Objective. Imidazoline receptor agonist moxonidine besides antihypertensive effect can increase insulin sensitivity, reduce leptin level, and improve lipid metabolism. However, the efficacy, tolerability and pleiotropic effects of moxonidine in postmenopausal women with essential hypertension (EH) and metabolic syndrome (MS) are not well established, and it was the purpose of this study. Design and methods. Forty-two postmenopausal women with EH and MS (mean age — 52,5 ± 0,4 years) were enrolled. Moxonidine therapy (400–600 mkg/ daily) lasted for 12 weeks. Waist (WC) and hip (HC) circumferences, WC/HC ratio, body mass index (BMI), insulin, leptin level, glucose, blood serum lipid profile, index of insulin resistance (HOMA-IR) and index of functional activity of pancreatic beta cells (HOMA-FB), echocardiography, intima-media thickness of common carotid arteries. Results. Moxonidine therapy was associated with decrease, body weight and BMI decrease, high-density lipoprotein cholesterol and HOMA-FB index increase. Left atrium diameter and volume decreased, left ventricular diastolic function improved. Conclusions. Moxonidine is an effective antihypertensive drug for the treatment of postmenopausal hypertensive women with MS, which improves some metabolic, hemodynamic parameters and leads to the decrease of the left atrium volume and diameter.

Objective: To evaluate serum adiponectin levels in hypertensive patients with abdominal obesity. Design and method: We examined 183 hypertensive patients aged 30–55 years (mean age 45,14+/-0,43) with abdominal obesity (waist circumference above 94 cm in men and above 80 cm in women). 41% of patients were overweight (BMI 28,01+/-0,14 kg/m2), 59% were obese (BMI 35,11+/-0,36 kg/m2). 20 normotensive subjects with BMI < 25 kg/m2 formed control group. Adiponectin and insulin levels were evaluated by ELISA (DRG, USA). Fasting plasma glucose was detected by standard biochemical method. To evaluate insulin resistance Homeostasis Model Assessment was used (HOMA-IR). Results: There were no difference in mean BMI between males and females with abdominal obesity. Serum adiponectin level in patients with abdominal obesity was 19,32+/-1,24 ng/ml, and it did not vary among overweight and obese patients (20,42+/-1,21 ng/ml, 19,19+/-0,74 ng/ml, accordingly, p > 0,05), but in healthy controls it was higher 25,93+/-0,88 ng/ml, p < 0,05. Plasma adiponectin levels were higher in women than in men (21,74+/-0,74 ng/ml and 16,62+/-1,01 ng/ml accordingly, p = 0,001). HOMA-IR in patients with abdominal obesity was higher in BMI 30 kg/m2 than in overweight subjects (6,30+/-0,69 vs 3,41, p = 0,001) and in hypertensive patients when compared to normotensive subjects (5,82+/-0,67 vs 4,02, p = 0,008). Correlations were seen between HOMA-IR and waist circumference (r = 0,42, p = 0,0001), BMI (r = 0,40, p = 0,0001) and adiponectin level (r = -0,21, p = 0,003). Correlations were also present between adiponectin level and BMI (r = -0,2, p = 0,004) and waist circumference (r = -0,3, p = 0,004). We also revealed correlations between adiponectin level and age (r = 0,3, p = 0,001), family history of cardiovascular disease and obesity (r = -0,2, p = 0,012). Conclusions: In abdominal obesity adiponectin levels do not differ between hypertensive and normotensive subjects. Adiponectin level is higher in healthy control group than in obese patients as well as women than in men. Insulin resistance index (HOMA-IR) is higher in obese hypertensive patients than in overweight and normotensive subjects.

Цель. Оценить риск инсульта и характер антитромботической терапии на амбулаторном и стационарном этапах лечения у пациентов с неклапанной фибрилляцией предсердий. Материал и методы. Проведен анализ 576 историй болезни пациентов, госпитализированных в кардиологическое отделение в 2013 г. Изучены факторы риска развития инсульта и системных эмболий по шкале CHA2DS2VASc и оценена антитромботическая терапия. Результаты. Фибрилляция предсердий диагностирована у 26,3% больных. Неклапанная фибрилляция предсердий выявлена у 82,2% из них. По шкале CHA2DS2-VASc 2 и более баллов имели 111 (88,8%) пациентов, 1 балл — 13 (10,4%) больных и 0 баллов имел лишь 1 больной. Среднее количество баллов по шкале CHA2DS2-VASc у пациентов с фибрилляцией предсердий 3,9 ± 1,0. Только 40% больных с неклапанной фибрилляцией предсердий получали антикоагулянты на догоспитальном этапе. Антиагреганты получали 38,4% больных и 21,6% пациентов не получали антитромботическую терапию. Лишь 26,8% из пациентов, принимавших варфарин, при госпитализации имели целевое значение МНО. Терапия антикоагулянтами в клинике была назначена 93 больным (74,4%). Выводы. Большинство пациентов с неклапанной фибрилляцией предсердий, госпитализированных в клинику кардиологии, имеют высокий риск развития инсульта и системной эмболии, но не получают адекватную антитромботическую терапию.

Objective: To evaluate serum adiponectin levels in hypertensive patients with abdominal obesity. Design and method: We examined 183 hypertensive patients aged 30–55 years (mean age 45,14+/-0,43) with abdominal obesity (waist circumference above 94 cm in men and above 80 cm in women). 41% of patients were overweight (BMI 28,01+/-0,14 kg/m2), 59% were obese (BMI 35,11+/-0,36 kg/m2). 20 normotensive subjects with BMI < 25 kg/m2 formed control group. Adiponectin and insulin levels were evaluated by ELISA (DRG, USA). Fasting plasma glucose was detected by standard biochemical method. To evaluate insulin resistance Homeostasis Model Assessment was used (HOMA-IR). Results: There were no difference in mean BMI between males and females with abdominal obesity. Serum adiponectin level in patients with abdominal obesity was 19,32+/-1,24 ng/ml, and it did not vary among overweight and obese patients (20,42+/-1,21 ng/ml, 19,19+/-0,74 ng/ml, accordingly, p > 0,05), but in healthy controls it was higher 25,93+/-0,88 ng/ml, p < 0,05. Plasma adiponectin levels were higher in women than in men (21,74+/-0,74 ng/ml and 16,62+/-1,01 ng/ml accordingly, p = 0,001). HOMA-IR in patients with abdominal obesity was higher in BMI 30 kg/m2 than in overweight subjects (6,30+/-0,69 vs 3,41, p = 0,001) and in hypertensive patients when compared to normotensive subjects (5,82+/-0,67 vs 4,02, p = 0,008). Correlations were seen between HOMA-IR and waist circumference (r = 0,42, p = 0,0001), BMI (r = 0,40, p = 0,0001) and adiponectin level (r = -0,21, p = 0,003). Correlations were also present between adiponectin level and BMI (r = -0,2, p = 0,004) and waist circumference (r = -0,3, p = 0,004). We also revealed correlations between adiponectin level and age (r = 0,3, p = 0,001), family history of cardiovascular disease and obesity (r = -0,2, p = 0,012). Conclusions: In abdominal obesity adiponectin levels do not differ between hypertensive and normotensive subjects. Adiponectin level is higher in healthy control group than in obese patients as well as women than in men. Insulin resistance index (HOMA-IR) is higher in obese hypertensive patients than in overweight and normotensive subjects.

Objective. To assess total and high-molecular weight adiponectin (AN) and (HMWAN) level in women with abdominal obesity (AO) and arterial hypertension (HTN) — citizens of St Petersburg aged 30–55 years old. Design and mеthods. We examined 94 women with AO (IDF, 2005), mean age 45,3 ± 0,1 years. Compari-son group included 16 healthy women without АО. The levels of AN, HMWAN and insulin were determined by ELISA method (DRG, USA). Serum lipids were determined by enzymatic method (COBAS INTEGRA 400/700/800, Germany). The homeostasis model was used to assess the insulin resistance HOMA-IR. Results. HTN was diagnosed in 48,4 % women with АО (IDF, 2005). The level of total and high-molecular weight adiponectin was lower in subjects with АО compared to the healthy women (р 0,05). However, the HMWAN level was lower in hypertensive subjects with АО compared to the normotensive women (р < 0,01). The highest insulin level and НОМА-IR were found in hypertensive women with АО and the lowest level of total AN (1st tertil). At the same time women with the lowest HMWAN concentration (1st tertil) had the highest levels of systolic and diastolic blood pressure (BP), waist circumference, insulin, glucose, triglycerides and НОМА-IR. Linear regression analysis confirmed the correlation between the levels of HMWAN and BP (β = –0,21, р = 0,03). Conclusions. The high-molecular weight adiponectin level is lower in women with AO and HTN compared to the normotensive subjects with AO. Low level of high-molecular weight adiponectin might be considered a factor for HTN development in women with AO.

Objective: To assess the prevalence and forms of metabolic syndrome in patients with abdominal obesity in population of St Petersburg according to criteria of International Diabetic Federation (IDF, 2005) and European Cardiology Society (ESH and ESC, 2007). Design and methods. 966 employees, aged 30-55 years, were examined. Waist circumference, weight, body mass index (BMI), height, blood pressure were measured. The levels of total cholesterol, triglycerides (TG), low- and high- density cholesterol (LDL-C and HDL-C), glucose were defined by COBAS INTEGRA 400/700/800. Results. 52,1 % subjects had abdominal obesity (AO) in accordance with IDF criteria (2005). Different components of MS were found in 91,3 % subjects with AO. The occurrence of MS components among patients with AO according to criteria of IDF and ESH-ESC was the following: arterial hypertension (AH) — 78,6 %, low level of HDL-C — 54,2 and 46,4 %, high level of TG — 35,4 and 34,3 % and disorders of glucose metabolism — 39,1 and 35,6 %, respectively. MS was found in 66,5 (IDF, 2005) and 55,9 % (ESH and ESC, 2007) subjects with AO respectively (p > 0,05). The majority of patients had 3 components of MS, and it occurred more frequently in subjects older than 50 years and in patients with BMI > 40 kg/m 2 . Conclusion. Arterial hypertension is the second component of MS in subjects with AO. Combination of AO, arterial hypertension and low level of HDL-C is the most prevalent clinical form of MS in population of St Petersburg.

Objective: To assess the prevalence and forms of metabolic syndrome in patients with abdominal obesity in population of St Petersburg according to criteria of International Diabetic Federation (IDF, 2005) and European Cardiology Society (ESH and ESC, 2007). Design and methods. 966 employees, aged 30-55 years, were examined. Waist circumference, weight, body mass index (BMI), height, blood pressure were measured. The levels of total cholesterol, triglycerides (TG), lowand highdensity cholesterol (LDL-C and HDL-C), glucose were defined by COBAS INTEGRA 400/700/800. Results. 52,1 % subjects had abdominal obesity (AO) in accordance with IDF criteria (2005). Different components of MS were found in 91,3 % subjects with AO. The occurrence of MS components among patients with AO according to criteria of IDF and ESH-ESC was the following: arterial hypertension (AH) — 78,6 %, low level of HDL-C — 54,2 and 46,4 %, high level of TG — 35,4 and 34,3 % and disorders of glucose metabolism — 39,1 and 35,6 %, respectively. MS was found in 66,5 (IDF, 2005) and 55,9 % (ESH and ESC, 2007) subjects with AO respectively (p > 0,05). The majority of patients had 3 components of MS, and it occurred more frequently in subjects older than 50 years and in patients with BMI > 40 kg/m 2. Conclusion. Arterial hypertension is the second component of MS in subjects with AO. Combination of AO, arterial hypertension and low level of HDL-C is the most prevalent clinical form of MS in population of St Petersburg.

Baranova, E.; Belyaeva, O.; Bolshakova, O.; Chubenko, E.; Berezina, A.; Berkovich, O.; Karonova, T.; Kozlova, S.; Bazenova, E.; Shlyakhto, E. Author Information

Chubenko, E.1; Belyaeva, O.1; Bolshakova, O.2; Berkovich, O.2; Bazhenova, E.1; Karonova, T.1; Baranova, E.1; Shlyakhto, E.2 Author Information

Chubenko, E.; Belyaeva, O.; Bazhenova, E.; Berkovich, O.; Baranova, E.; Shlyakhto, E. Author Information

Chubenko, E.; Belyaeva, O.; Bolshakova, O.; Berkovich, O.; Bazhenova, E.; Chernetcova, E.; Monosova, K.; Baranova, E.; Shlyakhto, E. Author Information

Study Objective: To evaluate influence of moxonidine therapy on carotid wall thickness, heart structural and functional parametres in hypertensive postmenopausal women with metabolic syndrome (MS). Material and Methods: 26 hypertensive (AH grades 1–2) postmenopausal women with metabolic syndrome 45–55 years old (52,5+/−0,4 years). MS was diagnosed according to ESC-ESH (2007) criteria. Patients were treated with moxonidine (200–600 mcg/day) orally. Structure and function of the heart and the intima-media thickness of carotid arteries were reviewed by ultrasound method before therapy and on 12-th week of treatment with moxonidine. Statistical analyses were performed using SPSS 17.0 for Windows (SPSS, Inc., Chicago, IL, USA). Results: 14 (53,8%) hypertensive postmenopausal women with MS had elevated left ventricle mass index (LVMI more than 110 g/m2). 9 (34,6%) patients had LV diastolic dysfunction. We revealed correlation between LVMI, interventricular septum thickness, E/A ratio and systolic BP (r = 0,4; 0,4 and -0,4, accordingly; p = 0,02; 0,04 and 0,02 accordingly). Positive correlation was revealed between interventricular septum thickness and diastolic BP (r = 0,4; p = 0,07); left atrium diameter and diastolic BP (r = 0,4; p = 0,04). Moxonidine therapy did not changed intima-media thickness of carotid arteries (0,86+/−0,03 mm vs 0,81+/−0,04 mm; p = 0,05) and LVMI (114,0+/−3,4 g/m2 and 113,9+/−3,4 g/m2, p > 0,05). LV diastolic function improved: E/A ratio increased from 1,05+/− 0,03 to 1,20+/− 0,03 (p < 0,001), and IVRT decreased from 97,3+/−3,0 msec to 91,8+/−3,1 msec (p < 0,001). Number of patients with E/A ratio less than 1,0 decreased from 9 (34,6%) to 2 (7,7%) women (ð < 0,05). Left atrium diameter reduced (4,30+/−0,08 cm and 4,21+/−0,07 cm; p < 0,05), left atrium volume also decreased (29,8+/−0,6 ml/m2 and 29,1+/−0,6 ml/m2; p < 0,05), (picture). Conclusion: Moxonidine therapy improved left ventricle diastolic function and decreased left atrium diameter and left atrium volume in hypertensive postmenopausal women with metabolic syndrome.

Study Objective: To evaluate serum leptin concentration in obese and hypertensive men and women. Material and Methods: 525 patients with abdominal obesity (AO) were examined: 388 women (73,9%) and 137 men (26,1%), age 45,8 ± 0,3 years, 56% patients were hypertensive (AH grades 1–2). 50 normal weight and normotensive people (38 women and 12 men) were examined, age 40,5 ± 0,9 years. AO was diagnosed according to IDF criteria (2005). Office blood pressure (BP) was measured by Korotkov method. Serum leptin concentration was determined by ELISA. Statistical analyses were performed using SPSS 17.0 for Windows (SPSS, Inc., Chicago, IL, USA). Results: Serum leptin concentration (SLC) in normal weight and normotensive women was greater than in men (27,9 ± 2,8 vs 6,3 ± 1,7 ng/ml, p < 0,001). Obese patients had hyperleptinemia: leptin level was greater in obese men than in normal weight subjects (38,4 ± 3,2 vs 6,3 ± 1,7 ng/ml, p < 0,001); obese women also had greater leptin level than normal weight women (66,1 ± 2,3 vs 27,9 ± 2,8 ng/ml, p < 0,001). There was no difference between SLC in the groups of obese hypertensive and obese normotensive men (31,5 ± 2,7 vs 38,4 ± 3,2 ng/ml, p > 0,05). A trend towards higher level of SLC in obese hypertensive as compared to normotensive obese women (78,0 ± 2,8 vs 66,1 ± 2,3 ng/ml, p = 0,07) was observed (table). Leptin level in obese women was higher in hypertensive postmenopausal, than in hypertensive premenopausal and postmenopausal normotensive women (79,8 ± 7,4 vs 59,3 ± 3,1 vs 54,7 ± 4,4 ng/ml, p < 0,05). There was no difference between leptin level in obese hypertensive and normotinsive premenopausal women (59,3 ± 3,1 vs 63,5 ± 2,6 ng/ml, p > 0,05). Conclusion: Obese men and women had hyperleptiemia. Serum leptin level in obese women was significantly greater then in obese men. Postmenopausal obese hypertensive women had higher leptin level, than premenopausal. Serum leptin concentration was higher in hypertensive obese postmenopausal women than in normotensive postmenopausal obese women. There was no difference between serum leptin level in hypertensive and normotensive obese men.

Background. Imidazoline receptor agonist moxonidine besides its antihypertensive effect, can increase insulin sensitivity, reduce leptin level, improve lipid metabolism. However, the efficacy, tolerability and pleiotropic effects of moxonidine in postmenopausal women with essential hypertension (EH) and metabolic syndrome (MS) are not well established, and it was the objective of this study. Design and methods. 30 postmenopausal women with EH and MS (52,5 ± 0,4 years old) were included. Moxonidine was administered (400-600 mkg/day) for 12 weeks. Waist circumference (WC), hip circumference (HC), WC/HC ratio, body mass index (BMI), insulin, leptin level, glucose, lipid profile of blood serum, index of insulin resistance (HOMA-IR) and index of functional activity of pancreatic beta cells (HOMA-FB), echocardiography, intima-media thickness (IMT) of common carotid arteries (CCA). Results. Moxonidine therapy was associated with blood pressure (BP) decrease, body weight and BMI decrease, high-density lipoprotein (HDL) cholesterol and HOMA-FB index increase. Left atrium diameter and volume decreased, left ventricular diastolic function improved. Conclusions. Moxonidine is an effective antihypertensive drug for the treatment of postmenopausal hypertensive women with MS, which improves a range of metabolic, hemodynamic parameters and leads to the decrease of left atrium volume and diameter.

Obesity is characterized by increased concentration of leptin and disturbance of the feedback between hyperleptinaemia and enhanced appetite. The hyperleptinaemia is often combined with hyperglycaemia and arterial hypertension and seems to be a predictor of acute cardiovascular events. Leptin inhibitors might be used in the future for therapy in case of the metabolic syndrome.