Vol 19, No 10 (2017)

The article discusses the evidence base, limitations and prospects for the use of combined multicomponent drugs in the prevention of cardiovascular diseases. Complex of antihypertensive, lipid-lowering, hypoglycemic and antiplatelet therapy significantly reduces the risk of cardiovascular complications and fatal events. However, in real clinical practice, a full implementation of all these approaches is not always carried out, which reduces the effectiveness of preventing cardiovascular diseases.

Elderly patients with arterial hypertension belong to the categories of high and very high risk. The article discusses the selection of optimal combination therapy for the elderly, the possibility of increasing adherence to treatment, discusses the evidence-based advantages of a triple fixed combination of perindopril/indapamide/amlodipine.

This article presents an algorithm for choosing the optimal drug for the treatment of arterial hypertension, classification of arterial hypertension, describes the main group of hypotensive drugs with the characteristic of their mechanism of action and the development of possible side effects. The authors of the article describe the hypotensive drug of the group of angiotensin II AT1 receptor blockers - candesartan (Hyposart, Akrikhin company). The article presents the results of multicenter randomized studies of candesartan in patients with arterial hypertension, nephropathy associated with diabetes mellitus and heart failure. This article presents the algorithm for choosing optimal hypotensive drug, as well as shows evidence-based information concerning efficacy and safety of the drug candesartan. Candesartan provides dose-dependent antihypertensive effect in all categories of patients with arterial hypertension and can be recommended in wide clinical use.

In the context of global warming with an increase in heat waves, associated with an increase in cardio - vascular morbidity and mortality of particular interest is the effect of cardiac drugs on adaptation to high temperatures. This review represents the results of European and national research on the safety of therapy during the long and short heat waves. Recommendations are presented on the correction of therapy during this period. Required component of therapy of hypertension during heat waves is a home blood pressure monitoring. The development of clinically significant hypotension requires a reduction in the dose of antihypertensive drugs. We recommend starting with a reduction in the dose and/or elimination of diuretics and nitrates. Complete withdrawal is not recommended. It is recommended to prefer to calcium channel antagonists, angiotensin converting enzyme inhibitors and selective beta-blockers in the case of increased blood pressure during the heat wave. Patients should be informed about the additional protective effect of statins in order to increase adherence. Taking diuretics patients need individual daily monitoring fluid intake and body weight.

Presents a clinical case, which compares performance of brachial blood pressure and central aortic pressure with subclinical organs damage. It has been suggested that central pressure, as an indicator of vascular aging, appropriate to measure not only in hypertensive patients, but also in all people after age 50.

This article presents the overview of the scientific data and the results of clinical studies of mineralocorticoid receptor antagonists. Spironolactone is a selective mineralocorticoid receptor antagonist and has affinity for androgen and progesterone receptors, whereas eplerenone - is a highly selective antagonist. Differences in the pharmacokinetics of drugs are metabolism and the relationship between the drug and plasma proteins: eplerenone is not unexposed to presystemic metabolism and has relatively low (approximately 50%) level of plasma proteins. We have many evidence-based clinical studies concerning eplerenone in the treatment of arterial hypertension in both monotherapy and in combination with other drugs; high effectiveness of antihypertensive effect in comparison with other drugs. Eplerenone shows organ-protective effect on the regression of left ventricular hypertrophy and microalbuminuria (4E-LVH-Study). The efficiency of eplerenone is described in the treatment of patients with chronic heart failure (EPHESUS, EMPHASIS-HF). Eplerenone has good tolerance and lower frequency of side effects in the sexual sphere.

Background. Effective treatments in heart failure (HF) patients with ischemic etiology have not been fully established. Nicorandil, combination of nitrate component and sarcolemmal adenosine triphosphate-sensitive potassium channel opener, is a potent vasodilator of coronary and peripheral vessels and has been used as an antianginal agent. Therefore, we examined impacts of nicorandil on cardiac mortality in ischemic HF patients. Methods. Consecutive 334 HF patients with ischemic etiology were retrospectively registered and divided into 2 groups based on oral administration of nicorandil: nicorandil group (n=116) and non-nicorandil group (n=218). We retrospectively examined cardiac mortality. Results: In the Kaplan-Meier analysis (mean follow-up period 963 days), cardiac mortality was significantly lower in the nicorandil group than in the non-nicorandil group (11.2% vs 19.7%, р=0.032). In the Cox proportional hazard analysis, usage of nicorandil was a suppressor of cardiac mortality (hazard ratio 0.512, 95% confidence interval 0.275-0.953, р=0.035), and this result was consistent in several subgroup analyses, such as left ventricular ejection fraction, percutaneous coronary intervention, coronary artery bypass graft, diabetes, р-blockers, and statins. Conclusion. Nicorandil is potentially effective for reducing mortality in patients with ischemic HF Trial registration. This was a retrospective study

The article is devoted to the safety of statins in terms of hepatotoxicity. These recommendations are presented in terms of monitoring liver function in patients receiving statins. The choice of the optimal scheme of statin therapy from the perspective of the efficiency/safety ratio are discussed.

Omega-3 essential fatty acids have major roles in all sorts of bodily processes. Numerous observational studies demonstrate that increase consumption of fishmeal as a replacement of the nutrient deficiency caused by modern dietary habits tends to reduce risk of cardiovascular diseases. Taking omega 3 fatty acids capsules during therapy may significantly reduce sudden cardiac death in patients with a history of myocardial infarction; improve survival in congestive heart failure patients; possess antiarrhythmic effect. The main purpose of this review is to draw attention of doctors to this important therapeutic area and to remind that the use of omega-3 fatty acids is appropriate and effective for primary and secondary prevention of cardiovascular diseases, as well as to emphasize the necessity of its wide-ranging use in patients with myocardial infarction, heart failure, and adding in the combination therapy of arrhythmia.

The article presents the classification and the pathogenesis of pulmonary arterial hypertension. The article also presents a modern literature review of application of endothelin-1 receptor antagonist bosentan in different variants of pulmonary hypertension and the characteristics of the drug application in practice. The article shows the recent studies results concerning the application of bosentan in clinical practice.

Metabolic syndrome (MS) rightly lies in the application of scientific and therapeutic and preventive efforts of modern medicine that unites the interests of specialists of various profiles due to its high prevalence, social weight and influence on the prognosis. The idea of appropriate metabolic, hormonal-regulatory, cardiovascular disorders, united within the MS, underscores the ambiguity of the pathogenesis of this condition, the difficulty of finding effective and safe methods of treatment in terms of comorbidity and prognostic significance. In the modern literature, the issue of prioritizing the use of bariatric interventions in obese individuals is being actively discussed. This review focuses on the possibilities of using metabolic surgery in a MS in the context of influencing other components included in this concept

The review considers the hypothesis of the "amyloid cascade” and the "calcium" hypothesis in the onset and progression of Alzheimer's disease in the light of recent experimental data. Particular attention is paid to the change in the homeostasis of Ca2+ and Ca2+ ions upon the action of cytotoxic р-amyloid peptides (Ар-peptides) and hyperphosphorylated tau proteins on neurons. Using the example of the dihydropyridine blocker of Ca2+ -channels of nitrendipine, new mechanisms of its protective action are presented, which are associated with a decrease in the formation of Ар-peptides and their removal from the brain into the blood (clearance Ар).