Improvement of endothelial function and external respiration in patients with comorbidity of hypertension and stage III chronic obstructive pulmonary disease, using nitric oxide donor — L-­arginine

Abstract

Objective — to improve the efficacy of pharmacotherapy for patients with comorbidity of arterial hypertension (AH) and stage III chronic obstructive pulmonary disease (COPD) (group C), using an exogenous nitric oxide donor — L-arginine by correction of endothelial function as well as to improve pulmonary ventilation and quality of life in general.Materials and methods. This study involved 102 patients with stage 2 arterial hypertension (AH) (2-nd and 3-rd degree) including 82 patients with AH and concomitant COPD III stage, group C, and 20 patients with essential hypertension of the identical stage and degree at the age of (65.5 ± 4.12). According to the treatment 82 patients with AH and COPD were divided into two groups, homogeneous by age, sex, duration of AH and COPD. Group I — the control group (CG) — included 40 patients receiving basic therapy only, group II — the main group (MG) — included 42 patients, who received L-arginine hydrochloride in addition to basic therapy. Patients with AH were divided similar.Results and discussion. It has been observed that chronic obstructive disease burdened the course of hypertension by cardiorespiratory system rates deterioration. According to the spirogram in patients with comorbidity the forced expiratory volume in one second was (38.28 ± 1.33) % compared to patients with АH (67 ± 2.84) indicating a reverse negative correlation with the indicator of endothelin — 1 (ET 1) level in plasma(r = –0.45, р < 0.05). Thus, in patients with AH and concomitant COPD, the bronchial patency was significantly impaired due to increasing of endothelin — 1 (ET 1) level — marker of vasoconstriction and endothelial dysfunction (ED). 3 months after basic therapy with L-arginine, a number of positive effects in combination therapy was established: the decrease of endothelin — 1 (ET 1) level in plasma due to treatment, contributed to the improvement of endothelial function, increase in ventilation and gas exchange, as indicated by increased Tiffeneau index, while in the CG — significant changes in ventilation rates have not been noted, which is associated with the absence of bronchial obstruction in this patient cohort, the level of ET 1 decreased (p < 0.05) and significantly improved the endothelial function.Conclusions. The addition of L-arginine to the combined therapy of patients with hypertension accompanied by COPD, resulted in the potentiation of antihypertensive therapy, improvement of bronchial patency and endothelial function as well as to the improvement of quality of life in general.