Improving blood pressure control, organoprotection and metabolic disorders correction in patients with hypertension switching from diuretic-based combinations to fixed combination lisinopril + amlodipine + rosuvastatin

The aim of the study was to assess the possibility of fixed combination Lisinopril + amlodipine + rozuvastatin to improve arterial elesticity in patients with hypertension and high pulse wave velocity, despite previous diuretic-based combination antihypertensive therapy. Materials and methods. In an open, observational study duration of 24 weeks was included 60 patients on previous diuretic-based combination antihypertensive therapy. All participants underwent 24-hour blood pressure monitoring, applanation tonometry (augmentation index and central blood pressure), pulse wave velocity measurement, laboratory tests (lipid profile, fasting glucose, insulin resistance index - NOMA), leptin, high-sensitivity C-reactive protein before and after the switching to a fixed combination of lisinopril + amlodipine + rosuvastatin. Results. According to measurements of office blood pressure switching of patients on double combinations based on diuretics to a fixed combination of lisinopril + amlodipine + rosuvastatin, a further decrease in systolic blood pressure (SBP) by 13.7% and diastolic BP (DBP) by 18.8% was observed. According to the ABPM, the decline in the average daily SBP was 15.8%, DBP - 22.5%, average SBP - 16.2%, DBP - 19.8%. The combination of lisinopril + amlodipine + rosuvastatin reduced PWV by 15.9%, augmentation index by 13.5%, central SBP by 8.4% (

WAYS OF MENOPAUSAL HORMONAL THERAPY IN CORRECTION OF METABOLIC DISORDERS AND ANGIOPROTECTION IN POSTMENOPAUSAL WOMEN

Aim. To compare effectiveness of non-drug therapy together with menopausal hormonal therapy (MHT) — estradiol hemihydrate 1 mg/drospirenon 2 mg (Angeliq® Bayer Pharma AG (Germany)) related to normalization of anthropometric and metabolic parameters, elasticity values and vascular age in women with metabolic syndrome (MS) in postmenopause.Material and methods. The open-label prospective comparative controlled randomized study in 2 parallel groups. Sixty female patients (mean age 55,26±5,63 y.) with MS (according to IDF 2005 criteria) were randomized equally 1:1 into 2 groups. During 36 weeks patients of 1st group (n=30) received life style modification recommendations and monotherapy by Angeliq® , patients from 2nd group (controls, n=30) only followed life style modification. Groups were comparable by baseline clinical and demographic parameters. All patients received instructions for diet, physical activity and life style changes. Anthropometric, metabolic and instrumental assessments were done at baseline, in 12 and 36 weeks of therapy.Results. Prescription of MHT in MS patients in postmenopause led to body weight decrease, decrease of percent composition of visceral fat, improvement of metabolic parameters, vascular elasticity and decrease of vascular age. There were no adverse events related to the drug during the study.Conclusion. Angeliq® is effective and safe medication for low-dosage continuous combination MHT in menopausal MS that facilitates improvement of anthropometric parameters, vascular elasticity and vascular ageing

SLOW RELEASE MELATONINE IN METABOLIC SYNDROME SYMPTHOMATICS CORRECTION

Aim. To compare effectiveness of metformin monotherapy (Mf) and combination of metformin with slow release melatonine (MfM) from the perspective of correction of anthropometric, hemodynamical parameters, premature vascular ageing and somnological status in patients with metabolic syndrome (MS).Material and methods. An open label prospective comparative study conducted, in 3 parallel groups: 238 MS patients (IDF, 2005) having, at the moment of prescreening, sleep disorders (less than 19 points in Questionnaire of self sleep evaluation), were randomized to 3 groups. During 12 weeks all patients underwent life style correction that included regimen of meal intake, normalization of “sleepwakefulness” rhythm, physical activity. In addition to this, first group patients (n=80) received Mf, and second (n=78) — combination MfM (Circadin 2 mg). Controls (n=80) were patients without pharmaceutical interventions. Groups were comparable by the baseline clinical and demographic characteristics. Sleep quality, anthropometric and metabolic parameters, adipocytokine level and vascular elasticity parameters were assessed at baseline and in 12 weeks after treatment.Results. The results of the study performed have proved the feasibility of melatonine slow release addition to standard MS therapy in circadian disorders (CD). MfM no only normalizes the rhythm “sleep-wakefulness”, but also retards vascular ageing, has positive profile of cardiovasular and metabolic effects, acting on insulin resistance as trigger of MS development. Serious adverse events were not marked during the study. Conclusion. Combination therapy by MfM is more effective than monotherapy by Mf in correction of body overweight, carbohydrate and lipid metabolism disorders in MS with CD

OPTIMAL ORGANOPROTECTION, CONTROL OF bLOOD PRESSURE AND METAbOLIC DISORDER WITH THE FIxED COMbINATION OF LISINOPRIL, AMLODIPINE AND ROSUVASTATIN IN SYSTEMIC HYPERTENSION

Aim. Evaluation of the ability of the fixed combination of lisinopril, amlodipine and rosuvastatin (Equamer) in achievement of additional angioprotection in patients with systemic arterial hypertension (AH) and high pulse wave velocity (PWV), regardless of previous antihypertensive therapy (AHT).Material and methods. To the open multicenter observational study 24 weeks duration, 60 patients included, taking double AHT during 6 months. All participants underwent ambulatory 24 hour blood pressure (BP) monitoring, applanation tonometry (augmentation index and central BP), pulse wave velocity assessment, laboratory tests (lipids, fasting glucose, insulin resistance index (HOMA), leptin, high sensitive C-reactive protein (hsCRP) before and after transition to the fixed combination of lisinopril, amlodipine and rosuvastatin (Equamer).Results. By the data from office BP measurement, after transition of patients from the double combinations to fixed combination of lisinopril, amlodipine and rosuvastatin, there was additional decrease of systolic BP (SBP) by 14,3% and diastolic BP (DBP) by 18,5%. By the data from ABPM, decrease of SBP was 16,1%, and DBP — 21,8%. Combination of lisinopril, amlodipine and rosuvastatin decreased PWV by 14,4%, augmentation index by 14,5%, central SBP by 8,1% (p<0,01 for all comparisons with baseline). Fixed combination of lisinopril, amlodipine and rosuvastatin made it to decrease low density lipoproteides by 44%, triglycerides by 36,1% and increase of high density lipoproteides by 10,3% (p<0,01 for all with baseline). Usage of combination of lisinopril, amlodipine and rosuvastatin showed significant decrease of insulin resistance, hsCRP and leptin levels.Conclusion. Fixed combination of lisinopril, amlodipine and rosuvastatin makes it to better control BP, improve vascular elasticity parameters (augmentation index, PWV, central BP) and facilitates the improvement of lipid and glucose metabolism, decrease of inflammation, leptin resistance in patients taking at baseline double antihypertensive therapy

ADDITIONAL ANGIOPROTECTION AND METAbOLIC DISORDERS CORRECTION IN TREATMENT OF ARTERIAL HYPERTENSION PATIENTS REACHED TARGET bLOOD PRESSURE LEVELS, WITH FIxED COMbINATION OF PERINDOPRIL AND INDAPAMIDE

Aim. Evaluation of the ability of fixed combination of perindopril and indapamide (Noliprel Bi Forte) to achieve additional angioprotection in patients with arterial hypertension already reached target blood pressure (BP) at previous antihypertension therapy with losartan and hydrochlorothiazide (HCT).Material and methods. To open observational study, lasting 12 weeks, 25 patients included, those who had been taking losartan+HCT 100/12,5 mg. Results. During the study, all patients underwent 24 hour BP monitoring, applanation tonometry (augmentation index assessment and of central BP), measurement of pulse wave velocity (PWV), laboratory tests (lipids, fasting glucose, HOMA index, homocystein, leptin, adiponectin, high-sensitive C-reactive protein (hsCRP), vascular age assessment). After shifting the therapy with losartan and HCT to combination perindopril and indapamide, BP decreased additionally by 3,9%, and diastolic BP — 5,4% (p<0,05). There was decrease of augmentation index by 9,4% and vascular age by 6,0% (p<0,05). There was also decrease of leptin level by 14,5%, hsCRP by 11,0%, and increase of adiponectin by 9,9% (p<0,05).Conclusion. The fixed combination perindopril and indapamide does have advantages for losartan and HCT combination in BP control, vascular elasticity improvement, and facilitates the decrease of body mass index, insulin resistance and non-infectious inflammation