INFLUENCE OF LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND HEART DYSSYNCHRONY ON THE COURSE OF ARTERIAL HYPERTENSION WITH COMORBID PATHOLOGY.

The aim of the study is determination of the role of left ventricular dysfunction and heart dyssynchrony in the disease's course and prognosis in patients with arterial hypertension and diabetes mellitus type 2 (DM2T) and obesity. A retrospective analysis of clinical and special exam results was carried out in different groups: 1st group (n = 49), is characterized by worsening course (WC) of the disease, that was estimated 6 months after the beginning of the study; 2nd group (n = 86) without worsening of disease's course. The criterion of worsening course in patients was exaggeration of target-organ damage. The diastolic function of the myocardial infarction was assessed by recording the Doppler transmitral diastolic flow. Heart dyssynchrony was determined in the M-mode and pulse-wave/continuous-wave Doppler (PW/CW). The diastolic function of the LV has significant association with the progression of hypertension. The results of the study show that both slowdown and acceleration of the maximum early ventricular filling velocity (E) were indicative for patients with progression of the disease, and moderate E values was significantly more frequent in the group without progression of the disease. The maximum late ventricular filling velocity parameter (A) (acceleration) was significantly more common in the 1st group (p ≤ 0.001), and the moderate value of A index (≤ 0.71 msec.) was diagnosed more often in the group without progression. Furthermore, the decline of LV relaxation velocity (E/A ≤ 1.0) was detected in the group with disease's progression significantly more often (p ≤ 0.001) compared with the 2nd group, therefore we suppose that it has a pathogenic significance. In addition, a decrease in diastolic filling time ≤ 200 ms, as well as a slowing of the time of isovolumic relaxation of the LV (IVRT ≥ 201 ms) both revealed a pathogenic significance (p ≤ 0,001), which were diagnosed more often (p ≤ 0.001) in the group with disease's progression. Violation of diastolic function is a significant factor of the hypertension progression in patients with T2DM. The presence of LV dyssynchrony that is associated with the LV hypertrophy is a great predictor for the worsening course in hypertensive patients with T2DM and obesity.

[MODERN MEANS FOR THE TREATMENT OF ATRIAL FIBRILLATION IN DIABETIC PATIENTS].

The authors discuss modern approaches to the treatment of atrial fibrillation with reference to diabetic patients. The studies carried out thus far showed the importance of differential anti-arrhythmic therapy taking account of the clinical form of ciliary arrhythmia. The possibility of surgical and preventive treatment (up-stream therapy) is demonstrated.

[THE OBESITY IMPACT ON INFLAMMATORY MARKERS IN PATIENTS WITH ARTERIAL HYPERTENSION].

The aim of the study was to determine the concentrations of inflammatory markers C-reactive protein (C-RP) and cytokines - IL-1ß, IL-4 in patients with arterial hypertension (AH) and obesity. The study involved 64 patients with hypertension, who were divided into 2 groups. The first (main group) consisted of 39 patients with arterial hypertension II degree and obesity 1 st. The second group was performed by 25 patients diagnosed with hypertension II degree without obesity. The study of serum cytokines was carried out by ELISA using the company>s «Ukrmedservis¼ sets, Ukraine, and for the C-RP - set, company «DRG International Inc.¼ (USA) following instructions. Obesity was assessed by body mass index and waist to hip ratio. The study found that hypertension with obesity is characterized by a more pronounced increasing in the C-RP and IL-1 ß and reducing in anti-inflammatory IL-4, in comparison with the control group. And this is the evidence of a significant activation of inflammatory processes in such cohort of the patients. Thus immunoinflammatory disorders are essential in the development of hypertension in combination with obesity. A direct link is detected between obesity and the severity of inflammation in patients with hypertension.

[Peripheral vessel wall changes in hypertensive patients with gout].

AIM: To investigate the specific features of arterial wall endothelial dysfunction and stiffness in patients with hypertension concurrent with gout. SUBJECTS AND METHODS: A total of 54 patients were examined and divided into 2 groups. A study group consisted of 33 hypertensive patients with gout and a comparison group included 21 hypertensive patients without hyperuricemia. The patients did not differ in blood pressure (BP) readings. Uric acid was determined by the reaction with tungstophosphoric solution AT (Reagent, Dnepropetrovsk, Ukraine). The validity of results was checked using the control sera (Biocont C, Russia). Enzyme immunoassays and Doppler studies were used to investigate peripheral vasoregulation. Body mass index, intima-media thickness (IMT), pulse wave velocity (PWV), cardio-ankle vascular index (CAVI), endothelin-1 (ET-1), and endothelium-dependent vasodilation (EDVD) were determined. RESULTS: All the studied indicators have directly or indirectly a negative impact, by deteriorating the function of the vessel wall. The found arterial structural changes suggest that there is an early atheromatous process in the arterial wall of hypertensive patients with gout. Addition of gout promotes endothelial dysfunction and worsens the course of hypertension. An elevation of indicators, such as PWV, CAVI, and ET-1 levels, has the poorest prognosis for the course of hypertension. CONCLUSION: The determination of CAVI, PWV, ET-1 levels, arterial stiffness index along with additional criteria, such as EDVD and IMT, may be used as criteria for a cardiovascular risk in hypertensive patients.