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The following review assesses socially significant disease - hypertension (AH) - and the problem of finding an effective antihypertensive therapy. Twynsta® drug (manufacturer Boehringer Ingelheim Pharma) - modern combined antihypertensive drug, which not only provides effective blood pressure control, but also due to the protective effect has been proved for all target organs improves the life expectancy of patients with hypertension. The clinical studies show that combination of telmisartan and amlodipine provides additional benefits in the treatment of patients with metabolic syndrome (by improving the carbohydrate and lipid metabolism), patients with impaired renal function (by inducing the regression of proteinuria), as well as left ventricular hypertrophy (by causing regression of the latter). The recently completed studies have shown that telmisartan acts as a selective PPAR-receptor modulator.In the present review it is shown that Twynsta® represents modern combined antihypertensive drugs and has a clinically proven favorable efficacy and safety profile.

The data from clinical trials that have examined the efficacy and safety of modern third generation calcium antagonist-lercanidipine is presented herein. Results of the following studies demonstrate that treatment with lercanidipine leads to a marked reduction in systolic and diastolic blood pressure without a significant impact on heart rate. Unique pharmacokinetic characteristics of the drug provide its high efficacy and safety, tolerability, convenience, acceptance and high adherence of the said CA in AH patients. Additional lercanidipine properties allow us to recommend the use of this CA in associated pathology cases.

The review article presents data on the significance of activation of different components of the renin-angiotensin-aldosterone system (RAAS) in metabolic disorder progression and organ damage processes. Based on the analysis of the pharmacological properties of drugs and clinical evidence, the authors discuss the problems of the choice of RAAS blockers. The mechanisms of drug action on metabolic processes, atherogenesis, and vascular damage are discussed.

Study objective. To assess the association between intracardiac hemodynamics and airway obstruction with pulmonary hyperinflation in patients with chronic obstructive pulmonary disease.Materials and methods. Ninety-six patients with chronic obstructive pulmonary disease, aged 40 to 75 years, without concomitant cardiovascular disease, were examined and divided into 4 groups according to the severity of the disease. The patients underwent general clinical examination, spirometry, 24-hour pulse oximetry and echocardiography with assessment of linear and volumetric parameters, as well as diastolic function of left and right ventricles.Results. Linear and volumetric parameters of the left ventricle, LV myocardial mass and geometry in the examined patients with chronic obstructive pulmonary disease matched threshold values. The progression of the severity of chronic obstructive pulmonary disease was accompanied by decrease of the end-diastolic size of the left ventricle, ratio of peak early to late diastolic filling velocity for the left ventricle (E/A) without significant changes in the left ventricle isovolumetric relaxation time (IVRT). Moderate correlations of the inspiratory capacity with the end-diastolic size of the left ventricle (r=0.612; p=0.001) and the left ventricle E/A (r=0.464; p=0.001); forced expiratory volume in 1 second (FEV1) with the left ventricle E/A (r=0.600; p=0.011) were established. As a result of the logistic regression performed, the predictor value of the inspiratory capacity was confirmed (Wald χ2 — 5.795; р=0.024). Impairment of left ventricular diastolic function of grade I was revealed in 12 (31.6 %) patients in group 2, in 7 (24.1 %) patients in group 3, and in 9 (56.2 %) patients in group 4.Conclusion. Airway obstruction severity and pulmonary hyperinflation progression in patients with chronic obstructive pulmonary disease and without concomitant cardiovascular disease is associated with a decrease of left ventricular size and diastolic filling, contributes to the development of the left ventricular diastolic dysfunction, predominantly due to the decrease in filling velocity parameters.

The paper aimed to present evidence of the effect of some pathophysiological features of chronic obstructive pulmonary disease (COPD) on cardiac remodeling in patients free of overt cardiovascular diseases, traditional cardiovascular risk factors and pulmonary hypertension. Contrary to traditional beliefs that cardiac abnormalities in COPD have been mainly associated with the right ventricle, several recent studies have shown an independent effect of pulmonary hyperinflation and emphysema on left ventricular (LV) diastolic filling and LV hypertrophy. Pulmonary hyperinflation and emphysema cause intrathoracic hypovolemia, low preload, small end-diastolic dimension and mechanical compression of LV chamber which could worsen end-diastolic stiffness. Interestingly, that the presence of LV hypertrophy in COPD patients is important but currently poorly understood area of investigation. Pulmonary hyperinflation, increased arterial stiffness and sympathetic activation may be associated with LV hypertrophy. Two-dimensional ultrasound speckle tracking studies have shown the presence of sub-clinical LV systolic dysfunction in patients even with moderate COPD and free of overt cardiovascular diseases. Sarcopenia related to the inflammatory-catabolic state in COPD and hypoxia could play an important role regarding LV systolic dysfunction. Recent data reported the effects of long-acting bronchodilators on reducing lung hyperinflation (inducing lung deflation). Further studies are required to evaluate the effects of pharmacological lung deflation therapy on cardiac volume and function.

Aim. To study the relationships between clinical and functional features of chronic obstructive pulmonary disease (COPD) and status of cardiovascular system with focus on identifying factors associated with the atrial fibrillation (AF) in patients with COPD.Material and methods. Patients (n=94) with COPD out of exacerbation and airways obstruction of 2-4 degree (GOLD 2013) were examined. The spirometry, daily pulse oximetry, 24-hour ECG and blood pressure monitoring with vascular wall stiffness estimation, echocardiography were performed. Levels of high-sensitivity C-reactive protein (CRP) were also assessed.Results. AF paroxysms were found in 46 patients, including newly diagnosed ones in 22 patients. According to the results of multiple correlation analysis, the frequency of AF paroxysms correlated with forced expiratory volume in 1 sec (FEV1) (R=-0.348; p=0.013), minimum oxygen saturation of the blood (min%SpO2) (R=-0.356; p=0.011), CRP level (R=0.442; p=0.001), the sizes of both atria (p

Churg-Strauss syndrome is a rare autoimmune disease with small-vessel vasculitis. We report a case of 60-year-old man. The presence of hypereosinophilia, asthma, sinusitis and extravascular eosinophil accumulation led to the diagnosis of Churg-Strauss syndrome. The patient was effectively treated with methylprednisolone, cyclophosphamide.

Aim. To study the relationships between clinical and functional features of chronic obstructive pulmonary disease (COPD) and status of cardiovascular system with focus on identifying factors associated with the atrial fibrillation (AF) in patients with COPD.Material and methods. Patients (n=94) with COPD out of exacerbation and airways obstruction of 2-4 degree (GOLD 2013) were examined. The spirometry, daily pulse oximetry, 24-hour ECG and blood pressure monitoring with vascular wall stiffness estimation, echocardiography were performed. Levels of high-sensitivity C-reactive protein (CRP) werealso assessed.Results. AF paroxysms were found in 46 patients, including newly diagnosed ones in 22 patients. According to the results of multiple correlation analysis, the frequency of AF paroxysms correlated with forced expiratory volume in 1 sec (FEV1) (R=-0.348; p=0.013), minimum oxygen saturation of the blood (min%SpO2) (R=-0.356; p=0.011), CRP level (R=0.442; p=0.001), the sizes of both atria (p

Aim. To study the retina state by functional methods in patients with arterial hypertension (HT) of various degrees. Material and methods. Patients with uncomplicated HT of 1-3 degrees (n=81) and healthy subjects (n=20) of control group were examined. Routine (direct ophthalmoscopy) and functional (evaluation of contrast and color sensitivity of the retina, electroretinography) methods were used. Results. Functional retinal changes (reduction in color and contrast sensitivity) progressed with increasing HT degree. These changes were located in the area of central retinal artery (paramacular area) and area of choroidal blood flow (macular region). Retinal bioelectrical activity disturbance was also found by the electroretinography. Conclusion. The identified functional disorders suggest the retina involvement in the pathological process even in the early HT and may be associated with its severity. It confirms a relationship of HT with disorders of eye as a target organ in HT. Published data and results of our studies can refute the point of view about impossibility of changes assessment on the eye fundus in patients with uncomplicated HT, and indicates that it was premature exclusion of the eye from the list of target organs in HT.

Published data often contain conflicting views on the relationship of retina changes in arterial hypertension (HT) with cardiovascular disorders and target organs lesions. Along with the classification and pathophysiology of hypertensive retinopathy, evidence for its association with the HT course, target organ lesions and prognosis is presented. Functional disorders of the eyes point at the involvement of retina into the pathological process even in HT early stages and are able to reflect the severity of hypertension. This supports a close relationship of HT with eye disease as a target organ. Available data support also possibility to assess changes on the eye fundus in patients with uncomplicated HT, indicating that it was premature decision to exclude eyes from the list of target organs in HT.

Aim. To evaluate antihypertensive efficiency of benasepril therapy (Lotensin, Novartis) and its effects on microcirculation, endothelium function, system of cytoprotection, ophthalmoscopic and functional characteristics of eye retina in patients with arterial hypertension (AH). Material and methods. 40 patients with AH of 1-3 degree (AH1, AH2, and AH3) were studied. After wash-out period all patients were prescribed benasepril 5-10 mg daily. If necessary, hydrochlorothiazide 12,5 mg daily was added. Treatment lasted during 6 months. Patients were examined at the beginning and at the end of the study. Ambulatory blood pressure (BP) monitoring was carried out. Microcirculation was assessed by method of laser Doppler flowmetry. Stable plasma metabolites of nitric oxide (NO) were determined by spectral photometry. Cytoprotection was assessed by content of heat shock proteins (HSP70) in leucocytes of peripheral blood. Ophthalmoscopy, color and contrast static campimetry with evaluation of sensory-motor reaction (SMR) time in different fields of vision were carried out. Results. Therapy with benasepril allowed to improve daily profile of BP and to reach its target level in all AH patients. Number of patients with spastic type of microcirculation decreased. Functional condition of endothelium improved which revealed in normalization of endothelial production of NO. Therapy with benasepril resulted in intracellular HSP70 level decrease which testified restriction of cellular destruction. The cytoprotective effect of benasepril was stronger in patient with severe AH. Therapy with benasepril resulted in SMR time decrease which signifies its positive influence on retinal blood flow. Evaluation of contrast and color sensitiveness of retina allowed to reveal and quantitatively assess earlier dysfunctions of retinal tissue perfusion, compared to ophthalmoscopy. Conclusion. Benasepril is an efficient antihypertensive drug which improves microcirculation, endothelium function and retinal perfusion, has cytoprotective effect. Color and contrast static campimetry is an adequate method for quantitative assessment of retinal perfusion and allows objectively to evaluate damage of eye as target organ of AH.

Aim. To study effect of antihypertensive therapy with amlodipine maleat (Stamlo® M, “Dr. Reddy’s”, India) on morphofunctional heart indices, intensity of systemic inflammation and oxidative stress in patients with arterial hypertension (HT) with chronic obstructive pulmonary disease (COPD).Material and methods. 20 patients with COPD II-III stage (GOLD 2006) in remission and HT 1-2 stage were involved in the study. Morphofunctional heart indices, respiratory function, levels of C-reactive protein (CRP) and oxidative stress (lipid peroxidation products (LPP) – acilhydroperoxides) were evaluated.Results. Amlodipine maleat therapy provides target level of blood pressure (BP) according to ambulatory BP monitoring with improvement of pathological type of daily BP profile. Reduction of diastolic dysfunction of left and right ventricles was revealed. Therapy was safe in terms of respiratory function. Significant CRP and LPP levels reduction was observed.Conclusion. Amlodipine maleat therapy has high antihypertensive effect, organoprotective properties and safety in hypertensive patients with COPD. Besides this therapy demonstrates systemic anti-inflammatory action and reduces oxidative stress.

Aim. To evaluate intensity of endothelial dysfunction, processes of apoptosis, state of central and peripheral hemodynamics and to evaluate how these characteristics are influenced by angiotensin II receptors antagonists (ARA II) – candesartan (Atacand) and losartan (Cosaar) in patients with chronic cor pulmonale (CCP) at different stages of disease.Material and methods. 100 patients with chronic obstructive pulmonary disease (COPD), complicated by CCP were included into the study. Caspase activity as apoptosis induction marker, von Willebrand factor, production of nitric oxide in blood plasma and condensate of breathing out air were assessed. 70 patients received ARA II (50 patients – candesartan 4-8 mg daily, 20 patients – losartan 50-100 mg daily), 30 patients received neither ARA II nor angiotensin converting enzyme inhibitors (ACEI).Results. Significant increase in intensity of endothelial dysfunction and activation of apoptosis processes were registered according to growth of CCP severity. After 6 months of therapy von Willebrand factor decreased by 25,2% and 27,7% in candesartan and losartan groups respectively (p

The review is devoted to the modern data about mechanisms of cardiovascular dysfunction in patients suffering diabetes mellitus type 2, especially to the role of oxidative stress. It is determined that oxidative stress is involved in the development of myocardial ischemia, reperfusion-syndrome, endothelial dysfunction and atherogenesis. There are data that angiotensin converting enzyme inhibitor, zofenopril, has both cardio- and vasoprotective activities as well as antioxidative effect. These features are rationales to use it in patients with ischemic heart disease and diabetes mellitus.

Currently, a greater emphasis is placed on the search for additional biomarkers of chronic heart failure (CHF). Galectin-3, a marker of fibrosis and inflammation, has shown himself as a biomarker of CHF in many studies, but the dynamics of its levels in patients with concomitant diabetes mellitus (DM) type 2 is not well-studied.Aim. To identify diagnostic significance of galectin-3 plasma level evaluation and its correlations with echocardiographic criteria for patients with CHF and DM type 2.Material and methods. The study included 33 patients with ischemic CHF (all patients had a history of myocardial infarction) and DM type 2. The patients were divided into two groups according to the left ventricle (LV) ejection fraction (EF): a group with CHF and preserved ejection fraction (PEF) (EF≥50%) and with CHF and reduced ejection fraction (EF

Characteristics of atrial fibrillation pathogenesis in patients with chronic obstructive pulmonary disease are discussed. The impact of chronic obstructive pulmonary disease treatment on the onset and course of atrial fibrillation, as well as approaches to the treatment of atrial fibrillation in this category of patients are also considered.

The importance of the optimal choice of antihypertensive treatment strategy is currently widely recognised. The evidence obtained over the last five years justifies the revision of the traditional approach towards the tactics of mono- and combination antihypertensive therapy. It is essential to ensure that the patient-centred tactics of mono- and combination therapy choice is based on the detailed analysis of the clinical status.

In total, 40 patients with various stages of arterial hypertension (AH) were examined. All patients received nifedipine GITS as monotherapy or in combination with hydrochlorothiazide for 6 months. Nifedipine GITS demonstrated not only good antihypertensive activity, but also substantial organo-protective effects. Cardioprotection manifested in the reduction of left ventricular (LV) hypertrophy and LV diastolic dysfunction, as well as in correction of pathological LV geometry types. Vasoprotection was manifested in the correction of pathological microcirculation types. In addition, retinal functional status was improved.

Aim. To investigate the features of endothelial function, apoptosis, micro- and macrohemodynamics in patients with chronic obstructive pulmonary disease (COPD) and chronic cor pulmonale (CCP), as well as to study the effects of a highly selective beta-1-adrenoblocker (B-1-AB) nebivolol on these parameters..Material and methods. The study included 38 COPD patients with CCP (26 and 12 with CCP decompensation and compensation, respectively), aged 46-77 years. All participants received not only COPD and CCP therapy, but also an ACE inhibitor nebivolol (2.5-5 mg once a day) for 6 months.Results. CCP patients were characterised by substantial endothelial dysfunction (ED), pathological NO hyper-production, elevated level of Willebrand factor, and increased apoptosis. Additionally, hypercoagulation, platelet hyper-aggregation, and heart systolic and diastolic dysfunction were observed. Nebivolol therapy was associated with reduced NO hyper-production: in plasma — to 13,34±1,44 mkm (p

Aim. To study the effects of hormone replacement therapy (HRT) on metabolic profile, insulin resistance (IR), central and peripheral hemodynamics, endothelial function and antioxidant activity in postmenopausal women with metabolic syndrome (MS).Material and methods. The study included 30 postmenopausal women with MS, receiving Angeliq medication (estradiol 1 mg, drospirenone 2 mg) for 6 months. At baseline and 6 months after the start of the treatment, fasting and two-hour postprandial levels of lipids, glucose, and insulin were measured. The other parameters included HOMA-IR index, body composition and visceral fat percentage, 24-hour blood pressure monitoring (BPM), echocardiography, microcirculation (MC) parameters, endothelial dysfunction and oxidative stress markers.Results. Mean body mass index (BMI) decreased from 30,9 kg/m2 to 30,2 kg/m2 (р=0,068), while mean visceral fat percentage changed from 40,6% at baseline to 42,2% after 6 months (р=0,002). These changes were explained by natural menopause course, as well as progressing IR and menopausal MS. BP levels were effectively reduced, according to the 24-hour BPM data; all participants achieved target BP levels. Left ventricular (LV) myocardial mass index significantly decreased from 116,1 to 110,8 (р

Aim. To compare the effects of antihypertensive medications (AHM) on central hemodynamics, metabolic profile, insulin resistance (IR), oxidant and antioxidant systems in postmenopausal patients with metabolic disturbances and Stage I-II arterial hypertension (AH).Material and methods. The study included 47 postmenopausal women with metabolic syndrome (MS) and Stage I-II AH. Group I (n=31) received an ACE inhibitor spirapril (6 mg/d) for 6 months. Group II (n=16) received various AHM administered as a part of ambulatory therapy. At baseline and after 6 months of the treatment, all participants underwent 24-hour blood pressure monitoring (BPM), echocardiography, lipid profile (LP) and IR index HOMA assessment, oral glucose tolerance test, double energy X-ray absorptiometry with general and regional analysis of body composition, as well as the measurement of lipid acylhydroperoxide levels and erythrocyte superoxide dismutase activity.Results. In both groups, target BP levels were achieved. In Group I, left ventricular myocardial mass index (LVMMI) significantly decreased (р

Aim. То compare the effects of hormone replacement therapy (HRT) and antihypertensive therapy (AHT) on metabolic profile, insulin resistance (IR) and central hemodynamics in postmenopausal women with metabolic syndrome (MS).Material and methods. In total, 46 postmenopausal women with MS were examined. Group I (n=30) received estradiol (1 mg/day) and drospirenone (2 mg/day) for 6 months (Angeliq medication). Group II (n=16) received various antihypertensive medications. At baseline and after 6 months of the treatment, lipid profile, glycemia and insulinemia, IR index HOMA-IR, body composition, Kuperman index (modified by E..M. Vikhlyaeva) were assessed, 24-hour blood pressure monitoring (BPM) and echocardiography were performed.Results. In Group I, body mass index (BMI) reduced from 30,9 kg/m2 to 30,2 kg/m2 (p=0,068); in Group II, it increased from 30,6 kg/m2to 31,3 kg/m2 (p=0,003). Visceral fat tissue percentage was 40,6 %. at baseline and 42,2 % after 6 months in Group I, comparing to 41,0 % and 42,2 %, respectively, in Group II (p=0,018). Angeliq medication demonstrated good antihypertensive activity. In Group I, left ventricular myocardial mass index (LVMMI) significantly reduced from 116,1 g/m2 to 110,8 g/m2 (p

In total, 25 patients with acute myocardial infarction (MI) and 25 patients with MI and Type 2 diabetes mellitus (DM-2) received an ACE inhibitor zofenopril (zocardis) for 6 months, as a part of their basis therapy. Lipid peroxidation and antioxidant system dynamics, endogenous cytoprotective mechanisms - NO and HSP70 stress proteins - were assessed during first 24 hours after hospitalization, as well as 1 and 6 months after MI. Long-term zofenopril therapy was associated with reduced levels of free-radical lipid peroxidation, due to protective antioxidant enzyme activation and increase in serum total antioxidant activity. The medication also improved the parameters ofprotective HSP70 system and endothelial function.

Aim. To investigate endothelium-regulating and antioxidant effects of trandolapril and verapamil SR combination (Tarka) in patients with arterial hypertension (AH) and chronic obstructive pulmonary disease (COPD).Material and methods. In total, 42 COPD and AH patients, aged 48-70 years, were examined. All participants received continuous basis COPD treatment and 16-week Tarka therapy. At baseline and at the end of the study, lung function, systemic inflammation, oxidative stress and antioxidant potential parameters were measured.Results. All patients achieved office-measured target blood pressure (BP) levels. Bronchial conductivity increase was explained by therapy-associated improvement in pulmonary hemodynamics. The medication was safe and well-tolerated by patients with COPD and AH. Decrease in C-reactive protein levels, possibly explaining antiinflammatory medication effect, pointed to the suppression of endothelium-damaging influences. The treatment was also associated with decreased lipid peroxidation, reduced serum levels of acylhydroperoxides, and increased concentration and activity of antioxidant enzymes.Conclusion. AH and COPD therapy should include antihypertensive agents with pleiotropic effects, specifi- cally, suppressing systemic inflammation, correcting endothelial function, and enhancing antioxidant potential. These characteristics could act as additional criteria of AH treatment effectiveness in patients with combined cardiovascular and respiratory pathology.

The review is devoted to ACE inhibitor therapy in arterial hypertension (AH) management. The mechanisms of ACE inhibitors’ effects on oxidative stress, endothelial dysfunction, insulin and glucose metabolism are discussed. The data on pharmacological characteristics of zofenopril and its use in AH are presented.

Aim. The principal objective of this randomized, comparative, open clinical trial PRESTIGE was to determine the time of achieving optimal therapeutic dozes of ACE inhibitors. The secondary goal was to assess dynamics of chronic heart failure (CHF) functional classes (FC) during the treatment. Material and methods. The study involved 125 patients with Q-wave acute myocardial infarction (MI): 68 males, 57 females; mean age 67 years. All participants were randomized into perindopril or captropril groups (n=63 and 62, respectively). In dose titration, starting doses were 2 mg/d and 18.75 mg/d, respectively. Recommended daily doses were 4-8 mg once per day for perindopril, and 75-150 mg, three times per day, for captropril. Treatment and follow-up period lasted for 6 months. ACE inhibitor efficacy was assessed by measuring brain natriuretic peptide (BNUP) levels - at baseline, Weeks 8 and 24. Quality of life (QoL) was assessed by two methods: by “health line” and standard Minnesota University Questionnaire for heart failure patients. Incidence of death and hospitalization due to cardiovascular causes was also registered. Results. At Week 8, there was a significant reduction in BNUP level (to 296.5±16.7 pmmol/l; or by 25.4%; р=0.004) in perindorpil group, and to 342.7±13.8 pmmol/ml (by 19.1%; NS; р=0.06) in captopril group. At 6 months, QoL improved in perindopril group (reduced total QoL score, 23.8; р=0.047), and did not change comparing to Week 3, in captopril group (31.4). Conclusion. MI patients with left ventricular dysfunction, early administered ACE inhibitors, achieved target dose of perindopril faster than that of captopril. That was associated with improved clinical course (CHF FC, QoL) in perindopril group.

Chronic cor pulmonale.

Capacity resistive model of blood circulation and its usage in hemodynamics evaluation in patients with arterial hypertension.

Antianginal and anti2ischemic effectiveness and tolerability of oxicardin in patients with stable angina of I-III functional classes: results of a Russian multicenter Russia.

We have studied values of daily blood pressure monitoring, echocardiography and blood reology in 75 patients (average age 57.5+1.3 years) with mild and moderate arterial hypertension with a various combination of metabolic risk factors (abdominal adiposis, NIDDM, altered glucose tolerance, dislipidemia.We have shown that in most patients with arterial hypertension is combined with metabolic disorders aggravating the course of arterial hypertension.

A novel approach to estimating hemodynamics in the arterial portion of the vasculature.