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

Cardiology service of the south federal region: problems and perspectives

The South Federal Region (SFR) is characterized by unfavorable demographic situation, reflecting general situation in the whole country. For 2004, disease incidence in SFR has increased by 8, 7 %, and disease prevalence - by 7, 8 %. Mortality was high in all SFR subjects. In-hospital mortality (SFR, 2005) due to cardiovascular disease (CVD) was 3, 22 per 100 admitted patients, 15, 9 - for acute myocardial infarction, 7, 09 - due to cerebrovascular pathology, 4, 11 - for chronic coronary heart disease, and 0, 13 - due to high blood pressure. Prevalence of dispanser follow-up among CVD patients was 31, 77 % in 2002, 31, 29 % in 2003, 30, 96 % in 2004, and 31, 4 % in 2005. Taking into account the need for the National Health Project realization, the problems of hospital bed restructuring, health workers' professional level improvement, and preventive technology implementation are most actual

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

ENALAPRIL MALEATE IN TREATMENT OF ARTERIAL HYPERTENSION IN PATIENTS WITH DIABETES MELLITUS

The study includes 25 patients with arterial hypertension (AH) and 25 patients with non-insulin dependent diabetes mellitus (NIDDM) combined with AH. All patients, at baseline and 2 weeks following treatment with enalapril maleate (Enam, Dr.Reddy’s Laborotories Ltd., India), general clinical examination as well as measurement of blood glucose, cholesterol, lipoproteins, triglycerides; conventional echo and evaluation of vasomotoric function of endothelium by D.S. Celermajer’s method. We have shown that even with blood pressure decreasing to the same levels, endothelium-dependent relaxation improved best in the group with NIDDM whereas LV diastolic function dynamics did not differ significantly; those changes having strong correlation to the levels of serum lipoproteins and triglycerides. The results suggest enalapril maleate not just a nephropotective measure in patients with AH and NIDDM, but also as a medication for heart protection in such patients

Enalapril and endothelial function in arterial hypertension patients of various age

Vasoactive endothelial function (EF) was assessed in 48 patients with arterial hypertension (AH) (18 participants under 60 years, 30 patients older than 60). Enalapril ("Enam", Dr Reddy's, India) effects on EFwere studied. AH patients were characterized by impaired vasoactive EF, correlating with age. In older patients, endothelial reaction to nitroglycerin was also disturbed. Three-month "Enam" therapy was associated with EF normalization. In blood pressure-normalizing doses, "Enam "facilitated improvement of initially impaired endothelial cells' sensitivity to shear stress

Arterial hypertension features in the elderly and their correction

Aim. To study vasomotor endothelial function (EF) in the elderly patients with arterial hypertension (AH), during its pharmaceutical correction. Material and methods. In total, 66 individuals aged over 60 years, with isolated systolic and systole-diastolic AH (ISAH, SDAH) were examined. All patients underwent 24-hour blood pressure monitoring (BMP), ultrasound assessment of EF and intima-media thickness (IMT), endotelin-1 level (ET-1) measurement, and lipid profile assessment. All participants received Nifecard® XL (Lek, Slovenia), for 6 months. Results. In ISAH patients, endothelial reaction to reactive hyperemia was significantly weaker than that in SDAH participants. AH patients had insufficient brachial artery vasodilatation in nitroglycerin test, as well as increased ET-1 levels. Maximal ET-1 levels were registered in SDAH individuals. After six-month Nifecard® ХL treatment, vascular EF substantially improved. According to 24-hour BPM data, BP circadian rhythm disturbances were quite common, being observed in 80% of ISAH patients, and 44.4% of SDAH subjects. During 6-month therapy, Nifecard® ХL demonstrated high antihypertensive activity: BP circadian rhythm normalized, number of patients with normal circadian rhythms doubled, and number of patients with unsatisfactory nighttime BP decrease, or nighttime AH, decreased. Conclusion: EF normalization and target BP level achievement are the main tasks of AH treatment. Long-acting, extended-release calcium antagonists are effective in the elderly patients

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

PECULIARITIES OF PURINE METABOLISM AND LIPID PEROXIDATION IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Aim. To study purine metabolism and lipid peroxidation in patients with acute myocardial infarction with ST segment elevation (STEMI) in dependence on severity of acute heart failure (AHF). To evaluate effects of thrombolytic therapy on purine metabolism and lipid peroxidation.Material and methods. 91 patients (age 60,8±1,2 y.o.) with STEMI and AHF (Killip 1-3) was included into the study. Patients were randomized into 3 groups in dependence of AHF severity. Markers of purine metabolism (activity of 5’- nucleotidase, xantineoxidase and uric acid level) and lipid peroxidation (superoxide dismutase and catalase activity, superoxide-anione radical level) were evaluated.Results. Purine metabolism activity increases, antioxidant and prooxidant balance disturbs at the condition of energy deficiency. AHF progression leads to increase in xanthine oxidize activity, urinary acid level and lungs edematization. Thrombolytic therapy increases antioxidant activity (response on reperfusion), but does not lead to purine metabolism stabilization.Conclusion. Thus, severity of heart failure in patients with STEMI correlates with disorders of purine and lipid metabolism. Thrombolytic therapy leads to rising in antioxidant protection, but does not lead to stabilisation of purine metabolism