[Comparative efficiency of indapamide combinations with various derivaties of calcium antagonists in patients with arterial hypertension].

The study included 59 patients aged 42-65 yr with grade II AH. They underwent 24 hour AP monitoring and Doppler echocardiography before and 16 weeks after onset of the study. The patients were randomly allocated to 2 groups. In group 1, they were given combined therapy with indapamide and verapamil retard. Patients of group 2 were treated with indapamide and amlodipine. AP circadian rhythm returned to normal in 83 and 78.6% of the patients in groups 1 and 2 respectively. Combined therapy in group 1 was especially beneficial for patients with type 1 left ventricular diastolic dysfunction, daily non-dipper profile, and hyperkinetic type of blood circulation. In group 2, the most pronounced changes were documented in patients with type II-III left ventricular diastolic dysfunction and hypokinetic type of circulation.

[Efficacy of calcium antagonists depending on the functional state of parathyroid glands in patients with hypertensive disease].

Hypotensive and cardioprotective effects of amlodipine (normodipine) were evaluated in 65 patients (35 men and 30 women) with grade II essential arterial hypertension treated with regard for calcium-controlling parathyroid function. 24 hour Holter monitoring, Doppler-cardiography, and blood PTH measurement were performed before and 6 months after the onset of therapy. The patients were divided into 3 groups depending on PTH levels (0-25, 26-50, and over 51 pg/ml). Changes of structural and functional cardiac parameters and AD were most prominent in group 3 in the form of decreased left ventricular hypertrophy, improved ventricular diastolic function, and marked hypotensive effect. The group was significantly different from group 1 in terms of these characteristics. Univariate analysis revealed correlation of PTH levels with left ventricular mass, mean daily systolic and diastolic AD, and left ventricular diastolic function. It is concluded that evaluation of calcium-regulating parathyroid function is necessary for optimization of antihypertensive therapy with calcium antagonists.

[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.

[Evaluation of hypotensive and antiischemic effects of a combination of dihydropyridine and non-dihydropyridine calcium antagonists in patients suffering from coronary artery disease with arterial hypertension].

The hypotensive and antiischemic activity of combined therapy with dihydropyridine group (amlodipine) and non-dihydropyridine group (verapamil retard) calcium antagonists (CA) as well as tolerance to this therapy were studied in 43 patients suffering from coronary heart disease (CAD) with II-III functional class exertional angina and II degree essential hypertension during 24 weeks. Twenty-four-hour ECG and blood pressure (BP) monitoring and Doppler EchoCG were done. The combination of amlodipine and verapamil retard in different day doses made it possible to achieve target BP levels in 86% of cases, improved circadian BP pattern and decreased left ventricular myocardial mass index (18.5% on the average; p < 0.01). The study also demonstrated prominent antiischemic and antianginal effects of the therapy, including patients with left ventricular hypertrophy. A decrease in myocardial ischemic (both painful and painless) episode frequency and the total duration of ST segment depression were the most pronounced changes. The combination of amlodipine and verapamil retard had a substantially lower rate of adverse effects compared with that of each of the component when used separately thanks to mutual neutralization of their side-effects or a possibility to lower their doses. Thus, the combination of CA from different groups possesses high hypotensive and antiischemic activity and good tolerance, which allows recommending it for treatment of patients suffering from CAD with arterial hypertension.

[Efficacy of and tolerance to combined therapy with dihydropyridine and non-dihydropyridine Ca antagonists in patients with moderate arterial hypertension].

The authors of the article studied efficacy of combined therapy with dihydropyridine and non-dihydropyridine Ca antagonists, its influence on structural and functional condition of the heart in 53 patients (28 men and 25 women) with moderate arterial hypertension (AH), and their tolerance to the therapy. Before and during the treatment the patients underwent 24-hour arterial pressure (AP) monitoring and Doppler echoCG. Due to combined therapy with isoptin SR and corinfar retard complete hypotensive effect (AP < 140/90 mmHg) was achieved in 83% of cases, and partial effect (diastolic pressure lowered by 10 mmHg)--in 17%. The therapy significantly reduced left ventricular mass index (14.6% on the average; p < 0.01), and improved diastolic function: E/A increased by 10.3% (p < 0.05), and isovolumetric relaxation time decreased by 13.6% (p < 0.01). Combined therapy also resulted in a 1.5 to 4 time reduction in the frequency of side effects of isoptin SR and corinfar retard due to reduction in their doses and/or mutual neutralization of their side effects. The paper demonstrates high antihypertensive efficacy of and good tolerance to the combination of dihydropyridines and non-dihydropyridines when they are administered for prolonged therapy in patients with moderate AH.

[Electrocardiographic diagnosis of ischemic lesions of the myocardium in patients with artificial pacemaker]. / Vozmozhnosti élektrokardiograficheskoi diagnostiki ishemicheskikh porazhenii miokarda u bol'nykh s iskusstvennym voditelem ritma serdtsa.

137 patients with artificial cardiac pacemaker (ACP) were examined to ascertain origin and changes of the end of spontaneous ventricular complexes (SVC) in ventricular pacing. The examination program included the ACP inhibition test, K test, veloergometry (VEM), echocardiography. Intermittent pacing has revealed depression of ST segment and/or inversion of T wave of SVC in 109 (79.6%) patients. After inhibition (switch off) of ACP in spontaneous heart rhythm 45 (41.3%) patients got free of the above shifts or showed a less number of pathological ECG leads (Chaterie's syndrome). In positive K test conducted after inhibition of ACP normalization of the SVC end in additional 11.0% cases. True Chaterie's syndrome is characterized by reversibility of ST wave depression and/or inversion of T wave of SVC in long spontaneous rhythm and a positive potassium test. In ischemic damage to the myocardium or postinfarction scars, changes of the SVC end part were stable, combined in many cases with pathological changes of QRS-complex, positive VEM test. Hyperdiagnosis of microfocal myocardial infarction in intermittent ventricular pacing was observed in 78% cases, especially due to Chaterie's syndrome. Thus, analysis of ECG changes is important for the choice of a valid policy of management of patients with ACP.

[Non-pharmacological correction of arterial pressure in hypertensive patients with a pacemaker]. / Nemedikamentoznaia korrektsiia arterial'nogo davleniia u bol'nykh s iskusstvennym voditelem ritma serdtsa, stradaiushchikh gipertonicheskoi bolezn'iu.

Frequency-dependent hypotensive effect of cardiac pacing (CP) regarding type of circulation and stimulation regime under programmed changes of impulse frequency from 50 to 90 imp/min was studied in 92 patients (53 males, 39 females) with essential hypertension of the first, second and third degree and isolated systolic arterial hypertension. The rise of the above frequency over 80 imp/min was accompanied with a significant fall in systolic arterial pressure (SAP) in patients with hyperkinetic circulation while heart rhythm under 60 imp/min resulted in a significant lowering of diastolic arterial pressure (DAP) in patients with eukinetic and hypokinetic type of circulation. In regime VVI both SAP and DAP lowering was more pronounced than in AAI regime. The most prominent hypotensive effect was seen in VVI-stimulation complicated by ventriculoatrial conduction. Reprogramming of impulse frequency normalized arterial pressure in 43.3% patients with hyperkinetic type of circulation. Thus, a frequency-dependent hypotensive effect of programmed CP can be used for non-pharmacological correction of arterial hypertension and optimization of effectiveness of anti-hypertensive treatment in paced patients.