Goldrin E. Activity of ACE-independent angiotensin II formation pathway enzyme - chymase - in the dynamics of treatment of patients with essential hypertension.

Object of the study: hypertension disease. Purpose of the study: To improve the efficacy of HD treatment and to reduce the risk of complication development basing on the study of the changes in the activity of ACE-independent pathway of angiotensin II (chymase) formation during the treatment of the patients with HD, broadening the ideas about the pathogenetic factors of the disease and administration of adequate therapy with the account of the results of the research. Methods of research: To achieve the purpose of the work all the patients were performed generally accepted clinical laboratory investigations. The amount of total cholesterol, cholestorol of high density liporoteins and triglycerides was determined using enzyme technique. To study morpho-functional indices and those of intracardiac hemodynamics, two dimensional echocardiography was used. To study the level of proteinases, non-tripsinoid proteinases, chymase activity, tonin, tripsin-inhibiting activity of alph-1-inhibitor of proteinases,alpha-2-macroglobulin, high-sensitivity enzyme techniques worked out at Institute of Therapy of Academy of Medical Science of Ukraine were used. Theoretical and practical results: The research demonstrated an important role of the study of the changes in the activity of proteolytic enzymes, in particular enzyme of ACE-independent way of formation angiotensin II (chymase) in HD which allowed to improve the quality of early diagnosis of the complications which occur in this disease as well as to administer an adequate effective therapy with the account of individual peculiarities. Evaluation of the amount of total cholesterol and high density lipoproteins together with chymase activity evaluation can be recommended for prognosis of coronary disease and atherosclerosis development. Effective therapeutic approaches to correction of disturbances in myocardium contractility and hemodynamic changes in the patients with HD basing on the use of cardioselective beta-blockers, ACE inhibitors and antagonists of angiotensin II receptors with the account of the activity of the system proteinase-proteinase inhibitor was worked out. Novelty: More thorough study of the components of renin-angiotensin system, clinically and pathogenetically significant parameters in HD during the treatment was carried out. New effective methods of evaluation of activity of ACE-independent pathways of formation of angiotensin II were revealed, the criteria of efficacy and rational schemes of application of antihypertension drugs in HD with the account of the level of activity of enzyme of ACE independent pathways of angiotensin II formation (chymase) were determined. It was shown that the use of cardioselective beta-blockers and antagonists of angiotensin II receptors as monotherapy and in combination allowed to influence positively clinical hemodynamic indices of cardiovascular system as well as stimulated the activity of proteolytic enzymes in patients with HD. Degree of introduction: The results of the work were introduced into the practice of therapy and cardiology departments of Institute of Therapy (Academy of Medical Sciences of Ukraine), Kharkiv Regional Hospital, City Clinical Hospital No. 11, Department of Hospital Therapy (Bukovyna State Medical Academy), out-patient department of Chenivtsi Regional Cardiology Hospital. Sphere of application: medicine, cardiology.