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Rational Pharmacotherapy in Cardiology

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Vol 2, No 2 (2006)
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https://doi.org/10.20996/1819-6446-2006-2-2

4-8 269
Abstract

Importance of the stroke as one of the main reason of population mortality and invalidity is considered. Stroke risk factors including arterial hypertension are described. The main pharmacotherapy ways of primary and secondary stroke prevention are discussed.

ORIGINAL STUDIES

9-17 293
Abstract

Aim. To evaluate effects of long-term treatment with rilmenidine compared with atenolol on lipid and glucose metabolism and cardiovascular remodeling in hypertension. Material and methods. 37 patients with hypertension were randomized to rilmenidine 1-2 mg/day or atenolol 50-100 mg/day for 26 weeks. Standard oral glucose tolerance test with a parallel measurement of insulin and glucose levels was performed. The “areas under the curve” (AUC) for insulin and glucose were calculated. Plasma lipids, left ventricular mass index (LVMI) and intima-media thickness (IMT) were measured. Brachial artery diameter during reactive hyperemia was used to test endothelium-dependent vasodilatation (EDVD). Results. Blood pressure reduction was equally achieved in both treatment arms. The fasting glucose level increased in the atenolol group from 4.8±0.6 to 5.2±0.7 mmol/l (p<0.01). The AUC of glucose in rilmenidine group decreased from 860±93 to 737±66 mmol/min/l (p<0.05), and it increased from 937±86 to 989±88 mmol/min/l (p<0.05) in the atenolol group. Rilmenidine showed a positive effect on lipid levels, while in the atenolol group a significant decrease of high density lipoprotein was observed. LVMI decreased with rilmenidine by 9.6% (p<0.05) and by 6,9% (not significantly) with atenolol. IMT significantly decreased in the rilmenidine. EDVD slightly increased on rilmenidine, while on atenolol group it remained unchanged. Conclusion. Our data suggest that in hypertensive patients central inhibition of sympathetic drive can produce favorable effects on glucose and lipid metabolism compared with standard β-blockade with a similar antihypertensive efficacy. Rilmenidine also provides beneficial effects on cardiovascular remodeling and altered endothelial function in hypertension.

18-24 251
Abstract

Aim. To assess influence of enalapril and uncontrolled antihypertensive therapy on insulin resistance, endothelium function, markers of inflammation, and platelet activity in patients with metabolic syndrome (MS). Material and methods. 41 patients with MS (21 women and 20 men, aged 58±2 years) were included into open parallel controlled study. MS was defined according to III report of USA Educational Program on cholesterol (2001). Patients were divided into 2 groups. Patients of the 1st group received enalapril (Enam, Dr. Reddy’s) 10 mg daily with further dose titration to 20 mg daily. Patients of the  2nd group continued receiving the same antihypertensive therapy as before (15% - inhibitors of angiotensin converting enzymes, 15% - в-blockers, 15% - diuretics, and 20% of patients - combined therapy). Study duration was 12 weeks. Results. Therapy with enalapril during 3 months resulted into significant decrease in systolic and diastolic blood pressure (BP) by 13 and 9% respectively. BP level decreased insignificantly (by 4,5 and 2% respectively) in controlled group. Ratio of plasma concentration of glucose to insulin in the 1st group increased by 14% before glucose load, and by 25% (p<0,05) 2 hours after peroral glucose load, while in the 2nd group decrease in these figures was noted by 12 and 5% respectively. This shows that treatment with enalapril, unlike uncontrolled antihypertensive therapy, lead to decrease in insulin resistance. Cuff test revealed significant increase in growth of brachial artery diameter in the group of patients, who received enalapril (12% before treatment, and 17% after treatment). Regular antihypertensive therapy didn’t change this parameter significantly (13 and 13,8% respectively). C-reactive protein level decreased by 48% (p<0,05) in the 1st group. Insignificant increase of this marker’s level was observed in the 2nd group. Platelet functional activity in both groups didn’t change significantly. Conclusion.  Together with strong antihypertensive effect, enalapril monotherapy is more efficient than regular antihypertensive therapy in reducing insulin resistance and chronic subclinical inflammation, as well as it has priority in improving endothelium depending vasodilatation.

25-31 226
Abstract

Aim. To study antihypertensive efficacy of long-acting metoprolol, its influence on heart rate variability and therapy compliance in hypertensive patients during long-term (48 weeks) treatment. Material and Methods. After 2 weeks of wash-out period 30 hypertensive patients were prescribed long-acting metoprolol (Egilok Retard, EGIS) in dose of 50-100 mg once daily. If necessary the dose was increased up to 200 mg daily on 2 or 8 week, and on 12-16 weeks hydrochlorothiazide 12,5-25 mg daily and then nifedipine 20 mg daily were added. Ambulatory blood pressure monitoring (ABPM) and daily ECG monitoring were applied on 24 and 48 weeks. Patient quality of life was estimated. Results. In 48 weeks 22 patients (73,3%) continued the treatment. 5 patients dropped out because of low compliance and 3 patients because of low efficacy. Therapy discontinuation because of side effects was necessary in no one case. Monotherapy with metoprolol provided excellent results in 15 (68%) and combined therapy - in 7 (32%) patients. In comparison with starting data on 48 week of treatment significant reduction in 24-hour , day and night systolic blood pressure (BP) was registered on 10,4±1,6; 11,3±1,7 and 5,2±1,9 mm Hg, respectively, as well as diastolic BP on 7,7±1,1; 8,1±1,3 and 4,1±1,3 mm Hg, respectively. Time index of hypertension for 24-hour systolic and diastolic BP decreased significantly. Daily BP profile normalized. Normalization of BP and heart rate variability was observed among patients with its initial disturbances. The frequency of hypertensive symptoms such as headache and dizziness reduced on 58% and 64%, respectively. Capacity for work improved significantly. Conclusion. Long-acting metoprolol is effective antihypertensive medicine providing high level of compliance with long-term therapy.  Long-acting metoprolol is especially indicated to hypertensive patients with sympathetic system overactivity.

32-36 333
Abstract

Aim. To compare effect of long-term treatment with lisinopril and enalapril on quality of life (QL) and blood pressure (BP) daily profile in patients with stable arterial hypertension (AH). Material and methods. Analysis of three studies conducted in our center during last 4 years are presented (totally 86 patients were included). Protocol of studies was unified: after wash-out period ambulatory blood pressure monitoring (ABPM) and QL were assessed. Afterwards, patients were switched to active therapy with enalapril or lisinopril. After long-term treatment with these drugs QL and ABPM and QL were assessed again. Results. Both drugs decreased in systolic and diastolic BP, time index and didn't change heart rate and night BP dipping. With lisinopril treatment, significant improvement in physical condition, efficiency at work, psychological profile and capacity for social contacts was observed, while treatment with enalapril positively influenced only on physical condition and intensity of negative psychological profile in patients with stable AH. Conclusion. In patients with stable AH lisinopril had better influence on QL than enalapril. Therapy with both drugs lead to significant decrease in systolic and diastolic BP and didn't change heart rate and night BP dipping.

37-42 241
Abstract

Aim. To reveal peculiarities of arterial hypertension (AH) diagnosis and therapy and their matching with international and national guidelines on AH. Material and Methods. An interview among Moscow physicians dealing with hypertensive patients was conducted in April-June 2005. Interview was taken with specially worked out forms containing 15 questions about hypertensive patient management. 102 physicians took part in interviewing, among them 65 internists and 37 cardiologists. Among interviewed physicians 56 ones were from outpatient clinics, 19 - from diagnostic centers, 14 - from hospitals, 5 - from commercial medical centers, 4 - from research center and 3 physicians had private practice.  Results. 80,4% of interviewed physicians correctly determined the main goals of AH therapy. 16% of doctors did not indicate blood pressure level below 140/90 mm Hg as target level of secondary prevention. Mainly antihypertensive therapy was presented by four classes of medicines, their shares were as follow: ACE inhibitors - 35%, beta-blockers – 28%, diuretics – 26% and calcium antagonists – 10%. Other classes of antihypertensive medicines (antagonists of angiotensin-II receptors, central acting medicines) made about 1% of share. When choosing original medicine among several suggested trade marks, only 22% of doctors defined the medicine correctly. Original medicines made only 29,4% prescriptions in real medical practice. Conclusion. Real practice of AH diagnosis and therapy considerably differs from international and national guidelines on AH. It is possibly related with lack of appropriate knowledge among physicians as well as problems in public health service.   

43-48 209
Abstract

Aim. To study the influence of long-term therapy with perindopril on the heart inotropic function in patients with chronic postinfarction aneurism. Material and methods. 21 patients suffering ischemic heart disease with postinfarction cardiosclerosis, chronic aneurism of left ventricle and chronic heart failure of functional class III-IV according to NYHA were observed. All patients took perindopril, 2-4 mg daily. Before and after 6 months of therapy myocardial contractile function of left and right ventricles was studied by balanced radioventriculography with segmental and phase analysis of histogram. Results. In patients with chronic postinfarction aneurism significant structural and functional abnormalities were revealed: reduction of left ventricular ejection fraction up to 17,8 ± 3,2 %, the same for right ventricular up to 22,1±4,4 %, their considerable dilation with reduction of filling and expulsion velocity. After 6 months of therapy with  perindopril  improvement of clinic status of patients, tendency towards  increase of both ventricles general ejection fraction, enlargement of maximal filling velocity and filling velocity during 1/3 of diastole as well as tendency to reduction of both ventricles end diastolic and systolic volumes were registered. In left ventricle there were normokinetic zones in 35 (21%) segments, hypokinetic zones in 24 (14%), akinetic zones in 54 (32%) and dyskinetic zones in 17 (10%) segments. In right ventricle there were normokinetic zones in 45 (27%) segments, hypokinetic zones in 62(37%), akinetic zones in 54 (32%) and dyskinetic zones in 7 (4%) segments. After 6 months of therapy with perindopril tendency towards improvement of local myocardial contractility was registered. Conclusion. In patients with chronic postinfarction aneurism deterioration of general and local myocardial contractility were registered. Accurate link between left ventricle local myocardial contractility and localization of aneurism were not revealed. After 6 months of therapy with perindopril tendency towards improvement of general and local myocardial contractility of both ventricles was registered.

POINT OF VIEW

49-56 203
Abstract

Lipid metabolism issues are reviewed. Ways of cholesterol transformation are represented thoroughly; proteins regulating its transportation are described. Important place takes the role of high density lipoproteins in backward transportation of cholesterol from peripheral tissues. Possibilities of pharmacological activation of this system, aimed at prevention and treatment of atherosclerosis are discussed.

57-60 254
Abstract

The article underlines necessity of statins treatment for patients with high risk of cardio-vascular events. It is noted that in our country these drugs are used extremely seldom. The problem of generic-statins equivalence to original drugs is considered.

61-66 254
Abstract

Data about heart rate variability analysis in healthy people and patients with chronic heart failure are reviewed. Prognostic value of time-domain and spectral measures is mentioned. Influence of standard therapy on heart rate variability is described.

THERAPY GUIDELINES



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