[Clinical efficacy of calcium channel blockers slow the third generation of lercanidipine in the treatment of patients with arterial hypertension and metabolic disorders (review)].

Arterial hypertension is the most common risk factor in patients with metabolic disorders. In the selection of antihypertensive therapy it is necessary to consider not only the anti-hypertensive and organoprotective effects of drugs and their metabolic effects, which has prognostic value. Calcium antaginists, along. Lercanidipine related to the third generation dihydripyridine calcium antagonist, has been much more selective for the so-called slow calcium channels of vascular smooth muscle cells, which is associated with a good hypertensive, organo and metabolic action. Combination therapy with an ACE inhibitor and a calcium channel blocker is also a justified tactic for the management of patients with high-risk cardiovascular and metabolic disorders. Attention is paid new fixed combinations, including angiotensin converting enzyme inhibitors and calcium antagonists.

[Assessment of efficiency of patients' therapeutic education in chronic heart failure treatment].

Patients' therapeutic education is one of the modern approaches to improvement of quality of chronic heart failure (CHF) treatment. Purpose of the study was evaluation of the effect of therapeutic education on life quality and need of rehospitalization in patients with CHF. 57 patients with CHF of NYHA III-IV functional class (FC) randomized in two - intervention and control groups - were observed. Patients from intervention group took therapeutic education on the following topics: general information about CHF, CHF symptoms, dietary nutrition during CHF and CHF medicative therapy. Patients' functional state was evaluated by means of NYHA FC and 6-minute test. Life quality was evaluated with specific method - Minnesota Living with Heart Failure Questionnaire (MLHFQ). FC improvement by one class occurred in 72.4% of cases in the education group, by two classes - in 6.9%. Improvement of CHF FC occurred in 57.1% of cases and upgrade of FC in 10.7% in the control group. According to 6-minute test data, veracious increase of tolerance to physical loads was noted in the education group and tendency to worsening of tolerance - in the control group. Life quality studies by MLHFQ method revealed statistically significant improvements in the education group and tendency to worsening - in the control group. During three months period rehospitalization was not observed in the education group, while 3 hospitalizations have been registered in the control group during the same period due to CHF exacerbation. Lethal outcome was not registered in either group. Accordingly, results of our investigation confirmed that non-observance of physician's recommendations by patients with CHF leads to increase of repeated recommendations and worsening of life quality. One of the reasons of bad compliance in patients with CHF is absence of organization of individual work with patients. This may be overcome by means of therapeutic education in patients with CHF.

[Angiotensin-converting enzyme inhibitor treatment of heart failure due to dilated cardiomyopathy].

To assess effects of enalapril and Accupro on clinical status left ventricular remodeling and systolic function in patients with heart failure due to dilated cardiomyopathy. STUDY STRUCTURE: Randomized, open, controlled, duration -- 6 months. PATIENTS: 31 patients with dilated cardiomyopathy (mean age 46+/-2 years). TREATMENT GROUPS: Standard therapy (glycosides, diuretics, peripheral vasodialtors) -- 9 patients. Standard therapy plus enalapril (10-20 mg/day) - 11 patients; standard therapy plus accupro (slow titration from 5 to a maximum 20 mg/day)-- 11 patients. CRITERIA OF EVALUATION: NyHa functional class, 6 -- minute wall test, echocardiographical parameters of left ventracular systolic function, while some parameters of remodeling deteriorated. Standard therapy did not change clinical status or left ventrical systolic function, while some parameters of remodeling deteriorated. Enalapril improved clinical status, left ventricular systolic function and affected favorably left ventricular remodeling. Accupro compared with enalapril produces greater influence on left ventricular remodeling. Our study suggests that intrinsic differences exist between quinaprilat and enalaprilat that determine the ability to improve endotelium vasodilation, their different affinity to tissue ACE.