BACKGROUND: Obesity is a metabolic disorder that becomes epidemic. Visceral adiposity increases the risk of arterial hypertension, diabetes mellitus and other comorbidities. According to this, the main aim of obesity treatment is not only a weight loss but also a decrease of the risk of comorbidities. AIMS: to assess the efficiency and safety of sibutramine in patients with obesity and arterial hypertension, to evaluate the drug influence on epicardial fat thickness. MATERIALS AND METHODS: 57 patients aged 35-60 with obesity and arterial hypertension were included in the study. All patients at the beginning and after 7 months of follow-up underwent complex examination including anthropometric measurement, ECG, office and ambulatory blood pressure measurement, echocardiography. Patients with controlled arterial hypertension were included. During the first month of follow-up patients were given general weight loss recommendations. Then sibutramine was added. Control visits to assess efficiency and safety of drug treatment were held after 1 and 6 months of follow-up. RESULTS: Women predominated among the study participants. Visceral adiposity was approved by anthropometric measurements among all patients. Most patients had impaired left ventricle geometry: concentric remodeling or hypertrophy. During the first month of follow-up the weight loss was mild: 2 kg (less than 2%) in average. Sibutramine for 1 month the weight loss increased: 3.7 kg (more than 2%) in average. After 6 months of drug administration the weight loss of patients consisted 8.6 kg (6.2%) in average. According to echocardiography results indexed mass of LV myocardium decreased in all patients more significantly in women. Also in this group of patients significant decrease of epicardial fat thickness was revealed. Adverse events of sibutramine were revealed in 26.3% of patients. The most frequent were constipation (12.3%) and dry mouth (10.6%). The severity of symptoms persisted for 1 month and then decreased, additional therapy was not required. CONCLUSIONS: Sibutramine treatment of obesity promotes effective weight loss, influences the adipose tissue distribution, decreases the progress of associated comorbidities. Sibutramine is an effective and safe drug that can be used in patients with visceral adiposity and controlled arterial hypertension.

The presence of metabolic syndrome (MS) in a patient allows him to be assigned to a group at high risk for atherosclerosis, cardiovascular events, coronary heart disease, and type 2 diabetes mellitus. In addition, MS negatively affects not only the heart and vessels, but also kidney function, which leads to chronic kidney disease (CKD). MS is pathogenetically associated with CKD and is an independent prognostic factor of the development of the latter, namely, the involvement of the kidney frequently determines prognosis and quality of life in these patients. The paper gives a modern view on the concept of MS and CKD and considers its main diagnostic criteria, etiology, and pathogenesis. The study of the relationships between MS and CKD may suggest that the high prevalence of kidney dysfunction in the general population is largely determined by metabolic nephropathies, including obesity-related nephropathy. The identification of risk factors and poor prognostic markers in this category of patients seems to be extremely important for the early diagnosis of the disease and their timely elimination is one of the main approaches to the comprehensive prevention of CKD in these patients.

1 Государственный научно-исследовательский центр профилактической медицины директор -академик РАМН Р.Г. Оганов 2 Московский государственный медико-стоматологический университет ректор -профессор О.О. Янушевич 1 В.Н. Шишкова, 2 А.Б. Хадзегова, 2 Е.Н. Ющук Сибутрамин в лечении ожирения Резюме. Статья посвящена проблеме терапии ожирения в современных условиях. Особое внимание уделяется выбору препаратов для медикаментозной коррекции массы тела с учетом индивидуальных особенностей пациента. Приведены данные о наиболее эффективных режимах терапии ожирения с применением сибутрамина. В клинической практике сибутрамин может оказывать благоприятное влияние на показатели метаболизма, артериального давления, а также на качество жизни и психоэмоциональное состояние пациентов. Представлены результаты российских и зарубежных клинических исследований по оценке эффективности и безопасности применения сибутрамина для снижения массы тела у различных категорий больных, имеющих нарушения менструальной и репродуктивной функции, сахарный диабет 2 типа и артериальную гипертензию. Ключевые слова: ожирение, терапия ожирения, артериальная гипертензия, сибутрамин, орлистат.Resume. The article covers the problems of obesity treatment in contemporary conditions. Particular attention is given to choice of dugs for medical correction of body mass with regard to individual peculiarities of the patient. Given data concerning the most effective regimens of obesity treatment with the use of sibutramine. In clinical practice sibutramine can have a favorable influence on metabolic parameters, blood pressure, as well as on quality of life and psychoemotional well being of the patients. We represent the results of Russian and foreign clinical trials accessing the effectiveness and safety of sibutramine use for body mass reduction in different groups of patients, with disordered menstrual and reproductive functions, diabetes mellitus type 2 and arterial hypertension.

Objective. To study the effectiveness of carvedilol, tiotropium bromide and indacaterol in complex therapy on clinical and functional parameters in patients with CHF of ischemic origin in combination with COPD. Material and methods. The study included 98 patients aged 45–75 years, suffering from CHF II–III FC with post-infarction cardiosclerosis, LV ejection fraction less than 45% and COPD of 2–3 degrees (GOLD). In addition to basic therapy all patients received carvedilol and were divided into 3 groups: tiotropium was administered in the 1st (36 people), indacaterol in the 2nd (32 people), and a combination of tiotropium and indacaterol in the 3rd (30 people). At baseline and after 6 months of follow-up, the clinical condition, exercise tolerance were assessed, the quality of life was assessed using the clinical state rating scale (SHOX) and MRC dyspnea scale, questionnaires of University of Minnesota (MLHFQ) and St. George’s Hospital (SGRQ). EchoCG, 24-hour blood pressure monitoring with simultaneous ECG recording, and spirometry test were performed. Results. The use of carvedilol in combination with tiotropium and indacaterol (both in mono and in combination) as part of complex therapy of CHF II–III FC of ischemic genesis with COPD is safe and effective: the clinical condition of patients improved, quality of life, frequency and duration of ischemia episodes decreased significantly, significantly increased LVEF, decreased pulmonary hypertension, improved condition of the bronchopulmonary system.