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The aim of the study was to evaluate the effect of type 2 diabetes mellitus (T2DM) and obesity influence on the left ventricular (LV) remodeling peculiarities in hypertensive patients. Materials and methods. In total, 327 patients, aged 38–74 years, were comprehensively examined. The enrolled patients were divided into 4 groups in dependence of the presence of associated disease: the 1st group – n = 87 hypertensive patients with T2DM combined with obesity, the 2nd group – n = 71 hypertensive patient with T2DM and the 3rd group – n = 65 hypertensive patients with obesity; the comparison group consisted of 74 patients with essential hypertension (EH) but without obesity or diabetes. Echocardiography was performed according to the standard method of H. Feigenbaum to estimate the LV parameters. HbA1c was determined by turbidimetric method. Serum glucose levels were determined by ELISA. Results. When comparing the three patient groups with those who had only EH, the most significant influence was found in combined influence of T2DM and obesity on the development of unfavorable type of LV remodeling with values of χ2 = 29.371 and Pearson's contingency coefficient (C) ‒ 0.393 (P < 0.05). The presence of concomitant T2DM without obesity had a significant moderate relationship with the development of unfavorable LV geometry, χ2 = 11.029 and C ‒ 0.266 (P < 0.05), which indicates a much smaller impact on the process compared to the polymorbid effect of T2DM with obesity. Comparison of patients with a combination of EH and obesity with those who had only EH did not show a significant effect of concomitant obesity on the development of unfavorable types of LV geometry with values of χ2 and C: 0.529 and 0.062, respectively (P > 0.05). Conclusions. Essential hypertension with type 2 diabetes mellitus and obesity polymorbidity, but not in combination with type 2 diabetes mellitus or obesity alone, has the most significant association with hypertrophic types of LV remodeling. The co-existence of type 2 diabetes mellitus and obesity in hypertensive patients leads to the development of predominantly LV concentric hypertrophy.
The study analyzes the predictive value of clinical and anamnestic parameters in the effectiveness of therapy of hypertension with obesity and chronic bronchitis. The results shown that some clinicoanamnestic factors of hypertension with obesity and chronic bronchitis can be used for determining the efficiency of ramipril in the treatment. The most informative criteria were the duration and the stage of hypertension as well as age of the patient and the presence of concomitant diseases, in particular type 2 diabetes. Given results causes the desirability and feasibility of the applying of these criteria at all levels of medical and preventive assistance for the stratification of the effectiveness of therapeutic tactics.
The use of telmisartan in the treatment of arterial hypertension with obesityThe combined course of arterial hypertension (AH) with overweight or abdominal obesity is considered as one of the most common type of comorbid pathology leading to a significant increase of cardiovascular complications. Aim. To study the effects of telmisartan on the intracardiac hemodynamics, the functional state of the myocardium, the lipid and carbohydrate profile in patients with arterial hypertension (AH) and obesity. Materials and methods. 50 patients with AH of stage II were examined, they were divided into 2 groups. The first (main) group consisted of 23 patients with stage II arterial hypertension and the normal body weight. In the second group (reference group) there were 27 patients, who were diagnosed with AH of stage II and obesity. The diagnosis was verified using laboratory instrumental methods in accordance with the recommendations of the European Cardiologic Society (2013). Obesity was assessed by the body mass index and the waist to the hip ratio. The lipid profile was determined by the enzymatic method. Results. It has been found in the study that the level of values of systolic blood pressure (SBP) in hypertensive patients with the normal body weight treated with telmisartan decreased by 14.5 %, while diastolic blood pressure (DBP) reduced by 11.4 %. In patients with AH of stage II having obesity the SBP level also decreased by 13.4 % and DBP -by 11.5 %. In 3 months of treatment the regression dynamics of the end-diastolic and end-systolic dimensions of the heart in the group of patients without obesity led to a significant decrease in these parameters compared to the baseline values. In obese patients these indicators also decreased; however, they did not reach reliable values. When treating with telmisartan there was a decrease in lipids in AH patients (total cholesterol (TC)-(5.5 %), cholesterol of low density lipoproteins (LDL) -6.2 %, triglycerides (TG) 7.8 %, cholesterol of HDL -by 10.4 % (p <0.05), there were also unreliable changes in AH patients associated with obesity (total cholesterol -by 5.9 %, LDL -5.1 %, TG -8.8 % and increased cholesterol of HDL -by 6.4 %). After the treatment the indicators of carbohydrate metabolism decreased (glycosylated hemoglobin (HbA1c) by 8.45 % and 19.17 %, insulin -by 3.2 % and 13.38 % glucose -by 5.65 % and 4.73 %, respectively, in groups). Conclusions. The study has shown that telmisartan has indirect positive effects on intracardiac hemodynamics due to decrease of blood pressure both in AH patients having the normal body weight and patients with obesity. The use of telmisartan as an antihypertensive agent gives a hypolipidemic effect, improves the parameters of the carbohydrate metabolism in AH patients with the normal body weight and with obesity. These data can be markers for assessing the effectiveness of hypotensive therapy with telmisartan.
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