№ 9 (2014)

In vitro effects of the drug Actovegin (calf blood hemodialysate) on the formation of oxygen radicals by blood phagocytes in whole blood samples (50-100 μI) in patients with II-III NYHA functional class heart failure (HF) were evaluated. The changes of superoxide anion (O 2-) secretion were recorded using lucigenin-dependent chemiluminescence by «Biotox-7» luminometer. Bacterial tripeptid FMLP (Formyl-Methionyl-Leucyl-Phenylalanine) at a dose of 3 μМ was used as stimulant for phagocytes. Blood phagocytes in patients with HF were initially preactivated (primed), as evidenced by the spontaneous formation of oxygen radicals as a result of their interaction with the plastic wall of the cuvet, as well as the subsequent pronounced response to the FMLP. For the first time, in blood samples of patients with heart failure, it was found that Actovegin had dose-dependent effect on the spontaneous and FMLP-induced reduction of O 2- generation. Significant inhibitory effect was observed at doses above 1 mg/ml. Actovegin had completely suppressed phagocyte response to FMLP. In a cell-free system of generation of oxygen radicals, Actovegin had dose-dependent effect on their reduction. In combination of Actovegin with antioxidant Trolox, each of these drugs reduced or completely inhibited the effects of another drug. Based on the lack of additivity effect in action of Actovegin and Trolox, it was concluded that these drugs have the same mechanism of action. These data indicate that Actovegin may have anti-inflammatory effects and inhibit the oxidative stress in system hypoxia in different organs and tissues of patients with heart failure as a result of removing the oxygen radicals formed.

The article presents the results of the study involving 100 women with arterial hypertension (AH) and stable coronary heart disease (CAD); the study was aimed to the evaluation of antihypertensive efficacy of ACE inhibitor zofenopril and angiotensin II receptor blocker valsartan using once a day and twice a day administration. Follow-up period was 24 weeks. It has been shown that combined antihypertensive therapy based on administration of valsartan twice a day may have advantages over the use of zofenopril in women with a combination of arterial hypertension and stable coronary artery disease.

The article presents the history of the investigation of the renin-angiotensin-aldosterone system (RAAS) and its role in the cardiovascular continuum. The major steps of the synthesis of the main mediator - angiotenzin II - and structure of RAAS with detailing the functions of the angiotensin receptor are discussed in detail. Possible places of RAAS blockade using sartans, angiotenzin receptor blockers, are discussed. The mechanisms of blockade of angiotensin receptors - AR1, and its clinical significance in the treatment of cardiovascular diseases are described in detail. Comparative characteristics of two generations of angiotensin receptor blockers are presented. The literature data on the clinical relevance and the pleiotropic effects of telmisartan, second generation bifunctional sartan, the in the treatment of cardiovascular diseases are demonstrated.

The problem of management of patients with dementia is highly relevant due to its high prevalence and a large social significance. Patients with cognitive disorders, however, have a very low treatment compliance, which greatly reduces effectiveness of therapy. Best treatment compliance is revealed among patients receiving memantine (Akatinol Memantine) due to its high therapeutic effect in cognitive disorders, and good tolerability.

Article is devoted to aspects of the use of drug Phenotropil. The therapeutic effects achieved while taking the drug are described in detail; in particular, its neuromodulatory action is emphasized. Some experimental studies demonstrating the advisability of use of Phenotropil in ischemic-hypoxic cerebral injury are presented. The results confirm the pharmacological effects of Phenotropil incorporating a combination of nootropic, anxiolytic and antioxidant mechanisms of action. It is concluded that use of this drug is extremely important for patients with cerebrovascular diseases.

Therapy with β-adrenergic receptor blockers leads to a decrease in the risk of death and serious cardiovascular complications in patients with chronic heart failure (CHF). Treatment with β-blockers has a particular significant effect on the risk of fatal ventricular arrhythmias in patients with high risk of sudden death. Bisoprolol is metabolically neutral and has good bioavailability, long half-life, and balanced clearance. High efficacy and good tolerability allows to consider this drug as one of the main medicines recommended for use in patients with CHF.

Identification of the patients at high risk for a stroke, with subsequent preventive drug treatment allows to reduce the incidence of stroke. The article presents an overview of current guidelines for management of patients with atrial fibrillation (AF) on the example of a specific clinical case. For the majority of patients with nonvalvular AF, new oral anticoagulants are preferred with respect to vitamin K antagonists; they have similar efficacy, favorable safety profile and do not require selection of maintenance dose and subsequent monitoring of coagulation system. According to a meta-analysis of clinical studies, rivaroxaban has benefits for patients at high risk of coronary events. Comfortable reception mode provides high patient’s compliance to the treatment.