Clinical efficiency of exogenous L-arginine in patients with essential hypertension against the background of chronic obstructive pulmonary disease

Abstract

Chronic obstructive pulmonary disease (COPD) and essential hypertension (EH) are one of the most common, leading and current problems of practical public health.

The purpose of this study was to evaluate the clinical efficacy of the metabolic correction agent (“Tivortin”) in the complex treatment of patients with COPD in the presence of EH.

Materials and methods. We examined 23 patients with the diagnosis of EH stage II and COPD stage II as the main group, mean age 51.72 ± 1.22; various cardiovascular risk, without adequate systematic antihypertensive therapy; disease duration – 7.52 ± 1.14; 82.6 % – active smokers, pack-years index – 17.23 ± 2.69. All patients of the main group took L-arginine aspartate in the form of a 4.2 % solution intravenously, 100 ml 1 time per day (course of 10–12 days) with the subsequent transfer to the solution for oral administration of 10 ml 5 times a day (course of 3 months ± 3 days).

The comparison group (n = 15, age 49.15 ± 1.40), comparable in clinical and demographic parameters to the main group, was also studied (initially and after 3 months) and received similar traditional therapy for EH and COPD without the use of a metabolite drug – exogenous L-arginine “Tivortin”.

Diagnosis of COPD and hypertension was carried out on the basis of generally accepted criteria. The quality of life (QOL) parameters were assessed according to the SF-36 “Short Health Assessment Questionnaire”.

The metabolism of glutathione and the state of the thiol-disulfide balance was studied by the content of oxidized and reduced glutathione and the activity of the enzymes glutathione-S-transferase, glutathione reductase and glutathione peroxidase in the blood serum. The content of ST2, CASPASE-7 and CASPASE-9 in the blood was determined using the appropriate ELISA test systems.

Results. The administration of L-arginine contributed to the suppression of oxidative stress and the restoration of the thiol-disulfide balance and, as a result of the above processes, inhibited the apoptosis in the body of patients with comorbidity. The expression level of ST2 protein after treatment of patients with EH and COPD by “Tivortin” decreased by half, and the compensatory ability of the patient body, which is to enable the cardioprotective signaling cascade to prevent fibrosis and remodeling of the heart in the most optimal way, will be realized after the experimental treatment. In addition to the regression of clinical symptoms, normalization of blood pressure and improvement of bronchial patency against the background of a decrease in the level of activity of apoptotic markers, there is a restoration of the quality of life, both physical and psychosocial status.

Conclusions. The additional use of L-arginine against the background of conventional therapy with COPD and EH promotes more significant and reliable suppression of oxidative stress and restores thiol-disulphide balance and, as a result of the above-mentioned processes, inhibits the intensification of apoptosis in patients with this comorbidity. In addition to regression of clinical symptoms, normalization of blood pressure and improvement of bronchial patency on the background of lowering the activity of apoptotic markers, there is a significant recovery of QOL, both physical and psychosocial status.