New approaches to treatment of bradyarrhythmia in patients with obstructive sleep apnea syndrome

AIM: To confirm or reject effects of CPAP on sleep asystole and to elucidate possible dependence on correction of respiratory disorders. MATERIAL AND METHODS: Thirteen patients (11 males and 2 females aged 19 to 66 years) with bradyarrhythmia (BA) arising in sleep participated in the study. BA was caused by transient atrioventricular block of the degree II-III in 9 cases (69%), episodes of sinus node arrest and/or synoatrial block in 6 (46%) cases. Two (15%) patients had combination of BA forms. To diagnose sleep respiratory disorders, polysomnography (PSG) was made. Diagnostic criteria of sleep obstructive apnea syndrome (SOAS) were apnea/hypopnea index (AHI) more than 5 episodes for 1 hour sleep. The patients were divided into two groups. Individual selection of therapeutic pressure under PSG control was performed in SOAS patients (the study group). CPAP-therapy was effective in AHI < 5. In the control group (AHI < 5) such selection was made too. CPAP-therapy was effective in the controls if episodes of apnea/hypopnea were not registered through the night of monitoring. RESULTS: In the study group CPAP-therapy was effective. The AHI decreased from 73.2 to 4.4, oxygen saturation of arterial blood increased from 74 to 85%, mean duration of asystoles fell from 5.2 to 1.3 s, pauses with duration more than 2 s disappeared. In the control group sleep apnea/hypopnea episodes disappeared but in asystole CPAP was uneffective. CONCLUSION: CPAP-therapy is effective and pathogenetically sound method of treating patients with nocturnal bradyarrhythmia associated with sleep respiratory disorders.     

Placebo-controlled study of short-term hypotensive effect of intranasal ventilation with continuous positive pressure upper respiratory tract therapy in patients with stage I arterial hypertension

AIM: To compare a short-term hypotensive effect of intranasal ventilation with continuous positive airway pressure (CPAP-therapy) in patients with arterial hypertension stage I and placebo-control patients. MATERIAL AND METHODS: The CPAP-therapy and placebo-control groups consisted of 12 young men with arterial hypertension (AH) stage I. They were matched by age, body mass index, smoking habits, arterial pressure 24-h monitoring (APM) and night cardiorespiratory monitoring. Patients of the treatment group received CPAP-therapy (REMstar Choice, Respironics, USA) followed by repeated APM. Patients of the placebo group used a nasal mask without turning on the apparatus. Then a repeated APM was performed. RESULTS: As shown by improved APM data, CPAP-therapy was effective in AH stage I. Positive response was the greatest for systolic and diastolic hypertensive load. CONCLUSION: The above results may serve as an argument in support of a positive relation between elevated resistance of the upper respiratory airways in sleep and systemic AH.     

Nocturnal hypoxic episodes and structural changes in left ventricular myocardium in patients with mild-to-moderate arterial hypertension

AIM: To study correlations between structural changes of the left ventricle (LV) in patients with mild and moderate arterial hypertension (AH) and severity of hypoxic night episodes. MATERIAL AND METHODS: The examination of 50 patients (mean age 52 +/- 1 year) with mild and moderate hypertension included echocardiographic measurement of LV myocardial mass, calculation of LV myocardial mass index. LV hypertrophy was stated in the index 125 g/m2 for men and 110 g/m2 for women. 24-h monitoring of arterial pressure (TM-2425) and night monitoring of hemoglobin saturation of arterial blood with oxygen (SaO2) using pulsoxymeter NONIN 8500M were made. The data processing was performed with the use of original program ARM-SaO2. Dissaturation was stated if SaO2 fell by 4% and more compared to the previous stable level at initial SaO2 level above 90%. The patients were divided into two groups according to the number of dissaturation episodes: group 1 (more than 20 dissaturation episodes) and group 2 (less than 20 episodes). RESULTS: The groups were comparable by gender, duration of hypertension, body mass index, systolic and diastolic arterial pressure, heart rate. In group I, pulse arterial pressure, systolic arterial pressure load for 14 hours, day and night were significantly higher. Patients with dissaturation had a significantly higher LV myocardial mass and more frequent LV hypertrophy (128 +/- 6 and 106 +/- 5 g/m2 and 56 and 20%, respectively). The correlation and multifactor regression analysis showed a predictive value not only of the pressor parameters but also of indices of night hypoxia in relation to structural changes of LV myocardium. CONCLUSION: The presence of significant hypoxic episodes in sleep in AH patients indicates risk to develop structural changes of LV myocardium.     

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 blood pressure profile in patients with mild and moderate arterial hypertension and sleep apnea/hypopnea

AIM: To evaluate 24-hour blood pressure (BP) profile in arterial hypertension (AH) patients (pts) with desaturation signs of sleep apnea/hypopnea syndrome (SAHS). MATERIAL AND METHODS: We investigated 61 pts (44 males and 17 females) aged between 23-70 (52 +/- 2) years with mild to moderate AH. BP monitoring was performed with multisensor system TM-2425 (A&D, Japan). We assessed the following parameters: mean 24-h, awake, sleep systolic (S), diastolic (D) and pulse (P) BPs, systolic and diastolic BP loads ("normalized area under the curve"--NAUC). A normal circadian rhythm of BP was defined when nocturnal fall of SBP was > 10% and < 20%. The morning rise of BP we assessed by speed of increase of mean BP from 4 a.m. to 12 a.m. The nocturnal monitoring of arterial oxygen saturation(SaO2) was performed with pulseoximeter "NONIN 8500M" (USA). The analysis of the results was performed with the original program ARM-SaO2". The presence of SAHS was confirmed when the number of 4% desaturations were greater than 15 per hour or in the presence of group episodes of 4% desaturation below 90%. In 19 pts we revealed desaturation signs of SAHS. The comparison group included pts without SAHS (n = 42). We compared the groups regarding 24-h BP profile parameters. RESULTS: SAHS group had the following parameters significantly higher: mean 24-h (151.7 +/- 4.5 vs 142.9 +/- 2.4 mm Hg, p < 0.07) and sleep SBPs (142.8 +/- 5.1 vs 132.7 +/- 2.6 mm Hg, p < 0.05); mean 24-h (65.2 +/- 2.6 vs 55.9 +/- 1.9 mm Hg, p < 0.008), daytime (65.6 +/- 2.7 vs 56.6 +/- 2.0 mm Hg, p < 0.01) and sleep PBPs (64.1 +/- 2.7 vs 53.1 +/- 1.9 mm Hg, p < 0.002); 24-h (20.1 +/- 3.8 vs 12.6 +/- 1.8 mm Hg, p < 0.05) and sleep NAUC of SBP (24.6 +/- 4.4 vs 15.3 +/- 2.2 mm Hg, p < 0.03). In the group with SAHS were significantly higher the frequency of abnormal circadian rhythm of SBP (84 vs 57%, p < 0.05) and the speed of morning rise of mean BP (23.3 +/- 5.9 vs 8.5 +/- 2.8 mm Hg/h, p < 0.01). CONCLUSION: Our results suggest that pts with desaturation signs of SAHS are characterized by unfavourable changes in 24-h BP profile parameters, first of all owning to sleep systolic and pulse blood pressures with alteration of circadian rhythm and high speed of morning rise of BP.     

Atrial Natriuretic Peptide in Habitual Snorers

We studied nocturnal and early morning variations in the concentration of plasma atrial natriuretic peptide (ANP) in 17 men who habitually snored. The subjects had a mean age of 51.0 ± 5.8 years, range 41–62 y with a mean body mass index (BMI) of 32.9 ± 7.3 kg/m². The concentration of plasma ANP was measured by radio-immunoassay of venous samples at 10 p.m., midnight, 6 p.m. and 8 p.m. All night sleep recordings were conducted with the static charge sensitive bed to monitor body and breathing movements and a BIOX III Pulse Oximeter for the blood oxygen saturation level.

Nine patients were defined as having the obstructive sleep apnea syndrome (OSAS). No significant diurnal variation for ANP concentrations was detected. At 8 a.m. five OSAS patients and two others had ANP concentrations above normal (70 pg/ml). Neither mean oxygen saturation during the night nor arterial hypertension discriminated between the high and low ANP groups at 8 a.m. The best discriminators for a high concentration of ANP at 8 p.m. were marked obesity (BMI >30 kg/m²), over 400 movements lasting less than five seconds, and over 30% of active sleep per night. In a multivariate regression analysis age, percentage of active sleep during the night, BMI and the median oxygen saturation level during the night explained 76.4% of the total variance of ANP at 8 a.m. In a similar analysis the median oxygen saturation level during the night and BMI both explained the variance of ANP significantly. The whole model explained 53.7% of the variance of the ANP concentrations at 6 a.m. Our results show that heavy snorers and patients with obstructive sleep apnea syndrome may have high concentrations of ANP. This emphasises the importance of taking the snoring and sleeping history of patients with high concentrations of ANP levels.     

Respiratory sleep disorders in patients with congestive heart failure

AIM: To examine respiration in sleeping patients with congestive heart failure (CHF). MATERIAL AND METHODS: Night cardiorespiratory monitoring was made in 30 CHF patients with coronary heart disease (CHD), arterial hypertension and dilated cardiomyopathy. The control group consisted of 16 patients with obstructive sleep apnea and hypopnea (OSAH) free of CHF. RESULTS: Respiratory sleep disorders were registered in all the examinees. Moderate and severe OSAH occurred more often. CHF patients vs controls had shorter inhalation, expiration, overall duration of the respiratory cycle, higher rate of the respiratory movements. With aggravation of the respiratory disorders in sleeping CHF patients, minute ventilation, respiratory volume and mean inspiratory flow arose. In severe OSAH there was low functional residual lung capacity and high intraalveolar volume in end expiration positive pressure. The above changes may cause fatigue and weakness of the respiratory muscles and alter intracardiac hemodynamics. CONCLUSION: For CHF patients it is recommended to perform CPAP-therapy in sleep.     

呼吸机辅助下手术治疗阻塞性睡眠呼吸暂停低通气综合征疗效分析

目的:阻塞性睡眠呼吸暂停低通气综合征患者通过术前应用呼吸机治疗,然后进行手术,对患者获得的手术效果进行评价分析。方法:选取2017年1月至2020年1月到重庆市綦江区人民医院收=治的阻塞性睡眠呼吸暂停低通气综合征患者60例作为研究对象,随机分为观察组和对照组,每组30例。对照组通过常规手术进行治疗,观察组在对照组患者的基础之上通过呼吸机辅助治疗,对2组患者的睡眠紊乱指数、嗜睡程度评分、夜间平均氧饱和度、夜间最低氧饱和度以及治疗总有效率进行比较,从而对呼吸机辅助治疗的治疗效果进行研究。结果:观察组患者的睡眠紊乱指数、嗜睡程度评分、夜间平均氧饱和度、夜间最低氧饱和度分别为:(12.1±0.8)%,(97.9±0.9)%、(89.6±3.6)%、(17.2±2.0)%;对照组患者的睡眠紊乱指数、嗜睡程度评分、夜间平均氧饱和度、夜间最低氧饱和度分别为:(15.6±2.6)%,(90±3.2)%,(75.4±6.8)%,(40.3±5.8)%,2组比较差异有统计学意义(P<0.05);观察组患者的治疗总有效率为90.0%,高于对照组患者的70.0%,差异有统计学意义(P<0.05)。结论:阻塞性睡眠呼吸暂停低通气综合征患者通过呼吸机辅助手术治疗,治疗效果明显,患者睡眠质量得到明显提高,值得推广应用。     

睡眠呼吸暂停综合征病人夜间监测的护理

[目的]探讨睡眠呼吸暂停综合征监测的护理措施.[方法]回顾性分析62例潜在睡眠呼吸障碍病人采用多导睡眠仪进行夜间监测的临床资料.[结果]本组监测显示,单纯打鼾6例,阻塞性睡眠呼吸暂停综合征37例,中枢性睡眠呼吸暂停综合征1例,混合性睡眠呼吸暂停综合征(低通气与阻塞性)16例,2例因监测中病情变化终止监测,转送病房治疗后康复出院.[结论]加强睡眠呼吸暂停综合征夜间监测的护理是减少睡眠呼吸暂停综合征病人危险因素及顺利完成监测的重要措施.     

Peripheral arterial tonometry, oximetry and actigraphy for ambulatory recording of sleep apnea

Autonomous nervous functions change with sleep stages and show characteristic changes associated with sleep disorders. Therefore, continuous monitoring of autonomous nervous functions during sleep can be used for diagnostic purposes. Recently, the peripheral arterial tonometry (PAT) has been introduced to determine peripheral arterial vascular tone on the finger being determined by sympathetic activity. We investigate a new ambulatory recording system which uses PAT, oximetry and actigraphy (Watch-PAT) in order to detect sleep apnea and arousal. The Watch-PAT is battery operated and attached to the wrist and has two finger sensors. Twenty-one patients with suspected sleep apnea were recorded with cardiorespiratory polysomnography and the new system in parallel. Seventeen recordings could be evaluated. The correlation for the apnea/hypopnea index derived from the sleep laboratory and the respiratory disturbance index derived from the Watch-PAT was r = 0.89 (p < 0.01) and between arousals and the respiratory disturbance index was r = 0.77 (p < 0.01). The correlation for the total sleep time compared between the two systems was r = 0.15 (n.s.). The Watch-PAT detects apneas and hypopneas with a reasonable reliability and it is very sensitive to arousals. The number of Watch-PAT events lies between the sum of apneas plus hypopneas and arousals. Arousals are not unique to apnea events and therefore the specifity of the Watch-PAT is limited. In conclusion, the Watch-PAT is well suited to perform therapy control studies in patients suffering from sleep apnea and being treated.     

Obstructive sleep apnea--a risk factor for arterial hypertension

Obstructive sleep apnea is frequently found in middle-aged men. Usually, these patients are obese and therefore predisposed to hypertension. This study aimed to elucidate the relationships between hypertension, obesity and obstructive sleep apnea in 48 men suffering from sleep apnea. Hypertension was found in 39 of them (= 81%), 27 patients (= 56%) were morbidly obese (Broca index above 125%), 17 patients (= 36%) were moderately obese (Broca index between 100 and 125%) and 4 patients (= 8%) showed normal weight (Broca index below 100%). Severity of sleep apnea did not correlate with obesity or hypertension. Patients with sleep apnea who were hypertensive were significantly (p less than 0.025) more obese than those with normal blood pressure. Compared with an unselected population showing a similar degree of obesity, patients with obstructive sleep apnea showed a higher prevalence of hypertension and this is independent of age. These findings establish sleep apnea as a risk factor for hypertension.     

阻塞性睡眠呼吸暂停低通气综合征并新诊断的高血压手术治疗后血压变化观察

目的观察阻塞性睡眠呼吸暂停低通气综合征（OSAHS）合并新诊断高血压病患者手术治疗后血压的变化情况。方法选择2012年9月至2014年3月在甘肃省人民医院鼾病科手术治疗的OSAHS合并新诊断的高血压病患者102例,分别行鼻中隔黏膜下矫正术、鼻内镜下鼻窦开放术、鼻息肉摘除术、腭咽成形术,术前及术后3、6个月进行多导睡眠监测、24 h动态血压监测、胸部X线摄片、纤维鼻咽镜等检查;观察术后3、6个月的血压变化。结果手术治疗后3、6个月患者体质指数（BMI）无明显变化,呼吸紊乱指数（AHI）和平均呼吸暂停时间较术前均显著下降,平均血氧饱和度（Sp O2）较术前显著升高（P均〈0.05）。手术治疗后3、6个月患者静息状态下的收缩压和舒张压、全天平均收缩压和舒张压、白天平均收缩压和舒张压、夜间平均收缩压和舒张压均较术前下降（P均〈0.05）,其中夜间平均收缩压和平均舒张压的下降更明显。静息状态下的收缩压和舒张压、平均收缩压和舒张压在术后3个月和6个月之间比较差异无统计学意义（P均〉0.05）。所有患者在手术治疗后的静息状态下血压恢复正常58例,缓解率为56.9%。结论 OSAHS相关高血压患者术前综合评估,确定个体化术式,术后辅助综合治疗,可收到良好降压效果。     

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).     

Obstructive sleep apnea: clinical significance and correlations with arterial hypertension

Obstructive sleep apnea (OSA) occurs rather frequently. It often combines with arterial hypertension (AH) and contributes to development and course of such severe conditions as stroke, myocardial infarction, arrhythmia, sudden death in sleep. Lack of adequate knowledge of relevant symptoms, cause-effect relationships leads to mistakes in management of patients. AH patients with OSA should receive combined treatment including hypotensive drugs and correctors of sleep respiratory disorders.     

Relationship among the severity of sleep apnea syndrome,cardiac arrhythmias,and autonomic imbalance

The relationship between obstructive sleep apnea syndrome (OSAS), cardiac arrhythmias, and conduction disturbances in adults remains controversial. Early studies showed a higher prevalence than more recent and designed epidemiological studies. To clarify the actual prevalence of cardiac arrhythmias and conduction disturbances in patients referred for assessment of OSAS, a prospective cohort study was conducted: 147 consecutive patients (103 men; mean age of 54.5 +/- 10.7 years) underwent time-synchronized polysomnography and ECG Holter monitoring. OSAS was diagnosed in 66 (44.9%) of them based on an apnea hypopnea index (AHI) > or = 10. Prevalence of heart failure, of prior myocardial infarction, of hypertension, and of ventricular arrhythmias were similar in patients with or without OSAS. Nocturnal paroxysmal asystole was significantly more prevalent in OSAS patients (10.6 vs 1.2%; P < 0.02) and the number of episodes of bradycardia and pauses increased with the severity of the syndrome. Almost all bradycardic events occurred in patients with severe OSAS (AHI > 30), prolonged periods of arterial oxyhemoglobin desaturation, and low diurnal awake PaO2. Moreover, using heart rate variability analysis, nocturnal sinusal dysfunction contrasted with a blunted diurnal parasympathetic modulation of the sinus node. Frequent nocturnal nonsustained supraventricular tachycardias were predominantly found in patients with severe sleep related breathing disorders; however, an increased risk of ventricular arrhythmias was not found. Under continuous positive airway pressure treatment, the 1-year follow-up of OSAS patients with nocturnal pauses did not reveal any arrhythmic event justifying a specific intervention.     

高血压合并阻塞性睡眠呼吸暂停低通气综合症联合治疗的疗效观察

目的：抗高血压药物、经鼻持续气道正压通气（nCPAP）联合治疗高血压合并阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者，评价联合治疗是否优于药物治疗。方法：72例合并OSAHS的高血压患者随机分为治疗组和对照组各36例：治疗组在常规抗高血压药物治疗的同时进行nCPAP治疗，对照组仅予常规抗高血压药物治疗。6个月后分析两组治疗前后血压及睡眠呼吸监测参数变化。结果：治疗组收缩压（SBP）、舒张压（DBP）、脉压（PP）、心率（HR）、睡眠呼吸暂停低通气指数（AHI）、最长呼吸暂停时间和最低脉搏容积血氧饱和度与对照组比较差异有统计学意义（P〈0．01）。结论：nCPAP联合抗高血压药物是治疗高血压并OSAHS患者的一种有效方法。     

中等强度有氧运动对难治性高血压合并阻塞性睡眠呼吸暂停综合征患者的影响

目的:探讨中等强度有氧运动对难治性高血压并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者的影响。方法:选取难治性高血压并OSAHS患者60例。采用多导联睡眠呼吸监测分析系统进行夜间7 h连续监测。根据睡眠呼吸暂停低通气指数(AHI)将入选患者分为非OSAHS组(A组)、轻度OSAHS组(B组)、中度OSAHS组(C组)及重度OSAHS组(D组),并实行中等强度有氧运动,每周训练5次,共持续8周。比较干预前后血压、AHI及体质量指数(BMI)变化。结果:经中度有氧运动干预8周后,各组患者舒张压、收缩压、BMI均较干预前降低(P0.05);与干预前相比,干预后A组AHI无明显变化(P0.05);轻度、中度及重度OSAHS组AHI均降低(p0.05)。收缩压与AHI、BMI三者间呈正相关,舒张压与AHI相关性不强(r=0.211,P=0.021),舒张压与BMI无明显相关(r=0.046,P=0.617)。结论:中等强度有氧运动能够改善难治性高血压并OSAHS患者血压和通气功能,是难治性高血压合并OSAHS的潜在治疗手段之一。     

Sleep-Disordered Breathing in Recipients of Implantable Defibrillators

Study Objectives: To examine the prevalence and clinical significance of sleep-disordered breathing in patients with implantable cardioverter defibrillators (ICD).
Methods and Results: Overnight sleep studies were performed in 129 ICD recipients who had no history of sleep apnea. The mean left ventricular ejection fraction (LVEF) was 29 ± 11%. Mild, moderate, and severe sleep apnea was diagnosed in the presence of an apnea/hypopnea index (AHI) of 5–15/h, 15.1–30/h, and >30/h, respectively. No sleep apnea was present in 49 patients (38%), 57 (44%) had central sleep apnea (CSA), and 23 patients (18%) had obstructive sleep apnea (OSA). Mild, moderate, and severe sleep apnea were present in 25%, 31%, and 44% of patients with CSA, compared with 52%, 22%, and 26% of patients with OSA (P < 0.05). LVEF was similar in patients with versus without OSA or CSA. Patients with CSA were significantly older and had a higher prevalence of ischemic cardiomyopathy than patients without sleep apnea.
Conclusions: Previously undiagnosed CSA is common in ICD recipients. Severely disordered breathing during sleep was more prevalent among patients with CSA than patients with OSA. This prospective, observational study will examine the long-term clinical significance of sleep-disordered breathing in ICD recipients.     

Clinico-genetic aspects of the hypotensive response and regression of left ventricular hypertrophy in arterial hypertension patients

AIM: To study clinicogenetic determinants of left ventricular hypertrophy (LVH) regress in 52-week antihypertensive therapy to achieve the target arterial pressure (AP) < 140/90 mm Hg. MATERIAL AND METHODS: I/D-polymorphism of angiotensin converting enzyme gene, T174M-polymorphism of angiotensinogen gene, A1166C-polymorphism of angiotensin II ATI-receptor gene (ATII), 4a/b-polymorphism of endothelial NO-synthetase gene (eNOS) were determined in 64 patients (24 males, 40 females, mean age 54 +/- 1.1 years) with arterial hypertension (AH) and LVH. Echocardiography, laboratory tests, clinical measurements of blood pressure (BP) and 24-h AP monitoring were made after 4 weeks of placebo and 52 weeks of treatment. RESULTS: Baseline values of LV myocardium mass index (LVMMI) correlated significantly with mean 24 hour and night systolic arterial pressure; 24-h, day and night pulse pressure (PP). In patients with regress of LVH the degree of LVMMI reduction significantly correlated with lowering of day and night PP, baseline level of neutrophils, uric acid and creatinine 52 weeks after treatment. Groups made by polymorphism, did not significantly differ by initial LVMMI, frequency of achievement of target AP. In patients with genotypes ID/II and aa, the level of achieved diastolic arterial pressure was significantly lower than in other groups. Resistant LVH was seen in 42.2% patients. Frequency of AP normalization was higher in the group of patients with LVH regress (48.6% vs 25.9%; p < 0.05). Resistant LVH occurred more frequently in patients with genotype DD (64.0 vs 28.2% in patients with II/ID, p < 0.05) and in patients with genotype 4ab (62.9 vs 30.4% in patients with genotype aa and 21.4%--with genotype bb; p < 0.05 in both cases). In patients with resistant LVH frequency of DD genotype increased (59.3 vs 24.3% in patients with regress of LVH; p < 0.01), genotype AA (74.5 vs 48.6%; p < 0.01) and genotype ab (63.0 vs 27.0%, p < 0.01). CONCLUSION: Regress of LVH in AH patients depends on dynamics and complex interactions of some hemodynamic, laboratory and genetic parameters.     

Significance of pharmacological blockade of angiotensin II type I receptors for correction of abnormal 24-hour blood pressure profile depending on its variability in patients with arterial hypertension stage II

AIM: To specify variable 24-h arterial hypertension (AH) stage II profile and to assess significance of pharmacological block of the end of the renin-angiotensin-aldosteron system for correction of the determined disorders. MATERIAL AND METHODS: The study was made of 46 men (mean age 42.8 +/- 3.28 years) with stage II AH and 25 normotensive controls (mean age 39.2 +/- 3.10 years). Depending on the magnitude of mean 24-h AP variability (APV), hypertensive patients were divided into two groups. Variability of systolic and/or diastolic AP (SAPV and DAPV, respectively) was considered high in at least 15.2 and/or 12.3 mm Hg variability, respectively, and normal at less values. RESULTS: AP 24-h profile in men with AH stage II and high APV compared to patients with normal APV is characterized by higher frequency of AP rise and less frequency of its night fall. In patients with high APV the drug eprosartan (teveten) is more effective in correction of hypertension and night fall of AP. CONCLUSION: Eprosartan has an adequate corrective activity in relation to absolute values of SAP and DAP in different hours. The highest hypotensive activity of the drug was seen in persons with initially high circadian AP variability within 24 hours.