Preview

Cardiovascular Therapy and Prevention

Advanced search

Optimizing antihypertensive therapy in postmenopausal women with metabolic syndrome

Abstract

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<0,001). In Group II, only a tendency towards LVMMI reduction was observed (р=0,062). Body mass index and visceral fat tissue percentage increased in both groups. Spirapril therapy was associated with increased levels of high-density lipoprotein cholesterol, HDL-CH (p=0,001), and decreased concentration of triglycerides (р=0,03). In Group II, no LP dynamics was observed, while IR increased. Spirapril therapy was associated with IR index (HOMA) normalisation (р<0,001) and improved oxidant-antioxidant bal¬ance (р<0,001), with no similar changes in Group II.

Conclusion. Spirapril demonstrated beneficial effects on carbohydrate and lipid metabolism, IR and oxidant-antioxidant parameters, as well as cardioprotective activity.

About the Authors

O. N. Poryvkina
Moscow State Medico-Stomatological University
Russian Federation


T. V. Adasheva
Moscow State Medico-Stomatological University
Russian Federation


V. S. Zadionchenko
Moscow State Medico-Stomatological University
Russian Federation


O. Yu. Demicheva
Moscow City Clinical Hospital No. 11, Moscow City Healthcare Department
Russian Federation


T. M. Terekhova
Moscow State Medico-Stomatological University
Russian Federation


Z. O. Grineva
Moscow State Medico-Stomatological University
Russian Federation


References

1. The Task Force for the management of arterial hypertension of the European Society of Hypertension and of the European Society of Cardiolody. 2007 Guidelines for the management of arterial hypertension. J Hypertens 2007; 25: 1105-87.

2. Диагностика и лечение артериальной гипертонии. Национальные клинические рекомендации. Москва 2008; 20-56.

3. Schmidt MI, Duncan BB, Bang H, et al. Identifying individuals at high risk for diabetes: The Atherosclerosis Risk in Communities study. Diabetes Care 2005; 28: 2013-8.

4. Сметник В.П., Шестакова И.Г. Современные представления о менопаузальном метаболическом синдроме. Cons med 2003; 5(9): 543-6.

5. Бритов А.Н., Быстрова М.М. Заместительная гормональная терапия в профилактике сердечно-сосудистых заболеваний у женщин с артериальной гипертонией и ишемической болезнью сердца. Cons med 2002; экстравыпуск: 7-10.

6. Артериальная гипертония у женщин в постменопаузе. Круглый стол. Кардиология 2003; 4: 88-95.

7. Tuomilehto J, Lindstrom J, Eriksson JG, et al; Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344(18): 1343-50.

8. Mancia G, Bombelli M, Corrao G, et al. Metabolic syndrome in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study: daily life blood pressure, cardiac damage, and prognosis. Hypertension 2007; 49: 40-7.

9. Califf RM. Insulin resistance: a global epidemic in need of effective therapies. Eur Heart J 2003; 5: 13-8.

10. Staessen JA, Bieniazewski L, Brosens I, Fagard R. The epidemiol¬ogy of menopause and its association with cardiovascular disease. In Messerli F (ed): Hypertension and Other Cardiovascular Risk Factors After the Menopause. New York, Marsel Dekker Inc 1995; 43-78.

11. Dagenais GR, Pogue J, Fox K, et al Angiotensin-convertingenzyme ingibitors in stable vascular disease without left ventrtcular systolic disfunction or heart failure: a combined analyseis of three trials. Lancet 2006; 368(9535): 581-8.

12. Zwieten PA, Mancina G. The metabolic syndrom a therapeutic challenge. 2007; 99.

13. Небиеридзе Д.В. Ингибиторы АПФ: метаболические и сосудистые эффекты. РМЖ 2005; 15: 3-6.

14. Young JB, Landsberg L. The role of the sympathoadrenal system in modulating energy expenditure. Clin Endocrinol Metab 1984; 13: 475-99.

15. Astrup A, MacDonald IA. Sympathoadrenal system and metabolism. In: Bray GA, Bouchard C, James WPT (eds). Handbook of Obesity Marcel Dekker: New York, 1998; 491-511.

16. Osei SY, Price DA, Laffel LM, et al. Effect on angiotensin II antagonist eprosartan on hyperglycaemiainduced activation of intrarenal renin-angiotensin system in healthy humans. Hypertension 2000; 36(1): 122-6.

17. Punzi HA. Antyhypertensive and Lipid-Lowering Heart Attack Treal Study; Trinity Hypertension Research Institute. Metabolic issues in the Antihypertensive and Lipid-Lowering Heart Attack Treal Study. Curr Hypertens Rep 2004; 6: 106-10.

18. Opie LH, Schall R. Old antihypertensives and new diabetes. J Hypertens 2004; 22: 1453-8.

19. Scholkens BA, Unger T. ACE Inhibitors, Endothelial function and Atherosclerosis. Amsterdam Media Medica Publications. March 1993; 36.

20. Kumar KW, Das UM. Are free radicals involved in the pathobiology of human essential hypertension? Free Rad Res Commun 1993; 19: 59-66.

21. Ярема Н.И., Коновалова Г.Г., Ланкин В.З. Изменение активности антиоксидантных ферментов у больных гипертонической болезнью. Кардиология 1992; 32(3): 46-8.

22. Кения М.В., Лукаш А.И., Гуськов Е.П. Роль низкомолекулярных оксидантов при окислительном стрессе. Усп совр биол 1993; 4: 456-69.


Review

For citations:


Poryvkina O.N., Adasheva T.V., Zadionchenko V.S., Demicheva O.Yu., Terekhova T.M., Grineva Z.O. Optimizing antihypertensive therapy in postmenopausal women with metabolic syndrome. Cardiovascular Therapy and Prevention. 2009;8(3):29-34. (In Russ.)

Views: 431


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1728-8800 (Print)
ISSN 2619-0125 (Online)