[Antiastenic effect of sequential levocarnitine and acetylcarnitine therapy in patients with cardiovascular diseases]. / Antiastenicheskii effekt posledovatel'noi terapii levokarnitinom i atsetilkarnitinom patsientov s serdechno-sosudistoi patologiei.

OBJECTIVE: Evaluation of the antiasthenic effect of sequential therapy with levocarnitine (LC) and acetylcarnitine (ALC) in patients with arterial hypertension and/or ischemic heart disease (CHD) with asthenic syndrome (AS). MATERIAL AND METHODS: An open comparative study included 120 patients aged 54-67 years in patients with arterial hypertension and/or coronary artery disease with AS. Patients of group1 (n=60), in addition to basic therapy for the underlying disease, received LC (Elcar solution for intravenous and intramuscular injection of 100 mg/ml, the company PIQ-PHARMA) intravenously for 10 days at a dose of 1000 mg/day, followed by a transition to oral administration of ALC (Carnicetine, the company PIQ-PHARMA) 500 mg (2 capsules) 2 times a day for 2 months. Group2 patients (n=60) received only basic therapy for major diseases. The duration of observation was 70 days. The severity of AS was assessed using the MFI-20 questionnaire (MultidiMensional Fatigue Inventory) and the visual analog scale VAS-A (Visual Analog Scale Measuring fatigue). RESULTS: In patients of group1, a statistically significant decrease in various manifestations of AS was noted. The differences were significant both in comparison with the baseline level and in comparison with the 2nd group. The endothelium-protective effect of LC and ALC has been established. CONCLUSION: The results obtained indicate that in such comorbid patients, the use of LC and ALC reduces the severity of AS manifestations, and the established endotheliotropic properties of the drugs allow them to be recommended as part of the complex personalized therapy of patients with cardiovascular diseases.

Readiness of clinical laboratory diagnostics and cardiologists to implement the recommendations of the fourth universal definition of myocardial infarction.

This study describes the problems of the implementation of the fourth universal definition of myocardial infarction in the medical institutions of four cities: Volgograd (with Volzhsky), Yekaterinburg, Perm, Ufa, and districts of the Volgograd region. The multicenter study was conducted in the form of a questionnaire of specialists in cardiology and laboratory services. After a survey of cardiac specialists, it was found that a third of them did not see the benefits of the hs-cTn test recommended for the diagnosis of myocardial infarction, and almost half of the specialists surveyed believed that myoglobin was a necessary test for detecting myocardial infarction. Probably, this is due to the fact that 16 clinical diagnostic laboratories from the 5 above regions still perform the determination of myoglobin in patients with suspected myocardial infarction. The material and technical support of medical and diagnostic institutions generally meets the requirements of the fourth universal definition of myocardial infarction. However, there is a problem of «qualitative¼ equipment of the regions of the Volgograd region, since only 3 out of 31 districts declared the possibility of carrying out a quantitative determination of hs-cTn , and qualitative analysis was carried out on platforms that are not monitored by the IFCC. It is worrying that almost half of the specialists of the clinical and diagnostic laboratories of the central district hospitals of the Volgograd region did not indicate the manufacturer of reagents for determining troponins. Thus, in the educational programs of advanced training of specialists in cardiology and laboratory services, it is necessary to include aspects related to the explanation of analytical characteristics, the characteristics of the technology for performing troponin tests and the related interpretation options for the results.

[Possibilities of sequential levocarnitin and acetylcarnitin treatment in correcting cognitive deficiency in patients with cardiovascular diseases]. / Vozmozhnosti posledovatel'noi terapii levokarnitinom i atsetilkarnitinom v korrektsii kognitivnogo defitsita u patsientov s serdechno-sosudistoi patologiei.

OBJECTIVE: To evaluate the effectiveness of sequential therapy with levocarnitine and acetylcarnitine in patients with cardiovascular pathology (arterial hypertension and/or coronary heart disease) and moderate cognitive deficits. MATERIAL AND METHODS: The study included 120 patients aged 54-67 years. The main group of patients (n=60) in addition to the basic treatment of the underlying disease received l-carnitine (Elkar solution for intravenous and intramuscular injection of 100 mg/ml, the company «PIK-FARMA¼)/jet during 10 days in a dose of 1000 mg/day, with following transition to oral administration of acetyl-l-carnitine (Carnitin, the company «PIK-FARMA¼), 500 mg (2 cap Sula) 2 times a day for 2 months. The comparison group (n=60) received basic therapy for major diseases. The total duration of follow-up was 70 days. RESULTS: The results obtained indicate that in such comorbid patients, the use of levocarnitine and acetylcarnitine reduces the severity of cognitive deficits. An important aspect of their pathogenetic effect on the severity of cognitive deficits may be the possibility of correcting endothelial dysfunction. The use of levocarnitine and acetylcarnitine in patients with cardiovascular pathology has demonstrated good tolerability and safety.

[Effect of Tadalafil SZ on endothelial function in patients with erectile dysfunction].

The aim of the study was to assess the efficacy and safety of taking tadalafil at a dose of 5 mg per day or 20 mg "on demand" for the state of endothelial function, the severity of erectile dysfunction (ERD) and urodynamics in men with mild to moderate ERD. MATERIALS AND METHODS: The study included 60 male patients with benign prostatic hyperplasia aged 44 to 60 years with erectile dysfunction and cardiovascular pathology (arterial hypertension, ischemic heart disease). All patients were divided into 3 groups of 20 people. Patients of the 1st group for the treatment of ERD were prescribed tadalafil (Tadalafil SZ, NAO Severnaya Zvezda) in a daily dose of 5 mg / day. Men of the 2nd group took tadalafil 20 mg "on demand", but at least 1 time per week. The third group, in which tadalafil was not prescribed, served as a control. The duration of the study was 4 weeks. RESULTS: A significant effect of tadalafil on indicators of endothelial dysfunction (endothelin-1, nitric oxide, stiffness and reflection index, endothelial function indicator) was demonstrated. The use of tadalafil at a dose of 5 mg daily for four weeks has been shown to be advantageous compared to the use of 20 mg "on demand". Daily intake of tadalafil at a dose of 5 mg and 20 mg "on demand" was safe for patients with cardiovascular disease. CONCLUSION: The data obtained make it possible to recommend this drug for the correction of endothelial dysfunction in patients with benign prostatic hyperplasia, including patients with concomitant cardiovascular diseases.

[Influence of Therapy With Fixed Combination of Perindopril and Amlodipine on Parameters of Elasticity of Main Vessels and Microcirculation in Patients With Arterial Hypertension and Type 2 Diabetes Mellitus].

OBJECTIVE: to assess in patients with arterial hypertension and type 2 diabetes the effect of perindopril / amlodipine fixed combination on arterial wall stiffness (AWF) and microcirculation, and relationship between AWF parameters and the state microcirculation. MATERIALS AND METHODS: We included in this study 30 patients aged 45-65 years. All patients received fixed perindopril arginine / amlodipine besylate combination for 12 weeks. Examination included measurement of AWF of main arterial blood vessels and evaluation of the state of microcirculation. RESULTS: Target blood pressure was achieved in 100 % of patients. Mean values of pulse wave velocity of elastic and muscle-type vessels decreased by 8.5 and 10.3 %, respectively; number of patients with paradoxical test also significantly decreased (p>0.05). Shunting index and myogenic tone significantly decreased by 21 and 33.6 %, respectively. We also observed significant reduction of endothelium-dependent tone component (Δ%=36.3 %), significant rise of mean value of perfusion (Δ%=19.7 %), and significant increase of the respiratory test index (Δ%=4.5 %). There was a statistically significant redistribution of patients by types of microcirculation: the percentage of patients with hyperemic type increased from 26.7 to 43.3 %. CONCLUSION: In patients with arterial hypertension and type 2 diabetes mellitus perindopril arginine / amlodipine besylate fixed combination demonstrated high antihypertensive efficacy, positive effect on parameters of elasticity of main vessels and microcirculation.

[The clinical significance of insulin resistance, impaired carbohydrate and lipid metabolism in the development of microcirculation pathology in patients with chronic heart failure and type 2 diabetes mellitus].

Patients with chronic heart failure and diabetes mellitus type 2 experience continuous progression of organ damage as a result of hemodynamic and metabolic disorders. An important role in pathogenesis of organ damage belongs to pathological types of microcirculation, endothelial dysfunction and insulin resistance. But the role of insulin resistance and its contribution to the formation of endothelial dysfunction and peculiarities of microcirculation in patients with chronic heart failure and type 2 diabetes mellitus is unknown. This study shows significant association between insulin resistance, disorders of carbohydrate and lipid metabolism, development of microcirculatory disturbances and endothelial dysfunction.

[Possibilities of Correction of Endothelial Dysfunction at the Background of Combined Antihypertensive Therapy in Patients With Arterial Hypertension and Type 2 Diabetes].

AIM: To evaluate the impact of a 12-week combined antihypertensive therapy with enalapril + indapamide on endothelial dysfunction in patients with arterial hypertension (AH) and diabetes mellitus (DM) type 2. MATERIALS AND METHODS: 30 patients with AH stage II-III and DM type 2 age from 40 to 65 years were included into research. The combined antihypertensive therapy with enalapril 28.6 ± 1.9 + indapamide 2.5 ± 0 mg/day was assigned for 12 weeks. We studied endothelial function by determining the concentration of NO metabolites and endothelin-1 in serum and urine, the results of occlusion test. RESULTS: After 12-week therapy, 100% of the patients achieved BP goals. There was no impairment of carbohydrate metabolism. Endothelial function was improved in hypertensive patients with T2DM: there were increases in both serum and urinary NO production (by 381 and 48.2%, respectively) and decreases in urinary endothelin-1 secretion (by 56.3%). The number of patients with normal microcirculation increased from 13.3 to 53.3% (p < 0.001) by reducing the number of patients with abnormal (hyperemic and stagnant-stasic) types of microcirculation. CONCLUSION: Twelve-week treatment with the combined antihypertensive medication. The combined antihypertensive therapy with enalapril + indapamide is highly effective and safe for recovering endothelial function in hypertensive patients with T2DM.

[Unsolved problems of cytoprotective therapy in patients with coronary heart disease].

The paper gives data on the proven efficiency of myocardial cytoprotection with the pFOX inhibitors trimetazidine and meldonium for coronary heart disease. However, no algorithm has been defined for their differentiated use at different ischemic remodeling stages in these patients in terms of the mechanism of metabolic effects. Sequential use of meldonium and trimetazidine in different periods of acute and chronic myocardial ischemia may become one of the possible ways to increase the efficacy of the pFOX inhibitors.

[Possibilities of Correction of Endothelial Dysfunction at the Background of Combined Antihypertensive Therapy in Patients With Arterial Hypertension and Type 2 Diabetes].

AIM: To evaluate the impact of a 12-week combined antihypertensive therapy with enalapril + indapamide on endothelial dysfunction in patients with arterial hypertension (AH) and diabetes mellitus (DM) type 2. MATERIALS AND METHODS: 30 patients with AH stage II-III and DM type 2 age from 40 to 65 years were included into research. The combined antihypertensive therapy with enalapril 28,6+/-1,9 + indapamide 2,5+/-0 mg/day was assigned for 12 weeks. We studied endothelial function by determining the concentration of NO metabolites and endothelin-1 in serum and urine, the results of occlusion test. RESULTS: After 12-week therapy, 100% of the patients achieved BP goals. There was no impairment of carbohydrate metabolism. Endothelial function was improved in hypertensive patients with T2DM: there were increases in both serum and urinary NO production (by 381 and 48,2%, respectively) and decreases in urinary endothelin-1 secretion (by 56,3%). The number of patients with normal microcirculation increased from 13.3 to 53.3% (p<0.001) by reducing the number of patients with abnormal (hyperemic and stagnant-stasic) types of microcirculation. CONCLUSION: Twelve-week treatment with the combined antihypertensive medication The combined antihypertensive therapy with enalapril + indapamide is highly effective and safe for recovering endothelial function in hypertensive patients with T2DM.

[Cardio-Nephroprotection the Most Important Goal of Antihypertensive Therapy in Patients With Type 2 Diabetes].

AIM: to study the opportunities for cardio and nephroprotection by 6-month combined antihypertensive therapy with lisinopril and amlodipine in hypertensive patients with diabetes mellitus (DM) type 2. MATERIALS AND METHODS: 30 patients with arterial hypertension (AH) stage II-III, chronic kidney disease (CKD) stages 2-3 and type 2 DM were included in to research. We evaluated the results of the physical examination, blood pressure monitoring (ABPM), structural and functional state of the heart and kidneys. Combined analysis the risk of progression of CKD and cardiovascular complications (CVC) depending on the glomerular filtration rate (GFR) and albuminuria (AU) was performed. We also studied carbohydrate and lipid metabolism and estimated the severity of insulin resistance (IR). RESULTS: Against the background of long-term therapy by Equator 100% of patients had achieved target BP values. The circadian BP profile was significantly improved. There was a significant decrease in the index of left ventricular mass by 8.0%, a decline of PU by 58% and AU by 43.6%, respectively. There was the redistribution of patients to assess the combined risk of CKD progression and CVC: 50% of patients in the group crossed a moderate risk by reducing the percentage of patients at high and very high risk of 36.7% and 13.4%, respectively (p<0,001), as well as significant improvement in metabolic parameters and reduction in IR. A statistically significant correlation between IR and condition of the heart and kidney was determined. CONCLUSION: Long-term combined therapy with lisinopril and amlodipine fully meets the modern requirements for antihypertensive therapy - it leads to a significant reduction in the risk of progression of CKD and development of the CVC and is metabolically neutral. The decrease in the combined risk of CKD progression and development CVC was associated with cardio and nephroprotective action of the Equator, as well as with a reduction in the negative impact of IR in patients with AH and type 2 DM.

[Cardio-Nephroprotection--the Most Important Goal of Antihypertensive Therapy in Patients With Type 2 Diabetes].

AIM: to study the opportunities for cardio and nephroprotection by 6-month combined antihypertensive therapy with lisinopril and amlodipine in hypertensive patients with diabetes mellitus (DM) type 2. MATERIALS AND METHODS: 30 patients with arterial hypertension (AH) stage II-III, chronic kidney disease (CKD) stages 2-3 and type 2 DM were included in to research. We evaluated the results of the physical examination, blood pressure monitoring (ABPM), structural and functional state of the heart and kidneys. Combined analysis the risk of progression of CKD and cardiovascular complications (CVC) depending on the glomerular filtration rate (GFR) and albuminuria (AU) was performed. We also studied carbohydrate and lipid metabolism and estimated the severity of insulin resistance (IR). RESULTS: Against the background of long-term therapy by Equator 100% of patients had achieved target BP values. The circadian BP profile was significantly improved. There was a significant decrease in the index of left ventricular mass by 8.0%, a decline of PU by 58% and AU by 43.6%, respectively. There was the redistribution of patients to assess the combined risk of CKD progression and CVC: 50% of patients in the group crossed a moderate risk by reducing the percentage of patients at high and very high risk of 36.7% and 13.4%, respectively (p < 0.001), as well as significant improvement in metabolic parameters and reduction in IR. A statistically significant correlation between IR and condition of the heart and kidney was determined. CONCLUSION: Long-term combined therapy with lisinopril and amlodipine fully meets the modern requirements for antihypertensive therapy--it leads to a significant reduction in the risk of progression of CKD and development of the CVC and is metabolically neutral. The decrease in the combined risk of CKD progression and development CVC was associated with cardio and nephroprotective action of the Equator, as well as with a reduction in the negative impact of IR in patients with AH and type 2 DM.

[Correction of endothelial dysfunction in hypertensive patients with type 2 diabetes mellitus during combined antihypertensive therapy].

AIM: To evaluate the impact of 6-month antihypertensive therapy with the combined drug amlodipine + lisinopril (ekvator) on endothelial dysfunction (ED) and carbohydrate metabolic parameters in patients with hypertension and type 2 diabetes mellitus (DM). SUBJECTS AND METHODS: The investigation enrolled 30 patients aged 40-65 years with Stages II-III hypertension concurrent with type 2 DM. All the patients received combined antihypertensive therapy with amlodipine + lisinopril for 24 weeks. Endothelial function (EF) was studied from the serum and urine concentrations of the metabolites nitric oxide (NO) and endothelin-1 (ET-1) and from occlusion test results. Carbohydrate metabolic parameters were estimated. Insulin resistance (IR) was judged from basal insulin concentrations, followed by the calculations of the Homeostasis Model Assessment (HOMA) index. RESULTS: Following 24 weeks of therapy with amlodipine + lisinopril and close adherence to dietary recommendations, all the patients achieved the target levels of blood pressure and glycated hemoglobin (HbA1c). There was a significant improvement in EF in hypertensive patients with type 2 DM: NO production was increased in both the serum and urine (by 122.8 and 65.8%, respectively). ET-1 secretion was naturally decreased in both the serum and urine (by 26.1 and 76.1%, respectively; p < 0.05). Analysis of the vascular component of EF during treatment with the combined drug amlodipine + lisinopril revealed a statistically significant patient redistribution by the types of microcirculation and the results of an occlusion test, by calculating the responsiveness of large arteries: the number of patients with normal microcirculation increased from 13.3 to 86.7% and that of patients with hyperemic microcirculation declined from 66.7 to 0. The number of patients with a paradoxical occlusion test significantly reduced from 46.7% at baseline to 20% after 24 weeks of treatment with the combined medication amlodipine + lisinopril. Fasting blood glucose levels and HOMA index were decreased by 22.1 and 22.4%, respectively (p < 0.05). There were statistically significant correlations between the HOMA index and the concentrations of NO in the urine (r = -0.45) and blood (r = -0.54) and those of ET-1 in the blood (r = -0.54). CONCLUSION: Twenty-four-week combined antihypertensive therapy with the drug amlodipine + lisinopril is safe and highly effective in EF recovery and favorably affects carbohydrate metabolic parameters in the hypertensive patients with type 2 DM.

[Efficacy and safety of bisoprololal in hypertensive patients with cardiovascular disease and chronic obstructive pulmonary disease].

Efficacy and safety of bisoprolol in hypertensive patients with cardiovascular disease and chronic obstructive pulmonary disease. A comparative study on the efficacy and safety of bisoprolol and sustained release metoprolol succinate in patients with arterial hypertension (AH), cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) was conducted. High antihypertensive efficacy and good tolerability of bisoprolol and metoprolol succinate sustained release was shown in hypertensive patients with CVD and COPD. Bisoprolol versus metoprolol succinate sustained release was more effective in reducing the number of PVCs in hypertensive patients with CVD and COPD. After 12 weeks of therapy of bisoprolol there was a trend to reduce the number of patients with concentric left ventricular hypertrophy by 16.6 % (from 83.3% at baseline vs 66.7% after 12 weeks of treatment, p < 0.1). Despite the fact that the identified changes in respiratory function (ERF) in both groups did not reach certainty bisoprolol versus metoprolol succinate sustained-release was a lesser extent influenced the performance of ERF and more - to reduce dyspnea to the evaluation scales Borg and mMRC (delta% = -7.1 in fixed vs delta% = -3.8 in control groups and delta% = -5.6 vs delta% = 0 respectively) in patients with AH, CVD and COPD.

[Use of meldonium in the combination treatment of patients with heart failure in the early postinfarction period].

AIM: To evaluate the impact of 10-14-day intravenous administration of meldonium as part of combination therapy in patients with chronic heart failure in the early post-infarction period on the recovery period, structural and functional parameters, and heart rate variability (HRV). SUBJECTS AND METHODS: The investigation enrolled 60 patients (men and women) aged 45 to 75 years at weeks 3-4 after post-myocardial infarction with symptoms of Functional Class II-III heart failure. All the patients underwent 24-hour electrochocardiography monitoring, cardiac echocardiography, and HRV study. After dividing the patients into 2 groups, Group 1 (a study group) (n = 30) was given intravenous meldonium (idrinol) 1000 mg/day in addition to the basic therapy of coronary heart disease. The patients in the study and control (Group 2; n = 30) groups were at baseline matched for age, gender, disease severity, and basic therapy pattern. RESULTS: Following 10-14 days of treatment, both groups showed clinical improvement and the favorable changes in cardiac structural and functional parameters and HRV values, which were more pronounced in the patients receiving meldonium. CONCLUSION: The patients with CHF using meldonium as part of combination therapy in the early post-infarction period were observed to have clinical improvement, a significant reduction in the rate of angina attacks and in the need for nitrates, a decrease in the number of arrhythmic and ischemic episodes, and favorable changes in cardiac structural and functional parameters and HRV values.

[Role of pFox inhibitors in the treatment of patients with acute myocardial ischemia].

AIM: To evaluate the anti-ischemic and anti-anginal efficacy of meldonium (Idrinol) in its short-term use as part of combination therapy in patients with chronic heart failure in the early post-infarction period. SUBJECTS AND METHODS: The investigation enrolled 60 patients (men and women) aged 45 to 75 years at weeks 3-4 after postmyocardial infarction with symptoms of Functional Class II-III heart failure. All the patients underwent physical examination, 24-hour ECG monitoring, heart rate variability (HRV) study, and quality of life assessment using the Seattle questionnaire. After randomization of the patients into 2 groups, Group 1 (a study group) (n = 30) was given intravenous Idrinol 1000 mg/day in addition to the basic therapy of coronary heart disease. The study and control (Group 2; n = 30) groups were matched for age, gender, disease severity, and basic therapy pattern. RESULTS: Following 10-14 days of treatment, both groups showed clinical improvement and the autonomically normalizing effect of meldonium (Idrinol), which were more pronounced in Group 1 patients. CONCLUSION: Meldonium (Idrinol) was effective when parenterally administered in a dose of 1000 mg/day for 10-14 days as part of combination therapy in the early post-infarction period, which showed up as clinical improvement, a significant reduction in the frequency of angina attacks and in the need to use nitroglycerin, a decrease in the number of arrhythmia episodes, and its normalizing effect of HRV.

[Effect of combination antihypertensive therapy on circadian blood pressure and metabolic parameters in patients with type 2 diabetes mellitus].

AIM: To assess effect of combined antihypertensive therapy with lisinopril and amlodipine on circadian blood pressure (BP), insulin resistance (IR), carbohydrate and lipid metabolism in patients with arterial hypertension (AH) and type 2 diabetes mellitus (DM). MATERIAL AND METHODS: Combination of amlodipine (6.0±0.4 mg/day) and lisinopril (12.0±0.9 mg/day) was given to 30 patients (age 40-65 years) with stage I-II AH and DM type 2) for 24 weeks. All patients underwent ambulatory BP monitoring. Parameter studied comprised glucose levels, glycosylated hemoglobin (HbAlc), basal insulin, lipid profile in the venous blood and insulin resistance (IR). All patients received glucose-lowering drugs and followed diet recommendations. RESULTS: All patients achieved target BP values and concentrations of HbAlc. After 24 weeks of treatment the following parameters were significantly different from baseline values: mean systolic BP (SBP) (-15.6%), mean diastolic BP (DBP), (-16.2%), time index (pressure load--PL) SBP day (-50.1%), PL DBP day (-51.3), PL DBP night (-59.2%), SBP variability (-15.8%), values of morning SBP and DBP increase (both -41.8%), rates of morning rise of SBP (-74.1%) and DBP (-65.8%), percentage of patients with increased variability of SBP (-36.7%), of DBP (- 23.3%), of SBP day (-36.7%), of DBP day (-30.0%). Significant decreases of fasting blood glucose level (-22.1%), concentrations of total cholesterol (-8.8%), low density lipoprotein cholesterol (-15%), triglycerides (-4.4%), and metabolic index (-32.7%) were also observed. CONCLUSION: In patients with hypertension and type 2 DM 24 week antihypertensive therapy with lisinopril and amlodipine significantly improved circadian blood pressure profile, reduced severity of IR without negative effect on carbohydrate and lipid metabolism.

[Efficacy of adaptol and the possibility of its differential use in patients with anxiety disorders after myocardial infarction].

AIM: To evaluate the efficacy and safety of adaptol in a dose of 1500-2000 mg/day in combination therapy for anxiety disorders (AD) in the early post-myocardial infarction period. SUBJECTS AND METHODS: The trial included 94 patients with AD who were divided into a study group of 60 patients and a control group of 34 patients. In addition to basic therapy, the study group took adaptol in a dose of 1500-200 mg/day for 30 +/- 2 days; the control group received basic therapy only. RESULTS: The drug given in a dose of 1500-2000 mg/day in the patients with AD in the early post-myocardial infarction period was found to have high anxiolytic, autonomically normalizing, stress-protective activities and a positive effect on heart rate variability just one month after treatment. The highest efficacy of Adaptol was observed in patients with baseline hypersympathicotonic and normal autonomic responsiveness. CONCLUSION: Adaptol proved to be more effective in patients with baseline hypersympathicotonic and normal autonomic responsiveness, which permits the drug to be differentially used in relation to the baseline type of autonomic responsiveness.

[Endothelial dysfunction is a target for combination antihypertensive therapy in hypertensive patients with type 2 diabetes mellitus].

AIM: To evaluate the impact of combination antihypertensive therapy with lisinopril + amlodipine (Ekvator) on endothelial dysfunction in patients with hypertension and concurrent type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: The trial enrolled 30 patients aged 40 to 65 years with Stages II-Ill hypertension concurrent with T2DM. All the patients received combination antihypertensive therapy with lisinopril + amlodipine (ekvator) for 12 weeks. Endothelial function was studied from serum and urinary NO and endothelin-1 concentrations and occlusion test results. 24-hour blood pressure (BP) monitoring and echocardiography were performed; arterial elastic properties and renal function were investigated. RESULTS: After 12-week therapy, 93.3% of the patients achieved BP goals. Endothelial function was improved in hypertensive patients with T2DM: there were increases in both serum and urinary NO production (by 53.5 and 57.1%, respectively) and decreases in serum and urinary endothelin-1 secretion (by 27.7 and 69.6%, respectively). The number of patients with normal microcirculation increased from 13.3 to 73.3% (p < 0.001). There was significant improvement in 24-hour AP monitoring readings and reductions in the left ventricular mass index by 10.7% and microalbuminuria by 27.7%; the number of patients with increased pulse wave velocity along the elastic arteries declined by 30%. CONCLUSION: Twelve-week treatment with the combined antihypertensive medication ekvator is highly effective and safe for recovering endothelial function and improving the state of target organs in hypertensive patients with T2DM.

[Additional advantages of mexicor used in combined therapy of coronary heat disease and diabetes mellitus of 2nd type].

This open prospective randomized 16-week study of combined therapy of coronary heat disease (CHD) and and diabetes mellitus of 2nd type (DM2) with secondary non-alcoholic fatty liver disease (NAFLD) including mexicor was designed to estimate structural and functional liver characteristics. Mexicor was shown to act as a hepatoprotector reducing the frequency of cytolithic syndrome when used together with statins in combined therapy of atherogenic dyslipidemia. It also significantly decreased the number of patients with elevated levels of gamma-glutamyltranspeptidase. These changes suggest favourable prognosis for patients with CHD and DM2 because enhanced activity of this enzyme is believed to be a predictor of high cardiovascular risk. Mexicor promoted combined hypolipidemic effect, reduced the degree of insulin resistance, improved hepatic metabolism, and lowered cardiovascular risks in patients with CHD and DM2.

[Impact of combination antihypertensive therapy on heart rate variability parameters and target organ status in patients with arterial hypertension and type 2 diabetes mellitus].

AIM: To evaluate the impact of combination antihypertensive therapy with ekvator on heart rate variability (HRV) parameters and target organ status in patients with arterial hypertension (AH) and type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: The investigation enrolled 30 patients aged 40-65 years with Stages II--III AH concurrent with T2DM. All the patients received combination antihypertensive therapy with amlodipine + lisinopril for 12 weeks. HRV parameters, baseline autonomic tone, and autonomic responsiveness were studied, by analyzing ECG reading of their hearts in the 5-minute segments. Echocardiography was performed and arterial elastic properties and renal functional were examined. RESULTS: 12-week ekvator therapy showed a high (93.3%) rate of achieved goal blood pressure (BP) levels. There was a statistically significant reduction in resting tension index by 66% and during an active orthostatic test by 43.5% during combination antihypertensive therapy with amlodipine and lisinopril. Twelve weeks after treatment, the normal type of autonomic responsiveness was prevalent (53.4%) in patients with AH and T2DM, with a significant decline in the number of persons with asympaticotonic autonomic responsiveness. There was a significant decrease in left ventricular mass index by 10.7% and microalbuminuria by 27.7% and a 30% decline in the number of patients with a higher pulse wave velocity along the elastic arteries. There were close highly significant correlations between the parameters of HRV and the status of target organs (heart, kidney, and vessels). CONCLUSION: 12-week ekvator treatment not only normalizes effectively BP and has a favorable impact on target organs, but also improves HRV parameters in the patients with AH and T2DM, in this connection, HRV may be, in our opinion, regarded as another combination antihypertensive therapy target.