[Endothelin aggression in pathogenesis of chronic cardiac failure and approaches to its therapeutic correction].
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Biomedical subjects
Publications and source records attributed to L I Ol'binskaia.
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Modern approaches to prevention of venous thromboembolic complications in patients with chronic heart failure are analyzed in this review which contains results of large studies of low molecular weight heparins. In MEDENOX trial the use of enoxaparin in medical patients was associated with 63% reduction of risk of thrombosis. The authors own experience showed that 2 weeks of therapy with enoxaparin in patients with chronic stage IIB-III heart failure caused significant lowering of soluble fibrin-monomer complexes, fibrinogen, and index of turbo-dynamic potential. These changes evidenced for decreased intravascular blood coagulation. Thus enoxaparin can be effectively used for prevention of thrombosis and thromboembolism in patients with chronic heart failure. Novel antithrombotic agents fondaparinux, idraparinux, ximelagatran, recombinant thrombomodulin are perspective medications for prevention of venous thromboses and embolism in medical patients.
AIM: To examine the course of chronic cardiac failure (CCF), morphofunctional parameters of the heart in correlation with activity of cytokine system; to evaluate effectiveness, tolerance and safety of combined CCF treatment including a cardioselective beta-adrenoblocker bisoprolol in patients with CCF FC I-IV having a high plasm level of tumor necrosis factor alpha (TNF-alpha). MATERIAL AND METHODS: The concentration of TNF-alpha in plasm of 40 patients with IHD complicated by CCF of FC I-IV and ejection fraction under 45% was measured at enzyme immunoassay. The treatment included combined therapy with diuretics, cardiac glycosides, peripheral vasodilators, ACE inhibitors, bisoprolol (group I) or no bisoprolol (group II). RESULTS: CCF patients with TNF-alpha had a significantly reduced IMT, more frequent episodes of CCF decompensation, longer CCF history, lower EF and threshold exercise intensity. In group I patients all these parameters improved. CONCLUSION: CCF patients with elevated plasm levels of TNF-alpha showed a severe course of the disease, low IMT, abnormal myocardial contraction and exercise tolerance. The addition of bisoprolol to combined treatment of the above patients improves their clinical condition, morphological parameters of the heart and exercise tolerance.
AIM: To assess efficacy and safety of a generic preparation of simvastatin Vasilip (KRKA) in ischemic heart disease patients with hypercholesterolemia or combined hyperlipidemia. MATERIAL: Patients (n=167, age 36-73 years) with ischemic heart disease and moderate hypercholesterolemia or combined hyperlipidemia. METHODS: Duration of simvastatin administration was 12 weeks. All patients received 20 mg/day for 6 weeks. Then those patients who did not achieve target low density lipoprotein (LDL) cholesterol level (3.0 mmol/l) were given 40 mg/day for 6 more weeks. Other patients continued to take 20 mg/day. RESULTS: The use of Vasilip was associated with lowering of total, LDL cholesterol and triglycerides (by 28, 39 and 10%, respectively) and 18% elevation of high density lipoprotein cholesterol. Target LDL CH level was achieved in 107 patients (66.9%). In 47 patients (29.4%) LDL CH concentration remained higher than target level but decrease of LDL CH exceeded 10%. Six patients (3.8%) did not respond to therapy. Treatment was stopped because of adverse effects in 2.4% of patients. CONCLUSION: A generic preparation of simvastatin Vasilip in a 12-week open noncomparative study demonstrated substantial lipid lowering activity and did not induce serious adverse reactions.
Twenty-four hour blood pressure (BP) monitoring was used for the study of BP 24-hour rhythms and variability in adolescents with hypertension and their normotensive counterparts. The data obtained evidenced for active participation of sympatho-adrenal system in genesis of juvenile hypertension: hypertension was predominantly systolic, BP elevation as a rule was associated with increased heart rate and pulse pressure. Episodes of BP elevation were registered mostly during day time. Desynchronization of 24-hour rhythms due to pronounced BP lowering during sleep characteristic for this age group found its reflection in values of nocturnal BP dipping. More than 1/3 of adolescents with episodes of elevated BP had 'white coat' hypertension.
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AIM: To compare clinical, cost-effect efficacies and safety of simvastatin Zokor and generic Vasilip in correction of dislipoproteinemia in patients with ischemic heart disease. MATERIAL AND METHODS: The original statin Zokor and generic statin Vasilip were given for 8 weeks in a dose 20 mg/day. RESULTS: Vasilip and Zokor demonstrated similar hypolipidemic efficacy and safety, but Vasilip administration was more cost-effective. CONCLUSION: Simvastatin Vasilip is recommended for wider use in clinical practice because it is clinically and cost effective.
AIM: To study the effectiveness and tolerance of a combined drug logimax in patients with essential hypertension (EH). MATERIAL AND METHODS: The antihypertensive activity and safety of logimax was evaluated in 15 EH patients at week 10 of therapy. RESULTS: Logimax has a good antihypertensive effect for 24 hours in 86.7% patients. This was evidenced by the lowered mean systolic and diastolic pressures shown during 24-hour monitoring. Logimax was well tolerated. There were no side effects in 73.3% of the patients. CONCLUSION: The combined drug logimax is indicated for patients with EH as an antihypertensive agent to treat and prevent cardiovascular events.
AIM: To evaluate peculiarities and trends in 24-hour arterial pressure (AP) profile and bronchoobstructive syndrome (BOS) in patients with chronic obstructive pulmonary diseases (COPD) and arterial hypertension (AH) on combined treatment including enalapril maleate. MATERIAL AND METHODS: Changes in BOS as shown by clinical data, data of peakflowmetry and external respiration function as well as in AP 24-hour profile according to 24-hour monitoring were studied in 50 patients with exacerbation of bronchial asthma and chronic bronchitis treated for 4 weeks with conventional broncholytic and antiinflammatory modalities, in 28 patients with mild and moderate AH receiving combined therapy including enalapril maleate. RESULTS: In exacerbation of COPD, 24-h AP profile is characterized by high frequency of the curve "non-dipper". Concomitant mild and moderate AH was diagnosed in more than half of the examinees. The addition of enalaprile maleate to the treatment in many cases lowered systolic and diastolic AP, normalized sympathicoadrenal system and 24-hour AP rhythm, reduced dyspnea, improved exercise tolerance, sleep. Good tolerance of the drug was seen in patients with exacerbation of COPD. CONCLUSION: In exacerbation of COPD it is recommended to monitor AP for 24 hours for early detection of AH and initiation of combined treatment with correction of bronchoobstructive syndrome and hemodynamic disorders. As a hypotensive drug, enalapril maleate is adequate in such patients.
Registration of 24-hour blood pressure in adolescents with and without hypertension revealed active participation of sympathetic nervous system in genesis of juvenile hypertension. Hypertension in adolescents was mainly systolic, blood pressure elevation as a rule was accompanied by accelerated heart rate and increased pulse pressure. Episodes of blood pressure elevations occurred mostly during day time. Desynchronization of 24-hour rhythms due to excessive nocturnal blood pressure lowering was found to be typical for this age group. More than two thirds of adolescents with episodes of blood pressure elevation had also 'white coat hypertension'.
Circadian rhythm of hemodynamic load by double product (heart rate x systolic blood pressure) was studied in 224 patients with essential hypertension (EH) treated with different antihypertensive drugs for 8-12 weeks and in 23 healthy subjects. The main feature of the rhythm was a marked morning rise in all the patients including non-dippers and night-peakers without nocturnal blood pressure fall. The examined drugs showed different effects on mean 24-h and morning values of the double product.
AIM: To study effects of perindopril, indapamid and their combination on stratification of essential hypertension (EH) risk factors. MATERIAL AND METHODS: The 10-year risk to develop cardiovascular complications was assessed in 85 EH patients before and after 12 months of treatment with perindopril, indapamid and their combination. RESULTS: The high risk of cardiovascular complications in the above patients reduced by 21.5, 14.8 and 26.6% 12 months after treatment with perindopril, indapamid and their combination, respectively. CONCLUSION: Low risk of cardiovascular complications was related not only with a fall in systolic and diastolic blood pressure but also with positive effect on left ventricular hypertrophy, absence of negative influence on total cholesterol, glucose in blood plasma.
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Changes in 24-h profiles of arterial pressure following treatment with zolpidem were studied in 12 patients with essential arterial hypertension and chronic sleep problems on enalapril. One week treatment with zolpidem improved quality of sleep, increased a circadian index of systolic arterial pressure, 3 non-dipper patients recovered circadian rhythm of arterial pressure. The antihypertensive effect at night was higher when enalapril was used in combination with zolpidem than in monotherapy with enalapril.
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