Tabachenko O. The significance of apelin-12 and obestatin in the progression of structural and functional changes of the left ventricle in arterial hypertension and diabetes mellitus type 2.

The goal of dissertation is to optimize the diagnosis and treatment of arterial hypertension in combination with diabetes mellitus type 2 based on studies of pathogenetic role of adipose tissue hormones apelin-12 and obestatin in the development of structural and functional changes in left ventricular metabolic disorders, and the analysis of their predictive value. The study shows that apelinemiya and obestatinemiya are dependent on the severity and duration of arterial hypertension and length of diabetes mellitus type 2. In the presence of diabetes mellitus type 2 in patients with arterial hypertension the level of apelin-12 was higher by 18.31% than in patients without diabetes and the obestatin level is lower by 8.49%. Reduced activity of apelin-12 and obestatin is associated with the progress of left ventricular hypertrophy and with the formation of concentric or eccentric types of left ventricular hypertrophy in patients with arterial hypertension with concomitant diabetes mellitus type 2. The progress of such eccentric hypertrophy is detected under extension of diabetes mellitus type 2 over 10 years in patients with arterial hypertension. Apelin-12 concentration above 75 percentile reveals antagonistic effects on left ventricular hypertrophy in patients with arterial hypertension associated with diabetes mellitus type 2. The study shows the presence of comorbidity influence arterial hypertension and diabetes mellitus type 2 parameters of carbohydrate and lipid metabolism as an increase of proaterohenic factions in the absence thereof antiatherogenic parameters that is especially clear under conditions of prolongation of diabetes mellitus type 2 duration over 10 years. The pleyotropic effects of apelin-12 are found and it shows a positive inotropic effect and brings influence on atherogenic and antiatherogenic fraction lipidohram regardless of the duration of metabolic disorders in the form of diabetes mellitus type 2. Apelin-12 with obestatin are involved in the regulation of left ventricular hypertrophy in patients with arterial hypertension and diabetes mellitus type 2 and also participate in the regulation of blood pressure. The use of azilsartan medoxomil or quinapril shows the positive therapeutic effect but with predominance of azilsartan medoxomil action against reducing left ventricular remodeling and antihypertensive effect. Apelin-12 level has prognostic informative regarding the development of left ventricular hypertrophy at levels less than 1.3 ng / ml. High predictive value parameters lipidohram, and apelin-12 and obestatin allows to include them into the forecast model types remodeling for clinical use.