ФУНКЦІОНАЛЬНИЙ СТАН СЕРЦЕВО-СУДИННОЇ СИСТЕМИ ЗА РЕЗУЛЬТАТАМИ ВЕЛОЕРГОМЕТРІЇ І ЛІПІДНИЙ СКЛАД КРОВІ У ХВОРИХ НА СТАБІЛЬНУ ІШЕМІЧНУ ХВОРОБУ СЕРЦЯ ЗАЛЕЖНО ВІД КІЛЬКОСТІ УРАЖЕНИХ КОРОНАРНИХ АРТЕРІЙ

SUMMARY. Ischemic heart disease (IHD) occupies a leading position in cardiac pathology. Prolonged myocardial ischemia is the cause of mortality and disability of the population, regardless of the socio-economic development of the country. The main proven risk factors for cardiovascular disease are hyper- and dyslipidemia and abdominal obesity. The aim of the study – to analyze hemodynamic and ergometric parameters of the heart according to veloergometry (VEM) data, lipid composition of the blood and to evaluate anthropometric data in patients with stable coronary artery disease depending on the number of coronary arteries (CA) affected. Material and Methods. The study involved 62 patients with stable coronary heart disease with functional angina (FC) III with heart failure (HF) IIА FC III with preserved left ventricular ejection fraction (LVEF). Among the surveyed men were dominated by 52 persons (83.9 %). The mean age of the patients was (61.2±1.2) years. Clinical groups are divided into subgroups depending on the number of affected CA: in 16 (25.8 %) patients according to the coronary angiography (CAG) revealed a single-vessel lesion, and in 46 (74.2 %) patients – a multi-vessel. Results. Coronary and myocardial reserves and myocardial contractility according to VEM were shown to be reduced in both observation subgroups, however, such changes were observed in the case of two or more CA (p<0.05). According to anthropometric indices, body mass index (BMI) and waist circumference exceeded the normative value in 42 (67.7 %) patients (p<0.001), and in patients with multivascular CA the data of patients with the affected one CA (p<0.05) prevailed. The amount of total cholesterol (TC), triglycerides (TG), low and high density lipoprotein cholesterol (LDL cholesterol, HDL cholesterol) in the serum were significantly different in both groups of patients (p<0.05).РЕЗЮМЕ. Среди кардиальной патологии ишемическая болезнь сердца (ИБС) занимает ведущую позицию. Длительная ишемия миокарда является причиной смертности и инвалидизации населения независимо от социально-экономического развития страны. Основными доказанными факторами риска развития сердечно-сосудистых заболеваний являются гипер- и дислипидемия и абдоминальное ожирение. Цель – проанализировать гемодинамические и эргометрические показатели сердца по данным велоэргометрии (ВЭМ), липидный состав крови и оценить антропометрические данные пациентов со стабильной ИБС в зависимости от количества пораженных коронарных артерий (КА). Материал и методы. В исследовании приняли участие 62 больных стабильной ИБС со стенокардией напряжения функционального класса (ФК) ІІІ с сердечной недостаточностью (СН) ІІА ФК ІІІ с сохраненной фракцией выброса левого желудочка (ФВ ЛЖ). Среди обследованных преобладали мужчины – 52 человека (83,9 %). Средний возраст пациентов составил 61,2±1,2 года. Клинические группы поделены на подгруппы в зависимости от количества пораженных КА: у 16 (25,8 %) больных по данным коронароангиографии (КАГ) обнаружено однососудистое поражение, а у 46 (74,2 %) пациентов – многососудистое. Результаты. Доказано, что коронарный и миокардиальный резервы и сократительная способность миокарда по данным ВЭМ были сниженными в обеих подгруппах наблюдения, однако выраженными такие изменения наблюдались в случае поражения двух и более КА (р<0,05). Антропометрические показатели – индекс массы тела (ИМТ) и окружность талии – превышали нормативное значение у 42 (67,7 %) больных (р<0,001), причем у пациентов с многососудистом поражением КА эти изменения были более выражены, чем у пациентов с пораженной одной КА (р<0,05). Количество холестерина общего (ХСЗ), триглицеридов (ТГ), ХС липопротеидов низкой и высокой плотности (ХС ЛПНП, ХС ЛПВП) в сыворотке крови достоверно отличалось в обеих группах пациентов (р<0,05).РЕЗЮМЕ. Серед кардіальної патології ішемічна хвороба серця (ІХС) займає провідну позицію. Тривала ішемія міокарда, незалежно від соціально-економічного розвитку країни, є причиною смертності та інвалідизації населення. Основними доведеними факторами ризику розвитку серцево-судинних захворювань є гіпер- та дисліпідемія й абдомінальне ожиріння. Мета – проаналізувати гемодинамічні та ергометричні показники серця за даними велоергометрії (ВЕМ), ліпідний склад крові та оцінити антропометричні дані у пацієнтів із стабільною ІХС залежно від кількості уражених коронарних артерій (КА). Матеріал і методи. У дослідженні взяли участь 62 хворих на стабільну ІХС з стенокардією напруги функціонального класу (ФК) ІІІ із серцевою недостатністю (СН) ІІА ФК ІІІ із збереженою фракцією викиду лівого шлуночка (ФВ ЛШ). Серед обстежених переважали чоловіки – 52 особи (83,9 %). Середній вік пацієнтів становив (61,2±1,2) року. Клінічні групи поділені на підгрупи залежно від кількості уражених КА: у 16 (25,8 %) хворих за даними коронароангіографії (КАГ) виявлено односудинне ураження, а в 46 (74,2 %) пацієнтів – кількасудинне. Результати. Доведено, що коронарний та міокардіальний резерви і скоротлива здатність міокарда за даними ВЕМ виявилися зниженими в обох підгрупах спостереження, проте вираженими ці зміни були у випадку ураження двох і більше КА (р<0,05). Антропометричні показники – індекс маси тіла (ІМТ) та обвід талії – перевищували нормативне значення у 42 (67,7 %) хворих (р<0,001), причому в пацієнтів із ураженням двох і більше КА ці зміни були більш виражені, ніж у пацієнтів з ураженою однією КА (р<0,05). Кількість холестерину загального (ХСЗ), тригліцеридів (ТГ), ХС ліпопротеїдів низької та високої щільності (ХС ЛПНЩ, ХС ЛПВЩ) в сироватці крові достовірно відрізнялися у обох групах пацієнтів (р<0,05)

Клініко-економічна оцінка фармакотерапії хворих на туберкульоз у відділеннях інтенсивної терапії протитуберкульозних диспансерів

Aim. To conduct the clinical and economic evaluation of the prescription leaflets of patients with complicated forms of tuberculosis and co-infection with TB / HIV.Materials and methods. In the study 70 medical cards of inpatients with life-threatening complications of TB and TB/HIV/AIDS treated in six departments of anesthesiology and intensive therapy of regional anti-TB dispensaries of Ukraine were considered; such methods as retrospective clinical and economic: frequency / ABC analysis; analytical-synthetic; and graphic were used.Results. In intensive therapy departments there were patients with TB (34 %) and TB/HIV/AIDS (66 %) with pulmonary insufficiency (37 %) and polyorganic insufficiency syndrome (simultaneously progressive disorders of hemostasis, acute respiratory distress syndrome, hepato-renal insufficiency – 19 %) with a chance to survive or die 51 % to 49 %. Most often the cause of death was cerebral edema (53 %) and multiple organ failure (23 %). On average, patients stayed 12 ± 11 bed-days in the departments; they had 1701 prescriptions with 223 medicines. The leaders in the frequency of prescriptions were: Analgin sol. for inj. 500 mg/ml, amp. 2 ml, No. 10, Yuria-Pharm; Dimedrol sol. For inj. 10 mg/ml, amp. 1 ml, No. 10, Darnitsa; Furosemide sol. for inj. 10 mg / ml, amp. 2 ml, No. 10, Zdorovia. The total cost of the pharmacotherapy consumed by patients was 3 574.95 UAH/for 1 patient.Conclusions. The qualitative composition of pharmacotherapy taken by patients in the antituberculosis dispensaries needs to be improved on the model of the world standards: development of the Unified Protocol for providing medical care to patients with TB, co-infection of TB/HIV/AIDS with urgent states in intensive therapy departments is necessary.Цель: клинико-экономическая оценка листов назначений больных с осложненными формами туберкулеза (ТБ) и ко-инфекции ТБ/ВИЧ.Материалы и методы: 70 медицинских карт стационарных больных ТБ и ТБ/ВИЧ/СПИД с осложнениями, угрожающими жизни, которые находились на лечении в шести отделениях анестезиологии и интенсивной терапии областных противотуберкулезных диспансеров Украины; ретроспективный клинико-экономический – частотный/АВС-анализы, аналитически-синтетический, графический.Результаты исследования. В отделениях интенсивной терапии чаще всего находились больные ТБ (34 %) и ТБ/ВИЧ-инфекцией/СПИД (66 %) с легочной недостаточностью (37 %) и синдромом полиорганной недостаточности (одновременно прогрессирующими нарушениями систем гемостаза, острым респираторным дистресс-синдромом, гепато-ренальной недостаточностью, 19 %) с шансом выжить или умереть 51 на 49 %. Смерть чаще всего наступала от отека головного мозга (53 %) и полиорганной недостаточности (23 %). В среднем больные находились в отделениях (12 ± 11) койко-дней, им было сделано 1701 назначение 223 ЛП. Лидерами по частоте назначений были: анальгин, р-р д/ин. 500 мг/мл, амп. 2 мл, № 10, «Юрия-Фарм»; димедрол, р-р д/ин. 10 мг/мл, амп. 1 мл, № 10, «Дарница»; фуросемид, р-р д/ин. 10 мг/мл, амп. 2 мл, № 10, «Здоровье». Общая стоимость фармакотерапии больных составила 3574,95 грн/на 1 пациента.Выводы. Качественный состав предназначенной реанимационным больным противотуберкулезных диспансеров фармакотерапии требует усовершенствования по примеру мировых стандартов: необходима разработка унифицированного протокола оказания медицинской помощи больным ТБ, ко-инфекцией ТБ/ВИЧ/СПИД с неотложными состояниями в отделениях интенсивной терапии.Мета: клініко-економічна оцінка листків призначень пацієнтів з ускладненими формами туберкульозу (ТБ) та ко-інфекції ТБ/ВІЛ. Матеріали та методи: 70 медичних карток стаціонарних хворих на загрозливі для життя ускладнення ТБ і ТБ/ВІЛ/СНІД, які знаходились на лікуванні у шести відділеннях анестезіології та інтенсивної терапії обласних протитуберкульозних диспансерів України; ретроспективний клініко-економічний – частотний/АВС-аналізи, аналітично-синтетичний, графічний.Результати дослідження. У відділеннях інтенсивної терапії найчастіше перебували хворі на ТБ (34 %) і ТБ/ВІЛ-інфекцію/СНІД (66 %) із легеневою недостатністю (37 %) та синдромом поліорганної недостатності (одночасно прогресуючими порушеннями систем гемостазу, гострим респіраторним дистрес-синдромом, гепато-ренальною недостатністю, 19 %) із шансом вижити чи померти 51 на 49 %. Смерть найчастіше наставала від набряку головного мозку (53 %) і поліорганної недостатності (23 %). У середньому хворі знаходилися у відділеннях (12 ± 11) ліжко-днів, їм було зроблено 1701 призначення 223 ЛП. Лідерами за частотою призначень були: анальгін, р-н д/ін. 500 мг/мл, амп. 2 мл, № 10, «Юрія-Фарм»; димедрол, р-н д/ін. 10 мг/мл, амп. 1 мл, № 10, «Дарниця»; фуросемід, р-н д/ін. 10 мг/мл, амп. 2 мл, № 10, «Здоров’я». Загальна вартість фармакотерапії хворих становила 3574,95 грн/на 1 пацієнта.Висновки. Якісний склад призначеної реанімаційним пацієнтам протитуберкульозних диспансерів фармакотерапії потребує удосконалення на зразок світових стандартів: необхідною є розробка Уніфікованого протоколу надання медичної допомоги хворим на ТБ, ко-інфекцію ТБ/ВІЛ/СНІД із невідкладними станами у відділеннях інтенсивної терапії

Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia

BACKGROUND Patients with elevated triglyceride levels are at increased risk for ischemic events. Icosapent ethyl, a highly purified eicosapentaenoic acid ethyl ester, lowers triglyceride levels, but data are needed to determine its effects on ischemic events. METHODS We performed a multicenter, randomized, double-blind, placebo-controlled trial involving patients with established cardiovascular disease or with diabetes and other risk factors, who had been receiving statin therapy and who had a fasting triglyceride level of 135 to 499 mg per deciliter (1.52 to 5.63 mmol per liter) and a low-density lipoprotein cholesterol level of 41 to 100 mg per deciliter (1.06 to 2.59 mmol per liter). The patients were randomly assigned to receive 2 g of icosapent ethyl twice daily (total daily dose, 4 g) or placebo. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or unstable angina. The key secondary end point was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS A total of 8179 patients were enrolled (70.7% for secondary prevention of cardiovascular events) and were followed for a median of 4.9 years. A primary end-point event occurred in 17.2% of the patients in the icosapent ethyl group, as compared with 22.0% of the patients in the placebo group (hazard ratio, 0.75; 95% confidence interval [CI], 0.68 to 0.83; P<0.001); the corresponding rates of the key secondary end point were 11.2% and 14.8% (hazard ratio, 0.74; 95% CI, 0.65 to 0.83; P<0.001). The rates of additional ischemic end points, as assessed according to a prespecified hierarchical schema, were significantly lower in the icosapent ethyl group than in the placebo group, including the rate of cardiovascular death (4.3% vs. 5.2%; hazard ratio, 0.80; 95% CI, 0.66 to 0.98; P=0.03). A larger percentage of patients in the icosapent ethyl group than in the placebo group were hospitalized for atrial fibrillation or flutter (3.1% vs. 2.1%, P=0.004). Serious bleeding events occurred in 2.7% of the patients in the icosapent ethyl group and in 2.1% in the placebo group (P=0.06). CONCLUSIONS Among patients with elevated triglyceride levels despite the use of statins, the risk of ischemic events, including cardiovascular death, was significantly lower among those who received 2 g of icosapent ethyl twice daily than among those who received placebo. (Funded by Amarin Pharma; REDUCE-IT ClinicalTrials.gov number, NCT01492361

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Effect of L-arginine on Blood Pressure Profile and Bronchial Patency in Patients with Hypertension Complicated by Pulmonary Hypertension of Bronchopulmonary Origin

The article deals with the problem of peripheral hemodynamics adjustment to the systemic and pulmonary circulation, circadian blood pressure (BP) profiles and respiratory ventilation in patients with stage 2 hypertension, complicated by obstructive pulmonary disease, with the use of L-arginine that is exogenous source of nitric oxide. Materials and methods. We observed 100 patients with stage 2 hypertension (the 2nd and 3rd degree) including 80 patients with hypertension, complicated by stage 2 pulmonary hypertension of bronchopulmonary origin, and 20 patients with essential hypertension with identical stage and degree at the age of 56.5±4.12. Results. It was observed that chronic obstructive disease complicates the course of hypertension by peripheral hemodynamics deterioration and increases in systolic blood pressure in the pulmonary circulation leading to cardiac remodeling. A number of positive effects of L-arginine used in combination therapy in patients with arterial and pulmonary hypertension was established. They included the hypotensive effect of hemodynamic preparations, decreased number of patients with a night –peaker and non-dipper profiles, improved ventilation and gas exchange, index Tifno value increasing and reducing pulmonary hypertension. Conclusions. L-arginine, used in combination therapy in patients with hypertension accompanied by chronic obstructive disease, induces potentiation of antihypertensive therapy, improvement of bronchial patency and normalization of circadian blood pressure profiles

Hypertension of Both the Pulmonary and Systemic Circulations and the Vasodilator Properties of L-Arginine (Acute Drug Testing)

The article highlights the problems of the correction of endothelial dysfunction and peripheral hemodynamics of both the pulmonary and systemic circulations in patients with arterial hypertension (AH) stage II and co-existent chronic obstructive pulmonary disease (COPD) by acute intravenous L-arginine infusion. Materials and methods. 20 patients with AH stage II and co-existent COPD in remission phase without respiratory failure with the average age of 48±3.9 years (males to females = 1:1) suffering from pulmonary hypertension of bronchopulmonary genesis (the main group) who received L-arginine and 10 patients of corresponding age and gender who were injected a solution of 0.9% sodium chloride (the control group) were included in the study. Intravenous infusions (4.2% L-arginine hydrochloride and saline solutions) were performed once using acute drug testing at the rate of 10 drops per minute within the first 10 minutes and increasing the drip rate by 15 drops per minute. Results. An expressive hypotensive effect in case of acute administration of L-arginine in the systemic circulation during the infusion and over the next 24 hours with a reduction in both systolic and diastolic blood pressure was noted. The pressure in the pulmonary artery had a tendency to decrease over the next 24 hours. When performing Celermaier – Sorensen test an increase in brachial artery diameter before and after the exposition to air and reduction in intima-media thickness were detected. Conclusions. L-arginine hydrochloride has a synchronous hypotensive effect on the hypertension of both the pulmonary and systemic circulations and is involved in the functional correction of endothelial dysfunction. It can be used in the complex treatment of patients with AH with co-existent COPD

The features of leukogram parameters in patients with acute myocardial infarction and arterial hypertension

Мета дослідження: вивчення популяційного складу лейкоцитів у хворих на гострий Q-інфаркт міокарда, який виник на тлі артеріальної гіпертензії, і його зв’язок з типом ремоделювання серцевого м’яза. Об’єкт і методи: обстежено 130 хворих з інфарктом міокарда (ІМ), яких розділили на 2 групи — 67 пацієнтів з ІМ без артеріальної гіпертензії (АГ) і 63 — з АГ. Проводили ЕхоКГ, визначали тип геометрії лівого шлуночка. Визначали кількість лейкоцитів в крові і їх популяції. Результати: відзначали збільшення кількості лейкоцитів у крові хворих на ІМ на 21% (p <0,001), а при ІМ і АГ — на 23,75% (p <0,001). У хворих з ІМ і АГ збільшення лейкоцитів було за рахунок нейтрофілів, лімфоцитів і моноцитів. У той час, як у хворих на ІМ тип геометрії лівого шлуночка (ЛШ) не впливав на показники лейкограми, при супутній АГ відзначали значне збільшення кількості моноцитів при концентричній гіпертрофії і ремоделюванні міокарда ЛШ. Висновки. Гострий ІМ, який виник на тлі АГ, характеризується збільшенням загальної кількості лейкоцитів за рахунок нейтрофілів, лімфоцитів і моноцитів. Концентричне ремоделювання і гіпертрофія ЛШ характеризуються збільшенням кількості моноцитів, що можна розглядати як незалежний предиктор патологічного ремоделювання міокарда; Цель исследования: изучение популяционного состава лейкоцитов у больных острым Q-инфарктом миокарда, который возник на фоне артериальной гипертензии, и его связь с типом ремоделирования сердечной мышцы. Объект и методы: обследованы 130 больных с инфарктом миокарда (ИМ), которых разделили на 2 группы - 67 пациентов с ИМ без артериальной гипертензии (АГ) и 63 - с АГ. Проводили ЭхоКГ, определяли тип геометрии левого желудочка. Определяли количество лейкоцитов в крови и их популяции. Результаты: отмечали увеличение количества лейкоцитов в крови больных ИМ на 21% (p<0,001), а при ИМ и АГ - на 23,75% (p<0,001). У больных с ИМ и АГ увеличение лейкоцитов было за счет нейтрофилов, лимфоцитов и моноцитов. В то время, как у больных ИМ тип геометрии левого желудочка (ЛЖ) не влиял на показатели лейкограммы, при сопутствующей АГ отмечали значительное увеличение количества моноцитов при концентрической гипертрофии и ремоделировании миокарда ЛЖ. Выводы. Острый ИМ, который возник на фоне АГ, характеризуется увеличением общего количества лейкоцитов за счет нейтрофилов, лимфоцитов и моноцитов. Концентрическое ремоделирование и гипертрофия ЛЖ характеризуются увеличением количества моноцитов, что можно рассматривать как независимый предиктор патологического ремоделирования миокарда; Nowadays, arterial hypertension (AH) is possesses among 1 billion people worldwide and caused of 7.5 millions death every year. The age-related correlation between AH and incident of myocardial infarction (MI) and stroke was established: 54% cases of acute disturbances of cerebral circulation and 47% cases of acute coronary syndrome caused by high blood pressure. In the 1980s and 1990s, experimental evidence derived predominantly from large animal studies suggested that post infarction inflammation may accentuate ischemic myocardial injury in the reperfused heart; thus, inhibition of inflammatory signals was considered a potentially promising therapeutic target. In the infarcted heart, sudden necrosis of a large number of cardiomyocytes results in release of their intracellular contents and initiates an intense inflammatory reaction. Leukocytes play crucial role in acute and chronic inflammation. It’s known their role in MI incident and prognosis. But their count in different types of myocardial remodeling is still unknown. The purpose of study was to investigate of leukocyte population count in patients with MI and preliminary AH and discover its connection with myocardial remodeling. Object and methods. 130 patients with ST-elevation MI were involved to this study: 82 males (63.07%) and 48 (36.93%) females. The average age was (64.68±12.59) years. All patients were divided into 2 groups: 67 persons without AH and 63 persons with AH. Control group - 30 practically healthy persons similar for age and sex. Transthoracal echocardiography was performed and types of myocardial remodeling were calculated according to the recommendations of the American Society of Echocardiography (ASE) and the European Association of Echocardiography. The count of leukocytes and their population in blood were studied. Results. The leukocyte’s count in patients with acute MI was higher for 21% compared control group, and in patients with MI and previous AH - for 23.75% (p<0.001). We observed the increase of neutrophils, monocytes and lymphocytes in blood of patients with MI and AH compared with patients with MI without AH. No differences in leukocyte count and their population in blood in patients with acute MI without AH were observed. The monocyte’s count in blood of patients with MI and previous AH was higher for 25% in excentric hypertrophy, for 28.95% in concentric hypertrophy and for 35.71% in concentric remodeling of left ventricle (p<0.05). Conclusions. Acute myocardial infarction with preliminary arterial hypertension is characterized of leukocyte count increase with high levels of neutrophils, monocytes and lymphocytes. Concentric remodeling and concentric hypertrophy of left ventricle myocardium is characterized of monocyte count growth which can be used as predictor of pathological myocardial remodeling