Vol 21, No 5 (2019)

10 июня 2019 г. академику Евгению Ивановичу Чазову исполнилось 90 лет. Евгений Иванович - человек, заложивший основы доказательной медицины, с его деятельностью связан настоящий прорыв в теоретической и практической кардиологии, он является вдохновителем и организатором высокоэффективной структуры специализированной помощи кардиологическим больным, создания лекарств и реабилитационных программ.

Relevance. Arterial hypertension (AH) is one of the most common chronic diseases in the world and is the leading cause of serious complications on the part of many organs. To date, there are no clinical guidelines on the choice of drug therapy in men and women, which was the basis for conducting this study. Aim. To study the antihypertensive efficacy and adherence to treatment of the fixed combination of amlodipine/indapamide/perindopril in patients with uncontrolled hypertension at the age of 50-65 years. Materials and methods. Inclusion criteria: outpatient patients, age 50-65 years, AH 2-3 degree, not achieving the target values of blood pressure on a double antihypertensive combination. Initially and after 3 months of treatment, we collected complaints, anamnesis, determined anthropometric indicators, adherence to treatment and quality of life, ambulatory blood pressure monitoring (ABPM). Results. Against the background of 12-week therapy, there was a decrease in men with SBP from 171.8±8.1 to 132.7±8.3 mm Hg (p<0.001), DBP - from 101.9±5.1 to 81.1±3.7 mm Hg (p<0.001); in women, from 171.3±3.3 to 130.1±0.5 mm Hg (p<0.001) and from 100.5±1.6 to 80.3±1.1 (p<0.001), respectively. Target values of blood pressure achieved in all women and 94% of men. The use of a triple fixed combination of drugs contributed to the improvement of the day and night levels of SBP and DBP, blood pressure variability according to ABPM in both men (p<0.001) and in women (p<0.001). Improved adherence was noted in 31.2% of men (p=0.001) and in 45% of women (p<0.001). In women, this was facilitated by regular intake of the drug (p=0.001, r=0.88), in men, a dose of 5 mg + 1.25 mg + 4 mg (p=0.019, r=0.32) was taken. Increased adherence to treatment correlated with an improvement in the daily variability of DBP in both women (p=0.026, r=0.35) and in men (p=0.028, r=-0.31). Treatment with a triple fixed combination of drugs led to an improvement in indicators, covering almost all the components of the quality of life in women, and the physical component in men. Conclusion. The use of a fixed combination of amlodipine/indapamide/perindopril in patients with uncontrolled hypertension has high antihypertensive efficacy, allowing you to achieve target blood pressure levels during 12-week therapy in 100% of women and in 94% of men, increasing adherence to treatment with a satisfactory safety profile and metabolic neutrality, which allows us to consider this combination as a drug of choice for uncontrolled hypertension in both men and women.

Interview with the head of the clinomic laboratory at the National Medical Research Center for Preventive Medicine of the Ministry of Health of Russia, cardiologist, lipidologist, Candidate of Medical Sciences Alexandra I. Ershova

The article provides information only on antiarrhythmic drugs which are widely used in Russian clinical practice and include propafenone, amiodarone, sotalol and lappaconitine. There is a certain number of studies which investigated not only an efficacy but also a safety of each of these drugs. On the one hand, the treatment of arrhythmias in clinical practice has traditionally been considered a challenge because of the abundance of types of arrhythmias, and sometimes because of the aggressive action of antiarrhythmic drugs with the possibility of proarrhythmic and extracardiac complications. On the other hand, we often deal with a comorbid patient who has not only the evident structural disorder of the heart, but also comorbidity that should be considered when selecting the diagnostic algorithm and treatment regimen for a particular heart rhythm disorder. It is important to remember that a key point for a prescription of antiarrhythmic drugs should always be a balance between the efficacy and safety of the drug, since one must clearly realize the purpose of the treatment and take all precautions to avoid even more problems than those for which therapy is performed.

Ventricular arrhythmias often complicate the course of chronic heart failure (CHF) and are one of the main causes of sudden cardiac death (VSS). The article presents current data on the management of patients with CHF with "potentially dangerous" ventricular arrhythmias, drug and non-drug methods of primary prevention of VSS, including the use of implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT). An important place in the presented work is devoted to the treatment of stable VT and improvement of the prognosis for life-threatening ventricular arrhythmias (VT/VF): indications for use of class III antiarrhythmic, ICD and catheter ablation. It was noted that for patients with CHF who have sustained VT or who survived after circulatory arrest (VF), the optimal treatment is CD implantation, rather than pharmacotherapy. The presented material is based on data from modern international guidelines (ESC, AHA/ACC/HRS) for the treatment of CHF, ventricular arrhythmias and SCD prevention, as well as the results of a number of controlled studies and own clinical experience in the treatment of arrhythmias.

The article presents the importance of the problem of diagnostics and treatment of patients with diabetes mellitus (DM) type 2 in the light of steady increase of the prevalence of the disorder and its complications. Chronic hyperglycemia is a leading factor of cardiovascular disorders development associated with damage of eyes, kidneys, cardiac vessels, brain, and lower extremities arteries that results in disability and mortality of patients with DM type 2 and defines its social significance. The article provides definition of DM concept and classification, characterizes DM type 2 and other glycemic disorders diagnostic criteria. It is outlined that glycated hemoglobin (6.5% and more) is the diagnostic criterion for DM type 2. Special attention is given to glycemia self-control with the use of Contour™ Plus One glucometer, the distinguishing feature of which is the possibility of synchronization with mobile application Contour™ Diabetes. Therapeutic goals of DM type 2 treatment are defined according to ADA/EASD-2018 consensus (American Diabetes Association/ European Association for the Study of Diabetes) and Russian Association of Endocrinologists algorithms (2019). Recommendations for personalization of antihyperglycemic drugs choice in various clinical cases in consideration of rational drug combinations are given. Particular advantages of treatment using Russian guidelines are discussed.

Objective. To analyze cardiovascular disorders, lipid metabolism disorders, compliance level and quality of life of liver transplant recipients and to develop individualized approach to prediction of complications development with the use of artificial neural networks. Materials and methods. In the retrospective part of the study a database of primary documents of 135 patients (81 male, 54 female) who underwent orthotopic liver transplantation (OLT) in State Budgetary Healthcare Institution “Research institute - Prof. S.V. Ochapovskii Regional Clinical Hospital №1” in Krasnodar was developed. The present article analyses recipients cardiovascular status before and 4 years after liver transplantation as well as lipid and carbohydrate metabolism disorders at 6, 12, 24, 36, and 48 months with the use of Statistica 10.0 (Tibco, USA) software. In the prospective part questionnaire survey of the patients about compliance and quality of life was conducted. The designed recipients database was used for development of neural networks models in the program unit in Microsoft Visual C# 2015 software development environment for prognosis of complications development in liver transplant recipients according to combined endpoint - transplant hepatitis, thrombosis, tumors and episodes of transplant rejection. Results. Total cholesterol level was 3.6±1.6 mmol/L before transplantation, after 6 months, 12 months, 2, 3, and 4 years it increased by 16.7, 19.4, 27.8, 38.9 и 38.9%, respectively. Triglycerides level dynamics compared with baseline level before transplantation increased by 29.3, 41.7, 36.7, 52.2, 43.0% after 6 months, 1 year, 2 years, 3 years, and 4 years, respectively. Low density lipoprotein level before operation was 2.3±1.4 mmol/L and in 2 years increased by 8.7%, in 3 and 4 years by 21.7 и 26.1%, respectively. Before transplantation arterial hypertension was diagnosed in 21.5% of patients, the number increased to 29.6% during the observation period. Diabetes mellitus was diagnosed in 14.4% of patients before transplantation and in 22.7% of patients 4 years after it. Four years after liver transplantation the amount of patients with ischemic heart disease and chronic heart failure increased by 27.4 and 20.7%. Both in female and male liver transplant recipients low compliance to treatment was observed according to Morisky-Green questionnaire test. Most differences between recipients and healthy people were observed in “physical functioning” score - by 31.3%, “role functioning defined by physical functioning” - by 60.8%, “general state of health” - by 33.4%, “role functioning defined by emotional state” - by 52.9%. Characteristics of cardiovascular status of liver recipients, compliance and quality of life were included in artificial neural networks in program “Complication prognosis in liver recipients” with total predictive capability of the network accounted for 98.49%. Conclusion. In liver recipients frequency of cardiovascular disorders, diabetes mellitus and lipid metabolism disorders increased in comparison with pre-transplantation period. Study of compliance, quality of life and formed database of clinical, laboratory, and instrumental data on patients before transplantation and in 5 periods of time after it along with the use of neural networks allowed creating a program “Complication prognosis in liver recipients”, certificate of registration of computer program №2019614005.