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Disclaimer. The ESC Guidelines represent the views of the ESC and were arrived at after careful consideration of the available evidence at the time they were written. Health professionals are encouraged to take them fully into account when exercising their clinical judgement. The guidelines do not, however, override the individual responsibility of health professionals to make appropriate decisions in the circumstances of the individual patients, in consultation with that patient, and where appropriate and necessary the patient's guardian or carer. It is also the health professional's responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

Рабочая группа по реваскуляризации миокарда Европейского общества кардиологов (esc) и Европейской ассоциации кардиоторакальных хирургов (eActs) Разработаны с участием Европейской ассоциации по чрескожным сердечно-сосудистым вмешательствам (eApcI) Авторы/члены Рабочей группы: stephan Windecker* (Председатель esc) (Швейцария), philippe Kolh* (Председатель eActs) (Бельгия), Fernando Alfonso (Испания), Jean-philippe collet (Франция), Jochen cremer (Германия), Volkmar Falk (Швейцария), Gerasimos Filippatos (Греция), christian Hamm (Германия), stuart J. Head (Нидерланды), peter Jüni (Швейцария), A. pieter Kappetein (Нидерланды), Adnan Kastrati (Германия), Juhani Knuuti (Финляндия), Ulf Landmesser (Швейцария), Günther Laufer (Австрия), Franz-Josef Neumann (Германия), Dimitrios J. Richter (Греция), patrick schauerte (Германия), Miguel sousa Uva (Португалия), Giulio G. stefanini (Швейцария), David paul taggart (Соединённое Королевство), Lucia torracca (Италия), Marco Valgimigli (Италия), William Wijns (Бельгия), and Adam Witkowski (Польша). В подготовке данных рекомендаций приняли участие следующие подразделе-ния esc: Ассоциации esc: Ассоциация специалистов по острой сердечно-сосудистой помощи (Acute cardiovascular care Association; AccA), Европейская ассоциа-ция специалистов по методам визуализации сердечно-сосудистой системы (european Association of cardiovascular Imaging; eAcVI), Европейская ассоциа-ция специалистов по сердечно-сосудистой профилактике и реабилитации (european Association for cardiovascular prevention & Rehabilitation; eAcpR), Европейская ассоциация аритмологов (european Heart Rhythm Association; eHRA), Ассоциация специалистов по сердечной недостаточности (Heart Failure Association; HFA). КомитетРабочие группы esc: Сердечно-сосудистая клеточная электрофизиология, Магнитная резонансная томография сердечно-сосудистой системы, Сер-дечно-сосудистая фармакология и медикаментозная терапия, Сердечно-сосудистая хирургия, Коронарная патофизиология и микроциркуляция, Ядер-ная кардиология и КТ сердца, Периферическая циркуляция, Тромбоз, Коро-нарная болезнь сердца.Советы esc: Кардиологическая практика, Первичная сердечно-сосудистая помощь, Уход за сердечно-сосудистыми больными, Смежные профессии.Содержание данных рекомендаций, подготовленных Европейским Общест-вом Кардиологов (european society of cardiology, esc) опубликовано исклю-чительно для использования в личных и образовательных целях. Не допуска-ется коммерческое использование содержания рекомендаций. Рекомендации esc не могут быть переведены на другие языки либо воспроизведены, полно-стью или частично, без письменного согласия esc. Для получения данного согласия письменная заявка должна быть направлена в oxford University press -организацию, издающую european Heart Journal и официально упол-номоченную esc, рассматривать подобные заявки.Отказ от ответственности. Рекомендации esc отражают взгляды esc и осно-ваны на тщательном анализе научных данных, доступных во время подготовки данных рекомендаций. Медицинским работникам следует придер живаться данных реко...

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Abstract-The aim of this study was to investigate the effects of the vasodilating ␤-blocker nebivolol and the cardioselective ␤-blocker metoprolol succinate on aortic blood pressure and left ventricular wall thickness. We conducted a randomized, double-blind study on 80 hypertensive patients. The patients received either 5 mg of nebivolol or 50 to 100 mg of metoprolol succinate daily for 1 year. Their heart rate, central and brachial blood pressures, mean arterial pressure, augmentation index, carotid-femoral pulse wave velocity, and left ventricular wall thickness were measured at baseline and at the end of the study. Nebivolol and metoprolol significantly reduced heart rate, brachial blood pressure, and mean arterial pressure to the same degree. However, reductions in central systolic and diastolic blood pressures, central pulse pressure, and left ventricular wall thickness were significant only in the nebivolol group. The change in left ventricular septal wall thickness was significantly correlated with central systolic blood pressure change (rϭ0.41; Pϭ0.001) and with central pulse pressure change (rϭ0.32; Pϭ0.01). No significant changes in augmentation index or carotid-femoral pulse wave velocity were detected in either treatment group. This proof-ofprinciple study provides evidence to suggest that ␤-blockers with vasodilating properties may offer advantages over conventional ␤-blockers in antihypertensive therapy; however, this remains to be tested in a larger trial. lood pressure (BP) varies throughout the arterial tree because of pulse wave amplification, a phenomenon of wave reflection and arterial stiffness. 1 Because of pulse wave amplification, reduction in brachial BP does not reflect changes in central BP, which may become a more important target in the treatment of hypertension. Recent data from the Strong Heart Study 2 confirm earlier results from smaller studies on high-risk patients 3,4 that central pulse pressure is superior to brachial pulse pressure in the prediction of further cardiovascular events. Moreover, several studies have demonstrated that brachial BP is not a good surrogate for the hemodynamic effects of drug therapies on central circulation. The recently published EX-PLOR Study 5 and the Conduit Artery Function Evaluation Study 6 clearly demonstrated that angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers have a more pronounced effect on reducing central BP compared with the cardioselective ␤-blocker (BB) atenolol. Different effects of BB on central BP can explain the findings of a recent meta-analysis published by Law et al, 7 which demonstrates a slight inferiority of BB in preventing stroke. The detrimental effect of BB on central BP has generated criticism regarding its use as first line therapy for essential hypertension. Dhakam et al 8 questioned the hypothesis that the inferiority of atenolol in reducing central BP is a class effect of BB. They demonstrated that the novel vasodilating BB nebivolol (NEB) reduces central BP si...

Levosimendan is a new calcium sensitizer developed for the short-term intravenous treatment of congestive heart failure. The aims of the present open-label, nonrandomized study were to determine the tolerability, hemodynamic effects, and the basic pharmacokinetics of levosimendan and its metabolites during an extended continuous infusion of levosimendan. Twenty-four patients with New York Heart Association (NYHA) III-IV heart failure in two groups of 12 patients were exposed to either 0.05 microg/kg/min or 0.1 microg/kg/min of levosimendan for 7 days. Heart rate and blood pressure were measured, and blood samples for the determination of plasma concentrations of the parent drug and its metabolites were drawn daily during the infusion and the 10 to 15 days' follow-up. The 7-day infusion was well tolerated and no premature discontinuations occurred. Both systolic and diastolic blood pressure decreased maximally by 6 mmHg in the lower and by 11 mmHg in the higher levosimendan dose groups during the infusion period (p < 0.05 for both groups). The mean heart rate values increased maximally by 18 and 26 beats/min in the lower and higher levosimendan dose groups, respectively (p < 0.001 for both groups). The hemodynamic effects peaked at the end of the infusion period and thereafter slowly declined during the follow-up. After the recommended infusion period of 24 hours, the mean heart rate increase was only 2 and 6 beats/min in the lower and higher levosimendan dose groups, respectively. The elimination half-life of levosimendan was approximately 1 hour and of the metabolites 70 to 80 hours. It can be concluded that levosimendan, even administered considerably longer than the recommended 24 hours, was well tolerated. The 7-day infusion induced a prolonged increase in heart rate and a minor decrease in blood pressure. The long-lasting effects are probably explained by the active metabolite.

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These results indicate that calcification of the aorta is independently associated with aortic stiffness and serum 25(OH)D level in patients with PAD and in healthy subjects. Aortic stiffness and abnormal vitamin D level may contribute to vascular calcification and are related to higher severity grade of atherosclerotic disease.