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Talipov Rustam Mirkabilovich, Tulaboyeva Gavhar Mirakbarovna, Tashkent Institute of Physician Improvement, Tashkent, Uzbekistan E-mail: [email protected]
The effectiveness of ACE inhibitors and sartans patients with acute myocardial infarction in the elderly on a distant stage monitoring
Abstract: Therapy normopress and enalapril, against the background of basic therapy has shown efficacy in the development of the pathological process of regression, reduced fraction of atherogenic lipids, improve endothelial dysfunction and recovery of myocardial contractility. At the same time, more pronounced and significant dynamics found in patients with myocardial infarction treated with normopress.
Keywords: acute myocardial infarction, hypertension, ACE inhibitors, sartan, endothelial dysfunction.
Relevance
The problem of rational pharmacotherapy ofAMI draws attention due to several reasons. There are a large number of drugs and non-drug therapies used in the treatment of patients with AMI. But quite often there is no objective information regarding the comparative effectiveness of various drugs and treatment regimens. Endothelial dysfunction is the first link in the pathophysiology of cardiovascular-renal continuum, which is based on the progressive vascular disease [1], exacerbated by the influence of risk factors such as arterial hypertension (AH), and leads to kidney and heart failure and death [2]. The blockade of the renin-angiotensin-aldosterone system (RAAS) using ACE inhibitors and sartans and elimination of the negative influence of angiotensin II is a rational approach to achieve regression of endothelial dysfunction [2; 3].
Aim of work
Evaluating the effectiveness ofACE inhibitors and angiotensin receptor blockers II in the management of patients with acute myocardial infarction arterial hypertension in the elderly.
Materials and methods of investigation
The clinical observations and studies carried out in the cardiology department of Tashkent City Clinical Hospital № 7 served as a basis for this work. This is a retrospective study of patients admitted to the Tashkent Hospital № 7 with MI. Patients of both sexes were included. As a result of screening of patients in accordance with the criteria included 631 patients 386 of them older than 60 years, the average age was 70.92 ± 7.22. This open randomized prospective comparative study included 141 patients with the established diagnosis of acute myocardial infarction and arterial hypertension. The study does not include patients older than 80 years with symptoms of decompensated hepatic and renal failure, decompensated diabetes, chronic heart failure (CHF) with over the FC II and III at the time of admission. The patients were selected randomly. Group 1included 66 patients treated with Losartan in the average daily dose of 61.9 ± 32.5 mg. (Normopress 50 mg. CCL Pakistan), Group 2 included75 patients treated with Enalapril in the average daily dose of 6.5 ± 2.0 mg.
The groups were comparable on the baseline characteristics (sex, age, premorbid background, extend of myocardial damage, degree ofhypertension, comorbidities), and the level of decrease in the heart rate (HR).
All patients received standard therapy (including ^-blockers in 21.1 % of cases, statins — 29.6 %, desagregants — 82 %, diuretics — 31 %, calcium antagonists — 15 %, retard forms of nitrates — 64, 74 %) for 2 months. Patients of Group 1 received Normopress, in average daily dose of 61.9 ± 32.5 mg., patients of Group 2 received Enalapril in average daily dose of 6.5 ± 2.0 mg. All patients were surveyed, outcomes were reported, complete physical examination and prospective analysis of patient medical records were carried out. Complete physical examination included the stratification of risk factors: measurement of blood pressure and heart beat rate in dynamics, clinical urine analysis, clinical blood analysis, biochemical blood analysis (including: lipid profile, coagulation profile, troponin I, indicators of antioxidant system of the blood, electrocardiogram (ECG), echocardiogram. All indicators were assessed within 5 days from the date of admission and after 2 months.
Methods of statistical analysis of the study results: we used the package of statistical applications MEDIOSTAT. Besides, the standard methods of variation statistics were used: calculation of mean value, standard deviation (M ± m), and Student's test (p < 0.05).
Results of investigation
At admission, systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with myocardial infarction were high (fig. 1). During the 2 months of observation, all patients maintained the self-control diaries reflecting their BP, heart beat rate and state of health. Comparison of the mean values of SBP surveyed on the 20th -25th day and after 2 months, revealed a significant advantage of hypotensive effect achieved with Normopress, compared to that of Enalapril which provided significantly less effect (fig. 1).
The effectiveness of ACE inhibitors and sartans patients with acute myocardial infarction in the elderly on a distant stage monitoring
Fig.1. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) values (p*** < 0.001; p** < 0.01 *; p < 0.05 compared to baseline values)
In the Group 1 decrease in SBP values was 27 % (p < 0.001), while in the Group 2 it was 23 % (p < 0.01). DBP values in Group 1 reduced by 29 % (p < 0.01), while in the Group 2 it
reduced by 12 % (p < 0.01). The average day and night heart rates at the beginning and at the end of the study did not differ between the study groups.
Table 1. - Indicators of activity of Lipid peroxidation-antioxidant system (POL-AOS), ratio of POL/AOS in the serum of patients with acute myocardial infarction (M ± m)
Group MDA, nmol/l SOD, CU/ml CT, mkkat/min/l POL/AOS
Before treatment After treatment Before treatment After treatment Before treatment After treatment Before treatment After treatment
Group 1 N = 66 8.5 ± 0.20* 5.0 ± 0.07** 1.44 ± 0.03* 1.66 ± 0.03 14.0 ± 0.17* 15.99 ± 0.57 6.70 ± 0.30** 3.32 ± 0.07**
Group 2 N = 75 9.3 ± 0.8* 6.36 ± 0.12* 1.4 ± 0.21* 1.67 ± 0.02 14.5 ± 1.6* 15.82 ± 0.55 7.1 ± 0.7** 4.21 ± 0.26*
Control group N = 20 3.3 ± 0.08 2.4 ± 0.03 16.9 ± 0.16 2.2 ± 0.1
Note: * — р < 0.05;** — р < 0.01 significance of differences compared to the control group. MDA — malondialdehyde, SOD — superoxide dismutase, CT — catalase.
In both study groups the MDA value increased by 37 % and 37 % (p < 0.05) compared to the control group. POL/AOS ratio in both groups almost equally elevated compared to the control group (33 % and 31 %) (p < 0.05). Along with the increase in the above values, the reduction of SOD is registered (60 % and 50 %) (p < 0.05) and CT (33 % and 31 %) (p < 0.05).
In our studies, after 2 months of therapy in Group 1the serum MDA reduced by 59 % (p < 0.01), while in the 2nd Group — by 35.5 % (p > 0.05). This means, that Normopress and Enalapril reduce the processes of free radical oxidation in the blood of patients with acute myocardial infarction, which, undoubtedly, is of
fundamental importance to improve the functional activity of the NO-system. It was established that Normopress, inhibited the activity of POL process and, consequently, free radical oxidation in the body of patients to a greater extent than Enalapril. One of reasons for the decrease in activity oflipid peroxidation process in the body of patients with AMI was the activation of antiradical defense enzymes — SOD and CT.
The study has shown that SOD activity in the blood of patients with acute myocardial infarction treated with Normopress and Enalapril relatively increases and there is no statistically significant differ in the results. A similar pattern is also observed with regard to the CT.
Fig. 2. Indicators of lipid metabolism ( p** < 0,01; p* < 0.05 significance of differences between
the groups): TC — total cholesterol; TG — triglycerides; HDL — high-density lipoprotein; VLDL — very low density lipoprotein; LDL — low-density lipoprotein; KA — atherogenic index
A positive dynamics is observed in both groups after 2 months with regard to the blood lipids in patients with myocardial infarction, which is characterized by a decrease in total cholesterol (31 %, p < 0.01; 24.5 %, p < 0.01), triglycerides (19.5 %, p < 0.01; 20.0 %, p < 0.05), LDL (13 %, p < 0.05; 9 % uncertain (UC)).
On the 5th day of admission and after 2 months, all patients have undergone echocardiography. In Group 1 the index of end-systolic volume (ESV) was 89.41 ± 1.4 ml. and in Group 2 it was 87.07 ± 1.7 ml.; the index of end-diastolic volume (EDV) in Group 1 was 159.6 ± 2.101 ml. and in Group 2 it was 154.45 ± 2.161 ml.
The EF indicator in patients with acute myocardial infarction was 45.21 ± 0.54 (Group 1) and 46.14 ± 0.61 % (Group 2), no differences between the groups were detected. On the 2nd month of therapy in Groups 1 and 2 a significant uncertain reduction of EDV, ESV and increase in EF were observed.
The results analysis showed that both Normopress and Enala-pril lead to increase in serum basic NO metabolites in patients with AMI. Thus, after two months of treatment with Enalapril, the activity of NO complex in serum increased by 49 % (p > 0.05). While when taking Normopress, this indicator increased by 50.0 % (p > 0.05) in comparison with the initial value (fig. 3).
Group 1 NO, mcmol/1, before treatment ONOO, mcmol/1, before treatment Control Group
Fig. 3. Indicators of serum NO system in patients with AMI
However, the NO level in patients of both Groups remained significantly lower than in the control group. The reduction was identified in ONOO concentration by 29 % (p < 0.05) in the first group and by 11 % (p < 0.05) in the second group.
Thus, the 2 month therapy with Normopress and Enalapril, associated with the basic therapy has shown efficacy in the development
of regression of the pathological process, the increase in AOS, reducing the activity of lipid peroxidation process, reducing the fraction of atherogenic lipids, improvement of endothelial dysfunction and restoration of myocardial contractility. At the same time, our research revealed more pronounced and significant dynamics in patients with MI treated with Normopress.
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Teshabaeva Dilnavoz Abdihamidovna, Republican Specialized Scientific-Practical Medical Center of Dermatology and Venerology, Ministry of Health of the Republic of Uzbekistan, researcher E-mail: [email protected]
Clinical-microbiological parameters of the atopic dermatitis
Abstract: This report presents results of the study of clinical features of atopic dermatitis in 120 patients in relation to the character of contamination with staphylococcal flora on the skin of patients.
Keywords: atopic dermatitis, pathogenesis, clinical forms, staphylococcal flora, contamination.
The pathological changes in the skin, developing at the atopic decrease in quantity of other representatives of the normal micro-dermatitis (AD), result in favorite conditions for growth and devel- flora (propion bacteria, streptococci, gram negative microorgan-opment of the total number of microorganisms with predominant isms) [1; 3; 5; 6; 7; 8]. As a result the infectious agents have become staphylococcal flora (predominantly of Staphylococcus aureus) and active inductors of the strengthening of the immunopathological
