Rational Pharmacotherapy in Cardiology

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Vol 6, No 2 (2010)
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141-144 198

In the issue.


145-148 349

Aim. To evaluate opinion of doctors about modern pharmacotherapy possibilities in patients with ischemic heart disease (IHD) and about basic problems of pharmacotherapy implementation.

Material and methods. Interviews of doctors from various health care institutions in Moscow and Voronezh were performed in 2009. Interview was performed with questionnaire containing 5 questions. Doctors of different specialties (n=64 from Moscow and n=69 from Voronezh) participated in interviewing.

Results. The majority of doctors in Moscow and Voronezh were sure in advantage of IHD pharmacotherapy vs coronary angioplasty and stenting (55% and 63%, respectively). Only 37% and 32% of doctors in Moscow and Voronezh, respectively, believed in real achievement of target levels of low density cholesterol and 45% and 61% of them, respectively, considered high cost of statins as the main limit for its implementation.

Conclusion. On one hand interviews among practicing doctors in Moscow and Voronezh demonstrated satisfied knowledge of modern clinical guidelines on IHD therapy. On the other hand they gave understanding why doctors not always follow these guidelines.


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Aim. To study influence of beta-blockers carvedilol and metoprolol tartrate on platelet aggregative ability, evaluated by three different methods, in patients with acute ST segment elevation myocardial infarction (STEMI).

Material and methods. A total of 86 men aged 36-68 with uncomplicated STEMI were included into an open, comparative, randomized study. Patients were randomized into two groups of beta-blocker treatments. Patients (n=44) of the first group received carvedilol; patients (n=42) of the second one - metoprolol tartrate. Parameters of platelet hemostasis: the maximum amplitude and rate of platelet aggregation induced by ADP, ristomycin and collagen; mean platelet volume (MPV); serum level of soluble CD40 ligand (sCD40L) were evaluated on the 2nd and 24th day after STEMI onset.

Results. In patients with uncomplicated STEMI carvedilol more prominently reduced in vitro platelet aggregation induced by adenozin-5'-diphosphate in high concentration, ristomycin and collagen than metoprolol tartrate. Сarvedilol also more significantly decreased MPV in comparison with metoprolol tartrate. However, effect of both carvedilol and metoprolol tartrate on the level of another platelet aggregation marker - sCD40L was comparable.

Conclusion. Carvedilol and metoprolol tartrate have similar effect on platelet aggregation though in according to some tests carvedilol more prominently reduces platelet aggregation than metoprolol tartrate.

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Aim. To evaluate efficacy, safety and influence on quality of life of controlled release metoprolol tartrate (CRMT) in patients with arterial hypertension of 1-3 degree.

Material and methods. 603 patients (256 men and 347 women; 60,1 y.o., in average) with hypertension of 1-3 degree were examined. 67 hypertensive patients had diabetes mellitus (DM). Study duration was 2 months. All patients started monotherapy by CRMT 50-100 mg OD. After 15 days of CRMT therapy daily dose could be increase to 100-150 mg, if the target blood pressure (BP) levels were not reached. After 1 month of treatment if necessary CRMT daily dose could be increased again up to 150-200 mg or another antihypertensive drug could be added. The forth visit after 2 month of therapy was last one. Antihypertensive efficacy, safety and quality of life (by visual analogue scale) were assessed at every visit. Besides the main blood biochemical parameters and electrocardiograms were analyzed for the safety control.

Results. 591 patients completed the study, 12 patients dropped out the study (because of side effects or low treatment compliance). After 2 months of therapy systolic and diastоlic BP was reduced by 36 and 17 mmHg respectively (р<0,001 for both), and target BP levels was achieved in 72,9% and in 78,2% of patients respectively (р<0,01 for both). Target systolic BP (<130 mmHg) and diastolic BP (<80 mmHg) levels were achieved in 27,3% and 28,8% of hypertensive patients with DM, respectively (р<0,01 for both).Side effects were observed in 3,2% of patients. 87% of patients considered therapy tolerability as a good one. CRMT therapy resulted in quality of life rise from 55,7 to 75,4 points (р<0,001) by the end of therapy.

Conclusion. Study results show high efficacy and safety of CRMT in the therapy of hypertensive patients including hypertensive patients with DM.

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Aim. To study antihypertensive efficacy and safety of valsartan-based therapy (Diovan, Novartis Pharma) as well as patient’s compliance and influence of treatment on several aspects of sexual function.

Material and methods. 114 doctors from 81 medical institutions of Russia participated in this prospective multicenter observation study. 650 hypertensive patients (average age 53,9±0,4 y.o.) were enrolled. The evaluation of therapy efficacy was based on analysis of systolic (SBP) and diastolic (DBP) blood pressure (BP) changes. Safety and compliance of treatment was also analyzed. The evaluation of sexual function was performed with 5 universal questions selected form the International Index of Erectile Function. These questions could be asked in both men and women. The valsartan dose was 80-320 mg OD. A combination of the valsartan with hydrochlorothiazide (12,5-25 mg/d), amlodipine (5-10 mg/d) or any other antihypertensive was allowed.

Results. Significant similar decrease of SBP and DBP was observed in smoking and non-smoking patients (37,5/18,5 and 37,6/15,9 mm Hg respectively, р<0,01 vs baseline). 312 patients (56,9% men, 43,1% women) completed sexual function survey. After 12 weeks of treatment the number of patients without sexual activity and with 1-2 successful sexual attempts in the last 4 weeks significantly decreased from 22 to 16% and from 44 to 30% respectively (р<0,05). Significant increase in the number of patients with 5-6 and 7-10 successful sexual attempts was observed (from 7 to 20% and from 0 to 7% respectively, р<0,05). The treatment resulted in significant increase in the number of patients, who characterized their sexual life satisfaction as “very satisfied” (from 11 to 25%, р<0,01).

Conclusion. During the course of effective antihypertensive treatment there was a significant increase in sexual function and general satisfaction with sexual life in patients with arterial hypertension, which could have favorable long-term consequences in increased compliance to the antihypertensive therapy.

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Aim. To evaluate efficacy and safety of amlodipine maleate in patients with chronic obstructive pulmonary disease (COPD), bronchial asthma (BA) and concomitant arterial hypertension.

Methods. Patients (n=40) with COPD (n=20) or BA (n=20) and hypertension of 1-2 degree were examined. Amlodipine maleate was used as antihypertensive drug. The spirometry, ambulatory blood pressure monitoring, vascular oscillometry (evaluation of arterial stiffness), vascular Doppler imaging (evaluation of endothelial function) was performed initially and in 6 months of treatment.

Results. The high efficacy of amlodipine maleate as antihypertensive drug was found in patients with COPD or BA and hypertension without dependence on bronchial obstruction severity. The positive influence of amlodipine on endothelial function and vascular rigidity was also observed.

Conclusion: study results confirm the rationales of amlodipine use in patients with COPD or BA and hypertension.

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Aim. To compare efficacy of enalapril and perindopril in patients with arterial hypertension (HT) and left ventricle systolic dysfunction.

Material and methods. Patients (n=51) with HT and left ventricle systolic dysfunction (ejection fraction<45%) were included in the prospective open randomized comparative study. Patients were randomized into 2 groups of therapy with enalapril 10-20 mg BID (n=25) or with perindopril 4-8 mg OD (n=26). Hydrochlorothiazide (12,5-25 mg OD) was added in case of ineffective therapy. Routine clinical examination, ambulatory blood pressure (BP) monitoring, an electrocardiogram, an echocardiography were performed in all patients.

Results. The 24-hour and night antihypertensive effect of enalapril was more prominent than this of perindopril. Target BP level was reached in 21 patients (84%) of enalapril group and in 20 patients (76,9%) of perindopril group. 8 (30,8%) patients of perindopril group did not reach night target BP level vs 3 (12%) patients of enalapril group. Similar improvement of the left ventricle systolic function was observed in both groups.

Conclusion. Enalapril and perindopril demonstrated comparable antihypertensive and cardioprotective effect.


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The possibilities and evidence base of clopidogrel use in clinical practice are discussed. Data about the main trails on clopidogrel efficacy in treatment and second prevention of atherothrombotic complications are presented. The results of the comparative trails of original and generic clopidogrel are also reviewed.

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Influence of the combined antihypertensive therapy, including combination of ACE inhibitors and dihydropyridine calcium channel blocker (DCCB), on frequency of cardiovascular events is studied in many trails. Advantages of the combination of ACE inhibitor and DCCB which is one of the most rational are discussed. Both components are vasodilators and have synergistic mode of action in arterial hypertension. Combination of ACE inhibitor and DCCB allows neutralizing of antiregulatory mechanisms reducing drug efficacy. Results of clinical trails which promoted of the fixed combination of lisinopril (10 mg) and amlodipine (5 mg) are presented. Safety and organoprotective properties of this combination are also shown according to the trail results.

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Large epidemiological trails shown that hypercholesterolemia is one of the main risk factor of ischemic heart disease (IHD). Correction of the hypercholesterolemia with GmGKoA reductase inhibitors (statins) essentially reduces IHD morbidity and mortality. The lower serum level of low density lipoprotein is - the lower risk of cardiovascular diseases and their complications are. Efficacy and safety of atorvastatin therapy in high doses is discussed in patients with IHD and dyslipidemia. Atorvastatin in high doses is more effective than standard therapy for prevention of cardiovascular complications. Atorvastatin is also effective in patients with recurrent cardiovascular events. Atorvastatin in high doses is safe and well tolerated. Serious side effects due to atorvastatin use (myopathy and rhabdomyolysis) are very rare. Generic atorvastatin 80 mg OD in ATLANTIC study was effective and safe. However efficacy and safety of other atorvastatin generics in dose of 80 mg OD is not well studied and it is necessary further studies.

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Modern approaches to a choice of beta-blockers for treatment of patients with chronic heart failure depending on the statistical and clinical significance of randomized clinical trails results are considered. Beta-blocker «class-effect» is discussed in context of beta-blocker therapeutic tactics. Data about bisoprolol usage for prevention of sudden death in patients with left ventricle systolic dysfunction is also presented.

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The refractory arterial hypertension (HT) is diagnosed, if therapy with three antihypertensive drugs from different classes (including a diuretic) in optimal doses did not provide target blood pressure (BP) level. Prevalence of a refractory HT is high and reaches up 10-30% among hypertensive patients. However, poor BP control is often caused by patient non-compliance with the medical recommendations, an inadequate estimation of BP level, and "white coat" HT. It is classified as a pseudo resistance. Obesity, salt and alcohol overconsumption, taking some drugs worsen BP control. Secondary HT causes (sleep apnea syndrome, kidney diseases, renal artery stenosis, and primary hyperaldosteronism) are more possible in patients with refractory HT. Specific treatment of these diseases improves BP control and long-term prognosis. Successful treatment of refractory HT includes detection and correction of reversible risk factors and reasons of the secondary HT, use of the effective combined therapy with the aldosterone antagonist. Improvement of patient compliance is one of key factors of effective treatment.


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Data about efficacy and safety of acetylsalicylic acid usage as antiplatelet drug and for cancer prevention are presented.

216-219 370

Aim. To study the balance between activity of lipid peroxidation, antioxidant system and ferrum content in blood, lymph and myocardium of rats with experimental myocardial infarction (EMI).

Material and methods. Experimental study included 116 Wistar male rats (200-220 g of body mass). The EMI was caused by subcutaneous adrenaline injection (0.2 mg/100 g of body mass). The EMI was confirmed by electrocardiography and histopathologic data. The plasma/lymph ferrum index was calculated as blood/lymph ferrum content ratio. The neutrophil chemiluminescence analysis was also performed. Intensity of lipid peroxidation was evaluated by levels of malonic dialdealdehyde, the diene conjugates and diketones. The catalase activity and recovered glutathione was assessed in the erythrocyte hemolysate. Activity of superoxide dismutase was determined in serum; total blood antioxidant activity was assessed by chemoluminescent method.

Results. The neutrophil activity and lipid peroxidation intensity was increased. The total blood antioxidant activity was reduced (in 2.5-5 times) as well as catalase activity and recovered glutathione level.

Conclusion. The balance disorders between lipid peroxidation and antioxidant activity can result in myocardial injury. The ferrum redistribution from serum to lymph is observed in clinical course of myocardial infarction.

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Translation and publication of the paper is performed with the permission of American College of Cardiology and under control of Society of Cardiology of the Russian Federation. Paper Műnzel T, Gori T. Nebivolol. The somewhat-different β-adrenergic receptor blocker was initially published in J Am Coll Cardiol 2009;54:1491–9 © 2009 by the American College of Cardiology Foundation.


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Внешние эксперты: Haruhiko Abe (Япония), David G. Benditt (США), Wyatt W. Decker (США), Blair P. Grubb (США), Horacio Kaufmann9 (США), Carlos Morillo (Канада), Brian Olshansky (США), Steve W. Parry (Великобритания), Robert Sheldon (Канада), Win K. Shen (США)

Члены Комитета Европейского общества кардиологов по практическим рекомендациям (ESC Committee for Practice Guidelines: CPG): Alec Vahanian (Председатель) (Франция), Angelo Auricchio (Швейцария),Jeroen Bax (Нидерланды), Claudio Ceconi (Италия), Veronica Dean (Франция), Gerasimos Filippatos (Греция), Christian Funck-Brentano (Франция), Richard Hobbs (Великобритания), Peter Kearney (Ирландия), Theresa McDonagh (Великобритания), Keith McGregor (Франция), Bogdan A. Popescu (Румыния), Zeljko Reiner (Хорватия), Udo Sechtem (Германия), Per Anton Sirnes (Норвегия), Michal Tendera (Польша), Panos Vardas (Греция), Petr Widimsky (Чехия)

Рецензенты: Angelo Auricchio (Координатор от CPG) (Швейцария), Esmeray Acarturk (Турция), Felicita Andreotti (Италия), Riccardo Asteggiano (Италия), Urs Bauersfeld (Швейцария), Abdelouahab Bellou4 (Франция), Athanase Benetos6 (Франция), Johan Brandt (Швеция), Mina K. Chung3 (США), Pietro Cortelli 8 (Италия), Antoine Da Costa (Франция), Fabrice Extramiana (Франция), Jose´ Ferro7 (Португалия), Bulent Gorenek (Турция), Antti Hedman (Финляндия), Rafael Hirsch (Израиль), Gabriela Kaliska (Словакия), Rose Anne Kenny6 (Ирландия), Keld Per Kjeldsen (Дания), Rachel Lampert 3 (USA), Henning Mølgard (Denmark), Rain Paju (Эстония), Aras Puodziukynas (Литва), Antonio Raviele (Италия), Pilar Roman5 (Испания), Martin Scherer (Германия), Ronald Schondorf 9 (Канада), Rosa Sicari (Италия), Peter Vanbrabant 4 (Бельгия), Christian Wolpert1 (Германия), Jose Luis Zamorano (Испания).

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European Guidelines for the diagnosis and management of syncope 2009. What is the news? 


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Congress of the American College of Cardiology 2010: crisis of clinical guidelines.

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Uniform Requirements for Manuscript Submitted to Biomedical Journals: Writing and Editing for Biomedical Publication (2008).


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To the 60-th anniversary of the birth of Prof. Yuri Isaevich Grinstein.

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Russian National congress of cardiology in October 5-7, 2010.

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Russian cardiologists about “affairs of the heart”.

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