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Title: Pathogenetic advances of fosinopril sodium with hydrochlorothiazide in obese hypertensive patients
Authors: Ashcheulova, T.V.
Gerasimchuk, N.N.
Rezunenko, Y.K.
Demydenko, G.V.
Kochubiei, O.A.
Keywords: Essential hypertension
body mass index
oxidative stress
fosinopril sodium
Issue Date: Oct-2017
Citation: Рathogenetic advances of fosinopril sodium with hydrochlorothiazide in obese hypertensive patients / T. V. Ashcheulova, N. N. Gerasimchuk, Y. K. Rezunenko, G. V. Demydenko, O. A. Kochubiei // Georgian medical news. – 2017. – № 10 (271). – Р. 35–39.
Abstract: Essential hypertension (EH) stays the important public challenge, because of leading positions in morbidity and mortality in not only Ukraine, but also worldwide. This number is predicted to increase 1.5 billion by 2025. Unfortunately half of that population is unaware of present hypertension [20]. Numerous clinical studies have established the relationship of high blood pressure with increasing body weight. In particular, in the INTERSALT study, carried out in 52 population groups, showed direct correlation between body mass index (BMI) and elevated blood pressure [21]. In Hypertension Control Program was found that 50% of surveyed middle-aged overweight have hypertension (EH), and 2/3 cases of the hypertension are associated with obesity [27]. Framingham study showed that 78% of men and 65% of women has hypertension and are obese [14]. Data confirmed by Swedish Obesity Study [28] where 44-51% of individuals with obesity have essential hypertension. Consequently, increasing in body weight is a potential risk factor for essential hypertension. Finally, the term "obesity induced hypertension" appears. Obesity-associated hypertension is a multicomponent process, and the pathogenesis includes increasing in circulating blood volume, vasoconstriction, hyperreactivity of sympathetic and renin-angiotensin-aldosterone system (RAAS), prediabetes, dyslipidemia and other metabolic disorders. Investigations of the last decade showed that one of the early phases of the pathogenesis of this comorbid pathology is the development of endothelial dysfunction (ED). Elevated levels of angiotensin secreted by the adipocytes, is an important link between visceral obesity and ED, as proved by the correlation of waist - to - hips ratio with the level of mRNA angiotensinogen in visceral and subcutaneous adipose tissue. The subsequent increasing of angiotensin II tissue level stimulates the secretion of superoxide that is known as leading - factor in the etiology of ED. Currently, leading role of the endothelium and nitric oxide in the pathogenesis of cardiovascular complications of hypertension is proved [24, 18, 19]. The leading role in reducing endothelium-dependent vasodilation belongs to the intracellular oxidative stress (OS) as free radical oxidation dramatically reduces the production of NO by endothelial cells [6,1]. Endothelial dysfunction and OS are becoming the new therapeutic targets in the treatment of hypertensive patients. It should be noted that the analyses of pharmacological properties of antihypertensive drugs pay little attention to this aspect. According to some researchers, OS can be a promotor of proinflammatory cytokines system activation. Among the pro-inflammatory cytokines, tumor necrosis factor-α (TNF-α) deserves particular attention in context of hypertension [1,2,7,16,17,29]. Thus, Zahorska-Markiewiez [30] was found in blood of patients with essential hypertension increased content of C-reactive protein (CRP) and TNF-α. It hemodynamic stress caused by hypertension, is stimulus of increased release into the blood of proinflammatory cytokines, including TNF-α [10,15] which, in turn, can modulate the structure and function of the cardiovascular system. The most important predisposal for the maximum reduction in cardiovascular risk in hypertension is achieving the target BP, which may be a problem in presence of overweight and obesity. In many cases there is a need in combination of two antihypertensive drugs that should be metabolically neutral [8,25]. Thus, the scientific justification of treatment regimens in hypertensive patients with overweight and obesity, the study of the antioxidant efficacy of combined antihypertensive therapy is extremely relevant and important for today’s practical healthcare. Despite the large number of antihypertensive drugs and the scientific study of the principles of treatment of patients with hypertension, it would be a mistake to assume that the problem is completely solved.
Appears in Collections:Наукові праці. Кафедра пропедевтики внутрішньої медицини № 1, основ біоетики та біобезпеки

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