The dissertation work is devoted to optimization of treatment for patients with primary hypertension with type 2 diabetes based on the study of pathogenetic role of angiotensin 1-7 and apelin in the development of cardio-metabolic disruptions. A significant decrease in the levels of angiotensin 1-7 and apelin in the blood of patients with primary hypertension with type 2 diabetes was found in comparison with practically healthy individuals, and angiotensin 1-7 - in comparison with patients with hypertension without diabetes. Levels of angiotensin 1-7 in the blood of patients with primary hypertension with type 2 diabetes showed a significant negative correlation with systolic blood pressure, diastolic blood pressure and mean blood pressure, and with such parameters of left ventricle remodeling as end-diastolic dimension, left ventricle mass and left ventricle mass index. Moreover, the deficiency of angiotensin 1-7 in these patients is associated with a more severe course of hypertension and a structural and functional reorganization of the left ventricle - left ventricle hypertrophy and type II diastolic dysfunction of left ventricle. Blood levels of apelin in patients with primary hypertension and type 2 diabetes correlate negatively with glycated hemoglobin, insulin, levels of proatherogenic lipids (triglycerides, low density lipoprotein cholesterol), left ventricle remodeling parameters (septum wall thickness, posterior wall thickness, left ventricle mass index), the size of the left atrium, and positively with the glomerular filtration rate. Apelin deficiency in these patients is associated with a prolonged duration of hypertension, diabetes, decreased glomerular filtration rate, and development of concentric left ventricle hypertrophy and diastolic dysfunction of left ventricle. The blood apelin level in patients with primary hypertension and type 2 diabetes is one of the most important prognostic factors of abnormal cardiac remodeling, the development of which can be predicted using a multivariate prognostic model with prognostic criteria, allocated by the method of stepwise logistic regression, which include sex, diabetes, degree of hypertension, duration of hypertension, low density lipoprotein cholesterol, and high density lipoprotein cholesterol in the blood. Use of angiotensin receptor blocker olmesartan as part of a combination antihypertensive treatment, in contrast to angiotensin conversation enzyme inhibitor ramipril, contributes to a significant increase in blood levels of angiotensin 1-7. In patients with hypertension with type 2 diabetes with baseline low blood levels of angiotensin 1-7, anti-hypertensive therapy based on olmesartan, in contrast to ramipril, leads to a significant decrease in the severity of left ventricle hypertrophy.
