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We present in this review data on home blood pressure variability (HBPV) with consideration of its definition and threshold values. We also present own classification and discuss analysis of results of HBPV and their interpretation in observational and clinical studies, including own data. Experience in this area accumulated during last 30 years, information on pathophysiological mechanisms, prognostic properties of HBPV may be useful for a physician from practical point of view.

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The aim of this work was to study morpho-functional myocardial characteristics in patients with masked arterial hypertension (AH) and white coat hypertension (WCH) given antihypertensive therapy (AHT) and without it. This cross-sectional cohort study included employees of a large industrial enterprise who annually underwent routine medical examination supplemented by 24 hr AP monitoring and echocardiography carried out at specified time of the working day. The participants of the study were divided into 6 groups based on the relationship between clinical AP and mean AP during work. Group I comprised 20 (7%) subjects with normal AP, group 2--20 (7%) with masked AH, group 3--40 (14%) with WCH, group 4--81 (28.3%) with optimal A HT effect, group 5--64 (22.4%) with unmanifest inefficiency of AHT, group 6--40 (14%) with WCH during AHT. Criteria for masked AH and unmanifest AHT inefficiency were clinical AP below 140 and 90 mm Hg in combination with mean AP during work 135 and/or 85 mm Hg and higher. Echocardiography was performed in a standard positions in M- and B-modes as well as in three Doppler regimes. One-factor ANOVA was used to analyze differences between the groups and Pearson's Chi-square test to determine the relationship between categorical variables. 206 (72%) of the 286 employees of the large industrial enterprise had a diagnosis of AH. It was shown that ambulatory AP values obtained by 24 hr monitoring better characterized the patient's condition than clinical AP since they correlated with the frequency of disorders in the target organs and the risk of cardiovascular complications in patients with AH. Patients with masked AH more frequently developed left ventricular hypertrophy and diastolic dysfunction than those having normal clinical and ambulatory AP. The mean width of the left ventricle wall and left ventricular isovolumic relaxation time (therefore, the degree of LV hypertrophy and diastolic dysfunction) in the patients with unmanifest inefficiency of AHT were greater than in those with optimal AHT effect. The occurrence of WCH was comparable in the two groups. These data were used to determine intensity of preventive AHT at the workplace with a view to improving medical and occupational prognosis.

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Prevalence and predictors of masked arterial hypertension (AH) in patients receiving antihypertensive therapy (concealed treatment inefficacy--CTI) was studied on material of data base comprising 219 observations. Drugs from 5 groups were used. Prevalence of CTI AH with the use of various definitions was 8.1-17.4%. With the help of procedure of logistic regression analysis the following predictors of CTI were selected: (1) sociopsychological--high working capacity, high psychological abilities and social self feeling; (2) parameters of 24-hour BP profile--24-hour variability, variability during working period, minimal daytime BP level, time of maximal BP. According to our data CTI is most probable during treatment with calcium antagonists and beta-adrenoblockers.

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AIM: To assess in the aggregate hemodynamic peculiarities and changes of the myocardium as well as contribution of hypertension in formation of coronary risk in metabolic syndrome (MS). MATERIAL AND METHODS: Patients (n=290) with hypertension of I-II degree and duration > or = 5 years were subjected to laboratory (parameters of lipid spectrum, glucose and insulin levels) and instrumental (24-hour blood pressure monitoring, echocardiography) examination. Criteria of MS were fasting insulin > 18 mcU/ml and/or glucose/insulin ratio < 6; blood pressure (BP) > or = 140/90 mm Hg; triglycerides > or = 200 mg/dl and/or high density lipoprotein cholesterol < 39 mg/dl; body mass index > 25 kg/m(2) with waist/hip circumference ratio > or = 0.95 (for men) or > or = 0.80 (for women); impaired glucose tolerance according to WHO criteria. PROCAM model was used for calculation of total coronary risk. RESULTS: 37% of patients with hypertension had all components of MS. Hypertension took third place among contributors to formation of total coronary risk with input of 20%. Diastolic BP positively correlated with triglycerides, total cholesterol, index of insulin resistance and parameters of abdominal obesity. Mean 24 hour systolic and pulse BP in patients with MS were significantly higher than in a group of patients with hypertension without metabolic disturbances. Patients with MS had thicker left ventricular posterior wall and interventricular septum what was associated with increased end-systolic and end-diastolic dimensions as well as myocardial mass of the left ventricle. CONCLUSION: In patients with MS 24 hour BP profile is impaired at the account of high pulse BP and lack of nocturnal lowering of systolic and diastolic BP and is associated with concentric left ventricular hypertrophy.

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Effects of the standard doses of telmisartan (20-80 mg) and enalapril (5-10 mg) on the arterial pressure (AP, circadian monitoring), psychological state (Minnesota Multiphase Personality Inventory questionnaire, Russian version), and quality of life (General Well-Being Questionnaire) were studied in a randomized, parallel group trial in 30 patients with stable, soft-to-moderate arterial hypertension. The initial control 2-week period was followed by a 12-week period of active therapy. It was established that the long-term administration of both drugs in standard doses produced comparable antihypertensive effect, reliably reducing the averaged AP characteristics. Both drugs also improved the quality of life: enalapril influenced predominantly the psychological score, while telmisartan increased both psychological score and social score. Long-term administration of both drugs had a positive effect on the psychological state of hypertensive patients.

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Main advantages of the use of 24-hour blood pressure (BP) monitoring for assessment of effects of antihypertensive therapy consist in more precise selection of patients requiring drug treatment and more objective evaluation of results of therapy. However methodological limitations also exist. Among them are susceptibility of results to regression to the mean, insufficient understanding of many characteristics of 24-hour BP profile, interdependence (co-linearity) of various parameters. Lack of convincing data on prognosis of patients whose antihypertensive treatment has been guided by 24-hour BP monitoring also presents a serious problem. Promising direction of further research is investigation of reproducibility and reliability of different parameters of BP monitoring in relatively short-term studies including those with surrogate end points.

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AIM: To compare efficacy and safety of nifedipin-retard (cordaflex-retard, Egis, Hungary) used in monotherapy and in combination with metoprolol (egilok, Egis, Hungary) in patients with arterial hypertension (AH). MATERIAL AND METHODS: The study included 20 patients with AH stage I-II (12 males, 8 females, mean age 57.3 years, mean duration of the disease 8.6 years). Nifedipin-retard was given in a daily dose 40 mg/day (20 mg twice a day) in monotherapy and 20 mg/day in combination with metoprolol which was administered 50 mg twice a day (a daily dose 100 mg/day). The control examination consisted of a physical examination, measurement of arterial pressure (AP) by Korotkov, registration of heart rate, ECG, 24-h AP monitoring, echocardiography. RESULTS: By 24-h AP monitoring, a 4-week treatment with nifedipin-retard alone resulted in lowering of systolic arterial pressure. The combined treatment produced a more pronounced fall both in systolic and diastolic pressure. Diastolic left-ventricular function improved in combined therapy. Side effects observed in nifedipin-retard monotherapy got much more weaker when this drug combined with metoprolol. CONCLUSION: Combination of nifedipin-retard with metoprolol provides better clinical response and tolerance than monotherapy with nifedipin-retard.

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Blood pressure (BP) self-measurement (SM) is a promising method of investigation of patients with hypertension capable to provide information unobtainable neither with traditional office measurements nor with 24-hour BP monitoring. Advantages of BPSM are as follows: accessibility, low effect of anxiety on results of BP measurement; possibility of long-term monitoring of BP. Conditions which should be satisfied in order to realize these advantages include availability of individually selected measurement device, correct fulfillment of measurements, sufficient frequency of measurements, exact reporting of results to a physician. Besides inherent possibility of incorrect measurements BPSM has some other limitations - tendency to underestimation of real BP level and relatively low sensitivity in diagnosis of hypertension. At present BPSM can be used both for diagnosis of hypertension and for assessment of efficacy of antihypertensive therapy. Comparative value of BPSM and 24-hour blood pressure monitoring for clinical pharmacology deserves special investigation. In some difficult cases ('white coat hypertension', 'pseudoresistance to therapy') BPSM should apparently precede 24-hour BP monitoring.

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The influence of a long-term treatment with losartan (50-100 mg o.d.) and captopril (25-50 mg b.i.d.) followed by the abrupt therapy cessation was studied in an open randomized placebo-controlled parallel group trial. The study was performed on a group of 22 essential (soft to moderate) hypertensive male patients, which entered the trial when a mean daytime diastolic blood pressure was BP > or = 90 Torr. The antihypertensive effect of losartan was more pronounced and homogeneous than the effect of an equivalent dose of captopril. The group-average trough/peak ratios upon the losartan treatment were 61.5 and 61.3% for the systolic and diastolic BP (against 21.2 and 26.9% for captopril), respectively. At the same time, the smoothness index values of the patients treated with losartan and captopril showed no significant difference. Neither treatment with any of the two drugs nor the therapy cessation affected the circadian BP profile or the BP variability. The abrupt termination of the drug administration did not cause a withdrawal syndrome: on the contrary, a significant effect of the captopril and losartan treatment (statistically reliable against the placebo control) persisted for at least four days after the therapy cessation. Taking into account poor homogeneity of the antihypertensive effect of captopril in patients with a stable moderate hypertension treated b.i.d., the drug administration is recommended according to the t.i.d. schedule. In this group of patients, losartan and captopril are probably more expediently administered in combination with other hypertensive drugs.

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AIM: To investigate 24-h evenness of an antihypertensive effect of angiotensin II receptor blocker losartan vs captopril by four parameters of arterial pressure (AP) monitoring. MATERIAL AND METHODS: An open, cross-over, placebo-controlled trial was made in 22 patients with mild/moderate arterial hypertension (AH). Four parameters of AP monitoring were assessed: TPR, SI, rate of AP morning rise, index of AP morning rise. RESULTS: In losartan treatment TPR for systolic and diastolic AP were 61.5 and 61.3%, respectively, IS made up 0.74 +/- 0.13 and 0.64 +/- 0.09, respectively. For captopril these values reached 21.2 and 26.9%, 0.51 +/- 0.14 and 0.47 +/- 0.10, respectively. Differences by SI between the two drugs were statistically insignificant. Both drugs did not raise the rate and index of AP morning rise significantly. CONCLUSION: When administered in a single daily dose 100 mg, losartan produced a regular antihypertensive effect throughout 24 hours. Captopril (twice a day in a dose 50 mg) effect was not regular enough. This means that some patients need a three-times-a day regimen of captopril. Of the four parameters, SI is most informative for evaluation of antihypertensive effect evenness.

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AIM: To study hemodynamic effects of replacement hormone therapy (RHT) with trisecvens, beta-blocker betaksolol and their combination in perimenopausal and menopausal women with hypertension. MATERIAL AND METHODS: The study was made of 60 menopausal women aged 45-60 with mild and moderate arterial hypertension (AH). The women had no contraindications to either RHT or beta-blockers. They were randomized into three groups: group 1 received trisekvens, group 2--trisekvens plus betaksolol in a dose 10-20 mg/day, group 3--betaksolol. Arterial pressure (AP) and heart rate (HR) were measured before the treatment, in one month and each three months for a year. ECG and echo-CG were registered before treatment and each 3 months of the therapy. AP monitoring covered 50% of the patients of each group before the treatment and after 1 and 3 months of it. The data were analysed according to SAS system. RESULTS: Group 1 patients showed no significant changes in AP and HR. Group 2 and 3 patients' AP lowered, in group 2 the fall of systolic AP being more pronounced. 12-month therapy brought about a 10.3% decrease in left ventricular myocardial mass index in group 2. CONCLUSION: RHT with trisekvens in combination with beta-blocker in long-term use potentiates the effect on systolic AP and reduced hypertrophy of the left ventricle. RHT does not produce a significant effect on AP in women with AH recorded before the menopause.

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AIM: The study of hypotensive efficacy of high-cardioselective beta-blocker betaxolol, its effects on lipid and carbohydrate metabolism, menopausal syndrome in females with mild and moderate arterial hypertension. MATERIALS AND METHODS: 20 postmenopausal 45-59-year-old women entered the trial of betaxolol. They had diastolic blood pressure 90-114 mm Hg. Beta-blockers were not contraindicated. Arterial pressure, heart rate, body mass, blood lipid spectrum, glucose and insulin levels were evaluated before the treatment, 1, 3 and 6 months after it. RESULTS: Betaxolol safely and effectively lowered blood pressure. Blood lipid spectrum remained unchanged. A transitory rise in fasting insulin levels did not worsen glucose tolerance despite a small gain in body mass. Menopausal syndrome relieved due to good effect of betaxolol on vasomotor disorders. CONCLUSION: Betaxolol has a good hypotensive effect in the absence of adverse effects on lipid and carbohydrate metabolism. A reduction of menopausal syndrome was also achieved.

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The antihypertensive effect of daily doses of three beta-adrenoblockers (Bisoprolol, 10 mg once a day, propranolol, 80 mg twice a day, and methoprolol, 100 mg twice a day), and placebo was examined in 14 patients with persistent mild and moderate hypertension during a double blind cross-over study by using 24-hour monitoring of blood pressure and its routine measurements. The latter made by a mercury sphygmomanometer indicated that the antihypertensive and negative chronotropic effect of Bisoprolol in a dose of 10 mg remained 24 hours after its administration and it did not significantly differ from that of the two other agents given in the above doses. The application of 24-hour blood pressure monitoring allows a more pronounced antihypertensive effect of bisoprolol to be revealed during 24 hours than that displayed by the two agents. Bisoprolol is an effective and safe antihypertensive agent.

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