Hribeniuk O. The importance of non-alcoholic fatty liver disease in modification of hypertension course and possibilities for optimization of pharmacological correction.

The dissertation was aimed to optimize the management and treatment of arterial hypertention (AH) and non-alcoholic fatty liver disease (NAFLD) comorbidity. 170 patients with 2 stage AH (109 (64%) patients with nonalcoholic steatohepatosis) were examined. The control group consisted of 30 practically healthy volunteers of the corresponding sex and age. The association between concomitant nonalcoholic steatohepatosis with higher office systolic and pulse arterial pressure, significant higher ambulatory blood pressure monitoring measurements; increased frequency of carotid artery atherosclerotic plaques registration; significant increase of arterial stiffness; progression of endothelial dysfunction were fixed. Significant proatherogenic changes shift of the lipid profile, increasing Lp(a) level, development of insulin resistance (IR), non-specific system inflammation activation, mainly due to significant increasing TNF? level, and decreasing of adiponectin serum level were established in patients with comorbidity of 2 stage AH and NASP compared to these without concomitant liver impairment, p ? 0,05. The presence of NAFLD in separate patient groups with 2 stage AH with optimal body weight (OBW), overweight, premorbid obesity was accompanied by more significant (p?0.05) changes in the structural and functional parameters of the heart, blood vessels and neurohumoral markers compared with patients with OBW, overweight and 1-2 grades obesity without signs of concomitant liver impairment. Significant (p?0.05) increase of total cholesterol and low density lipoproteins (LDL), Lp(a), TNF? levels, IR development; significant adiponectin level reduction were fixed among overweight patients in subgroup with comorbidity of hypertension and NASP compared to patients without concomitant fatty liver impairment. The subgroups with a combined course of AH, NASP and different body mass index are not differ from each other by most indicators of metabolic status. The pathogenetical patient image with the comorbid flow of hypertension and NASP, which reflected the specificity of the course of AH in patients with concomitant NASP and demonstrated a characteristic complex of clinical-instrumental-biochemical disorders inherent to these patients, was created. The investigation of different pharmacotherapy variants in patients with 2 stage AH and NASP comorbidity discovered that the complex of ursodeoxycholic acid (UDCA) combined with standard therapy showed positive changes of metabolic status and contributed to a more significant decrease in lipid metabolism. The complex treatment with meldonium was associated with positive effects of the hemodynamic parameters (contributed to the normalization of BP level, reduced BP variability and restoration of endothelium vascular-motion function) with positive effect on lipid, carbohydrate, fat metabolism indicators and activity of nonspecific systemic inflamation. These changes could reduce a cardiovascular risk in patients with a combination of AH and NASP. Consequently, both UDCA and meldonium can be recommended for use in the complex therapy of patients with AH and NAFLD comorbidity.