Aim. To compare the efficacy of adding original moxonidine and its generics to previous ineffective antihypertensive therapy in patients with poorly controlled arterial hypertension (AH).Material and methods. This observational prospective non-randomized study included 120 patients with poorly controlled blood pressure on the previous antihypertensive therapy. All patients underwent clinical evaluation, including anthropometric and laboratory indexes, and 24-hour blood pressure monitoring (24-h BPM) at baseline and after 12 weeks of observation. Office systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR) were recorded after 4 and 12 weeks of treatment. During the observation period, 4 equal groups were formed: group 1, Physiotens was added to the treatment; group 2, Moxonitex; group 3, Moxonidine SZ; and group 4, Moxonidine Canon. Statistical analysis was performed with the StatTech v.4.2.7 software (© OOO StatTech, Russia).Results. After 4 weeks of therapy, the BP target was achieved significantly more frequently in group 1 (63% of patients) compared to groups 2 (36.7% of patients), 3 (16.7% of patients), and 4 (16.7% of patients) (p<0.05). At 12 weeks, office SBP, DBP, and HR were significantly decreased in all groups, but the decrease was significantly greater in group 1. The therapy was associated with a more pronounced decrease in all studied 24-h BPM parameters in the Physiotens group than in other groups, as well as with a significantly more frequent normalization of the 24-h BP profile, in 66.7% of patients vs. 46.7%, 33.4%, and 23.2% of patients in groups 2, 3, and 4, respectively.Conclusion. The treatment with original moxonidine demonstrated advantages over generic drugs in terms of achieving the BP goal, reducing office BP and HR, and improving 24-h BPM parameters.

The article considers the most common causes of renal artery patency, diagnostic process algorithms and differential diagnosis for renal artery stenosis at different ages. The first significant clinical manifestation of renal artery stenosis of various etiologies is arterial hypertension (AH). It is poorly controlled AH, including resistant AH, developing at a young age, that is the basis for the diagnostic search for secondary causes of high blood pressure, including narrowing of the renal arteries. The article presents a clinical case of uncontrolled AH in a young man. A comprehensive assessment of clinical manifestations, laboratory and instrumental examination results made it possible to diagnose unilateral renal artery stenosis of atherosclerotic genesis.

The work outlines the causes of development, clinical manifestations and basic principles of diagnosis and treatment of Crohn’s disease. The authors give their own clinical observation: a case of an atypical course of this disease.

Background. Anxiety-depressive disorders (ADD) afflict almost half of patients with arterial hypertension (AH). AH aggravation by psychoemotional disorders causes a more severe illness and rapid target organ injury, particularly, the increased arterial stiffness and central aortic pressure (CAP). However, the prospects of combined antihypertensive-antidepressant treatments in AH-ADD patients remain largely unexplored.Objectives. The effect assessment in combined antihypertensive-psychocorrective therapy on circadian blood pressure (BP), vascular stiffness and CAP, anxiety and depression in women with AH and ADD.Methods. The study enrolled 60 AH-ADD women randomised between two cohorts. Cohort 1 received a fixed combination of valsartan and hydrochlorothiazide, bisoprolol and sertraline antidepressant; cohort 2 only had same combined AH therapy. Past 24 weeks of trial, all patients had a general clinical examination and daily blood pressure monitoring (DBPM) with BpLab Vasotens (Petr Telegin Ltd., Russia) and control of daily BP, CAP and vascular stiffness. The psychometric HADS and CES-D scales were used along with psychiatric counselling.Results. Past four weeks of treatment, the target blood pressure (TBP) was revealed in 60 and 36.7% patients, and in 90 and 66.6% — past eight weeks in cohorts 1 and 2, respectively. Cohort 1 vs. 2 required a lower valsartan dose to attain TBP. Past six months, both cohorts showed improved main DBPM values reflecting vascular stiffness and CAP. However, a statistical decrease in nocturnal central and peripheral BP, as well as improved BP variability and vascular stiffness were registered at antidepressant use. A normalised daily BP profile was significantly more frequent in cohort 1. In addition, sertraline had a significant ADD-reductive impact.Conclusion. An antidepressant-combined conventional AH therapy in AH-ADD women facilitated a faster TBP achievement at lower AH agent doses and the significantly improved DBPM (nocturnal specifically), arterial stiffness and CAP values. A sertraline treatment improved the psychoemotional patient state.

В работе изложены основные принципы диагностики рака поджелудочной железы. Приведены собственные клинические наблюдения: случай этого заболевания, иллюстрированный лабораторно-инструментальными методами диагностики и верифицированный по результатам аутопсии.

Purpose of the study. Evaluating the effectiveness of the various options of combination antihypertensive therapy (AHT) in women with arterial hypertension (AH) and metabolic syndrome (MS) and hypothyroidism. Material and methods. The study included 163 women with hypertension, metabolic syndrome, and hypothyroidism, the median age of 53.5 (48-60) years; in 73 (44.8%) women were diagnosed with subclinical hypothyroidism (SH), 90 (55.2%) overt hypothyroidism (OH). Patients with both SH and OH, depending on the source of the heart rate (HR) was appointed as one of the following combination of AHT. If heart rate <75 beats/min, patients (n=100) received a combination of the dihydropyridine calcium antagonist (AA) amlodipine 5 mg/day, and angiotensin receptor blockers II (ARB) losartan 50 mg/day, with heart rate >75 beats/min (n=63) a combination of amlodipine 5 mg/day and imidazoline receptor agonist (IRA) moxonidine 200 micrograms/day. The failure to achieve target blood pressure (BP) after 4 weeks of dose drugs doubled with subsequent evaluation of the effectiveness even after 4 weeks. At baseline and after 6 months of therapy, all patients underwent daily blood pressure monitoring (DBPM). Results. At 8 weeks, the use of a combination of AA+ARB target BP level was registered in 26 (59%) of 44 women with SH and 34 (60.7%) of the 56 OH. In the group of women who took the AA+IRA, after 8 weeks of the target blood pressure was observed in 24 (82.8%) of 29 patients with SH and 28 (82.4%) of 34 to OH. Register the target blood pressure was observed significantly more frequently (p<0,05) when using a combination of AA+IRA compared with AA+ARBs as' with SH and OH. As a result of the combination of DBPM AA and ARBs in patients with SH and OG provided a significant reduction in average daily, daytime and nighttime systolic and diastolic blood pressure (SBP and DBP), the time index of SBP and DBP during the day and night hours. The therapy of AA and IRA regardless of the severity of hypothyroidism, there was a significant improvement in all indicators DBPM: average daily, daytime and nighttime SBP and DBP, time index and variability in SBP and DBP during the day and at night. Furthermore, as in the SH and OH significantly more pronounced positive changes most DBPM parameters were recorded using IRA in combination with AA compared with a combination AA+ARB. Significant increase in the number of women with optimal BP daily. profile dipper observed only when using amlodipine and moxonidine. Conclusion. In women with hypertension, hypothyroidism and MS, regardless of the severity of decline of thyroid function and combination of the dihydropyridine AA IRA had an advantage over the AA combination with ARBs, since most patients provided achieving target blood pressure and clinically significant positive impact on BPM indicators. The results can be used in selecting the optimal AHT in patients with hypertension, MS, and the manifest subclinical hypothyroidism.

Objective. Determination of the effectiveness and safety of different dosing regimens during the day (in the morning or at bedtime) combination therapy including azilsartan medoxomil in patients with essential hypertension and metabolic syndrome (MS). Design and methods. The study included 60 patients with uncontrolled hypertension and MS (age median 59 (54-65) years). Patients were randomized in two groups: group 1 (n=30) received azilsartan medoxomil 40 mg/day, and indapamide retard 1,5 mg/day in the morning; group 2 (n=30) azilsartan medoxomoil 40 mg at bedtime and indapamide retard 1,5 mg in the morning. All patients at baseline, and after 4 and 12 weeks assessed levels of office blood pressure (BP), heart rate (HR); at baseline and after 12 weeks was conducted ambulatory BP monitoring (ABPM). Evaluated the main indicators of circadian blood pressure profile, as well as the central aortic pressure (CAP) and the rigidity of the vascular wall: systolic, diastolic, and mean arterial pressure in the aorta, aortic augmentation index, pulse wave velocity in the aorta, the augmentation index. Study results were processed using the program Statistica 6.1 by methods nonparametric statistics. Results. Regardless of the regimen used azilsartan destination as part of combination therapy after 4 weeks showed a significant (p<0.05) reduction in SBP and DBP. After 12 weeks of observation target blood pressure was recorded 27 (90%) patients of group 1 and 29 (96.7%) group 2. As a result of ABPM after 12 weeks of treatment in both groups showed a statistically significant (p<0.05) improvement in all parameters investigated. However, positive changes such indicators as an index time of hypertension in the day and night hours, SBP, DBP, and BP variability during the night, the morning rise of systolic as well as the speed of morning rise in SBP and DBP were more pronounced in the appointment azilsartan medoxomil at bedtime compared to morning reception. The use of both treatment regimens provided significant (p<0.05) increase frequency registration profile dippear and reduction non-dipper. Importantly, irrespective of the time of taking the drugs in both groups occurred significant (p<0.05), and a comparable improvement in rigidity and CAP vascular wall. Conclusion. When combined with essential hypertension and MS azilsartana use of combination drug therapy provided achievement of the target values of blood pressure in the majority of patients, a significant improvement in the main indicators of ABPM, CAP, and the rigidity of the vascular wall, as well as the normalization of daily profile of blood pressure in the majority of patients, regardless of dosing regimen during the day. However, the combination of indapamide retard morning - azilsartan medoxomil at bedtime accompanied by a significantly greater positive changes most ABPM parameters, especially at night.