Vol 18, No 1 (2016)

The review presents data concerning the optimization of pharmacotherapy of hypertension to reduce the risk of cardiovascular diseases and their complications fixed combinations of antihypertensive drugs, on the basis of application perindopril and indapamide.

We analyzed the correlation between the starting dose and the corrected one within 2 weeks of outpatient or inpatient treatment of Bisoprolol (b-AB) in 48 elderly (mean age 56±7.9 years old) and 65 senile (mean age 87±6.4 years old) patients with arterial hypertension associated with chronic cardiovascular and bronchopulmonary diseases in remission in clinical practice due to the presence of the wide range of b-adrenergic blocking agents (b-AB) dosing in the treatment of cardiovascular diseases. Bisoprolol was prescribed as the second or third additional agent in combination with angiotensin-converting enzyme inhibitor, angiotensin II receptor blocker, calcium channel blocker and diuretic to low to target blood pressure and to slow the heart rate. We revealed that effective and tolerated dose of Bisoprolol was 1.25-2.5 mg in more than 1/2 of elderly patients and more than 80% of senile patients. We identified the clinical situations where low doses of Bisoprolol should be prescribed in elderly patients, and the recommendations on managing the therapy with the focus on monitoring diuretic profile to prevent possible urodynamic disorders. We made the conclusion showing the need of lowest dosage of Bisoprolol (2.5 mg) application in clinical practice.

The article discusses the importance of diuretic therapy in patients with chronic heart failure, using evidence-based results, monitoring the efficacy and safety. Special attention is paid to the loop diuretics, especially torsemide, recommended for long-term use not only as diuretic therapy, but also as a novel neurohumoral modulator from the standpoint of organoprotective property.

Issues of interruption of paroxysmal atrial fibrillation (AF). Discussed in detail the tactics of "pill in the pocket", including the clinical case. Despite convincing data from clinical trials and practice, the method of "pill in pocket" with the use of propafenone is rarely used. A protocol on management of paroxysmal AF to be used in an outpatient setting.

The article deals with the literature review concerning the candesartan cilexetil application in patients with arterial hypertension, chronic heart failure, chronic kidney disease, diabetes mellitus and other conditions. Particular attention is paid to the special aspects of the pharmacokinetics and pharmacodynamics of the drug, organoprotective properties, metabolic neutrality and safety application.

The article considers the possibility of 5 major classes of antihypertensive drugs to reduce the risk of dementia and to impact on cognitive functions. It is noted that angiotensin-converting enzyme inhibitors do not have a class effect associated with cerebral protection. We show in detail the results of perindopril usage for the prevention of dementia and improvement of cognitive functions. We discuss the mechanisms of cerebral protection in case of applying perindopril.

The aim of the study is to assess the antiarrhythmic action of ivabradine in patients with comorbid pathology, and associated with the combination of effort angina and chronic obstructive pulmonary disease following coronary artery bypass graft surgery.Materials and methods: we examined 120 men with stable effort angina functional classes II-III 3 years after coronary artery bypass graft surgery using the hardware-software complexes “ETON” and “Holter-DMS”. The article describes the following results: the application of ivabradine can reduce ventricular extrasystoles.Conclusion: we recommend using ivabradine in patients with ischemic heart disease combined with chronic obstructive pulmonary disease after coronary artery bypass graft surgery because of significant antianginal effect of this drug: such as reducing the number of angina attacks, improving the quality of life of patients, increasing heart rate variability.

Macronodular bilateral adrenal hyperplasia (MBAH) in major cases is genetically-determined disease, which is manifested by symptoms of hypercortisolism. The MBAH is a diagnostic challenge due to the lack of usual clinical features, the questionable laboratory data, the great amount of tests, the different cutoff points and the lack of specificity of radiological characteristics.According to the latest data, a central role in hormonal hypersecretion and cellular proliferation in MBAH play aberrant membrane receptors of adrenal cortex, ectopic adrenocorticotropic hormone production, defects in adenylate cyclase and Wnt signaling systems, disorders of steroidogenesis. However, the exact molecular mechanisms, responsible for the development of MBAH, are unknown. The identification of pathogenetic mechanisms of development MBAH will allow to develop new methods of timely diagnostics and comprehensive treatment of the disease.