Recently, the diastolic heart function has been studied no less than the systolic function. Age-related changes in cardiovascular system determine many features of chronic heart failure (CHF) in patients of advanced age. Due to the present lack of information, it is important to study oxidative stress and to assess the role of age-related changes on endothelial dysfunction in diastolic CHF. To study the levels of oxidative stress markers and endothelial function in diastolic CHF patients from various age groups. In total, 146 men aged 31-75 years were examined, with restrictive type of diastolic CHF of various aetiology, and NYHA class II-III. All participants were divided into two groups by their age. The control group included 30 healthy volunteers. The levels of malonic dialdehyde (MDA), diene conjugates (DC), catalase (CAT), as well as laboratory markers of endothelial dysfunction (TNF-alpha, IL-1-beta, MAU, C-reactive protein, and NO), were measured. The older patients with diastolic CHF demonstrated higher serum levels of MAU, TNF-alpha, and lower concentration of NO. Therefore, they had more severe endothelial dysfunction and free-radical stress activation (higher MDA and DC levels, lower CAT concentration), comparing to the younger patients. This could explain more severe clinical course of CHF and adverse prognosis in elder patient groups.

In chronic heart failure (CHF) in patients with coronary heart disease (CHD), the intracardiac venous system (IVS) changes dramatically; however, there are virtually no studies on IVS in CHF. The present study assessed IVS (coronary sinus and large cardiac veins) by Doppler echocardiography and cardiac multispiral computed tomography. The peripheral venous system (PVS) was assessed by peripheral venous pressure (PVP) measurement with the Waldman device. All participants were divided into three groups by CHF stage: Stage IIA, Functional Class (FC) III-IV (n=24); Stage IIB, FC III-IV (n=46); and Stage III, FC IV (n=27). In CHF, PVP was significantly elevated, with venous sinus size and large cardiac vein diameter substantially increased. The observed IVS changes depended on CHF stage. The results of the study demonstrate that in patients with CHF and CHD, the IVS involvement plays an important role in CHF development and progression.

Cardiac embolism, often associated with atrial fibrillation, plays an important role in stroke pathogenesis. Stroke prevention requires targeting all risk factors. The paper is focused on the role of atrial fibrillation in stroke development, as well as on the relative importance of various medication groups in secondary stroke prevention (the original study data). The pharmaceutical treatment of patients with ischemic stroke should be targeted at blood pressure reduction to the target levels (<130 and 80 mm Hg), with the medications decreasing the risk of secondary stroke most effectively (calcium antagonists, diuretics, ACE inhibitors). Anticoagulant (warfarin) therapy in patients with atrial fibrillation should be controlled by the international normalised ratio (target levels 2,0-3,0).

The study investigated the effects of cardiocyte protectors, mexicor and mildronate, in combination with ACE inhibitors, on blood levels of lipid peroxidation products, vascular endothelial function, circadian profile of blood pressure, and left ventricular morphology and function in patients with arterial hypertension. The results obtained supported the importance of cytoprotectors mexicor and mildronate, combined with ACE inhibitors, in the complex management of arterial hypertension. Compared to mildronate, mexicor more effectively influenced blood levels of lipid peroxidation products, circadian blood pressure profile, and left ventricular diastolic myocardial function.

In total, 40 elderly patients with arterial hypertension (AH) were examined. Seventy percent received indap monotherapy (2,5 mg/d), and 30% – combined therapy (indap plus lisinopril). The follow-up period lasted for 12 months. At baseline and after the end of the treatment, all participants underwent 24-hour blood pressure monitoring (BPM), echocardiography, the measurement of blood lipid profile, glucose, uric acid, and potassium levels, as well as assessment of renal function and quality of life (QoL). After 12 months of indap therapy, stable target blood pressure (BP) levels had been achieved, with reduced mean circadian, mean day-time and mean night-time BP, decreased BP load and morning BP surge rate, but without negative effects of BP variability. Beneficial dynamics of 24-hour BP profile was observed. No negative influences of long-term indap therapy on lipid, carbohydrate, and purine metabolism, as well as on serum potassium levels, were registered. Twelvemonth indap therapy increased elasticity of large vessels, significantly decreased left ventricular myocardial mass, and also improved renal function and QoL in elderly AH patients.

The paper presents modern views on beta-blocker therapy in clinical practice. The beta-blocker group is heterogeneous in terms of clinical usage. The recent critical comments by some researchers on beta-blocker therapy should not misguide the practitioners, who always need to ask themselves the key question: what specific beta-blockers are discussed. In fact, some beta-blockers, especially non-selective ones, could demonstrate negative effects and are contraindicated in specific clinical situations. The problem of negative metabolic influences is particularly important for the patients with metabolic syndrome and Type 2 diabetes mellitus (DM-2). However, modern super-selective beta-blockers did not have these negative effects and could be widely used in clinical practice, even in patients with metabolic syndrome and DM-2.

The molecular and genetic markers for primary and secondary prevention of coronary heart disease (CHD) were identified based on the analysis of lipid metabolism gene polymorphisms – lipoprotein lipase (LPL); apolipoprotein E (apoE); and I/D polymorphism of ACE in CHD patients from various age groups, including elderly individuals, and with various clinical variants of CHD (II-III Functional Class stable angina, unstable angina, myocardial infarction (MI), post-infarction cardiosclerosis), as well as in the control group of healthy volunteers. ACE gene DD genotypes, LPL gene H+/+ genotypes, and Е3Е4 increased the MI risk in CHD patients and could be regarded as high-risk markers [4,6-8]. Genotype DD was associated with higher risk of recurrent MI, life-threatening MI complications, and severe heart failure. Moreover, DD genotype was linked to specific personality traits (hostility and Type A behavior), which act as psychological risk factors of CHD and explain delayed medical attendance [2,9]. ApoE gene ε2 allele and LPL gene H allele were observed significantly more often in CHD patients aged over 90 years, compared to younger individuals. Therefore, these alleles could be regarded as the markers of stable clinical CHD course [4].

Aim: To search the literature assessing lercanidipine effectiveness, tolerability, and benefits in arterial hypertension (AH) treatment. Data sources: The literature search was performed using MEDLINE (1966 – September 2006), EMBASE Drugs and Pharmacology (1980 – September 2006), and Current Contents/Clinical medicine (Week 24, 2005 – Week 30, 2006). Medication instructions were also studied for lercanidipine, nifedipine, and amlodipine, to compare adverse event information. Study and data selection: The English-language papers presenting clinical trials, abstracts, and literature reviews were included. Data synthesis: Lercanidipine is a new dihydropyridine calcium antagonist (CA), used for AH treatment. Although the medication is not available in USA, it is widely used in other countries. In two randomised controlled studies, including 400 patients with mild to moderate AH, lercanidipine effectiveness was similar to that in two other dihydropyridine CA – felodipine and slow-release nifedipine, as demonstrated by a significant decrease in systolic and diastolic blood pressure (SBP, DBP) levels after four weeks. In a longer study (12 months), lercanidipine (10 mg/d) normalised BP in 49% of the patients as soon as after 4 weeks of the therapy. A post-marketing study, including 9500 patients, confirmed the previous results: in 64%, DBP level reached 90 mm Hg or lower, and in 32%, BP was controlled (<140/90 mm Hg). In elderly patients, lercanidipine, similar to lacidipine and nifedipine, demonstrated a decrease in DBP comparable to that for nifedipine (-18,3 and -17,7 mm Hg, respectively). In contrast to the other dihydropyridine CA, lercanidipine is characterized by lower rates of adverse effects (lower leg edema, in particular). One study showed that fewer participants stopped their treatment due to adverse effects in the lercanidipine (0,9%) and nifedipine (3,8%) groups than in the felodipine group (4,5%). Lercanidipine also demonstrated antihypertensive activity similar to that in other antihypertensive medications, such as atenolol, captopril, and losartan. Conclusions: Lercanidipine could be used as a first-choice medication for AH treatment, since the available literature data confirm its comparative effectiveness and better tolerability, comparing to other antihypertensive agents. Further randomised double-blind clinical trials should be performed to clarify the place of lercanidipine among other medications for AH treatment.