Efficacy of OSMO-Adalat in patients with arterial hypertension in combination with kinked precerebral arteries

AIM: To evaluate effectiveness of OSMO-adalat in combination of arterial hypertension (AH) with kinked precerebral arteries (KPA). MATERIAL AND METHODS: Before and after a 3-month course of OSMO-Adalat in a dose 30 and 60 mg, 28 patients with AH (degree 2-3) and KPA were examined for arterial pressure (AP), dyscirculatory encephalopathy, orthostatic stability, ischemic heart disease, transitory ischemic attacks, side effects of therapy. RESULTS: A complete normalization of AP was achieved in 9(32.1%) patients, in the rest patients the effect was partial. 24-h AP profile improved in all the cases. OSMO-Adalt relieved coronary insufficiency and dyscirculatory encephalopathy, improved tolerance of orthostatic loads. Syncopes, transitory ischemic attacks and strokes were not observed. Severe head ache was the cause of the treatment discontinuation in one patient. CONCLUSIONS: Therapy with OSMO-Adalat of patients with AH combination with KPA provides a good hypotensive effect and relieves symptoms of encephalopathy, myocardial ischemia and orthostatic insufficiency in low risk of side effects.     

Clinical efficacy of xefocam and its effect on arterial pressure and heart rhythm variability in patients with rheumatoid arthritis in combination with arterial hypertension

AIM: To try clinical response to xefocam, its safety, effects on arterial pressure and heart rhythm variability in rheumatoid arthritis (RA) patients with arterial hypertension (HT). MATERIAL AND METHODS: Xefocam (lornoxicam), a new non-steroid antiinflammatory drug, was given for 12 weeks in a daily dose 12 mg/day to 44 RA patients (mean age 54.5 +/- 7.3 years). 24-h arterial pressure monitoring was made with Cardiotens-01 device. RESULTS: Xefocam in a dose 12 mg/day has shown good tolerance, a high analgetic and antiinflammatory effect as indicated by a positive response of articular syndrome, a significant fall of systolic arterial pressure, decreased heart rate, better heart rhythm variability. CONCLUSION: In hypertensive RA patients xefocam in a dose 12 mg/day proved effective and safe.     

Efficacy of cytoprotective agent Mexicor in urgent cardiology

AIM: To study efficacy of cytoprotector mexicor in patients with unstable angina (UA), acute myocardial infarction (MI), hypertensive crises (HC) in combined therapy with conventional drugs. MATERIAL AND METHODS: An open randomized study included 338 patients with acute forms of ischemic heart disease (IHD) and arterial hypertension running with crises. Combined therapy of 20 patients with UA, 90 patients with MI and 43 patients with HC (study groups) was supplemented with mexicor in a dose 6-9 mg/kg/day. The control matched patients (20, 86 and 79 patients, respectively) received conventional treatment alone. The effects of the treatments were assessed by ultrasound investigation of the heart in M-, B- and Doppler modes, by ECG and arterial pressure 24-h monitoring, by activity of lipid peroxidation (LPO). RESULTS: Adjuvant therapy of urgent cardiological conditions with mexicor diminished oxidant stress, left ventricular dysfunction. In MI patients mexicor promoted reduction of the akinesia zones, recovery of disturbed segmentary contractility. In UA patients mexicor contributed to more pronounced decrease in the frequency, duration and severity of myocardial ischemia, enhanced stabilization of angina. In HC patients mexicor promoted earlier normalization of a 24-h AP profile and variability of cardiac rhythm, recurrence rate of HC decreased 2-fold. CONCLUSION: The addition of mexicor to conventional therapy of UA, MI, HC improves clinical course of these diseases, reduces oxidant stress, accelerates recovery of cardiac contractility and left ventricular diastolic function, normalization of central hemodynamics.     

Hypotensive effect of long-acting garlic tablets allicor (a double-blind placebo-controlled trial)

AIM: To evaluate a hypotensive action of long-acting garlic powder tablets allicor in patients with mild or moderate hypertension and to compare allicor effects with those of foreign analog--kwai garlic tablets. MATERIAL AND METHODS: A double-blind, randomized and placebo-controlled study enrolled 85 patients with mild or moderate hypertension. The patients were divided into 4 groups: group 1 received allicor in a dose 600 mg/day, group 2--2400 mg/day, group 3--kwai in a dose 900 mg/day, group 4--placebo. RESULTS: Allicor produced reaction in both systolic and diastolic pressure. An increase of allicor daily dose to 2400 mg does not provide an additional hypotensive effect. Kwai results in only systolic but not diastolic arterial pressure lowering. CONCLUSION: Allicor is more effective than kwai in reduction of diastolic blood pressure. It can be recommended as a hypotensive treatment in mild and moderate arterial hypertension.     

Sitaxsentan: a novel endothelin-A receptor antagonist for pulmonary arterial hypertension

Sitaxsentan is an orally active, selective endothelin-A receptor antagonist that may benefit patients with pulmonary arterial hypertension by blocking the vasoconstrictive effects of endothelin-A receptors, while maintaining the vasodilator and endothelin-1 clearance functions of the endothelin-B receptors. In its first randomized, placebo-controlled study, sitaxsentan improved exercise capacity assessed by the 6-min walk test, New York Heart Association functional class, cardiac index and pulmonary vascular resistance in New York Heart Association Class II, III and IV patients with idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension related to connective tissue disease or congenital heart disease. Although doses of 100 and 300 mg once daily demonstrated equivalent efficacy, the lower dose had a better safety profile. Additional studies are ongoing to assess the relative safety and efficacy of 50 and 100 mg once-daily dosing. The most common side effects include rhinitis, headache, peripheral edema, chest pain, nausea, constipation, increased prothrombin time/international normalized ratio (in patients on warfarin), flushing and insomnia. As with other endothelin receptor antagonists, increases in hepatic transaminases have been observed with sitaxsentan. Initial studies using the selective oral endothelin-A receptor antagonist sitaxsentan in pulmonary arterial hypertension patients have revealed a favorable risk-benefit therapeutic profile with the 100 mg once-daily dose.     

Assessment of the efficacy and tolerance of delayed-action nifedipine as the monotherapy or in combination with metoprolol in patients with arterial hypertension

AIM: To compare efficacy and safety of nifedipin-retard (cordaflex-retard, Egis, Hungary) used in monotherapy and in combination with metoprolol (egilok, Egis, Hungary) in patients with arterial hypertension (AH). MATERIAL AND METHODS: The study included 20 patients with AH stage I-II (12 males, 8 females, mean age 57.3 years, mean duration of the disease 8.6 years). Nifedipin-retard was given in a daily dose 40 mg/day (20 mg twice a day) in monotherapy and 20 mg/day in combination with metoprolol which was administered 50 mg twice a day (a daily dose 100 mg/day). The control examination consisted of a physical examination, measurement of arterial pressure (AP) by Korotkov, registration of heart rate, ECG, 24-h AP monitoring, echocardiography. RESULTS: By 24-h AP monitoring, a 4-week treatment with nifedipin-retard alone resulted in lowering of systolic arterial pressure. The combined treatment produced a more pronounced fall both in systolic and diastolic pressure. Diastolic left-ventricular function improved in combined therapy. Side effects observed in nifedipin-retard monotherapy got much more weaker when this drug combined with metoprolol. CONCLUSION: Combination of nifedipin-retard with metoprolol provides better clinical response and tolerance than monotherapy with nifedipin-retard.     

Effect of divalproex on metabolic parameters is dose related in migraine prophylaxis

OBJECTIVE: To examine the metabolic effects of three divalproex dosing regimens in patients with migraine. BACKGROUND: Epidemiological and clinical studies have demonstrated a strong association between serum lipid levels and the development of coronary artery disease. Thus, it is important to understand the impact of chronically administered medications on serum lipids. Metabolic properties of divalproex, an approved and commonly used treatment for migraine prophylaxis, have not been systematically studied in patients with migraine. METHODS: Adult patients with migraine were randomized to receive one of three daily doses of divalproex (500 mg [n = 45], 1000 mg [n = 43], or 1500 mg [n = 44]) or placebo (n = 44) for 12 weeks. Post hoc analyses were performed to determine the effects of divalproex on total cholesterol, glucose, weight, and body mass index (BMI). RESULTS: The treatment groups were similar at baseline based on demographic and clinical characteristics and the use of concomitant medications. Divalproex resulted in a dose-related mean decrease from baseline in total cholesterol: -5.7 mg/dL or 3% reduction with 500 mg/day; -8.4 mg/dL or 4% reduction with 1000 mg/day; and -12.8 mg/dL or 7% reduction with 1500 mg/day (P < .05 for 1500 mg/day vs. placebo). There were no differences between any divalproex dose group and placebo for mean change from baseline in glucose, weight, or BMI. CONCLUSIONS: Divalproex results in a dose-dependent reduction in serum cholesterol within the first 3 months of therapy, with no significant change in serum glucose or BMI.     

Sitaxsentan: a novel endothelin-A receptor antagonist for pulmonary arterial hypertension

Sitaxsentan is an orally active, selective endothelin-A receptor antagonist that may benefit patients with pulmonary arterial hypertension by blocking the vasoconstrictive effects of endothelin-A receptors, while maintaining the vasodilator and endothelin-1 clearance functions of the endothelin-B receptors. In its first randomized, placebo-controlled study, sitaxsentan improved exercise capacity assessed by the 6-min walk test, New York Heart Association functional class, cardiac index and pulmonary vascular resistance in New York Heart Association Class II, III and IV patients with idiopathic pulmonary arterial hypertension and pulmonary arterial hypertension related to connective tissue disease or congenital heart disease. Although doses of 100 and 300 mg once daily demonstrated equivalent efficacy, the lower dose had a better safety profile. Additional studies are ongoing to assess the relative safety and efficacy of 50 and 100 mg once-daily dosing. The most common side effects include rhinitis, headache, peripheral edema, chest pain, nausea, constipation, increased prothrombin time/international normalized ratio (in patients on warfarin), flushing and insomnia. As with other endothelin receptor antagonists, increases in hepatic transaminases have been observed with sitaxsentan. Initial studies using the selective oral endothelin-A receptor antagonist sitaxsentan in pulmonary arterial hypertension patients have revealed a favorable risk–benefit therapeutic profile with the 100 mg once-daily dose.     

Clinical and vascular effects of ACE inhibitor enalapril in combination with thiaside-like diuretic indapamide in hypertensive outpatients. Results of the multicenter trial POEMA

AIM: To evaluate efficacy and safety of a 6-month treatment of 237 patients with arterial hypertension (AH) of degree 1-3 with ACE inhibitor enalapril (mean dose 21.9 +/- 9.0 mg/day), 49.4% of which received adjuvant indapamide (2.5 mg/day), to study effects of this therapy on rigidity of the major arteries by dynamics of pulse wave velocity (PWV) and US rigidity index beta (RIB). MATERIAL AND METHODS: The study included only patients with initially elevated PWV which was detected in 266 (53%) of 501 examinees. RESULTS: Lowering of systolic and diastolic blood pressure (BP) was 16.8 and 14.0% to treatment month 3 and, in addition, 1.6 and 1. 7% to month 6, respectively (p < 0.001). Target BP (< or = 140/90 mm Hg) was achieved in 82.7% patients. During the trial 3 (1.2%) patients withdrew because of severe cough. Slowdown of PWV measured by brachiomalleolar (PWVbm) and carotid-femoral (PWVcf) methods was equal in the course of the trial and made up 2.45 and 6.1% to treatment month 3 (p < or = 0.05 for both) and additional 3.25 and 7.4% to month 6 (p < 0.001 for both), respectively. High PWV normalized completely in 42.6% patients. After 6 months of the trial US RIB decreased by 30.5% (p < or = 0.001). The correlation analysis detected a significant correlation between SAP fall and PWV decrease only during the first 3 months of therapy (r = 0.402, p = 0.005). In month 3-6 the correlation became insignificant (r = 0.28, p = 0.055). CONCLUSION: Combination of enalapril and indapamide is effective and safe in outpatients with arterial hypertension of the first-third degree and baseline high rigidity of the vascular wall. This treatment reduces PWV and rigidity of the major arteries associated with BP lowering (in the treatment month 1-3) and a vasoprotective effect of the drugs.     

Experience in application of various antidepressants in gerontology

The article presents data on the effectiveness of comorbide therapy with amlodipine and antidepressants of various groups in patients more than 65 years old suffering from coronary artery disease (CAD), arterial hypertension (AH), and comorbide depression. Eighty-eight patients with stable FC I-III stenocardia, accompanied by AH and comorbide depression, were examined. The patients were divided into three groups. Patients in group I (n = 21) received amlodipine therapy in a dose of 2.5 to 5 mg/day with amitriptyline in a dose of 25 mg/day. Group II patients (n = 25) received tianeptine in a dose of 25 mg/day in addition to amlodipine in a dose of 2.5 to 5 mg/day. Group III patients (n = 20) were treated with a combination of amlodipine 2.5 to 5 mg/day with sertraline in a dose of 50 mg/day. The comparison group consisted of 22 patients who received monotherapy in a dose of 2.5 to 5 mg/day. The study revealed that all these combinations with different antidepressants significantly lowered the average depression score and significantly improved the quality of life, unlike amlodipine monotherapy. The best combination was amlodipine plus tianeptine, which did not only demonstrate antidepressive and anxiolytic effects, but also led to improvement in prognostically significant parameters of cardiac rhythm variability in elderly patients with comorbide depressive disorders underlied by stable stenocardia and arterial hypertension.     

Control of arterial hypertension in stroke prevention

According to epidemiological surveys arterial hypertension increases the risk of death of coronary heart disease 3-hold, of hemorrhagic and ischemic strokes--6-fold. Treatment of arterial hypertension leads to a significant fall in the risk of strokes and ischemic heart disease. The PROGRESS trial demonstrates that antihypertensive therapy of patients with the history of acute cerebral circulation disorder with ACE inhibitor perindopril is effective in secondary prophylaxis in such patients.     

Spirapril in patients with hypertension: clinical experience in Germany

AIM: To examine efficacy and tolerability of a single daily dose of 6 mg quadropril (spirapril). MATERIAL AND METHODS: An open multicenter study enrolled 5000 out-door patients with hypertension. All the patients received an ACE inhibitor quadropril for 3 months with four control visits (on week 0, 4, 8 and 12). RESULTS: Quadropril caused a marked decrease in systolic and diastolic blood pressure. At the end of the study 89.4% of patients had a systolic blood pressure reduction of at least 15 mm Hg and 85.4% had a diastolic blood pressure reduction of at least 10 mm Hg. There were no clinically significant heart rate changes. The overall tolerability of the drug was estimated as good or very good in 95.3% of patients. Only 2.9% of patients had side effects during treatment with once daily dose of 6 mg quadropril. No serious side effects were observed. CONCLUSION: 6 mg daily dose of quadropril is an effective and safe therapy for arterial hypertension.     

Metabolic and hemodynamic effects of combined treatment with metformine and rosiglitasone (avandium) in patients with diabetes mellitus type 2 and high cardiovascular risk

AIM: To study efficiacy of 24-week combined therapy with metformin and rosiglitasone in correction of metabolic parameters, blood pressure and total cardiovascular risk in patients with diabetes mellitus type 2. MATERIAL AND METHODS: Blood pressure, body mass, glycemia and blood lipids, hyperinsulinemia, fat mass were studied in 30 patients with diabetes mellitus type 2 and hypertension on metformine treatment in a dose 1500 mg/day. When they entered the trial, metformine treatment was combined with rosiglitasone in a dose 4 mg/day. The combined treatment continued for 24 weeks. RESULTS: The above combination significantly improved carbohydrate and lipid metabolism. The levels of fasting and postprandial glycemia, glycosylated hemoglobin, insulin resistance index significantly reduced. Both total and visceral fat tissue mass diminished. Improvement was seen in 24-h blood pressure monitoring data and intracardiac hemodynamics. Total cardiovascular risk decreased by three scales. Side effects were not registered. CONCLUSION: Combined use of metformine and rosiglitasone in patients with diabetes type 2 is pathogenetically sound, highly effective and safe.     

辛伐他汀治疗老年冠心病的疗效及安全性临床研究

目的：不同剂量他汀类药对老年冠心病患者血脂及血清C-反应蛋白（CRP）浓度的影响。方法：将65例老年稳定性冠心病伴高脂血症患者随机分为低剂量治疗组（n=37）和高剂量治疗组（n=28），低剂量治疗组口服辛伐他汀20mg／d，高剂量治疗组口服辛伐他汀40mg／d；疗程均为6周。结果：疗程结束后两组血脂指标（TC、TGL、DL—C）及CRP均较治疗前降低（P〈0．05），两组间结果差异无显著性意义（P〉0．05）。两组均无不良反应发生。结论：他汀类药对老年冠心病患者也具有良好的降脂效应，且能有效降低患者的CRP，安全性亦好。     

Osmo-adalat in the treatment of isolated systolic and systolic-diastolic arterial hypertension in aged patients

AIM: To examine efficiency and tolerance of osmo-adalat in monotherapy of mild and moderate arterial hypertension (AH) in the elderly. MATERIAL AND METHODS: 60 AH patients were randomized into two groups. Group 1 received osmo-adalat monotherapy in daily dose 30 mg for 3 weeks. These were 14 patients with isolated systolic AH (ISAH) and 16 patients with essential hypertension (EH). Of group 2 patients, 15 with ISAH and 15 with EH received cordipin in a dose 10 mg three times a day. All the patients underwent 24-h monitoring of arterial pressure, in 18 patients arterial pressure and ECG were registered in parallel for 24 hours. RESULTS: AH treatment with osmo-adalat is rather effective. This is proved by its positive effect on shifted profile of arterial pressure in patients with ISAH and EH. A fall of arterial pressure on the peak of osmo-adalat antihypertensive action is not associated with hypotonic overloading of target organs, myocardial ischemia and increased heart rate. A single intake of osmo-adalat provides a smooth circadian control of arterial pressure in elderly hypertensive patients, the end effect being 50% of the peak one. The drug is well tolerated. Side effects do not require osmo-adalat discontinuation. CONCLUSION: Osmo-adalat in a single daily dose 30 mg is effective and safe in the treatment of mild and moderate AH in elderly patients.     

MRT assessment of metabolic and thrombolytic therapy effects on postinfarction left ventricular remodeling

AIM: To examine effects of trimetasidine on morphofunctional indices of the left ventricle (LV) in myocardial infarction (MI) patients on combined treatment. MATERIALS AND METHODS: Seventy five patients with primary macrofocal MI were randomized into 2 groups. Patients of group 1 (n = 38) received a combination of bisoprolol (beta-blocker) with enalapril (ACE inhibitor) in individual doses under control of blood pressure and blood creatinine level. Group 2 (n = 37) patients received the same combination of drugs and, in addition, trimetasidine in a dose 70 mg/day from postmyocardial day 7-10 for 6 months. Two subgroups from the groups were given systemic thrombolytic therapy (STLT) with streptokinase. MRT and cine-MRT of the heart were made for measurement of LV morphofunctional parameters. RESULTS: Low-field MRT of the heart in MI patients treated with adjuvant STLT (1500000 U within 6 hours after MI onset) and trimetasidine (preductal MB) in a dose 70 mg/day from the disease day 7-10 registered a significant inhibition of pathological LV postinfarction remodeling: a decrease of body surface indexed LV end diastolic volume by 10.3%, systolic volume--by 15.4%, LV myocardial tension--by 14.0%, sphericity index--by 7.1%; an increase in the index of relative wall thickness by 5.3%, cardiac index--by 9.2% compared to the group treated without trimetasidine. CONCLUSION: 6-month therapy with trimetasidine of MI patients leads to a significant regress of morphofunctional changes accompanying LV remodeling. Pathological LV postinfarction remodeling inhibits significantly in MI patients combined treatment of whom included STLT (streptokinase in a dose 1500,000 U within 6 hours after acute MI onset and trimetasidine in a dose 70 mg/day on postmyocardial infarction day 7-10).     

Comparative efficiency of prolonged diet and drug therapies for hyperlipidemias in patients with ischemic heart disease

It is well known now that hypolipidemic therapy is able to inhibit development of atherosclerosis. This decreases the rate of coronary complications. However, the problem of adequate pharmacotherapy duration has not been solved yet, as long-term treatment may provoke side effects. This study compared efficacy of hyperlipidemia (HLE) correction by long-term hypolipidemic diet (HD) and pharmacotherapy (PT) in patients with ischemic heart disease (IHD). 93 HLE patients with IHD aged 50-65 years entered the study. Enduracin used for 16-24 weeks (Endurance Products Company, USA) in a dose 1500 mg/day has reduced cholesterol by 15.7%, low density lipoproteins--by 19.2%, triglycerides--by 26%. High density lipoproteins rose by 15.7%. Besafibrat (Germany) in a dose 600 mg/day is indicated for patients with isolated hypertriglyceridemia (reduced triglycerides by 41.2%). Enduracin is indicated for patients with moderate levels of atherogenic serum lipids in isolated and combined HLE if fibrates are contraindicated. Diet lowered LDLP and VLDLP insignificantly and did not change HDLP. Prolongation of diet did not enhance the effect this allowing using diet therapy as background treatment.     

Use of high dose naloxone in acute stroke: possible side-effects

The effects of high dose naloxone in humans have not been studied extensively. We treated 36 patients who had acute ischemic cerebral infarction with high doses of naloxone to evaluate potential efficacy and toxicity. All patients were treated with a 160-mg/m2 (4-mg/kg) loading dose followed by 80 mg/m2.h (2 mg/kg.h) x 24 h. There were no statistically significant changes in group mean arterial pressure, respiratory rate, or heart rate in response to the loading dose or infusion, although clinically significant changes did occur in four patients. Twenty-three patients had adverse reactions possibly related to naloxone, the most common of which were nausea (n = 20), bradycardia and/or hypotension (n = 3), myoclonus (n = 1), and hypertension (n = 1). Seven patients had naloxone discontinued for possible adverse reactions. All adverse reactions abated with discontinuation of naloxone and/or pharmacologic therapy when indicated. No deaths were attributable to naloxone treatment. High dose naloxone appears to be well tolerated in the majority of elderly patients with acute cerebral infarction.     

西地那非治疗婴幼儿先天性心脏病术后肺动脉高压

[目的]观察西地那非对婴幼儿先天性心脏病(简称先心病)手术后严重肺动脉高压的疗效.[方法]总结本院2009年1月至2010年6月应用西地那非治疗婴幼儿室间隔缺损合并重度肺动脉高压共33例.本组术毕停体外循环后置管测定肺动脉压力仍超过体动脉压力(桡动脉置管测定外周动脉压)50%以上,术后1d给予鼻饲西地那非,初始剂量0....     

Sildenafil for primary and secondary pulmonary hypertension

BACKGROUND: Sildenafil is a selective inhibitor of cyclic guanosine monophosphate-specific phosphodiesterase type 5, an enzyme that is abundant in both lung and penile tissues. Sildenafil is widely used to dilate penile arteries, suggesting that it may also dilate pulmonary arteries in patients with pulmonary hypertension. However, the long-term hemodynamic effects and safety of the drug in pulmonary hypertension are not known. METHODS: One patient with primary pulmonary hypertension and another with secondary pulmonary hypertension caused by collagen disease were given 50 mg oral sildenafil during cardiac catheterization for assessment of the acute hemodynamic effects of the drug. The patients were then given maintenance treatment with 25 mg oral sildenafil twice a day. Long-term hemodynamic effects were evaluated by repeated cardiac catheterization after 3 months, with the last oral dose given 15 hours before the procedure. The acute hemodynamic effects of sildenafil after the long-term treatment were studied during the same cardiac catheterization. RESULTS: Sildenafil did not affect aortic pressure, but it significantly decreased pulmonary artery pressure and increased cardiac index, thereby reducing pulmonary vascular resistance. Long-term maintenance therapy with 25 mg oral sildenafil twice a day remarkably improved the clinical condition of the patients, without causing any adverse effects; New York Heart Association functional classification returned to class II (from class III). The acute efficacy of sildenafil was well preserved after the long-term treatment; there was no tolerance. CONCLUSIONS: The data strongly suggest that sildenafil can be used as a valuable pulmonary vasodilator in patients with pulmonary hypertension, with good long-term hemodynamic effects and safety. The results necessitate larger trials to confirm these observations in a larger cohort of patients.