Kramarova V. Primary hypertension patients with metabolic changes: clinical course, mechanism of vascular disorders, prognosis, treatment, secondery preventive.

This work was dedicated to the description of new possibilities to indicate predictors of events in patients with essential arterial hypertension which have metabolic disorders. Based on investigation of 380 patients with essential arterial hypertension 1-3 degree metabolic disorders structure, suffer from change under basal hyperinsulinemia on coagulation and lipid levels, remote results, and effects of nonmedication therapy were defined. It was determined that insulinemia as such is related to higher aggregational activity of platelets interacting with ADP and ristomycin compared to control, whereas the patients with normal insulin levels have increased aggregation of platelets interacting with ADP and collagen compared to control. It was demonstrated that increase in RF levels, IX factor was observed in 49.2% of patients with essential arterial hypertension compared to control. However, in patients with basal hyperinsulenimia this condition was observed in 76.8% of cases and were set against the background of decreased activated partial thromboplastin time and higher F, RF levels, factor IX activity compared to control. Hyperinsulemia was related to the decrease of t-PA activity (6 times lower), if compared to patients without hyperinsulemia. The prognostic value of indicators was researched in patients with essential arterial hypertension. The average follow-up period was 4.5 years. Occurrence frequency was evaluated for the following strict end-points: death from any cause; death of cardio-vascular diseases; non-fatal myocardial infarction (MI), non-fatal ischemic stroke (IS), transient ischemic attack (TIA). Untoward impact of hyperinsulinemia on arterial hypertension course and outcome was demonstrated on the basis of the patients observation and analysis of intervals preceding the onset of events (Kaplan Meier estimator). This was observed in a statistically significant increase of adverse cardio-vascular events compared to normal insulin concentrations in blood (43.9% vs 24.4%) (р=0.0074). Predictors indicators were elucidated and aiming at the improvement of the system for complications risks for istalment a multi-factor risk model was developed. Medication therapy downs lipids count, platelet aggregation and the increased level of blood tension but has no impact on body weight, nor on insulin levels. An indicated diet restricting the intake of carbohydrates down to 250 gram per day having been prescribed for the 12-week period made it possible to decrease the body weight, downed the level of basal insulin, and intensified fibrinolysis