VASCULAR REMODELING IN HYPERTENSIVE PATIENTS WITH DIABETES AND OBESITY

Abstract

The article deals with the problem of changing in the vascular wall in patients with hypertension, combined with type 2 diabetes and obesity. Structural and functional indicators such as the pulse wave velocity (PWV), the thickness of the carotid intima-media complex (CIMT), the cardio ankle vascular index (CAVI), the aortic stiffness index (ASI) and laboratory data, namely endothelin-1 and endothelium dependent vasodilation (EDVD) were studied. Purpose of the study. Study of the characteristics of endothelial dysfunction and arterial wall stiffness in patients with arterial hypertension (AH) in combination with diabetes mellitus type 2. Methods: 69 patients were examined, 39 consisted the 1st (main) group with AH of the stage II in combination with diabetes (19 men (60.6%), average age 56.7 ± 6.4 years. The comparison group (2nd) is represented by 30 patients with hypertension stage II without carbohydrate metabolism disorders - 17 (60.2%) men, average age 54.9 ± 6.1 years. Patients did not differ according to the levels of blood pressure (BP). HbA1c was determined by reaction with a phosphorus-tungsten. Enzyme immunoassay and Doppler methods of investigation of peripheral vasoregulation were used. Results. The level of PWV in patients with essential hypertension combined with diabetes mellitus is exceeded by 5.11% (p>0.1) comparing to the group without diabetes. At the same time, CAVI was increased in the main group by 8.3% (p> 0.1) comparing to the 2nd group. Analysing the results of the evaluation ED of the endothelial function of the endothelium and the stiffness of the arteries in the whole, it should be noted that levels of ASI, CIMT, ET-1, PWV and CAVI in the main group are higher than in the group without concomitant diabetes mellitus. All studied parameters, directly (ET-1) or indirectly (PWV, CAVI), or through increased rigidity (ASI, CIMT) have an adverse effect, worsening the function of the vascular wall. The identified structural changes in the arteries indicate the presence of early atheromatous process in the arterial wall in patients with hypertension with diabetes. The addition of diabetes contributes to endothelial dysfunction and worsens the course of hypertension. An unfavourable prognosis for the course of hypertension with diabetes mellitus has an increase in such indicators as PWV, ASI, ET-1 level. Conclusion. Determination of ASI, PWV, ET-1 level along with such additional criteria as EDV and CIMT can be used as risk criteria for the development of cardiovascular complications in patients with combined course of AH and diabetes mellitus. The further deeper studies of endothelial function and artery wall remodelling in patients with hypertension combined with diabetes are necessary, and searching for new additional diagnostically significant markers in patients of this cohort seems to be perspective.

Keywords

• hypertension
• diabetes mellitus
• arterial stiffness
• endothelial function