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Modern tactics of antihypertensive therapy with fixed dose combination or with free combinations of antihypertensive drugs are reviewed in the article. The evidence that a flexible regimen of combination antihypertensive therapy is more reasonable in the modern treatment of arterial hypertension is presented. The question of the characteristics of hypertensive patients in whom lowering blood pressure to lower target levels may be useful to improve the prognosis is discussed considering the results of the analysis of data on participants in a randomized clinical trial SPRINT. Approaches to reducing the incidence of adverse events caused by antihypertensive therapy in such patients in general and in elderly and senile patients who have not only a higher likelihood of achieving advantages of more intensive antihypertensive therapy regimens for influencing the prognosis, but also a higher risk of complications, due to therapy are considered. The problem of less high efficacy of using replicated antihypertensive drugs (generics) compared to the original drugs is discussed.

The article discusses approaches to the choice of antihypertensive drugs, which may be based on the adoption and implementation of new clinical guidelines for the management of patients with arterial hypertension. This paper provides data on the efficacy and safety of candesartan, an antihypertensive drug, which advantages were identified during a large number of randomized clinical trials. It discusses the recently published data on the effectiveness of more intensive regimens of antihypertensive therapy to reduce the risk of moderate cognitive impairment in patients with arterial hypertension. In this regard, the authors provide data of the previously completed studies, which showed the effect of candesartan on the rate of cognitive decline in patients with arterial hypertension in the elderly and senile age. The features of the pharmacological characteristics of candesaratan that can remotely explain its clinical efficacy are considered. The data of experimental studies of candesartan in animals, which contribute to the concept of the possible effects of candesartan, are presented.

The article discusses aspects of drug-induced falls in elderly comorbid patients against the background of polypragmasy and also assesses the role of drug interactions that are highly dangerous according to the risk of falling. A drug audit of the obtained pharmacotherapy database was performed in patients with comorbid pathology older than 75 years, in order to identify fall-risk-increasing drugs, ranked according to the degree of risk of falling, their significant interactions and with using the traffic light classification. The data on the analysis of the contribution of psychotropic, cardiological drugs and their combination on the risk of developing a fall in the hospital in comorbid patients of old age against polypragmasy are presented.

Background. The fall in the elderly is observed much more often than in younger people, and according to statistics the number of people over 65 years who have suffered a fall during the year reaches 30 %, while the probability of injury. Most of the falls in elderly patients does not lead to injury, but the developing at the same time unfavorable psychological discomfort can sharply limit the usual activity, lead to the formation of dependence on outside help, disadaptation in the home and form a fear of a possible fall. Falls, accompanied by the development of trauma, are observed in 10–15 % of cases. The objective was to study the relationship between polymorbidity, polypragmasia and the development of the fall in elderly patients cardiological profile.Results. Polymorbidity prevailed in the group of patients who suffered a fall in the hospital (8.9 ± 2.6 vs 7.5 ± 1.5 in men. 8.5 ± 2.2 vs 7.2 ± 1.6 in women). In patients undergoing a decline, it was also noted, and polypharmacy to a greater extent than cohort patients without falling (9.4 ± 1.9 vs 78.4 ± 2.2 in men. and 9.6 ± 2.7 vs 9.1 ± 2.5 for women). In addition, patients who suffered a fall in the hospital by age were older than patients in the comparison group (86 ± 6 vs 85 ± 5 in men, 87 ± 5 vs 84 ± 5 in women). We also revealed the tendency of the predominance of women in the subgroup of patients with the incidence and development of trauma. Conclusion. Minimizing the amount of drugs received, as the fight against polypragmasy can help reduce the incidence of falls in elderly patients.

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.

A role of angiotensin-converting enzyme (ACE) inhibitors in cardiovascular diseases treatment and prevention is discussed. Some large randomized clinical trials are analyzed. Physical and chemical properties of drugs and its evidence base are considered among possible factors of ACE inhibitors choice. A problem of ACE inhibitor choice is also discussed in context of secondary prevention of cardiovascular complications in arterial hypertension and after myocardial infarction. It is concluded that the choice of any drug for cardiovascular disease treatment is mainly determined by its evidence base.

Aim. To study effects of ramipril, molsidomine and their combinations on morphofunctional heart indices and clinical status of patients with chronic heart failure (CHF), which complicated an ischemic heart disease (IHD).Material and methods. 41 patients with CHF class II-III (NYHA), which complicated IHD (postinfarction cardiosclerosis) were included in the study. Patients did not receive ACE inhibitors. Patients were split in 3 groups: patients of the 1st group received ramipril, patients of the 2nd group - molsidomine and patients of the 3rd group – combination of ramipril and molsidomine. Clinical examination, laboratory tests, electrocardiogram, cardiac ultrasonograthy, exercise tolerance test was performed before treatment and after 3 months and 1 year of treatment.Results. Improvement of clinical status and decrease of class NYHA was found in 38,5% of patients in ramipril group; in 33,3% of patients in molsidomine group and in 23,1 % of patients in combined therapy group. Increase of ejection fraction on 17 % from initial level was found in patients receiving combined therapy; on 25,2% - in patients receiving molsidomine; and on 12,4% - in patients receiving ramipril. Decrease of residual volumes of a left ventricle also was detected.Conclusion. All therapies (ramipril, molsidomine and their combination) in patients with CHF class II-III and postinfarction cardiosclerosis are clinically and hemodynamically effective in long term implementation.

Aim. To evaluate antianginal and antiischemic activity of molsidomine (Corvaton) in stable angina pectoris of II-III functional class (FC).Material and methods. 45 patients with II FC (31 persons) and III FC of angina (14 persons) were included into the study. All patients took molsidomine in individual doses during 3 months. Antianginal and antiischemic activity of molsidomine was estimated by veloergometric tests.Results. Molsidomine therapy resulted in disappearance of angina pectoris in 41, 7% of patients with stable angina of II-III FC and reduction of ST depression.Conclusion. Molsidomine is an effective antianginal and antiischemic medicine in patients with stable angina of II-III FC and provides the stable effect during long-term usage.

Apixaban is a "new" oral anticoagulant, direct Xa factor inhibitor with a good evidence base of the efficacy in the prevention of ischemic stroke in patients with atrial fibrillation. The article is devoted to apixaban use in clinical practice: examination before apixaban administration, clinical situation when laboratory control and monitoring are needed, drugs interactions (at the level of CYP3A4, P-gp), management of patients with bleeding because of apixaban therapy (including antidotes application), perioperative management of patients receiving apixaban.

Data of the negative effect of high concentrations of aldosterone in the blood for cardiovascular disease, which served as the theoretical basis for wider use in clinical practice of the drugs belonging to the class of aldosterone receptor blockers is presented. Evidence-based data on efficacy and safety of aldosterone receptor blockers, which were obtained in the course of several randomized clinical trials is performed. Particular attention is paid to aspects of the clinical use of selective aldosterone receptor blocker eplerenone, including current data, which makes reasonable extension of indications for its use in treating patients with chronic heart failure. Data on indications of eplerenone use in patients with hypertension, especially in the case of associated target organ damage is presented.

Orthogonal polarization spectral (OPS) imaging is a new technique that can be used to visualize the microcirculation with reflected light. It uses hemoglobin absorption to visualize the red blood cells (RBCs). Thus the method could fail at low hematocrit (Hct). The aim of this study was to validate OPS imaging for quantitative measurements of diameter and functional capillary density (FCD) under conditions of hemodilution of varying degrees to achieve a wide range of Hcts. The validation was performed in the dorsal skinfold chamber of nine awake Syrian golden hamsters. Measurements of vessel diameter and FCD were performed off-line using Cap-Image on video sequences captured using OPS imaging and standard intravital fluorescence microscopy at baseline, 85, 70, 55, and 40% of the initial Hct. For hemodilution, isovolumic exchange of blood for 6% Dextran 60 was performed. Bland-Altman plots for the vessel diameter and FCD show good agreement between the two methods for both parameters at all studied Hcts. As expected, there was a systematic bias of approximately 4 microm in the diameter measurements since the RBC column was measured and not the intravascular diameter. In conclusion, OPS imaging can be used to measure diameter and FCD at a wide range of Hcts.

The purpose of this investigation was to clarify whether the light exposure of fluorescently marked leukocytes and/or plasma influences the leukocyte behavior (rolling and firm adhesion). Anaesthetized Balb/c mice were laparotomized to expose the mesentery of the terminal ileum. Animals were randomly assigned to 5 experimental groups. One group was studied in trans-illumination mode, the other four groups received iv-bolus injections of either FITC-dextran (FITC-dx) 150 kD, rhodamine 6 G (rh6G), a combination of FITC-dx and rh6G, or acridine orange, respectively, and were then studied in epi-illumination mode. In each animal, eight vessels (6 venules, 2 arterioles) were exposed five times for 60 sec. to continuous light of the appropriate excitation wavelength with a 20-min. interval between exposures. The vessel diameters and leukocyte-endothelial cell interactions were quantified using intravital fluorescence microscopy. The diameters of arterioles and postcapillary venules remained unchanged in all groups studied. Rolling and adherent leukocytes were observed in postcapillary venules only and there were no significant differences between all groups. Under these conditions, the exposure of fluorescently labeled leukocytes and/or plasma to standard light levels for up to 300 seconds has no significant impact on leukocyte-endothelial cell interactions in mesenteric postcapillary venules.

The Cytoscan Model E-II (Cytometrics Inc., Philadelphia, Pa., USA) is a newly developed instrument which functions as an intravital microscope and is small and easily portable. Through the use of orthogonal polarization spectral (OPS) imaging, the Cytoscan Model E-II delivers images of the microcirculation which are comparable to those achieved with intravital fluorescence videomicroscopy (IFM), but without the use of fluorescent dyes. The purpose of this study was to validate the Cytoscan Model E-II instrument against IFM. The experiments were carried out on striated muscle in the dorsal skinfold chamber of the awake Syrian hamster. The following parameters were measured in identical regions of interest in the same animal under baseline conditions and 0.5 and 2 h after a 4-hour period of pressure-induced ischemia: arteriolar diameter, venular diameter and venular red blood cell velocity. Bland-Altman plots showed good agreement between the two techniques for venular red blood cell velocity. As expected, arteriolar and venular diameters as measured by the Cytoscan were on average 5 microm smaller than the values from IFM, since the Cytoscan measures the red blood cell column width and IFM measures luminal diameter. Thus, OPS imaging can be used to make valid measurements of microvascular diameter and red blood cell velocity in tissues., (Copyright 2000 S. Karger AG, Basel)