[Effect of 12-Months Therapy With Perindopril A on Structural-Functional State of the Microcirculatory Vascular Bed in Patients With Chronic Heart Failure].

BACKGROUND: Experimental and clinical data confirm that endothelial dysfunction (ED) of microvessels is one of mechanisms of progression of chronic heart failure (CHF). PURPOSE: To assess the impact of 12-month treatment with perindopril A (5-10 mg/day) on structural and functional state of microcirculatory vascular bed in patients with CHF. MATERIAL AND METHODS: We included into this study 30 patients aged 45-70 years with NYHA class II-III CHF. All patients received perindopril A 5-10 mg/day for 12 months. For assessment of endothelial function we used test with reactive hyperemia. During this test we evaluated flow dependent vasodilation by photoplethysmography, and registered the state of skin capillary network by computer videocapillaroscopy. We also measured level of proinflammatory cytokines - von Willebrand factor, and -tumor necrosis factor (-TNF). RESULTS: After treatment with perindopril A 5 we observed improvement of microvascular endothelial function (occlusion index rose from 1.5 [1.2; 2.9] to 2.0 [1.7; 2.4], p=0.03), and of functional state of the finger skin capillary network (percentage of perfused capillaries rose from 88 [77; 95] to 95 [87; 97], p=0.05, percentage of recovered capillaries rose from 8 [4.5; 12.1] to 14.2 [9.3; 17.1], p=0.04). These effects were associated with significant lowering of (-TNF) level (from 6.58 [3.72, 10.3] to 3.35 [0.15; 6.33] g/L, p<0.01).

[Comparative analysis of antioxidant activity of nebivolol in patients with chronic heart failure with and without concomitant type 2 diabetes].

UNLABELLED: Consistent neurohormonal activation of sympatho-adrenal system in patients with chronic heart failure (CHF) and hyperglycemia contributes to development of oxidative stress--one of the most important pathogenetic mechanisms of endothelial dysfunction. PURPOSE: To study the impact of nebivolol concerning modification of clinical and hemodynamic indicators and parameters of oxidative stress in patients with CHF and with or without concomitant diabetes mellitus type 2 (DM2). MATERIAL: Nebivolol was used in complex therapy of CHF in 82 patients, suffering from NYHA class I - III CHF (EF < 50%) of ischemic genesis with or without comorbid DM2, average age 63.2 +/- 8.2 years. RESULTS: After 8 months of therapy significant improvement of clinical status was observed in both groups, tolerance to physical activity increased (significant reduction of average class of CHF in the group with DM2 from 2.5 +/- 0.58 to 2.125 +/- 0.71, p = 0.001, and in the second group from 2.3 +/- 0.5 to 1.9 +/- 0.4, p = 0.01). We also noted in both groups increase of plasma oxidative resistance (reduction of intensity of fast flash in lipid peroxidation h from 7 to 6 mm, p = 0.016, and from 8 to 6 mm, p = 0.03, respectively) and increase of antioxidant plasma protection (increase of SH-groups from 154.19 to 182.4 mmol/1, p = 0.00035, and from 176 to 205, p = 0.004, respectively). CONCLUSION: Nebivolol is a modern neurohormonal modulator, which contributes to reverse evolution of oxidative changes in patients with CHF and hyperglycemia.