Aim. Optimization of therapy in patients with arterial hypertension (HT) 1-2 grade considering heart rate variability (HRV) and efficacy of metoprolol tartrate in long-acting presentation (Egilok retard) during 96 weeks of usage Material and methods. 33 patients with mild to moderate HT were treated with Egilok retard. Doses were titrated from 50 to 200mg\daily. If the target level of blood pressure (BP) wasn't reached, hydrochlorothiazide (12,5-25 mg / daily) was added. Ambulatory BP and ECG monitoring with HRV analysis were carried out before start and after 24, 48, 96 weeks of therapy, echocardiography after 48 and 96 weeks. Life quality was estimated by four-grade scale Results. After 96 weeks 20 patients continued this therapy (60,6 %). Monotherapy provided of BP target level in 13 patients (65 %), combined therapy in 7 (35 %). The high patient compliance to the treatment was based on considerable and stable antihypertensive effect, absence of side effects and improvement of life quality during 96 weeks as well as consideration of HRV type. It was suggested to split patients in groups with high, normal and low levels of HRV. It was mostly difficult to reach BP targets in patients with low HRV level. They took combined therapy in 62 % (p > 0,005) 7 patients demonstrated normalization of disturbed diastolicfunction which means heart remodelling regress. The longer therapy with Egilok retard showed more significant cardioprotective effect. Conclusion. Long-term therapy with Egilok retard provides improvement of life quality and significant cardioprotective effect. Beta-blocker therapy can be optimized by consideration of HRV patient type. Rational Pharmacother. Card. 2007; 3: 27-32
Aim. To evaluate antihypertensive and metabolic effects of the therapy based on carvedilol (C) in comparison with metoprolol (M) in hypertensive patients with overweight or obesity. Material and methods. 320 patients were involved in multicenter, randomized open parallel study. One part of the patients received C 12,5 mg BID (Vedicardol, “Sintez”), another part – M 25 mg/day BID. Doubling dose of β-blockers (BB) and switching patients to combined therapy with AML 5-10 mg OD (Amlorus, “Sintez”) and hydrochlorothiazide (HCT) 12,5-25 mg OD was performed if necessary. The study duration was 24 weeks. Results. Significant reduction of systolic and diastolic blood pressure was revealed in both groups, there was no difference between groups (р=0,88 and p=0,61 respectively). Switching patients to combined therapy with AML and HCT was made more often in M group than in C group (p>0,05). Prescription of BB resulted in significant reduction of the heart rate, there was no difference between groups (p=0,61). 96,2% patients of group C and 95,5% of group M reached target levels of BP. Significant reduction of glucose (p<0,01) and uric acid levels were registered in group C as well as tendency to lowering of total cholesterol (TC) and low density lipoprotein cholesterol (LDLC) levels. 34 adverse effects were registered during observation period: 24 in group C and 10 in group M (p>0.05), half of them were not related to BB taking. Conclusion: Controlled antihypertensive therapy, based on С and M, allows reaching target levels of BP in majority of patients with overweight or obesity. Switching to combined therapy was made more seldom in group of С than in M group. Both drugs demonstrated metabolic neutrality, however significant lowering of glucose and uric acid levels and tendency to lowering of TC an LDLC levels was observed only in group С.
Aim. To study antihypertensive efficacy of long-acting metoprolol, its influence on heart rate variability and therapy compliance in hypertensive patients during long-term (48 weeks) treatment. Material and Methods. After 2 weeks of wash-out period 30 hypertensive patients were prescribed long-acting metoprolol (Egilok Retard, EGIS) in dose of 50-100 mg once daily. If necessary the dose was increased up to 200 mg daily on 2 or 8 week, and on 12-16 weeks hydrochlorothiazide 12,5-25 mg daily and then nifedipine 20 mg daily were added. Ambulatory blood pressure monitoring (ABPM) and daily ECG monitoring were applied on 24 and 48 weeks. Patient quality of life was estimated. Results. In 48 weeks 22 patients (73,3%) continued the treatment. 5 patients dropped out because of low compliance and 3 patients because of low efficacy. Therapy discontinuation because of side effects was necessary in no one case. Monotherapy with metoprolol provided excellent results in 15 (68%) and combined therapy in 7 (32%) patients. In comparison with starting data on 48 week of treatment significant reduction in 24 hour, day and night systolic blood pressure (BP) was registered on 10,4±1,6; 11,3±1,7 and 5,2±1,9 mm Hg, respectively, as well as diastolic BP on 7,7±1,1; 8,1±1,3 and 4,1±1,3 mm Hg, respectively. Time index of hypertension for 24-hour systolic and diastolic BP decreased significantly. Daily BP profile normalized. Normalization of BP and heart rate variability was observed among patients with its initial disturbances. The frequency of hypertensive symptoms such as headache and dizziness reduced on 58% and 64%, respectively. Capacity for work improved significantly. Conclusion. Long-acting metoprolol is effective antihypertensive medicine providing high level of compliance with long-term therapy. Long-acting metoprolol is especially indicated to hypertensive patients with sympathetic system overactivity.
Aim. To study clinical effectiveness of a calcium antagonist nifedipine SR in patients with various clinical variants of Stage I-II arterial hypertension (AH), aged over 60 years. Material and methods. An open, prospective, 48-week study included 48 patients with Stage I-II AH (mean age 66,15±4,81 years). Participants with systolo-diastolic AH (SDAH) and isolated systolic AH (ISAH) received nifedipine SR (Cordaflex RD) (40 mg/d). Treatment effectiveness was assessed by the dynamics of office blood pressure (BP) measurements and 24-hour BP monitoring (BPM). Organo-protection was assessed by echocardiography parameters and microalbuminuria (MAU) level. Vasoprotection was assessed by volume sphygmography and endothelial dysfunction parameters. Results. Nifedipine SR therapy normalized circadian BP profile, reduced pressure load parameters and pulse BP, improved systolic and diastolic function, facilitated myocardial hypertrophy regression, and decreased the number of MAU individuals in both groups, especially in those with ISAH. In addition, nifedipine SR facilitated arterial remodeling regression in elderly patients: in ISAH participants, its effect was mostly targeted at elastic vessels; in SDAH individuals, on muscular vessels and endothelial dysfunction correction. Conclusion. Nifedipine SR therapy for 48 weeks demonstrated stable antihypertensive and organo-protective effects in elderly patients.
Aim. Optimization of therapy in patients with arterial hypertension (HT) 1-2 grade considering heart rate variability (HRV) and efficacy of metoprolol tartrate in long-acting presentation (Egilok retard) during 96 weeks of usage. Material and methods. 33 patients with mild to moderate HT were treated with Egilok retard. Doses were titrated from 50 to 200mg\daily. If the target level of blood pressure (BP) wasn’t reached, hydrochlorothiazide (12,5-25 mg\daily) was added. Ambulatory BP and ECG monitoring with HRV analysis were carried out before start and after 24, 48, 96 weeks of therapy, echocardiography - after 48 and 96 weeks. Life quality was estimated by four-grade scale. Results. After 96 weeks 20 patients continued this therapy (60, 6%). Monotherapy provided of BP target level in 13 patients (65%), combined therapy – in 7 (35%). The high patient compliance to the treatment was based on considerable and stable antihypertensive effect, absence of side effects and improvement of life quality during 96 weeks as well as consideration of HRV type. It was suggested to split patients in groups with high, normal and low levels of HRV. It was mostly difficult to reach BP targets in patients with low HRV level. They took combined therapy in 62% (p>0,005). 7 patients demonstrated normalization of disturbed diastolic function which means heart remodelling regress. The longer therapy with Egilok retard showed more significant cardioprotective effect. Conclusion. Long-term therapy with Egilok retard provides improvement of life quality and significant cardioprotective effect. Beta-blocker therapy can be optimized by consideration of HRV patient type.
Objective. To evaluate the antihypertensive and organoprotective effects of the calcium antagonist slow release Nifedipine (Cordaflex RD) and diuretic Indapamid MR in patients with isolated systolic hypertension (ISH). Design and methods. 46 patients with ISH (66,2 ± 4,8 years) were included. Patients were divided into 2 clinical groups: 1st group (n = 26) took cordaflex RD, and 2nd group (n = 20) was given the Indapamide MR. The cardioand angioprotective effects of the medications was evaluated. Results and conclusions. Cordaflex leads to the decrease of both systolic and diastolic blood pressure (SBP and DBP), whereas Indapamide influences SBP more, than DBP. Based on echocardiography results, both medications decreased the heart wall thickness, improved systolic and diastolic left ventricular function. Cordaflex RD significantly improved the diastolic left ventricular function. Both Cordaflex RD and Indapamide favorably influenced peripheral arteries endothelial function in elderly subjects with ISH. Both medications effectively reduced the index of the true stiffness CAVI.
Objective. To evaluate the antihypertensive and organoprotective effects of the calcium antagonist - slow release Nifedipine (Cordaflex RD) and diuretic Indapamid MR in patients with isolated systolic hypertension (ISH). Design and methods. 46 patients with ISH (66,2 ± 4,8 years) were included. Patients were divided into 2 clinical groups: 1st group (n = 26) took cordaflex RD, and 2nd group (n = 20) was given the Indapamide MR. The cardio- and angioprotective effects of the medications was evaluated. Results and conclusions. Cordaflex leads to the decrease of both systolic and diastolic blood pressure (SBP and DBP), whereas Indapamide influences SBP more, than DBP. Based on echocardiography results, both medications decreased the heart wall thickness, improved systolic and diastolic left ventricular function. Cordaflex RD significantly improved the diastolic left ventricular function. Both Cordaflex RD and Indapamide favorably influenced peripheral arteries endothelial function in elderly subjects with ISH. Both medications effectively reduced the index of the true stiffness CAVI.
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