Buriakovska O. Optimization of therapy of hypertension in combination with diabetes mellitus on the basis of sleep disorders correction

44.1% of patients with established diseases of the cardiovascular system have problems with the quality or duration of sleep. 36.9% of patients with hypertension had insomnia. Hypnotics are given to up to 15% of patients with hypertension. Hypnotics have been shown to increase the risk of cardiovascular events. Patients with insomnia have a 21% higher risk of developing hypertension compared to those with quality sleep. Insomnia and type 2 diabetes have been shown to reinforce each other, and this leads to an increase in the rate of development of each condition. More than 40% of patients with type 2 diabetes suffer from insomnia. There are almost no datas in the modern literature on the effect of antihypertensive therapy on the formation of various sleep disorders. Therefore, the aim of the study was to increase the effectiveness of treatment of hypertension in combination with type 2 diabetes by correcting sleep disorders. The dissertation research is based on a comprehensive examination of 143 patients. Patients with a combination of hypertension and type 2 diabetes were the first group of 82 people, 38 patients with isolated hypertension were the second group, and 23 healthy volunteers were the control group. This study consisted of three stages: the first and second stages were presented in the form of a cross-sectional study, and the third - a prospective. For the first time, the effect of antihypertensive therapy in patients with isolated hypertension and its combination with type 2 diabetes on insomnia, and the effect of training in "Schools of Health" on circadian sleep and wakefulness disorders were studied. According to the results of a comprehensive examination of patients, the peculiarities of the clinical course of these nosologies were established. The frequency of sleep disorders in patients with a combined course of hypertension and type 2 diabetes mellitus and an isolated course of hypertension was revealed. After studying the indicators of sleep quality and duration, as well as the presence of daytime sleepiness, their effect on lipid and carbohydrate metabolism, as well as hemodynamic parameters was demonstrated. The diagnostic value of markers: cortisol and prolactin has been demonstrated. The potential effect of antihypertensive therapy has been determined. Namely, amlodipine therapy had a positive effect on the ability to maintain continuous sleep in patients with hypertension and type 2 diabetes, whereas indapamide therapy had a significant negative effect on sleep quality in patients with hypertension and type 2 diabetes. For the first time, the relationship between antihypertensive therapy and sleep disorders has been studied. Based on the definition of the type of sleep disorders, an algorithm for their correction in patients with hypertension and type 2 diabetes was developed, which is quite convenient in general medical practice, both at primary and secondary and tertiary levels of care.