Optimizing the treatment of patients with arterial hypertension and concomitant coronary heart disease using Trizipin (meldonium)

Yu.M. Sirenko, O.L. Rekovets, S.M. Kushnir, O.O. Torbas, T.I. Gavrilenko, N.O. Rizhkova

Abstract


Background. The literature discusses the use of metabolic therapy in patients with cardiological disorders, including the impact of such therapy on endothelial function. One of the most popular metabolic drugs is meldonium. The aim of our study was to examine the effect of meldonium in patients with arterial hypertension (AH) and coronary heart di­sease (CHD) on the levels of blood pressure (BP) and citrulline in the blood after 1 month of therapy. The primary endpoint was changes in blood levels of citrulline in patients from the group of combination therapy using meldonium (Trizipin for injections and pills Trizipin Long). Secondary endpoints were reduction and achievement of target BP (< 140/90 mmHg), improved quality of life according to EQ-5D questionnaire, changes in erectile function in men, improved adherence to treatment. Materials and methods. We have examined 38 patients with AH and CHD (24 men, 14 women). All patients were divided into 2 groups of therapy. Patients of the first group (n = 20) received basic treatment for AH and CHD with addition of Trizipin intravenously for 10 days, then Trizipin Long was administered at a dose of 1,000 mg once daily for 1 month (manufactured by Microkhim company, Ukraine). Patients of the second group (n = 18) received basic treatment for AH and CHD without Trizipin. The control group consisted of 7 apparently healthy people. Before treatment and 1 month after, patients underwent examinations, such as electrocardiography, office BP measuring, ambulatory BP monitoring, echocardiography, laboratory blood tests (complete blood count, K, Na, bilirubin, creatinine, creatinine clearance, glucose, alanine aminotransferase, aspartate aminotransferase, cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, very-low-density lipoprotein cholesterol, L-citrulline levels in the blood plasma), filled out quality of life questionnaire EQ-5D, adherence to treatment questionnaire, questionnaire of erectile function in men (The international index of erectile function). Results. The ave­rage age of patients was 60.43 ± 1.80 years. The average body mass index — 28.60 ± 0.90 kg/m2. The average office systolic (SBP) and diastolic BP (DBP) at baseline was 147.03 ± 2.79 mmHg and 85.34 ± 1.54 mmHg. The average office heart rate (HR) — 71.31 ± 1.71 bpm. Mean BP levels du­ring ambulatory monito­ring were: SBP — 128.36 ± 2.45 mmHg, DBP — 78.95 ± 1.72 mmHg. The average daily HR — 72.41 ± 1.57 bpm. In the group of basic treatment, blood citrulline level significantly increased from 34.36 ± 1.29 µmol/l to 41.31 ± 1.51 µmol/l (p < 0.05), and in the group of patients treated with Trizipin citrulline levels significantly decreased from 33.43 ± 1.71 µmol/l to 29.33 ± 1.42 µmol/l (p < 0.05). We compared the initial level of citrulline in the treatment groups and the group of apparently healthy individuals. Citrulline levels in patients with AH and CHD were significantly higher compared with the group of apparently healthy indivi­duals — 25.73 ± 1.70 µmol/l vs 33.89 ± 1.69 µmol/l in the group of patients with AH and CHD (p < 0.05). When comparing the final levels of citrulline after treatment, we noticed that in the group of patients treated with Trizipin levels of citrulline in the end of therapy were close to that of in apparently healthy people, while in the group of basic treatment, citrulline level increased substantially and was significantly different from the control group. Adherence to treatment has improved only in Trizipin group (p = 0.03). There were no changes in erectile function in both groups. The quality of life according to the EQ-5D has improved due to the reduction of anxiety and depression in Trizi­pin group. Conclusions. Treatment based on Trizipin contributed to the reduction of office BP in patients with AH and CHD, decrease of blood citrulline; quality of life was better due to the reduction of anxiety and depression. Adding Trizipin to the basic therapy has improved adherence to treatment in patients with AH and CHD compared to the group of basic therapy.


Keywords


arterial hypertension; coronary heart disease; citrulline; adherence to treatment

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DOI: https://doi.org/10.22141/2224-1485.1.51.2017.96249

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