Potential of valsartan+sacubitril therapy in hypertensive heart disease

The course of hypertension is often complicated by left ventricular hypertrophy (or hypertensive heart disease, HHD). The main “corridor” of natural HHD is development of heart failure with preserved ejection fraction (HFpEF). With HFpEF, the bioavailability of natriuretic peptides (NP) is significantly reduced, as a result of which the activity of cGMP-PKG signaling pathway, which plays a key role in maintaining normal diastolic function, weakens. It is possible to increase the activity of this pathway using the neprilysin inhibitor sacubitril. In case of HFpEF, the greatest efficacy from valsartan+sacubitril therapy should be expected in patients with severe concentric LVH, who have the most pronounced natriuretic peptide deficiency. Valsartan+sacubitril therapy has a clear hypotensive effect, causes a reversal of left ventricular hypertrophy and fibrosis. Since no effective treatment has yet been found for HFpEF, the main way for HHD treatment should be to prevent the diastolic dysfunction progression, which justifies valsartan+sacubitril therapy starting from the early/ asymptomatic stages

AN ADAPTOGEN USAGE IN OUTPATIENT PRACTICE TO IMPROVE CARDIOVASCULAR ADAPTATION TO ABNORMAL CLIMATIC CONDITIONS (THE HEAT)

Aim. To evaluate the drug implied to improve the metabolic resistance to stress (adaptogen), Qudesan®, on its influence on cardiovascular system, psychological status and life quality of patients with average to high cardiovascular risk in the extreme climatic conditions (the summer heat).Material and methods. We included 60 patients; for 30 of those the Qudesan® 40 gtts. qd was added to standard drug therapy; other 30 patients were controls. We measured office BP, potassium and sodium concentrations; malonic dialdehyde (MDA), superoxidedysmutase (SOD) in erythrocytes. Then the relation of MDA/SOD was calculate. Patients also completed the questionnaire made up for this study. Results. In the Qudesan® group during the heat period we found lowering of SBP (А -13,8 mmHg, p=0,02), DBP (А -4,5 mmHg, p=0,05) and PWV (А -0,8 m/s, p=0,05) absent in the control. Also in Qudesan® group the concentration of sodium starts to increase during the heat period (А +1,0 mM/l, p=0,008). This increase becomes significant by september (А +1,7 mM/l, p=0,008) and is probably adaptive. The level of MDA (p<0,05) and MDA/SOD relation, the signs of "antioxydant potential", in blood were increasing significantly during the summer heat only in control group. The complaints on heart rhythm disorders (p=0,04) and on CHF worsening (p=0,09) after the end of heat period were more common in control group. That is the Qudesan® shows adaptogenic effect and can be used to improve adaptability during the heat period and its switching to cloder time in patients with compensated CVD