The article contains data on beta-blocker efficacy in cardiology – the results of large, randomized clinical trials, and evidence-based clinical guidelines on beta-blocker therapy.

Aim. To prove the benefits of long-term controlled antihypertensive therapy in patients with mild to moderate arterial hypertension (MiAH, MoAH), comparing to standard treatment in real-world clinical settings.
Material and methods. The study was a multi-center, randomized, comparative, prospective clinical trial in two parallel groups of MiAH and MoAH patients. The first group (intervention group, IG) received strictly regulated, step-wise AH treatment, including ACE inhibitor spirapril. The second group (control group, CG) continued standard antihypertensive treatment, administered earlier by the observing physician. The study lasted up to one year.
Results. In total, PROLOG study included 1742 patients: 854 in IG, and 888 in CG. The follow-up was completed for 1522 participants. There were 651 males (37.6%), and 1081 females (62.4%). Blood pressure (BP) substantially decreased in both groups, but during the whole follow-up period, the inter-group differences in systolic and diastolic BP (SBP, DBP) were statistically significant. Target BP levels (SBP <140 mm Hg, DBP <90 mm Hg) were registered more often in IG: 69.4% vs 39.3% in CG after 3 months, and 83.6% vs 66.9%, respectively, after 12 months. By the end of the study, cardiovascular risk reduction was observed in both groups, but was more prominent in IG: 33% vs 22%, respectively.
Conclusion. More effective SBP and DBP decrease, as well as BP target level achievement, due to controlled stepwise AH treatment in IG implicated greater improvement in life prognosis, comparing to CG. PROLOG results demonstrated cardiovascular risk reduction for both groups, but in IG it was greater by 50% than in CG.

Literature data on essential arterial hypertension role in stroke pathogenesis are reviewed. Antihypertensive therapy potential in risk reduction of acute stroke is demonstrated. The roles of various drug classes in primary stroke prevention are compared.

The article is focused on the role of endothelium and vasoactive endothelial factors in arterial hypertension (AH) development. Special attention is given to platelet functional state, blood rheology, and microcirculatory disorders’ role in AH pathogenesis.

Aim. To study efficacy and safety of dihydropyridine calcium antagonists (CA), and amlodipine, in particular, in patients with arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD).
Material and methods. The study included 32 patients with Stage I-II AH and COPD in remission, as well as 27 patients with Stage I-II essential AH without COPD. All participants were administered amlodipine for 12 weeks. At baseline and after 12 weeks of treatment, circadian blood pressure profile (CBPP), echocardiography and lung function (LF) parameters were assessed.
Results. In patients with AH and COPD, amlodipine course treatment provided stable 24-hour BP control, decreased BP load, normalized BP circadian rhythm and variability, reduced pulmonary hypertension and pathologic left ventricular remodeling (LVR), improved right ventricular (RV) systolo-diastolic function, as well as LF parameters.
Conclusion. Modern dihydropyridine CA, and amlodipine, in particular, can be used as first-line medications for AH correction in COPD patients.

Aim. To study the association between family history and verified coronary heart disease (vCHD) in 25-64-year-old population of Novosibirsk City (data from cross-sectional epidemiological studies).
Material and methods. As a part of the program WHO-MONICA, 7111 males and 5523 females from the nonorganized population of Novosibirsk City were examined. To identify independent risk factors for CHD, stepwise multiple logistic regression analysis was performed.
Results. Prevalence of CHD in FH was 26.8% in males, and 37.7% in females. Independent factors, significantly increasing vCHD risk in males, were: advanced age (OR=1.10), atherogenicity index (AI) (OR=1.10), body mass index (OR=1.04), arterial hypertension (AH) (OR=1.63), CHD in FH (OR=1.71), AH in sisters (OR=1.63), AH in parents (OR=1.41); and in females: advanced age (OR=1.06), AI (OR=1.13), AH (OR=2.0), mother’s death from myocardial infarction (OR=2.28), father’s intermittent claudication (OR=4.13), diabetes mellitus in parents (OR=1.59).
Conclusion. CHD in FH is an independent population risk factor for CHD. Due to its high prevalence and simple assessment, in can be used for identifying high-risk groups in need for primary prevention.

Aim. To compare effectiveness and tolerability of a regular treatment with two nitrates – moderately long-acting isosorbide dinitrate and very long-acting isosorbide-5-mononitrate – in patients with coronary heart disease (CHD) and stable effort angina.
Material and methods. The study included 30 patients with verified CHD: 4 females, 26 males; mean age 50.5 years. In total, 21 participants had myocardial infarction (MI) in anamnesis, including 3 with recurrent MI. At coronaroangiography, 6 individuals had coronary stenosis of ≥75%, in at least one artery. Mean duration of stable angina was 8.2 years; 21 patients had functional class (FC) II angina, and 9 – FC III angina, by Canadian Cardiology Association’s classification. Pharmacodynamics was studied in placebo, isosorbide-5-mononitrate, and isosorbide dinitrate treatment regimens. Antianginal and antiischemic effects were assessed by increased physical stress (PS) tolerance – increased time before moderately intensive angina episode, by at least 120 s, comparing to placebo. Each drug was administered for 4 weeks, control period between the courses lasted for 7 days.
Results. All patients regularly received individually selected doses of antianginal medications. The therapy was associated with statistically significant increase in all PS tolerance parameters, measured one hour after medication’s intake, comparing to placebo. Isosorbide-5-mononitrate and isosorbide dinitrate treatment was associated with 14 and 18 adverse events, respectively.
Conclusion. In CHD patients with FC II-III stable effort angina, isosorbide-5-mononitrate therapy (in an individual dose, once per day) demonstrated a clear, sustained antianginal effect, was well-tolerated, and did not cause clinically manifested tolerance.

Aim. To study long-term results of coronary artery (CA) stenting, according to baseline clinical and coronaroangiography (CAG) data.
Material and methods. The study included 66 males who underwent coronary stent implantation. One to three years later, all participants were retrospectively divided into several groups. Patients without coronary events (CE) comprised CE- Group (n=44), patients with CE – CE+ Group (n=22). Second CAG was performed in 49 patients with 56 stent-implanted CA. CAG signs of restenosis were not found in 35 stenting cases (Restenosis- Group), being registered in 21 stenting cases (Restenosis+ Group). Stepwise multiple regression was used for analyzing the results obtained.
Results. After stent implantation, CE risk was affected by smoking status, number of hemodynamically significant stenoses, low diameter of stented CA, balloon inflation time, and minimal effective intervention (MEI) level. Restenosis risk was linked to unstable angina presence, serum triglycerides level, stenosis type, MEI, and low increase in CA diameter after stenting.
Conclusion. In selecting treatment tactics for coronary heart disease patients, and assessing the risk of adverse outcomes after CA stenting, a complex of factors affecting CE and restenosis rates should be taken into account, as well as minimally traumatic technique of coronary stenting should be used.

The article is devoted to modern perspectives of ACE inhibitor therapy in patients with acute myocardial infarction (AMI). ACE inhibitor efficacy is analyzed, according to the results of large randomized studies. These trials have demonstrated ACE inhibitors’ positive effects on cardiovascular event rates. In particular, ACE inhibitors reduced lethality, incidence of heart failure, ischemic events, revascularization, hospitalization due to unstable angina and MI. Varying ACE inhibitors’ effectiveness in general vs individual approach to recruiting subjects into clinical trials, and in various therapy start regimens, is emphasized.

The article presents recommendations on infectious endocarditis (IE) prevention and treatment, according to the latest evidence on risk-benefit ratio for each intervention. IE in anamnesis, prosthetic valves or other artificial implants, surgery-created ducts, complicated congenital heart disease with cyanosis, are regarded as high-risk situations. IE prevention, focused on Streptococcus viridans and NACEK microorganisms before dental, respiratory or esophageal interventions, and on Enterococci and Streptococcus bovis before gastro-intestinal and urogenital interventions, is performed with amoxicillin and clindamycin. Ethiotropic antimicrobial therapy includes penicillins, cephalosporins, aminoglycosides, and vancomycine. Indications for surgery are: heart failure due to acute aortic or mitral regurgitation; resistant fever and bacteriemia for 8 days and longer, despite adequate antimicrobial therapy; abscesses, fistulas, ruptures of one or more valves; heart blocks; myocarditis – the signs of process dissemination, and antibiotic-resistant flora involvement (fungi, Brucella, Coxiella).

Aim. To study efficacy and safety of propafenone (loading single dose of 600 mg per os) in treating atrial fibrillation (AF) paroxysms.
Material and methods. The study included 233 patients with persistent AF, aged 31-62 (mean age 57.6 ± 2.8 years), from 10 Russian regions. For AF paroxysm treatment, all patients received propafenone (600 mg per os).
Results. Propafenone restored sinus rhythm in 196 patients (84%). Mean time to restoring sinus rhythm was 220 ± 60 minutes. In the first 4 hours, anti-AF effect of propafenone was observed in 150 participants (64%). Adverse events were registered in 15 patients (6%): intraventricular block - in 7 individuals (3%), Stage II atrio-ventricular block – in 6 (3%), dyspepsia – in 2 patients (0.9%). Blood pressure drop to 100/70 mm Hg was observed in 24 cases (10%). Adverse effects disappeared without any additional therapy.
Conclusion. Propafenone therapy (600 mg per os) effectively and safely restored sinus rhythm in 84% of the patients with persistent AF. The mean time of sinus rhythm conversion was 220 ± 60 minutes; in the first 4 hours, sinus rhythm was restored in 64% of the patients.

The article is devoted to one of the most actual problems in modern arrhythmology - treatment of paroxysmal supraventricular tachycardias. Modern views on diagnostics and treatment of atrio-ventricular (AV) nodal reciprocating tachycardia and AV reciprocating tachycardia with extra nodal accessory pathways’ involvement are presented. Vagal maneuvers for paroxysm termination are described in detail. Algorithms for differential diagnostics and antiarrhythmic therapy selection, according to arrhythmic mechanisms, are presented. 

Very high prevalence of obesity and metabolic syndrome (MS) is well known. The need for early treatment start and more selective pharmaceutical treatment of MS has been noted in many publications. As pathogenetic therapy, numerous methods for body mass (BM) reduction have been proposed, due to well-known prevalent role of obesity in MS pathogenesis. Because of various reasons, many medications haven’t achieved wide acceptance in clinical settings. The article summarizes the experience in BM reduction with an effective drug – orlistat (Xenical®). Based on the authentic authors’ data, beneficial effects of orlistat on carbohydrate and lipid metabolism, 24-hour blood pressure profile, and cerebral perfusion are demonstrated. The authors prove that orlistat is highly recommended for cardiovascular complication risk reduction in MS patients.

Aim. To assess autonomous regulation of heart rhythm in metabolic syndrome (MS) patients and clinically healthy individuals, using heart rate variability (HRV) analysis.
Material and methods. The main group included 23 MS patients, the control group – 22 healthy individuals. All participants underwent 24-hour Holter ECG monitoring, with temporal HRV analysis.
Results. In MS patients, all HRV parameters were significantly lower than in healthy individuals (p<0.001). Nevertheless, after including mean 24-hour HR into analysis, the difference between examined HRV parameters became only borderline significant. Similar data was obtained for mean daytime HRV parameters; no difference for mean nighttime HRV parameters was detected after adjustment for HR and age.
Conclusion. MS patients demonstrated autonomous dysfunction, manifested as relative sympathic hypertonus. Autonomous regulation correction can be performed with imidazoline receptor agonists.

This review is devoted to pharmacological characteristics, action mechanisms, hypolipidemic activity, and pleiotropic effects of a new hypolipidemic medication – ezetimibe, inhibiting intestinal cholesterol absorption. The combination of ezetimibe with other hypolipidemic drugs (statins, fibrates, bile acid sequestrants) is described in detail. Initial doses of various statins, together with one tablet (10 mg) of ezetimibe, reduce low-density cholesterol level as effectively as maximal statin doses.

Long-chain omega-3 polyunsaturated fatty acids (ω-3 PUFA): eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) - have some important biological effects that can be used in cardiology. Long-chain omega-3 PUFA intake, in the dose of 3-4 g/d and more, decrease hypertriglyceridemia, thrombogenesis, inflammatory and immune processes, and vascular tonus. Free EPA and DHA act as structural components of cell membranes; they modify –inhibit trans-membrane ion channels; demonstrate antiarrhythmic effects; increase heart rate variability. In GISSI-Prevenzione study, among patients taking omega-3 PUFA, the incidence of combined end-point (total mortality, nonfatal myocardial infarction (MI), and stroke (S)) was lower than that in placebo group, by 15-16% (Р=0.02). Cardiovascular death risk, plus nonfatal MI and S risk, was also lower, comparing to placebo group (-20-21%; Р=0.006). The risk reduction was maximal (-45%; Р=0.0006) for sudden death; its risk was decreased as early as after 4 months of treatment.

Ratio of atherothrombotic risk and risk of hemorrhage complications should be estimated before aspirin prescription as a component of cardiovascular event prevention. It is unlikely that there exists a daily aspirin dose, possessing antiplatelet efficacy, but without gastro-intestinal (GI) hemorrhage risk.
Data of large-scale randomized trails have demonstrated the benefits of clopidogrel, with fewer adverse effects and better tolerability. According to CAPRIE trail results, clopidogrel should be prescribed to high-risk patients unable to take aspirin. It is recommended to use only minimal effective aspirin doses in combination with clopidogrel. The strategy of GI protection with proton pump inhibitors and/or H. pylori eradication for aspirin-taking patients at high risk of GI bleeding is widely discussed in literature. Up to now, there is little evidence supporting this strategy that is most important for life-long protection against atherothrombotic events.

ACE inhibitors play an important role in treatment of arterial hypertension, chronic heart failure, as well as in prevention of stroke and coronary heart disease complications. A new ACE inhibitor, cylasapril, is characterized by high antihypertensive efficacy and good tolerability. Cilasapril demonstrates cardio-, angio-, and nephroprotective effects. In patients with Type 2 diabetes mellitus and chronic renal insufficiency, cilasapril controls blood pressure, decreases proteinuria, and increases creatinine clearance. High cilasapril efficacy was proved in a Russian multicenter clinical trial, Initiative Program.