Firsova I. Changes in the indices of cardiac structural and functional state, daily profile of blood pressure, endothelial function, insulin resistance in patients with essential hypertension and their correction by using antagonists of renin-angiotensin - aldosteron system

The dissertation focuses on evaluating the changes of daily arterial blood pressure, indices of endothelial function, insulin resistance in developing structural and functional impairements of the left ventricle in patients with essential hypertension and optimizing therapy with antagonists of renin - angiotensin - aldosteron system losartan and enalapril. According to the results of examining for 102 patients with essential hypertension the myocardium mass and the type of geometry of the left ventricle are determined to depend on the changes in the parameters of daily blood pressure monitoring; the increased left ventricle myocardial mass index depends on to a greatly degree the deranged circadian cycle of arterial blood pressure and the indices of daily loaded systolic arterial blood pressure. When studying endothelium dependent vasodilation of the brachial artery in patients with essential hypertension it was registered the increased cavity of the left ventricle (end-diastolic volume index of the left ventricle) and the deranged indices of diastolic function. The increased level of NO metabolites - nitrates-nitrites was founded in the blood serum in 87.8 per cent of the examinees that was associated with the evident increased thickness of the left ventricle back wall, relative thickness of the left ventricle walls, the ventricle cavity, deranged diastolic function of the left ventricle, the increased heart rate, the decreased endothelium-dependent vasodilation and thicken complex of intima-media. Insulin resistance was determined in 55 per cent of the patients (HOMA - IR > 2.77); it was accompanied by the increased relative thickness of the walls and deranged diastolic function of the left ventricle as compared to those in the patients with no insulin resistance. The treatment using losartan as well as by means of enalapril during 24 weeks was accompanied by the decrease in the index of the left ventricle of myocardial mass by 11.5 per cent for losartan and 8.7 per cent by enalapril (p<0.001) and by the improved parameters of the left ventricle diastolic function which were more evident against the background of losartan; the evident improved endothelium dependent vasodilation was manifested in the equal degree, the degree of the decrease in the nitrates-nitrites level and the indices of insulin resistance was higher than that in the group who received losartan.