In the issue.

The CAMELLIA trial: scientific value and recommends for practitioner.

Aim. To study prevalence and features of cardiovascular diseases (arterial hypertension, ischemic heart disease, chronic heart failure) in patients with chronic obstructive pulmonary disease (COPD).

Material and methods. 233 patients with COPD (229 men, 4 women; 55,3±0,6 y.o.) were examined. General clinical examination, including body mass index calculation, 6-min walk test, blood analysis, electrocardiography, echocardiography, investigation of respiratory function, pulsoxymetry was carried out. Cardiac Infarction Injury Score (CIIS) index was also evaluated.

Results. COPD is associated with arterial hypertension in 62,2% of cases, ischemic heart disease - 27%, carotid atherosclerosis - 43,6%, chronic heart failure in 23,6% of cases. Risk factors of ischemic heart disease in COPD patients include: age, COPD severity, bronchial obstruction severity (decrease of forced expiratory volume), systemic inflammation (high level of C-reactive protein). Patients with severe and very severe COPD had CIIS index >20 1,8 times more often than patients with moderate COPD. Significant correlation of CIIS index with pulmonary hypertension (r=0,21, p<0,05), end-diastolic dimension of right ventricle (r=0,24, p<0,05) and left ventricle (r=0,33, p<0,05), left ventricle ejection fraction (r=-0,40, p<0,01) was found.

Conclusion. COPD is associated with cardiovascular diseases. CIIS index can help to detect previous myocardial infarction in COPD patients.

Aim. To evaluate efficacy of the combined therapy (sotalol and constant electric cardiostimulation in AAI regimen) at two atrial electrode position: in low back part of interatrial septum (IAS) and in right atrial auricle (RAA).

Material and methods. 20 patients with tachy-brady syndrome were examined. They were randomized in 2 groups depending on atrial electrode position. Sotalol (160 mg daily) was prescribed to all patients in a month after implantation of constant atrial pacemaker (CAP). A number of atrial fibrillation paroxysms (AFP) was evaluated initially, in a month after CAP implantation and in a month after start of sotalol therapy.

Results. Significant AFP reduction was observed in IAS stimulation, unlike RAA stimulation. Sotalol addition had essential significance in the termination or reduction of AFP. Sotalol effect did not depend on atrial electrode position.

Conclusion. Sotalol usage together with constant electric cardiostimulation significantly reduces AFP irrespectively of atrial electrode position. 

Aim. To compare tolerability of various antihypertensive combinations in patients with arterial hypertension (HT).

Material and methods. 140 patients with HT with history of non-effective antihypertensive therapy were randomized in 4 groups, 35 patients in each. Patients of group A received indapamide retard/perindopril; group B - indapamide retard/amlodipine; group C – amlodipine/lisinopril; group D – amlodipine/bisoprolol. Therapy duration was 12 weeks.

Results. 28 (20%) patients dropped out of the study. All antihypertensive combinations significantly decreased blood pressure level. Patients of group A did not stop therapy because of adverse events. 6 (17,1%) dropped out of the study because of ineffective therapy in maximal doses and therapy rejection. Palpitation was a reason of drug withdrawal in 3 (8,6%) of 8 (22,9%) dropped patients of group B. Low limb edema was a reason of drug withdrawal in 4 (11,4%) of 8 (22,9%) dropped patients of group D. Cough was a reason of drug withdrawal in 4 (11,4%) of 5 dropped patients of group C. Dose reduction was needed in some patients of all groups because of hypotension.

Conclusion. The adverse events were observed in 25% of patients during 12 weeks of therapy. The patients received indapamide retard/amlodipine and amlodipine/bisoprolol had the highest rate of drug withdrawal because of adverse events. Low limb edema, cough and palpitation were the most frequent adverse events needed therapy withdrawal.

Aim. To evaluate changes of quality of life (QL) in young hypertensive patients having «Health School» educational course in comparison with patients having standard non-drug therapy.

Material and methods. 114 young patients with arterial hypertension, stage 1, and low and moderate cardiovascular risk were involved in the study. Patients were randomized in 2 groups. Patients of the 1st group (n=59) were trained at «Health School». Patients of the 2nd group had the routine doctor consultation. Changes of systolic and diastolic blood pressure (BP) and QL were evaluated in 6, 12 and 36 months.

Results. Decrease of systolic and diastolic BP as well as improvement of QL was observed in both groups. However «Health School» demonstrated significantly higher efficacy in comparison with routine consultation.

Conclusion. Non-drug correction of the risk factors is effective method of BP control in young hypertensive patients. High efficacy of «Health School» educational course allows recommending it for implementation in practical medicine. 

Aim. To study effects of bioflavonoid quercetin (corvitin) on left ventricle (LV) systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST) after cardiac revascularization.

Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o.) were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of group B received corvitin additionally to standard therapy before cardiac revascularization. Echocardiography initially and stress-echocardiography with dobutamine after status stabilization (at 8-10 days of disease) were performed.

Results. Dobutamine test (with low and high doses) showed myocardial viability in patients of group B. Patients of group A had irreversible LV systolic dysfunction in 32 % of segments. Corvitin slowed down LV dilatation progression in patients with ACS+ST. It resulted in the end-diastolic and end-systolic indexes did not change within 10 days. The LV ejection fraction was more increased in patients of group B in comparison with patients of group A.

Conclusion. The early corvitin prescribing has positive effects on LV systolic function and prevents post-reperfusion complications. 

Aim. To evaluate efficacy and safety of combined antihypertensive therapy based on ramipril, metoprolol tartrate, amlodipine bensilate and rilmenidine dihydrogen phosphate in hypertensive patients with chronic glomerulonephritis (CGN) and normal renal function.

Material and methods. 136 patients (39,2±14,6 y.o.) with hypertensive type of primary CGN and with normal renal function were examined. Clinical blood pressure (BP) and 24-hour ambulatory BP monitoring (ABPM) were evaluated initially and in 12 months of antihypertensive therapy.

Results. Significant decrease of clinical BP was observed in 12 months of therapy in all patients. Target BP level was reached in 37 % of patients. ABPM indices were also improved: average BP levels and hypertensive burden time decreased, speed of morning BP raise was slow down, there was a tendency to 24-hour BP rhythm improvement. Tolerability of combined therapy was good.

Conclusion. The combined antihypertensive therapy based on ramipril, metoprolol tartrate, amlodipine bensilate, rilmenidine dihydrogen phosphate showed good efficacy and safety in hypertensive patients with CGN and normal renal function.

Aim. Clinico-economical analysis of arterial hypertension (HT) treatment

Material and methods. 78 patients with HT were involved into the study. Patients were spitted into two groups depending on HT degree. The first group – 38 patients with HT 1 degree. The second one – 40 patients with HT 2 degree. Patients of group 1 had initial antihypertensive therapy with angiotensinconverting enzyme inhibitors. If target level of blood pressure (BP) had not been reached, therapy was changed on fixed combination of lisinopril and hydrochlorothiazide. Patients of group 2 had initial combined antihypertensive therapy with lisinopril and hydrochlorothiazide. If it was needed amlodipine maleat was added. Clinico-economical analysis was performed according to “cost-efficacy” approach at the end of 3 month therapy.

Results. About 50% of hypertensive patients do not follow physician recommendations in out-patient practice. They decrease a dose of medicine or stop therapy themselves. More than 6% of them perform self-treatment.

Conclusion. Analysis showed that therapy of patients with HT of 1 degree is economically more profitable regarding target BP achievement. It is more reasonable to start antihypertensive therapy with fixed low dose combination and add calcium antagonists if it is needed in patients with HT of 2 degree.

Results of large randomized clinical trails on beta-blockers therapy of myocardial infarction (MI) with ST segment elevation (COMMIT/CCS-2, CAPRICORN) are analyzed. Last changes in guidelines regarding beta-blockers prescription to patients with MI are presented. Data of the studies comparing influence of metoprolol tartrate and carvedilol on MI pathogenesis are presented. Possible indications and treatment schemes for carvedilol in patients with acute MI are discussed.

Beta-blockers application in modern cardiologic practice is reviewed with focus on beta-blocker advantages in treatment of patients with arterial hypertension associated with ischemic heart disease. Bisoprolol usage specifics caused by its pharmacokinetics and a pharmacodynamics are specially considered. Bisoprolol advantages in patients with chronic heart failure and a chronic obstructive pulmonary disease are presented. All data are supported by results of randomized clinical trails.

Lesion of gastrointestinal mucous coat is the main factor limited acetylsalicylic acid (ASA) use in patients with atherothrombosis. Up to date the mostly comprehensible way to decrease gastrointestinal complications is taking ASA in the lowest effective dose, which is not higher than 75-81 mg daily. It is necessary if possible to avoid ASK usage in combination with other antiaggregants, anticoagulants, non-steroid and steroid anti-inflammatory drugs. Routine antiulcer therapy is not indicated for patients treated with ASA because there is a lack of clinical research data about efficacy of this approach. In high risk of dangerous gastrointestinal complications H. pylori eradication is recommended in combination with long term preventive therapy with gastric secretion inhibitors. Proton pump inhibitors are more preferred.

Currently stress-echocardiography or so-called burden echocardiography is essential method of patient examination to reveal latent ischemic heart disease (IHD). That is one of the mostly informative non-invasive methods of IHD diagnosis as well as efficacy evaluation of coronary angioplasty, surgical and pharmacological treatments of IHD. Dobutamine usage as a stress-agent at burden echocardiography allows evaluating not only ischemia but a myocardial vitality in post infarction area as well as clarify severity of valve stenosis, pulmonary hypertension and extent of latent obstruction of exhaust duct of the left ventricle. Method possibilities are presented as well as test protocol, main indications and contraindications.

The definition of primary prevention of cardiovascular diseases is presented. Statins preventive value in patients without cardiovascular diseases is analyzed. Randomized controlled studies on primary prevention with statins are briefed. Therapeutic equivalence of statin generics with originator is discussed. 

Angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) slow down progression of cardiovascular diseases and reduce risk of mortality and life threatening complications. What it is better to prescribe for patient in a concrete clinical case – ACE inhibitors or ARB? Authors compare these drug classes (mechanism of action, indications, evidense base of clinical trails, treatment costs and safety). The place of ACE inhibitors and ARB in modern therapy of cardiovascular diseases is defined. Results of the recent trails (ONTARGET, TRANCEND, PRoFESS, I-PRESERVE) are discussed.

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008 (ending).

ESC Guidelines for the diagnosis and treatment of heart failure: what is new?

Launch of the biggest international register on monitoring patients with ischemic heart disease: press-conference at ESC congress in Barcelona. CLARIFY.

Chance to survive.