Background: The presence of even subclinical forms of heart failure in type 2 DM is associated with a negative prognosis of the disease, leading to a significant increase in the frequency of hospitalizations and mortality. Aims: Identification of left ventricle subclinical dysfunction in terms of its diastolic function, deformation parameters and rotational properties of the myocardium in patients with type 2 diabetes. Materials and methods: A prospective case-control single-center study, performed simultaneously in groups of patients with type 2 diabetes and hypertension. To identify left ventricular dysfunction (LV), an echocardiographic study was performed, including tissue dopplerography and Speckle Tracking Echocardiography. Results: We examined three groups of patients comparable in age and sex distribution, with no obvious clinical signs of heart failure. Group I comprised 56 patients with type 2 diabetes and moderate hypertension. Group II included 52 patients with type 2 diabetes without an increase of blood pressure. Group III (54 people) consisted of patients with hypertension without diabetes. The use of tissue dopplerography and Speckle Tracking Echocardiography allows more often (p˂0.05) to detect signs of LV dysfunction in patients with type 2 diabetes compared with routine echocardiography methods. In patients with a combination of type 2 diabetes and hypertension, an unfavorable restrictive variant of diastolic dysfunction is more common (p˂0.05) in contrast to patients with diabetes without hypertension or those with hypertension without diabetes. The combination of type 2 diabetes and hypertension to a greater extent leads to an increase in the longitudinal global deformation of the left ventricle compared with patients who had only one of these diseases (p˂0.05). A decrease in the Global area strain was expressed (p˂0.05) in patients with type 2 diabetes, regardless of the presence of concomitant hypertension. Conclusions: This study shows the importance of using tissue dopplerography and Speckle Tracking Echocardiography in the diagnosis of subclinical heart failure. The results indicate a high prevalence of subclinical systolic-diastolic LV dysfunction in type 2 diabetes, which is aggravated in the presence of concomitant hypertension in patients without obvious clinical signs of heart failure and other cardiovascular diseases.
Secondary cardiorenal syndrome (CRS) in patients with type 2 diabetes is a combined cardiac and renal pathology with a combined and complex not fully understood pathogenesis, quickly leads to the death of the underlying disease. In this case, a violation of the function of one organ affects the functional state of another, and vice versa. An important role in the CRS pathogenesis is played renin-angiotensin-aldosterone system activation, leading to the progression of cardiac and renal hemodynamic disorders. The aim was to study the parameters of intrarenal hemodynamics and their relationship with the level of aldosterone and natriuretic peptide in patients with secondary cardiorenal syndrome in type 2 diabetes mellitus. In the course of the study, 48 patients with type 2 diabetes and secondary CRS were examined. There were 24 men and 24 women. The average age of the examined patients was 60.3 ± 7.5 years. The duration of type 2 diabetes in patients was 9.53±2.82 years. The control group consisted of 40 practically healthy volunteers matched by sex and age. The formation of secondary CRS in type 2 diabetes is accompanied by an increase concentrations of the N-terminal cerebral natriuretic propeptide (p <0.001) and aldosterone (p <0.001), the development of renal vascular remodeling and a decrease hemodynamic renal parameters. In patients with CRS and type 2 diabetes the presence of negative correlations between the level of aldosterone and the velocity indices of blood flow in the kidneys and a positive relationship with the indices of resistance of the renal arteries was found, as well as positive relationships between the level of NT-proBNP and indices of resistance in the vessels, negative - with speed indicators. In the course of multiple regression analysis, the influence of NT-proBNP and aldosterone levels on the predicted values of the peak velocity in the interlobular arteries (R2 = 0.30), glomerular filtration rate (R2 = 0.48) was established.
Hypertension is one of the most common disease of the cardiovascular system. Important components of a rational antihypertensive therapy are drugs that block the RAAS. The aim of the study was to conduct a comparative evaluation of the effectiveness of blockade of the renin-angiotensin-aldosterone system with drug combinations – aliskiren and amlodipine and combination of ramipril and amlodipine in patients with hypertension and increased body weight. 50 patients with hypertension of stage II, II degree, high and very high risk were involved in the study. Patients were randomized into two groups depending on the received treatment. The first group (25 patients) consisted of patients treated with combined therapy including ramipril and amlodipine, the second group (25 patients) consisted of patients receiving a combination of aliskiren and amlodipine. The control group (25 people) included apparently healthy people. By the 12th week of the study the daily average systolic blood pressure in the first group was 146 (145; 150) mm Hg and 131 (130; 137) mm Hg in the second group, respectively, the daily average diastolic blood pressure was equal to 94 (91; 96) mm Hg in the first group and 81 (80; 82) mm Hg in the second group . By the 12th week of treatment plasma renin levels in the first group was equal to 73 (50; 78) and 15 (14; 27) in the second group, respectively, the level of angiotensin-I in the first group was 6 (4; 7) and 1,4 (1,1; 1,9) in the second group, aldosterone levels in the first group was equal to 134 (132; 145) and 130 (123; 132) in the second group, respectively. It is found that combination of aliskiren and amlodipine have the advantage over the combination of ramipril and amlodipine in achieving of purposeful level of systolic and diastolic blood pressure in patients with hypertension and overweight. The purposeful level of blood pressure reached to 56,6% of patients in group I and 80% of patients in group II to 12th week of the study. Receiving both combinations equally reduces plasma aldosterone levels at the same time receiving a combination of aliskiren and amlodipine accompanied by a decrease in plasma rennin level of 69% and angiotensin-I of 67%, while the combination of ramipril and amlodipine increases of these hormones on 68% and 65% respectively. Thus, using combination of ramipril and amlodipine more effective in patients with low rennin hypertension , patients with normal and high rennin hypertension necessary combination of aliskiren and amlodipine.
Summary. Among the causes of end-stage renal failure essential arterial (EAH) hypertension has a leading place. One of thepathogenic mechanisms of hypertensive nephropathy is a violation of intrarenal blood flow. The purpose of this study was to conduct an early diagnosis of intrarenal blood flow disorders using Doppler examination and comparison of these data with the standard criteria of nephropathy in EAH. Materials and methods. 80patients with stage II EAH were examined. Results. In patients with grade II and III EAH noted depletion of intrarenal blood flow, characterized by low Vmax and Vmin, while there was an increase IR characterizing renal vascular resistance. Hyper phase in hypertensive nephropathy was characterized by a relative increase in hemodynamic indices at the level of the trunk of the renal artery and segmental artery with a reduction in the small arteries to the level in healthy people. Hypofiltration phase was characterized by a significant reduction of velocity indexes that accompanied by a decreasing of vascular resistance (theirpseudonormalization). In assessing renal hemodynamics in patients with EAH and microalbuminuria showed a decreasening of Vmin and increasening of IR. A inverse correlation between the level of night BP decreasing and IR segmental artery (r = - 0,61, p<0,05). Conclusions: 1. In patients with essential hypertension grade IIand IIImarked depletion of intrarenal blood flow characterized by a decrease in peak systolic and minimum diastolic velocity. At the same time there is increasing resistance indices characterizing renal vascular resistance. 2. Early stage of fypertensive nephropathy criteria before the development of microalbuminuria, hyperfiltration can be the increase in the indices at the level of resistance of main and segmental arteries according to Doppler examination of renal vessels. 3. In patients with essential hypertension and microalbuminuria there is a decrease in diastolic velocity and resistive index increase, indicating an increase in intrarenal vascular resistance and may also be a diagnostic criterion of nephropathy. 4. The inverse correlation between the level of nighttime decrease in blood pressure and segmental artery resistance index indicate the negative impact of the lack of night reduction in blood pressure to renal function in hypertension.
The monograph is devoted to the actual problem of modern clinical medicine – proteinuria. The appearance of protein in the urine, often a symptom of kidney damage, is important diagnostic and prognostic value. The wide spread of proteinuria among patients with various diseases makes this problem urgent and studied. This monograph is designed for a large number of readers: from medical University students to doctors of various specialties.
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