Clinical efficacy of combined use of physical training and a fixed combination of an angiotensin receptor blocker II - valsartanumand the calcium antagonist - amlodipine on ambulatory (III) stage of rehabilitation in smoking patients with comorbid diseases (coronary heart disease, hypertension and chronic obstructive pulmonary disease)

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Abstract

Goal. The study of the clinical efficacy of combined use of systematic physical training (PT) and a fixed combination of a blocker of receptors for angiotensin II (ARB), valsartanum (Val) to dihydropyridine calcium antagonist (AA) with amlodipine (AML), appointed as part of standard therapy for smokers in patients with cardio-pulmonary pathology outpatient (III) stage of rehabilitation. Material. The study included 30 men aged 40 to 65 years. All patients were treated with statins, aspirin, .-blockers, selective and systematic FT performed 3 times a week for 4 months (duration of the training - 60 minutes with a period of moderate intensity training load of 50-60% of the threshold power cycling). After randomization, patients were divided into two groups: Group 1 (n=12) received additional angiotensin converting enzyme inhibitors (ACEI) and 2nd (n=18) - the combined preparation Exforge ® (AML 5-10 mg/Val 60 mg). Study duration - 4 months. Methods. In a study conducted clinical examination, bicycle stress test (VEM-test), echocardiography (echocardiography), ambulatory blood pressure monitoring (ABPM), spirometry, determination of concentrations of lipids and lipoproteins, glucose, fibrinogen, uric acid, creatinine, a calculation of glomerular filtration rate by MDRD. They used questionnaires: Hospital Anxiety and Depression Scale (HADS), St George's Hospital (SGRQ) and quality of life (QOL) SF-36. Results. Against the background of the FT, combined with taking an ACE inhibitor or a fixed combination of AML/Val, reduced the number of smoked cigarettes at 20.8±5.2 pieces (<0.001) and 25.6±4.2 pieces (<0.001), respectively. Also, there was a significant decrease in heart rate: in the group of ACE inhibitors on the FT+3,7±4,4 beats/min in group FT+AML/Val at 6.4±4.1 beats/min (p=0,09 between groups). Reveals reduction of office blood pressure (BP): systolic blood pressure (SBP) at 37.3±6.3 mm Hg (p<0,001) in the FT+ACEI and 36.1±6.9 mm Hg (p<0.001) in the FT+AML Val, diastolic blood pressure (DBP) at 19.6±3.9 mm Hg (p<0,001) and 18.2±4.4 mm Hg (p<0.001), respectively. According ABPM smokers and train patients on therapy AML/Val group when compared with FT+ACEI noted a marked decrease in the average daily maximum SBP (-3 mm Hg, p<0.05), daily (at -4, 4 mm Hg, p<0.05) and the night (to -1,2 mm Hg, p<0.05) and diastolic blood pressure variability in the night hours (-1.6 mm Hg, p<0.05). After 4 months of receiving FT was observed in the growth of the basic parameters of physical performance to a greater extent in the treatment of AML/shaft against receiving ACE inhibitors: FN capacity by 51.4% (p<0.001) and 32.3% (p<0.001), with a total length of FN by 51.6% (p<0.001) and 41,4% (p<0.001). Time to development of angina attack at HEM-sample after the FT in treated AML/Val increased to a greater extent (29.1%, p<0.05) against taking ACE inhibitor therapy. Both groups noted positive changes in the structural and functional parameters of the heart according to echocardiography due to lower average pressure in the pulmonary artery. In both groups there was an improvement of function parameters of external respiration, but to a greater extent in the group FT+AML/Val, as well as indicators of psychological status and quality of life. Conclusion. The inclusion of patients with a very high risk of cardiovascular events with comorbid disorders in the short (4 month) physical rehabilitation program phase III (on an outpatient basis) gives a positive clinical effect, worse when its combined with cardioprotective therapy (ACE inhibitors or AK/ARBs). This effect was most pronounced when joining the FT fixed combination of AML/Val.

About the authors

M. G Bubnova

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

Email: mbubnova@gnicpm.ru
д-р мед. наук, проф., рук. отд. реабилитации и вторичной профилактики сочетанной патологии с лабораторией профилактики атеросклероза и тромбоза ФГБУ ГНИЦ ПМ 101990, Russian Federation, Moscow, Petroverigsky per., d. 10, str. 3

Yu. N Sulim

Nordic Health Center

врач-кардиолог отд-ния кардиологии и функциональной диагностики ООО «Скандинавский центр здоровья» 111024, Russian Federation, Moscow, ul. 2-ia Kabel’naia, d. 2, str. 25

D. M Aronov

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

д-р мед. наук, проф., рук. лаб. кардиологической реабилитации ФГБУ ГНИЦ ПМ, засл. деят. науки РФ 101990, Russian Federation, Moscow, Petroverigsky per., d. 10, str. 3

N. K Novikova

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

канд. пед. наук, ст. науч. сотр. лаб. кардиологической реабилитации отд. реабилитации и вторичной профилактики сочетанной патологии ФГБУ ГНИЦ ПМ 101990, Russian Federation, Moscow, Petroverigsky per., d. 10, str. 3

V. A Vygodin

State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation

вед. науч. сотр. ФГБУ ГНИЦ ПМ 101990, Russian Federation, Moscow, Petroverigsky per., d. 10, str. 3

N. N Meshcheryakova

Research Institute of pulmonology FMBA of Russia

канд. мед. наук, ст. науч. сотр. лаб. легочной реабилитации и исследования состояния здоровья легочных больных ФГУ НИИ пульмонологии 105077, Russian Federation, Moscow, ul. 11-ia Parkovaia, d. 32

References

  1. Balkissoon R, Lommatzsch S, Carolan B, Make B. Chronic obstructive pulmonary disease: a concise review. Med Clin North Am 2011; 95: 1125-41.
  2. Sidney S, Sorel M, Quesenberry C.P et al. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program. Chest 2005; 128: 2068-75.
  3. Holguin F, Folch E, Redd S.C et al. Comorbidity and mortality in COPD-related hospitalizations in the United States, 1979 to 2001. Chest 2005; 128: 2005-11.
  4. Selvaraj C.L, Gurm H.S, Gupta R et al. Chronic obstructive pulmonary disease as a predictor of mortality in patients undergoing percutaneous coronary intervention. Am J Cardiol 2005; 96: 756-9.
  5. Kjoller E, Kober L, Iversen K, Torp-Pedersen C. Importance of chronic obstructive pulmonary disease for prognosis and diagnosis of congestive heart failure in patients with acute myocardial infarction. Eur J Heart Fail 2004; 6: 71-7.
  6. Salisbury A.C, Reid K.J, Spertus J.A. Impact of chronic obstructive pulmonary disease on post - myocardial infarction outcomes. Am J Cardiol 2007; 99: 636-41.
  7. Iribsrren C, Tecawa I.S, Sydney S, Friedman G.D. Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men. N Engl J Med 1999; 343: 1773-80.
  8. Anthonisen N.R, Connett J.E, Enright P.L et al. Lung Health Study Research Group. Hospitalizations and mortality in the Lung Health Study. Am J Respir Crit Care Med 2002; 166: 333-9.
  9. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease 2013. Available from: http://www.goldcopd.org/uploads/users /files/GOLD_Report_2013_Feb20.pdf. Accessed July 20, 2013.
  10. Vestbo J, Hurd S.S, Agusti A.G et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013; 187 (4): 347-65.
  11. Barnes P.J, Celli B.R. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009; 33 (5): 1165-85.
  12. American Thoracic Society, European Respiratory Society. Skeletal muscle dysfunction in chronic obstructive pulmonary disease. A statement of the American Thoracic Society and European Respiratory Society. Am J Respir Crit Care Med 1999; 159 (4 Pt. 2): S1-S40.
  13. Wust R.C, Degens H. Factors contributing to muscle wasting and dysfunction in COPD patients. Int J Chron Obstruct Pulmon Dis 2007; 2 (3): 289-300.
  14. Whittom F, Jobin J, Simard P.M et al. Histochemical and morphological characteristics of the vastus lateralis muscle in patients with chronic obstructive pulmonary disease. Med Sci Sports Exerc 1998; 30 (10): 1467-74.
  15. Gosker H.R, Zeegers M.P, Wouters E.F, Schols A.M. Muscle fibre type shifting in the vastus lateralis of patients with COPD is associated with disease severity: a systematic review and meta - analysis. Thorax 2007; 62 (11): 944-9.
  16. Jobin J, Maltais F, Doyon J.F et al. Chronic obstructive pulmonary disease: capillarity and fiber - type characteristics of skeletal muscle. J Cardiopulm Rehabil 1998; 18 (6): 432-37.
  17. Barreiro E, Gea J, Corominas J M, Hussain S N. Nitric oxide syntheses and protein oxidation in the quadriceps femoris of patients with chronic obstructive pulmonary disease. Am J Respir Cell Mol Biol 2003; 29 (6): 771-8.
  18. Gosker H R, Hesselink M K, Duimel H et al. Reduced mitochondrial density in the vastus lateralis muscle of patients with COPD. Eur Respir J 2007; 30 (1): 73-9.
  19. Maltais F, Simard A A, Simard C et al. Oxidative capacity of the skeletal muscle and lactic acid kinetics during exercise in normal subjects and in patients with COPD. Am J Respir Crit Care Med 1996; 153 (1): 288-93.
  20. Johnston K, Grimmer-Somers K. Pulmonary rehabilitation: overwhelming evidence but lost in translation? Physiother Can 2010; 62: 368-73.
  21. Ли В.В., Задионченко В.С., Адашева Т.В. и др. Хроническая обструктивная болезнь легких и артериальная гипертония - метафизика и диалектика//CardioСоматика. 2013; 1: 5-10.
  22. Адашева Т.В., Федорова И.В., Задионченко В.С. и др. Антигипертензивная терапия у больных хронической обструктивной болезнью легких: преимущества антагонистов кальция. Рациональная фармакотер. в кардиологии. 2008; 5: 39-45.
  23. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (revised 2011). www.goldcopd.com.
  24. Devereux R.A, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 1977; 55: 613-8.
  25. Johnston K, Grimmer-Somers K. Pulmonary rehabilitation: overwhelming evidence but lost in translation? Physiother Can 2010; 62: 368-73.
  26. Fischer M.J, Scharloo M, Abbink J.J et al. Drop - out and attendance in pulmonary rehabilitation: the role of clinical and psychosocial variables. Respir Med 2009; 103: 1564-71.
  27. Garrod R, Marshall J, Barley E, Jones P.W. Predictors of success and failure in pulmonary rehabilitation. Eur Respir J 2006; 27: 788-94.
  28. Sabit R, Griffiths T.L, Watkins A.J et al. Predictors of poor attendance at an outpatient pulmonary rehabilitation programme. Respir Med 2008; 102: 819-24.
  29. Bustamante M.J, Valentino G, Kramer V et al. Patient Adherence to a ardiovascular Rehabilitation Program: What Factors Are Involved? Int J Clin Med 2015; 6: 605-14.
  30. Turk-Adawi K.I, Oldridge N.B, Tarima S.S et al. Cardiac Rehabilitation Enrollment Among Referred Patients. Рatient and organizational factors. J Cardiopulmon Rehabilit Prevent 2014; 34: 114-22.
  31. Hassan H.A, Aziz N.A, Hassan Y, Hassan F. Does the duration of smoking cessation have an impact on hospital admission and health - related quality of life amongst COPD patients? Int J COPD 2014; 9: 493-9.
  32. Бубнова М.Г., Аронов Д.М., Сулим Ю.Н., Выгодин В.А. Клиническая эффективность фиксированной комбинации блокатора рецепторов к ангиотензину II валсартана с антагонистом кальция амлодипином у курящих больных с ССЗ и хронической обструктивной болезнью легких//CardioСоматика. 2015; 1: 24-35.
  33. Baessler A, Hengstenberg C, Holmer S et al. Long - term effects of in - hospital cardiac rehabilitation on the cardiac risk profile. A case - control study in pairs of siblings with myocardial infarction. Eur Heart J 2001; 22: 1111-8.
  34. Yusuf S, Hawken S, Ounpuu S et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case - control study. Lancet 2004; 364: 937-52.
  35. Prugger Ch, Wellmann J, Heidrich J et al, on behalf of the EUROASPIRE Study Group. Passive smoking and smoking cessation among patients with coronary heart disease across Europe: results from the EUROASPIRE III survey. Eur Heart J 2014; 35: 590-8. doi: 10.1093/eurheartj/eht538.
  36. Sturchio A, Gianni A.D, Campana B et al. Coronary Artery RIsk Management Programme (CARIMAP) Delivered by a Rehabilitation Day - Hospital. Impact on patients with coronary artery disease. J Cardiopulmon Rehabilitat Prevent 2012; 32: 386-93.
  37. Turnbull F, Neal B, Ninomiya T et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta - analysis of randomised trials. BMJ 2008; 336: 1121-3.
  38. Бубнова М.Г., Сеченова Е.В., Аронов Д.М. Оценка эффективности ранней комплексной постстационарной реабилитации больных коронарной болезнью сердца после вмешательств на коронарных сосудах на диспансерно - поликлиническом этапе Эффективная фармакотер. в кардиологии и ангиологии. 2011; 1: 86-91.
  39. Аронов Д.М., Красницкий В.Б., Бубнова М.Г. и др. Физические тренировки в комплексной реабилитации и вторичной профилактике на амбулаторно - поликлиническом этапе у больных ишемической болезнью сердца после острых коронарных осложнений. Российское кооперативное исследование. Кардиология. 2006; 9: 33-8.
  40. Аронов Д.М., Бубнова М.Г., Красницкий В.Б. и др. от имени исследователей. Клинические эффекты годичной программы физических тренировок у больных АГ трудоспособного возраста, перенесших острый инфаркт миокарда. Российское рандомизированное контролируемое клиническое исследование. Системные гипертензии. 2015; 12 (4): 61-8.
  41. Aronov D.M, Bubnova M.G, Anzimirova N.V, Novikova N.K. Clinical efficacy of physical rehabilitation program in patients after myocardial infarction complicated by congestive heart failure. Eur J Heart Failure 2015; 17 (Suppl. 1): 109. doi: 10.1002/ejhf.277.
  42. Bubnova M.G, Aronov D.M, Krasnitsky V.B et al. Effectiveness of physical rehabilitation program in hypertensive patients after acute myocardial infarction (A COOPERATIVE RUSSIAN TRIAL). J Hypertension 2014; 32 (e-Suppl. 1): e420.
  43. Awad-Elkarim A.A, Bagger J.P, Albers C.J et al. A prospective study of long term prognosis in young myocardial infarction survivors: the prognostic value of angiography and exercise testing. Heart 2003; 89: 843-7.
  44. Verdecchia P, Schilaci G, Borgioni C et al. Adverse prognosis significance of concentric remodeling of the left ventricle in hypertensive patients with normal left ventricular mass. J Am Coll Cardiol 1995; 25: 871-8.
  45. Hole D.J, Watt G.C, Davey-Smith G et al. Impaired lung function and mortality risk in men and women: findings from the Renfrew and Paisley prospective population study. BMJ 1996; 313: 711-5; discussion 715-716.
  46. Seeger H, Mueck A.O, Lippert T.H. Effects of valsartan and 17-beta - estradiol on the oxidation of low - density lipoprotein in vitro. Coron Artery Dis 2000; 11: 347-9.
  47. Tsutamoto T, Wada A, Maeda K et al. Angiotensin II type 1 receptor antagonist decreases plasma levels of tumor necrosis factor alpha, interleukin 6 and solubile adhesion molecules in patients with chronic heart failure. J Am Coll Cardiol 2000; 35: 714-21.
  48. Mancini G.B.J, Etminan M, Zhang B et al. Reduction of Morbidity and Mortality by Statins, Angiotensin-Converting Enzyme Inhibitors, and Angiotensin Receptor Blockers in Patients With Chronic Obstructive Pulmonary Disease JACC 2006; 47 (12): 2554-60.
  49. Wood D. Established and emerging cardiovascular risk factors. Am Heart J 2001; 141 (2): 49-57.

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