Contribution of Carbohydrate Metabolism Disorders to the Development of Target Organ Damage in Hypertensive Patients with Metabolic Syndrome

Abstract Objective: The relationship between glucose abnormality and cardiovascular and renal functions in hypertensive patients with metabolic syndrome (MetS) was examined in this study. Methods: The population included 85 hypertensive patients with MetS. MetS is defined according to IDF, 2005 criteria. Metabolic measures included lipids, plasma insulin, glucose tolerance test, and insulin sensitivity by the homeostasis model assessment. M-and B-mode ultrasounds were used to determine left ventricular (LV) hypertrophy, endothelium-dependent vasodilation and intima media thickness. Results: Hypertensive patients who have had either impaired glucose tolerance (IGT) and hyperinsulinemia or a combination of both have expressed a higher degree of LV hypertrophy, LV diastolic dysfunction, endothelium dysfunction and lipid disorders. Conclusions: The presence of the IGT and hyperinsulinemia changes for the worse cardiovascular remodeling processes in hypertensive patients with MetS and it is association with high risk of target organ damage. IJBM 2011; 1(3):132-138

Antiremodelling Efficacy and Clinical Safety of Zofenopril in Patients with Grade 1and 2 Hypertension

Objective: to estimate the antihypertensive, antiremodelling efficacy and clinical tolerability of the monotherapy with Zofenopril in patients with Grade 1 and 2 hypertension (HT 1 and 2) Materials and Methods: The study included 30 patients aged from 30 to 60 years with HT 1 and 2 (ESH/ESC, 2013) without severe comorbidities and cardiovascular complications. Zofenopril was prescribed as monotherapy to HT patients who had never been treated before or patients after one week of lavage from previous antihypertensive therapy, who did not reach target levels of BP. Before and during treatment all patients were checked on office BP using Korotkov’s method and ambulatory blood pressure monitoring (ABPM). Echocardiography and Doppler sonography were carried out by standard methods using the recommendations of the American Society of Echocardiography. Intima-media thickness (IMT) of the carotid artery and brachial artery was measured by a 7.5MHz high-resolution ultrasound. Assessment of flow-mediated dilation (FMD) of the brachial artery was used as a method of determining endothelial function. Results: A 12-week monotherapy with Zofenopril in average daily dose of 36.0±19.54 mg showed a high antihypertensive efficacy and a good safety profile without side effects. We noted a reliable decrease in systolic BP (SBP), diastolic BP (DBP), mean BP, and pulse pressure (PP) by -19.53±5.93%, -18.64±7.18%, BP -19.05±6.14%, and -20.65±12.07%, respectively. Target SBP, DBP, and SBP+DBP were reached in 90%, 86.6%, and 83.3% of patients, respectively. We found a significant regression of LVH, significant improvement in volume indicators of LV echogeometry and parameters of FMD of the brachial artery, as well as a decrease in IMT of carotid and brachial arteries. Monotherapy with Zofenopril showed metabolic neutrality regarding the lipid and carbohydrate metabolism, a good safety profile without the side effects and undesired events

Left Ventricular Mass Appropriateness in Hypertensive Patients with Metabolic Syndrome

The objective of this study was to evaluate the frequency of inappropriate left ventricular (LV) mass (iLVM) and factors associated with iLVM in hypertensive patients with metabolic syndrome (MetS). The study included 178 male patients (mean age 45.9±10.5 yrs) with hypertension (HT) and MetS. iLVM in HT patients with MetS was associated with LV diastolic dysfunction and an intensity of vascular remodeling process. Hyperinsulinemia contributes to LVM appropriateness, which aggravates the cardiovascular remodeling with development of the significant LV diastolic dysfunction and endothelium dysfunction