[Antihypertensive effect of enalapril and lisinopril administered in combination with nonsteroid anti-inflammatory agents]. / Antigipertenzivnyi éffekt énalaprila i lizinoprila pri primenenii nesteroidnykh protivovospalitel'nykh preparatov.

AIM: To study the effects of nonsteroid antiinflammatory drugs (NSAID) on antihypertensive activity of ACE inhibitors with different metabolic activity. MATERIAL AND METHODS: 30 patients aged 45-70 years with arterial hypertension of degree I-II who had moderate and high risk of cardiovascular complications and concomitant spinal osteochondrosis with radicular syndrome. 20 patients received sequential treatment. Four variants of the course treatment were used: 1) monotherapy with enalapril maleate (2 mg twice a day); 2) enalapril maleate (5 mg twice a day) in combination with NSAID; 3) monotherapy with lisinopril (10 mg once a day); 4) lisinopril (10 mg once a day in combination with NSAID. 10 patients received enalapril (10 mg once a day) and acetylsalicylic acid (500 and 100 mg). RESULTS: To the end of the treatment week 2 good and satisfactory antihypertensive effect was achieved in 70 and 85% on enalapril and lisinopril, respectively. NSAID addition to enalapril worsened its antihypertensive activity, to lisinopril--the negative effect was much less. CONCLUSION: The data suggest metabolic conception of competitive interaction of ACE inhibitors with NSAID. Therefore, ACE inhibitors should be used differentially in active therapy with NSAID.

[A trial of the use of low-molecular-weight heparin (fraksiparin) in myocardial infarct]. / Opyt primeneniia nizkomolekuliarnogo geparina (fraksiparina) pri infarkte miokarda.

Efficacy and safety were studied of nonfractionated versus low-molecular heparines (NFH, LMH) in acute myocardial infarction (AMI). A total of 99 AMI patients entered the trial including those after thrombolytic therapy. The highest preventive effect in respect to both venous and arterial thrombosis was achieved at subcutaneous administration of NFH in twice daily dose 12500 U and LMH in a single daily dose 25000 U. High doses of LFH promoted hemorrhagic complications which were absent in administration of LMH. NFH had a proaggregant action on the platelets. It is concluded that LMH is an effective and safe modality in the treatment of AMI patients acting through inhibition of activity of blood coagulation factor X, antiaggregant effect on platelets, improving microrheology of red cells and activation of fibrinolysis.

[Vascular mechanisms of disorders of rheological properties of the blood in patients with myocardial infarction]. / Sosudistye mekhanizmy narusheniia reologicheskikh svoistv krovi u bo'lnykh infarktom miokarda.

The contribution made by vascular factors to impairment of blood rheological properties was demonstrated on the basis of examination of 65 apparently healthy persons by using a vascular occlusion test. The vascular endothelium showed a decrease in fibrinolytic, anticoagulant, antiaggregatory activities. The new term "hemorheological tolerance to vascular occlusion" was proposed to use. A number of quantitative and qualitative indices for normal hemorheological tolerance were identified. The paper provides data on the frequency of particular mechanisms responsible for its decrease. It also emphasizes that the knowledge of the mechanisms of vascular impairments makes it possible to choose a combined drug therapy for myocardial infarction in a differential fashion.

Anturan for secondary prophylaxis of myocardial infarction.

273 patients suffering from ischemic heart disease were treated with Anturan for one year at a daily dosage of 800 mg. The number of cardiovascular complications was significantly reduced, compared to the control group.

[Role of erythrocyte membrane cholesterol in disorders of their structuro-functional status in patients with ischemic heart disease]. / Rol' kholesterina membran éritrotsitov v narushenii ikh strukturno-funktsional'nogo sostoianiia u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Increased molar cholesterol/phospholipid ratios, significantly increased membrane microviscosity, reduced filterability through a 3 micron-pore filter, increased aggregation and longer disaggregation time, and occasional abnormally large cells were found in erythrocyte assays of 80 coronary patients, as compared to normal subjects. It is suggested that erythrocyte microrheologic disorders are related to excessive cellular cholesterol content in coronary patients.

[Methods of diagnosing unstable stenocardia and monitoring its treatment]. / Metody diagnostiki nestabil'noi stenokardii i kontrolia za ee lecheniem.

The informative value of various functional and laboratory diagnostic methods was reviewed in 150 patients with unstable angina (UA). High informativeness (92%) and sensitivity (83%) of isometric hand grip under computerized electrocardiographic monitoring was demonstrated for the diagnosis and control of treatment in these patients. Isometric loading brought out a dramatically reduced coronary reserve, latent heart failure and electrical instability of the myocardium. The cold test with a small area of skin exposure is of low diagnostic value in UA cases and cannot be recommended for clinical use. Serial myoglobin assays add to the accuracy of diagnosis and have high predictive value.

[Prinzmetal's angina as a variant of the preinfarct state]. / Stenocardia tipa Printsmetala kak variant predynfarktnogo sostoianiia.

The clinical course of variant angina pectoris has been analyzed in 11 patients, in 5 of them acute myocardial infarction supervened while in hospital. The character of painful attacks, ECG changes in some patients fully resemble the clinical picture of unstable angina pectoris. The direct relationship has been established between the variant angina pectoris and the development of myocardial infarction which suggests that this state is an urgent one. Certain aspects of pathogenesis of variant angina pectoris and its treatment are discussed.

[Blood rheological effects in ischemic heart disease treated with antianginal and thrombolytic agents]. / Gemoreologisheskie éffekty u bol'nykh ishemicheskoi bolezn'iu serdtsa pri lechenii antianginal'nymi i tromboliticheskimi sredstvami.

In 161 patients with different forms of ischaemic heart disease the authors studied changes of the blood viscosity, erythrocyte aggregation and of thrombocytes during treatment with modern antianginal and the thrombolytic agents. Treatment with nitroglycerin in tablets and Sustac revealed no statistically significant differences in the changes of the haemorheological parameters. The mainly thrombocyte disaggregational effect was shown by micristin (aspirin/propranolol in the daily dose of over 120 mg) and verapamil (the daily dose over 160 mg). The use of dipyridamol, trental and nonachlazin was accompanied both by the decrease of functional activity of thrombocytes and by the decrease of the blood viscosity as a result of improvement of the functional properties of erythrocytes. Sodium nitroprusside depressed shortly the aggregation of platelets and decreased the blood viscosity at the expense of the decrease of the haematocrit. The use of streptokinase (avelisine) in patients with acute myocardial infarction was accompanied by defibrinisation of the blood, by marked decrease of the aggregation facility of formed elements of the blood and its viscosity. The results suggest that the haemorheological mechanisms participate in the antianginal effect of the drugs studied.

[State of hemostasis and blood rheology in congestive circulatory insufficiency]. / Sostoianie gemostaza i reologii krovi pri zastoinoi nedostatochnosti krovoobrashcheniia.

One hundred and ninety-eight patients with congestive circulatory insufficiency were examined; 54 had stage IIA, 88 stage IIB, and 56 stage III of the disease. Blood viscosity, blood platelet and erythrocyte aggregation, fibrinogen disintegration products, and soluble fibrin were determined and the protamine sulfate test was performed. Statistically significant reduction of hematocrit, increase of erythrocyte aggregation, dysfunction of blood platelets, and increase in the content of products of fibrinogen and fibrin disintegration were revealed with progression of congestive circulatory insufficiency. These changes are evidence of disseminated intravascular coagulation in such patients and are important in prognostication.

[Pharmacotherapy of peripheral arteriosclerosis]. / Farmakoterapiia perifericheskogo ateroskleroza.

Peripheral atherosclerosis was treated in 178 patients: 90 were given pyridinol carbamate for 2--4 months, 40 pentoxyphylline, 30 cetedil, and 18 received butalamine. in intermittent claudication pyridinol carbamate and trental proved most effective, cetedil (straten) was less effective. The favourable effect of pyridinol carbamate is associated with its action both on the state of microcirculation and on the content of lipids. A significant decrease in the level of blood triglycerides was observed during treatment with pyridinol carbamate. Pentoxyphylline reduced blood viscosity and platelet aggregation in patients with peripheral atherosclerosis but had no effect on the blood lipid content. Cetedil did not reduce blood viscosity although it decreased the aggregation of erythrocytes and inhibited the second phase of platelet aggregation. The objective criterion for the improvement of circulation in the affected extremities was increased tolerance to load, particularly in medication with pyridinol carbamate and trental.

[Fibrinogen metabolism in congestive circulatory insufficiency]. / Metabolizm fibrinogena pri zastoinoi nedostatochnosti krovoobrashcheniia.

Using 125I-labelled fibrinogen the metabolism of this protein was studied in 29 patients with II-III stage congestive circulatory insufficiency due to ischemic heart disease and rheumatic heart diseases. It was established that with the progression of circulatory insufficiency fibrinogen half-life increased. The body content of total fibrinogen increased with the gradual intensification of circulatory insufficiency due to growth of the extravascular (noncirculating) fraction. The growth is associated with the intensified egress of circulating fibrinogen into the extravascular space (thrombus, tissue, etc.). The role of disseminated intravascular clotting and consumption coagulopathy in the pathogenesis of congestive circulatory failure is discussed.

[Change in rheographic properties of blood in congestive circulatory insufficiency treated with diuretics]. / Izmenenie reologicheskikh svoistv krovi u bol'nykh s zastoinoi nedostatochnost'iu krovoobrashcheniia pri lechenii diuretikami.

Proceeding from a dynamic study of the rheological properties of blood in 85 patients with stage II-III congestive circulatory insufficiency treated with diuretics (Furosemid, Hypothiazid, Uregit, Verospiron) a conclusion is made that a rational employment of diuretic agents does not result in any increase in blood concentration, and does not increase the risk of thrombotic complications. On the contrary, in some patients with stage IIB-III circulatory insufficiency some normalization of the rheological properties of blood, that had been impaired before the treatment, was noted. The use of diuretics only moderately increased the hematocrit and blood viscosity values, but decreased the aggregation of the erythrocytes and platelets. The improvement of the rheological properties of blood was attributed to the normalization of the water-electrolyte disorders that the patients had had. In cases in which thrombotic complications occurred a low hematocrit and blood viscosity level was common, while the erythrocytes and platelets aggregation was increased.