GENDER DIFFERENCES OF ARTERIAL HYPERTENSION AND ANTIHYPERTENSIVE THERAPY

Aim. To study gender differences of endothelial vasomotor function and pulse wave velocity (PWV) in patients with arterial hypertension (HT) and to evaluate effects of amlodipine (Normodipine, Gedeon Richter) on these parameters.Material and methods. 57 patients with HT of 1-2 stages were involved in the study. Patients were randomized to 4 groups: women under 50 y.o. (group 1), women older than 60 y.o. (group 2), men under 50 y.o. (group 3) and men older than 60 y.o. (group 4). Endothelium vasomotor function was estimated by ultrasonography. PWV was estimated by volume sphygmography. Patients received antihypertensive therapy with amlodipine during 12 weeks.Results. The lowest levels of systolic blood pressure (BP), normal endothelium function and PWV were observed in women with normal menses. The highest levels of pulse BP were found in menopausal women. Amlodipine monotherapy had better antihypertensive effect in women than in men. BP target levels were reached in 60% of amlodipine treated women. Besides amlodipine improved vascular endothelial function.Сonclusion. Disorders of endothelial function and PWV begin later in women than in men, however after menopause the rate of these disorders development in women is faster than in men of similar age

The influence of antyhypertensive therapy of valsartan and fixed combination with hydrochlorothiazide use on pulse-wave velocity and central arterial pressure in patients with arterial hypertension of 1-2 grades in international VICTORY clinical trial

Objective - to explore influence of valsartan monotherapy use and its use in combination with hydrochlorothiazide (HCTZ) on pulse-wave velocity (PWV) and central arterial pressure (CAP) in patients with arterial hypertension (AH) of 1-2 grades in international VICTORY clinical trial. Materials and methods. The international multicenter prospective randomized clinical study VICTORY that lasted for 16 weeks included patients with 1-2 grades AH. In patients who previously received antihypertensive therapy a 7 days washout period was carried out. All patients started their therapy with 80 mg valsartan (Valsacor®, KRKA, Slovenia); in Russia the starter dose of Valsacor®, KRKA was 160 mg in previously treated patients that did not influence the study results. If after 4 weeks of treatment BP was more than 140/90 mm hg (more than 130/80 mm hg in high risk patients or in diabetes mellitus patients) the dose of valsartan was increased to 160 mg (320 mg in Russia) or diuretic in fixed combination with valsartan was added (160 mg valsartan/12.5 mg HCTZ): Valsacor® H 160 (KRKA, Slovenia). If target BP after 8 weeks of treatment was not reached valsartan dose was increased to 320 mg or fixed combination of valsartan and diuretic (160 mg/12.5 mg) was used. If target BP after 12 weeks of treatment was not reached - valsartan and diuretic 320 mg/12.5 mg were used. PWV and CAP (SphygmoCor®, AtCorMedical) were assessed at baseline and after 16 weeks of treatment. The primary endpoints were assessment of the impact of studied medications on aortic stiffness, aortic augmentation index and comparison of absolute medians of reached central and peripheral BP reduction with baseline value. Results. Of 365 patients included in the study 74 were included in PWV and CAP study subgroup. Valsartan and its combination with HCTZ were effective in CBP reduction. The mean absolute reduction of central systolic and diastolic BP after 16 weeks of treatment was 19.7±12.9 mm hg and 13.9±8.5 mm hg, respectively (

EFFICACY AND SAFETY OF FIXED COMBINATION OF LISINOPRIL AND HYDROCHLOROTHIAZIDE FOR MANAGEMENT OF VASCULAR DISORDERS IN PATIENTS WITH ARTERIAL HYPERTENSION

Aim. To study endothelial disorders and artery elasticity disorders in patients with arterial hypertension (HT), as well as possibility of their correction by lisinopril or by fixed low dose combination of lisinopril and hydrochlorothiazide.Material and methods. 99 patients with HT were included in the study. Patients were randomized into 2 groups. Patients of the 1st group were treated with the fixed low dose combination of lisinopril (5мг) and hydrochlorothiazide (12,5 mg). Patients of the 2nd group were treated with lisinopril alone. The amlodipine was added in case of insufficient therapy. Pulse wave velocity was defined by volume sphygmography. Tests for evaluation of microalbuminuria and activity of von Willebrand factor were performed.Results. Endothelium function disorders were observed in a half of the patients with HT aged 60 y.o. and older. The fixed low dose combination of lisinopril and hydrochlorothiazide was more effective than lisinopril monotherapy in target blood pressure achievement. Positive changes of endothelium function indicators were founded in both groups of therapy. This fixed combination had also a good safety profile.Conclusion. Lisinopril alone or in low dose combination with hydrochlorothiazide improves endothelium function and decreases microalbuminuria level in patients with HT and high body mass index

EFFICACY AND SAFETY OF FIXED COMBINATION OF LISINOPRIL AND HYDROCHLOROTHIAZIDE FOR MANAGEMENT OF VASCULAR DISORDERS IN PATIENTS WITH ARTERIAL HYPERTENSION

Aim. To study endothelial disorders and artery elasticity disorders in patients with arterial hypertension (HT), as well as possibility of their correction by lisinopril or by fixed low dose combination of lisinopril and hydrochlorothiazide.Material and methods. 99 patients with HT were included in the study. Patients were randomized into 2 groups. Patients of the 1st group were treated with the fixed low dose combination of lisinopril (5мг) and hydrochlorothiazide (12,5 mg). Patients of the 2nd group were treated with lisinopril alone. The amlodipine was added in case of insufficient therapy. Pulse wave velocity was defined by volume sphygmography. Tests for evaluation of microalbuminuria and activity of von Willebrand factor were performed.Results. Endothelium function disorders were observed in a half of the patients with HT aged 60 y.o. and older. The fixed low dose combination of lisinopril and hydrochlorothiazide was more effective than lisinopril monotherapy in target blood pressure achievement. Positive changes of endothelium function indicators were founded in both groups of therapy. This fixed combination had also a good safety profile.Conclusion. Lisinopril alone or in low dose combination with hydrochlorothiazide improves endothelium function and decreases microalbuminuria level in patients with HT and high body mass index.</p

FROM THE SHORT ACTING NIFEDIPINE TO AMLODIPINE AND FIXED COMBINATIONS. HIGHLIGHTS THE PROBLEM FROM THE CURRENT GUIDELINES POINT OF VIEW

Calcium antagonists (CA) therapy of patients with arterial hypertension is focused on the base of current recommendations. Results of some large clinical trials confirm high antihypertensive efficacy of this therapeutic class. Special attention is devoted to implementation of fixed combinations on the basis of CA. Advantages of these combinations in hypertension therapy are discussed

MICROALBUMINURIA AS A FORECAST FACTOR FOR CARDIO-VASCULAR COMPLICATIONS AND A MARKER OF THERAPY EFFICACY IN PATIENTS WITH ARTERIAL HYPERTENSION

Aim. To assess the microalbuminuria (MAU) and vascular wall elasticity in patients with essential hypertension (HT) and evaluate the possibilities to reduce in fatal cardiovascular risk due to lisinopril (Listril, Dr Reddy’s) therapy.Material and methods. 42 patients (60,3±0,83 y.o.) with HT were involved in the study. Pulse wave velocity was estimated by volume sphygmography. MAU levels were detected with micral-test (Roche Diagnostics, Germany). Patients received lisinopril as a first-step antihypertensive drug, if necessary the dose of lisinopril was increased or amlodipine was added. The treatment lasted for 12 weeks.Results. MAU was revealed more often in patients with increased body mass index as compared with whole population of hypertensive patients. MAU was associated with increased vascular wall stiffness. Lisinopril therapy during 4 weeks allowed to reach target level of blood pressure (BP) in 42,9% of patients and decreased in MAU level by 54,5%. Therapy continuation during 12 weeks allowed to reach target level of BP in 90,4% of patients and reduce in fatal cardiovascular risk by 36,6%.Conclusion. Lisinopril therapy resulted in significant reduction in BP, MAU and fatal cardiovascular risk in patients with HT

VASCULAR BED PECULIAR PROPERTIES IN PATIENTS WITH ISCHEMIC HEART DISEASE AND ARTERIAL HYPERTENSION. ROLE OF ANTIPLATELET THERAPY

Aim. To study state of vascular wall within different levels of vascular bed in patients with arterial hypertension (HT) and ischemic heart disease (IHD), and the possibility of the correction of revealed disorders with antiplatelet agent — clopidogrel 75 mg/day. Material and methods. 40 patients with HT of 1-2 degree and IHD (stable angina of I-II functional class) were included into the study. 20 healthy volunteers were included into the control group. Pulse wave velocity (PWV) was evaluated by volumetric sphygmography. Microvasculature (MC) was evaluated by computerized ultrasound Doppler velocimetry. Plasma activity of von Willebrand factor (vWF) was evaluated by direct quantitative enzyme-linked immunosorbent chemical analysis. Results. Patients with HT and IHD have abnormalities of all levels of the vascular bed compared with subjects of control group: endothelial function (increased vWF), MC disorders (lack of the linear flow velocity augmentation 1.4% vs 23.7%), as well as increase in PWV in elastic type vessels (13.27±0.53 vs 8.37±0.76 m/s). Strong positive correlation (r=0.71; p&lt;0.05) between HT duration and average linear velocity of blood flow was detected. Disease duration had direct correlation with MC disorders and PWV. There is correlation between MC changes and PWV in elastic vessels. Increase in vWF (168.7±9.1%) was detected in 28 (70%) patients of the main group. Blood flow velocity augmentation &gt;20% during the test was observed in 27 (67.5%) patients treated with clopidogrel. Conclusion. Clopidogrel has effects on MC disorders and significantly reduces the vWF activity level

CUMULATIVE CARDIO-VASCULAR RISK IN HYPERTENSIVE PATIENTS: EFFECTS OF ANGIOTENSIN CONVERTING ENZYME INHIBITORS

Aim. To assess cumulative cardio-vascular (CV) risk and elasticity of big-to-middle size arteries in hypertensive patients depending on age, sex and enalapril (Enap, Dr. Reddy’s) effects on these features.Material and methods. 143 patients with arterial hypertension of 1-2 stages were split in 3 groups: 1st – patients younger than 55 y.o. (17 men, 27 women before menopause); 2nd – patients aged 55-65 y.o. (16 men, 38 women); 3rd – elder than 65 y.o. (11 men, 34 women). Fatal CV risk according to SCORE scale and cumulative risk of acute coronary disease (CAD) events according to PRCAM program was assessed before and after 4 weeks of enalapril therapy (5-30 mg/d). Besides the speed of pulse wave spread (SPWS) was determined by method of volume sphygmography.Results. Normal SPWS in elastic arteries was observed in women under 55 y.o. SPWS disturbances were detected in elderly patients. Lower blood pressure (BP) levels and better plasma lipid profile was found in women of young and middle age in comparison with these in men of the same age. More than 80% of hypertensive patients have high CV risk, especially in elderly ones. Enam improved SPWS in elastic arteries, reduced BP and cumulative CV risk.Conclusion. There are gender and age differences between BP levels, SPWS indices, plasma lipid profiles and cumulative CV risks in hypertensive patients. Enalapril improves these characteristics.</p

CLINICO-ECONOMICAL ANALYSIS OF THE TREATMENT EFFICACY IN PATIENTS WITH ARTERIAL HYPERTENSION OF 1-2 DEGREES

Aim. Clinico-economical analysis of arterial hypertension (HT) treatmentMaterial and methods. 78 patients with HT were involved into the study. Patients were spitted into two groups depending on HT degree. The first group – 38 patients with HT 1 degree. The second one – 40 patients with HT 2 degree. Patients of group 1 had initial antihypertensive therapy with angiotensinconverting enzyme inhibitors. If target level of blood pressure (BP) had not been reached, therapy was changed on fixed combination of lisinopril and hydrochlorothiazide. Patients of group 2 had initial combined antihypertensive therapy with lisinopril and hydrochlorothiazide. If it was needed amlodipine maleat was added. Clinico-economical analysis was performed according to “cost-efficacy” approach at the end of 3 month therapy.Results. About 50% of hypertensive patients do not follow physician recommendations in out-patient practice. They decrease a dose of medicine or stop therapy themselves. More than 6% of them perform self-treatment.Conclusion. Analysis showed that therapy of patients with HT of 1 degree is economically more profitable regarding target BP achievement. It is more reasonable to start antihypertensive therapy with fixed low dose combination and add calcium antagonists if it is needed in patients with HT of 2 degree.</p

ECOLOGICAL STRESS AND ITS EFFECTS ON ESSENTIAL HYPERTENSION AND CHRONIC OBSTRUCTIVE BRONCHITIS DEVELOPMENT IN ROSTOV-ON-DON INHABITANTS

Aim. To study prevalence of essential hypertension (HT) and chronic obstructive bronchitis (COB) among Rostov-on-Don population, to assess influence of ecological stress on HT and COB development and to find the ways to improve therapy of combined pathology.Material and methods. Single-stage epidemiologic study of Rostov-on-Don population was carried out. The study included questionnaire to reveal main risk factors of chronic noninfectious diseases, a number of laboratory and instrumental indices.Results. Prevalence of HT and COB is significantly higher in patients, living in ecologically unfavorable districts. Rigidity and stretch ability of vascular wall influence the course and development of HT as well as atrial natriuretic factor. Carbonic anhydrase inhibitor, acetazolamide, when is added to standard therapy increases in its efficacy in blood pressure control, decrease in blood pressure in pulmonary artery and correction of disturbed acidbase balance in patients with HT combined with COB.Conclusion. The connection between unfavorable ecology and HT and COB development is demonstrated. Adjuvant therapy with acetazolamide is proposed to increase in efficacy of HT and COB standard therapy