Shorikov E. The markers of endothelial dysfunction, heart and vessels remodelling in patients with hypertensive disease associated with comorbid type 2 diabetes mellitus: genetic, morphofunctional, coagulative and phar-macoeconomic determinants of treatment

The thesis deals with the study of inter-compromised mechanisms of arterial hypertension and type 2 diabetes mellitus by means of a comprehensive investigation of endothelial dysfunction markers, heart and vessels remodeling, metabolic, coagulative and genetic determinants as well as examination of therapeutic programs on the basis of the disorders found. The conception of inter-compromised arterial hypertension and diabetes mellitus is defined. A prognostic level of the endothelial molecule of 1-paltelet adhesion and von Willebrand factor are determined in order to diagnose endothelial dysfunction of patients with comorbid course of hypertension and type 2 diabetes mellitus. Disorders of collagen-dependent platelet aggregation and disorders of ADP-dependent aggregation are found. Polymorphic variants of NOS3Т(-786)С (С allele), MTHFR С667Т (Т allele) and GPIb? С482Т (Т allele) genes are proved to be associated with the risk of vascular injury, and carrying of homozygous gene types promotes more marked disorders of the endothelial dysfunction and platelet aggregation. Early signs of macroangiopathy on the level of the carotid, brachial and femoral vessels are found to be presented by local disorders of elastic properties with increased stiffness, reduced elasticity, decreased distensibility. 24-week treatment with Ramipril or Losartan has been found to result in increased elasticity of vessels and improve their ability to deformity. Clinical and pharmacoeconomic efficacy of the combined anti-hypertensive therapy have been substantiated the combination “Ramipril + Bisoprolol” to reduce the risk of acute coronary syndrome and atrial fibrillation, administration of Ramipril with Indapamide in patients with a high risk of cardiorenal syndrome.