[Postregistration study of comparative assessment efficacy of the use of fixed combination of nebivolol and amlodipine for the treatment of patients with moderate and high degree of arterial hypertension].

AIM: of the study was to assess efficacy of the use of fixed combination of nebivolol and amlodipine in patients with moderate and high degree of arterial hypertension (AH). MATERIAL AND METHODS: Patients with diagnosis of primary AH (n=124) were divided into 2 groups by random sample method. Patients of group 1 (n=62) received of fixed combination of nebivolol and amlodipine, while those of group 2 (n=62) received free combination of nebivolol and amlodipine. Study drugs were administered both as initial therapy and replacement of preceding treatment. Duration of observation was 3 months with visits after first 2 weeks and in 1, 2, and 3 months after enrollment. RESULTS: Starting from 2nd week visit of fixed combination of nebivolol and amlodipine treated patients had significantly lower levels of systolic and diastolic AP. Already after 2 weeks of combined two-component therapy 60% of group 1 and 52% of group 2 patients achieved target AP. Target AP was achieved by the end of month 1 by 86 and 71%, of month 2 - by 93 and 78% of patients in groups 1 and 2, respectively. In 3 months almost all patients had target AP, but in 1.6% of group 1 and 2.3% of group 2 patients this level was achieved after addition of a thiazide diuretic. Patients receiving of fixed combination of nebivolol and amlodipine achieved noromosyslolia more quickly compared with patients who received free combination of nebivolol and amlodipine. CONCLUSION: Combined therapy with fixed combination of nebivolol and amlodipine appears to be one of effective approaches to treatment of patients with moderate and high degree AH.

[Myocardial revascularization before abdominal aortic surgery in patients with ischemic heart disease].

We retrospectively analyzed 2 cohorts of patients treated in two clinics implementing different strategies of preoperative examination and lowering of perioperative cardiac risk. Patients in clinic 1 (group I, n=86, mean age 59.4+/-7.7 years) were subjected to coronary angiography (CAG) and if indicated - to preventive myocardial revascularization. In patients of clinic 2 (group II, n=95, mean age 54.3+/-6.5 years) only medical therapy was used. In group I CAG was performed in 90%, and myocardial revascularization - in 28% of patients. Total number of complications and hospital mortality were significantly higher in group II compared with group I (20 vs. 8%, p=0.023; 10.5 vs. 2.3%, =0.026). Myocardial infarction was the cause of 6 deaths (6.3%) in group II, while in group I there were no cardiac complications. Thus compared to control group strategy with routine CAG and preventive myocardial revascularization before abdominal aortic surgery was associated with less perioperative complications, myocardial infarctions, and lower mortality.

[Long-term survival after reconstructive surgery on non-coronary arteries in different age groups].

The study was aimed at assessing long-term survival after reconstructive surgery on non-coronary arteries in different age groups as well as the confounding factors. 469 case histories were analyzed retrospectively. The most patients underwent coronary angiography (CA) and preventive myocardial revascularization along with non-coronary artery exam. The mean follow-up period was 57.5 +/- 14.9 months. The groups were similar in terms of aspirin and statin therapy; however, older patients more often received beta-blockers and ACE inhibitors (p < 0.03). The number of patients who undergone CA increased with age (p = 0.002). Older patients had higher long-term mortality (p = 0.008) and poorer long-term survival (p = 0.001) as compared to patients below 60 years of age. The risk of death increased with age (OR 1.11; p = 0.001), in smokers (OR 2.79; p = 0.009) and in case of complications in the postoperative period (OR 4.09; p = 0.001). In turn, lower mortality was associated with CA and further preventive myocardial revascularization, if medical reasons (OR 0.15; p = 0.001). Thus, routine CA and preventive myocardial revascularization were associated with lower long-term mortality. This allows recommending an aggressive preoperative assessment to this category of patients.

[Impact of old age on risk of perioperative complications in non-coronary vascular surgery].

The objective of the study was to assess coronary arteries and the rate of perioperative complications in elderly patients undergoing non-coronary vascular surgery. 412 medical records of patients aged 60.8 +/- 8.5 years undergone non-coronary vascular surgery were analyzed retrospectively. All the patients had a coronary angiography and, if indicated, a preventive myocardial revascularization performed before a surgery. Patients who were over 70 years old had more often significant coronary stenotic lesions (64.5%) than those who were less than 60 years old (59.4%). A myocardial revascularization was significantly more often (p = 0.03) done for patients, who were less than 70 years old (32.7-36.5%), than for those aged over 70 years (14.5%). The groups did not differ in the frequency of beta-blockers, statins and ACE-inhibitors administration (p = 0.42). The groups were also similar in the rate of perioperative complications, including mortality rates. A preventive myocardial revascularization strategy in patients with significant coronary artery disease appears to be an essential stage in the treatment nondependent of the coronary artery disease clinical course. The age per se should not be a reason to refuse those patients in performing non-coronary vascular surgery.

[Role of coronary angiography in decreasing cardiac complications rate during vascular operations].

In order to assess the prevalence of coronary artery lesions in patients running various clinical risks of cardiovascular complications prior to surgical interventions on cardiac vascular basins, we performed a retrospective analysis of 392 case histories (340 men and 52 women, mean age 61.0±8.5 years). All patients in the preoperative period underwent coronary angiography (CAG). For the analytical purposes, the patients were subdivided into four groups. Group One (n=44) comprised patients without clinical risk factors, Group Two (n=184) was composed of those diagnosed as having one clinical risk factor. Group Three (n=122) comprised those with two clinical risk factors, and finally Group Four (n=42) was composed of those presenting with three and more clinical risk factors. CAG revealed that 91% of patients had coronary artery lesions. Haemodynamically significant lesions of three coronary arteries and/or stenosis of the left coronary artery trunk were observed in 15.6% of patients with no clinical risk factors of cardiac complications, in 19.0% of patients with one such factor, in 28.5% of those with two risk factors, and in 42.2% of patients with three and more risk factors. Preventive myocardial revascularization was performed in 22.7% of cases, more often in Group Three and Group Four patients. The number of postoperative complications in the groups did not differ significantly. The total hospital mortality rate was low (0.8%), with all 3 lethal outcomes observed amongst the patients with one clinical risk factor (1.6%). Hence, clinical preoperative stratification of the risk by means of the Lee index prior to vascular operations fails to reveal a considerable part of patients with prognostically unfavourable lesions of coronary arteries, and thus it should seemingly be used in this patient cohort with caution.