Vol 90, No 1 (2018)


Realities and prospects of remote blood pressure monitoring in hypertensive patients

Boytsov S.A.


Despite the success in increasing the effectiveness of treatment of arterial hypertension (AH), frequency of achieving target levels of blood pressure (BP) in hypertensive patients and the scope of their regular supervision in most countries of the world, including in the Russian Federation are insufficient. Modern telemedicine technology, involving remote monitoring of blood pressure, have the potential to significantly improve the situation. The analysis in the world of research on this subject showed the presence of benefits and advantages as well as the barriers and disadvantages in comparison with the common practice of monitoring of patients AG. But the overall balance is in favor of this technology. In the Russian Federation in the presence of a single domestic randomized studies of remote monitoring of blood pressure in hypertensive patients currently undergoing a pilot project in seven regions of the country. Practice shows that with proper organization of the work achieved good results in the achievement of target BP levels. To date, in our country, taking into account the accumulated international and domestic experience, the full normative and methodical base, and the availability of affordable hardware, and proven organizational technologies can and should expand the practice of remote blood pressure monitoring in hypertensive patients. This will significantly increase the proportion of hypertensive patients that are under medical supervision, and significantly improve the effectiveness of antihypertensive therapy. Immediate consequence of such practices will reduce the number of calls to urgent and emergency care reduction in the number of trumpeter, and further reducing the number of strokes and myocardial infarctions, and ultimately reducing cardiovascular mortality.
Terapevticheskii arkhiv. 2018;90(1):4-8
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Cardiovascular disease and associated comorbid conditions as determinants of adverse perinatal outcomes in pregnancy - an analysis of the results of the register of pregnant BEREG

Stryuk R.I., Burns C.A., Filippov M.P., Brytkova Y.V., Borisov I.V., Barkova E.L., Gomova T.A., Kozina E.A., Nagirnyak O.A.


The Aim of the BEREG Registry was to analyze the prevalence and structure of cardiovascular diseases, associated comorbid conditions and assess their effects on pregnancy and perinatal outcomes in real clinical practice.In Tula city regional perinatal center the observation study named "Assessment of the clinical condition of the pregnant women with cardiovascular disease during gestation, at child delivery, at the early postpartum period and at twelve months after childbirth and assesment of perinatal outcomes, condition of the fetus and the newborn and the quality of treatment of these patients groups.All eligibly pregnant women hospitalized in 2014 to "Tula regional perinatal center" have been recruited in the Registry. Clinical and demographic data at admission, obstetric history, laboratory and instrumental examination data, previous medical history have been investigated. The following endpoints were evaluated: maternal mortality, death of the fetus and newborn baby; preeclampsia or/and eclampsia, heart failure, arrhythmia, thromboembolism events.Statistical processing of obtained data was carried out using the software package STATISTICA10.0 (StatSoft, USA).The study included 3214 women delivered babies in the perinatal center in 2014, of which 691 (21,4%) were diagnosed with cardiovascular disease (CVD) in most cases (451 women, 65,9%) - these were different clinical variants of arterial hypertension (AH). Five women (0.7%) had acquired and 23 women ( 3.3%,) congenital heart defect, non-significant heart development abnormities were found in 80 subjects, (11.6%). and Cardiac arrhythmias and conductivity disturbance have beenrevealed in 116 and 16 cases (16.8% and 2.3%) correspondingly.Patients with CVD were significantly older than women without CVD and more often had a variety of disorders of carbohydrate metabolism, overweight, obesity and chronic varicose disease of the lower extremities. Pregnancy in women with CVD significantly more often was complicated by the threat of interruption, placental insufficiency, preterm and operative babies delivery.Arterial hypertension as well as obesity, placental insufficiency and threatened miscarriage became prognostically unfavorable conditions that contributed of premature birth and fetal death. Fetal death or newborn babies death took place in 1,3% of all the subjects enrolled. In this cohort antenatal death have been registered in 43,2%, intrapartum one in 2.3% and neonatal death in 54.5%.Negative rognostic factors for low birth-weight babies were: placental insufficiency, various clinical variants of AH, obesity and infectious diseases; less input had endocrine diseases and risk of abortion.Adverse factors for the fetus death or newborn death were different clinical variants of arterial hypertension and the risk of abortion in any trimestre of pregnancy.
Terapevticheskii arkhiv. 2018;90(1):9-16
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Quantitative assessment of adherence to treatment in patients with atrial fibrillation in real clinical practice

Skirdenko J.P., Nikolaev N.A.


Aim of the study: to quantitatively evaluate features of adherence to treatment in patients with atrial fibrillation (AF) in Omsk region in conditions of real clinical practice.Materials and methods: in a prospective controlled study in 137 patients with AF 35-85 years quantitatively examined adherence to treatment and its structure. Statistical processing of data were performed using parametric (Student's t-test) and nonparametric (Wald-Wolfowitz, Kolmogorov- Smirnov, Pearson) analysis.Results: the most committed to treatment of AF patients older than 65 years. Regardless of age women are more committed to treatment than men. With increasing severity of AF symptoms in men, reduced adherence to treatment, in women is increasing commitment to the modification of lifestyle and drug therapy. In patients with paroxysmal AF adherence to drug therapy is higher than with a constant form. The increase in the number of comorbidities in men and women accompanied by a growing commitment to the modification of lifestyle and drug therapy, with a decrease in women adherence to medical support. If patients with AF the amount of medication increases, reduced adherence to medical support. Conclusion: quantitative structural analysis of adherence to treatment in patients with AF identified previously do not consider the characteristics associated with gender, age, disease and drug therapy significantly influence treatment outcome.
Terapevticheskii arkhiv. 2018;90(1):17-21
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Morbidity and mortality of the Russian population from acute respiratory viral infections, pneumonia and vaccination

Bilichenko T.N., CHuchalin A.G.


In order to assess the impact of influenza vaccination and pneumococcal infection (PI) were studied seasonal morbidity and mortality because of influenza, acute respiratory viral infections (ARVI) and pneumonia among the population of the Russian Federation during 2012-2016 timeframe.The methods. There were analyzed the data of Federal service for surveillance in consumer rights protection and human welfare (Rospotrebnadzor) on influenza vaccination and PI and ARVI morbidity (including influenza), diseases of the respiratory system (DRS). The information on mortality of the population of Russia because of these diseases received from official publications of the Federal State statistics service (Rosstat) and The Ministry of health of the Russian Federation (Ministry of Health of Russia) on the mortality rates of the population of Russia because of these illnesses. Results: the analysis revealed that compared to 2015, in 2016 the incidence rate of ARVI in total Russian population was increased to 5,7%. The incidence rate of influenza in 2016 reached 60,5 cases per 100 thousand of the total population and was higher than the 1,8 times than in 2015 (34,01 on 100 thousand people). The incidence rate of pneumonia in total population was increased by 24,0% in 2016 compared to 2015. According to Rosstat data, the increase of deaths because of influenza and ARVI was mainly in the first semester of 2016, which was associated with influenza epidemic. Mortality because of pneumonia dropped by 10,8% and from other DRS - by 6,9%, which might indicate on the improvement of the quality of medical care and prevention of DRS. Reduction in the mortality rate because of pneumonia also was due to significant influenza vaccination coverage and the increasing number of children and adults vaccinated against PI.
Terapevticheskii arkhiv. 2018;90(1):22-26
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The complex analysis of risk factors, influencing on the progression of chronic obstructive ulmonary disease

Nikitin V.A., Starodubtseva I.A., Vasilieva L.V., Popov A.V.


Aim.The aim of the study is the analysis of risk factors, influencing on the progression of chronic obstructive pulmonary disease. Materials and methods. 259 patients with chronic obstructive pulmonary disease (COPD) I and III stages, mean age 54,3±11,7 and the duration of the disease 10,1±5,7. Patients were divided into 2 groups: I group (n=119) - with III stage of disease, II group (n=140) - COPD with I stage. 30 healthy were involved in control group. The risk factors of progression of COPD were determined with the use of regressive and correlative analyses. Results. The level of markers of systemic inflammation in serum of patients with COPD: TNF-α (RR 3,25); IL-8 (RR 2,1); hs-CRP (RR 3,52) in combination with traditional risk factors (long course of the disease (RR 2,3), age (RR 1,65), smoking (RR 1,65), and also obesity (RR 2,45), early menopause (RR 3,52), hereditary respiratory predisposition (RR 3,05), and also coexisting cardiovascular pathology increase the risk of COPD progression several times. Conclusion. According to the results of this trial, unmodified risk factors such as hereditary predisposition, early menopause, long course of the diseases and coexisting cardiovascular pathology contribute significantly on progression of COPD. The relative risk increases with increasing of concentration of markers of systemic inflammation (TNF-α, IL-8 and hs-CRP),that correlate with clinical manifestations of COPD: cough, shortness of breath on VAS in mm.
Terapevticheskii arkhiv. 2018;90(1):27-30
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Stress in the family - association with prevalence of cardiovascular diseases in men of the open city population

Akimova E.V., Akimov M.J., Gakova E.I., Kayumova M.M., Gafarov V.V., Kuznetsov V.A.


The aim of the study was to establish associations of the prevalence of coronary artery disease (CAD), metabolic syndrome (MS) and arterial hypertension (AH) with family stress in open male population of Tyumen aged 25-64 years. Materials and methods. Cross-sectional epidemiological survey was conducted on representative sample of 1000 individuals (250 in every 4 decades: 25-34, 35-44, 45-54, 55-64 years) formed from the election list of males in one of the administrative districts of Tyumen. The response to cardiac screening was 85.0% - 850 patients. Different types of CAD were defined based on standard methods in epidemiological surveys. "Certain" CAD and "possible" CAD were determined according to extended epidemiological criteria. IDF criteria (2005) were used for the MS assessment, AH was considered as a component of the MS. A questionnaire of WHO MONICA «Knowledge and attitude to health» was used to analyze stress in families. The results of the study showed that more than 80% of males in open urban population, mostly older individuals, had a stable marital status last twelve months, while one-third of the male population had conflicts in their families and the fifth part did not have the opportunity to relax at home. Male patients with CAD had family stress more frequently during last 12 months on extended epidemiological criteria. In the open male population aged 25-64 years with MS and AH there was found more stable marital status versus comparison groups. Conclusion. Standardized methods and the accumulated database should be used to continue objective monitoring of the epidemiological situation of cardiovascular diseases and psychosocial risk factors in open urban population during regional preventive program.
Terapevticheskii arkhiv. 2018;90(1):31-35
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23-year dynamics (1994-2016) relationships to its health, behavioral characteristics and prevention of cardiovascular diseases among women 25-44 years in Russia /Siberia

Gafarov V.V., Panov D.O., Gromova E.A., Gagulin I.V., Gafarova A.V., Krymov E.A.


Purpose. To determine the 23-year dynamics (1994-2016) of attitudes toward one's health, behavioral characteristics and the prevention of cardiovascular diseases in an open population among women 25-44 years old in Russia / Siberia (Novosibirsk). Material and methods. In the framework of the third screening of the MONICA program for the study of trends and control of cardiovascular diseases and the MONICA-psychosocial (MOPSY) subprogram, in 1994 a random representative sample of women aged 25-64 years of age from one from the districts of Novosibirsk (n = 870, the average age is 45.4±0.4 years); in the age group 25-44 years - 284 persons. In 2016 years. in the framework of screening studies on the budgetary issue of NIITPM No. gos. reg. 01201282292, a random representative sample of women aged 25-44 years old in the same district of Novosibirsk (n = 540) was examined. Attitude to their health, behavioral characteristics and the prevention of cardiovascular diseases were studied using the "Knowledge and attitude to their health" scale, validated for the Russian population under the WHO "MONICA" program. The chi-square test (x2) was used to calculate the indices. The criterion of statistical significance was the reliability of the result at p<0.05. Results: The analysis showed that in the open population among women aged 25-44 years, there is a positive dynamics in assessing their health (21% and 50.7%, respectively). But, despite this, 50% of women negatively assess their health and 96% note the probability of getting a serious illness for 5-10 years. Most women believe in the ability of medicine to successfully prevent and treat heart disease, but the proportion of people using health resources for preventive purposes remains extremely low and does not exceed 10%. In the open population among women aged 25-44 years for 23 years there is an increase in stress in the workplace and the trend of growth in changes in marital status. Recorded in the period 1994-2016 gg. changes in the behavior of womenassociated with health: increased the proportion of people who gave up smoking and regularly doing physical exercises, and improved eating behavior.Conclusion: It was found that among women aged 25-44 years there is a positive dynamics in relation to the prevention of behavioral risk factors for CVD. But despite this, half of women negatively assess their health and use health resources only slightly.
Terapevticheskii arkhiv. 2018;90(1):36-44
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Production and genetic risk factors for cardiovascular diseases among petrochemical industry workers

Gimaeva Z.F., Bakirov A.B., Karimova L.K., Gimranova G.G., Mukhammadiyeva G.F., Karimov D.O.


Aim. To study the production and genetic factors affecting the cardiovascular system (CVS) in the petrochemical industry workers. Subjects and methods. There was carried out an assessment of the working conditions and the state of health of 860 workers of petrochemical plants males, including 548 apparatchiks (main group) and 312 fitters of instrumentation and automation (comparison group). The main risk factors with subsequent assessment of cardiovascular risk (SSR) on the scale SCORE (Sistematic COronary Risk Evaluation) were studied. The analysis of the frequency distribution of deletion polymorphisms of GSTM1 and GSTT1 glutathione among the workers of the basic trades involving patients with cardiovascular disease (CVD) and practically healthy workers. Results. The development and progression of CVD in petrochemical production workers affects a complex working environment hazards and the labor process, corresponding, according to R2.2.2006-05, classes, working conditions 3.1-3.3 Labor intensity. The most common form of cardiovascular nosology was hypertonic disease (HD), identified in 46,9% of apparatchiks and 29,2% of fitters of instrumentation and automation. Determination of the relative risk etiological share of the working environment factors in the development of HD showed high degree of professional conditioning of the disease in a group of apparatchiks (RR=1,58, and EF=36,7%). Molecular genetic factor predisposing to the development of CVD, is the deletion of the GSTM1 gene. This genetic marker could be used as a predictor of individual risk criterion CVD. Conclusion. A comprehensive assessment of working conditions of workers of petrochemical plants showed that the priority factors of occupational risk for apparatchiks are air pollution of the working area with harmful substances (class 3.1-3.2), noise (class 3.1) and labor intensity (class 3.1). It has been established that in the formation of cardiovascular diseases under the influence of production factors, genetic factors can participate.
Terapevticheskii arkhiv. 2018;90(1):49-53
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Prevalence of noncommunicable diseases risk factors in the Kyrgyz Republic

Kaliev M.T., Meimanaliev T.S., Djumagulova A.S., Habicht J.


Aim. To investigate the prevalence of noncommunicable diseases (NCD) risk factors in the Kyrgyz Republic. Subjects and methods. By using WHO STEPS approach survey findings were estimated from 2623 Kyrgyz residents aged 25-64 years. It was determined the prevalence of behavioral risk factors for NCDs, the prevalence of hypercholesterolemia and hyperglycemia. STEPS survey has covered all regions of the Kyrgyz Republic. Results. NCD-related death rates are the leading causes (76,8%) of mortality among the population of the Kyrgyz Republic. STEPS approach survey showed high prevalence of NCDs main risk factors among 2623 Kyrgyz residents aged 25-64 years.Conclusion. High prevalence of NCDs main risk factors shows that there is necessity to develop effective policy to raise public awareness of healthy life style, health promotion, collaboration with all sectors of civil society.
Terapevticheskii arkhiv. 2018;90(1):45-48
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Clinical features of cardiac lesion in patients with generalized sarcoidosis

Popova E.N., Strizhakov L.A., Sholomova V.I., Ponomarev A.B., Moiseev S.V., Brovko M.U., Bondarenko I.B., Ponomareva L.A., Fomin V.V.


The article presents a clinical observation of two patients with generalized sarcoidosis. The woman typical granulomatous changes in the lungs and lymph nodes combined with atrial fibrillation, kidney failure and hereditary thrombophilia, men with atherosclerotic coronary arteries, re-myocardial infarction, cholestasis, tubulointerstitial nephritis. The accession of systemic manifestations was accompanied by increase of level of angiotensin-converting enzyme in the blood serum, morphological examination of lung tissue in both cases there were high histological activity of vasculitis and granulomatous inflammation. Extrapulmonary symptoms regressed when conducting immunosuppressive therapy. Discusses modern aspects of diagnosis of sarcoidosis in clinical practice.
Terapevticheskii arkhiv. 2018;90(1):54-59
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Treatment of gastroparesis with botulinum toxin in patient after allogenic bone marrow transplantation

Galstyan G.M., Pashkova M.V., Popova O.Y., Makarova P.M., Dubnyak D.S., Kuzmina L.A., Parovichnikova E.N.


The case report of botulinum toxin treatment of gastroparesis in a patient following allogenic bone marrow transplantation is described. The causes of gastroparesis and methods of prevention and treatment are discussed. It was noted that pyloric injection of botulinum toxin can improve symptoms and gastric emptying.
Terapevticheskii arkhiv. 2018;90(1):60-64
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Relapsing polychondritis in medical practice of dermatovenerologist

Tlish M.M., Kuznetsova T.G., Naatyzh Z.Y., Psavok F.A., Irizilyan G.A., Tkachenko N.G.


Recurrentpolyhedritis is a rare rheumatic disorder with a wave-like course, presumably ofautoimmune nature,characterizedbya widespread inflammatorylesion of the cartilaginous structures and other connective tissue of the ears, joints, nose, larynx, trachea, eyes, valvular heart, kidneys and blood vessels.The description of the own observation of recurrent polychondritis.
Terapevticheskii arkhiv. 2018;90(1):65-67
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Place of vitamin D in the prevention of premature aging and the development of age-associated diseases

Drapkina O.M., Shepel R.N., Fomin V.V., Svistunov A.A.


There is an ongoing search for the molecular and biochemical mechanisms underlying the development of aging and age-associated diseases. At the same time there is growing evidence geroprotective properties of vitamin D.In this review, described in detail the possible mechanisms by which vitamin D affects differentiation, cell proliferation and apoptosis, and describes the potential benefits of this vitamin in the fight against aging and age-related diseases.
Terapevticheskii arkhiv. 2018;90(1):69-75
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The modern therapy of systemic vasculitides: perspectives and challenges

Novikov P.I., Zykova A.S., Moiseev S.V.


Systemic vasculitis is a heterogeneous group of inflammatory diseases, which are classified according to the diameter of the affected vessels. The treatment of systemic vasculitis is no longer empirical, because of increasing number of randomized clinical trials in this field. In recent years, there was a trend to limit the cumulative dose of glucocorticosteroids and immunosuppressive drugs, partially through biological drugs usage. However, biologic therapy is not always superior to combination of glucocorticosteroids and cytotoxic drugs. The efficacy of different biologic drugs varies in patients with different forms of systemic vasculitis, which creates the ground forpersonalized therapy of these diseases. Another serious problem is the absence of strict criteria to immunosuppressive therapy intensification, especially in vasculitis, affecting large vessels, due to the lack of reliable laboratory markers of disease activity. The article reviews modern approaches to the treatment of some types of systemic vasculitis, including ANCA-associated vasculitides, giant cell arteritis, Takayasu`s arteritis and cryoglobulinemic vasculitis.
Terapevticheskii arkhiv. 2018;90(1):76-85
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Perspectives of using pulmonary arterial stiffness indicators to evaluate the prognosis of patients with pulmonary arterial hypertension

Simakova M.A., Ryzhkov A.V., Kazymly A.V., Naimushin A.V., Lukinov V.L., Moiseeva O.M.


Objective: the aim of the study was to characterize the mechanical properties of the pulmonary arterial wall (PA) in patients with pulmonary arterial hypertension (PAH) using magnetic resonance imaging (MRI) of the heart, and to determine their diagnostic and prognostic value. Materials and methods: 57 patients with PAH were examined. The diagnosis of PAH was verified according to the recommendations of the ERS/ESC from 2015. All patients underwent a detailed echocardiographic (ECHO) study, MRI of the heart and right heart catheterization (RHC). To calculate the stiffness of the pulmonary artery wall, the MRI and RHC data were used. Results: We identified a correlation between the functional class of PAH and the parameters of hemodynamic, physical performance, ECHO parameters of the right chambers. There were no differences in the stiffness of the pulmonary artery wall, depending on the functional class of PAH. Among the six stiffness indicators, only pulsation index was associated with the structural and functional parameters of the right ventricle and pulmonary vascular resistance. Conclusion: The MRI pulsation index is the simpleststiffness index of the pulmonary artery wall and the most promising one for evaluating the prognosis of patients with PAH.
Terapevticheskii arkhiv. 2018;90(1):86-92
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