We studied the effect of thiazide-like diuretic – indapamide on fibrosis development in the left ventricle of young spontaneously hypertensive rats (SHR) and assessed the involvement of nitric oxide in this process. Six-week-old male SHR were treated with indapamide (1 mg/kg/day) for six weeks. Age-matched SHR were used as hypertensive and Wistar-Kyoto rats (WKY) as normotensive control. Systolic blood pressure was measured by tail-cuff plethysmography. Nitric oxide synthase (NOS) activity, protein expressions of endothelial (eNOS) and inducible NOS (iNOS), myocardial fibrosis and collagen type I and III were determined in the left ventricle. Indapamide treatment partially prevented SBP increase in SHR (SHR+Indapamide: 157±4, SHR: 171±3, WKY: 119±3 mmHg). Indapamide prevented myocardial fibrosis development in SHR, but without affecting collagen type I to type III ratio. Indapamide did not affect NOS activity as well as eNOS and iNOS protein expressions in the left ventricles evaluated by both Western blot and immunohistochemically. In conclusion, our results indicate that indapamide-induced prevention of myocardial fibrosis is not mediated by nitric oxide-related mechanism., P. Janega, S. Kojšová, L. Jendeková, P. Babál, O. Pecháňová., and Obsahuje bibliografii a bibliografické odkazy
Podáváme přehled současných názorů na kombinační léčbu a na postavení fixních kombinací v léčbě hypertenze podle doporučení ESH/ESC a ČSH z roku 2013. Mezi nejčastěji doporučované dvojkombinace patří blokátor renin-angiotenzinového systému (ACEI nebo sartan) a blokátor vápníku, dále blokátor renin-angiotenzinového systému a diuretikum a blokátor vápníku a diuretikum. V roce 2014 se na českém trhu objevila fixní kombinace ACE inhibitor (perindopril), blokátor vápníku (amlodipin) a diuretikum (indapamid). Ve studii the PIANIST u 4 731 nedostatečně kontrolovaných hypertoniků fixní trojkombinace perindopril, amlodipin a indapamid vedla ke snížení krevního tlaku o 28,3/13,8 mm Hg a k dostatečné kontrole hypertenze u 92 % nemocných. Výhoda fixních kombinací je především ve větší komplianci nemocného, a tím v lepší kontrole hypertenze. Trojkombinaci k dobré kontrole tlaku potřebuje asi třetina hypertoniků., We present an overview of the present views on combination treatment and on fixed combinations in the treatment of hypertension according to guidelines of ESH/ESC and ČSH from 2013. The most frequently recommended dual combinations include a blocker of the renin-angiotensin system (ACEI or sartan) and a calcium channel blocker, and further a blocker of the renin-angiotensin system and a diuretic and a calcium channel blocker and a diuretic. In 2014 a fixed-dose combination of an ACE inhibitor (perindopril), a calcium channel blocker (amlodipine) and an diuretic (indapamide) appeared on the Czech market. Within the PIANIST study including 4 731 insufficiently controlled hypertensives, a fixed-dose triple combination of perindopril, amlodipine and indapamide led to a decrease in blood pressure by 28.3/13.8 mm Hg and to a sufficient control of hypertension in 92 % of patients. The advantage of fixed combinations primarily consists in greater compliance of patients and thereby in a better control of hypertension. About 1/3 of hypertensives need a triple combination for a satisfactory blood pressure control., and Jindřich Špinar, Jiří Vítovec, Lenka Špinarová, Miroslava Bendová