Consilium Medicum, №03 2015
About
The article deals with the examination of the role and main indications of 24-hour blood pressure (BP) monitoring according to recommendations concerning the current diagnosis and treatment of arterial hypertension (AH). We indicate the main parameters of 24-hour blood pressure monitoring method. Currently, on the evaluating the efficacy of antihypertensive therapy one should take into account not only the measurement of office BP parameters but also the impact of the drug on the level of mean systolic and diastolic daytime and night-time BP. We study the literature data on the predictive value of circadian rhythm of BP disoders. We mark the prevalence of different types of circadian profile of BP. We underline that, according to the predictive value of lack of nocturnal BP fall, it is very important to take into account the very high prevalence of this phenomenon among patients with AH, and in case of antihypertensive drugs selection one should take into account the effect on the BP level in non-dippers. We analyze the literature data on the efficacy of new drug from angiotensin II receptor blockers (ARBs) – azilsartan medoxomil, registered in the Russian Federation in 2014, for the application in case of circadian rhythm of BP disoders. It is found that this drug has the advantage in comparison with the other members of the ARBs class (valsartan, olmesartan) in the form of strong power antihypertensive effect in a 24-h period according to the 24-hour blood pressure monitoring results.
Key words: arterial hypertension, angiotensin II receptor blockers, azilsartan medoxomil, blood pressure, 24-hour blood pressure monitoring, blood pressure at night, circadian profile of blood pressure, circadian rhythm of blood pressure.
O.D.Ostroumova 1,2, I.I.Kopchenov1, G.N.Shchukina1
8-13
1A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1;
2I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
Diuretics are widely used in clinical practice in the treatment of arterial hypertension. The thiazide (thiazide-type) and loop diuretics are widely used in general clinical practice. The article deals with the questions of rational choice of diuretics, using the available evidence-based data, the results of drug interaction and the monitoring of efficacy and safety of the therapy. The special attention is paid to torasemide – loop diuretic, which is recommended for long-term pharmacotherapy of arterial hypertension.
Key words: arterial hypertension, pharmacotherapy, the treatment of arterial hypertension, antihypertensive therapy, antihypertensive drugs, diuretics, thiazide diuretic, thiazide-type diuretics, hydrochlorothiazide, indapamide, loop diuretics, drug interaction, torasemide.
T.E.Morozova , I.Yu.Yudina
14-18
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trube¬tskaia, d. 8, str. 2
The article describes the basic principles of pharmacotherapy in case of hypertensive crisis from the position of the last foreign and domestic clinical recommendations and individualization of fast-acting antihypertensive drugs. We discuss the management of complicated or uncomplicated hypertensive crisis, arresting the crisis in pregnant women and people who use psychoactive substances.
Key words: complicated or uncomplicated hypertensive crisis.
A.I.Ponomareva1, O.G.Kompaniec1, O.G.Ni2, A.E.Babich 3, M.S.Strokan1
19-22
1Kuban State Medical University of the Ministry of Health of the Russian Federation. 350063, Russian Federation, Krasnodar, ul. Sedina, d. 4;
2Regional Clinical Hospital №2 of the Ministry of Health of the Krasnodar Region. 350012, Russian Federation, Krasnodar, ul. Krasnykh partizan, d. 6/2;
3Prof. S.V.Ochapovsky Clinical Hospital №1 of the Ministry of Health of the Krasnodar Region. 350029, Russian Federation, Krasnodar, ul. 1 Maia, d. 16
The adverse effect of rapid heart rate (HR) at the course of ischemic heart disease (IHD) is well known. Rapid HR can lead to a mismatch between the increased oxygen needs of the myocardium and the ability to adequate increase in coronary blood flow. We showed the review of the studies concerning ivabradine, aimed at the exploring the opportunities of HR reduction, the reduction of angina pectoris attacks in patients with IHD, the influence on the risk of death and cardiovascular complications. We showed that the reduction of heart rate in patients with angina pectoris should improve patient state of health, exercise tolerance, but did not significantly affect prognosis.
Key words: ischemic heart disease, heart rate, angina pectoris, prognosis.
A.A.Kirichenko
23-25
Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation. 125993, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
The article deals with the application of loop diuretics in patients with compensated heart failure – the patients without the signs of fluid retention, when diuretics application doesn't seem undoubted as in case of patients with edema syndrome. We discussed the mechanisms of formation of left ventricular filling high pressure in these patients; the possibility of filling pressure correction and, consequently, the improvement of the functional status of patients using loop diuretics; the advantages of using these loop diuretics under such conditions with additional antifibrotic characteristics of torsemide in comparison with other loop diuretics, as well as with thiazide diuretics.
Key words: heart failure, left ventricular filling pressure, loop diuretic, torasemide.
A.G.Ovchinnikov
26-32
Scientific dispensary department of A.L.Myasnikov Institute of Clinical Cardiology, Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a
Discussed key issues of the treatment of atrial fibrillation (AF), including antithrombotic therapy and i pharmacological cardioversion of paroxysms of AF using tactics "pill in the pocket" on a specific clinical case. Despite the compelling data from clinical trials, the tactics "pill in the pocket" with propafenone is rarely used. Proposed protocol for interruption paroxysm of AF for use in the outpatient setting.
Key words: treatment of atrial fibrillation, paroxysm of atrial fibrillation, "pill in the pocket".
A.V.Syrov
34-37
Advisory-diagnostic center №6 of the Department of Health of Moscow. 127474, Russian Federation, Moscow, Keramicheskii pr., d. 49b
The analytical article realized the current status of antiplatelet prevention in patients with history of myocardial infarction. After brief historical information the design and results of the PEGASUS-TIMI 54 study (Prevention of Cardiovascular Events in Patients with a Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54) particularly discussed. The results of the study showed that P2Y12 platelet receptor inhibitor ticagrelor can be considered as basic element of long-term dual antiplatelet therapy in patients after myocardial infarction. The final decision concerning the possibility of ticagrelor application in a new indication should be given by the special allowing organizations and expert communities. The study results let us suppose that ticagrelor 60 mg twice daily can be used for discussed purpose in clinical practice in future.
Key words: ticagrelor, myocardial infarction, antiplatelet drug, secondary prevention.
O.V.Averkov
38-43
People’s Friendship University of Russia. 117198, Russian Federation, Moscow, ul. Miklukho-Maklaia, d. 6;
O.M.Filatov City clinical hospital №15 of the Department of Health of Moscow. 111539, Russian Federation, Moscow, ul. Veshniakovskaia, d. 23
Venous thromboembolism is a common serious condition associated with high morbidity and mortality. Currently developing endovascular treatment approaches are effective and safe alternative to the standard conservative therapy. There is a great need to develop the early thrombus removal endovascular methods in our country, which would improve the prognosis and reduce mortality in patients with severe massive pulmonary embolism and deep vein thrombosis.
Key words: pulmonary embolism, deep vein thrombosis, catheter-directed thrombolysis, pharmacomechanical trombectomy.
M.A.Maslennikov 1, N.S.Sinkevich2, A.P.Savchenko3
44-48
1N.I.Pirogov City clinical hospital №1 of the Department of Health of Moscow. 119049, Russian Federation, Moscow, Leninskii pr-t, d. 10, korp. 5;
2Russian Cardiological Scientific-Industrial Complex of the Ministry of Health of the Russian Federation. 121552, Russian Federation, Moscow, ul. 3-ia Cherepkovskaia, d. 15a;
3Russian Medical Academy of Postgraduate Education of the Ministry of Health of the Russian Federation. 123995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
The article deals with the current understanding of the prevalence and clinical significance of atrial fibrillation in patients with acute coronary syndrome. We have described the approaches in the treatment of this group of patients using antithrombotic therapy. On the basis of consensus papers released by the European Society of Cardiology 2014 the special place was taken by the novel oral anticoagulants as an alternative to warfarin for patients with acute coronary syndrome and atrial fibrillation. We showed the results of clinical studies and statistical subanalysis, which could be used as the basis for application of novel oral anticoagulants as a part of triple antithrombotic therapy, including dabigatran 110 mg twice daily.
Key words: atrial fibrillation, acute coronary syndrome, antithrombotic therapy, triple antithrombotic therapy, dabigatran.
O.L.Barbarash , V.V.Kashtalap
49-53
Scientific-Research Institute for Complex Issues of Cardiovascular Disease. 650002, Russian Federation, Kemerovo, Sosnovyi bul., d. 6;
Kemerovo State Medical Academy of the Ministry of Health of the Russian Federation. 650029, Russian Federation, Kemerovo, ul. Voroshilova, d. 22a
The review shows the characteristics of heterogeneous group of drugs – calcium channel blockers and, in particular, diltiazem. We indicate the basic mechanisms of action of calcium channel blockers, as well as the safety and efficacy of their usage in case of different cardiovascular diseases.
Key words: diltiazem, phenylalkilamines, dihydropyridines, benzodiazepines, diphenylpiperazines, diarilaminopropylamines, verapamil, cinnarizine, bepridil, calcium antagonists, calcium channel blockers, atrial tachycardia, vasospastic angina pectoris, arterial hypertension, ischemic heart disease, chronic cardiac failure, left ventricular hypertrophy.
V.S.Zadionchenko1, G.G.Shehyan1, A.A.Yalymov 1, A.M.Schikota1, O.M.Sherstyannikova2, E.U.Asymbekova2
54-62
1A.I.Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation. 127473, Russian Federation, Moscow, ul. Delegatskaia, d. 20, str. 1;
2A.N.Bakulev Scientific Centre of Cardiovascular Surgery. 121552, Russian Federation, Moscow, Rublevskoe sh., d. 135
The review article shows the literature data concerning the usage of mineralocorticoid receptor antagonists of the Russian market, – spironolactone and eplerenone in different groups of patient, including primary hyperaldosteronism, arterial hypertension, heart failure, myocardial infarction, chronic kidney disease. The special attention is paid to the questions of tolerance of the drug and safety. We made an attempt to use differential approaches in the choice of spironolactone and eplerenone application in different subgroups of patients.
Key words: mineralocorticoid receptor antagonists, spironolactone, eplerenone, primary hyperaldosteronism, arterial hypertension, heart failure, myocardial infarction, chronic kidney disease.
D.A.Napalkov
63-67
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trube¬tskaia, d. 8, str. 2
The effective therapy of diabetes mellitus is impossible without active participation of the patient. And it is very important for the patients to be appropriately trained to control the disease and they should have at their disposal modern glucometers, which are in compliance with international standards and easy in management. Changes of the last version of national recommendations indicate the importance of self-monitoring in the disease control. This article reflects the current accuracy requirements for devices for analyzing blood glucose data.
Key words: diabetes mellitus, self-monitoring, glycemic control, hypoglycemia, hyperglycemia, glucometer.
S.V.Nedogoda, I.N.Barikina, A.S.Salasiuk , V.O.Smirnova, E.A.Popova
68-72
Volgograd State Medical University of the Ministry of Health of the Russian Federation. 400131, Russian Federation, Volgograd, pl. Pavshikh bortsov, d. 1
The review deals with a multi-faceted relationship between periodontal disease and cardiovascular disease.
Key words: periodontal disease, cardiovascular disease, relationship.
D.I.Trukhan , L.Yu.Trukhan
73-79
Omsk State Medical Academy of the Ministry of Health of the Russian Federation. 644099, Russian Federation, Omsk, ul. Lenina, d. 12
Practical use of 3D and 4D Echocardiography is discussed in the article. Interesting clinical cases are illustrated the main principles of using of this technologies in Echocardiography. Current value and potential advantages of 3D and 4D Echocardiography in clinical practice are shown as well.
Key words: echocardiography, 3D echocardiography, 4D echocardiography.
M.K.Rybakova , V.V.Mit'kov
80-84
Russian Medical Academy for Postgraduate Education of the Ministry of Health of the Russian Federation. 123995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1