Vol 19, No 5 (2017)

The problem of dementia has a very important medical, social and economic importance in terms of the ageing of population. This review deals with the place of arterial hypertension as a risk factor for dementia and detection methods for dementia in the real clinical practice. The authors have analyzed the questionable association between blood pressure level and the development and progression of various types of dementia. The article showed the information about the efficacy of modern antihypertensive therapy for prevention of dementia with a focus on the potential of nitrendipine (calcium antagonist), which had showed the cerebroprotective potential in a number of investigational studies and large scale randomized placebo-controlled trial Syst-Eur.

In a review article presents an analysis of the main causes of resistance to antihypertensive treatment and uncontrolled arterial hypertension. The article deals with the discussion of the selection of combined antihypertensive treatment. The authors have shown the benefits of 3-component combined therapy consisting of calcium antagonist - amlodipine, angiotensin-converting enzyme inhibitor - perindopril and thiazide-like diuretic - indapamide. The analysis of the study demonstrates the efficacy and safety of fixed dose combination of perindopril/indapamide/amlodipine.

Topicality. Evaluation of diastolic characteristics of the left ventricle (LV) in patients with hypertensive heart is important due to the fact that they are formed at a time of increasing myocardial mass of LV, able to progress, manifesting the clinical syndrome of chronic heart failure mainly in old age. Aim is to determine the efficacy of perindopril and ivabradine in the correction of blood pressure and contraction heart rate, as well as the functional parameters of LV myocardial function, vasoregulating function of the endothelium of peripheral arteries in patients with hypertensive disease. Object and methods. The study included 43 men aged 52-64 years with diagnosis of "hypertensive disease" without systematic application of antihypertensive drugs in the past, who had no clinical signs of chronic heart failure, had sinus rhythm more than 75 per minute at rest. The control group included 21 men, comparable in age, without deviation in electrocardiogram and physical signs of heart disease. Echocardiography was performed in all patients included in the study with the help of which the main parameters at rest were defined. We also used Pulse-wave Doppler LV inflow and tissue Doppler mode where we evaluated the movement of the lateral part of the mitral valve ring and phase index of LV. Endurance cycle test was conducted for 2 minutes at 25, 50 and 75 Watts. The function of the endothelium and arterial stiffness were examined by the method of computer based finger-photoplethysmography. The study was divided into 3 visits: on the first visit patients were appointed perindopril (Prestarium® A, Servier) in a dose of 10 mg/day; on the second visit ivabradine (Coraxan®, Servier) in a dose of 7.5 mg twice a day was added for a month; and the third visit was the final stage of the study. Results. The systolic and diastolic pressure during lying down position, sitting position and under load of 25 watts during the last visit of the group of patients with hypertensive disease did not differ from the control group, according to the results of blood pressure measurement. Ivabradine in addition to perindopril significantly increased the bradycardia effect and the results in investigated group of patients and in the control one were practically the same taking into account heart rate in a wide range of physiological states. Peripheral vascular endothelial function indicator during the observation completely normalized. In the study of phase index of LV we showed that physical activity and changing body position could significantly influence towards the increase, both in healthy people and in patients with hypertensive heart. Conclusion. We demonstrated significant hypotensive effect of perindopril at rest, and at dynamic load and the efficacy of ivabradine in heart rate normalization. We showed the high sensitivity of phase index of LV as a marker of left ventricular dysfunction, the dynamic changes of the index in response to normalizing the blood pressure and heart rate, regardless of LV myocardial mass, as well as the ability to normalize vasculomotor function of endothelium of peripheral artery, that provided the basis for improving vascular stiffness parameters later.

This review deals with the problem of safety of acetylsalicylic acid (ASA) therapy. ASA is the most often appointed antiaggregant with a wide range of indications. At the same time, the increased risk of hemorrhage significantly complicates the practice of appointment of the antithrombotic therapy. The review shows the basic approaches in the prevention of complications and safety of different forms of ASA.

Thrombosis is a common pathology underlying ischemic heart disease, ischemic stroke, and venous thromboembolism. Ultrasound duplex scanning is an important part in the diagnostic evaluation looking for potential cardiovascular sources of thrombosis. Spontaneous echo contrast (SEC) in the left atrium or left ventricle is known to be associated with a higher risk of thromboembolism from the heart. The principles applicable to the assessment of the SEC in the chambers of the heart can be used to study by the SEC in brachiocephalic vessels.

Torasemide is a representative of a new generation of loop diuretics, which shows high efficacy and safety in the treatment of patients with heart failure and arterial hypertension. This drug does not only affect the symptoms, but also intervenes in the pathogenesis of cardiovascular disease continuum, improves the quality of life and the prognosis of cardiac patients. The clinical studies showed the efficacy and good tolerability of Trigrim® (local drug torasemide) which could be widely recommend in the treatment of patients with arterial hypertension, edema syndrome, and in presence of chronic heart failure.

Interview with A.Yu.Mayorov