[Refractory hypertension: diagnosis and treatment optimization].

Resistant hypertension occurs in up to 15% of patients with arterial hypertension in Russia. Medical treatment of resistant hypertension must include minimum 3 medications with maximum or maximum tolerated doses besides one of the medications must be diuretic. According to department of arterial hypertension of the Burdenko Main Military Clinical Hospital to achieve the target levels of arterial blood pressure it was necessary to prescribe 4-5 components antihypertension therapy in patients. Authors suggested an algorithm of diagnosis and treatment of patients with resistant hypertension with the help of surgical method. This method is based on decreasing of sympathic nervous system activity by selective break of neuronal connections with the help of interventional intravascular radio-wave ablation. Endovascular renal sympathetic denervation allows to effectively control arterial blood pressure, to optimize antihypertensive therapy, but this method does not cure from arterial hypertension.

[Possibilities of early surgical correction of postinfarction remodeling of the heart].

Postinfarction remodeling of the heart (PIRH) has unfavorable prognostic value because is associated with elevated risk of fatal arrhythmias, emergence and progression of heart failure. Reversibility of PIRH in early period after myocardial infarction causes interest. We followed dynamics of echocardiographical parameters in a patient who had undergone myocardial infarction with subsequent aorto-coronary bypass operation. Values of left ventricular end diastolic and end-systolic volumes were as follows: baseline - 147 and 70, in the process of infarction - 281 and 141, in 1 month after infarction - 298 and 194, in 10 days after surgery - 194 and 88, in 1 year after surgery - 194 and 83 ml, respectively. Thus PIRH is substantially reversible in the early period after myocardial infarction followed by adequate cardiac muscle revascularization. In can be supposed that at the moment of infarction an abrupt progression of stenotic atherosclerosis of the coronary arteries occurs due to complete or subtotal occlusion of vessels, what aggravates myocardial ischemia and predominantly determines course of subsequent PIRH.

[Postinfarction angina in elderly patients: results of surgical and drug treatment]. / Postinfarktnaia stenokardiia u bol'nykh pozhilogo vozrasta: rezul'taty khirurgicheskogo i medikamentoznogo lecheniia.

Clinical and angiographical characteristics and results of surgical treatment and drug therapy were assessed in 49 men with postinfarction angina (mean age 64.1-/+3.5 years) and 112 patients with progressing and stable angina (mean age 63.8-/+3.0 years). Of 49 patients with postinfarction angina 30 were subjected to coronary artery bypass grafting (CABG) while 19 were treated with drugs only. Remote results were known in 17 and 19 patients of surgical and conservative groups, respectively. Average duration of follow-up was 66-/+20 months. Compared with patients with progressing and stable angina those with postinfarction angina had similar amplitude of ST-segment deviation during stress tests, ejection fraction, average number of involved coronary vessels, and profile of concomitant diseases, but higher prevalence of left main stenoses (23.6 and 40.8%, respectively, p=0.05). Among patients with postinfarction angina available for follow-up long-term survival of those treated with CABG was higher compared with patients treated conservatively (p=0.02). Nonfatal myocardial infarction developed in 17.7 and 31.6%, symptomatic improvement was registered in 76.5 and 5.3% of patients in surgical and conservative groups, respectively. In patients with postinfarction angina aged >or=60 years CABG surgery compared with drug therapy was associated with better survival and improved symptomatic status.

[Prospects for prognosis in cardiac surgery: experience from using discriminant linear analysis]. / O vozmozhnostiakh prognozirovaniia v kardiokhirurgii: opyt primeneniia diskriminantnogo lineinogo analiza.

The authors evaluate the possibility of using the discriminant linear analysis in predicting the unfavourable outcomes at aortocoronary bypass. There were investigated 98 patients (the mean age 64.4 +/- 3.0 years) who underwent the surgical revascularization of myocardium in 1992-1997. 56 signs characterizing the demographic, clinical-and-instrumental and operational indices were analyzed. The obtained discriminant equation of operation outcome prediction included 15 signs. The operation for unstable angina, the cholesterol level and the patient's age were the most informative parameters. The total per cent of correct classification was 87.8%. According to the authors' experience the discriminant linear analysis is the informative method of multi-dimensional statistical analysis permitting to reveal the most significant signs that influence on the prognosis of surgical intervention.