THE PLACE OF NEBIVOLOL IN RATIONAL THERAPY OF CONGESTIVE HEART FAILURE

The prevalence of congestive heart failure (CHF) is growing further with age, and 65% of the sufferers are in the age group from 65 to 80 y.o. Despite success in CHF treatment, mean year mortality is about 6%, and mortality of those with clinically salient CHF reaches 12%. To increase duration of life it is important to prescribe efficient drug therapy, that must include beta-adrenoblockers (BAB), especially in CHF with low ejection fraction (EF) of the left ventricle (LV). Taken into account the results of SENIORS and NEMESIDA, in the year 2013 Nebivolol was included to the National Guidelines on diagnostics and treatment of CHF (IVth review). Benefits on Nebivolol are super-selectivity, vasodilation due to NO release, ability to decrease central aortal pressure, good tolerability and low risk of side effects, especially in patients with concomitant diseases. Nebivolol is effective in coronary heart disease (CHD) and arterial hypertension (AH)

PREDICTION ROLE OF THE LEFT VENTRICLE REMODELLING IN ARTERIAL HYPERTENSION PATIENTS

Aim. To study the influence of various geometric models of the left ventricle (LV) on long-term prognosis in arterial hypertension (AH).Material and methods. Totally, 180 AH patients studied at the age 50,5±6,7 y.o., for 10 years of follow-up. All patients at the inclusion stage underwent standard clinical and functional investigation, 2D-echocardiography, 6-minute walking test, NT-proBNP.Results. By EchoCG theLV hypertrophy (LVH) was found 1,8 times more frequently than by ECG. Normal geometry of theLV was found in 25,5%, concentric LVH — 42,8%, eccentric LVH — 11,7%.Conclusion. By the multifactorial analysis, LVH was independent predictor of adverse prognosis and, in combination with other independent factors (age, male gender, 6-minute walking test, NT-proBNP level in plasma) did double the probability of an adverse cardiovascular risk

PREDICTION ROLE OF THE LEFT VENTRICLE REMODELLING IN ARTERIAL HYPERTENSION PATIENTS

Aim. To study the influence of various geometric models of the left ventricle (LV) on long-term prognosis in arterial hypertension (AH).Material and methods. Totally, 180 AH patients studied at the age 50,5±6,7 y.o., for 10 years of follow-up. All patients at the inclusion stage underwent standard clinical and functional investigation, 2D-echocardiography, 6-minute walking test, NT-proBNP.Results. By EchoCG theLV hypertrophy (LVH) was found 1,8 times more frequently than by ECG. Normal geometry of theLV was found in 25,5%, concentric LVH — 42,8%, eccentric LVH — 11,7%.Conclusion. By the multifactorial analysis, LVH was independent predictor of adverse prognosis and, in combination with other independent factors (age, male gender, 6-minute walking test, NT-proBNP level in plasma) did double the probability of an adverse cardiovascular risk

Methabolic and immune aspects of cardiovascular disease in car drivers

Immune and hormonal status, together with metabolic syndrome (MS) clinic, were examined in 207 males - car drivers (CD) suffering arterial hypertension (AH), coronary heart disease (CHD) or their combination (mean age 47.7 ± 5. 1). In CD with MS, prevalence of subclinical hypothyrosis (41.5 %) was almost twice as high as in healthy individuals (22.2 %). Besides, among the former, increased levels of leptin, fibrinogen, ACTH, Cortisol, and decreased T-cell immunity were more prevalent than in CD with isolated AH, and in healthy people. Positive correlation between leptin level and increased body weight, TTG, insulin and triglycerides levels was observed

A COMPARISON OF THE MAIN ANTIHYPERTENSIVE DRUGS FROM THE VIEWPOINT OF AORTIC STIFFNESS MODIFICATION IN ARTERIAL HYPERTENSION

A plenty of trials confirm the importance of aortic wall stiffness evaluation during estimation of the cardiovascular risk and the need for novel drugs influencing this parameter. Most of hypotensive medications modify arterial wall siffness by one or another way. So the usage of drug combination might be more effective. Insufficient impact of betaadrenoblockers on central artrial pressure is linked to peripheral vasoconstriction. The drugs within this class having vasodilatory properties significantly reduce central aortic pressure

ASSESSMENT OF THE LEFT VENTRICLE SYSTOLIC FUNCTION WITH ULTRASOUND 2D-STRAIN TECHNOLOGY IN ARTERIAL HYPERTENSION

Aim. The assessment of global longitudinal deformation and velocity of deformation of the left ventricle (LV) in arterial hypertension (AH) patients for diagnostics of preclinical systolic function disorders.Material and methods. Totally, 105 AH patients investigated, age 53,3±5,7 y. o., and 35 age and gender matched almost healthy persons. All patients underwent standard clinical and functional investigation with evaluation of diastolic and systolic function with additional assessment of global longitudinal deformation of theLV.Results. In AH theLVhypertrophy (LVH) more often was associated with the male gender and higher levels of arterial pressure, which required prescription of combination antihypertension therapy. In 19 (32,8%) of LVH patients there was increased volume of the left atrium more than 34 mL/m2 , of E/e’ value more 10 and systolic pressure in pulmonary artery more 35 mmHg, that witnessed on the increase of pulmonary artery wedge pressure increase. Of those 9 (15,5%) patients with concentric LVH complained on dyspnea and exercise intolerance related to chronic heart failure and normal ejection fraction, but with decreased longitudinal deformation of LV (-16,3±0,8%). Global longitudinal deformation in normal geometry of the LV was -19,5±0,9% and was significantly higher than in concentric remodeling (-18,3±0,9%), concentric (-17,6±0,9%) and excentric (-18,7±0,7%) LVH.Conclusion. In AH the application of 2D-strain makes it to reveal the disorders of longitudinal systolic LV function even before hypertrophy development, though more significant decrease of global longitudinal deformity of LV is marked in its concentric hypertrophy. In chronic heart failure with saved ejection fraction, together with disordered systolicLVfunction there is a decrease of its longitudinal deformation

AORTIC STIFFNESS ASSESSMENT IN PATIENTS WITH ARTERIAL HYPERTENSION AND OBESITY

Cardiovascular disease (CVD) remains the leading cause of death in most developed countries. Morphological and functional status of large arteries plays an important role in the pathogenesis of CVD. At the moment, there are two main methods of aortic stiffness assessment: pulse wave velocity (PWV) measurement and central PW analysis. In advanced age, aortic stiffness increases, which manifests in increased PWV, elevated central blood pressure, and increased parameters of reflected PW. Similar changes can be observed in young patients with arterial hypertension. The existing evidence concerning obesity effects on aortic stiffness is contradictory and warrants further clarification

Natriuretic peptides and chronic heart failure in arterial hypertension patients

The review is devoted to natriuretic peptides perspectives in left ventricular (LV) systolic and diastolic dysfunction assessment and LV hypertrophy diagnostics in arterial hypertension (AH) patients. The data describing possible antihypertensive therapy effects on brain natriuretic peptide level in AH patients are presented

Rivaroxaban with or without aspirin in stable cardiovascular disease

BACKGROUND: We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. METHODS: In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg once daily). The primary outcome was a composite of cardiovascular death, stroke, or myocardial infarction. The study was stopped for superiority of the rivaroxaban-plus-aspirin group after a mean follow-up of 23 months. RESULTS: The primary outcome occurred in fewer patients in the rivaroxaban-plus-aspirin group than in the aspirin-alone group (379 patients [4.1%] vs. 496 patients [5.4%]; hazard ratio, 0.76; 95% confidence interval [CI], 0.66 to 0.86; P<0.001; z=−4.126), but major bleeding events occurred in more patients in the rivaroxaban-plus-aspirin group (288 patients [3.1%] vs. 170 patients [1.9%]; hazard ratio, 1.70; 95% CI, 1.40 to 2.05; P<0.001). There was no significant difference in intracranial or fatal bleeding between these two groups. There were 313 deaths (3.4%) in the rivaroxaban-plus-aspirin group as compared with 378 (4.1%) in the aspirin-alone group (hazard ratio, 0.82; 95% CI, 0.71 to 0.96; P=0.01; threshold P value for significance, 0.0025). The primary outcome did not occur in significantly fewer patients in the rivaroxaban-alone group than in the aspirin-alone group, but major bleeding events occurred in more patients in the rivaroxaban-alone group. CONCLUSIONS: Among patients with stable atherosclerotic vascular disease, those assigned to rivaroxaban (2.5 mg twice daily) plus aspirin had better cardiovascular outcomes and more major bleeding events than those assigned to aspirin alone. Rivaroxaban (5 mg twice daily) alone did not result in better cardiovascular outcomes than aspirin alone and resulted in more major bleeding events