Vol 18, No 5 (2016)
Articles
Azilsartan medoxomil/chlorthalidone combination therapy: new prospects in light of SPRINT, HOPE-3 and ACCORDION trials
Abstract
The results of several large trials (НОРЕ-3, ACCORDION and SPRINT) proved the usefulness of tight control of blood pressure in patients at moderate and high risk for cardiovascular complications, for successful cardiovascular risk management and the importance of early combination antihypertensive therapy. Trials showed the need of dual maximum hypotensive effect combinations with favorable metabolic profile and organ protective potential, such as azilsartan-chlorthalidone fixed combination.
Consilium Medicum. 2016;18(5):8-14
8-14
Current issues in the choice antihypertensive drugs
Abstract
In the context of an ever-expanding market of medicines practitioner is constantly faced with the issue of choosing the proper drug. The paper discusses the practical issues of prescribing antihypertensive drugs and the successive stages of choosing a particular drug in each clinical case. Special attention is paid to the selection of original and/or generic drugs, as well as clinical and pharmacoeconomic benefits of the original drug bisoprolol (Concor).
Consilium Medicum. 2016;18(5):17-22
17-22
Dihydropyridine calcium channel blockers in the treatment of arterial hypertension: efficacy and safety of felodipine
Abstract
The article presents the classification, mechanisms of action and clinical effects of calcium channel blockers application. We discussed the advantages dihydropyridine calcium channel blockers application in certain clinical situations. We demonstrated the clinical pharmacology in detail, the results of studies on the efficacy, safety and organ protection of dihydropyridine calcium channel blockers such as felodipine.
Consilium Medicum. 2016;18(5):23-29
23-29
The possibility to use of modern loop diuretic torasemide in the complex antihypertensive therapy
Abstract
Diuretics for several decades remain an integral part of antihypertensive therapy. The place of loop diuretics in the treatment of patients with arterial hypertension until recently was limited by the presence of additional indications (chronic heart failure, chronic kidney disease) or treatment of hypertensive crisis. Torasemid allowed to extend the use of loop diuretics in the complex antihypertensive therapy because of the effective and prolonged natriuretic action, additional properties (antialdosteronic, antifibrotics, vasodilating), as well as the lack of the rebound syndrome and safe metabolic profile.
Consilium Medicum. 2016;18(5):30-35
30-35
The Contemporary History of the drug therapy in patients with arterial hypertension: is antihypertensive therapy only one way of treating?
Abstract
This article discusses the results of the recently concluded randomized and observational studies, which may significantly affect application of antihypertensive and lipid-lowering agents as well as may affect application of combined agents containing constant doses of drugs having an effect on blood pressure and blood lipid concentrations. We showed new data concerning the best approaches to use statins for the purpose of primary prevention. We discussed the possible changes for target arterial pressure and probably for threshold level of arterial pressure in a wide range of patients suffering from arterial hypertension. We discussed the role of new combined drug called Ekvamer, containing constant doses of amlodipine, lisinopril and rosuvastatin, to reduce the risk of cardiovascular disease complications associated with atherosclerosis.
Consilium Medicum. 2016;18(5):36-42
36-42
Ivabradine in the complex therapy of coronary heart disease and coronary heart disease complications
Abstract
Studies undertaken in recent years have shown the interaction between the frequency of heart beat and human longevity. Ivabradine is the representative of a novel class of drugs that exclusively reduce heart rate - sinus node If channel inhibitors. Ivabradine treatment significantly enhances the possibility of pharmacological management of patients with stable angina pectoris. The studies on the assessment of efficacy of ivabradine in patients with acute coronary syndrome are continuing.
Consilium Medicum. 2016;18(5):43-47
43-47
Efficiency of coronary heart disease standard therapy in combination with nikorandil in patients with angina. Study of the correlation of endothelial dysfunction with data of laboratory and instrumental investigations
Abstract
We investigated the association of indicators of endothelial dysfunction (ED) in patients with angina pectoris with the data of laboratory and instrumental studies - clinical indicators of current angina, myocardial remodeling processes, pro - inflammatory markers and blood lipids. Also evaluated antiischemic, antianginal, cardioprotective, endothelioprotective and antiatherosclerotic efficiency of standard therapy of coronary heart disease (CHD) compared with a combination of CHD standard therapy with the drug of group of potassium channel activators nikorandil in patients with II-III angina functional class in long - term administration. Results of the study indicate a significant correlation between ED performance indicators and the number and duration of episodes of myocardial ischemia, some myocardial morphofunctional parameters, lipid profile and inflammatory markers. The inclusion of nicorandil into the standard therapy of CHD leads to more significant changes in the ED parameters and atherogenesis, clinical evaluation of angina pectoris, myocardial remodeling processes, pro-inflammatory factors.
Consilium Medicum. 2016;18(5):48-52
48-52
On the way to optimization approach for the treatment of chronic thromboembolic pulmonary hypertension
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is unique and potentially curable pathology. However, if surgery is not possible in patients with persistent or residual CTEPH after thromboendarterectomy the specific therapy that is usually used in pulmonary arterial hypertension (PAH) can be prescribed. The first drug from the soluble guanylate cyclase promoters known as riociguat was approved in our country for the treatment of patients with inoperable and residual CTEPH in 2014. Riociguat is discussed as the drug of first choice in the Russian recommendations for the diagnosis and treatment of CTEPH 2015. Inhaled iloprost is recommended as 2nd-line permanent treatment in patients with inoperable CTEPH. Endothelin receptor antagonists and phosphodiesterase type 5 inhibitors are the third-line drugs. Common arrangements and standard treatment in case of CTEPH patients do not differ from the treatment approaches in PAH patients. CTEPH patients should take oral anticoagulants for the rest of life to maintain a target INR of 2.5-3.5. Drug of choice is warfarin - vitamin K antagonist. New anticoagulants are not recommended due to absence of statistical significance. Low molecular weight heparins are recommended as an alternative in case of intolerance to warfarin or increased risk of developing bleeding.
Consilium Medicum. 2016;18(5):53-58
53-58
Balloon pulmonary angioplasty for inoperable chronic thromboembolic pulmonary hypertension
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease, developing as a result of chronic obstructive pulmonary disease leading to sustainable elevation in pulmonary vascular resistance and right ventricular failure. The selected method for CTEPH treatment is endarterectomy but in a number of patients this method is contraindicated because of high-risk surgery and/or technical impossibility of surgery in case of damage to the distal pulmonary arteries. Transluminal pulmonary angioplasty in patients with inoperable CTEPH is an effective method for the treatment, of great further prospects.
Consilium Medicum. 2016;18(5):59-61
59-61
Pulmonary thromboendarterectomy: state of the problem
Abstract
Pulmonary endarterectomy is the method of choice in treatment of chronic thromboembolic pulmonary hypertension. There are a lot of factors still restricting the widespread use of these operations. Among them are the difficulties of diagnosing and patient selection, the peculiarities of operation and postoperative treatment, the unawareness of cardiological community about surgical outcomes. We discuss the preparation of the patient to pulmonary endarterectomy, standards of the surgery and postoperative treatment. The possible causes of adverse outcomes are also discussed.
Consilium Medicum. 2016;18(5):62-66
62-66
What we know about candesartan: clinical applications
Abstract
Sartans - one of the youngest groups of antihypertensive drugs, but their efficacy in many clinical situations convincingly proved. Candesartan - one of the most studied sartans. It has a pronounced dose-dependent long-term antihypertensive effect, reduces left ventricular hypertrophy, protects from stroke, renal protection gives effect, slows the progression of chronic heart failure and prevents the development of paroxysmal atrial fibrillation. It not only metabolically neutral but also capable of increasing the sensitivity of peripheral tissues to insulin and exert a beneficial effect on lipid metabolism. That is candesartan meets all requirements for modern medicines.
Consilium Medicum. 2016;18(5):67-69
67-69
Role of rosuvastatin in the primary and secondary prevention of cardiovascular disease
Abstract
Atherosclerosis and the main complications of atherosclerosis continue to dominate in the structure of morbidity and mortality in Western countries and Russia. Total cholesterol level increase due to low-density lipoprotein, according to the results of epidemiological studies is one of the major risk factors for the development and progression of atherosclerosis. Clinical studies helped to determine the target blood lipid and lipoprotein levels, which were associated with minimal risk of fatal and nonfatal cardiovascular events. Only the achievement of target lipid levels associated with drug application and non - drug acting is the predictor to estimate the efficacy of activity in prevention of atherosclerosis. The GALAXY programme was held to investigate rosuvastatin effect and enrolled over 170 000 patients. Over the past 10 years, the series of studies of rosuvastatin application concerning the hypolipidemic efficacy and the effects on the markers of inflammation (such as ARIES, COMETS, DISCOVERY, EXPLORER, MERCURI I-II, ORBITAL, PULSAR, STELLAR, etc.), of rosuvastatin impact on regression of atherosclerosis according to surrogate endpoints (METEOR, ORION, ASTEROID) and of rosuvastatin effects on cardiovascular and total mortality in special populations (CORONA, AVRORA, JUPITER) were completed. The appearance of qualitative generic rosuvastatin (and in particular the drug Tevastor®, Teva Pharmaceuticals) has made the modern hypolipidemic therapy more accessible to patients. The results of comparative clinical studies have demonstrated that Tevastor® is totally bioequivalent to the original rosuvastatin. Tevastor® is an effective drug preventing bad ischemic outcomes (cardiovascular death, stroke, myocardial infarction) and the progression of heart failure. The favorable effect of Tevastor® is the decrease in the frequency of ischemic episodes and their duration, the increase of the antiarrhythmic treatment effect, the improvement of central hemodynamics parameters and Tevastor® is slowing down the process of left ventricular remodeling. Tevastor® is well tolerated «statin» and has a comparable safety profile to other available statins. Thus, Tevastor® can be considered as a drug improving the prognosis and the course of several cardiovascular diseases.
Consilium Medicum. 2016;18(5):70-76
70-76
Inhibitor If-sinus channels ivabradine - a drug, increases the effectiveness of treatment of chronic heart failure and coronary heart disease
Abstract
The results of numerous Russian and foreign studies have shown that the application of ivabradine as a part of complex therapy in patients with ischemic heart disease and chronic heart failure is a real possibility to improve the efficacy of these patients treatment.
Consilium Medicum. 2016;18(5):77-81
77-81
Efficacy and safety of various acetylsalicylic acid formulations
Abstract
The review article discusses the efficacy and safety of 3 different acetylsalicylic acid (ASA) formulations: a simple (uncoated, non-enteric coated), enteric coated and buffered formulations. We discussed in detail the results of several domestic clinical studies concerning the direct comparison of enteric coated and buffered formulations of ASA. It was shown that the dosage form of the drug can affect both the efficiency and safety of the treatment. In particular, we have shown the data that the buffered formulation has more significant antiplatelet effect and in a lesser degree damages the mucous membrane of the gastrointestinal tract in comparison with enteric coated ASA formulations.
Consilium Medicum. 2016;18(5):82-88
82-88
The current status of transcatheter heart valve replacement, using the valve-in-valve technique
Abstract
Transcatheter heart valve replacement is widely used in clinical practice, and this technic founds the application in repeated valve replacements nowadays. Transcatheter heart valve re-replacement is a procedure of valve-in-valve implantation into a deteriorated bioprosthesis and is the only method which can significantly reduce the risk of surgical treatment, nowadays. The article describes the basic principles in the planning of valve-in-valve implantation, as well as the current status of the problem and the prospects for the development of this direction.
Consilium Medicum. 2016;18(5):89-92
89-92
Modern endovascular technologies and long-term prognosis in patients with left main coronary artery disease
Abstract
Coronary artery bypass grafting (CABG) is known as the gold standard treatment of unprotected left main coronary artery (LMCA) disease and has the highest level of evidence in European and American recommendations. However development of endovascular methods of treatment, and first of all decrease of in-stent-restenosis allow us to consider angioplasty and stenting of LMCA as an alternative method to CABG. The comparative world analysis of results of percutaneous coronary interventions and CABG is provided in article. It tells also how efficiency of percutaneous coronary interventions depends on such factors as: lesion localization, diabetes, type of drug-eluting stent.
Consilium Medicum. 2016;18(5):93-97
93-97
Self-monitoring blood glucose levels and glycemic control in diabetes mellitus: medical and psychological aspects
Abstract
Glycemic control plays an important role in the management of diabetes mellitus (DM) and in reducing the risk of the development of acute and late complications of diabetes. One of the causes of poor glycemic control in patients with DM is insufficient or unthought self-monitoring of blood glucose. The results of the studies have demonstrated that the increase in the frequency of self-monitoring blood glucose can lead to the decrease in glycosylated hemoglobin level in patients with type 1 DM. The issue concerning the economic and clinical necessity for regular glycemic control due to questionable data of clinical trials is particularly acute problem in patients with type 2 DM. DM patients are characterized by poor compliance to carry out self-monitoring of blood glucose recommendations. The most frequent causes of poor self-control are psychological, social and economic. It is expected that well-defined scheme of glycemic control, followed by consultation by the physician in charge instead of regular fasting glucose test will have better clinical significance. As a result of technology development, the process of self-monitoring of blood glucose is simplified and minimizes the technical errors during glycemic control. New criteria for analytical accuracy of the portable devices for analyzing blood glucose data have been shown.
Consilium Medicum. 2016;18(5):98-102
98-102
Liver damage in patients with ischemic chronic heart and type 2 diabetes - a treacherous tandem: possible additional organoprotective therapy
Abstract
The presented data on the structure and functional state of the liver in patients with ischemic chronic heart failure (CHF) and type 2 diabetes. Showcased additional opportunities organoprotective (hepato-, cardioprotective) taurine therapy in combination therapy in patients with CHF and type 2 diabetes. Noted additional hypoglycemic, lipid-lowering capabilities of taurine, a positive effect on the severity of insulin resistance.
Consilium Medicum. 2016;18(5):103-109
103-109