Algorithms for the diagnosis and treatment of idiopathic pulmonary arterial hypertension

Background. Pulmonary hypertension (PH) is a hemodynamic and pathophysiological condition characteri-zed by an increase in the average pressure in the pulmonary artery > 20 mm Hg and is evaluated according to the data of the right heart catheterization (RHC). In most cases, PH is not an independent disease but is a manifestation of other diseases. Idiopathic pulmonary arterial hypertension (IPAH) is a diagnosis that it is established by excluding all other causes of PH (damage to the left heart, connective tissue diseases, HIV infection, lung diseases, portal hypertension, congenital heart defects, a history of pulmonary thromboembolism, etc.). In IPAH, the etiology of the disease is unknown. Pathogenesis and symptoms of PH. Vasoconstriction, microthrombosis, and vascular remodeling are the three main pathophysiological elements in PH. Symptoms of PH are non-specific: shortness of breath, rapid fatigue, chest pain during physical exertion, and sometimes syncopal states are observed. Decompensated patients have signs of right-sided heart failure (edemas, ascites, bloating, pulsation of the jugular veins). Diagnosis. The diagnostic algorithm for РH consists of two stages. The first one is located outside the expert сenter, and the second one is located directly in the PH expert center. When this disease is suspected and there are typical symptoms and signs, all patients undergo an echocardiographic examination. Then, under certain conditions (for example, the absence of the underlying cause of PH), the patient is referred to the PH expert center, where it is possible to conduct RHC. Evaluating the prognosis. Evaluation of patients with IPAH is necessary to improve disease control and transition from a higher risk to a lower one. Prognosis assessment is comprehensive and is determined based on clinical status, symptom progression, syncope, results of a 6-minute walk test and NT-proBNP, results of examination methods (cardiopulmonary exercise test, echocardiography or MRI of the heart, hemodynamic assessment). Treatment. The main objectives of IPAH treatment are reducing the severity of symptoms, slowing the progression of the disease, improving the quality and increasing the life expectancy of patients. First of all, these are general measures (physical activity, prevention and management of pregnancy), prevention of infectious diseases, social and psychological assistance, monitoring compliance with the regime, recommendations for travel/journey, maintenance therapy (oral anticoagulants, diuretics, digoxin, oxygen therapy). Patients with a positive vasoreactive test are prescribed with calcium channel blockers. In all other patients, specific PH therapy may include prostaglandins (inhaled, intravenous, and subcutaneous forms), prostacyclin receptor antagonists, endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and soluble guanylate cyclase stimulants. Surgical treatment. One of the options for surgical treatment of IPAH is atrial septostomy — the creation of a perforation in the atrial septum. This leads to decompression of the right chambers of the heart and increases the preload on the left ventricle, which leads to an increase in cardiac output. In case of ineffectiveness of all the above methods of treatment and significant progression of the disease, patients are indicated for lung transplantation or heart — lung complex.

Clinical determinants of coronavirus disease COVID-19 manifestation

The article presents the review of modern publications on the assessment of the factors which have impact on susceptibility, clinical course and outcomes of COVID-19 infection. Statistical data on rate of increased blood pressure and adverse clinical signs of infection disease in different populations are shown. The important role of angiotensin-converting enzyme 2 as functional cellular receptor for coronavirus and its participation in multiple systemic manifestations of COVID-19 are presented. The mechanisms of damage effects of cigarette smoking in virus pneumonia have been described. According to literature data, the relationship between metabolic disorders related to obesity and risk of severe coronavirus course is emphasized. From a pathophysiological point of view, an explanation is given for the occurrence of threatening complications in patients with a new coronavirus infection in the presence of diabetes mellitus — massive lung damage, acute respiratory distress syndrome, prothrombotic condition, venous and arterial thrombosis.

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Parameters of cardiac hemodynamics in patients with diabetes mellitus with impairment of renal function

Currently, diabetes mellitus (DM) is a complex global problem, which is increasing every year. So, in 2019, diabetes mellitus was detected in 463 million adults (from 20 to 79 years old) in the world. And the main cause of death in patients with diabetes mellitus is cardiovascular complications. The study was aimed investigate the features of functional and structural changes in the heart in patients with type 2 diabetes mellitus and nephropathy. A total of 98 patients with type 2 diabetes mellitus were examined, out of which 78 patients had diabetic nephropathy (DN) of varying severity. The control group consisted of 20 healthy patients. After a clinical examination, depending on the state of renal function, all patients were divided into the following groups: group I — patients with type 2 diabetes mellitus without signs of nephropathy (n = 36), group II — patients with type 2 diabetes mellitus with normal glomerular filtration rate (GFR) and albuminuria (n = 33), group III — patients with type 2 diabetes mellitus with decreased GFR and albuminuria (n = 29). To study changes in hemodynamics and structural parameters of the heart, patients underwent transthoracic echocardiography on an ULTIMA PA ultrasound machine (Radmir, Ukraine) using a sectoral phased transducer with a frequency range of 2–3 MHz according to the standard technique based on the recommendations of the American Echocardiographic Society. To determine indexing indicators, the patients underwent anthropometric measurements. Patients with DN and albuminuria and decreased GFR showed an increase in the linear dimensions of the heart in comparison with controls and patients without signs of nephropathy. With DN, patients have a significant increase in left ventricular mass and a significant increase in the detection rate of left ventricular hypertrophy up to 91.3 % in patients with albuminuria and preserved renal function and up to 100 % with a decrease in GFR.

Table salt and added free sugar as nutrient “targets” in preventive dietetics in essential hypertension and associated diseases (literature review)

A review of foreign and native sources of literature from scientometric databases provides data on the harmful and beneficial properties of such well-known nutrients as table salt and sugar in essential hypertension and associated diseases, primarily in abdominal obesity and diabetes mellitus. The historical aspects of obtaining these nutrients, their participation in the pathogenesis of hypertension, the physiology of sodium and glucose metabolism are considered; the evidence base for prospective epidemiological studies is provided; the negative impact of these products on the intestinal microbiota, alarming statistics of salt and added free sugar abuse in population of different countries, social, economic and medical aspects of excess salt and sugar as risk factors for chronic non-communicable diseases emergence and progression of arterial hypertension are noted. The methods for assessing their amount in food, approaches to inhibiting salt and sugar-rich food abuse are given; the attention on the materials of the WHO, European, American, and Ukrainian guidelines on the safe amount of both nutrients is focused. The paper gives advice on rational nutrition of patients and options for modern diets, first of all, a low-salt DASH diet (Dietary Approaches to Stop Hypertension) from the standpoint of salt and sugar limiting.

Lixarit — clinical and pharmaceutical aspects of efficacy and safety of flecainide acetate generic drug

The article considers the use of flecainide, an antiarrhythmic agent. The results of comparing the bioequivalence of Lixarit, flecainide acetate generic drug (flecainide acetate, 100 mg tablets, Laboratorios Normon SA, Spain), and Apocard®, flecainide acetate reference drug (Health Care Ltd, UK, 100 mg tablets), are presented.

On the problem of the relationship between arterial hypertension and coronavirus disease (COVID-19): literature review

The literature review is devoted to the problem of the relationship between arterial hypertension and coronavirus disease (CVD; COVID-19), which has attracted attention from the very beginning of the pandemic of this infectious disease. The literature data, despite certain disagreements, indicate a higher incidence of CVD (COVID-19) among hypertensive patients, especially the elderly and patients with comorbid cardiovascular diseases, obesity, and diabetes mellitus. Besides, it has been shown that in these patients, CVD (COVID-19) has a more severe course. In this regard, these categories of patients need to provide effective treatment and prophylactic care and create conditions for the prevention of CVD (COVID-19) infection based on the modern European standards.

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The structure of the drug therapy prescription to cardiac patients during the primary care: the lessons of the OZIRKA study

The structure of prescriptions of cardiac drugs by the primary care physicians has remained unknown for a long time. We decided to use the data of the OZIRKA study, which aimed to investigate the effect of Ozalex (rosuvastatin) on lipid and cholesterol levels in patients with lipid metabolism disorders and hypercholesterolemia, and to assess the structure of prescriptions in real clinical practice, as well as the effectiveness of cardiovascular risk factors monitoring. We sincerely hope that the data we have obtained will optimize the treatment plan for primary care patients, improve their prognosis and survival, and provide the practitioner with evidence of the safety and efficacy of rosuvastatin that can be transferred to routine clinical practice.

Hypertensive retinopathy: clinical aspects

Funduscopic examination has long been recognized as the most affordable way to assess the condition of small diameter vessels. However, accumulation of new research data, changes in the requirements for the management of patients with various diseases require a return to the clinical, prognostic significance of fundoscopy and the specification of indications for its conduction in certain situations. This article discusses the prevalence of retinopathy depending on the etiological factor, criteria and stages of its development. Until now, a number of issues regarding retinopathy have not been finally resolved, in particular the classification optimal for routine practice, method of its study, etc. It is believed that changes in the fundus blood vessels reflect parallel changes in the vessels of other regions, but this is not always so. A moderate prognostic value of “mild” retinopathy has been established in terms of the risk of cardiovascular diseases, with moderate retinopathy, this relationship reaches a strong level, and with a malignant one, there is a strong correlation with death. The article discusses indications for fundoscopy in routine clinical practice, taking into account the latest scientific data and international recommendations. For the treatment of hypertensive retinopathy, only adequate control of blood pressure is recommended, which can reduce the signs of retinopathy. The authors concluded that the prognostic value of stage 1–2 hypertensive retinopathy is minimal and does not affect patient management. The latter eliminates the need for fundoscopy in patients with mild, controlled arterial hypertension, not suffering from diabetes, with the exception of young patients. Fundoscopy is required in patients with difficult-to-control and resistant arterial hypertension, high variability of blood pressure.