Kurshubadze Е. Cardiac, vascular and endothelial mechanisms of chronic heart failure with hypertension combined with chronic kidney disease.

The dissertation is a theoretical generalization and proposed a new solution to a scientific problem to study the pathogenic mechanisms of chronic heart failure and their relation to cardiac, vascular and endothelial factors in patients with chronic kidney disease and developed the concept of a differentiated treatment depending on the impact on the process of remodeling, vascular and endothelial mechanisms. Total of 153 patients with chronic heart failure, I-IV functional class (classified NYNA), out of which 121 patients a chronic kidney disease, hypertension - at 34 feature of the structural and functional reorganization of LV myocardium in patients with CHF and hypertension are to increase myocardial mass, which is associated with thickening of its walls and the increase in its cavities. With the progression of hypertensive remodeling contribute to the development of heart failure defined geometry violation infarction, the appearance of diastolic dysfunction due to the development of pathological types of mitral flow. The emergence and development of CHF in CKD due to the formation of concentric left ventricular hypertrophy, in combination with diastolic dysfunction.j Increasing the degree of hypertension is accompanied by the evolution of the structural and functional changes in the myocardium in the direction of the eccentric hypertrophy', rigid type of mitral blood flow and deterioration of functional class of heart failure. The evolution of the structural and functional changes in indices of LV determines circadian blood pressure (r=0,36, p<0,01), and display of systolic dysfunction correlates with daytime and nighttime blood pressure variability (r=0,32, p<0,01; r=0,32, p<0,01). In this disorder sosudistoreguliruyuschey endothelial function is one of the factors that contribute to pathological remodeling due to the predominance vazokontriktornih reactions and has a correlation with increased activity lipid peroxidation (r=0,32, p<0,01), humoral indicators of endothelial dysfunction in as increasing the content of endothelin-1 (r=0,32, p<0,01), von Willebrand factor (r = 0,32, p O.01) due to the suppression of nitric oxide (r=0,32, p<0,01). Heart failure and hypertension therapy with an ACE inhibitor (fosinopril 10 mg/day) in combination with nebivolol (10 mg/day) for 12 months, accompanied by a decrease of LV remodeling, CHF stage and restores hypotensive reaction resistance vessels with improved endothelial systems of regulation of blood pressure.