Vol 17, No 5 (2015)

The article deals with the examination of the role and main indications of 24-hour blood pressure (BP) monitoring according to recommendations concerning the current diagnosis and treatment of arterial hypertension (AH). We indicate the main parameters of 24-hour blood pressure monitoring method. Currently, on the evaluating the efficacy of antihypertensive therapy one should take into account not only the measurement of office BP parameters but also the impact of the drug on the level of mean systolic and diastolic daytime and night-time BP. We study the literature data on the predictive value of circadian rhythm of BP disoders. We mark the prevalence of different types of circadian profile of BP. We underline that, according to the predictive value of lack of nocturnal BP fall, it is very important to take into account the very high prevalence of this phenomenon among patients with AH, and in case of antihypertensive drugs selection one should take into account the effect on the BP level in non-dippers. We analyze the literature data on the efficacy of new drug from angiotensin II receptor blockers (ARBs) - azilsartan medoxomil, registered in the Russian Federation in 2014, for the application in case of circadian rhythm of BP disoders. It is found that this drug has the advantage in comparison with the other members of the ARBs class (valsartan, olmesartan) in the form of strong power antihypertensive effect in a 24-h period according to the 24-hour blood pressure monitoring results.

The article describes the basic principles of pharmacotherapy in case of hypertensive crisis from the position of the last foreign and domestic clinical recommendations and individualization of fast-acting antihypertensive drugs. We discuss the management of complicated or uncomplicated hypertensive crisis, arresting the crisis in pregnant women and people who use psychoactive substances.

The article deals with the application of loop diuretics in patients with compensated heart failure - the patients without the signs of fluid retention, when diuretics application doesn't seem undoubted as in case of patients with edema syndrome. We discussed the mechanisms of formation of left ventricular filling high pressure in these patients; the possibility of filling pressure correction and, consequently, the improvement of the functional status of patients using loop diuretics; the advantages of using these loop diuretics under such conditions with additional antifibrotic characteristics of torsemide in comparison with other loop diuretics, as well as with thiazide diuretics.

Discussed key issues of the treatment of atrial fibrillation (AF), including antithrombotic therapy and i pharmacological cardioversion of paroxysms of AF using tactics "pill in the pocket" on a specific clinical case. Despite the compelling data from clinical trials, the tactics "pill in the pocket" with propafenone is rarely used. Proposed protocol for interruption paroxysm of AF for use in the outpatient setting.

Venous thromboembolism is a common serious condition associated with high morbidity and mortality. Currently developing endovascular treatment approaches are effective and safe alternative to the standard conservative therapy. There is a great need to develop the early thrombus removal endovascular methods in our country, which would improve the prognosis and reduce mortality in patients with severe massive pulmonary embolism and deep vein thrombosis.

The review shows the characteristics of heterogeneous group of drugs - calcium channel blockers and, in particular, diltiazem. We indicate the basic mechanisms of action of calcium channel blockers, as well as the safety and efficacy of their usage in case of different cardiovascular diseases.

The effective therapy of diabetes mellitus is impossible without active participation of the patient. And it is very important for the patients to be appropriately trained to control the disease and they should have at their disposal modern glucometers, which are in compliance with international standards and easy in management. Changes of the last version of national recommendations indicate the importance of self-monitoring in the disease control. This article reflects the current accuracy requirements for devices for analyzing blood glucose data.

Practical use of 3D and 4D Echocardiography is discussed in the article. Interesting clinical cases are illustrated the main principles of using of this technologies in Echocardiography. Current value and potential advantages of 3D and 4D Echocardiography in clinical practice are shown as well.