COMBINED ANTIHYPERTENSIVE THERAPY: ACE INHIBITOR PLUS CALCIUM CHANNEL BLOCKER. NEW ADVANTAGES OF THE KNOWN COMBINATION

Advantages of combined therapy of patients with arterial hypertension are considered. Special attention is paid to usage of ACE inhibitor and calcium antagonist combination

EUROPEAN GUIDELINES ON MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS PRESENTING WITH PERSISTENT ST-SEGMENT ELEVATION 2008. WHAT CHANGED? (COMMENTS TO UPDATED)

European guidelines on management of acute myocardial infarction in patients presenting with persistent ST-segment elevation 2008. What changed? (comments to updated)

Comparative laboratory effectiveness of low molecular weight heparins in patients with acute coronary syndrome and no ST segment elevation

Aim. To compare anti-Xa plasma activity levels in patients with acute coronary syndrome (ACS) and no ST segment elevation (non-STE ACS), receiving enoxaparin, nadroparin, or dalteparin. Material and methods. In total, 90 patients with non-STE ACS were divided into three groups (n=30 in each group), by the type of low molecular weight heparin (LMWH) administered. All groups were comparable by age and gender structure, body mass index, and creatinine clearance levels. Anti-Xa activity was measured at admission and 6 hours after the first LMWH injection. Results. In all groups, anti-Xa activity was significantly increased at 6 hours after the first LMWH injection. At the end of the follow-up period, the change in this parameter was 0,73±0,11 IU/ml, with baseline level of 0,07±0,05 IU/ml, in the enoxaparin group. In the dalteparin group, the respective values were 0,52±0,12 and 0,05±0,03 IU/ ml, and in the nadroparin group, they were 0,61±0,10 and 0,06±0,05 IU/ml, respectively. The percentage of patients with achieved therapeutic anti-Xa activity (≥0,6 IU/ml) was maximal in the enoxaparin group (93%), being significantly higher than in the dalteparin and nadroparin groups (63% and 77%, respectively). Conclusion. Enoxaparin, dalteparin, and nadroparin therapy in non-STE ACS patients was associated with significantly increased plasma anti-Xa activity. However, the percentage of the patients with achieved therapeutic levels of anti-Xa activity was maximal in the enoxaparin group

CARDIO-ANKLE VASCULAR INDEX (CAVI) AND ARTERIAL STIFFNESS ASSESSMENT AT MEDICAL PREVENTION DEPARTMENTS AND UNITS

Aim. To study the clinical potential and feasibility of the assessment of cardio-ankle vascular index (CAVI) at medical prevention departments and units.Material and methods. The study included 66 patients (13 men and 53 women; mean age 52,26±11,2 years) with very low to very high total cardiovascular risk (CVR) levels and SCORE index 0–25% (mean SCORE index 3,18±4,34%), who underwent volume sphygmography and automatic CAVI measurement.Results. There was a moderately strong, statistically significant correlation between CAVI and age; CAVI and systolic blood pressure (SBP); and CAVI and SCORE. While higher CAVI values were observed among non-smokers and patients with arterial hypertension, these differences were not statistically significant.Conclusion. As a method for arterial stiffness assessment, CAVI measurement is easy to perform, does not require any special preparation, and can be used at medical prevention departments and units as a part of a more detailed preventive examination. A moderately strong, statistically significant correlation was observed between CAVI and SCORE, as well as between CAVI and such SCORE components as age and SBP. However, further research is needed in order to clarify the possibility of CAVI inclusion in prognostic models

WHAT DO PATIENTS WITH ATRIAL FIBRILLATION KNOW ABOUT STROKE AND SYSTEMIC EMBOLISM PREVENTION? DATA OF THE PRIMA-TERRA REGISTRY

Aim. To study the awareness and opinion of patients with atrial fibrillation (AF) about the stroke prevention.Material and methods. This study based on the questionnaire survey of 544 patients from three regions of Russia is the third part of the PRIMA-TERRA register. The survey was carried out in the period from 01.12.2012 to 01.07.2013 by independent employees on a special questionnaire of 9 questions. The ratio of men and women was 42% vs 58%, respectively, the average age was 65.6Ѓ}8.2 years. The AF duration was 7.6Ѓ}2.0 years. The average score of CHA2DS2-VASc was 3.4Ѓ}1.4.Results. Less than 70% of patients were informed of possible AF complications, of which less than a third – about the risk of stroke. Only 62% of patients believed that they take drugs for the stroke prevention, of which only 31% took warfarin, 15% new oral anticoagulants (NOAC). The majority of patients received antiplatelet agents and their combinations – medications not recommended for this purpose by modern National and European cardiology guidelines. Less than 60% of the respondents were informed about the NOACs, while clinically significant information about the benefits of this group of drugs was provided by doctors only to 18% of patients. The main reason limiting the widespread use of NOACs is the high cost of these drugs.Conclusion. Awareness of patients about AF thromboembolic complications is extremely inadequate. For the prevention of stroke, most patients take antiplatelet agents and their combinations, less than a half – anticoagulants. The main reason for refusing to receive the NOACs is the high cost of this group of drugs

Incidence and structure of sudden cardiac death among working population of the Bryansk region. GERMINA register data

Aim. To study the incidence and structure of sudden cardiac death (SCD) among the working population of the Bryansk region, as well as to determine its share in the structure of total and cardiovascular mortality in this age group.Material and methods. We analyzed the structure and incidence of SCD in 417740 people of working age (25-64 years) in five major areas of the Bryansk region and the city of Bryansk in 2012. Medical records (outpatient card, patient’s chart, autopsy protocol, a medical certificate of death) of 1447 people of working age who died from diseases of the circulatory system were analyzed.Results. 106 cases corresponded to the criteria for SCD, which determined the frequency of SCD 25.4 per 100000 working-age population. The predominance of men over women (85% vs 15%) was marked. Only 24% of cases of SCD occurred in hospitals, while 76% - in outpatient settings. A strong association between SCD and age was noted. Chronic (43%) and acute (37%) forms of ischemic heart disease turned out to be the main clinical entities that caused SCD.Conclusion. The share of SCD in total and cardiovascular mortality was 2.9% and 7.3% respectively. Strong correlation between SCD rate and age was found. Chronic and acute forms of ischemic heart disease turned out to be the main clinical entities that caused SCD

IMPACT OF ALCOHOL CONSUMPTION ON SUDDEN CARDIAC DEATH OCCURENCE BY THE REGISTRY GERMINA (REGISTRY OF SUDDEN CARDIAC DEATH OF ECONOMICALLY ACTIVE INHABITANTS IN BRYANSK REGION)

Aim. To investigate on the role of alcohol in sudden cardiac death onset (SCD) in economically active inhabitants.Material and methods. Totally, medical documentation was analyzed, of 1447 economically active inhabitants of Bryansk region in 2012, died due to circulatory causes: the outpatient chart, the inpatient chart, medical death certificate, forensic autopsy, common autopsy. The SCD criteria fulfilled 106 cases. With a unified questionnaire, 26 relatives were surveyed, and medical staff, of those who agreed to respond. In section of 61 corpse, alcohol concentration was measured, with the level of intoxication defined.Results. By the data from official documents, the part of alcohol cardiomyopathy (ICD I42.6) was 7% from all death cases of suddenly died economically active inhabitants. Outpatient charts and case histories documented the fact of alcohol abuse in 36% of those who requested medical help while alive. Relatives or medical staff, contacted with the died just before the death, confirmed alcohol overconsumption in 42%. Corpse blood investigation revealed 27% specimens with alcohol, and about a half of cases the concentration was at more than moderate intoxication.Conclusion. Alcohol plays significant role in SCD development in economically active inhabitants. Abuse with the alcohol beverages leads to development and progression of structural and functonal changes in the heart — the substrate for life-threatening ventricular arrhythmias. Also, in many cases alcohol might be the trigger for fatal rhythm disorders

THE HISTORY OF CARDIOREHABILITATION: FROM A STRICT 2-MONTH BED REST TO SCANDINAVIAN WALKING

The literary review provided, on the topic of complex cardiorehabilitation program formulation of patients with cardiovascular disease, beginning from the origins to recent state. The stageing issues considered and continuity, timeline of exercises begin. The recommendations given for introduction of the novel methods of exercises as secondary prevention of the main disease, their efficacy and safety

ANTIHYPERTENSIVE TREATMENT WITH COMBINED DRUG OF LOSARTAN AND HYDROCHLOROTHIAZIDE

Aim:  to evaluate efficiency and safety of the combined antihypertensive drug Lozap Plus (50 mg losartan, 12,5 mg hydrochlorothiazide) in patients with arterial hypertension (AH) of I-III grade with high and very high cardiovascular risk. Material and methods: 30 patients with AH of I-III grade (13 men and 17 women aged 51.9±1.9) were observed. Patients received Lozan Plus (Zentiva, Czech Republic) 1 time in the morning during 12 weeks. Ambulatory blood pressure monitoring (ABPM), echocardiography, biochemical blood analysis were carried out, microalbuminuria (MA) was determined, quality of life was assessed. Results: After 2 weeks of therapy decrease in office systolic blood pressure (BP) was observed, and after 4 weeks - in diastolic BP. After 12 weeks of treatment decrease in BP became more significant. Target systolic and diastolic BP was reached in 83.3% and 90% of patients respectively. Decrease in systolic BP was observed in 24 hrs. (from 141.9±1.9 to 128.6±0.8 mmHg, p<0.001), in daytime (from 146.8±2.6 to 135.8±1.0 mmHg, p<0.01) and in nighttime (from 131.5±1.9 to 118.8±1.9 mmHg, p<0.001). Diastolic BP also decreased: in 24 hrs. (from 91.7±1.8 to 78.7±1.6 mmHg, p<0.05), in daytime (from 94.3±1.3 to 85.0±1.2 mmHg, p<0.05) and in nighttime (from 83.5±2.0 to 71.2±1.7 mmHg, p<0.01). Daily variability of BP, time index of BP and morning BP rise (from 37.6±2.0 to 23.9±1.9 mmHg, p<0.001) reduced. Normalization of daily profile of BP was observed in the majority of patients after 12 weeks of Lozap Plus therapy. Treatment resulted in reduction of number of patients with myocardial hypertrophy (from 50% to 30%, p<0.01), and of patients with diastolic dysfunction of left ventricle (from 43.3% to 30%, p<0.05). Therapy with Lozap Plus during 12 weeks was followed by decrease in MA from 56.7±1.1 mg/l to 9.0±0.5 mg/l. Lozap Plus demonstrated metabolic safety by assessing carbohydrate, lipid, nitric and electrolyte blood parameters. Increase in quality of life was observed by week 12 of treatment. Conclusion: Lozap Plus is efficient antihypertensive drug providing cardio- and nephroprotection, which doesn’t cause metabolic disturbances and improves quality of life of hypertensive patients