Application of L-arginine in patients with hypertension in combination with COPD in aspect of effect on platelet activity

Abstract

Objective. To investigate the relationship between platelet (Pl) adhesive activity and total cardiovascular risk (CVR) and the effect of L-arginine (Tivortin®, “Yuria-Pharm”) on morpho-functional parameters of Pl activity in patients with arterial hypertension (AH) in combination with chronic obstructive pulmonary disease (COPD).
 Materials and methods. The study included 44 patients with AH stage II in combination with COPD clinical categories A-D in the stable phase of diseases (group I) and 15 healthy individuals (group II). The calculation of the CVR by SCORE, the study of the degree of adhesion (Adh) Pl (optical turbidometry, analyzer AP 2110, Belarus). 20 patients (IA group) in addition to standard therapy of AH and COPD for 4 weeks received 4 g of L-arginine (Tivortin®, “Yuria-Pharm”), 10 patients (IB group) received only standard therapy. Before and at the end of therapy, the study was performed Pl Adh, in 10 patients of IA – transmission electron microscopy (TEM) Pl (electron microscope PEM-100-01 (SELMP, Ukraine). Statistical processing of the obtained results was performed using the program Statistica 6.1.
 Results and discussion. In group I the average age was 56.0±6.7, men – 35 (79.5 %), body mass index (BMI) – 26.3 [24.0; 30.3] kg/m2, active smokers – 25 (57 %). In group II the average age was 52.7±4.9, men – 10 (66.7 %), BMI – 25.4 [24.3; 26.2] kg/m2, active smokers were not detected. The degree of Pl Adh in group I was higher than in group II (42.0 [36.0; 52.0] %) vs 29.0 [26.0; 34.0] %; p=0.005). In patients of group I the degree of Pl Adh had a direct correlation with the CVR by SCORE (R=0.50; p=0.001). Against the background of therapy in the IA group, the degree of Pl Adh decreased from 42.0 [34.0; 52.0] % to 30.0 [26.0; 39.0] % (p=0.004), in the IB group – from 38.5 [36.0; 47.0] % to 36.0 [33.5; 43.0] % (p=0.18). According to the results of TEM of Pl in patients of IA group, the number of activated forms of Pl decreased from 45.0 [43.0; 48.0] % to 37.0 [33.0; 41.0] % (p=0.028), aggregated Pl – from 11.5 [10.0; 9.5] % to 9.5 [8.0; 12.0] % (p=0.043), degranulated Pl – from 16.5 [16.0; 20.0] % to 11.0 [9.0; 13.0] % (p=0.028). No adverse effects were identified during L-arginine therapy.
 Conclusions. Increased adhesive activity of Pl in stable patients with AH in combination with COPD is associated with the total CVR by SCORE. The use of L-arginine (Tivortin®, “Yuria-Pharm”) effectively and safely helps to reduce the functional activity of Pl in this category of patients.