OPTIMIZATION OF PHARMACOTHERAPY IN A POLYMORBID PATIENT WITH A COMBINATION OF CHRONIC HEART FAILURE AND CHRONIC KIDNEY DISEASE. CLINICAL CASE

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Abstract

Chronic heart failure (CHF) accounts for 8.9% of all cardiovascular diseases in Russia. The most common combination of etiological causes in patients with CHF is a combination of arterial hypertension and coronary heart disease. Concomitant kidney pathology and a combination of risk factors increase the risk of cardiovascular complications and death in patients with CHF. Angiotensin converting enzyme (ACE) inhibitors are first-line drugs in the treatment of patients with CHF. According to the clinical guidelines for CHF 2018 captopril, enalapril, lisinopril, ramipril, trandolapril, and fosinopril are considered safe and effective for patients with CHF and impaired renal function. All these drugs are prescribed to comorbid patients with minimal dosages and subsequently titrated to the target doses. Depending on the glomerular filtration rate, the dosages of almost all ACE are adjusted downward in the range of 10-50 ml/min/1.73 m2, with the exception of fosinopril. Even at a glomerular filtration rate of <10 ml/min/1.73 m2, fosinopril is considered safe because it has a double balanced route of excretion through the kidneys with urine and liver with bile in a ratio of 1:1. Therefore, fosinopril appear to be the first-choice ACE inhibitor. A clinical example in this article shows the successful experience of using a combination of antihypertensive drugs as a fosinopril angiotensin converting enzyme inhibitor, bisoprolol beta blocker and spironolactone mineralocorticoid receptor antagonist in a patient with arterial hypertension, chronic heart failure, and a history of chronic kidney disease. Its high antihypertensive, cardio- and nephroprotective efficacy and safety were shown: the ability to reduce blood pressure level, the of left ventricular myocardial hypertrophy and the microalbuminuria, to compensate for manifestations of heart failure.

About the authors

Olga D. Ostroumova

Russian Medical Academy of Continuous Professional Education

Email: ostroumova.olga@mail.ru
д-р мед. наук, проф., зав. каф. терапии и полиморбидной патологии, зав. лаб. клинической фармакологии и фармакотерапии Moscow, Russia

Irina A. Aliautdinova

Russian Medical Academy of Continuous Professional Education

канд. мед. наук, ассистент каф. терапии и полиморбидной патологии Moscow, Russia

Vasilii N. Butorov

Russian Medical Academy of Continuous Professional Education

канд. мед. наук, доц. каф. терапии и полиморбидной патологии Moscow, Russia

Aleksei I. Kochetkov

Russian Medical Academy of Continuous Professional Education

канд. мед. наук, доц. каф. терапии и полиморбидной патологии Moscow, Russia

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