Background. The aim was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH). Material and methods. The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally prescribed a third antihypertensive drug. Of the 98 patients who were assigned to triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy. Results. After 6 months of therapy, unlike patients without resistance, individuals with resistant AH had more pronounced cardiovascular remodeling and metabolic disorders, disbalance of oxidative stress-antioxidant protection, proinflammatory activity and higher activity of the renin-angiotensin-aldosterone system. Patients with true resistance differed from pseudo-resistant patients by having significantly lower body mass index (BMI); in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone, higher activity of oxidative stress system, lower levels of general antioxidant protection, higher adiponectin levels, and lower leptin level. Conclusions. Obese patients with true resistance differed from pseudo-resistant patients by having significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress-antioxidant protection and less pronounced adipokine imbalance.

Background: Hereditary component plays a significant role in the formation of insulin resistance (IR) - one of the pathogenetic links of arterial hypertension (AH) and type 2 diabetes mellitus (DM2). However, the genetic predisposition to IR can not be realized and does not manifest itself clinically in the absence of appropriate factors of the environment (excessive nutrition, low physical activity, etc.). Objective: The review summarizes the results of studies which describe the contribution of genetic polymorphism to the formation and progression of AH, DM2 and their comorbidity in various populations. Results: In many studies, it has been established that genetic polymorphism of candidate genes is influenced by the formation, course and complication of AH and DM2. According to research data, the modulating effect of polymorphism of some genetic markers of AH and DM2 on metabolism and hemodynamics has been established. The results of numerous studies have shown a higher frequency of occurrence of AH and DM2, as well as their more severe course with adverse genetic polymorphisms. At the same time, the role of genetic polymorphism in the formation of AH and DM2 differs in different populations. Conclusion: Contradictory data on the influence of gene polymorphisms on the formation of AH and DM2 in different populations, as well as a small number of studies on the combined effects of several polymorphisms on the formation of comorbidity, determine the continuation of research in this direction.

Aim: To evaluate activity of oxidative stress (OS) as marker of vascular aging in different age groups of patients with combined course of arterial hypertension (HT) and type 2 diabetes mellitus (T2DM). Methods: 126 patients (average age 57.8 ± 6.2 years) with stage II HT and compensated T2DM were divided into 2 subgroups: 2a (n = 59)-aged 45-60 years; 2b (n = 97)-aged 61-75 years; 30 patients with isolated stage II HT (comparison group), 20 practically healthy individuals (control group). The activity of antioxidative [glutathione peroxidase, sulfhydryl groups (SH-groups)] and oxidative [malonic dialdehyde (MDA)], 8-hydroxy-2-deoxyguanosine (8-OH-dG) systems in blood serum, were studied. Results: A significant increase in MDA levels (P < 0.05) and SH-groups (P < 0.05) compared with healthy volunteers was observed. Patients in 2b group had lower MDA values than in 2a (6.25 ± 0.33 μmol/L, 7.07 ± 0.44 μmol/L, respectively, P > 0.05). In the 2b group, in comparison with 2a patients, a decrease in thiol status was observed (P > 0.05). The level of 8-OH-dG was increased in patients with HT and T2DM, but there was also an age-associated increase in the average 8-OH-dG in the 2b group. Conclusion: The age-associated changes in the OS in comorbid course of HT and T2DM did not have significant differences. Nevertheless, the presence of correlations between various indexes that are included in the concept of "vascular aging" and indicators of oxidant-antioxidant systems in different age groups allows us to make an assumption about the significant influence of the oxidative status on the status of vascular age, especially in the older age group persons.

Національний фармацевтичний університет Харківський національний медичний університет* Національна медична академія післядипломної освіти імені П. Л. Шупика** Статини: фармакоекономічні аспекти застосування препаратів групи інгібіторів ГМГ-КоА-редуктази Великі надії на зниження високої смертності від серцево-судинних захворювань покладаються на статини, застосування яких обумовлено ефективною дією препаратів, широкими показаннями до застосування, тривалим і позитивним досвідом застосування, високою доказовою базою. Мета. Метою роботи стало формування сучасного уявлення про структуру ринку та аналіз доступності інгібіторів ГМГ-КоА-редуктази. Матеріали та методи. Дослідження здійснювали згідно з Державним реєстром лікарських засобів України, АТС-класифікацією, даними системи «Equalizer». Роботу виконано з використанням статистичного, логічного і графічного методів, а також методів маркетингового аналізу. Результати. В роботі здійснено аналіз асортименту, вартості денної дози препаратів, фізичної та економічної доступності інгібіторів ГМГ-КоА-редуктази. Визначено, що ринок є імпортозалежним-частка вітчизняних препаратів складає біля 35 %. Препарати структуровані за АВС-класифікацією, визначені препарати-лідери. Проаналізована економічна та фізична доступність препаратів групи ГМГ-КоА-редуктази, яка загалом свідчить про їх високу та середню доступність на фармацевтичному ринку України. Висновки. Лідерами визначено 9 препаратів, серед яких тільки 2 препарати вітчизняного виробництва, що свідчить про можливість розвитку програми з імпортозаміщення саме цієї групи препаратів. Залежно від МНН та виробника ціни на препарати варіюють у дуже широких межах, що обумовлює можливість вибору препарату з урахуванням економічної доступності. Ключові слова: інгібітори ГМГ-КоА-редуктази; лікарські засоби; фармацевтичний ринок; економічна доступність

Background. The goal of our study was to investigate the content and particularities of change of vascular endothelial growth factor-A (VEGF-A) levels as a marker of endothelial dysfunction (ED) in patients with hypertension (HT) with or without type 2 diabetes mellitus (T2DM) and with or without subclinical hypothyroidism (SH). Material and methods. Two hundred and eleven patients with hypertension stage II were divided into 3 groups: Group 1-with HT (n = 55); Group 2-with AH and T2DM (n = 97); Group 3-with HT, T2DM and SH (n = 59). The patients in Group 3 were divided into 3 subgroups depending on TSH levels: 3a (n = 26)-TSH 4.0-6.0 mIU/L; 3b (n = 20)-TSH 6.1-8.0 mIU/L; 3c (n = 13)-TSH 8.1-10.0 mIU/L. We evaluated lipids, carbohydrate metabolism, serum insulin concentration, insulin resistance index-HOMA, and the level of VEGF-A in plasma. Results. The levels of VEGF-A in Group 2 was significantly lower vs. Group1 (323.94 ± 22.17 pg/mL and 413.15 ± 29.02 pg/mL, respectively (p < 0.05)). The patients in Group 3d had lower VEGF-A levels than the patients in Group 1, but higher than those in Group 2. Among Group 3 patients, the levels of VEGF-A were the lowest in the 3a subgroup (375.91 ± 19.81 pg/mL), significantly different from 3b and 3c subgroups (p < 0.05), for which no differences were found (p > 0.05.). In the 3a subgroup VEGF-A levels were significantly higher than in Group 2 patients (p < 0.05). Conclusion. These data confirms the hypothesis of increasing ED in hypothyroidism even at the subclinical level.

Objective: to study the effect of statin therapy on the oxidative and antioxidant systems parameters in patients with arterial hypertension (AH) and cocomitant type 2 diabetes mellitus (DM2T). Materials and methods.126 patients (55 males and 71 females, average age was 57.8 ± 6.2 years) with AH stage II and compensated DM2T were divided into 2 groups: the 1 group -with AH and DM2T (n = 69), who were constantly taking statins (rosuvastatin 10 mg/day or atorvastatin 20 mg/day) for at least 1 year; the 2 group -patients with AH and DM2T (n = 57) who did not take statins. The control group included 20 healthy volunteers. The parameters of lipid and carbohydrate metabolism, the degree of insulin resistance (HOMA-IR), the state of the oxidant system (malonic dialdehyde level -MDA), the antioxidant system (the activity of glutathione peroxidase (GPO) and the level of sulfhydryl groups -SH-groups) were evaluated. The statistics was carried out using the Statistica software package, version 8.0.Results. In the 1st group only the levels of LDL cholesterol significantly differed from the control group (P < 0.05). In the 2nd group the levels of total cholesterol and LDL cholesterol were expected to be higher than in the 1st group (P < 0.05) and the control group (P < 0.05). Despite the higher level of fasting glucose in the 2nd group than in the 1st group, HOMA-IR in the 1st group was higher than in the 2nd group (7.48 ± 1.76 and 7.17 ± 1.54, respectively, P > 0.05). In the 1st group in comparison with the 2nd group unreliable increase in GPO and SH-groups levels on the background of the increase in MDA levels (P > 0.05) were observed.Conclusions. The use of statins in low doses in AH combined with DM2T was accompanied by a nonsignificant improvement of antioxidant protection parameters on the background of increased insulin resistance and increased activity of lipid peroxidation.Вплив статинотерапії на показники окислювального стресу в пацієнтів з артеріальною гіпертензією та цукровим діабетом 2 типу В. Д. НемцоваМета роботи -вивчити вплив терапії статинами на параметри оксидантної та антиоксидантної систем у пацієнтів з артеріальною гіпертензією (АГ) у поєднанні з цукровим діабетом 2 типу (ЦД2T).Матеріали та методи. 126 пацієнтів (55 чоловіків і 71 жінка, середній вік -57,8 ± 6,2 року) з АГ II стадії та ЦД2Т у стадії компенсації поділили на дві групи: 1 -пацієнти з AГ і ЦД2T (n = 69), які постійно приймали статини (розувастатин 10 мг/добу або аторвастатин 20 мг/добу) принаймні 1 рік, 2 група -пацієнти з АГ і ЦД2Т (n = 57), які не приймали статини. 20 здорових добровольців становили контрольну групу. Досліджувались параметри ліпідного та вуглеводного обміну, ступінь інсулінорезистентності (HOMA-IR), стан оксидантної системи (за рівнем малонового діальдегіду -МДА), стан антиоксидантної системи (активність глутатіонпероксидази (ГПО) та рівень сульфгідрильних груп -SH-груп). Статистика опрацьована за допомогою програмного забезпечення Statistica версії 8.0.Результати. У 1 групі тільки рівень холестерину ЛПНЩ вірогідно відрізн...

Sustained hypertension causes structural, functional, and neurohumoral abnormalities in the heart, a disease commonly termed hypertensive heart disease (HHD). Modern concepts of HHD, including processes of remodeling leading to the development of various LVH patterns, HF patterns accompanied by micro- and macrovasculopathies, and heart rhythm and conduction disturbances, are missing in the available definitions, despite copious studies being devoted to the roles of myocardial and vascular fibrosis, and neurohumoral and sympathetic regulation, in HHD development and progression. No comprehensive and generally accepted universal definition and classification of HHD is available to date, implementing diagnostic criteria that incorporate all the possible changes and adaptions to the heart. The aim of this review series is to summarize the relevant literature and data, leading to a proposal of a definition and classification of HHD. This first article reviews the processes of initial myocardial remodeling, and myocardial and vascular fibrosis, occurring in HHD. We discuss important pathophysiological and microstructural changes, the different patterns of fibrosis, and the biomarkers and imaging used to detect fibrosis in HHD. Furthermore, we review the possible methods of targeting myocardial fibrosis in HHD, and highlight areas for further research.

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