Experience in the use of valsartan with the aim to inhibit progression of kidney failure in patients with chronic glomerulonephritis

AIM: To assess the effect of valsartan, angiotensin-II receptor blocker type 1, on key factors of progression of chronic renal failure (CRF)--arterial hypertension (AH), proteinuria (PU), sodium excretion (SE)--in patients with chronic glomerulonephritis (CGN) and initial affection of renal function. MATERIAL AND METHODS: 11 patients (mean age 33.7 +/- 13.3 years, mean duration of nephritis 8.6 +/- 6.4 years, male to female ratio 8:3) with AH (AP > 140/90 mm Hg) and marked PU (> 1 g/day) who had not received immunosuppressive drugs for at least 6 months before the trial were given valsartan. It was administered after the period of "washing out" at the initial dose 80 mg/day with further addition of diuretics or raising the dose twice (in hyperuricemia) to decrease AP under 140/90 mm Hg. The duration of the treatment was 3 months. RESULTS: After 3 months of valsartan therapy systolic arterial pressure fell from 162 +/- 18 to 138 +/- 20 mm Hg (p < 0.05), diastolic pressure from 100 +/- 8 to 92 +/- 15 mm Hg (single measurements). 24-h monitoring of AP showed a significant lowering of mean 24-h and night systolic and diastolic AP, day-time diastolic AP, 24-h time index of systolic and diastolic AP. Initial antiproteinuric effect was observed after 1 month of the treatment and after 3 months of therapy PU reduced significantly (from 5.7 +/- 6.0 g/day to 3.3 +/- 3.3 g/day). After 3 months sodium excretion significantly rose, while creatinine level and glomerular filtration rate did not. Potassium rose in one patient. CONCLUSION: In CGN with initial CRF valsartan in a dose 80-160 mg/day produces a pronounced antihypertensive and antiproteinuric actions, stimulates sodium excretion. No serious side effects were noted. It is necessary to continue studies on the ability of valsartan to inhibit progression of CRF.     

Methodological approaches to estimation of morning urge of arterial pressure in essential hypertensives

AIM: To estimate the time intervals of a morning arterial pressure urge (MAPU) and MAPU characteristics in patients with essential hypertension (EH). MATERIAL AND METHODS: The study enrolled 70 patients (50 male and 20 female) with EH of the first (n = 41) and second (n = 20) degrees aged 34-65 years (mean age 50.4 +/- 0.9 years). The control group consisted of 9 healthy men. Morning dynamics of arterial pressure (AP) and heart rate (HR) was studied basing on the data of 24-h AP monitoring (Spacelabs-90207, USA). RESULTS: Dynamics of AP from nocturnal to diurnal patterns in both hypertensive and normotensive subjects falls into 3 phases: a premorning urge (from 4-5 a.m. to waking up) with a characteristic slow rise in AP and HR; a morning urge (from waking up for 4-5 hours) with a characteristic forced AP and HR rise); a diurnal urge (from 11 a.m. to 13-14 p.m.) with characteristic slowing down of AP and HR rise. Patients with EH of the first and second degree vs normotensive subjects had unfavourable changes in morning dynamics of AP and HR: a significant progressive growth of maximal systolic and diastolic pressure proportional to mean circadian AP levels; a rise of morning hours index of AP which characterizes amplitude-speed features of AP and HR. CONCLUSION: To characterize MAPU most completely it is recommended to estimate the following parameters: wave index (to assess AP conversion from one level to another), mean rate of AP change per hour (to prevent influence of random factors on the rate of MAPU); relative maximal values of AP (to estimate maximal AP values in morning hours and nocturnal mean AP).     

Antihypertensive effect of captopril and enalapril in endothelin-infused rats

Comparative effects of angiotensin converting enzyme inhibitors and calcium channel blockers were assessed in rats infused chronically with synthetic endothelin. When 50 mg/kg/day of captopril orally or 6 mg/kg/day of enalapril intraperitoneally was administered simultaneously with 60 micrograms/kg/day of endothelin, the systolic blood pressure was on Day 1 142.7 +/- 5.9 mmHg (p less than 0.05) or 128.7 +/- 6.7 mmHg (p less than 0.05), respectively, compared to the rise to 163.8 +/- 4.7 mmHg when endothelin alone was infused. The antihypertensive effect of captopril or enalapril was sustained for the entire experimental period and was not associated with a significant change in urinary sodium excretion, whereas both drugs induced a significant increase in urine volume. Chronic infusion of angiotensin II intraperitoneally at a subpressor dose (400 micrograms/kg/day) reversed the antihypertensive effect of captopril in endothelin-infused rats. When 6 mg/kg/day of benidipine or 10 mg/kg/day of nilvadipine orally was administered simultaneously with 60 micrograms/kg/day of endothelin, the systolic blood pressure was on Day 1 137.0 +/- 2.4 mmHg (p less than 0.05) or 119.7 +/- 5.9 mmHg (p less than 0.05), respectively, compared to the rise when endothelin alone was infused. The antihypertensive effect of benidipine or nilvadipine was sustained for the entire experimental period and was not associated with any significant changes in urine volume and urinary sodium excretion. These results indicate that the reduced sensitivity of the peripheral arteries to endothelin may be involved in the mechanism of the hypotensive action of angiotensin converting enzyme inhibitors, dependent on the suppressed angiotensin II formation.     

氯沙坦钾与卡托普利对高血压左心室肥厚逆转作用的比较

目的：研究科素亚逆转高血压患者左室肥厚的作用。方法：分别对39名高血压病人用科素亚及35名高血压病人用卡托普利治疗6个月。观察治疗前后的血压及室间隔厚度（IVS）,左心室后壁厚度（PWT）,左心室心肌重量（LVM0,左心室重量指数（LVMI）等指标的变化。结果：两组经治疗后血压及IVS,PWT,LVM,LVMI等指标均有明显的改善。结论：科素亚与卡托普利一样有逆转高血压患者左室肥厚作用。     

Correction of sleep disorders and efficacy of antihypertensive monotherapy in elderly patients: use of ivadal]

AIM: To assess effects of ivadal (zolpidem) on arterial pressure (AP) in the cycle sleep-awake in aged patients with insomnia who have failed hypotensive monotherapy with different drugs, i.e. whose AP remained abnormal at night. MATERIALS AND METHODS: The trial included 25 aged patients (17 females, 8 males, mean age 66.4 +/- 3.7 years) with isolated systolic arterial hypertension (AH) of the first-second degree (WHO classification, 1999) and insomnia. AH duration averaged 8.7 +/- 3.7 years. All the patients have received antihypertensive monotherapy. As shown by the initial 24-h monitoring, patients with elevated night AP had significantly lower mean score by the questionnaire "Subjective Sleep Characteristics" and more frequently suffer from insomnia. These patients were given a hypnotic drug ivadal (zolpidem) in a single daily dose 5 mg in the evening for 10 days. On the treatment night 10 monitoring of AP was repeated. RESULTS: Ivadal treatment has significantly improved all the subjective parameters of sleep and 24-h AP profile, lowered sleep and awake AP. CONCLUSION: Ivadal treatment raises efficacy of a hypotensive monotherapy in aged patients with isolated systolic AH and insomnia.     

24-hour arterial hypertension profile and heart rhythm variability in patients with arterial hypertension and NIDDM

The study covered 72 patients with non-insulin-dependent diabetes mellitus (NIDDM) whose mean age was 54.2 +/- 0.8 years, duration of the disease 8.6 +/- 3.6 years. They had also mild or moderate arterial hypertension mean duration of which was 12.4 +/- 4.3 years. The examination of the patients consisted of 24-h arterial pressure (AP) monitoring, Holter ECG monitoring, cardiointervalography. For eight weeks 19 patients received enalapril (5-20 mg/day), 14 patients were given felodipin (5-10 mg/day) and 15 patients were treated with valsartan (80-160 mg/day). Enhanced activity of the sympathetic nervous system in hypertensive subjects with NIDDM raises daily average values of systolic and diastolic AP, variability and speed of AP morning rise. In NIDDM patients with moderate arterial hypertension vegetative regulation of AP was more stressed than in mild hypertension. Optimal medication of NIDDM patients' arterial hypertension may consist of ACE inhibitors and antagonists of angiotensin II receptors. These drug lower stress of the sympathetic nervous system and thus promote normalization of daily profile of AP.     

Blockers of angiotensin receptors: a novel approach to the treatment of secondary pulmonary hypertension

AIM: To evaluate efficacy of losartan, a blocker of angiotensin receptors, in combined treatment of secondary pulmonary hypertension (SPH) in patients with chronic obstructive bronchitis (COB). MATERIAL AND METHODS: Losartan effects on hemodynamics, blood gases and clinical course of the disease were studied in 29 patients with COB and SPH (mean age 52 +/- 1.7 years). A control group consisted of 15 patients (mean age 51 +/- 1.5 years) treated with cardiac glycosides and diuretic drugs. M- and B-mode Doppler echocardiography registered hemodynamic parameters. 24-h monitoring of AP and ECG were made by standard methods. Blood gases and venous rheology were examined. RESULTS: Losartan administration in COB patients with SPH improved hemodynamics. Stroke index rose from 36.3 +/- 2.1 to 45.8 +/- 2.1 ml/m2 (by 26.2%, p < 0.01) in SPH functional class III, from 26.3 +/- 1.9 to 32.7 +/- 2.1 ml/m2 (by 24.3%, p < 0.01) in functional class IV Cardiac index rose by 22.2 and 21.1%, respectively. Pulmonary hemodynamics improved too: systolic pressure in pulmonary artery fell by 25.7% in functional class III, by 18.6% in functional class IV. Losartan normalized a 24-h AP profile, reduced the number of painless myocardial ischemia. CONCLUSION: Use of losartan in combined therapy of patients with COB and SPH improves clinical status of the patients, corrects basic cardiohemodynamic parameters, has a positive effect on AP profiles without negative impact on blood gas composition and rheology.     

Clinical, metabolic, age-related, and biorhythmologic aspects of daily arterial pressure profiles in patients with arterial hypertension

The work was designed to study daily arterial pressure (AP) profile in 103 patients aged 20-70 (48.6 +/- 12.) years with grade I-II arterial hypertension and its relation to selected metabolic parameters, heliogeophysical factors and age. The patients underwent 24-hr AP monitoring, calculation of body mass index, measurement of blood glucose and cholesterol levels. Non-dippers showed higher mean nocturnal AP values than dippers probably due to higher BMI, glucose and cholesterol levels. These patients were more sensitive to heliophysical factors. Patients above 60 years displayed higher AP values in morning hours compared with 21-40 year-old ones. These data can be used in the development of primary and secondary prophylaxis of arterial hypertension.     

Efficacy and tolerance of ACE inhibitor invoril and angiotensin I At-receptor blocker diovan in patients with stages I-II of arterial hypertension

A controlled parallel trial was conducted to study an antihypertensive action and tolerance of invoril in a dose of 10-20 mg/day (twice a day) vs diovan in a single dose of 80-160 mg/day in 60 patients (25 men and 35 women) aged under 65 years with arterial hypertension of the first and second degree. Follow-up was 6 weeks. The assessment was made by the data of clinical and biochemical blood tests, ophthalmological examination, registration of ECG and echo-CG. Arterial pressure was measured weekly by a doctor and daily (in the morning and evening) by patients themselves. A complete antihypertensive effect (AP < 150/90 mm Hg) in monotherapy with invoril was achieved in 18 (60%) patients, in therapy with diovan in 26 (86.7%) patients. At the end of the treatment systolic arterial pressure fell in group 1 by 22.6%, diastolic one by 19.2%; in group 2--by 23.4 and 19.7%, respectively. Side effects of invoril treatment occurred in 8 (26.7%) patients, of diovan treatment--in 3 (10%). Thus, invoril and diovan are highly effective and safe drugs for treatment of arterial hypertension of the first and second degree. Antihypertensive effectiveness and tolerance of invoril are inferior to those of diovan.     

Diagnosis and roentgeno-endovascular treatment of patients with renin-dependent arterial hypertension and secondary aldosteronism without damage to the main renal arteries

Bilateral electrocoagulation of the central veins of the adrenals (ECVA) was performed in 13 patients with stable and malignant arterial hypertension (AH). The renin-dependent character of AH was supported by positive reaction of arterial pressure (AP) to the test dose of captopril (25 mg). The vasorenal origin of the impairment was excluded on the basis of the peripheral captopril test findings, pharmacorenography with captopril. Bilateral ECVA was done during angiography. The manipulation turned out technically successful in 11 left (85%) and 9 right (70%) adrenals. The AP began lowering from the first days of the intervention and got stabilized by day 4 to 5. There was a significant decline of AP within the observation period up to 1 year and a reduction of the elevated aldosterone content and plasma renin activity with the content of ACTH being unchanged. After the manipulation 2 patients could fully discontinue the intake of hypotensive drugs. In 11 patients, the dose of the drugs could be reduced.     

Antihypertensive efficacy, tolerance and safety of lisinopril (sinopril) and captopril (capoten) in patients with mild and moderate arterial hypertension

AIM: To compare effectiveness, tolerance and safety of two inhibitors of angiotensin-converting enzyme--sinopril (lisinopril) and capoten (captopril)--in outpatient treatment of patients with mild and moderate hypertension. MATERIALS AND METHODS: The patients were randomly assigned to sinopril or capoten groups. Sinopril was given in daily dose 10-40 mg, capoten--in daily dose 25-100 mg for 8 weeks. In insufficient antihypertensive effect of monotherapy on day 21, hydrochlortiaside was added. The effect was judged by influence on arterial pressure, heart rate, tolerance (questionnaire), safety (blood count, urinalysis. ECG). RESULTS: Sinopril produced good antihypertensive effect in 73.3% of patients (monotherapy) and 88.9% (combined therapy). For capoten it was 68.9 and 82.2%, respectively. The time of the beginning of the antihypertensive effect (4-20 days after the start of the treatment) for sinopril and copoten differed insignificantly and depended on hypertension severity (mild or moderate). Tolerance of both drugs was good, serious side effects were absent. Discontinuation of the drugs was needed in 4% of patients, only. No negative action on bioelectric activity of the heart, clinical and biochemical blood indices were found. CONCLUSION: Sinopril and capoten demonstrate high antihypertensive activity.     

Combined therapy with amlodipin and lisinopril in arterial hypertension: efficacy of a low-dose combination

AIM: To assess antihypertensive efficacy of a low-dose combination of amlodipin with lisinopril in the treatment of patients with arterial hypertension (AH) of the second degree. MATERIAL AND METHODS: A total of 42 patients with the second degree of AH (16 males, 26 females, mean age 55-9 +/- 1.9 years) entered an open, comparative and controlled trial. They were divided into three groups by the treatment. Group 1 (n = 14) received amlodipin (normodipin, Gedeon Richter) monotherapy in a mean dose 8.9 +/- 0.6 mg/day, group 2 (n = 12) - lisinopril (diroton, Gedeon Richter) in a mean dose 17.5 +/- 1.4 mg/day, group 3 (n = 16) was given combined therapy with amlodipin+lisinopril in a dose 6.8 +/- 0.7 and 8.7 +/- 0.6 mg/day, respectively. The drugs were given for 12 weeks. The efficacy of the treatment was assessed by the results of 24-h monitoring of blood pressure, echocardiography, endothelium-related vasodilatation of the brachial artery (ERVD), dopplerographic investigation of circulation in the middle cerebral artery (MCA), heart rate and cost-effect estimation. RESULTS: Combined low-dose treatment with amlodipin and lisinopril for 12 weeks allowed achievement of target blood pressure in more patients and lower systolic and diastolic blood pressure than monotherapy with each of the drugs. There was also a positive effect on E/A index, ERVD, MCA circulation. CONCLUSION: Low-dose combined treatment with lisinopril and amlodipin is more effective and cost-efficient. Moreover, lisinopril addition to amlodipin corrects side effects of amlodipin on central nervous system.     

The relationship between the 24 hour arterial pressure profile with heart changes in patients with essential hypertension

A 24-h profile of arterial pressure (AP), structural-geometrical changes of the left ventricle (LV) and severity of hypertensive heart were compared in 47 patients with essential hypertension. Absolute AP and LV geometric models were not related. In patients with concentric LV hypertrophy, the time index (TI) of night systolic hypertension was significantly higher than TI in excentric LV hypertrophy. A relationship was found between mean day systolic pressure, a morning rise in AP and form of LV hypertrophy. The severity of hypertensive heart correlated with TI of 24-h systolic arterial pressure (SAP), TI of 24-h diastolic arterial pressure (DAP), mean 24-h SAP, mean daytime SAP, mean night SAP, mean 24-h DAP, mean daytime DAP, a morning rise in DAP. Thus, a 24-h AP profile, a morning rise in DAP, 24-h hypertension time correlate with LV structural-geometric changes and severity of hypertensive heart.     

Antihypertensive effects of parenteral nicardipine alone and in combination with captopril

We studied the safety and efficacy of intravenous nicardipine alone and in combination with oral captopril. Sixteen patients with essential hypertension received a single oral dose of captopril, 50 mg, to be certain that excessive hypotension would not occur. Nicardipine was given intravenously as a 2 mg bolus, followed by an infusion at a rate designed to lower the supine diastolic blood pressure at least 10 mm Hg; then oral captopril, 50 mg, or placebo was given. The next week, nicardipine was again infused, but the alternate oral treatment was given. Intravenous nicardipine reduced blood pressure from 156 +/- 15/101 +/- 5 mm Hg (mean arterial blood pressure 120 +/- 6 mm Hg) to 140 +/- 11/88 +/- 4 mm Hg (mean arterial blood pressure 105 +/- 5 mm Hg). When captopril was added to nicardipine, the mean arterial blood pressure fell an additional 8 mm Hg but the heart rate did not increase. The combination of angiotensin-converting enzyme inhibition and calcium channel blockage produces additive antihypertensive effects without additional reflex tachycardia.     

The response to normobaric hypoxia and its duration in arterial hypertension patients as shown by a prospective study

A placebo-controlled parallel trial studied an antihypertensive action of interrupted normobaric hypoxia (INH) in 63 male patients with arterial hypertension (AH) of the first degree and low and moderate risk of vascular complications. The placebo group consisted of 18 patients with AH of the first degree matched by age, the disease duration, initial level of systolic and diastolic pressure. An INH course consisted of 15 daily procedures. INH monotherapy implied oxygen content lowering to 10%. A 6-month follow-up was made with the use of 24-h AP monitoring. The INH course resulted in a significant decrease in systolic and diastolic AP, total peripheral vascular resistance. A morning rise of systolic pressure became slower. A favourable effect of normobaric hypoxia on AP 24-h rhythm was observed. A good hypotensive effect was achieved in 85.7% patients. A 6-month follow-up confirmed a long-term hypotensive effect of INH.     

Antihypertensive mechanism of captopril in renal hypertensive rats: studies with a nonpeptide angiotensin II receptor antagonist and an angiotensin II monoclonal antibody

The validity of using EXP6803, a nonpeptide angiotensin II (AII) receptor antagonist, and KAA8, an AII monoclonal antibody, as specific tools for studying the physiology of AII has been established previously. In this study, we used these specific probes to examine the role of blocking AII formation in the antihypertensive effect of captopril in conscious renal artery-ligated rats (RALRs), a high renin, renal hypertensive model. Mean arterial pressure and plasma renin activity in a typical group of RALRs averaged 175 +/- 5 mm Hg and 28.2 +/- 6.2 ng of angiotensin 1 per ml/hr (n = 6), respectively. The antihypertensive effect of captopril (3 mg/kg i.v.) was determined in RALRs given either EXP6803 (30 mg/kg + 2 mg/kg/min i.v.) or KAA8 (10 mg + 1 mg/min i.v. per rat) with the corresponding vehicle-treated RALRs. These doses of EXP6803 and KAA8 were very effective in blocking the pressor response to AII but not to norepinephrine or vasopressin in RALRs. Captopril decreased mean arterial pressure by 44 +/- 2 and 53 +/- 8 mm Hg in the groups treated with the vehicles of EXP6803 (n = 5) and KAA8 (n = 5), respectively. In the presence of EXP6803 (n = 5) or KAA8 (n = 5), the antihypertensive effect of captopril was almost or totally abolished. Indomethacin did not alter the antihypertensive effect of captopril. These results suggest that the antihypertensive effect of captopril in conscious RALRs is due mainly to the blockade of AII formation. Furthermore, circulating AII rather than locally formed AII appears to play a major role in maintaining hypertension in hypertension in RALRs.     

Glomerular hemodynamics of the clipped kidney: effects of captopril and diltiazem.

Glomerular hemodynamics of the clipped kidney in two kidney-one clip Goldblatt-hypertensive rats were studied by micropuncture techniques after administration of either captopril (20 mg/kg of b.wt./day p.o.) or diltiazem (3 mg/kg of b.wt./hr i.v.). Both drugs decreased mean arterial and poststenotic renal arterial pressure to comparable levels. Total kidney glomerular filtration rate was not significantly different in the three groups (0.78 +/- 0.09 in hypertensive controls, 0.62 +/- 0.11 after captopril and 0.74 +/- 0.07 ml/min/g of kidney weight after diltiazem). Glomerular capillary pressure fell significantly in both treated groups but was lower in captopril-treated animals (60 +/- 2 in hypertensive controls, 45 +/- 2 after captopril and 53 +/- 1 mm Hg after diltiazem, both P < .05 vs. hypertensive controls). Afferent arteriolar resistance was lowered in both treatment groups to the same extent, whereas only captopril decreased efferent arteriolar resistance. Single nephron filtration rate of cortical nephrons was not altered significantly by captopril due to a 96% increase in the ultrafiltration coefficient and a 58% rise in glomerular plasma flow, whereas diltiazem increased ultrafiltration coefficient by 62% but did not affect glomerular plasma flow. These studies indicate that, despite of decreased effective filtration pressure, glomerular filtration rate is well preserved after converting enzyme inhibition. Captopril and diltiazem have different effects on glomerular hemodynamics within the stenosed kidney.     

Evaluation of potential losartan-phenytoin drug interactions in healthy volunteers

BACKGROUND: Phenytoin, a cytochrome P450 (CYP) 2C9 substrate, has a narrow therapeutic index and nonlinear pharmacokinetics. Therefore there is the potential for significant concentration-related adverse effects when phenytoin is coadministered with other CYP2C9 substrates. Losartan, an antihypertensive agent, is also a substrate for CYP2C9. OBJECTIVE: Our objective was to assess the effects of losartan on the pharmacokinetics of phenytoin and the effects of phenytoin on the pharmacokinetics of losartan in a healthy population of volunteers. METHODS: A prospective, randomized, 3-period crossover study was conducted in 16 healthy volunteers with phenytoin alone, phenytoin in combination with losartan, and losartan alone. Each treatment was given for 10 days with a 3-week washout period between treatments. On day 10, plasma concentrations of phenytoin and plasma and urine concentrations of losartan and its active carboxylic-acid metabolite E3174 were measured to determine steady-state pharmacokinetic parameters. RESULTS: Coadministration of losartan had no effect on the pharmacokinetics of phenytoin. Coadministration of phenytoin increased the mean area under the concentration-time curve from time zero to 24 hours [AUC(0-24)] of losartan by 17% (355 +/- 220 ng x h/mL versus 427 +/- 177 ng x h/mL; P =.1), but this difference was not statistically significant. In the 14 CYP2C9*1/*1 subjects, the mean AUC(0-24) of losartan was increased by 29% (284 +/- 84 ng x h/mL versus 402 +/- 128 ng x h/mL; P =.008). Coadministration of phenytoin significantly reduced the AUC(0-24) of E3174 by 63% (1254 +/- 256 ng x h/mL versus 466 +/- 174 ng x h/mL; P =.0001) and the formation clearance of losartan to E3174 (1.91 +/- 0.8 mL/h per kilogram versus 0.62 +/- 0.4 mL/h per kilogram; P =.0001). CONCLUSIONS: Losartan, a CYP2C9 substrate, had no effect on the pharmacokinetics of phenytoin. However, phenytoin inhibited the CYP2C9-mediated conversion of losartan to E3174.     

Twenty-four-hour profile of arterial pressure in patients with hypothyroidism

The purpose of the investigation was to study the effects of hypothyroidism on the 24-hour profile of arterial pressure (AP). One hundred and fifty-one patients (mean age 52 +/- 3.2 years) with primary hypothyroidism and concomitant arterial hypertension were examined; the patients received substitutive therapy (levothyroxine sodium) and standard hypotensive therapy (ACE inhibitors and indapamide). Twenty-four-hour AP monitoring was performed; the level of thyrotropic hormone was measured by immune enzyme assay. The patients were distributed into two groups according their thyroid status. Group 1 consisted of 72 patients with compensated hypothyroidism; 79 patients with decompensated hypothyroidism constituted group 2. The study found the following facts about patients with decompensated hypothyroidism: higher systolic AP, high variability of nocturnal AP, insufficient decrease in AP during day hours, and accelerated morning AP increase. The results suggest that hypothyroidism has significant effects on the 24-hour AP profile, and its decompensation lowers the efficacy of hypotensive therapy.     

Characteristics of hypotensive effect in patients with arterial hypertension and desaturation signs of obstructive sleep apnea syndrome during sleep

AIM: To estimate the efficacy of 8-week antihypertensive monotherapy in patients with arterial hypertension (AH) regarding the presence of obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: We analysed the results of 24-h blood pressure (BP) monitoring of 26 inpatients (mean age 54 +/- 2 years) with mild (n = 18) and moderate (n = 8) AH before and after 8 weeks of treatment with 5-10 mg amlodipine or 50-100 mg of losartan once daily to assess blood pressure profile parameters. The patients underwent nocturnal monitoring of arterial oxygen saturation (pulsoximeter NONIN-8500 M, USA). The presence of OSAS was confirmed when a characteristic clinical picture was combined with the presence of significant (> 4%) sleep desaturation episodes > 15 episodes per hour or the presence of group desaturation episodes below 90%. Seven hypertensive patients with OSAS were assigned to group 1, nineteen patients without OSAS--to group 2. The differences in estimated parameters between the groups were tested by Mann-Whitney U test, the dynamics of BP profile parameters--by Wilcoxon matched pairs test. RESULTS: In group 1 there were no significant differences by most of BP profile parameters before and after antihypertensive treatment, except mean nocturnal systolic BP. In group 2 a significant hypotensive effect was seen by all parameters of BP profile except BP variability. Hypotensive efficacy in group 2 was 1.5-2 times higher vs group 1, but the difficulties were not significant. CONCLUSION: Antihypertensive therapy in hypertensive patients with OSAS is less effective than in those without OSAS but it is not uneffective.