Vegetative regulation of arterial pressure in patients with arterial hypertension and non-insulin-dependent diabetes mellitus (NIDDM)

72 patients with NIDDM (duration 5.3 +/- 3.1 years) aged 41-60 years were examined. They had also mild or moderate hypertension (duration 12.1 +/- 4.5). Control groups consisted of 15 NIDDM patients free of hypertension, 15 hypertensive patients without diabetes, 15 healthy subjects. All the patients have undergone 24-h monitoring of arterial pressure (APM) and computed cardiointervalography (CIG). As shown by CIG, hypertensive patients with NIDDM had sympathotonia which resulted from hypofunction of parasympathetic and hyperfunction of the sympathetic nervous systems. APM demonstrated enhanced variability of arterial pressure and its inadequate fall at night in patients of this group and normotensive patients with diabetes.     

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.     

Use of nebivolol in patients with mild and moderate hypertension

AIM: To evaluate the effectiveness and safety of the beta-adrenoblocker nebivolol in patients with mild and moderate essential hypertension. MATERIAL AND METHODS: The trial enrolled 20 patients. 11 of them had mild and 9 moderate arterial hypertension (mean age 47.1 +/- 9.52 years, hypertension history 6.98 +/- 2.75 years). 2-5 days after discontinuation of hypotensive drugs the examination was made including blood count, ECG, echocardiography, 24-h AP monitoring. It was repeated on days 56-60 of nebivolol therapy. Arterial pressure and heart rate were measured at the start of the treatment and 1, 3, 5 and 8 weeks later. RESULTS: Nebivolol treatment significantly reduced systolic arterial pressure in 30% and diastolic arterial pressure in 50% patients, heart rate decreased on the treatment day 7-10. On the treatment day 56-60 systolic and diastolic pressure lowered significantly in 53.3% and 66.7% patients, respectively. The analysis of changes in echocardiographic evidence found no significant shifts in volume and linear parameters. Nebivolol was well tolerated by 85% patients. Side effects included head ache, cardialgia, dizziness, weakness and nausea. CONCLUSION: Nebivolol (nebilet) is an effective hypotensive drug with mild side effects. Further studies on nebivolol effects on myocardial mass are needed.     

Evaluation of the evenness of the antihypertensive effect of losartan and captopril by using a 24-hour monitoring of arterial pressure

AIM: To investigate 24-h evenness of an antihypertensive effect of angiotensin II receptor blocker losartan vs captopril by four parameters of arterial pressure (AP) monitoring. MATERIAL AND METHODS: An open, cross-over, placebo-controlled trial was made in 22 patients with mild/moderate arterial hypertension (AH). Four parameters of AP monitoring were assessed: TPR, SI, rate of AP morning rise, index of AP morning rise. RESULTS: In losartan treatment TPR for systolic and diastolic AP were 61.5 and 61.3%, respectively, IS made up 0.74 +/- 0.13 and 0.64 +/- 0.09, respectively. For captopril these values reached 21.2 and 26.9%, 0.51 +/- 0.14 and 0.47 +/- 0.10, respectively. Differences by SI between the two drugs were statistically insignificant. Both drugs did not raise the rate and index of AP morning rise significantly. CONCLUSION: When administered in a single daily dose 100 mg, losartan produced a regular antihypertensive effect throughout 24 hours. Captopril (twice a day in a dose 50 mg) effect was not regular enough. This means that some patients need a three-times-a day regimen of captopril. Of the four parameters, SI is most informative for evaluation of antihypertensive effect evenness.     

Daily profile of arterial pressure in patients with arterial hypertension,continuously living in Tyumen polar region

AIM: To study a 24-h profile of arterial hypertension and affection of target organs in hypertensive population of the Tyumen North. MATERIAL AND METHODS: 62 patients (43 men and 19 women, age 18-50 years) with arterial hypertension (AH) living in the North of the Tyumen region entered the test group. The control group consisted of 56 AH patients (36 men and 20 women) matched by age. They lived in the zone of moderate climate (in Tyumen). 24-h arterial pressure (AP) monitoring was made starting on day 2 of the patients' arrival in Tyumen. Echocardiography was made on the arrival day. The examination of the groups was conducted against "clean" background. RESULTS: The groups did not differ significantly by age, sex, AH duration, office systolic and diastolic pressure (SP, DP). However, 37 patients from the test group on arrival in Tyumen showed normalization of both office AP and mean 24-h AP. 25 patients from this group sustained high office and mean 24-h AP. An abnormal 24-h AP profile with nocturnal hypertension was recorded in 76.6% of the test group and 28.31% patients of the control group. Left ventricular hypertrophy was significantly more pronounced in the test group than in the control one. CONCLUSION: In 2/3 patients from the North with AH stage 1 and 2 office AP and mean 24-h AP normalized upon their arrival to the zone of moderate climate but their left ventricular hypertrophy was more severe and changes in a 24-h AP profile with nocturnal hypertension persisted.     

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.     

Complex assessment of efficacy and tolerance of metoprolol CR/ZOK in treating hypertension

AIM: To study efficacy and tolerance of betaloc ZOK (Astra-Zeneca, UK) in patients with stage I-II (WHO classification) essential hypertension. MATERIAL AND METHODS: 27 patients were enrolled in the study (13 men and 14 women, mean age 40.6 +/- 1.57 years). Complete physical examination, ambulatory blood pressure monitoring, assessment of central hemodynamics, microcirculation were made before the treatment and on the treatment week 8. RESULTS: Monotherapy with betalok ZOK (50-100 mg/day) resulted in a significant lowering of mean daily, day and night systolic and diastolic arterial pressure. Variability index was reduced, circadian rhythm of blood pressure did not change. 28% had to take diuretics (arifon or hypotiazide). CONCLUSION: Betaloc ZOK (50-100 mg) is highly effective in patients with mild to moderate essential hypertension.     

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.     

Comparative anti-hypertensive effectiveness and tolerance of drugs in patients with mild and moderate arterial hypertension

120 patients with mild and moderate arterial hypertension were treated outpatiently for 6 weeks with dilren (group 1), norvask (group 2), invoril (group 3) and caposide (group 4). Each group consisted of 30 patients. The drugs were given in doses: 300 mg/day, 5-10 mg/day, 10-20 mg/day and 1 tablet a day (50 mg capoten + 25 mg hydrochlortiaside), respectively. Arterial pressure was measured by patients in the morning and in the evening. A complete hypotensive response (AP < 140/90 mm Hg) to dilren was achieved in 25(83.3) patients, norvask in 22(73.3%), invoril in 18(60%), caposide in 13(43.3%) patients. The other 45(37.5%) patients responded partially. Side effects occurred in 31(25.8%) of 120 patients. In caposide, norvask, invoril and dilren treatment they were recorded in 9(30.3%), 8(26.7%), 8(26.7%) and 6(20%) patients, respectively. 11 patients withdrew because of side effects. Thus, dilren (300 mg/day), norvask (5-10 mg/day) and invoril (10-20 mg/day) are effective and safe in mild and moderate arterial hypertension. Caposide (1 tablet a day) failed to provide an adequate fall in arterial pressure throughout 24 hours.     

Clinico-functional evaluation of hypotensive effect of carvedilol in elderly patients with mild and moderate arterial hypertension

AIM: To study a hypotensive activity of carvedilol (dilatrend, Beringer Mannheim GMBH), its influence on 24-h profile of arterial pressure (AP), baroreceptor control of BP and vegetative regulation of the heart in elderly patients with mild and moderate arterial hypertension (AH). MATERIAL AND METHODS: A 3-week monotherapy with carvedilol in a single dose 25 mg/day was conducted in 47 elderly patients with mild or moderate isolated systolic or essential hypertension. The effect of the treatment was assessed by the data of synchronous 24-h monitoring of blood pressure (BP), ECG, by variability of the cardiac rhythm (Cardio Tens, Cardio Tens 01, Meditech, Hungary), baroreceptor regulation of BP (the study of synocarotid areas by the method of "cervical" camera). RESULTS: Carvedilol produced a positive trend in the clinicofunctional indices of the circulation. The hypotensive effect lasted 24 hours in 78.8% of the examinees. The drug had no negative effect on the circadian rhythm of AP, is active early in the morning, did not induce a rise in the hypotonic load or diagnostically significant deviation of ST segment, reduced AP variability, improved vegetative and baroreceptor regulation of blood circulation. CONCLUSION: Carvedilol in a dose 25 mg/day is an effective monotherapy of mild and moderate AH in elderly patients.     

Use of phisiotens for the treatment of arterial hypertension in elderly patients

AIM: To study effectiveness and safety of physiotens in elderly patients with essential hypertension (degree 1-2). MATERIAL AND METHODS: The trial enrolled 10 patients (6 males and 4 females) at the age of 60 to 75 years (mean age 66.4 +/- 3.7 years) with untreated or ineffectively treated essential hypertension (degree I-II by WHO classification). The disease stood for 17 +/- 5.3 years. Physiotens was given for 2 weeks in a single daily dose 0.2-0.4 mg. 24-h blood pressure monitoring, standard neuropsychological examination, echoCG, assessment of quality of life (Visual Analog Scale, Disability Scale) were performed before and after the treatment. RESULTS: Physiotens significantly reduced systolic and insignificantly diastolic pressure in daytime and at night; improved memory and thinking; 24 weeks of the treatment led to a decrease in left ventricular myocardium mass (by 13%, on the average) and in the thickness of left ventricular walls (by 7% on the average) as well as in life quality. CONCLUSION: Long-term physiotens treatment of elderly patients with mild and moderate hypertension provides a fall in day and night arterial pressure, regression of left ventricular myocardium mass, improves quality of life, memory and thinking.     

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.     

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.     

Comparative effects of amlodipine (stamlo) and enalapril (enam) on arterial pressure, painless myocardial ischemia and diastolic function of left ventricle in patients with arterial hypertension

43 patients with mild and moderate arterial hypertension received monotherapy with either stamlo (Dr. Reddy's laboratories, India) in a daily dose 9.5 +/- 0.5 mg (n = 33), or enam (n = 26) in a daily dose 28 +/- 1.5 mg, or stamlo treatment was followed in 10 days by enam (n = 16). Before and after the treatment 24-h monitoring was made of arterial pressure, left ventricular diastolic function and silent myocardial ischemia. Adequate lowering of arterial pressure was observed in 90 and 77% of patients after stamlo and enam treatment, respectively. Stamlo showed more potent antiischemic action and had a positive effect on left ventricular filling.     

Thiaside diuretics in combination with inhibitors of angiotensin-converting enzyme in patients with diabetes mellitus type 2 comorbid with arterial hypertension

AIM: To study the effect of co-renitek monotherapy for 16 weeks on parameters of 24-h monitoring of arterial pressure, carbohydrate, lipid, purin metabolism in patients with mild and moderate arterial hypertension (AH) and diabetes mellitus (DM) type 2. MATERIAL AND METHODS: 20 patients with DM type 2, mild or moderate AH received co-renitek (1-2 tablets a day) for 16 weeks. Before the treatment and 16 weeks later the patients were examined (24-h AH monitoring, carbohydrate, lipid, purin, electrolyte metabolism). RESULTS: Co-renitek treatment of DM type 2 patients with hypertension led to a significant lowering of mean systolic and diastolic pressure, improvement of 24-h AP profile and reduction of fasting glucose level. Co-renitek proved to be metabolically neutral in relation to lipid, purin and electrolyte metabolism. CONCLUSION: Co-renitek is effective and safe antihypertensive drug for treatment of arterial hypertension in patients with diabetes mellitus type 2.     

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.     

Circadian rhythms and seasonally dependent variability of arterial pressure in patients with arterial hypertension in the Khanty-Mansiysky region

Key parameters of 24-h blood pressure monitoring (BPM) in 46 18-50-year-old patients (men and women) with arterial hypertension (AH) stage I, II and 33 healthy persons living in the Tyumen North (Khanty-Mansiysky Region, the town of Nyagan) were investigated. The comparison group consisted of 55 patients with AH stage I, II and 33 healthy persons living in moderate climate (Tyumen) matched by sex, age, duration of AH, office systolic and diastolic arterial pressure (SAP, DAP). General patterns of 24-h and seasonal rhythms of AP fluctuations in healthy northerners and citizens of moderate climatic zone and mismatch of these rhythms in AH patients more evident in the northerners are shown. Paired correlations were obtained which indirectly confirm the priority role of daily AP rhythm in development of visceral lesions irrespective of the season of the year and climatic load. In the North, when winter meets spring, a surge of SAP, DAP and mean AP occurs as well as an increase in heart rate, number of patients with disturbed circadian profile of AP. In moderate climate these changes are more typical for summer period. The results of the study necessitate design of programs of additional pharmacological and preventive measures for hypertensive northerners with consideration of AP seasonal rhythms and climatic load.     

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.     

On the issue of the diagnosis "boundary arterial hypertension"

Many-year observation of patients with arterial hypertension revealed that late diagnosis of the initial stage of the disease was typical. Time elapsed from the first medical record of an arterial pressure (AP) of higher than 140/90 mmHg to the moment the diagnosis of arterial hypertension was made was 4.5 +/- 1.6 years in 16 out of the 198 subjects. The authors offer new criteria for the diagnosis of boundary arterial hypertension based on 24-hour AP monitoring (unfavorable type of 24-hour AP profile) and veloergometry (hypertensive response to physical load). Active screening for boundary arterial hypertension based on instrumental examination is recommended, and an algorithm for its search is offered.     

Lipid and non-lipid effects of enduracin in patients with arterial hypertension]

AIM: To analyze lipid and non-lipid effects of 6-month administration of enduracine in patients with marked dislipoproteinemia suffering from arterial hypertension with ischemic heart disease or without it. MATERIALS AND METHODS: 40 hypertensive patients (27 males and 13 females, mean age 52.43 +/- 1.68 years) entered the study of enduracine effects. Most of them received enduracine for 6 months in a dose 1500 mg/day. Lipids levels were measured in all the patients. Blood flow along major brain arteries was determined at transcranial dopplerography in 23 patients. RESULTS: A 6-month course of enduracine in a dose 1500 mg/day promoted normalization of serum lipid spectrum, vascular tonicity and reactivity of cerebral arteries, produced a mild hypotensive effect. CONCLUSION: Endurance (a long-acting form of nicotinic acid) has favourable lipid and non-lipid effects in patients with dislipoproteinemias and arterial hypertension in the presence or absence of ischemic heart disease.