Marek Klocek

Effect of Amlodipine, Quinapril, and Losartan on Pulse Wave Velocity and Plasma Collagen Markers in Patients With Mild-to-Moderate Arterial Hypertension

BACKGROUNDnCarotid-femoral pulse wave velocity (PWV) is a prognostic factor in arterial hypertension. Modification of PWV, apart from blood pressure (BP) lowering seems to be important in the evaluation of antihypertensive drugs. One of the underlying causes arterial stiffening is arterial wall fibrosis. Plasma collagen I metabolites: carboxy (PICP) and amino (PINP) propeptides are considered as a valuable approach in the assessment of arterial fibrosis. The purpose of the present study was to compare changes in BP, PWV, plasma aldosterone, and collagen metabolites after treatment with amlodipine, quinapril, and losartan.nnnMETHODSnOne hundred eighteen patients with mild-to-moderate essential arterial hypertension were randomized to treatment with 10 mg/d of amlodipine (group 1), 20 mg/d of quinapril (group 2), or 2 x 50 mg/d of losartan (group 3). At baseline, and after 3 and 6 months analysis of variance was performed to compare changes in BP, PWV, aldosterone, PICP, and PINP among subjects with adequate BP control on monotherapy (group 1, n = 38, group 2, n = 37, group 3, n = 24).nnnRESULTSnBlood pressure decreased equally in all groups. Among patients with comparable BP values on monotherapy, only quinapril-treated patients showed a significant decrease in PWV, aldosterone, and PICP as compared with baseline values. Multiple regression analysis showed that PWV was significantly affected by: age (beta = 0.36; P =.021), systolic BP (beta = 0.45; P =.014), and PICP (beta = 0.27; P =.038).nnnCONCLUSIONSnIn hypertensive subjects PWV depends on age, systolic BP, and collagen synthesis. Of the three drugs with comparable BP-lowering efficacy only quinapril significantly decreases PWV, plasma aldosterone, and PICP.

Rilmenidine – its antihypertensive efficacy, safety and impact on quality of life in perimenopausal women with mild to moderate essential hypertension

Objectives. A prospective, open‐labeled study to assess the antihypertensive effect of monotherapy with rilmenidine and its impact on quality of life (QoL), as well as on biochemical parameters in perimenopausal women with essential hypertension. Design and methods. Fifty‐five perimenopausal women with mild to moderate essential hypertension (mean age 51.4±2.4 years) were enrolled. At baseline and after 12‐week monotherapy with rilmenidine, we assessed: systolic (SBP) and diastolic (DBP) blood pressure (BP), heart rate (HR), fasting glucose, serum creatinine and total cholesterol levels. QoL was also assessed at baseline and at 12 weeks by two standardized questionnaires: the Short Form – 36 (SF‐36) and the Subjective Symptoms Assessment Profile (SSAP). Statistical analysis was performed using Students t‐test to compare changes in BP, QoL and biochemical parameters during therapy with rilmenidine. Results. After 12 weeks of therapy, there was a significant decrease in BP and HR. Normalization of BP was observed in 46 (84%) women. Rilmenidine did not influence serum creatinine, fasting glucose and lipid profile. Treatment was very well tolerated by the patients and no side‐effects were noted. Both the SF‐36 and the SSAP demonstrated improvement in general QoL. We observed a significant improvement in all SF‐36 subscales. In the SSAP, a similar significant improvement was found, except dizziness subscale. Improvement in QoL was not related to reduction of BP. Conclusions. Monotherapy with rilmenidine is safe and effective in BP treatment and significantly improves QoL in perimenopausal women with essential hypertension.

Quality of Life in Patients with Implantable Cardiac Devices

In recent years, there has been considerable development in the treatment of arrhythmias and atrioventricular (AV) conduction disturbances through the use of implantable cardiac devices (e.g., pacemakers, cardioverter defibrillators). Such devices may serve several functions, but their primary purpose is to prevent syncope and sudden cardiac death.

P-300: Early renal damage and collagen metabolism determines arterial stiffness in diabetic hypertensives

Rehabilitation Program. Results: 32 men ( mean age 67 /-11 yrs), 20 were hypertensives, 8 had diabetes, only 3 patients were currently smoking. There was no change in the mean arterial pressure, pulse pressure or large artery compliance. There was significant improvement in the small artery compliance. This became insignificant when those patients who were already doing intense workout before the acute coronary events were added. Conclusion: A comprehensive cardiac rehabilitation program improves the small artery compliance significantly in deconditioned male patients with coronary artery disease.This improvement becomes insignificant when those who were following intense exercise program were added. Endothelial dysfunction plays an important role in the pathogenesis of coronary artery disease. We speculate that endothelial function improves with comprehensive cardiac rehabilitation program in deconditioned men. Further studies are needed to test this hypothesis.