Vol 17, No 10 (2015)

The article deals with the different aspects of the combined therapy in arterial hypertension. We discuss complementary effects and advantage of combination of angiotensin II receptor blockers (ARBs) and diuretic; describe clinical setting where the usage of that combination is preferred. We have been analyzing in detail, the available literature data concerning efficacy, including comparative efficacy, and safety of using combination of azilsartan and chlorthalidone. We underline the advantages of azilsartan among ARBs class and chlorthalidone among diuretics.

We show the pharmacoepidemiology review concerning diuretics usage for the treatment of arterial hypertension, the role of loop diuretics, in particular torasemide.

Arterial hypertension (AH) is a modifiable wide-spread risk factor for common cardiovascular diseases. The large number of observations during several studies showed that obstructive sleep apnea syndrome (OSA) was an independent risk factor for AH. This article deals with OSA pathogenetic mechanisms, considering the model of bidirectional relationship between OSA and AH, as well as the effect of CPAP-therapy (Constant Positive Airway Pressure, CPAP) on blood pressure in hypertensive patients. There are many open questions concerning the pathogenesis of OSA, its effect on the cardiovascular system and prognosis, nowadays. Despite the fact that the decrease in blood pressure during CPAP-therapy in patients with OSA is usually small, a small drop in blood pressure, even a few mm Hg can significantly reduce the cardiovascular risk, but the combination of drug therapy and CPAP-therapy can result in significant decrease in blood pressure, especially in people with poorly controlled AH. Patients who have been attended clinics, specializing in the diagnosis and treatment of hypertension should be examined for the presence or absence of OSA as a possible modifiable risk factor.

This article deals with the topic of snoring and obstructive sleep apnea from the viewpoint of otorhinolaryngologist. We showed the causes, diagnostics and ways of correcting these conditions.

The article discusses current algorithm for choice of drugs for rate control in atrial fibrillation. It is shown that algorithm use in clinical practice may lead to excessive prescribing of digoxin and b-blockers compared to non-dihydropyridine calcium antagonists. A modified algorithm is proposed to extend indications for use of diltiazem. A rationale is provided for diltiazem-apixaban combination to reduce the cost of anticoagulation therapy.

This review presents the problems of acetylsalicylic acid (ASA) application in general clinical practice. We showed that this was the most commonly used antiplatelet drug and it was very important to take the correlation of efficiency and risk of complications into account during the appointment of this drug. We described the problems associated with risk assessment and treatment selection in patient with subclinical atherosclerosis. We showed main associations between the different atherosclerosis markers and risk of coronary and cerebral complications; the results of meta-analysis concerning the efficiency of antiplatelet therapy. We discussed the possibilities for the prevention of the gastrointestinal tract damage. The application of the lowest effective quantity of ASA was the most important act for safe usage. The combination of ASA and small antacid doses could make its application more safety without significantly affecting the drugs efficiency.

Aortic valve (AV) stenosis is a disease with steadily progressive course and associated with poor prognosis. The development of new technologies helps to develop new methods of AV prostheses; in particular, we use transcatheter aortic valve implantation (TAVI) especially in high-risk surgical patients, nowadays. TAVI was performed in 152 patients with critical aortic stenosis in the Department of cardiovascular surgery of Russian Cardiological Scientific-Industrial Complex, from February 2010 till June 2015. The comparative characteristics of primary TAVI outcomes, received in RCSIC, were similar to the results of the other studies. Hospital mortality during the observation period was 7.8%; these data were appropriate to various international registers. Thus, the TAVI procedure was a good alternative to surgical AV prosthesis in elderly patients with concomitant diseases. Important aspect of TAVI success was coordinated action of multidisciplinary team consisting of cardio-vascular surgeon, cardiologist, and specialists of the various research methods, the anesthesiologist, as well as paramedics, which was specifically emphasized in the recommendations. Currently, researchers are trying to get answers to questions concerning the reduction of stroke rate and transient ischemic attacks after TAVI, the application of TAVI in young patients and in patients with lower risk.

Diabetes mellitus (DM) is a heterogeneous group of metabolic disorder characterized by hyperglycemia, micro - and cardiovascular complications. According to the data of International Diabetes Federation (IDF), the number of patients with DM has been progressively increasing. DM can be determined in 7 million people and 3.8 million of them die annually from the causes associated with DM. The most significant factor leading to heart muscle damage in case of DM is hyperglycemia that can damage the myocardium. The mechanisms of endothelial dysfunction in patients with DM are associated with the synthesis reduction and the amplification of the angioprotective factor disintegration (nitric oxide) due to oxidative stress, nowadays. There is an existence of another important factor - diabetic cardiomyopathy, which can affect the cardiac prognosis in patients with DM. Long-lasting DM leads not only to the development of coronary arteries atherosclerosis, diabetic cardiomyopathy, but also to autonomic neuropathy affecting the heart and blood vessels. Many studies showed that disinsulinism and impaired insulin sensitivity were important determinants of DM and impaired glucose tolerance. The achievement of target glycemic levels close to nondiabetic status would bring to the significant reduction of the micro - and macrovascular complications development.