In a series of articles the authors discuss literature data concerning epidemiology of pulmonary arterial hypertension (PAH), its modern classification, peculiarities of its pathogenesis and ...treatment in various diseases and conditions. The last 14-th communication contains consideration of issues of differentiated administration of modern pulmonary vasodilators to patients with PAH taking into account etiology and severity of the disease, availability of evidence based efficacy and safety data, method of application, and contraindications. In patients with PAH of II and III functional class (FC) endothelin receptor blocker bosentan is believed to be the drug of first choice. Bosentan can be administered orally. In patients with significant liver involvement phosphodiesterase inhibitor type 5 sildenafil should be used instead of bosentan for long term treatment of PAH. Sildenafil also can be taken orally. If bosentan is not sufficiently effective it can be combined with sildenafil; inhalations of prostanoid iloprost can be added to this combination when necessary. Is this tiple combination is not effective iloprost inhalations can be replaced by subcutaneous treprostinil or continuous intravenous infusion of epoprostenol. In patients with IV FC PAH therapy is started with subcutaneous administration of treprostinil or infusion of epoprostenol, while bosentan or/and sildenafil is added when necessary.
Torasemide is a loop diuretic and has been used for the treatment of both acute and chronic congestive heart failure (CHF) and arterial hypertension (AH). Torasemide is similar to other loop ...diuretics in terms of its mechanism of diuretic action. It has higher bioavailability (>80%) and a longer elimination half-life (3 to 4 hours) than furosemide. In the treatment of CHF torasemide (5 to 20 mg/day) has been shown to be an effective diuretic. Non-diuretic dosages (2.5 to 5 mg/day) of torasemide have been used to treat essential AH, both as monotherapy and in combination with other antihypertensive agents. When used in these dosages, torasemide lowers diastolic blood pressure to below 90mm Hg in 70 to 80% of patients. Antihypertensive efficacy of torasemide is similar to that of thiazides and related compounds. Thus low-dose torasemide constitutes an alternative to thiazides in the treatment of essential AH.
In a series of articles the authors discuss literature data concerning epidemiology of pulmonary hypertension (PH), its modern classification; peculiarities of its pathogenesis and treatment in ...various diseases and conditions. In the nine communication they describe presentations of PH and methods of its instrumental diagnostics. This part also contains discussion of problems of differential diagnosis of diseases which can be complicated by PH, contemplation of natural course of primary (idiopathic) PH and factors determining its prognosis.
In a series of articles the authors discuss literature data concerning epidemiology of pulmonary arterial hypertension (PAH), its modern classification; peculiarities of its pathogenesis and ...treatment in various diseases and conditions. The twelfth communication contains consideration of inhaled nitrous oxide and three available inhibitors of phosphodiesterase type 5 (sildenafil, tadalafil, and vardenafil). The place of nitrous oxide in diagnostics and short term treatment of PAH is discussed. Analysis of results of randomized controlled studies assessing efficacy and safety of sildenafil in patients with primary (idiopathic) PAH and PAH associated with connective tissue diseases and congenital heart diseases with systemic-to-pulmonary shunts is presented.
In a series of articles the authors discuss literature data concerning epidemiology of pulmonary arterial hypertension (PAH), its modern classification; peculiarities of its pathogenesis and ...treatment in various diseases and conditions. The tenth communication contains consideration of results of controlled trials of prostacyclin and its synthetic analogues in patients with primary (idiopathic) PAH, and PAH associated with diffuse diseases of connective tissue, congenital heart disease, HIV-infection. Continuous intravenous infusion of prostacyclin (epoprostenol) has made a revolution in the treatment of patient with severe PAH because its long-term use is associated with improvement of survival of patients refractory to high doses of calcium antagonists. Subcutaneous administration of treprostinil and especially inhaled iloprost substantially widen possibilities of prolonged use of prostanoids in patients with various forms of PAH. Literature data on application of different prostanoids for long term treatment of patients with PAH, their side effects, indications and counterindications for their administration are analyzed in this communication.
In a series of articles the authors discuss literature data concerning epidemiology of pulmonary arterial hypertension (PAH), its modern classification; peculiarities of its pathogenesis and ...treatment in various diseases and conditions. The 13-th communication contains consideration of surgical and interventional procedures used in treatment of patients with severe PAH when drug therapy is not feasible or ineffective. Discussion of criteria of selection of patients for lung transplantation, balloon atrial septostomy, and pulmonary thromboendarterectomy, as well as immediate and long term results of these surgical interventions is also presented. Balloon atrial septostomy is usually performed as a " bridge " to lung transplantation. Pulmonary thromboendarterectomy is used in patients with severe PAH caused by chronic pulmonary artery thromboembolism when 3 month intravenous therapy with epoprostenol turns out to be ineffective.
In a series of articles the authors consider clinical pharmacology and experience of clinical application of blockers of platelet P2Y12 receptors, most well known representatives of which ticlopidine ...and clopidogrel according to chemical structure belong to thienopyridine derivatives. In the first communication pharmacodynamics and pharmacokinetics of the first thienopyridine ticlopidine are described in detail. Results of randomized studies in which cerebro and cardioprotective efficacy and safety of ticlopidine was studied in patients with cerebrovascular, peripheral artery diseases, and acute coronary syndromes are discussed. It has been established that ticlopidine is more effective and safe in patients having undergone coronary and femoral bypass surgery. Results of meta analyses have shown which evidence that ticlopidine is not less and may be more effective than clopidogrel in patients after coronary bypass surgery. Most frequent and most severe side effects of ticlopidine and measures of their prevention are also considered.
Hypocholesterinemic drugs from the statins class are effective means of primary and secondary prevention of ischemic heart disease (IHD) in middle aged men who comprised predominant majority of ...patients participating in randomized controlled trials (RCT). Proofs of favorable influence of statins on origination and progression of IHD in women and elderly people are less convincing. In majority of RCTs of therapy with statins results of which were analyzed separately for men and women no lowering of rates of coronary events were found among women and people older then 65 - 70 years. Moreover in some trials increases of all cause mortality were observed in statin treated patients at the account of deaths from non-cardiovascular causes (cancer deaths in particular). In the PROSPER trial pravastatin not only turned out useless in men and women aged 70 - 82 years, but significantly increased rate of breast cancer. In ALLHAT-LLT in patients aged 65 years and older and in women pravastatin lowered neither total number of nonfatal myocardial infarctions and IHD deaths, nor total mortality. In SPARCL and TNT in which efficacy and safety of high dose statin (e.g. atorvastatin 80 mg/day) was assessed there occurred augmentation of risk of hemorrhagic stroke and mortality from noncardiovascular causes including cancer and infections. One of meta-analyses of RCTs revealed significant increase in breast cancer risk associated with treatment with statins, in another meta-analysis more close relationship was noted between statins and development of cancer in elderly patients. Thus the problem of efficacy and safety of long-term therapy with statins remains open and requires further investigation.
Results of the investigation of metoprolol CR/XL which was conducted in large randomized controlled study MERIT-HF in patients with chronic heart failure (CHF) are presented. In the whole trial this ...beta1-selective blocker lowered mortality of patients with CHF. Analysis of results in subgroups shows that metoprolol CR/XL was equally effective in middle aged and old patients, in men and women.
