Rational Pharmacotherapy in Cardiology

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Vol 3, No 4 (2007)
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6-10 488

Aim. To estimate arterial hypertension (AH) prevalence among population of Republic of Bashkortostan (RB), prevalence of end-organ damages and the associated clinical conditions in hypertensive patients.

Material and methods. 1648 people from 10 regions of RB were examined. Standard questionnaires were used - socially-demographic, health condition, WHO cardiologic questionnaire, women’s health.

Results. The urban and rural AH prevalence, AH prevalence in men and women, as well as AH comorbidities prevalence is studied. There is a high frequency of myocardial infarction and cerebral strokes in AH patients. Prevalence of end-organ damage and the associate clinical conditions is various in men and in women.

Сonclusion. Available data will help to develop primary and secondary AH prevention taking into account risk factors.


11-14 2083

Aim. To estimate the prevalence of atherothrombotic complications depending on platelet sensitivity to acetylsalicylic acids (ASA) in patients with stable angina.

Material and methods. 96 patients with stable angina of II-III functional classes received basic therapy included ASA (125 mg daily) to prevent atherothrombotic complications. Platelet ability to aggregation was assessed with laser aggregometer. Resistance to ASA was determined, if cumulative index of platelet aggregation (after stimulation with ADF, 5 µmol\l) remain on the level of 50-70% in spite of ASA. Atherothrombotic complications (cardiovascular death, myocardial infarction, unstable angina, cerebral stroke) were registered during 24-36 months.

Results. Resistance to ASA was detected in 24% of patients. Atherothrombotic complications were registered in 66% of patients with ASA resistance (myocardial infarction or unstable angina were observed in 14 patients of 21 ones) and in 27% of patients with sensitivity to ASA (myocardial infarction or unstable angina were observed in 19 of 70 ones). Besides, resistance to ASA was associated with high rate of thrombosis of installed stents or coronary artery bypasses.

Conclusion. In patients with unstable angina insufficient inhibition of platelet aggregation with ASA is associated with 2, 45 times increase in risk of atherothrombotic complications and higher rate of thrombosis of installed stents or coronary artery bypasses.

15-18 442

Aim. To compare enalapril (E) and diltiazem (D) efficacy in menopausal women with arterial hypertension (AH) using three methods of blood pressure (BP) measurement.

Material and methods. There was a cross-over randomised study with E and D included 22 menopausal women with AH. E was given at a daily dose of 5-20 mg and D – at a daily dose of 180-360 mg. At baseline and at the end of each treatment period ambulatory blood pressure monitoring (ABPM) was carried out. Self blood pressure measurement (SBPM) was performed during all study period. To assess a steadiness of antihypertensive effect we calculated smoothness index and trough-to-peak ratio based on ABPM data.

Results. Ambulatory 24-h systolic BP and diastolic BP were decreased in the E group (-15.2/-9.6 mm Hg) and in the D group (-10.9/-6.0 mm Hg). E demonstrated a greater antihypertensive effect on SBPM results in the evening. Values of smoothness index on E treatment were slightly higher than on D treatment (0.86±0.15/0.64±0.13 vs 0.67±0.17/0.62±0.15). Trough-to-peak ratio was inconclusive in this study.

Conclusions. Results of the study have shown some advantages of antihypertensive therapy with E compared with these of D in slow release formulation (both drugs at a single daily dose) in menopausal women. A sustained antihypertensive effect without negative influence on circadian BP profile allows to consider E as one of perspective agents for the AH treatment in this type of patients. 

19-24 5010

Aim. To assess the effect of β-adrenoblockers (BAB) on myocardial remodeling, immuno-inflammatory reactions and endothelial dysfunction in patients with ischemic heart disease and chronic heart failure (CHF).

Material and methods. 84 patients with ischemic CHF of II-IV functional class were involved in the study. They were randomized in two groups. The first group was presented with 43 patients receiving carvedilol in addition to standard therapy for 24 weeks; the second group was presented with 41

patients receiving metoprolol. Echocardiography, 6-minute walk test were applied. Blood levels of primary and secondary lipid peroxidation (LP) products, cytokines, endothelin-1 (ET-1), intercellular adhesive molecule (VCAM-1) were determined.

Results. Both of BAB improved the clinical condition and physical working ability of patients with CHF. Carvedilol in comparison with metoprolol was more effective in myocardial remodeling prevention, inhibition of pro-inflammatory cytokines [tumor necrosis factor alpha (TNF-α), interleukins (IL-1β IL-6)] and LP. Besides carvedilol increased in endothelium-dependent vasodilatation and reduced in ET-1 and VCAM-1 levels.

Conclusion. Long-term carvedilol treatment has anti-inflammatory, antioxidant and endothelium-protective effects as well as improves haemodynamics. 

25-31 2022

Aim. To estimate an effect of metabolic corrector mildronate on cardiac hemodynamics and endothelium function in patients with ischemic heart disease (IHD) and heart failure (HF)

Material and methods. 60 patients with IHD and HF of I-III functional class according to NYHA were included into the study. 30 patients of the main group received mildronate at a daily dose of 1000 mg during 3 months additionally to standard therapy. Patients of the control group took standard therapy only. Cardiac function was estimated by 4D Gated Equilibrium Radionuclide Ventriculography. The endothelium function was measured as endothelium dependent vasodilation.

Results. During 3 months mildronate therapy resulted in increase of left ventricular (LV) ejection fraction, peak filling and peak ejecting rate of LV.

Conclusion. Metabolic corrector mildronate has positive effect on cardiac function in patients with IHD and CHF.

33-38 662

Aim. To assess an efficacy of antihypertensive therapy with calcium antagonist, angiotensin converting enzyme inhibitor and β-blocker in patients with arterial hypertension (AH) taking into account influence on central and peripheral hemodynamics.

Material and methods. 60 patients with AH of I-II stage, 1-2 grade were studied. They were split in 3 groups. Patients of the first group received amlodipine (Tenox), 5-10 mg/d, the second group – fosinopril (Monopril), 10-20 mg/d and the third group – metoprolol (Metocard), 50-200 mg/d.

Diuretics were added when necessary. Ambulatory blood pressure (BP) monitoring, echocardiography, ultrasound investigation of brachiocephalic and main cerebral arteries, test on reactive hyperemia and nitroglycerine were conducted before and after 6 months of therapy.

Results. Amlodipine, fosinopril and metoprolol had similar antihypertensive effect. Amlodipine was more effective in comparison with fosinopril and metoprolol in reduction of left ventricular (LV) myocardial mass and improving of LV diastolic function. Amlodipine and fosinopril had positive effect on vascular remodeling. Metoprolol reduced in BP morning elevation and heart rate, but had no effect on systolic BP variability.

Conclusion. Amlodipine, fosinopril and metoprolol have similar antihypertensive effect but different influence on the heart, arteries, BP variability and hemodinamics.


39-45 544

A review is devoted to a comorbidity of myocardial infarction and anxious and depressive disorders. In the first part (Rational Pharmacother. Cardiol. 2007;3:41-51) data concerning prevalence of depression in myocardial infarction, pathophysiological mechanisms connecting depression and ischemic heart disease (IHD) were given. Influence of concomitant depressive disorders on clinical state and forecast of patients after myocardial infarction was discussed. The second part of the review is devoted to the anxious disorders in myocardial infarction as well as to influence of anxious and depressive disorders on life quality of patients with myocardial infarction. Besides, contemporary approaches to the therapy of anxious and depressive disorders in patients with IHD are discussed.

46-50 1511

The problem of improvement of modern diagnostic technologies is discussed. Introduction of algorithmic approach is able to optimize diagnostics and its costs. Various algorithmic models, their features and structure are reviewed. As an example the algorithm of differential diagnostics of hypokaliemia is presented.

51-54 558

Aim. To study effect of long-acting theophylline (Theotard, KRKA) and combination of salmeterol and fluticasone (Seretide, GlaxoSmithKline) on heart rhythm variability (HRV) and number of arrhythmic episodes in patients with chronic obstructive pulmonary disease (COPD).

Material and methods. 144 patients with COPD and 35 patients of control group were examined. The analysis of HRV and Holter monitoring were made f on 2th and 14th days.

Results. Treatment with both drugs led to increase in power of low- and high frequencies and their ratio (LF/HF), decrease in rate of supraventricular and ventricular arrhythmias. Theophylline therapy raised in a number of single and pair supraventricular extrasystoles. Treatment with combination of salmeterol and fluticasone did not change a number of extrasystoles.

Conclusion. Combination of salmeterol and fluticasone is more preferable as a broncholytic therapy for patients with COPD and heart rhythm disorders.

55-57 1405

Aim. To study extra- and intracranial hemodynamics in patients with chronic hepatitis of different activity.

Material and methods. Ultrasonography of the cerebral blood flow was performed in 576 patients with chronic hepatitis.

Results. Contralateral hemyspherical asymmetry (more than 30 %) of the maximum linear rate of blood flow in the medium cerebral arteries and decrease in resistance index (0,55±0,09) and pulsativity index (1,34±0,66) were found in 33,8 % of patients with chronic hepatitis of high activity. Collateral blood flow reduction through connecting arteries of Willis circle was revealed in 13,8 % of patients. The tortuosity of arteries and thickening of intima-media complex was found in patients with chronic hepatitis (mainly of high activity). It leads to decline of cerebral blood flow.

Conclusion. Symptomatic and asymptomatic cerebral blood flow disturbances were observed in 23,2% and 38,8% of patients with active chronic hepatitis respectively.


58-60 1964

Angiotensin converting enzyme inhibitors are the first line medicine for the treatment of the most of cardiovascular diseases. There is no class-effect for these drugs in myocardial infarction therapy. Moreover in myocardial infarction angiotensin converting enzyme inhibitors have significant intra-group differences. Ramipril is the one of the most studied drug of this group recommended for patients after acute myocardial infarction.


63-70 2264

Characteristics and classification of different patterns of paroxysmal atrial fibrillation are presented. Main indications to restoration of sinus rhythm are discussed. The features of main medications used to terminate of atrial fibrillation are given. The choice of antiarrhythmic drug is considerate. Necessity of individual approach to therapy tactics is proved.


71-99 1777

The Task Force on Diabetes and Cardiovascular diseases of the European Society of Cardiology and of the European Association for the Study of Diabetes.

European Heart Journal (2007) 28, 88-136.

100-103 298

Comments on Guidelines on diabetes, pre-diabetes, and cardiovascular diseases.

104-109 2142

Results and comments on ADVANCE study.

110-111 322

News of Congress of European society of cardiology, Vienna, September 1-5, 2007.

112-114 312

Educational master-class on arterial hypertension and cardiovascular risk. Moscow, September 12-13, 2007.

115-116 1791

Practical secrets of successful professional presentation in cardiology.

117 262
On the anniversary of academician A.I. Martynov.
118 276
On the anniversary of academician R.S. Karpov.
119 248
On the anniversary of academician V.S. Moiseev.
120 279
On the anniversary of professor P.Y. Dovgalevskiy.
121 269
On the anniversary of professor S.Y. Martsevich.

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