[Gender-related differences in the efficacy of treatment of hypertensive and coronary heart diseases in aged and elderly patients by angiotensin II receptor blockers and angiotensin converting enzyme inhibitors].

The aim of the work was to study hemodynamics and clinical symptoms before and after treatment of arterial hypertension (AH) and coronary heart disease (CHD) using angiotensin II receptor blockers and angiotensin converting enzyme inhibitors depending on the patients' sex. A total of 150 patients with AH and CHD were examined (80 women and 70 men, mean age 70 a 66 yr respectively). Eighty two of them (group 1) were given receptor blockers (losap, losartan, lorista, bloctran) and 63 (group 2) inhibitors (prestarium, noliprel). Effectiveness of treatment was evaluated from the results of 24-hr AP monitoring, daily self-control of AP (as described by Korotkov) and responds to questionnaires. The effectiveness of receptor blockers showed marked gender-specific differences. Specifically, they reduced systolic and diastolic pressure and improved well-being in women. In men, this treatment decreased the frequency of angina attacks, headache, and heart throbs. Enzyme inhibitors caused a greater reduction of diastolic AP in women but less pronounced gender-related changes in dynamics of main AP and ECG parameters than receptor blockers.

[Relation between microcirculation parameters and Pc3 geomagnetic pulsations].

An individual analysis of long-term monitoring of microcirculation parameters of nine healthy volunteers showed that an increase in the geomagnetic activity led to an increase in tissue perfusion, variability of blood flow and growth of the amplitude of neurogenic and myogenic oscillations in four volunteers. It was found that the degree of microcirculation sensitivity to the level of geomagnetic activity values with time and is proportional to its average level in the period of measurement. A comparison of frequency ranges of oscillations of blood flow and variations of the geomagnetic activity shows that neurogenic and myogenic oscillations showing the highest sensitivity to the geomagnetic activity have the same frequency as geomagnetic Pc3 pulsations. The pulsations of this frequency range are excited mainly during geomagnetic disturbances, which may explain the correlation between the microcirculation parameters and the Kp index. The relation of the amplitude-frequency characteristics of Pc3-pulsations can explain the results obtained using the alternating magnetic fields.

[Melatonin in the combined treatment of cardiovascular diseases].

The aim of the work was to assess effectiveness of melatonin monotherapy (MT) and combined treatment (CT) in aged patients with arterial hypertension (AH) and coronary heart disease (CHD). A group of 170 patients (mean age 64 years) included 61 ones with CHD and 100 with AH. ECG, AP, and echoCG monitoring was performed before and 21 days after treatment along with clinical examination and evaluation of oxidative and antioxidative activities in erythrocytes. Treatment efficiency was compared in the study and randomized control groups. The data obtained suggest antihypertensive action of MT. CT with melatonin and antihypertensive drugs had better outcome than standard therapy in control groups. Inclusion of melatonin in CT of CHD produced marked anti-ischemic and anti-anginal effects and normalized oxidant/antioxidant balance. It is concluded that melatonin should be an important component of MT and CT of cardiovascular diseases.

[Factors affecting intima-media thickness in carotid arteries in diabetes mellitus of the young].

The aim of the work was to measure intima-media thickness IMT), study lipid and carbohydrate metabolism and factors contributing to the development of vascular complications in type 1 and 2 diabetes mellitus (DM) of the young. It included 63 patients aged 18-40 years (40 with DM1 and 13 with DM2). Glycated hemoglobin was measured on a AzSYM immunoenzyme analyzer, lipid metabolism studied using a Cobas Integra 400 Plus analyzer, and IMT estimated based on the ultrasound technique (Volision--750 Exert with 10 MHz sensors). Patients with DM of the young showed higher IMT values than age-matched healthy subjects. IMT tended to increase after the age of 33 years and with duration of DM. DM did not cause a decrease of blood HDL levels. Smoking had negative effect on the vascular wall in DM patients.

[Efficacy of traditional therapy and chronotherapy using prestarium in elderly patients with polymorbid syndrome].

The aim of the work was to compare efficiency of traditional therapy with prestarium (tert-butylamine salt) and chronotherapy with prestarium A (arginine salt) in elderly patients with polymorbidity syndrome (diabetes mellitus, nephropathy, grade I-II chronic hepatic insufficiency). All patients underwent standard clinical and laboratory examination including measurement of glycemic profile, plasma urea, creatinine, K+ and Na+, AP monitoring, ECG, and echo-CG. The results suggest persistent hypotensive effect of prestarium and prestarium A within 4 days after the onset of therapy. However, in patients with a more severe disease, twice lower doses of prestarium A were needed to achieve positive effect and transform circadian AP rhythm from non-dipper to dipper pattern.

[Use of prestarium (perindopril) in patients with polymorbidity syndrome (AH, DM, nephropathy)].

The study included 20 patients aged 61-86 (mean 73.1 +/- 3.1) years with stage II hypertensive disease, type 2 diabetes and nephropathy with signs of grade I chronic renal insufficiency (CRI). The major parameters measured were AP, HR, laboratory characteristics of carbohydrate metabolism and renal function. Prestarium given at a dose of 4 mg BID had not only antihypertensive but also negative chronotropic effect, decreased energy consumption by myocardium, and normalized daily AP profile (24 hr AP monitoring). Adequate control of diabetes ensured close-to-normal carbohydrate metabolism. Prestarium therapy did not cause further aggravation of renal insufficiency in patients with grade I CRI, nor did it alter creatinine and urea levels.

[The use of monopril in elderly patients with arterial hypertension and coronary heart disease].

We examined 20 patients (mean age 69.4 yr) with stage II AH and CHD. 13 ones suffered CHD with stable FC II and III angina, two others had myocardial infarction. The patients were given monopril, 10 mg BID (08.00 & 20.00). Those with CHD were additionally treated with cardiket (20 mg BID) or monocinque (20 mg BID). If appropriate, hypothiazide or triampur compositum (25 mg each) was given in the morning. Usual clinical examination was supplemented by dynamic studies and evaluation of clinical symptoms on day 21 after therapy including systolic and diastolic AP, pulse and mean dynamic AD, double product, heart rate, ECG, echoCG, AP and ACG monitoring. The above treatment produced marked antihypertensive and antianginal effects in the absence of adverse events.

[Correction of the disturbed coagulation circadian rhythm in patients with type 1 diabetes mellitus treated by aspirin chronotherapy].

Circadian rhythms of hemostasis were studied in 20 healthy subjects and 30 patients with type 1 diabetes mellitus before and after conventional therapy (CT) with aspirin (125 mg thrice daily) and chronotherapy (ChN) with aspirin taken once daily at 22.00 (i.e., two hours before the acrophase of the blood coagulation activity revealed during a chronobiological study of hemostasis pripor to the initiation of the treatment). The parameters measured in the study included results of the auticoagulation test, hemolysate of the aggregation test, thrombin time, fibrinogen level, fibrinolytic activity, fibrinolygase activity, and antithrombin III level at 07 h 00 min, 11 hr 00 min, 15 hr 00 min, 19 hr 00 min, 23 hr 00 min, and 03 hr 00 min in 20 healthy subjects and 30 patients with type 1 diabetes mellitus. The data obtained were treated by cosinor analysis as described by F. Halberg. The results suggest internal and external synchronization of circadian rhythms and hemostatic parameters in healthy subjects. Coagulation activity, platelet aggregation in daytime, and blood anticoagulative potential at night increased. In diabetic patients, circadian patterns of hemostasis were disturbed by a combination of enhanced coagulation activity and platelet aggregation with a decrease of anticoagulative potential throughout 24 hours. The maximum disturbance (acrophase) occurred at night. Combined CT with aspirin and insulin therapy caused mean daily levels of plasma and platelet hemostasis to decrease in the absence of normalization of their circadian rhythms. CT not only decreased these parameters and increased anticoagulation activity but also tended to improve chronobiological structure of hemostasis. This effect was reached using thrice lower doses of aspirin.

[Melatonin in combined therapy of patients with stable angina and arterial hypertension].

Study of 2 randomized groups of patients with coronary heart disease, stable exertional angina combined with arterial hypertension, receiving traditional treatment and combined therapy with inclusion of melatonin, was performed. All patients (43 persons at the age from 44 to 69 years) before and after treatment underwent daily monitoring of arterial pressure (AP) by system "BR-102 Schiller", Switzerland. As a result of study, in the group of traditional treatment positive dynamics such as significant decrease in average daily values of systolic arterial pressure (SAP) from 159.7 +/- 3.4 to 146.1 +/- 4.6 (p = 0.02), diastolic arterial pressure (DAP) from 92.7 +/- 1.2 to 88.6 +/- 1.3 (p = 0.03), average daytime AP indices, average nighttime SAP indices, was noticed. SAP and DAP variability was significantly decreased only at daytime from 23.1 +/- 1.7 to 18.8 +/- 1.4 (p = 0.05) and from 18.1 +/- 0.5 to 16.5 +/- 0.4 respectively. Insufficient decrease in SAP and DAP at nighttime was detected. Inclusion of melatonin in traditional therapy leaded to more expressed decrease in average daily, daytime and nighttime AP indices and significant decrease in load by pressure value (SAP and DAP time indices were significantly reduced both at daytime and at nighttime). Degree of SAP and DAP nighttime decrease initially was upon the average 8.1 +/- 1.1% and 7.0 +/- 1.0% respectively (non-dippers), and after combined treatment was 13.4 +/- 0.9% (p = 0.003) and 11.0 +/- 1.1% (dippers), which proved recovery of normal daily AP profile. Significant decrease in SAP variability at daytime from 22.3 +/- 1.8 to 15.1 +/- 1.2 (p = 0.003), at nighttime from 16.1 +/- 1.4 to 12.7 +/- 1.0 (p = 0.05) in DAP variability at daytime from 17.5 +/- 0.4 to 14.5 +/- 0.4 (p < 0.001), at nighttime from 13.1 +/- 0.7 to 11.1 +/- 0.7 (p = 0.05).

[Evaluation of different methods of treatment of patients with stable stenocardia combined with arterial hypertension according to echocardiographic data].

The authors evaluated the influence of three alternative methods of treatment of coronary artery disease (CAD) and stable exertional stenocardia accompanied by arterial hypertension on systolic and diastolic left ventricular (LV) function. The three methods were: conventional therapy with monocinque, chronotherapy with monocinque, and therapy with a combination of monocinque and melatonin. All the 65 patients aged 44 to 69 years underwent echoCG with Vivid 7 ultrasound scanner (USA) before and after the treatment. The study showed that chronotherapy with monocinque had the most favorable effect on LV diastolic function, which manifested by an increase in peak E from 0.47 +/- 0.02 to 0.53 +/- 0.02 m/s (p = 0.006) and peak E/peak A ratio from 0.77 +/- -0.05 to 0.93 +/- 0.05 (P = 0.002), as well as a decrease in peak A from 0.65 +/- 0.03 to 0.56 +/- 0.03 m/s (p = 0.05). Complex treatment with monocinque and melatonin improved systolic and diastolic LV function better than did conventional therapy. The favorable influence on myocardial contractility manifested by a reduction in end systolic LV size from 3.66 +/- 0.04 to 3.42 +/- 0.02 cm (p < 0.001), end diastolic LV volume from 126.7 +/- 1.3 to 118.4 +/- 1.1 ml (p < 0.001), and end systolic LV volume from 55.1 +/- 1.0 to 47.0 +/- 0.8 ml (p < 0.001), as well as an increase in ejection fraction from 56.5 +/- 0.9 to 60.3 +/- 0.8% (p = 0.003) and shortening fraction from 27.9 +/- 1.3 to 33.0 +/- 0.4% (p = 0.001). The normalizing effect on LV diastolic function manifested by an increase in peak E from 0.46 +/- 0.02 to 0.54 +/- 0.02 m/sec (p = 0.009) and peak E/peak A ratio from 0.68 +/- 0.05 to 0.82 +/- 0.05 (p = 0.002).

[Efficacy of conventional mono mac therapy and mono mac chronotherapy of painless myocardial ischemia in patients with insulin-independent diabetes].

60 patients, suffering from coronary heart disease with painless myocardial ischemia (PMI) and insulin-independent diabetes (IID), were randomized into two groups. The first group included 18 patients, who received conventional mono mac therapy in a dose of 20 mg twice a day, the second--42 patients, whose treatment consisted in mono mac chronotherapy, i.e. they were administered a single dose of 10 to 20 mg of the drug 30 minutes before a PMI episode, revealed by means of Holter ECG-monitoring, before the beginning of the treatment. All the patients underwent examination, which consisted in Holter ECG-monitoring and Echo-CG, before and after a 15-day mono mac therapy course and adequate IID treatment. The study demonstrated that the total length and number of PMI episodes within a 24-hour interval, as well as the average episode length, were significantly less in the second group, compared with conventionally treated patients. The chronotherapy allowed a 2-fold reduction in mono mac doses.

[Effectiveness of metabolic preparations in complex treatment of elderly patients with postinfarction cardiosclerosis and circulatory insufficiency].

The paper presents the results of an examination of 129 elderly patients with CHD who had had a myocardial infarction and suffered from II-III functional class heart failure. The patients were divided into four groups. The patients in the first group were administered complex therapy (CT) only; the second group received CT plus a composition of replaceable amino acids (CRAA) sublingually and orally, the third group received CT plus a placebo and the fourth--CT plus melatonin in doses of 3 and 6 mg. The efficiency of the treatment was assessed by the dynamics of clinical manifestations and by means of echoCG and Holter ECG-monitoring; parameters of lipid peroxidation and antioxidative protectability in erythrocytes were measured. The comparison of the results suggests that addition of CRAA and melatonin in a dose of 6 mg to CT is more effective than CT only. This was proved by the more pronounced positive dynamics of clinical symptoms, the improval of the myocardial contractility and normolizing influence on the balance in the oxidant/antioxidant system.

[ECG and BP monitoring in patients with stable angina and essential hypertension on therapy with monocinque].

The authors studied ECG and arterial pressure (AP) parameters in 24 patients with stable angina and arterial hypertension aged 57.9 +/- 1.6 years, receiving 14-day complex therapy including administration of monocinque in a dose of 20 mgs 2 times a day. A portable Digitrak-Plus Zymed Holter 1810 device (USA) was used to monitor ECG, and a portable Meditech ABPM-04 device (Hungary)--to monitor AP. The therapy substantially reduced episode frequency as well as total length and amplitude of ST segment depression. At the same time, the patients displayed decrease of day and night systolic and diastolic AP, as well as of their mean daily values.

Hereditary determination of several hemodynamic indices. / Nasledstvennaia obuslovlennost' nekotorykh gemodinamicheskikh pokazatelei.

Investigation of the genetic determination of hemodynamic indices (the volume of circulating blood, the time of total blood circuit, the rate of lesser blood flow and the minute heart volume) is carried out in 16 mono- and 15 dizygotic twin pairs. The volume of circulating blood only was found to be highly genetically determined (G = 0.90). The role of heredity and environment was almost the same in genesis of the time of total blood circuit and the rate of lesser blood flow (G = 0.34 and 0.48 respectively), while the effect of environment is prevailed for the minute heart volume. The coefficient of genetic determination G is considered to be the most competent estimate among other indices of heredity, because it makes possible to isolate the additive variance and the variance of determing genetic component of phenotypical dispersion of a character. On the basis of the parameters studied, a multifactorial character of hemodynamics indices inheritance is suggested.

[Time-dependent effects of antihypertensive agents and chronocorrecting action of melatonin in patients with arterial hypertension]. / Vremia-zavisimye éffekty antigipertenzivnykh preparatov i khronokorrigiruiushchee deistvie melatonina u bol'nykh arterial'noi gipertoniei.

The chronopharmacodynamics of angiotension-converting enzyme (ACE) inhibitors, such as ramipril (R), enalapril (E), acetene (A), caposide-50 (C-50) and the effect of the epiphyseal neurohormone melatonin used alone and in combination with cozaar (Co) and cintome (Ci) in the randomized groups including 124 patients with arterial hypertension (AH). The ACE inhibitors were given in the morning, afternoon, and evening. Co and Ci were used in the morning. Melatonin was given at 10.00 p.m. 10-14 days before and after therapy, 24-hour monitoring (Astracard, Russia) and echocardiography (Toshiba, Japan) were performed. Analyzing the findings indicated the time-dependent hemodynamic effects of R, E, and C-50. Ci, A, and Co were found to have antihypertensive and vasodilatory effects without normalizing the chronostructure of circadian rhythms of major hemodynamic parameters. By producing antihypertensive and vasodilatory effects, melatonin leads to the recovery of circadian hemodynamic organization when used alone and in combination with Co, Ci, and ACE inhibitors.

[Chronopharmacodynamics of delayed-action cardiac glycosides and nitrates]. / Khronofarmakodinamika serdechnykh glikozidov i nitratov prolongi- rovannogo deistviia.

In 96 patients with coronary heart disease and stage II circulatory failure, the chronopharmacodynamics of strophanthin, corglycon, and nitrosorbide was studied by using acute clinical and pharmacological tests in the morning (8.00 a.m.), in the afternoon (2.00 p.m.), and in the evening (8.00 p.m.). Central and peripheral hemodynamic parameters were measured prior to and following 5, 15, 30, 60, and 120 min of intravenous injection of cardiac glycosides or sublingual administration of nitrosorbide in a dose of 10 mg for 240 min. The investigations showed that there were the most profound hemodynamic changes in the morning if strophanthin was used and in the afternoon if corglycon was given. The maximal reduction in heart pre- and afterload was seen in the morning when nitrosorbide was applied, the most improvement in central hemodynamic parameters was observed in the evening when nitrosorbide was used.

[Correlation between the indicators of blood coagulation and lipid metabolism in patients with stenocardia during the 24-hour period]. / Korreliatsionnye sviazi mezhdu pokazatelliami gemokoaguliatsii i lipidnogo obmena u bol'nykh stenokardiei v techenie sutok.

The correlation between the main parameters of blood coagulation and lipid metabolism were examined dynamically during 24 hours in 49 patients with angina pectoris. Circadian fluctuations of varying degrees of direct and inverse correlation were found in the concentration of cholesterol, beta-lipoproteins, non-esterified fatty acids, lecitin, total lipids, triglycerids, on the one hand, and the level of free heparin, the fibrinolytic activity, fibrinogen, thrombine time, platelets count in 1 mm3 of blood, on the other hand.

[Level of tyrosine in the blood of patients with acute myocardial infarction during the assessment of corticosteroid hormone production]. / Soderzhanie tirozina v krovi u bol'nykh ostrym infarktom miokarda pri otsenke obespechennosti kortikosteroidnymi gormonami.

Variations of blood 11-HOCS and tyrosine suggested as an indicator of tissue glucocorticoid provision were investigated in 54 patients with acute myocardial infarction (AMI). Where AMI takes a favourable course, the adrenocortical activity meets bodily requirements in about 25% of patients, whereas 30% show states of transitory hormonal deficit during the first 4-5 days of the disease. In severe AMI with multiple combined complications, tissue glucocorticoid deficiency was found in 73% of patients, the majority of those having high blood 11-HOCS levels. A profound disorder of the glucocorticoid control of metabolic processes is suggested.

[Analysis of the role of genetic and environmental factors in predicting therapeutic effectiveness in arterial hypertension]. / Analiz roli geneticheskikh i sredovykh faktorov v prognozivoraniia éffektivnosti terapii arterial'noi gipertonii.

The method of canonic correlation revealed three predictors of the efficacy of treatment in acute clinical pharmacological tests for preparations of anaprilin, hemiton and dopegit according o the values of systolic and diastolic arterial pressure, rate of cardiac contractions during the primary clinical examination and the gain in the patient's weight. Appraisal of the relative role of genetic and environmental factors in prognosing the efficacy of a drug showed that the genetic factors have the highest effect in prognosing the efficacy of dopegit and the least effect in predicting the efficacy of anaprilin.

[Effect of anaprilin on the peripheral circulation of patients with arterial hypertension]. / Vliianie anaprilina na perifericheskoe krovoobrashchenie u bol'nykh arterial'noi gipertoniei.

The influence of a course therapy with anaprilin alone on the peripheral circulation in patients with essential hypertension of the early stages was investigated. Anaprilin was shown to have a significant effect on the peripheral blood circulation in the skeletal muscles expressed as veno- and artery dilatation, with the predominance of the former.