Безопасность β2-агонистов и атровента у больных хроническими обструктивными болезнями легких в сочетании с ишемической болезнью сердца

The aim of this study was to evaluate safety and efficacy of salbutamol, fenoterol and ipratropium bromide in patients with bronchial asthma (BA) associated with ischaemic heart disease (IHD). One hundred and twenty five patients with exacerbation of moderate to severe BA entered the study. Sixty four of them were diagnosed associated IHD (angina pectoris of II to III functional class and postinfarct cardiosclerosis). All the patients were divided into 4 group, receiving fenoterol, salbutamol, ipratropium bromide and Berodual correspondingly as via dosing aerosol and nebulizer. The bronchodilating effect of the drugs was assessed using peakflowmeter. Moreover, oxygen saturation, arterial blood pressure were measured and 24-hour ECG Holter monitoring was performed. As a result, nebulized therapy with short-acting β2-agonists gave a significant bronchodilating effect and did not cause considerable hemodynamic disorders and myocardial ischaemia. When using high doses of these drugs in patients with BA and associated IHD the efficacy/safety ratio decreased due to possible hemodynamic disturbances, hypoxemia and myocardial ischaemia induction. The alternative bronchodilator to control the bronchoobstructive syndrome in such patients is to be ipratropium bromide.Целью исследования явилась оценка эффективности и безопасности сальбутамола, фенотерола и ипратропиума бромида у больных бронхиальной астмой (БА) с сопутствующей ИБС. В исследование было включено 125 больных среднетяжелой и тяжелой БА в период обострения. У 64 пациентов диагностирована сопутствующая ИБС в виде стенокардии напряжения II-III функционального класса и постинфарктного кардиосклероза. Все пациенты были разделены на 4 равные группы, получавшие фенотерол, сальбутамол, ипратропиума бромид и беродуал соответственно в дозированном аэрозоле и через небулайзер. Оценка бронхолитического действия препаратов проводилась с помощью пикфлоуметра. Кроме этого, больным измерялись сатурация кислорода, артериальное давление, проводилось 24-часовое холтеровское мониторирование. Небулайзерная терапия короткодействующими β2-агонистами, оказывая выраженный бронхолитический эффект, не сопровождается существенными гемодинамическими нарушениями и ишемией миокарда. При использовании высоких доз препаратов соотношение эффективность/безопасность снижается за счет возможных гемодинамических нарушений, гипоксемии и индукции ишемии миокарда у больных БА и сопутствующей ИБС. Для купирования бронхообструктивного синдрома альтернативным эффективным бронхолитиком у таких больных является ипратропиума бромид

Renal function and cardiovascular risk in rheumatoid arthritis

Aim. To study renal function and its association with cardiovascular risk factors in rheumatoid arthritis (RA). Material and methods. The study included 257 RA patients aged 29—69 years. Results. Reduced glomerular filtration rate (GFR) <60 ml/min was observed in 146 (56,8 %) RA patients. Renal dysfunction was associated with non-steroid anti-inflammatory drug (NSAID) therapy (OR 24,5; p<0,01), microalbuminuria (OR 17,8; p<0,01), high RA activity by DAS 28 (OR 6,1; p<0,01), pulse blood pressure (PBP) >55 mm Hg (OR 4,38; p<0,01), arterial hypertension (AH) (OR 3,15; p<0,01), atherogenic dyslipidemia (DLP) (OR 2,83; p<0,01), RA duration >10 years (OR 2,8; p<0,01), hyperglycaemia (OR 2,35; p<0,05), age >50 years (OR 2,17; p<0,01) and “non-dipper” BP profile (OR 1,85; p<0,05). GFR negatively correlated with vascular stiffness index (r=-0,23; p<0,01), LV myocardial mass index (r=-0,2; p<0,05), C-reactive protein level (r=-0,31; p<0,01), RA activity by DAS 28 (r=-0,29; p<0,01), age (r=-0,33; p<0,01), RA duration (r=-0,29; p<0,01), intima-media thickness (IMT) (r=-0,28; p<0,01), mean circadian systolic BP level (r=-0,19; p<0,05) and PBP level (r=-0,31; p<0,01), as well as SCORE-assessed cardiovascular risk level (r=-0,17; p<0,05). Conclusion. In RA, GFR reduction is a complication of chronic inflammation and long-term NSAID therapy. It is associated with AH, atherogenic DLP, and high cardiovascular risk

EFFICACY AND SAFETY OF VASOACTIVE BETA-BLOCKERS IN ACUTE PHARMACOLOGICAL TEST IN HYPERTENSIVE PATIENTS OF DIFFERENT AGES

Aim. To evaluate a short-term efficacy and safety of nebivolol and carvedilol in hypertensive patients of different ages in acute pharmacological test (APT).Material and methods. 119 patients with arterial hypertension (HT) 2-3 degrees aged 33-89 y.o. were involved into the study. Patients were split into 2 groups according to age: young and middle-aged patients (30-59 y.o.); elderly and senile patients (≥60 y.o.). All patients were randomized for carvedilol (12.5 mg once daily) or nebivolol (5 mg once daily) therapy after wash-out period (3-10 days). Ambulatory blood pressure monitoring (ABPM) was performed one day before and one day after first drug taking and ABPM indices were compared.Results. APT with carvedilol and nebivolol in patients of young and middle age showed significant antihypertensive effect on systolic (-6.9 and -6.0 mm Hg, resp.), diastolic (- 4.6 and -4.7 mm Hg, resp.) and pulse (-1.7 and -1.4 mm Hg, resp.) blood pressure (BP). In patients of elderly and senile age the first daily dose of nebivolol did not have influence on systolic and pulse BP (-2.73 and +0.50 mm Hg, resp., p&gt;0.05), unlike carvedilol (-5.27 and -1.43 mm Hg, resp. p&lt;0.05). Carvedilol and nebivolol increased of hypotension time index for diastolic BP in younger (7,6 and 7,7%, resp.) and elder (11 and 8,2% resp.) patients.Conclusion. Carvedilol in initial dose reduces systolic and pulse BP more significantly than nebivolol does in hypertensive elderly and senile patients. Increase of hypotension time index for diastolic BP revealed for both drugs can limit their use in patients with initially low diastolic BP.</p

EFFICACY AND SAFETY OF VASOACTIVE BETA-BLOCKERS IN ACUTE PHARMACOLOGICAL TEST IN HYPERTENSIVE PATIENTS OF DIFFERENT AGES

Aim. To evaluate a short-term efficacy and safety of nebivolol and carvedilol in hypertensive patients of different ages in acute pharmacological test (APT).Material and methods. 119 patients with arterial hypertension (HT) 2-3 degrees aged 33-89 y.o. were involved into the study. Patients were split into 2 groups according to age: young and middle-aged patients (30-59 y.o.); elderly and senile patients (≥60 y.o.). All patients were randomized for carvedilol (12.5 mg once daily) or nebivolol (5 mg once daily) therapy after wash-out period (3-10 days). Ambulatory blood pressure monitoring (ABPM) was performed one day before and one day after first drug taking and ABPM indices were compared.Results. APT with carvedilol and nebivolol in patients of young and middle age showed significant antihypertensive effect on systolic (-6.9 and -6.0 mm Hg, resp.), diastolic (- 4.6 and -4.7 mm Hg, resp.) and pulse (-1.7 and -1.4 mm Hg, resp.) blood pressure (BP). In patients of elderly and senile age the first daily dose of nebivolol did not have influence on systolic and pulse BP (-2.73 and +0.50 mm Hg, resp., p&gt;0.05), unlike carvedilol (-5.27 and -1.43 mm Hg, resp. p&lt;0.05). Carvedilol and nebivolol increased of hypotension time index for diastolic BP in younger (7,6 and 7,7%, resp.) and elder (11 and 8,2% resp.) patients.Conclusion. Carvedilol in initial dose reduces systolic and pulse BP more significantly than nebivolol does in hypertensive elderly and senile patients. Increase of hypotension time index for diastolic BP revealed for both drugs can limit their use in patients with initially low diastolic BP