Vol 23, No 6 (2021)

Aim. Caused by SARS-CoV2 virus coronavirus disease (COVID-19) is characterized not only by the lung deterioration but be serious injury of vascular endothelium and system of hemostasis. We investigated changes in blood cellular elements in patients at admission and discharge from the hospital. Materials and methods. Samples of venous blood of 31 patients of the hospital with a confirmed diagnosis of COVID-19 (28 with average and 3 with severe degree) were analyzed using electron microscopy and citofloumetry. The blood was taken from cubital vein at admission and on discharge the patients. Results. Electron microscopy showed that at admission to the hospital the number of circulating endothelial cells in all patients was significantly (40-100 times) greater compared to healthy persons. Numerous fenestrae are revealed in EC membrane. Their diameter comparable to the size of supercapsid in SARS-CoV-2 virus which attests the penetration of the virus into EC where it replicated and returned to circulation. As a result, the blood vessels denuded, their permeability increased resulting in tissue edema, inflammation, activation of the platelets, and pronouncedly augmented thrombosis. Infection with COVID-19 provoked formation of stacked (aggregated) red blood cells capable to clog microvascular bed and to diminish oxygen supply to the tissues. In some patients, such abnormalities persisted even on discharge from the hospital Conclusion. Analysis of the blood on discharge from the hospital showed that despite normalization of basic hematological parameters characteristic of inflammation, the virus-induced negative effects were not entirely eliminated. These sequelae can provoke the post-COVID syndrome in patients who endured COVID-19.

The introduction of fixed combinations for the treatment of arterial hypertension (AH) is an effective strategy to address the public health burden of cardiovascular disease. This strategy is reflected in modern international guidelines for the treatment of AH and is supported by World Health Organization. The use of fixed combinations allows solving key practical problems to achieve better results and improve the prognosis of AH: ensuring the greatest decrease in blood pressure (BP) and a lower target BP level, shortening the time period for obtaining target BP, increasing adherence to treatment. Fixed combinations include classes of antihypertensive drugs, which, when combined, have an additive or synergistic effect in lowering BP, help to reduce/mitigate side effects, reduce the number of pills and increase patient adherence, solving the problem of polypharmacy. Single dosing per day of fixed combinations is another important benefit, providing adherence, longer duration of action, and reduced diurnal fluctuations in BP. The clinical benefits of fixed combinations have been confirmed in a number of large studies and meta-analyzes. The modern tactics of using fixed combinations provides for their use at different stages/degrees of BP increase. In this regard, fixed combinations with subtherapeutic, therapeutic and maximum therapeutic doses of components have been developed. For the use of fixed combinations as an initial therapy for AH, drugs with subtherapeutic doses of components that are not used in monotherapy are proposed. In such cases, thanks to the complementary selection of combined drugs, it is possible to achieve a more significant and timely BP reduction, with fewer side effects. Modern fixed combinations are based on three main classes of antihypertensive drugs - RAAS blockers (ACE inhibitors and ARBs), calcium antagonists and diuretics. There are 2 principal approaches to combinations: a combination of RAAS blockers with diuretics (diurethic-use) or a combination of RAAS blockers with calcium antagonists (diuretic-free). This preference is due to evidence-based medicine data, including questions of efficacy, tolerability, side effects, and confirmation in clinical trials. In the clinical guidelines for the treatment of hypertension, these combinations are considered preferred (evidence level A). Over time, more and more fixed combinations become generic and reliable generic combination drugs for the treatment of hypertension appear, which reduces the cost factor and makes the therapy economically acceptable.

Chronic noncommunicable diseases are associated with high mortality and high costs of medical care, and therefore require safe, effective and affordable therapy. When choosing a generic drug, a doctor may be guided by the assumption that the bioequivalence of medicinal substances is an indirect confirmation of their therapeutic efficacy. Absolute confidence in the same efficacy of original and generic drugs can only emerge after well-designed studies comparing therapeutic equivalence. The results of the Russian multicenter, open, randomized KARDIOKANON study, the purpose of which was to compare two options for complex therapy based on the use of only original or only generic drugs in persons with stable coronary artery disease, showed the comparability of the effectiveness of original and reproducible drugs of the pharmaceutical company "Canonpharma Production” in achieving the target value of arterial pressure, heart rate, low density lipoprotein and impact on quality of life. A sufficient variety of drugs produced by this pharmaceutical company opens up opportunities for the appointment of any of them, but further large controlled studies are needed to finally confirm the bioequivalence, therapeutic efficacy and interchangeability of original and reproducible drugs.

Non-adherence is a frequent pattern in patients with dyslipidemia. Reasons of this are not only medical problem. Non-adherence influences on longterm life prognosis in cardiovascular disease. Problems of non-adherence and barriers front to patient and his physician discussed.

Stimulating growth factor expressed by gene 2 (ST2) and natriuretic peptides (BNP and NT-proBNP) reflect the flow of two different, but intersecting biological processes, so the markers provide independent and complementary information on the patient's condition. Being markers of hemodynamic instability or stretching of cardiomyocytes NT-proBNP/BNP is more suitable for detecting chronic heart failure, but this is not enough to rehospitalize patients for 30 days with the predictive qualities of this marker. ST2 is the strongest and clinically significant prognostic marker of cumulative cardiovascular events and mortality. The use of new highly specific cardiobiomarkers will make it possible to predict the development of cardiovascular complications with a high degree of predictive value, and therefore will allow prophylactically prescribing appropriate pathogenetic therapy aimed at improving the quality of life of patients, reducing mortality from cardiovascular diseases and reducing the economic costs of the state for treating heart failure and cardiovascular complications.