Rudenko T. Optimization of diagnostics of endothelial dysfunction with hypertension in combination with obesity and its correction.

The thesis is dedicated to the questions on improvement of diagnostics and treatment of arterial hypertension in combination with obesity basing on studying of cardio-vascular and humoral mechanisms of hypertension pathogenesis and development on this basis of targeting drug therapy. The study involved 136 hypertensive patients, 104 of which with overweight or obesity, 32 patients exclusively have hypertension I, II and III, and 25 healthy normotensive individuals composing the control group. Established that the prognostic significance of ED in patients with hypertension and related obesity exceeds that for isolated hypertension. It was proved that the degree of vascular (decrease of endothelium related vasodilatation and endothelium unrelated vasodilatation), cardiac (heart cavities dilatation, myocardial hypertrophy and diastolic dysfunction) and humoral (activation of vasopressor and proinflammatory mechanisms) disorders correlates with the degree of progression of hypertension and related obesity. That allows considering hypertension and obesity predictors of progression of ED. Proved that for early diagnosis of CVS, monitoring the adequacy of treatment, predicting disease outcome in patients with hypertension and obesity it is advisable to determine the nature of myocardial remodeling, state of the vascular movable function of the endothelium and humoral mechanisms involved in the formation of ED. It was determined that combined therapy with the use of ACE inhibitors, beta-blockers and lipid-lowering drug, is effective in reducing blood pressure to target levels, promotes physiological profile "dipper", improves endothelial function and lipid metabolism and reduces activity of vasospastic mechanisms.