Search

Aim      To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods  The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion      In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

.

The purpose of the study was a comparative study of antiplatelet activity of acetylsalicylic acid drugs, produced in gastro-resistant form trombopol 75 mg and aspirin cardio 100 mg in patients with high risk of cardiovascular events. Effect of trombopol 75 mg versus 100 mg aspirin cardio on platelet aggregation in 30 patients with high risk of cardiovascular events during 3 week treatment period was studied. Design method: blind, randomized, crossover method. Three weeks before the initial therapy, for those patients, who received antiplatelet platelet therapy at the time of inclusion in the study, this therapy was withdrew ("wash-out period"), after which patient was given one of the study drug (sequence of courses was s determined according to the scheme of randomization) with the recommendation of taking it daily in the morning at the same time. At each visit, before the next dose of the drug, blood samples for determination of ADP-induced platelet aggregation were taken, physical examination, measurement of blood pressure (BP) and heart rate were recorded, adverse events were recorded. Follow-up visit was performed 3 weeks later. 21 days after first study drug withdrawal, a second similar course of therapy with another drug was performed. Antiplatelet efficacy of aspirin was assessed by its effect on spontaneous and ADP- induced platelet aggregation. Aggregation activity was determined by turbidometric method by changing of translucent ability of the blood sample during the formation of aggregates after 2 minutes of exposure. As an inducer of aggregation ADP solutions of three concentrations (0.5, 1 and 2 mM) were used. No significant difference between compared drugs in influence on aggregation ability of platelets after 3 weeks of daily intake was found. No adverse events associated with taking of studied drugs were registered. It was concluded that, generic APD - trombopol 75 mg and aspirin cardio 100 mg were equivalent on antiplatelet efficacy and tolerability.

Aim: Achievement of target blood pressure (BP) levels in subjects with metabolic syndrome (MS) by the method of stepwise antihypertensive therapy and assessment of metabolic effects of combination of spirapril and nifedipine retard., Material and Methods: Patients (n=20, 12 women, 8 men, mean age 54+/-3 years) with MS were first given spirapril (6 mg/day). Nifedipine retard (40 mg/day) was added if target BP was not achieved after 4 weeks. Study duration was 12 weeks. The following parameters were measured at baseline and at study end: heart rate, blood pressure, body mass, waist circumference, parameters of lipid spectrum, content of insulin including index HOMA IR, blood glucose (fasting and during oral glucose tolerance test)., Results: Target BP levels were achieved in 18 patients (90%)--in 11 with moexipril monotherapy, in 9--after addition of nifedipine. Lowering of systolic and diastolic BP from baseline was 11 and 14%, respectively. After 3 months of combination antihypertensive therapy triglyceride levels decreased by 28% while high density lipoprotein cholesterol (CH) increased 6%. Total, low density lipoprotein CH and coefficient of atherogenecity did not change as well as fasting blood glucose after fast and oral glucose tolerance test. Concentration of fasting immunoreactive insulin significantly decreased by 34% entailing 35% decrease of insulin resistance. Therapy was well tolerated, side effects were transitory and did not cause withdrawal of treatment., Conclusion: In patients with MS and mild hypertension monotherapy with spirapril and combination of spirapril with nifedipine retard caused lowering of BP to target level in 55 and 90%, respectively. Combination of spirapril and nifedipine retard exerts positive metabolic action.

Aim: To assess in the aggregate hemodynamic peculiarities and changes of the myocardium as well as contribution of hypertension in formation of coronary risk in metabolic syndrome (MS)., Material and Methods: Patients (n=290) with hypertension of I-II degree and duration > or = 5 years were subjected to laboratory (parameters of lipid spectrum, glucose and insulin levels) and instrumental (24-hour blood pressure monitoring, echocardiography) examination. Criteria of MS were fasting insulin > 18 mcU/ml and/or glucose/insulin ratio < 6; blood pressure (BP) > or = 140/90 mm Hg; triglycerides > or = 200 mg/dl and/or high density lipoprotein cholesterol < 39 mg/dl; body mass index > 25 kg/m(2) with waist/hip circumference ratio > or = 0.95 (for men) or > or = 0.80 (for women); impaired glucose tolerance according to WHO criteria. PROCAM model was used for calculation of total coronary risk., Results: 37% of patients with hypertension had all components of MS. Hypertension took third place among contributors to formation of total coronary risk with input of 20%. Diastolic BP positively correlated with triglycerides, total cholesterol, index of insulin resistance and parameters of abdominal obesity. Mean 24 hour systolic and pulse BP in patients with MS were significantly higher than in a group of patients with hypertension without metabolic disturbances. Patients with MS had thicker left ventricular posterior wall and interventricular septum what was associated with increased end-systolic and end-diastolic dimensions as well as myocardial mass of the left ventricle., Conclusion: In patients with MS 24 hour BP profile is impaired at the account of high pulse BP and lack of nocturnal lowering of systolic and diastolic BP and is associated with concentric left ventricular hypertrophy.

Aim: To assess effect of combined antihypertensive and lipid lowering therapy on main characteristics of metabolic syndrome and total coronary risk., Material: Seventy five patients with metabolic syndrome aged 40-59 years were included into an open study with parallel groups in which the following combinations of lipid lowering and antihypertensive drugs were used for sweeksinch: atorvastatin + perindopril (n=17, group 1); simvastatin + atenolol (n=17, group 2); fenofibrate + atenolol (n=21, group 3), and simvastatin + indapamide (n=20, group 4). Systolic and diastolic blood pressures (BP), blood serum concentrations of total cholesterol (CH), low density lipoprotein (LDL) and high density lipoprotein (HDL) CH, glucose and immunoreactive insulin were measured before and after treatment. Total coronary risk was calculated according to the PROCAM model., Results: Treatment was associated with decreases of systolic and diastolic BP (from 11% in group 1 to 18,4% in group 2), lowering of total CH (by one third in groups 1 and 2, by 20% in groups 3 and 4), and triglycerides (by 2 times in group 3 and by 7-21% in other groups). Increases of HDL CH were observed in groups 2-4. There were no significant changes of markers of insulin resistance. Baseline total coronary risk was high (37%). Treatment was accompanied with lowering of total risk by 57.4-70%., Conclusion: Combined antihypertensive and lipid lowering therapy leads to pronounced lowering of high coronary risk in metabolic syndrome.

The purpose of the work was to investigate the relationship between immediate results of the electroimpulse therapy and such roentgenocardiometric data as the voloume of the heart, the cardio-thoracic index, Moore's coefficient, the extent of the left atrium enlargement and of the radius of the contrasted esophagus deviation. An analysis of the experience gained with 197 defibrillation of the heart in patients with rheumatic heart diseases complicated by auricular fibrillation bears proof to a high degree of reliability achieved through inclusion of roentgenocardiometric data in prognosing the resultant effect of the electroimpulse therapy.