The Results of ACES (Antihypertensive Combinations' Long Term Efficacy Comparing Study): Analysis of Metabolic Effects of Antihypertensive Combination Therapies.

BACKGROUND: More than 50 % of hypertensive patients have lipid disorders, and one-third of hypertensive patients have impaired glucose metabolism. Owing to the high prevalence of metabolic risk factors and/or comorbidities, antihypertensives with favorable or neutral metabolic effects are preferred. Based on the available evidence, diuretics and ß-blockers are heterogeneous regarding their metabolic effects. OBJECTIVE: The aim of ACES (Antihypertensive Combinations' Long Term Efficacy Comparing Study) was to compare the efficacy and metabolic effects of a carvedilol/indapamide free combination, a fixed-dose combination of perindopril/amlodipine, and a fixed combination of perindopril/indapamide in everyday practice. METHODS: This study was a 6-month, multi-center, prospective, observational, non-interventional, open-label clinical study. The data of 9124 outpatients (4898 female, 4226 male; mean age 61.7 ± 11.7 years) with mild, moderate, or severe essential (primary) hypertension with one or more metabolic risk factors were subjected to statistical analysis. At visits one (day 1), three (month 3), and four (month 6), the following metabolic parameters were monitored: fasting blood glucose, glycosylated hemoglobin, estimated glomerular filtration rate, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triglycerides, and serum potassium, sodium, creatinine, and uric acid levels. A total of 3888 patients took perindopril/amlodipine, while 2992 took perindopril/indapamide, and 2244 took a combination of carvedilol/indapamide. Statistical analysis was carried out using the one-paired t test and the Chi square test; the two-sided level of significance was set at 0.05. RESULTS: The observed changes in the main metabolic parameters were favorable and similar in all therapeutic groups: fasting blood glucose decreased by 5.5-5.5-5.5 %, total cholesterol by 9.0-10.2-9.9 %, and triglycerides by 12.7-15.4-13.8 % (respectively in perindopril/amlodipine, perindopril/indapamide and carvedilol/indapamide groups). CONCLUSIONS: Based on our findings, we conclude that the metabolic profile of indapamide is very similar to the metabolically neutral and well-documented metabolic profiles of the calcium-channel blocker amlodipine and the vasodilator ß-blocker carvedilol and that all the combinations studied had similar beneficial effects on the main metabolic parameters. The favorable changes of metabolic parameters are because of the discontinuation of active substances (e.g., conventional thiazides, second-generation ß-blockers) used in the previous therapy, which were associated with unfavorable metabolic effects, and to the increase in the ratio of administered lipid-lowering drugs and oral antidiabetic drugs.

[The "blue man"]. / A "kék ember"

The authors present the case of a 63-year-old man who was evaluated for symptoms of lung fibrosis, blue face and epithelopathy affecting both eyes. All these symptoms could be attributed to the adverse effects of amiodarone. Thyroid disorders, which are the most common side-effects of amiodarone treatment were absent. The authors want to draw attention to the potential side effects of amiodarone.

Effects of hypertension therapy based on eprosartan on systolic arterial blood pressure and cognitive function: primary results of the Observational Study on Cognitive function And Systolic Blood Pressure Reduction open-label study.

BACKGROUND: Recent studies have indicated a relationship between hypertension and cognitive function but therapeutic trials of antihypertensive therapy on the prevention of cognitive disorders have produced controversial findings. METHODS: The Observational Study on Cognitive function And Systolic Blood Pressure Reduction is an open-label trial in 28 countries designed to evaluate the impact of eprosartan-based therapy on cognitive function. The Mini-Mental State Examination was used as a global tool for the comprehensive assessment of cognitive function, with an intention to treat a cohort of 25 745 hypertensive patients aged at least 50 years during a follow-up interval of 6 months. Blood pressure therapy was initiated with eprosartan 600 mg/day with provision for additional medication to be introduced after 1 month in patients with insufficient blood pressure response. RESULTS: Use of eprosartan, either as monotherapy or in combination regimens, was associated with a substantial reduction in arterial blood pressure from 161.9/93.1 mmHg at baseline to 136.1/80.8 mmHg at 6 months (P < 0.0001). The overall mean Mini-Mental State Examination score at completion of follow-up was 27.9 +/- 2.9 compared with 27.1 +/- 3.4 at baseline (P < 0.0001). A significant correlation was shown between the mean absolute response of Mini-Mental State Examination and the magnitude of systolic blood pressure reduction. At the end of the study, patients with systolic blood pressure less than 140 mmHg had a larger improvement in Mini-Mental State Examination [0.88 +/- 0.01 (SEM)] than those with systolic blood pressure between 140 and 159 mmHg [0.69 +/- 0.02 (SEM); P < 0.001], or than those with systolic blood pressure of at least 160 mmHg [0.38 +/- 0.05 (SEM); P < 0.0001]. Furthermore, cognitive decline was demonstrated in multiple linear regression to be independently associated with age [odds ratio 1.19 (1.14; 1.25)], Mini-Mental State Examination at baseline [odds ratio 1.19 (1.14; 1.25)], systolic blood pressure at baseline [odds ratio 1.20 (1.13; 1.27)] and systolic blood pressure reduction [odds ratio 0.77 (0.73; 0.82)]. CONCLUSION: The results of the Observational Study on Cognitive function And Systolic Blood Pressure Reduction are supportive of the proposition that antihypertensive therapy based on drugs that target the renin-angiotensin system is associated with preservation of cognitive function.

[New medical therapies for the treatment of systolic heart failure]. / Uj lehetóségek a systolés szívelégtelenség gyógyszeres kezelésére.

Heart failure is characterized by sodium and fluid retention, sympathetic overactivation, parasympathetic withdrawal, vasoconstrictor activation and cytokine elevation. New therapies for heart failure attempt to control neurohormonal activation and limit progressive left ventricular dysfunction. Nesiritide (human B-type natriuretic peptide) is a recently approved new vasodilator that has been given to almost 1000 patients in numerous clinical investigations, it belongs to a new class of heart failure drugs known as natriuretic peptides. Nesiritide decreases pulmonary capillary wedge pressure, systemic vascular resistance, mean right atrial pressure and pulmonary artery pressure, while improving cardiac index, stroke volume and heart failure symptoms. Many endothelin receptor antagonists are in various stages of development. Early clinical studies have demonstrated beneficial cardiovascular hemodynamic effects. Other new drugs for heart failure also include calcium sensitizers, neutral endopeptidase and vasopeptidase inhibitors, aldosteron receptor antagonists, vasopressin antagonists and cytokine inhibitors. All are being actively investigated and many show significant promise as beneficial therapies in the treatment of heart failure.

[Diastolic heart failure]. / Diastolés szívelégtelenség.

The rhythmic contraction and relaxation of the heart supply the body with the appropriate amount of blood. If the pump function deteriorates, heart failure occurs. After a symptom-free period of varying length, the clinical case of decompensatio cardiaca develops. The pathophysiological basis of the disease is abnormal systolic and/or diastolic function. The pathophysiology and therapy of systolic heart failure is well-known, however, the consequence of impaired diastolic function has not been fully revealed. Both cardiogenic shock and pulmonary edema can be caused by acute left heart failure. The main difference between the two disorders is that while cardiogenic shock is caused by systolic dysfunction, pulmonary edema is the consequence of impaired diastolic function. The importance of diastolic dysfunction is highlighted by the fact that the disorder can be caused by the most frequent diseases (hypertension, diabetes mellitus, coronary heart disease, myocardiac infarction). Consequently, in case of risk factors, it is very important to consider the possibility of diastolic dysfunction and be aware of the diagnostic and therapeutic options.