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Background: The main factors that increase the risk of cardiovascular accidents and mortality among patients with COVID-19 include hyperglycemia, arterial hypertension and dyslipidemia. Therefore, all patients with COVID-19 and metabolic syndrome should receive antihypertensive (AHT), hypolipidemic (GLT) and hypoglycemic therapy (GGT). Currently, there is a limited number of studies regarding the effectiveness and safety of this therapy in patients with COVID-19., Aim: Evaluate the clinical outcomes of patients with COVID-19, depending on the recipient of AHT, GLT and GGT., Materials and Methods: A retrospective analysis of the clinical outcomes "discharged/died" of 1753 patients with COVID-19 was carried out depending on the received AHT, GLT and GGT., Results: A significant reduction in the risk of mortality among patients with COVID-19 was observed during therapy with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers ACE inhibitors/ARBs (OR 0.39, 95% CI 0.210.72; p0.05) and b-adrenergic blockers b-AB (OR 0.53, 95% CI 0.281; p0.05). At the same time, against the background of therapy with ACE inhibitors/ARBs and b-ABs, the chance of mortality decreased more significantly among patients with type 2 diabetes mellitus (T2DM) compared with patients without T2DM. Diuretic therapy was associated with a 3-fold increase in the chances of death: OR 3.33, 95% CI 1.884.79; p0.05. Statin therapy did not affect clinical outcomes in COVID-19 patients. On the background of therapy with oral hypoglycemic drugs, the risk of mortality decreased 5-fold (OR 0.19, 95% CI 0.070.54; p0.05). Against the background of insulin therapy, there was an increase in mortality risk by 2.8 times (OR 2.81, 95% CI 1.55.29; p0.05)., Conclusion: A significant reduction in mortality among patients with COVID-19 was observed during therapy with ACEI/ARB, b-AB, and oral hypoglycemic therapy. Increased risk of death was associated with insulin therapy and diuretic therapy.

Background: Data on the national level and worldwide show a higher rate of mortality in patients with diabetes mellitus (DM) due to COVID-19, which determines the high relevance of risk factor analysis for outcomes in DM patients to substantiate the strategy for this category of patients., Aim: To assess the effect of clinical and demographic parameters (age, gender, body mass index (BMI), glycemic control (HbA1c), and antidiabetic and antihypertensive drugs, including ACE inhibitors and ARBs) on clinical outcomes (recovery or death) in patients with type 2 DM., Materials and Methods: A retrospective analysis of the Russian Register of Diabetes database was performed, including patients with type 2 DM (n=309) who suffered pneumonia/COVID-19 in the period from 01.02.2020 to 27.04.2020 and the indicated outcome of the disease (recovery or death) RESULTS: The percentage of lethality was determined to be 15.2% (47 of 309 people). The degree of lethality was found to be significantly higher in males (OR=2.08; 95% CI 1.1–3.9; p=0.022) and in patients on insulin therapy (OR=2.67; 95% CI; 1.42–5.02; p=0.002), while it was significantly lower in patients with an age <65 years (OR=0.34; 95% CI 0.18–0.67; p=0.001) and in patients receiving metformin (OR=0.26; 95% CI 0.14–0,5; p<0.0001), antihypertensive therapy (OR=0.43; 95% CI 0.22–0.82; p=0.009), β-blockers (OR=0.26; 95% CI 0.08–0.86; p=0.018), diuretics (OR=0.4; 95% CI 0.17–0.93; p=0.028) and renin-angiotensin system blockers (ACE inhibitors or ARBs) (OR=0.36; 95% CI 0.18–0.74; p=0.004). A tendency to an increase in lethality at higher rates of HbA1c and BMI was present, but it did not reach a statistical significance. Differences between patients receiving insulin therapy and those who were not receiving the insulin therapy were observed as follows: a significantly longer duration of type 2 DM (13.4 vs. 6.8 years, respectively; p<0.0001), worse overall glyacemic control (HbA1c: 8.1% vs. 7.0%, resp.; p<0.0001), and three times more frequent failure to achieve the HbA1c goal by more than 2.5% (14.7% vs. 5.9%, resp.; p=0.04)., Conclusion: The identified risk factors for lethality in patients with type 2 DM indicate that good glycemic control and previous treatment with metformin and antihypertensive drugs (including RAS blockers) could reduce the frequency of deaths. In patients on insulin therapy, a higher lethality degree was associated with worse glycemic control.

Aim: To define the prognostic value of arterial hypotension (AH) episodes in patients with chronic heart failure (CHF)., Subjects and Methods: One hundred and ninety-nine patients (mean age 57.2 +/- 10.5 years) were examined. Functional Class I, II, III, and IV CHF was diagnosed in 24, 92, 82, and 1 patients, respectively. The cause of CHF was coronary heart disease concurrent with hypertensive disease in 160 patients. AH was diagnosed when their blood pressure (BP) was < or = 100/60 mm Hg during medical visits and daytime BP < or = 100/60 mm Hg and nocturnal BP < or = 85/47 mm Hg were measured during 24-hour BP monitoring (BPM). The follow-up lasted 24 months. The major end-point was a combined measure of death rates from any cause, incidence rates of myocardial infarction (MI) or stroke., Results: AH was identified in 6.5% of the patients with CHF when BP was measured during their medical visit; 24-hour BPM revealed hypotensive episodes in 65.8%. There were no differences in the major endpoint in relation to the presence of AH episodes. MI developed only in patients with systolic AH episodes (5 versus 0 patients; chi2 = 5.55; p = 0.02) and the risk of MI was associated with the greater magnitude of diastolic AH., Conclusion: 24-hour BPM can substantially increase the detection rate of potentially dangerous BP changes. Almost three fourths of patients with CHF were observed to have AH episodes during a day. The use of angiotensin-converting enzyme (ACE) inhibitor/ diuretic, ACE inhibitor/mineral corticoid receptor antagonist, ACE inhibitor/nitrate combinations in the treatment of patients with CHF increase the risk of transient AH. In patients with CHF, the risk of MI is associated with the detection of systolic AH episodes and the magnitude of diastolic AH.

In a review article we presents an analysis of the new recommendations of the European Society of hypertension (ESH) and the European Society of Cardiology (ESC) on the management of arterial hypertension (2013). Main attention is paid to the tactics of antihypertensive therapy and the choice of drugs in the treatment of early hypertension. Target blood pressure levels in are discussed the historical aspect. Criteria for applicftion of monotherapy in the treatment patients with hypertension, and possible mechanisms for selection of antihypertensive drug are also discussed.

Aim: To evaluate the impact of intake of cardiac drugs on adaptation to abnormal heat in patients with cardiovascular diseases (CVD)., Subjects and Methods: The study covered 188 patients with CVD, who had visited the Research Dispensary Department in January 2011. General clinical examination, biochemical blood analysis, and electrocardiography were made; the hospital anxiety and depression scale, the visual analog scale, and the questionnaire specially developed for this investigation were used. The authors considered acute myocardial infarction, acute stroke, hospital admission, a medical emergency team call, temporary disability (days), hypertensive crises, and unplanned visits to a doctor as estimated outcomes (endpoints) and the number of undesirable reactions a week during the abnormal heat and from September to December 2010 as a combined endpoint., Results: There were a larger number of weekly adverse reactions than usual and a reduction in quality of life (QL) during the abnormal heat. Both an increase and a reduction in the dose of cardiac drugs during the abnormal heat were associated with its worse tolerability. The use of angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (CCB) was an independent factor associated with the smaller number of complications during the abnormal heat. That of diuretics was an independent factor that was associated with a more decrease in QL in elderly patients during the heat. The intake of angiotensin receptor blockers (ARB) or nitrates was an independent factor associated with the larger number of complications during the abnormal heat., Conclusion: The use of ACE inhibitors and CCB is associated with fewer complications during the abnormal heat of 2010. The intake of diuretics in patients over 65 years of age and that of ARB or nitrates was associated with worse heat tolerance.

It is a case report of bleeding when using dabigatran in patient with renal failure caused by the concurrent use of spironolactone and angiotensin-converting enzyme (ACE) inhibitors. The patient (75 years old) at the decompensation of chronic heart failure in the background of persistent atrial fibrillation was appointed the combination of ACE inhibitors, spironolactone, and dabigatran. 10 days after the start of using spironolactone and dabigatran bleeding was marked with decrease in hemoglobin levels to 69 g/l, creatinine level increases to 3.6 mg/dL (glomerular filtration rate by MDRD 18 ml/min/1,73 m2), and potassium to 5.5 mEq/ l. Against the background of the abolition of drugs normalization of renal function was marked. The question of an increased risk of nephrotoxicity with concurrent use of ACE inhibitors and spironolactone is discussed.

The authors undertook comparative analysis of the effica,cy and safety of PPARv-activating angiotensin-2 receptor blocker telmisartan (40--80 mg/day) in 80 patients with arterial hypertension (AH) and metabolic disorders (MD). Holter monitoring revealed a more pronounced anti-hypertensive effect of telmisartan compared with enalapril in patients with AH, MD, and compromised renal function. Similarly, telmisartan exerted more apparent positive effect on lipid and carbohydrate metabolism and had renoprotective action in patients with nephrogenic AH (it decreased proteinuria, stabilized creatinine clearance and serum potassium level whereas enalapril caused further deterioration of these parameters). It is concluded that telmisratan is more effective and safer than enalapril in patients with AH and MD.

The study was based on 478 oncology patients (72.1 +/- 3.6 years old) with cardiovascular comorbidities operated from 1991 to 2008 in regards of abdominal and pelvic mainly 3rd stage tumors with multimodal general anesthesia (4.2 +/- 1.6 hours). In prospective group (n = 302) all patients received cardiovascular treatment, while in retrospective group (n = 176) only 48.9% received it. The evaluation of the cardiovascular therapy effect was based on the peri-operative and postoperative HR and BP dynamics. The occurrance of noticeable bradycardia and drop of BP lower than 90/60 mm Hg was considered as a deviation. It is revealed that the cardiovascular therapy with beta adrenoblockers and calcium antagonists leads to an intraoperative bradycardia in 59.8% and 73.7% of cases, while in patients without the aforementioned therapy in 26.6% and 46.4% of cases respectively (p < 0.05). Antiarrhythmics don't have a noticeable impact on the development of bradycardia (p = 0.204). Intraoperative hypotension on the basis of ATP inhibitor treatment developed in 92.2% of patients statistically significant (p < 0.01). Monotherapy with calcium antagonists or nitrates leads to the development of hypotension in 55.2% and 41.4% of cases respectively, though in patients without the given therapy a lot more often (p < 0.05). In the case of combined calcium antagonist/nitrate therapy hypotension develops in 55.5% of cases, and in 72.3% without the therapy (p < 0.05). For the means of prevention of cardiovascular complications during the surgical treatment it is appropriate to keep the therapy with nitrates, though vasodilatives should be canceled 12 hours before the surgery.

We gave perindopril (10 mg/day) for 24 weeks to 30 patients with arterial hypertension and obesity and proved its ability to effectively lower arterial pressure, exert cardio-, angio-, and nephro-protection, improve parameters of lipid, carbohydrate and purine metabolisms in these patients. Moreover perindopril in these patients diminished manifestations of insulin resistance, hyperleptinemia, and inflammation; it also exerted pronounced positive effect on anthropometric parameters and percent of fat deposits. Basing on the aggregate of clinical and pharmacodynamics effects perindopril can be considered the drug of choice for treatment of arterial hypertension at the background of obesity.

Hypertension is one of the most common cardiovascular diseases. The development and progression of hypertension is associated with prolonged hyper activation of the renin-angiotensin-aldosterone system. ACE inhibitors and angiotensin receptor blockers (ARBs) are highly effective medicines and are widely used in the treatment of cardiovascular diseases: hypertension, congestive heart failure, coronary heart disease. The main pharmacological effects of ACE inhibitors and ARBs are hypotensive, neurohumoral, antiproliferative, cardio- and nefroprotective functions, as well as constantly improving endothelial function. In accordance with the article, hypertensive effectiveness, tolerability and organ-protective properties of valsartan are noticeable among patients with hypertension, obesity and erectile dysfunction, taking this medicine.

Effect of enalapril and telmisartan on hemodynamic indices, structural-functional parameters of the left ventricle, and vasomotor function of arterial endothelium was studied in 49 patients (mean age 48.3+/-3.2 years) with 1-2 degree arterial hypertension (AH) and abnormal relaxation type of left ventricular diastolic dysfunction. Enalapril was given to 24 and telmisartan to 25 patients. Examination included 24-hour arterial pressure monitoring, echocardiography, duplex scanning of the left brachial artery. At the background of therapy with enalapril target levels of systolic and diastolic arterial pressure (AP) were achieved in 79.2 and 70.85% of patients. This was associated with 54.2% reduction of number of non-dippers and night peakers. Therapy with telmisartan (30 weeks) besides effective AP control provided normalization of 24-hour AP profile in 90% of patients with pathological circadian rhythm. This was accompanied by improvement of vasomotor endothelial function of arteries, positive dynamics of structural-functional parameters of the left heart chambers, improvement of indices of left ventricular diastolic function.

Reninangiotensinaldosterone system is a key link in regulation of blood pressure and causes the target organ damage in hypertensive patients. For many years is not lost interest in the pharmacological blockade of RAAS in order to achieve target levels of BP and prevent damage target organs, particularly kidneys. Most recently recommended for clinical application of direct rennin inhibitor--aliskiren, a number of researcher have proven expressed nephroprotective effect. However, at present there is no unequivocal answer to the question whether there are advantages in combined RAAS blockade in hypertensive patients with use of aliskiren and angiotensinconverting enzyme inhibitor or angiotensin receptor blocker.

It has been demonstrated in a series of studies that erectile dysfunction (ED) appears to be one of risk factors and predictors of ischemic heart disease (IHD). According to the SSRC PM data in a cohort of 300 men with high cardiovascular risk ED was diagnosed in 61% of cases, while among 300 men with verified diagnosis of IHD was detected in 92.7% of cases. According to recommendations of the European Society of Urology changes of life style and correction of risk factors should precede therapy of ED or be components of complex therapy. It is known that some antihypertensive drugs (nonselective beta-adrenoblockers, thiazide diuretics) can negatively affect erectile function. According to data of comparative randomized clinical study average therapeutic doses of thiazide-like and thiazide diuretics in combination with ACE inhibitors do not worsen erectile function. Data on effect of lipid lowering therapy on erectile function are equivocal. Type 5 phosphodiesterase inhibitors (PDI) are first line preparations for the treatment of patients with ED. Safety of combination of type 5 PDI with main groups of antihypertensive drugs has been demonstrated in persons with risk factors of CVD and ED. The use of type 5 PDI in men depends on degree of compensation of cardiovascular system. In unstable cardiovascular events preparations of this group can be also carefully used. Simultaneous administration of nitrates is a contraindication for type 5 PDI.

We examined 212 patients aged 52-70 years with persistent symptomatic atrial fibrillation (AF). Comparison of AF substrates in patients with (n=26) and without (n=27) type 2 diabetes mellitus (DM2) revealed slowing of intraatrial conduction, increased vulnerability of atria, and more pronounced worsening of left ventricular diastolic function among DM2 patients. Comparison of groups of patients with (n=32) and without (n=33) diabetic cardiac autonomic neuropathy (CAN) revealed augmentation of adrenergic influences on the heart and comparatively higher antirecurrence efficacy of sotalol among patients with CAN. In 94 patients with type 2 DM complicated with CAN after randomization we administered antiarrhythmic therapy with sotalol in combination with perindopril (n=33), lipoic acid (n=31), perindopril and lipoic acid (n=30), and compared results with sotalol monotherapy. In 6 months percentage of patients in sinus rhythm was significantly higher in the group of combination therapy (sotalol plus perindopril plus lipoic acid). This was probably a result of simultaneous correction of disturbances caused by both "diabetic cardiomyopathy" and CAN.

This paper reviews prevalence of chronic cardiac insufficiency and effects of depression and anxiety conditions on its clinical course and prognosis. Clinical and experimental findings are discussed with reference to the role of the rennin-angiotensin-aldosterone system in pathogenesis of chronic cardiac insufficiency, depression, and certain psychic and nervous diseases. Special attention is given to the influence of CAE inhibitors on mental health of elderly subjects.

It is necessary to take into account presence of concomitant pathology while prescribing hypotensive therapy to patients with arterial hypertension (AH). Hydrophilic angiotensin converting enzyme inhibitors (ACEI) (lisinopril) which are not metabolized in the liver are theoretically safest in liver cirrhosis. We have examined and treated 180 patients with AH and assessed efficacy and tolerability of ACEI lisinopril and enalapril with consideration of their pharmacokinetic peculiarities in patients with various severity of involvement of the liver (steatosis or cirrhosis). Advantage of hypotensive effect of lisinopril (which required no biotransformation in the liver) over enalapril based on its pharmacokinetic properties has been demonstrated.

The purpose of the study was to evaluate hemodynamic and anti-ischemic effects of moexipril in patients with postinfarction left ventricular dysfunction (PL VD) and moderate left ventricular heart failure (NYHA functional class II-III). The subjects of the study were 21 male patients (aged 52.4 +/- 1.1 years) with CHD and PLVD, related to old large-focal anterior myocardial Q-wave infarction. 4-week treatment with ACF-inhibitor moexipril in an average dose of 10.7 +/- 0.4 mg per day clinically improved the patients' condition, which was characterized by 32.2% reduction of stenocardia attack frequency (p < 0.01) and 36.4% decrease in nitroglycerin demand (p < 0.01). Activity tolerance increased by 39.2% (p < 0.001), and echoCG found a 16.5% increase of LV ejection fraction (p < 0.05). Conjunctival biomicroscopy showed that moexipril substantially improved microcirculation (MC); total conjunctival index significantly decreased by 21.7%. The results of the 4-week moexipril administration demonstrate hemodynamic and anti-ischemic effects of the new ACF inhibitor, its positive influence on transcapillary oxygen exchange and MC in patients with PLVD, associated with NYHA functional class II-III heart failure.

The results of the analysis of diagnostic significance of examination of natural antibodies (Nab) to agiotensin-converting enzyme (ACE) and its substrates in the serum of hypertensive patients indicate that concentration of Nab to ACE differ from this mean concentration in donors. An elevated level of Nab to ACE may be considered as a compensatory reaction to increased content of the enzyme in vascular endothelium and blood flow. The same patients were examined for antibodies to peptide angiotensin II (AT-II). Enzyme immunoassay has shown that a significantly elevated level of antibodies to AT-II was only in 5 examinees. The same patients had also high Nab to ACE. The study of a group of ischemic heart disease patients with adverse effects attributed to bronchial affection treated with enalapril and diroton (ACE inhibitors) demonstrates that deterioration of cough and external respiration function is not related to exacerbation of existing chronic pulmonary inflammation. None of the patients had elevated body temperature or inflammatory changes in the blood, other signs of inflammation. Enzyme immunoassay also proved that the initial level of Nab equaled mean value for donors or was insignificantly lower. Blood serum patients with side effects contained a significantly (p < 0.02) elevated quantities of Nab to bradikinin vs initial values. Thus, the proposed method of solid phase enzyme immunoassay quantifies Nab to ACE and its substrates in the patients.

86 patients with chronic obstructive pulmonary diseases (COPD) and tuberculosis in combination with COPD complicated by chronic pulmonary heart (CPH) received a 18-month continuous treatment with enalapril (enap, D. Reddis Laboratories). It was found that the addition of enap, an inhibitor of ACE, to combined therapy of CPH patients is pathogenetic as it results in lowering of blood pressure in pulmonary artery, remodeling of hypertrophic right ventricle of the heart and decline of left ventricular dysfunction, in improvement of functional state of the lungs, in arrest of progression of cardiac failure. Long-term administration of the drug induced no serious side effects and is well tolerated.

Aim: To study efficacy of enalapril, ACE inhibitor, in preparation to surgery of hypertensive patients with concomitant surgical diseases., Material and Methods: An open controlled randomised study of the action of enalapril preoperative therapy on hemodynamics was made in 55 hypertensive patients aged 36-68 years with surgical abdominal diseases., Results: Before surgery, the study group of 30 patients were given enalapril for a month. The control group of 24 patients received a month therapy with adelphan and papasol. The study group achieved a greater fall in the morning and evening systolic arterial pressure and morning diastolic pressure. These falls allowed elective operative interventions. Intraoperative hyperdynamic reactions, cardiac arrhythmia, intraoperative myocardial ischemia occurred less frequently in the study group. Enalapril provided better intraoperative peripheral blood saturation with oxygen., Conclusion: Enalapril, an ACE inhibitor, can be used as a hypotensive drug for preparation of hypertensive patients for elective surgery because it regulates processes providing effective stabilization of arterial pressure, adequate supply of oxygen to peripheral blood.

Efficacy and safety of an angiotensin converting enzyme inhibitor quinapril were assessed in a 12 week study on 258 patients with 1-2 degree hypertension and various concomitant pathology. The use of quinapril as monotherapy (10-40 mg/day) or in combination with hydrochlorothiazide (12.5 mg/day) was associated with blood pressure (BP) normalization (<140/90 mm Hg) or more then 10% BP lowering in 88% of patients. In the end of the study average blood pressure was 134/84 mm HG. Quinapril was well tolerated. These results allow to recommend the scheme of quinapril use utilized in the study for wide application for the treatment of outpatients with hypertension.

Analysis of epidemiological, cohort and randomized studies of antihypertensive drugs containing reports of development of malignant neoplasms shows that long term use of some antihypertensive drugs while preventing cardiovascular complications has been associated with increased risk of malignancies. Most convincing evidence exists for association between the use of diuretics and renal cancer. Association between the use of reserpine and breast cancer in women, between atenolol and some types of cancer in elderly men also can not be ruled out. There is no proof of existence of either negative or positive correlation between malignant neoplasia and long-term use of calcium antagonists, angiotensin converting enzyme inhibitors or angiotensin receptor blockers.

To assess dynamics of structural-functional parameters of the circulatory system including the state of the cardiopulmonary baroreflex (CPBR) in patients with ischemic heart disease (IHD) and cardiac failure (CF) on losartan treatment, we studied 14 IHD men with CF (NYHA functional class II-III), mean age 54.6 +/- 7.1 years. Before and after losartan treatment the patients were examined using echocardiography, radiocardiography with 131-I albumin, occlusion plethysmography, 131-I hippuran clearance. CPBP was estimated by the change in circulation flow rate in the forearm in low body rarefaction by means of low pressure camera. Losartan was given in maximal tolerance dose (25-100 mg/day). Examination in the end of the treatment demonstrated diminished venous tone, increased blood flow in the forearm, reduced volume of circulating plasm, elevated hematocrit, higher ratio of early to late filling peaks of the left ventricle, progression of baroreflex dysfunction. Thus, long-term losartan treatment promoted improvement in peripheral vascular tonicity, diastolic function of left-ventricular myocardium, reduction in circulating plasm volume, progression of baroreflex dysfunction.

Aim: To study effects of ACE inhibitors in patients with diffuse renal diseases at the stage of chronic renal failure (CRF)., Material and Methods: Acute changes in renal filtration and in renal hemodynamics in response to 100-200 mg captopril were studied in 7 patients with CRF and 6 patients with intact renal function. Effects of long-term ACE inhibitors were retrospectively studied in 50 patients with CRF (27 men, 23 women, mean age 46.0 +/- 1.9 years, 7 patients were over 60 years old). Sixteen patients were selected from this group who were followed up for a long time. They were examined for CRF progression rate when given conventional antihypertensive treatment and after treatment with ACE inhibitors., Results: Acute response to ACE inhibitors was the following: SCF fell by 18.4% on the average by the end on therapy week 1; by the end of week 3 renal hemodynamics showed stability, SCF returned to normal, effective renal plasm flow rose by 16.9%, serum potassium rose significantly after 7 days of treatment but did not reach 6 mmol/l. Effects of long-term ACE inhibitor in CRF: the treatment was discontinued after 30-60 days in 12 of 50 patients because of high creatinine (> 20%); in 38 patients ACE inhibitor had a pronounced antihypertensive and antiproteinuric action for 2-3 years, creatinine growth inhibited. Progression of CRF became slow., Conclusion: ACE-inhibitors in CRF had a nephroprotective effect but blood creatinine levels should be controlled especially within the first 1-2 months of treatment.

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.

Harmonic combination of efficacy and safety allowed angiotensin converting enzyme inhibitors (ACEI) to conquer popularity among physicians in the treatment of hypertension, heart failure, myocardial infarction, diabetic and non-diabetic nephropathy. This multiprofile application is determined by their action not only on systemic but also on tissue renin-angiotensin systems which augmented activity plays important role in genesis of various pathological states. One of novel and most promising directions of use of ACEI especially of those with inherent high tissue specificity and vascular selectivity (quinapril, perindopril, ramipril, trandolapril) is the treatment of atherosclerosis. Antiatherosclerotic effects of ACEI were studied in a variety of clinical trials with assessment of their effect on long term outcome. These trials demonstrated positive action of ACEI on the clinical course of cardiovascular and cerebrovascular diseases. Expediency of prescription of ACEI to patients with atherosclerosis of coronary vessels and other vascular beds irrespective of the presence of hypertension and heart failure becomes now obvious.

The influence of a long-term treatment with losartan (50-100 mg o.d.) and captopril (25-50 mg b.i.d.) followed by the abrupt therapy cessation was studied in an open randomized placebo-controlled parallel group trial. The study was performed on a group of 22 essential (soft to moderate) hypertensive male patients, which entered the trial when a mean daytime diastolic blood pressure was BP > or = 90 Torr. The antihypertensive effect of losartan was more pronounced and homogeneous than the effect of an equivalent dose of captopril. The group-average trough/peak ratios upon the losartan treatment were 61.5 and 61.3% for the systolic and diastolic BP (against 21.2 and 26.9% for captopril), respectively. At the same time, the smoothness index values of the patients treated with losartan and captopril showed no significant difference. Neither treatment with any of the two drugs nor the therapy cessation affected the circadian BP profile or the BP variability. The abrupt termination of the drug administration did not cause a withdrawal syndrome: on the contrary, a significant effect of the captopril and losartan treatment (statistically reliable against the placebo control) persisted for at least four days after the therapy cessation. Taking into account poor homogeneity of the antihypertensive effect of captopril in patients with a stable moderate hypertension treated b.i.d., the drug administration is recommended according to the t.i.d. schedule. In this group of patients, losartan and captopril are probably more expediently administered in combination with other hypertensive drugs.

Aim: To study the hypotensive effect of the first dose in administration of perindopril and enalapril in patients with chronic cardiac failure (CCF)., Material and Methods: The trial enrolled 213 patients with CCF of functional class II-III (mean age 57 +/- 1.4 years, 155 males and 58 females). The patients were randomized into 2 groups. Group 1 received perindopril in a dose 2 mg, group 2 received enalapril. Arterial pressure was measured for 10 hours with a 30-min interval, in the last 3 hours--once an hour. First dose hypotension was stated if systolic pressure was < 90 mmHg, diastolic under 60 mmHg, mean pressure < 75 mmHg after the first intake of the drug., Results: Significant differences in the baseline pressure between the groups were absent. None of the patients demanded therapy of arterial hypotension. Side effects of hypotension were absent. In group 1 systolic pressure fell under 90 mmHg in 8(7.7%) patients, in group 2--in 24(22.0%) patients (p = 0.004), diastolic pressure fell under 60 mmHg in 47(45.2%) and 60(55.1%) patients, respectively (p = 0.151). Mean arterial pressure was < 75 mmHg in 42(40.4%) and 62(56.9%) patients, respectively, (p = 0.016). Multivariate correlation analysis has revealed a direct correlation between the first dose hypotension and age (r = 0.159, p < 0.01) and age > 70 years (r = 0.258, p < 0.01), acute myocardial infarction (r = 0.244, p < 0.01) and inverse correlation with the initial arterial pressure (r = -0.208, p < 0.01).

Wide use of angiotensin-converting enzyme (ACE) inhibitors in clinical settings is to a certain extent associated with a small number of side effects developing after taking the above medicines. The most prominent ill effects of ACE inhibitors include hypotension, acute renal impairement in those patients presenting with stenosis of the renal artery or manifest circulatory insufficiency, hyperpotassemia developing because of taking potassium-storing diuretics; cough, Quincke's edema, headache, syncope, orthostatic hypotension, nausea, diarrhea, skin eruption.

The authors examined 68 patients aged from 42 to 68 years with ischemic heart disease without a history of myocardial infarction and with angina pectoris of exertion functional class 2-3 and circulatory insufficiency class 2 (according to NYHA criteria). The criteria serving as the reason for relating patients to the follow-up group were left-ventricular end-diastolic volume > 160 ml, ejection fraction < 30%, cardiothoracic index > 0.55, threshold power of endured loads within a range of 71.5 +/- 2.30 watt. After stabilization of the clinical status by means of basic therapy (nitrates, blockers of slow calcium channels, diuretics, antiaggregants), all patients were divided into two follow-up groups. The first group consisted of 36 patients who received renitec (10 mg/24 h), patients of group 2 were given enap in the same dose. The course of treatment lasted 12 weeks. The effectiveness of treatment was controlled by echocardiography according to the standard methods in M- and B-regimens. Analysis of the obtained data showed that within 12-day follow-up renitec demonstrated higher effectiveness and lesser incidence of side-effects than did enap given in the same dose.

24-hour monitoring of arterial pressure was performed before, 3 and 9 weeks after moexipril treatment (daily dose 7.5-15 mg) for mild and moderate hypertension. Of 15 patients treated 66.6% responded to the 9-week course. Adjuvant hypothiazid elevated the effect to 73.6%. Moexipril lowered mean 24-h diastolic pressure without changing the 24-h pressure curve or heart rate. Antihypertensive moexipril effect was higher in the day time. Variability of diastolic arterial pressure was lower at night.

The authors made an open-comparative trial of fosinopril (Fosinorm) efficacy and tolerability in 20 patients (9 males and 11 females) with stage II mild and moderate essential hypertension accompanied with disturbed glucose tolerance and dyslipidemia. Fosinorm was given in a dose 10 - 20 mg/day under 24-h monitoring of blood pressure. Diastolic pressure returned to normal in 19 (95%) patients, one patient showed a good hypotensive response. The mean 24-h fall in the systolic and diastolic pressure was significant and made up for systolic pressure 7.5% (9.2% and 9.2%), respectively. Fosinorm had a minimal effect on carbohydrate metabolism, total cholesterol, serum triglycerides. The conclusion is made that Fosinorm is a highly effective antihypertensive drug positively influencing 24-h profile of blood pressure in the absence of negative action on carbohydrate and lipid metabolism.

Overall sixty patients with hypertensive disease were examined for clinical effectiveness of the prolonged-action inhibitor angiotensine-converting enzyme renitek (enalapril maleate, MJD). The treatment schedule included placebo over two weeks, renitek as monotherapy, 20 mg daily, over 6 weeks, if the patients failed to derive any benefit from the therapy, they were placed on a 4-week combined therapy of renitek plus hydrochlorothiazide. Renitek was found to dispel cardialgias, reduce frequency of attacks of cardiac angina. In the hemodynamic structure, a positive inotropic effect was identified as was reduction of energy expenditure of the myocardium, total peripheral vascular resistance, diminution of post- and preloads on the myocardium, with the mass of the left ventricular myocardium growing less.

20 patients with essential hypertension and diabetes mellitus (DM) type II were given Capoten (100-125 mg/day for 6 weeks) followed in a 2-week interval after its course termination by ramipril (10.0-12.5 mg/day). 50% of patients were sensitive to Capoten, 50% were resistance: 35 and 40% to ramipril, respectively. Ramipril was discontinued because of toxicity in 25% of patients. Hypotensive effects of ramipril were weaker than Capoten, though the former drug appeared more potent in lowering of peripheral vascular resistance at rest and at reactive hyperemia. Vasodilatation did not differ much.

The data on angiotensin converting enzyme inhibitors, a new class of drugs used in the treatment of cardiovascular diseases such as arterial hypertension and heart failure are considered. The information on clinical pharmacology of the drugs, short-term and long-term results of treatment, side effects, drug interactions is presented.