Vol. 6, Issue 8 (2017)

Author(s):
Luybov Dron and Iryna Kupnovytska

Abstract:
The aim: of the research was to improve the effectiveness of pharmacotherapy for patients with hypertensive disease and co-existent chronic obstructive pulmonary disease using an exogenous nitric oxide donor – L-arginine through the correction of structural and functional indices of the heart, pulmonary ventilation and according to patients’ life quality. Materials and Methods: The study included 102 patients with stage II second-degree/third-degree hypertensive disease; among them, there were 82 patients with hypertensive disease and co-existent chronic obstructive pulmonary disease and 20 patients with hypertensive disease (essential hypertension) of a similar stage and degree at the age of 65.5±4.12 years. According to treatment, 82 patients with hypertensive disease and chronic obstructive pulmonary disease were divided into two homogeneous groups according to age, sex, duration of hypertensive disease and chronic obstructive pulmonary disease. Group I (the control group) included 40 patients undergoing basic therapy only. Group II (the main group) included 42 patients, who, in addition to basic therapy, received L-arginine. Results and Discussion: There was noted a precipitating effect of chronic obstructive pulmonary disease on the clinical course of hypertensive disease through the worsening of the indicators of the cardiorespiratory system. In patients with hypertensive disease and co-existent chronic obstructive pulmonary disease, the left ventricle was characterized by an increase in metric and volumetric indices – end-systolic dimensionincreased by 17.8%, end-systolic volume increased by 44.4% compared to patients with isolated hypertensive disease (p<0.05). The size of the left atrium in patients with chronic obstructive pulmonary disease was 42.5±2.13 mm, i.e. it was larger than that in patients with hypertensive disease reflecting left ventricular remodeling and indicating the development of diastolic dysfunction (p<0.05). The mean systolic pressure within the pulmonary circulation of patients with hypertensive disease was 19% higher than in healthy persons (p<0.05), while in patients with comorbidity, it was 128% higher than that in healthy persons (p<0.001). According to the spirogram, in patients with comorbidity, the forced expiratory volume in one second was 48±1.1% compared to patients with hypertensive disease - 70±2.8% (р<0.01) indicating a moderate positive correlation with the indicator of physical functioning (r= 0.45; р<0.05). Thus, in patients with hypertensive disease and co-existent chronic obstructive pulmonary disease, bronchial patency is significantly impaired thereby increasing systolic pressure within the pulmonary circulation and creating a pathogenic basis for the development of cardiac remodeling as well as resulting in lower quality of life indices including general health, physical functioning, role limitations due to physical health and vitality. After 3 months of pharmacotherapy with L-arginine, there was observed a number of positive effects on the clinical course of comorbidity involving the cardiovascular and respiratory systems: the decrease in blood pressure within the pulmonary circulation by 54% (p<0.001) due to treatment contributed to the increase in ventilation and gas exchange as indicated by increased lung capacity and, especially, increased Tiffeneau index; left ventricular end-systolic volume reduced by 8.6% (p<0.05) indicating positive dynamics of left ventricular contractile function. Generally, under the influence of L-arginine, the indicators of general health improved by 31.6%(p<0.05), while in the control group they improved by 17.6% only (p<0.05). Conclusions: The use of L-arginine in combination treatment of patients with hypertensive disease and co-existent chronic obstructive pulmonary disease promotes the potentiation of antihypertensive therapy as well as the improvement of bronchial patency, structural and functional indices of the heart and, therefore, has a positive effect on life quality.