Showing papers in "Racionalʹnaâ Farmakoterapiâ v Kardiologii in 2010"
TL;DR: Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009).
Abstract: Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009).
1,574 citations
TL;DR: The authors’ work will be published in full at the 2016ESC Committee for Practice Guidelines: CPG conference in Washington, DC on 5 June 2016.
Abstract: Внешние эксперты: Haruhiko Abe (Япония), David G. Benditt (США), Wyatt W. Decker (США), Blair P. Grubb (США), Horacio Kaufmann9 (США), Carlos Morillo (Канада), Brian Olshansky (США), Steve W. Parry (Великобритания), Robert Sheldon (Канада), Win K. Shen (США) Члены Комитета Европейского общества кардиологов по практическим рекомендациям (ESC Committee for Practice Guidelines: CPG): Alec Vahanian (Председатель) (Франция), Angelo Auricchio (Швейцария),Jeroen Bax (Нидерланды), Claudio Ceconi (Италия), Veronica Dean (Франция), Gerasimos Filippatos (Греция), Christian Funck-Brentano (Франция), Richard Hobbs (Великобритания), Peter Kearney (Ирландия), Theresa McDonagh (Великобритания), Keith McGregor (Франция), Bogdan A. Popescu (Румыния), Zeljko Reiner (Хорватия), Udo Sechtem (Германия), Per Anton Sirnes (Норвегия), Michal Tendera (Польша), Panos Vardas (Греция), Petr Widimsky (Чехия) Рецензенты: Angelo Auricchio (Координатор от CPG) (Швейцария), Esmeray Acarturk (Турция), Felicita Andreotti (Италия), Riccardo Asteggiano (Италия), Urs Bauersfeld (Швейцария), Abdelouahab Bellou4 (Франция), Athanase Benetos6 (Франция), Johan Brandt (Швеция), Mina K. Chung3 (США), Pietro Cortelli 8 (Италия), Antoine Da Costa (Франция), Fabrice Extramiana (Франция), Jose´ Ferro7 (Португалия), Bulent Gorenek (Турция), Antti Hedman (Финляндия), Rafael Hirsch (Израиль), Gabriela Kaliska (Словакия), Rose Anne Kenny6 (Ирландия), Keld Per Kjeldsen (Дания), Rachel Lampert 3 (USA), Henning Molgard (Denmark), Rain Paju (Эстония), Aras Puodziukynas (Литва), Antonio Raviele (Италия), Pilar Roman5 (Испания), Martin Scherer (Германия), Ronald Schondorf 9 (Канада), Rosa Sicari (Италия), Peter Vanbrabant 4 (Бельгия), Christian Wolpert1 (Германия), Jose Luis Zamorano (Испания).
183 citations
TL;DR: Results of the study shown PT efficacy in patients with IHD after cardiovascular events is shown, and it is advisable to introduce PT program in real practice as well as adequate pharmacotherapy.
Abstract: Aim. To study efficacy of moderate-intensity physical training (PT) and evaluate lipid-lowering therapy in patients with ischemic heart disease (IHD) after acute coronary events in real practice. Material and methods. A total of 392 patients survived during last 3-8 weeks myocardial infarction, unstable angina or myocardial revascularization were included into the study. Inclusion of patients with stable angina pectoris after hospital treatment was also possible. Patients were randomized to the main (n=197) and control (n=195) groups. Patients of the main group received moderate-intensity PT. All patients received beta-blocker, nitrate, ACE inhibitors and acetylsalicylic acid. Frequency of lipid-lowering therapy prescription and its efficacy were assessed in both groups. Duration of the study was 1 year. The efficacy of interventions was evaluated by the dynamics of plasma lipid levels, results of bicycle ergometry and clinical end points. Results. We observed increase in exercise test duration by 32% (p<0.001), efficiency of heart work by 12% (p<0.05), decrease in frequency of angina attacks by 51% (p<0.001) in the main group. Decrease in total cholesterol (TC) by -3.6% (p<0.05) and increase in high density lipoproteins (HDL) cholesterol by 12.3% (p<0.01) were also observed. Differences in the dynamics of physical tolerance, levels of TC, HDL cholesterol and the TC/HDL cholesterol ratio were significant at intergroup comparison. Lipid-lowering drugs implementation was inadequate in both groups. Target plasma levels of low density lipoproteins (LDL) cholesterol were reached in no one group. We registered less cardiovascular events in the main group in comparison with control one (14% vs 28%, respectively) as well as hospitalizations due to IHD (11% vs 18%, respectively) and number of days of disability (2.2 vs. 4.2 days per patient annually, respectively). Differences in mentioned clinical end point rates were significant between groups (p<0.05). Conclusion. Results of the study shown PT efficacy in patients with IHD after cardiovascular events. Lipid-lowering therapy is conducted inefficiently in patients with IHD in real practice. It is advisable to introduce PT program in real practice as well as adequate pharmacotherapy.
5 citations
TL;DR: High prevalence of HT, hypercholesterinemia, and overweight were found out among physicians despite of their knowledge of actual clinical guidelines on cardiovascular diseases therapy and prevention.
Abstract: Aim. To evaluate a prevalence of cardiovascular risk factors among physicians, awareness about their own cardiovascular risk factors as well as their knowledge about actual clinical guidelines. Material and methods. 71 physicians (age 44,7±9,7 y.o.) practicing in city of Nizhni Novgorod were included into the study. They were examined to reveal cardiovascular risk factors and interviewed about main methods of cardiovascular diseases treatment and prevention. Results. Arterial hypertension (HT) prevalence among physicians was 38%, awareness about HT occurrence - 28%, own blood pressure control - 11% of physicians. The prevalence of hypercholesterinemia was 44%, 65% of physicians did not know their own plasma cholesterol level. Physicians had obesity or overweight in 21% and 42% respectively. 91% of physicians demonstrated knowledge about cardiovascular risk factors, 90% and 79% of them were sure regarding possibility to achieve target blood pressure and lipid levels, respectively. Conclusion. High prevalence of HT, hypercholesterinemia, and overweight were found out among physicians despite of their knowledge of actual clinical guidelines on cardiovascular diseases therapy and prevention.
4 citations
TL;DR: Occurrence of pathologic Q-wave on ECG and time of its appearance should be taken into account to assessed short- and long-term prognosis of myocardial infarction.
Abstract: Aim. To evaluate short- and long-term prognosis of myocardial infarction (MI) depending on occurrence of pathologic Q-wave on ECG and time of its appearance. Material and methods. 616 patients with initial ST-elevated MI were included into the study — 254 women and 362 men, aged 62.1±11.2. All patients were split up three groups depending on occurrence of pathologic Q-wave on ECG and time of its appearance. First group consisted of 311 patients with early Q-wave (during first 6 hours from onset of MI symptoms). Second group consisted of 120 patients with late Q-wave (from 6 to 24 hours from onset of MI symptoms). Third group consisted of 185 patients with non-Q-wave MI. Results. The hospital lethality in the patients with early Q-wave was significantly higher than this in patients of the second and the third groups. However, we didn’t reveal significant differences between patients with late Q-wave and patients without Q-wave on ECG. The incidences of cardiac death (sudden death and fatal MI), non-fatal MI and hospitalization because of unstable angina was assessed during next two years. During the follow-up period patients of three groups had similar incidences of the non-fatal MI and hospitalization because of unstable angina. However, incidence of cardiac death was significantly higher in early Q-wave group in comparison with non-Q-wave group. Conclusion. Occurrence of pathologic Q-wave on ECG and time of its appearance should be taken into account to assessed short- and long-term prognosis of MI.
4 citations
TL;DR: The high efficacy of amlodipine maleate as antihypertensive drug was found in patients with COPD or BA and hypertension without dependence on bronchial obstruction severity and the positive influence ofAmlodIPine on endothelial function and vascular rigidity was also observed.
Abstract: Aim. To evaluate efficacy and safety of amlodipine maleate in patients with chronic obstructive pulmonary disease (COPD), bronchial asthma (BA) and concomitant arterial hypertension. Methods. Patients (n=40) with COPD (n=20) or BA (n=20) and hypertension of 1-2 degree were examined. Amlodipine maleate was used as antihypertensive drug. The spirometry, ambulatory blood pressure monitoring, vascular oscillometry (evaluation of arterial stiffness), vascular Doppler imaging (evaluation of endothelial function) was performed initially and in 6 months of treatment. Results. The high efficacy of amlodipine maleate as antihypertensive drug was found in patients with COPD or BA and hypertension without dependence on bronchial obstruction severity. The positive influence of amlodipine on endothelial function and vascular rigidity was also observed. Conclusion: study results confirm the rationales of amlodipine use in patients with COPD or BA and hypertension.
4 citations
4 citations
TL;DR: The population of ACHD patients should be considered according to both the sex and age: <50, 50-79 and ≥80 y.o., being comparable with the male level, and then exceed it in ≥80Y.o.
Abstract: Aim. To study gender and age characteristics of incidence rate, mortality and lethality in acute coronary heart disease (ACHD). Material and Methods. Analysis of the ACHD (ICD-10 codes: I21.0-I22.9, I20.0, I24) morbidity, mortality and lethality, depending on sex and age was performed in the population (n=285 736; 46% men) of several city administrative districts of Voronezh, Ryazan and Khanty-Mansiysk. Morbidity, mortality and lethality were calculated on the basis of medical documentation as well as cases identified by the study protocol. Results. The ACHD morbidity and mortality in men were 1.99 and 1.79 times higher (p<0,001), respectively, than these in women. The studied parameters increase with age, reaching a maximum in 50-59 y.o., have a plateau in 60-79 y.o. and then they decrease. Morbidity and mortality in women increase with age, but reach a maximum in 70-79 y.o., being comparable with the male level, and then exceed it in ≥80 y.o. Age curve of lethality in men has J-alike shape with minimum in patients of 50-79 y.o. Women have a line age curve with minimum in patients of <50 y.o. Conclusion. The population of ACHD patients should be considered according to both the sex and age: <50, 50-79 and ≥80 y.o. Every of these population group has special epidemiological characteristics.
3 citations
TL;DR: Data of the evidence based medicine about bisoprolol treatment of patients with cardiovascular diseases and usage in smoking cardiovascular patients is presented.
Abstract: Data of the evidence based medicine about bisoprolol treatment of patients with cardiovascular diseases (arterial hypertension, ischemic heart disease, chronic heart failure, rhythm disorders) are presented. Implementation of bisoprolol generics as well as bisoprolol usage in smoking cardiovascular patients is also discussed.
3 citations
TL;DR: The possible indications for the choice of two component antihypertensives combinations are presented and the advantages of ACE inhibitor+calcium channel blocker combination are shown in terms ofAntihypertensive efficacy, organoprotective properties, and positive metabolic effects.
Abstract: The possible indications for the choice of two component antihypertensives combinations are presented. The advantages of ACE inhibitor+calcium channel blocker combination are shown in terms of antihypertensive efficacy, organoprotective properties, and positive metabolic effects. Clinical aspects of ACE inhibitor+thiazide diuretic combination usage, its possible side effects and ways to minimize them are considered.
3 citations
TL;DR: Russian Experts’ Consensus on Metabolic Syndrome Problem in the Russian Federation: Defenition, Diagnosis Criteria, Primary Prevention and Treatment.
Abstract: Russian Experts’ Consensus on Metabolic Syndrome Problem in the Russian Federation: Defenition, Diagnosis Criteria, Primary Prevention and Treatment.
TL;DR: The high efficacy of amlodipine + lisinopril + hydrochlorothiazide combination, including one on the basis of generics, confirms the high effectiveness of combined antihypertensive therapy based on generics.
Abstract: Data of evidence-based cardiology and clinical guidelines that define the position of combined therapy to achieve the targets of hypertension (HT) treatment (achievement and maintenance of the target blood pressure (BP) level, protection of the target organs, improvement of the quality of life in hypertensive patients) are presented in the article. The advantages of rational combined therapies (potentiation of antihypertensive effect, reduction of a number of adverse events) are considered. Studies of therapeutic efficacy and safety of combined antihypertensive therapy based on generics are important. The advantages of combined therapy in achievement of target BP levels are presented on example of comparative study of new generic and original amlodipine in patients with HT of 1-2 degrees. Target BP level was reached respectively in 90% and 97% of patients with HT in groups of generic and original amlodipine combined with generic lisinopril and hydrochlorothiazide. Safety profile was acceptable. This confirms the high efficacy of amlodipine + lisinopril + hydrochlorothiazide combination, including one on the basis of generics.
TL;DR: Functional disorders of the eyes point at the involvement of retina into the pathological process even in HT early stages and are able to reflect the severity of hypertension, which supports a close relationship of HT with eye disease as a target organ.
Abstract: Published data often contain conflicting views on the relationship of retina changes in arterial hypertension (HT) with cardiovascular disorders and target organs lesions. Along with the classification and pathophysiology of hypertensive retinopathy, evidence for its association with the HT course, target organ lesions and prognosis is presented. Functional disorders of the eyes point at the involvement of retina into the pathological process even in HT early stages and are able to reflect the severity of hypertension. This supports a close relationship of HT with eye disease as a target organ. Available data support also possibility to assess changes on the eye fundus in patients with uncomplicated HT, indicating that it was premature decision to exclude eyes from the list of target organs in HT.
TL;DR: Key positions of Guidelines on the prevention, diagnosis, and treatment of infective endocarditis issued by the Task Force of ESC in 2009 are explained in the comments.
Abstract: Key positions of Guidelines on the prevention, diagnosis, and treatment of infective endocarditis issued by the Task Force of ESC in 2009 are explained in the comments. Recent opinions on these items are presented.
TL;DR: It is shown that the use of cardioverter defibrillators compared with pharmacotherapy is more effective in prevention of fatal outcomes.
Abstract: Highlights of primary prevention of death in patients with ventricular arrhythmias (VA) are discussed. Overview of all main clinical trials exploring various anti-arrhythmic drugs in prevention of death in patients with VA is It is emphasized that in patients with organic heart disease and VA only beta-blockers and amiodarone are able to reduce mortality, while other drugs have no effect on mortality, or they even increase mortality mainly due to arrhythmogenic effect. Recent clinical studies of the cardioverter-defibrillators efficacy in these patients are presented. It is shown that the use of cardioverter defibrillators compared with pharmacotherapy is more effective in prevention of fatal outcomes.
TL;DR: High antihypertensive efficacy, improvement of respiratory function, and safety allows recommending amlodipine maleate (Stamlo-M) for usage in hypertensive patients with COPD.
Abstract: Aim. To study antihypertensive efficacy and safety of amlodipine maleate as well as its influence on respiratory function, C reactive protein plasma level, glucose and lipid metabolism in patients with arterial hypertension (HT) and chronic obstructive pulmonary disease (COPD). Material and methods. 50 patients with HT 1-3 grade and COPD I-II stage in remission were randomized into two groups. 31 patients of the first group were treated with amlodipine maleate (Stamlo-M) 5-10 mg/d alone or in combination. 19 patients of the second group received any other antihypertensive therapy except dihydropyridine calcium antagonists. Results. Amlodipine in combined therapy has high antihypertensive efficacy providing achievement of target blood pressure levels and improvement of 24-hour blood pressure profile. Amlodipine therapy improved respiratory function and reduced systolic blood pressure in pulmonary artery. Amlodipine has no negative influence on metabolic status, did not increase sympathetic activity, and reduced C reactive protein levels. It demonstrated good tolerability and safety. Conclusion. High antihypertensive efficacy, improvement of respiratory function, and safety allows recommending amlodipine maleate (Stamlo-M) for usage in hypertensive patients with COPD.
TL;DR: The gender differences of RAAS activity were revealed with higher aldosterone level in postmenopausal hypertensive women in comparison with men.
Abstract: Aim. To study the correlation of the renin-angiotensin-aldosterone system (RAAS) activity with the female sex hormone levels and markers of target organ damage in patients with arterial hypertension (HT). Material and methods. Patients with HT (20 men and 39 postmenopausal women) were involved into the study. The dynamic renal angioscintigraphy and echocardiography were performed, plasma rennin activity (PRA), levels of aldosterone, estradiole and 17-hydroxiprogesterone were determined by radioimmunoassay. Results. Higher aldosterone level was found in women in comparison with men (212,5±123,9 pg/ml and 148,9±82,5 pg/m, respectively, р=0,03). Negative relations between aldosterone and estradiol levels (r=-0,3; p=0,04), and between aldosterone and 17-hydroxyprogesterone levels (r=-0,318; p=0,04), and positive relations between aldosterone concentration and PRA (r=0,555; p=0,04) was found in women. Besides, correlation between levels of female sex hormones, aldosterone and renal blood flow indicators, glomerular filtration rate, left ventricular mass index (LVMI) were found in women. These correlations were not found in men. Conclusion. The gender differences of RAAS activity were revealed with higher aldosterone level in postmenopausal hypertensive women in comparison with men. Relationships between PRA, levels of aldosterone and female sex hormones and renal blood flow indices, LVMI were also found in women.
TL;DR: Details of the management of patients receiving oral anticoagulants (vitamin K antagonists) for a long time and needed in dental treatment are discussed and modifications of the patient dental health card are offered to prevent complications associated with blood clotting disorders.
Abstract: Details of the management of patients receiving oral anticoagulants (vitamin K antagonists) for a long time and needed in dental treatment are discussed. Assessment of bleeding and thromboembolism risk in the perioperative continuation or termination of warfarin therapy is shown. Potential of the local hemostatic agents is specified. Modifications of the patient dental health card are offered to prevent complications associated with blood clotting disorders.
TL;DR: Up to date data about changes of cardiovascular system related to androgen hormone levels reduction are presented to help in understanding of pathogenesis of many metabolic and clinical changes.
Abstract: The correlation of age-dependent reduction in sex hormones level and changes of cardiovascular system in men was shown recently. High prevalence and various clinical features of age-dependent hypogonadism demands to know diagnostics and management of patients with these disorders. Up to date data about changes of cardiovascular system related to androgen hormone levels reduction are presented. They should help in understanding of pathogenesis of many metabolic and clinical changes. Active attention to the problem of age-dependent hypogonadism, knowledge of organism functions in men with low androgen levels will help to optimize treatment, to avoid of mistakes in patient management, to reduce a risk of severe diseases and finally to improve quality of life and life expectancy of these patients.
TL;DR: The Revised CONSORT Statement for Reporting Randomized Trials: Explanation and Elaboration (2001) (Part II).
Abstract: The Revised CONSORT Statement for Reporting Randomized Trials: Explanation and Elaboration (2001) (Part II).
TL;DR: Details of pre-hospital medical care organization in patients with acute coronary syndrome (ACS) with ST segment elevation and the importance of reperfusion as a key approach to ACS patients treatment is emphasized.
Abstract: Details of pre-hospital medical care organization in patients with acute coronary syndrome (ACS) with ST segment elevation are discussed. The algorithm of pre-hospital diagnostics and emergency cardiac care to these patients is presented. The necessary methods of examination, drugs and their dosages are specified. The importance of reperfusion as a key approach to ACS patients treatment is emphasized. Advantages and disadvantages of reperfusion therapeutic methods and algorithm of their choice are presented.
TL;DR: The evidence basis and advantages of the lisinopril usage in a clinical practice as antihypertensive drug are presented and pharmacyacoeconomic aspects of lisinopsin usage in arterial hypertension are considered.
Abstract: The evidence basis and advantages of the lisinopril usage in a clinical practice as antihypertensive drug are presented. Special attention is paid to organoprotective lisinopril effects and lisinopril implementation at special clinical conditions (chronic obstructive pulmonary disease comorbidity, elderly patients, and concomitant liver diseases). Pharmacoeconomic aspects of lisinopril usage in arterial hypertension are also considered.
TL;DR: Responsibility to moderate or high intensive physical exercise may depend on baseline metabolic profile and should be taken into account under development of preventive programs for modifying risk factors of cardio-vascular diseases and type 2 diabetes mellitus.
Abstract: Aim. To investigate effects of acute physical exercise of varying intensity on lipid metabolism in middle aged men. Material and methods. Two bouts of physical exercise of moderate and high intensity were performed in 54 clinically healthy men aged 30-45 y.o. without obesity with subsequent assessment of lipid profile (total cholesterol, high density lipoprotein cholesterol, triglyceride levels, and atherogenic index). Effect of physical exercise on the lipid profile as studied both in the whole group and in subjects with and without insulin resistance. Results. Acute physical exercise of moderate and high intensity produced beneficial effects on lipid parameters (increase in cholesterol of high density lipoprotein level and reduction of atherogenic index). Increased intensity of physical exercise caused more prominent improvement of lipid profile in subjects without insulin resistance. However subjects with insulin resistance had weaker response to physical exercise than individuals without insulin resistance did and increased intensity of physical exercise did not cause significant improvement of lipid parameters in subjects with insulin resistance. Conclusion. Response to moderate or high intensive physical exercise may depend on baseline metabolic profile. It should be taken into account under development of preventive programs for modifying risk factors of cardio-vascular diseases and type 2 diabetes mellitus.
TL;DR: TrI correlates with CHF severity and probably has prognostic value in these patients, and was significantly higher in patients with registered end points than in those with stable CHF course.
Abstract: Background. Chronic heart failure (CHF) progression is accompanied by remodeling of muscular, collagen and vascular elements of myocardium. This can lead to increase in serum concentrations of myocardial lesion markers (cardiac troponin I (TrI) and myoglobin) which seem to correlate with poor prognosis in patients with CHF. Aim. To estimate correlations between cardiac TrI, myoglobin, creatine phosphokinase MB-fraction (MB-CPK) serum concentrations and disease severity and prognosis in CHF patients. Material and methods. Fifty eight patients with CHF of different etiology were included into the study. Physical examination, clinical and biochemical blood assays, chest X-ray study, echocardiography and ECG daily monitoring (initially and at the end of the study) were carried out. TrI and myoglobin levels were estimated by immunoenzymometric assay. The follow-up period was 6 months. The following end points were used: CHF worsening caused hospital admission, acute myocardial infarction, and lethal outcome. Results. Mean TrI and myoglobin concentrations equaled 0.04 [0.02; 0.06] ng/ml and 62.95 [35.86; 77.28] μg/l, respectively. Demographic characteristics of patients (gender, age) did not influence these markers levels. TrI concentration correlated with CHF severity: it was significantly higher in patients with CHF of functional class (FC) III-IV than in those with CHF of FC I-II (p<0.001). Negative correlation was revealed between TrI level and ejection fraction (p<0.001). TrI concentration was significantly higher in patients with life-threatening ventricular arrhythmia than in patients without it (p=0.001). Besides, TrI level was significantly higher in patients with registered end points than in those with stable CHF course (p=0.001). Conclusion. TrI correlates with CHF severity and probably has prognostic value in these patients.
TL;DR: Data about efficacy and safety of long-term therapy with acetylsalicylic acid in patients with cardiovascular diseases are presented and the main practical ways to reduce the possible gastrointestinal complications of the treatment are discussed.
Abstract: Data about efficacy and safety of long-term therapy with acetylsalicylic acid in patients with cardiovascular diseases are presented. The main practical ways to reduce the possible gastrointestinal complications of the treatment are discussed.
TL;DR: Lisinopril provides organ protection in various stages of the cardiovascular continuum and improves the life prognosis in patients with ischemic heart disease and chronic heart failure.
Abstract: The most socially significant cardiovascular diseases are recently considered from the standpoint of "cardiovascular continuum". Changes in neurohumoral factors especially activation of the renin-angiotensin-aldosterone system (RAAS) play a key role in the pathogenesis of the cardiovascular continuum. The first drugs that block RAAS were ACE inhibitors. Lisinopril deserves special attention among the ACE inhibitors. Lisinopril — one of the most known and well-studied drugs in this group with proven organoprotective properties. This allows its use in various clinical situations. Lisinopril is used for hypertension treatment long ago and there are a lot of evidences of its high antihypertensive efficacy currently. Lisinopril provides organ protection in various stages of the cardiovascular continuum and improves the life prognosis in patients with ischemic heart disease and chronic heart failure.
TL;DR: Reasonability of ACE inhibitor and thiazide diuretic combination is supported due to more effective blood pressure control, organoprotection improvement and side events risk reduction.
Abstract: Peculiarities of the mode of action and clinical use of fixed low-dose combination of lisinopril and hydrochlorothiazide are discussed. Reasonability of ACE inhibitor and thiazide diuretic combination is supported due to more effective blood pressure control, organoprotection improvement and side events risk reduction. Results of the clinical studies on efficacy and safety of this combination in hypertensive patients with different concomitant diseases are presented.
TL;DR: Three stages of LRHT evolution have similar pathogenesis and different expression of morphofunctional changes in the juxtaglomerular complex and in the adrenal cortex as well as different respond to enalapril test (20 mg/daily).
Abstract: Aim. To find out similarities and differences between various evolutionary stages of low rennin hypertension (LRHT), and to develop its diagnostic criteria. Material and methods. Patients (n=190) with LRHT and the high cardiovascular risk were included into the study. All patients received ACE inhibitor, enalapril 10 mg twice a day, during 4 weeks. Before and after enalapril treatment plasma renin activity (PRA) and plasma aldosterone level (PAL) were determined by radioimmunoassay method in active patients. 24-hour urinary excretion of epinephrine (UEE) and norepinephrine (UENE) was also determined by laser flowmetry. Results. Three forms of LRHT were defined among all patients: 1) patients (n=144) with essential LRHT had stimulated renin, eu- or hyperaldosteronism without adrenal hyperplasia; 2) patients (n=14) with transient LRHT had nonstimulated renin, eualdosteronism, presence or absence of adrenal hyperplasia; 3) patients (n=32) with the primary idiopathic hyperaldosteronism had nonstimulated renin, hyperaldosteronism and adrenal hyperplasia. Conclusion. Three stages of LRHT evolution are found out. They have similar pathogenesis and different expression of morphofunctional changes in the juxtaglomerular complex and in the adrenal cortex as well as different respond to enalapril test (20 mg/daily).
TL;DR: In patients with uncomplicated STEMI carvedilol more prominently reduced in vitro platelet aggregation induced by adenozin-5'-diphosphate in high concentration, ristomycin and collagen than metoprolol tartrate.
Abstract: Aim. To study influence of beta-blockers carvedilol and metoprolol tartrate on platelet aggregative ability, evaluated by three different methods, in patients with acute ST segment elevation myocardial infarction (STEMI). Material and methods. A total of 86 men aged 36-68 with uncomplicated STEMI were included into an open, comparative, randomized study. Patients were randomized into two groups of beta-blocker treatments. Patients (n=44) of the first group received carvedilol; patients (n=42) of the second one - metoprolol tartrate. Parameters of platelet hemostasis: the maximum amplitude and rate of platelet induced by ADP, ristomycin and collagen; mean platelet volume (MPV); serum level of soluble CD40 ligand (sCD40L) were evaluated on the 2nd and 24th day after STEMI onset. Results. In patients with uncomplicated STEMI carvedilol more prominently reduced in vitro platelet induced by adenozin-5'-diphosphate in high concentration, ristomycin and collagen than metoprolol tartrate. Сarvedilol also more significantly decreased MPV in comparison with metoprolol tartrate. However, effect of both carvedilol and metoprolol tartrate on the level of another platelet marker - sCD40L was comparable. Conclusion. Carvedilol and metoprolol tartrate have similar effect on platelet though in according to some tests carvedilol more prominently reduces platelet aggregation than metoprolol tartrate.