Vol 7, No 2 (2016)

The goal lies in the study of amlodipine effects on levels of blood pressure (BP), hypertensive reaction under isometric exercise, lipid and carbohydrate metabolism, platelet hemostasis, quality of life (QoL) and psychological status in patients with arterial hypertension (AH), obese abdominal type. Material and methods. The study included 30 patients with hypertension of the 1st and 2 nd degree in age from 37 to 72 years (mean age 56.6±7.9 years) with abdominal obesity type. After a 2-week period "cleanse" of patients, amlodipine was administered at an initial dose of 5 mg, with an increase up to 2 weeks in the absence of 10 mg of achieving target blood pressure (less than 140/90 mm Hg). The total duration of treatment took 6 weeks. In a study conducted, the clinical examination and ambulatory BP monitoring were also included, and a manual isometric test was taken, to determine the concentration of lipids and lipoproteins, glucose and insulin platelet aggregation (spontaneous and under the influence of adenosine acid) was evaluated, as well as adrenaline in different concentrations. The questionnaires on quality of life, Hospital Anxiety and Depression Scale were used as well. Results. Against the background of 6 weeks of therapy with amlodipine, a decrease in blood pressure levels, as measured by the patient in a sitting position (21.7±8.2/12.3±4.6 mm Hg, p<0.001) and in the standing position (19.8±6.9/11.5±5.5 mm Hg, p<0.001). Appointment of amlodipine to patients with hypertension obesity has led to positive changes in the diurnal blood pressure profile. This was combined with a decrease in the heart rate of the patient in the sitting position (at 4.2±6.4 beats / min, p=0.002) and standing (at 2.6±5.9 beats/min, p=0.03). After 6 weeks of receiving amlodipine at the peak of isometric exercise were detected decrease in average blood pressure levels (20.2±11.6/10.2±5.2 mm Hg, p<0.001), heart rate (at 4.2±6.6 beats / min, p=0.002) and the value of the "double work" (30.2%, p<0.05). In response to isometric exercise there was a decrease in diastolic blood pressure level of growth (6.9%, p=0.012) and the value of the "double work" (21.9%, p<0.05). The therapy with amlodipine was observed decrease in total cholesterol and low density lipoprotein cholesterol. The concentration of blood glucose and insulin therapy remained stable. There was a positive trend to a decrease in platelet aggregation under the action of adenosine. QoL in patients with hypertension and obesity was significantly improved after 6 weeks of receiving amlodipine. Conclusion. In patients with hypertension and obesity demonstrated high antihypertensive efficacy of amlodipine, including the conditions of isometric exercise, inducing hypertensive reaction.

The article deals with the issue of genetic determination of atrial fibrillation. In particular, it is shown that a rare polymorphism rs2200733 T allele on chromosome 4q25 statistically more frequently (p=0,029) in patients with atrial fibrillation compared with the control group data. The question of the functional significance of this polymorphism in the development of electrical instability of the atrial myocardium is also addressed.

Goal. The study of the clinical efficacy of combined use of systematic physical training (PT) and a fixed combination of a blocker of receptors for angiotensin II (ARB), valsartanum (Val) to dihydropyridine calcium antagonist (AA) with amlodipine (AML), appointed as part of standard therapy for smokers in patients with cardio-pulmonary pathology outpatient (III) stage of rehabilitation. Material. The study included 30 men aged 40 to 65 years. All patients were treated with statins, aspirin, .-blockers, selective and systematic FT performed 3 times a week for 4 months (duration of the training - 60 minutes with a period of moderate intensity training load of 50-60% of the threshold power cycling). After randomization, patients were divided into two groups: Group 1 (n=12) received additional angiotensin converting enzyme inhibitors (ACEI) and 2nd (n=18) - the combined preparation Exforge ® (AML 5-10 mg/Val 60 mg). Study duration - 4 months. Methods. In a study conducted clinical examination, bicycle stress test (VEM-test), echocardiography (echocardiography), ambulatory blood pressure monitoring (ABPM), spirometry, determination of concentrations of lipids and lipoproteins, glucose, fibrinogen, uric acid, creatinine, a calculation of glomerular filtration rate by MDRD. They used questionnaires: Hospital Anxiety and Depression Scale (HADS), St George's Hospital (SGRQ) and quality of life (QOL) SF-36. Results. Against the background of the FT, combined with taking an ACE inhibitor or a fixed combination of AML/Val, reduced the number of smoked cigarettes at 20.8±5.2 pieces (<0.001) and 25.6±4.2 pieces (<0.001), respectively. Also, there was a significant decrease in heart rate: in the group of ACE inhibitors on the FT+3,7±4,4 beats/min in group FT+AML/Val at 6.4±4.1 beats/min (p=0,09 between groups). Reveals reduction of office blood pressure (BP): systolic blood pressure (SBP) at 37.3±6.3 mm Hg (p<0,001) in the FT+ACEI and 36.1±6.9 mm Hg (p<0.001) in the FT+AML Val, diastolic blood pressure (DBP) at 19.6±3.9 mm Hg (p<0,001) and 18.2±4.4 mm Hg (p<0.001), respectively. According ABPM smokers and train patients on therapy AML/Val group when compared with FT+ACEI noted a marked decrease in the average daily maximum SBP (-3 mm Hg, p<0.05), daily (at -4, 4 mm Hg, p<0.05) and the night (to -1,2 mm Hg, p<0.05) and diastolic blood pressure variability in the night hours (-1.6 mm Hg, p<0.05). After 4 months of receiving FT was observed in the growth of the basic parameters of physical performance to a greater extent in the treatment of AML/shaft against receiving ACE inhibitors: FN capacity by 51.4% (p<0.001) and 32.3% (p<0.001), with a total length of FN by 51.6% (p<0.001) and 41,4% (p<0.001). Time to development of angina attack at HEM-sample after the FT in treated AML/Val increased to a greater extent (29.1%, p<0.05) against taking ACE inhibitor therapy. Both groups noted positive changes in the structural and functional parameters of the heart according to echocardiography due to lower average pressure in the pulmonary artery. In both groups there was an improvement of function parameters of external respiration, but to a greater extent in the group FT+AML/Val, as well as indicators of psychological status and quality of life. Conclusion. The inclusion of patients with a very high risk of cardiovascular events with comorbid disorders in the short (4 month) physical rehabilitation program phase III (on an outpatient basis) gives a positive clinical effect, worse when its combined with cardioprotective therapy (ACE inhibitors or AK/ARBs). This effect was most pronounced when joining the FT fixed combination of AML/Val.

Goal. Description of the influence of systematic phisical training (PT) on some indicators of physical performance (Fed) and the assessment of daily locomotor activity and psychological status of patients after myocardial infarction and were followed for 16 years. Material and methods. We observed 11 patients (9 men and 2 women) who after acute myocardial infarction (AMI) have participated in a one-year rehabilitation program, the basis of which amounted to the controlled PT of medium intensity (50-60%). Subsequently, patients continued PT program in hospital and in the home environment (observation of patients was 16 years). Programs of systematic PT were performed in a hospital, carried out with a small break in 2014-2015. Patients are constantly trained (ie the period of continuous PT amounted to 2 years), while a program of home exercises, patients try to perform consistently. They all underwent clinical examination, had a load test performed on a cycle ergometer protocol submaximal loading, questionnaires were evaluated by physical activity, level of subjective control, anxiety and depression and adherence to therapy estimated. Results. Blood pressure (BP) in patients were stable: in 2014 (prior to the beginning of organized PT) systolic blood pressure (SBP) was 127.9±15.2 mm Hg and diastolic blood pressure (DBP) - 74±6.3 mm Hg. In 2 years (2015) after the resumption of organized PT SBP decreased slightly to 121.2±7.0 mm Hg (p<0.05 to the value in 2014), DBP has not changed (79.9±5.4 mm Hg). In 1999, 9 patients were smoking, 2014 - 2 smoking people left, that is, 7 patients to stop smoking with the support of other group members altogether. Patients monitored their cholesterol (LDL) in the blood: 4 patients (36%) through diet and statins, 6 patients (54.5%) - only statins and only one patient - by diet. Motor activity in patients in 2014 was at the level of moderate (77.2±8.3 by questionnaire ODA23+) and remained so in 2015. Patients remained average tolerance physical exercise (PE) and they carried out the same amount of total physical work at HEM-sample and in 1999 (122±25 W) and in 2015 (113±25 W, p>0.05), ie, 16 years. In 2015, when compared with the 1999 peak of PE decreased SBP by 4.6% (p<0.05), mean arterial pressure (12%, p<0.01), double product (DP) magnitude 12.1% (p<0.01), as well as the rate increase efficiency of the heart by the DP to 33,4% (p<0.01). The average score on the anxiety level was 5.7±0.8 and the level of depression 5.8±0.6. Adherence to treatment was high in 70% of patients, ie, 4 points (the average score for the group of 3.8±0.2 on a scale of compliance by Morisky-Green). Conclusion. Involving patients in physical rehabilitation program in a group, in which established social relationships, there is the psychological comfort and prevalent sense of high responsibility for their own health on a background of good awareness through regular contact with the doctor to a large extent explains the phenomenon of long-term high level of commitment of these patients physical rehabilitation and treatment.

Coronary artery bypass grafting (CABG) is known as the gold standard treatment of unprotected left main coronary artery (LMCA) disease and has the highest level of evidence in European and American recommendations. However development of endovascular methods of treatment, and first of all decrease of in-stent-restenosis allow us to consider angioplasty and stenting of LMCA as an alternative method to CABG. The comparative world analysis of results of percutaneous coronary interventions and CABG is provided in article. It tells also how efficiency of percutaneous coronary interventions depends on such factors as lesion localization, diabetes, type of drug-eluting stent.

The article describes the clinical and psychosocial particulars of type 2 diabetes mellitus in older adults. Are presented treatment goals and the importance of glycemic control in these patients.

The lecture discusses the current methods of pain relief, inhibition of thrombus formation process in the coronary artery, restoring blood flow in the coronary artery and prevent it retrombosis in patients with acute coronary syndrome. The results of large randomized clinical trials of the effectiveness of antiplatelet agents, anticoagulants, fibrinolytic agents, indications for their use and dosing regimens. The results of clinical application of non-drug methods of restoration of coronary blood flow. Settle guidelines for choosing the optimal strategy for patients with acute coronary syndrome, depending on the characteristics of myocardial injury and the degree of cardiovascular risk.