[Modified method for determining the normal values of the aortic root diameter in the focus of aortic pathology in individuals with congenital connective tissue disorders].

INTRODUCTION: Enlargement of the aortic root of occurs in many cases with cardiovascular disease, including congenital connective tissue disorders (CCTD), especially its differentiated and undifferentiated forms (UCCTD). A common deficiency of the generally accepted methods for diagnosing an aortic root dilation may be that persons with CCTD and cardiovascular diseases of potentially having a broader aortic root diameter could be included in the reference groups. The purpose of our study was to develop a modified method for determining the normal aortic root diameter in group of individuals without CCTD and cardiovascular diseases. MATERIALS AND METHODS: The study included 464 apparently healthy people, men and women aged 15 to 65 years. All patients underwent general clinical examination, echocardiography. On the basis of external and internal signs of CCTD, patients with UCCTD were identified - the UCCTD group (n = 208) and without this pathology - the main group (n = 256). The calculation of the normal aortic root diameter (NARD) was made in accordance with the methods of Roman M. J. et al. (1989) and Devereux R. B. et al. (2012). The upper limit values of NARD (UL NARD) were calculated according to the algorithms of Roman M. J. et al. (1989), Devereux R. B. et al. (2012), Campens L. et al. (2014). RESULTS: The data obtained in the main group was used to develop a modified method for the determination of NARD. The mean values by echocardiography and calculated values of the aortic root by modified method of this study were practically the same in the main group, whereas the mean value of NARD calculated by the methods of Roman M. J. et al. and Devereux R. B. et al. in this sample were significantly higher in relation to the listed values. As the NARD values, the UL NARD were significantly higher for all evaluated algorithms in comparison with the modified method. In the group of patients with UCCTD, 13 cases of aortic root dilation were found according to the method of Roman M. J., compared to 19 cases by the modified method. At the same time, 3 patients with aortic root enlargement by the mew method had 7 points of systemic involvement, thus corresponding to the Ghent criteria of Marfan syndrome. The methods of Campens L. and Devereux R. B. were less sensitive, revealing only 5 and 1 patients with aortic root dilatation, respectively. CONCLUSIONS: The results of the study demonstrate that, in order to obtain more reliable information on the condition of the root of the aorta and its proper values, the modified method obtained in the course of the study can be used. This method is more sensitive in detecting the enlargement of the aortic root in CCTD and in diagnosing syndromic CCTD.

[Controlled diuretic monotherapy in hypertensive patients: Efficiency and metabolic safety]. / Kontroliruemaya monoterapiya diuretikami u bol'nykh arterial'noi gipertoniei: effektivnost' i metabolicheskaya bezopasnost'.

AIM: To evaluate the antihypertensive efficiency and metabolic effects of controlled monotherapy with hydrochlorothiazide (HCT) and indapamide retard (IR) in hypertensive patients. SUBJECTS AND METHODS: The study included 50 patients with Stage II essential hypertension, grades 1-3 blood pressure (BP) elevation, who received 3-month monotherapy with IR (n=25) or HCT (n=25). Changes were determined in BP, blood lipid, glucose, and potassium levels. The efficiency of antihypertensive therapy was evaluated in the entire group and subgroups of patients identified in accordance with the used diuretic and the presence (n=27) or absence (n=23) of therapy at previous stages. RESULTS: A total of 54% of the patients included in the study achieved target BP after 3 months of therapy. The proportion of individuals with normalized BP was comparable in the HCT and IR groups (52 and 56%, respectively) and in previously treated patients and those who used for the first time antihypertensive drugs (51.8 and 56.5%, respectively). Normalization of systolic and diastolic BPs was achieved in 78 and 58% of the patients, respectively. Target BP was achieved in 94,1%, 42,9% and 16,7% of patients with grades 1,2 and 3 hypertension, respectively. IR proved to be metabolically neutral whereas HCT was found to significantly increase the blood levels of triglycerides and glucose by 15.3% (p<0.05) and 12.2% (p<0.05), respectively. CONCLUSION: Controlled diuretic monotherapy allows BP normalization in more than 50% of the hypertensive patients. HCT and IR have similar antihypertensive efficiency. Because of the negative changes observed in lipid and carbohydrate metabolism with the use of relatively small doses of HCT, IR is a preferential alternative in the long-term treatment of hypertensive patients.

[Endothelial and metabolic effects of perindopril in patients with essential hypertension].

OBJECTIVE: To elucidate endothelial and metabolic effects of perindopril and their interaction in patients with uncomplicated essential hypertension. METHODS: The study involved 30 patients treated with perindopril (5-10 mg/day) for 3 months. The following parameters were registered at baseline and at the end of the study: body mass index, waist circumference, blood lipids and glucose, flow-mediated vasodilation (FMVD) of brachial artery assessed by ultrasound. RESULTS: Treatment with perindopril was associated with significant improvement of FMVD (6.7 ± 4.1% versus 8.7 ± 5.4% at the end of the study, p<0.05) as well as decrease of blood triglycerides (-18%, p<0.05) and glucose (-9%, p<0.01) with no significant changes of other metabolic parameters. Correlation analysis showed no relationship between changes of FMVD and blood pressure during the study (r= -0.14, p=0.42 r= -0.13, p=0.46 for systolic and diastolic blood pressure, respectively) whereas inverse association was observed with changes of blood glucose (r= -0.50, p<0.01). CONCLUSIONS: Thus our data confirm the ability of perindopril to restore impaired endothelial function in patients with essential hypertension independently of blood pressure reduction and make possible to propose its positive metabolic effect relative to changes associated with insulin resistance. It seems that endothelial effect of perindopril may in part be related to diminished adverse influence of metabolic changes on vascular wall.

[Direct comparison of endothelial and metabolic effects of perindopril combination with indapamide retard or hydrochlorothiazide].

OBJECTIVE: Our aim was to compare changes of vascular and metabolic parameters in patients with essential hypertension on treatment with combination of perindopril with either indapamide retard or hydrochlorothiazide. METHODS: The study involved 40 patients who were randomly assigned to perindopril 5-10 mg/day in combination with indapamide retard (P+I) 1.5 mg/day (n = 20) or with hydrochlorothiazide (P+HT) 25 mg/day (n=20). Waist circumference, body mass index, blood lipids and glucose, endothelial function (EF) determined as the change of resistance index after inhalation of salbutamol, arterial stiffness measured as mean pulse wave velocity after sublingual trinitroglycerin (PWVtng) were evaluated at baseline and 6 months thereafter. Vascular responses were calculated from digital pulse waves registered using photoplethysmography. RESULTS: Dynamics of BP after 6 months did not differ significantly between groups. Treatment with combination of P+HT resulted in significant decrease of EF (-24,3%, p<0,05) accompanied by negative changes of triglycerides (+13,4%, p<0,05) and glucose levels (+9,8%, p<0,05), whereas combination of P+I did not affect endothelial function and was metabolically neutral. PWVtng significantly decreases on both regiments of treatment with the trend in favor of P+I combination (-13,4%, p<0,001 versus -9,8%, p<0,01 for P+I and P+HT combinations, respectively). CONCLUSION: Thus, despite the similar BP reduction the combination of ACE-inhibitor--perindopril with indapamide retard possesses more favorable vascular and metabolic effects compared to combination with hydrochlorothiazide that potentially may account for different prognosis of patients with arterial hypertension on long-term treatment.

[Detection of structural changes of large arteries by characteristics of peripheral pulse wave: comparison with high resolution ultrasonic investigation].

AIM: To compare high-resolution ultrasound of major arteries and the method of vascular stiffness evaluation by digital volume pulse photoplethysmography after sublingual nitroglycerin in diagnosis of structural vascular changes. MATERIAL AND METHODS: The comparison of the two methods was made in 110 volunteers (mean age 31.9 +/- 11.5 years). The study protocol included measurement of blood pressure (BP), blood lipids and glucose, evaluation of IMT of the carotid arteries by ultrasonography, baseline stiffness index (SIbl) and after sublingual nitroglycerin (SIng) by photoplethysmography. Reproducibility of photoplethysmography was evaluated in 20 volunteers (mean age 20.3 +/- 1.4 years) with repeated measurement after 1 week. The results were tested in 40 volunteers of different age groups. RESULTS: There were significant correlations of IMT, SIbl and SIng with risk factors and close interrelations of these parameters. SIng better explained variability of IMT compared to SIbl (r = 0.79, R2 = 0.62, p < 0.001 versus r = 0.67, R2 = 0.45, p < 0.001, respectively). Relations of IMT with risk factors were lost after correction for SIng. Reproducibility of SIng was higher than SIbl (+/- 5.1% versus +/- 10.9%, respectively) and than those for IMT found in the literature. Mean IMT values for random sample evaluated by ultrasonography and calculated by estimated equation of linear regression for SIng and IMT did not differ significantly (0.576 +/- 0.087 mm versus 0.570 +/- 0.074 mm, p = 0.44; r = 0.71, p < 0.001, mean difference 0.007 +/- 0.051 mm). CONCLUSION: The method of vascular stiffness measurement is comparable with ultrasonography in terms of vessel structure evaluation and possesses higher reproducibility. The test with nitroglycerin substantially increases its diagnostic potential and reproducibility.

[Possibilities of using indices of vascular wall function as markers of negative metabolic effects of treatment with thiazide diuretics in patients with essential hypertension].

AIM: To evaluate the influence of antihypertensive and metabolic effects of thiazide diuretics on vascular endothelial function and coronary risk (CR) in patients with essential hypertension (EH). Materials and methods. The study included 50 EH patients treated with indapamide retard (n = 25) or hydrochlorothiazide (n=25) during 12 weeks. Changes in blood pressure, blood lipid and glucose levels, Framingham algorithm-calculated coronary risk (CR), the brachial response to endothelium-dependent and endothelium-independent stimuli, studied by high-resolution ultrasound, were evaluated. Results. Indapamide retard (1.5 mg/day) and hydrochlorothiazide (25 mg/day) showed the similar antihypertensive effect. Indapamide retard was metabolically neutral whereas hydrochlorothiazide increased the blood levels of triglycerides and glucose by 15.3% (p < 0.05) and 12.2% (p < 0.05), respectively. The calculated CR decreased by 21.3% (p < 0.01) on indapamide retard treatment and practically unchanged on hydrochlorothiazide. There were significant group differences in the effects of the drugs on endothelium-dependent vasodilatation. The latter tended to improve by indapamide retard (+8.9%; p = 0.10) and to significantly worse by hydrochlorothiazide (-17.0%; p < 0.05). Hydrochlorothiazide-induced changes in total cholesterol, triglycerides, and low-density lipoprotein cholesterol were directly related to calculated CR changes (r = 0.69, r = 0.58, and r = 0.57, respectively; p < 0.01) and the changes in blood glucose levels were inversely related to those in vascular endothelial function (r = -0.52; p < 0.01). Such relations were not observed on indapamide retard. Conclusion. The negative metabolic effects of hydrochlorothiazide induce negative changes in vascular endothelial function just at early stages of therapy. These changes may be used as a predictor of a coronary risk during thiazide diuretic treatment in patients with EH.

[Comparative assessment of hypotensive, metabolic, and endothelial effects of indapamide-retard and hydrochlorothiazide in patients with essential hypertension].

AIM: To compare hypotensive, metabolic, and endothelial effects of indapamide-retard and hydrochlorothiazide. MATERIAL AND METHODS: Patients (n=50) with essential hypertension were given either indapamide-retard (1.5 mg/day, n=25) or hydrochlorothiazide (25 mg/day, n=25) for 12 weeks. Dynamics of the following parameters were studied: blood pressure, blood lipids and glucose, total coronary risk, carotid artery intima-media thickness, reaction of brachial artery to endothelium-dependent and endothelium-independent stimuli registered by high resolution ultrasound. RESULTS: Indapamide-retard and hydrochlorothiazide demonstrated similar hypotensive efficacy. Indapamide-retard turned out to be metabolically neutral while in patients receiving hydrochlorothiazide we observed significant elevation of triglycerides (+15.3%, p<0.05) and glucose (+12.2%, p<0.05). This resulted in the lack of lowering of total coronary risk during treatment with hydrochlorothiazide. Significant intergroup differences were revealed in effects on endothelium-dependent vasodilation with tendency to improvement and to significant worsening (-17%, p<0.05) in indapamide and hydrochlorothiazide treated patients, respectively. CONCLUSION: Despite similar hypotensive efficacy there were significant differences in metabolic and endothelial effects of 2 diuretics in favor of indapamide. This could potentially matter for long term cardiovascular prognosis.

[Effect of enalapril maleate on vascular endothelial function and platelet-endothelial interactions in patients with essential hypertension]. / Vliianie terapii énalaprila maleatom na funktsiiu sosudistogo éndoteliia i trombotsitarno-éndotelial'nye vzaimosviazi u bol'nykh gipertonicheskoi bolezn'iu.

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.