Rational Pharmacotherapy in Cardiology

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Vol 5, No 2 (2009)
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8-17 380

Aim. To evaluate the structure of drug prescriptions in acute coronary syndrome (acute myocardial infarction and unstable angina) on the first day of hospital therapy in Saratov city and Saratov region.

Material and methods. Retrospective pharmacoepidemiology study was carried out in 1276 patients with acute coronary syndrome (ACS) without elevation ST during first 24 hours.

Results. Prescription of drugs with proven efficacy in ACS was higher in Saratov city clinical hospital than this in Saratov municipal hospital or hospitals of Saratov region. There were no significant differences in drug prescriptions in Saratov municipal hospital and hospitals of Saratov region.

Conclusion. The first day therapy of ACS depends on hospital type.


18-21 367

Aim. To study effect of the bone metabolism modulator strontium ranelate on bone mineral density (BMD) and to evaluate it pleiotropic effects on cardiovascular remodeling in women with postmenopausal osteoporosis (PO) and a arterial hypertension (HT).

Material and methods. 45 women with PO, HT (1-2 stage) and medium/high cardiovascular risk were included in the study. 23 patients of the main group received strontium ranelate 2 g once daily additionally to antihypertensive and calcium replacement therapies. Before therapy and after 10 months MBD was evaluated by dual-energy x-ray absorbtiometry (DEXA) with usage of peripheral densitometer. Strontium ranelate effects on carotid intima-media thickness (duplex scanning) and morphofunctional cardiac indices (echocardiography) also were assessed.

Results. Strontium ranelate therapy in patients with PO and HT leads to BMD rising and retardation of cardiovascular remodeling.

Conclusion. Strontium ranelate is effective antiosteoporotic drug with positive influence on morphofunctional cardiac indices and carotid intima-media thickness. 

22-26 575

Aim. To compare influence of amlodipine and spirapril on ambulatory blood pressure profile, including antihypertensive effect smoothness in patients with arterial hypertension (HT).

Methods. 39 patients (aged 53,7±10,0 y.o.) with HT were included in the open, randomized, cross-over study, 30 patients completed study. The duration of every therapies was 4 weeks, initial control period and wash-out period between therapies lasted 1 week. The initial daily dose of amlodipine was 5 mg, standard dose of spirapril (6 mg/daily) was not changed during the trial. After 1-2 weeks of treatment amlodipine dose was increased up to 10 mg/daily as well as dihydrochlorothiazide was added, if necessary. Ambulatory blood pressure monitoring (ABPM) was performed initially and at the end of both therapies.

Results. Both drugs demonstrated good antihypertensive effect according to ABPM data. Decrease of systolic/diastolic blood pressure was 11,2±1,8/7,6±1,2 mm Hg in amlodipine therapy and 10,0±1,8/7,1±1,2 in spirapril therapy (p<0,0001). The smoothness indexes (SI) were 0,65/0,45 and 0,55/0,45, respectively, differences between two therapies were not significant. However the individual analysis of the SI distribution (with SI=0,5 as a satisfactory criterion), showed that antihypertensive effect smoothness is better in amlodipine therapy than this in spirapril one.

Conclusion. Amlodipine has prominent as well as smooth antihypertensive effect, that gives it advantages in the long-term antihypertensive therapy.

27-32 489

Aim. To study endothelial disorders and artery elasticity disorders in patients with arterial hypertension (HT), as well as possibility of their correction by lisinopril or by fixed low dose combination of lisinopril and hydrochlorothiazide.

Material and methods. 99 patients with HT were included in the study. Patients were randomized into 2 groups. Patients of the 1st group were treated with the fixed low dose combination of lisinopril (5мг) and hydrochlorothiazide (12,5 mg). Patients of the 2nd group were treated with lisinopril alone. The amlodipine was added in case of insufficient therapy. Pulse wave velocity was defined by volume sphygmography. Tests for evaluation of microalbuminuria and activity of von Willebrand factor were performed.

Results. Endothelium function disorders were observed in a half of the patients with HT aged 60 y.o. and older. The fixed low dose combination of lisinopril and hydrochlorothiazide was more effective than lisinopril monotherapy in target blood pressure achievement. Positive changes of endothelium function indicators were founded in both groups of therapy. This fixed combination had also a good safety profile.

Conclusion. Lisinopril alone or in low dose combination with hydrochlorothiazide improves endothelium function and decreases microalbuminuria level in patients with HT and high body mass index.

33-38 600

Aim. To compare two therapies based on carvedilol or metoprolol in hypertensive patients with overweight and obesity.

Material and methods. 320 patients with arterial hypertension (1-2 degree) were involved in the study. 160 patients received carvedilol and 160 patients – metoprolol. Both randomized groups were comparable on the main clinical characteristics.

Results. By the end of the study both systolic and diastolic blood pressure (SBP, DBP) reduced in both groups р<0,0001. There were not differences of antihypertensive effect between investigated drugs (р=0,88 for SBP and р=0,61 for DBP). By the end of the study body mass index decreased by 0,52±0,10 kg/m2 (р<0,0001) in carvedilol group and by 0,26±0,10kg/m2 (р<0,01) in metoprolol group. Carvedilol in comparison with metoprolol had more positive effects on glucose (р<0,01) and lipid blood levels. By the end of the study urine acid blood level reduction was observed in carvedilol group (-16,6 μmol/l) while an increasing tendency - in metoprolol group. Carvedilol did not have negative effect on serum potassium and creatinine levels. Adverse effects rate was 6,3% in carvedilol group and 3,8% - in metoprolol group.

Conclusion. The results of open, randomized CAMELLIA trial confirmed antihypertensive effect and good tolerability of carvedilol in common clinical practice as well as demonstrated some its advantages in patients with metabolic syndrome. Carvedilol has positive metabolic effects on lipid, glucose and uric acid levels. Carvedilol therapy is more preferable in patients with arterial hypertension and metabolic risk factors.

39-48 463

Aim. To evaluate factors contributing to development of inertness in doctors of the primary care which treat and follow-up patients with cardiovascular diseases (CVD).

Material and methods. The anonymous poll was carried out among 184 primary care physicians. The questionnaire included information about sex, age, time and conditions of work, established stereotype of practice, knowledge of current guidelines on CVD treatment. The study was one-stage with usage of questionnaire.

Results. High prevalence of inertness was observed among physicians. Only 43 (26,4%) of doctors had active stereotypes of practice, which prevent inertness. These physicians have more often post-graduate specialization, read international guidelines, foreign and web-journals, evaluate higher non-drug approaches to prevention and therapy and they more often initiate long-term patient observation.

Conclusion. Inertness is common behavior feature among primary care. The main reasons of this inertness are insufficient knowledge of modern guidelines on CVD treatment and lack of skills on its practical usage.

49-54 372

Aim. To determine the main mechanisms of chronic pericarditis (CP) on the basis of chronic pericardium inflammation study with morphological, laboratory and instrumental methods.

Material and methods. 139 patients with CP were involved in the study. The analysis of clinical data, results of laboratory and instrumental examination as well as morphological data of 27 pericardectomies was performed.

Results. The morphological features in 92,5% of cases did not depend on disease aetiology. Inflammation signs are founded in 74,1% of pericardium samples. Inflammatory reaction of adjacent fatty tissue and changes of the pericardium nervous system also was revealed. The levels of immune status markers in patients with CP significantly depended on inflammation activity and they did not depend on disease causes. Anti-inflammatory cytokine levels (receptor antagonist of IL-1 alpha (RAIL-1 alpha) above 700 pg/ml is founded in patients with subclinical disease feature. RAIL level below 300 pg/ml took place in serious and recurring CP.

Conclusion. CP is a result of pericardium inflammation with involving adjacent fatty tissue and with changes of the pericardium nervous system. Relationship between disease clinical course and RAIL-1 level was found. CP progression and new pathogenesis mechanisms is discussed. 

55-58 710

Aim. To study effect of antihypertensive drugs on quality of life (QoL) of patients with stable arterial hypertension (HT).

Material and methods. Results of some studies with similar design involving totally 170 patients with HT, aged 57,2±8,8 y.o., were analyzed. HT duration was 11,2±8,3 years. Patients received antihypertensive monotherapy with diltiazem, amlodipine, enalapril, lisinopril, metoprolol and telmisartan during 1-3 months. 24-hour blood pressure (BP) monitoring, QoL was performed before and after treatment.

Results. All antihypertensive drugs significantly reduced systolic and diastolic BP and did not affect QoL. ACE inhibitors similarly improved QoL.

Conclusion. Antihypertensive drugs (diltiazem, amlodipine, enalapril, lisinnopril, metoprolol, telmisartan) do not worsen QoL of patients with HT.

59-64 1477

Aim. To compare antihypertensive, antianginal and antiischemic efficacy of β1-selective adrenoblockers (betaxolol and metoprolol tartrate) in patients with arterial hypertension (HT) of 1-2 degree associated with stable angina class II.

Material and methods. 100 patients (aged 23-66 y.o.) with HT associated with stable angina or without angina were involved in the study. Patients were randomized into 2 groups (G1 and G2). G1 patients were treated with betaxolol, and G2 patients – with metoprolol tartrate. Ambulatory BP and electrocardiogram monitoring, exercise stress-test, echocardiography, evaluating of respiratory function, blood analysis was performed initially and in 30 and 90 days of treatment.

Results. Target BP level was reached in 44 (88%) patients treated with betaxolol (average daily dose 10±4 mg). 34 patients of G1 took 10 mg daily. Target BP level was reached in 41 (82%) patients treated with metoprolol tartrate (average daily dose 150±27 mg). 30 patients of G2 took 150 mg daily. Exercise tolerance increased and a number of ischemic ST segment depressions reduced significantly in both groups. There were no significant differences in antihypertensive, antianginal, and antiischemic efficacy between groups.

Conclusion. Betaxolol advantage is an ability to maintain target BP level more than 24 hours. A possibility to take betaxolol once a day raises patient’s compliance with therapy.


65-69 404

Modern definition of pulmonary arterial hypertension (PAH) as well as data on prevalence and incidence of secondary PAH in systemic disease of connective tissue is presented,  including data of USA, France and Scotland registers. The main chains of pathogenesis, classification approaches, clinical features and diagnostics are described. 

70-74 328

Aim. To assess an efficacy of adaptol in women with arterial hypertension (HT) during postmenopausal period.

Material and methods. Postmenopausal women (n=60) with HT were examined. Patients of the active group (n=30) received adaptol 500 mg BID during 2 months additionally to basic antihypertensive therapy with enalapril and hydrochlorothiazide (Renipril HT). Patients of control group (n=30) received only basic therapy. Clinical conditions, anxiety level, autonomic dysfunction, quality of life (QoL) were estimated.

Results. Addition of adaptol to the antihypertensive therapy improved one’s well-being and QoL, reduced anxiety level and autonomic dysfunction.

Conclusions. Some advantages of therapy including adaptol were found in postmenopausal women with HT.


75-78 353

Approaches to the evaluation of drug efficacy and safety are discussed. The specifics of clinical and observational trails are presented. The trail data on statins efficacy and safety are held up as a model.


79-82 835

There is grate interest to ACE inhibitors which have cardioprotective and neproprotective effects. Ramipril efficacy in ischemic heart disease prevention as well as ramipril positive effect on myocardium in adolescents is presented on the base of some trails. Ramipril ability to delay of diabetic and non-diabetic nephropathy progression is also discussed.

83-88 391

Results of clinical trials devoted to β-adrenoblocker use in arterial hypertension (HT) are presented. Differences between β-adrenoblockers as well as β-adrenoblocker use in hypertensive patients with concomitant diseases are shown. The β-adrenoblocker position in up-to-date guidelines on HT diagnosis and treatment is discussed.

89-97 544

The innovative approaches to antihypertensive pharmacotherapy and advantages of modern antihypertensive drugs are discussed on the basis of randomized controlled trial. The recommendations for usage of different class of antihypertensive drugs including their combinations are presented.

98-102 364

Problems of educational programs for patients with cardio-vascular diseases in schools of health are discussed. Comparison of andragogic (adult education) and pedagogic education models are analyzed. The pedagogic education model is currently dominating in school of health. To increase of education efficacy in school of health implementation of andragogic principles is recommended. 


123-125 257

News of the last cardiology congresses: there is what to think over.

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)