values, notify the attending physician. The patient receives feedback in the form of SMS-messages to his mobile phone: time for BP measuring, taking drugs and recommendations for the therapy correction. Payment is carried out according to the approved Mandatory Medical Insurance Fund tariff. Conclusion. The introduction of remote blood pressure monitoring will reduce the cost of providing medical care by reducing the number of hypertension complications, open up prospects for research and development of medical professionals. Fundamentally new conditions will arise for the study of chronopharmacology of antihypertensive drugs in patients with hypertension.

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Objective: Taking low sodium diet enhances the hemodynamic effect of reninangiotensin system blockers. In a recent study, the systemic exposures of candesartan and atenolol, substrates of P-glycoprotein (Pgp) or cytochrome P 3A4 (CYP3A4), was reduced around 30% when on a high-sodium diet, but that of valsartan and ramipril, non-substrates of Pgp or CYP3A4, was not. This study aimed to investigate the effect of high sodium diet on the pharmacokinetics of fimasartan.Design and method: The study design was a two-diet, two-period, two-sequence, randomized, open label and cross-over with 1-week diet-washout and 2-weeks drugwashout interval. Eligible subjects had either low sodium (50 mEq/day) or high sodium diet (300 mEq/day) for 7 days on the 1st hospitalization period and had the other diet at the 2nd period. On the 7th morning of each period, subjects received a single dose of fimasartan 60 mg in the fasting state. The pharmacokinetic blood samples were drawn for 24 hours after the administration. The pharmacokinetic parameters were estimated by noncompartmental analysis. Results:A total of 17 subjects completed the study and 1 of them had 24-urinary sodium values over 100 mEq while on low sodium diet. The pharmacokinetic analysis was performed in 16 subjects excluding a noncompliant subject. The geometric mean ratios (high/low sodium diet) and their 90% confidence intervals (CIs) for Cmax, AUC(0-24) and AUC(inf) were 0.84 (0.60-1.18), 0.91 (0.78-1.05) and 0.90 (0.79-1.03), respectively. There were no serious adverse events reported. Conclusions:The systemic exposure of fimasartan, which is a CYP3A4 substrate but not a Pgp substrate, was slightly (about 10%) lower on high sodium diet than on low sodium diet, but the difference was not clinically nor statistically significant (<0.05).Objective: Results of the real-world studies suggest that cardiovascular prognosis depends on the initial antihypertensive therapy (AHT). There are no data concerning it in Bulgaria. The aim of study was to examine the initial antihypertensive therapeutic strategy (monotherapy/combination therapy (CT) and individual therapeutic classes in Bulgaria.Design and method: Prospective, observational, noninterventional design. Data were obtained from 770 geographically diverse primary care sites (77% GPs, 23% cardiologists). All patients didn't receive any AH drugs at least 3 months before inclusion in observation. BP control (<140/90 mmHg) was estimated on months 2, 4, 6 and 12 after initiated of AHT.Objective: To determine the correlations of mean daily parameters of the central aortic pressure with level of glomerular filtration rate (GFR) and microalbuminuria (MAU), and to assess their dynamics during the 16-week treatment in patients with metabolic syndrome (MS) and arterial hypertension (AH) 1-2 degrees. Design and method:The study included 20 patients with MS combined with hypertension (16 men and 4 women), mean age -49,9 ± 9,8 years, BMI -33,4 ± 4,5 kg/m2, WC -109 8 ± 9,9 cm. An ambulatory BP monitoring using the device BpLab with analy...