[The efficiency of combinations of Enalapril and long-acting Nifedipin and Moxonidine in patients with arterial hypertension and a metabolic syndrome].

The aim of the study was to obtain a comparative evaluation of antihypertensive efficacy, tolerability and influence of combine therapy on myocardium mass, diastolic function of a left ventricle, lipid and carbohydrate exchange in patients with arterial hypertension in metabolic syndrome. Out of 40 examined cases 20 patients took enalapril and long-acting nifedipin and 20 ones--enalapril and moxonidine. All examination were been performed before administration of drugs and 6 months after the therapy. The dynamics of indices of ambulatory blood pressure monitoring, echocardiography, cycle ergometry, anthropometry, lipid, carbohydrate exchange and tolerability of conducted therapy was been evaluated. The use of this combination of the drugs may be recommended to be included in the treatment of arterial hypertension within the bounds of metabolic syndrome, as in most of cases they promote an achievement of target blood pressure level, have a cardioprotective action, high tolerability and favorable metabolic profile. The combination of enalapril and long-acting nifedipin has a more evident antihypertensive activity but a therapy with enalapril and moxonidine has a positive effect on the indices of carbohydrate exchange.

[The influence of antihypertensive agents on plasmatic and vascular-thrombocytic homeostasis in metabolic syndrome].

The combined therapy with enalapril and prolonged-release verapamil, as well as with enalapril and moxonidine significantly increases the level of antiatherogenic high-density-lipoprotein cholesterol, reduces the atherogenicity coefficients, decreases the concentrations of glucose, glycosylated hemoglobin, and soluble fibrinmonomeric complexes and the aggregation activity of thrombocytes, activates plasminogen in the blood of patients under conditions of metabolic syndrome with arterial hypertension. At the same time the enalapril monotherapy has no significant influence on the parameters of lipid and carbohydrate metabolism and the plasmatic and vascular-thrombocytic homeostasis.

[Propranolol treatment of effort angina in patients with arterial hypotension]. / Pripranolol pri lecheniii stenocardii napriazheniia u bol'nykh arterial'noi gipotoniei.

AIM: To compare antianginal efficacy and tolerability of propranolol therapy in patients with stable angina pectoris and chronic hypotension (Hpts) and normotensive patients with angina of effort (Npts). MATERIAL AND METHODS: A randomized, single-blind, placebo-controlled study was made in 35 Hpts and 38 Npts was made using bicycle exercise tests, echocardiography, stress myocardial scintigraphy with 77-199. RESULTS: Acute bicycle exercise tests showed high anti-ischemic activity of propranolol in 86% Hpts and 65% Npts. Stable antianginal propranolol effect in 57% Hpts was accompanied with a decrease of myocardial perfusion defect. Secondary resistance or pseudotolerance to an antianginal effect of propranolol was observed in 43% Hpts in 4-12 weeks (vs 0 of Npts; p < 0.01) as evidenced by T-199 stress myocardial scintigraphy. Hpts with secondary resistance and pseudotolerance to propranolol had lower control hypotension and bradicardia (p < 0.05), more anginal attacks (p < 0.001). CONCLUSION: Hpts had rapidly developing secondary resistance and pseudotolerance to propranolol antianginal effect, bad tolerability of the drug.

[Diltiazem and verapamil therapy in patients with angina pectoris associated with arterial hypotension]. / Terapiia diltiazemom i verapamilom u bol'nykh stenokardiei na fone arterial'noi gipotonii.

A randomized blind cross-over study with placebo lead-in compared efficacy of calcium antagonists diltiazem and verapamil in 71 patients with stable angina concurrent with arterial hypotension (group 1) and 38 normotensive patients with ischemic heart disease (group 2). By acute bicycle exercise test evidence, verapamil was effective in 80% and 82% patients of group 1 and 2, respectively, dilitiazem--in 67 and 77%, respectively. Cumulation of the effect (p < 0.01) to the third month of verapamil course was comparable in both groups. Tolerance to an antianginal effect of dilitazem developed in 53% patients of group 1 (against 30% in group 2, p < 001) in 2-4 weeks of therapy (against 4-12 weeks in group 2, p < 0.05). By stress 199-T1 scintigraphy of the myocardium, administration of effective doses of diltiazem reduced the number of hypoperfused segments by at least 30%.

[Nitrates in therapy of effort angina in hypotensive patients]. / Nitraty v terapii stenokardii napriazheniia u bol'nykh s arterial'noi gipotenziei.

A randomized single blind cross-over trial with placebo lead-in has been conducted in 71 anginal patients with arterial hypotension (group 1) and 38 ischemic heart disease patients with normal arterial pressure (group 2) to compare efficacy of therapy with isosorbide dinitrate (ID), sustac-forte (SF), isosorbide dinitrate retard (IDR) and trinitrolong (TN). Paired bicycle exercises revealed that in group 1 patients ID was low effective in 49%, SF--in 61%, IDR was highly effective in 97% and TN--in 96%. In group 1 tolerance to antianginal effect of ID, SF and IDR shown by stress myocardial scintigraphy with Tl-199 developed earlier--in 2-4 weeks in 63-70% patients (versus 22-27% in group 2; p < 0.01). Recovery of ID, SF, IDR effect required prolongation of the drug withdrawal period to 8-16 days (versus 3-5 days in group 2; p < 0.05). TN therapy remained effective for 3 months. Resistance to ID, SF in group 1 was relative and depended on dosage form of nitrates.

[Long-acting isosorbide dinitrate and molsidomin in the treatment of effort angina in patients with arterial hypotension]. / Izosorbida dinitrat i molsidomin prolongirovannogo deistviia pri lechenii stenokardii napriazheniia u bol'nykh s arterial'noi gipotoniei.

AIM: To compare effectiveness and tolerance of isosorbide dinitrate (ID) and molsidomin in retard forms in patients with effort angina (EA) in combination with arterial hypotension (AH). MATERIAL AND METHODS: A randomised blind cross-over trial with lead-in placebo period trial compared efficiency of retard ID and molsidomin in 65 EA patients with AH (group 1) and 40 normotensive patients with coronary heart disease (group 2). RESULTS: Bicycle exercise has shown that retard ID and molsidomin retard were highly effective in group 1 (97% vs 92% 0 and group 2 (100 and 95%, respectively). Molsidomin retard treatment improved myocardial perfusion and was effective for a year in both groups. CONCLUSION: Retard ID was highly effective in anginal patients with AH but its tolerance is also high. Molsidomin retard is proposed as alternative treatment in anginal patients with AH.

[The comparison of the efficacy of atenolol and isosorbide dinitrate therapy in chronic hypotension patients with stable angina pectoris]. / Sravnenie éffektivnosti terapii atenololom i izosorbida dinitratom u bol'nykh so stenokardiei napriazheniia v sochetanii s arterial'noi gipotenziei.

Antianginal efficacy of atenolol (A) and isosorbide dinitrate (ID) was compared in a long-term randomized, single-blind, crossover, placebo controlled trial in 71 patients with combined stable angina pectoris and chronic hypotension (Hpts) and in 38 normotensive patients with angina of effort (Npts). Paired bicycle tests showed anti-ischemic activity of drugs: A in 75% and ID in 49% of Hpts, A in 83% and ID in 82% of Npts. Antianginal effect of 25 mg A was observed in 49% of Hpts (vs 6% of Npts; p < 0.01). Secondary resistance to A effect was developed on the treatment week 2-4 in 13% of Hpts (vs 0 in Npts) tolerance to ID effect--on week 1-2 in 71% of Hpts (vs 15% of Npts; p < 0.01) as evidenced by T1-199 exercise myocardial scintigraphy. Hpts needed individual ID therapy with a long-term ID-free period during 8-16 days (vs 3-5 in Npts; p < 0.05) to avoid tolerance. Stable antianginal ID effect manifested with a decrease of myocardial perfusion defect size by 43.1 +/- 1.3% (p < 0.05).

[Effect of nifedipine (corinfar) on cerebrovascular circulation in patients with exertion-induced stenocardia]. / Vliianie nifedipina (korinfara) na mozgovoe krovoobrashchenie u bol'nykh so stenokardiei napriazheniia.

Headache as a side effect of corinfar treatment courses for angina of effort was more commonly seen in patients with pretreatment dystonic rheoencephalographic changes. A single corinfar dose produced a drop of venous tone. Corinfar-associated headache was less common in patients after long-term treatment with high-dose nitroglycerin.

[Late complications of VVI electric stimulation in patients with sick sinus syndrome]. / Oslozhneniia élektrostimuliatsii v rezhime VVI u bol'nykh s sindromomslabosti sinusovogo uzla v otdalennom periode.

Forty-nine patients, including 38 with documented bradysystolic sick-sinus syndrome (type I) and 11 with bradytachycardiac sick-sinus syndrome (type II) were studied. Follow-up of 24 patients with VVI stimulation (34 +/- 4 months) and 7 patients with AAI stimulation (23 +/- 1.2 months) demonstrated that VVI stimulation was associated with retrograde ventriculo-atrial conduction in 71% of patients, causing paroxysms of atrial fibrillation (5 patients, 4 of those having type I sick-sinus syndrome). Six patients developed permanent atrial fibrillation (including 5 with type I sick-sinus syndrome). Retrograde conduction slowed down the pulse rate because of ineffective ventricular response in 6 patients. Nine patients with retrograde conduction developed circulatory insufficiency.