Dynamics of the vascular wall state in the treatment of patients with hypertension combined with obesity and diabetes mellitus
Background. Obesity and diabetes mellitus (DM) are considered to be the most important risk factors for arterial hypertension. Endothelial dysfunction is one of the principal causes of hypertension progression. Different schemes of combined drug therapy lead to an improvement in the state of the endothelium. The purpose of the work was to study the dynamics of endothelial function parameters in hypertensive patients with obesity and DM when using combined therapy. Materials and methods. Fifty four patients were enrolled in the study. Anthropometric data, carotid endothelial and aortic function, endothelin, total nitratenitrite content were evaluated in all subjects. Results. There was a decrease in both systolic (by 7.36 and 6.36 %, p < 0.05, respectively) and diastolic blood pressure (by 9.2 and 8.29 %, p < 0.05, respectively, in groups 1 and 2). In case of nonfixed drug therapy, the index of aortic stiffness (IAS) decreased by 7.05 % (p > 0.1), the intimamedia thickness (IMT) — by 5.48 % (p > 0.1), the level of endothelin1 — by 31.27 % (p > 0.1), whereas total nitric oxide (NO) content increased by 8.35 % (p > 0.1), endotheliumdependent vasodilation (EDVD) — by 10.5 % (p > 0.1). With a fixed combination of antihypertensive drugs, more pronounced changes occurred: IAS decreased by 10.96 % (p < 0.05), IMT — by 8 %, endothelin1 — by 31.52 % (p < 0.05), while total NO increased by 8.7 % (p < 0.05), and EDVD — by 11.8 % (p < 0.05). Conclusions. In hypertensive patients with obesity and DM, there is an increase in the arterial stiffness, intimamedia thickness, an increase in the level of endothelin, and a decrease in EDVD and the level of total nitrates. Fixed combination stimulates EDVD, improves the mechanisms of autoregulation and elastic properties of muscular vessels, and is more significant in controlling blood pressure.
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