Nemtsova V. Clinical, pathogenetic and prognostic aspects of the combined course of hypertension, type 2 diabetes mellitus and subclinical hypothyroidism.

The dissertation deals with optimization of early diagnostic, prediction of course, risk of complications and treatment tactics in patients with comorbid course of hypertension, type 2 diabetes mellitus and subclinical hypothyroidism by comprehensive evaluation of clinical and pathogenetic mechanisms, endothelial dysfunction, oxidative stress, systemic inflammation and vascular aging processes. It was found that in patients with hypertension in combination with type 2 diabetes mellitus and subclinical hypothyroidism with thyroid-stimulating hormone levels above 6.0 ?IU/ml signs of oxidative stress, mainly due to reduced antioxidant defence, endothelial dysfunction, chronic systemic inflammation and telomeres shortening were greater expressed than at lower levels of TSH, which allows to consider the level of TSH 6.0 ?IU/ml as a threshold for increasing cardiovascular risk in the case of the studied comorbid conditions. The diagnostic and prognostic value of telomere length as a biomarker of cardiovascular risk in patients of different age groups with combined course of hypertension, type 2 diabetes mellitus without thyroid dysfunction and in the presence of subclinical hypothyroidism were determined. The multivariate model for predicting the development of cardiovascular complications and an algorithm for early comprehensive diagnosis and therapeutic and prophylactic tactics for prevention of cardiovascular complications in patients with combined course of hypertension and type 2 diabetes mellitus depending on the thyroid functional state has been developed. The expediency of including levothyroxine in the complex treatment of patients with combined course of hypertension, type 2 diabetes mellitus and subclinical hypothyroidism to improve a course and reduce the risk of cardiovascular complications development by improving hormonal-metabolic, anthropometric factors and vascular aging processes has been scientifically substantiated.