[Current possibilities in the outpatient treatment of postmyocardial infarction].

The lecture is intended for primary health care physicians and dedicated to the comprehensive rehabilitation and follow-up of postmyocardial infarction patients at an outpatient stage. The lecture material is based on the results of analyzing the Russian and foreign literature and on the author's experience. The section on nondrug treatment for myocardial infarction attaches particular significance to the exposure of risk factors for the disease. Long-term drug prevention of recurrences at the present level is examined.

[Combined antihypertensive therapy in patients with arterial hypertension and type 2 diabetes].

The aim of the study was to assess effect of 12-week long combined therapy with quinapril (accupro), an ACE inhibitor, and diuretic indapamide SR on arterial pressure (AP), carbohydrate and lipid metabolism, and safety of the treatment in patients having arterial hypertension (AH) with and without DM2. Sixty outpatients with grade II-III AH (mean age 55.3 +/- 9.6 yr) were divided into 2 groups: group 1 (n = 30) comprised patients with AH and DM2, group 2 (n = 30) included patients with AH alone. Combined therapy with daily doses of 23.3 +/- 9.8 g accupro and 1.5 mg indapamide reduced systolic and diastolic AP by 30.2 and 27.3% respectively in group 1 and by 27.6 and 27.1% in group 2. In patients with AH and DM2, fasting and postprandial blood glucose levels decreased by 7.3 and 5.2% and HbA1c by 8.9% (p < 0.05). Total cholesterol, triglycerides, and LDL cholesterol tended to decrease in both groups. HDL cholesterol significantly (p < 0.05) increased by 11.1% in group 1 and 10% in group 2 Side effects were documented only in 8.3% of the patients and did not require withdrawal of therapy. It is concluded that antihypertensive treatment with quinapril (accupro), an ACE inhibitor, and diuretic indapamide SR may be recommended for long-term therapy of AH concomitant with DM2.

[Combined antihypertensive treatment of patients with hypertension and type 2 diabetes mellitus].

AIM: To investigate antihypertensive efficacy, effects on endothelial, diastolic function of the left ventricle and metabolism of combination of ACE inhibitor quinapril (accupro) with diuretic indapamide SR in patients with hypertension of the second-third degree and type 2 diabetes mellitus (DM) and free of DM. MATERIAL AND METHODS: Outpatient treatment was given to 60 patients with AH (mean age 55.3 +/- 9.6 years) in combination with mild or moderate DM (group 1) and free of DM (group 2). The patients were observed for 12 weeks. Clinical and biochemical blood tests, ECG, echo-CG, measurements of blood pressure were made in all the patients. RESULTS: Quinapril course (mean dose 23.3 +/- 9.8 mg/day) in combination with indapamide (1.5 mg/ day) produced a complete hypotensive effect in group 1 (23 patients, 76.7%), in group 2--25 (83.3%). DM patients demonstrated reduction of fasting and postprandial glycemia and cholesterol, time of isovolumic relaxation reduced in group 1 by 9.1%, in group 2 by 19.8% (p < 0.01). Left ventricular diastolic function improved, endothelium-dependent vasodilation in diabetics rose by 40%, non-endothelium-dependent--by 21.8%, in hypertensive patients free of DM--by 51.9 and 43.2%, respectively. CONCLUSION: Combination of quinapril with indapamide produces a significant antihypertensive effect in patients with AH of degree II-III associated with type 2 DM, improves carbohydrate and lipid metabolism, left ventricular diastolic function.

[Metabolic syndrome: prevalence among outpatients with arterial hypertension, the efficacy of treatment].

The purpose of the investigation was to study prevalence of specific variants of metabolic syndrome (MS) in patients with arterial hypertension (AH), and assess the efficacy of antihypertensive therapy in outpatient departments using drug-and non-drug methods. The subjects, 680 patients with MS and I to III degree AH, underwent clinico-anthropometric examination, lipidography, and fasting blood sugar measurement; outpatient and in-patient medical records were analyzed. Various variants of MS were found in 86.7% of the patients. Combination of AH, dyslipidemia, and excessive body weight (BW) was revealed in 32.5% of the patients; the same combination, but with normal BW, was revealed in 19.2% of the subjects; AH with obesity and carbohydrate metabolic disturbances was found in 19.1% of the subjects; AH with excessive BW alone was found in 6.2% of the patients; AH with hyperglycemia and dyslipidemia was revealed in 5.4% of the cases. The study also found that 30% of the patients did not receive any therapy at all, 34.3% received irregular treatment, only 35.7% of the subjects took medications on a regular basis, and only 12.4% of the patients target arterial pressure levels were had been achieved. Thus, the therapy of patients with AH and MS does not meet current requirements. Low patients'compliance with drug- and non-drug therapy and the fact that physicians do not follow scientifically based standards of treatment are the main reasons for the low efficacy of AH treatment.

[Comparative characteristics of treatment quality in patients with arterial hypertension in the system of primary health service].

AIM: To compare quality of therapy and examination of target organs in hypertensive patients in the system of primary health service for 1995-1996 and 2003-2004. MATERIAL AND METHODS: A retrospective analysis of 1301 case histories of outpatients treated in 1995-1996 and 720 patients treated in 2003-2004 has been made. A special chart was compiled for evaluation of diagnosis and treatment quality. The results were compared. RESULTS: Adelphan and clophelin prescription reduced from 71.1 (in 1995) to 4.0% (in 2004), 75.8 to 32.6%, respectively. ACE inhibitors prescription rate rose from 3.1 to 40.2%, beta-adrenoblockers--from 5.1 to 13.6%, calcium antagonists--from 6.2 to 7.9%, diuretics--from 9.8 to 12.6%. Coverage with hypotensive therapy increased from 80.1 to 84.6%. Regular treatment was given to 21.1 and 28.8% patients, respectively, while the number of untreated hypertensive subjects decreased from 19.9 to 15.2%, respectively. For the decade studied target-organs were examined more frequently. CONCLUSION: More effective present-day drugs are now used much more frequently, though quality of therapy remains low. Causes of this situation are poor social support, incompliance of the patients, the physicians are not aimed at prevention of hypertension complications.

[Efficacy and tolerance of ACE inhibitor invoril and angiotensin I At-receptor blocker diovan in patients with stages I-II of arterial hypertension]. / Effektivnost' i perenosimost' ingibitora APF invorila i blokatora ATI-retseptora angiotenzina II diovana u bol'nykh arterial'noi gipertoniei I-II stadii.

A controlled parallel trial was conducted to study an antihypertensive action and tolerance of invoril in a dose of 10-20 mg/day (twice a day) vs diovan in a single dose of 80-160 mg/day in 60 patients (25 men and 35 women) aged under 65 years with arterial hypertension of the first and second degree. Follow-up was 6 weeks. The assessment was made by the data of clinical and biochemical blood tests, ophthalmological examination, registration of ECG and echo-CG. Arterial pressure was measured weekly by a doctor and daily (in the morning and evening) by patients themselves. A complete antihypertensive effect (AP < 150/90 mm Hg) in monotherapy with invoril was achieved in 18 (60%) patients, in therapy with diovan in 26 (86.7%) patients. At the end of the treatment systolic arterial pressure fell in group 1 by 22.6%, diastolic one by 19.2%; in group 2--by 23.4 and 19.7%, respectively. Side effects of invoril treatment occurred in 8 (26.7%) patients, of diovan treatment--in 3 (10%). Thus, invoril and diovan are highly effective and safe drugs for treatment of arterial hypertension of the first and second degree. Antihypertensive effectiveness and tolerance of invoril are inferior to those of diovan.

[Comparative anti-hypertensive effectiveness and tolerance of drugs in patients with mild and moderate arterial hypertension]. / Sravnitel'naia antigipertenzivnaia éffektivnost' i perenosimost' preparatov u bol'nykh s miagkoi i umerennoi arterial'noi gipertenziei.

120 patients with mild and moderate arterial hypertension were treated outpatiently for 6 weeks with dilren (group 1), norvask (group 2), invoril (group 3) and caposide (group 4). Each group consisted of 30 patients. The drugs were given in doses: 300 mg/day, 5-10 mg/day, 10-20 mg/day and 1 tablet a day (50 mg capoten + 25 mg hydrochlortiaside), respectively. Arterial pressure was measured by patients in the morning and in the evening. A complete hypotensive response (AP < 140/90 mm Hg) to dilren was achieved in 25(83.3) patients, norvask in 22(73.3%), invoril in 18(60%), caposide in 13(43.3%) patients. The other 45(37.5%) patients responded partially. Side effects occurred in 31(25.8%) of 120 patients. In caposide, norvask, invoril and dilren treatment they were recorded in 9(30.3%), 8(26.7%), 8(26.7%) and 6(20%) patients, respectively. 11 patients withdrew because of side effects. Thus, dilren (300 mg/day), norvask (5-10 mg/day) and invoril (10-20 mg/day) are effective and safe in mild and moderate arterial hypertension. Caposide (1 tablet a day) failed to provide an adequate fall in arterial pressure throughout 24 hours.

[The comparative assessment of follow-up for hypertensive patients]. / Sravnitel'naia kharakteristika dispansernogo nabliudeniia za patsientami s arterial'noi gipertenziei.

The quality of outpatient follow-up was compared in hypertensive patients of the primary care system in 1995 vs 1997. Case records have been retrospectively analyzed for 1301 patients and 1335 ones treated in 6 Kemerovo outpatient clinics in 1995 and 1997, respectively. A special sheet was used for recording the data. More investigations of the target organs were made in 1997. An increase was found in the number of tests for total cholesterol, creatinine, blood glucose, blood count, urinalysis, ultrasound scanning of the kidneys and adrenals, ECG. More patients were taking drugs. Adelphan administration decreased by 32%, clophelin by 30%. More frequently were prescribed ACE inhibitors, calcium antagonists, beta-adrenoblockers. Quality of care for hypertensive patients is still low. This is explained by deficient social care, poor medical education of the patients, rejection of active treatment by many patients.

[Long-term monotherapy with prestarium, anap and lomir in patients with mild and moderate arterial hypertension: clinical efficacy, hemodynamics and morphofunctional parameters of heart]. / Dlitel'naia monoterapiia prestariumom, énapom i lomirom u bol'nykh miagkoi i umerennoi arterial'noi gipertoniei: klinicheskaia éffektivnost', gemodinamika i morfofunktsional'nye pokazateli serdta.

AIM: To assess effectiveness of blood hypertension treatment with inhibitors of angiotensin converting enzyme and calcium channels blocker. MATERIALS AND METHODS: 83 outpatients with mild and moderate blood hypertension received monotherapy with prestarium, anap and lomir for 12 months. The trends in parameters of blood pressure, total peripheral vascular resistance, thickness of the interventricular septum and left ventricular posterior wall were estimated. RESULTS: Long-term effective monotherapy with prestarium, anap and lomir was possible in 47, 62 and 45% of the patients, respectively. Diastolic pressure lowered by 25, 24 and 25%, total peripheral vascular resistance reduced by 20, 19 and 22%, respectively. The three drugs produced similar positive effects on left ventricular thickness, had no negative effects on bioelectric activity of the heart, clinical and biochemical blood counts. CONCLUSION: Prestarium, anap and lomir are effective against hypertension and diminish left ventricular hypertrophy in hypertensive patients.

[Comparative efficacy of and tolerance to prestarium and lomir in long-term treatment of hypertensive subjects]. / Sravnenie éffektivnosti i perenosimosti prestariuma i lomira pri dlitel'nom lechenii bol'nykh arterial'noi gipertenziei.

An antihypertensive action and tolerance of prestarium and lomir were studied in 31 and 33 hypertensive patients, respectively. They had hypertension stage I-II and took the drug for 12 months. Monotherapy with prestarium in a dose 8 mg/day and lomir (10 mg/day) given twice a day provides a complete hypotensive effect for a year in 56 and 62% of patients, respectively. Combinations prestarium + ariphon, lomir + anapriline or verapamil increased the above number to 100%. The occurrence of side effects of long-term lomir monotherapy was 4 times higher than due to prestarium therapy (39.4 versus 9.7%, respectively).

[Problems in secondary prevention of arterial hypertension in primary health care system]. / Problemy vtorichnoi profilaktiki arterial'noi gipertonii v pervichnom zvene zdravookhraneniia.

AIM: Assessment of the quality of follow-up of patients with arterial hypertension (AH) within the framework of primary health care system. MATERIALS AND METHODS: A retrospective analysis of outpatient case histories of 927 patients with AH treated at 6 health centers in the city of Kemerovo in 1995-1996 was carried out. A special table was created in order to assess the quality of follow up. This table included all data on the follow-up. RESULTS: The study revealed an insufficient volume of examinations of target organs over the latest two years: total analysis of the urine was carried out in only 572 patients, total cholesterol measured in 228, the fundus oculi examined in 384, and ECG performed in 615 patients; echoCG of the heart and major vessels was carried out in only 111 patients and loading tests in 24. Antihypertensive therapy was administered to 758 patients; only 216 of these took drugs regularly, 163 used none at all, and 543 patients took drugs only during exacerbations of disease. Very often they used ineffective drugs longer used now and caused numerous side effects: clofelin, adelphan, rauwolphine, dibasole, papaverine, magnesium sulfate. CONCLUSION: The quality of follow-up of patients with AH does not meet the modern requirements to follow-up due to various causes: 1) social neglect of patients; 2) physicians neglect modern recommendations on the diagnosis and treatment of AH; 3) physicians' efforts are not aimed at the prevention of disease complications, prolongation of the life span of patients, and improvement of the quality of their life; 4) patients are not ready to active treatment.

[Errors in the diagnosis of a cardial syndrome in reflux esophagitis]. / Oshibki v diagnostike kardial'nogo sindroma pri refliuks-ézofagite.

Cases of diagnosis of angina pectoris and myocardial infarction erroneously made in patients suffering from reflux esophagitis are reported. The description and analysis are given of the causes underlying the above misdiagnosis and clinical manifestations of reflux esophagitis.

[Treatment of supraventricular paroxysmal tachycardia by intravenous administration of ATP]. / Kupirovanie nadzheludochkovoi paroksizmal'noi takhikardii vnutrivennym vvedeniem ATF.

The results of treatment of supraventricular paroxysmal tachycardia by the intravenous administration of ATP in a dose of 10-30 mg make it possible to consider ATP as an agent of choice for relieving supraventricular paroxysmal tachycardia under conditions of emergency medical aid.