Factors affecting adherence to physical training in the outpatient phase of rehabilitation, in patients after coronary artery bypass grafting.

Aim      To evaluate the outpatient physical exercise (PE) compliance and the affecting factors in patients after coronary bypass (CB).Material and methods  The study included 67 men with ischemic heart disease younger than 75 years who had had CB. All patients were randomized to 2 groups: group 1 exercised on a bicycle ergometer at the rehabilitation center, under the monitoring of medical staff; patients of group 2 performed home-based exercise (HBE) by dosed walking. In the preoperative period, at one month after CB, and after 3 months of exercise, the following was evaluated: clinical condition of patients in different groups, plasma concentrations of lipids, body weight index, waist circumference, echocardiography and bicycle ergometry data, and questionnaire data (SF-36, Bek's Depression Inventory). At 3 months of follow-up, the outpatient exercise compliance and the affecting factors were also evaluated.Results The study demonstrated the effectiveness of the proposed alternative 3-month program of home-based PE. Both the patients exercising on a bicycle and those performing HBE had increased exercise tolerance (ET) and improved blood lipid concentrations. The number of obese patients decreased. Also, depression severity decreased, quality of life (physical and psychological components) improved, and compliance with drug therapy increased in both groups. Analysis of the training attendance in the recommended period showed that patients who had undergone CB were insufficiently adherent to physical rehabilitation programs, regardless of the program type (home-based or monitored). The highest PE adherence was observed in men with the following characteristics: married, working urban residents, with a previous history of cardiovascular diseases, who had regularly taken medications in the preoperative period, and who also had higher quality of life.Conclusion      The proposed outpatient 3-month physical rehabilitation programs increase the effectiveness of CB, which is evident as improved adherence to modifying cardiovascular risk factors, increased ET, optimization of the psychological status and quality of life, and improved compliance with drug therapy. However, despite the proposed alternative, home-based 3-month physical rehabilitation programs aimed at increasing the treatment compliance, the level of ET remained low. This requires further improvement of methods for monitoring and motivation of patients to physical rehabilitation and psychological support that would start already at the preoperative stage.

[Effect of perindopril on the processes of subclinical inflammation in patients with arterial hypertension and type 2 diabetes mellitus].

We conducted comparative analysis of treatment 52 patients (7 men and 45 women aged 42-64 years, mean age 51.1 years) with I-II degree arterial hypertension (AH) and type 2 diabetes mellitus with the use of angiotensin converting enzyme inhibitor perindopril and with of other drugs. During 6 months effective control of AH was achieved on both treatments. We assessed changes in target organs at the background of 1 year therapy based on the use of perindopril or other antihypertensive preparations. Favorable changes of 24 hour indexes of arterial pressure accord in the group of perindopril treated patients compared with the group of patients treated with other antihypertensive drugs. Therapy with perindopril exerted organoprotective effect which manifested as lowering of microalbuminuria and augmentation of endothelium dependent vasodilation. We demonstrated ability of perindopril to affect proinflammatory status: to suppress factors of subclinical inflammation (interleukin-6 and C-reactive protein) and to elevate level of anti-inflammatory interleukin-10.

[The role of subclinical inflammation in the formation of early signs of cardiac lesions in hypertensive disease].

Compromised diastolic relaxation of the left ventricle occurs in hypertensive disease with and without its hypertrophy. Classic ventricular hypertension takes some time to develop during which manifestations of myocardial diastolic dysfunction remain the sole criterion (marker) of the lesion. Patients with uncomplicated arterial hypertension display interrelated changes in inflammation, endothelial function, and disorders at the level of different organs. These relationships are believed to be underlain by common neurohumoral mechanisms.