HYPERTENSION IN POSTMENOPAUSAL WOMEN: RATIONALE FOR THE USE OF CALCIUM CHANNEL BLOCKERS IN ANTIHYPERTENSIVE THERAPY

The choice of antihypertensive drugs for the treatment of hypertensive patients is discussed. Modern recommendations on the use of antihyperten-sive drugs in various clinical situations (lesion of target organs and the presence of concomitant conditions) are presented. Characteristics of patients with hypertension and obesity in the postmenopausal period are presented with using authors own data. The expediency of using the last generation of calcium channel blockers in this clinical situation with an emphasis on lercanidipine is justified

Analysis of the structural state formed in titanium at the final severe plastic deformation stage

The structural state of iodide titanium after deformation by drawing at 77 K, which is the final stage of severe plastic deformation (SPD), has been analyzed and estimated in this work. The SPD has been implemented by a sequential combination of deformation techniques (compression-squirting-extrusion-drawing) that provide different stress epures. The temperature dependence of the logarithmic damping decrement of torsional oscillations in the 77-250 K temperature range has been studied to give a physical interpretation of the nonmonotonic change in the strength of the iodide titanium after SPD and to compare the calculated strength with that obtained for low purity titaniu

Роль жирных кислот при воспалении, атеросклерозе, метаболических нарушениях и подагре

Fatty acids (FA) are present in all types of organisms and play an important role in energy metabolism. The length and number of double bonds in the FA of membrane phospholipids determine the viscosity, the activity of transport systems and enzymes, and also the susceptibility to lipid peroxidation. The review discusses the influence of free unsaturated FAs with short and long chains on various inflammatory mechanisms, including atherosclerosis. It has been shown that FAs can reduce endothelial activation and affect the metabolism of eicosanoids. A new model of fundamental factors determining the variability of the timing, degree and duration of acute inflammatory reactions in the deposition of urate crystals in tissues, in which FAs play an important role is considered, using gout as an example. In the future, the study of FAs will expand the understanding of the pathophysiology of chronic inflammation in various diseases, metabolic disorders and atherosclerosis and enable the development of new treatment strategies. Жирные кислоты (ЖК) присутствуют в организмах всех видов и играют важную роль в энергетическом обмене. Длина и количество двойных связей в ЖК фосфолипидов мембран определяют вязкость, активность транспортных систем и ферментов, а также восприимчивость к перекисному окислению липидов. В обзоре рассмотрено влияние свободных ненасыщенных ЖК с короткой и длинной цепями на различные воспалительные механизмы, включая атеросклероз. Показано, что ЖК могут снижать активацию эндотелия и влиять на метаболизм эйкозаноидов. На примере подагры рассмотрена новая модель фундаментальных факторов, определяющих вариабельность сроков, степени и продолжительности острых воспалительных реакций при отложениях кристаллов уратов в тканях, при которых ЖК играют важную роль. В будущем изучение ЖК позволит расширить представления о патофизиологии хронического воспаления при различных заболеваниях, метаболических нарушениях и атеросклерозе и разработать новые стратегии лечения.

Current Guidelines for the Treatment of Arterial Hypertension in Patients with Diabetes Mellitus and Chronic Kidney Disease

The current understanding of the management of patients with diabetes mellitus (DM) based on the concept of the cardiovascular continuum involves not only the prevention and treatment of cardiovascular diseases (CVD), but also the prevention and treatment of chronic kidney disease (CKD). The fact is that patients with DM and CKD represent a special group of patients with a very high risk of CVD and cardiovascular mortality. Such patients require early diagnosis and timely identification of risk factors for the development and progression of CKD for their adequate correction. Arterial hypertension, along with hyperglycemia, is the main risk factor for the development and progression of CKD in patients with diabetes. In this regard, the choice of antihypertensive therapy (AHT) in patients with diabetes is of particular importance. The basis of AHT in diabetes and CKD is the combination of a blocker of the renin-angiotensin-aldosterone system (an angiotensin-converting enzyme inhibitor [ACE inhibitor] or an angiotensin II receptor blocker [ARB]) and a calcium channel blocker (CCB) or a thiazide / thiazide-like diuretic. The task of the performed AHT is to achieve the target level of blood pressure (BP). At the same time, the optimal blood pressure values in patients with diabetes and CKD are blood pressure values in the range of 130-139/70-79 mm Hg. If the target blood pressure is not achieved, it is necessary to intensify antihypertensive therapy by adding a third antihypertensive drug to the therapy: CCB or a diuretic (thiazide / thiazide-like or loop). In case of resistant hypertension, it is necessary to consider the possibility of adding antagonists of mineralocorticoid receptors, other diuretics or alpha-blockers to the conducted AHT. Beta-blockers can be added at any stage of therapy if the patient has exertional angina, a history of myocardial infarction, atrial fibrillation, and chronic heart failure. The need to normalize blood pressure parameters by prescribing combined antihypertensive therapy in patients with diabetes and CKD is explained by a decrease in renal and cardiovascular risks, and, therefore, a decrease in the risk of mortality in this cohort of patients

The Peculiarity of Process and Treatment of Arterial Hypertension in Patients with Type 2 Diabetes Mellitus

Arterial hypertension (AH) is powerful and modifying factor of developing macrovascular and microvascular complications of diabetes. Patients with AH and diabetes belong to group with high and very high levels risk of developing cardiovascular complications and chronic kidney disease. The combination of type 2 diabetes mellitus and AH dramatically increases the risk of developing terminal stages of microvascular and macrovascular diabetic complications: blindness, end-stage chronic kidney disease, amputation of the lower extremities, myocardial infarction, cerebral stroke, worsens the patients prognosis and quality of life. There is ample evidence that blood pressure control in diabetic patients may be critical for improving long-term prognosis. This observation does not lose its relevance even with the emergence of new antidiabetic drugs with proven cardio- and nephroprotective effects. Modern clinical researchers and meta-analysis show the priority of combined antihypertensive therapy, which increases the efficacy of blood pressure correction and prophylaxis of long-term complications in patients with type 2 diabetes. In this article we want to pay attention to features of AH in patients with diabetes, to bi-directional pathogenic mechanisms, to discuss the new algorithms of the treatment and therapeutic needs of these patients. It is important to accent the understanding of the integrity and unity of pathogenic mechanisms which are needed in correction. Innovative antihyperglycemic therapy demonstrates the ability of blood pressure decrease. The synergy of effects let us successfully realize the strategy of multi-factor control and reduce a risk of micro- and macrovascular complications

Dynamics of lipid and carbohydrate metabolism parameters in women with menopausal metabolic syndrome, receiving glucose-lowering therapy

Aim. To assess the tolerability and the impact of various glucose-lowering medications on carbohydrate and lipid profile and anthropometric parameters in women with menopausal metabolic syndrome (MMS). Material and methods. The baseline examination included 122 women in early postmenopause. Thirty three patients with MS, carbohydrate metabolism disturbances, and/or insulin resistance (IR) were included in the 12-week open comparative study. Group I (n=15) received acarbose (150 mg/d) for 12 weeks, while Group II (n=18) was administered metformin (850 mg/d) for 12 weeks. At baseline and 12 weeks later, anthropometry, oral glucose tolerance test with insulin and C-peptide level measurement, and lipid profile assessment were performed. Results. Acarbose therapy was associated with a reduction in body weight (BW), body mass index (BMI), waist circumference (WC), fasting insulin, post-load insulin, post-load C-peptide, and HOMA-IR index. However, no significant improvement in lipid metabolism parameters was observed in the acarbose group. Metformin treatment was linked to a significant reduction in BW, WC, glycated hemoglobin, post-load glucose, C-peptide, and insulin, as well as to an increase in post-load Caro index. Conclusion. Women with MMS, carbohydrate metabolism disturbances, and/or IR, require not only non-pharmaceutical lifestyle modification, but also glucose-lowering pharmaceutical therapy with acarbose or metformin. In particular, it should be considered that metformin, but not acarbose, reduces the levels of total cholesterol and triglycerides

Sakharnyy diabet 2 tipa, arterial'naya gipertenziya i risk serdechno-sosudistykh oslozhneniy

Основной причиной летальности при сахарном диабете являются сосудистые осложнения, в патогенезе которых основная роль принадлежит гипергликемии и ее метаболическим эффектам. Риск макро- и микроангиопатии у больных сахарным диабетом 2 типа прямо зависит от уровня гликемии. Программа ONTARGET, в которой исследуется влияние блокады РААС с использованием телмисартана на многие составляющие сердечно-сосудистого континуума, и окончание которой ожидается в 2008 г., позволит получить новые данные о результатах лечения пациентов с сердечно-сосудистыми заболеваниями и СД

ELECTROPHYSIOLOGICAL PROPERTIES OF THE WPW SYNDROME IN ADOLESCENTS

We have studied 43 patients aged 15 to 18 with ventricular pre-excitation through the Kent bundle. A complex examination included ECG, echocardiography, Holter monitoring, transesophageal stimulation, and transesophageal ECG. The phenomenon of WPW was noted in 20 persons, WPW syndrome in 23. We have shown the influence of vegetative nervous system on the AV-conduction and an extra conducting pathway. A constant and transitory variant of ventricular pre-excitation was noted in the absence of high vagus tone. A hidden variant of pre-excitation is related to a significant vagus influence. In adolescents prone to high sympathetic tone ventricular pre-excitation through the Kent bundle is manifested as the WPW syndrome whereas the WPW phenomenon is observed with the nervous system inclined to a more pronounced vagal tone. Transesophageal stimulation with atropin is indicated for adolescents to assess the nature of pre-excitation through the Kent bundle adequately and reveal arrhythmias

ELECTROPHYSIOLOGICAL PROPERTIES OF THE WPW SYNDROME IN ADOLESCENTS

We have studied 43 patients aged 15 to 18 with ventricular pre-excitation through the Kent bundle. A complex examination included ECG, echocardiography, Holter monitoring, transesophageal stimulation, and transesophageal ECG. The phenomenon of WPW was noted in 20 persons, WPW syndrome in 23. We have shown the influence of vegetative nervous system on the AV-conduction and an extra conducting pathway. A constant and transitory variant of ventricular pre-excitation was noted in the absence of high vagus tone. A hidden variant of pre-excitation is related to a significant vagus influence. In adolescents prone to high sympathetic tone ventricular pre-excitation through the Kent bundle is manifested as the WPW syndrome whereas the WPW phenomenon is observed with the nervous system inclined to a more pronounced vagal tone. Transesophageal stimulation with atropin is indicated for adolescents to assess the nature of pre-excitation through the Kent bundle adequately and reveal arrhythmias

THERAPY OF ARTERIAL HYPERTENSION AND PREVENTION OF CARDIOVASCULAR DISEASES IN WOMAN OF REPRODUCTIVE AGE SUFFERING FROM MIGRAINE. CLINICAL REVIEW

A clinical case of the arterial hypertension in combination with migraine is considered in a woman of a reproductive age. The tactics of the antihypertensive therapy is discussed from the point of view of therapy of arterial hypertension and prevention of cardiovascular diseases and prevention of migraine attacks. Existing recommendations on prevention of cardiovascular and cerebrovascular diseases in women are analyzed and an algorithm of the drug therapy based on the available data about the general nature of pathophysiological mechanism of development of arterial hypertension and migraine is provided