INFLUENCE OF POSTMENOPAUSE ON THE FORMATION OF CHRONIC HEART FAILURE IN WOMEN WITH ARTERIAL HYPERTENSION

Abstract

Introduction. Chronic heart failure (CHF) is one of the leading causes of disability and mortality in the population, with a high prevalence in the world and an unrelenting rate of increase in morbidity. Recently, there has been an increasing prevalence of CHF in women, in old age, compared to men, its prevalence becomes three times greater. In postmenopause, the frequency of arterial hypertension (AH), coronary heart disease, which creates conditions for the development of CHF, increases significantly. Therefore, it is relevant to study the characteristics of CHF on the background of hypertension in postmenopausal women with the aim of timely diagnosis and treatment in the initial stages. The purpose of the work is an analytical study with the determination of the leading pathogenetic mechanisms of the formation of CHF against the background of hypertension in postmenopausal women. Main part. The review presents the main ideas about pathogenetic mechanisms of CHF development and progression. The role of neuro-humoral activation, hemodynamic overload in conditions of hypertension, violation of the metabolism of the extracellular matrix with the formation of myocardial stiffness is indicated. The main attention is paid to the new concept of the development of CHF, which consists in the influence of immune activation and systemic inflammation. The role of pro-inflammatory cytokines in the development of endothelial dysfunction, remodeling of the myocardium and the progression of CHF is noted. An independent factor of pathogenetic changes in the development of CHF is hypoestrogeny in postmenopause. Mechanisms of activation of pressor systems in conditions of estrogen deficiency and mediated effects are presented, including molecular mechanisms of connective tissue dysmetabolism, cardiohemodynamic consequences and their interrelationship. Common links were found in the pathogenesis of hypertension, CHF and processes accompanying postmenopause. The pro-inflammatory signaling cascades involved and activated in the mechanisms of CHF formation in postmenopausal women, in particular, with the participation of interleukin ST2, osteoprotegerin, are described in detail. The importance of hypoestrogenia in the activation of pro-inflammatory mechanisms with the development of osteodysmetabolism, myocardial fibrosis and remodeling and their relationship through the prism of systemic inflammation is substantiated. Potential early markers of the development of CHF are presented, and possible directions of therapeutic influence are indicated. Conclusions. The review systematizes modern ideas about the pathogenetic mechanisms of the development of CHF in postmenopausal women against the background of hypertension, which determines the prospects for solving the problematic issues of diagnosis and treatment of CHF.

Keywords

• chronic heart failure,arterial hypertension,postmenopause,pathogenetic mechanisms.