Search

Objective — to compare effects of spironolactone and moxonidine as the fourth component of the treatment of resistant hypertension (RT) on the stiffness of the main arteries. Materials and methods. We retrospectively selected 60 patients with resistant hypertension from the database of secondary and pulmonary hypertension, treated on the basis of M. D. Strazhesko Institute of Cardiology. From them, thirty patients who received spironolactone as the fourth component to the combination of three antihypertensive drugs after not reaching the target blood pressure (BP) level, were included in group C. The rest 30 patients who received moxonidine were assigned to group M. Patients with secondary hypertension were excluded from this study. In group C, the initial spironolactone dose was 25 mg per day, and it was increased up to 50 mg per day in 6 patients. In group M, the initial moxonidine dose was 0.2 mg twice daily, it was increased up to 0.4 mg twice daily in 16 patients and up to 0.6 mg twice daily in 3 patients. Patients in both groups were administered three‑component antihypertensive therapy with maximum doses in one tablet (renin‑angiotensin system blocker + calcium antagonist + diuretic). The degree of arterial stiffness was assessed by cardio‑ancle vascular index (CAVI). Results. During 12 months of follow‑up, spironolactone was discontinued in 3 (10 %) patients due to the development of side effects: 1 case of gynecomastia, 1 case of hyperkalemia and one case of severe diarrhea. In group M, drug withdrawal was registered in 4 patients (13 %, the difference with group C — not significant): 2 cases of severe drowsiness, 1 case of nausea with vomiting and 1 case — dizziness without hypotension. Therefore, 27 patients from group C and 26 patients from group M were included in the final data analysis. In group C, the values of office SBP significantly decreased from 149.3 ± 6.5 to 127.4 ± 5.5 after 3 months and 124.3 ± 4.3 mm Hg after 12 months (p 0.05) and on the left — 9.2 ± 1.6 and 9, 3 ± 1.6 (p > 0.05). However, the CAVI value after 12 months significantly decreased in group C from 9.5 ± 1.2 at baseline to 8.6 ± 1.2 after 12 months (p 0.05). Conclusions. Treatment with spironolactone, used as the fourth component of resistant hypertension therapy, significantly reduced the arteries stiffness as evidenced by the CAVI index, and promoted a significant regression of left ventricular hypertrophy.

Ganna D Radchenko, Yuriy M Sirenko Department of Symptomatic Hypertension, “National Scientific Center “The M.D. Strazhesko Institute of Cardiology”” of National Academy of Medical Science, Kyiv, UkraineCorrespondence: Ganna D RadchenkoDepartment of Symptomatic Hypertension, “National Scientific Center “The M.D. Strazhesko Institute of Cardiology”” of National Academy of Medical Science, 5, Narodnogo Opolchenia Str, Kyiv, 03680, UkraineTel +380 667128405Email rganna@bigmir.netBackground: In a previous study, the cardio-ankle vascular index (CAVI) was increased significantly in idiopathic pulmonary arterial hypertension (IPAH) patients compared to the healthy group and did not much differ from one in systemic hypertensives. In this study the relations between survival and CAVI was evaluated in patients with IPAH.Patients and Methods: We included 89 patients with new-diagnosed IPAH without concomitant diseases. Standard examinations, including right heart catheterization (RHC) and systemic arterial stiffness evaluation, were performed. All patients were divided according to CAVI value: the group with CAVI ≥ 8 (n = 18) and the group with CAVI < 8 (n = 71). The mean follow-up was 33.8 ± 23.7 months. Kaplan–Meier and Cox regression analysis were performed for the evaluation of our cohort survival and the predictors of death.Results: The group with CAVI≥ 8 was older and more severe compared to the group with CAVI< 8. Patients with CAVI≥ 8 had significantly reduced end-diastolic (73.79± 18.94 vs 87.35± 16.69 mL, P< 0.009) and end-systolic (25.71± 9.56 vs 33.55± 10.33 mL, P< 0.01) volumes of the left ventricle, the higher right ventricle thickness (0.77± 0.12 vs 0.62± 0.20 mm, P < 0.006), and the lower TAPSE (13.38± 2.15 vs 15.98± 4.4 mm, P< 0.018). RHC data did not differ significantly between groups, except the higher level of the right atrial pressure in patients with CAVI≥ 8– 11.38± 7.1 vs 8.76± 4.7 mmHg, P< 0.08. The estimated overall survival rate was 61.2%. The CAVI≥ 8 increased the risk of mortality 2.34 times (CI 1.04– 5.28, P = 0.041). The estimated Kaplan–Meier survival in the patients with CAVI ≥ 8 was only 46.7 ± 7.18% compared to patients with CAVI < 8 - 65.6 ± 4.2%, P = 0.035. At multifactorial regression analysis, the CAVI reduced but saved its relevance as death predictor - OR = 1.13, CI 1.001– 1.871.Summary: We suggested the CAVI could be a new independent predictor of death in the IPAH population and could be used to better risk stratify this patient population if CAVI is validated as a marker in a larger multicenter trial.Keywords: idiopathic pulmonary arterial hypertension, systemic arterial stiffness, pulse wave velocity, cardio-ankle vascular index, survival

Contains fulltext : 286841.pdf (Publisher’s version ) (Closed access) BACKGROUND: Resistant hypertension is associated with increased cardiovascular risk. The endothelin pathway has been implicated in the pathogenesis of hypertension, but it is currently not targeted therapeutically, thereby leaving this relevant pathophysiological pathway unopposed with currently available drugs. The aim of the study was to assess the blood pressure lowering efficacy of the dual endothelin antagonist aprocitentan in patients with resistant hypertension. METHODS: PRECISION was a multicentre, blinded, randomised, parallel-group, phase 3 study, which was done in hospitals or research centres in Europe, North America, Asia, and Australia. Patients were eligible for randomisation if their sitting systolic blood pressure was 140 mm Hg or higher despite taking standardised background therapy consisting of three antihypertensive drugs, including a diuretic. The study consisted of three sequential parts: part 1 was the 4-week double-blind, randomised, and placebo-controlled part, in which patients received aprocitentan 12·5 mg, aprocitentan 25 mg, or placebo in a 1:1:1 ratio; part 2 was a 32-week single (patient)-blind part, in which all patients received aprocitentan 25 mg; and part 3 was a 12-week double-blind, randomised, and placebo-controlled withdrawal part, in which patients were re-randomised to aprocitentan 25 mg or placebo in a 1:1 ratio. The primary and key secondary endpoints were changes in unattended office systolic blood pressure from baseline to week 4 and from withdrawal baseline to week 40, respectively. Secondary endpoints included 24-h ambulatory blood pressure changes. The study is registered on ClinicalTrials.gov, NCT03541174. FINDINGS: The PRECISION study was done from June 18, 2018, to April 25, 2022. 1965 individuals were screened and 730 were randomly assigned. Of these 730 patients, 704 (96%) completed part 1 of the study; of these, 613 (87%) completed part 2 and, of these, 577 (94%) completed part 3 of the study. The least square mean (SE) change in office systolic blood pressure at 4 weeks was -15·3 (SE 0·9) mm Hg for aprocitentan 12·5 mg, -15·2 (0·9) mm Hg for aprocitentan 25 mg, and -11·5 (0·9) mm Hg for placebo, for a difference versus placebo of -3·8 (1·3) mm Hg (97·5% CI -6·8 to -0·8, p=0·0042) and -3·7 (1·3) mm Hg (-6·7 to -0·8; p=0·0046), respectively. The respective difference for 24 h ambulatory systolic blood pressure was -4·2 mm Hg (95% CI -6·2 to -2·1) and -5·9 mm Hg (-7·9 to -3·8). After 4 weeks of withdrawal, office systolic blood pressure significantly increased with placebo versus aprocitentan (5·8 mm Hg, 95% CI 3·7 to 7·9, p

Objective We suggested: 1) patients with idiopathic pulmonary hypertension (IPAH) have active factors which could damage not only the pulmonary but systemic arteries too as in arterial hypertensive patients; 2) if these changes were present, they might correlate with other parameters influencing on the prognosis. This study is the first attempt to use cardio-ankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH. Methods A total of 112 patients were included in the study: group 1 consisted of 45 patients with new diagnosed IPAH, group 2 included 32 patients with arterial hypertension, and in the control group were 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe; segment carotid-femoral arteries) and muscular artery stiffness (PWVm; segment carotid-radial arteries), CAVI, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI. Results The groups were adjusted for principal characteristics influenced on arterial stiffness. IPAH patients had significantly (P 8.0 at right and/or left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (β=1.104, P=0.008, CI 1.026-1.189) and TAPSE (β=0.66, P=0.016, CI 0.474-0.925). Conclusion In spite of equal and at normal range BP level, the age-adjusted patients with IPAH had significantly stiffer arteries than the healthy persons and they were comparable with the arterial hypertensive patients. Arterial stiffness evaluated by CAVI correlated with age and TAPSE in IPAH patients. Based on our results it is impossible to conclude the pathogenesis of arterial stiffening in IPAH patients, but the discovered changes and correlations suggest new directions for further studies, including pathogenesis and prognosis researches.

The aim was to assess the arterial stiffness changes in patients with resistant arterial hypertension (AH) and obstructive sleep apnea (OSA) and possibilities of its correction by continuous positive airway pressure (CPAP)-therapy. Design: In 10 month follow-up study were included 46 patients with RAH, who were divided into groups: 1-st - patients with RAH and moderate to severe OSA on CPAP (n=21); 2-nd - patients with RAH and moderate to severe OSA without CPAP (n=25). They underwent somnography by dual-channel portable monitor device, office and ambulatory blood pressure monitoring, echocardiography and applanation tonometry. All patients received similar antihypertensive therapy according to 2013 ESH Guidelines for the management of arterial hypertension. Results: Patients with RAH and OSA (mean apnea-hypopnea index (AHI) 36.5±2.7 event h-1) in comparison with patients with RAH without OSA (mean AHI 3.4±0.2 event h-1) had significantly higher body mass index (34.2±0.7 vs 31.6±0.7 kg m-2, P Conclusion: The combination of therapy continuous positive airway pressure with antihypertensive treatment in patients with resistant arterial hypertension and moderate to severe obstructive sleep apnea improved achievement of target blood pressure, decreased arterial stiffness and decreased central blood pressure.

the ability and advances of analytical regularization technique – that is already half of a century the trademark of Radiophysical school of IRE NAS of Ukraine- are demonstrated for solving the most advanced problems of the modern electromagnetics.

Background and aim: The aim of the study was to establish the effect of valsartan and combination of valsartan and hydrochlorothiazide (HCTZ) on pulse wave velocity (PWV) and central blood pressure (CBP) in a large population of patients with mild to moderate arterial hypertension. Methods: This was an international, multicentre, open-label, prospective trial. After one week of washout in previously treated patients, 74 subjects were treated with valsartan or valsartan combined with HCTZ for 16 weeks according to the protocol. Naive patients received the treatment immediately. During the active treatment, four visits were planned for each patient to obtain data for the primary and secondary efficacy. At the beginning and at the end of the study PWV and CBP were determined with central arterial pressure waveform analysis (SphygmoCor ® , Atcor Medical). This study is registered with clinicaltrialsregister.eu, EudraCT number 2012-005129-57. Results: The results of the present VICTORY trial showed that valsartan and combination of valsartan and HCTZ effectively reduced the brachial blood pressure in patients with mild to moderate arterial hypertension as well as PWV, central systolic blood pressure and central diastolic blood pressure. The effects on the augmentation index were not statistically significant. Conclusions: Valsartan and valsartan/HCTZ improve arterial stiffness in patients with mild to moderate hypertension.

A discontinuous Galerkin time-domain method (DGTD) enhanced with exact absorbing boundary conditions (EACs) for characterizing transient electromagnetic interactions on periodic three-dimensional (3-D) gratings is proposed. The EACs are derived rigorously and discretized using a high-order scheme in space and time. The periodic boundary conditions (PBCs) under oblique incidence are also discussed. Implementation of the EACs and PBCs within the DGTD framework is described in detail. Numerical results demonstrate that the accuracy of the discretized EACs matches to that of the discretized Maxwell equations. Additionally, the accuracy and efficiency of the DGTD with the EACs are found to be superior to that of the same DGTD with the perfectly matched layers or approximate absorbing boundary conditions.

Background and aim: The aim of the trial was to establish the efficacy and safety of Valsacor ® (valsartan) and Valsacombi ® (combination of valsartan and hydrochlorothiazide) in a wide variety of patient populations with mild to moderate arterial hypertension. Methods: We performed an international, multicentre, open-label, prospective trial. After one week of washout in previously treated patients, the patients were treated for 16 weeks according to the protocol. Naive patients entered the treatment period immediately. During the active treatment, four visits were planned for each patient to obtain the data for the primary and secondary efficacy endpoints analysis. The principal methods were blood pressure (BP) measurement, additionally in a subgroup of patients, assessment of erectile function. The initial dosage of valsartan 80 mg/day was titrated up to 320 mg/day to achieve the BP goal, with the addition of hydrochlorothiazide (HCTZ) in a fixed-dose combination (FDC), if needed. Results: Mean ± standard deviation changes from baseline at week 16 were –26.6 ± 10.4 mm Hg (systolic BP) and –14.8 ± 7.6 mm Hg (diastolic BP). A total of 91% of the patients treated with either valsartan or valsartan FDC achieved the BP goal. Adverse reactions were experienced by 7.1% of the patients, with the most common being headache (1.9%), palpitation (1.6%), dizziness (1.6%), and fatigue (1.6%), during the whole trial. Conclusions: The results of the VICTORY trial show that valsartan and valsartan FDC effectively reduce the BP in patients with mild to moderate arterial hypertension and have a good tolerability profile.

Aim: To evaluate the characteristics of patients with resistant arterial hypertension (RAH) and assessed the prevalence of true resistant hypertension in patients who takes 3 and more antihypertensive agents. Materials and methods: The study included 1146 patients with AH who received 3 or more antihypertensive drugs. The average level of systolic (SBP) / diastolic (DBP) blood pressure was (174,60 ± 0,64) / (100,50 ± 0,38) mm Hg. Results: Our data showed that in patients who received 3 or more drugs in (31%) goal blood pressure was not reached, it means true resistant hypertension. 3 drugs were received (51.4%) patients, 4 drugs - (37.1%), 5 drugs - (9.1%), and 6 drugs - (2.4%) of patients. ACE inhibitors were prescribed in 65.5%, calcium antagonists - in 69.9%, diuretics - in 91.8%. Beta-blockers - 75.5%, AT II blockers - 33.5%, aldosterone receptor blockers - 12.8%. Fixed combinations - 71.9%. Patients who did not achieve targeted SBP (31%) had higher cortisol (155.0 ± 44.0 vs 35.9 ± 20.8 ng/l), left ventricular mass index (147.5 ± 3.46 vs 135.3 ± 1.74 g/m 2 ), obesity (42.9% vs 37.5%), kidney abnormality (2.7% vs 0.8%), nephropathy (1.3% vs 0.2%), and heart failure (16.9% vs 8.5%). Patients taking 4 and more drugs had higher glucose levels - (6.20 ± 0.09) mmol/l vs (5.90 ± 0.14) mmol/l (p Conclusion: patients who received 3 or more antihypertensive drugs in 31% had true resistant hypertension. They had higher blood cortisol level, left ventricular mass index, obesity, kidney abnormality and more often heart failure.

The aims of the study were: (1) to evaluate the Ukrainian reality of survival in patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH); and (2) to determine predictors of death. A total of 281 patients were enrolled (52 [18.5%] with CTEPH, 229 [81.5%] with PAH). Long-term survival (Kaplan–Meier) and its predictors (Stepwise binary logistic regression and Cox's proportional hazards analyses) were evaluated in adult patients with PH (diagnosed by right heart catheterization [RHC]) within a prospective registry at a single referral center in Kyiv, Ukraine. Follow-up period was up to 51 months. The Kaplan–Meier survival rate for the total cohort was 93.3%, 86.8%, and 81.5% at one, two, and three years, respectively. Survival was better in patients with congenital heart diseases (CHD) in comparison with idiopathic PAH (long rank P = 0.002), connective tissue diseases (CTD; long rank P = 0.001) and CTEPH (long rank P = 0.04). Univariate Cox's predictors of death were: functional class IV (odds ratio [OR] = 4.94; 95% confidence interval [CI] = 2.12–11.48), presence of ascites (OR = 4.52; 95% CI = 2.21–9.24), PAH-CTD (OR = 3.07; 95% CI = 1.07–8.87), PAH-CHD (OR = 0.28; 95% CI = 0.11–0.68), HR on treatment > 105 beats per min (OR = 7.85; 95% CI = 1.83–33.69), office systolic BP 300 pg/mL (OR = 4.98; 95% CI = 1.49–16.6), right atrium square > 22 cm 2 (OR = 14.2; 95% CI = 1.92–104.89), right ventricular square in diastole (OR = 1.08; 95% CI = 1.03–1.14), right ventricular square in systole (OR = 1.08; 95% CI = 1.02–1.11), mean pressure in right atrium per each 1-mmHg increase (OR = 1.02; 95% CI = 1.02–1.19). In multivariate Cox regression analyses only presence of ascites, office systolic BP 300 pg/mL were associated with survival.

Ganna D Radchenko, Liliya O Mushtenko, Yuriy M Sirenko State Institute “National Scientific Center “Institute of Cardiology named after acad.M.Strazhesko” of Ukrainian National Academy of Medical Science, Kyiv, Ukraine Background: The EPHES trial (Evaluation of influence of fixed dose combination Perindopril/amlodipine on target organ damage in patients with arterial HypErtension with or without iSchemic heart disease) compared the dynamics of target organ damage (TOD) in hypertensive patients with and without ischemic heart disease (IHD) treated with the fixed-dose combination (FDC) perindopril + amlodipine. Methods: The analysis included 60 hypertensive patients (aged >30 years): 30 without IHD and 30 with IHD. At randomization, FDC was administered at a daily baseline dose of 5/5 mg with uptitration to 10/10 mg every two weeks. If target blood pressure (BP

G D Radchenko,O O Torbas,Yu M Sirenko State Institute National Scientific Center, M.D. Strazhesko Institute of Cardiology, National Academy of Medical Science, Kyiv, Ukraine Objective: According to the European Society of Cardiology/European Society of Hypertension 2013 guidelines, evaluation of aortic blood pressure (BP) is needed in young with isolated systolic hypertension (ISH), but using special devices is not common, especially in Ukraine, where only a few centers have these devices. The purpose of our study was to identify the simple clinical predictors for differentiation (with or without elevated aortic systolic BP [SBP]) of the young with ISH without the need for further extensive work-up. Patients and methods: The study included 44 young men (mean age: 32.2±1.3years) with office SBP ≥140mmHg and office diastolic BP (DBP)

This article is devoted to the theoretical and experimental study of diffraction radiation effects. Diffraction radiation is generated by the scattering of an eigenfield of densitymodulated electron beam or a surface eigenwave of open dielectric waveguide on a nearby periodic structure. For the first time, these effects were studied using rigorous models exploiting exact absorbing conditions (EACs). This article also details the design and experimental testing of radiating elements for planar diffraction antennas with extremely low sidelobe levels, which exploit diffraction radiation effects.

International audience; OBJECTIVE:The aim of the Advanced Approach to Arterial Stiffness study was to compare arterial stiffness measured simultaneously with two different methods in different age groups of middle-aged and older adults with or without metabolic syndrome (MetS). The specific effects of the different MetS components on arterial stiffness were also studied.METHODS:This prospective, multicentre, international study included 2224 patients aged 40 years and older, 1664 with and 560 without MetS. Patients were enrolled in 32 centres from 18 European countries affiliated to the International Society of Vascular Health & Aging. Arterial stiffness was evaluated using the cardio-ankle vascular index (CAVI) and the carotid-femoral pulse wave velocity (CF-PWV) in four prespecified age groups: 40-49, 50-59, 60-74, 75-90 years. In this report, we present the baseline data of this study.RESULTS:Both CF-PWV and CAVI increased with age, with a higher correlation coefficient for CAVI (comparison of coefficients P

OBJECTIVE:: To evaluate perindopril 3.5mg/amlodipine 2.5mg once daily, a novel fixed-dose combination adapted for first-step treatment in patients with hypertension. This fixed dose had to be equivalent to amlodipine 5mg in terms of blood pressure efficacy, but with an expected better tolerability profile. We selected two drugs with complementary modes of action, with doses chosen so that each drug would contribute similarly to the overall blood pressure-lowering effect METHODS:: An international, randomized, double-blind, placebo-controlled study with six equal parallel treatment arms and an 8-week randomized treatment period, whose design, clinical significance and non-inferiority criteria were in accordance with European guidelines. RESULTS:: In all, 1581 patients with mild-to-moderate uncomplicated hypertension (mean age 51.7 years) were randomized and 94.7% completed the study. The combination was statistically and clinically superior to placebo (between-group differences: SBP: -7.22mmHg, DBP: -4.12mmHg, P

Several lines of research indicate that statins can lower blood pressure (BP) independently of their lipid-lowering effects when used as monotherapy and in combination with antihypertensive agents. This short-term, open-label study examined whether statin therapy had a synergistic effect on the BP-lowering efficacy of perindopril/amlodipine in a subgroup of patients in the PERSPECTIVA study with concomitant hypertension and hypercholesterolemia, with or without statin at baseline. The PERSPECTIVA study recruited 732 adults with untreated or uncontrolled hypertension. This subgroup analysis of PERSPECTIVA included 587 patients with concomitant hypertension and hypercholesterolemia (mean age 56.7 years) of whom 226 were receiving a statin at baseline (statin [+] group) and 361 were not (statin [−] group). All patients received treatment with single-pill combination perindopril/amlodipine at a dose of 5/5, 10/5 or 10/10 mg/day. The study duration was 60 days with follow-up visits for BP monitoring at 7, 15, 30 and 60 days. At day 60, BP control (

A b s t r ac t Background To assess potentially elevated cardiovascular risk related to new antihyperglycemic drugs in patients with type 2 diabetes, regulatory agencies require a comprehensive evaluation of the cardiovascular safety profile of new antidiabetic therapies. We assessed cardiovascular outcomes with alogliptin, a new inhibitor of dipeptidyl peptidase 4 (DPP-4), as compared with placebo in patients with type 2 diabetes who had had a recent acute coronary syndrome. Methods We randomly assigned patients with type 2 diabetes and either an acute myocardial infarction or unstable angina requiring hospitalization within the previous 15 to 90 days to receive alogliptin or placebo in addition to existing antihyperglycemic and cardiovascular drug therapy. The study design was a double-blind, noninferiority trial with a prespecified noninferiority margin of 1.3 for the hazard ratio for the primary end point of a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Results A total of 5380 patients underwent randomization and were followed for up to 40 months (median, 18 months). A primary end-point event occurred in 305 patients assigned to alogliptin (11.3%) and in 316 patients assigned to placebo (11.8%) (hazard ratio, 0.96; upper boundary of the one-sided repeated confidence interval, 1.16; P

The authors expound the method of exact absorbing boundary conditions, which solves one of the most important theoretical problems in computational electrodynamics, namely, the problem of equivalent replacement of an open (with infinite domain of analysis) initial boundary value problem by a closed (with bounded computation domain) one. This method, being mathematically strict, allows proper formulation and numerical study of transient and steady-state processes in various open resonant systems. The authors present local (in space and time) and non-local exact absorbing conditions for virtual boundaries located in cross-sections of regular waveguides or in free space. The elaborated concept of the so-called virtual feeding waveguides allows to solve many practically interesting radiation problems. The approach outlined in this chapter was implemented in software for solving both scalar (plane and axially symmetric) and vector problems.

In this chapter, authors construct the dyadic Green’s function for a biaxial anisotropic media. Among the obtained analytical results, worthy of mention are the representation of the singular part of the Green’s function in an explicit form and the representation of its regular part in the form of a relatively simple double integral over a limited region. These results are aimed at developing efficient numerical algorithms and asymptotic representations in the problems of wave scattering in anisotropic media.

The chapter discusses practically realizable algorithms of model synthesis of direct-flow compressors built on the basis of rectangular, circular or coaxial waveguides. Resonance and distributed switches have been designed to ensure effective energy accumulation and release into output waveguides or free space. The authors dwell on peculiarities of radiation of high-power short pulses by simple monopole antennas with coaxial feeding waveguides. They also design a novel phased antenna array, whose each radiating element is an active compressor. Particular attention is given to the study of such physical processes in compressors as energy accumulation, switching from the accumulation mode into the mode of energy release, and radiation of short high-power pulses into free space.

The chapter is devoted to the problems of analysis and applied usage of the diffraction radiation phenomena, which are exploited in antennas and generators for millimeter and submillimeter waves. The diffraction radiation occurs when surface waves of open waveguides or eigenfields of charged-particle beams are transformed by periodic gratings into radiated fields. Main properties of the diffraction radiation phenomena have been studied using the given-current approximation and rigorous methods taking into account actual size of devices exploiting the phenomena. The algorithm of experimental synthesis of planar diffraction antennas with record-breaking low side lobes level has been developed and applied to design a real-world device.

A novel formulation of the problem of wave diffraction by abrupt and volume discontinuities in a waveguide is presented in this chapter. In the context of this formulation, the authors succeeded in solving a number of the long-discussed problems concerning mathematical properties of matrix models of the mode-matching technique. In particular, they rigorously justified the possibility to use the truncation technique, unconditionally converging in the norm of a space of infinite sequences, for numerical implementation of the developed matrix models. The operator-matrix analysis of the mode-matching technique has shown that the proposed approach leads to the operator Fresnel formulas, which generalize properly the well-known Fresnel formulas to the scattering operators.

Proper design of e-cient microwave energy compressors requires precise understanding of the physics pertinent to energy accumulation and exhaust processes in resonant waveguide cavities. In this paper, practically for the flrst time these highly non-monotonic transient processes are studied in detail using a rigorous time-domain approach. Additionally, in∞uence of the geometrical design and excitation parameters on the compressor's performance is quantifled in detail.

BACKGROUND AND OBJECTIVES:: It is well established by a large number of randomized controlled trials that lowering blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) by drugs are powerful means to reduce stroke incidence, but the optimal BP and LDL-C levels to be achieved are largely uncertain. Concerning BP targets, two hypotheses are being confronted: first, the lower the BP, the better the treatment outcome, and second, the hypothesis that too low BP values are accompanied by a lower benefit and even higher risk. It is also unknown whether BP lowering and LDL-C lowering have additive beneficial effects for the primary and secondary prevention of stroke, and whether these treatments can prevent cognitive decline after stroke. RESULTS:: A review of existing data from randomized controlled trials confirms that solid evidence on optimal BP and LDL-C targets is missing, possible interactions between BP and LDL-C lowering treatments have never been directly investigated, and evidence in favour of a beneficial effect of BP or LDL-C lowering on cognitive decline is, at best, very weak. CONCLUSION:: A new, large randomized controlled trial is needed to determine the optimal level of BP and LDL-C for the prevention of recurrent stroke and cognitive decline.

BACKGROUND AND OBJECTIVES:: The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design. PROTOCOL DESIGN:: The European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment trial is a prospective multinational, randomized trial with a 3×2 factorial design comparing: three different SBP targets (1

ABCD : Appropriate Blood pressure Control in Diabetes ABI : ankle–brachial index ABPM : ambulatory blood pressure monitoring ACCESS : Acute Candesartan Cilexetil Therapy in Stroke Survival ACCOMPLISH : Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension ACCORD : Action to Control Cardiovascular Risk in Diabetes ACE : angiotensin-converting enzyme ACTIVE I : Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events ADVANCE : Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation AHEAD : Action for HEAlth in Diabetes ALLHAT : Antihypertensive and Lipid-Lowering Treatment to Prevent Heart ATtack ALTITUDE : ALiskiren Trial In Type 2 Diabetes Using Cardio-renal Endpoints ANTIPAF : ANgioTensin II Antagonist In Paroxysmal Atrial Fibrillation APOLLO : A Randomized Controlled Trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly People ARB : angiotensin receptor blocker ARIC : Atherosclerosis Risk In Communities ARR : aldosterone renin ratio ASCOT : Anglo-Scandinavian Cardiac Outcomes Trial ASCOT-LLA : Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm ASTRAL : Angioplasty and STenting for Renal Artery Lesions A-V : atrioventricular BB : beta-blocker BMI : body mass index BP : blood pressure BSA : body surface area CA : calcium antagonist CABG : coronary artery bypass graft CAPPP : CAPtopril Prevention Project CAPRAF : CAndesartan in the Prevention of Relapsing Atrial Fibrillation CHD : coronary heart disease CHHIPS : Controlling Hypertension and Hypertension Immediately Post-Stroke CKD : chronic kidney disease CKD-EPI : Chronic Kidney Disease—EPIdemiology collaboration CONVINCE : Controlled ONset Verapamil INvestigation of CV Endpoints CT : computed tomography CV : cardiovascular CVD : cardiovascular disease D : diuretic DASH : Dietary Approaches to Stop Hypertension DBP : diastolic blood pressure DCCT : Diabetes Control and Complications Study DIRECT : DIabetic REtinopathy Candesartan Trials DM : diabetes mellitus DPP-4 : dipeptidyl peptidase 4 EAS : European Atherosclerosis Society EASD : European Association for the Study of Diabetes ECG : electrocardiogram EF : ejection fraction eGFR : estimated glomerular filtration rate ELSA : European Lacidipine Study on Atherosclerosis ESC : European Society of Cardiology ESH : European Society of Hypertension ESRD : end-stage renal disease EXPLOR : Amlodipine–Valsartan Combination Decreases Central Systolic Blood Pressure more Effectively than the Amlodipine–Atenolol Combination FDA : U.S. Food and Drug Administration FEVER : Felodipine EVent Reduction study GISSI-AF : Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico-Atrial Fibrillation HbA1c : glycated haemoglobin HBPM : home blood pressure monitoring HOPE : Heart Outcomes Prevention Evaluation HOT : Hypertension Optimal Treatment HRT : hormone replacement therapy HT : hypertension HYVET : HYpertension in the Very Elderly Trial IMT : intima-media thickness I-PRESERVE : Irbesartan in Heart Failure with Preserved Systolic Function INTERHEART : Effect of Potentially Modifiable Risk Factors associated with Myocardial Infarction in 52 Countries INVEST : INternational VErapamil SR/T Trandolapril ISH : Isolated systolic hypertension JNC : Joint National Committee JUPITER : Justification for the Use of Statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin LAVi : left atrial volume index LIFE : Losartan Intervention For Endpoint Reduction in Hypertensives LV : left ventricle/left ventricular LVH : left ventricular hypertrophy LVM : left ventricular mass MDRD : Modification of Diet in Renal Disease MRFIT : Multiple Risk Factor Intervention Trial MRI : magnetic resonance imaging NORDIL : The Nordic Diltiazem Intervention study OC : oral contraceptive OD : organ damage ONTARGET : ONgoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial PAD : peripheral artery disease PATHS : Prevention And Treatment of Hypertension Study PCI : percutaneous coronary intervention PPAR : peroxisome proliferator-activated receptor PREVEND : Prevention of REnal and Vascular ENdstage Disease PROFESS : Prevention Regimen for Effectively Avoiding Secondary Strokes PROGRESS : Perindopril Protection Against Recurrent Stroke Study PWV : pulse wave velocity QALY : Quality adjusted life years RAA : renin-angiotensin-aldosterone RAS : renin-angiotensin system RCT : randomized controlled trials RF : risk factor ROADMAP : Randomized Olmesartan And Diabetes MicroAlbuminuria Prevention SBP : systolic blood pressure SCAST : Angiotensin-Receptor Blocker Candesartan for Treatment of Acute STroke SCOPE : Study on COgnition and Prognosis in the Elderly SCORE : Systematic COronary Risk Evaluation SHEP : Systolic Hypertension in the Elderly Program STOP : Swedish Trials in Old Patients with Hypertension STOP-2 : The second Swedish Trial in Old Patients with Hypertension SYSTCHINA : SYSTolic Hypertension in the Elderly: Chinese trial SYSTEUR : SYSTolic Hypertension in Europe TIA : transient ischaemic attack TOHP : Trials Of Hypertension Prevention TRANSCEND : Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease UKPDS : United Kingdom Prospective Diabetes Study VADT : Veterans' Affairs Diabetes Trial VALUE : Valsartan Antihypertensive Long-term Use Evaluation WHO : World Health Organization ### 1.1 Principles The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology …