No 8 (2010)

The present article discusses issue of criteria for assessment of clinical and statistical significance of randomized clinical trials aimed to evaluation of drug efficacy, in particular, beta-blockers (BB). Such results allow us to change current clinical guidelines for the use of medicines. On the choosing of BB for the treatment of cardiovascular disease or prevention the development of complications, physicians should focus primarily on the clinical evidence of a particular drug use. Statistically significant reduction in the risk of development of the complications of cardiovascular diseases, as well as high clinical significance of the results, should be established in studies dedicated to evaluation of BB effectiveness.

The increase of pulse wave velocity (PWV) clearly reflects the increase in rigidity and pathological remodeling of vascular wall, as well as associated increase in risk of cardiovascular complications. The article discusses the clinical and prognostic significance of determining the PWV and possibilities of its pharmacological correction, in particular with lisinopril (Lisigamma), which is able to significantly improve the blood vessel elasticity and lead to normalization of the PWV in case of its initial increase.

The article is dedicated to the modern principles of preparation of cardiac patients for extracardiac surgical interventions. The authors have conducted comparison of the latest recommendations of the American College of Cardiology/American Heart Association and the European Society of Cardiology on this matter. According to the ACC/AHA recommendations, clinician must observe six major phases of assessment in preparing of patients for surgery; according to the European recomendations - seven phases. Aspects of premedication, in particular, advisability of the use of b-blockers in the perioperative management are discussed.

This literature review is dedicated to recent data for some pathogenetic aspects of formation and progression of cognitive impairment of vascular genesis. It was shown that preventive and therapeutic correction by statins contributes to the prevention of formation of cognitive impairment of vascular genesis and further progression to vascular dementia. Therefore, it has not only biomedical implication, but also socio-economic significance.

Cerebrovascular diseases are one of the major problems of modern neuroscience. The most common disease - chronic cerebral ischemia (CCI), resulting in vascular dementia in some cases. The CCI most often occurs in elderly patients with burdened somatic history. Development of CCI is based on structural changes of the vascular wall, increased blood viscosity, increased platelet aggregation and impaired deformability of erythrocytes. Drugs with complex mechanism of action, which provide the normalization of cerebral hemodynamics and improvement of microcirculation, are widely used in the complex treatment of patients with CCI. One of these drugs, Vasonit (international name - pentoxifylline) is an effective and safe treatment for CCI.

The article presents analysis of unwanted side reactions (USR) of antihypertensive drugs in patients with hypertension reported by general practitioners. There were 162 reports (458 USR) for ACE inhibitors; the average number of USR was 2.83 per patient, the class-specific USR - 1.17. The most common USR was cough (66%). There were 84 reports (294 USR) for the use of calcium antagonists; the average number of USR was 3.5 per patient, class-specific USR - 2.4. The most frequent USR - edema (46%), headache (35%). The differences in the number and characteristics of the USR using amlodpine and nifedipine were identified. There were 58 reports (208 USR) for the use of beta-blockers; the average number of USR was 3.59 per patient, the class-specific USR - 2.53. The tolerability of beta-blockers was characterized by the widest range of USR on different systems in comparison with other classes of drugs. The differences in the characteristics of USR in women and elderly patients were identified. There were 14 questionnaires (45 USR) for the use of diuretics; the average number of USR was 3.2 per patient; 5 questionnaires (15 USR) for the use of angiotensin-II receptor antagonists, the average number of USR - 3 per patient; 3 questionnaires (18 USR) for the use of drugs with central action; the average number of USR - 6 per patient. The use of generics of antihypertensive drugs (especially, ACE inhibitors generics) was accompanied by large number of USR in comparison with the use of original drugs. The severity of USR and hospitalization rate was greater against the background of use of beta-blockers.

The article presents results of assessment of the effect of indapamide retard on the daily blood pressure (BP), echocardiographic parameters, and blood biomedical measurements in 50 patients aged 45 to 88 years with isolated systolic hypertension. Against a backdrop of 12-month use of indapamide, average daily blood pressure and left ventricular hypertrophy were significantly reduced. This drug has metabolic neutrality and good tolerability.

Postmyocardial infarction syndrome includes such clinical signs as arthralgia, fever, increased ESR, pleurisy and a key sign - pericarditis with effusion. It was named from the American physician William Dressler, who has first described this syndrome. Currently, Dressler's syndrome remains important, relatively rare but all the same possible complication of acute myocardial infarction. The timely detection of Dressler's syndrome and its adequate treatment are discussed. It is emphasized that acetylsalicylic acid and other drugs for secondary prevention of cardiovascular complications (β-blockers, statins, clopidogrel) must be used for treatment of this syndrome.