Ryndina N. Metabolic therapy of myocardial dysfunction and correction of vascular endothelial function in patients with rheumatoid arthritis with hypertension.

Thesis is devoted to the improvement of the treatment algorithm of patients with stage II hypertension combined with rheumatoid arthritis by the additional appointment of differentiated metabolic therapy to correct myocardial dysfunction, vascular endothelial function and oxidative stress processes using meldonium, and L-arginine. It was founded that in patients with hypertension in combination with rheumatoid arthritis significantly prevailed concentric left ventricular hypertrophy in 79 % of patients. The highest predictor value for impaired DF of LV in patients with hypertension combined with rheumatoid arthritis was found in IL 1-B (95% CI 0,798 to 0,939) at the optimal distribution point > 9,67 pg/ml, and ADMA AUC 0,879 sensitivity 75.95 %, and specificity 100%, (95% CI 0,795 to 0,937) at the optimum distribution point >0,715 μmol/l. The highest predictor value for detecting fluid in the pericardial cavity was also found in ADMA AUC 0,913 (95% CI AUC 0,836 to 0,961) at the optimum distribution point >0,841 μmol/l, sensitivity 94,12%, and specificity 85,53%. The expediency of additional appointment of metabolic therapy in patients with hypertension combined with RA has been established. In the subgroup of patients with hypertension combined with RA who received meldonium there was a significant decrease in systemic inflammatory response rates. The additional prescription of L - arginine significantly influenced the correction of endothelial dysfunction and lipid profile. In patients with hypertension in combination with RA against the background of additional prescription of metabolic therapy, a significant decrease in indicators of oxidative stress was revealed.