[Antihypertensive and organ-protective action of a 36-week monotherapy with telmisartan in hypertensive patients].

AIM: To study hypotensive effectiveness and organ-protective properties of telmisartan in patients with essential hypertension (EH). MATERIAL AND METHODS: The trial enrolled 33 patients with EH of stage II, blood pressure (BP) elevation of the first and second degree, with ultrasound-diagnosed left ventricular (LV) hypertrophy and/or increased thickness of intima-media complex (IMC) of the muscular-elastic vessels. The patients received 40-80 mg/day telmisartan monotherapy for 36 weeks. Hypotensive efficacy of the drug was assessed at 24-hr BP monitoring, a protective effect--at echocardiography and ultrasound duplex scanning of the vessels. RESULTS: A 36-week telmisartan monotherapy significantly improved all the analysed parameters of 24-hr BP monitoring. LV myocardial mass reduced by 12.7%, index of this mass--by 12.9%. Overall thickness of intima-media of the muscular-elastic vessels (common carotid and femoral arteries) lowered by 11.9%. CONCLUSION: Long-term telmisartan monotherapy improves parameters of 24-hr BP monitoring, protects the heart and the vessels against remodeling, promotes reduction of LV hypertrophy and intimamedia thickness of muscular-elastic arteries.

[Correction of episodes of transitory myocardial ischemia with trimetazidine in patients with ischemic heart disease combined with type 2 diabetes mellitus].

Data of treatment of 45 patients with stable angina combined with type 2 diabetes mellitus are presented. Supplementation of standard anti-ischemic therapy with cytoprotective preparation trimetazidine MB (Preductal MB) revealed greater efficacy of treatment manifesting not only by decrease of functional class in observed patients but also by increase of volume of performed physical load, decrease of episodes of ischemia during 24 hours (according to Holter monitoring data), as well as decrease of mean duration of ischemia (painful and painless). A conclusion is made about feasibility of prescribing cytoprotective preparation trimetazidine MB while providing complex therapy to patients with stable form of ischemic heart disease.

[Effect of spirapril on remodeling of the heart in patients with mild and moderate arterial hypertension].

Patients (n=62) with mild and moderate arterial hypertension were examined with the help of echocardiography and Doppler echocardiography. For 12 weeks these patients received 6 mg/day of spirapril. Under influence of this therapy severity of left ventricular hypertrophy diminished, and quantity of pathological types of cardiac remodeling decreased.

[Use of transesophageal electrostimulation of the heart for evaluating the effectiveness of anti-anginal therapy]. / Primenenie chrespishchevodnoi élektrostimuliatsii serdtsa dlia otsenki éffektivnosti antianginal'noi terapii.

Investigation and treatment of 32 patients with stable angina and 17 patients with acute myocardial infarction are reported. The efficiency of antianginal treatment was assessed on the basis of clinical data as well as the results of repeated functional tests (esophageal electrostimulation of the heart) and central hemodynamic changes. It is demonstrated that the esophageal electrostimulation test can be used to assess the efficiency of antianginal medication on the basis of anginal threshold increment. A new long-acting nitrate, Isomak R (forte), has been shown to be an effective antianginal drug; it increases physical stress tolerance, prevents attacks of angina of effort or angina at rest, significantly decreases pulmonary arterial occlusion pressure, peripheral arterial pressure and total peripheral resistance. No important side effects have been recorded.

[Accelerated exercise test for the evaluation of transesophageal cardiac pacing]. / Uskorennyi nagruzochnyi test chrezpishchevodnoi élektricheskoi stimuliatsii serdtsa.

The diagnostic potentialities of the unique procedure of transesophageal cardiac pacing (TECP) exercise test were examined. The accelerated one-stage TECP test was started just at a rate equal to the heart rate submaximal for a patient's age, and continued up to 1 min. The test was considered to be positive with horizontal or obliquely descending ST segment depression greater than or equal to 2 mm. The procedure was used to examine 116 patients: 75 with coronary heart disease and 41 with neurocirculatory dystonia. A high (93 versus 84%) diagnostic sensitivity was displayed by the proposed modified exercise test versus the graded test. Noteworthy, it is possible to substantially reduce the duration of exercise test (1 min versus 5-7 min of the graded test). The accelerated TECP test is safe for patients, easy-to-use and fails to cause any complications.

[Is there an alternative to traditional stress tests? (One more time about transesophageal cardiac pacing)]. / Est' li al'ternativa traditsionnym nagruzochnym testam? (ili eshche raz o chrespishchevodnoi élektricheskoi stimuliatsii serdtsa).

AIM: To assess diagnostic potential of transesophageal cardiac pacing in patients with ischemic heart disease. MATERIAL: One hundred patients with overt or suspected ischemic heart disease (IHD) unable to perform or complete standard exercise test. METHODS: In addition to clinical investigation and transesophageal cardiac pacing stress Doppler echocardiography was carried out in 60 and coronary angiography in 30 patients. RESULTS: Transesophageal pacing was completed in 95% of patients. Sensitivity of the test for diagnosis of IHD was 85%, specificity--77%, predictive value of positive and negative results--95 and 73%, respectively. Combined use of transesophageal pacing and Doppler echocardiography increased sensitivity of diagnosis of IHD up to 92%. Blood pressure increment during transesophageal pacing did not exceed 10 mm Hg. CONCLUSION: Transesophageal cardiac pacing is a highly informative, simple, safe and widely available selective stress test. Results of this test does not depend on concomitant pathology and physical fitness of a patient. Therefore it presents an alternative to standard stress tests and is a method of choice in many diagnostic situations.

[Relation between indices of ECG cartography, central hemodynamics and myocardial energy metabolism in acute infarct]. / Vzaimosviaz' mezhdu pokazateliami kartografirovaniia EKG, tsentral'noi gemodinamiki i énergeticheskogo metabolizma miokarda pri ostrom infarkte.

A study of 30 patients with acute myocardial infarction, including the assessment of central hemodynamic parameters, ECG records from 35 leads and the investigation of myocardial energy metabolism by means of lactate, nonesterified fatty acids and glucose measurement in coronary venous blood, demonstrated that hyperkinetic hemodynamics was associated with a great spread of the necrotic and ischemic zone and predominant myocardial extraction of nonesterified fatty acids in uncomplicated acute myocardial infarction. It is suggested that propranolol should be used in those cases where hyperkinetic hemodynamics complicate the course of acute myocardial infarction.

[Clinical and metabolic effects of cardioselective beta-adrenoblockers nebivolol and metoprolol in patients with hypertension and ischemic heart disease associated with type 2 diabetes]. / Klinicheskie i metabolicheskie éffekty kardioselektivnykh beta-adrenoblokatorov nebivolola i metoprolola u bol'nykh arterial'noi gipertoniei i ishemicheskoi bolezn'iu serdtsa v sochetanii s sakharnym diabetom 2-go tipa.

AIM: To compare efficacy and safety of cardioselective beta-adrenoblockers nebivolol and metoprolol in patients with hypertension and ischemic heart disease (IHD) combined with type 2 diabetes. MATERIAL AND METHODS: Patients with IHD, class II-III angina and moderately severe compensated or subcompensated type II diabetes (n=35, 29 with grade 1-2 hypertension according to WHO 1999 classification) were divided into 2 groups with similar clinical and laboratory characteristics. Patients of group 1 received metoprolol (50-100 mg/day), of group 2--nebivolol (5-7.5 mg/day) for 8 weeks. Data of physical investigation, exercise tests, 24-hour blood pressure and heart rate monitoring, analysis of lipid spectrum and glycemic profile were used for assessment of treatment efficacy. RESULTS: Decrease of number of anginal attacks and nitroglycerine requirement was more pronounced in nebivolol treated patients. The use of both drugs was associated with lowering of blood pressure and heart rate. There were no unfavorable changes of parameters of carbohydrate and lipid metabolism. Pronounced (by 19.2%) lowering of triglycerides was observed in nebivolol treated patients. Both drugs were well tolerated. CONCLUSION: Nebivolol and metoprolol are effective and safe antianginal agents in patients with IHD and hypertension combined with type 2 diabetes. However in doses used nebivolol produced more favorable metabolic and hemodynamic effects.

[Effect of isoptin on myocardial hemodynamics and contractility during an anginal attack induced by the atrial stimulation test]. / Vliianie izoptina na gemodinamiku i sokratimost' miokarda vo vremia pristupa stenokardii, vyzvannogo testom predserdnoi stimuliatsii.

The effect of 10 mg intravenous isoptin on myocardial hemodynamics, contractility and metabolism during an anginal attack provoked by the atrial stimulation test was examined in 15 coronary patients with angina of effort. Isoptin administration increased anginal threshold, reduced the values indicative of cardiac activity and myocardial oxygen requirement and had no basic effect on coronary flow, while metabolic manifestations of ischemia were neutralized. Isoptin is recommended as an effective means of treatment for angina of effort in patients with atherosclerotic lesions of coronary arteries.

[Assessment of efficacy and safety of nebivolol in patients with stable effort angina]. / Otsenka éffektivnosti i bezopasnosti primeneniia b-adrenoblokatora tret'ego pokoleniia nebivolola u bol'nykh so stabil'noi stenokardiei napriazheniia.

AIM: To study efficacy and safety of nebivolol in patients with stable angina pectoris. MATERIAL: Twenty patients with stable effort angina pectoris and positive exercise test without contraindications to beta-blockers, signs of NYHA class III-IV heart failure, and obstructive lung disease. After 5-7 days of control period all patients were given nebivolol (starting dose 5 mg/day) for 8 weeks. Graded exercise tests on treadmill and patient's diaries were used for assessment of treatment efficacy. RESULTS: Treatment with nebivolol (5-10 mg o.d. ) was associated with significant slowing of heart rate, lowering of blood pressure, and increase of exercise duration until appearance of angina or 1 mm ST-segment depression. Nebivolol did not affect left ventricular ejection fraction, bronchial conductance, or results of biochemical tests (including lipid profile). Adverse reaction (dizziness which disappeared after lowering of a dose) was registered in 1 patient. CONCLUSION: Nebivolol is an effective drug for the treatment of patients with stable angina.