[Ramipril in the treatment of hypertension. The pharmacodynamic validation of its efficacy in the therapy of initial cardiac and renal involvement]. / Ramipril pri lechenii gipertonicheskoi bolezni. Farmakodinamicheskoe obosnovanie éffektivnosti terapii nachal'nykh porazhenii serdtsa i pochek.

A clinical trial of 75 hypertensive subjects in stage II of the disease receiving ramipril monotherapy has established a marked efficacy of the above treatment. Individually adjusted single doses varied from 2.5 mg to 7.5 mg/day. The drug was well tolerated and had mild adverse effects (dry cough) in 2% of the patients. Long-term 12-week ramipril treatment in effective for hypertension doses is able to reduce myocardial mass without inhibition of the pumping capacity in the patients with left ventricular hypertrophy of the myocardium. In primary signs of nephroangiosclerosis hypertension correction was associated with improvement of filtration function and an increase in effective renal flow of plasma. The above pharmacodynamic effects make it possible to consider ramipril an effective hypotensive agent with organ-protective properties.

[The specificity of the hypotensive effect of calcium antagonists in hypertension]. / Spetsifichnost' gipotenzivnogo éffekta antagonistov kal'tsiia pri gipertonicheskoi bolezni.

The purpose of the study was to define prognostic criteria that determine individual sensitivity to the hypotensive effect of slow calcium channel blockers. After two weeks of placebo therapy 45 patients suffering from essential hypertension underwent an acute pharmacological test (APT) with nifedipine in a dose of 30 mg. Then the patients received monotherapy with nitrendipine in the increasing doses for 12 weeks. The drug effect on the renin-angiotensin-aldosterone system and the level of ionized calcium in the blood serum was estimated. In 17 patients who responded to the APT by a decrease of the mean arterial pressure (MAP) by not less than 20%, arterial pressure was corrected with nitrendipine administered in a dose not exceeding 20 mg. 28 patients whose MAP dropped by 10 to 20% in response to the APT required higher drug doses (40 mg). 7 patients in whom the MAP dropped less than 10% were practically refractory to the monotherapy with nitrendipine. A close negative correlation was found between the degree of the MAP lowering in response to the APT during nitrendipine monotherapy and plasma renin activity as well as the concentration of ionized calcium in the blood serum. The low content (less than 1.0 mmol/l) of ionized calcium in the blood serum of patients suffering from essential hypertension appeared the most valuable predictor for the hypotensive effect of the slow calcium channel blockers.