Нужно ли лечить артериальную гипертензию 1 степени?
Because of the strategy of early diagnosis of arterial hypertension (AH) the majority of patients with prescription of the antihypertensive therapy (AHT) have grade 1 hypertension (AH1). Accumulated scientific evidence on the efficacy and safety of AHT for AH1 is insufficient for introduction of the active therapy, and the balance of harms and benefits is not clear in relation to AHT for AH1. The development of the next generation Russian guidelines for AH management in application to AH1 should take into account the totality of the scientific evidence as well as the perspective of the introduction of the national drug provision scheme. The best way to do it is to introduce more accurate diagnostic criteria for AH1 and the recommendation not to initiate the drug AHT for AH1 in cases of low cardiovascular risk.
In the internal medicine wide spectrum the gastroenterology is one of the chapters, less enlightened by the scientific evidence. It does not mean that the practice of the grasntroenterology may ot be improved by the systematic use of the approaches of the evidence based medicine
The significance of medical care and treatment in social security law is analysed.
Control of heart rate (HR) is an important target during treatment of patients with stable angina. In a number of cases it can be achieved by the use of β adrenoblockers. But often a necessity arises to enhance pulse slowing therapy with the use of combinations of drugs exerting negative chronotropic effect. We present here results of the CONTROL study (n=1777), conducted with the aim of studying antianginal efficacy and tolerability of the If channels blocker ivabradine used in combination with β adrenoblockers in patients with stable functional class II-III angina and frequency of attacks ≥3/week and HR>70 bpm. The use of ivabradine for 12 weeks allowed to achieve greater reduction of frequency of anginal attacks (by 4 per week, 95% confidence interval 3-6) compared with the group of usual care (treatment at physicians discretion). At the end of the study in ivabradine group 43% of patients had no angina at all, HR lowering ≤60 bpm was noted in 46% of patients (in the comparison group14 and 6%, respectively, p<0.001). Reduction of frequency of attacks of angina correlated with HR lowering, more with pulse rate measured by patients themselves (r=0.411, p<0.001), than with values measured at visits to physicians (r=0.266, p<0.001). Rate of lethal outcomes as well as rate of nonfatal cardiovascular complications (myocardial infarction, stroke, urgent revascularization) were similar in compared groups. In ivabradine group compared with usual care group there were less hospitalizations (5.0 and 8.6%, respectively, p=0.021), calls for emergency service (13.3 and 25.4%), and sick leaves (6.6 and 13.1%, p=0.018). Adverse reactions were noted in 130 patients (8.7%) in ivabradine group and in 29 patients (10.0%) in usual care group p=0.580).
The emergence on the Russian market of new forms of sales and services, like online-shopping, has formed a new sphere of communication - client/customer service to the actual and potential clients/customers by email. This area is actively developing in Russia for the last 10 years. On the basis of the analysis of the examples of e-mails, sent to the real people by the customer services of 115 different companies, the author formulates the main trends of the use of forms of address in this sphere.
A new approach to investigate a radial artery pulse signal rhythmic structure is considered based on a simultaneous analysis of a set of oscillatory components determined by parameters of various elements of unit oscillations. Based on a comparative analysis of the spectral density types defined by different parameters of a pulse signal, an essential distinction between them has been revealed. An opportunity of increasing the number of informative features by means of simultaneous analysis of pulse signal rhythmic structure oscillatory component set is shown. The study has been carried out using experimental material obtained during children’s clinical examinations focused on detecting the initial stage arterial hypertension in infancy and adolescence. The informativeness of the pulse signal rhythmic structure parameters was estimated as applied to this task, showing that maximum informativeness is inherent to indicators defined by oscillatory components of the pulse signal dicrotic wave temporal parameter.
Abstract The paper presents a meta-analysis of open-label antihypertensive effectiveness studies of indapamide SR (Arifon Retard, Servier Laboratories, France) in hypertensives. 24 Russian (n = 4952) and 4 foreign (n = 4634) studies were included in analysis. Russian studies show that indapamide retard both as a monotherapy and a component of the combination therapy leads to a 17,8/14,0 % decrease of systolic/diastolic blood pressure that is a reduction for 29.2 (95 % CI 28,9–29,5)/12,3 (12,1–12,5) mmHg in patients with uncontrolled hypertension. Baseline blood pressure was the main predictor of its reduction, and the most signifi cant reduction for 32,6 (95 % CI 25,5–39,6) mmHg was seen when the average baseline systolic blood pressure exceeded 170 mmHg. Antihypertensive effi cacy of indapamide retard was similar in Russian and foreign studies. However, incidence of therapy-related side effects was higher in Russian studies than in foreign ones (5,9 and 3,3 % respectively, p < 0,001). Therefore, meta-analysis based on the data of open Russian studies confi rms the antihypertensive effectiveness of indapamide retard and demonstrates the comparability of the results to those found in multicenter foreign studies.
This prototype development explains the challenges encountered during the ISO/IEEE 11073 standard implementation process. The complexity of the standard and the consequent heavy requirements, which have not encouraged software engineers to adopt the standard. The developing complexity evaluation drives us to propose two possible implementation strategies that cover almost all possible use cases and eases handling the standard by non-expert users. The first one is focused on medical devices (MD) and proposes a low-memory and low-processor usage technique. It is based on message patterns that allow simple functions to generate ISO/IEEE 11073 messages and to process them easily. MD act as X73 agent. Second one is focused on more powerful device X73 manager, which do not have the MDs' memory and processor usage constraints. The protocol between Agent and Manager is point-to-point and we can distribute the functionality between devices.
Developed both implementation X73 Agent and Manager will cut developing time for applications based on ISO/EEE 11073.