cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1373Research ArticleАРТЕРИАЛЬНАЯ ГИПЕРТОНИЯARTERIAL HYPERTENSIONКомбинированная антигипертензивная терапия у больных с метаболическим синдромомCombined antihypertensive therapy in treating patients with metabolic syndromeМычкаВ. Б.MychkaV. B.victoria-mychka@yandex.ruФлегонтоваН. В.FlegontovaN. V.DartMahaVishnu@gmail.comИвановК. П.IvanovK. P.victoria-mychka@yandex.ruШариповаГ. Х.SharipovaG. Kh.victoria-mychka@yandex.ruЧазоваИ. Е.ChazovaI. E.victoria-mychka@yandex.ruИнститут клинической кардиологии им. А.Л. Мясникова ФГУ “Российский кардиологический научно-производственный комплекс” Росмедтехнологии, г. МоскваA.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Federal Agency on High Medical Technologies. Moscow200820062008732430Copyright © Мычка В.Б., Флегонтова Н.В., Иванов К.П., Шарипова Г.Х., Чазова И.Е., 20082008Мычка В.Б., Флегонтова Н.В., Иванов К.П., Шарипова Г.Х., Чазова И.Е.Mychka V.B., Flegontova N.V., Ivanov K.P., Sharipova G.K., Chazova I.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1373Цель

Цель. Изучить эффект монотерапии трандолаприлом и комбинацией трандолаприла с верапамилом в течение 24 недель на показатели суточного мониторирования артериального давления (СМАД), углеводного, липидного, пуринового обменов, чувствительности тканей к инсулину и микроальбуминурии (МАУ) у больных мягкой и умеренной артериальной гипертонией (АГ) в сочетании с метаболическим синдромом (МС).

Материал и методы

Материал и методы. В исследование включены 20 больных АГ I или II степеней и МС. Трандолаприл назначали в начальной дозе 2 мг/сут. утром. Через неделю при необходимости доза трандолаприла удваивалась. Еще через неделю больным, не достигшим целевого уровня АД, добавляли верапамил СР в дозе 240 мг/сут. До лечения и через 24 недели терапии всем пациентам определяли уровень МАУ, показатели углеводного, липидного обменов, СМАД.

Результаты

Результаты. У 6 больных целевой уровень АД был достигнут на фоне монотерапии трандолаприлом в дозе 4 мг/сут. 14 пациентам для достаточного антигипертензивного эффекта понадобилось добавить верапамил СР в дозе 240 мг/сут. Достоверно уменьшилась концентрация глюкозы в крови натощак и постпрандиального уровня С-пептида (р<0,05). Значимо снизился уровень общего холестерина и холестерина липопротеидов низкой плотности. Показатели МАУ существенно не менялись по сравнению с началом исследования: 13,0+5,8 мг/л и 12,9+4,33 мг/л.

Заключение

Заключение. Комбинация трандолаприла и верапамила проявила себя не только как метаболически нейтральная; на фоне хорошего антигипертензивного эффекта улучшились показатели углеводного, липидного обменов.

Aim

Aim. To study the effects of 24-week treatment with trandolapril, as monotherapy or combined with verapamil, on parameters of 24-hour blood pressure monitoring (BPM), carbohydrate, lipid, and purine metabolism, tissue insulin sensitivity and microalbuminuria (MAU) in patients with mild to moderate arterial hypertension (AH) and metabolic syndrome (MS).

Material and methods

Material and methods. The study included 20 patients with Stage I-II AH and MS. Initial dose of trandolapril was 2 mg/d, administered in the morning. If needed, trandolapril dose was doubled one week later. One more week later, all patients not achieving target BP levels were administered verapamil SR (240 mg/d). At baseline and 24 weeks after therapy start, levels of MAU, carbohydrate and lipid metabolism, 24-hour BPM were measured.

Results

Results. Six patients achieved target BP levels receiving trandolapril monotherapy only (4 mg/d). For 14 participants, additional treatment with verapamil SR (240 mg/d) was necessary for achieving target BP levels. Fasting glucose and postprandial C-reactive protein levels significantly decreased (p<0,05), as well as the levels of total cholesterol (CH) and low-density lipoprotein CH. MAU levels were similar to baseline parameters: 13,0+5,8 and 12,9+4,33 mg/1.

Conclusion

Conclusion. Trandolapril and verapamil combination, being metabolically neutral, demonstrated good antihypertensive effects and improvement of carbohydrate and lipid metabolism parameters.

артериальная гипертонияметаболический синдроминсулинорезистентностьтрандолаприлarterial hypertensionmetabolic syndromeinsulin resistancetrandolaprilReferencesDahlof В., Sever P.S., Poulter N.R. et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bend-oflumethiazide as required, in the ASCOT-BPLA: a multicenter randomized controlled trial. Lancet 2005; 366: 895-906.Dahlof В., Sever P.S., Poulter N.R. et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bend-oflumethiazide as required, in the ASCOT-BPLA: a multicenter randomized controlled trial. Lancet 2005; 366: 895-906.Giverts M.M. Manipulation of the renin-angiotensin system. Circulation 2001; 104(5): 14-8.Giverts M.M. Manipulation of the renin-angiotensin system. Circulation 2001; 104(5): 14-8.Lender D., Arauz-Pacheco C., Breen L. et al. A Double Blind Comparison of the Effect of Amlodipin and Enalapril on Insulin Sensitivity in Hypertensive Patients. Am J Hypertension 1999; 12: 298-303.Lender D., Arauz-Pacheco C., Breen L. et al. A Double Blind Comparison of the Effect of Amlodipin and Enalapril on Insulin Sensitivity in Hypertensive Patients. Am J Hypertension 1999; 12: 298-303.Kannel W.B. Potency of vascular risk factors as the basic for antihypertensive therapy. Eur Heart J 1992; 13: 34-2.Kannel W.B. Potency of vascular risk factors as the basic for antihypertensive therapy. Eur Heart J 1992; 13: 34-2.Maarek M. Efficacite et tolerance du trandolapril chez l'hypertendu en surpoids. Ann Cardiol Angeiol 1996; 45(6): 343-51.Maarek M. Efficacite et tolerance du trandolapril chez l'hypertendu en surpoids. Ann Cardiol Angeiol 1996; 45(6): 343-51.Adalet K. Trandolapril in overweight patients with mild-to-moderate essential hypertension: The Turkish multicenter study. Current therap res 1996; 57(12): 980-8.Adalet K. Trandolapril in overweight patients with mild-to-moderate essential hypertension: The Turkish multicenter study. Current therap res 1996; 57(12): 980-8.Dahlof B., Sever P.S., Poulter N.R. et al, ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendofiumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial. Lancet 2005; 366: 895-906.Dahlof B., Sever P.S., Poulter N.R. et al, ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendofiumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial. Lancet 2005; 366: 895-906.Pepine C.J., Handberg E.M., Cooper-DeHoff R.M. et al, INVEST Investigators. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003; 290: 2805-16.Pepine C.J., Handberg E.M., Cooper-DeHoff R.M. et al, INVEST Investigators. A calcium antagonist vs a non-calcium antagonist hypertension treatment strategy for patients with coronary artery disease. The International Verapamil-Trandolapril Study (INVEST): a randomized controlled trial. JAMA 2003; 290: 2805-16.Griendling K.K., Minieri C.A., Ollerenshow J.D. et al. Angiotensin II stimulates NADH and NADH oxydase activity in cultured vascular smooth muscle cells. Circ Res 1994; 74(6): 1141-8.Griendling K.K., Minieri C.A., Ollerenshow J.D. et al. Angiotensin II stimulates NADH and NADH oxydase activity in cultured vascular smooth muscle cells. Circ Res 1994; 74(6): 1141-8.Plosker G.L., Sorcin E.M. Quinapril: a review of its pharmacology and therapeutic efficacy in cardiovascular disorders. Drugs 1994 Aug; 48(2): 227-52.Plosker G.L., Sorcin E.M. Quinapril: a review of its pharmacology and therapeutic efficacy in cardiovascular disorders. Drugs 1994 Aug; 48(2): 227-52.Lender D., Arauz-Pacheco C., Breen L. et al. A Double Blind Comparison of the Effect of Amlodipin and Enalapril on Insulin Sensitivity in Hypertensive Patients. Am J Hypertens 1999; 12: 298-303.Lender D., Arauz-Pacheco C., Breen L. et al. A Double Blind Comparison of the Effect of Amlodipin and Enalapril on Insulin Sensitivity in Hypertensive Patients. Am J Hypertens 1999; 12: 298-303.Ruilope L.M., de la Sierra A., Moreno E. et al. Prospective comparison of therapeutical attitudes in hypertensive type 2 diabetic patiens uncontrolled on monotherapy. A randomized trial: the EDICTA study. J Hypertens 1999; 17: 1917-23.Ruilope L.M., de la Sierra A., Moreno E. et al. Prospective comparison of therapeutical attitudes in hypertensive type 2 diabetic patiens uncontrolled on monotherapy. A randomized trial: the EDICTA study. J Hypertens 1999; 17: 1917-23.Fernandes R., Puig J.G., Rodriguez-Perez J.C. et al. Effect of two antihypertensive combinations on metabolic control in type-2 diabetic hypertensive patiens with albuminuria: a randomised, double-blind stude. J Human Hypertens 2001; 15: 849-56.Fernandes R., Puig J.G., Rodriguez-Perez J.C. et al. Effect of two antihypertensive combinations on metabolic control in type-2 diabetic hypertensive patiens with albuminuria: a randomised, double-blind stude. J Human Hypertens 2001; 15: 849-56.Ruggenenti P. Preventing microalbuminuria in type 2 diabetes. N Engl J Med 2004; 351: 1941-51.Ruggenenti P. Preventing microalbuminuria in type 2 diabetes. N Engl J Med 2004; 351: 1941-51.

The authors declare that there are no conflicts of interest present.