[The influence of vascular remodeling and endothelial vasomotor function on the efficacy of indapamide retard in patients with hypertensive disease].

The influence of vascular remodeling and endothelial vasomotor function on the efficacy of indapamide retard was studied in 92 patients (49 men and 43 women) with stage I-II hypertensive disease and grade I-II arterial hypertension by observation of dynamics of the results of 24 hour AP monitoring and heart rhythm variability (HRV), cardio- and vasoprotective efects. The patients were divided into comparable groups. Group 1 was comprised of 40 patients without structural changes of the humeral artery (HA), group 2 included 52 patients undergoing HA remodeling. It was shown that antihypertensive efect of indapamide was virtually identical in both groups. Dynamics of left ventricular and HA structural/functional characteristics in group 2 was more pronounced than in group 1. Conversely, changes of spectral and time-dependent characteristics of HRV in group I were more significant than in group 2; they included suppression of reciprocal hyperactivity of the sympathetic nervous system. In the absence of structural vascular changes, the anti-hypertensive, cardio- and vasoprotective effects of indapamide retard were realized via neurohumoral blockade whereas direct vascular action of the drug prevailed in case of vascular remodeling and endothelial dysfunction

[Dynamics of electrophysiological parameters of the heart in hypertensive patients depending on a 24-h profile of arterial pressure, left ventricular geometry and metabolic disorders].

AIM: To examine conduction system and repolarization in the ventricles and heart rate variability in hypertensive patients with consideration of 24-h blood pressure profile, left ventricular (LV) geometry and metabolic disorders. MATERIAL AND METHODS: 24-h monitoring of blood pressure, diagnostic transesophageal electrostimulation of the left ventricle, echocardiography were made and duration and dispersion of QT interval, variability of the intervals R-R (SDNN) were assessed in 73 untreated patients aged 42 to 57 years with essential hypertension of the second degree. RESULTS: It is shown that hypertensive patients having left ventricular hypertrophy (LVH), metabolic syndrome (MS) and pathologic 24-h blood pressure profile have also a depressed function of the sinus-atrial node and atrioventricular conduction, marked electric instability of the atria and ventricles. Such patients are at high risk to develop arrhythmia (3-5 times higher than patients without LVH, MS, with normal circadian blood pressure rhythm). CONCLUSION: Electric heart remodeling associated with LVH, MS and disturbances of circadian blood pressure pattern enhances electric instability and risk to develop cardiac arrhythmia.