In clinical practice, the most common category of patients with comorbid pathology, namely hypertension with gout, but there are isolated publications on their pathogenetic relationship and burden. 122 patients with hypertension were examined. The main group consisted of 72 patients with hypertension in combination with gout, the comparison group - 50 patients with hypertension, the control group - 20 patients with gout, a group of almost healthy patients without hypertension and gout - 20 people. According to the results of the study, a high prevalence of hypertension was found among the examined patients with gout - 78.3%, which was ahead of the development of the latter in 68.1% of cases. The incidence of metabolic syndrome (MS) (IDF) is significantly higher in patients with hypertension in combination with gout than in patients with gout (67 (93.1%) vs. 5 (25.0%), respectively p<0.01)). The combination of components of MS (hypertension, diabetes mellitus (DM) type 2 - 4.2%, obesity - 95.8%), dyslipidemia: hypercholesterolemia - 30.6%, hypertriglyceridemia - 36.1%) with gout contributes to a significant increase in the number affected joints (8.0 (7.0; 10.0), p<0.05), frequency (4.0 (5.0; 9.0), p<0.05) and duration of exacerbation (7.8 (8.0; 10.0), p<0.05), increases cardiovascular (CV) risk on the scales SCORE (5.3%, p<0.05) and PROCAM (10.6%, p<0.05) in contrast to those without MS. The following components of severe gout in the case of its combination with hypertension are outlined: the duration of arthritis (p<0.05) and the last exacerbation of gout in the last year (p<0.01); intensity of pain on the visual analog scale (VAS) (p<0,01). The role of ferritin as a marker of inflammation and a predictor of exacerbation in gout is demonstrated and the features of the clinical course associated with the level of ferritin are determined. When assessing the factors accompanying the exacerbation, correlations were found between episodes exacerbation of arthritis and level of ferritin (rs=0.69; p<0.01), highly sensitive C-reactive protein (hsCRP) (rs=0.53; p<0.01), on the basis of which the logistic analysis and ROC-analysis were carried out the model of forecasting exacerbation gouty arthritis was developed. For each unit of ferritin increase, the chance of developing arthritis exacerbation increases by 0.98 times. The frequency of hyperferritinemia in combination with hyperuricemia is observed in 51.4% of cases, which is associated with the duration of the last exacerbation of gout (rs=0.24; p<0.05), the number of gout outbreaks during the year (rs=0.44; p<0.01), the intensity of pain according to VAS (rs=0.36; p<0.01), the total number of affected joints (rs=0.31; p <0.01) in contrast to those with a normal level ferritin and hyperuricemia. Significant correlations of clinical manifestations of gout with the PROCAM scale were established: direct relationship risk with age of onset (rs=0.32; p<0.05) and duration of gout (rs=0.43; p<0.05). The prevalence of certain CV risk factors was determined: male gender - 90.3%, age - 55.0 (47.0; 60.0) years, heredity - 20.8%, smoking - 56.1%, obesity - 95.8 %, DM type 2 - 4.2%, dyslipidemia - 77.8%, increased BP in all patients. The quality of life of patients with hypertension in combination with gout is reduced to a greater extent than in patients with hypertension or gout alone, due to factors such as: age, total number of affected joints, duration the last exacerbation of gout and age of gout onset. The main criteria for the appointment of antihypertensive drugs - in the case of more pronounced disorders of purine and lipid metabolism - losartan, more pronounced structural and functional changes the left ventricle - ramipril. During the 6-month continuous treatment, an increase the quality of life in terms of physical component of health by 27.7% in patients receiving losartan and by 20.4% in those receiving ramipril (p<0.01), and by the indicator of the psychological component of health by 18.4% in the subgroup of losartan and by 17.5% (p<0.01) in the subgroup of ramipril. A probable decrease in the HAQ-DI was found only in patients who received ramipril compared to baseline before treatment by 33.3% (p<0.05). It was determined that in case of exacerbation of gout in patients with the number of outbreaks per year ≥5, the duration of the last outbreak of gout ≥16 days, the total number of affected joints ≥6, the intensity of pain for VAS ≥40.0 mm, it is recommended to determine ferritin levels at the primary stage. When the level of ferritin >400.0 ng/mL is prescribed the drug deferoxamine - dose of 500 mg per day to achieve the target level of ferritin in the range from 100.0 to 200.0 ng/mL. It is proposed to refer patients with hypertension in combination with gout the older age group, history of gout ≥4 years, UA level ≥462.3 μmol/L, hsCRP ≥7.4 mg/L to ultrasound examination the neck vessels, for early detection of atherosclerotic lesions of the carotid arteries.
