Vol 20, No 1 (2018)


Aspects of angiotensin receptor blockers use in hypertensive patients (focused on candesartan)

Evdokimova A.G., Kovalenko E.V., Evdokimov V.V., Tebloev K.I., Lobanova E.G.


The article presents a literature review on effectiveness, safety and impact on prognosis of candesartan use in patients with hypertension, diabetes mellitus, and chronic kidney disease. The emphasis is made on benefits of candesartan use compared with other drugs of this group.
Consilium Medicum. 2018;20(1):8-14
pages 8-14 views

Cardioprotective effect of eplerenone

Kirichenko A.A.


The negative impact of hyperaldosteronism in patients with congestive heart failure (CHF) is related not only to fluid retention but also to electrolyte imbalance. Aldosterone that can influence endothelium, vascular smooth muscle cells, and cardiomyocytes directly, induces fibrosis and hypertrophy that in turn promotes the diastolic dysfunction development and rhythm disturbance. Mineralocorticoid receptor (MCR) blockade is followed by left ventricular mass reduction that improves its contractile function and results in brain natriuretic peptide level reduction. EPHESUS and EMPHASIS-HF trials showed that adding MCR antagonists to ACE inhibitors and b-adrenoblockers additionally improves the clinical course and prognosis in patients with CHF. Early administration of eplerenone in patients with myocardial infarction with ST-segment elevation results in CHF development decrease. According to the latest guidelines on CHF treatment it is recommended to use threefold neurohormonal blockade - combination of renin-angiotensin-aldosterone system blockers (ACE inhibitors and angiotensin II receptor blockers) combined with b-adrenoblockers and MCR antagonists in patients with CHF after class II. This management regimen (including diuretics and cardiac glycoside prescription) improves not only patients’ quality of live but also disease prognosis. Spironolactone and eplerenone are considered equally effective. Though in clinical practice eplerenone an agent of choice because of its better tolerability and fewer side effects.
Consilium Medicum. 2018;20(1):15-20
pages 15-20 views

Captopril in cardiovascular disease management

Terpigorev S.A., Nikishenkov A.M., Kabanova T.G., Zadionchenko V.S., Yalymov A.A., Shekhyan G.G., Shchikota A.M., Ivanova N.A., Bogatyrova K.M.


The article presents the description of angiotensin-converting enzyme inhibitor - captopril. Captopril pharmacokinetics and mechanisms of its organic protective effects are discussed. The authors present the results of multicentral randomized studies of captopril use in patients with arterial hypertension, diabetic nephropathy, myocardial infarction and heart failure. The results of clinical studies confirm the high effectiveness of captopril use in cardiovascular disease management.
Consilium Medicum. 2018;20(1):21-26
pages 21-26 views

Modern instrumental diagnosis of coronary heart disease in women and its prognostic importance

Lupanov V.P.


Recent decades have seen a growing recognition that the understanding of sex differences in cardiovascular disease is vital to optimal diagnosis and management, particularly of women. There is simultaneously an increasing appreciation of the multifactorial nature of ischemic heart disease (IHD) in many patients, in whom disease may extend beyond the epicardial coronaries. While obstructive coronary artery disease (CAD) remains underdiagnosed in women and still represents a major burden of disease, women also present with nonobstructive CAD more commonly than men. Indeed, microvascular dysfunction, coronary artery vasospasm, and coronary dissections contribute to a larger proportion of IHD in women than men. Here, we review the symptom presentation of women with IHD and the noninvasive modalities used to risk stratify women with suspected IHD.
Consilium Medicum. 2018;20(1):27-32
pages 27-32 views

Percutaneous coronary interventions in comparison with medical therapy in patients with chronic ischemic heart disease: results of long-term follow-up

Kuznetsov V.A., Samoilova E.P., Bessonov I.S., Gultyaeva E.P., Berdinskikh S.G., Gorbatenko E.A., Dyachkov S.M., Yaroslavskaya E.I.


Determining the optimal treatment strategy for patients with stable coronary heart disease is a matter of debate. Fr om the Register of Coronary Angiography Operations, 2 groups of patients with stable ischemic heart disease were selected. The first group consisted of 150 patients, for whom in addition to medical therapy (MT) was performed percutaneous coronary intervention (PCI). The comparison group included patients with stable coronary heart disease who were on isolated MT. The median of observation in both groups was 93 [48; 126] months. In the groups, the overall mortality rate, the presence of myocardial infarction (MI), coronary artery bypass grafting (CABG) were assessed. And also were analyzed the combined point of MACE (major adverse cardiac events), including MI, CABG and mortality. An analysis of the long-term results showed that the mortality rate in the PCI group was lower (3.5% vs 9.6%, p=0.037). In this case, the frequency of MI was higher in the group wh ere PCI was performed (16.7% vs 7.4%, p=0.018). The frequency of coronary bypass and the development of MACE events did not reveal statistically significant intergroup differences. Thus, percutaneous coronary interventions in combination with drug therapy are an effective and safe method for the treatment of stable coronary artery disease and are characterized by a significant decrease in the mortality rate in comparison only with MT. In patients with PCI, a higher incidence of non-fatal myocardial infarction is detected with remote observation.
Consilium Medicum. 2018;20(1):33-37
pages 33-37 views

Statins and diabetes mellitus: cardiologist’s point of view

Ostroumova O.D.


The article concerns statin use in patients with diabetes mellitus for cardiovascular risk reduction in primary and secondary prevention. Data on target levels of low-density lipoprotein in various subgroups of patients with diabetes mellitus receiving therapy with statins is presented. Also results of randomized clinical trials and meta-analyses that indicate the increase of risk for new events of diabetes mellitus associated with statins use are discussed. The article also presents data on the prevalence of this adverse event, its dependence on the dosage and duration of statin use, and benefit-risk profile. The populations of patients with the highest risk for diabetes mellitus associated with statins use are listed.
Consilium Medicum. 2018;20(1):38-45
pages 38-45 views

Pre-diabetes: can diabetes mellitus development be avoided?

Zabelina V.D.


Because of a worldwide epidemic of diabetes mellitus the disease prophylaxis is one of the most important issues nowadays. Pre-diabetes lasts for 6-12 years before diabetes mellitus type 2 manifests. In that period it is possible to cease the carbohydrate metabolism disorder development. Screening for carbohydrate metabolism disorder including glycated hemoglobin tests and glucose loading test with 75 g glucose is essential in populations where risk of diabetes development is high. In case of pre-diabetes lifestyle changes are recommended: increase of physical activity, weight reduction, keeping to diet cutting on fats and easily digested carbohydrates, enrichment the ration with dietary fiber. Metformin use is reasonable. It is recommended for patients to control the glucose level with portative glucose monitor that fulfill the present accuracy standards.
Consilium Medicum. 2018;20(1):46-53
pages 46-53 views

Chronic obstructive pulmonary disease and comorbid cardiovascular disease: in the context of guidelines

Ostroumova O.D., Kochetkov A.I.


The article presents a modern view on chronic obstructive pulmonary disease (COPD) and comorbid cardiovascular disease, the epidemiology is also discussed. The influence of comorbid disease on exacerbation development, prognosis and outcomes is demonstrated. Possible pathogenesis that contributes to high rate of comorbid cardiovascular disease development in patients with COPD and also to synergism in their development is presented. With regard to actual clinical guidelines the advances in COPD patients with comorbid cardiovascular disease management and treatment are discussed.
Consilium Medicum. 2018;20(1):54-61
pages 54-61 views

Cerebroprotection in patients with hypertension and comorbid disease

Mamedov M.N.


The review concerns some aspects of cerebrovascular comorbidities and major vessels disease. Hypertension is one of the main reasons for cerebral stroke. For primary and secondary prevention of cerebral stroke and its late effects development, adequate treatment of hypertension is required. Cognitive impairment in elderly patients is widely discussed nowadays. Effective antihypertensive therapy with calcium antagonists, such as nitrendipine, reduces cognitive impairment and demention development, particularly, of vascular genesis.
Consilium Medicum. 2018;20(1):62-65
pages 62-65 views

Preparations of the first line for atrial fibrillation of precurities in patients with minimal structural heart changes

Miller O.N., Tarasov A.V., Pavenko E.N.


Atrial fibrillation is the most common arrhythmia in clinical practice. Number of patients with atrial fibrillation increases every year, primary due to the general aging of the population, as well as the presence of comorbidities. There are huge amount of research carried due to the search for optimal treatment and the most effective management of patients. In the given review the modern methods of the medicated sinus rhythm restoration and we analyzed updated recommendations of the Еuropean Society of Cardiology 2016 year.
Consilium Medicum. 2018;20(1):66-70
pages 66-70 views

Framework for management and controversial aspects of principal supraventricular tachycardia types pharmacotherapy

Bunin Y.A., Miklishanskaya S.V.


Supraventricular tachycardia (SVT) is a unifying term that embodies various types of tachycardia with narrow QRS complexes (less than 0.12 s). These types are widely represented in general population (2.2 per 1000 population) and can be whether paroxysmal or chronic. It was established that SVT can manifest both in children and in adults. The article presents a modern view on strategy and tactics of rescue and preventive therapy in patients with SVT. The information is presented according to international recommendations on patients with SVT management, results of several controlled trials and personal authors experience in arrhythmia management. Some controversial aspects of SVT management are also discussed.
Consilium Medicum. 2018;20(1):71-78
pages 71-78 views

Edema pharmacotherapy in patients with hepatic cirrhosis and congestive heart failure: loop diuretics in focus

Ketova G.G., Popov A.Y., Babich A.E., Luchinina E.V.


The article covers similarities and differences of edema syndrome pathogenesis in congestive heart failure and hepatic cirrhosis as well as sites of action of different diuretics types. The regimen of salt restriction and such medications as spironolactone, eplerenone and acetazolamide are not widely used in everyday clinical practice. Compared with furosemide, torasemide is a more popular diuretic because of better pharmacodynamics profile and safety. Torasemide is a pharmacologic agent with anti-aldosterone and antihypertensive effects. It also has dose-related diuretic effect. When used in dosage of 2.5-5 mg it predominantly has antihypertensive and anti-aldosterone effects with weak natriuretic action that allows its use in everyday hypertension therapy. In medium dosage of 5-20 mg it is more often used in edema syndrome treatment whether in monotherapy or in combination with other diuretics except for loop diuretics. The anti-aldosterone mechanism is based on torasemide ability to block aldosterone receptors in kidneys and heart and lower aldosteron secretion in adrenal glands. It allows to slow down remodeling processes of heart muscle in patients with congestive heart failure and explains positive effects in edema of different genesis management.
Consilium Medicum. 2018;20(1):79-83
pages 79-83 views

Nosological diagnosis in patients with venous thromboembolic events

Kirichenko A.A., Polyakova O.A.


Venous thromboembolic events (VTE) include deep and superficial vein thrombosis as well as pulmonary thromboembolism that contributes significantly to mortality and disability in developed countries. VTE are often found in therapeutic patients, patients with blastomatous diseases, cardiac failure and various acute and chronic inflammatory diseases. It is important to consider all risk factors but still identification of the underlying disease that led to thrombophilia and hemodynamic disorders is often the priority. As an example we present a case of vena saphena magna thrombophlebitis that was complicated by small pulmonary arteries thrombembolia. Among the disease characteristics were: progressive heart failure with diastolic function failure predominance while there were no obvious causative factors. The attempts to find an explanation of multiple lesions resulted in diagnosing amyloidosis in the patient. A focused search of the underlying condition resulted in myeloma diagnosis in spite of lack of many indicative clinical and laboratory manifestations.
Consilium Medicum. 2018;20(1):84-87
pages 84-87 views
pages 88-89 views

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