Rational Pharmacotherapy in Cardiology

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Vol 1, No 1 (2005)
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4-8 433

Aim. To prove the advantage of the long-term controlled antihypertensive therapy compared with the real usual standard therapy in patients with mild to moderate arterial hypertension.

Material and methods. It was multicenter, randomized, prospective parallel-group study in patients with mild to moderate hypertension. One part of patients (treatment group) received the strongly regulated stepped antihypertensive therapy based on ACE-inhibitor spirapril, the second one (control group) continued their usual standard therapy prescribed by doctors of polyclinics or other patient care institutions. The study lasted one year.

Results. 1742 patients were enrolled in the study, 854 patients were included in the treatment group and 888 – in the control group. 220 patients dropped out of the study by different reasons, and 1552 patients finished the study. There were 651 (37,6%) men and 1081 (62,4%) women. It was substantial decrease in blood pressure in both group, but distinctions between systolic and diastolic blood pressure in the treatment and control group during the study were significant.

The target levels of blood pressure (systolic < 140 mm Hg and diastolic < 90 mm Hg) were registered substantially more frequent in the patients of treatment group than in control group (69,4% и 39,3% after three months and 83,6% и 66,9% after 12 months of the treatment correspondingly).

Conclusion. Controlled stepped antihypertensive therapy resulted into more significant decrease in systolic and diastolic blood pressure and more frequent achievement of target levels of blood pressure in comparison with control group. It supposes better prognosis of patients.

9-12 364

Arterial hypertension (AH) is the most frequent risk factor of cardiovascular diseases and related mortality in all developed countries. Altough therapy with antihypertensive drugs significantly reduces this risk, patients with stable mild hypertension have poor compliance with the treatment. The reasons and levels of inadequacy of antihypertensive therapy in this group of patients are well-known.

Aim. To evaluate the awareness level of own disease, adequacy of therapy only in those patients with stable mild arterial hypertension, who are complied with recommendations of physicians concerning AH treatment and changing of mode of life. It was also planned to reveal possible grounds for inadequate secondary prevention of cardiovascular disease.

Materials and methods. 76 patiens with stable mild arterial hypertension were included into study. They didn’t have any serious concomitant diseases and were complied with the recommendations of physicians concerning secondary prevention of cardiovascular disease. Questionnaire of State Research Center for Preventive Medicine “Assessment of awareness level of own disease in patients with stable arterial hypertension” was used in the study.

Results. It was revealed, that the majority of patients, invoved in the study, were nonsmokers and regularly took antihypertensive drugs. 70% of questioned patients reached the target arterial blood pressure levels, while patients with arterial hypertension in general Russia population received regular and efficient treatment in less than 30-20%. Drugs treatment of questioned patients almost didn’t differ from that, which received patients in out-patient clinics of Moscow: in both cases ACE inhibitors were preferred. Only 29% of questioned patients knew their lipid levels in blood and none of the patients took drugs, reducing levels of lipids in blood. Half of the patients, that took part in our study, had increased level of body mass index.

Conclusions. Inadequate secondary prevention of cardiovascular disease in patients, complied with the recommendations of physicians is mainly connected with 1) insufficient awareness of physicians of new drugs and treatment schemes; 2) underevaluation of hyperlipidemia as one of the main risk factors of cardiovascular disease and related mortality by physicians, and consequent absence of hypolipidic therapy; 3) negligence to such risk factor as exceeding weight and consequent unawareness of body mass index norms by patients with arterial hypertension.

13-18 340

Wide presence of original drugs’ copies, the so-called “generics”, on the pharmaceutical market is analyzed. The positive side of this expansion is connected with the lower price of generics, which makes it possible to decrease the costs of treatment. From the other side with the advent of big number of copies of the original drugs it becomes more difficult to assess the quality of each particular generic. Russian legislation in the field of registration allows selling in the country almost all drugs, which have at least minimal similarity to the original. The problem of pre-registration studies of bioequivalency of original and analogue drugs, therapeutical equivalency is widely observed. Concrete proposals of how to prevent the overflow of the Russian market with the generics with the unproved efficacy and safety are considered.

19-23 406

The problem of nitrate formulation choice in treatment of patients with ischemic heart disease is reviewed. Importance of development of shortacting nitrates in form of spray, containing nitroglycerin or isosorbid dinitrate, is highlighted. Polycomponent effects of nitrates, ensuring antianginal and antiischemic effect in patients both with stable and acute forms of ischemic heart disease are enumerated. Problem of side effects, frequency of tolerance development in long-term nitrates treatment and tolerance prevention method by interrupted nitrates prescription are analyzed. Wide opportunities of contemporary therapy with nitrates through development of new forms of special drugs, containing isosorbid – 5 – mononitrate in microspheres, are emphasized.

24-30 607

Aim. To investigate efficacy and safety of nicotine chewing gum and inhaler in individuals trying to quit smoking. To assess expected reduction of cardiovascular disease (CVD) and total mortality relative risks (RR).

Material and methods. In this open, parallel study, 169 relatively healthy male smokers aged 18-60 years were randomly assigned to free choice vs admission of Nicorette gum (2/4 mg) or inhaler (10 mg). At baseline, all participants smoked ≥15 cig/d, for ≥3 years. The intervention phase lasted 3 months; follow-up evaluations were made at 3, 6 and 12 months after nicotine replacement therapy (NRT) initiation.

Results. Twelve-month results were obtained for 152 subjects (response rate 89.9%). Point prevalence abstinence and reduction (smoking ≤50% of basic daily cigarette amount) rates were 19.7% and 35.5%, respectively. Neither abstinence, nor reduction rates depended on Nicorette form (gum vs inhaler), or on choice vs admission factor. The main predictors of long-term efficacy were nicotine dependence severity and contacts with other smokers.

NRT was not associated with negative dynamics in objective health parameters (blood pressure, heart rate, ECG parameters, body weight, and body mass index) or self-evaluation of health. Both Nicorette forms seemed to be safe and well-tolerated.

At 12 months, the expected mean RR reduction for CVD mortality reached 19%, for total mortality – 21%.

Conclusion. In Russian clinical settings, NRT efficacy and safety are similar to that demonstrated in numerous international trials. NRT can be recommended as one of the methods of assistance to quit smoking and, therefore, for CVD risk reduction.

31-36 505

Smoking is a well – known risk factor of many diseases. It influences the efficacy and safety of drug treatment by affecting the course of different physiological processes and modifying the metabolism of drugs. The number of researches showed decrease in efficacy of some cardiovascular drugs in smokers.

Aim. To compare efficacy and safety of selective and non-selective beta–adrenoceptor blockers in smokers and nonsmokers with chronic ischemic disease.

Material and Methods. Antianginal efficacy of drugs in patients of both groups was evaluated by burden tests on treadmill, effective doses of bisoprolol and propranolol were adjusted.

Results. The result shows that smokers two times more often need prescription of double doses of drugs. Depressed antianginal activity of both beta-adrenoceptor blockers, especially of non-selective propranolol, in smokers was revealed. When evaluating the parameters of spirography, it was found that non-selective beta-adrenoceptor blocker propranol statistically significant decreases figures of bronchial passage, irrespective of the status of smoking. Moreover, with propranol treatment, bigger number of side effects is registered in both groups, demonstrating 30% more in smokers compared to nonsmokers.

Conclusion. Smoking attenuates efficacy and safety of beta-blockers, especially these of non-selective ones.

37-42 418

A role of menopause as a cardiovascular risk factor is reviewed. Menopause influence on the cardiovascular system may be mediated by body fat re-allocation, metabolic, hemodynamic and pro-inflammatory changes. Besides, estrogen deprivation has a direct effect on the arterial wall. Lifestyle modification, lipid-lowering and antihypertensive treatment should be considered for cardiovascular risk reduction in postmenopausal women.

43-48 585

Results of large-scale studies (QUIET, HOPE, EUROPA, PEACE, CAMELOT), devoted to assessment of the role of ACE inhibitors in treatment of patients with stable form of ischemic heart disease without heart failure are analyzed. Different efficacy of the representatives of this class toward risks of coronary events development and cerebral-vascular complications is shown, as well as the overall mortality risk due to cardiovascular reasons. Favorable therapeutic effects of inhibiting RAS activity in patients without left ventricle dysfunction are demonstrated in studies EUROPA with perindopril 8 mg, and HOPE with ramipril 10 mg. That became the ground of inclusion of these drugs into recommendations for treatment of all patients with ischemic heart disease after myocardial infarction, in addition to antiplatelet, lipid reducing remedies and beta-blockers.


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ISSN 1819-6446 (Print)
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