The article is devoted to the role of antihypertensive drugs in cerebroprotection, importance of such drugs in reducing the risk of stroke and cognitive disorders in patients with arterial hypertension (AH). The article provides the definition, classification and pathogenetic mechanisms of cognitive impairment in elevated blood pressure (BP). It also presents epidemiological characteristics of the incidence of stroke and cognitive disorders in hypertension. The influence of elevated blood pressure as a factor increasing the risk of cerebrovascular complications is considered. Particular attention is paid to the issue of a sharp rise in BP in the early morning hours, which is typical for patients with AH. The clinical significance of excessive early morning hypertension is discussed. The authors emphasize the difficulties and importance of correcting the morning rises in blood pressure as one of the objectives of antihypertensive therapy. The article presents data on the distinctive features of the pharmacokinetics and pharmacodynamics of candesartan, an angiotensin II receptor blocker with an extremely long-term action. The clinical efficacy of candesartan in the treatment of AH and the risk of cerebrovascular complications, especially stroke and cognitive impairment, has been demonstrated from the point of view of evidence-based medicine.

Orphan diseases are life-threatening, chronic, progressive and leading to a reduction in life expectancy or disability conditions. Patients with rare diseases are one of the vulnerable population groups, which is caused by several factors, such as insufficient awareness of practitioners about such diseases, complicated and lengthy diagnosis, and imperfection of legal environment in the area of pharmacological support of orphan diseases, when only 24 orphan diseases (List-24) are determined, which are treated at the expense of the RF subjects.

Imperfection of federal orphan diseases legislation is shown on the example of providing patients with PAH-specific therapy: only idiopathic form of pulmonary hypertension is included in the federal List-24, there is no well-established mechanism of pharmacological support for patients with chronic thromboembolic pulmonary hypertension (CTEPH) that is not included in the List-24. The article describes the successful experience in providing patients with orphan diseases, regardless of the inclusion of nosology in List-24 in Moscow, through the creation and implementation of the transparent medical and pharmacological support regulation for patients with orthopaedic diseases, which settled the timely process of provision of patients with the necessary therapy. As a result, patients with CTEPH also have access to existing pathogenetic treatment that can prolong life and improve the quality of life of such patients. 

The review article summarized the positions of experts on the clinical and prognostic significance of multifocal atherosclerosis in patients with different forms of coronary heart disease and the impact of this phenomenon on overall cardiovascular risk based on the foreign and domestic studies, the guidelines of the European and North American Cardiological and Surgical Associations. It also presents the review of the modern clinical guidelines for antithrombotic therapy in patients with peripheral atherosclerosis. The review presents prospects for the optimization of antithrombotic therapy based on a recent clinical study.

Of 875 patients being under the clinical follow-up at one of the polyclinics in Chelyabinsk, 216 (24.7%) had coronary artery disease (CAD) without arterial hypertension (AH) in past medical history. The authors conducted the comparative study of risk factors and clinical and instrumental features of the disease in 50 patients with isolated coronary artery disease and in 50 patients with coronary artery disease against the background of AH. It was found that the disease onset was more often manifested in the form of angina pectoris in patients with stable coronary artery disease without AG , and in the form of myocardial infarction in patients with CAD and AH. Pathological heredity, obesity, diabetes mellitus were more common in patients with the combination of CAD and AH. Stenosis of over 50% of at least one coronary artery is more often identified in patients with CAD and normal arterial pressure (AP). The full range of beta-blockers and calcium channel blockers may be prescribed to patients with CAD without AH in no more than 20% of cases due to excess drop in AP. The prescription of anti-ischemic drugs trimetazidine OD and ivabradine increased the CAD without AH, where these drugs probably should be referred to the first choice drugs.

A rational combination of drug and invasive management of a patient with stable coronary artery disease can significantly reduce the risk of cardiovascular complications and improve the quality of life. New technologies can significantly improve the results of treatment of these patients only if the prescribed regimens are followed. Meanwhile, adherence to cardiovascular therapy is low, and the task of its increase, in particular the regular use of antiplatelet drugs and statins, is very relevant. One of the effective methods of improving adherence is the appointment of fixed combinations of drugs.

The CVD death rates remain high now. The concurrent course of coronary artery disease (CAD) and diabetes mellitus (DM) has an unfavourable prognosis, requires specific therapy and the use of measures to prevent severe complications. DM sometimes hinders the timely diagnosis of CAD, which in this case is characterized by an atypical course and has no florid symptoms. This often causes serious pathological complications or death. The atherothrombosis forms the basis of pathogenesis of severe conditions. Atherothrombosis is not only a generalized, but also a constantly progressive disease, for which reason it is necessary to carry out both primary and secondary prevention. According to the existing guidelines of European Society of Cardiology and Society of Cardiology of Russian Federation, acetylsalicylic acid (ASA) is recommended at small doses as the first-line drug for the prevention of vascular events in patients with CAD. This article discusses the experience of using ASA according to the conducted studies and in practical medicine by the clinical example of a female patient.

The diagnosis of stable ischemic heart disease begins with a careful clinical examination of the patient and non-invasive testing to identify the disease. Patients with very low and very high pretest probability should not undergo various non-invasive tests. Various non-invasive tests are available to assess the presence of coronary heart disease in patients with an intermediate probability of ischemic heart disease (15–65%). The combination of anatomical with functional non-invasive tests helps improve diagnostic capabili of the disease.

The role of specific approaches to the management of patients with heart failure (HF) increases steeply with increasing age, as the patients of this age need attention to geriatric problems: reduced mobility, multiple diseases and cognitive impairment. Senile asthenia is a syndrome that reflects a decline in physiological reserve and increased vulnerability to various stressors. Senile asthenia is detected in 15–74% of patients with heart failure, the prevalence depends on the method of diagnosis and the studied population. This review discusses the effects of senile asthenia, comorbidity and geriatric syndromes on diagnosis, treatment, and outcomes in elderly patients with heart failure. The detection of senile asthenia in patients with HF is important from a clinical point of view, since this condition has an adverse effect on the course of heart failure and is associated with a higher incidence of emergency hospitalization and mortality. Bodily exercises can improve mobility, and the introduction of nursing observation can enhance treatment adherence among patients.

The article is devoted to the diagnosis and management of patients with myocarditis, and its role in the development of chronic heart failure (CHF). It also determined the role of specific therapy and approaches to the treatment of CHF in patients with this pathology.

Diabetes mellitus (DM), due to its high incidence and prevalence, presents an urgent problem for the scientific community, which requires new ways of treating and preventing complications. Existing hypoglycemic treatment approaches do not always contribute to the achievement of glycaemic targets.

Objective. Study of Subetta-based therapy for patients with DM 1 and DM 2 in real-life clinical practice.

Materials and methods. The program involved 71 patients with DM 1 and 289 patients with DM 2, HbA1c ≥ 7.0%, who took Subetta in combination therapy of diabetes. The duration of the program was 12 weeks. The laboratory examination included the determination of the level of HbA1c, fasting plasma glucose.

Results. The administration of Subetta in complex therapy of DM 1 and DM 2 led to a significant reduction in HbA1c from 9.2 ± 1.85 to 8.13 ± 1.29 mmol/L and from 8.62 ± 1.54 to 7.49 ± 1.1 mmol/L, respectively (p<0.0001), reduction of fasting blood glucose from 9.33 to 7.65 mmol/l and from 9.25 to 7.08 mmol/l, respectively (p<0.0001). The effectiveness of therapy is highly appreciated by patients and physicians. The use of Subetta was not accompanied by the development of hypoglycemia and other adverse effects.

Conclusion. In real-life clinical practice, use of new locally developed antidiabetic drug Subetta demonstrated a significant decrease of HbA1c and fasting blood glucose, with no episodes of hypoglycemia in patients with DM 1 and DM 2. 

The aim was to study the effect of taurine in the complex therapy of patients with coronary artery disease associated with type 2 diabetes mellitus (DM2) who underwent coronary revascularization.

Material and methods. Examined 53 patients with coronary artery disease associated with type 2 diabetes, after undergoing endovascular revascularization of the myocardium, which were distributed in 2 groups. The 1st group included 30 patients who received, in addition to basic therapy, taurine at a dose of 500 mg 2 times a day. In group 2 (n = 23) – patients who received only basic therapy of ischemic heart disease and diabetes. Body mass index, waist and hip volume, as well as physical tolerance by means of Bicycle ergometry and 6-minute walk test were evaluated. Indicators of carbohydrate and lipid metabolism wer e determined, insulin resistance index was calculated.

Results. At the end of 16-week therapy, physical tolerance according toVEM in group 1 increased by 29.67% (p<0.01), in group 2-by 9.14% (p>0.05). The distance during the 6-minute walk test was significantly increased in both groups: by 34.37% and by 25.80%, respectively. Patients of group 1 had a significant decrease in BMI by 11.52%, postprandial glucose level by 19.38% (p = 0.018), insulin by 18.90%, glyca ted hemoglobin (HbA1c) by 13.21%, insulin resistance index by 17.65%, triglyceride by 14.14% (p<0.05), low density lipoprotein cholesterol by 16.05% (p<0.01).), aspartate aminotransferases and alanine aminotransferases – by 27.75% and 16.52%, respectively.

Conclusion. Sup plement taurine standard therapy of coronary heart disease associated with type 2 diabetes mellitus, in patients who have undergone endovascular myocardial revascularization, has a positive effect on the performance of carbohydrate and lipid metabolism, reduces body weight, improves physical performance. 

In clinical trials of drugs, including sodium-glucose co-transporter-2 inhibitors (SGLT2), the main reason for the discontinuation of the therapy are side effects. However, there are additional factors that affect the discontinuation of the therapy in real clinical practice. This paper presents assessment of adverse events against the background of SGLT2 therapy with empagliflozin, identification of risk factors for these phenomena, and analysis of the reasons for discontinuation of SGLT2 therapy in real clinical practice. The study included 86 patients with type 2 diabetes mellitus, who were prescribed empagliflozin SGLT2 for the first time. During the trial, 24 (27.9%) cases of side effects were reported: infection in the genitourinary tract – 13 (15.1%) cases, hypoglycemia – 7 (8.1%) cases, and hypotension – 4 cases (4.7%). In general, the risk factors for adverse events were female gender, BMI ≥ 30 kg/m2 and reduced estimated glomerular filtration rate (eGFR<60 mL/min/1.73m2). The empaglyflosin therapy was discontinued in 37.1% of patients for the following reasons: the development of side effects – 11.6%, lack of efficacy of the therapy – 8.1%, the cost of the drug – 13.9%, other reasons – 3.5%. Thus, in real clinical practice, not only the development of side effects, but also socio-economic factors play an important role in supporting medication adherence.

The article discusses new data obtained in the course of several large observational studies evaluating the quality of prevention of cardiovascular diseases caused by atherosclerosis in the modern population. It also considers the the problem of insufficiently frequent use of lipid-lowering drugs in modern clinical practice. New data are presented on the benefits of using statins, in particular atorvastatin, for the purpose of not only secondary, but also primary prevention, as well as the preservation of the efficacy and safety of statin therapy over a long period. Possible benefits of using atorvastatin are discussed, including the possibility of more rapid achievement of the clinical effect that was reported during the randomized controlled clinical trial, which can play a role in the choice of certain statins in certain clinical situations. The recently published results of the analysis of data on the subjects of the ASCOT-LLA (Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm) study, which were obtained with long-term follow-up, are discussed. The article considers the new data on the probably excessively conservative approach to the selection of target levels of low-density lipoprotein cholesterol in the blood that were obtained during the large observational studies. The modern concept of “primary prevention” of cardiovascular diseases caused by atherosclerosis is considered. The recent data presented in the article include the features of the use of atorvastatin in clinical practice, which may be an additional reason for increasing the frequency of its use in clinical practice for the purpose of both secondary and primary prevention.

Modern clinical practice requires obligatory use of results of laboratory researches, international experience demonstrates the need of the clinic in laboratory information for making up to 70% of medical decisions. Described a large number of biomarkers of cardiovascular diseases, high diagnostic efficiency with sufficient level of evidence is shown not for all. In article the possibilities of a modern laboratory in determining markers of myocardium damage (troponins, hFABP), myocardial stress (natriuretic peptides) and neurohumoral regulation (copeptin), the diagnostic and predictive importance of these researches are considered.

Features of anti-hypertensive therapy amlodipiny at patients with the arterial hypertonia (AH) with comorbid pathology  – kislotozavisimy diseases (KZZ), accepting омепразол, depending on genetic features of the patient are studied and analysed. It is shown that a certain genetic polymorphism of an isoenzyme of P450 3A4 cytochrome can shift a metabolism of an omeprazol towards P450 3A4 cytochrome and promote more expressed oppression of activity of this enzyme. Depending on rate of a metabolism at the sick AG and KZZ receiving a combination of an amlodipin and an omeprazol various anti-hypertensive effect of an amlodipin can be observed. Reliable differences in dynamics of indicators of daily monitoring of the arterial blood pressure (ABP) at sick AG - slow metabolizator and sick AG – fast and intermediate metabolizator are received. Decrease of the activity of an isoenzyme of P450 3A4 cytochrome at patients - slow metabolizator leads to retardation of a metabolism of an amlodipin and, as a result, to rising of its concentration in a blood plasma that is clinically shown by more expressed anti-hypertensive effect.

The article presents the results of a study of the quality of life in 102 non-surgically treated patients with chronic rheumatic heart disease (CRHD) over 5 years. The authors used questionnaires to assess the quality of life: the Short Form Medical Outcomes Study (SF-36), the Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Minnesota Living with Heart Failure Questionnaire (MHFLQ). During 5-year follow-up, a statistically significant decrease in the total index of SF-36 physical health component from 36.39 ± 0.54 to 34.04 ± 0.74 and the functional status KCCQ from 23.14 ± 0.56 to 21.2 ± 0.58 was recorded against a 18.6 meters decrease in 6 minute walk distance, an increase in dyspnoea according to a visual analogue scale, a 0.1 cm2 decrease in the mitral orifice area and an increase in the atrium size. According to the summary of the SF-36 mental health component, the total clinical KCCQ indicator, and according to MHFLQ data, no statistically significant changes were observed. Two summary indicators of the KCCQ questionnaire had a significant correlation with SF-36: the functional KCCQ status correlated with the physical (correlation coefficient 0.689) and SF-36 mental (correlation coefficient 0.365) health components. The overall clinical KCCQ indicator also correlated with the SF-36 physical (correlation coefficient 0.305) and mental health – 38.65 ± 0.73 (correlation coefficient 0.588) components. Thus, SF-36 and KCCQ proved to be the most appropriate questionnaires to assess the quality of life of patients with CRDS.