ABSTRACT
The aim of the study was to investigate the dynamics of arterial stiffness and endothelial function parameters under the influence of perindopril arginine and indapamide fixed combination in arterial hypertension (AH) patients. 30 persons with 1-3 degree AH were included into the study. The treatment duration was 24 weeks. Central aortic blood pressure (BP), augmentation pressure and index (AIx), carotid-femoral and carotid-radial pulse wave velocity (PWV), brachial artery endothelium-dependent vasodilatation (EDVD), office and ambulatory BP as well as orthostatic BP falls were evaluated under the influence of selected therapy. 27 patients completed the study protocol. Results showed that aortic systolic BP was significantly reduced by 10.7 mmHg, augmentation pressure - by 3.6 mmHg and AIx - by 6.5%. Carotid-radial PWV decreased by 0.8 m/s. Carotid-femoral PWV did not change. We also revealed the EDVD increase by week 12. The EDVD growth was correlated with degree of aortic systolic BP reduction (r=-0.48, p=0.02). Office and ambulatory BP declined by 15.8/10.0 and 10.0/7.5 mmHg respectively. The target BP <140/90 mmHg was achieved in 20 (74.1%) persons. At the same time the orthostatic hypotension did not rise. Conclusion. We concluded that perindopril arginine/indapamide fixed combination improved vascular function in hypertensive patients by wave reflection reduction, peripheral arterial stiffness lowering and endothelial function improvement.
Subject(s)
Blood Pressure/drug effects , Endothelium, Vascular , Hypertension , Indapamide , Perindopril , Vascular Resistance/drug effects , Administration, Oral , Antihypertensive Agents/administration & dosage , Antihypertensive Agents/adverse effects , Antihypertensive Agents/pharmacokinetics , Arteries/drug effects , Arteries/physiopathology , Biological Availability , Drug Combinations , Drug Synergism , Endothelium, Vascular/drug effects , Endothelium, Vascular/physiopathology , Female , Humans , Hypertension/drug therapy , Hypertension/physiopathology , Indapamide/administration & dosage , Indapamide/adverse effects , Indapamide/pharmacokinetics , Male , Middle Aged , Perindopril/administration & dosage , Perindopril/adverse effects , Perindopril/pharmacokinetics , Pulse Wave Analysis/methods , Treatment Outcome , Vasodilation/drug effectsABSTRACT
We studied dynamics of arterial pulse pressure (APP) during active orthostatic test (AOT) in relation to cardiac and vascular involvement in 198 elderly patients with arterial hypertension. We measured and compared parameters of hemodynamics, rate of detection of risk factors, signs of affection of the heart and vessels in subgroups with elevation of APP (n=50), lowering of APP by more than 10 mm Hg (n=50) and intermediate deviations of APP (n=98) in orthostasis. In patients with elevation of APP during AOT smoking, increased aortic stiffness, history of myocardial infarction were detected more often and risk of development of cardiovascular diseases according to SCORE system was higher than in patients with lowering of APP or absence of its dynamics. Patients with lowering of APP more than 10 mm Hg significantly more often had cerebrovascular disease appearing as history of cerebral strokes and/or transitory ischemic attacks. The conclusion was made about possible significance of orthostatic increment of APP as supplementary marker of cardiovascular risk in elderly patients with arterial hypertension.
Subject(s)
Blood Pressure/physiology , Coronary Vessels/physiopathology , Heart/physiopathology , Hypertension/physiopathology , Hypotension, Orthostatic/diagnosis , Hypotension, Orthostatic/physiopathology , Aged , Female , Humans , Hypertension/diagnosis , Hypertension/epidemiology , Hypotension, Orthostatic/epidemiology , Male , Risk Factors , Smoking/epidemiologyABSTRACT
Using 48-h Holter monitoring of ECG and ambulatory blood pressure monitoring, 28 patients (13 men, 15 women, mean age 66.6 +/- 7.7 years) with cerebral vascular insufficiency of the I-II stage in combination with chronic coronary heart disease and essential arterial hypertension have been examined. Quantitative parameters of myocardial ischemia episodes and hypotension conditions were calculated and compared before the beginning (the first 24 h of monitoring) and during taking the daily dose of 30 mg of cavinton forte (the second 24 hours of monitoring). The distribution of ischemia and hypotension episodes in the periods of the maximal supposed effect of the drug was analyzed. Cavinton forte neither contributes to the manifestation and average frequency of myocardial ischemia episodes nor influences parameters and the character of short-term arterial hypotension episodes. The drug reduces quantity and duration of blood pressure nocturnal fall. It is concluded that initial cavinton forte treatment of cerebral vascular insufficiency in patients with chronic coronary heart disease in combination with arterial hypertension is safe when combined with hemodynamically active antihypertensive and antiischemic therapy.
