Clinical, cardio-hemodynamical, and respiratory effects of ACE inhibitor cilazapril in patients with arterial hypertension and chronic obstructive pulmonary disease
Abstract
Aim. To investigate effects of an ACE inhibitor, cilazapril, on daily blood pressure (BP) profile, cardiac morphofunctional parameters, lung function (LF) and quality of life (QoL) in patients with arterial hypertension (AH) combined with chronic obstructive pulmonary disease (COPD).
Material and methods. We observed 30 individuals with AH (13 males, 17 females; mean age 60.31±7.71 years). Stage I AH was diagnosed in 1 patient (3.3%), Stage II AH – in 24 (80%), Stage III AH – in 5 (16.7%). Mild COPD was observed in 16 participants (53.3%), moderate COPD – in 11 (36.7%), severe COPD – in 3 (10%). All participants underwent 24-hour BP monitoring, echocargiography (EchoCG), LF assessment at baseline and after 4 weeks of cilazapril treatment (2.5 mg/d).
Results. Four-week cilazapril treatment in patients with AH and COPD demonstrated an antihypertensive effect in 78.6% of cases, normalized circadian BP rhythms, facilitated decrease of left and right atrial sizes (-7.4% and - 6%, respectively), left and right ventricular end-diastolic volumes (-2.8% and –8.1%, respectively), left ventricular myocardial mass (LVMM) and LVMM index (LVMMI), mean pulmonary artery pressure (-9.2%). Cilazapril treatment was associated with positive dynamics in spirography parameters (67% of cases): FEV1 increased by 11.4%.
Conclusion. In patients with AH and COPD, ACE inhibitor cilazapril demonstrated high antihypertensive activity, safety, and beneficial effects on LF and QoL.
Material and methods. We observed 30 individuals with AH (13 males, 17 females; mean age 60.31±7.71 years). Stage I AH was diagnosed in 1 patient (3.3%), Stage II AH – in 24 (80%), Stage III AH – in 5 (16.7%). Mild COPD was observed in 16 participants (53.3%), moderate COPD – in 11 (36.7%), severe COPD – in 3 (10%). All participants underwent 24-hour BP monitoring, echocargiography (EchoCG), LF assessment at baseline and after 4 weeks of cilazapril treatment (2.5 mg/d).
Results. Four-week cilazapril treatment in patients with AH and COPD demonstrated an antihypertensive effect in 78.6% of cases, normalized circadian BP rhythms, facilitated decrease of left and right atrial sizes (-7.4% and - 6%, respectively), left and right ventricular end-diastolic volumes (-2.8% and –8.1%, respectively), left ventricular myocardial mass (LVMM) and LVMM index (LVMMI), mean pulmonary artery pressure (-9.2%). Cilazapril treatment was associated with positive dynamics in spirography parameters (67% of cases): FEV1 increased by 11.4%.
Conclusion. In patients with AH and COPD, ACE inhibitor cilazapril demonstrated high antihypertensive activity, safety, and beneficial effects on LF and QoL.
About the Authors
L. I. Olbynskaya
I.M. Sechenov Moscow Medical Academy, Moscow
Russian Federation
Russian Federation
A. A. Belov
I.M. Sechenov Moscow Medical Academy, Moscow
Russian Federation
Russian Federation
A. O. Yusupova
I.M. Sechenov Moscow Medical Academy, Moscow
Russian Federation
Russian Federation
References
1. Дегтярева С.А., Демихова О.В., Шмелев Е.И. и др. Энам (эналаприл) в лечении хронического легочного сердца. Больница – Hospital 1999; 6-7: 15-6.
2. Косов И.Н., Якушин СС. Влияние ренитека на вегетативный гомеостаз больных ГБ на фоне хронического бронхита. VI Пульмонологический конгресс. Москва 1997; 1481.
3. Лютай А.В., Шутемова Е.А., Егорова Л.А. и др. Эффективность престариума в лечении хронического легочного сердца. Тер архив 2000; 9: 60-3.
4. Метелица В.И. Справочник по клинической фармакологии сердечно-сосудистых лекарственных средств. Москва «Медпрактика» 1996; 278 с.
5. Ольбинская Л.И., Андрущишина Т.Б., Белов А.А. Эффективность и безопасность антигипертензивной терапии Диротоном у больных хроническими обструктивными заболеваниями легких. РМЖ 2002; 10: 53-7.
6. Ольбинская Л.И., Белов А.А. Суточный профиль артериального давления у больных хроническими обструктивными заболеваниями легких в сочетании с артериальной гипертонией на фоне терапии эналаприлом. Тер архив 2002; 3: 59-62.
7. Франгулян Р.Р. Роль ренин-ангиотензиновой системы в патогенезе легочной гипертензии у больных хроническими обструктивными заболеваниями легких. Клин мед 2000; 10: 18-20.
8. Чучалин А.Г. Хронические обструктивные болезни легких. Москва «Издательство Бином» 2000; 196 с.
9. Chen W, Cheng D. The change of plasma level of endothelin-1 in patients with cor pulmonale and the effects of Captopril. Hua Xi Yi Ke Da Xue Xue Bao. 1999; 30(2): 179-81.
10. Dart R, Gollub S, Lazar J, et al. Treatment of systemic hypertension in patients with pulmonary disease: COPD and asthma (special reports). Chest 2003; 123(1): 222-43.
11. Haberbosch W, De Simone R, Dietz R, et al. Improvement of diastolic filling in hypertensive patients treated with cilazapril. J Cardiovasc Pharmac 1991; 17: 159-62.
12. Kawakami Y, Munakata M, Yamaguchi E, et al. Molecular studies of bronchial asthma, sarcoidosis and angiotensin converting enzyme inhibitor-induced cough. Respirology 1998; 3(1): 45-9.
13. Maclean AA, Liu M, Fisher S, et al. Targeting the angiotensin system in posttransplant airway obliteration: the antifibrotic effect of angiotensin converting enzyme inhibition. Am J Respir Crit Care Med 2000; 162(1): 310.
14. Marshall RP, Gohlke P, Chambers RC, et al. Angiotensin II and the fibroproliferative response to acute lung injury. Am J Physiol Lung Cell Mol Physiol 2004; 286(1): 156-64.
15. Marshall RP. The pulmonary renin-angiotensin system. Curr Pharm Des 2003; 9(9): 715-22.
16. Qing F, McCarthy TJ, Markham J, et al. Pulmonary angiotensinconverting enzyme (ACE) binding and inhibition in humans. A positron emission tomography study. Am J Respir Crit Care Med 2000; 161(6): 2019-25.
17. Rosenthal JB, Osowski U. Tolerance and efficacy of antihypertensive therapy by cilazapril in common practice. Cardiology 1996; S7: 54-9.
18. Scribner AW, Loscalzo J, Napoli C. The effect of angiotensinconverting enzyme inhibition on endothelial function and oxidant stress. Eur J Pharmacol 2003; 482(1-3): 95-9.
19. Tavli T, Gocer H. Effects of cilazapril on endothelial function and pulmonary hypertension in patients with congestive heart failure. Jpn Heart J 2002; 43(6): 667-74.
20. The Cilazapril-Captopril Multicenter Group. Comparison of the effects of cilazapril and captopril versus placebo on exercise testing in chronic heart failure patients: a double-blind, randomized, multicenter trial. Cardiology 1995; 86(1): 34-40.
21. Vlahakos DV, Kosmas EN, Dimopoulou I, et al. Association between activation of the renin-angiotensin system and secondary erythrocytosis in patients with chronic obstructive pulmonary disease. Am J Med 1999; 106(2): 158-64.
22. Waeber B, Weidmann P, Wohler D, et al. Albuminuria in diabetes mellitus. Am J Hypertens 1996; 9: 1220.
Review
For citations:
Olbynskaya L.I., Belov A.A., Yusupova A.O. Clinical, cardio-hemodynamical, and respiratory effects of ACE inhibitor cilazapril in patients with arterial hypertension and chronic obstructive pulmonary disease. Cardiovascular Therapy and Prevention. 2005;4(1):42-48. (In Russ.)
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