Possible genetically determined mechanisms of arterial hypertension in tobacco smoking.

Te increase in the prevalence of arterial hypertension (AH) in populations, ineffective treatment, the need for risk stratifcation, prevention, early diagnosis and successful treatment, actualize genomic studies to develop a personalized therapeutic approach to AH. Te review investigates the possible genetically determined mechanisms of the development of hypertension and endothelial dysfunction caused by polymorphism of the genes of endothelial nitric oxide synthase (eNOS) and enzymes of phases I and II of the xenobiotics detoxifcation system. Te probable interaction of both systems under the influence of harmful environmental factors, including tobacco smoking, and in the gestational period is discussed. It is proposed to study AH candidate genes in the xenobiotics detoxifcation system, the carriage of different variants of which can determine the sensitivity or resistance to antihypertensive pharmacotherapy, which can be useful for developing of the personalized tactics of managing patients with AH.

[Risk factors and the course of myocardial infarction in elderly women].

AIM: to elucidate risk factors and special features of myocardial infarction (MI) in elderly women. MATERIAL AND METHODS: We included into the study 217 women aged 34 to 89 years who had Q-wave or non Q-wave MI and were admitted for treatment in the cardiology department. These patients were divided into two age groups - younger than 60 years (n=79, mean age 51.6+/-5.9 years) and more or equal 60 years (n=138, mean age 71.7+/-6.9 years). RESULTS: The following risk factors were more frequent among older women: hypertension (95.7 vs 89.9%), diabetes mellitus (32.2 vs 24%). Women aged <60 years more often had obesity (43.0 vs 26.8%), dyslipidemia (63.3 vs 42.8%), smoking (18.9 vs 0.7%), and premature menopause (12.8% vs 5.0%). Women aged <60 years had combinations of 3 or 4 risk factors. Coronary angiography was carried out in 34.2% of women aged <60 years and in 18.8% of older women. Women aged <60 years compared with older women more often had single vessel coronary artery stenosis (55.6 and 23.3%, respectively), whereas in women aged more or equal 60 years prevailed multivessel coronary artery involvement (22.2 and 42.3%, respectively). MI in elderly women was more often complicated by Killip class III-IV acute heart failure, arrhythmias, recurrent MI, and hemotamponade, while younger women (aged <60 years) more often had early postinfarction angina and Dressler syndrome.

[The reactants of acute phase of inflammation and anti-inflammatory cytokines under various complications of cardiac infarction].

The article presents the results of analysis of blood serum from 60 patients (aged 58.9 +/- 1.5 years) with Q-genous complicated and non-complicated cardiac infarction. The study evaluated the content of various proteins of acute phase (alpha-2-macrogloblin, alpha-1-antitripsin. lactofferin) and cytokines inducing their synthesis (IL-6, IL-1beta, L-8). The examinations carried out on 1st, 7th and 14th day of development of cardiac infarction. It is demonstrated that under cardiac infarction complicated by cardiogenic shock on first day of diseases high levels of lactoferrin and lower levels of macroglobulin are detected in blood serum. On the 1-7th day of disease the high levels of lactofferin on the background of invariable concentration of macroglobulin accompany the edema and congestive processes in lungs under cardiac infarction. On the 1-7th day the high levels of lL-6 and IL-8 were detected under large-focal cardiac infarction independently of presence/absence of complications.

[Diovan effectiveness in combined treatment of severe arterial hypertension]. / Effektivnost' diovana v kombinirovannom lechenii tiazheloi artrerial'noi gipertonii.

AIM: To assess effectiveness of diovan, a novel angiotensin-II antagonist, in combined hypotensive treatment of patients with severe arterial hypertension. MATERIAL AND METHODS: 15 patients with severe arterial hypertension received diovan in a dose 80-160 mg/day for 8 weeks in combination with clofelin, beta-adrenoblockers, ACE inhibitors, diuretics prescribed before the start of diovan. Diovan effects were studied by 24-h monitoring of arterial pressure, tolerance, changes in blood counts, central hemodynamics. RESULTS: Adjuvant hypotensive treatment with diovan lowered arterial pressure to satisfactory levels in 80% of patients. 13.3% did not respond to diovan. 6.7% of patients were withdrawn because of allergy. Only 2 patients of those who completed the diovan course developed side effects in first two weeks of the treatment--they had head ache. CONCLUSION: Diovan is effective in combination with clofelin, ACE inhibitors, diuretics, beta-adrenoblockers.

[Dilren efficacy in postmyocardial infarction patients]. / Effektivnost' dil'rena u bol'nykh, perenesshikh infarkt miokarda.

25 survivors of primary macrofocal myocardial infarction (MI) were treated for a year with children. The response in 9(36%) patients was achieved with a single dose 180 mg, in 16(64%) patients with concomitant arterial hypertension the dose was raised to 300 mg. No fatal outcomes were registered. Repeated IM developed in 4(16%) patients. 15(60%) patients improved, deterioration was seen in 4(16%) patients. Dilren-induced complications occurred in 3(12%) patients.

[Effectiveness and safety of amlodipine in secondary prevention in patients with myocardial infarction]. / Effektivnost' i bezopasnost' amlodipina vo vtorichnoi profilaktike u bol'nykh infarktom miokarda.

Amlodipin (norvask) effectiveness was studied in 18 patients who survived primary Q-myocardial infarction. The 2-year treatment produced a positive effect in 66.6% patients, a negative one--in 11.1%. One patient died, a repeat non-fatal MI developed in 2 patients. Complications were registered in 1 patient. The drug reduced the number of angina attacks, amount of nitroglycerin (by 46.6 and 45.5%, respectively), the tolerance increased by 26.7, cardiac performance by 59.9%. It also led to a fall of both systolic and diastolic blood pressure (by 14.0 and 9.9%, respectively). Heart rate remained unchanged. Left ventricle underwent adaptive remodeling, myocardial ischemia diminished in the number of episodes and their duration. Frequent atrial and rare ventricular extrasystole disappeared in 1 patient.

[Expediency of long-term anti-angina therapy and physical exercises in patients with angina pectoris and a history of myocardial infarction]. / Tselesoobraznost' dlitel'noi antianginal'noi terapii pri fizicheskikh trenirovkakh u bol'nykh, perenesshikh infarkt miokarda i stradaiushchikh stenokardiei.

Altogether 105 patients were investigated 1.5-2 mos after myocardial infarction. They were divided into 2 groups: 1) 57 patients on nitrates or anapriline for one year; 2) 48 patients on acetylsalicylic acid (0.25 g/day) and nitrates by strict indications. Patients of the both groups performed physical exercises for one year by the methods developed at the All-Union Cardiology Research Center. The differences between Groups 1 and 2 were statistically insignificant in deaths (3.5 and 4.2%, respectively), recurrent myocardial infarctions (8.8 and 6.3%), CHD exacerbations (12.2 and 20.8%), higher tolerance, performance volume, double product, and threshold oxygen consumption. It was concluded that during a year therapy in patients with myocardial infarction who performed physical exercises, the long-term antianginal therapy chosen on an individual basis had no advantages over low-dose acetylsalicylic acid and a single use of nitrates (according to strict indications).

[Experience with the superselective third-generation beta-adrenoblocker nebivolol used to treat patients with prior myocardial infarction]. / Opyt primeneniia superselektivnogo beta-adrenoblokatora III pokoleniia nebivolola v lechenii bol'nykh perenesshikh infarkt miokarda.

The effectiveness and safety of therapy with nebivolol and its effects on life quality (LQ) were studied in 71 patients with prior myocardial infarction (MI) with an ejection fraction of 40% or more. The follow-up lasted 1 year. The mean daily dose of the drug was 3.66 +/- 0.11 mg. Echocardiography, bicycle ergometry, daily ECG monitoring, survey according to the questionnaires developed by V. P. Zaitsev, a researcher of All-Russian Cardiology Research Center, Russian Academy of Medical Sciences, to the depression scale (DS), the personality scale (PS) and reactive anxiety scale (RAS) by Spilberg-Khanin were performed. The study was conducted on the day of initiation of outpatient treatment, following 3 months and 1 year. After 3 months of therapy, clinical improvement was observed in 83% of the patients and it preserved at the same level till the end of the first year: exercise tolerance and the total volume of work increased significantly (p < 0.001), 97% of the examinees returned to work. Nebivolol produced an antiarrhythmic effect in 66.7% of the patients with high Lown gradation premature beats. Therapy with the agent showed a low mortality rates (1.4%), few number of cardiovascular excesses (4.2%), and good tolerability (7.2%). By the end of the first year, cardiac remodeling improved insignificantly: end-systolic volume, end-diastolic volume, left ventricular myocardial mass decreased by 6.4, 1.4, and 7%, respectively; fraction ejection increased by 2.3% of the baseline values. The parameters of LQ improved: the RAS scores reduced by 18.4%; the number of patients with high PS scores decreased significantly (p < 0.05) due to the increase in the number of patients with its moderate level (p < 0.01) and, what is significant, erectile function did not deteriorate. Thus, nebivolol demonstrated its high effectiveness and safety during prolonged therapy of patients with prior MI, without cardiodepressive activity and favorable impact on their LQ.