Vol 17, No 10 (2015)


Arterial hypertension and the kidney

Chikhladze N.M., Chazova I.E.


Rterial hypertension (AH) can be a cause and consequence of kidney pathology. The article deals with the characteristics of kidney pathology in case of hypertensive disease, as well as with the clinical course, diagnosis and approaches for treating secondary forms of AH associated with kidney disease. We showed the modern understanding of chronic kidney disease associated with AH and the risk of cardiovascular complications.
Consilium Medicum. 2015;17(10):8-12
pages 8-12 views

Combined therapy in hypertension: a new fixed-dose combination of angiotensin II receptor blockers and diuretics (azilsartan medoxomil and chlorthalidone)

Ostroumova O.D., Fomina V.M.


The article deals with the different aspects of the combined therapy in arterial hypertension. We discuss complementary effects and advantage of combination of angiotensin II receptor blockers (ARBs) and diuretic; describe clinical setting where the usage of that combination is preferred. We have been analyzing in detail, the available literature data concerning efficacy, including comparative efficacy, and safety of using combination of azilsartan and chlorthalidone. We underline the advantages of azilsartan among ARBs class and chlorthalidone among diuretics.
Consilium Medicum. 2015;17(10):13-18
pages 13-18 views

The influence of fixed-dose combination of amlodipine and bisoprolol on vascular elasticity in patients with arterial hypertension

Nedogoda S.V., Salasiuk A.S., Tsoma V.V., Chumachek E.V.


The aim of the study is to evaluate antihypertensive efficacy and effects on the vascular elasticity and metabolic indicators in case of application of two fixed-dose combinations of bisoprolol and amlodipine and enalapril and hydrochlorothiazide in patients with arterial hypertension. Materials and methods. 60 patients suffering from arterial hypertension were included in reference-controlled, randomized blind study among parallel group of drugs: bisoprolol (5 mg) and amlodipine (5 mg), enalapril (10 mg) and hydrochlorothiazide (12.5 mg); all 60 patients were examined initially and after 12 weeks of the treatment for central and peripheral arterial elasticity. Results. There was no significant difference in the antihypertensive efficacy between the drugs. The combination of bisoprolol and amlodipine showed significant positive effect on the indices of angioprotection and lipid and carbohydrate metabolism. The degree of positive effect was highest in patients with baseline heart rate over 75 beats per minute.
Consilium Medicum. 2015;17(10):19-22
pages 19-22 views

The role of diuretics in the treatment of arterial hypertension: focus on new loop diuretic - torasemide

Leonova M.V.


We show the pharmacoepidemiology review concerning diuretics usage for the treatment of arterial hypertension, the role of loop diuretics, in particular torasemide.
Consilium Medicum. 2015;17(10):23-27
pages 23-27 views

Chest pain: current issues clinical diagnosis and treatment of angina pectoris

Trukhan D.I., Davydov E.L.


The problem of proper diagnostic interpretation of chest pain is one of the most complex and urgent in internal medicine. According to the frequency of occurrence is dominated cardiac causes (angina pectoris, myocardial infarction), chest pain. The article deals with current issues of clinical diagnosis of angina pectoris and one of the important aspects of drug therapy - antiplatelet therapy with acetylsalicylic acid.
Consilium Medicum. 2015;17(10):28-33
pages 28-33 views

Obstructive sleep apnea syndrome and arterial hypertension: bidirectional relationship

Litvin A.Y., Mikhailova O.O., Elfimova E.M., Bugaev T.D., Chazova I.E.


Arterial hypertension (AH) is a modifiable wide-spread risk factor for common cardiovascular diseases. The large number of observations during several studies showed that obstructive sleep apnea syndrome (OSA) was an independent risk factor for AH. This article deals with OSA pathogenetic mechanisms, considering the model of bidirectional relationship between OSA and AH, as well as the effect of CPAP-therapy (Constant Positive Airway Pressure, CPAP) on blood pressure in hypertensive patients. There are many open questions concerning the pathogenesis of OSA, its effect on the cardiovascular system and prognosis, nowadays. Despite the fact that the decrease in blood pressure during CPAP-therapy in patients with OSA is usually small, a small drop in blood pressure, even a few mm Hg can significantly reduce the cardiovascular risk, but the combination of drug therapy and CPAP-therapy can result in significant decrease in blood pressure, especially in people with poorly controlled AH. Patients who have been attended clinics, specializing in the diagnosis and treatment of hypertension should be examined for the presence or absence of OSA as a possible modifiable risk factor.
Consilium Medicum. 2015;17(10):34-39
pages 34-39 views

One third of cardiac patients suffer from respiratory failure during sleep. What should we do?

Buzunov R.V.


The article discusses the relationship between sleep apnea and cardiac pathology with the point of somnologist view. We show screening and diagnostic methods of breathing disorders during sleep, which can be applied not only in special somnology, but also in cardiac departments by efforts of the departments stuff.
Consilium Medicum. 2015;17(10):40-41
pages 40-41 views

The role of otorhinolaryngologist in solving snoring problems and obstructive sleep apnea syndrome

Svistushkin V.M.


This article deals with the topic of snoring and obstructive sleep apnea from the viewpoint of otorhinolaryngologist. We showed the causes, diagnostics and ways of correcting these conditions.
Consilium Medicum. 2015;17(10):41-42
pages 41-42 views

Several cases of ticagrelor application on conducting fibrinolytic therapy of ST elevation myocardial infarction

Pochinka I.G., Botova S.N., Strongin L.G., Suvorov A.V., D'iachkova K.I., Pimankina M.S.


There have been found limited number of publications devoted to ticagrelor application as a part of antiplatelet treatment on conducting systemic thrombolysis in patients with ST elevation myocardial infarction. The paper showed the analysis of such therapy safety, based on hospital data registers; we found out 54 cases of ticagrelor application within the first 24 hours after thrombolysis. The usage of ticagrelor was not accompanied by an increased risk of bleeding complications in comparison with standard clopidogrel therapy.
Consilium Medicum. 2015;17(10):43-44
pages 43-44 views

Diltiazem in atrial fibrillation: effectiveness, safety, drug-sparing properties

Beldiev S.N.


The article discusses current algorithm for choice of drugs for rate control in atrial fibrillation. It is shown that algorithm use in clinical practice may lead to excessive prescribing of digoxin and b-blockers compared to non-dihydropyridine calcium antagonists. A modified algorithm is proposed to extend indications for use of diltiazem. A rationale is provided for diltiazem-apixaban combination to reduce the cost of anticoagulation therapy.
Consilium Medicum. 2015;17(10):45-49
pages 45-49 views

The characteristics of torasemide application in patients with arterial hypertension and chronic heart failure

Evdokimov V.V., Evdokimova A.G., Lozhkina M.V., Tebloev K.I.


Diuretics are drugs that increase the amount of urine and excretion of sodium. However, the application of most of diuretics is limited by the diuretics adverse influence on the electrolyte balance, carbohydrate, lipid and purine metabolism. This article shows the modern diuretics classification. Special attention is paid to loop diuretics, in particular, torasemide. Torasemide possesses prolonged action, reduces the risk of hypokalemia developing and has antihypertensive, diuretic and antialdosteronic effects. We discuss the advantage and clinical efficacy of prolonged release torasemide (Britomar).
Consilium Medicum. 2015;17(10):50-56
pages 50-56 views

Acetylsalicylic acid medications in patients with asymptomatic atherosclerosis: risk or benefit?

Minushkina L.O.


This review presents the problems of acetylsalicylic acid (ASA) application in general clinical practice. We showed that this was the most commonly used antiplatelet drug and it was very important to take the correlation of efficiency and risk of complications into account during the appointment of this drug. We described the problems associated with risk assessment and treatment selection in patient with subclinical atherosclerosis. We showed main associations between the different atherosclerosis markers and risk of coronary and cerebral complications; the results of meta-analysis concerning the efficiency of antiplatelet therapy. We discussed the possibilities for the prevention of the gastrointestinal tract damage. The application of the lowest effective quantity of ASA was the most important act for safe usage. The combination of ASA and small antacid doses could make its application more safety without significantly affecting the drugs efficiency.
Consilium Medicum. 2015;17(10):57-60
pages 57-60 views

Transluminal balloon angioplasty of pulmonary arteries in patients with inoperable chronic thromboembolic pulmonary hypertension (first experience in Russia)

Danilov N.M., Matchin Y.G., Martynyuk T.V., Fedotenkov I.S., Chazova I.E.


Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe disease, based on the persistent violation of ventilation-perfusion ratio and increase in pulmonary vascular resistance. The only way to stop the progression of right ventricular heart failure in patients with CTEPH was thromboendarterectomy, until later. In some cases, thromboendarterectomy was contraindicated in patients with lesions of distal branches of the pulmonary vascular tree, despite the high efficiency of surgical treatment. The method of endovascular correction of thrombosis in distal branches of the pulmonary artery (transluminal balloon angioplasty) was appeared several years ago. This method demonstrated the high efficiency and safety in patients with inoperable CTEPH. This article deals with the first experience of angioplasty of pulmonary arteries application in Russia.
Consilium Medicum. 2015;17(10):61-66
pages 61-66 views

5-year experience with transcatheter aortic bioprosthetic valve implantation in Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation

Imaev T.E., Komlev A.E., Saidova M.A., Margolina A.A., Akchurin R.S.


Aortic valve (AV) stenosis is a disease with steadily progressive course and associated with poor prognosis. The development of new technologies helps to develop new methods of AV prostheses; in particular, we use transcatheter aortic valve implantation (TAVI) especially in high-risk surgical patients, nowadays. TAVI was performed in 152 patients with critical aortic stenosis in the Department of cardiovascular surgery of Russian Cardiological Scientific-Industrial Complex, from February 2010 till June 2015. The comparative characteristics of primary TAVI outcomes, received in RCSIC, were similar to the results of the other studies. Hospital mortality during the observation period was 7.8%; these data were appropriate to various international registers. Thus, the TAVI procedure was a good alternative to surgical AV prosthesis in elderly patients with concomitant diseases. Important aspect of TAVI success was coordinated action of multidisciplinary team consisting of cardio-vascular surgeon, cardiologist, and specialists of the various research methods, the anesthesiologist, as well as paramedics, which was specifically emphasized in the recommendations. Currently, researchers are trying to get answers to questions concerning the reduction of stroke rate and transient ischemic attacks after TAVI, the application of TAVI in young patients and in patients with lower risk.
Consilium Medicum. 2015;17(10):67-72
pages 67-72 views

Prevention of stroke and dementia in high-risk patients

Ostroumova O.D.


The article deals with the high-risk of stroke in patients with arterial hypertension (AH) - elderly and senile patients, isolated systolic AH, diabetes mellitus. We show the modern recommendations for antihypertensive therapy in high-risk patients to reduce the risk of stroke. We discuss the results of Syst-Eur trial (The Systolic Hypertension in Europe), in which the calcium antagonist nitrendipine ± enalapril has reduced the risk of stroke and dementia, including new cases of Alzheimer's disease.
Consilium Medicum. 2015;17(10):73-76
pages 73-76 views

The relationship between metabolic disorders and insulin resistance in patients with diabetes mellitus

Dorofeeva G.B., Dorofeev I.V.


Diabetes mellitus (DM) is a heterogeneous group of metabolic disorder characterized by hyperglycemia, micro - and cardiovascular complications. According to the data of International Diabetes Federation (IDF), the number of patients with DM has been progressively increasing. DM can be determined in 7 million people and 3.8 million of them die annually from the causes associated with DM. The most significant factor leading to heart muscle damage in case of DM is hyperglycemia that can damage the myocardium. The mechanisms of endothelial dysfunction in patients with DM are associated with the synthesis reduction and the amplification of the angioprotective factor disintegration (nitric oxide) due to oxidative stress, nowadays. There is an existence of another important factor - diabetic cardiomyopathy, which can affect the cardiac prognosis in patients with DM. Long-lasting DM leads not only to the development of coronary arteries atherosclerosis, diabetic cardiomyopathy, but also to autonomic neuropathy affecting the heart and blood vessels. Many studies showed that disinsulinism and impaired insulin sensitivity were important determinants of DM and impaired glucose tolerance. The achievement of target glycemic levels close to nondiabetic status would bring to the significant reduction of the micro - and macrovascular complications development.
Consilium Medicum. 2015;17(10):77-80
pages 77-80 views

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