Objective: to identify the of bisoprolol effectiveness predictors in patients with stable angina after myocardial infarction.Materials and methods: 107 patients with stable angina who underwent myocardial infarction aged 35–65 years (mean age 54,7 ± 6,2 years) were examined in an open, comparative, register study, of which groups were generated: with the achieved and unreached target heart rate (60 or less in 1 minute). Additionally, the respondents were stratified into subsamples by the presence of ADRB1 gene Arg389Gly polymorphism. All patients underwent a 5-minute study of heart rate variability (HRV) in the background sample and in active orthostasis and the determination of the ADRB1 gene polymorphism (Arg389Gly, rs1801253) by PCR. All patients received bisoprolol in the selected optimal maximum-tolerated dose.The main results: respondents who did not reach the target heart rate significantly more often complained about heartbeat and heart rhythm interruptions (p = 0,003), increased incidence of cardiac pain episodes (p = 0,02), noted a high demand for nitrates (p = 0,03) and significantly more often sought medical help. In respondents with the achieved target heart rate, sympathetic influences were less expressed in the background HRV sample with significantly higher parasympathetic influences expression by contrast. The number of sympathicotonics in terms of HRV at rest was significantly higher among respondents with unreached heart rate. When comparing the frequencies of alleles in respondents with the achieved target heart rate, a significant (p = 0.0001) prevalence of carriers of the Gly allele of the ADRB1 gene Arg389Gly polymorphism was revealed. The heart rate in carriers of the Gly allele in homo-or heterozygous form was significantly lower than in carriers of the homozygous genotype Arg389Arg.Conclusion: The predictors of the bisoprolol effectiveness in achieving the target heart rate in patients with stable angina after MI are: a stress index less than 104.5 cu. in the background sample of a 5-minute HRV, the presence of the polymorphic Gly allele of the ADRB1 gene Arg389Gly polymorphism, the age of less than 46 years, and the total spectrum power in the background HRV sample of more than 1309 ms.

The effect of co-and polymorbidity in increasing the heart rate (HR) pathology on achieving the target HR in the beta-adrenergic blockers (BAB) treatment of patients with stable coronary heart disease (CHD) after myo­ cardial infarction (MI) is studied. As part of an open, one-center, comparative study, 320 patients who had had MI more than 6 months ago were examined. They were counted on an outpatient HR and selected the optimal maximum tolerated dose of BAB in achieving HR, then were divided into 2 groups: 1) with a resting HR <60 per min. and 2) with resting HR> 60 per min. Co-and polymorbidity in increasing the HR pathology and its severity in the studied groups were identified and compared. Results: co-and polymorbidity in the increasing НАУЧНЫЕ ВЕДОМОСТИ Серия: Медицина. Фармация. 2019. Том 42, No 2 181 the HR pathology was significantly more common in patients with heart rate> 60 per 1 min .: smoking (p = 0.002); latent alcohol abuse (p = 0.024); carbohydrate metabolism disorders (p = 0.01); congestive heart failure (p = 0.01) with a functional class of 3 or more (p = 0.02); anemia (p = 0.04) and latent iron deficiency (p = 0.02); respiratory failure of 2 or more degrees (p = 0.03); high situational (p = 0.01) and high personal anxiety (p = 0.007). The number of co-and polymorbidity in the increasing HR pathologies in the group with HR> 60 in 1 min. were more: more patients with three (p = 0.008), four or more (p <0.001) of such diseases and condi­ tions at the same time. The Charlson comorbidity index was also higher in this group (p <0.05). Conclusion: in 55.9% of the studied patients it was not possible to reach the target HR, it was associated with an older age (p = 0.048) and the presence of co-and polymorbidity in the increasing HR pathology. Ключевые слова: стабильная ишемическая болезнь сердца, инфаркт миокарда, коморбидная патология, полиморбидная патология, целевая частота сердечных сокращений.

We developed and embedded in research and clinical practice of the method of quantitative evaluation of adherence to treatment in clinical medicine. Assessment of adherence is investigated by completion of the questionnaire. Analysis of the answers allows us to quantitatively calculate the indicators of adherence to drug therapy, medical support, modification of lifestyle and integral adherence to treatment. In accordance with the obtained results, an adherence can be «high,» «satisfactory» or «unsatisfactory», serving as a basis for making research or treatment decisions. Dynamic quantitative assessment of adherence allows to assess the current efficacy of interventions and to forecast their trends. The questionnaire is recommended for use in clinical practice when treating patients with chronic diseases, as well as at the stages of organization and execution of clinical studies and clinical trials.

Aim. To study the clinical effectiveness of patient-oriented therapy in polymorbid patients with arterial hypertension (HT) in comparison with the conventional therapy by the assessment of rationality (secondary combined endpoint) and total mortality (primary endpoints). Material and methods. Dynamics of rationality and total mortality were evaluated in a circular prospective study in 1000 polymorbid patients with HT under patient-oriented or conventional therapies. Results. The strategy of patient-oriented therapy demonstrated a statistically significant advantage over conventional therapy by the criterion of the secondary combined endpoint, starting from 24 week (Student's t-test: p=0.049 at the 50th and 100th weeks; p=0.002 at the 150th week; p=0.004 at the 200th week). By the end of the study in the patient-oriented group, a positive trend in rationality indicators was achieved in the absolute majority of respondents, while in the conventional therapy group the majority of the baseline parameters changed insignificantly. The total mortality rate in the group of conventional therapy showed a trend of outstripping growth compared with the patient-oriented therapy group, starting from the 50th week of the study. This growth trend was maintained until the end of the study and was of an exponential nature. Differences in total mortality in the samples were statistically significant. A strong correlation was found between the increase in "rationality" indices and the decrease in total mortality. Conclusion. The approach based on management of treatment by criterion of rationality, demonstrated an opportunity of increase in efficiency of treatment, including a reduction in total mortality without the involvement of additional resources and medical interventions.