PECULIARITIES OF 24-HOUR BLOOD PRESSURE MONITORING IN HYPERTENSIVE PATIENTS DEPENDING ON THE FUNCTIONAL STATE OF THE THYROID GLAND.

The aim of the work was to study the influence of the functional state of the thyroid gland on the peculiarities of the clinical course of arterial hypertension (AH) and indicators of Ambulatory blood pressure monitoring (ABPM). The study included 130 patients with AH, of whom: Group 1-50 patients with AH in combination with hypothyroidism (mean age - 56,34±10,23 years, mean duration of AH - 8,76±6,81 years, duration of hormone replacement therapy for hypothyroidism - 9,38±5,70 years); Group 2-50 patients with AH in combination with thyrotoxicosis (mean age 52,62±12,70 years, mean duration of AH -6,54±4,02 years, duration of thyrotoxicosis - 3,90±2,56 years). The control group consisted of 30 patients with AH, who were statistically comparable in age - 56,23±7,64 years, duration of AH -8,87±4,45 years, in whom thyroid dysfuctation was excluded during the examination. Patients underwent ABPM after achievement of the target systolic blood pressure (SAR) level ˂ 140 mm Hg against the background of the prescribed antihypertensive therapy. Patients with AH, both in the presence of hypothyroidism and in the presence of thyrotoxicosis have worse control of blood pressure than patients with AH without thyroid dysfunction, and reliably more often have masked uncontrolled hypertension (p1-2=0.232; p1-k=0.003; p2-k=0.036). In patients with AH and hypothyroidism when reaching the office ADS ˂ 140 mm Hg against the background of the prescribed antihypertensive therapy, the level of thyroid hormone > 5.96 мМЕ∕ l is an independent factor, which is associated with the lack of adequate control of ADS at night (according to the results of ROC - analysis). In patients with AH and thyrotoxicosis when reaching the office ADS ˂140 mm Hg against the background of prescribed antihypertensive therapy, the level of thyrotrophic hormone ≤0.1 мМЕ∕l is an independent factor, which is associated with the lack of adequate control of ADS at night (according to the results of ROC - analysis).

[Atrial fibrillation after mitral valve replacement].

Atrial fibrillation at patients with mitral valve disease is a common complication, both before and after surgery. The analysis of factors associated with the risk of atrial fibrillation in patients with mitral valvular disease was perfomed. It has been established that the conduct of surgery in patients with mitral valve contributes not only to improve the clinical course of the disease, but also the restoration of sinus rhythm.

[Exrercise tolerance in patients with coronary artery disease after coronary artery stenting].

The aim of the research is to investigate the impact of coronary stenting on exercise tolerance after 4-8 week and after 12-15 months. The study involved total 90 patients with coronary artery disease, who underwent coronary stenting. All patients underwent clinical examination, including an assessment of their condition, the frequency of angina attacks, echocardioscopy, resting ECG was recorded in all the patients in the standard 12 -lead veloergometry. Statistical processing was performed using Statistica 6.0 for Windows, the method of Wald - Wolfowitz . Data are presented as arithmetic means and error average M ± m. We used a statistical method of calculation - the median ranks (with the median calculated by the usual rules of statistics - the arithmetic mean of the central members of the ordered series). Significant differences were assessed by t-test . The level of significance was considered significant when p <0,05. According to the monitoring data of patients have a significant increase in exercise tolerance: threshold power increased by 63% and in 12-15 months by 58 % compared with the original. The duration of the test conducted after stenting increased by almost 2 -fold. In addition, significantly reduced the proportion of patients whose test results were evaluated as positive. Stenting of the coronary arteries after 4-8 weeks promotes the significant increase in exercise tolerance that persists after 12-15 months. The factors of associated with insufficient increase in exercise tolerance after stenting according veloergometry are: female gender, diabetes, smoking cessation further contributes to the increase in the threshold of physical activity.