Vol 24, No 10 (2022)


Optimization of blood pressure control in patients with resistant arterial hypertension and visceral obesity

Deneka I.E., Rodionov A.V., Fomin V.V.


Aim. To evaluate the course of resistant arterial hypertension in patients with visceral obesity, to identify predictors of unsatisfactory shot-term and long-term treatment outcomes, to optimize therapy and improve adherence to treatment.

Materials and methods. A total number of 90 individuals with a history of refractory or resistant arterial hypertension and visceral obesity were a subject of intensive study. The prospective analysis group consisted of 30 patients with an individualized management plan each, whereas the retrospective group of real clinical practice included 60 participants. At baseline, all patients were taking antihypertensives like ACE inhibitors or angiotensin II receptor blockers (ARBs)/angiotensin-converting enzyme inhibitors, calcium channel blockers (CCBs), and a diuretic. After the initial examination, therapy was individually optimized for each patient in accordance with current clinical guidelines. Most patients in the retrospective group received ARBs valsartan or losartan, CCBs amlodipine, the diuretics indapamide and torasemide, the β-blockers bisoprolol and metoprolol, the α2-agonist moxonidine, and the mineralocorticoid receptor antagonist spironolactone. Patients in the prospective group were prescribed ARBs telmisartan and azilsartan, the CCB lercanidipine, thiazide and thiazide-like diuretics indapamide and chlorthalidone, the β-blockers nebivolol and carvedilol, the α1-blocker doxazosin, and spironolactone. A re-examination was performed 2 months later. Subsequently, regular communication was maintained with participants of the prospective group during 8 months using a messenger. Communication with patients of the retrospective group was not maintained. All the patients were then asked to self-report their health status by conducting a telephone survey.

Results. After 2 months, according to the data of the follow-up, in the retrospective group the target values of mean daily SBP and DBP were observed in 35 and 36.7% of patients, though the statistics among the patients in the prospective group were 66.7 and 60%, respectively. After 10 months, according to the results of the interviews, the target values of SBP and DBP were observed in 10 and 18.3% of patients, though the statistics among the patients in the prospective group were 93.3 and 96.7%, respectively. In the retrospective group, 78.3% of patients changed the previously selected therapy, in the prospective group this figure was only 20%. In the retrospective group, anthropometric data did not change, while in the prospective group, weight and waist circumference significantly decreased (p<0.05).

Conclusion. Maintaining regular contact with patients and a well-rounded treatment strategy with individualized choice and dosage of medications with an emphasis on modern metabolically neutral drugs with a prolonged duration of action led to better BP control, increased adherence to therapy and indicated significant weight loss among the patients from the prospective group.

Consilium Medicum. 2022;24(10):671-680
pages 671-680 views

On the issue of low adherence of patients to antihypertensive therapy: the use of therapeutic drug monitoring of drugs: A review

Leonova M.V.


Low adherence of patients to antihypertensive therapy remains an urgent problem and is recognized as the main cause of insufficient BP control at the population level. In this regard, to increase the motivation of patients in clinical practice, methods for assessing adherence (compliance) to drugs. Along with indirect assessment methods (questionnaires, self-reports, pill counts, etc.), which, however, do not always reflect the real patient’s adherence, more objective is the measurement of antihypertensive drug concentrations in physiological fluids – therapeutic drug monitoring (TDM). For these purposes, methods of high-performance liquid chromatography with mass spectrometry were recently adapted, reference ranges of antihypertensive drug concentrations in blood serum and urine for standard doses of drugs were determined, as well as criteria for assessing complete or partial non-compliance. There have been a number of studies using TDM to assess adherence, which show a high rate of non-compliance (low compliance) of more than 50% of cases with a variability from 25 to 86.1%, with complete non-compliance – 10.1–34.5% in patients with uncontrolled and/or resistant hypertension (>3 antihypertensive drug). In a population of patients with a normal course of hypertension, taking 1–2 antihypertensive drug, the level of non-compliance according to the results of TDM did not exceed 10%. Comparison of the TDM method with indirect methods of assessing adherence did not reveal consistency; at the same time, the detection of antihypertensive drug better characterized the clinical problems of patients with arterial hypertension. In clinical practice, direct assessment methods (TDM) can be used to measure adherence in problem patients with uncontrolled hypertension and high cardiovascular risk despite optimal therapy.

Consilium Medicum. 2022;24(10):682-686
pages 682-686 views

Combination therapy of newly diagnosed intermediate-risk pulmonary arterial hypertension: A review

Lyapina I.N., Zvereva T.N., Martynyuk T.V.


Advancements in the specific therapy of pulmonary arterial hypertension (PAH) and new combination therapy strategies and escalation treatment over the past decade have significantly improved disease control, slowed its progression, and improved quality of life and patient survival. This review provides a detailed discussion of current strategies for PAH-specific therapy available in the Russian Federation for patients with classical and non-classical PAH who fail to achieve treatment goals and remain at intermediate risk of disease progression/mortality.

Consilium Medicum. 2022;24(10):688-695
pages 688-695 views

Anatomy of the coronary arteries and localization of coronary atherosclerosis in siblings with coronary heart disease

Kamolov I.H., Semitko S.P., Zhuravlev A.S., Chernysheva I.E., Tsereteli N.V., Sandodze T.S., Azarov A.V., Fomin V.V., Ioseliani D.G.


There is no doubt that there is a similar genetic predisposition in close relatives to the development of cardiovascular disease, while the features of coronary anatomy and possible commonality of pathological process in close relatives remain beyond research interest.

Aim. To study the anatomy of the coronary arteries, the nature and severity of coronary lesion in pairs of male siblings suffering from coronary artery disease, in comparison with control pairs of patients who are not closely related.

Materials and methods. This retrospective study included 87 male patients. The main group (58 patients or 29 couples) consisted of siblings with a “horizontal” hereditary burden for coronary artery disease. The control subgroup included 29 big brothers of the main group and another 29 patients who unrelated to them. To assess the degree of anatomy identity of the coronary bed in pairs of patients, we used a comparative characteristic of 25 segments of the coronary arteries (SyntaxScore). If there was similarity in anatomy and in the severity of the atherosclerotic process, each segment was assigned one point. In terms of the ratio of the total scores to the total number of segments (n=25), each pair of patients was assigned anatomical and atherosclerotic identity indexes.

Results. According to the results of the study, the average indices of anatomical and atherosclerotic identity indexes were significantly higher in pairs of sibs compared to control pairs of patients (0.92 versus 0.88, p=0.008 and 0.92 versus 0.76, p<0.001 respectively). When analyzing atherosclerotic lesions of the coronary arteries in pairs of sibs, a statistically significant coincidence of lesions in a number of segments of the coronary arteries was revealed, with the highest agreement in the left main coronary artery (κ=0.869, p<0.001) and in the proximal segments of the main branches of the coronary arteries: left anterior descending artery (κ=0.786, p<0.001) and right coronary artery (κ=0.812, p<0.001). In the group of control pairs, such regularities were not revealed.

Conclusion. In siblings with “horizontal” hereditary burden for coronary artery disease along the sibling line, the average anatomical and atherosclerotic identity indexes are significantly higher compared to control pairs. In pairs of siblings, there is the highest and most reliable probability of developing coronary atherosclerosis in the left main coronary artery and in the proximal segments of the left anterior descending artery and right coronary artery.

Consilium Medicum. 2022;24(10):696-702
pages 696-702 views

Bridging therapy according to new clinical guidelines: A review

Pavlenko T.A., Lebedeva A.Y., Protsenko D.N.


In modern world it is really important to know how to manage patients taking anticoagulant or antiplatelet therapy. There is an increasing number of patients, who have gone through PCI or any other cardiac intervention and who also need another surgery which cannot be postponed till the end of dual antiplatelet therapy. The number of patients who take oral anticoagulant has also increased last years. Algorithms of perioperative bridging therapy and antiplatelet therapy discontinuation can help to decrease both ischemic and hemorrhagic complications. Multidisciplinary risk assessment remains a critical component of perioperative care.

Consilium Medicum. 2022;24(10):703-712
pages 703-712 views

Contrast-associated acute kidney injury after percutaneous coronary interventions in patients with acute coronary syndrome: a real-world study

Kuznetsov V.A., Mironova O.I., Gritsanchuk A.M., Fomin V.V.


Aim. To study the incidence of contrast-associated acute kidney injury (CA-AKI) in patients with various forms of the acute coronary syndrome (ACS).

Materials and methods. An observational, open, single-center, prospective study included 83 patients with ACS with indications for percutaneous coronary intervention. Of these, 40 were included in the ST-segment elevation ACS group, and 43 patients were included in the non-ST-segment elevation ACS group. The study is registered at ClinicalTrials.gov as NCT04163484. Before the intervention, all patients had a general examination, ECG, complete blood count, blood chemistry, and blood coagulation tests. Later, 24 and 48 hours after the intervention, the serum creatinine (SC) trend was assessed. The primary endpoint was the development of in-hospital CA-AKI according to KDIGO criteria within 72 h or before hospital discharge.

Results. An increase in SC level by 25% from the baseline was observed in 6 patients in each subgroup of ACS. A marked increase in SC by 50% and a decrease in glomerular filtration rate were reported only in 2 patients (one in each subgroup of ACS).

Conclusion. The study showed that the incidence of CA-AKI in patients with ACS with ST-segment elevation was 2.3%, and in the group of patients with ACS without ST-segment elevation – 2.5%.

Consilium Medicum. 2022;24(10):713-717
pages 713-717 views

Microporous surface as a new solution for stent surface modification: A review

Kamolov I.H., Asadov D.A., Sandodze T.S., Chernysheva I.E.


The introduction of coronary stents into clinical practice has reduced repeated patient visits compared with balloon angioplasty alone. Also, drug-eluting stents substantially reduced the restenosis incidence. Therefore, later complications related to the implantation of a stent coated with a cytostatic-containing polymer became more relevant. The mechanism of late stent complications is multifactorial. It is mainly due to the body's response to the prolonged indwelling of the drug carrier polymer on the coronary stent's surface. There is a trend towards the return of polymer-free drug coating technologies, which are implemented through certain modifications of stent surfaces for better drug retention and proper drug distribution. It is mainly achieved using drug depots in various reservoirs: grooves, nanoparticles in the matrix compound, micropores, through and blind micro reservoirs, etc. New promising technologies for crystallizing cytostatic drugs or depositing them in specially designed reservoirs show good preclinical and clinical results, comparable or even superior to approved coronary stents. Micropores as carriers for antiproliferative agents on the stent surface are a promising direction to rejecting the use of polymers in stents.

Consilium Medicum. 2022;24(10):718-725
pages 718-725 views

Catestanin – a promising biological marker for heart failure: A review

Alieva A.M., Teplova N.V., Reznik E.V., Ettinger O.A., Faradzhov R.A., Khachirova E.A., Kovtiukh I.V., Kotikova I.A., Sysoeva D.A., Bigushev I.R., Nikitin I.G.


The epidemic of heart failure (HF) is one of the problems that the global health system has been facing for decades. HF is a multicomponent clinical syndrome caused by dysfunction of the heart and its pathological remodeling. In addition to the well-known natriuretic peptides, a number of cardiovascular biological markers have now been identified that provide clinicians with additional opportunities in diagnosing, classifying, predicting, and monitoring the effectiveness of treating patients with HF. From the position of establishing the sympathetic load in patients with HF, it seems very promising to assess the concentrations of catestatin. The presented data of our literature review suggest that catestatin is probably a reliable biological marker of the activity of the sympathetic division of the autonomic nervous system, and its elevated concentrations in patients with HF reflect the severity of the pathological process. However, despite the reliable results of studies, the clinical significance of assessing the values of this marker both separately and in the framework of a multimarker model requires further study in larger prospective clinical studies.

Consilium Medicum. 2022;24(10):726-731
pages 726-731 views

Heart failure as a complication of myocardial infarction: rational therapy. Case report

Zhirov I.V., Safronova N.V., Tereshchenko S.N.


Heart failure (HF) is still a frequent complication of myocardial infarction. Timely identification of subjects at risk for HF development and early initiation of guideline-directed HF therapy in these patients, can decrease the HF burden. This article aims at summarizing clinical data on established pharmacological therapies in treating post-MI patients with left ventricular systolic dysfunction and signs and symptoms of HF.

Consilium Medicum. 2022;24(10):732-740
pages 732-740 views

Study of the rs1800795 polymorphism of the IL6 gene to verify the clinical portrait of a patient with chronic heart failure: gender aspects

Khazovа E.V., Boulashova O.V., Valeeva E.V.


Background. Genetic studies in cardiology allow to identify predisposition and predict the course of multifactorial cardiovascular diseases by identifying the association of polymorphic loci of candidate genes with the clinical phenotype. One of these diseases associated with poor prognosis is chronic heart failure (CHF). Activation of pro-inflammatory cytokines is one of the key aspects of the development and progression of CHF.

Aim. To identify the features of the clinical course of CHF of ischemic etiology in patients, taking into account the gender and genotype of the rs1800795 polymorphism of the IL6 gene.

Materials and methods. Four hundred fourteen patients of both sexes with stable CHF of ischemic origin, aged 66.4±10.4 years, were included. Clinical characteristics of men and women of each genotype of the rs1800795 polymorphism of the IL6 gene were compared. Genotyping of the rs1800795 polymorphism of the IL6 gene was performed by real-time polymerase chain reaction.

Results. In male patients with CHF, the frequency of allele C was higher than in the control group (p=0.04). Homozygous carriers of the C allele showed a greater risk of developing atrial fibrillation (p=0.021). In terms of biochemical parameters, in patients with a heterozygous genotype, compared with homozygotes for the G allele of the rs1800795 polymorphism of the IL6 gene, the levels of cholesterol, triglycerides (TG), cholesterol not associated with high-density lipoproteins (non-HDL-cholesterol) were higher (p=0.044, p=0.019, p=0.016). Patients with the CC genotype of the rs1800795 polymorphism of the IL6 gene females compared with men were more likely to have III–IV functional class of CHF (p=0.001) and had a high heart rate (p=0.021). Male patients of the CG genotype were more likely to undergo coronary interventions (p=0.001). In women of the CG genotype, CHF was more often combined with DM (p=0.015), the level of non-HDL-cholesterol (p=0.04) was higher, and glomerular filtration rate was lower than in men (p=0.001). Comparison of the GG genotype revealed a higher incidence of chronic kidney disease in women (p=0.022). Women had significantly lower glomerular filtration rate (p=0.001), systolic blood pressure (p=0.004). The level of such biochemical parameters as cholesterol (p=0.001), TG (p=0.019), low-density lipoprotein cholesterol (p=0.002) was reduced, except for high non-HDL-cholesterol (p=0.001). There were more men with left ventricular ejection fraction <40% (p=0.009), women with left ventricular ejection fraction >50% (p=0.002).

Conclusion. The identified phenotypic and gender differences create prerequisites for determining patient-oriented genetic risk, opening up new opportunities for preventing the progression and complications of CHF.

Consilium Medicum. 2022;24(10):741-746
pages 741-746 views

Options for approaches to nephrectomy in patients with end-stage chronic kidney disease caused by autosomal dominant polycystic kidney disease: A review

Simonov P.A., Firsov M.A., Arutunyan V.S., Laletin D.I., Alekseeva E.A.


Autosomal-dominant polycystic kidney disease is a common kidney disease that affects all racial groups around the world, occupies one of the leading places in the structure of urological diseases and forms a significant contribution to the structure of all causes leading to the end stage of chronic renal failure, disabling patients in this group and hence leading to the inevitability of renal replacement therapy. A highly effective clinical method for replacing lost kidney function is kidney transplantation. Based on the fact that the number of patients with this pathology is increasing, it is necessary to search for and introduce clear criteria for the best care, taking into account the high likelihood of developing infectious complications, hematuria, the absence or presence of diuresis, arterial hypertension in this category of patients. The article reflects the various methods of nephrectomy in patients suffering from autosomal dominant polycystic kidney disease, as well as how approaches to nephrectomy have evolved. The results of complications, as well as patient and graft survival in domestic and foreign studies, in which bilateral or ipsilateral nephrectomy was used using open or laparoscopic access before, during or after kidney transplantation, are demonstrated. Preference is rightfully given to minimally invasive methods of surgical treatment. Taking into account the already reduced resources of the organism of these patients, the volume and method of surgical treatment should be carefully chosen, taking into account safety, efficacy and risk minimization.

Consilium Medicum. 2022;24(10):747-752
pages 747-752 views

Primary enuresis in adults: pathogenesis, clinical course and modern approaches to treatment: A review

Kuzmin I.V.


The review article presents current data on the epidemiology, classification, pathogenesis, risk factors, diagnosis, and features of the clinical course of primary enuresis in adults. The main methods of treatment of patients with primary enuresis are described in detail. It has been shown that in the treatment of this category of patients, the leading role is given to the use of a synthetic analogue of the antidiuretic hormone desmopressin. A detailed analysis of the pharmacological properties and clinical use of desmopressin in patients with primary enuresis is presented. The advantages of prescribing a sublingual form of desmopressin, which ensures its high efficiency and good tolerability of therapy.

Consilium Medicum. 2022;24(10):753-758
pages 753-758 views

The role of urological pathology in the development of terminal renal failure

Simonov P.A., Firsov M.A., Dunc D.A., Bezrukov E.A., Ivliev S.V.


Background. Chronic kidney disease (CKD) is one of the most serious and pressing health problems worldwide today. The end stage of CKD leads to disability and dramatically reduces the quality of life, which is caused by the need for continuous renal replacement therapy. The causes of CKD are various and are often caused by urological pathology.

Materials and methods. Five hundred eighty seven case histories of patients with CKD on renal replacement therapy in the Krasnoyarsk Territory for 2022 were analyzed. Most of them were patients with chronic glomerulonephritis (38%) and urological diseases (29%). Other reasons that led to hemodialysis are diabetic nephropathy (12%), hypertensive nephropathy (8%), mixed nephropathy (5%). Systemic diseases with kidney damage, oncological diseases, rejection of a kidney transplant, genetic diseases – 2% each.

Results. Оne hundred and seventy patients with urological diseases are on program hemodialysis. The mean age of this group of patients was 56.2 years. The incidence of CKD varies slightly between men (48%) and women (52%). The structure of the incidence of urological pathology is as follows: all patients somehow had signs of chronic pyelonephritis. Of 170 people, only 15% had primary chronic pyelonephritis as the main cause of end-stage CKD. The remaining 81% of patients showed signs of secondary pyelonephritis. Patients with polycystic kidney disease accounted for 44%, patients with urolithiasis – 13%, patients with anomalies in the development of the kidneys and urinary tract – 7%, vesicoureteral reflux, with prostate adenoma – 5% patients with signs of a neurogenic bladder 3% and 3% – patients with ureteral structure. Patients with oncological pathology accounted for 4%.

Conclusion. Over the past decade, the structure of diseases of patients on hemodialysis has changed. Due to the more accessible diagnostic service in the region, the proportion of urological pathologies in patients is increasing. At the same time, the timely use of reconstructive, minimally invasive, nephron-sparing operations can reduce the risks of progression of CKD. However, the number of end-stage patients is steadily increasing, requiring continued development of the hemodialysis service and other forms of renal replacement therapy.

Consilium Medicum. 2022;24(10):759-762
pages 759-762 views

The prevalence of hypertension among patients with psoriasis in clinical practice

Kuzmina O.A., Mironova O.I., Lepekhova A.A., Fomin V.V.


Background. Psoriasis is a systemic chronic immune-mediated inflammatory skin disease of a multifactorial nature that affects about 2 to 3% of the population worldwide. Given the systemic nature of the disease, the level of comorbid diseases is high, especially those associated with damage to the cardiovascular system. According to the results of various meta-analyzes, it has been proven that among patients with psoriasis, the risk of developing hypertension is high.

Aim. To evaluate the prevalence of arterial hypertension (AH) among patients with psoriasis.

Materials and methods. We present an open, prospective, observational clinical trial, which includes 60 patients diagnosed with psoriasis vulgaris of varying severity and psoriatic arthritis. All patients underwent clinical and laboratory tests, including the level of total cholesterol, glucose, creatinine, C-reactive protein, calculation of glomerular filtration rate. Body mass index, blood pressure level according to the Korotkov method, severity of the disease by determining psoriasis area and severity Index (PASI), dermatological quality of life index (DLQI), levels of hospital anxiety and depression according to the HADS scale were also assessed. The SCORE2 scale was used to assess cardiovascular risk in patients aged 40 to 69 years, the SCORE 2OP scale for patients aged 70 to 89 years, respectively. Cardiovascular risk was defined as low for patients under 40 years of age. All study participants were examined for the presence of AH.

Results. The prevalence of hypertension was 25%, with prevalence among men (15%). The prevalence of hypertension is directly proportional to the severity of psoriasis (13% with hypertension in patients with severe psoriasis, 12% with hypertension with moderate psoriasis, 2% with hypertension with mild psoriasis).

Conclusion. Given the high prevalence of AH among patients with psoriasis, it is necessary to form a multidisciplinary approach to the treatment of patients, including a thorough assessment of cardiovascular risk in clinical practice.

Consilium Medicum. 2022;24(10):763-766
pages 763-766 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies