Yankevich A. Clinical, metabolic and heаmodinamic peculiarities of different structural and functional types of hypertensive heart.

Object of the study: arterial hypertension 1-2 stage. Purpose of the study: optimisation of hypertensive heart diagnostics and improvement of blood circulation impairments evaluation in hypertensive patients taking into account presence of the metabolic syndrome. Methods of the investigation: structural and functional parameters and type of left ventricular geometry were diagnosed by ultrasound method in B- and M-mode of scanning. Plasma concentration of fasting glucose and after oral glucose tolerance test as well as total lipids, total cholesterol, triglycerides, low and high density lipoproteins cholesterol were measured by immunoenzyme method. Content of plasma insulin was measured by radioimmune method. Daily blood pressure profile was established by 24-hours monitoring. The neurohumoral regulation of blood circulation was assessed by heart rate variability analysis in rest state and in active orthostatic test. Theoretical and practical results: the benefit of left ventricular geometric remodelling types determination was proved as integral characteristic which reflects peculiarities of central heamodynamic and functional state of myocardium. At the same time, the appropriateness of myocardium mass indexation by height in 2.7 degree was emphasized for adequate evaluation of obesity contribution to left ventricular hypertrophy. It was revealed that decreasing of insulin sensitivity in hypertensive patients is closely related to waist circumference that allows to perform express diagnostics of the insulin resistance at early stage of clinical examination. The value of heart rate variability investigation based on short recordings of electrocardiogram was grounded as screening method that allows to suspect abnormalities of daily blood pressure profile, metabolic disorders and left ventricular remodelling in patients with arterial hypertension. Novelty: the considerable impact of different echocardiographic methodological approaches on prevalence of left ventricular geometric patterns in patients with 1-2 stage of arterial hypertension was revealed. The contribution of insulin in the concentric variants of left ventricular geometric remodelling was established. It was demonstrated that relation between plasma insulin concentration and left ventricular myocardium mass is mainly determined by concomitant obesity and power of this relation is depended of myocardium mass indexation method. It was revealed that relatively high, but not exceed normal limit, basal plasma cortisol concentration in hypertensives is associated with atherogenic plasma lipid profile and high pulse pressure. Also, stable high daily blood pressure is related to increasing both walls thickness and cavity size of left ventricle. The prospects of using the changes of heart rate variability parameters in orthostatic test were proved for detection the persons with adverse course of arterial hypertension (presence of left ventricular hypertrophy, metabolic syndrome, daily blood pressure profile abnormalities). Degree of introduction: the results of the research were introduced into the work of therapy departments of city hospital No. 11 (Kharkiv), city hospital (Lozovaya, Kharkiv region). Methodical recommendations "Use of daily blood pressure monitoring for prognosis of the arterial hypertension course diagnostics of hypertension complications and making of individual treatment scheme" are published. Sphere of application: medicine, therapy and cardiology departments. 61561