Bek N. The influence of metabolic cardiovascular risk factors on the electrical stability of the myocardium in patients with essential hypertension and obesity: diagnostic and prognostic value

The thesis was aimed at improving diagnosis and prognosis of influences of metabolic cardiovascular risk factors on the myocardial electrical stability in patients with essential hypertension combined with obesity, considering gender-specific features. Elevated uric acid levels were associated with higher body mass index, waist circumference, systolic blood pressure, and C-reactive protein (CRP) levels in both genders; and additionally with higher pulse pressure and maximal nighttime QTc in males; and with a decline in glomerular filtration rate (GFR), increased serum creatinine, higher daytime dQT, decreased heart rate variability (HRV) and disorders of wave structure at night. Higher pulse pressure, lower LV ejection fraction, higher levels of very low density lipoprotein cholesterol and triglycerides, and increased total and nighttime dQT were observed in patients with asymptomatic hyperuricemia. Hyperleptinemia in the main group was associated with higher CRP levels, end-diastolic right ventricular dimension and decreased GFR. Inverse correlations between time parameters of HRV (daytime pNN50%, daytime and nighttime SDNN indices, nighttime SDNN, daytime RMSSD, and total SDANN) and daytime VLF-waves with maximal values of overall QTc were found in patients with hyperleptinemia and low adiponectin levels, suggesting the adverse impact of such adipocytokine combination on cardiac electrophysiological processes .Basing on the results of prospective study with a follow-up period of 30 months, unfavorable prognostic factors of essential hypertension associated with obesity or overweight were defined. It was shown that body weight, serum levels of uric acid, leptin, C-reactive protein, and total cholesterol, maximal nighttime QT dispersion, pulse pressure were informative predictors of uncomplicated hypertensive crisis, non-fatal myocardial infarction and stroke. Industry - medicine.