[Possibilities of Correction of Endothelial Dysfunction at the Background of Combined Antihypertensive Therapy in Patients With Arterial Hypertension and Type 2 Diabetes].

AIM: To evaluate the impact of a 12-week combined antihypertensive therapy with enalapril + indapamide on endothelial dysfunction in patients with arterial hypertension (AH) and diabetes mellitus (DM) type 2. MATERIALS AND METHODS: 30 patients with AH stage II-III and DM type 2 age from 40 to 65 years were included into research. The combined antihypertensive therapy with enalapril 28.6 ± 1.9 + indapamide 2.5 ± 0 mg/day was assigned for 12 weeks. We studied endothelial function by determining the concentration of NO metabolites and endothelin-1 in serum and urine, the results of occlusion test. RESULTS: After 12-week therapy, 100% of the patients achieved BP goals. There was no impairment of carbohydrate metabolism. Endothelial function was improved in hypertensive patients with T2DM: there were increases in both serum and urinary NO production (by 381 and 48.2%, respectively) and decreases in urinary endothelin-1 secretion (by 56.3%). The number of patients with normal microcirculation increased from 13.3 to 53.3% (p < 0.001) by reducing the number of patients with abnormal (hyperemic and stagnant-stasic) types of microcirculation. CONCLUSION: Twelve-week treatment with the combined antihypertensive medication. The combined antihypertensive therapy with enalapril + indapamide is highly effective and safe for recovering endothelial function in hypertensive patients with T2DM.

[Correction of endothelial dysfunction in hypertensive patients with type 2 diabetes mellitus during combined antihypertensive therapy].

AIM: To evaluate the impact of 6-month antihypertensive therapy with the combined drug amlodipine + lisinopril (ekvator) on endothelial dysfunction (ED) and carbohydrate metabolic parameters in patients with hypertension and type 2 diabetes mellitus (DM). SUBJECTS AND METHODS: The investigation enrolled 30 patients aged 40-65 years with Stages II-III hypertension concurrent with type 2 DM. All the patients received combined antihypertensive therapy with amlodipine + lisinopril for 24 weeks. Endothelial function (EF) was studied from the serum and urine concentrations of the metabolites nitric oxide (NO) and endothelin-1 (ET-1) and from occlusion test results. Carbohydrate metabolic parameters were estimated. Insulin resistance (IR) was judged from basal insulin concentrations, followed by the calculations of the Homeostasis Model Assessment (HOMA) index. RESULTS: Following 24 weeks of therapy with amlodipine + lisinopril and close adherence to dietary recommendations, all the patients achieved the target levels of blood pressure and glycated hemoglobin (HbA1c). There was a significant improvement in EF in hypertensive patients with type 2 DM: NO production was increased in both the serum and urine (by 122.8 and 65.8%, respectively). ET-1 secretion was naturally decreased in both the serum and urine (by 26.1 and 76.1%, respectively; p < 0.05). Analysis of the vascular component of EF during treatment with the combined drug amlodipine + lisinopril revealed a statistically significant patient redistribution by the types of microcirculation and the results of an occlusion test, by calculating the responsiveness of large arteries: the number of patients with normal microcirculation increased from 13.3 to 86.7% and that of patients with hyperemic microcirculation declined from 66.7 to 0. The number of patients with a paradoxical occlusion test significantly reduced from 46.7% at baseline to 20% after 24 weeks of treatment with the combined medication amlodipine + lisinopril. Fasting blood glucose levels and HOMA index were decreased by 22.1 and 22.4%, respectively (p < 0.05). There were statistically significant correlations between the HOMA index and the concentrations of NO in the urine (r = -0.45) and blood (r = -0.54) and those of ET-1 in the blood (r = -0.54). CONCLUSION: Twenty-four-week combined antihypertensive therapy with the drug amlodipine + lisinopril is safe and highly effective in EF recovery and favorably affects carbohydrate metabolic parameters in the hypertensive patients with type 2 DM.

[Efficacy and safety of bisoprololal in hypertensive patients with cardiovascular disease and chronic obstructive pulmonary disease].

Efficacy and safety of bisoprolol in hypertensive patients with cardiovascular disease and chronic obstructive pulmonary disease. A comparative study on the efficacy and safety of bisoprolol and sustained release metoprolol succinate in patients with arterial hypertension (AH), cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) was conducted. High antihypertensive efficacy and good tolerability of bisoprolol and metoprolol succinate sustained release was shown in hypertensive patients with CVD and COPD. Bisoprolol versus metoprolol succinate sustained release was more effective in reducing the number of PVCs in hypertensive patients with CVD and COPD. After 12 weeks of therapy of bisoprolol there was a trend to reduce the number of patients with concentric left ventricular hypertrophy by 16.6 % (from 83.3% at baseline vs 66.7% after 12 weeks of treatment, p < 0.1). Despite the fact that the identified changes in respiratory function (ERF) in both groups did not reach certainty bisoprolol versus metoprolol succinate sustained-release was a lesser extent influenced the performance of ERF and more - to reduce dyspnea to the evaluation scales Borg and mMRC (delta% = -7.1 in fixed vs delta% = -3.8 in control groups and delta% = -5.6 vs delta% = 0 respectively) in patients with AH, CVD and COPD.

[Effect of combination antihypertensive therapy on circadian blood pressure and metabolic parameters in patients with type 2 diabetes mellitus].

AIM: To assess effect of combined antihypertensive therapy with lisinopril and amlodipine on circadian blood pressure (BP), insulin resistance (IR), carbohydrate and lipid metabolism in patients with arterial hypertension (AH) and type 2 diabetes mellitus (DM). MATERIAL AND METHODS: Combination of amlodipine (6.0±0.4 mg/day) and lisinopril (12.0±0.9 mg/day) was given to 30 patients (age 40-65 years) with stage I-II AH and DM type 2) for 24 weeks. All patients underwent ambulatory BP monitoring. Parameter studied comprised glucose levels, glycosylated hemoglobin (HbAlc), basal insulin, lipid profile in the venous blood and insulin resistance (IR). All patients received glucose-lowering drugs and followed diet recommendations. RESULTS: All patients achieved target BP values and concentrations of HbAlc. After 24 weeks of treatment the following parameters were significantly different from baseline values: mean systolic BP (SBP) (-15.6%), mean diastolic BP (DBP), (-16.2%), time index (pressure load--PL) SBP day (-50.1%), PL DBP day (-51.3), PL DBP night (-59.2%), SBP variability (-15.8%), values of morning SBP and DBP increase (both -41.8%), rates of morning rise of SBP (-74.1%) and DBP (-65.8%), percentage of patients with increased variability of SBP (-36.7%), of DBP (- 23.3%), of SBP day (-36.7%), of DBP day (-30.0%). Significant decreases of fasting blood glucose level (-22.1%), concentrations of total cholesterol (-8.8%), low density lipoprotein cholesterol (-15%), triglycerides (-4.4%), and metabolic index (-32.7%) were also observed. CONCLUSION: In patients with hypertension and type 2 DM 24 week antihypertensive therapy with lisinopril and amlodipine significantly improved circadian blood pressure profile, reduced severity of IR without negative effect on carbohydrate and lipid metabolism.

[Endothelial dysfunction is a target for combination antihypertensive therapy in hypertensive patients with type 2 diabetes mellitus].

AIM: To evaluate the impact of combination antihypertensive therapy with lisinopril + amlodipine (Ekvator) on endothelial dysfunction in patients with hypertension and concurrent type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: The trial enrolled 30 patients aged 40 to 65 years with Stages II-Ill hypertension concurrent with T2DM. All the patients received combination antihypertensive therapy with lisinopril + amlodipine (ekvator) for 12 weeks. Endothelial function was studied from serum and urinary NO and endothelin-1 concentrations and occlusion test results. 24-hour blood pressure (BP) monitoring and echocardiography were performed; arterial elastic properties and renal function were investigated. RESULTS: After 12-week therapy, 93.3% of the patients achieved BP goals. Endothelial function was improved in hypertensive patients with T2DM: there were increases in both serum and urinary NO production (by 53.5 and 57.1%, respectively) and decreases in serum and urinary endothelin-1 secretion (by 27.7 and 69.6%, respectively). The number of patients with normal microcirculation increased from 13.3 to 73.3% (p < 0.001). There was significant improvement in 24-hour AP monitoring readings and reductions in the left ventricular mass index by 10.7% and microalbuminuria by 27.7%; the number of patients with increased pulse wave velocity along the elastic arteries declined by 30%. CONCLUSION: Twelve-week treatment with the combined antihypertensive medication ekvator is highly effective and safe for recovering endothelial function and improving the state of target organs in hypertensive patients with T2DM.

[Impact of combination antihypertensive therapy on heart rate variability parameters and target organ status in patients with arterial hypertension and type 2 diabetes mellitus].

AIM: To evaluate the impact of combination antihypertensive therapy with ekvator on heart rate variability (HRV) parameters and target organ status in patients with arterial hypertension (AH) and type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: The investigation enrolled 30 patients aged 40-65 years with Stages II--III AH concurrent with T2DM. All the patients received combination antihypertensive therapy with amlodipine + lisinopril for 12 weeks. HRV parameters, baseline autonomic tone, and autonomic responsiveness were studied, by analyzing ECG reading of their hearts in the 5-minute segments. Echocardiography was performed and arterial elastic properties and renal functional were examined. RESULTS: 12-week ekvator therapy showed a high (93.3%) rate of achieved goal blood pressure (BP) levels. There was a statistically significant reduction in resting tension index by 66% and during an active orthostatic test by 43.5% during combination antihypertensive therapy with amlodipine and lisinopril. Twelve weeks after treatment, the normal type of autonomic responsiveness was prevalent (53.4%) in patients with AH and T2DM, with a significant decline in the number of persons with asympaticotonic autonomic responsiveness. There was a significant decrease in left ventricular mass index by 10.7% and microalbuminuria by 27.7% and a 30% decline in the number of patients with a higher pulse wave velocity along the elastic arteries. There were close highly significant correlations between the parameters of HRV and the status of target organs (heart, kidney, and vessels). CONCLUSION: 12-week ekvator treatment not only normalizes effectively BP and has a favorable impact on target organs, but also improves HRV parameters in the patients with AH and T2DM, in this connection, HRV may be, in our opinion, regarded as another combination antihypertensive therapy target.

[The place of ß-adrenoblockers in the treatment of cardiovascular disease in patients with chronic obstructive pulmonary disease].

Review is devoted to the place of ß-adrenoblockers in the treatment of cardiovascular disease (CVD) in patients with chronic obstructive pulmonary disease (COPD). Currently, it is expedient to use cardioselective -adrenoblockers, such as bisoprolol, metoprolol succinate, carvedilol and nebivolol for the treatment of patients with CVD and COPD. Bisoprolol has the greatest (of all the cardioselective ß-adrenoblockers) evidence base of data on the efficacy and safety of using in patients with COPD and CVD. While using a cardioselective ß-adrenoblockers external respiration function (ERF) should be controlled. When clinical signs of worsening airway conductance appear, and adverse effects on ERF parameters are observed, ß-adrenoblockers dosage should be reduced, while maintaining lower respiratory functions need to be canceled. In general, the use of cardioselective ß-adrenoblockers in patients with CVD and COPD is safe, and the benefits of the drugs in this group exceed the risks of exacerbation of COPD. If possible the use of 2-agonists should be limited in patients with CVD in the treatment of COPD because of their negative impact on the cardiovascular system - the preferred use of anticholinergic drugs.