Systemic inflammation and complications of”vascular" comorbidity in patients with COPD

In this article the authors examine the chronic obstructive pulmonary disease (COPD) from the standpoint of comorbidity — in close connection with other common diseases of modern social comorbid patient. This article presents the known and suspected, confirmed and studied basic mechanisms of the pathogenesis of COPD and a number of systemic diseases. Typical pathological process, which the authors explain the stages of formation of comorbidity is a chronic systemic inflammation. On the pages of this paper reviewed the most famous today inflammatory markers and a causal connection with the increase of their concentration and worsening destabilization of these disease entities and clinical conditions such as coronary heart disease, hypertension, diabetes, obesity, atrial fibrillation, stroke, osteoporosis and malignant neoplasm

The comorbid patients with arterial hypertension, chronic heart failure and chronic kidney disease: the role of fosinoprile

This article discusses clinicopharmacological niches of fosinopril, one of the most popular ACE inhibitors in daily outpatient practice. The authors cover aspects, where fosinopril has advantages over other ACE inhibitors and angiotensin II receptor blockers (sartans) from the point of view of therapy, cardiology and clinical pharmacology. The theses taken as a basis of the article are confirmed by the authors, who named and reviewed the leading clinical trials of fosinopril and its potentially possible combinations with diuretics and calcium channel blockers. The article also covers issues and satellite phenomena of “vascular” comorbidity in patients with arterial hypertension, chronic heart failure and chronic kidney disease; describes the mechanisms of their development and mutual aggravation; examines the points of administration and the evidence for the efficacy and safety of fosinopril in this cohort of patients. One of the main theses of this article is the importance of organ-protection (-cardio, -nefro, -angio). The main directions and postulates of its implementation are provided using the example of ACE inhibitors

A patient with atrial fibrillation and comorbidities in clinical practice

This article focuses on the etiology and pathogenesis of nonvalvular atrial fibrillation in patients with comorbidities such as coronary artery disease, heart failure, type 2 diabetes, and chronic kidney disease. The authors discuss the interconnection of atrial fibrillation and these diseases, and also note the need for protection of such patients (prevention of cardioembolic stroke and other systemic embolism, reduction of coronary risk, improvement of prognosis, slowing the progression of renal dysfunction, increasing medical adherence, etc.) by adequate antithrombotic therapy that does not lose effectiveness and/or safety in presence of multiple diseases and polypharmacy

EFFECTIVENESS OF MELDONIUMIN IN CHRONIC HEART FAILURE PATIENTS

This article discusses the relevance of the high mortality of cardiovascular diseases (CVD) and their complications. Provides an overview of research conducted in the field of treatment of chronic heart failure and other cardiovascular diseases. In treatment notes medications that possess cytoprotective effects that affect cellular metabolism, ionic homeostasis, structure and function of membranes. Proved the feasibility of the introduction of Meldonium in the complex therapy of patients with CHF

IMPROVING THE METHODOLOGY OF CONTINUOUS MEDICAL EDUCATION IN THE CONTEXT OF ARTERIAL HYPERTENSION TREATMENT

Aim. To assess the role of the algorithm-based selection of antihypertensive therapy (AHT) and the continuous medical education in the treatment of arterial hypertension (AH).Material and methods. Based on the autopsy data, we analysed the prevalence of AH and the structure of its complications and comorbidities among 3239 patients of a multidisciplinary Moscow City hospital. We also analysed the practices of preceding ambulatory AHT and conducted the survey on the quality of continuous medical education lectures delivered to internal medicine specialists working at polyclinics.Results. Among patients who died from cardiovascular disease, a high prevalence of AH (96,1%) was combined with prevalent target organ damage (TOD), a strong association between blood pressure (BP) levels and the risk of major cardiovascular events, and a wide range of comorbidities and AH complications. There was a lack of universal AHT schemes and regimens for patients of similar age, gender, and nature and severity of comorbidities.Conclusion. Achievement of target BP levels failed to prevent major cardiovascular events which resulted in fatal outcomes. AHT was administered without adequate consideration of organo-protective and pleiotropic effects of antihypertensive medications. The development of an algorithm which considered age, gender, TOD presence, and previous major cardiovascular events in the selection of AHT had improved the doctors’ understanding of the lecture information