RESUMEN
AIM: To evaluate the efficacy and safety of a fixed-dose combination of the angiotensin-converting enzyme inhibitor lisinopril 10 mg and the calcium antagonist amlodipine 5 mg (ekvator) in conjunction with rosuvastatin (mertenil). SUBJECTS AND METHODS: The investigation enrolled 50 patients (mean age 57.9 years) with essential hypertension. All the patients received the fixed-dose antihypertensive combination. Stable Functional Class I or II exertional angina was in 46% of the patients. The remaining 54% were found to have brachiocephalic atherosclerosis. All the patients had dyslipidemia and were given rosuvastatin. RESULTS: The mean systolic blood pressure (SBP) initially reached 164.26 mm Hg. During the whole follow-up, the reduction in mean SBP generally accounted for 22.6% (p = 0.000). At the study inclusion, the mean diastolic blood pressure (DBP) reached 99.38 mm Hg. The total decline in mean DBP was 19.3% (p = 0.000). The mean level of total cholesterol (TC) decreased significantly by 32.1% (p = 0.000); that of triglycerides (TG) also fell significantly by 31.8% (p = 0.04); that of high-density lipoproteins increased insignificantly by 11.1% (p = 0.599); that of low-density lipoproteins (LDL) dropped significantly by 47.5% (p = 0.000). CONCLUSION: Being safe, the fixed-dose lisinopril and amlodipine combination is effective in lowering blood pressure in patients with hypertensive disease (HD) concurrent with coronary heart disease (CHD) or atherosclerotic changes in the carotid artery. The use of rosuvastatin in patients with HD concurrent with CHD during 2 months causes positive changes in the blood lipid composition as a significant reduction in the-levels of (TC), LDL, and TG.
Asunto(s)
Amlodipino , Enfermedad Coronaria , Dislipidemias , Fluorobencenos , Hipertensión , Lisinopril , Pirimidinas , Sulfonamidas , Amlodipino/administración & dosificación , Amlodipino/farmacocinética , Antihipertensivos/administración & dosificación , Antihipertensivos/farmacocinética , Presión Sanguínea/efectos de los fármacos , Enfermedad Coronaria/sangre , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/tratamiento farmacológico , Relación Dosis-Respuesta a Droga , Combinación de Medicamentos , Monitoreo de Drogas , Quimioterapia Combinada , Dislipidemias/sangre , Dislipidemias/complicaciones , Dislipidemias/tratamiento farmacológico , Hipertensión Esencial , Femenino , Fluorobencenos/administración & dosificación , Fluorobencenos/farmacocinética , Humanos , Hipertensión/sangre , Hipertensión/complicaciones , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipolipemiantes/administración & dosificación , Hipolipemiantes/farmacocinética , Metabolismo de los Lípidos/efectos de los fármacos , Lisinopril/administración & dosificación , Lisinopril/farmacocinética , Masculino , Persona de Mediana Edad , Pirimidinas/administración & dosificación , Pirimidinas/farmacocinética , Rosuvastatina Cálcica , Sulfonamidas/administración & dosificación , Sulfonamidas/farmacocinética , Resultado del TratamientoRESUMEN
The history of the Kazan School of Therapists numbers two centuries of scientific achievements and discoveries. German Professors F.H. Erdman and K.F. Fuks laid the groundwork for clinical teaching continued by Russian therapists N.A. Skandovsky, N.A. Vinogradov, A.P. Kazem-Bek, N.K. Goryaev, and other distinguished scientists. The prominent scientists of the 20th century made great contributions to the development of modern therapy; the names of M.N. Cheboksarov, Z.I. Malkin, A.G. Teregulov, and I.G. Salikhov are known and they are respected by the world medical public.
Asunto(s)
Educación Médica/historia , Facultades de Medicina/historia , Universidades/historia , Aniversarios y Eventos Especiales , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Federación de RusiaRESUMEN
One of the foundations of the modern treatment of myocardial infarction (MI) is a combination antiplatelet therapy consisting of acetylsalicylic acid (ASA) and clopidogrel. Pharmacodynamic and clinical studies have demonstrated that the polymorphism CYP2C19 (CYP2C19*2 allele) is associated with a reduced antiplatelet effect of clopidogrel and an increase in the incidence of severe cardiovascular complications. The study included 97 patients with MI. Coronary angiography was performed with subsequent standard treatment of MI, including stenting of the infarct-related coronary artery. CYP2C19 polymorphism was determined by polymerase chain reaction. At 6months, outcomes were determined. The frequency of allele CYP2C19*2 was 22.7%. We found statistically insignificant differences in the prevalence of CYP2C19 gene polymorphism in different forms of myocardial infarction. In contrast to the authors, who previously published data on the effect of CYP2C19 gene polymorphism on cardiovascular complications, we found no differences according to genotype. CYP2C19 gene polymorphism does not influence the prognosis for the next six months, if to patient follow medical recommendations, including the regular use of clopidogrel.
Asunto(s)
Hidrocarburo de Aril Hidroxilasas/genética , Biotransformación/genética , Infarto del Miocardio/genética , Ticlopidina/análogos & derivados , Anciano , Angioplastia Coronaria con Balón , Aspirina/administración & dosificación , Aspirina/farmacocinética , Clopidogrel , Angiografía Coronaria , Citocromo P-450 CYP2C19 , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/terapia , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/farmacocinética , Polimorfismo Genético , Stents , Ticlopidina/administración & dosificación , Ticlopidina/farmacocinética , Resultado del TratamientoRESUMEN
The polymorphic markers Ala455Val of the THBD gene and Arg353Gln of the F7 gene were tested for association with the frequency of unfavorable outcomes in patients with a history of acute ischemic heart disease. The study involved 1145 patients hospitalized in cardiology clinics of Moscow, St. Petersburg, Kazan, Chelyabinsk, Perm, Stavropol, and Rostov-on-Don because of acute ischemic heart disease. The patients were followed up for up to 62.5 months. None of the markers displayed a significant association with the time to an endpoint. The patients were then grouped by sex. In females, the frequency of unfavorable outcomes (fatal or nonfatal myocardial infarction and fatal or nonfatal stroke) was higher in carriers of allele Val of the Ala344Val polymorphic marker of the THBD gene and carriers of genotype Arg/Arg of the Arg353Gln polymorphic marker of the F7 gene, but the difference was not statistically significant. Such an increase in frequency was not observed in males. To study the combined effect of the polymorphic markers of the THBD and F7 genes, the course of ischemic heart disease was compared for two female subgroups. One included carriers of allele Val of the Ala344Val polymorphic marker of the THBD gene and genotype Arg/Arg of the Arg353Gln polymorphic marker of the F7 gene; the other subgroup included carriers ofgenotype Ala/Ala of the Ala455Val polymorphic marker of the THBD gene and allele Gln of the Arg353Gln polymorphic marker of the F7 gene. The frequency of unfavorable outcomes in the first subgroup was higher than in the second one. The time to an endpoin was 40.5 months (95% confidence interval (CI) 33.5-47.6) in the first subgroup and 51.6 months (95% CI 45.0-58.1) in the second subgroup (chi2 = 4.15, P = 0.042). The results made it possible to assume that the F7 and THBD genes play an important role in genetic predisposition to unfavorable outcomes in patients with a history of acute ischemic heart disease.
Asunto(s)
Enfermedad de la Arteria Coronaria/complicaciones , Factor VII/genética , Predisposición Genética a la Enfermedad , Infarto del Miocardio/genética , Infarto del Miocardio/mortalidad , Trombomodulina/genética , Enfermedad Aguda , Anciano , Alelos , Progresión de la Enfermedad , Femenino , Estudios de Asociación Genética , Marcadores Genéticos , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Moscú , Infarto del Miocardio/patología , Polimorfismo Genético , PronósticoRESUMEN
With the aim to assess prevalence of aortic stenosis (AS) and prognostic value of its detection among survivors of acute coronary syndrome (ACS) we examined 851 patients included into multicenter prospective study of risk factors of serious vascular events and death after acute coronary syndrome. The patients were enrolled into the study in stable condition on 10th day after onset of myocardial infarction (MI) or unstable angina (UA). Examination involved medical history, laboratory tests and echocardiography. Afterwards all cases of death and serious vascular events were registered. Severity of AS was specified by maximal aortic flow rate: 1st degree > 2.5, 2nd degree 3.0-4.0, 3rd degree > 4.0 m/s. AS was detected in 16 patients (1.9%). AS severity was 1st, 2nd and 3rd degree in 9, 4 and 3 patients, respectively. Patients with AS were significantly older (77.4 vs. 61.3 years, p < 0.001), more often had history of chronic heart failure (CHF) (81.3 vs. 53.2%, p = 0.021) and lowered renal function (66.7 vs. 34.0%, p < 0.041). At multifactorial analysis independent prognostic value in relation to development of serious events showed age > 75 years (OR 1,395 [1.023-1.902], p = 0.036), history of CHF (1.319 [1.015-1.713], p = 0.038), history of MI (1.692 [1.320-2.170], p < 0.001), left ventricular diastolic dimention (1.023 [1.005-1.041], p = 0.012), left atrial diameter (1.024 [1.001-1.047], p = 0.037) and presence of AS (3.211 [1.742-.,916], p < 0.001). Prevalence of preexisting AS among patients who have had MI/UA is 1.9% what is similar to data of European Heart Survey ACS-II (1.8%). Presence of AS of any severity in a survivor of ACS worsens prognosis independently of other known risk factors.
Asunto(s)
Síndrome Coronario Agudo , Estenosis de la Válvula Aórtica , Válvula Aórtica , Enfermedades Cardiovasculares , Síndrome Coronario Agudo/complicaciones , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/fisiopatología , Factores de Edad , Anciano , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/patología , Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/patología , Estenosis de la Válvula Aórtica/fisiopatología , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/etiología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/fisiopatología , Femenino , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/patología , Enfermedades de las Válvulas Cardíacas/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Federación de Rusia/epidemiología , Índice de Severidad de la Enfermedad , Sobrevivientes/estadística & datos numéricos , UltrasonografíaRESUMEN
We investigated the association of gene IL6 G(-174)C polymorphism and gene IL10 G(-1082)A polymorphism with coronary artery disease (CAD) in the Russian population. A total of 1145 patients with CAD diagnose on the basis of clinical studies in cardiological hospitals of Moscow, St -Petersburg, Kazan, Chelyabinsk, Perm, Stavropol and Rostov-on-Don. Supervision term was 9.10 +/- 5.03 months (the maximum term 18 months). In case of gene IL10 G(-1082)A polymorphism we determined that patients with CAD diagnose and A alleles gene IL10 had unfavorable outcome more often than patients with homozygous G alleles. Survival time from end point from carrier genotype GA and AA is 11.68 +/- 0.67 months against 12.69 +/- 0.65 months from carrier phenotype GG gene IL10 (chi2 = 4.13, p = 0.042). The group studied do not differ significantly with respect to the distributions of gene IL6 G(-174)C alleles and genotypes. However in case combined group studies of gene IL10 G(-1082)A polymorphism and IL6 G(-174)C polymorphism we determined that patients with CAD diagnose and carrier genotype GG gene IL6 and genotype GA and AA gene IL10 had unfavorable outcome more often (survival time 11.01 +/- 1.24 months) than patients with genotype CC and CG gene IL6 and genotype GG gene IL10 (survival time 13.28 +/- 0.83 months) chi2 = 10.23, p = 0.017. The obtained data allows assuming the important role of the IL6 and IL10 genes which are responsible for functioning of inflammation system, in the accelerated formation of failures at the patients who had a coronary syndrome.
Asunto(s)
Síndrome Coronario Agudo/genética , Síndrome Coronario Agudo/mortalidad , Alelos , Interleucina-10/genética , Interleucina-6/genética , Polimorfismo de Nucleótido Simple , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/metabolismo , Anciano , Femenino , Genotipo , Humanos , Interleucina-10/metabolismo , Interleucina-6/metabolismo , Masculino , Persona de Mediana Edad , Valor Predictivo de las PruebasRESUMEN
We investigated the association of polymorphisms of genes FGB G(-455)A and PROCC(-1654)T with coronary artery disease (CAD) in the Russian population. A total of 1145 patients with CAD diagnose on the basis of clinical studies in cardiological hospitals of Moscow, St. Petersburg, Kazan, Chelyabinsk, Perm, Stavropol and Rostov-on-Don. Supervision term was 1.14 +/- +/- 0.33 years (the maximum term 3.2 years). The group studied do not differ significantly with respect to the distributions of G(-455)A alleles and genotypes. However in case of gene PROC C(-1654)T polymorphism we determined that patients with CAD diagnose and Talleles of PROC gene had unfavorable outcome more often than patients with homozygous C alleles. Survival time from end point from carrier phenotype TT and CTis 2.19 +/- 0.18 r. years against 2.46 +/- 0.16 from carrier phenotype CCgene PROC. The obtained data allows to assume the important role of the genes which are responsible for functioning of system of a hemostasis, in the accelerated formation of failures at the patients who had a coronary syndrome.
Asunto(s)
Síndrome Coronario Agudo/genética , Síndrome Coronario Agudo/mortalidad , Fibrinógeno/genética , Predisposición Genética a la Enfermedad , Polimorfismo de Nucleótido Simple , Proteína C/genética , Alelos , Supervivencia sin Enfermedad , Femenino , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Federación de Rusia/epidemiología , Tasa de SupervivenciaRESUMEN
We assessed effect of antihypertensive drugs from various classes on humoral parameters of endothelial function - levels of asymmetrical dimethyl-arginine (ADMA) and metabolites of nitrous oxide (MNO) - in 106 patients with I-II degree arterial hypertension before and after 2 weeks of treatment. Two weeks treatment with various antihypertensive drugs did not lead to significant changes of ADMA levels. However antihypertensive drugs from various classes produced different effects on levels of MNO. Combination antihypertensive preparation indapamide and perindopril caused significant elevation of MNO level in patients with I-II degree arterial hypertension what appears to be indirect reflection of augmentation of nitrous oxide formation and improvement of endothelial function.
Asunto(s)
Antihipertensivos/uso terapéutico , Arginina/análogos & derivados , Endotelio Vascular/metabolismo , Hipertensión/sangre , Óxido Nitroso/sangre , Vasodilatación/fisiología , Anciano , Antihipertensivos/administración & dosificación , Arginina/sangre , Presión Sanguínea/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Endotelio Vascular/efectos de los fármacos , Endotelio Vascular/fisiopatología , Estudios de Seguimiento , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/fisiopatología , Indapamida/administración & dosificación , Indapamida/uso terapéutico , Persona de Mediana Edad , Perindopril/administración & dosificación , Perindopril/uso terapéutico , Resultado del Tratamiento , Vasodilatación/efectos de los fármacosAsunto(s)
Presión Sanguínea/efectos de los fármacos , Hipertensión , Indapamida , Perindopril , Adulto , Anciano , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , Combinación de Medicamentos , Monitoreo de Drogas , Resistencia a Medicamentos , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Indapamida/administración & dosificación , Indapamida/efectos adversos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Perindopril/administración & dosificación , Perindopril/efectos adversos , Desarrollo de Programa , Estudios Prospectivos , Factores de Riesgo , Federación de Rusia , Resultado del TratamientoAsunto(s)
Antihipertensivos , Hipertensión , Administración del Tratamiento Farmacológico/tendencias , Antihipertensivos/administración & dosificación , Antihipertensivos/efectos adversos , Antihipertensivos/farmacocinética , Monitoreo Ambulatorio de la Presión Arterial , Relación Dosis-Respuesta a Droga , Combinación de Medicamentos , Sinergismo Farmacológico , Humanos , Hipertensión/diagnóstico , Hipertensión/tratamiento farmacológico , Federación de Rusia , Prevención Secundaria/tendencias , Sociedades Médicas , Resultado del TratamientoAsunto(s)
Medicamentos Genéricos/farmacología , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/prevención & control , Ticlopidina/análogos & derivados , Aspirina/farmacología , Clopidogrel , Quimioterapia Combinada , Medicamentos Genéricos/economía , Electrocardiografía , Costos de la Atención en Salud , Humanos , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/fisiopatología , Inhibidores de Agregación Plaquetaria/farmacología , Prevención Secundaria/economía , Ticlopidina/economía , Ticlopidina/farmacología , Resultado del TratamientoAsunto(s)
Antagonistas Adrenérgicos beta/administración & dosificación , Diabetes Mellitus Tipo 2/complicaciones , Hipertensión/tratamiento farmacológico , Metoprolol/administración & dosificación , Isquemia Miocárdica/tratamiento farmacológico , Adolescente , Antagonistas Adrenérgicos beta/efectos adversos , Adulto , Anciano , Femenino , Humanos , Hipertensión/etiología , Masculino , Metoprolol/efectos adversos , Persona de Mediana Edad , Isquemia Miocárdica/etiología , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM: It is the fragment of the trial aimed at the study of demographic indices and components of cardiovascular risk in patients over 55 with known and newly diagnosed arterial hypertension (AH) by referral to outpatient clinic depending on AH type. MATERIAL AND METHODS: For a week, 140 therapists from 14 regions of the Russian Federation measured AP in all persons aged 55 and older visiting outpatient clinics. A total of 5582 persons were examined. 3847 of them were already diagnosed to have hypertension. Primary diagnosis of hypertension was made in 5.7 examinees out of 2442. RESULTS: Patients with previous diagnosis of hypertension vs those with primary diagnosis had significantly greater index of body mass, had more often overweight, obesity and diabetes mellitus. Isolated systolic AH was encountered in 56% of all the primary cases. High and very high risk to develop cardiovascular complications was encountered in 59.9% of primary patients and 85.8% of those previously diagnosed. CONCLUSION: Patients aged 55 and older with newly diagnosed isolated systolic AH had the following most common factors of risk of cardiovascular complications: overweight, obesity, smoking, dyslipidemia, diabetes mellitus. In treated patients these risk factors are: overweight, obesity, dyslipidemia, diabetes mellitus, smoking.