Danilevych T. Clinical and prognostic value of the level of aldosterone in the patients with arterial hypertension and frequent attacks of atrial fibrillation, ways to increase the effectiveness of antiarrhythmic therapy

Thesis is devoted to solving the actual problem of modern cardiology – to improve the efficiency of the treatment of the patients with arterial hypertension (AH) and frequent attacks of atrial fibrillation (AF) by studying the clinical and prognostic role of aldosterone, assessing clinical efficacy of 1C class (propafenone and ethacysin) at different vegetative variants of AF and in combined therapy with renin-angiotensin-aldosterone system blockers (perindopril and losartan) and mineralocorticoid receptor antagonist (eplerenon). The association of plasma level of aldosterone with the presence of AH, AF, abdominal obesity, persistent form and adrenal variant of AF, increased intima-media thickness of carotid arteries and concentric hypertrophy of left ventricle, presence of mitral and tricuspid regurgitation has been proved. The use of 1C class of antiarrhythmic drugs (propafenone and ethacysin) in patients with AH and frequent attacks of AF for 6 months in 35,8 % of cases leads to the complete elimination of arrhythmia attacks and in 64,2 % – partial antiarrhythmic effect. The antiarrhythmic efficacy of propafenone is associated with higher (> 154 pg/ml), while ethacysin – with lower (<121 pg/ml) plasma level of aldosterone. The use of fixed combination of losartan with hydrochlorthiazide and eplerenon is associated with higher antiarrhythmic efficacy of 1C class of preparations.