Vol 23, No 1 (2021)
Articles
Kidneys and COVID-19
Consilium Medicum. 2021;23(1):7-10
7-10
Gouty (urate) nephropathy
Abstract
Clinical variants of kidney damage in gout including asymptomatic disorders of uric acid metabolism are discussed. The risk factor for hyperuricemia and associated kidney damage, clinical variants of gouty nephropathy and approaches to its treatment are presented.
Consilium Medicum. 2021;23(1):11-14
11-14
Biomarkers of acute kidney disease. Potential application in practice
Abstract
Acute kidney injury (AKI) is a common clinical syndrome. Its variety of presentation explains the absence of “kidney troponin”. Many research projects of new biomarkers are ongoing now. The enormous number of biomarkers has been identified already. It makes difficult to choose the correct test and dictates the importance of the fastest and most accurate introduction of AKI biomarkers into clinical practice. The integration of appropriately selected biomarkers in routine clinical practice for high-risk patients of AKI is very important. Currently, serum creatinine (sCr) and urine output are used to define AKI in accordance with the definition of KDIGO (Kidney Disease: Improving Global Outcomes), which have a number of significant limitations for practitioners, including the inability to diagnose AKI before serum creatinine levels increase. Practitioners need systematic information about the latest AKI markers and possible situations, when and for which patient groups they can be used. This is the main goal of our review.
Consilium Medicum. 2021;23(1):15-19
15-19
Diabetic nephropathy: what should cardiologist remember
Abstract
Prevalence of diabetes mellitus (DM) progressively increases around the world. Diabetic nephropathy (DN) is significant reason of end-stage renal disease and it is associated with high risk of cardiovascular disease and mortality. Necessity of expensive renal replacement therapy for patients with prominent vascular diabetic complications and end-stage renal disease has significant socio-economic impact. DM, as a one of leading causes of kidney diseases, competes for stricted resources of public health. Renal replacement therapy in patients with DM does not solve the whole problem, because survival of such patients is low, comparing with another kidney diseases, first of all because of cardiovascular diseases. Good control of glycaemia, blood pressure and cholesterol level and prescription of renin-angiotensin-aldosterone system inhibitors and statins decrease cardiovascular risk and slow down DN progression, as it was shown in many clinical trials. So patients with DM and DN should receive complex therapy for risk reduction of kidney disease and cardiovascular disorders progression.
Consilium Medicum. 2021;23(1):20-24
20-24
Hyperuricemia as a risk factor of contrast-induced acute kidney injury
Abstract
Aim. To assess the prevalence of contrast-induced acute kidney injury (CI-AKI) in patients with stable coronary artery disease (CAD) and hyperuricemia. Materials and methods. Patients with stable CAD receiving optimal medical therapy and with indications to coronary angiography and possible coronary angioplasty were included in an observational open prospective cohort study. The protocol of the study was registered in clinicaltrials.gov with ID NCT04014153. We conducted a sub-analysis of the group of patients with hyperuricemia (uric acid level >7 mg/dl). Results. We included 1023 patients with stable CAD. 32 patients suffered from hyperuricemia. The rate of CI-AKI in this group was 6.25% (2 patients), that was lower than in patients with normal levels of uric acid (13.1%). The difference was not statistically significant probably due to the small number of patients with hyperuricemia. The patients with hyperuricemia had proteinuria 3 times more frequently, than patients without, the rate of diabetes mellitus was 7% higher as well as anemia by 4.5% but didn’t reach statistical significance. Conclusion. The rate of CI-AKI in patients with hyperuricemia was twice lower than in patients with normal levels of uric acid. More research needs to be conducted in patients with metabolic syndrome in larger groups.
Consilium Medicum. 2021;23(1):25-27
25-27
Resistant arterial hypertension
Abstract
The review provides modern data on the examination and treatment tactics of patients with resistant arterial hypertension (RAH). The prevalence of RAH is about 10-15%, with a significant proportion of pseudo-resistance cases associated with low adherence to therapy, inaccurate blood pressure measurement technique, and increased arterial stiffness in the elderly. In patients with RAH, it is necessary to exclude secondary hypertension, of which drug hypertension associated with the use of nonsteroidal anti-inflammatory drugs, nasal sympathomimetics, oral contraceptives, as well as those caused by obstructive sleep apnea syndrome or primary hyperaldosteronism are prevalent. Secondary hypertension is often asymptomatic, therefore, additional examination is required for patients without the classic signs of these diseases. Pharmacotherapy of RAH includes a high-dose combination of antihypertensive drugs. In the first instance, first-line drugs (the renin-angiotensin system blockers, calcium antagonists, thiazide diuretics) should be combined with mineralocorticoid receptor antagonists, which have a good evidence base (PATHWAY-2, ReHOT studies), and then other reserve drugs. The study of interventional methods for the treatment of RAH continues. To date, the effectiveness of renal denervation has been proven. The study of the method of carotid baroreflex amplification continues.
Consilium Medicum. 2021;23(1):28-31
28-31
Features of the management of patients with atrial fibrillation during the COVID-19 pandemic: current questions and possible answers
Abstract
This publication is devoted to the tactics of management of patients with atrial fibrillation during the pandemic of new coronavirus infection (COVID-19). Among the key issues of relevance during this period, we thought it possible to consider the epidemiology, prevalence, and pathophysiological mechanisms of atrial fibrillation in patients with COVID-19, as well as treatment strategies with regard to obvious hospitalization, rhythm control/restoration and prevention of thromboembolic events. A separate issue is the tactics regarding the prescription or continuation of therapy aimed at the prevention of thromboembolic events and possible drug interactions in patients treated for COVID-19 and receiving anticoagulant therapy with direct oral anticoagulants for atrial fibrillation.
Consilium Medicum. 2021;23(1):32-34
32-34
Hemostasis disorders, thrombosis, antiphospholipid antibodies in patients with COVID-19
Abstract
The article provides an overview of main blood clotting disorders in coronavirus infection 2019 (COVID-19), which is associated with several hematological changes. Patients with COVID-19 develop typically two hemostasis disorders - an increased D-dimer levels and moderate thrombocytopenia, which occur in more than 40% of cases. Other hemostasis abnormalities, which are frequently reported in COVID-19, included prolonged prothrombin time (PT), also expressed as international normalized ratio, prolonged thrombin time, and activated partial thromboplastin time (APTT), which were typical acute phase reactions. Prolonged APTT or PT, and thrombocytopenia are common, especially in patients with severe clinical course. It has been hypothesized that increased D-dimer concentration and prolongation of PT, APTT are associated with higher mortality in patients with COVID-19. Disseminated intravascular coagulation occurs most often in severe cases of COVID-19 (about 2% of all hospitalized patients) and indicates a poor prognosis, i.e. about 90% mortality. It remains unclear whether SARS-CoV-2 can induce antiphospholipid antibodies. An increased incidence of positive lupus anticoagulants was observed in patients with COVID-19, it can be assumed that all patients with COVID-19 in whom antiphospholipid antibodies are revealed should be monitored and receive thromboprophylaxis even with no history of thromboembolism.
Consilium Medicum. 2021;23(1):35-42
35-42
Acute ST-segment elevation myocardial infarction in COVID-19 patients: a single hospital experience
Abstract
The COVID-19 pandemic has dramatically changed the lives of people and the work of hospitals and the health system. The rapid spread of infection, high mortality and congestion in hospitals are of high concern. Due to insufficiently causes, the number of admissions of patients with acute coronary syndrome (ACS) has significantly decreased in many centers, while timely intervention significantly improves the prognosis of AMI patients with ST segment elevation. Aim. To assess the clinical characteristics of patients with ST-segment elevation AMI during the re-profiling of the center for patients with COVID-19. Materials and methods. In total, the center worked to receive patients with COVID-19 and ACS for one month, during which 8 AMI patients with ST segment elevation were hospitalized. SARS-CoV-2 was diagnosed on the basis of nasopharyngeal or oropharyngeal smear PCR, serum IgM and IgG, or lung CT, which were performed on the day of admission, regardless of the severity of the condition. Segment elevation AMI was diagnosed based on typical clinical presentations accompanied by ST-segment elevation or newly diagnosed LBBB. Stenosis was considered as an infarction-related lesion in the presence of angiographic signs of thrombotic occlusion or subocclusion. Obstructive coronary artery disease was defined as >50% stenosis based on visual assessment of angiography. Results. All patients had ST-segment elevation, 6 (75%) patients had typical pain syndrome, 2 (25%) patients had pain syndrome accompanied by shortness of breath. SARS-CoV-2 was detected by PCR in 4 (50%), in 2 (25%) - an increased titer of IgM and IgG. CT scan showed 7 (87.5%) changes characteristic of COVID-19. Severe (CT3) and moderately severe (CT2) lesions were found in 4 (50%) patients. All patients underwent coronary angiography, thrombolysis was not performed. All patients had obstructive coronary artery disease requiring revascularization. When compared with the same calendar interval of the previous 3 years, the decrease in hospitalization for AMI with ST elevation was 50% or more. However, when comparing pain-door and door-balloon time intervals, no significant differences were found (p=0.786 and p=0.300, respectively). Conclusion. All patients with suspected ST-segment elevation AMI had obstructive coronary artery disease requiring revascularization. There was a significant decrease in the number of patients with AMI with ST-segment elevation without changing the time intervals before hospitalization and intervention.
Consilium Medicum. 2021;23(1):43-47
43-47
Sodium-glucose co-transporter-2 inhibitors in patients with heart failure. What's new? What are the prospects?
Abstract
This review presents the main results of recently (in 2020) published clinical studies investigating additional properties of drugs of the family of sodium-glucose co-transporter type 2 (SGLT2) inhibitors in patients with heart failure (HF). Of these, the most important is the EMPEROR-Reduced study which demonstrates the superiority of empagliflozin over placebo in preventing cardiovascular death and hospitalization for HF in patients with chronic HE with reduced left ventricular ejection fraction (LVEF). An important finding of this study is that, as in a recent study with a similar design with dapagliflozin - DAPA-HF, the benefit of SGLT2 inhibitors was independent on the presence or absence of diabetes mellitus in patients. The use of empagliflozin in patients with acute HF was studied in the EMPA-RESPONSE-AHF pilot study, in which, although there was no difference between placebo and the drug in the effect on the primary endpoint events, there was a clear trend towards improvement in clinical outcomes under the treatment with empagliflozin after 1 and 2 months of follow up. Administration of another member of the SGLT2 inhibitors family - so-tagliflozin - in the SOLOIST-WHF study in patients with diabetes and recent worsening HF (with any LVEF) was associated with a significant decrease in adverse events. In the VERIT CV study, another SGLT2 inhibitor, ertugliflozin, although it had no effect on long-term outcomes in patients with diabetes and cardiovascular disease, was better than placebo in preventing hospitalization for heart failure. Overall, the recently completed studies of SGLT2 inhibitors show that drugs of this family, which already play an important role in the treatment of patients with HF with reduced LVEF, may in the future become an important component of therapy in a wider range of patients with various types of HF.
Consilium Medicum. 2021;23(1):48-51
48-51
Statins in certain patient populations: scientific evidence and algorithms for practicing physicians
Abstract
Treatment with 3-hydroxy-3-methylglutaryl coenzyme A-reductase inhibitors (statins) is the basis for primary and secondary prevention of atherosclerosis and is regulated by many international and Russian guidelines and consensus. Data from lipid-lowering studies with "hard" endpoints showed that combination therapy can also lead to a further reduction in cardiovascular (CV) risk with the achievement of very low levels of low-density lipoprotein cholesterol (0.5-1 mmol/L) without increasing the risk of side effects. Despite the scientific progress in this field, there are large barriers between the recommendations and the real clinical practice of using statins in our country. As before, even patients with a very high CV risk are prescribed low and medium doses of statins by doctors of various specialties; the possibilities of combination therapy are still poorly realized. This review will provide an analysis of the evidence base, as well as an attempt to harmonize recommendations, expert consensus on optimizing statin therapy in certain patient groups - in primary prevention (low/moderate CV risk), in patients with high/very high CV risk in patients with arterial hypertension and dyslipidemia, as well as in patients with confirmed familial hypercholesterolemia. This publication presents possible algorithms for the use of statins in these categories of patients, which, in the author's opinion, will be useful for practicing physicians in their day-to-day clinical practice.
Consilium Medicum. 2021;23(1):52-60
52-60
Use of combination pills with acetylsalicylic acid and clopidogrel in coronary artery disease. Efficacy and assessment of adherence to treatment: Kobra Study
Abstract
Aim. Assessment of the efficacy and adherence to treatment with acetylsalicylic acid (ASA) and clopidogrel combination drug compared to separate administration of the drugs in patients with acute coronary syndrome and patients with chronic coronary syndrome after coronary stent implantation. Materials and methods. The study included 100 patients randomized to receive either original clopidogrel (Plavix® Sanofi) only or original ASA (Aspirin® Cardio Bayer) only or the generic fixed drug combination (Plagril® A Dr. Reddy's Laboratories Ltd.). Over the first 7-10 days after the index event, all patients were treated with a separate drug in the hospital, then received double antiplatelet therapy with appropriate drugs on an outpatient basis for 4 months, and purchased the drugs on their own for the last 2 months of follow-up. Monitoring the efficacy of therapy and patient adherence to treatment was carried out according to the clinic data, platelet aggregation indicators and blood thromboxane B2 (TXB2), salicylic acid and clopidogrel metabolite (carboxylic acid) levels on the 7th day after disease onset and after 8 and 16 weeks of treatment. Results. Most of the patients were elderly (mean age 68.3±10.6 years), of them 35% were women. After 8 and 16 weeks of treatment in hospital, platelet aggregation indicators did not differ between patients taking separate drugs or a fixed combination. The generic Plagril® A inhibited the aggregation response similarly to the original drugs. At moment of randomization, baseline blood TXB2, salicylic acid and the carboxyl metabolite of clopidogrel levels were comparable in both groups of patients (p>0.05). After 8 weeks of therapy, patients taking Plagril® A had significantly lower TXB2 levels compared with the separate administration of Plavix and Aspirin Cardio: 0.1±0.05 ng/ml vs 0.2±0.23 ng/ml, respectively (p<0.001). After 16 weeks, TXB2 levels reached 0.28±0.56 ng/ml vs 0.43±0.48 ng/ml, respectively (p=0.006). There were no differences in blood salicylic acid and clopidogrel carboxyl metabolite blood levels between the groups of patients during the entire study period. Adherence to antiplatelet therapy during inpatient period of treatment was 100%. In the first 8 weeks, it decreased to 74.5%, and after 16 weeks - to 71.5%. When taking the drugs separately, missing rate was higher in ASA group: 21.2% vs 5% in clopidogrel group. Conclusion. Plagril® A is bioequivalent and as effective as the original ASA and clopidogrel taken separately, in terms of the effect on platelet activity and blood clopidogrel metabolite levels. The adherence to a fixed combination of clopidogrel and ASA in patients with acute coronary syndrome and patients with chronic coronary syndrome is significantly higher than when these drugs are taken separately, both at the stages of free treatment and when purchasing drugs on their own.
Consilium Medicum. 2021;23(1):61-69
61-69
Possibilities of combination lipid-lowering therapy in a patient with very high cardiovascular risk (dinical case)
Abstract
The article demonstrates the possibility of prescribing an effective and safe lipid-lowering combination of the most tolerated doses of statins in combination with ezetimibe, using the example of a patient with severe lipid metabolism disorders in the post-infarction period. It has been shown that in real clinical practice, patients with acute coronary syndrome and persisting high LDL values are quite common, despite of the prescription of statins. These patients need closer follow-up and wider use of combined lipid-lowering therapy by adding ezetimibe to maximally tolerated doses of statins. Current clinical guidelines allow this to be done when patients fail to achieve target LDL values (>1.4 mmol/L) with statins monotherapy. This approach is effective and safe, which is illustrated by this hereditary clinical case. In routine clinical practice mandatory lipids control is required 4-6 weeks after patient’s discharge from the hospital for acute coronary syndrome. If the target lipids values were not achieved with the maximum dosage of statins, a mandatory using the combination therapy with ezetimibe is required.
Consilium Medicum. 2021;23(1):70-73
70-73
Clinical case of a successful treatment of uncontrolled arterial hypertension in a 67-year-old patient with captopril
Abstract
Effective blood pressure (BP) control remains an actual problem - according to the results of the multicenter study ESSE-RF, only 11.3% of women and 7.6% of men achieve it. Inadequate treatment of arterial hypertension often leads to clinically significant increase of BP without signs of damage to target organs. Such patients should be treated in out-patient setting by oral antihypertensive medications according to modern algorithms. It is also necessary to prescribe medications for subsequent long-term control of BP, if the patient has not previously taken them, or to optimize this type of therapy, if it was initially inadequate. The article presents a clinical case, which demonstrates that timely personalized treatment of uncontrolled hypertension leads to stabilization of the patient’s condition. Teaching the patient to self-relieve episodes of increased BP is of paramount importance. Modern pharmacological drugs allow achievement of the main goal of treatment - improvement the life’s prognosis due to both keeping blood pressure values at the target level and positively influencing other risk factors for the development of cardiovascular diseases.
Consilium Medicum. 2021;23(1):74-79
74-79
Left ventricular myocardial dysfunction and parameters of ambulatory blood pressure monitoring in patients with arterial hypertension and frailty
Abstract
Aim. To study and analyze the systolic and diastolic left ventricle (LV) function, parameters of the ambulatory blood pressure (BP) monitoring in patients over 65 years of age with arterial hypertension, depending on the presence of frailty. Materials and methods. We examined 77 patients over 65 years of age (25 men and 52 women) with arterial hypertension, who were divided into two groups: with the presence of frailty (38 people) and its absence (39 people). To detect frailty, we used the "Age is not a hindrance" questionnaire validated in Russia and the "Get up and go" test. The examination included echocardiography with tissue doppler and ambulatory BP monitoring. Results. In both groups, LV systolic function remained within normal values, while diastolic function was impaired. In the group of people without frailty, type 1 of left ventricular diastolic dysfunction prevailed in 63% of cases, in the group with frailty, type 2 of left ventricular diastolic dysfunction with increased filling pressure was registered in 77% of cases. In both groups, both isolated systolic arterial hypertension and normal indicators of SBP and DBP were recorded during the day. Systolo-diastolic hypertension and hypotension have been presented by individual cases. At the same time, significant differences (p<0.05) in the groups were revealed by the index of time of hypertension SBP at night and were higher in patients with frailty. Correlations were found between the time index of hypertension and SBP at night with the volume index of the left atrium in groups with frailty (0.34; p<0.05) and without frailty (0.40; p<0.05), as well as the time index of hypertension and SAD at night with the maximum rate of regurgitation on the tricuspid valve (0.42; p<0.05) and with estimated systolic pressure in the pulmonary artery (0.41; p<0.05) in the group with frailty. Conclusion. In the group of patients with arterial hypertension older than 65 years without frailty, violations of the left ventricular diastolic function by the type of slowing relaxation predominate, while in the group of patients with senile asthenia, violation of the left ventricular diastolic function by the type of pseudonormalization with increased filling pressure prevails. Features of the ambulatory BP monitoring of patients with hypertension older than 65 years with the presence of frailty are higher values of the time index of hypertension SBP at night. An increase in the time index of hypertension and SBP in patients with hypertension older than 65 years with frailty is associated with an increase in the volume of the left atrium, the rate of tricuspid regurgitation and systolic pressure in the pulmonary artery. The obtained data may indicate an adverse effect of frailty on the progression of heart failure in patients with arterial hypertension, which requires a comprehensive approach with the participation of a geriatrician in the management of such patients.
Consilium Medicum. 2021;23(1):80-83
80-83
Reducing the risk of chronic heart failure development in patients with arterial hypertension from the position of evidence medicine (focus on candesartan)
Abstract
Arterial hypertension is the main risk factor for the development of cardiovascular complications and makes a significant contribution to cardiovascular morbidity, including chronic heart failure, and mortality, amounting to more than 45%. The leading risk factors for the development of cardiovascular diseases also include a violation of lipid and carbohydrate metabolism. Current treatments for cardiovascular disease include the administration of angiotensin II receptor blockers. This article provides an overview of the literature data on the efficacy, safety profile of candesartan, high adherence to this drug in patients with arterial hypertension, chronic heart failure, impaired carbohydrate and lipid metabolism. The advantages of candesartan in comparison with other representatives of this group of drugs in the prevention of chronic heart failure are emphasized according to large-scale international randomized trials.
Consilium Medicum. 2021;23(1):84-92
84-92
Multisystem effect of cytoprotection
Abstract
The anti-ischemic and pleiotropic effects of a drug from the group of myocardial cytoprotectors - trimetazidine are discussed in the article. Currently, trimetazidine is recommended by experts of the scientific medical community as an effective antianginal drug for the treatment of patients of different ages diagnosed with stable angina. Trimetazidine, a reversible competitive inhibitor of 3-ketoacyl coenzyme A thiolase, has a good safety and tolerability profile, improves physical performance in patients with stable angina pectoris and ischemic cardiomyopathy, and is considered as an agent that affects the energy metabolism of cells under conditions of ischemia, optimizing the use of oxygen myocardium due to increased aerobic glycolysis and a decrease in the intensity of oxidation of free fatty acids. The results of the VASCO-angina study allow us to consider a daily dose of trimetazidine 70 mg as a standard therapeutic dose in the treatment of patients with coronary artery disease. The KARDIOKANON study confirmed the clinical equivalence of the original and reproducible drug trimetazidine - Deprenorm® SR (manufactured by Canonpharm Production, Russia) in the secondary prevention of coronary artery disease and its complications. Pleiotropic effects: anti-atherosclerotic, anti-inflammatory, nephroprotective, neuroprotective, allow expanding the use of trimetazidine in clinical practice.
Consilium Medicum. 2021;23(1):93-98
93-98
Levels of high-sensitivity C-reactive protein in young and middle-aged working men
Abstract
Cardiovascular diseases remain the leading cause of death in the working age population. In recent decades, more and more attention has been attracted to a subacute chronic inflammatory process as the cause of the progression of atherosclerosis and the development of atherothrombosis. A high-sensitivity C-reactive protein (hs-CRP) is recognized as an independent marker of cardiovascular disease risk, comparable in value to cholesterol or blood pressure. Aim. Measurement of hs-CRP levels in the group of initially healthy young and middle-aged working men. Materials and methods. The study included 349 men aged 28 to 56 years, who undergo periodic medical examination at the Diagnostic and Rehabilitation Center of “Gazprom transgaz Moscow” OOO from November 2018 to February 2020.The examination was carried out according to an employee occupation by order of the Ministry of Health and Social Development of Russia No. 302n. dated 12.04.2011. Additionally, a blood test for hs-CRP was performed. Results. An increase in hs-CRP >2 mg/L was found in 26.7% of the men examined. In the majority of cases (89.2%), the increase in CRP ranged between 2 and 5 mg/L, in 7.5% of cases - between 5 and 10 mg/L, and only in 3,2% it exceeded 10 mg/L. All patients with elevated hs-CRP levels showed no signs of an acute inflammatory reaction. A direct correlation of hs-CRP levels with overweight and abdominal obesity, which increases with age, was revealed. In 151 men, hs-CRP levels were assessed in dynamics, of which baseline increase of >2 mg / l was noted in 28.5%, and after a year -in 23.2%. When assessing the absolute value of biomarker concentration, an increase in this indicator after a year was registered in 45.3% of men. Conclusion. The high incidence of increased baseline hs-CRP levels in the group of relatively healthy young and middle-aged working men, and the tendency for this indicator to increase after a year in 45.3% of men makes it appropriate to include routine measurement of the basal hs-CRP concentration in men over 40 years of age in screening programs and standards of medical examinations.
Consilium Medicum. 2021;23(1):99-102
99-102
Experience of using a fixed combination of ramipril and indapamide in clinical practice
Abstract
Relevance. Arterial hypertension is one of the most common cardiovascular diseases in the adult population, but much has already been achieved in its treatment. The advantages of combination therapy, according to the clinical recommendations "Arterial Hypertension in Adults" in 2020, are as follows: an increase in the degree of blood pressure reduction is much stronger than an increase in the dose of a single drug; the possibility of physiological and pharmacological synergy between drugs of different classes, which may underlie a more pronounced reduction in blood pressure and better tolerability of treatment; suppression of the opposite mechanisms of increasing blood pressure. Aim. Aim of the study was to study the effect of the antihypertensive drug - Konsilar-D24 on the clinical picture, HRV data, and hemodynamic parameters in patients with stage II hypertension of the 2nd degree. Materials and methods. 40 patients with stage II AH and grade 2 AH were examined. During the outpatient examination, all patients were evaluated for HRV, SCAD, SMAD, ECHO-KG, ECG, GFR, laboratory and biochemical examination (UAC, OAM, blood bch-creatinine, urea, glucose, ASAT, ALAT), and the SF-36 quality of life questionnaire. Results. An increase in SVVR, a decrease in blood pressure, and an increase in the quality of life of the patient. Discussion: Konsilar-D24 is an effective antihypertensive agent for grade 2 hypertension in the complex treatment of stage II hypertension. Against the background of therapy, there is a persistent achievement of target figures, an increase in vagal tone. There is a metabolic neutrality of the drug, as well as nephro and cardioprotective effects.
Consilium Medicum. 2021;23(1):103-108
103-108