[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.

[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.

[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.

[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.

[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.

[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).

[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.

[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).

[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.

[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.

[Temporal organization of external respiratory function in elderly patients with chronic obstructive lung disease]. / Temporal organization of external respiratory function in elderly patients with chronic obstructive lung disease.

The clinical course and the circadian, circaseptan, and circasemiseptan chronostructure of external respiratory function (ERF) were studied in 26 elderly patients with chronic obstructive lung diseases before and after routine therapy (RT). ERF was studied on a meta-test spirograph (Russia) and a Ferraris medical peak flowmeter (UK). The values of ERF and bronchial patency were measured every 4 hours within 7 days before and after 10-day RT. The latter included euphylline, expectorants, and antibacterial drugs, if indicated. The patients also use "on-demand" dosage aerosol inhalators not more than 3-5 times a day. The chronobiological data were analyzed by the averaged group cosinor test described by F. Halberg. The results of the study made it possible to detect the impaired temporary organization of ERF and bronchial patency, the phenomena of external and internal desynchronism both prior to and following RT. It clinical effect occurred on day 5.5 after RT. Before RT, circadian variations were found in respiratory volume (RV), respiratory minute volume (RMV), vital capacity (VC), forced expiratory value per sec (FEV1), the Tiffeneau test, and peakflowmetry. After RT, they remained other than variations in RV. The average daily values of VC, FEV1, Tiffeneau test, PO2, and KIO2 statistically significantly increased. The increases of MESORs and other indices tended to be significant. Circasemiseptan variations were found in RV, VC, and FEV1 before RT. After treatment, these were detected in respiration rate (RR), RMV, VC, and KIO2. The MESORs of RMV, VC, FEV1, and KIO2 statistically significantly increased. Prior to and following RT, there were virtually no 7-day (circaseptan) variations, other than those in RR before therapy. The MESORs of VC, FEV1, MVL, and RD statistically significantly increased. The MESORs of other parameters of ERF tended to be significant. Thus, RT led to the improved circadian and circasemiseptan organization of ERF and, to a lesser degree, to that of circaseptan chronostructure of the parameters of ERF.

[Pharmacodynamics of nonessential amino acids in elderly patients with post-infarction cardiac sclerosis]. / Farmakodinamika zamenimykh aminokislot u pozhil'nykh bol'nykh postinfarktnym kardiosklerozom.

We studied pharmacodynamics of an amino acids complex (AAC) in 60 elderly patients (a mean age 71.6 years) with ischemic heart disease, postinfarction cardiosclerosis (PIC), circulatory insufficiency stage I-II. The patients were randomized into 3 groups, 20 persons each. Group 1 received standard therapy (ST) and placebo, group 2--ST + AAC (one tablet of 70 mg 3 times a day), group 3--ST + AAC sublingually in the same dose. Clinical symptoms, results of ECG Holter monitoring and echocardiography were assessed before the treatment and on treatment day 18. Positive effects of AAC used in combination with ST in relation to clinical symptoms, myocardial contractility and ischemia. No differences in efficacy were observed with oral and sublingual AAC administration.

[Effects of nebuliser treatment with berotec on external respiratory function, bronchial permeability, hemodynamics, acid-alkaline balance, oxygen saturation, and their circadian structure in elderly patients with chronic obstructive pulmonary disease]. / Vliianie nebulaizernoi terapii berotekom na funktsiiu vneshnego dykhaniia, bronkhial'nuiu prokhodimost', gemodinamiku, kislotno-shchelochnoe sostoianie, saturatsiiu kisloroda i ikh vremennuiu organizatsiiu u pozhilykh bol'nykh khronicheskoi obstruktivnoi bolezn'iu legkikh.

AIM: To study the effects of nebuliser therapy with berotek on clinical symptoms, external respiration function (ERF), bronchial permeability, hemodynamics and their temporal organisation in elderly patients with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: The study enrolled 20 COPD patients (mean age 64.9 +/- 1.9 years) with obstructive respiratory insufficiency of the second-third degree given nebuliser therapy with berotek as adjuvant to conventional treatment (the study group) and 12 COPD patients (mean age 69.7 +/- 2.5 years) given only conventional treatment (the control group). The following parameters were examined: ERF, BP, HD, AAB, OS (SaO2) in venous blood before and after treatment. Chronobiological studies of BP and HD were performed for 7 days at the beginning and end of the study. RESULTS: Berotek efficacy manifested on the treatment day 3 as improvement in the symptoms, IRF, BP, a rise in SaO2 and PaCO2 and a fall in PaCO2 in venous blood. Circadian chronostructure of peakflowmetry, systolic and diastolic blood pressure, mean arterial pressure persisted. Circaseptal and circasemiseptal rhythms of BP and HD disappeared. CONCLUSION: Nebuliser therapy with berotek has a positive effect on clinical symptoms, ERF, BP, gas exchange in the lungs, SaO2, HD and their circadian chronostructure.

[Efficacy of emoxypine in combined therapy for elderly patients with postinfarct cardiosclerosis and heart failure]. / Effektivnost' emoksipina v kompleksnoi terapii pozhilykh bol'nykh posinfarktnym kardiosklerozom i serdechnoi nedostatochnost'iu.

Forty-four patients with coronary heart disease, angina pectoris, prior myocardial infarction, and NYHA Functional Class II-IV heart failure were examined. Group 1 patients received emoxypine during combined therapy (CT). Group 2 patients took CT alone (a control group). The results of the study suggest that emoxypine significantly improves the clinical symptomatology and shows marked antianginal and antiischemic effects. As compared with the control group, Group 1 shows a more significant hemodynamic improvement. Moreover, the inclusion of emoxypine into CT for elderly patients with prior myocardial infarction produces a normalizing effect on oxidative stress. By taking into account the foregoing, it should be stated that it is expedient to include emoxypine into CT for this category of patients.

[Optimization of sanatorium treatment of patients with essential hypertension stage II by chronotherapy]. / Optimizatsiia sanatorno-kurortnogo lecheniia bol'nykh gipertonicheskoi bolezn'iu II stadii metodami khronoterapii.

A comprehensive chronodiagnostic examination and treatment were performed in 45 patients with essential hypertension stage II aged 37 to 68 years taking 21-day treatment at sanatorium Osetia. The patients were divided into 2 groups: 20 patients of group 1 received basic antihypertensive treatment (enap, hypothiaside) and sulfurated hydrogen balneotherapy not adjusted to individual biorhythm; 25 patients of group 2 received the same treatment by adjusted to biorhythmic phases of basic cardiovascular indices and chronotype established according to Estberg's questionnaire. Estimation of the rhythms of the integral indices of physiological functions (systolic and diastolic arterial pressure, heart rate, body temperature) and "individual minute" was made within 3 days in 4-h intervals. Hemodynamics was studied before and in the end of the treatment with echocardiography, dopplerechocardiography and rheoencephalography. Positive shifts were registered in both groups: a significant fall in arterial pressure, total peripheral vascular resistance, double product and cardiac performance. Patients of group 2 had greater number of significant rhythms of physiological function parameters, primarily circadian, more frequent recovery of amplitude and phase parametric characteristics, better improvement of cerebral circulation, contractile and diastolic functions of the myocardium, reduction of the required medication doses and 2-fold lowering of side effects rate.

[Effects of altiazem PP and dilren on clinical symptoms, hemodynamic parameters and their chronologic structure in patients with stable angina]. / Vliianie altiazëma PP i dilrena na klinicheskuiu simptomatiku, pokazateli gemodinamiki i ikh khronostrukturu u bol'nykh stabil'noi stenokardiei.

Effects of altiazem PP-180 ("Berlin Chemie", Germany; "Menarini Group". Italy) and dilren-300 ("Sanofi", France) on clinical symptoms and circadian hemodynamic chronostructure were studied in 22 patients with coronary heart disease (CHD) with stable angina pectoris of functional class II-III. Tetrapolar chest rheography (TCR), echocardiography (Echo-CG), ECG, arterial pressure measurement (APM) by N. S. Korotkov were used for examination. TCR, ECG and APM were made 6 times a day: at 10.00, 14.00, 18.00, 22.00, 02.00 and 06.00. The drugs were given in a single daily dose at 08.00 for 10 days. The information was processed statistically and by F. Halberg's cluster analysis. The results showed that altiazem PP and dilren had an antianginal activity which is stronger in dilren administration. The drugs produced moderate hypotensive and vasodilating effects. Altiazem PP raised mean daily level of stroke and minute volumes and their indices. Dilren raised ejection fraction and reduced the double product. Dilren normalized chronostructure of hemodynamic circadian rhythms.