T.N. Timofeeva’s research while affiliated with Moscow Medical and other places

Aim. To study the incidence of arterial hypertension (AH) and to evaluate AH effects on morbidity and mortality levels, in the presence of associated clinical conditions (ACC), target organ damage (TOD), risk factors (RFs), and various social characteristics, among the nonorganized Bryansk Region population. Material and methods. The study included a representative population sample (n=2435), examined in 2004. Response rate was 83,6%; the age of the participants ranged from 19 to 64 years. Results. AH incidence in men and women reached, respectively, 36,63 and 36,8 per 1000 person-years. In total, 101 deaths were registered, with 45,6% represented by cardiovascular disease (CVD), and 29,7% by coronary heart disease (CHD). Among CVD deaths, 65,2% were coronary deaths. AH incidence was associated with age, hypercholesterolemia, alcohol consumption, heart rate (HR), various RF combinations, high normal blood pressure (BP), and place of residence. Mortality levels were significantly higher in AH patients with ACC, TOD, and RFs. The SCORE-assessed total CVD risk increased to high and very high levels in men aged over 50 years, while in women, moderate risk levels were reached only at the age of 60. Conclusion. Development and implementation of preventive AH programmes should incorporate the assessment of ACC, TAD, and RFs. Place of residence should also be taken into account, since the current epidemiological situation is worse among rural residents.

Aim. To assess the dynamics of arterial hypertension (AH) prevalence in the Russian population, patients' awareness, treatment with antihypertensive agents (AHA), treatment effectiveness, and the determinants of the latter. Material and methods. As a part of the Federal Target Programme "Prevention and treatment of arterial hypertension in the Russian Federation", four randomly selected population samples from various Russian regions were examined in 2003-2004, 2005-2006, 2007-2008, and 2009-2010. Results. In the Russian population, AH prevalence was 39,7%, being higher in women (40,5%) than in men (38,0%). No significant changes in AH prevalence were observed for the analysed period. Patients' awareness was 81,1% (82,9% in women vs. 77,9% in men). AHA therapy prevalence increased from 62,6 % to 66,1%. The most widely used AHA included ACE inhibitors, diuretics, and beta-adrenoblockers; old medications were taken by 17,7% of the patients only. Conclusion. AH prevalence in the Russian population was 39,7% and did not change over the recent years. However, there was an increase in the percentage of patients taking AHA, as well as in the percentage of women with effectively treated AH. In addition, the treatment with recommended AHA became more prevalent. Ineffective therapy was typically due to lower education level, alcohol abuse, or co-existing risk factors.

Aim. To study the dynamics of arterial hypertension (AH) epidemiology in urban and rural population of Bryansk Region, aged 19-64 years. To evaluate AH awareness, treatment, and control in the local healthcare settings. Material and methods. Random representative samples of the urban and rural Bryansk Region population - men and women aged 19-64 years - were selected. The study sample was constructed in three stages: selection of policlinics and central regional hospitals; selection of healthcare catchment areas; and selection of households (flats). At the first stage, a random urban and rural sample of 2345 people (response rate 78%) was examined; at the third stage, a sample of 1909 individuals (response rate >70%) was examined. The data were collected using a unified registration form (140-1/u). The study was performed as a part of the Target Federal Program, Ministry of Health. Results. In rural men and women, AH prevalence was 25,9% and 35,4%, while in their urban peers, it was 30% and 38,6%, respectively. The respective levels of AH awareness in urban and rural participants varied from 87,5% to 90,4%, and from 86,6% to 94,6%. In rural and urban samples, AH treatment percentages were 60,3%-76,8% and 77,5%-82,9%, respectively. Effective blood pressure control was achieved in 14,3%-13,8% and 10,1%-29,8% of rural and urban AH patients, respectively. The most popular antihypertensive medications were ACE inhibitors (59,0%-64,1%), diuretics (34,8%-37,0%), beta-adrenoblockers (12,8%-31,6%), and calcium antagonists (10,5%-12,4%). Conclusion. The urban population of Bryansk Region demonstrated higher levels of AH prevalence, awareness,. treatment, and especially control throughout the four-year follow-up period.

The authors assess relative risk (RR) of coronary heart disease (CHD), stroke (S), cardiovascular disease (CVD), and total mortality, according to smoking status, alcohol intake, and educational level in women. In ex-smokers and current smokers, mortality RR was significantly and dose-dependently increased. In occasional and low-dose drinkers, RR of CVD, CHID, and total mortality was reduced. At the same time, in moderate drinkers, RR was similar to that in frequent and high-dose drinkers. Mortality RR was inversely linked to educational level: in highly educated women, RR was substantially lower than in participants with lower educational levels.

The article is devoted to methodical recommendations on sample selection in regions with varying population size; representativeness assessment criteria; standard diagnostic methods for arterial hypertension (AH), risk factors, target organ status, and concomitant pathology; total cardiovascular risk assessment, as a part of the Target Federal Program << Arterial hypertension prevention and treatment in Russian Federation, 2002-2008 >>.

The paper contains data on prevalence of low, normal, excessive body mass and obesity among urban male populations aged 20-54 years in different regions. Relative risk of death associated with body mass was estimated on the basis of a twenty years prospective study of sample populations in Moskva and St-Peterburg and level of attributed risk was used for assessment of contribution of body mass to cardiovascular mortality and mortality from other chronic diseases. Levels of main risk factors, smoking intensity and alcohol consumption were studied in deciles of body mass index distribution.

Prevalence of hypertension among men aged 20-54 years in 17 cities of different regions was related to risk factors and ischemic heart disease mortality. The latter was recorded during the period of 6 years. Overall prevalence of hypertension was 33,6% however three groups of populations were distinguished: with low (25,2%), medium (33,7%) and high (44,8%) prevalence of hypertension. Body mass, age, alcohol, smoking, and dyslipoproteinemia contributed significantly to the prevalence of hypertension. Mortality increased with elevation of blood pressure. Relative risk of death was higher in populations with high and medium compared with low prevalence of hypertension.

Data of cross sectional and prospective epidemiological studies of men aged 40 - 59 years in Moscow and St.Petersburg were used for investigation of the relationship between alcoholic status and levels of systolic and diastolic blood pressure, excessive body mass, total cholesterol, triglycerides, high density lipoprotein cholesterol and smoking. Systolic and diastolic blood pressures, level of high density lipoprotein cholesterol and intensity of smoking rose with increase of alcohol consumption. Coronary, cardiovascular and total mortality were lower among those men who had consumed moderate amounts of alcohol during the week preceding the initial interview. Mortality rates were higher among abstainers and heavy drinkers and thus the mortality/alcohol consumption curve was "U"-shaped. Relative age-adjusted risk of coronary, cardiovascular, stroke and all-cause deaths was lower in all groups of drinkers compared to groups of nondrinkers.

The trends in prevalence of ischemic heart disease (IHD) and risk factors for 1985-1995 have been studied on random representative samples of male population from Moscow. For the decade studied IHD incidence increased, especially in younger males. Changes in IHD risk factors were the following: systolic and diastolic pressures were on the increase. HDLP cholesterol and total cholesterol in the blood lowered, total triglycerides were unchanged, incidence of smoking remained high.

Prevalence of ischemic heart disease, coronary risk factors, and nutritional habits in samples of urban aboriginal and migrant male populations in some geographical regions were correlated with postmortem extent of vascular atherosclerotic lesions. Nationality associated characteristics of development of atheroslerosis were revealed: in migrant compared to autochthon men higher risk factor profile and atherogenic diet corresponded to greater extent of vascular atherosclerosis and more pronounced lumen obstruction.