Vol 5, No 1 (2014)

The study examined the effectiveness of drug correction of high numbers of blood pressure (BP) by means of modern groups of antihypertensive drugs, the effect of a fixed combination of perindopril and indapamide on circadian blood pressure monitoring, and a commitment to patients of antihypertensive therapy, based on the opened simple randomization three groupswere formed: 1st comprised of 21 patients with isolated systolic hypertension (ISAH) and 22 patients with systolic-diastolic hypertension (SDAH) - they all received monotherapy with calcium antagonists (amlodipine 10 mg/day); Group 2 - of 16 ISAH patients and 24 SDAH patients - who received monotherapy with perindopril (2 mg/day) and the third group - of 17 patients with ISAH and 14 patients with SDAH - who received combination therapy with the drug noliprel (Servier) with a fixed combination of perindopril (2 mg) and indapamide of 0,625 mg. Treatment efficacy was assessed primarily to reduce the absolute numbers of blood pressure, and taken into account as a reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP), uncontrolled drop of which, according to the literature, in elderly patients can have fatal consequences

The information content of Framingham, SCORE model and, statusmetriya in the evaluation of the total ten-year cardiovascular risk in an isolated sample of 207 males without clinical manifestations of atherosclerosis was investigated. Detected that most of the observations from persons who had attained over a 10-year period of the combined end point, the models qualified incorrectly, which didn’t meet the requirements of individual risk assessment in a limited sample group of males. Statusmetrichesky algorithm, in contrast to the accepted system of risk stratification, significantly more of the entities attributed to high-risk and significantly less - to the low-risk category. Sensitivity of the model was 73,9%, specificity - 74,7%, the total information value - 74,5%.

These recommendations contain the procedure for choosing patients with stable angina pectoris and effective combination therapy of antianginal drugs from the three main groups (nitrates, calcium channel blockers and b-blockers) by repeated tests with physical exercise on a bicycle ergometer. We show how to determine the optimal combination of these drugs to the patient considering clinical data, tolerability and acceptability of the proposed treatment.The guidelines are intended for cardiologists, therapist, specialists in functional diagnosis, and scientific workers specialized in cardiac units. The guidelinesare recommended by Educational and Methodological Association of medical and pharmaceutical education in Russian universities as a textbook for doctors’ postgraduate education system.

The article presents a literature review of prevalence, prognosis and treatment of overt tactics of chronic heart failure (CHF) in patients with type 2 diabetes mellitus (T2DM). Application of modern pharmacological preparations and instrumental treatment of cardiovascular disease (CVD) increases life expectancy and improves the quality of life of patients with CHF as with normal carbohydrate metabolism (UO), and with type 2 diabetes. However, the risk of cardiovascular mortality (CAS) in patients with type 2 diabetes, compared to having a normal carbohydrate metabolism remains unchanged.Insulin resistance (IR) and compensatory hyperinsulinemia (GI) play a key role in the pathogenesis of type 2 diabetes. Ongoing research in the twentieth century of coronary heart disease (CHD) and heart failure in patients with type 2 diabetes revealed adverse effects of sulfonylurea medications on the metabolic processes in the myocardium and increased risk of death in patients with severe coronary artery disease. In comparison with sulfonylurea drugs, metformin and insulin not only reduces the risk of cardiovascular disease, but also can prevent or delay the development of type 2 diabetes in individuals with impaired glucose tolerance (IGT) and impaired fasting glucose. Metformin acts on the key link of pathogenesis - insulin resistance, affecting the lower incidence of cardiovascular diseases, the development of chronic disease and mortality compared with insulin and sulfonylurea drugs. However, in patients with chronic heart failure is contraindicated the use of thiazolidinediones and metformin is limited tothe severity of CHF I-II FC NYNA. With effective treatment of chronic heart failure by cardiologists in patients with type 2 diabetes, affecting therapy with insulin resistance should be mandatory.

To assess the efficacy and safety application ivabradine to control the heart rate before the procedure computed tomography coronary angiography (CTCA) in young patients with connective tissue dysplasia (CTD) were surveyed 65 patients (age 24,9±6,4 years; 40 men). Patients were divided into 2 groups: group 1 (n=47; 29 men) to achieve the heart rate <65 BPM ap-pointed ivabradine; group 2 (n=18; 11 men) was appointed bisoprolol. The effective average doses were as follows: group 1 - ivabradine 7,87±1,95 mg/day; group 2 - bisoprolol - 7,27±of 2,08 mg/day. Target heart rate, acceptable image quality were achieved by the absolute majority of patients in both groups. In group 2 has a distinct trend to reduction of blood pressure with severe subjective manifestations: 5 patients (8/18) complained of general weakness, headaches, episodes of dizziness; 4 patients (6/18) immediately after completion of the procedure MSCT marked ortostatical hypotension, which required the provision of medical assistance. In group 1 ortostatical hypotension after the procedure CTCA was also observed in 4 patients (4/47), which was significantly less than in group 2 (c2=4,40; p =0,0363). For the first time it is shown that the use of inhibitor of If-channels sinus node ivabradine for CTCA in this group of patients can effectively monitor the heart rate with the achievement of satisfactory quality CT image, has the following advantages over drugs group of b-blockers on tolerability and safety.

Recent epidemiological studies have shown that lifestyle modification such as aerobic exercise reduces the incidence of cardiovascular morbidity and mortality in the general population. But still poorly understood mechanisms underlying the antiatherogenic and anti-hypertensive effects of physical training. Hypertension is associated with impaired endothelial function, which is mediated by a decrease in the bioavailability of nitric oxide (NO). In animals with simulated hypertension and in people with essential hypertension exercise had been shown to improve endothelial function. This suggests that hypertension, as well as endothelial dysfunction is reversible. It is assumed that changes in lifestyle, including physical exercise, prevent cardiovascular complications by improving endothelial function in patients with hypertension. It is believed that exercise increase the synthesis of NO and reduce levels of inactivation, which results in increased bioavailability of NO. This review presents the potential mechanisms that underlie the positive effect of training on endothelial function in patients with hypertension.