Trischuk N. The functional state of endothelium in patients with arterial hypertension and ischemic heart disease.

Object of the study: Patients with arterial hypertension and coronary artery disease with or without chronic heart failure. Purpose of the study: To optimize the treatment for coronary artery disease (CAD) and arterial hypertension basing on the study of structural functional state of the left ventricle, vasocon-strictor and vasodilating endothelium-dependent mechanisms. Methods of research: General clinical and laboratory methods, ultrasound study of the heart with the use of morphological and functional indices of diastolic and systolic function of the heart; evaluation of endothelium function, determining endothelin-1 amount in the peripheral venous blood, metabolite of prostacy-clin 6-keto-PGF1-?, cAMP and cGMP. Theoretical and practical results: Peculiarities of endothelium dysfunction and structural changes in the myocardium depending on the course of CAD, presence of AH and circulatory insuffi-ciency, which can be used for determining endothelium dysfunc-tion and substantiation of IACE and AIIAR administration. Early diagnostic test in patients with AH can be disturbance of diastolic function due to reduction of passive filling of the left ventricle and presence of concentric hypertrophy of the myocar-dium which suggest of the necessity of drug correction of the above disorders with the use of RAAS modulators at the begin-ning of the disease. Combination of increased endothelin-1 amount and diastolic insufficiency of the left ventricle is an indi-cation to the use of IACE for correction of both diastolic dys-function of the left ventricle and reduction of activity of the ex-isting endothelium-dependent mechanisms of the disease patho-genesis. Novelty: The characteristics of the changes of endothelium func-tion and structural functional characteristics of the left ventricle in arterial hypertension and CAD were established. The influence of combination of CAD, AH and circulation insufficiency on these parameters was shown. It was shown that increase in endo-thelium function was accompanied by structural functional changes in the left ventricle which were characterized by con-centric remodeling in AH and changes to dilatation remodeling of the left ventricle in CAD. Arterial hypertension was shown to be characterized by distur-bances in the functional state of the endothelium due to increase of endothelin-forming mechanisms and reduction of NO influ-ence due to reduction in NO synthesis and prostacyclin forma-tion. CAD is characterized by activation of endothelium-dependent mechanisms, increased activity of antagonist mecha-nisms, i.e. prostacyclin formation. The presence of circulatory insufficiency considerably in-creases endothelium dysfunction which is manifested by activa-tion of endothelium-dependent mechanisms (increase in endothe-lin-1 and cAMP) which is a secondary messenger of catechola-mine pharmacodynamic effect realization. Reduction of NO-dependent mechanisms activity and moderate activation of prostacyclin-mediated influence was established, which was proven by reduction of cGMP and increase in 6-keto-PGF1-?. The influence of RAAS-IACE modulators, Enalapril and AII re-ceptor blocker, Lozartan, manifests by tendency to normalization of endothelium-dependent mechanisms of cellular-humoral changers in the form of reduction of endothelin-1 level in the blood, increase in cGMP and 6-keto-PGF1-? level. The changes in structural functional state of the left ventricle under the influence of Enalapril manifests by increase in diastolic relaxation of the left ventricle myocardium, reduction in the diastolic size of the heart and systolic and diastolic blood pressure. Degree of introduction: The findings of the research were introduced into the work of treatment and educational institutions of Kharkiv (Institute of Therapy of Academy of medical sciences of Ukraine, Balakliya Central District Hospital, Clinical Hospital No. 26, City Clinical Hospital of Emergency Medical Aid). Sphere of application: Medicine, cardiology.