[From results of BEAUTIFUL trial to results of SHIFT trial: BEAUTIFUL possibility to make a SHIFT in current guidelines].

The article is devoted to results of randomized clinical trails BEAUTIFUL and SHIFT. Position of If-inhibitor ivabradine in current guidelines on management of patients with stable angina and heart failure is discussed.

[Clinical-pharmacoeconomical aspects of ß-adrenoblockers use in patients with ischemic heart disease undergoing coronary artery bypass grafting].

Aim of this study was to assess clinical and pharmacoeconomic effects of long term use of adrenoblockers in patients with ischemic heart disease (IHD) undergoing coronary artery bypass grafting. Patients with IHD (n=294) were included in open, prospective, randomized clinical trial. The follow up period was 3 years. It was noted that long term use of bisoprolol in comparison with atenolol and metoprolol was characterized by more pronounced increase of exercise tolerance, lower rate of angina recurrence and lower expenses for treatment of patients with IHD.

[How to increase the adherence to treatment of patients with arterial hypertension and dyslipidemia: focus on fixed combination of amlodipine and atorvastatin].

The article is devoted to the problem of treatment patients with arterial hypertension and dyslipidemia. Questions of adherence to antihypertensive and lipid lowering therapy are discussed. Effects of first fixed combination amlodopine and atorvastatin, which deals with more than one risk factor, are analyzed.

[Ivabradine in the treatment of patients with angina pectoris: lessons of the BEAUTIFUL trial].

The article is devoted to results of additional analysis of a randomized, double-blind, placebo-controlled, parallel-group BEAUTIFUL trial. Effects of If inhibitor ivabradine in patients with ischemic heart disease, left ventricular dysfunction and stable angina were analyzed.

[Clinical-pharmacoeconomic aspects of trimetazidine modified release use in patients with ischemic heart disease undergoing coronary artery bypass grafting].

The aim of this study was to evaluate clinical and pharmacoeconomic effects of long-term use of trimetazidine MR in patients with ischemic heart disease (IHD) undergoing coronary artery bypass grafting (CABG). Patients with IHD (n=306) were included in open, prospective, randomized clinical trial. One group (group 1, n=153) was pretreated with trimetazidine MR two weeks prior to CABG and continued to take trimetazidine MR for 3 years after the procedure. The other group without of trimetazidine MR (group 2, n=153) was the group of comparison. All patients received conventional therapy of IHD. Six hours after CABG serum creatinine kinase and creatinine-kinase MB were significantly lower in group 1 than in group 2. Rate of ischemic events was also lower in patients treated with trimetazidine MR. Long-term use of trimetazidine MR was characterized by improvement of left ventricular systolic function and exercise tolerance and associated with lower expenses for treatment. We concluded that trimetazidine MR appeared to reduce myocardial reperfusion injury after CABG in patients with IHD.

[Antihypertensive treatment compliance and obstacles to its improvement. Results of Russian program ARGUS-2].

AIM: To study barriers made by the patients for adequate treatment of arterial hypertension. MATERIAL AND METHODS: The ARGUS-2 trial was made in 15 centers of 13 cities of Russia. Anonymous questionnaire survey covered 1298 patients (796 outpatients and 502 inpatients). The patients answered the following questions: 1) what are basic problems of life with hypertension; 2) compliance with intake of antihypertensive drugs; 3) causes of missed intakes of the drugs; 4) opposition to intake of drugs by the patients. Questioning procedure was preset by the trial protocol. RESULTS: Only 37.4% (38.9% outpatients, 34.6% inpatients) were the treatment adopters. Drug intake was missed most frequently because offorgetting. The problems of life with hypertension were differently interpreted by patients and physicians: for the latter main problems were financial and routine while AH complications were on the 6-7 place. The latter were of primary importance for the patients while financial problems took place 4-6 Barriers to regular intake for the patients were poor self-control and unawareness about side effects of the drugs. CONCLUSION: Complience of the patient can be improved only by complex approach: improvement of education, higher motivation, active involvement of patients into the treatment process, better contacts between the physician and the patient.

[Problems of a physician-patient interaction and control of arterial hypertension in Russia. Main results of scientific-practical program ARGUS-2].

OBJECTIVE: To study the problems of physician-patient cooperation, patient- and physician related barrieres to target blood pressure (BP) achievement and to demonstrate improvement of BP control with indapamide SR 1.5 mg, when given to patients remaining uncontrolled while receiving antihypertensive therapy without thiazide diuretics (TD). METHODS: The trial Improvement of Arterial Hypertension Control in High-Risk Hypertensive Patients (ARGUS-2) run in 15 Russian centres during the year 2006. Retrospective analysis of medical notes of 684 outpatients and 575 inpatients with arterial hypertension. Validated questionnaires were used for interview of 373 physicians and 1298 patients. The study of Arifon retard efficacy was carried out in 1438 outpatients with difficult-to-control hypertension. RESULTS: BP was above the goal level in 97.1% pts at the first analyzed visit to an outpatient department. Antihypertensive therapy was unchanged in 20.5% cases, the drug dose was increased in 46,6%, additional medication was administered in 36,8%. In 30.8% pts antihypertensive agent was substituted by another class drug. At the last analyzed visit target BP was found in 24.4% pts. BP control was poorer in pts with BP goal <130/80 mmHg (20.1%) than in those with higher target BP (25.9%). Achievement of BP goal was associated with combination therapy, higher rate of TD administration and with more frequent visits to physician. During hospitalization target BP <140/<90 mmHg was achieved in 87.1%,<130/<80 mmHg in. 76.2%. Arifon retard administration resulted in target BO achievement in 84.5% patients. Physicians percept low adherence to antihypertensive treatment, lack of patients knowledge about risk related to arterial hypertension, economical problems as main barriers to improvement of arterial hypertension management. Patients considered economical problems related to antihypertensive treatment more much less important than physicians did. CONCLUSION: The study results suggest the importance of therapeutic inertia overcome to improve arterial hypertension management in Russia. Low rate of multiple combination therapy and TD prescription are important features of therapeutic inertia. Polar perception of problems related to arterial hypertension by physicians and patients should be considered as influencing factors for educational programs development.

[The level of C-reactive protein and major artery elasticity in patients with ischemic heart disease].

AIM: To assess elasticity of the major arteries in patients with ischemic heart disease (IHD) with reference to concentration of C-reactive protein (CRP). MATERIAL AND METHODS: A total of 52 IHD males (mean age 54 +/- 1.58 years) with functional class I-III angina pectoris and heart failure entered the trial. Major artery elasticity was defined by velocity of the pulse wave. Response of the major arteries (a. radialis) to circulation intensification was evaluated with reactive hyperemia test. Concentration of CRP was determined by enzyme immunoassay. RESULTS: There is a significant correlation between pulse wave velocity for elastic arteries and the levels of C-reactive protein (r = 0.34; p = 0.018). In investigation of endothelium-dependent reactivity we detected significant changes in the response of muscular-type artery to enhancement of blood flow. CRP concentration significantly correlated with pulse wave velocity inhibition in response to blood flow intensification (r = 0.49; p = 0.0005). CONCLUSION: Elevation of C-reactive protein in blood plasma of IHD patients may point to marked changes in elasticity of major arteries. Simultaneous assessment of lipid spectrum and CRP enhances diagnostic significance of each index, separately.

[Value of central aortic pressure measurement in patients with arterial hypertension.].

The article is devoted to analysis of the effects of antihypertensive drugs on central aortic pressure in patients with arterial hypertension. Results of ASCOT-CAFcapital short I, Cyrillic trial are discussed. The importance of investigation of large arteries in arterial hypertension was noted.

[Changes of elastic properties of magistral arteries in patients with ischemic heart disease during treatment with atorvastatin and simvastatin].

AIM: To elucidate effect of atorvastatin and simvastatin on elastic properties and reactivity of large arteries in patients with ischemic heart disease. MATERIAL: Patients (n=38) with ischemic heart disease receiving atorvastatin (10 mg/day, n=20) and simvastatin (20 mg/day, n=18). METHODS: Elasticity of arteries was assessed by pulse wave propagation velocity measured by Coloson computer system. Test with reactive hyperemia was used for assessment of large muscular type vessels reactivity in response to blood flow augmentation was assessed by. RESULTS: Treatment with statins for 6 months was associated with positive changes of elasticity of arteries of elastic type (-10.05% and -4.66% in atorvastatin and simvastatin treated patients, respectively) and endothelium dependent reactivity of arteries of muscular type (-16.01%, p<0.001 and -11.1% p<0.001 compared with initial values in atorvastatin and simvastatin treated patients, respectively). CONCLUSION: Therapy with statins positively affects parameters of elasticity and reactivity of large arteries.

[Effect of beta-Blocker Bisoprolol on Function of Hibernating Myocardium in Patients With Chronic Heart Failure of Ischemic Etiology]. / Vliianie beta1-adrenoblokatora bisoprolola na vosstanovlenie funktsii giberniruiushchego miokarda u bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu ishemicheskoi étiologii.

AIM: To elucidate effect of beta-blocker bisoprolol on hibernating myocardium in patients with congestive heart failure (CHF) of ischaemic etiology without concomitant use of angiotensin converting enzyme inhibitors. MATERIAL AND METHODS: Men (n=21, mean age 51,1+/-2,3 years) with NYHA class II-III congestive heart failure were divided into 2 groups according to results of dobutamine stress-echocardiography: with (group I, n=11), and without (group II, n=10) hibernating myocardium. All patients received bisoprolol (mean daily dose 8.9+/-0.5 mg) for 6 months. RESULTS: In both groups treatment was associated with NYHA class lowering (36.7%, p=0.002, in group 1, and 33.5%, p=0.02, in group II), significant increase of tolerance to physical exercise, improvement of quality of life. Left ventricular ejection fraction significantly increased (+10.5%, p=0.008) in patients with hibernating myocardium and practically did not change in group II (+4,8%, p=0,08). Meanwhile number of normokinetic zones increased by 94,4% in group I (p=0.008) and by 37,5% (p=0,02) in group II. This was associated with reduction of wall motion score index by 10.6%, p=0,009, and 8.2%, p=0,009, respectively. CONCLUSION: These results evidence for efficacy of treatment of patients with heart failure and hibernating myocardium with beta-blocker bisoprolol. In patients with heart failure of ischemic etiology bisoprolol facilitates transition of a part of myocardium from hypokinetic to normokinetic state.

[Debates on the concomitant use of aspirin and Angiotensin converting enzyme inhibitors: will the consensus be reached?]. / Debaty po povodu sovmestnogo primeneniia aspirina i ingibitorov angiotenzinprevrashchaiushchego fermenta: budet li dostignut konsensus?

During last 10 years the potential interaction between aspirin and angiotensin converting enzyme inhibitors (ACEI) has received considerable attention. Retrospective analysis of randomized trials and their meta-analyses gave conflicting results concerning existence and effects of this interaction. Taking into consideration proven benefit of both aspirin and ACEI, restricting their combined use is premature. Further studies of this issue are warranted.

[Effect of fixed low dose combination of perindopril and indapamide on processes of cardiovascular remodeling in previously untreated patients with hypertension]. / Vliianie fiksirovannoi nizkodozovoi kombinatsii perindoprila i indapamida na protsessy serdechno-sosudistogo remodelirovaniia u ranee ne lechennykh patsientov s arterial'noi gipertoniei

AIM: To assess changes of blood pressure (BP) and processes of cardiovascular remodeling during treatment of previously untreated patients with hypertension with fixed low dose combination of perindopril and indapamide. MATERIAL: Patients with untreated hypertension (n=30, mean age 46.7+/-1.8 years, 16 men, 14 women) received low-dose perindopril (2 mg) - indapamide (0.625 mg) combination for 6 months. METHODS: Twenty four-hour BP monitoring, measurement of left ventricular (LV) mass index and wall and interventricular septal thickness, carotid artery intima-media thickness, pulse wave velocity and cerebral blood flow velocity. RESULTS: Target BP level was reached in 83.3% of patients. BP monitoring revealed significant lowering of daytime and nocturnal systolic BP (-13.2%, p<0.0001 and -14.5%, p<0.0001, respectively), daytime and nocturnal diastolic BP (- 14.3%, p<0.0001 and -15.3%, p<0.0001, respectively). Significant reduction of LV mass index (-12%, p=0.0002) was also observed. Both LV posterior wall and interventricular septal thicknesses were reduced as well (-5.1%, p<0,01). This was accompanied by decreases of intima-media thickness of right and left carotid arteries (-5,4%, p=0.04 and -5,3%, p=0.01, respectively), reduction of stiffness of elastic arteries (carotid-femoral pulse wave velocity decreased by 8%, p=0.003), and increase of cerebral blood flow velocity. CONCLUSION: The use of perindopril/indapamide combination in hypertensive patients was associated BP lowering and positive effects on remodeling both of the heart and large and medium arteries.

[Heart rate variability in patients with hypertension and type 2 diabetes treated with long acting calcium antagonists]. / Variabel'nost' ritma serdtsa pri lechenii bol'nykh arterial'noi gipertoniei i sakharnym diabetom 2-go tipa antagonistami kal'tsiia prodlennogo deistviia.

BACKGROUND: Enhanced sympathetic activity is a potential cause of increased risk of cardiovascular complications during treatment of hypertension and type 2 diabetes. MATERIAL AND METHODS: Heart rate variability (HRV) was assessed before and after 12-16 weeks of treatment with calcium antagonists in 89 patients with mild and moderate hypertension. RESULTS: Changes of majority of parameters of 24 hour blood pressure monitoring were in general favorable however lowering of magnitude and rate of morning blood pressure rise was observed only in verapamil treated patients. Analysis of HRV showed that treatment with all long acting calcium antagonists under study was associated with enhancement of sympathetic activity. In supine position nifedipine treated compared with verapamil treated patients exhibited greater sympathetic activity. In upright position changes of HRV parameters characteristic for increased sympathetic activity were also more pronounced in dihydropyridine treated compared with verapamil treated patients. CONCLUSION: Effect of calcium antagonists on parameters of HRV is negative and this should be taken into consideration when antihypertensive treatment of patients with hypertension and type 2 diabetes is selected.