[Affection of target organs in hypertensive patients with and without metabolic syndrome].

AIM: To study damage to the heart, kidneys and vessels in patients with arterial hypertension (AH) of different severity with and without metabolic syndrome. MATERIAL AND METHODS: The trial enrolled 303 patients with AH of the first-third degree aged 25-70 years (mean age 52 +/- 18 years), 110 males and 193 females. The patients were matched by sex and age. All the patients were divided into two groups: group 1 (n = 151) without metabolic syndrome (MS) and group 2 (n = 152) with MS. The following parameters were studied: lipid spectrum, blood glucose, glomerular filtration rate, MAU, data of 24-h blood pressure monitoring, echocardiography, Doppler ultrasonography of the brachiocephalic arteries. RESULTS: Early AH was accompanied with diastolic LV myocardial dysfunction, subnormal glomerular filtration rate and the presence of MAU. In AH of the second degree there was LV remodeling. In AH of the third degree left ventricular myocardial mass (LVMM) and thickness of intima-medial complex (TIM) were increased. Close correlations were found between the disturbance of diastolic function and MAU, thickness of interventricular septum and thickness of the inferior wall and LVMM index with MAU. Less manifest correlation existed between diastolic dysfunction and TIM, thickness of the interventricular septum and thickness of the inferior wall and TIM. CONCLUSION: The presence of metabolic syndrome contributes to earlier and more serious damage of the target organs in patients with arterial hypertension.

[Heart rate variability dynamics during treatment of arterial hypertension].

UNLABELLED: Investigation of the dynamics of heart rate variability (HRV) in anti-hypertension therapy can facilitate the evaluation of the effectiveness of treatment. AIM OF INVESTIGATION: to compare anti-hypertension effect of monotherapy with nebivolol and dilatrend with dynamics of HRV and the estimation of the state of patients with mild arterial hypertension (AH) and metabolic syndrome (MS). MATERIAL AND METHODS: HRV was studied in 42 patients with mild AH and MS at the age of 32-60. Eighteen of them were treated with 5 mg of nebivolol during 24 weeks, and twenty-four with 25-50 mg of dilatrend during 16 weeks. All the patients were subjected to 24-hour ECG monitoring with analysis of HRV and arterial pressure (AP) before and after treatment. The main feature of HRV analysis was investigation of dependence of sinus arrhythmia on the mean value of heart rate (HR) RESULTS: With nebivolol treatment AP decreased in 11 patients, HRV became better in 9 patients. 7 cases manifested coincidence of AP reduction and HRV improvement. In 6 cases out of 7 when AP did not decrease, HRV did not change. Worsened HRV was observed in 3 cases: in one case with growing AP and in 2 cases with decreasing AP. All the patients, except one, regarded their state as improved. With dilatrend treatment AP lowered in 16 cases. In 9 cases HRV became better, in 11 cases it remained the same, and in 4 cases it became worse. Positive HRV dynamics in 7 cases out of 9 was accompanied by lowering of AP, while negative dynamics was observed in one case with rise of AP and in three cases with very low AP or in the absence of AP dynamics. 14 patients felt better, 6 of them manifested better level both of AP and HRV. CONCLUSION: The method of 24-hour HRV analysis based on assessment of dependence of the value of sinus arrhythmia on HR is useful in evaluating the effectiveness of anti-hypertension therapy. As a rule, an effective decrease in AP is accompanied with improvement of HRV. The absence of improvement of deterioration of HRV in anti-hypertension therapy is a factor which should be taken into consideration when choosing the mode of therapy.

[The role of psychopharmacotherapy in combined treatment of patients with metabolic syndrome and depression].

AIM: To evaluate efficacy and tolerance of combined treatment with antidepressant cipramil in patients with metabolic syndrome (MS). MATERIAL AND METHODS: We examined 23 MS patients with depression (mean age 47 +/- 7.4 years). For diagnosis and somatic state evaluation we used clinical, device and laboratory tests. The clinicopsychopathological method, MADRS and CGI scales were applied for assessment of mental state and treatment efficacy. RESULTS: We achieved positive effects of 12-week combined somatotropic and psychotropic therapy on carbohydrate metabolism: a significant decrease of fasting blood glucose from 6.6 +/- 1.4 to 6.2 +/- 0.7 mmol and postprandial (2 hours after meal) glucose from 8.6 +/- 1.5 to 7.8 +/- 0.8 mmol/l, of waist circumference from 106.0 +/- 11.93 to 103.5 +/- 12.3 cm, body mass index from 32.5 +/- 4.54 to 31.4 +/- 4.76 kg m2, systolic blood pressure from 154.52 +/- 7.4 to 137.91 +/- 13.8 mm Hg and diastolic blood pressure from 90.1 +/- 6.2 to 81.0 +/- 6.6 mm Hg. A significant change in the levels of total cholesterol and triglycerides was not registered. CONCLUSION: Administration of antidepressant in MS patients relieved depression. This improved carbohydrate metabolism, lowered blood pressure and body mass index.

[The role of telmisartan in the treatment of metabolic syndrome].

AIM: To evaluate telmisartan effects on 24-h blood pressure profile, sensitivity to insulin, carbohydrate and lipid metabolism in patients with metabolic syndrome (MS) and arterial hypertension (AH). MATERIAL AND METHODS: Twenty patients with MS and AH of the degree I-II received telmisartan in a dose 80 mg/day. 24-h BP monitoring, tests for total cholesterol, HDLP, LDLP cholesterol, triglycerides, glucose, glucose tolerance test were made before and 24 weeks after the treatment. RESULTS: Telmisartan reduced all the study parameters of blood pressure, body mass, fasting and post-prandial hyperglycemia, postprandial hyperinsulinemia. Telmisartan raised peripheral tissue sensitivity to insulin, normalized phases of insulin secretion. Total cholesterol, LDLP cholesterol diminished while HDLP went up. CONCLUSION: Telmisartan has a specific ability to partially activate receptors stimulating proliferation of peroxisomes and improve regulation of carbohydrate and lipid metabolism, to reduce body mass.

[Metabolic syndrome diagnosis in patients with arterial hypertension and obesity].

AIM: To develop a universal method of metabolic syndrome (MS) diagnosis which is valid irrespective of the version in patients with documented arterial hypertension (AH) and obesity. MATERIAL AND METHODS: MS was diagnosed according to two versions (WHO and ATPIII) in 517 males and 1041 females aged 20 to 75 years. All the patients had documented obesity and hypertension. RESULTS: Two versions used (WHO and ATPIII) provided the same results only in 44% patients: MS was confirmed in 16% and rejected in 28%. The rest 56% patients had MS only by one of the versions. A computer program has been created for making decision about MS presence in obese patients with hypertension. CONCLUSION: A diagnostic rule has been elaborated for MS diagnosis by associated disorders with accuracy of 94% even in the absence of information about such key components of MS as HDLP and triglycerides.

[Primary prophylaxis of cerebrovascular complications in patients with metabolic syndrome].

AIM: To study effects of antihypertensive therapy with bisoprolol and actovegin on cerebral perfusion in patients with metabolic syndrome. MATERIAL AND METHODS: Thirty patients (18 women and 12 men) with metabolic syndrome and mild arterial hypertension took bisoprolol alone in a dose 5-10 mg/day, and fifteen patients received combined therapy (bisoprolol and actovegin) for 12 weeks. Before the study and 12 weeks later measurements were made of carbohydrate and lipid metabolism, single photon emission computed tomography investigated brain perfusion. RESULTS: Improvement of brain perfusion was observed after both monotherapy with bisoprolol and its combination with actovegin. CONCLUSION: Monotherapy with bisoprolol and bisoprolol combination with actovegin improved brain perfusion but the combination was more effective.

[Cerebral perfusion in patients with metabolic syndrome].

Cerebral perfusion was studied in patients with arterial hypertension combined with metabolic syndrome and diabetes mellitus type II. The data is compared to the results obtained for patients with a single disorder--metabolic syndrome, diabetes mellitus type II and arterial hypertension without metabolic alterations. It is shown that patients with disregulation of carbohydrate and lipid metabolism are more vulnerable to cerebral blood supply alterations. A level of perfusion was the same in patients with metabolic syndrome and diabetes mellitus type II. Besides, an acetazolamide application revealed that patients with metabolic syndrome had reduced cerebral vascular autoregulation.

[Body mass loss due to orlistat therapy and multiple factors of cardiovascular risk].

AIM: To study effects of body mass loss due to orlistat on carbohydrate and lipid metabolism, insulin resistance, 24-h profile of arterial pressure (AP), left ventricular myocardial hypertrophy, brain perfusion in patients with metabolic syndrome (MS). MATERIAL AND METHODS: Thirty middle-aged patients with MS entered the trial. They received orlistat in a dose 120 mg twice a day for 24 weeks. Before and after the treatment the patients' carbohydrate and lipid metabolism, insulin resistance were studied, 24-h monitoring of arterial pressure, echo-cardiography were made. Brain perfusion was studied with single-photon emission computed tomography in 18 patients. Results. All the patients lost much weight. This was accompanied with improved indices of AP profile, metabolism of carbohydrates and lipids, insulin resistance, left ventricular hypertrophy, brain perfusion. Conclusion. Orlistat treatment weakens basic factors of cardiovascular risk.

[Thiaside diuretics in combination with inhibitors of angiotensin-converting enzyme in patients with diabetes mellitus type 2 comorbid with arterial hypertension]. / Vozmozhnosti primeneniia tiazidnykh diuretikov v kombinatsii s ingibitorami angiotenzinprevrashchaiushchego fermenta u bol'nykh sakharnym diabetom tipa 2, sochetaiushchimsia s arterial'noi gipertoniei.

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.

[Cerebrovascular complications in metabolic syndrome: possible approaches to decrease risk]. / Tserebrovaskuliarnye oslozhneniia pri metabolicheskom sindrome: vozmozhnye podkhody k snizheniiu riska.

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.

[Results of nonmedical interventions in multicenter randomized open study of efficacy of lifestyle modification and therapy with quinapril in patients with obesity and hypertension]. / Rezul'taty mnogotsentrovogo randomizirovannogo otkrytogo issledovaniia po izucheniiu éffektivnosti izmeneniia obraza zhizni i terapii ingibitorami angiotenzinprevrashchaiushchego fermenta (kvinaprilom) u bol'nykh ozhireniem i arterial'noi gipertoniei (EKO).

There is a pathogenetic interrelationship between obesity and hypertension. Moreover it has become evident that the use of most modern and active antihypertensive drugs can not be effective without concomitant treatment of obesity. This study was conducted in 18 cities of Russian Federation in order to demonstrate influences of lifestyle changes on hypertension and levels of cardiovascular risk factors. The objective was to attract attention of physicians and patients to the problem of obesity and hypertension and to their inherent dangers.

[The use of insulin-modified intravenous glucose tolerance test in the diagnosis of insulin resistance in patients with metabolic syndrome]. / Ispol'zovanie insulinmodifitsirovannogo vnutrivennogo gliukosotolerantnogo testa dlia diagnostiki insulinrezistentnosti u patsientov s metabolicheskim sindromom.

Fifty-five patients (mean age 42.3) with clinical signs of metabolic syndrome were investigated. The peroral glucose-tolerance and insulin-modified intravenous glucose-tolerance tests were used in the diagnosis of insulin-resistance. According to the SI index, a lower tissue sensitivity to insulin was detected in 48 (87%) of patients; it is noteworthy, that a low SI index was registered in some of them, when indirect signs of insulin-resistance, like hyperglycemia, hyperinsulinemia, were absent.

[Cardiovascular complications of type 2 diabetes]. / Serdechno-sosudistye oslozhneniia sakharnogo diabeta 2-go tipa.

Cardiovascular complications due to micro- and microangiopathy are main causes of death of patients with type 2 diabetes. Principal role in development of these complications belong to hyperglycemia which triggers such pathological processes as endothelial dysfunction, oxidative stress, impairment of hemostasis and blood rheology. Therefore glucose lowering therapy is pathogenetic not only for diabetes but also for its cardiovascular complications. Glucose lowering drugs should be maximally effective and safe for the cardiovascular system. These requirements gliclaside which in addition to pronounced glucose lowering effect also acts on all links of the pathogenesis of micro- and macroangiopathies. While selecting cardiovascular drugs one should take into consideration their effect on carbohydrate metabolism and cardioprotective properties. Angiotensin converting enzyme inhibitors are leaders in this field.

[Role of hypothalamo-hypophyseal-adrenal axis in the pathogenesis of arterial hypertension in patients with prolactinoma of the anterior lobe of the hypophysis]. / Rol' gipotalamo-gipofizarno-nadpochechnikovoi osi v patogeneze arterial'noi gipertonii u bol'nykh s prolaktinomoi perednei doli gipofiza.

AIM: To elucidate mechanisms underlying arterial hypertension (AH) in patients with hyperprolactinemia, prolactin-secreting adenoma of the anterior lobe of the hypothesis, in particular. MATERIAL AND METHODS: 9 females with microprolactin-secreting and 4 females with macroprolactin-secreting adenoma of the anterior lobe of the hypophysis (mean age 33.8 +/- 3.7 years) were examined using radioimmunoassay of the hormones, computed tomography, MR-tomography of the adrenals and brain. RESULTS: Humoral regulation of the hypothalamic-hypophyseal-adrenal axis was found different in patients with microadenoma due to dopaminergic insufficiency of the hypothalamus and in patients with macroadenoma--tumor of the hypophyseal genesis. Patients with microadenoma were diagnosed to have low-renin diastolic arterial hypertension with clinical symptoms of hyperaldosteronism and high levels of plasma aldosterone. Patients with macroadenoma had normal arterial pressure, aldosterone levels and plasma renin activity. Treatment with parlodel, agonist of dopaminergic receptors, reduced arterial pressure, prolactin level, plasma aldosterone and raised plasma renin activity in patients with microadenoma. Such changes were not observed in patients with macroadenoma. CONCLUSION: It is suggested that one of the causes of AH in patients with microprolactin-secreting hypophyseal adenoma lies in hyperaldosteronemia which develops as a result of dopaminergic insufficiency of the hypothalamus and hyperprolactinemia.

[The prolonged-action form of Lomir (isradipine) in the treatment of mild and moderate essential hypertension]. / Forma lomira (isradipina) prolongirovannogo deistviia pri lechenii miagkoi i umerennoi éssentsial'noi gipertonii.

24-hour monitoring of arterial pressure has been performed outpatiently in 20 subjects with mild or moderate essential hypertension using portable system Space Labs 90207. The design of the study implied 2 weeks of observation without any treatment followed by a 4-week course of lomir SRO-5 plus a 2-week course of lomir administration in a double dose. Control examination was performed at the end of each period. It was established that a 4-week lomir course results in a lowering of systolic and diastolic pressure by 8.4 + -2.1 and 6.9 + -1.3 mm Hg, respectively. Double-dose lomir was also effective: a fall in both systolic and diastolic pressure by 15.6 + -3.2 and 8.1 + -1.8 mm Hg, respectively, was achieved.