Rational Pharmacotherapy in Cardiology

Journal Information
ISSN / EISSN : 1819-6446 / 2225-3653
Current Publisher: Stolichnaya Izdatelskaya Kompaniyaizdat (10.20996)
Total articles ≅ 1,482
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Latest articles in this journal

O. V. Tsygankova, T. I. Batluk, L. D. Latyntseva, E. V. Akhmerova, N. M. Akhmedzhanov
Rational Pharmacotherapy in Cardiology, Volume 16, pp 557-563; doi:10.20996/1819-6446-2020-08-19

Primary hyperaldosteronism is an existence of a functional autonomous source with increased aldosterone production (full or partial) in relation to the renin-angiotensin system. Increased production of aldosterone by the adrenal cortex is the most common form of a secondary hypertension despite the low attention of internists to the problem. The success of a treatment and a prognosis of these patients depend on correct choice of screening (aldosterone/renin ratio) and clarifying diagnostic methods. There are clear algorithms for conducting these tests in accordance with Russian and International recommendations in the respective groups of patients. The purpose of this case report is to demonstrate the long way to diagnosis of primary hyperaldosteronism in a young patient with refractory hypertension, right adrenal adenoma, and clinical (convulsions, weakness) and laboratory signs of hypokalemia. It should not only have made the diagnosis easy, but it could have also absolutely justified the surgical tactics. Unfortunately, the final verification of the disease by carrying out a saline test was accomplished 13 years after the debut of hypertension and 10 years after the primary visualization of the adrenal adenoma.
Yu. A. Argunova, T. N. Zvereva, S. A. Pomeshkina, A. V. Ivanova, O. M. Polikutina, O. V. Gruzdeva, V. V. Kashtalap, O. L. Barbarash
Rational Pharmacotherapy in Cardiology, Volume 16, pp 508-515; doi:10.20996/1819-6446-2020-08-06

Aim. To evaluate the effectiveness of a comprehensive prehabilitation program including the optimization of drug therapy for patients undergoing elective coronary artery bypass grafting (CABG).Material and methods. 56 male patients with stable angina referred to elective on-pump CABG were enrolled in a study. All patients were screened for eligibility according to the inclusion/exclusion criteria and then randomized into two groups. Group 1 patients (n=28) underwent preoperative management (prehabilitation) for 14 days, including patient education and physical rehabilitation. Trimetazidine in a dose of 80 mg per day was added to the standard drug therapy. Group 2 patients (n=28) underwent similar preoperative management, but with the standard drug therapy without trimetazidine. In addition to the routine methods of preoperative management, all patients underwent the 6-minute walk test (6MWT) to assess exercise tolerance and speckle tracking echocardiography to measure left ventricular (LV) longitudinal deformation. Serum troponin T was measured in all patients. The measurements were performed at admission and after the surgery.Results. Patients did not differ in the main clinical and demographic data, as well as the main preoperative speckle tracking echocardiography findings. The intraoperative parameters were comparable in both groups. The rate of early postoperative complications was 61% (n=17) in Group 1 and 64% (n=18) in Group 2 (p>0.05). LV ejection fraction significantly decreased postoperatively in both groups (pConclusion. The addition of trimetazidine in a dose of 80 mg daily in the prehabilitation program for patients undergoing elective CABG demonstrated better postoperative indicators of LV longitudinal deformation and an increase in exercise tolerance. Obtained findings allowed considering this approach to the preoperative management as an additional method of cardiac protection and optimization of the functional status of patients.
S. I. Farag, O. S. Arafa, A.A. E. Hassan, H. M. Mashhour, A. M. Bendary
Rational Pharmacotherapy in Cardiology, Volume 16, pp 522-527; doi:10.20996/1819-6446-2020-08-14

Coagulation status with vitamin K antagonists (VKAs) needs to be monitored carefully to ensure maximal efficacy with minimal complication rates.Aim. To study the international normalized ratio (INR) values in patients on VKAs in selected area, find out which patient characteristics that is associated with good INR control and calculation of the time in the therapeutic range (TTR) according to the number of INR/Patient.Material and methods. A total of 200 patients with non-valvular atrial fibrillation prescribed vitamin K antagonist as anticoagulant were evaluated. They were divided into two groups: group I with TTR≥65% (n=93) and group II with TTR2DS2-VASc score and HAS-BLED score, respectively. Presence of comorbid diseases was assessed by the Charlson index. TTR was calculated using Rosendaal method.Results. Patients in group I (TTR≥65%) were younger (p2DS2-VASc score was 1.0 and HAS-BLED score – 0.0), and also had fewer comorbidities (mean Charlson index was 0.0; pConclusion. It was found that high level of education compared to lower levels is the only significant independent predictor for obtaining good INR control.
O. L. Barbarash, V. V. Kashtalap, I. A. Shibanova
Rational Pharmacotherapy in Cardiology, Volume 16, pp 607-613; doi:10.20996/1819-6446-2020-08-08

Modern data on comorbidity in coronary artery disease (CAD) are presented in the article, as well as its frequency, dependence on the age, clinical and prognostic significance, and increasing relevance for practical health care. The positions of one of the components of cardiovascular comorbidity – multifocal atherosclerosis – are presented. The existing approaches to the detection and clinical assessment of multifocal atherosclerosis, as well as to the management of the high risk of ischemic events in such patients, are outlined. The main positions on the prevention of the risk of cardiovascular complications in patients with CAD and atherosclerosis of the peripheral arteries using a combination of the anticoagulant – rivaroxaban and the antiplatelet agent – acetylsalicylic acid, are highlighted on the basis of the results of clinical studies. Promising possibilities of using such a therapeutic approach to the management of comorbid patients in routine clinical practice are presented.
M. V. Zhuravleva, E. V. Luchinina, T. V. Shelekhova, S. Yu. Serebrova, S. A. Belkov, A. I. Dmitriev, G. I. Gorodetskaya
Rational Pharmacotherapy in Cardiology, Volume 16, pp 601-606; doi:10.20996/1819-6446-2020-08-12

Modern tactics of treatment of arterial hypertension (AH) involves the use of both monotherapy and combination therapy. Monotherapy is recommended primarily for low-risk patients with systolic blood pressure (BP)< 150 mm Hg. Monotherapy should also be preferred in very high risk patients with high normal BP and frail elderly patients. However, combination therapy is recommended for most hypertensive patients as initial therapy. Starting combination therapy is more effective in lowering BP than monotherapy. Even at low doses, it is usually more effective than maximum dose monotherapy. The most commonly prescribed combinations today contain a renin-angiotensin system blocker (angiotensin converting enzyme inhibitors or angiotensin II receptor blocker) with a calcium antagonist or diuretic. The combination of lisinopril with amlodipine not only proved its high efficiency in various international and Russian studies, but also turned out to be pharmacoeconomically more profitable. Fixed combinations of lisinopril and amlodipine are the optimal choice in the treatment of hypertensive patients, due to all the advantages of both components: higher efficacy and safety rates compared to monotherapy and better patient adherence to treatment.
A. S. Kurekhyan, M. I. Smirnova, V. M. Gorbunov, Ya. N. Koshelyaevskaya, A. D. Deev, M. M. Loukianov
Rational Pharmacotherapy in Cardiology, Volume 16, pp 542-549; doi:10.20996/1819-6446-2020-08-20

Diagnosis of the blood pressure (BP) phenotype is the most important indication for its ambulatory measurement because BP phenotype is associated with cardiovascular complications and death. The study of BP phenotypes is important for patients with hypertension (HT) and comorbidity, including asthma and chronic obstructive pulmonary disease (COPD). The combination of HT with these lower airway diseases (LAD) leads to the mutual influence of pathologies creates difficulties in the drugs choice and may affect BP phenotype in HT patients.Aim. To compare in the prospective investigation various characteristics of BP phenotype in HT patients considering LAD (asthma or COPD).Material and methods. The prospective cohort study of ambulatory patients with HT (n=156) was carried out. The part of these patients had asthma or COPD (n=69). The clinical measurements and 24-hour BP monitoring, spirometry, clinical and biochemical blood tests, standard examination were performed, initially and after 12 months. BP phenotype were determined by the ratio of clinical BP and ambulatory BP considering their threshold values. Standard statistical methods and multivariate analysis were used.Results. Patients with LAD had 2 times more often prognostically unfavorable phenotypes: ineffective antihypertensive therapy (AHT) 37.3% vs 15.7% and masked AHT inefficiency 7.5% vs 4.5%; white coat HT on treatment (WCH) and effective AHT were less common(29.9% vs 42.7%; 25.5% vs 37.1%, respectively, p 148 mm Hg (b=2.733, p=0.040), LAD (b=1.015, p=0.011), serum total cholesterol (b=0.350, p=0.043), degree of nighttime diastolic BP decrease (for 13.1-18.0% b=-2.130, p=0.004; for 18.1-24.0% b=-2.509, p=0.001). The factors associated with masked AHT inefficiency in comparison to effective AHT were heart rate in orthostasis >87 beats/min(b=3,512, p=0.006) and SBP in orthostasis 141-148 mm Hg (b=3.405, p=0.004).Conclusion. The prevalence of prognostically unfavorable BP phenotypes (ineffective AHT and masked AHT inefficiency) is two times higher in HT patients with LAD. The first is associated with LAD presence, sex, and serum cholesterol; both phenotypes interrelated with hemodynamic parameters including degree of nighttime diastolic BP decrease. We found no association between AHT and LAD therapy with the BP phenotypes in this study. However, larger works in this area are required, including analysis of outcomes in long-term prospective studies.
S. Yu. Martsevich
Rational Pharmacotherapy in Cardiology, Volume 16, pp 635-637; doi:10.20996/1819-6446-2020-08-09

The data from the observational study of M. Fralick et al. were analyzed in the article. The authors analyzed a large database of patients with atrial fibrillation and concluded that rivaroxaban is inferior to apixaban in its ability to prevent ischemic stroke and systemic embolism and is more likely to cause bleeding. Serious methodological defects of the analysis take place. No statistical methods are capable of correcting the absence of such important information in the database as the doctor's motives for prescribing a particular drug, as well as the patient's adherence to taking it. It is also noted that the patients included in the study, according to clinical characteristics, did not correspond to the typical population of patients with atrial fibrillation. The author considers the conclusions made in the mentioned work to be unauthorized.
V. I. Podzolkov, A. I. Tarzimanova, A. E. Bragina, K. K. Osadchiy, R. G. Gataulin, K. A. Oganesyan, N. V. Lobova, Z. B. Jafarova
Rational Pharmacotherapy in Cardiology, Volume 16, pp 516-521; doi:10.20996/1819-6446-2020-08-05

Aim. To study changes in vascular wall stiffness in patients with obesity and paroxysmal atrial fibrillation (AF) during sinus rhythm retention.Material and methods. The study included 86 obese patients aged 38 to 72 years. Patients were divided into 2 groups: 42 patients with paroxysmal AF and obesity (Group I) and 44 patients with obesity and without rhythm disturbance (Group II). All patients were evaluated for the main parameters of arterial wall stiffness: the heart-ankle vascular index (CAVI) and the ankle-brachial index (ABI) in the right and left main arteries.Results. Body mass index (BMI) did not differ significantly between groups. The prevalence of visceral obesity in patients with paroxysmal AF was significantly higher than in patients without heart rhythm disorders. The study of vascular wall rigidity revealed a significant increase in the CAVI index in patients with paroxysmal AF compared with this in patients without cardiac arrhythmia. The average value of the CAVI index was 9.61±1.51 and 7.92±0.18, respectively (p=0.0003). In patients with obesity and paroxysmal AF, correlations were found between waist circumference to hip circumference (WC/HC) ratio and CAVI index (r=0.455, p=0.004); WC/height ratio and CAVI index (r=0.443, p=0.003); between WC and CAVI index (r=0.493, p=0.002). A positive direct relationship was found between CAVI index and the frequency of AF attacks during the year: r=0.782 (p=0.001).Conclusion. A significant increase in the CAVI index, indicating a change in vascular wall stiffness, was found in patients with obesity and paroxysmal AF when compared with overweight patients without heart rhythm disorders. The increase in the CAVI index was correlated with the increase in WC, the WC/HC ratio, and WC/height ratio. There was a significant direct relationship between the CAVI index and the frequency of arrhythmia attacks in patients with obesity and paroxysmal AF.
M. A. Druzhilov, T. Y. Kuznetsova
Rational Pharmacotherapy in Cardiology, Volume 16, pp 585-589; doi:10.20996/1819-6446-2020-08-15

There is evidence of a correlation between epicardial adipose tissue and the presence and severity of coronary heart disease, the development of hypertrophy, impaired diastolic and systolic function of the left ventricle, enlargement, fibrosis and electrophysiological remodeling of the atria, the occurrence and severity of supraventricular arrhythmias. There is also a lot of evidence of the influence of both non-drug methods and drugs on the severity and functional activity of epicardial adipose tissue, which can be considered as a potentially modifiable factor of cardiovascular risk, the various therapeutic interventions target and a criterion for their effectiveness. Its unique characteristics suggest the advisability of pharmacological strategies aimed at regulating the expression of genes encoding the secretion of adipocytokines and adipocyte function, and a dynamic assessment of the severity of epicardial fat during therapy can be a tool to evaluate its effectiveness in various cardiovascular diseases.
N. M. Gafurova, E. V. Shikh, O. D. Ostroumova
Rational Pharmacotherapy in Cardiology, Volume 16, pp 595-600; doi:10.20996/1819-6446-2020-03-04

Heart failure (HF) is a growing public health problem with an estimated prevalence of 38 million patients worldwide. Congestion and formation of edema – are typical symptoms of heart failure. Diuretics are the mainstay of therapy in heart failure and are used to relieve congestion and improve exercise tolerance. Also, the administration of diuretics should be considered to reduce the risk of HF hospitalization. Loop diuretics are used by nearly 80% of all chronic HF patients and remain the drugs of choice. Although diuretics are one of the most prescribed classes of drugs, recommendations for their titration scheme for long-term use have not yet been finalized, nor have there been major prospective randomized controlled studies on the effect of diuretics on morbidity and mortality. A Cochrane meta-analysis has shown that in patients with chronic HF, loop and thiazide diuretics might reduce the risk of death and worsening of HF in comparison to placebo and could lead to improved exercise capacity. Guideline recommends the use lowest possible dose of diuretics due to probable electrolyte disturbances, further neurohormonal activation, accelerated kidney function decline, and symptomatic hypotension. Diuretic resistance is associated with an unfavorable prognosis and an increased risk of readmission. There are significant pharmacokinetic differences between the loop diuretics. Compared with furosemide, torasemide has a high bioavailability irrespective of food intake, and carries a longer half‐life and duration of effect; also, the benefits of torasemide are its additional anti-fibrotic and neurohormonal effects. Optimization of diuretic therapy in patients with HF remains a challenge and requires further research, as well as an individual approach to patients, since there is no convincing evidence base.
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