The aim of the research was to determine the relationship between the activity of serum immunoinflammatory and neuro humoral factors as well as blood pressure in both the pulmonary and systemic circulations of patients with arterial hypertension and chronic obstructive pulmonary disease and the possibility of their optimization using L-arginine.
Materials and Methods: The study included 140 patients with stage II second-degree/third-degree arterial hypertension; among them, there were 82 patients with arterial hypertension and co-existent first-degree/second-degree pulmonary hypertension of bronchopulmonary origin in chronic obstructive pulmonary disease remission phase. The comparison group included 58 patients with arterial hypertension of a similar stage and degree. The average age of patients in the main group was 58.5±5.12 years; the average age of patients in the comparison group was 59.5±3.22 years. The duration of arterial hypertension in the main group was 6.2±1.78 years; the duration of chronic obstructive pulmonary disease was 10.4±2.93. According to treatment, 82 patients with arterial hypertension and chronic obstructive pulmonary disease were divided into two homogeneous groups according to age, sex, duration of arterial hypertension and chronic obstructive pulmonary disease. Group I included 40 patients undergoing basic therapy only. Group II included 42 patients, who, in addition to basic therapy, received intravenous infusion of 4.2% L-arginine hydrochloride solution No 5 (Tivortin, manufactured by Yuria-Pharm, Ukraine) at a dose of 100 ml and continued taking the medicine using oral dosage form (1 tablespoon 5 times a day) for three months.
Results and Discussion: The activity of proinflammatory factors was significant in both patients with arterial hypertension and co-existent chronic obstructive pulmonary disease and those with essential hypertension. In patients with comorbidity, the concentration of interleukin-6 was 8.2 times higher as compared to healthy individuals and 1.4 times higher (p<0.001) as compared to patients with arterial hypertension. The activity of tumor necrosis factor-alpha increased as well. In patients of the main group, serum atrial natriuretic peptide concentration was 66% higher as compared to those with isolated arterial hypertension (р<0.05) and 6 times higher than that in healthy individuals (р<0.001). Serum endothelin-1 concentration was 1.3 and 3.9 higher, respectively (р<0.001). After the two-week course of treatment with L-arginine, the clinical condition of patients of the main group improved significantly - apparently due to a reduction in blood pressure in both the pulmonary and systemic circulations. Serum concentration of interleukin-6 and tumor necrosis factor-alpha decreased by 32% and 38%, respectively, undergoing significant changes similar to vasoactive substances – atrial natriuretic peptide and endothelin-1, 3 months after treatment (р<0.05).
Conclusions: L-arginine, which was used in combination treatment of patients with arterial hypertension and co-existent chronic obstructive pulmonary disease, affected pathogenetic mechanisms of both diseases and improved their clinical course.