Rational Pharmacotherapy in Cardiology

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Vol 1, No 2 (2005)
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4-8 418

Aim. To estimate antihypertensive, organ protective and metabolic efficiency of angiotensin converting enzyme (ACE) inhibitor spirapril in patients with arterial hypertension (AH).

Material and methods. 30 patients with AH of I-II grade with different cardiovascular risk were included into the study. Spirapril was prescribed in the dose of 3 mg once daily. If necessary, daily dose could be increased to 6 mg after two weeks, and after next 4 weeks hydrochlorothiazide in daily dose 12,5-25 mg could be added. Treatment lasted 16 weeks. Before and after 16-week treatment ambulatory blood pressure monitoring (ABPM) was carried out. At the same time vasodilatation tests for reactive hyperemia and nitroglycerin were held, microalbuminuria and β2-microglobulinuria levels were defined, figures of lipid and glucose metabolism were studied, questionnaires for quality of life were filled in.

Results. 27 patients with AH finished the study according to protocol. Treatment with spirapril within 16 weeks caused normalization of blood pressure in 60% of patients, decreased levels of microalbuminuria (p<0,05) and β2-microglobulinuria (p<0,05), recovered significantly disrupted endothelial function according to the results of vasodilatation tests (p<0,01), improved patients quality of life (p<0,05). Spirapril didn’t change lipid and glucose metabolism, regardless that in 1/3 of cases it was used in combination with hydrochlorothiazide.

Conclusion. Spirapril is a highly efficient antihypertensive drug with organ protective effect and metabolic neutrality. According to the revealed qualities it can be recommended to patients with AH with high cardiovascular risk.

9-13 390

Aim. To study if menopause influences the blood pressure (BP) decrease level during nighttime in women with metabolic syndrome.

Methods. 84 women with metabolic syndrome are examined, from them 52 are in postmenopause (average age is 56 [SD 5] years) and 32 are in premenopause (average age is 44 [5] years). Anthropomorphic measurements were made, levels of office BP and heart rate were assessed, ambulatory BP monitoring was carried out, lipids and glucose of blood serum were studied.

Results. Clinical parameters, characterizing metabolic syndrome, didn’t vary between the groups. Number of patients with insufficient decrease of BP in postmenopausal women didn’t differ significantly from the number of such women in premenopausal period (for systolic BP: 64% versus 52%, p=0,288; for diastolic BP: 34% versus 42%, p=0,469). Nevertheless, when evaluating the level of systolic BP decrease during nighttime as continuous variable, significant differences between groups are revealed (M±SEM [95% CI]: 4.4±1.5% [1.4-7.3] in postmenopausal women versus 11.3±1.7% [7.9-14.8] in premenopausal women, p=0,011).

Conclusion. Postmenopause associates with insufficient systolic BP decrease during nighttime in women with metabolic syndrome.

14-19 518

Aim. To estimate an efficiency and tolerability of rilmenidine in hypertensive patients with different types of blood pressure (BP) daily profile – dipper and non-dipper.

Methods. 23 patients with essential hypertension (EH), I-II stages, were included into the study. They were treated with rilmeneidine 1 mg daily during one month. Ambulatory BP monitoring (ABPM) and office BP measurements were made before and after the treatment. Based on ABPM results all patients were divided into two groups: with adequate decrease of BP at nighttime (dipper, D), and with insufficient decrease of BP at nighttime (non-dipper, ND).

Results. One month rilmenidine monotherapy resulted in BP normalization in 52% of patients. Decrease in 24-hour BP, daytime and nighttime BP, burden with BP and BP variability during daytime was observed in both groups. A distinction in rilmenidine influence on BP daily index was revealed: initially normal BP daily index didn’t change in D group, while initially decreased BP daily index increased in ND group. Rilmenidine reduced the speed of morning BP rise in patients of ND group.

Conclusion. Results of the study testify efficiency and satisfactory tolerability of monotherapy with rilmenidine 1 mg daily in patients with EH of I-II stages. For patients with insufficient decrease in BP during nighttime rilmenidine provides normalization of BP daily profile intensifying BP night decrease and reducing the speed of morning BP rise.

20-24 579

Aim. To compare information value of antihypertensive effect equability parameters for two drug formulations of nifedipine: long-acting one (nifedipine-XL) and short-acting one (nifedipine-sa).

Material and methods. 147 patients with arterial hypertension (age 53,8±12,5 years) were included into multicenter, cross over design study. Duration of wash-out period was 2 weeks; duration of each treatment course – 4 weeks; interval between courses – 1 week. The following doses of drugs were used: nifedipine-XL – 30-60 mg once daily, nifedipine-sa – 10-20 mg three times a day. Daily blood pressure monitoring (DBPM – Schiller BR-102) was made initially, at the end of each treatment course and at the end of interval between courses. To assess the equability of drug antihypertensive effect “smoothness index” (SI) and coefficient trough effect/peak effect were used (COTP). Information value of these indexes (treatment vs. initial) was assessed by the logical regress analysis.

Results. Nifedipine-XL and nifedipine-sa had significant antihypertensive effect according to DBPM data and clinical measurements. Equability of both drugs was similar. χ2 Wald range was 14,7-18,7 (p<0,0001) for SI and 12,7-22,8 for COTP (p<0,001-0,0001).

Conclusion. Similar information value of SI and COTP can be explained by the homogeneity of studied patients. Usage both of these indexes for estimation of antihypertensive effect equability is connected with same methodical limits.

25-31 429

More than a half of patients with stable mild to moderate arterial hypertension (AH) have dizziness. Rather often these patients need to take drugs, reducing blood pressure (BP) in combination with those, reducing intensity of dizziness. As patients with stable AH have bad compliance with the treatment, it is necessary to consider not only drug efficiency, but also its influence on quality of life (QL).

Aim. To assess influence of combined therapy with betagistin hydrochlorid and lisinopril on QL and neurological status of patients with stable mild to moderate AH.

Material and methods. 67 patients with stable AH of I-II grades, risk 2-3 and medium intensity of dizziness took part in randomized, cross over design, placebo-controlled study. After 2 weeks of “wash-out” period all patients received lisinopril alone or lisinopril in combination with betagistin. Every therapy regimes lasted 1 mouth. Evaluation of QL, intensity of dizziness, daily BP was made before and at the end of each therapy regimes, evaluation of neurological status – before and at the end of the first therapy regime.

Results. Therapy with both schemes of treatment resulted in comparable decrease in BP level. Treatment with both regimes relieved dizziness and concomitant symptoms. Combined therapy with betagistin and lisinopril showed improvement of almost all the elements of QL, while monotherapy with lisinopril – of only several ones. Combined treatment with lisinopril and betagistin had more favorable influence on QL, and neurological status.

Conclusion. The main reason, which caused dizziness in patients with stable AH, was chronic double-sided changes in vestibular system. Combined treatment with lisinopril and betagistin had more positive influence on QL and neurological status than monotherapy with lisinopril. BP decrease according to the two schemes of therapy was comparative in both therapy regimes.

32-36 310

Aim. Assessment and quality of diagnostics of treatment of patients with arterial hypertension (AH) and their conformity with international and national recommendations on AH.

Material and methods. The poll among physicians of Volgograd and Volgograd region, who took part in the regional conference, devoted to the problems of AH, was carried out in April 2004. The questionnaire included 13 questions about peculiarities of AH patients’ management 128 physicians took part in the poll, from them 90 thetapeutists (general physicians), 24 cardiologists, and 14 physicians of different therapeutic specializations.

Results. Variability of conceptions of physicians on some principals of diagnostics and treatment of AH patients is revealed. Insufficient knowledge of criteria for division patients according to the risk category of cardiovascular complications. The same is observed for definition of AH grade according to the blood pressure level, and of the main approaches AH patients treatment. From all the questioned physicians only 25.2% correctly evaluated the risk level of cardiovascular diseases, 21% of physicians wrongly assessed the AH grade according to the blood pressure Level.

Conclusion. Results, show that real practice of diagnostics and treatment of AH significantly deviates from international and national recommendations on AH.

37-42 540

Aim. To study influence of mildronate (M) on treatment efficiency of patients with ischemic heart disease (IHD), receiving standard antianginal therapy (AAT)

Materials and methods. Double-blind, randomized, placebo-controlled study was carried out in parallel groups. All patients continued the earlier prescribed AAT without changes. After control period (10-14 days) was over, randomization of patients either to the treatment group (M 500mg twice per day), or to the control group (placebo (Pl) twice per day) was made for 6 weeks therapy. Criterion of treatment efficiency: increase in duration of trial with burden on treadmill (TB), decrease in angina attack frequency (AA) and reduction in nitroglycerin taking (NTT). TB was carried out at the beginning (TB-1), at the end of the control period (TB-2), and at the end of the treatment (TB-3).

Results. TB-1 and TB-2 had good reproducibility, their duration didn’t differ. At the end of the treatment additionally with M, growth in duration of TB-3 (p=0,002) was registered, while there was no growth of TB duration with the Pl treatment (p=0,07). During the treatment decrease in AA number both with M (p=0,002), and with Pl (p=0,02) was noted. With M treatment decrease in NTT treatment (p=0.02) was observed, while NTT with Pl didn’t change (p=0,7). Number of side effects, registered with M and Pl, didn’t differ.

Conclusion. Mildronate provides additional benefits for patients with IHD with stable burden angina, when they do not reach desired effect with the prescribed AAT.

43-47 354

An article gives in a comprehensive manner the main idea of pharmacokinetics, as the science about rules of substances behavior in the internal environment of the organism, as well as of main parameters of pharmacokinetic researches. The article provides vivid and very  persuasive examples of high practical importance of this science both for creating new medical forms of drugs and for choosing the optimal of therapy regime.


48-53 413

Results of large-scale studies carried out during last 10 years and devoted to the assessment of statines efficiency in prevention of ischemic heart disease (IHD), are analyzed. Decrease in risks of myocardial infarction, instable angina pectoris and mortality by 25-40%, ischemic stroke – by 25-30% (CARE, LIPID, WOSCOPS, AFCAPS/TexCAPS, HPS, ASCOT-LLA, CARDS) is demonstrated. Recommendations for statines prescription for primary and secondary prevention of cardiovascular diseases, including IHD and ischemic stroke, are significantly expanded. New goals in holesterol of low density lipoproteid (HLDL) reduction are discussed, aswell as problems of statin treatment safety. The choice of the drug must be based on clinical research data, considering efficiency and safety at long-term use, as well as possibilities of achieving new goal level of HLDL.

54-60 6676

The article provides the large prospective researches data which testify the more important role of systolic blood pressure increase in arterial hypertension forecast. Here comes the conclusion that the most perspective drugs for systolic blood pressure reduction today are diuretics. Indapamid SR (Arifon retard) stands out for its efficiency and safety among diuretics.


61 226

Notes to the european recommendations of acute myocardial infarction in patients presenting with ST-segment elevation.

96-98 318

Informed consent of patient on medical interference.

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)