Klitsunova J. Heart rate variability and endothelial factors of hemostasis and fibrinolysis in patients with symptomatic renal parenchymatous arterial hypertension and medication ways of its correction

Protected the thesis, which is devoted to the study of the role of the variability of cardiac rhythm and endothelial factors of hemostasis and fibrinolysis in the formation of symptomatic renal arterial hypertension and set the opportunity to therapeutic correction of identified violations of the ACE inhibitor Ramipril,diuretic Indapamide and the antagonist of calcium Amlodipine besylate. In patients with symptomatic renal arterial hypertension were identified changes in the indices of heart rate variability and daily monitoring of arterial blood pressure,which are characterized by violations of the daily rhythm,a reduction in the overall variability of cardiac rhythm,the oppression of the parasympathetic activity and a shift of vegetative homeostasis in the direction of the sympathetic modulation with a parallel increase in capacity of the VLF.Data were obtained about the increase of the average values of blood pressure variability,indices square hypertension,a violation of the morning of arterial pressure,intensity of which increase with the progress in the degree of arterial hypertension and correlates with the level of renin,aldosterone,daily urinary excretion of catecholamines.It is established,that in patients with symptomatic renal arterial hypertension takes place oppression of the anticoagulant and fibrinolys capacity of the blood plasma in consequence of the progressive (with increasing AH degree) to reduce the activity of a protein C and antitrombina III and increasing the content of plasminogen.Proven positive effect three months outpatient treatment with Ramipril,Indapamide and Amlodipine besylate on the dynamics of the indicators of monitoring of blood pressure and the "office" of its values,which is the achievement of target levels of blood pressure in patients with different variants of the night pressure reduction.In the work confirmed the link between the daily allocation of adrenaline and noradrenaline and the type of the night reduction of blood pressure.The three-month outpatient therapy Ramipril,Indapamide and Amlodipine besylate was accompanied by a significant reduction in the daily excretion of adrenaline and noradrenaline.And the plasma concentration of aldosterone.Analysis of the data DBPM allowed to reveal a high inverse correlation between the majority of indicators DBPM and the most important indicators of kidney function.