THE EFFECT OF COMBINED ANTIHYPERTENSIVE THERAPY ON THE BASIC PARAMETERS OF THE LEFT VENTRICLE MYOCARDIUM STRUCTURE AND FUNCTION IN WOMEN WITH METABOLIC SYNDROME AND HYPOTHYROIDISM
https://doi.org/10.20996/1819-6446-2012-8-4-509-514
Abstract
Aim. To study the effect of combined antihypertensive therapy on the basic parameters of the left ventricle (LV) myocardium structure and function in women with arterial hypertension (HT), metabolic syndrome (MS) and hypothyroidism. Material and methods. Women (n=196) with HT grade 2–3 and MS were included into the study. Standard clinical examination including an assessment of thyroid status, ambulatory blood pressure (BP) monitoring and echocardiography was performed at baseline and after 6 months. The patients were split into 3 groups: control (without hypothyroidism) with subclinical and manifested (symptomatic) hypothyroidism (SH and MH). Depending on baseline heart rate (HR) patients of each group received a combination of amlodipine+losartan (A+L) in HR <85/min or a combination of amlodipine+moxonidine (A+M) in) in HR ≥85/min. Results. The significant antihypertensive effect was found in patients of the control group due to both A+L and A+M combination (target BP was reached in 85.7 and 88.2%, respectively). In patients with hypothyroidism significant antihypertensive effects was observed only during A+M therapy (target BP in SH and MH was achieved in 82.8 and 82.4%, respectively). In the control group A+L and A+M combinations increased a number of patients with normal LV geometry (85.7 and 86.7, respectively) and diastolic function (78.6 and 80%, respectively). In hypothyroidism A+M therapy resulted in more prominent increase in a number of patients with normal LV geometry (75% in both SH and MH) and diastolic function (in SH and MH 83.3 и 85.7%, respectively) than these in A+L therapy (р<0.05). Conclusion. The combination of A+M has advantages over A+L combination in antihypertensive efficacy as well as in the effect on the structural and functional state of the LV myocardium in women with HT and MS associated with hypothyroidism.
About the Authors
V. V. Skibitskiy
Kuban State Medical University
Russian Federation
Russian Federation
A. V. Fendrikova
Kuban State Medical University
Russian Federation
Russian Federation
N. E. Pykhalova
Kuban State Medical University
Russian Federation
Russian Federation
References
1. National guidelines for the diagnosis and treatment of metabolic syndrome. Kardiovaskulyarnaya Terapiya i Profilaktika 2007;6 (6) suppl 2: 1–22. Russian (Национальные рекомендации по диагностике и лечению метаболического синдрома. Кардиоваскулярная Терапия и Профилактика 2007;6 (6) Приложение 2: 1–22).
2. Chazova I. E., Mychka V.B. Metabolic syndrome. Moscow: Media Medika; 2004. Russian (Чазова И. Е., Мычка В.Б. Метаболический синдром. М.: Медиа Медика; 2004).
3. Hak A.E., Pols H.A., Visser T.J. et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study. Ann Intern Med 2000; 132 (4): 270–278.
4. Luboshitzky R., Herer P. Cardiovascular risk factors in middle-aged women with subclinical hypothyroidism. Neuro Endocrinol Lett 2006; 25 (4): 262–266.
5. Vanderpump M.P., Tunbridge W. М. Epidemiology and prevention of clinical and subclinical hypothyroidism. Thyroid 2005; 12: 839–847.
6. Kobalava Zh. D., Kotovskaja J. V., Moiseev V. S. Arterial hypertension. Keys to diagnostics and treatment. Moscow: GEOTAR-Media; 2009. Russian (Кобалава Ж. Д., Котовская Ю. В., Моисеев В. С. Артериальная гипертония. Ключи к диагностике и лечению. М.: ГЭОТАР-Медиа; 2009).
7. Mamedov M. N. Arterial hypertension in a framework of metabolic syndrome: special features and principles of drug correction. Cardiologiia 2004; 44(4): 95–100. Russian Мамедов М. Н. Артериальная гипертония в рамках метаболического синдрома: особенности течения и принципы медикаментозной коррекции. Кардиология 2004; 44(4): 95–100.)
8. Bindels A.J., Westendorp R.G., Frolich M. et al. The prevalence of subclinical hypothyroidism at different total plasma cholesterol levels in middle aged men and women: a need for case finding. Clin Endocrinol 1999; 50: 217–220.
9. Skibitskiy V.V., Pyhalova N.E., Fendrikova A.V. Features remodeling of the left ventricle myocardium in women with arterial hypertension and a metabolic syndrome against a hypothyroidism . Problemy Zhenskogo Zdorov'ya 2011; 2 (6): 10–15. Russian (Скибицкий В.В., Пыхалова Н.Е., Фендрикова А.В. Особенности ремоделирования миокарда левого желудочка у женщин с артериальной гипертонией и метаболическим синдромом на фоне гипотиреоза. Проблемы Женского Здоровья 2011; 2 (6): 10–15).
10. Vanderpump M. P., Tunbridge W. M. Epidemiology and prevention of clinical and subclinical hypothyroidism. Thyroid 2002;12:839–847.
11. Walsh J. P., Bremner A. P. et al. Subclinical Thyroid Dysfunction as a Risk Factor for Cardiovascular Disease. Arch Intern Med 2005; 165: 2467–2472.
12. Dedov I. I., Mel'nichenko G. A. Endocrinology. A national management. The short edition. Moscow: GEOTAR-Media; 2011. Russian (Дедов И. И., Мельниченко Г. А. Эндокринология. Национальное руководство. Краткое издание. М.: ГЭОТАР-Медиа; 2011).
13. Ganau A., Devereux R.B., Roman M.J. et al. Patterns of left ventricular hyperthrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19:1559–1560.
14. Cohen G.I., Pietrolungi J.F., Thomas J.D., Klein A.L. A particular guide to assessment of ventricular diastolic function using Doppler echocardiography. J Am Coll Cardiol 1996; 27: 1753–1760.
15. Thomas G.N., Chan P., Tomlinson B. The role of angiotensin II type 1 receptor antagonists in elderly patients with hypertension. Drugs Aging 2006; 23(2): 131–155.
16. Dahlof B., Devereux R.B., Kjeldsen S.E. et al. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE): A randomized trial against atenolol. Lancet 2002; 359: 995–1003.
17. Sanjuliani A.F., Francischetti E.A., Genethu de Abreu V et at. Effects of moxonidine on the sympathetic nervous system, blood pressure, plasma renin activity, plasma aldosterone, leptin, and metabolic profile in obese hypertensive patients. Journal of Clinical and Basic Cardiology 2004; 7 (1–4):19–25.
18. Chazova I.E., Almazov V.A., Shlyakhto E.V. Moxonidine improves glycaemic control in mildly hypertensive, overweight patients: a comparison with metformin (ALMAZ). Diabetes, Obesity and Metabolism 2006; 8: 456–65.
19. Mitrovic V., Patyna W., Schepper W. Haemodynamic and neurohormonal effects of moxonidine in patients with essential hypertension. Cardiovasc Drugs Ther 1991; 5: 967–972.
20. Messerli F. Moxonidine: a new and versatile antihypertensive. J Cardiovasc Pharmacol 2000; 35: 53–56.
21. Ernsberger P., Friedman J.E., Koletsky J. The I1 imidazoline receptor: from binding site to therapeutic target in cardiovascular disease. J Hypertens 1997; 15(1):9–23.
22. Dzhanashiya P.Kh., Selivanova G.B. Hypothyroidism and hypertension: unresolved questions of pathogenesis, diagnosis, and pharmacotherapy. Kardiovaskulyarnaya Terapiya i Profilaktika 2004; 3:125– 132. Russian (Джанашия П.Х., Селиванова Г.Б. Гипотиреоз и артериальная гипертензия: нерешенные вопросы патогенеза, диагностики и фармакотерапии. Кардиоваскулярная Терапия и Профилактика 2004; (3):125–132).
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Skibitskiy V.V., Fendrikova A.V., Pykhalova N.E. THE EFFECT OF COMBINED ANTIHYPERTENSIVE THERAPY ON THE BASIC PARAMETERS OF THE LEFT VENTRICLE MYOCARDIUM STRUCTURE AND FUNCTION IN WOMEN WITH METABOLIC SYNDROME AND HYPOTHYROIDISM. Rational Pharmacotherapy in Cardiology. 2012;8(4):509-514. (In Russ.) https://doi.org/10.20996/1819-6446-2012-8-4-509-514
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