To lower blood pressure (BP) and its properly further maintenance are a main goal of antihypertensive therapy. Many large studies have provided strong evidence that there is an association of elevated BP with a risk for cardiovascular events (CVE), such as stroke, (S), myocardial infarction (MI), and heart failure (HF). But none of the studies has indicated that a drug is more effective than another one in reducing the risk for CVE and death. A recent LIFE study has demonstrated the indisputable advantage of the angiotensin II receptor blocker (ARB) of the first type losar-tan over the ß-blocker atenolol in patients with arterial hypertension and left ventricular hypertrophy (LVH). The study covered 9193 patients aged 55 to 80 years who had a diastolic BP of 95-115 mm Hg or a systolic BP of 160-220 mm Hg and ECG signs of LVH. The study was double-blind, randomized, and parallel. The patients received either losartan in a daily dose of 50-100 mg or atenolol in the same daily dose; if the target BP (< 140/90 mm Hg) was not achieved, hydrochlorthiazide and other antihypertensive drugs could be supplemented. The study lasted about 4 years. It revealed that the use of losartran caused a reduction in a relative risk for cardiovascular death by 11 %, MI by 25%, new cases of diabetes mellitus by 25% as compared to therapy based on the ß-blocker atenolol.

During an open retrospective study, 6-month therapy with angiotensin-converting enzyme inhibitors (ACEl) was performed in 45 males with coronary heart disease (CHD) and manifestations of chronic heart failure (CHF)₁ of them 30 patients additionally received acetyl-salicylic acid in a daily dose of 125 mg. Clinical parameters, exercise tolerance, echocardiographic data and the major endothelial markers: the level of endothelin-1 (ET-1), blood circulating desquamated endotheliocytes (CDE), endothelium-dependent vasodilatation, the level of uric acid, the content of interleukin-8 (1L-8), were followed up. The findings have led to the conclusion that in patients with CHD and manifestations of CHF, contaminant aspirin therapy does not decrease the main clinical effects of ACEl and it contributes to a reduction in the functional class of angina pectoris, in the incidence of paradoxical vasoconstriction of the brachial artery. Aspirin in a daily dose of 0.12 5 fails to have a negative effect on the variations of left ventricular systolic function, on the parameters of brachial vasodilatation, on the changes in the blood levels of ET-1, CDE, 1L-8, and uric acid, but moderately decreases the antihypertensive effect of ACEI at the same time.

The study was undertaken to determine the serum concentration of an active form of transforming growth factor-bl (TGF-bl) and the functional status of leukocytes in patients with Stage II hypertensive disease (HD) and to assess the pathogenetic value and capacities of correction of detected changes with the angiotensin-converting enzyme (ACE) inhibitor quinapril. Materials and methods. Thirty patients with Stage II HD and 17 apparently healthy individuals were examined. The data of ultrasound studyofthe heart, radial and carotid arteries, the functional activity of leukocytes and the concentration of (TGF-bl) in the serum were assessed. Of them, 15 patients with HD were reexamined during treatment with quinapril (accupro, Pfizer, USA) in a daily dose of 10-40 mg for 12 weeks. Results. The study established an increase in the elevated serum levels of TGF-bl of hypertensive patients with HD and its association with the mass of the left ventricular myocardium, with the thickness of an intima-media complex of the common carotid arteries, and with endothelial dysfunction. A relationship is shown between the concentration of TGF-bl and the functional activity of leukocytes: elevated peripheral leukocytes, the adhesive capacity of neutrophils, the lymphocytic expression of the antiapoptic protein Bcl-2 and Fas-receptors. With quinapril treatment, a 10-mm Hg or more reduction in 87% of the patients was attended by the lower adhesion of neutrophils to the endothelium, with elevated Bcl-2-negative and Fas-positive lymphocytes. Conclusion. The changes in the serum levels of TGF-bl are associated with lesions of target organs and with the activation of leukocytes in HD. The decrease in leukocytic functional activity during therapy with quinapril did not depend on the antihypertensive effect of the drug.

The purpose of the study was to examine the effects of the AT₁-angiotensin receptor blocker eprosartan (Teveten, “Solvay Pharma”) on the level of blood pressure (BP) as compared with the functional state of the renin-angiotensin-aldosterone system in patients with arterial hypertension (AH) of different genesis. Eprosartan was given in a daily dose of 600 mg for 8 weeks. If there was no normalization of BP or achievement of its target level, the therapy was supplemented by hypothiazide in a dose of 25 mg. Thirty-thirty hypertensive patients with symptomatic BP of renal genesis. Clinical BP measurements indicated that 8-week eprosartan therapy caused a 10 mm Hg or more reduction in systolic BP in 26 (78,8%) patients, systolic BP becoming normal (less than 140 mm Hg) in 21 (63,6%) patients and diastolic BP (less than 90 mm Hg) in 23 (69,7%). Analyzing the antihypertensive effect of eprosartan in relation to the severity of AH has established that eprosartan significantly lowers BP in the groups of mild [143±3,42/86±4,25 mm Hg before treatment, 118±2,56/75±3,54 mm Hg (p<0,001) after treatment], moderate [151±2,9/94±2,81 mm Hg before treatment, 128±3,24/81±2,14 mm Hg (p<0,001) after treatment], and severe [199±3,1/116±2,51 mm Hg before treatment, l63±3,32/95±3,62 mm Hg (p<0,001) after treatment] forms of AH. At the same time the best effect was achieved in patients with mild and moderate forms of AH. Examining the renin-angiotensin-aldosterone system during therapy with eprosartan as compared to its antihypertensive effect has revealed a significant decrease in BP after 8-week therapy both in patients with normal and higher activity of renin (a decrease in systolic BP by 30.0±4,97 mm Hg and in diastolic BP by 16,8±7,8 mm Hg, p<0,001) and in diastolic BP by 16,8±7,8 mmHg, p < 0,001) and in those with low-renin form of AHby 14,2±2,34 mm Hg, p<0,001).The findings suggest that AT j-angiotensin receptor blockers are beneficial not only in hypertensive patients with high and normal ARP but also in those with ARP, which expands the field of their clinical use.

To examine the effects of eprosartan on the remodelling of the heart and large vessels, on endothelial dysfunction and autonomic circulatory regulation in patients with hypertensive disease, thirteen patients were included into the study: Doppler echocardiographic study and evaluation of left ventricular diastolic function were performed on a Vingmed CFM800 apparatus: the thickness of the carotid intima-media complex and the diameter of the brachial artery were determined on the same apparatus using a 7.5-MHz transducer in the reactive hyperemia test. Automatic balance was evaluated by the spectral assay of cardiac rhythm variations. The cardiopulmonary component of baroreflex was also tested. Blood pressure normalized in 3 patients following 24 weeks of therapy with eprosartan in a daily dose of 600 mg. Two patients were excluded due to therapeutic inefficiency. In the remaining patients, the antihypertensive effect was incomplete. The mass of the left myocardial myocardium decreased by 10.8%. there was an increase in brachial arterial dilatation in the reactive hyperemia test. The variations of cardiac rhythm were not significantly changed, the baroreflex tended to be decreased. Thus, long-term eprosartan therapy improves the structural and functional state of the heart and vessels and fails to affect the autonomic regulation of circulation.