Vol 85, No 9 (2013)


Simulation of a risk for cardiovascular diseases and their events at individual and group levels

Boĭtsov S.A., Shal'nova S.A., Deev A.D., Kalinina A.M.


The transition from the identification of individual risk factors to the assessment of an overall or total risk, in other words, to the creation of prognostic models should be now recognized to be one of the most important achievements in the epidemiology of chronic noncommunicable diseases. The paper comparatively analyzes major current prognostic algorithms for assessing the risk of cardiovascular diseases and their events and the advantages and disadvantages of these algorithms. The authors provide evidence that it is necessary to create national risk models, including the most promising new indicators.
Terapevticheskii arkhiv. 2013;85(9):4-10
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Influence of meteopathogenic factors on population visits for emergency medical care

Zunnunov Z.R.


Aim. To study the features of the impact of the extreme climate and weather factors of an arid area, which cause exacerbations of circulatory system diseases (CSD). Materials and methods. The authors have studied 32,339 visits for emergency medical care (EMC) because of exacerbations of CSD (coronary heart disease, angina pectoris (n = 29,932), myocardial infarction (n = 306), hypertensive crises (n = 2,101) and their events) when the Afghan wind forms in winter and spring and on heat discomfort days in summer. Meteological parameters, synoptic patterns, partial oxygen density (AOD) in the atmosphere, atmospheric electric potential gradient, and human heat sensation (equivalent and effective air temperatures (EEAT)) were estimated using the generally accepted three-hour gradations. Results. In the formation of the Afghan wind (24-48 hours before its surge, i.e. in the prodromal phase), the atmospheric electric potential gradient increased by 4-10 times. Atmospheric pressure fell by 15-20 mbar; air temperature rose by 10-15°C, AOD dropped by 15-25 g/m3 - a hypoxic type of weather formed. In the surge phase, the hypoxic type drastically changed to the spastic one - there was an increase in atmospheric pressure and a decrease in air temperature (by 12-19°C), which gave rise to circulatory hypoxia due to vascular spasm. The average daylight air temperature changed from +31.1 to +42.2°C, amounting to +36.6±1.2°С; EEAT was in the gradation of heat (27-30°C) and very heat (32°C or higher), AOD decreased (248.6±1.3 g/m3), a hyperthermia-and-hypoxia type of weather was observed. The rates of EMC visits by the population for CSD exacerbations were strongly correlated with the formation of the Afghan wind (Spearman rank correlation 0.82). In the prodromal and Afghan wind surge phases, the number of exacerbations of CSD increased by an average of 2.2-3.6 times. Analysis of annual patient visits by hours during a day showed that their first rise was seen at 9.00 to 12.00 and the second (more substantial) one at 18.00 to 21.00 (p < 0.05). However, in summer, the patient visit rates increased at 15.00 local legal time when there was human thermal sensation at the gradation of heat under hyperthermal hypoxia more frequently in people older than 70 years. Conclusion. The rates of EMC visits by patients for CSD exacerbations increased in the formation of the Afghan wind and in summer during significant heat discomfort; hypoxia (external weather and internal circulatory hypoxia) is a major pathophysiological factor in these situations.
Terapevticheskii arkhiv. 2013;85(9):11-17
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Endothelial NO synthase and connexin 37 gene polymorphisms as a risk factor for myocardial infarction in subjects without a history of coronary artery disease

Balatskiĭ A.V., Andreenko E.I., Samokhodskaia L.M., Boĭtsov S.A., Tkachuk V.A.


Aim. To define a role of connexin37 (Cx37) C1019T and endothelial nitric oxide synthase (eNOS) G894T polymorphisms in the development of myocardial infarction (MI) in subjects without a history of coronary artery disease. Subjects and results. The investigation enrolled 183 male patients, of whom 56 (18.1%) developed MI in the presence of clinically and instrumentally verified coronary heart disease (CHD) (except MI) and 127 (81.9%) patients did without any previous clinical signs of CHD. The gene polymorphisms were identified using polymerase chain reaction and restriction fragment length polymorphism analysis. Results. The spread of the G allele in the eNOS gene was 59.8% in the patients with MI in the presence of CHD and 75.6% in those with MI without a history of coronary artery disease (p<0.01). The GG genotype was found in 32.1 and 54.3%, respectively (p=0.01; the odds ratio (OR) was 2.5 with 95% confidence interval (CI) 1.3 to 4.9). The spread of the mutant T allele in the Cx37 gene was 29.5% in the patients with MI in the presence of CHD and 59.8% in those with MI without a history of coronary artery disease (p<0.01). The TT genotype was encountered in 7.1 and 42.5% of cases, respectively (p=0.01; OR 9.6 with 95% CI 3.3 to 28.4). There was no case of a combination of GG and TT genotypes among the patients with MI in the presence of CHD whereas this was found in 23.6% of the MI cases without a history of coronary artery disease (p<0.01). Conclusion. Determination of Cx37 C1019T and eNOS G894T polymorphisms may be used to detect a genetic predisposition to the development of MI in patients with hemodynamically insignificant atherosclerosis and in apparently healthy individuals.
Terapevticheskii arkhiv. 2013;85(9):18-22
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Early physical rehabilitation after elective percutaneous coronary interventions during incomplete revascularization: Exercise regimen calculation by ergospirometry

Martynova V.V., Andreev D.A., Doletskiĭ A.A., Abugov S.A., Saakian I.M.


Aim. To evaluate the efficiency and safety of outpatient physical exercises (PE), calculated using ergospirometry (ESM) in patients in the early periods after elective percutaneous coronary interventions (PCI) during incomplete coronary bed revascularization. Subjects and methods. Three hundred and eighty-three patients were screened. The trial enrolled the patients after elective PCI in its early periods (3 to 14 days) who had signed an informed consent document to participate in the investigation and who could perform themselves PE at home or visit the medical center. Patients with angioplasty complications (myocardial infarction, severe hematomas, major bleeding, etc.) who had standard contraindications to exercise testing and PE were excluded. The patients included in the trial (n = 50) were divided into 2 groups: 1) 21 patients who had undergone incomplete revascularization; 2) 29 patients who had complete revascularization. The authors estimated exercise endurance by ergospirometry before the investigation, 8 weeks after a course of exercises, and following 6 months and assessed quality of life (QL) using the SF-36 questionnaire. A physical rehabilitation program was elaborated for all the patients according to exercise test results. During the trial, all the patients were allocated to groups of home and clinic exercises using exercise bikes. Medical control of the patients who were exercising at home was made by their telephone conversation, control visits to the medical center at least once monthly, and their concurrently keeping an exercise diary in which each training (duration, intensity), health status, and blood pressure were recorded. The patients could consult their physician at any time if required. Results. In the incomplete and complete revascularization groups, VO2 max increased by 6 and 15%, respectively. Following 6 months, no additional increment in VO2 max was seen in the study groups. According to SF-36 data, QL improved in patients in both groups after 8 weeks and remained at the same level after 6 months. Conclusion. An early time course of exercises only in combination with regular medical control has a positive impact on exercise tolerance and QL and preserves its efficiency for at least 6 months regardless of the degree of revascularization.
Terapevticheskii arkhiv. 2013;85(9):23-28
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Efficacy of Adaptol and the possibility of its differential use in patients with anxiety disorders after myocardial infarction

Shilina N.N., Statsenko M.E., Sporova O.E., Lempert B.A.


Aim. To evaluate the efficacy and safety of adaptol in a dose of 1500-2000 mg/day in combination therapy for anxiety disorders (AD) in the early post-myocardial infarction period. Subjects and methods. The trial included 94 patients with AD who were divided into a study group of 60 patients and a control group of 34 patients. In addition to basic therapy, the study group took adaptol in a dose of 1500-200 mg/day for 30±2 days; the control group received basic therapy only. Results. The drug given in a dose of 1500-2000 mg/day in the patients with AD in the early post-myocardial infarction period was found to have high anxiolytic, autonomically normalizing, stress-protective activities and a positive effect on heart rate variability just one month after treatment. The highest efficacy of Adaptol was observed in patients with baseline hypersympathicotonic and normal autonomic responsiveness. Conclusion. Adaptol proved to be more effective in patients with baseline hypersympathicotonic and normal autonomic responsiveness, which permits the drug to be differentially used in relation to the baseline type of autonomic responsiveness.
Terapevticheskii arkhiv. 2013;85(9):29-34
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On the way to achieve hypertension treatment goals: results of the open observational program AESCULAP (Exforge - Clinical safety and efficiency of using a double combination of antihypertensive drugs in patients with uncontrolled blood pressure)

Chazova I.E., Martyniuk T.V.


Aim. To collect information on the efficiency and safety of a fixed-dose combination of amlodipine/valsartan in patients who failed to achieve blood pressure (BP) control in the use of the combination of an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) and a thiazide/thiazide-like diuretic. Subjects and methods. During routine clinical practice, the 12-week observation program covered 8594 hypertensive patients receiving a fixed-dose combination of amlodipine/valsartan 5/160, 10/160 mg (exforge, Novartis Pharma) with/without a diuretic. The inclusion criteria were 18 years of age or older; systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg) at the first visit; failure to achieve BP (≥140/90 mm Hg) control in the use of the combination of an ACE inhibitor or an ARB and a thiazide/thiazide-like diuretic; a patient's consent to participate in the program. The exclusion criteria were, besides the contraindications given in the drug use instruction, absent. Amlodipine/valsartan 5/160 or 10/160 mg were used after the previous ineffective therapy was discontinued. The patients visited their physician's office every 4 weeks. Results. The patients' baseline BP was 169.3/99.9 mm Hg. The risk of cardiovascular events was assessed as high in 38% of the patients and as very high in 43.1%. The previous therapy included thiazide or thiazide-like diuretics (92%), an ACE inhibitor (78.5%), an ARB (23.2%), Β-adrenoblockers (38.6%), calcium antagonists (23.1%), and other medications (25.5%). In the entire group, BP decreased from 169.3±15.6/99.9±9.3 to 129.1±9.1/80.3±6.4 mm Hg at the fourth visit. BP reductions at 12 weeks were 40.1±14.9/19.6±9.5 mm Hg. The therapy was effective in different treatment subgroups. At baseline, the majority of patients had grades 2 (53.1%) and 3 (35.4%) hypertension. At 12 weeks, 74% of the patients were found to have normal or high normal BP. Grade 3 hypertension was preserved only in 0.2% of the patients by the end of the program. BP goals were achieved in 79.5% of the patients. The therapy was well tolerated by the patients. Adverse reactions were observed in 3.1% of the patients and required treatment discontinuation in 0.5%. The most common side effect was peripheral edemas (1.4%). Conclusion. In the observation program AESCULAP using the fixed-dose combination of amlodipine/valsartan as different dosage regimens (5/160 and 10/160 mg) and/or a diuretic, there was a marked antihypertensive effect in different subgroups of patients with previously uncontrolled hypertension and the BP goals being achieved in 79.5% of cases. Most patients tolerated amlodipine/valsartan well and showed high compliance with the prescribed therapy. The rate of side effects in the AECULAP program was not greater than that (3.1%) in the earlier trials.
Terapevticheskii arkhiv. 2013;85(9):35-45
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The nature of a microcirculatory change in hypertensive patients during increased blood pressure

Vasil'ev A.P., Strel'tsova N.N., Sekisova M.A.


Aim. To evaluate changes in the microcirculation (MC) of hypertensive patients during increased blood pressure (BP). Subjects and methods. The investigation enrolled 66 patients with grades 2-3 hypertension and 57 apparently healthy individuals. After 2-day discontinuation of antihypertensive drugs, the patients were divided into 2 groups: 1) BP ≤140/90 mm Hg; 2) BP ≥160/100 mm Hg. MC was examined by laser Doppler flowmetry. Results. In the hypertensive patients, the episodes of higher BP are accompanied by the constriction of meta-arterioles and precapillaries, resulting in diminished capillary blood flow. A compensatory increase in pulse blood filling is attended by accelerated blood flow with decreased vessel diameters and increased shear stress. This creates conditions for the endothelial release of vasodilator mediators. However, the limited reserves of an endothelial relaxing effect are not enough to normalize BP. This resultant increase in tissue hemoperfusion is nonproductive since it is due to intensified shunt blood flow and venous plethora. Conclusion. Severe MC disorders in hypertensive patients with increased BP are characterized by incompetent compensatory mechanisms, reduced endothelial relaxing potential, and depressed capillary tissue diffusion. It may be believed that these disorders appreciably determine target organ involvements in hypertension.
Terapevticheskii arkhiv. 2013;85(9):46-51
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Is there an association of uric acid level with preclinical target organ damage in moderate-and high-risk hypertensive patients?

Dmitriev V.A., Oshchepkova E.V., Titov V.N., Rogoza A.N., Saidova M.A., Bolotova M.N., Gushchina O.V., Polevaia T.I.


Aim. To assess an association of uric acid level with preclinical target organ damage in patients with hypertensive disease (HD). Subjects and methods. The trial enrolled 100 patients (63 men and 37 women) with Stage I-II HD at moderate and high risk for cardiovascular events (CVEs). The mean age of the patients was 44.9±1.3 years. Their medical history showed that the duration of hypertension averaged 4.4±0.3 years. The average daily level of systolic blood pressure (BP) was 138.1±1.4 mm Hg and that of diastolic BP was 84.3±1.1 mm Hg. Results. The entire patient group showed a positive correlation between C-reactive protein (CRP) and serum uric acid (SUA) (r = 0.27; p < 0.01), suggesting that the nonspecific inflammatory processes were associated with uric acid levels in patients with HD. An intragroup analysis also revealed a relationship between CRP and SUA levels in the hypertensive patients at high risk for CVEs (r = 0.43; p = 0.01); this relationship was not found in those at their low risk. The hypertensive patients were ascertained to have elevated CRP levels and microalbuminuria, hyperuricosuria, and glomerular hyperfiltration when they had a SUA level >319 µmol/l. Conclusion. It can be assumed that the SUA level >319 µmol/l triggers the activation of nonspecific inflammatory processes, which in turn affects renal microvessels.
Terapevticheskii arkhiv. 2013;85(9):52-57
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Comparative characteristics of 24-hour blood pressure profile and heart rate variability in indigenous and non-indigenous patients with chronic coronary heart disease and hypertension from the Yamal-Nenets Autonomic District

Gapon L.I., Sereda T.V., Leont'eva A.V., Gul'tiaeva E.P.


Aim. To investigate the specific features of a 24-hour blood pressure (BP) profile and heart rate variability (HRV) in the indigenous peoples (Nenets, Khanty, Selcups, and Komis) and newcomers with chronic coronary heart disease (CHD) and hypertension, who lived in the Yamal-Nenets Autonomic District. Subjects and methods. Two hundred male and females patients aged 21 to 55 years (mean age 48.2±0.7 years) with chronic CHD and hypertension, who resided in the Far North, were examined. All the patients were divided into 4 groups: 1) 50 aboriginal patients with hypertension only; 2) 50 newcomers with hypertension only; 3) 50 natives with chronic CHD and hypertension; 4) 50 non-natives with the above conditions. The groups were matched for gender, age, and the duration of hypertension and CHD. To study the nature of changes in the 24-hour BP profile, all the patients underwent 24-hour ambulatory BP monitoring (ABPM) and HRV examination. Results. The HRV analysis revealed that all the groups had increases in sympathetic autonomic nervous system (ANS) activity (88% in Group 1; 96% in Group 2; 94% in Group 3, and 92% in Group 4) and decreases in parasympathetic ANS activity (76% in Group 1; 74% in Group 2; 78% in Group 3; and 72% in Group 4), which was suggestive of neurocardiopathy. Analyzing the data of 24-hour ABPM showed that among the natives, there were more patients with increased systolic and diastolic BP (SBP and DBP) variability and higher nocturnal SBP time index (TI). These groups also showed a preponderance of patients with abnormal 24-hour BP profiles as compared to the groups of newcomers (p = 0.034). Among the latter, there were more patients with higher SBP and DBP variability and increased daytime DBP TI and also more patients with a normal nocturnal BP reduction (p = 0.012). Conclusion. The group of indigenous populations displayed a predominance of non-dippers and night-pickers and higher nocturnal SBP and DBP whereas the group of non-indigenous ones exhibited a preponderance of dippers and higher daytime SBP and DBP variability.
Terapevticheskii arkhiv. 2013;85(9):58-62
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Endothelial dysfunction is a target for combination antihypertensive therapy in hypertensive patients with type 2 diabetes mellitus

Statsenko M.E., Derevianchenko M.V., Ostrovskiĭ O.V., Titarenko M.N., Shvets M.K., Bondarev A.M.


Aim. To evaluate the impact of combination antihypertensive therapy with lisinopril + amlodipine (Еkvator) on endothelial dysfunction in patients with hypertension and concurrent type 2 diabetes mellitus (T2DM). Subjects and methods. The trial enrolled 30 patients aged 40 to 65 years with Stages II-III hypertension concurrent with T2DM. All the patients received combination antihypertensive therapy with lisinopril + amlodipine (ekvator) for 12 weeks. Endothelial function was studied from serum and urinary NO and endothelin-1 concentrations and occlusion test results. 24-hour blood pressure (BP) monitoring and echocardiography were performed; arterial elastic properties and renal function were investigated. Results. After 12-week therapy, 93.3% of the patients achieved BP goals. Endothelial function was improved in hypertensive patients with T2DM: there were increases in both serum and urinary NO production (by 53.5 and 57.1%, respectively) and decreases in serum and urinary endothelin-1 secretion (by 27.7 and 69.6%, respectively). The number of patients with normal microcirculation increased from 13.3 to 73.3% (p<0.001). There was significant improvement in 24-hour AP monitoring readings and reductions in the left ventricular mass index by 10.7% and microalbuminuria by 27.7%; the number of patients with increased pulse wave velocity along the elastic arteries declined by 30%. Conclusion. Twelve-week treatment with the combined antihypertensive medication ekvator is highly effective and safe for recovering endothelial function and improving the state of target organs in hypertensive patients with T2DM.
Terapevticheskii arkhiv. 2013;85(9):63-68
pages 63-68 views

Risk factors for cardiovascular system damage in chronic kidney disease

Kutyrina I.M., Rudenko T.E., Savel'eva S.A., Shvetsov M.I., Vasil'eva M.P.


Aim. To study the prevalence of and risk factors (RF) associated with cardiovascular system damage in patients with predialysis diabetic and nondiabetic chronic kidney disease (CKD). Subjects and methods. The investigation enrolled 317 patients with CKD of various etiologies. In Group 1 (165 patients with CKD: 54% of men, 46% of women; mean age 46±15 years), the glomerular filtration rate (GFR) was 37.2 ml/min; the serum creatinine level was 2.9 mg/dl. Group 2 included 152 (41%) patients with type 2 diabetes mellitus (DM) (41% of men and 59% of women; mean age 57.3±7.1 years). The duration of DM averaged 10.4±7.1 years. All the patients underwent physical examination; the levels of glycated hemoglobin and adipose tissue hormones, urinary albumin excretion were additionally determined in the diabetic patients. Echocardiography was performed in 172 patients. The influence of populationwide and renal failure-associated RFs on the cardiovascular system was evaluated in CKD. Results. Clinical and instrumental examinations of 165 patients with Stages II-IV nondiabetic CKD revealed atherosclerosis of the aorta and the vessels of the heart, brain, kidney, and lower extremities in 60 (37%), 35 (24%), 30 (18%), 23 (14%), and 8 (5%), respectively. As atherosclerotic vascular lesion progressed, the incidence of cardiovascular events (CVE) increased. Left ventricular hypertrophy (LVH) was diagnosed in 37.3% of the patients with nondiabetic CKD. Along with traditional cardiovascular RFs (age, smoking, gender, arterial hypertension), the renal dysfunction-related factors (anemia, diminished glomerular filtration rate, elevated creatitine levels, and abnormal phosphorus and calcium metabolism) are of importance. An association was found between LVH, atherosclerotic vascular lesion, and heart valve calcification. According to EchoCG data, 36% of the patients with type 2 DM were diagnosed as having LVH. The RFs of the latter were albuminuria, obesity, and abnormal carbohydrate and purine metabolisms. There was an association of diabetic nephropathy with left ventricular remodeling processes and a history of CVE. Conclusion. The development of cardiorenal syndrome is observed in early-stage CKD and related to both traditional and renal RFs.
Terapevticheskii arkhiv. 2013;85(9):69-76
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Effect of eprosartan on the hemostatic system in patients with chronic kidney disease associated with hereditary thrombophilia

Kaliuzhin V.V., Sibireva O.F., Urazova O.I., Tkalich L.M., Zibnitskaia L.I., Kaliuzhina E.V., Sazonov É.A., Grankina V.I.


Aim. To study the effect of eprosartan, an angiotensin II type 1 (AT1) receptor blocker, with sympatholytic activity on the hemostatic system in patients with chronic kidney disease (CKD) associated with hereditary thrombophilia. Subjects and methods. The 12-week open-label uncontrolled trial included 31 patients with Stages I-II CKD: 15 patients with chronic glomerulonephritis and 16 with diabetic nephropathy burdening types 1 and 2 diabetes mellitus (DM) in 10 and 6 cases, respectively. In all the patients, CKD was associated with one of the heterozygous forms of thrombophilia: the polymorphic methylenetetrahydrofolate reductase gene variant C677T was found in 18 patients; the polymorphic coagulation factor V gene variant G1691A was in 9; and the polymorphic coagulation factor II gene variant G20210A in 4. Along with the thorough examination accepted in nephrology and endocrinology clinics, investigations of vascular-thrombocytic and secondary hemostasis and the anticoagulant and fibrinolytic systems were made before and after treatment. Results. Eprosartan therapy caused positive changes in the indicators of vascular-thrombocytic (diminished platelet aggregation, reduced surplus of von Willebrand factor and endothelin-1) and secondary (decreased coagulation factor VII activity, longer activated partial thromboplastin time) hemostasis and the anticoagulant (reduced antithrombin III deficiency) and fibrinolytic (elevated blood plasminogen concentrations) systems. Conclusion. The pleiotropic effects of eprosartan may be used to correct hypercoagulability syndrome in patients with CKD associated with hereditary thrombophilia.
Terapevticheskii arkhiv. 2013;85(9):77-81
pages 77-81 views

Current possibilities in the outpatient treatment of postmyocardial infarction

Nesterov I.I.


The lecture is intended for primary health care physicians and dedicated to the comprehensive rehabilitation and follow-up of postmyocardial infarction patients at an outpatient stage. The lecture material is based on the results of analyzing the Russian and foreign literature and on the author's experience. The section on nondrug treatment for myocardial infarction attaches particular significance to the exposure of risk factors for the disease. Long-term drug prevention of recurrences at the present level is examined.
Terapevticheskii arkhiv. 2013;85(9):82-85
pages 82-85 views

Differential diagnosis and treatment of neurogenic and psychogenic dysuria in case of overactive bladder syndrome

Shvarts P.G., Goriachev F.K., Plotnikov A.N., Savvin D.I., Popov S.V.


The diagnosis of neurogenic and psychogenic dysurias is the most difficult and controversial problem of modern urology, the solution of which requires a differentiated approach based on the comparison of neurological, psychic, and urologic symptoms. The basis for their diagnostic search is the method of substitution of found symptoms in the schemes of known urologic, neurological diseases and psychopathological states in the direction from the general to the particular, i.e. by the method of deductive reasoning. The results of diagnostic tests and pharmacological analysis only clarify the details of final diagnosis. When one patient has an organic lower urinary tract lesion concurrent with neurogenic dysuria is the most difficult diagnostic case. The diagnosis of such conditions necessitates the performance of ultrasound, neurophysiological, neuroimaging, and urodynamic studies. The neurogenic disorders are characterized by a concomitance of neurological and urologic symptoms that generally occur at the same time, by a change in urodynamic parameters, and by a positive effect of specific therapy encompassing anticholinergic, sympatholytic, and other neurotropic agents. Psychogenic dysurias are not attended by neurological deficit and the instrumentally signs of organic urinary tract lesion, but is always accompanied by the psychopathological symptoms of anxiety or depression. Moreover, there is a positive effect of psychotropic drugs (anxiolytics or antidepressants) and indifference to the use of neurourologic agents.
Terapevticheskii arkhiv. 2013;85(9):86-92
pages 86-92 views

The specific features of hypertension and the choice of treatment policy in old women

Podzolkov V.I., Bragina A.E., Nikitina T.I.


The paper discusses the specific features of the structure and function of the cardiovascular system and cardiovascular diseases, which depend on the age and hormonal status of women. Despite common principles in the antihypertensive treatment of male and female hypertensive patients, the latter have higher rates of adverse reactions from some medications, on the one hand, and special indications for the use of drugs, such as diuretics, on the other hand.
Terapevticheskii arkhiv. 2013;85(9):93-101
pages 93-101 views

What is the optimal choice of antihypertensive therapy based on: the class-specific effects or special properties of a drug?

Adasheva T.V., Samorukova E.I., Zadionchenko V.S., Nesterenko O.I.


The review article presents data on the significance of activation of different components of the renin-angiotensin-aldosterone system (RAAS) in metabolic disorder progression and organ damage processes. Based on the analysis of the pharmacological properties of drugs and clinical evidence, the authors discuss the problems of the choice of RAAS blockers. The mechanisms of drug action on metabolic processes, atherogenesis, and vascular damage are discussed.
Terapevticheskii arkhiv. 2013;85(9):102-106
pages 102-106 views

Angioprotektivnoe properties lowering drugs from the group of inhibitors of dipeptidyl peptidase-4

Oskola E.V., Shubina A.T., Karpov I.A.


Diabetes mellitus (DM) is a major health problem in all developed countries. It contributes to the development of atherosclerosis and increases the risk of cardiovascular events so blood glucose level correction is essential to preventing these complications. The relatively new and promising class of anti-diabetic drugs is dipeptidyl peptidase-4 inhibitors. By improving carbohydrate metabolism, they have angioprotective effects, such as anti-inflammatory and anti-atherosclerotic ones, including atherosclerotic plaque stabilization, improve endothelial function, lower blood pressure, and reduce the severity of albuminuria, which may have clinical implications for the prevention of macrovascular complications of type 2 DM.
Terapevticheskii arkhiv. 2013;85(9):107-112
pages 107-112 views

Trans isomers of unsaturated fatty acids increase the risk of atherosclerosis-related circulatory system diseases

Perova N.V., Metel'skaia V.A., Boĭtsov S.A.


The paper provides a review of the literature on a relevant non-drug prevention problem, namely the negative effect of trans isomers of unsaturated fatty acids (trans-UFA) on the risk of circulatory system diseases (CSD) and other chronic noncommunicable diseases. It gives data on the specific features of the structure and ability of trans-UFA to elevate the plasma levels of atherogenic low-density lipoproteins and to lower those of non/antiatherogenic high-density lipoproteins. The natural sources of their moderate content in the animal fats from ruminants and those of their redundant content in the margarines manufactured by hydrogenation of liquid vegetable oils are described. A new technology for preparing soft margarines (spreads) is presented, which can produce fatty products that do not virtually contain trans-UFA. There is evidence that trans-UFA can considerably raise the risk of CSD and their acute complications. It is concluded that the manufacture of fatty products with low and even no trans-UFA levels should be expanded in Russia to improve its population's health.
Terapevticheskii arkhiv. 2013;85(9):113-117
pages 113-117 views

Peroxisome proliferator-activated receptors-γ and hypertension: Lessons of the history of researches

Rasin M.S.


The paper analyzes data from the clinical use of thiazolidinediones, human genetic observations and experiments with peroxisome proliferator-activated receptor (PPAR-α) gene removal, and also those on the role of PPAR-γ and -Β in the function of the vascular endothelium, sympathetic autonomic nervous system, and renal sodium reabsorption. It is concluded that the tonic activity of PPAR is a universal protective mechanism counteracting the development of hypertension.
Terapevticheskii arkhiv. 2013;85(9):118-123
pages 118-123 views

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