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The impact of antihypertensive therapy with the angiotensin-converting enzyme inhibitor enalapril (enap) and with enalapril in combination with the long-acting calcium channel blocker verapamil SR (isoptin SR) on changes of plasmatic, vascular-thrombocytic hemostasis and lipid peroxidation in patients with metabolic syndrome and arterial hypertension was studied. Combined therapy with enalapril and verapamil significantly reduces the fasting glucose and glycated hemoglobin concentrations, the aggregation activity of thrombocytes in the patient's blood, inhibits the lipid peroxidation, increases the level of high-density lipoprotein cholesterol, and decreases the coefficient of atherogenecity. Combined therapy with enalapril and verapamil SR can be recommended for treatment of arterial hypertension in patients with metabolic syndrome.

The combined therapy with enalapril and prolonged-release verapamil, as well as with enalapril and moxonidine significantly increases the level of antiatherogenic high-density-lipoprotein cholesterol, reduces the atherogenicity coefficients, decreases the concentrations of glucose, glycosylated hemoglobin, and soluble fibrinmonomeric complexes and the aggregation activity of thrombocytes, activates plasminogen in the blood of patients under conditions of metabolic syndrome with arterial hypertension. At the same time the enalapril monotherapy has no significant influence on the parameters of lipid and carbohydrate metabolism and the plasmatic and vascular-thrombocytic homeostasis.

The aim of the study was to obtain a comparative evaluation of antihypertensive efficacy, tolerability and influence of combine therapy on myocardium mass, diastolic function of a left ventricle, lipid and carbohydrate exchange in patients with arterial hypertension in metabolic syndrome. Out of 40 examined cases 20 patients took enalapril and long-acting nifedipin and 20 ones--enalapril and moxonidine. All examination were been performed before administration of drugs and 6 months after the therapy. The dynamics of indices of ambulatory blood pressure monitoring, echocardiography, cycle ergometry, anthropometry, lipid, carbohydrate exchange and tolerability of conducted therapy was been evaluated. The use of this combination of the drugs may be recommended to be included in the treatment of arterial hypertension within the bounds of metabolic syndrome, as in most of cases they promote an achievement of target blood pressure level, have a cardioprotective action, high tolerability and favorable metabolic profile. The combination of enalapril and long-acting nifedipin has a more evident antihypertensive activity but a therapy with enalapril and moxonidine has a positive effect on the indices of carbohydrate exchange.