Vol 10, No 4 (2013)

The following article provides the latest recommendations of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) 2013 for the treatment of hypertension. Particular attention is given to the group of angiotensin receptor blockers and irbesartan.

Optimizing pharmacotherapy of arterial hypertension (AH) and varied selection of medicines remains an urgent problem for practitioners. However, despite the large variety of effective antihypertensive drugs, the control of blood pressure levels remains inadequate. Most patients require combined therapy with two or more agents to achieve target blood pressure levels, so the choice of second-line therapy is of particular importance. As adjunctive therapy in patients with uncontrolled hypertension a-blockerscan be used, which, in addition to the antihypertensive effect, have a number of other benefits including improved lipid profile and glucose metabolism, as well as reducing the symptoms of benign prostatic hyperplasia. Urapidil provides a-blocking effect and additionally exhibits the central sympatholytic effect which is mediated by stimulation of serotonin 5HT1A-receptor in the central nervous system. The evidence base suggests that the drug has antihypertensive effect in combination with a favorable metabolic profile, and has a good safety profile as well, and has no disadvantages inherent to a-blockers, in particular, the development of reflex tachycardia.

The following paper presents an analysis of fibrinogen and D-dimer levels and global index characterizing the anticoagulant function of protein C (TromboPas). 1104 people (25–64 years of age) of Tomsk adult unorganized population were examined within the framework of ECCE-RF-2012 (Epidemiology of cardiovascular diseases and their risk factors in the Russian Federation) project. The relationships of these parameters with the main demographic and clinical characteristics were analyzed. The presence of at least one of the markers of hypercoagulability, which include fibrinogen level higher than 3,7 g/l D-dimer – 500 ng / ml, and the index of inhibition of thrombin formation in the TromboPas (PICI%) test, that islower or equal to 84%, was found in 55,44% of the patients. At the same time, in 2,72% of the surveyed population a combination of all three hypercoagulation markers was observed, whereas a combination of at least one of the mentioned markers and / or risk factors such as arterial hypertension (AH) and obesity (BMI≥30 kg/m2) was observed in 36,87% of patients. Hypercoagulation markers, hypertension and obesity were absent only in 19,47% of patients. Thus, the results suggest a high risk of thrombotic complications of cardiovascular disease (CVD) in the studied population and justify the feasibility of developing adequate methods to prevent them.

Objective: to examine the characteristics of the regulation mechanisms of the cardiovascular system under the influence of climatic factors of the patients with arterial hypertension (AH) without comorbidity compared to the patients with AH and associated pathology (chronic obstructive pulmonary disease and/or bronchial asthma).Conclusion: during the spring of 2012 – winter of 2013 abnormal summer heat and abnormally low temperatures in winter in the central region of Russian Federation were not observed. Against this background, patients with AH, including with BOD did not have any significant changes of BP and HR in summer compared to those in spring. The increase of the daily average temperature in summer was followed by a significant increase of ventricular extrasystoles. In assessing of the endothelial dysfunction it was proved that it showed a significant deterioration due to hot weather. The best estimation of general health state was noted in winter period according to the VAS. The spirometric parameters of the patients with AH and BOD were significantly better at this time of the year.

Pulmonary arterial hypertension (PAH) drug therapy including prostanoids, endothelin receptor antagonists, type 5 phosphodiesterase inhibitors, can improve the possibilities for treatment and control of this progressive and irreversible disease. The modern research vector aims at exploring the potential therapeutic targets, as at developing new drugs that can affect the previously set target. NO synthase production disturbance plays an important role in PAH pathogenesis; this is determined by the powerful vasodylative action, as well as by anti-inflammatory, anti-proliferative, and antiaggregatory effects. Riociguat is the first in a new class of soluble guanylatecyclase stimulators to have proved effective in phase II of clinical trials. In a randomized, double-blind, placebo-controlled phase III of PATENT-1 (Pulmonary Arterial Hypertension soluble Guanilatcyclase-Stimulator Trial) study, 443 patients with PAH symptoms were randomized to receive placebo of riociguat in a single dose of 2,5 mg (with a dose titration based on tolerability to 2,5 mg three times a day) or a dose of 1,5 mg (with a dose titration according to portability to 1,5 mg three times a day). The study included patients not previously treated with PAH-specific therapy or those who have already taken endothelin receptor antagonists or prostanoids (except for parenteral ones). The primary endpoint of the PATENT-1 study was the distance dynamics in the 6-minute walk test (D6MH) to 12th treatment week. Secondary endpoints were: the dynamics of pulmonary vascular resistance (PVR), the level of NT-proBNP, functional class (FC) (WHO), the change in the time to developing of clinical deterioration, dyspnea (Borg index), indicators of quality of life and safety. By the 12th riociguat treatment week D6MH hasincreased by an average of 30 m in the group treated with the maximum single dose of 2,5 mg, or has decreased by an average of 6m in the placebo group (difference between groups, 36 m, 95% confidence interval 20–52 m, p<0,001). Riociguat hasimproved D6MH in patients not previously treated with PAH-specific therapy (38 m), and in those taking endothelin receptor antagonists or prostanoids (36 m). In riociguat groups compared with placebo a decrease in PVR and DLAsr. (p<0,0001) was noted, as well as an increase in cardiac index (p<0,0001), a reduction in NT-proBNP (p<0,0001), FC (p=0,003) and in the Borg index (p=0,002), the time of development of clinical deterioration (p=0,005) has increased as well. Riociguat therapy was also characterized by good toleration. Efficacy of treatment was maintained during long-term observation of PATENT-2study. In October 2013 riociguat (Adempas) was approved by the Food and Drug Administration (USA) for the treatment of patients in order to improve exercise tolerance and to prevent progression of PAH (idiopathic, inherited, PAH due to systemic connective tissue diseases).

Over the years b-blocker metoprolol is one of the commonly prescribed drugs for the treatment of various cardiovascular pathologies . The following review article discusses the classification of b-blockers , and pharmacokinetics of two metoprolol forms available on the market today: metoprolol tartrate (Vasocardin, Corvitolum, Egilok ) and metoprolol succinate (Betaloc ZOK). The role of metoprolol in the treatment of hypertension, coronary artery disease and heart failure is described here as well.