Vol 19, No 10 (2017)


Polypill in the prevention of cardiovascular diseases: evidence base, limitations and prospects (based on the report of the European Society for Hypertension)

Morozova T.E., Yudina I.Y., Karnoukh K.I., Shatskiy D.A.


The article discusses the evidence base, limitations and prospects for the use of combined multicomponent drugs in the prevention of cardiovascular diseases. Complex of antihypertensive, lipid-lowering, hypoglycemic and antiplatelet therapy significantly reduces the risk of cardiovascular complications and fatal events. However, in real clinical practice, a full implementation of all these approaches is not always carried out, which reduces the effectiveness of preventing cardiovascular diseases.
Consilium Medicum. 2017;19(10):8-12
pages 8-12 views

New opportunities to treat patients with high cardiovascular risk

Baryshnikova G.A., Chorbinskaya S.A.


At present, combined antihypertensive therapy has become one of the main directions of the treatment of arterial hypertension, especially with the use of fixed combinations (FC). Among the most effective combinations of antihypertensive drugs is a combination of angiotensin-converting enzyme inhibitors and calcium antagonists. Since almost 70% of patients show an increase in cholesterol, it is advisable to join the treatment with drugs from the group of statins. Abroad, in recent years, the creation of a polypyle - FC 3 or more components that affect different risk factors for the development of cardiovascular diseases is widely discussed. To the polypyle can be attributed FC, which includes an inhibitor of the angiotensin-converting enzyme lisinopril, calcium antagonist amlodipine and a lipid-lowering drug from the group of statins rosuvastatin. Use of this drug is expected to increase adherence to treatment and, accordingly, the effectiveness of therapy for patients with high cardiovascular risk.
Consilium Medicum. 2017;19(10):13-18
pages 13-18 views

Modern possibilities of treatment of arterial hypertension in elderly patients

Chukaeva I.I., Spiryakina Y.G., Litvinova S.N., Shterengas A.V., Denisova N.N.


Elderly patients with arterial hypertension belong to the categories of high and very high risk. The article discusses the selection of optimal combination therapy for the elderly, the possibility of increasing adherence to treatment, discusses the evidence-based advantages of a triple fixed combination of perindopril/indapamide/amlodipine.
Consilium Medicum. 2017;19(10):19-24
pages 19-24 views

Angiotensin receptor blockers II in the treatment of arterial hypertension in patients with comorbid pathology: the possibilities of candesartan

Trukhan D.L., Davydov E.L.


The results of numerous foreign and russian researches allow us to consider candesartan as an important component of an effective therapy for patients with arterial hypertension, including the elderly, as well as with concomitant chronic heart failure, chronic kidney disease, diabetes mellitus and other disorders in practice cardiologist and doctor of first contact (the therapist and general practitioner). K
Consilium Medicum. 2017;19(10):25-32
pages 25-32 views

Principles of drug therapy of arterial hypertension

Zadionchenko V.S., Shekhyan G.G., Yalymov A.A., Shchikota A.M.


This article presents an algorithm for choosing the optimal drug for the treatment of arterial hypertension, classification of arterial hypertension, describes the main group of hypotensive drugs with the characteristic of their mechanism of action and the development of possible side effects. The authors of the article describe the hypotensive drug of the group of angiotensin II AT1 receptor blockers - candesartan (Hyposart, Akrikhin company). The article presents the results of multicenter randomized studies of candesartan in patients with arterial hypertension, nephropathy associated with diabetes mellitus and heart failure. This article presents the algorithm for choosing optimal hypotensive drug, as well as shows evidence-based information concerning efficacy and safety of the drug candesartan. Candesartan provides dose-dependent antihypertensive effect in all categories of patients with arterial hypertension and can be recommended in wide clinical use.
Consilium Medicum. 2017;19(10):33-38
pages 33-38 views

Modern approaches to the use of triple-combination treatment of arterial hypertension

Mubarakshina O.A., Somova M.N.


Achieving target blood pressure levels is one of the leading aims of hypertensive therapy. The article shows the data on the benefits of combined antihypertensive therapy, discusses modern fixed-dose combinations, including the combinations containing three active substances. This overview of the studies demonstrates the efficacy and safety of fixed-dose combination containing long-acting dihydropyridine calcium antagonist - amlodipine, thiazid-like diuretic - indapamide and angiotensin-converting enzyme inhibitor - perindopril arginine.
Consilium Medicum. 2017;19(10):39-42
pages 39-42 views

Features therapy of cardiovascular diseases during heat waves

Smirnova M.D., Ageev F.T.


In the context of global warming with an increase in heat waves, associated with an increase in cardio - vascular morbidity and mortality of particular interest is the effect of cardiac drugs on adaptation to high temperatures. This review represents the results of European and national research on the safety of therapy during the long and short heat waves. Recommendations are presented on the correction of therapy during this period. Required component of therapy of hypertension during heat waves is a home blood pressure monitoring. The development of clinically significant hypotension requires a reduction in the dose of antihypertensive drugs. We recommend starting with a reduction in the dose and/or elimination of diuretics and nitrates. Complete withdrawal is not recommended. It is recommended to prefer to calcium channel antagonists, angiotensin converting enzyme inhibitors and selective beta-blockers in the case of increased blood pressure during the heat wave. Patients should be informed about the additional protective effect of statins in order to increase adherence. Taking diuretics patients need individual daily monitoring fluid intake and body weight.
Consilium Medicum. 2017;19(10):43-48
pages 43-48 views

The importance of polymorphisms of the ABCB1 and CYP3A5 genes in predicting the efficacy and safety of amlodipine in patients with arterial hypertension of 1-2 degree

Morozova T.E., Shikh N.V., Sychev D.A., Kalle E.G., Rigikova K.A.


Purpose. Increase of efficacy and safety of pharmacotherapy of AH 1-2 degree for personalization of choice of amlodipine dosage regimens based on genotyping according to ABCB1, CYP3A5. Materials and methods. Antihypertensive efficacy and tolerability of amlodipine was evaluated in 100 patients with AH 1-2 degree at the age of 49 to 67 years (compare age 53.9-10.9), depending on the genotypes of the ABCB1 and CYP3A5 genes. Results. Detection of the TT genotype by the polymorphic marker C3435T of the ABCB1 gene predicts an excellent antihypertensive efficacy of amlodipine (sensitivity 36.8%, specificity 90.3%), and therefore its initial dose may be 5 mg/day; detection of the HS genotype - lower antihypertensive efficacy (sensitivity 32.7%, specificity 86.6%), and therefore it is advisable to prescribe amlodipine at a dose of 10 mg/day. The detection of the GG genotype by the polymorphic marker A6986G of the CYP3A5 gene is associated with a higher risk of developing NDP (sensitivity 28.8%, specificity 92.7%), which makes undesirable growth to amlodipine from 5 to 10 mg. Occlusion. Carrying of different genotypes ABCB1 on polymorphic marker C3435T is associated with indicators of antihypertensive efficacy of amlodipine, and carriage of various CYP3A5 genotypes by polymorphic marker A6986G - with safety parameters for long-term use.
Consilium Medicum. 2017;19(10):49-52
pages 49-52 views

For the question of central aortic blood pressure: the clinical case

Voronina^ V.E., Sayganov S.A., Ivanova N.V., Grishkin Y.N.


Presents a clinical case, which compares performance of brachial blood pressure and central aortic pressure with subclinical organs damage. It has been suggested that central pressure, as an indicator of vascular aging, appropriate to measure not only in hypertensive patients, but also in all people after age 50.
Consilium Medicum. 2017;19(10):53-56
pages 53-56 views

Patient with chest pain on an outpatient visit (clinical case)

Syrov A.V.


The article on the clinical example deals with the diagnosis of pain in the chest. Following the current recommendations, it is not always possible to identify patients at high risk and prevent the development of cardiovascular complications. To increase the accuracy of diagnosis and treatment effectiveness, a more thorough assessment of each of the leading risk factors is needed.
Consilium Medicum. 2017;19(10):57-59
pages 57-59 views

The evolution of mineralocorticoid receptor antagonists: spironolactone and eplerenone

Leonova M.V., Alimova E.E., Eremina Y.N.


This article presents the overview of the scientific data and the results of clinical studies of mineralocorticoid receptor antagonists. Spironolactone is a selective mineralocorticoid receptor antagonist and has affinity for androgen and progesterone receptors, whereas eplerenone - is a highly selective antagonist. Differences in the pharmacokinetics of drugs are metabolism and the relationship between the drug and plasma proteins: eplerenone is not unexposed to presystemic metabolism and has relatively low (approximately 50%) level of plasma proteins. We have many evidence-based clinical studies concerning eplerenone in the treatment of arterial hypertension in both monotherapy and in combination with other drugs; high effectiveness of antihypertensive effect in comparison with other drugs. Eplerenone shows organ-protective effect on the regression of left ventricular hypertrophy and microalbuminuria (4E-LVH-Study). The efficiency of eplerenone is described in the treatment of patients with chronic heart failure (EPHESUS, EMPHASIS-HF). Eplerenone has good tolerance and lower frequency of side effects in the sexual sphere.
Consilium Medicum. 2017;19(10):60-65
pages 60-65 views

Modern approaches to the use of torasemide in cardiovascular diseases

Baryshnikova G.A., Chorbinskaya S.A., Stepanova I.I.


The authors discuss the selection of diuretic therapy in chronic heart failure with preserved ejection fraction and show information about antialdosterone and antifibrotic effect of torasemide and its ability to improve diastolic left ventricular function. This article also shows the data concerning antihypertensive efficacy of loop diuretic - torasemide, the possibilities of torasemide use in monotherapy and in combined therapy of arterial hypertension. The authors present the information about the mechanisms of antihypertensive action of torasemide, including unique antialdosterone effect. It is reported that there is no negative impact 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(10):66-72
pages 66-72 views

Decreased cardiac mortality with nicorandil in patients with ischemic heart failure

Yoshihisa A., Sato Y., Watanabe S., Yokokawa T., Sato T., Suzuki S., Oikawa M., Kobayashi A., Takeishi Y.


Background. Effective treatments in heart failure (HF) patients with ischemic etiology have not been fully established. Nicorandil, combination of nitrate component and sarcolemmal adenosine triphosphate-sensitive potassium channel opener, is a potent vasodilator of coronary and peripheral vessels and has been used as an antianginal agent. Therefore, we examined impacts of nicorandil on cardiac mortality in ischemic HF patients. Methods. Consecutive 334 HF patients with ischemic etiology were retrospectively registered and divided into 2 groups based on oral administration of nicorandil: nicorandil group (n=116) and non-nicorandil group (n=218). We retrospectively examined cardiac mortality. Results: In the Kaplan-Meier analysis (mean follow-up period 963 days), cardiac mortality was significantly lower in the nicorandil group than in the non-nicorandil group (11.2% vs 19.7%, р=0.032). In the Cox proportional hazard analysis, usage of nicorandil was a suppressor of cardiac mortality (hazard ratio 0.512, 95% confidence interval 0.275-0.953, р=0.035), and this result was consistent in several subgroup analyses, such as left ventricular ejection fraction, percutaneous coronary intervention, coronary artery bypass graft, diabetes, р-blockers, and statins. Conclusion. Nicorandil is potentially effective for reducing mortality in patients with ischemic HF Trial registration. This was a retrospective study
Consilium Medicum. 2017;19(10):74-78
pages 74-78 views

Treatment of chronic heart failure and arterial hypertension: two aims and one drug - torasemide

Trukhan D.I.


The current problem of public health is the optimization of drug therapy in patients with chronic heart failure and hypertension. Currently, the main indication for torasemide and other loop diuretics is chronic heart failure. Torasemide expands the use of loop diuretics in complex antihypertensive therapy due to a safe metabolic profile and multifactorial antihypertensive action.
Consilium Medicum. 2017;19(10):79-84
pages 79-84 views

Statins and the liver: a point of view from the cardiologist

Ostroumova O.D.


The article is devoted to the safety of statins in terms of hepatotoxicity. These recommendations are presented in terms of monitoring liver function in patients receiving statins. The choice of the optimal scheme of statin therapy from the perspective of the efficiency/safety ratio are discussed.
Consilium Medicum. 2017;19(10):85-88
pages 85-88 views

Statins and the liver: a point of view from the gastroenterologist

Kazyulin A.N.


Millions of people in the world should be given statins, and these drugs are taken by the large group of patients. Objective information concerning any adverse event associated with statin drugs is very important, because even the data showing low liver toxicity rate can lead to abrupt withdrawal or dose interruption of these life-saving drugs in a significant number of patients with increased risk of acute cardiovascular events. Statins are the agents of choice because of the existence of a dose-dependent effect and have the most significant hypolipidemic effect, and doctors can prescribe statins in a reduced dosing regimen. On the other hand, the needed drug is exposed to the minimal metabolism via the cytochrome P450 system and this can prevent the overloading of this system, drug metabolism disorders and development toxic (drug-induced) hepatitis. These effects are associated with rosuvastatin application. Rosuvastatin has the low frequency of unwanted drug reactions and best hypolipidemic activity of this class of drugs.
Consilium Medicum. 2017;19(10):89-95
pages 89-95 views

Omega-3 fatty acids in cardiology practice

Vasilev A.P., Streltsova N.N.


Omega-3 essential fatty acids have major roles in all sorts of bodily processes. Numerous observational studies demonstrate that increase consumption of fishmeal as a replacement of the nutrient deficiency caused by modern dietary habits tends to reduce risk of cardiovascular diseases. Taking omega 3 fatty acids capsules during therapy may significantly reduce sudden cardiac death in patients with a history of myocardial infarction; improve survival in congestive heart failure patients; possess antiarrhythmic effect. The main purpose of this review is to draw attention of doctors to this important therapeutic area and to remind that the use of omega-3 fatty acids is appropriate and effective for primary and secondary prevention of cardiovascular diseases, as well as to emphasize the necessity of its wide-ranging use in patients with myocardial infarction, heart failure, and adding in the combination therapy of arrhythmia.
Consilium Medicum. 2017;19(10):96-104
pages 96-104 views

Clinico-pharmacological substantiation of antiplatelet response variability with use of different dosage forms of acetylsalicylic acid

Zyryanov S.K., Butranova O.I.


Acetylsalicylic acid (ASA) is the most common antiaggregant for the prevention of cardiovascular disease, included in current international and Russian clinical guidelines. In order to optimize the safety profile of ASA, several different dosage forms have been created, in particular, the enteric-coated form of ASA (ECA). Studies on the relative efficacy and safety of immediate-release ASA and ECA have revealed cases of ASA therapy failure, defined as aspirin resistance. The results of the conducted studies indicate the minimum accidence of true aspirin resistance: most cases of ASA ineffectiveness as antiaggregant were associated with the phenomenon of pseudoresistance, which is based mainly on a decrease of the value of enteric-coated ASA bioavailability.
Consilium Medicum. 2017;19(10):105-112
pages 105-112 views

The role of endothelin-1 receptor antagonist bosentan in the treatment of pulmonary hypertension

Shostak N.A., Klimenko A.A., Demidova N.A.


The article presents the classification and the pathogenesis of pulmonary arterial hypertension. The article also presents a modern literature review of application of endothelin-1 receptor antagonist bosentan in different variants of pulmonary hypertension and the characteristics of the drug application in practice. The article shows the recent studies results concerning the application of bosentan in clinical practice.
Consilium Medicum. 2017;19(10):113-117
pages 113-117 views

Diabetes can be operated: challenge the habitual way of life as the hope of our patients

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Interview with A.S. Ametov prof., MD, PhD, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation
Consilium Medicum. 2017;19(10):118-122
pages 118-122 views

Prospects of bariatric interventions in patients with metabolic syndrome

Salukhov V.V., Black M.S., Barsukov A.V., Kharitonov M.A., Sveklina T.S., Vasiliev E.V.


Metabolic syndrome (MS) rightly lies in the application of scientific and therapeutic and preventive efforts of modern medicine that unites the interests of specialists of various profiles due to its high prevalence, social weight and influence on the prognosis. The idea of appropriate metabolic, hormonal-regulatory, cardiovascular disorders, united within the MS, underscores the ambiguity of the pathogenesis of this condition, the difficulty of finding effective and safe methods of treatment in terms of comorbidity and prognostic significance. In the modern literature, the issue of prioritizing the use of bariatric interventions in obese individuals is being actively discussed. This review focuses on the possibilities of using metabolic surgery in a MS in the context of influencing other components included in this concept
Consilium Medicum. 2017;19(10):123-131
pages 123-131 views

Monitoring glycemic control is the main part of successful treatment of diabetes mellitus

Biryukova E.V., Kapustina L.A.


Diabetes mellitus (DM) remains main problem of medicine in the 21st century, associated with the development of vascular complications that define prognosis and life expectancy. The major role in preventing chronic complications plays achieving glycemic control that is practically impossible without full patient participation in DM treatment. Monitoring glycemic control is the basis of the efficacy of antihyperglycemic therapy and prevention of hypoglycemia. The article discusses the results of studies and shows that the increase in the frequency of monitoring of blood glucose leads to a decrease of glycated hemoglobin levels in patients with DM. The selection of the best blood glucose meters is defined by its ease of use, ease of operation, and ease of obtaining results and of obtaining statistically significant results.
Consilium Medicum. 2017;19(10):132-136
pages 132-136 views

Effect of nitrendipine on Ca2+-homeostasis of neurons and activity of cytotoxic factors in Alzheimer's disease

Astashkin E.I.


The review considers the hypothesis of the "amyloid cascade” and the "calcium" hypothesis in the onset and progression of Alzheimer's disease in the light of recent experimental data. Particular attention is paid to the change in the homeostasis of Ca2+ and Ca2+ ions upon the action of cytotoxic р-amyloid peptides (Ар-peptides) and hyperphosphorylated tau proteins on neurons. Using the example of the dihydropyridine blocker of Ca2+ -channels of nitrendipine, new mechanisms of its protective action are presented, which are associated with a decrease in the formation of Ар-peptides and their removal from the brain into the blood (clearance Ар).
Consilium Medicum. 2017;19(10):137-142
pages 137-142 views

Dlitel'noe primenenie atsetilsalitsilovoy kisloty. Podkhody k povysheniyu priverzhennosti terapii

Anderzhanova A.A., Arkhipov M.V., Vavilova I.M., Zhuk V.S., Kuzin A.I., Kuz'mina-Krutetskaya S.R., Myasnikova E.M., Nedbaykin A.M., Novikova T.N., Oleynikov V.E., Pavlova T.V., Perepech N.B., Raff S.A., Rovda E.Y., Samakaev A.S., Spasenkov G.N., Treneva G.O., Khasanov N.R., Tsareva V.M., Shatilov A.P.


В рамках Европейского конгресса по сердечной недостаточности «Heart Failure» в Париже под председательством профессора Н.Б.Перепеча 29 апреля 2017 г. прошел круглый стол экспертов, посвященный проблеме приверженности терапии при длительном применении ацетилсалициловой кислоты (АСК).
Consilium Medicum. 2017;19(10):144-145
pages 144-145 views
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