Benefits of vasodilating beta-adrenoblockers for arterial hypertension treatment

Antihypertensive medications of the same class could differ by their pharmacodynamic parameters, which substantially affects the longterm treatment results. Nebivolol is one of the modern, highly selective β-adrenoblockers (β-AB). It is characterised not only by high β1-selectivity, but also by additional vasodilating activity, due to increased nitric oxide synthesis and, hence, beneficial metabolic effects. The results of the original studies and the external evidence demonstrate metabolic neutrality of nebivolol, absence of substantial changes in thyroid hormone levels, and improvement in heart rate variability, electrophysiological myocardial parameters, QT interval duration, and cerebral perfusion. Nebivolol is effective and safe even in higher-risk patients with metabolic syndrome and Type 2 diabetes mellitus

Benefits of a calcium antagonist, nifedipine GITS, in arterial hypertension treatment

Based on the results of international clinical trials, the clinical benefits of a dihydropyridine calcium antagonist, nifedipine GITS (slow-release gastrointestinal therapeutic-system) are discussed. Nifedipine GITS has been demonstrated to reduce cardiovascular morbidity and mortality effectively. The medication is safe and metabolically neutral even when administered as a long-term treatment

Open, multi-center randomized research and clinical program MINOTAUROS: intermediate data analysis

Aim. To assess indapamide (Arifon retard) effects on blood pressure (BP), carbohydrate, lipid, purine and electrolyte metabolism in patients with mild arterial hypertension (AH) and metabolic syndrome (MS). Material and methods. In total, 573 patients with mild AH and MS participated in MINOTAUROS Study (Patients with MetabolIc SyNdrOme - effecTiveness And ToleRability of ArifOn Retard in Arterial HypertenSion Treatment). All participants were randomized into two groups: 459 were administered Arifon retard and non-pharmaceutical treatment (Group I); 114 patients received only non-pharmaceutical treatment, without pharmaceutical antihypertensive therapy (control Group II). At baseline and after 12 weeks of therapy, BP, body mass (BM), waist circumference (WC), parameters of carbohydrate, lipid, purine, and electrolyte metabolism were measured.. Results. BM and WC decreased in both groups. Arifon retard therapy resulted in greater BP decrease, substantial improvement in carbohydrate and lipid metabolism, with unchanged purine and electrolyte metabolism parameters. Conclusion. Additional beneficial metabolic effects of Arifon retard, as well as its antihypertensive effectiveness, make it a diuretic of choice in treating MS and AH patients

Diuretics in patients with metabolic disturbances

Aim. To study antihypertensive effectiveness of indapamide retard, its effects on carbohydrate, lipid, purine, electrolyte metabolism in patients with mild arterial hypertension (AH) and metabolic syndrome (MS). Material and methods. The study included three phases: initial (screening), 12-week active treatment, and 36-week self-control phase. In total, 619 patients were randomized into two groups. Active treatment group received indapamide retard combined with non4pharmaceutical weight reduction measures; control group received non-pharmaceutical intervention only. At baseline, total cholesterol (CH), low-density lipoprotein CH (LDL-CH), uricacid, potassium, sodium levels were measured; glucose tolerance test was performed. After active treatment phase, all patients receiving indapamide retard and achieving target blood pressure (BP) levels were recommended to continue the treatment under self-control. Individuals failing to achieve target BP levels were recommended to take perindopril in addition. If needed, control group patients were also administered antihypertensive therapy. Results. After 12-week therapy, target BP levels were achieved in 61,8% of patients receiving indapamide retard, and 48,4% participants of control group; after 12 months - in 69,4% and 52,7%, respectively. Body weight significantly reduced in both groups, by 3 kg on average, waist circumference - by 3 cm. Carbohydrate and lipid metabolism parameters also improved: in 37% of active treatment patients and 25,2% of control group individuals glucose tolerance improved, atherogenicity index decreased. Indapamide retard therapy was well tolerated. Conclusion. Indapamide retard demonstrated good antihypertensive effectiveness and beneficial effects on carbohydrate and lipid metabolism in MS patients

Metabolic (cytoprotective) therapy of menopausal disturbances

The paper presents modern views on cardiovascular aspects of menopause and metabolic therapy of menopausal disturbances with meldonium (Mildronate®). The role of estrogen deficiency in climacteric disturbance development, key pathogenetic mechanisms of menopausal metabolic syndrome (MS), and relevant features of arterial hypertension and endothelial dysfunction development are discussed. The data on Mildronate® clinical use for cardiovascular prevention are summarized. The wide prevalence and multiple clinical manifestations of menopausal disturbances point to the need for their complex therapy. Mildronate® therapy is a new approach for systemic correction of metabolic disturbances in women with climacteric symptoms and menopausal MS

Moxonidine-based combination antihypertensive therapy in patients with metabolic syndrome

Aim. To assess the effects of moxonidine-based combination therapy on clinical status, laboratory parameters, and target organs in patients with metabolic syndrome (MS). Material and methods. In total, 60 MS patients with Stage 1-2 arterial hypertension (AH) were randomised into 3 groups. Group I was administered moxonidine (0,2-0,4 mg/d) and amlodipine (5-10 mg/d); Group II received moxonidine (0,2-0,4 mg/d) and hydrochlorothiazide (12,5 mg/d); Group III was treated with moxonidine (0,2-0,4 mg/d) and enalapril (10-20 mg/d). At baseline and after 24 weeks of treatment, the following characteristics were assessed: waist circumference (WC), body mass index (BMI), 24-hour blood pressure monitoring (BMP) parameters, left ventricular myocardial mass index (LVMMI), E/A ratio, isovolumetric relaxation time (IVRT), deceleration time (DT) of early diastolic velocity, peak Em velocity at interventricular septum and lateral wall levels, E/Em ratio (myocardial tissue Doppler echocardiography), pulse wave velocity (PWV) between descending aorta and aortic bifurcation levels (ultrasound method), and stiffness index β of ascending aorta. In addition, lipid, carbohydrate, and purine metabolism parameters were assessed; glomerular filtration rate (GFR) was calculated (MDRD method); and urine albumin levels were measured. Results. In Group I (moxonidine + amlodipine), target blood pressure (BP) levels were achieved in 70% of the patients. Systolic BP (SBP) levels, LVMMI, and DT decreased by 19,3±11,4 mm Hg, 4,4 g/m2 (p=0,09), and 10,6 ms (p<0,05), respectively. The increase in E/A ratio and Em annular velocity (Em av) reached 0,4 (p<0,05) and 1,4 cm/s (p<0,05), respectively, while E/Em av ratio decreased by 0,8 (p<0,05), and PWV decreased by 1,6 ms (p<0,05). The BMI decrease reached 0,7 kg/m2 (p<0,05). In Group II (moxonidine + hydrochlorothiazide), target BP levels were achieved in 40% of the participants, with a decrease in SBP levels by 14,7 mm Hg (p<0,05). DT was reduced by 9,4 ms (p<0,05), E/A ratio increased by 0,1 (p<0,05), while PWV, BMI, and GFR decreased by 1,3 m/s (p<0,05), 0,8 kg/m2 (p<0,05), and 5,6 ml/min/1,73 m2 (p<0,05), respectively. In Group III (moxonidine + enalapril), 60% of the patients achieved target BP levels, and SBP levels were reduced by 21,1 mm Hg (p<0,05). LVMMI decreased by 5,1 g/m2 (p<0,05), Em av increased by 0,3 cm/s (p<0,05), while the respective reduction in PWV, WC, and BMI reached 1,1 m/s (p<0,05), 1,8 cm (p<0,05), and 0,5 kg/m2 (p<0,05). All three groups demonstrated a significant reduction in urine albumin levels. Conclusion. The moxonidine-based combination therapy effectively reduced the levels of BP and urine albumin. The combination of moxonidine with amlodipine or enalapril improved cardiac structure and function, as well as renal excretory function. The combination of moxonidine and hydrochlorothiazide, however, negatively affected renal excretion. All three variants of combination therapy were metabolically neutral and demonstrated beneficial effects on visceral obesity

Obesity pharmaceutical correction in metabolic syndrome patients

Very high prevalence of obesity and metabolic syndrome (MS) is well known. The need for early treatment start and more selective pharmaceutical treatment of MS has been noted in many publications. As pathogenetic therapy, numerous methods for body mass (BM) reduction have been proposed, due to well-known prevalent role of obesity in MS pathogenesis. Because of various reasons, many medications haven’t achieved wide acceptance in clinical settings. The article summarizes the experience in BM reduction with an effective drug – orlistat (Xenical®). Based on the authentic authors’ data, beneficial effects of orlistat on carbohydrate and lipid metabolism, 24-hour blood pressure profile, and cerebral perfusion are demonstrated. The authors prove that orlistat is highly recommended for cardiovascular complication risk reduction in MS patients

Metabolic syndrome and angiotensin II receptor antagonists

Aim. To investigate the effects of angiotensin II receptor antagonist irbesartan on blood pressure (BP), tissue insulin sensitivity, carbohydrate and lipid metabolism, cerebral perfusion parameters in patients with arterial hypertension (AH), metabolic syndrome (MS), and Type 2 diabetes mellitus (DM-2). Material and methods. The study included 20 patients with AH only, 20 participants with AH + MS, and 20 individuals with AH + DM-2. At baseline and 24 weeks later, physical examination and measurement of body weight, blood glucose, immune-reactive insulin levels, insulin sensitivity index (intravenous insulin4modified glucose tolerance test) were performed. Cerebral perfusion was assessed by single-photon emission computed tomography with 99mTc-HMPAO. Results. Irbesartan therapy demonstrated good antihypertensive effect: target BP levels were achieved in 80% of AH patients, 70% of AH + MS participants, and 50% of AH + DM-2 individuals. Waist circumference reduced in all participants; blood glucose and lipid levels, initially increased, reduced significantly in AH + MS and AH + CD-2 patients. Blood insulin level, increased at baseline, decreased in AH + MS individuals, and insulin secretion improved in AH + DM-2 patients. Insulin sensitivity improved in all participants, but only in AH + MS it was statistically significant. Irbesartan therapy also improved cerebral perfusion, initially reduced, in all patient groups. Conclusion. Irbesartan demonstrated not only good anihypertensive effectiveness, but also positive metabolic and organo-protective effects

SPECIFICS OF METABOLIC SYNDROME PATHOPHYSIOLOGY IN WOMEN AT DIFFERENT PHASES OF CLIMACTERIC PERIOD

Aim. To study the specifics of metabolic syndrome (MS) course in women at different stages of climacterics and relationship with body mass and adipose tissue localization pattern.Material and methods. Totally 138 women included during the climacteric period: 1 st group — 52 women in premenopausal period; 2nd group — 86 women in early postmenopause. The age of participants for the 1st group was 49,1 (48,0;51,0) years, 2nd group — 53,9 (50,0;56,0) years. We studied lipid profile, MK and carbohydrate metabolism including C-peptide, IRI and HOMA-IR. The method for the hard phase IEA in blood plasma used to measure SHBG and dihydroepiandrosterin-sulphate (DHEAS). ABPM was performed for 24 hours by oscillometric method.Results. Most women in postmenopausal period had adverse metabolic changes in lipid and carbohydrate metabolisms relevant for MS. Lipid profile disorders in women at menopausal switch were found with the highest levels during early postmenopause. The highest intergroup differences were found by the levels of TG of the blood and relationship of TG to HDL, non-HDL. Also the increase of HOMA-IR marked in women at postmenopause 1,49 (0,80-2,2) and 0,82(0,3-1,4) units, resp., p<0,05).Two types of MS selected — MetONM and MS with overweight with the prevalence of the second type MS in 90,6% of women. The specifics of clinical presentation of MS in overweight is the severity of metabolic and hormonal changes — high levels of TG (2,2±1,7 и 1,65±0,3 mmol/L, p<0,01) and MK (371 ±84,4 и 342±71,8 mcmol/L, p<0,05), HOMA-IR (3,9 (1,8;6,0) и 2,8 (1,7;4,5) units, p<0,05), resp., and decrease of SHBG (387,7 (319,7;517,0) и 623,8 (396,3;720,0) nmol/L, p<0,01); more severe course of AH noted