Pankiv I. Modifying influence of direct renin inhibitor aliskiren on cardiorenal risk factors in patients with arterial hypertension and type 2 diabetes mellitus

The object of the research is patients with arterial hypertension (АH) and type 2 diabetes mellitus (DM). The aim is to improve treatment efficacy in patients with АH and type 2 DM on the basis of study of modifying influence of direct renin inhibitor on the level of blood pressure (BP), expressed of microalbuminuria (MAU), haemodynamic and morphometric heart parameters, hormonal-metabolic and functional violations. Methods - clinical, laboratory, instrumental, statistical. The novelty of the research lies in the following: it has shown the prevalence of МАU among patients with AH and DM; priority data are establishments of reliable dependence between the level of BP and frequency of МАU; it is set that authenticity of МАU grows at the increase of AH duration; it is well-proven that the presence of МАU can be examined not only as a marker of AH and DM progress but also as an important criterion for the estimation of degree of heart failure; influence of risk factors of development of cardiovascular diseases is studied on prevalence and expressed of signs of left ventricle diastolic dysfunction in patients with AH and type 2 DM; it is set that 85 % patients with АH and type 2 DM have echocardiographic signs of left ventricle diastolic dysfunction without the clinical displays of heart failure; dependence is well-proven between the indexes of left ventricle diastolic dysfunction and DM duration, level of BP and expressed of МАU; influence of therapy is first found out by preparation of direct renin inhibitor (aliskiren) on the indexes of left ventricle diastolic dysfunction and МАU; possibility of correction of early disorders of left ventricle diastolic dysfunction is educed with the help of aliskiren; dependence of efficiency of treatment of aliskiren is set on DM duration and МАU; intercommunication is educed between the degree of improvement of left ventricle dyastolic function, decline of BP and MAU on a background of aliskiren treatment. Results - frequency of MAU among patients with AH arrives at 68 % and depends on duration of disease; among patients with AH and type 2 DM prevalence of MAU arrives at 85.7 %; among practically healthy persons frequency of MAU presents 4.2 %; left ventricle dіаstolic disfunction was diagnosed in 87.7 % patients with AH and type 2 DM; the expressed of echocardiographic signs of left ventricle dіаstolic disfunction depends on the level of BP, MAU and duration of type 2 DM; the expressed antihypertension effect of direct renin inhibitor aliskiren during treatment the patients with AH and type 2 DM was observed; in 16 weeks there was a reliable decline of systolic BP on (22.3 ± 3.2) mm Hg and diastolic BP on (10.9 ± 1.7) mm Hg (р<0.05); on a background the reception of aliskiren decline of MAU was observed in 83.3 % patients; as a result of 16 weeks treatment of aliskiren there was statistically reliable decline of index of renin plasma activity on 18.4 %; aliskiren treatment allowed to attain normalization of indexes of left ventricle diastolic function in 22.6 % patients comparatively with 12.9 % patients from the group of olmesartan treatment. The results of the research have been introduced into medical institutions, scientific and educational process. The field is medicine.