ABSTRACT
Effect of enalapril and telmisartan on hemodynamic indices, structural-functional parameters of the left ventricle, and vasomotor function of arterial endothelium was studied in 49 patients (mean age 48.3+/-3.2 years) with 1-2 degree arterial hypertension (AH) and abnormal relaxation type of left ventricular diastolic dysfunction. Enalapril was given to 24 and telmisartan to 25 patients. Examination included 24-hour arterial pressure monitoring, echocardiography, duplex scanning of the left brachial artery. At the background of therapy with enalapril target levels of systolic and diastolic arterial pressure (AP) were achieved in 79.2 and 70.85% of patients. This was associated with 54.2% reduction of number of non-dippers and night peakers. Therapy with telmisartan (30 weeks) besides effective AP control provided normalization of 24-hour AP profile in 90% of patients with pathological circadian rhythm. This was accompanied by improvement of vasomotor endothelial function of arteries, positive dynamics of structural-functional parameters of the left heart chambers, improvement of indices of left ventricular diastolic function.
Subject(s)
Benzimidazoles , Benzoates , Enalapril , Hypertension/drug therapy , Vasodilation/drug effects , Ventricular Function, Left/drug effects , Ventricular Remodeling/drug effects , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Angiotensin-Converting Enzyme Inhibitors/pharmacokinetics , Benzimidazoles/administration & dosage , Benzimidazoles/adverse effects , Benzimidazoles/pharmacokinetics , Benzoates/administration & dosage , Benzoates/adverse effects , Benzoates/pharmacokinetics , Blood Pressure/drug effects , Blood Pressure Monitoring, Ambulatory , Brachial Artery/diagnostic imaging , Echocardiography , Enalapril/administration & dosage , Enalapril/adverse effects , Enalapril/pharmacokinetics , Female , Humans , Hypertension/physiopathology , Male , Middle Aged , Telmisartan , Treatment OutcomeABSTRACT
The study was designed to evaluate effect of enalapril and telmisartan on hemodynamic characteristics and diastolic function (DF) of left ventricle (LV) in patients with type 2 diabetes and arterial hypertension (AH). It included 64 patients aged 54.3 +/- 5.2 years. Those in group 1 (n = 31) were given enalapril (enap), patients of group 2 (n = 33) were treated with telmisartan (micardis). Examination included 24 hour AP monitoring, Holter ECG monitoring, and echocardiography. Compensation of metabolic disorders was evaluated from fasting and postprandial blood glucose and HbAc1 levels. Impaired LV DF was the main feature of affected myocardium in patients with DM2 and elevated AP in the absence of contractility disturbance. Enalapril therapy ensured the desired level of systolic and diastolic AP in 77 and 64.5% of the patients respectively in association with a decreased number of non-dippers and night-peakers in 45.4% of the observations in the absence of changes in HbAc1 level and LV DF. Treatment with telmisartan ensured within 24 weeks efficacious control of systolic AP and normalization of its daily profile in 87.5% patients with pathological circadian rhythm, besides improvement of carbohydrate metabolism and LV DF.
Subject(s)
Angiotensin II Type 1 Receptor Blockers/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Benzimidazoles/therapeutic use , Benzoates/therapeutic use , Diabetes Mellitus, Type 2/complications , Enalapril/therapeutic use , Hemodynamics/physiology , Hypertension/complications , Angiotensin II Type 1 Receptor Blockers/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Benzimidazoles/administration & dosage , Benzoates/administration & dosage , Blood Glucose/metabolism , Blood Pressure Monitoring, Ambulatory , Diabetes Mellitus, Type 2/blood , Diabetes Mellitus, Type 2/physiopathology , Diastole , Dose-Response Relationship, Drug , Drug Therapy, Combination , Enalapril/administration & dosage , Female , Follow-Up Studies , Hemodynamics/drug effects , Humans , Hypertension/drug therapy , Hypertension/physiopathology , Male , Middle Aged , Myocardial Contraction/drug effects , Myocardial Contraction/physiology , Telmisartan , Treatment Outcome , Ultrasonography , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathologyABSTRACT
AIM: To assess ivabradin and nebivolol efficacy in combined treatment of ischemic heart disease patients with chronic heart failure (CHF) of functional class (FC) II-III by NYHA, impact of these drugs on quality of life, circadian indices of myocardial ischemia (CMI), left ventricular (LV) contractility. MATERIAL AND METHODS: A total of 92 patients with CHF of FC II-III (mean age 57.3 +/- 4.5 years) were randomized into 3 groups. Patients of group 1 (n = 30) received combined basic therapy: inhibitors of ACE, diuretics, aspirin, statins, on demand nitrates. Patients of group 2 (n = 33) received basic combined treatment plus nebivolol (nebilet, Berlin-Chemie/Menarini) in a dose 5.0 mg/day. Group 3 (n = 29) was given basic therapy plus ivabradin (coraxan) in a mean dose 7.5 mg. RESULTS: The addition of ivabradin and nebivolol to combined treatment of ischemic heart disease with LV dysfunction brought about control over heart rate (HR), improved quality of life, reduced severity of CHF, CMI, number of episodes of painful and painless ischemia. In reduced by nebivolol HR addition of ibavradin improved systolic and diastolic LV function. The analysis of HR variability in ivabradin administration showed enhancement of parasympathic activity in the vegetative balance. Administration of nebivolol produced modulated attenuation of sympathic activity. CONCLUSION: Addition of ivabradin and nebivolol to combined treatment of ischemic heart disease with LV dysfunction raises efficacy of treatment.