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СЕТЕВОЙ НАУЧНО-ПРАКТИЧЕСКИЙ ЖУРНАЛ Y ТАУЧНЫЙ
СЕРИЯ «МЕДИЦИНА. ФАРМАЦИЯ» J. Ж. РЕЗУЛЬТАТ
УДК 616.12-008.331 - 616.13-089
Osipova O.A., Suyazova S.B., Nagibina A.I.
О.А. Осипова, А.И. Нагибина, С.Б. Суязова
CHOICE OF ANTIHYPERTENSIVE THERAPY IN HYPERTENSIVE PATIENTS WITH CRITICAL CORONARY ARTERY STENOSIS
ВЫБОР ГИПОТЕНЗИВНОЙ ТЕРАПИИ У БОЛЬНЫХ ГИПЕРТОНИЧЕСКОЙ БОЛЕЗНЬЮ НА ФОНЕ КРИТИЧЕСКОГО СТЕНОЗА КОРОНАРНЫХ АРТЕРИЙ
Abstract
Sixty patients with stages M-III AH were studied. ABPM was performed in all the patients. DBPP was assessed by the degree of nocturnal BP lowering. Patients were randomized into groups receiving perindopril or losartan potassium. Perindopril was prescribed at a dose of 4 mg/day with subsequent rising up to 8 mg/day during 7 days. The initial dose of losartan potassium was 25 mg with subsequent rising up to 50 mg 2 times a day. The duration of observation was 8 weeks. Thus, perindopril therapy in hypertensive patients in the preoperative CABG period increased the number of people with normal BP profile.
Key words: arterial hypertension;
blood pressure; ambulatory blood pressure monitoring; perindopril; losartan potassium; coronary artery bypass grafting.
Introduction. Arterial hypertension (AH) remains one of the most significant noncommunicable pandemics in human history, determining the structure of cardiovascular (CV) disease and mortality. Moreover, prolonged
Аннотация
Проведено исследование 60 больных
3 стадии АГ. Пациентам проведено суточное мониторирование артериального давления с оценкой суточного профиля АД по степени снижения ночного АД. Обследованные больные были рандомизированы в группы получавшие периндоприл и лозар-тан калия. Периндоприл назначали в дозе
4 мг/сут с последующей титрацией дозы до 8 мг/сут в течение 7 дней. Стартовая доза лозартана калия составила 50 мг/сут с последующей титрацией до 100 мг/сут в два приема. Длительность исследования составила 8 недель. В нашем исследовании установлено, что у больных гипертонической болезнью в предоперационном периоде АКШ назначение периндоприла приводит к увеличению количества пациентов с нормальным профилем АД.
Ключевые слова: артериальная гипертензия, артериальное давление, амбулаторное мониторирование артериального давления, периндоприл, лозартан калия, аортокоронарное шунтирование.
elevation of arterial blood pressure (BP) causes myocardial remodeling with worsening perfusion, accelerating of atherosclerotic processes in the arteries. Thus, the latter leads to the development of ischemic heart
Н
АУЧНЫЙ
РЕЗУЛЬТАТ
Osipova O.A., Suyazova S.B., Nagibina A.I.
ВЫБОР ГИПОТЕНЗИВНОЙ ТЕРАПИИ У БОЛЬНЫХ ГИПЕРТОНИЧЕСКОЙ БОЛЕЗНЬЮ НА ФОНЕ КРИТИЧЕСКОГО СТЕНОЗА
КОРОНАРНЫХ АРТЕРИЙ
disease (IHD), cardiosclerosis and heart failure
[1] . Target organ damage including the heart and blood vessels in hypertensive disease is determined by the presence of AH. But in its turn it correlates more closely with ambulatory blood pressure monitoring (ABPM) parameters, such as high absolute values, variability during the day as well as blood pressure load
[2] . Additionally, the target organ damage is associated with circadian rhythm of BP.
Based on these reasons, the goal of therapeutic effects should be in achieving the target BP less than 140/90 mm Hg as well as desensitization of resistive type arteries to presser effects. Taking this into consideration, among antihypertensive drugs the preference should be given to the use of inhibitors of angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists (APA) which have great opportunities to correct BP level [3].
Unlike thiazide derivatives and beta-blockers with negative effect on the development of atherosclerosis and diabetes, ACE inhibitors and ARA represent a class of antihypertensive drugs with metabolically neutral effect [4, 5], improving endothelial function [6], as well as restoring the balance between vasopressor and vasodilator systems [7]. In fact, the use of these antihypertensive drugs for effective control of BP as monotherapy is another important aspect of these groups of drugs. The use of monotherapy for reaching target BP has many advantages, especially in terms of adherence to therapy as well as achieving the optimum control over treatment. These drugs are also recommended for reduction in CV mortality, nonfatal myocardial infarction, and stroke, as well as the need for coronary angioplasty or coronary artery bypass grafting (CABG) [8].
IHD and cerebral stroke are most frequent among CV diseases occurring in patients with AH. AH and concomitant ischemic heart disease increase the risk of morbidity and mortality twofold and fall under a very high risk category by Framingham criteria (USA) and SCORE (European Society of Cardiology)
regardless of BP. Cerebral vascular events in patients who underwent CABG as well as higher incidence of neurological disorders (0.4% to 80%, depending on the diagnostic method) present a significant problem in cardiology, as hypertension is considered to be one of the major causes of postoperative stroke and encephalopathy after CABG [9].
ABPM gives the opportunity to reveal and identify changes of diurnal BP profile (DBPP) of both in terms of detection of high absolute values and variability of degree of nocturnal BP lowering and pressure load. Direct evidence of pathological morning BP raise results in increasing mortality from CV causes. Today the problem of choice of antihypertensive medications affecting DBPP is still challenging.
Objective. A comparative analysis of perindopril and losartan potassium effect in patients with III stage hypertensive disease on ABPM parameters in order to evaluate antihypertensive effect of these drugs in patients before CABG.
Materials and Methods. Sixty patients with III stage hypertensive disease after myocardial infarction (in more than 6 months before CABG) with stenotic coronary atherosclerosis (confirmed by coronary angiography) were reviewed. The present study was approved by the Ethical Committee and all patients gave informed consent. The exclusion criteria of the study were: rhythm disturbances in the form of frequent ventricular and supraventricular extra systoles (more than 6/ min), permanent atrial fibrillation; concomitant severe liver diseases, kidney, respiratory organs with respiratory failure, as well as cancer. All patients underwent routine clinical, laboratory and instrumental examination including physical examination, biochemical blood tests, urinalysis, electrocardiography, and ABPM.
Ambulatory BP monitoring was performed by means of AVRM-04 Recorder («Meditech», Hungary). Average levels of systolic BP (SBP), diastolic BP (DBP) and heart rate were measured during 24 hours. The time index was defined as the percentage of
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СЕТЕВОЙ НАУЧНО-ПРАКТИЧЕСКИЙ ЖУРНАЛ Y ТАУЧНЫЙ
СЕРИЯ «МЕДИЦИНА. ФАРМАЦИЯ» J. J. РЕЗУЛЬТАТ
BP measurements, during which BP level exceeded its threshold (140/90 mm Hg for wake hours and 120/80 mm Hg for night time). BP variability was calculated as standard deviation of 24 h SBP and DBP, daytime and nighttime separately. The diurnal profile was assessed by the degree of nocturnal BP lowering, and is defined as the ratio of the difference between the average values of BP during awake and sleep hours to the average daytime BP values expressed in percentage. Values more than 10% and less than 20% were taken as normal BP dipping. Concomitant therapy included antianginal (nitro agents) and antiplatelet agents (acetylsalicylic acid, 100 mg / day).
Thus, for routine antihypertensive therapy after ABPM all the patients were randomized into groups receiving perindopril (Perineva, KRKA) or losartan potassium (Losap, Zentiva). Perindopril was administered at a dose of 4 mg/ day with subsequent rising up to 8 mg/day for 7 days. The initial dosage of losartan potassium was 25 mg with subsequent increasing up to 50 mg 2 times a day (after 7 days of therapy). The duration of observation was 8 weeks. Inefficacy in therapy was a reason for the exclusion of
patients from the study and appointment of a combined therapy. Thus, the frequency of achieving target BP (< 140/90 mm Hg) was 61%.
Statistical analysis of the results was performed using the statistical package Statistica 6.0 (Statsoft Inc.). The data are given as Medians [25%; 75%] (Me [Me (n)-Me (b)]). In comparison of the non-normally distributed variables, the Mann-Whitney test was used to test the differences between two groups. For all normally distributed variables, the t-test was used for comparison between two groups. For correlation analysis, Pearson correlation coefficient and Spearman rank correlation coefficient were calculated. Scheffe method of linear contrasts was applied to detect all possible contrasts in individual groups as well as Fisher exact test - while comparing the frequency of adverse changes in the CV system [10].
Results of the study.
The average age of the patients was 56 (50; 60). Distribution of the patients according to the stage of hypertension and the presence of comorbidities and complications are presented in Table 1.
Table 1
Clinical characteristics of patients with AH
Indicator Perindopril Losartan potassium
n=35 n=25
Age, years Ме [25%; 75%] 54 (50; 60) 58 (51; 60)
AH duration, years 8.0 (5.0; 16.0) 12.0 (8.0; 16.0)
AH stage:
Stage II Hypertension 23 (65.7%) 15 (60.0%)
Stage III Hypertension 12 (34.0%) 10 (40%)
I FC CHF 12 (34.3%) 13 (52.0%)
II FC 15 (42.8%) 7 (28.0%)
III FC 8 (22.9%) 5 (20.0%)
A comparative analysis of the ambulatory monitoring of BP parameters in patients treated with perindopril and losartan potassium showed the following results (Tab. 2, 3). Perindopril
treatment reduced 24-hour and daytime SBP by 17.2% (p<0.0001) as compared to baseline, as well as nighttime BP - by 22.5% (p<0.0001). At the same time 24-hour and daytime DBP
Н
АУЧНЫЙ
РЕЗУЛЬТАТ
Osipova O.A., Suyazova S.B., Nagibina A.I.
ВЫБОР ГИПОТЕНЗИВНОЙ ТЕРАПИИ У БОЛЬНЫХ
ГИПЕРТОНИЧЕСКОЙ болезнью на фоне критического стеноза
КОРОНАРНЫХ АРТЕРИЙ
reduced by 18.3% and 17.6% (p<0.0001), respectively, whereas night DBP decreased by 27.2% (p<0.0001) as compared to baseline.
Thus, the pulse pressure and BP variability (VBP) of both systolic and diastolic were more significant at night, a decrease for SBP was 26.7% (p = 0.004) and 20.0% (p = 0.045) - for DBP. This was accompanied by decrease in
the number of non-dippers by 24.3% and night-peakers by 5.4%, as well as increase in number of dippers by 27.0% and over-dippers by 2.7%. Diurnal diastolic pressure also increased due to the group of dippers by 18.9% (p <0.01) and decreased due to non-dippers by 13.5%, night-peakers - by 2.7% as well as over-dippers - by 2.7%.
Table 2
ABPMparameters in the treatment with perindopril and losartan potassium
(Me [Me (n) - Me(b)])
Group 1 (n =35) Group 2 (n =25)
Parameters Perindopril Losartan >otassium
baseline after 8 weeks baseline after 8 weeks
24-hour 148.0 122.5* 161.5 120.0*
SBP (139.0; 159.0) (118.0; 125.0) (144.0; 168.0) (120.0; 127.0)°
Daytime 152.0 126.0* 165.0 126.0*
SBP (143.0; 166.0) (122.0; 132.0) (150.0; 179.0) (115.0; 131.0)
Nighttime 142.5 110.5* 149.0 111.0*
SBP (132.0; 148.0) (107.0; 116.0) (134.0; 150.0) (108.0; 123.0)
24-hour 90.0 73.5* 99.0 69.0*
DBP (83.0; 93.0) (65.0; 76.0) (87.0; 96.0) (62.0; 74.0) °
Daytime 94.0 77.5* 95.0 73.0*
DBP (85.0; 99.0) (72.0; 83.0) (92.0; 106.0) (70.0; 78.0) °
Nighttime 81.0 59.0* 81.0 66.0*
DBP (73.0; 84.0) (57.0; 67.0) (77.0; 89.0) (52.0; 71.0)
24-hour 63.5 48.0* 69.0 52.0*
PBP (58.5; 68.5) (45.0; 53.0) (64.0; 71.0) (48.5; 56.0)
Daytime 61.0 48.0* 68.0 52.5*
PBP (56.0; 65.0) (45.0; 52.0) (64.0; 73.0) (47.5; 54.0)
Nighttime 64.0 49.0* 19.0 51.5*
PBP (57.0; 71.0) (44.0; 53.0) (62.0; 68.0) (46.0; 57.5)
24-hour 16.0 14.0 67.0 13.0*
SBPV (14.0; 19.0) (12.0; 16.0) (16.0; 25.0) (12.5; 16.0) °
Daytime 15.0 12.0 13.5 13.0
SBPV (13.0; 20.0) (11.0; 14.0) (15.0; 24.0) (11.5; 13.5)
Nighttime 15.0 11.0 16.5 12.0
SBPV (13.0; 18.0) (9.0; 14.0) (12.0; 16.0) (10.5; 16.0) °
24-hour 14.0 13.0 13.5 12.5
DBPV (12.0; 16.0) (11.0; 14.0) (10.0; 18.0) (11.5; 13.0)
Daytime 13.0 11.0 9.0 10.5
DBPV (10.0; 15.0) (10.0; 13.0) (10.0; 15.0) (9.0; 11.5)
Nighttime 10.0 8.0 12.5 10.0
DBPV (8.0; 14.0) (7.0; 11.0) (8.0; 11.0) (9.0; 11.0) °
Notes: ° p<0.04 difference between drugs effect; * p 2-3, 4-5 <0.0001
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СЕТЕВОЙ НАУЧНО-ПРАКТИЧЕСКИЙ ЖУРНАЛ Y ТАУЧНЫЙ
СЕРИЯ «МЕДИЦИНА. ФАРМАЦИЯ» J. J. РЕЗУЛЬТАТ
Table 3
Diurnal profile of SBP and DBP under the influence of treatment withperindopril and losartan potassium
Diurnal profile Group 1 (n =35) Perindopril Group 2 Losartan (n =25) potassium Р (after the atment)
baseline after 8 weeks baseline after 8 weeks
1.24-hour SBP
Non-dipper 20 (54.1%) 11 (29.7%)* 11 (50.0%) 10 (45.5%) Р=0.027
Dipper 13 (35.1%) 23 (62.2%)* 9 (40.9%) 8 (36.4%) P=0.002
Night-peaker 3 (8.1%) 1 (2.7%)* 2 (9.1%) 4 (18.2%)* P=0.011
Over-dipper 1 (2.7%) 2 (5.4%)* 0 (0) 0 (0) Р=0.030
2. 24-hour DBP
Non-dipper 17 (45.9%) 12 (32.4%)* 10 (45.5%) 9 (40.9%) Р=0.043
Dipper 14 (37.8%) 21 (56.8%)* 8 (36.4%) 10 (45.5%) Р=0.014
Night-peaker 2 (5.4%) 1 (2.7%) 1 (4.5%) 1 (4.5%) Р=0.001
Over-dipper 4 (10.8%) 3 (8.1%) 3 (13.6%) 2 (9.1%) Р=0.032
Note: * p<0.05 compared with the periods before and after the treatment
Thus, the effect of perindopril treatment on diurnal rhythm of BP resulted primarily in a decrease in diastolic and pulse BP mostly at night and to a lesser extent in systolic BP, which in its turn led to an increase in the number of patients of dipper type. These changes indicate an improvement in the functioning of vasodilator mechanisms of vascular tone regulation.
The assessment of losartan potassium effect on ambulatory BP monitoring after 8 weeks of therapy showed that 24-hour SBP reduced as compared to baseline by 25.7% (p <0.0001), while daytime - by 23.6% (p <0.0001), nighttime - by 25.5% ( p <0.0001). 24-hour DBP reduced by 27.4%, daytime - by 26.3%, night time - by 18.5% (p = 0.003); whereas 24-hour pulse BP significantly reduced by 24.6% (p = 0.0006), daytime - by 22.8% (p = 0.0004) and nighttime -by 23.1% (p = 0.003). The positive dynamics of losartan potassium effect on BP during the day is evidenced by reduction in the values of 24-hour SBPV (up to 31.6%) and daytime DADV (by 16.0%).
A comparative analysis of the hypotensive effect of perindopril and losartan potassium therapy showed significantly much greater changes in VBP in group treated with losartan
potassium. Moreover, the number of patients with SBP corresponding to non-dippers maintained at the range of 45.5% in the group treated with losartan potassium that significantly (p = 0.027) differed from the group treated with perindopril. Additionally, a number of dippers for both systolic and DBP significantly increased up to 62.2% and 56.8%, respectively in group treated with perindopril in comparison with losartan therapy.
Thus, a comparative evaluation of the hypotensive effect of perindopril and losartan potassium therapy suggests that reduced DBPP is more preferable in the treatment with perindopril with reduction of VBP during the day. Antihypertensive effect of losartan potassium therapy is more significant in the daytime and nighttime, but it is accompanied by lower 24-hour VBP, although the number of patients corresponding to dippers was significantly less as compared to perindopril therapy.
Discussion of the results. The main goal in the treatment of AH is to minimize the risk of CV complications and death from them [11, 12]. The changes in the circadian rhythm of BP can lead to pathological hypertensive reactions of night peaker, which result in fatal events [13].
Н
АУЧНЫЙ
РЕЗУЛЬТАТ
Osipova O.A., Suyazova S.B., Nagibina A.I.
ВЫБОР ГИПОТЕНЗИВНОЙ ТЕРАПИИ У БОЛЬНЫХ ГИПЕРТОНИЧЕСКОЙ БОЛЕЗНЬЮ НА ФОНЕ КРИТИЧЕСКОГО СТЕНОЗА
КОРОНАРНЫХ АРТЕРИЙ
Taking this into consideration, BP level lowering as well as an increase in the number of dippers are significant tasks of modern cardiology, which can affect the reduction of cerebral fatal and nonfatal CV events. This applies primarily to ACE inhibitors, such as perindopril [14].
According to some researches, the data of additional cardioprotective properties of ACE inhibitors in IHD patients with AH cannot be explained only by the reduction in BP level. It is estimated that ACE inhibitors affect the basic pathological processes underlying coronary heart disease, such as vasoconstriction, structural changes in the vascular wall as well as left ventricular remodeling. The protective effect of ACE inhibitors on the development of atherosclerosis is possible due to their mechanisms of action. They lead to reducing angiotensin II and increasing the production of nitric oxide and bradykinin as well as improving vascular endothelium functions. One of the mechanisms of anti-ischemic action of ACE inhibitors is peripheral vasodilatation, eliminating the hemodynamic overload of the heart (by both filling and resistance), as well as the reduction of pressure in the ventricles [15]. In our study, we revealed the ability of perindopril to affect the transformation of pathogenic mechanisms of AH (restore circadian BP rhythm violations) by affecting the activity of the renin-angiotensin and related sympathetic nervous systems as well as by improving the vasoregulating endothelial function.
Conclusion. In patients with stage III AH, a significant increase in the average 24-hour, daytime and nighttime BP values, time index, pressure load as well as reduction of nocturnal BP lowering were identified. A high liability of DBPP with high variability was detected, that might be a predictor of acute CV and cerebral events. Thus perindopril therapy in hypertensive patients in the preoperative CABG period increased the number of people with normal BP profile. It is necessary to go on investigating the vascular and neurohormonal mechanisms of pathological remodeling and their relation with the efficacy and safety of antihypertensive therapy with drugs which normalize circadian rhythm of BP that in its turn allows to conduct adequate target correction in time.
References:
1. Dfez J. Arterial Hypertension in Patients with Heart Failure // Heart Fail. Clin. 2014. N 10 (2). pp. 233-242.
2. Zelveyan P.A., Oshepkova E.V.,
Buniatyan M.S. Circadian Rhythm of Blood Pressure and the State of Target Organs in Patients with Mild and Moderate forms of Essential Hypertension // Ter. Architect. 2001. N 2. P. 33-38.
3. Comparative Analysis of the Ambulatory Blood Pressure Monitoring Parameters in Patients with Arterial Hypertension and Chronic Heart Failure / Osipova O.A., Suiazova S.B., Vlasenko M.A., Godlevska O.M. // Fundamental Research. 2012. N. 7. pp. 146-150.
4. Dahlof B., Devereux R.B., Kjeldsen S.E. Cardiovascular Morbidity and Mortality in the Losartan Intervention For Endpoint Reduction in Hypertension Study (LIFE): a Randomized Trial AgainstAtenolol // The Lancet. 2002. N 359. pp. 995-1003.
5. The Goal of Blood Pressure in the Hypertensive Patient with Diabetes is Defined: now the Challenge is to go from Recommendations to Practice / Lopez-Jaramillo P., Lopez-Lopez J., Lopez-Lopez C., Rodriguez-Alvarez M.I. // Diabetol. Metab. Syndr. 2014. N 4. 6 (1). pp. 31.
6. Prestance for Correction of Endothelial Dysfunction in Patients with Acute Ischemic Stroke / Pribylova N.N., Bezzubtseva M.V., Sotnikova S.Yu., Semidotskaya I.Yu., Pribylov
S.A. // Medical Business / № 3 2013/ pp. 3235.
7. Alhenc-Gelas F., Tsai S., Callahan K.S. Stimulation of Prostaglandin Formation by Vasoactive Mediators in Cultured Human Endothelial cells // Basic Res. Cardiol. 1982. N 24. pp. 723-742.
8. Stroke in Coronary Artery Bypass Graft Surgery: an Analysis of the CASS Experience. The Participants in the Coronary Artery Surgery Study / Frye R.L., Kronmal R., Schaff H.V., Myers W.O. Int. J. Cardiol. 1992. N. 36. pp. 213-221.
9. Lupanov V.P. Angiotensin-converting Enzyme Inhibitors in the Treatment and
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СЕТЕВОЙ НАУЧНО-ПРАКТИЧЕСКИЙ ЖУРНАЛ Y ТАУЧНЫЙ
СЕРИЯ «МЕДИЦИНА. ФАРМАЦИЯ» J. J. РЕЗУЛЬТАТ
Prognosis of CHF Patients with Ischemic Heart Disease. Focus on Ramipril // Hypertension. 2010. N. 1 (9). pp. 45-50.
10. Lapach S.N., Chubenko A.V., Babich P.N. Statistical Methods in Biomedical Research Using Exel. 2 Ed.: MORION. 2001. 408 p.
11. Fagard R.H., Celis H. Prognostic Significance of Various Characteristics of Out-of-the-Office Blood Pressure // J. Hypertens. 2004. Vol. 22. pp. 1663-1666.
12. Effects of an Angiotensin-Converting-Enzyme Inhibitor on Cardiovascular Events in High-Risk Patients. HOPE Study Investigators. // N. Engk. J. Med. 2000. 342. pp. 145-153.
13. European Society of Hypertension-European Society of Cardiology Guidelines for the Management of Arterial Hypertension 2007 // J. Hypertens. 2007. Vol. 25. pp. 1101-1187.
14. Diagnosis and Treatment of Arterial Hypertension. Russian Recommendations (third revision). Formulated by the Committee of Experts of the Russian Medical Society on Arterial Hypertension and All-Russian Society of Cardiologists. Moscow, 2008.
15. Bulkina O.S., TalitskiT K.A., Karpov Iu.A. // Hypertrophy Of Left Ventricular Myocardium As Modifiable Risk Factor: New Possibilities Of Correction. Kardiologiya. 2006. N. 46 (3). pp. 68-72.
Литература:
1. Dfez J. Arterial Hypertension in Patients with Heart Failure // Heart Fail. Clin. 2014. N 10 (2). pp. 233-242.
2. Zelveyan P.A., Oshepkova E.V., Buniatyan M.S. Circadian Rhythm of Blood Pressure and the State of Target Organs in Patients with Mild and Moderate forms of Essential Hypertension // Ter. Architect. 2001. N 2. P. 33-38.
3. Comparative Analysis of the Ambulatory Blood Pressure Monitoring Parameters in Patients with Arterial Hypertension and Chronic Heart Failure / Osipova O.A., Suiazova S.B., Vlasenko M.A., Godlevska O.M. // Fundamental Research. 2012. N. 7. pp. 146-150. 4. Dahlof B., Devereux R.B.,
Kjeldsen S.E. Cardiovascular Morbidity and Mortality in the Losartan Intervention For Endpoint Reduction in Hypertension Study (LIFE): a Randomized Trial Against Atenolol // The Lancet. 2002. N 359. pp. 995-1003.
5. The Goal of Blood Pressure in the Hypertensive Patient with Diabetes is Defined: now the Challenge is to go from Recommendations to Practice / Lopez-Jaramillo P., Lopez-Lopez J., Lopez-Lopez C., Rodriguez-Alvarez M.I. // Diabetol. Metab. Syndr. 2014. N 4. 6 (1). pp. 31.
6. Prestance for Correction of Endothelial Dysfunction in Patients with Acute Ischemic Stroke / Pribylova N.N., Bezzubtseva M.V., Sotnikova S.Yu., Semidotskaya I.Yu., Pribylov S.A. // Medical Business / № 3 2013/ pp. 3235.
7. Alhenc-Gelas F., Tsai S., Callahan K.S. Stimulation of Prostaglandin Formation by Vasoactive Mediators in Cultured Human Endothelial cells // Basic Res. Cardiol. 1982. N 24. pp. 723-742.
8. Stroke in Coronary Artery Bypass Graft Surgery: an Analysis of the CASS Experience. The Participants in the Coronary Artery Surgery Study / Frye R.L., Kronmal R., Schaff H.V., Myers W.O. Int. J. Cardiol. 1992. N. 36. pp. 213-221.
9. Lupanov V.P. Angiotensin-converting Enzyme Inhibitors in the Treatment and Prognosis of CHF Patients with Ischemic Heart Disease. Focus on Ramipril // Hypertension. 2010. N. 1 (9). pp. 45-50.
10. Lapach S.N., Chubenko A.V., Babich P.N. Statistical Methods in Biomedical Research Using Exel. 2 Ed.: MORION. 2001. 408 p.
11. Fagard R.H., Celis H. Prognostic Significance of Various Characteristics of Out-of-the-Office Blood Pressure // J. Hypertens. 2004. Vol. 22. pp. 1663-1666.
12. Effects of an Angiotensin-Converting-Enzyme Inhibitor on Cardiovascular Events in High-Risk Patients. HOPE Study Investigators. // N. Engk. J. Med. 2000. 342. pp. 145-153.
13. European Society of Hypertension-European Society of Cardiology Guidelines for the Management of Arterial Hypertension 2007 // J. Hypertens. 2007. Vol. 25. pp. 1101-1187.
Н
АУЧНЫЙ
РЕЗУЛЬТАТ
Osipova O.A., Suyazova S.B., Nagibina A.I.
ВЫБОР ГИПОТЕНЗИВНОЙ ТЕРАПИИ У БОЛЬНЫХ ГИПЕРТОНИЧЕСКОЙ БОЛЕЗНЬЮ НА ФОНЕ КРИТИЧЕСКОГО СТЕНОЗА
КОРОНАРНЫХ АРТЕРИЙ
14. Diagnosis and Treatment of Arterial Hypertension. Russian Recommendations (third revision). Formulated by the Committee of Experts of the Russian Medical Society on Arterial Hypertension and All-Russian Society of Cardiologists. Moscow, 2008.
15. Bulkina O.S., TalitskiT K.A., Karpov lu.A. // Hypertrophy Of Left Ventricular Myocardium As Modifiable Risk Factor: New Possibilities Of Correction. Kardiologiya. 2006. N. 46 (3). pp. 68-72.
СВЕДЕНИЯ ОБ АВТОРАХ DATA ABOUT THE AUTHORS
Осипова Ольга Александровна,
д.м.н, доцент
Белгородский государственный национальный исследовательский университет. Кафедра госпитальной терапии Медицинского института ул. Победы, 85, г. Белгород, 308015, Россия
e-mail: osipova_75@inbox.ru osipova@bsu.edu.ru
Оуязова светлана Борисовна,
к.м.н., доцент
Белгородский государственный национальный исследовательский университет. Кафедра госпитальной терапии Медицинского института ул. Победы, 85, г. Белгород, 308015, Россия
e-mail: pol8bel@yandex.ru
Нагибина Анна игоревна,
клинический ординатор
Белгородский государственный национальный исследовательский университет. Кафедра госпитальной терапии Медицинского института ул. Победы, 85, г. Белгород, 308015, Россия
e-mail: inscreen@mail.ru
Osipova Ol'ga Aleksandrovna
Candidate of medicine sciences, Docent Belgorod State National Research University, Department of Hospital Therapy, nstitute of Medicine,
85 Pobeda St, Belgorod, 308025 Russia e-mail: osipova_75@inbox.ru osipova@bsu.edu.ru
Suyazova Svetlana Borisovna
Candidate of medicine sciences, Docent Belgorod State National Research University, Department of Hospital Therapy, nstitute of Medicine,
85 Pobeda St, Belgorod, 308025 Russia e-mail: pol8bel@yandex.ru
Nagibina Anna Igorevna,
clinical intern
Belgorod State National Research University, Department of Hospital Therapy, nstitute of Medicine,
85 Pobeda St, Belgorod, 308025 Russia e-mail: inscreen@mail.ru
