Objective. The aim is to test national questionnaire of treatment compliance of patients with arterial hypertension in the outpatient setting. Materials and methods. The study enrolled 60 patients with stages 1 and 2 arterial hypertension at the age of 45-75 years. We made general clinical examination, measurement of office blood pressure (BP) and biochemical blood assay, run questionnaire survey (hospital anxiety and depression scale (HADS), Morisky-Green test (4-item Medication Adherence Report Scale - MARS), national questionnaire of treatment compliance, assessment of quality of life using Visual Analogue Scale (VAS), calculated the number of pills taken by the patient, issuance and the analysis of returned diaries for self-monitoring. Total sampling was accounted for 43 patients.Results. National enquirer demonstrates statistically significant correlation of results compared to the results of treatment compliance, using Morisky-Green test, and compared to the index commitment based on the total number of pills taken by the patient from the blisters which had been prescribed by the doctor.

Aim. To evaluate psychosomatic aspects of adherence to antihypertensive therapy (AHT) in patients with arterial hypertension and its relationships with comorbid somatic disturbances.Subjects and methods. A total of 161 patients with arterial hypertension with duration of more than 12 months (19 women, 42 men) aged 53,4±11,4 years were included in the study. All studied patients were followed up in the outpatient department of the Cardiology Research Institutenamed after A.L.Miasnikov, Russian Cardiology Research and Production Complex, Ministry of Health of the Russian Federation, and were consented for the psychiatric examination. To evaluate the patient adherence to AHT the following questionnaires and scales have been used: original Complaint Questionnaire designed by the authors for patients with arterial hypertension, USK, USK-B, ORB, GOTD, and patient self-reported Morisky-Green medication adherence scale. Consistent with data of patient case histories and responses to questionnaires, studied subjects were classified into two groups of adherence levels to AHT: Group I - 30 (19%) subjects; 17 women/13 men; mean age 52,9±11,7 years - included patients with high adherence to AHT, who started medication right after being diagnosed for arterial hypertension, and were treated regularly. Group II - 131 (81%) subjects; 102 women/29 men; mean age 53,1±11,8 years - included patients with low adherence to AHT, with postponed initiation of AHT after the diagnosis, and irregular or absent treatment.Results and conclusions. Patients comprising Group I with high adherence to AHT were characterized by short duration of arterial hypertension, crisis-type of its onset followed by panic attacks; concomitant disorders (ischemic heart disease, arrhythmias, ulcer disease, thyroid gland abnormalities), high anxiety level, panic attacks, anxiety and phobic paroxysms, subclinical depressions (dysthymia, cyclothymia), anxiodepressivesituational adaptation reactions, and nozogenic (adaptive) anxiodepressive reactions (hypernozognosia). Patients comprising Group II with low adherence to AHT were characterized by more severe affective symptoms (depressive and maniacal phases of bipolar affective disorder and recurrent depressions) and different variants of pathocharacterologic personality development.

OBJECTIVE:to evaluate the relationship between arterial stiffness and bone metabolism in women with mild to moderate risk of cardiovascular disease (CVD). METHODS:In 103 postmenopausal women (mean age 57.0 years, 95% CI 50.0-64.0) with mild to moderate risk of CVD (SCORE<5), no more than mild hypertension, normal function of thyroid gland, without coronary artery disease, diabetes mellitus and secondary causes of osteoporosis pulse wave velocity between carotid and femoral sites (cfPWV, by applanation tonometry) and ankle and brachial sites (baPWV, by volume sphygmography) as well as bone mineral density at lumbar spine and femoral neck (by dual-energy X-ray absorptiometry) and blood serum levels of markers of bone turnover (total procollagen type I amino-terminal propeptide (PINP), osteocalcin, collagen type 1 cross-linked C-telopeptide (-CTX) by electrochemilumininescence immunoassay) were assessed. RESULTS:Compared with patients with normal mineral bone density (BMD) (n=27), patients with osteoporosis (n=31) had higher cfPWV and baPWV values (p<0.05). Patients with osteopenia did not differ from other groups (p>0.05). In osteoporosis group there were greater years since menopause, less body mass index than in normal BMD (in all cases p<0.05; ns between osteoporosis and osteopenia groups). Between all three groups there were no significant differences in age, smoking status, visit blood pressure, lipid levels and medication. CfPWV and baPWV values significantly positively correlated with age, systolic arterial pressure, years since menopause, procollagen type I N propeptide (all p<0.05), and significantly negatively correlated with BMD at hip neck (all p<0.05). Relationship between cfPWV and BMD at lumbar spine did not reach significant value (r=-0.18, p=0.068). No relationship was found between parameters of arterial stiffness and CTX and osteocalcin (all p>0.05). In the multivariate analysis cfPWV was significantly and independently associated with systolic blood pressure (=1.03, 95% CI 1.00-1.06, p=0.03) and BMD at hip neck (=0.01, 95% CI 0.001-0.07, p=0.003). CONCLUSION:Revealed association between arterial stiffness and bone metabolism may probably explain general mechanisms of arterial and bone damage in postmenopausal women with mild to moderate risk of cardiovascular disease.

The use of technical means, home automatic tonometers in particular, is one of the possible ways of enhancing therapy compliance. Aim: to evaluate the impact of the availability of an automatic tonometer on patient adherence to antihypertensive therapy and its efficiency. Subjects and methods. The investigation included 60 patients aged 45–75 years with grades 1–2 arterial hypertension. The patients were randomized to tonometer Group «OMRON» that was given an OMRON automatic tonometer and control Group that was not given the latter. Compliance-increasing methods, such as giving losartan free of charge, a self-control diary, and written recommendations, were used in all the study participants. General clinical examination, office blood pressure (BP) measurement, biochemical blood testing, and questioning using the hospital anxiety and depression scale (HADS), Morisky-Green test, and a visual analogue scale (VAS) were employed to assess quality of life. Results. Both groups achieved a reduction in systolic and diastolic blood pressures (SBP and DBP). The quality of life was improved only in Group «OMRON» (VAS scores increased from 64,8 to 73,6; p=0,01). At visit 1 (at week 3), the patients in both groups showed an equally high level of compliance. At visit 2 (at week 12) the compliance in Group «OMRON» increased up to 96,4% whereas that in Group «Control» decreased to 81,3% (a 15,1% difference; p

Aim. To assess the impact of automatic telephone survey with a differentiated reminder text, as well as of the survey combination with the self-control dairy, on the compliance with lipid-lowering and antihypertensive therapy and on therapy effectiveness during the long-term ambulatory follow-up.Material and methods. The study included 604 patients: 323 individuals with high or very high cardiovascular risk levels by SCORE scale and 281 participants with coronary heart disease (CHD). The patients were divided into two groups, according to their agreement to participate in the automatic telephone reminder survey ("Survey" and "Refusal"). All participants were also given a self-control diary. At baseline and one year later, the patients underwent general clinical examination, office blood pressure (BP) measurement, blood biochemistry assessment, and the measurement of therapy compliance (Morisky-Green test), anxiety, and depression levels (HADS scale).Results. The reduction in diastolic BP levels was significantly larger in the Survey group (p=0,04). This group also demonstrated a significantly larger decrease in the levels of total cholesterol (TCH) (p=0,0003) and low-density lipoprotein cholesterol (LDL-CH) (p=0,001), as well as a significantly larger increase in the levels of high-density lipoprotein cholesterol (HDL-CH) (p=0,04). The therapy compliance, assessed by the Morisky-Green test, improved in both groups; however, among CHD patients, a significant improvement was observed only in the Survey group (p<0,00001). The percentage of patients' submitting their self-control diaries was higher for the Survey group (p<0,0001).Conclusion. The automatic telephone reminder method provides an opportunity to significantly increase the therapy compliance.

Aim: to evaluate of the effectiveness of switching from beta-adrenoblockers (BAB) non-included into the guidelines for the management of chronic heart failure (CHF) to nebivolol and bisoprolol for outpatients.Subjects and methods. The study included 67 patients with stable Functional Classes (FC) II and II CHF who received the standard therapy and BAB non-included into the guidelines for the management of CHF. The patients were randomized to the groups taking bisoprolol (n = 35) or nebivolol (n = 32) in doses of 1.25 to 10 mg/day. Before and 6 months after therapy, the investigators assessed the patient's clinical status and quality of life (QL), performed a six-minute walk test and echography, and determined the blood level of the N-terminal fragment of brain natriuretic peptide prohormone (NT-proBNP).Results. The switching to bisoprolol and nebivolol was followed by a significant clinical improvement, a larger covered distance, and better QL. Left ventricular ejection fraction was increased along with a reduction in mean FC CHF. There were no significant changes in NT-proBNP in the total patient group, but it was significantly decreased in the subgroup of those with the baseline high level of the peptide.Conclusion. The switching of patients with stable CHF from therapy with BAB not included into the guidelines for the management of CHF to nebivolol or bisoprolol yields positive results and improves left ventricular systolic function (which is attended by the reduction in NT-proBNP levels) and may be recommended for treatment in the outpatient setting.

Aim. Arterial stiffness is a predictor of atherosclerosis. This study was conducted to develop a method of coronary atherosclerosis severity assessment by means of brachial-ankle pulse wave velocity (baPWV). Material and methods. We measured baPWV in 119 males (age 51.67 ± 7.25) who received coronary angiographic examination (CAG). The baPWV was measured by Vasera VS-1000 (Fukuda Denshi). Results. The patients were divided into two groups by severity of stenosis (group 1 - less than 50% stenosis, group 2 > 50%). The baPWV value was significantly greater in group 2 (n = 98, baPWV 13.15 ± 2.14 m/s, p = 0.004) than that in group 1 (n = 21, baPWV 12.13 ± 1.17 m/s). ROC-curve demonstrated that the best cut-off point of the baPWV for predicting occlusive atherosclerosis was 12.2 m/s. The area under ROC-curve was 0.66 (p = 0.034). An univariate binary logistic regression model demonstrated that only baPWV had a significant odds ratio for coronary stenosis > 50%: 2.68 (95% CI = 1.01-7.15), p = 0.043. Other risk factors were not significantly associated with severity of stenosis. Conclusion. The baPWV significantly reflects the severity of stenosis in middle-aged males opening new perspectives of noninvasive detection of coronary artery atherosclerosis in middle-aged males.