No 1 (2015)

One of the problems in the work of general practitioners and primary care physicians is the issue of rational management of bedridden elderly patients with comorbid pathology. The main cause of prolonged immobilization of elderly patients are cerebrovascular diseases (CVD). Management of these patients should include a comprehensive therapy, influencing on the few causes of the pathogenesis of underlying disease. The research of influence of meldonium in the complex therapy on blood pressure (BP) and lipid profile as the main risk factors for CVD was conducted. It is shown that the use of meldonium in the complex therapy of long-immobilized patients with CVD enhances the hypotensive and hypolipidemic effects, accelerates the achievement of the target values of blood pressure, as well as contributes to more efficient and rapid reduction in total cholesterol levels mainly due to triglycerides and low-density lipoprotein.

Clinical observation of a typical case of vascular comorbidity (VC, hypertension, myocardial infarction, atrial fibrillation) in a patient 68 years old with a fatal outcome is presented. The major elements in the formation of the VC are hypertension and atherosclerosis - pathological conditions that trigger the development of cardiovascular continuum and are characterized by multi-organ changes. Universal mechanism of VC is endothelial dysfunction that triggers a cascade of pathological vascular changes. The most important underlying disease leading to endothelial dysfunction is type 2 diabetes. The features of the VC in the Russian Federation are presented. It is emphasized that early detection of risk factors, adequate and regular monitoring of district physician and timely comprehensive treatment of the VC are the main objectives of outpatient care.

In the first stage of the present study 3239 anatomopathological autopsy protocols of patients admitted to a multidisciplinary hospital in Moscow due to decompensation somatic pathology. The cause of death in 1566 (48.3%) patients were acute and chronic forms of cardiovascular disease (CVD), in 1504 (96.1%) of these hypertension has occurred. In the second stage the assessment of the prevalence of diseases among the population attached to the clinic (35 000), on the basis of which the work was carried out, as well as of seeking medical care in the clinic and at home were conducted. In the third stage, the analysis of the incidence and different types of calls to the district therapists by patients with CVD was conducted. In the fourth stage, for a prospective study and follow-up study (12 months), a group of patients who prefer to apply mainly in emergency medical care was allocated, and further maintenance and treatment of who was carried out in accordance with current guidelines and standards. The analysis revealed the main shortcomings of the care of patients with CVD in the outpatient. As a result, management and treatment of CVD in accordance with modern standards and recommendations, adequate control of blood pressure and biochemical parameters as often as necessary to achieve their target levels showed a significant improvement of the clinical picture of the disease, improving quality of life, reduce the number of calls to the emergency medical care and emergency hospital admissions.