Vol 19, No 1 (2017)


Triple combination in the treatment of hypertension - the real way to improve blood pressure control

Morozova T.E., Yudina I.Y.


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.
Consilium Medicum. 2017;19(1):8-12
pages 8-12 views

Diuretics in the treatment of arterial hypertension. What's new?

Baryshnikova G.A., Chorbinskaia S.A.


Data on the antihypertensive efficacy of torasemide loop diuretic, its use as monotherapy and in the combination therapy of arterial hypertension are presented. Data on the mechanisms of antihypertensive action of torasemide are given, including unique antialdosterone action. It is reported that there is no negative effect on carbohydrate, lipid, purine metabolism and electrolyte balance, positive effect on the state of target organs, very good tolerability. The authors conclude that it is possible to use torasemide more widely in a "non-diuretic" dose (2.5-5 mg / day) for the treatment of arterial hypertension both in monotherapy and in combination with other antihypertensive drugs.
Consilium Medicum. 2017;19(1):13-17
pages 13-17 views

Methods of cardiovascular imaging for the detection of ischemic heart disease

Nikiforov V.S.


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.
Consilium Medicum. 2017;19(1):18-24
pages 18-24 views

Dual antiplatelet therapy after myocardial infarction on the example of the combination of acetylsalicylic acid and ticagrelor: For how long, in whom, and at what doses?

Averkov O.V., Vechorko V.I.


Abstract The analytical article presents the current state of secondary prevention in patients after myocardial infarction with the help of antiplatelet agents. The possibility of prolonging the duration of dual antiplatelet therapy to more than 1 year is among the innovations of recent years. We have discussed the components of long-term dual antiplatelet therapy and patient selection criteria for this treatment. According to the author’s point of view it is necessary to use combination of ticagrelor and acetylsalicylic acid in the early treatment of myocardial infarction. The results from the PEGASUS TIMI 54 study give arguments for prolonging the duration of effective dual antiplatelet therapy to more than 1 year on using low-dose ticagrelor (60 mg twice daily).
Consilium Medicum. 2017;19(1):25-29
pages 25-29 views

Optimal drug therapy for patients with stenocardia and its impact on mortality

Mazur N.A.


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.
Consilium Medicum. 2017;19(1):30-35
pages 30-35 views

Endovascular treatment of ischemic stroke: the history of development and first experience

Analeev A.I., Semitko S.P.


This article is devoted to the history of development of endovascular treatment of ischemic stroke and the review of modern technologies and perspectives for further development.
Consilium Medicum. 2017;19(1):36-41
pages 36-41 views

Rotational angiography and the role of rotational angiography in modern clinical practice

Klimov V.P., Azarov A.V., Semitko S.P., Vertkina N.V.


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.
Consilium Medicum. 2017;19(1):42-49
pages 42-49 views

Prevention of stroke, cognitive impairment and dementia in patients with hypertension during the provision of primary health care

Trukhan D.I., Davydov E.L.


The article deals with questions of prevention of stroke and cognitive impairment in hypertensive patients at the stage of primary health care. The data of the study Syst-Eur (The Systolic Hypertension in Europe) clearly demonstrate the effectiveness of the dihydropyridine calcium antagonist nitrendipine in reducing the risk of stroke, cognitive impairment and dementia in patients with hypertension. The emergence of the Russian pharmaceutical market, the drug nitrendipine - Nitremed - makes it possible to optimize the prevention of cerebrovascular disease and cognitive impairment in hypertensive patients.
Consilium Medicum. 2017;19(1):50-55
pages 50-55 views

Glycemic control in patients with diabetes mellitus and cardiac pathology

Kochergina I.I.


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.
Consilium Medicum. 2017;19(1):56-60
pages 56-60 views

Personalized medicine: clinical pharmacologist’s opinion

Sychev D.A., Shuev G.N., Torbenkov E.S., Adrijanova M.A.


Currently, clinical pharmacogenetics is a promising technology of personalized medicine. This makes it possible to assess risk factors for the development of the disease and adverse drug reactions better. Single nucleotide polymorphisms of the ADME determine an individual pharmacological response. We studied the role of CYP2C9*3 in response to warfarin, the association between CYP2C9 and NSAID-gastropathies, the association between CYP2D6*4 and the biotransformation of tricyclic antidepressants, the association between CYP2C19*2 and the efficacy of clopidogrel, the association between SLCO1B1*5 and statin-induced myopathies. We showed ethnic features of the distribution of allelic variants of genes. We proposed the module "Pharmacogenetics" in the framework of the introduction of computerized decision support systems. Thus, pharmacogenetic testing is a promising tool for personalized medicine, to improve the quality of therapy.
Consilium Medicum. 2017;19(1):61-68
pages 61-68 views

Place of candesartan in modern cardiology

Dobrynina N.V.


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.
Consilium Medicum. 2017;19(1):69-72
pages 69-72 views

Therapy for chronic heart failure: the possibilities of eplerenone

Vertkin A.L., Abdullaeva A.U., Knorring G.Y.


The development of chronic heart failure (CHF) is directly associated with a high risk of adverse outcomes in patients, including such case as sudden cardiac death. Medication management in CHF is a major health and social problem. The article deals with the use of mineralocorticoid receptor antagonists (MRA) in patients with CHF. The selective MRA - eplerenone plays the main role in this treatment, because of statistically significant evidence-based data.
Consilium Medicum. 2017;19(1):73-80
pages 73-80 views

Rational antiarrhythmic therapy in postoperative period of pulmonary vein ostia catheter isolation according to the efficacy and safety, for prevention of early recurrences of atrial tachyarrhythmias

Tarasov A.V., Davtyan K.V., Miller O.N.


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.
Consilium Medicum. 2017;19(1):81-87
pages 81-87 views

Heart damage in arterial hypertension. Management of hypertension and contractile dysfunction

Gurevich M.A., Kuzmenko N.A.


The review, based on the data of literature and long-term own studies, shows modern data, concerning the CVS damage in patients with hypertensive disease. The authors demonstrate the clinical and prognostic factors of left ventricle myocardial hypertrophy (LVH) in patients with arterial hypertension (AH) according to the data of echocardiography and electrocardiography. The progression of AH in the elderly is significantly complicated by concomitant diseases: ischaemic heart disease, diabetes mellitus, LVH, etc. The treatment of patients with AH is not associated only with lowering blood pressure but also call for left ventricular mass reduction as a prevention of chronic heart failure. Such drugs as angiotensin-converting enzyme inhibitors, sartans and calcium channel blockers have pathogenetic significance, associated with inhibition of the activity of the renin-angiotensin-aldosterone system. Candesartan is distinguished by the strength of AT1 receptor binding, slow dissociation and rebinding and has a clinically stable long-term antihypertensive effect. Candesartan helps controlling both morning systolic and diastolic BP.
Consilium Medicum. 2017;19(1):88-92
pages 88-92 views

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