Vol 19, No 5 (2017)


Arterial hypertension and dementia: the potential of calcium antagonist nitrendipine

Kotovskaya Y.V., Ostapenko V.S., Tkacheva O.N.


The problem of dementia has a very important medical, social and economic importance in terms of the ageing of population. This review deals with the place of arterial hypertension as a risk factor for dementia and detection methods for dementia in the real clinical practice. The authors have analyzed the questionable association between blood pressure level and the development and progression of various types of dementia. The article showed the information about the efficacy of modern antihypertensive therapy for prevention of dementia with a focus on the potential of nitrendipine (calcium antagonist), which had showed the cerebroprotective potential in a number of investigational studies and large scale randomized placebo-controlled trial Syst-Eur.
Consilium Medicum. 2017;19(5):8-13
pages 8-13 views

The role of candesartan in the treatment of arterial hypertension in comorbid patients

Berns S.A., Striuk R.I.


Nowadays, in the context of demographic ageing of population, there is an increase in the number of diseases in one patient. The most common combinations are ischaemic heart disease, arterial hypertension, chronic heart failure, diabetes mellitus and others. All announced diseases are involved in cardiovascular disease continuum in varying degrees. Angiotensin receptor blockers can effectively control blood pressure and have proven organoprotective effects. This article presents the literature review concerning the application of candesartan cilexetil in patients with arterial hypertension and comorbid conditions. The authors discuss the features of pharmacokinetics and pharmacodynamics of candesartan. They present evidence base of antihypertensive efficacy and target organ protection. The authors show the possibility to use Hyposart - generic candesartan with proven bioequivalence for original drug.
Consilium Medicum. 2017;19(5):14-19
pages 14-19 views

Resistant vs uncontrolled arterial hypertension: management

Adasheva T.V., Zadionchenko V.S., Fedorova I.V., Shakhrai N.B.


In a review article presents an analysis of the main causes of resistance to antihypertensive treatment and uncontrolled arterial hypertension. The article deals with the discussion of the selection of combined antihypertensive treatment. The authors have shown the benefits of 3-component combined therapy consisting of calcium antagonist - amlodipine, angiotensin-converting enzyme inhibitor - perindopril and thiazide-like diuretic - indapamide. The analysis of the study demonstrates the efficacy and safety of fixed dose combination of perindopril/indapamide/amlodipine.
Consilium Medicum. 2017;19(5):20-25
pages 20-25 views

The role of the genetic polymorphism determination in arterial hypertension pathogenesis with the aim of individualization medical therapy

Drobotya N.V., Arutyunyan L.V., Pirozhenko A.A.


Aim: to research the frequency of genotypes and alleles of the polymorphisms some genes distribution in patients with arterial hypertension (AH) and to assess the possibility of antihypertension therapy with regard to individual genotypic features. Materials and methods. The basis of work is investigation of 44 patients with AH and 20 healthy individuals. The investigation of AGT, ADD1, AGTR1, AGTR2, CYP11B2, GNB3, NOS3 genes polymorphism was carried out by amplification the relevant parts of genes with the method of polymerase chain reaction. Results. It was found the assotiation of higher risk of AH development and AGT, AGTR2 and NOS3 genes polymorphism. Conclusion. More frequently patients with AH may be carrier of polymorphic genes, which control different units of the renin-angiotensin-aldosterone system. Duly medicine prescriptions, which depress the activity of angiotensin-converting enzyme, affects on cardiovascular remodeling, reduces the risk of AH complications development.
Consilium Medicum. 2017;19(5):26-30
pages 26-30 views

Possibilities of perindopril and ivabradin in patients with hypertensive disease in the normalization of hemodynamics, myocardial dysfunction and vascular endothelium

Ivanova O.F., Lebedev P.A., Vvedenskaya I.P., Komarova M.V., Paranina E.V.


Topicality. Evaluation of diastolic characteristics of the left ventricle (LV) in patients with hypertensive heart is important due to the fact that they are formed at a time of increasing myocardial mass of LV, able to progress, manifesting the clinical syndrome of chronic heart failure mainly in old age. Aim is to determine the efficacy of perindopril and ivabradine in the correction of blood pressure and contraction heart rate, as well as the functional parameters of LV myocardial function, vasoregulating function of the endothelium of peripheral arteries in patients with hypertensive disease. Object and methods. The study included 43 men aged 52-64 years with diagnosis of "hypertensive disease" without systematic application of antihypertensive drugs in the past, who had no clinical signs of chronic heart failure, had sinus rhythm more than 75 per minute at rest. The control group included 21 men, comparable in age, without deviation in electrocardiogram and physical signs of heart disease. Echocardiography was performed in all patients included in the study with the help of which the main parameters at rest were defined. We also used Pulse-wave Doppler LV inflow and tissue Doppler mode where we evaluated the movement of the lateral part of the mitral valve ring and phase index of LV. Endurance cycle test was conducted for 2 minutes at 25, 50 and 75 Watts. The function of the endothelium and arterial stiffness were examined by the method of computer based finger-photoplethysmography. The study was divided into 3 visits: on the first visit patients were appointed perindopril (Prestarium® A, Servier) in a dose of 10 mg/day; on the second visit ivabradine (Coraxan®, Servier) in a dose of 7.5 mg twice a day was added for a month; and the third visit was the final stage of the study. Results. The systolic and diastolic pressure during lying down position, sitting position and under load of 25 watts during the last visit of the group of patients with hypertensive disease did not differ from the control group, according to the results of blood pressure measurement. Ivabradine in addition to perindopril significantly increased the bradycardia effect and the results in investigated group of patients and in the control one were practically the same taking into account heart rate in a wide range of physiological states. Peripheral vascular endothelial function indicator during the observation completely normalized. In the study of phase index of LV we showed that physical activity and changing body position could significantly influence towards the increase, both in healthy people and in patients with hypertensive heart. Conclusion. We demonstrated significant hypotensive effect of perindopril at rest, and at dynamic load and the efficacy of ivabradine in heart rate normalization. We showed the high sensitivity of phase index of LV as a marker of left ventricular dysfunction, the dynamic changes of the index in response to normalizing the blood pressure and heart rate, regardless of LV myocardial mass, as well as the ability to normalize vasculomotor function of endothelium of peripheral artery, that provided the basis for improving vascular stiffness parameters later.
Consilium Medicum. 2017;19(5):31-37
pages 31-37 views

Levocarnitine in the syndrome of low cardiac output in patients with acute myocardial infarction, dilated cardiomyopathy, myocardites and pulmonary embolism

Semigolovskiy N.Y., Azanov B.A., Ivanova E.V., Semigolovskiy S.N.


Literary review and own data are given on use of L-carnitine in patients with acute myocardial infarction, pulmonary embolism, myocarditis and dilated cardiomyopathy. Pilot clinical study of infusion form of L-carnitine Elcar (0.5-2.0 g daily in first 5-7 days) had shown its positive dose-dependent inotropic effect in 53 patients with acute myocardial infarction and low left ventricular ejection fraction (<40%), compared with similar 24 patients, who haven’t get any metabolic drugs. Elevation of low left ventricular ejection fraction was noted also in cases of pulmonary embolism, myocarditis and dilated cardiomyopathy. Thus, Elcar is an effective, affordable and safe positive inotropic agent. Article also covers the indications for use of Elcar in other areas of medicine - pediatrics, neurology, cardiosurgery, sports medicine.
Consilium Medicum. 2017;19(5):38-42
pages 38-42 views

The problem of the safety application of acetylsalicylic acid in practice of cardiologist and therapeutic

Minushkina L.O.


This review deals with the problem of safety of acetylsalicylic acid (ASA) therapy. ASA is the most often appointed antiaggregant with a wide range of indications. At the same time, the increased risk of hemorrhage significantly complicates the practice of appointment of the antithrombotic therapy. The review shows the basic approaches in the prevention of complications and safety of different forms of ASA.
Consilium Medicum. 2017;19(5):43-46
pages 43-46 views

Effects of switching of dual antiplatelet therapy in STEMI patients

Tavlueva E.V., Alekseenko A.V., Gruzdeva O.V., Barbarash O.L.


Purpose. To assess of the relationship between the level of the platelet aggregation and of interleukin-6 (IL-6) and C-reactive protein (CRP) in STEMI patients receiving clopidogrel or switching therapies to ticagrelor. Methods. The study enrolled 80 patients with STEMI. At the ambulance all patients received a loading dose of aspirin (250 mg) and clopidogrel (600 mg). After 24 hours patients were received with maintenance dose of aspirin (100 mg) and of clopidogrel 75 mg/ticagrelor 90 mg twice a day. ADP-induced platelet aggregation (1.25 and 2.5 mgr/ml), levels of IL-6 and CRP in blood plasma were assessed before switching therapies to ticagrelor and on the 7th day after switching therapies to ticagrelor. Results. On the 7th day after switching therapies to ticagrelor, platelet aggregation was significantly lower in patients on ticagrelor than in patients on clopidogrel (C: 45.61 [32.7; 56]%, T: 30.3 [13.3; 41.6]%, p=0.001). The level of CRP on the 7th day in the clopidogrel group was significantly higher than the level of CRP on the 7th day in the ticagrelor group: 25.3 (4.6; 46.4) ml/l and 17.5 (4.6; 20.9) mg/l, respectively (p=0.04). The level of IL-6 on the 7th day in the clopidogrel group was significantly higher than the level of IL-6 on the 7th day in the ticagrelor group: 7.03 (2.7; 11.3) pg/ml, and 2.8 (1.8; 4.2) pg/ml, respectively (p=0.01). Conclusion. On the 7th day after switching therapies to ticagrelor in STEMI patients levels of inflammatory markers (IL-6, CRP) were significantly higher in the group where ADP-induced platelet aggregation was higher.
Consilium Medicum. 2017;19(5):47-52
pages 47-52 views

Possibilities of duplex scanning of brachiocephalic vessels at patients from diseases associated with thrombosis in cardiovascular pathology cases

Nikiforov V.S., Lunina M.D., Balyasina N.S.


Thrombosis is a common pathology underlying ischemic heart disease, ischemic stroke, and venous thromboembolism. Ultrasound duplex scanning is an important part in the diagnostic evaluation looking for potential cardiovascular sources of thrombosis. Spontaneous echo contrast (SEC) in the left atrium or left ventricle is known to be associated with a higher risk of thromboembolism from the heart. The principles applicable to the assessment of the SEC in the chambers of the heart can be used to study by the SEC in brachiocephalic vessels.
Consilium Medicum. 2017;19(5):53-58
pages 53-58 views

The mineralocorticoid receptor blockers in the treatment of chronic heart failure

Kirichenko A.A.


The negative role of secondary aldosteronism associated with CHF is known for a long time. But the high level of aldosterone concentration is exclusively associated with water retention and electrolyte imbalance. Over the past decade we have accumulated data concerning the impact of hyperaldosteronism associated with CHF on the development of cardiac fibrosis, perivascular inflammation, endothelial dysfunction, stimulation of apoptosis and cardiomyocytes, progressive impairment of heart function, the development of life-threatening arrhythmias. The studies concerning the additional appointment of aldosterone antagonists in patients with CHF have revealed the significant reduction in the risk of sudden cardiac death and death from the progression of CHF, as well as the frequency of cardiovascular hospitalizations. According to the current recommendations, starting from the functional class II it is advisable to use a triple neurohormonal blockade - the combination of renin-angiotensin system blockers (IAPF) and beta blockers and aldosterone receptor antagonist. Such a scheme of managing the patient with CHF can improve not only the quality of life of serious patients, but also prognosis.
Consilium Medicum. 2017;19(5):59-63
pages 59-63 views

Modern possibilities of torasemide application in clinical practice

Batishcheva G.A., Mubarakshina O.A., Somova M.N., Evstigneeva A.S.


Torasemide is a representative of a new generation of loop diuretics, which shows high efficacy and safety in the treatment of patients with heart failure and arterial hypertension. This drug does not only affect the symptoms, but also intervenes in the pathogenesis of cardiovascular disease continuum, improves the quality of life and the prognosis of cardiac patients. The clinical studies showed the efficacy and good tolerability of Trigrim® (local drug torasemide) which could be widely recommend in the treatment of patients with arterial hypertension, edema syndrome, and in presence of chronic heart failure.
Consilium Medicum. 2017;19(5):64-67
pages 64-67 views

Ivabradine in clinical practice

Syrov A.V.


The article assesses the clinical properties of ivabradine. The uniqueness of the drug consists in blocking ion flow through the If channel of the sinus node. This leads to a decrease in the sinus rhythm, without affecting the level of arterial pressure, myocardial contractility and peripheral vascular resistance. Clinical situations have been disassembled in which ivabradine is effectively used.
Consilium Medicum. 2017;19(5):68-71
pages 68-71 views

School of diabetes as an element of DM therapy

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Interview with A.Yu.Mayorov
Consilium Medicum. 2017;19(5):72-74
pages 72-74 views

Small abnormalities of the heart and an open oval window: myths and reality

Rybakova M.K., Mitkov V.V., Baldin D.G.


The article deals with the problems of cardiac ultrasound interpretation in children and adolescents and the understanding and meaning of small abnormalities of the heart. The authors tried to work out what the structures of the heart were usually associated with small abnormalities, and what structures were normal anatomical parts of the heart. The authors proved the results using the data of the most widely read and best authors of the domestic and foreign literature on anatomy, cardiology and echocardiography.
Consilium Medicum. 2017;19(5):76-80
pages 76-80 views

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