To the question of the development of arterial hypertension in urban residents with obesity
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Abstract
Background. The relevance of the study is due to the need to optimize the prevention of arterial hypertension (AH) among the urban population of Ukraine, primarily those with obesity. The purpose was to detail the features of AH development in obese urban residents, and to develop a method for predicting AH in this category of the population. Materials and methods. A total of 1,094 residents of the city of Kharkiv who had not been treated for obesity and AH were examined. Body mass index, waist circumference, blood pressure were evaluated. Bioimpedance analysis was used to study body composition, immunoassay — serum levels of insulin, leptin, renin, aldosterone and clusterin. Features of central hemodynamics were assessed by the method of integral body rheography: stroke volume (ml), cardiac output (L/min), stroke volume index (ml/m2), cardiac index (L/min/m2) were determined. Results. It was found that middle-aged urban residents with obesity require intensification of preventive work in terms of AH development. In men, it should be started even before the age of 40. Development of concomitant pathology of AH and obesity in middle-aged people is due to the presence of insulin resistance, which is accompanied by changes in the circulating levels of insulin, leptin, aldosterone, in the stroke volume index and total peripheral vascular resistance, the occurrence of low-grade systemic inflammation in the body. Patients with obesity and AH differ from those with AH without obesity in terms of the level of volemia, the severity of changes in hemodynamics caused by the functioning of the heart, total peripheral vascular resistance, the degree of changes in the renin-aldosterone system, and the intensity of low-grade systemic inflammation. The results of the work made it possible to assert that one of the factors that primarily determine the development and progression of obesity in this category of the population is insulin resistance. Integral body rheography, a method for detecting changes in the stroke volume index, is an informative marker for the development and progression of AH. The presence of concomitant pathology of AH and obesity is characterized by changes in the levels of leptin and clusterin compared to the patients with obesity without hypertension, which should also be taken into account when developing therapeutic approaches. Conclusions. The approaches to the prognostic classification (created using the discriminant analysis program) of middle-aged urban residents — representatives of the Ukrainian population, identified in the process of work, can become the basis for optimizing the algorithms for the formation of risk groups for the development of obesity and AH.
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