Correction of hypertensive cardiac remodelling: comparison of different antihypertensive therapies.

The aim of the study was to compare the effects of long-term treatment with different types of antihypertensive drugs on left ventricular hypertrophy (LVH) and diastolic function in patients with essential hypertension. We examined 60 patients with mild to moderate hypertension from 35 to 55 years old (middle age 44.3 +/- 2.3 yrs) having no concomitant diseases. Patients were treated for six months with different types of antihypertensive drugs: 21 patient received nifedipine-retard 40 mg/day, 20--atenolol 100 mg/day, 10--losartan potassium 100 mg/day, 9--perindopril 4 mg/day. Cardiac structure and function was studied by echocardiography. For the left ventricle (LV) the diastolic mass normalised for body surface area (LVMI), the ratio of the early and atrial mitral inflow velocities (E/A), isovolumetric relaxation time (IVRT), relative wall thickness (RWT) were measured. After six months of treatment LVMI decreased by 9% in nifedipine group (P < 0.01), by 10.5% in atenolol group (P < 0.01), by 12% in losartan group (P < 0.01) and by 8.2% in perindopril group (NS). RWT decreased in all groups, while diastolic dimension index remained unchanged. The reversal of LVH was not related to blood pressure reduction. It was more significant in patients with initially higher values of LVMI. Antihypertensive effects of the drugs were comparable. Long-term treatment with all types of selected drugs improves cardiac structure and function independently of their antihypertensive action. Our data suggest that on the basis of the influence on cardiac remodelling no preference for any studied drug can be discerned. The work had the following source of support: the atenolol (Falitonsin) and nifedipine-retard (Corinfar-retard) were provided by the AWD Company (Germany), losartan potassium has been provided by Merck Sharp & Dohme Company and perindopril (Prestarium) by the Servier Group.

[Role of abdominal obesity in pathogenesis of insulin resistance syndrome]. / Rol' abdominal'nogo ozhireniia v patogeneze sindroma insulinorezistentnosti.

AIM: To study relationships between pathogenesis of obesity, essential hypertension (EH), hyperlipidemia, ischemic heart disease (IHD) and diabetes mellitus (DM) type II. MATERIALS AND METHODS: Glucose and insulin levels in blood, serum lipids were measured, glucose and prednisolone glucose tolerance tests were made in 75 patients with abdominal and 75 patients with gluteofemoral obesity. RESULTS: The results of the study of 75, 75, 763 and 340 patients with abdominal, gluteofemoral obesity, IHD and DM type II, respectively, show that pathogenesis of abdominal obesity, essential hypertension, hyperlipidemia, IHD, abnormal glucose tolerance and diabetes mellitus type II has common features: relative hypercorticoidism, insulin resistance and hyperinsulinemia. CONCLUSION: Abdominal obesity is the earliest symptom in composition of metabolic cardiovascular syndrome. Prevention or early treatment of this obesity can prevent or delay onset of diseases associated with this syndrome.

[Electrophysiological criteria for efficacy of different antiarrhythmics classes in patients with paroxysmal reciprocal atrioventricular nodal tachycardia]. / Elektrofiziologicheskie kriterii éffektivnosti antiaritmicheskikh preparatov raznykh klassov u bol'nykh s paroksizmal'noi retsiproknoi atrioventrikuliarnoi uzlovoi takhikardiei.

Clinical and electrophysiological studies of 510 patients with different paroxysmal reciprocal atrioventricular nodal tachycardias identified criteria for resistance of paroxysmal nodal tachycardia. Examination of changes in major electrophysiological parameters due to different antiarrhythmics established the specific features of their electrophysiological action and thereof criteria for the efficacy of antiarrhythmic therapy.

[Chronic insulin overdosage, hyperinsulinemia, atherosclerosis]. / Khronicheskaia peredozirovka insulina, giperinsulinemiia, ateroskleroz.

Biochemical and immunological indices were studied with regard to insulin dose in 321 patients with diabetes mellitus type I. Overdosage of insulin in these patients induced significantly more frequently clinical manifestations of atherosclerosis, marked shifts in lipid spectrum of the serum and in immunological picture. In diabetics on physiological doses of insulin atherosclerosis is a rare finding, lipid spectrum and immunological indices in stable normoglycemia did not differ much from controls. Implication of chronic insulin overdosage in mechanism of atherosclerosis onset is suggested.

[Prognostic significance of beta-2-microglobulin in multiple myeloma]. / K voprosu o prognosticheskom znachenii beta2-mikroglobulina pri mnozhestvennoi mielome.

Serum levels of beta 2-microglobulin (beta 2-M) have been assayed in 50 patients with multiple myeloma (MM) (stage 1-8, stage II-25. stage III - II and remission - 6). Smoldering MM was registered in 11 cases, active - 22 and aggressive - 17. Said level was significantly higher in MM patients than in healthy donors (p < 0,01) and correlated with stage and course in most cases: blood concentration of beta 2-M at stage I and in remission was found to be significantly lower than at stage II and III (p < 0,05, p < 0,05) while at stage III - higher than at stage II (p < 0,01). Serum level of beta 2-M was significantly higher in smoldering course than in healthy donors (p < 0,05) and lower than in active (p < 0,05) and aggressive MM (p < 0.01). Said concentration in blood proved significantly higher in aggressive course than in active MM (p < 0,05). Since some cases of active and aggressive MM revealed a low level of serum beta 2-M, reliance on this index as a sole prognostic test seems doubtful.

[The use of tactivin for treating patients with IHD]. / Primenenie taktivina dlia lecheniia bol'nykh IBS.

Immunomodulating drug tactivin was used for treatment of 29 IHD patients with low T-suppressor activity and high cell sensitization to apoprotein B-containing lipoproteins and with lipoprotein-antibody immune complex detected in the blood. Tactivin was injected subcutaneously in the dose 10 micrograms (5 injections for 12 days). Tactivin treatment normalized T-suppressor activity, lowered concentration of plasma lipoprotein-antibody immune complex and improved clinical course of IHD. The beneficial effect of tactivin was observed in 70% of patients during 2 months. 30% of patients needed a second course of treatment of recover normal immunological and clinical indices. The treatment with tactivin of IHD patients must be combined with application of routine antianginal drugs.

[The action of dipyridamole on megakaryocytopoiesis in regenerating and stationary bone marrow cell populations]. / Deistvie dipiridamola na megakariotsitopoéz v regeneriruiushchei i statsionarnoi populiatsiiakh kletok kostnogo mozga.

The effect of dipyridamole on megakaryocytopoiesis in regenerating and stationary populations of mouse bone marrow cells has been studied by heterotopic transplantation of the bone marrow using histological, electron microscopic and biochemical techniques. It is shown that drug administration induced destruction of megakaryocytes. In megakaryocytic cytoplasm giant lipid granules were found whose growth and number increase resulted in megakaryocytes kill. Gas-liquid chromatography was used to evaluate the effect of dipyridamole on distribution of lipid fatty acids of the stationary and regenerating populations of the bone marrow cells. A marked increase of the percentage of docosahexaenoic acid was found in lipids of the stationary population. Chronic dipyridamole administration caused an increase of percentage of myristic, palmitic oleic acids, and decrease of percentage of arachidonic and eicosapentaenoic acids in lipids of regenerating bone marrow cells population.

Atrial and digitalis-like natriuretic hormones in essential hypertension under functional loading.

To assess the relation of the two natriuretic hormones, atrial natriuretic peptide (ANP) and digitalis-like natriuretic factor (DLF), to hypertension, levels of ANP and DLF were measured under basal conditions and after salt and water loading in 31 normal subjects and 36 and 57 patients with Stage I or II essential hypertension (EH). DLF levels were higher in normal women than men; in EH-II patients, DLF levels were elevated among men but subnormal in women (P less than .02) and rose with water loading in both genders. In all groups ANP levels tended to be higher in women. Water loading increased ANP levels in EH-I patients (P less than .001) and caused less marked increases of ANP in control and EH-II women and men. ANP also tended to increase with salt loading. Both DLF and ANP were related to blood pressure in the subject groups (r = 0.75 to 0.96 and r = 0.27 to 0.75, respectively) and were also related to each other (r = 0.20 to 0.47). The role of ANP and DLF in hypertension are likely to be compensatory and directed against water-electrolyte metabolism disorders associated with elevated arterial pressure.

[Natriuretic hormones (atrial and digitalis-like) in patients with arterial hypertension during exercise]. / Natriureticheskie gormony (predserdnyi i digitalisopodobnyi) u bol'nykh s arterial'noi gipertenziei v usloviiakh funktsional'nykh nagruzok.

Blood levels of natriuretic hormones (atrial natriuretic peptide and digitalis-like natriuretic factor) were measured in 93 patients with Stages I and II essential hypertension and 31 healthy individuals. The baseline level of digitalis-like natriuretic factor was higher in the patients with Stage II essential hypertension than in the healthy individuals. This parameter was normal in the patients with Stage I hypertension. The concentration of atrial natriuretic peptide was not greatly different in the patients from that in the healthy persons. Water and salt loads were reported to affect the blood levels of natriuretic hormones. The levels of the hormones were shown to be correlated between them and with blood pressures and the activity of the renin-angiotension-aldosterone system. It was suggested that the natriuretic hormones might play a compensatory role in the pathogenesis of essential hypertension.

[Fundamental research--a basis for the synthesis of new hypotensive drugs]. / Fundamental'nye issledovaniia--osnova sinteza novykh gipotenzivnykh sredstv.

The paper presents the data showing the important significance of basic research into the mechanisms of circulation regulation in synthesizing new classes of antihypertensive agents. It also considers the hemodynamic mechanisms responsible for the antihypertensive effect of calcium antagonists, postsynaptic alpha 1-adrenoreceptor blockers and angiotensin-converting enzyme blockers to treat hypertensive disease. The paper gives the data suggesting the effects of the drugs on the adrenergic and humoral mechanisms of vascular tone regulation.

[Effect of biguanide derivatives on the indicators of lipid metabolism and the functional state of blood mononuclear cells in patients with insulin-dependent diabetes mellitus]. / Vliianie proizvodnykh biguanidov na pokazateli lipidnogo obmena i funktsional'noe sostoianie mononuklearov krovi u bol'nykh insulinozavisimym sakharnym diabetom.

The paper provides the biochemical and immunological findings from 287 patients with Type I diabetes mellitus with regard to the pattern of their management. It has been shown that the patients treated with non-physiological large-dose insulin more frequently display clinical signs of atherosclerosis profound changes in the serum lipid profile and some immunological parameters. It is concluded that chronic insulin overdosage may play a role in the mechanisms of atherosclerosis development. It is indicated that the use of biguanidine derivatives in the treatment of patients with Type I diabetes mellitus concurrent with insulin overdosage leads to correction of most unfavorable changes in biochemical and immunological parameters.