Vol 4, No 2 (2013)

The authors have studied heart rhythm variability at rest and with cognitive loading, types of coronary behavior and reactive and personal anxiety in 86 men of young age, officers of the land forces. 52 of them had hypertensive disease (HD) of I–II stage. 34 men had normal arterial blood pressure. Patients with HD in comparison with normotensive men turned out to have additional risk factors accompanied arterial hypertension. They were hypersympaticotonia, high level of personal anxiety and coronary behavior type A.

After making a detailed review on the cardiac and non-cardiac pleiotropic effects of statins, the author has attempted to present mechanisms for these effects. The author’s main point is that their non-cardiac pleiotropic effects in diseases of different organs and systems are exposed to statins thanks to the body’s established pathogenic modules that are available in diverse pathologies, including cardiovascular diseases; these are: type 2 diabetes mellitus, obesity, metabolic syndrome, and kidney, liver, and bronchopulmonary system disorders in microbial and viral diseases. In these diseases, the patients are found to have universal pathogenic modules of inflammation, oxidative stress, endothelial dysfunction, hyperangiotensinemia, and inadequate activation of peroxime proliferator-activated receptors. Statins exert an additional positive effect unassociated with their hypolipidemic activity on many of the above pathogenic modules. In most cases, the mechanism of action of statins could be revealed in the above diseases. Special investigations relying on the rules of evidence-based medicine are needed to confirm the found pleiotropic effects.

In a retrospective study based on the register of patients with coronary heart disease after coronary artery bypass grafting clinical and functional characteristics and long-term survival in 2398 men, age 54,8±6,3 were analized, depending on the passage of the recovery phase from 2000 to 2009. The results showed that people of pre-retirement age were sent to the sanatorium therapy stage (72,5%) with a mild coronary and myocardial insufficiency. Mortality in the long-term period of 1 year to 10 years in the group after sanatorium therapy stage was 7,9%, whereas among patients who have not undergone sanatorium rehabilitation mortality rate was higher – 8,4%. Analysis of survival by Kaplan-Meier method of patients after sanatorium rehabilitation revealed that 3, 5 and 10-year survival rate was significantly higher than in those that did not pass the sanatorium stage of treatment. Two tests – Gehan's Wilcoxon Test (p=0,01835), Cox-Mantel Test (p=0,02820) – confirmed the accuracy of the comparison groups.

The article (case history) discusses the strategy of management of the patient with resistant hypertension and comorbidity (diabetes, gout) according to current clinical guidelines.

Objective: to evaluate the antihypertensive efficacy and effect of nebivolol and valsartan on metabolic parameters and erective function in patients with hypertension, metabolic syndrome, and erectile dysfunction. Subjects and methods. A 12-week randomized, blind, controlled, parallel-group, comparative (nebivolol versus valsartan) trial enrolled 40 patients with hypertension, metabolic syndrome, and erectile dysfunction. Results. There were no significant differences between the drugs in their antihypertensive efficiency. Nebivolol exerted a more pronounced positive effect on cardioand angioprotection and lipid and carbohydrate metabolic parameters. It had no negative effect on metabolic parameters. Therapy with nebivolol versus valsartan produced a pronounced positive effect on blood androgen levels and erectile function. Moreover, the quality-of-life indicators also showed a significant improvement in the nebivolol group. Evaluation of the tolerability and adverse reactions of the drugs demonstrated no side effects in both groups.

Objective: to study the dose-dependent effect of rosuvastatin on blood lipids and lipoproteins (LP), endothelial functional activity, coagulation, and safety parameters in patients with hyperlipidemia (HLP) and hypertension after cerebral ischemic stroke (CIS). Subjects and method. The trial included 34 patients (mean age 59,4±7,4 years) with types IIa or IIb HLP and CIS-complicated hypertension. The patients were randomized to 2 groups: 1) rosuvastatin 10 mg and 2) rosuvastatin 20 mg. The trial lasted 12 weeks. The dose of rosuvastatin remained unchanged throughout the trial. The authors evaluated the impact of therapy on the blood concentration of lipids, LP, fibrinogen, end products of nitric oxide (NO) metabolism, and endothelin-1 (ET-1), cerebral blood flow by great cerebral artery Doppler ultrasound data, as well as the parameters reflecting the safety of the therapy. Results. After 12-week therapy with rosuvastatin 10 and 20 mg, there was a significant decrease in the level of cholesterol by 30 and 35%, low-density lipoprotein (LDL) cholesterol by 40 and 45%, and triglycerides by 18 and 26%, respectively. Increasing the dose of rosuvastatin was attended by a significant rise (by 18%) in the number of patients with target LDL cholesterol levels. Rosuvastatin therapy caused no changes in the high baseline level of fibrinogen. At the same time, at the rosuvastatin doses of 10 and 20 mg, the concentrations of end products of NO metabolism increased by 14,3 and 12,4%, respectively. The vasoprotective effect of rosuvastatin 20 mg showed itself just at therapy week 6. Significantly decreased ET-1 levels were found when rosuvastatin was given in a dose of 10 mg; this was directly related to the baseline concentration of ET-1. In the patients who had an ET-1 level of >0,51 fmol/ml, its drop was 22,5% (p<0,05). Some improvement of cerebral blood flow velocities in the internal carotid artery and in the V2/V3-segments of the vertebral artery might be expected in post-CIS patients taking the average dose (20 mg) of rosuvastatin. It should be remarked that the test doses of rosuvastatin are well tolerated and cause no adverse reactions. Conclusion. The antiatherogenic and pleiotropic effects of the two rosuvastatin doses 10 and 20 mg were shown in the post-CIS patients with HLP and hypertension. The pleiotropic activity of rosuvastatin, such as an increase in NO bioavailability and a reduction in ET-1 concentrations, was manifested when both the starting (10 mg) and average (20 mg) doses of rozuvastatin were used. At the same time, rosuvastatin showed dose-depended effects in lowering LDL cholesterol levels, enhancing NO bioavailability, and improving cerebral blood flow velocities.