Aim.To study the state of the main arteries and vascular age in conjunction with the level of leptin and adiponectin in patients with arterial hypertension (AH) and obesity.Material and methods. One hundred and twenty patients with AH stage II aged from 45 to 65 years were divided into 3 groups depending on body mass index (BMI). Group 1 was represented by patients with AH and normal BMI, the 2 group was represented by patients with AH and excessive BMI, the 3 group was represented by patients with AH in combination with obesity. A standard clinical examination was performed, the stiffness of the vascular wall was measured by measuring the pulse wave velocity (PWV) of the muscle and elastic vessels (PWVe), vascular age was calculated, and the laboratory markers of obesity were determined.Results.High percentage of visceral obesity was observed: 20,0% among people with normal BMI, 64,4% among overweight people and 100% among people with obesity (differences between 1 and 2, 1 and 3, 2 and 3 groups are reliable). A statistically significant increase in PWVe was detected in patients with AH and obesity in comparison with patients with AH and normal body weight (9,8 [8,5; 11,3] vs 8,0 [79; 8,1] m/s). Vascular age was higher in patients with AH and overweight or obesity compared with patients with AH and normal weight (670 [60,0; 76,0], 68,0 [60,0; 72,0] vs 58,0 [57,0; 60,0] years, respectively). A statistically significant increase in the concentration of leptin (6,9 [4,5; 15,1] vs 19,0 [74; 42,7] vs 53,8 [38,4; 75,8] ng/ml) was detected, as well as a decrease in adiponectin concentration from the 1 to the 3 group (44,9 [36,6; 55,8] vs 16,5 [12,5; 24,7] vs 18,6 [15,3; 22,4] ng/ml, respectively).Correlation analysis revealed the presence of highly reliable relationships between the parameters of rigidity of the main arteries and laboratory markers of obesity.Conclusion.The results indicated a negative effect of hyperleptinemia and hypoadiponectinemia on the elasticity of the vascular wall of the main arteries and the vascular age in hypertensive patients with its combination with overweight or obesity.
Международное общество по артериальной гипертензии и Мировая антигипертензивная лига организовали скрининговое исследование по измерению артериального давления (АД) под названием MMM19 -MAY MEASUREMENT MONTH 2019 для улучшения выявления повышенного АД и оценки контроля АД у пациентов с артериальной гипертензией (АГ). Цель. Определить приверженность к лечению российского населения по результатам скрининга АГ в рамках международной акции МММ19. Материал и методы. В течение мая 2019г в скрининге приняли участие 5394 человека из 21 региона России. Участие в акции было добровольным без ограничения по полу, возраст старше 18 лет. Во время скрининга трехкратно измерялось АД с помощью автоматических и механических тонометров, заполнялся опросник о наличии сахарного диабета, сердечно-сосудистых осложнений в анамнезе, курении и употреблении алкоголя. Также получена информация о дате последнего контроля АД и приеме статинов, ацетилсалициловой кислоты и антигипертензивных препаратов. Информация о росте и массе тела была получена со слов респондентов. Результаты. В анализ были включены данные 5274 пациентов в возрасте от 18 до 96 лет, из них 1834 мужчин (34,8%). Медиана возраста -25 лет, квартили -20 и 49 лет. Пропорция пациентов с АГ по результатам МММ19 в российской выборке составила 31,9%, а при исключении участников младше 25 лет -51,5%. Пациенты с АГ старше 25 лет принимают антигипертензивную терапию (АГТ) в 73,6%, при этом 38,6% пропускают прием препаратов, а достигают целевого уровня АД <130/80 мм рт.ст. только 11,8% мужчин и 17,2% женщин. Даже при использовании 4-5 антигипертензивных препаратов, только 20-30% участников акции достигали целевого уровня АД. Заключение. По результатам скрининга МММ19 в России лишь треть пациентов высокого риска измеряли АД в течение последних 12 мес., наблюдается низкая приверженность к приему АГТ и недостаточный контроль АГ. Более склонны к регулярному приему гипотензивных средств пациенты с АГ, имеющие в анамнезе сердечно-сосудистые осложнения.Ключевые слова: скрининг, артериальная гипертензия, артериальное давление, приверженность, осведомленность. Отношения и деятельность: нет.
Aim. To evaluate the insulin resistance contribution to pathogenesis of left ventricular (LV) remodeling in patients with hypertension (HTN) in combination with obesity and type 2 diabetes (T2D).Material and methods. The study included 320 patients with stage II-III HTN and stages 1-3B chronic kidney disease (CKD) aged 45-70 years: group 1 (n=102) — HTN patients only, group 2 (n=90) — patients with HTN and obesity, group 3 (n=96) — patients with HTN, obesity and T2D, group 4 (n=32) — patients with HTN and T2D. The groups were comparable in main clinical and demographic parameters. We performed a clinical examination, assessed cardiac structure, insulin levels and insulin resistance indices. We used nonparametric statistics, multiple regression, stepwise linear discriminant and canonical analyzes. Data are presented as Me [Q25; Q75], where Me is the median, Q25 and Q75-25 and 75 percentiles, respectively.Results. LV mass index was significantly higher in the group of HTN, obesity and T2D compared with HTN patients only (107,5 [9,5; 125,6] vs 96,0 [85,1; 106,1] g/m2 , respectively). The percentage of patients with LV hypertrophy was significantly higher in groups 2, 3 and 4 compared with group 1, and also in group 3 compared with groups 2 and 4. A stepwise discriminant analysis revealed that BMI increase in HTN±T2D patients was accompanied by an increase in values of metabolic index, triglyceride-to-highdensity-lipoprotein-cholesterol ratio. Canonical analysis showed that an increase in the median values of Insulin Resistance function in all groups was associated with a deterioration in the median values of Cardio function.Conclusion. The data obtained specifies the LV geometry characteristics, as well as the insulin resistance contribution to pathogenesis of LV remodeling in HTN patients with/without obesity and/or T2D.
Aim. To evaluate the role of systemic inflammation in decrease of magistral arteries elasticity and progression of endothelial dysfunction in arterial hypertension (AH) patients comorbid with obesity and/or type 2 diabetes (DM2).Material and methods. Ninety patients with AH stages II-III, 45-65 year old, were selected to 3 groups. Group 1 — patients with “isolated” AH, group 2 — AH with obesity, group 3 — AH and DM2 patients. Standard physical examination was done, vascular stiffness assessment by pulse wave velocity (PWV) measurement of the vessels of muscular (PWVm) and elastic (PWVe) types; the levels were measured of systemic inflammation markers, endothelial dysfunction and fibrosis.Results. PWVe and PWVe >10 m/s were significantly more common in group 3 patients comparing to group 1 (10,3 [9,5;11,7] vs 9,0 [8,0;11,3] m/s and 70 vs 40%, respectively). Concentration of C-reactive protein (CRP) was significantly higher in AH with DM2 comparing to AH and obesity or only AH (7,92 [4,77;16,15] vs 4,77 [4,53;5,43], 7,92 [4,77;16,15] vs 2,98 [0,65;7,19] mg/L, respectively). Level of endothelin-1 (E1) in blood serum increased significantly in 1 to 3 group, with significant differences in all groups. In AH and DM2 patients, concentration of collagen type 4 in the blood was statistically significantly higher than in AH and obesity patients and only AH (5,67 [3,58;9,20] vs 2,94 [2,57;8,45], 5,67 [3,58;9,20] vs 2,63 [2,23;7,28] ng/mL). Correlational analysis showed the presence of highly significant correlations in concentrations of CRP and PWVe (r=0,41), level of E1 (0,51), in E1 and duration of DM2 anamnesis (r=0,58), body mass index (r=0,35), smoking (r=0,54), PWVm (r=0,47), PWVe (r=0,47), in concentration of collagen type 4 and duration of DM2 anamnesis (r=0,36), PWVe (r=0,31). Conclusion. The data obtained witness on the negative influence of systemic inflammation on the elasticity of vascular wall of magistral arteries, and on its importance in progression of endothelial dysfunction in AH patients comorbid with obesity and DM2.
THE AIM:to evaluate the role of laboratory obesity markers in the progression of chronic kidney disease (CKD) and the development of cardiovascular complications in patients with arterial hypertension (AH) and obesity.PATIENTS AND METHODS. 120 patients with AH stage II-III aged from 45 to 70 years with unachieved target blood pressure values (BP) were divided into four comparable in sex, age, frequency of smoking occurrence, hypertension duration, the level of office systolic AD (SBP) and diastolic blood pressure (DBP) groups depending on the body mass index (BMI). We performed physical examination, evaluated the renal function, laboratory markers of obesity, analyzed the combined risk of CKD progression and the development of cardiovascular complications.RESULTS.There was a significant increase in the level of proteinuria (PU) and albuminuria (AU) among the patients in groups 3 and 4 compared with group 1 (301.3 [138.1, 691.0] and 305.7 [139.4, 646.9] vs 101.3 [47.9, 116.9] mg/g; 91.0 [65.9, 273.5] and 119.2 [91.0, 291.2 vs 42.2 [41.3; 51.1] mg/g, respectively), as well as a statistically significant decrease in the glomerular filtration rate (GFR) in patients of groups 3 and 4 compared with patients in group 1 (63,53,73 and 61,22,71 vs 72 [ 64; 98] mL / min / 1.73 m2). Serum leptin concentration increased from group 1 to group 4 (significant differences were found between groups 2,3,4 in comparison with group 1 and between group 4 in comparison with group 2), while the concentration of adiponectin decreased from group 1 to group 4 (the differences were significant between groups 2,3,4 in comparison with group 1). A statistically significant inverse correlation between GFR and leptin concentration (r = -0.42), a direct correlation between the concentration of adiponectin and GFR (r = 0.36), the inverse relationship between the concentration of adiponectin and PU (r = -0.33), AU (r = -0.24) were found.CONCLUSION.The study showed a statistically significant progressive deterioration in the renal function, as well as an increase in the combined risk of progression of CKD and the development of cardiovascular complications in AH patients with an increase in obesity with comparable values of office SAP and office DAP among the studied groups. The revealed reliable correlation interrelations between the parameters of renal function and obesity markers testify to the important pathogenetic role of leptin and adiponectin in the development and progression of CKD in patients with AH and obesity.
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