ABSTRACT
We conducted comparative analysis of clinico-economical efficacy of angiotensin converting enzyme inhibitors as components of combination therapy of patients with arterial hypertension and ischemic heart disease. Clinical efficacy of fosinopril, moexipril, perindopril, and ramipril was comparable: in compared groups statistically significant lowering of arterial pressure was achieved by day 6 of treatment and this lowering persisted up to day 36 of therapy with ramipril. All studied drugs were well tolerated. Ramipril was notable for highest economical efficacy determined by the method of \"minimization of expenditures\". Technology of assessment of clinico-economical effectiveness of preparations from the same pharmacological group can be used in compilation of standards of drug therapy of various diseases, basing on which a physician administers a concrete drug to a concrete patient.
Subject(s)
Angiotensin-Converting Enzyme Inhibitors/economics , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Drug Costs , Hypertension/drug therapy , Myocardial Ischemia/drug therapy , Cost-Benefit Analysis , Female , Follow-Up Studies , Humans , Hypertension/complications , Hypertension/economics , Male , Middle Aged , Myocardial Ischemia/complications , Myocardial Ischemia/economics , Treatment OutcomeABSTRACT
AIM: Evaluation of endothelial function and platelet-endothelial interactions in patients with essential hypertension and dynamics of these changes in the course of treatment with enalapril maleate. MATERIALS AND METHODS: The study included 37 patients with essential hypertension and 22 normotensive volunteers. 17 of hypertensive patients received enalapril maleate (enap, KRKA) 5-20 mg/day during the period of 1.5 months. The complex of investigations included: measurement of total plasma cholesteroi, 12-lead ECG, echocardiography, high-resolution ultrasound investigation of brachio-cephalic arteries, evaluation of flow-mediated dilation, measurement of von Willebrand's factor, spontaneous and induced platelet aggregation. RESULTS: Patients with essential hypertension exhibited higher levels of von Willebrand's factor in plasma and degree of spontaneous and induced platelet aggregation as well as lower responses of vessel wall to hemodynamic stimuli compared to normotensive healthy individuals. There was a strong correlation between endothelial function markers and CAD risk factors, elevation of platelet activity. Treatment with enalapril maleate led to a statistically significant decrease of von Willebrand's factor in plasma and ex vivo platelet aggregation whereas flow-mediated dilatation increased. Values of endothelial function markers and platelet activity approached to those of normotensive subjects and these changes were accompanied by a decrease of ECG signs of left ventricular hypertrophy. CONCLUSION: Patients with essential hypertension were found to have compromised endothelial function. However, the degree of endothelial dysfunction depends not on hemodynamic parameters, but on the cumulative effect of CAD risk factors. Treatment with enalapril maleate may lead to normalisation of endothelial function and decrease of platelet activity.
