Vol 19, No 1 (2017)

Ineffective control of blood pressure in patients with essential arterial hypertension in Russian patients (less than 30% women, 20% less than men) demonstrated in epidemiological studies. The article provides an overview of current capabilities to enhance the effectiveness of the treatment of hypertension using a triple combination antihypertensive therapy and the use of fixed combinations. The advantages of combination antihypertensive therapy, including long-acting dihydropyridine calcium channel blocker amlodipine, thiazide diuretic indapamide, and angiotensin-converting enzyme inhibitors perindopril in various clinical situations. A review of research evidence on the effectiveness and safety of a fixed combination of amlodipine/indapamide/perindopril.

This article is devoted to the role of the modern methods of cardiovascular imaging in the diagnosis of ischemic heart disease (IHD). Stress echocardiography, multislice computed tomography, magnetic resonance imaging and methods of nuclear cardiology have a high sensitivity and specificity in the verification of IHD. They are recommended for patients with intermediate pretest probability of IHD based on the evaluation of clinical symptoms and risk factors. Additionally, in patients with ischemic heart disease modern imaging techniques are useful for evaluation of myocardial viability.

In this clinical seminar (lecture) we argue the urgency to optimize the drug therapy in patients with stable angina pectoris. Today the quality of their treatment remains lower than it could be. In majority of cases the applied drug therapy does not allow to control the risk factors of inappropriate prognosis. Inadequate treatment of angina pectoris contributes to very high mortality rate due to cardiac diseases in Russian Federation. Prescription of drugs with proven positive effect is often based on non-optimal schemes. Moreover, there is a wide-spread tendency to prescribe metabolic drugs to patients with cardiovascular pathology and other diseases notwithstanding the fact that the pharmacoeconomic validity of such drugs remains to be demonstrated.

Nowadays, despite the advantages of non-invasive methods of diagnosis, direct angiography plays a key role in examining the blood vessels, and remains the gold standard. The method continues updating. It is possible to use rotational flat-panel angiography followed by 3D modeling, nowadays. Rotational angiography has been mainly used in neuroradiology procedures. The development in medical technologies has made it possible to acquire object-based 3D reconstruction method for evaluating angiographic images. 3D angiography has been used in the diagnosis of damage in vascular territories when planning the surgery or estimating the results of treatment. However, despite all of the benefits, rotational angiography is not routinely used as it deserves. To illustrate the use of this method in practice of city clinical hospital we show clinical cases as a part of the everyday practice of Regional Vascular Center SFHI City Clinical Hospital named after V.V.Veresaev, Moscow Health Department.

The article presents data on the prevalence of diabetes, the role of hyper - and hypoglycemia in the development of cardiovascular complications, the importance of self-monitoring for early detection of acute complications of diabetes and compensation.

Candesartan is one of the "youngest", but it is a well-studied representative of a pharmacological group of sartans; it has a strong long-term antihypertensive effect, can reduce left ventricular hypertrophy, and protect from stroke, to slow the progression of chronic heart failure, to prevent the development of paroxysms of atrial fibrillation, while possessing simultaneously properties and favorable metabolic effects.

The PROOF study is a randomized, prospective, open, comparative trial with the control group. The aim of the study is to investigate the complex approach in management and treatment and to estimate the efficacy and safety of antiarrhythmic drugs (AAD) monotherapy: propafenone, sotalol and verapamil in comparison with the control group of patients without AAD application for prevention of recurrences of atrial tachyarrhythmias (ATA) in the early and following postoperative periods of pulmonary vein (PV) ostia catheter isolation (LV). Material and methods: Patients’ diary, electrocardiography, 24-hour Holter ECG monitoring and percutaneous heart monitor - Reveal (Medtronic) were used to detect asymptomatic arrhythmias. 243 patients (mean age 56.09±10.14 years) were included according to the design of a randomized study. They are divided into 4 groups. Patients of Group 1 (n=61) received verapamil retard 240 mg/day, Group 2 (n=62) - propafenone 450 mg/day, Group 3 (n=60) - sotalol 160 mg/day, Group 4 - control group (n = 60) without AAD application. Results. The overall effectiveness of PV ostia isolation after one surgery was 66.6%: 67.2% - on applying protective antiarrhythmic drugs (AAD) and 65% - without AAD (p=0.75). The treatment was ineffective in 81 (33.4%) patients and 62 (25.5%) patients among them were offered repeat surgery. The overall effectiveness of invasive treatment after two manipulations was 88.5%: 88.55% - on applying AAD and 88.33% - without AAD (r = 0.83). During the first 3 months of the observation we registered 1.016±1.74 median number of electrical cardioversions in Group 1 (p=0.607), 0.40±1.03 - in Group 2 (p=0.0096) (statistically significant difference) and 1.033±1.52 - in Group 3 (p=0.152). The median number of hospitalizations during 3 months was 0.654±0.74 cases. The number of hospitalizations was 0.684±0.73 in Group 1 (p=0.178), 0.447±0.57 - in Group 2 (propafenone), 0.592±0.67 - in Group 3 (sotalol) (p=0.044) and 0.894±0.88 - in control group (without AAD) (p=0.0016). Propafenone and verapamil showed satisfactory safety profile of AAD application in the early postoperative period, but the result did not differ from the control group, however, in sotalol Grope we registered statistically significant increase of number of proaritmic effects - disorders of automatism associated with significant pauses in rhythm. Conclusion. AAD in postoperative period of PV ostia catheter isolation do not effect on the outcomes of invasive treatment after one or two surgeries, but can effect on the clinical course of postoperative period, by reducing the number of medication and electrical cardioversions and the number of hospitalizations, associated with irregular heart rhythm. We showed that propafenone was the rational AAD IC-class during that period, according to the efficiency and safety for prevention of early recurrence of ATA.