The Choise of Antihypertensive Drug Therapy
Hypertension is now seen as an integrated system of cardiovascular risk factors.(Weber M.1993.). The danger of coronary heart diseases increases with the number of risk factors (Kannel WB.1992.)
Prevalence of other coronary risk factors in hypertensives (Kaplan NM.,1993.)
|
Risk factor |
% |
|
Smoking |
35 |
|
Hypercholesterolemia >240mg/dl>200mg/dl |
40/85¹ |
|
Decreased HDL-cholesterol<40mg/dl |
25 |
|
Obesity |
40 |
|
Diabetes |
15 |
|
Hyperinsulinaemia |
50 |
|
Left ventricular hypertrophy |
30 |
|
Sedentary lifestyle |
>50 |
¹Hypercholesterolaemia >24omg/dl >200mg/dl, 85% (Poulter NR.,1991.)
Effects of antihypertensive agents on coronary risk factors (Kaplan NM.,1993.)
|
Coronary risk |
ACE |
Calcium |
Beta |
Diuretics |
Alpha- |
|
Blood pressure |
+ |
+ |
+ |
+ |
+ |
|
Cholesterol |
0 |
0 |
0 |
- |
+ |
|
HDL chol. |
0 |
0 |
- |
0 |
0 |
|
Glucose |
+ |
0 |
- |
- |
0 |
|
Hiperinsulinemia |
+ |
0 |
- |
- |
+ |
|
LVH |
+ |
+ |
+ |
+/0 |
+ |
|
+ positive effect |
0 neutral effect |
- negative effect |
|||
|
Antihypertensive Drug Therapy |
||
|
Drug Therapy |
Indications |
Contraindications |
|
Diuretics |
Congestive heart failure |
Diabetes |
|
Central alpha agonists |
Liver
disease(methydopa) |
|
|
Alpha blockers |
Hypercholesterolemia |
|
|
Beta blockers |
Coronary heart disease |
Bronchospastic disease |
|
ACE inhibitors |
Congestive heart failure |
Renal
failure |
|
Calcium antagonists |
Angina pectoris |
Bradiarrhythmias |
References
Cardiovascular Drugs and therapy.11th international Congress on Cardiovascular
Pharmacotherapy, Montreal, QC, Canada, 18-21 May 2002.
J Intern Med 1993; 234:317-323 JAMA 1990; 263:407-413. Clin Ther 1994;16:88-102.
Ann Intern Med 1992;116:238-244.
OUR INVESTIGATION
Effects of Lisinopril on left ventricular function
Andjelija Necin, Jelena Stamenkovic - Rebic, Zivojin Stamenkovic
Cardiovascular Dispensary, Novi Sad. Yugoslavia; Cardiovascular Institute,
S.Kamenica, Yugoslavia (Serbia)
The Aim of the study was to asses the effects of Lisinoptil (L) on left
ventricular performance in hypertensive patients (pts). 20 hypertensive pts 95<DBP>115
mmHg with left ventricular (LV) hypetrophy, mean age 50±10,7 yrs, were treated
with L. (5 mg -2o mg once daily)for 6 months.
Methods: All pts underwent complete echocardiographic examination before
and after treatment with L. We have measured: LV end diastolic diameter (LVEDD)
and end systolic diameter (LVESD),the interventricular septal (IVS) and
posterior wall (PLW) thicknees, LV mass (LVM), LVM index (LVMI), early pack
velocity (E), late pack velocity (A), the E/A ration, mitral flow deceleration
time (DT) and ejection fraction (RF).
Results are presented on the table:
|
Before th |
After th |
P |
|
|
LVEDD (cm) |
5.12 ± 0.42 |
4.96 ± o.41 |
NS |
|
LVESD (cm) |
3.18 ± 0.41 |
3.11 ± 0.38 |
NS |
|
IVS (cm) |
1.35 ± 0.11 |
1.01 ± 0.11 |
<0.001 |
|
PLW (cm) |
1.29 ± 0.12 |
1.1 ± 0.12 |
<0.001 |
|
LVN (g) |
153 ± 20.1 |
115 ±18.2 |
<0.001 |
|
LVMI (g/m²) |
148 ± 13.4 |
137 ± 12.9 |
<0.005 |
|
E/A ratio |
0.8 ± o.2o |
1.57 ± 0.25 |
<0.001 |
|
F (%) |
64 ± 8 |
68 ± 10 |
<0.005 |
After 12 weeks of treatment L. induced a significant
reduction in blood pressure in the study group from 16o ± 2.0/85 ± 1.2 mmHg to
134 ± 1.8/78 ± 1.4 (p<0.001).
Conclusion: L induced a significant reduction in blood pressure and
reduced LV hypertrophy and mass.L improved diastolic and systolic function of LV.
Abstract at 11th International Congress on Cardiovascular
Pharnacotherapy,Montreal,QC,Canada,18-21 May,2002.P337.
;
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