The role of hypersympathycotony in development of arterial hypertension in patients with metabolic syndrome: potential of pathogenetically sound therapy

AIM: To assess hypotensive efficacy and metabolic neutrality of moxonidine (physiotenz)--a selective agonist of imidasoline receptors--in patients with mild and moderate arterial hypertension (AH) associated with diabetes mellitus (DM) type 2. MATERIAL AND METHODS: Follow-up and treatment were conducted in 30 hypertensive diabetics (mean age 52.43 +/- 4.65 years). Mean duration of DM and AH was 4.77 +/- 2.69 and 6.93 +/- 2.98 years, respectively. The study was made of lipid exchange, glycemia, levels of glycosylated hemoglobin (GH), fasting and postprandial immunoreactive insulin. Hypotensive efficacy was examined by 24-h monitoring of arterial pressure after 16 weeks of therapy. RESULTS: Mean 24-h systolic arterial pressure fell by 8.02%, diastolic arterial pressure--by 6.47%. The drug had a good effect on a 24-h profile of arterial pressure: a significant decrease of day and night pressure load index, lowering of initially high 24-h variability of systolic and diastolic arterial pressure, normalization of two-phase profile of arterial pressure. Carbohydrate metabolism improved also: GH, glycemia, immunoreactive insulin decreased. There was a significant trend to a change in qualitative composition of blood lipid--a decrease in lipoproteins atherogenic fractions and a rise in HDLP. CONCLUSION: Physiotens is a highly effective hypotensive drug for use in mild and moderate AH in DM of type 2.     

Complex assessment of metabolic parameters in obese patients treated with xenical

AIM: To study effects of xenical combined with moderately hypocaloric diet on fat tissue mass, carbohydrate and lipid metabolism in patients with metabolic syndrome. MATERIAL AND METHODS: The study included 60 patients with body mass index (BMI) over 30 kg/m2, mild and moderate arterial hypertension, dyslipidemia, impaired glucose tolerance (IGT) and diabetes mellitus (DM) type 2. The patients were divided into two groups. 30 patients of group 1 received xenical in a dose 120 mg 3 times a day for 24 weeks. 30 patients of the control group received only the above diet for 24 weeks. The examination included 24-h monitoring of arterial pressure, anthropometric measurements, tests for glycemia, C-peptide, cholesterol, triglycerides (TG), LDLP, HDLP. RESULTS: Group 1 patients reduced their weight by 10.8 +/- 7.5 kg and fat tissue mass by 9.4 +/- 9.2 kg. This was in correlation with improvement of fatty, carbohydrate metabolism, arterial pressure. After 24 weeks of therapy xenical lowered cholesterol by 15%, LDLP cholesterol by 20%, TG by 28%, systolic and diastolic pressure by 5 and 4%. CONCLUSION: Combination of xenical with hypocaloric diet can be used in therapy of patients with metabolic syndrome.     

Role of thyroid pathology in pathogenesis of arterial hypertension in diabetes

190 patients with diabetes mellitus (DM) were examined: 24 patients with DM type 1 and 166 with DM type 2. Frequency of arterial hypertension (AH) in diabetics is higher than in population. AH in different DM types varies by pathogenesis. Symptomatic renal AH is typical for DM1, essential AH combining with renal one in 1/3 of cases--for DM2. Treatment of AH and DM often provokes hypothyroidism which can be iatrogenic because of continuous intake of sugar reducing and antihypertensive drugs with antithyroid and strumogenic actions. Hypothyroidism aggravates an AH course: arterial pressure becomes high and resistant to hypotensive therapy. DM makes difficulties in selection of hypotensive drugs as many of them alter metabolism and due to negative attitude of the patients to continuous intake of sugar reducing, antihypertensive drugs, thyroid hormones. Therefore, hypertensive diabetics should be prepared for treatment psychologically and receive only prolonged hypotensive drugs. In DM with AH medication of choice is ACE inhibitors as they are nephroprotective, had no negative effect on carbohydrate, fat metabolism and thyroid system.     

Cerebrovascular complications in metabolic syndrome: possible approaches to decrease risk

AIM: To compare brain perfusion in hypertensive patients with diabetes mellitus type 2 (DM2) or metabolic (MS) syndrome and hypertensive patients without clinicobiochemical signs of DM2 or MS; to study enoxaparin effects on brain perfusion in DM2 and arterial hypertension (AH). MATERIAL AND METHODS: Seventy patients included in the study were divided into three groups: 30 patients with DM2 and AH (group 1), 30 patients with MS and AH (group 2) and 10 AH patients without manifestations of MS or DM2 (group 3). All the patients have undergone single-photon emission computed tomography (SPECT) of the brain, carbohydrate and lipid metabolism were examined. RESULTS: Deterioration of brain perfusion was more prominent in DM2 and MS patients with AH than in hypertensive patients with normal metabolism. Stress test with acetasolamide revealed defective autoregulation of cerebral blood flow in hypertensive patients with DM2. A 6-week therapy with enoxaparin significantly improved brain perfusion in hypertensive patients with DM2. CONCLUSION: Enoxaparin treatment of hypertensive DM2 and MS patients with abnormal perfusion of the brain can be used for prevention of cerebrovascular complications.     

Effect of brerlipril in patients with non-insulin dependent diabetes mellitus and mild or moderate arterial hypertension as indicated by 24-h blood pressure monitoring]

AIM: To study a hypotensive effect of berlipril, an ACE inhibitor, using 24-h BP monitoring in patients with non-insulin-dependent diabetes mellitus (NIDDM) combined with stable mild or moderate arterial hypertension (AH). MATERIALS AND METHODS: 22 NIDDM patients with mild or moderate AH were treated with berlipril. 24-h monitoring of BP was made in all the patients before and 3 months after the treatment. RESULTS: A stable hypotensive effect of berlipril was achieved at its therapeutic dose 1.5 tablets a day once a day or divided into two doses a day. On treatment week 3-4 a hypotensive effect of berlipril enhanced in 5 patients. This may be due to ACE inhibitors action on the tissue component of the reninangiotensin system. CONCLUSION: Berlipril produces a high hypotensive effect and brings about a positive response of insulin-resistance in NIDDM associated with mild and moderate AH.     

Spirapril - a new long-acting ACE inhibitor: efficacy and safety in patients with arterial hypertension in combination with diabetes mellitus and impaired kidney function

AIM: To examine effectiveness and safety of quadropril. MATERIAL AND METHODS: Changes in blood pressure (BP), heart rate (HR), levels of glucose, potassium and creatinine, creatinine clearance were studied in 120 patients (48 males and 72 females, mean age 60.6 +/- 0.7 years) with mild to moderate arterial hypertension (AH) with average duration 13.8 +/- 0.7 years. The patients were divided into 3 groups: with AH (n = 40), AH + noninsulindependent diabetes mellitus (DM) (n = 43), AH and nephropathy (n = 37). 8-week treatment was performed with a standard dose of 6 mg/day (1 tablet of quadropril). Control examinations were made 2, 4 and 8 weeks after the treatment. RESULTS: After 8 weeks of treatment a decrease in systolic blood pressure in AH group was 24.0 +/- 3.0 mm Hg and in diastolic blood pressure 16.3 +/- 1.3 mm Hg (P < 0.001). In the group with DM this decrease was 22.4 +/- 2.8 mm Hg and 15.7 +/- 1.4 mm Hg (p < 0.001), respectively. In the group with nephropathy this decrease was 26.4 +/- 2.4 and 16.5 +/- 1.3 mm Hg (p < 0.001), respectively. Heart rate changed significantly only in diabetics: from 75.1 +/- 1.7 to 72.9 +/- 1.3 beats/min. Biochemical parameters in the hypertensive and diabetic patients did not change significantly. In the nephropathy group there was a significant decrease in creatinine and increase in creatinine clearance. Their level of glucose and potassium changed insignificantly. CONCLUSION: The treatment with quadropril results in a significant decrease in blood pressure, does not influence parameters of carbohydrate metabolism, improves nitrogen eliminating function of the kidneys.     

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.     

Applicability of fozinopril for correction of basic manifestations of metabolic syndrome in women with arterial hypertension

AIM: To evaluate effects of fozinopril on basic manifestations of metabolic syndrome in women with moderate and severe arterial hypertension (AH). Material and methods. Sixty women with AH aged 45 to 65 years entered the trial. Mean duration of the disease was 11 years. Arterial pressure (AP), carbohydrate, lipid and purin metabolism, lipid peroxidation, erythrocytic membranes resistance were examined before the trial and followed up for 6 months of the treatment. RESULTS: Fozinopril significantly reduced systolic and diastolic AP. A 6-month course of the drug brought target AP in 85.4% examinees, a good response was achieved in 96.4%. The treatment also significantly reduced the levels of insulin, C-peptide, triglycerides, increased content of HDLP cholesterol, relieved insulin resistance. Fozinopril demonstrated antioxidant, membrane stabilizing and hypouricemic efficacy. CONCLUSION: High antihypertensive efficacy and a positive action on basic manifestations of metabolic disorders allow us to recommend fozinopril as a basic drug for treatment of women with moderate and severe AH concurrent to insulin resistance syndrome.     

Urate affection of kidneys and metabolic disturbances in hypertensive patients]

AIM: To detect urate renal affection and correlations between purine metabolism, hyperinsulinemia, obesity, dyslipidemia in patients with arterial hypertension (AH). MATERIALS AND METHODS: 78 patients with mild, moderate and severe hypertension have undergone 24-h monitoring of arterial pressure and microalbuminuria test. RESULTS: Hyperuricemia was diagnosed in 21 of 78, hyperuricosuria in 27 patients. 13 patients had combination of hyperinsulinemia with obesity, dyslipidemia, arterial hypertension. Renal symptoms occurred in almost half of the patients with hyperuricemia. Disturbed 24-h rhythm and variability of arterial pressure were encountered more frequently in patients with hyperuricemia and hyperinsulinemia than in patients with normal purin metabolism and no other metabolic shifts. CONCLUSION: Renal abnormalities were found more frequently in hypertensive patients with hyperuricemia and those free of urate disturbances and metabolic changes. A positive correlation exists between body mass index and insulinemia (r = 0.58, p < 0.01), body mass index and uricemia (r = 0.37, p < 0.01), insulinemia and uricemia (r = 0.32, p < 0.01).     

Potential of combined hypoglycemic, antihypertensive, and hypolipidemic therapy in patients with diabetes mellitus and diabetic foot syndrome

The objective of this study was to assess the potential of combined therapy in patients with types 1 and 2 diabetes mellitus (DM) and diabetic foot syndrome (DFS). A total of 157 patients with DFS were observed over 3 months including 25 with type 1 DM and 132 with type 2 DM. In addition, 563 subjects without DFS were included in the study. Changes of arterial pressure (AP), carbohydrate and lipid metabolism under effect of hypoglycemic, hypolipidemic, and antihypertensive therapy combined with the local treatment of DFS were evaluated. Improvement of the glycemia level in patients with type 1 DM and DFS was achieved by intensive insulin therapy (IIT). Patients with poorly compensated type 2 DM (HbAc1 > 7%) and DSF were given IIT corrected with regard for obesity and insulin resistance (IR). Combined treatment of insulin with meformin or glyclaside with metformin is indicated to patients having compensated type 2 DM and a small ulcerative defect (Wagner's stages I-II) in the absence of infection, obesity, and IR. In patients with types 1 and 2 DM, AH, and DFS, AP was lowered by two- and three-component antihypertensive therapy respectively. Statins improved the lipid spectrum in patients with types 1 and 2 DM and DFS. The combined therapy having beneficial effect on AP, carbohydrate and lipid metabolism together with the local treatment and immobilization of the affected limb resulted in epithelization of ulcerative foot defects without amputation in 96 and 80% of the patients with type 1 and 2 DM respectively.     

The character of alterations of electrophysiological properties of myocardium in the patients with arterial hypertension associated with type 2 diabetes mellitus

The present study was designed to elucidate the character and severity of electrophysiological disturbances in the patients presenting with arterial hypertension (AH) associated with type 2 diabetes mellitus (DM). It included 55 patients with AH (mean age 50.4 +- 4.7 years) allocated to two groups. Group 1 was comprised of 25 patients with arterial hypertension and concomitant type 2 diabetes mellitus. Group 2 (n = 30) consisted of the patients with AH in the absence of diabetes. All the patients were examined using 12-lead ECG and high-resolution ECG (HR-ECG) supplemented by the analysis of late ventricular potentials (LVP) and cardiac rhythm variability (CRV). The study has demonstrated that diabetes mellitus in the patients suffering AH aggravates the disturbances in electrophysiological properties of myocardium compared with the patients having no metabolic disorders. These disturbances include changes of both repolarization and depolarization of myocardium. The patients with AH and concomitant diabetes mellitus had much higher values of dispersion and duration of QT-interval. Analysis of the results of HR-ECG in the two groups has revealed a significantly higher occurrence of late ventricular potentials in the patients with AH and concomitant type 2 DM (52% and 27% respectively; x2 = 4.43, p = 0.03). Analysis of rhythmograms showed progressive deterioration of temporal and spectral characteristics of CRV in the group of patients with AH and concomitant type 2 DM. Moreover; these patients were characterized by the reduction of sympathetic and parasympathetic influences on myocardium.     

Effects of angiotensin-converting enzyme (ACE) inhibitors on water-salt homeostasis in hypertensive patients living in Far North

The aim of the study was evaluation of ACE inhibitors (captopril and ramipril) effect on water-salt homeostasis in the treatment of patients with arterial hypertension (AH) living in the Far North of Russia. 100 male patients with mild and moderate AH were examined 2 weeks, 3 and 6 months after administration of captopril or ramipril. The drugs are shown to correct water-salt metabolism. This is explained by better renal function due to speeding up glomerular filtration and increased sodium excretion with urine, and by activity of humoral mechanisms (inhibited activity of plasma renin, low plasma concentration of aldosterone and its 24-h excretion). Comparison of captopril versus ramipril demonstrates advantages of prolonged ramipril in respect to regulation of water salt metabolism in the treatment of essential hypertension in the Far North.     

Tonocardin in complex treatment of diabetes mellitus concurrent with hypertension

AIM: To examine the effect of the alpha 1-adrenoblocker tonocardin (doxazosin) on the course of arterial hypertension (AH) and on carbohydrate and lipid metabolism and insulin resistance in patients with type 2 diabetes mellitus (DM) concurrent with AH. MATERIALS AND METHODS: 18 patients with type 2 DM concurrent with AH, treated with tonocardin for at least 12 weeks were examined; the fasting glycemia, the levels of blood glycosylated hemoglobin, serum total cholesterol and triglycerides, and the degree of insulin resistance (intravenous insulin load or insulin tolerance test and the insulin resistance index estimated by the HOMA method) were determined. RESULTS: Tonocardin treatment lowered systolic BP (from 159 +/- 19.83 to 136.57 +/- 17.43 mm Hg; by 14.5%), diastolic BP (from 93.38 +/- 12.98 to 79.12 +/- 11.69 mm Hg; by 15.28%), fasting glycemia (from 9.32 +/- 1.61 to 7.05 +/- 1.51 mmole/l; by 24.36%), glycosylated hemoglobin Ai (from 9.63 +/- 1.86 to 8.59 +/- 0.98%; by 10.8%), total cholesterol (from 6.09 +/- 0.57 to 5.4 +/- 0.4 mmole/l; by 11.4%), triglycerides (from 2.11 +/- 0.57 to 1.88 +/- 0.52 mmole/l; by 11%), glycemia after 30-min insulin load (from 9.32 +/- 1.61 to 5.77 +/- 1.57; by 39% and from 7.05 +/- 1.51 to 4.2 +/- 1.25 mmole/l; by 44% at the beginning and end of the follow-up, respectively), insulin resistance index (from 9.87 +/- 2.45 to 6.57 +/- 1.99; by 33.5%). CONCLUSION: The findings suggest that tonocardin exerts an antihypertensive effect and positively affects carbohydrate and lipid metabolisms, and diminishes insulin resistance in patients with type 2 DM concurrent with AH.     

Polymorphic markers of GNB3 (C825T), AGTR1 (A1166C) and ACE (A2350G and I/D) genes in patients with arterial hypertension combined with diabetes mellitus type 2

AIM: To elicit correlations of polymorphic markers of GNB3 (C825T), AGTR1 (A1166C), ACE (A2350G and I/D) genes with arterial pressure, left ventricular hypertrophy (LVH) and blood concentrations of proinflammatory cytokines in hypertensive patients with diabetes mellitus type 2 (DM2). MATERIAL AND METHODS: Clinical parameters (24-h arterial pressure profile, echocardiographic findings, immunoenzymes level) were studied in 89 hypertensive patients with DM2. These patients had different genotypes by the studied allele variants of the genes determined by polymerase chain reaction. RESULTS: Polymorphism of A1166C gene of type 1 vascular receptor of angiotensin II (AGTR1) contributes to formation of arterial hypertension (AH) signs diversity in DM2 patients. GNB3, a gene C825T polymorphic marker, showed a correlation with diastolic arterial pressure but this variant of the gene locus is not associated with LVH. However, G-allele of ACE gene contributes much to appearance of this pathological sign. Mean values of IL-1beta and TNF-alpha as well as the presence of LVH depended on genotypes by ACE gene (polymorphism I/D). CONCLUSION: Polymorphic markers of ACE and GNB3 candidate genes influence clinical diversity of pathological signs in DM2 patients through modification of AH and LVH severity and the level of proinflammatory cytokines.     

Risk of chronic renal failure in patients with non-insulin dependent diabetes mellitus with diabetic nephropathy and the stage of permanent proteinuria and arterial hypertension: role of clinical factors

AIM: To reveal prognostic factors which determine the risk of development of chronic renal failure (CRF) in patients with diabetes mellitus (DM) type II associated with diabetic nephropathy (DN) at the stage of continuous proteinuria in combination with arterial hypertension (AH). MATERIAL AND METHODS: A total of 60 AH patients suffering from type II DM with permanent proteinuria were examined. Chronic renal failure was registered in 21 patients. RESULTS: Among CRF patients, more frequent were males, high proteinuria and nephrotic syndrome, IHD, macroangiopathy of the lower limbs, VLDLP. CONCLUSION: Independent predictors of CRF in diabetes mellitus type II with AH and proteinuria were male gender, overweight, faster development of stable proteinuria from the time of diabetes diagnosis.     

24-Hour arterial pressure profile in chronic obstructive lung diseases in combination with arterial hypertension treated with enalapril

AIM: To evaluate peculiarities and trends in 24-hour arterial pressure (AP) profile and bronchoobstructive syndrome (BOS) in patients with chronic obstructive pulmonary diseases (COPD) and arterial hypertension (AH) on combined treatment including enalapril maleate. MATERIAL AND METHODS: Changes in BOS as shown by clinical data, data of peakflowmetry and external respiration function as well as in AP 24-hour profile according to 24-hour monitoring were studied in 50 patients with exacerbation of bronchial asthma and chronic bronchitis treated for 4 weeks with conventional broncholytic and antiinflammatory modalities, in 28 patients with mild and moderate AH receiving combined therapy including enalapril maleate. RESULTS: In exacerbation of COPD, 24-h AP profile is characterized by high frequency of the curve "non-dipper". Concomitant mild and moderate AH was diagnosed in more than half of the examinees. The addition of enalaprile maleate to the treatment in many cases lowered systolic and diastolic AP, normalized sympathicoadrenal system and 24-hour AP rhythm, reduced dyspnea, improved exercise tolerance, sleep. Good tolerance of the drug was seen in patients with exacerbation of COPD. CONCLUSION: In exacerbation of COPD it is recommended to monitor AP for 24 hours for early detection of AH and initiation of combined treatment with correction of bronchoobstructive syndrome and hemodynamic disorders. As a hypotensive drug, enalapril maleate is adequate in such patients.     

Left ventricular remodeling in association of arterial hypertension with diabetes mellitus type 2: correlation with gender and disease duration

AIM: To study specific features of left ventricular remodeling (LVR) in patients with hypertension and diabetes mellitus type 2 (DM-2). MATERIAL AND METHODS: The study group comprised 290 patients, the control group consisted of 79 patients with essential hypertension free of carbohydrate tolerance impairment. The age of the examinees ranged from 35 to 60 years. Structural-geometric left ventricular model was determined by echocardiography. Estimation of significant determinants of myocardial mass index (MMI) and types of left ventricular remodeling was made with multiple regression analysis and logistic regression. The parameters of 24-h monitoring of blood pressure, glycemic control, blood lipid-transport function, plasma insulin, aldosteron, hydrocortisone levels, blood rennin activity were used as independent variants. Incidence of registration of left ventricular excentric hypertrophy (LVEH) in the study group was higher as compared to control (27.6 and 16.5%, respectively; p < 0.05). A rise of left ventricular MMI in the study group was related to 24-h systolic arterial pressure and basal insulinemia (R2 = 0.4229). Development of left ventricular structural-geometric model in the study group depended on the gender, duration of diabetes, 24-h systolic blood pressure (direct correlation) and 24-h diastolic blood pressure (inverse correlation), R2 = 0.6500. In DM duration about 5 years, percentage of males with concentric left ventricular hypertrophy (CLVH) and LVEH was 63% versus 37% (chi-square 5.0815, p < 0.03). In longer diabetes LVEH was seen more frequently than CLVH (73.3 and 26.7%, respectively). Among women with left ventricular hypertrophy and hypertension under 10 years LVEH and CLVH were detected in 69.1 and 30.9% cases, respectively (chi-square 7.9356, p < 0.01). Later, these differences became less obvious (41.7 and 58.3%, respectively). CONCLUSION: Hypertensive patients with diabetes mellitus type 2 develop structural-geometric changes of the heart earlier. LVR in such patients is associated with gender, duration of DM and non-proportional growth of 24-h systolic blood pressure leading to gender-related differences in the time of formation of LVEH and CLVH.     

Lipid reducing and antioxidant action of mexicor in patients with diabetes mellitus type 2

AIM: To study mexicor effects on functional activity of beta-cells, insulin resistance, lipid metabolism and lipid peroxidation in patients with diabetes mellitus (DM) type 2. MATERIAL AND METHODS: Twenty patients with DM type 2 participated in a double blind randomized trial of mexicor vs placebo. Before and after therapy the following parameters were studied: plasma glucose before meal, immunoreactive insulin, glycosilated hemoglobin, cholesterol, triglycerides, LDLP and HDLP cholesterol, malonic dialdehyde, dienic conjugates, superoxide dismutase, catalase, glutathione peroxidase and alpha-tocopherol. RESULTS: Mexicor significantly improved compensation of carbohydrate metabolism by glucose and glycosylated hemoglobin in the blood, insulin resistance value, lipid metabolism and lipid peroxidation in activation of antioxidant enzymes. CONCLUSION: Mexicor in therapy of DM type 2 improves carbohydrate and lipid metabolism, lipid peroxidation, activates antioxidant defence enzymes, functional activity of beta-cells, reduces insulin resistance.     

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.     

Risk factors of diabetic nephropathy progression in patients with a long history of diabetic mellitus as shown by a retrospective analysis

AIM: To ascertain prognostic factors defining the risk of progression of diabetic nephropathy (DN) in patients with diabetes mellitus (DM) type 1 and 2 suffering from DM over 20 years. MATERIAL AND METHODS: A one-stage comparative trial studied 141 patients with DM type 1 and 149 patients with DM type 2 with DN of different severity and 20 year history of the disease. The follow-up study covered 34 CD-1 patients and 45 CD-2 patients with normo-, micro- and macroalbuminuria. The groups were made by the principle case-control. The control group consisted of 24 patients with DM-1 and 19 patients with DM-2 having stable renal function, the case group consisted of 10 and 26 patients, respectively, with DN progression. A total duration of the follow-up was 6 years. The end point of the analysis was chronic renal failure (CRF). RESULTS: Multivariate regression analysis has shown that the following risk factors of microalbuminuria in DM-1 and DM-2 are independent: the level of HbA1c (RR 3,1 and 2.7, respectively) and duration of arterial hypertension (RR 2.1 and 2.0, respectively); proteinuria - HbA1c (RR 4.4 and 3.4, respectively), systolic blood pressure (RR 3.4 and 3.1, respectively), CRF - systolic blood pressure (RR 5.0 and 4.5, respectively), triglycerides (RR 2.8 and 4.9, respectively) and hemoglobin (RR 3.3 and 5.3, respectively). IN DM-2 other risk factors of CRF were male sex (RR 2.0), family history of hypertension (RR 3.8) and 24-h proteinuria > 2 g (RR 6.7). CONCLUSION: Inadequate compensation of carbohydrate metabolism (HbA1c), arterial hypertension and dyslipidemia are main risk factors of MAU and its progression to proteinuria in DM patients. In progression of DN to CRF main risk factors are hypertension, dyslipidemia and severity of anemia.