[Clinical aspects of vaso-and cardioprotection in patients with primary and recurrent myocardial infarction].

The paper is devoted to characteristics of vascular and cardiac remodeling in patients with primary and recurrent myocardial infarction (MI). Data on multifocal atheroslerotic involvement of vessels in these patients associated with development of multivascular involvement of coronary arteries are presented. Emphasis is made on remodeling of vessels and the heart, parameters of vasodilation. We have elucidated frequency of vascular vasoconstrictory reactions in acute stage of MI and relationship between vascular and myocardial remodeling. Special consideration is given to possibility of correction of vascular vasoconstrictory reaction with indapamide. We have corroborated its administration starting from first days of treatment and demonstrated its effect during use for 3 months. We have established possibility of normalization of endothelium dependent vasodilation in most patients with primary MI. Expedience of the use of indapamide for prevention of development of chronic heart failure is stressed.

[Antihypertensive treatment compliance and obstacles to its improvement. Results of Russian program ARGUS-2].

AIM: To study barriers made by the patients for adequate treatment of arterial hypertension. MATERIAL AND METHODS: The ARGUS-2 trial was made in 15 centers of 13 cities of Russia. Anonymous questionnaire survey covered 1298 patients (796 outpatients and 502 inpatients). The patients answered the following questions: 1) what are basic problems of life with hypertension; 2) compliance with intake of antihypertensive drugs; 3) causes of missed intakes of the drugs; 4) opposition to intake of drugs by the patients. Questioning procedure was preset by the trial protocol. RESULTS: Only 37.4% (38.9% outpatients, 34.6% inpatients) were the treatment adopters. Drug intake was missed most frequently because offorgetting. The problems of life with hypertension were differently interpreted by patients and physicians: for the latter main problems were financial and routine while AH complications were on the 6-7 place. The latter were of primary importance for the patients while financial problems took place 4-6 Barriers to regular intake for the patients were poor self-control and unawareness about side effects of the drugs. CONCLUSION: Complience of the patient can be improved only by complex approach: improvement of education, higher motivation, active involvement of patients into the treatment process, better contacts between the physician and the patient.

[The character of dyslipidemia and myocardial and carotid arterial remodeling in young patients with essential hypertension].

The purpose of the investigation was to study the character of myocardial and vascular revascularization by the example of the carotid artery (CA) in young patients with arterial hypertension in correlation with biochemical and clinical data. Sixty-eight patients were examined. EchoCG and sonography were performed using SONOS 4500 device. Left ventricular myocardial mass (LVMM) was calculated using R. Devereus formula. Intimomedial thickness (IMT) was measured in the ostium of the common CA (CCA) bifurcation. Lipidogram was performed by "dry chemistry" method using Reflotron bioanalyzer. An elevated LVMM index was revealed in 65% of the subjects. Concentric left ventricular (LV) hypertrophy prevailed over other types of myocardial remodeling (53%). LV diastolic dysfunction was found in 23% of the patients; LV systolic dysfunction was revealed in 56% of the subjects. IMT was increased in 27% of cases, C- and S-shape curvatures were revealed in 56.6% of the patients. In 31.3% of the subjects, atherosclerotic plaques with a 20% to 50% stenosis were found. Various forms of dyslipidemia were revealed in 75.6% of the patients. In conclusion, dyslipidemia and lesion of target organs in a form of myocardial and vascular remodeling require active antihypertensive and hypolipidemic therapy to prevent complications.

[Problems of a physician-patient interaction and control of arterial hypertension in Russia. Main results of scientific-practical program ARGUS-2].

OBJECTIVE: To study the problems of physician-patient cooperation, patient- and physician related barrieres to target blood pressure (BP) achievement and to demonstrate improvement of BP control with indapamide SR 1.5 mg, when given to patients remaining uncontrolled while receiving antihypertensive therapy without thiazide diuretics (TD). METHODS: The trial Improvement of Arterial Hypertension Control in High-Risk Hypertensive Patients (ARGUS-2) run in 15 Russian centres during the year 2006. Retrospective analysis of medical notes of 684 outpatients and 575 inpatients with arterial hypertension. Validated questionnaires were used for interview of 373 physicians and 1298 patients. The study of Arifon retard efficacy was carried out in 1438 outpatients with difficult-to-control hypertension. RESULTS: BP was above the goal level in 97.1% pts at the first analyzed visit to an outpatient department. Antihypertensive therapy was unchanged in 20.5% cases, the drug dose was increased in 46,6%, additional medication was administered in 36,8%. In 30.8% pts antihypertensive agent was substituted by another class drug. At the last analyzed visit target BP was found in 24.4% pts. BP control was poorer in pts with BP goal <130/80 mmHg (20.1%) than in those with higher target BP (25.9%). Achievement of BP goal was associated with combination therapy, higher rate of TD administration and with more frequent visits to physician. During hospitalization target BP <140/<90 mmHg was achieved in 87.1%,<130/<80 mmHg in. 76.2%. Arifon retard administration resulted in target BO achievement in 84.5% patients. Physicians percept low adherence to antihypertensive treatment, lack of patients knowledge about risk related to arterial hypertension, economical problems as main barriers to improvement of arterial hypertension management. Patients considered economical problems related to antihypertensive treatment more much less important than physicians did. CONCLUSION: The study results suggest the importance of therapeutic inertia overcome to improve arterial hypertension management in Russia. Low rate of multiple combination therapy and TD prescription are important features of therapeutic inertia. Polar perception of problems related to arterial hypertension by physicians and patients should be considered as influencing factors for educational programs development.

[Epidemiologic and social aspects of arterial hypertension in subjects of young age (according to the data of examination of organized groups of employees in Smolensk]. / Epidemiologicheskie i sotsial'nye aspekty arterial'noi gipertonii u lits molodogo vozrasta (po rezul'tatam obsledovaniia organizovannogo trudovogo kollektiva Smolenska).

AIM: To study prevalence of arterial hypertension (AH) in young Smolensk population sample, AH risk factors, awareness of the patients about their disease, treatment compliance. MATERIAL AND METHODS: The in-office study covered 1068 employees. In diagnosis of AH, the patient answered the questions about AH risk factors, attitude to treatment. RESULTS: All was highly prevalent in the examined population (27.9%). Patients under 45 years of age accounted for 38.9% of all the examinees with AH. The risk factors included overweight and obesity (65.5%), smoking (53.5%), family AH history (52.6%). In spite of high awareness about AH (72.4%) and opinion about AH as an important social problem, young patients demonstrate low treatment compliance (12%). This is explained by psychological features of such patients. CONCLUSION: It is necessary to examine quality of life of AH patients aged under 45 years, setting up of special schools to maintain educational activity, psychological and rehabilitation care.

[Cardiovascular and metabolic effects in nebulizer therapy of bronchial asthma]. / Kardiovaskuliatornye i metabolicheskie éffekty pri nebulaizernoi terapii bol'nykh bronkhial'noi astmoi.

The aim of the study was examination of cardiovascular effects of nebulizer salbutamol (ventolin) therapy of bronchial asthma (BA). The efficiency of the drug was assessed in 38 BA patients by changes in clinical symptoms and rise of peak volume expiration rate. Before and after ventolin treatment (2.5-5 mg), measurements were made of central hemodynamics, microhemodynamics, cardiac arrhythmia, plasma electrolytes. The results of the tests indicate that nebulizer treatment with ventolin effectively and safely eliminates bronchoobstructive syndrome in BA patients. Systolic and diastolic arterial pressure, left ventricular end diastolic pressure, ventricular extrasystole declined, supraventricular extrasystole rose. Microcirculatory effects were both positive and negative. Plasma concentration of potassium ions reduced insignificantly.

[Prognostic value of chemiluminescent plasma response in patients with ulcers]. / Prognosticheskaia znachimost' khemiluminestsentnykh tipov reagirovaniia plasmy bol'nykh iazvennoi bolezn'iu.

Kinetics of peroxide chemiluminescence (PCL) of blood plasm was studied in 145 patients aged 17-55 years (108 cases of duodenal and 37 cases of gastric ulcer) and 92 healthy controls. Three types of plasm chemiluminescent curves were identified in healthy subjects and ulcer patients: stable, ascending and descending. PCL kinetics type in ulcer patients depends on the disease course.

[Dependence of clinical course and outcome of chronic duodenitis on some features of its pathogenesis]. / Zavisimost' klinicheskogo techeniia i iskhodov khronicheskogo duodenitaot nekotorykh osobennostei ego patogeneza.

The effects of acid, infectious (Helicobacter pylori) and neuroendocrine factors on the course and outcome of chronic duodenitis were studied in 57 patients aged 15-35 years. Within 5-year follow-up ulcer emerged in 26% of duodenitis patients. Ulceration occurred as a result of high acid production in the basal and stimulated phases, contamination of pyloric-antral mucosa with Helicobacter pylori, unbalance of serum hormones T4, TTH, FSH, ACTH. In risk of ulcerogenesis there were psychological shifts with appearance of pathological reaction to the disease. Consideration of pathogenetic specificity of different duodenitis forms and basing on objective and subjective criteria allow identification of ulcer risk group and early start of optimal therapy.

[The factors determining the course and outcome of chronic duodenitis in adolescents and young people]. / Faktory, opredeliaiushchie techenie i iskhod khronicheskogo duodenita u lits podrostkovogo i iunosheskogo vozrasta.

Causes involved in progression of duodenal lesions have been analyzed in 55 adolescents with chronic duodenitis. Five-year follow-up revealed factors with potential influence on the outcome: sex, acid-peptic factor, mucosal contamination with Helicobacter pylori, an initial morphological form of duodenitis. The latter developed into peptic ulcer in 15% of the male patients. Progression of duodenitis was associated with emergence of chronic gastritis. Motor biliary function deteriorated in 39% of the female patients with duodenitis. The prediction of chronic duodenitis outcome in adolescents facilitates the choice of adequate preventive measures.