EFFECTIVENESS OF METABOLIC ACTION OF MELDONIUM DIHYDRATE IN A COMORBID STATE – ARTERIAL HYPERTENSION, OBESITY AND GOUT
DOI:
https://doi.org/10.11603/1811-2471.2019.v0.i1.10045Keywords:
meldonium digitratis, arterial hypertension, obesity, goutAbstract
Arterial hypertension is a topical issue of modern health care in Ukraine due to its prevalence among different age groups, adverse prognostic significance as a factor that has a significant impact on cardiovascular morbidity and mortality.
The aim of the study – to evaluate the efficacy of meldonium dihydrate on endothelial dysfunction indices and arterial stiffness in patients with arterial hypertension combined with obesity and gout.
Materials and Methods. The study included 80 patients with EAG stage II degree 2, in combination with obesity and gout. Subgroup 1 – 20 patients receiving standard therapy: calcium channel blockers – amlodipine 5–10 mg/day, statin – atorvastatin 10–20 mg/day, netiazidic diuretic – indapamide 2.5 mg in the morning, allopurinol 100–300 mg/day. Subgroup 2 – 20 patients who, in addition to standard therapy, received Meldonium dihydrate (Metamax, Darnytsia, Ukraine) – 5 ml of 10 % solution was diluted in 15 ml of 0.9 % sodium chloride solution, injected intravenously over 10 days, followed by transfer on the capsule form – 250 mg 3 times a day for 1 month per os. We performed a clinical examination of patients and identified endothelium-dependent vasodilation (EDVD), endothelial-independent vasodilation (EIVD), thickness of the intima-media complex (IMCT), pulse wave propagation velocity (PWPV), CAVI, aortic rigidity index (ARI), ET-1 level in the blood.
Results. After 1 month, positive dynamics of EDVD was observed in 68.92 % (p<0.001), and after 6 months of treatment – by 70.81 % (p<0.001). After a month of application of meldonium dihydrate, the level of ET-1 decreased by 36.47 % (p<0.001), and after 6 months – by 36.69 % (p<0.001). Reliable changes were absent (p>0.05). CAVI declined already after 1 month of treatment – by 6.32 % (p<0.05), and after 6 months – by 8.24 % (p<0.05). After 1 month of treatment, IMCT decreased by 13.46 % (p<0.05), and after 6 months – by 16.34 % (p<0.01). PWPV also significantly decreased after 12 months (12.54 %) (p<0.01), and 6 months at 18.31 % (p<0.001).
Conclusions. Inclusion in standard therapy meldonium dihydrate leads to effective not only antihypertensive, but also anti-inflammatory and vasoprotective action.
References
(2014). Arterialna hipertenziia. Onovlena ta adaptovana klinichna postanova, zasnovana na dokazakh (2014 rik) [Arterial hypertension. Updated and Adapted Clinical Decision Based on Evidence (2014)]. Working Group on Arterial Hypertension of the Ukrainian Association of Cardiologists Arterіalna hіpertenzіia – Arterial Hypertension, 1 (21), 96-152 [in Ukrainian].
Kovalenko, V.M., & Kornatskyi, K. (2013). Rehionalni medyko-sotsialni problemy khvorob systemy krovoobihu. Dynamika ta analiz: analitychno-statystychnyi posibnyk [Regional medical and social problems of circulatory system diseases. Dynamics and analysis (analytical and statistical manual)]. Kyiv [in Ukrainian].
Solomenchuk T.M. (2013). Stratehiia anhioprotektsii pry likuvanni khvorykh na arterialnu hipertenziiu vysokoho kardiovaskuliarnoho ryzyku [Angioprotection strategy in the treatment of patients with high cardiovascular arterial hypertension]. Ukrainskyi medychnyi chasopys – Ukrainian Medical Herald, 4 (90). 103-106 [in Ukrainian].
Mancia, G., Fagard, K., & Narkiewicz, K. (2013). ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Journal of Hypertension, 31, 1281-1357.
Kolomoiets, M.Yu., & Vasheniak, O.O. (2012). Komorbidnist i polimorbidnist u terapevtychnii praktytsi [Comorbidity and polymorbidity in therapeutic practice]. Ukrainskyi medychnyi chasopys – Ukrainian Medical Herald, 5 (91), 140-143 [in Ukrainian].
Skliarov, Ye.Ya., & Bochar, O.M. (2013). Osoblyvosti perebihu arterialnoi hipertenzii na tli ozhyrinnia ta nealkoholnoi zhyrovoi khvoroby pechinky [Features of the course of arterial hypertension on the background of obesity and non-alcoholic fatty liver disease]. Praktychna medytsyna – Practical Medicine, 1, 9-14 [in Ukrainian].
Amosova,K.M., & Shishkіna,N.V., & Rudenko, Yu.V. (2017). Pokaznyky arterialnoi zhorstkosti, khvyl vidobrazhennia y shlunochkovo-arterialnoi vzaiemodii v patsiientiv z arterialnoiu hipertenziieiu i sertsevoiu nedostatnistiu zi zberezenoiu ta znyzhenoiu fraktsiieiu vykydu livoho shlunochka [Indicators of arterial rigidity, reflection waves and ventricular-arterial interaction in patients with arterial hypertension and heart failure with preserved and reduced left ventricular ejection fraction]. Ukrainskyi kardіolohіchnyi zhurnal – Ukrainian Cardiology Journal, 5, 13-17 [in Ukrainian].
Shuba, N.M. (2013). Giperurikemiya – multimorbidnaya patologiya v revmatologii [Hyperuricemia – multimorbid pathology in rheumatology]. Ukrainskyi revmatolohіchnyi zhurnal – Ukrainian Rheumatological Journal, 2 (52), 14-22 [in Russian].
Takayama, S., Kawamoto, R., & Kusunoki, T. (2012). Uric acid is an independent risk factor for carotid atherosclerosis in a Japanese elderly population without metabolic syndrome. Cardiovasc Diabetol., 10, 2-11.
Shuba N.M. (2015). Mekhanizmy razvitiya kardiovaskulyarnykh porazheniy pri revmaticheskikh boleznyakh i puti ikh korrektsii [Mechanisms of development of cardiovascular lesions in rheumatic diseases and ways of their correction. Zdorovia Ukrainy – Health of Ukraine, 1, 72-73 [in Russian].
Stadnіk S.M. (2013). Znachennia markeriv zapalennia u patohenezi kardio- ta tserebrovaskuliarnoi patolohii [The significance of inflammation markers in the pathogenesis of cardiopulmonary and cerebrovascular pathology]. Lіky Ukrainy – Drugs of Ukraine, 9-10 (175-176), 30-34 [in Ukrainian].
Solomenchuk, T.M., & Semehen-Bodak, H.V. (2011). Suchasna miokardialna tsytoprotektsiia pry ishemichnii khvorobi sertsia: ratsionalnyi vybir likarskoho zasobu [Modern myocardial cytoprotection at ischemic heart disease: rational choice of medication]. Mystetstvo likuvannia – Art of Treatment, 4, 56-61 [in Ukrainian].
Homazyuk, T.A. (2013). Aktualnyye voprosy metabolicheskoy terapii v obshchey vrachebnoy praktike [Topical issues of metabolic therapy in general medical practice]. Lіky Ukrainy – Drugs of Ukraine, 7 (173), 54-59 [in Russian].
James,P.A., Oparil, S., & Carter, B.L. (2014). Takticheskiye podkhody pri arterialnoy gipertenzii u vzroslykh: rukovodstvo, osnovannoe na dokazatelstvakh [Tactical approaches to arterial hypertension in adults: A guide based on evidence]. Zdorovia Ukrainy – Health of Ukraine, 26-31 [in Russian].
Skripnik, N.V. (2013). Metabolichna terapiia – perspektyvnyi napriam likuvannia tsukrovoho diabetu [Metabolic therapy is a promising pathogenetic trend in the treatment of diabetes mellitus]. Lіky Ukrainy – Drugs of Ukraine, 4 (170), 32-36 [in Ukrainian].
