Practical efficacy and safety of Konsilar D24 in patients with hypertension: data from the KONSONANS program

Aim. In practice, to evaluate the efficacy, safety and long-term adherence to therapy with a fixed-dose combination of ramipril/indapamide (Konsilar-D24) in patients with grade 1-2 hypertension (HTN) who have not achieved blood pressure (BP) control with prior therapy or have not taken antihypertensive therapy.Material and methods. This multicenter open-label observational program included 524 patients with grade 1-2 HTN who did not take antihypertensive therapy or did not reach the target BP level with mono or dual antihypertensive therapy, as well as patients shifted to Konsilar-D24 therapy no later than two weeks before the start of the program. All patients signed a written informed consent to participate in the program. The safety analysis set includes all patients who have taken at least one dose of a fixed-dose combination of ramipril/indapamide and have visited physician at least once during the program. The effectiveness analysis set included all patients in the safety population who completed the study in accordance with protocol (n=511). Clinical systolic blood pressure (SBP), diastolic BP (DBP) and heart rate were assessed at baseline, as well as at 0,5, 1, 3 and 6 months of treatment. A post hoc subgroup analysis of changes in BP and heart rate was performed depending on age, sex and baseline body mass index.Results. The fixed-dose combination of ramipril with indapamide significantly reduced SBP and DBP after 2-week treatment (-20,9±10,1 mm Hg; pConclusion. Despite the limitations inherent in observational studies, the KONSONANS program has demonstrated high efficacy and safety of fixed-dose combination of ramipril/indapamide taken once a day in hypertensive patients. Ramipril/indapamide fixed-dose combination therapy significantly improved BP control and achieved even lower individual target BP levels in the majority of hypertensive patients

Sex- and age-related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long-Term Registry

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients. Methods and results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P\ua0 64 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P\ua0=\ua00.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P\ua075 years. Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF 6445%

Angiotensin II and COVID-19. Secrets of interactions

The article describes current data on the relationship of renin-angiotensin system and related drugs with the risk of COVID-19 infection and its outcomes. Analysis of the latest publications did not reveal association of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with any risk of an unfavorable outcomes, and there was no data for withdrawal of these drugs

Fitness club members: a “forgotten” target group for cardiovascular prevention?

Aim. To assess physical and mental health status of the fitness club members. Material and methods. The study included 156 fitness club members (125 women, mean age 31±1 years; 9 men, mean age 39±5,5 years) who were interviewed in order to assess their medical history and physical activity levels. All participants underwent anthropometry and 3-minute Tecumseh step test. The Hospital Scale of Anxiety and Depression, Haim questionnaire on coping strategies, and visual analogue scale were also used. Results. The respondents considered themselves as having low levels of physical activity. “Heart disease” was reported by 16% of women. While 7,2% of women under 50 and 64% of women aged 50+ were aware of their high blood pressure, antihypertensive therapy was mentioned only by 9% of respondents. In women aged 50+ and in men, the values of body mass index were classified as obesity. Based on the step test results, “excellent” levels of exercise capacity were registered in 7,7%, “very good” in 6,5%, “good” in 7,7%, “satisfactory” in 26%, “poor” in 11,8%, and “very poor” in 40,3%. Hypertensive reaction to physical stress was observed in 27% and 5% of women aged under 50 and 50+, respectively. Almost one-fourth of women under 50 demonstrated affective disorders, predominantly anxiety, and a tendency towards non-constructive coping behaviour models. Individual goals of physical training were not always aligned with objective needs of the fitness club members. Conclusion. The physically active population group which attends fitness clubs demonstrated the presence of such cardiovascular risk factors as high blood pressure, overweight and obesity, and affective disorders. Fitness club members should receive regular compulsory consultations of the sports medicine specialist, in order to individualise the training programme, to identify people with low exercise capacity and pathological stress reaction (“risk group”), and to increase the safety of the fitness training process. To identify potential additional measures of cardiovascular prevention in physically active population groups, further research is warranted on physical and mental health of fitness club members

The role of beta-blockers in the treatment of hypertension in 2018 ESC/ESH guidelines

Arterial hypertension (AH) is the most common non­infectious disease in the world and in Russia, associated with high cardiovascular morbidity and mortality. In August 2018, new guidelines for the diagnosis and treatment of patients with arterial hypertension were presented at the European Congress of Cardiology. The article discusses the role of the sympathetic nervous system in the pathogenesis of hypertension and the current importance of beta­blockers in the treatment of hypertension

Recurrent ischemia after percutaneous coronary intervention

Aim. To study the incidence, time of development, and the main causes of recurrent myocardial ischemia after effective revascularization and percutaneous coronary intervention (PCI). Material and methods. The study included 108 patients PCI with coronary artery (CA) stenting (85 men (78,7 %), 23 women (21,3 %)), who were followed for two years. All participants underwent clinical examination, blood biochemistry, electrocardiography (ECG), 24-hour ECG monitoring, stress echocardiography (EchoCG), and coronary angiography (CAG). Results. After PCI, favorable clinical course of coronary heart disease (CHD) was observed in 72 patients (66,7 %), while recurrent ischemia or a reduction in FC of effort angina was registered in 36 (33,3 %). Among women, recurrent or persistent ischemia was more prevalent than among men: 13 (56,5 %) vs. 23 (27 %) cases (p=0,015). Positive test stress EchoCG was observed in 30 patients. Based on the repeat CAG results, recurrent ischemia was due to incomplete myocardial revascularization (n=15), in-stent restenosis (n=12), or atherosclerosis progression (n=10). Conclusion. Active clinical examination is recommended to all patients after PCI, especially women. Stress EchoCG is recommended within first 9 months after PCI for angina-free patients and at any time for patients with recurrent angina

Effectiveness, safety, and endothelial function effects of atorvastatin lipid-lowering therapy in coronary heart disease patients undergoing percutaneous coronary intervention

Aim. To study lipid-lowering and pleiotropic atorvastatin effects on lipid metabolism, endothelial function, fibrinogen level in coronary heart disease (CHD) patients who underwent myocardial revascularization (percutaneous coronary intervention). Material and methods. The study included 40 CHD patients who underwent successful coronary angioplasty and stenting. Inclusion criteria were: primary hyperlipidemia with total cholesterol (CH) level >4,5 mmol/l, low-density CH (LDLCH) level >2,5 mmol/l, and triglycerides level ≤3,5 mmol/l. Initial atorvastatin dose was 20 mg/d. Endothelial function was assessed in reactive hyperemia test, with calculation of endothelium-dependent vasodilatation (EDVD) parameter. Carotid artery ultrasound, with intima-media thickness assessment, was performed.The participants were examined at baseline and after 26 therapy weeks. Results. By the end of 14-week therapy period, target LDL-CH level <2,5 mmol/l was achieved in 56% of the patients, and by the end of Week 26 – in 74%. Mean EDVD was 2,8±1,23 at baseline and 2,984±0,881 26 weeks later (р=0,12). Baseline and control negative EDVD percentage was 56,5% and 34,78%, respectively. Therefore, long-term atorvastatin therapy was associated with improved EDVD, decreased negative EDVD percentage, and improved vasoactive endothelial function. Atorvastatin dose of 20 mg/d caused no clinically significantly adverse events during 26-week therapy course. Conclusion. Lipid-lowering therapy with atorvastatin is highly effective and safe. Due to its pleiotropic action, the medication should be used in patients after myocardial revascularization

EVALUATION OF LEFT VENTRICULAR REMODELING AFTER SURGICAL RECONSTRUCTION OF POSTINFARCTION ANEURYSM

Objective: To assess the effect of left ventricle reconstruction in patients with postinfarction aneurysm on remodeling and heart failure dynamics in the immediate and long-term postoperative period. Material and methods: 162 patients with IHD who underwent myocardial infarction and chronic left aneurysm were included in the study. All the patients underwent myocardial revascularization and reconstructive intervention in the LV cavity at the National Medical Research Center named after V.А. Almazov. Two groups of patients were formed, depending on the type of surgical intervention performed. Group 1 (n = 116) included patients who underwent linear plastic surgery of the left ventricle aneurysm. Group 2 (n = 46) identified patients who underwent an intraventricular plastic aneurysm of V. Dor. Results: In the early postoperative period, a statistically significant decrease in the volume of the LV cavity was observed and the global ejection fraction changed in both study groups. In patients with a significant degree of mitral insufficiency additionally did the plastic fibrous ring. The conducted single-factor analysis showed a statistically significant effect of correction of mitral insufficiency on CDD, DAC, and global ejection fraction. The majority of patients in both groups experienced a decrease in LV volumes in the long-term period. Predictors of unfavorable clinical course of heart failure in the long-term period were revealed: violation of contractility at the level of basal parts of the left ventricle with a decrease in the index of violation of local contractility more than 3, ejection fraction less than 35%, uncorrected mitral insufficiency II and more, increased level of natriuretic peptide 4 times from the upper limit of the norm. Conclusions: Combined operation makes it possible to improve the contractive function of left ventricular, to reduce the degree of mitral insufficiency, the functional class of heart failure