No abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are the most common drugs in clinical practice and account for 5–10% of all drugs prescribed each year. However, the use of this group of drugs is associated with the risk of a wide range of side effects, most of which are cardiovascular complications. In addition, NSAIDs interact with other drugs, for example, their effect on antihypertensive therapy has recently been recognized as particularly important. Improvement of not only efficacy, but also safety is another important principle of rational pharmacotherapy. Adverse drug reactions (ADR) can very often result from underlying genetic factors of the human body. In this regard, a personalized approach suggesting the prescription of drugs according to the individual characteristics of patients is especially important. In such cases, pharmacogenetic testing is the most promising method that identifies the genetic factors of patients and allows to predict patients’ responses to specific drugs. This applies especially to a large range of drugs metabolised via the cytochrome P450 system in the liver. Results from numerous studies show that the effect of P450 family gene polymorphism determines the individual sensitivity to antihypertensive drugs, as it is these isozymes that are involved in the metabolism of drugs used to treat arterial hypertension (AH). In particular, the cytochrome (CYP) 450 isoenzyme is one of the basic enzymes involved in the biotransformation of losartan, an angiotensin receptor antagonist. Therefore, the CYP2C9 gene polymorphism largely determines the pharmacological response to NSAIDs and affects the effectiveness of antihypertensive therapy due to the change in the drug metabolism, as well as the structure and function of the receptors, on which they have an effect.

Objective: A considerable proportion of the population due to both economic reasons and traditions appear to be experiencing chronic deficit in micronutrients, which may be deteriorated on the background of drug therapy being performed. The purpose of our study was to optimize pharmacotherapy of patients with first-ever prescribed diuretic-containing combined therapy for arterial hypertension (AH) by means of adding a vitamin-mineral complex. Method: To determine B-group vitamins (thiamine, riboflavin, pyridoxine) in blood plasma by means of high-performance liquid chromatography (HPLC) and, on achieving the target values of arterial pressure (AP), to analyse the patients' quality of life by means of such neuropsychological tests as the General Health Questionnaire -36 (GHQ-36) and WAM (wellbeing, activity, mood) questionnaire. Results: The group of patients receiving antihypertensive therapy alone demonstrated a decrease in blood plasma thiamine, riboflavin and pyridoxine from 34.5±4.2 to 25.4±3.2 ng/ml (p<0.05), from 11.3±1.5 to 7.8±1.1 ng/ml (p<0.05) and from 13.4±1.5 to 9.1±1.3 ng ng/ml, respectively. In patients receiving the vitamin-mineral complex additionally to drug therapy of AH, no significant alterations in the content of micronutrients in blood plasma were revealed. We noted more pronounced dynamics in the scores by the GHQ-36 and a more pronounced increase in the patients' activity by the WAM test, amounting to 28,9 Δ % and 15.51 Δ %, respectively (p<0.05). Conclusion: Supplementing antihypertensive pharmacotherapy with a vitamin-mineral complex makes it possible not only to maintain the level of micronutrients at the level of the physiological requirements but to improve the patients' quality of life as assessed by neuropsychological scales. Shikh et al. / Effect of vitamin-mineral complexes on quality of life of patients with arterial hypertension 2 / 6

Features of anti-hypertensive therapy amlodipiny at patients with the arterial hypertonia (AH) with comorbid pathology  – kislotozavisimy diseases (KZZ), accepting омепразол, depending on genetic features of the patient are studied and analysed. It is shown that a certain genetic polymorphism of an isoenzyme of P450 3A4 cytochrome can shift a metabolism of an omeprazol towards P450 3A4 cytochrome and promote more expressed oppression of activity of this enzyme. Depending on rate of a metabolism at the sick AG and KZZ receiving a combination of an amlodipin and an omeprazol various anti-hypertensive effect of an amlodipin can be observed. Reliable differences in dynamics of indicators of daily monitoring of the arterial blood pressure (ABP) at sick AG - slow metabolizator and sick AG – fast and intermediate metabolizator are received. Decrease of the activity of an isoenzyme of P450 3A4 cytochrome at patients - slow metabolizator leads to retardation of a metabolism of an amlodipin and, as a result, to rising of its concentration in a blood plasma that is clinically shown by more expressed anti-hypertensive effect.

Частота распространения сопутствующей патологии у больных с артериальной гипертонией (АГ), в частности, сочетание АГ и кислотозависимых заболеваний (КЗЗ), по данным разных авторов [1], колеблется от 11,6 до 50%. АГ и КЗЗ следует рассматривать как многофакторные и гетерогенные заболевания, которые закономерно сочетаются между собой. Общность патогенетических и этиологических процессов позволяет предположить, что их сочетанное формирование не является случайным и может усугублять течение основного патологического процесса. Наличие у пациента нескольких заболеваний обусловливает необходимость назначения комбинирован