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.
Aim. To evaluate an antihypertensive efficacy and influence on the arterial stiffness of 24-week treatment with metoprolol tartrate in patients with hypertension (HT) degree 1-2. Material and Methods. Patients with HT degree 1-2 (n=38) received therapy with metoprolol tartrate 50-200 mg QD for 24 weeks. Bifunctional daily blood pressure (BP) and electrocardiogramm monitoring with evaluation of central aortic pressure indicators as well as volume sphygmography were performed at baseline and after 24 weeks of therapy. Results. The 24-week therapy with metoprolol tartrate was effective in 47.2% of patients. Significant improvement in central aortic pressure [systolic BP decreased from 129.8±7.3 to 118.8±7.2 mm Hg; p<0.001; dyastolic BP decreased from 90 (87;93) to 80 (77;84) mm Hg; p<0.001] with the not significant changes of augmentation index (from 18.3±13.2 to 19.5±13.4; p>0.05). Significant reduction in arterial stiffness indexes was revealed with volume sphygmography: CAVI1 from 8.6 (8.1;9.6) to 8.0 (7.3;8.3); p<0.01; L-CAVI1 from 8.9 (7.6;9.9) to 7.9 (7.2;8.5), p<0.001. Conclusion. Metoprolol tartrate is an effective antihypertensive drug that improves the structural and functional properties of arteries.
The review presents the data of clinical studies of a new method for estimating the arterial stiffness by cardio-ankle vascular index (CAVI). The most significant factors influencing the vascular wall are analyzed and a CAVI measuring procedure and a calculation algorithm are described in detail. An association of the estimation of CAVI with other procedures determining the rigidity of the arterial wall is analyzed. A possibility for the practical application of this index to the study of the elastic properties of the vascular wall and for its use as a surrogate criterion to evaluate the vasoprotective effect of antihypertensive agents is considered.
Objective: To conduct a comparative analysis of the parameters of carotid arteries local stiffness in healthy subjects and patients with arterial hypertension (AH) 1-2 degree. Design and method: 56 subjects have been evaluated in total. Group 1 included 34 healthy normotensive subjects (mean age 47,1 ± 7,1 years; SBP 117,4 ± 6,9 mmHg, DBP - 74 (67.5; 80,0) mmHg). Group 2 consisted of 22 patients with hypertension of 1-2 degree (mean age 47,5 ± 6,9 years, SBP - 146,2 ± 7,1 mmHg, DBP - 93,0 ± 6,7 mmHg). Local arterial stiffness were evaluated on the ultrasonic device My Lab 90 (Esaote, Italy) by software for echotracking on the following parameters: systolic local (Loc Psys) and diastolic local pressure (Loc Pdia), the transverse distensibility coefficient (DC), the coefficient of transversal compliance (CC), stiffness index (α and β), local carotid pulse wave velocity (PWV), the thickness of the intima-media complex (IMT). Results: According to echo-tracking the local pressure values Loc Psys and Loc Pdia in group 1 was 102,7 (96,7; 110,4) and 70 (70,0; 80,0) mmHg; group 2 - 123,4 ± 8,0 and 90,0 (80,0; 95,0) mmHg (r < 0,05). DC indicator decreased with increasing pressure: in normotensive subjects - 0,02 (0,02; 0,03) 1/kPa, in hypertensive patients - 0,01 (0,01; 0,02) 1/kPa (r < 0,05). The values of local compliance CC in group 1 was 0,81 (0,63; 1,17) mm2/kPa, in group 2 - 0,55 (0,45; 0,73) mm2/kPa (r < 0,05). Stiffness index α and β were prevailed in hypertensive patients (10,5 (8,1; 12,4) and 6,0 (4,9; 7,6)) compared to healthy subjects (7,5 ± 2,5 and 3,8 ± 1,3) (r < 0,05). Subjects in control group had lower values of PWV - 6,3 ± 1,0 m/s, in patients with hypertension parameter was 8,8 (8,1; 9,5) m/s (r < 0,05). Healthy and hypertensive patients did not differ in IMT: 583,0 ± 95,9 and 605,3 ± 134,1 mu.m, respectively (ns). Conclusions: Based on the ultrasound of the carotid arteries by echo-tracking worsening of most parameters of local stiffness in hypertensive patients has been revealed. Development of remodeling in high blood pressure accompanied by a decrease of damping function of the vascular wall, as evidenced by an increase in pulse wave velocity, stiffness index, and reduced compliance and distensibility coefficient of the carotid arteries.
Objective: To conduct a comparative analysis of the local stiffness parameters of the carotid arteries in healthy subjects and patients with arterial hypertension (AH) 1-2 degrees. Design and method: Study involved 56 subjects. Group 1 included 34 healthy normotensive subjects (mean age 47,1 ± 7,1 years; SBP 117,4 ± 6,9 mmHg, diastolic blood pressure 74 (67,5; 80,0) mmHg). Group 2 consisted of 22 patients with hypertension of 1-2 degrees (average age 47,5 ± 6,9 years, SBP 146,2 ± 7,1 mmHg, diastolic blood pressure 93,0 ± 6,7 mmHg). Local arterial stiffness were evaluated by the ultrasonic device My Lab 90 («Esaote», Italy) using the echotracking software on the following parameters: local systolic (Loc Psys) and diastolic pressure (Loc Pdia), the coefficient of transverse extensibility (DC), the coefficient of lateral compliance (CC), stiffness index β, local carotid pulse wave velocity (PWV). Results: According to echotracking the local pressure values - Loc Psys and Loc Pdia in group 1 were the following: 102,7 (96,7; 110,4), and 70 (70,0; 80,0) mmHg.; group 2 - 8,0 and 123,4 ± 90,0 (80,0; 95,0) mmHg (p < 0,05). DC indicator decreased with increasing pressure: in healthy normotensive individuals - 0,02 (0,02; 0,03) 1/kPa, in hypertensive patients - 0,01 (0,01; 0,02) 1/kPa (p < 0,05). Values of local compliance of the CC in group 1 were 0,81 (0,63; 1,17) mm2/kPa, group 2 - 0,55 (0,45; 0,73) mm2/kPa (p < 0,05). Stiffness index β prevailed in patients with hypertension (10,5 (8,1; 12,4)) compared with healthy individuals (7,5 ± 2,5) (p < 0,05). The subjects in the control group had lower values of PWV - 6,3 ± 1,0 m/s in individuals with hypertension were 8,8 (8,1; 9,5) m/s (p < 0,05). Conclusions: According to echotracking an impairment of most parameters of local rigidity has been revealed in patients with hypertension. Progressive remodeling in conditions of high blood pressure is accompanied by a decrease in the damping function of the vascular wall, as evidenced by an increase in pulse wave velocity, stiffness index, and reduced coefficients of compliance and distensibility of the carotid arteries.
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