In the issue.

Aim. To evaluate chronic heart failure (CHF) course, functional and structural heart changes in patients with functional mitral regurgitation (MR) of various degrees.

Material and methods. A total of 104 outpatients (60-85 y. o.) with CHF of functional class II-IV by NYHA and functional MR of I-II degrees and MR of III-IV degrees were included into the study groups.

Results: Patients in both groups were comparable in sex, age, CHF duration, body mass index, systolic and diastolic blood pressure, clinical state by the clinical state scale, quality of life, anxious and depressive status. The majority of patients with MR III had significant left ventricle (LV) systolic dysfunction (p=0,029), severe CHF course (p=0,034), received furosemide (p=0.004) and digoxin (p=0,004). They had significant increase in end-diastolic dimension (p<0,001), end-systolic dimension (p<0,001), left atrium (p=0,004), end-diastolic volume (p<0,001), end-systolic volume (p<0,001), pulmonary artery pressure (p<0,001), decrease in LV relative wall thickness (p=0,021) and LV ejection fraction (p<0,001). Patients of this group were hospitalized because of CHF decompensation and ischemic heart disease exacerbation more often (p=0,045).

Conclusion. MR can be considered as one of sensitive predictors of LV geometry and function alteration in CHF patients and play an important role in symptoms development.

Aim. To study an importance of plasma N-terminal pro-brain natriuretic peptide (N-proBNP) in evaluation of severity and prognosis in patients with chronic heart failure (CHF) of ischemic genesis.

Material and methods. 77 patients (60 men and 17 women; 59,4±10,7 y.o.) with CHF of ischemic genesis were included in the study. All patients had sinus rhythm and history of Q wave myocardial infarction. Standard examination was performed to all patients. Besides N-proBNP plasma level and patients yearly survival were evaluated.

Results. N-proBNP plasma level had direct correlation with clinical indices (exercise tolerance, blood pressure, heart rate) and echocardiographic heart sizes. N-proBNP plasma level had relationship with prognosis of CHF patients. Baseline N-proBNP level was more than 2 times higher in died patients in comparison with survived patients. The yearly survival rate of CHF patients was 51,3% if N-proBNP level had been more than 400 fmol/ml (>15% of normal value). The clinico-laboratory index (based on N-proBNP plasma level) of severity and prognosis in CHF patients was developed.

Conclusion. The clinico-laboratory index based on N-proBNP plasma level is easy to use and can improve medical practice.

Aim. To estimate cardiorenoprotective effect of 12-month therapy by indapamide in elderly and senile patients with arterial hypertension (HT) and its influence on quality of life.

Material and methods. 40 elderly and senile patients with HT were examined. 70% of patients received monotherapy by indapamide 2,5 mg once daily and 30% of patients were treated with indapamide and lisinopril combination. Duration of observation was 12 months. Ambulatory blood pressure (BP) monitoring, echocardiography, plasma lipid profile, glycemia and uricemia levels and potassium serum level was evaluated initially and after 12 months of therapy. Glomerular filtration rate and albuminuria as well as patient quality of life also was evaluated.

Results. Target BP level was reached in all patients during 12 month therapy. Reduction of average 24-hour, day and night BP, BP load, rate of morning BP rising was observed. Negative influence on BP variability was not found. Improvement of daily BP profile also was found. The indapamide reduced left ventricle mass, improved renal function, vessel resistance and quality of life. Negative influence of long-term therapy with indapamide on lipid, glucose, purine metabolism and serum potassium level was not observed.

Conclusion. Indapamide is an effective antihypertensive drug for long-term treatment of elderly and senile patients with HT of 1-2 degree.

Aim. To compare influence of amlodipine and bisoprolol on peripheral vascular resistance (PVR) in carotid and vertebral arteries in elderly and senile men with arterial hypertension (HT) and ischemic heart disease (IHD).

Material and methods. 135 patients aged 35-90 y.o. were examined. PVR was determined by Doppler ultrasound in common (CCA) and internal (ICA) carotid arteries as well as vertebral artery (VA). Vascular remodeling was evaluated by volume sphygmography. The influence of the monotherapy with amlodipine or bisoprolol (2,5-5 mg once daily) on PVR in 54 patients of elderly and senile age with isolated systolic HT 1-2 degrees and IHD.

Results. Therapy with amlodipine decreased of peripheral resistance of CCA, ICA in elderly and senile men with isolated systolic HT 1-2 stages and IHD. Monotherapy with bisoprolol did not increase in PVR of CCA, ICA.

Conclusion. Amlodipine is effective antihypertensive drug with positive influence on pathogenetic mechanism of isolated systolic HT in elderly and senile patients.

Aim. To perform the comparative cost-efficacy analysis of various antihypertensive therapies in hypertensives patients.

Material and methods. 140 hypertensive patients with history of ineffective antihypertensive therapy were randomized in to 4 groups, 35 patients in each one. Patients of Group A received indapamide retard plus perindopril; group B - indapamide retard plus amlodipine; group C - amlodipine plus lisinopril; group D - amlodipine plus bisoprolol. The Russian version of general questionnaire MOS-SF-36 was applied for quality of a life estimated. Endothelium function was evaluated with B-mode ultrasonography (Acuson 128 ХР/10). Albuminuria level was detected by immunoturbometric method (Integra-700, Roche).

Results. The drug combination B had the least cost. The drug combination C was the most effective. The drug combination C was the most economically rational. The drug combination A was the least economically rational for BP reduction. However the drug combination A was comparable with drug combination C in effects on quality of life and on endothelium function, and it was the most economically rational for albuminuria reduction.

Conclusion. Indapamide retard plus perindopril combination is the most economically rational in patients with target-organ lesions (nephropathy). Lisinopril plus amlodipine combination is economically rational in patients without target-organ lesions. 

Aim. To evaluate a short-term efficacy and safety of nebivolol and carvedilol in hypertensive patients of different ages in acute pharmacological test (APT).

Material and methods. 119 patients with arterial hypertension (HT) 2-3 degrees aged 33-89 y.o. were involved into the study. Patients were split into 2 groups according to age: young and middle-aged patients (30-59 y.o.); elderly and senile patients (≥60 y.o.). All patients were randomized for carvedilol (12.5 mg once daily) or nebivolol (5 mg once daily) therapy after wash-out period (3-10 days). Ambulatory blood pressure monitoring (ABPM) was performed one day before and one day after first drug taking and ABPM indices were compared.

Results. APT with carvedilol and nebivolol in patients of young and middle age showed significant antihypertensive effect on systolic (-6.9 and -6.0 mm Hg, resp.), diastolic (- 4.6 and -4.7 mm Hg, resp.) and pulse (-1.7 and -1.4 mm Hg, resp.) blood pressure (BP). In patients of elderly and senile age the first daily dose of nebivolol did not have influence on systolic and pulse BP (-2.73 and +0.50 mm Hg, resp., p>0.05), unlike carvedilol (-5.27 and -1.43 mm Hg, resp. p<0.05). Carvedilol and nebivolol increased of hypotension time index for diastolic BP in younger (7,6 and 7,7%, resp.) and elder (11 and 8,2% resp.) patients.

Conclusion. Carvedilol in initial dose reduces systolic and pulse BP more significantly than nebivolol does in hypertensive elderly and senile patients. Increase of hypotension time index for diastolic BP revealed for both drugs can limit their use in patients with initially low diastolic BP.

Aim. In patients with acute coronary syndrome (ACS) to study an aggregation activity and morphology of erythrocytes and to assess their changes during therapy with acetylsalicylic acid, clopidogrel and combined antiplatelet therapy (acetylsalicylic acid and clopidogrel).

Material and methods. 98 patients (67 men and 31 women, aged 59,6±10,8 y.o.) with ACS were included in the study. Patients were split in 3 groups depending on prescribed antiplatelets (acetylsalicylic acid; clopidogrel; acetylsalicylic acid+clopidogrel). Aggregation activity and morphofunctional status of erythrocytes were evaluated at baseline, after 3 and 7 days of treatment.

Results. The highest efficacy of antiaggregant therapy was observed in patients receiving antiplatelet combination. In this group there was a maximal reduction of erythrocyte aggregation and a number of pathological erythrocytes in peripheral blood by the 3rd day of therapy. This effect was increasing by the 7th day.

Conclusion. The effect of all antiplatelet drugs was significant. The antiaggregant effect of clopidogrel was more significant than this for acetylsalicylic acid. Efficacy of combined therapy was higher than these for each drug alone. 

Aim. To study influence of the combined antihypertensive therapy on blood pressure (BP), glucose and lipid metabolism as well as cerebral blood flow in patients with metabolic syndrome (МS)

Material and methods. 60 patients with MS aged of 35-65 y.o. were included in the study. 29 patients of the 1st group received verapamil SR (240 mg once daily) and indapamide retard (1,5 mg once daily). 31 patients of the 2nd group received verapamil SR (240 mg once daily) and enalapril (12,2±5,9 mg BID). Ambulatory BP monitoring, lipid profile, insulin and C-peptide levels, standard glucose tolerance test were performed. The single-photon emission computer brain tomography was performed in 11 patients of each group.

Results. Combination of verapamil SR and enalapril showed more significant antihypertensive effect, improved carbohydrate metabolism and cerebral blood flow. However it worsened 24-hour BP profile. Combination of verapamil SR and indapamide retard increased fasting glycemia level within normal range, led to insignificant improvement of cerebral blood flow and did not worsen circadian BP rhythm. Both drug combinations improved lipid profile.

Conclusion. Both drug combinations can be prescribed to MS patients. However diuretic based therapy demands regular control of glycemia level.

Aim. To evaluate factors affecting hypoglycemic therapy in patients with type 2 diabetes mellitus (DM2) in real clinical practice.

Material and methods. 200 patients with DM2, who consented to take part in the questionnaire, were examined. Questionnaire data evaluation and clinical examination was performed as well as plasma levels of glucose, glycosylated hemoglobin (HbA1c) and lipids estimation.

Results. Low rate of diagnosed DM2 complications especially nephropathy was observed. 68% of patients had high level of glycosylated hemoglobin (HbA1c) because of their knowledge lack as well as inadequate glucose self-monitoring or it’s absent and uncommon combined glucose-lowering therapy. Depression was revealed in 43,5% of patients, especially in patients with chronic DM2 complications. Low incidence of depression was associated with good patient knowledge about DM2. Well informed patients had lower score according to CES-D scale than patients with DM2 complications.

Conclusion. Appropriate drug therapy, patients’ education, early depression diagnosis and treatment are necessary to improve glycemic control in DM2 patients.

Aim. To evaluate effects of broncholytic therapy on ventricular rhythm disorders and high resolution electrocardiogram indices in patients with chronic obstructive pulmonary disease (COPD).

Material and methods. 144 patients (54 women and 90 men; aged 47,1±1,5 y.o.) with COPD and 35 patients of control group without respiratory and cardiovascular diseases (23 men and 12 women; aged 42,4±2,8 y.o.) were examined. 24-hour ECG monitoring and high resolution ECG with time and spectral-time mapping of ventricular ECG complex were performed in patients additionally to routine examination.

Results. Reduction of ventricular rhythm disorders rate was detected during therapy with extended-release theophylline or salmeterol/fluticasone in patients with moderate and severe COPD. This effect was more significant for salmeterol/fluticasone treatment. Treatment with extended-release theophylline led to increase of a number of ventricular extra systoles in patients with severe COPD. Salmeterol/fluticasone treatment did not influence number of ventricular extrasystoles. Broncholytic therapy had positive influence on processes of ventricular depolarization. It was shown by high resolution ECG indicators improvement and by late ventricular potential rate reduction.

Conclusion. Salmeterol/fluticasone combination is more reasonable than extended-release theophylline for broncholytic therapy in patients with severe COPD and ventricular rhythm disorders.

Results of studies devoted to effects of various antihypertensive drugs on arterial stiffness in patients with arterial hypertension are presented. Advantages of angiotensin converting enzyme inhibitors and angiotensin receptor blockers are shown. Results of comparative studies on influence of combined therapy and monotherapy on arterial stiffness in hypertensive patients are also reviewed. Standard methods of arterial stiffness evaluation are estimated as mostly appropriate ones.

Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation.

Academician E.I. Sokolov – 80 years old.

To Professor S.A. Shalnova jubilee.

Antiaggregant therapy overcomes limits.

Information letter of Russian Medical Society of Arterial Hypertension.