No 9 (2015)

The review is devoted to the pharmacotherapeutic approaches in the treatment of dyscirculatory encephalopathy (DEP). The modern view of the etiology and pathogenesis of DEP is considered in detail. The basic groups of drugs of choice and their advantages and disadvantages are described. The results of meta-analyses and reviews of clinical trials evaluating the efficacy and safety of drugs used commonly in DEP are presented. It is emphasized that multiple aspects in the pathogenesis of DEP should be considered in the process of choice of therapy, that makes combination of agents affecting the various links in the pathogenesis of the disease and its individual symptoms as the most promising.

This review describes the main issues related to the use of nebivolol in patients with arterial hypertension (AH). The features of nebivolol are discussed in detail, as it is highly selective 3rd generation β-blocker having the action on the endothelial function and stimulating the synthesis of nitric oxide. Possible mechanism of organoprotective action of the drug ids described. Evidence of antihypertensive efficacy is presented. The effects of nebivolol on the state of the target organs in arterial hypertension, the metabolic effects of nebivolol, and the potentias for the ose of the drug in patients with diabetes mellitus, obesity, and metabolic syndrome are considered.

Article reviews the results of clinical trials of a new drug for the treatment of alcohol addiction «on demand». In contrast to classical approaches to the treatment of alcoholism, aimed to the achievement of total abstinence and prevention of relapses of alcohol consumption, alternative approach involves a gradual reduction in the amount of ethanol consumed by the use of the drug «on demand». Nalmefen is considered as the drug of choice for an alternative approach to the treatment of alcoholism. The article presented the evidence confirming that nalmefene is an effective drug for reduction of alcohol consumption in patients with alcohol addiction who do not want to completely stop the consumption of ethanol.

The article presents the results of the clinical evaluation of the the efficacy and tolerability of monotherapy with azilsartan medoxomil in 120 patients with I-II degree arterial hypertension. It was shown that azilsartan medoxomil used as monotherapy for 3 months at doses of 40 and 80 mg is an effective antihypertensive agent. It significantly improves the stiffness of the elastic and mixed type arteries, which helps to reduce the rigidity of the vascular wall, prevents vascular remodeling and development of atherosclerotic lesions. The drug was well tolerated by patients. There was a statistically significant decrease in blood glucose levels during treatment with azilsartan medoxomil. It is shown that azilsartan has nephroprotective properties, and significantly reduces the microalbuminuria. As a result, the drug significantly improves the quality of life of patients and reduces the level of anxiety according the Hamilton scale score.

Masked arterial hypertension (MAH) is often observed in young people who have no clinical signs of cardiovascular disease, and is accompanied by end-organ damages to the same extent as a stable arterial hypertension (SAH). For the diagnosis or exclusion of MAH in individuals without obvious signs of arterial hypertension, a sensitive, specific and cost-effective test is required. The present study has evaluated the hypertensive reaction to 30-second arbitrary breath-holding (breath-holding test) in 269 young subjects with no evidence of cardiovascular diseases. Of 269 normotensive subjects with office BP <140/90 mm Hgб53 had a positive test results, and 34 (12.6%) were diagnosed with MAH confirmed by positive results of 24-hour blood pressure monitoring. None of the 201 people with negative results of breath-holding test had MAH as confirmed by 24-hour blood pressure monitoring. The results of the pressor response to the breath-holding test and 24-hour blood pressure monitoring were in line in 93% of cases, and false-negative test results were absent. Breath-holding test can be used effectively to exclude MAH in healthy individuals and to identify individuals with MAH who require further examination and observation.

In acute and chronic back pain, it is advisable to administrate B vitamins in addition to the therapy with non-steroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants: in acute back pain - an injectable form of the drug Milgamma, in chronic back pain - tablet forms (Milgamma compositum); this allows to achieve pain relief more quickly, reduce the dose and duration of treatment with NSAIDs. In case of presence of neuropathic component (lightning, burning pain) in acute and chronic back pain, it is necessary to add antidepressants (amitriptyline) and anticonvulsants (gabapentinoids - gabapentin or pregabalin) to the treatment.

The article presents the main clinical and neurological signs of discirculatory encephalopathy (DE). The approaches to the treatment of DE aimed at correcting the risk factors for its development, improving cerebral blood flow and metabolism of the brain are consi-dered.