Even in the absence of concomitant cardiovascular (CV) pathology, patients with RA have a significant increase in CV risk to 51%. In patients with RA, H is found twice as often, is characterized by poorer control and frequent combination with RA. Preclinical atherosclerosis is registered in 32.7% of patients with RA, which is characterized by earlier and faster development, increasing CV risk. A difficult problem in the treatment of H remains in the case of its combination with RA. Spironolactone is recommended for patients with RH in the absence of good BP control. Spironolactone has been shown to prevent or reduce myocardial fibrosis and improve CV prognosis. Blockade of mineralocorticoid receptors leads to a decrease in the incidence of atherosclerotic plaques, endothelial dysfunction and inflammatory activity. Administration of spironolactone may cause a decrease in TNF-α and IL-6 levels in patients with RA. However, the question of the course, pathogenesis and treatment of patients with H, in particular RH, in combination with RA remains unclear.
The purpose of the study: based on a comprehensive study of the structural and functional state of the heart and main arteries, systemic hemodynamics, indicators of daily monitoring of BP and determination the circadian rhythm, cytokine status, the structure of H, cognitive, anxiety, and depressive disorders and quality of life, to establish clinical and pathogenetic features and to optimize the therapy of patients with H and its resistant form in combination with RA.
Tasks:
1. Assess systemic hemodynamics, structural and functional status of the heart, main arteries, endothelial function, the total risk of CV complications in patients with H and its resistant form in combination with RA.
2. To determine the parameters and features of circadian rhythm of BP according to its daily monitoring in patients with H and its resistant form in combination with RA.
3. To determine the levels of matrix metalloproteinase-3, pro- (IL-6), and anti-inflammatory (IL-10) cytokines in patients with H and its resistant form in combination with RA.
4. To determine the prevalence, structure, and nature of cognitive disorders, anxiety and depressive disturbances, and quality of life in patients with H and its resistant form in combination with RA.
5. To investigate the relationship between the structural and functional state of the heart, main arteries, daily BP profile, endothelial dysfunction, the level of matrix metalloproteinase-3, IL-6, IL-10, cognitive and anxiety-depressive disorders, activity, age, features, and the effectiveness of basic therapy in patients with H and its resistant form in combination with RA with the identification of adverse signs of the latter.
6. Carry out a comparative analysis of the effect of combined antihypertensive therapy depending on the addition of spironolactone on the structural and functional state of the heart and main arteries, daily BP parameters, endothelial function, level of matrix metalloproteinase-3, IL-6, IL-10 on the same type of basic therapy on RA in combination with H.
Scientific novelty. Scientific data on the prevalence of H and RH were obtained and the total risk of CV complications in patients, when combined with RA, was estimated. Based on a comprehensive study of the structural and functional state of the heart and main arteries, ABPM, markers of inflammation, levels of IL-6, IL-10, the cognitive and psycho-emotional status of patients with RH in combination with RA expanded knowledge about the features of H in the presence of RA, which is associated with the duration of the combined pathology, the degree of RA activity, the presence of systemic manifestations and the effectiveness of RA therapy. Scientific data on pathological changes of the daily BP profile in patients with H depending on the presence and features of RA. It was first shown that night-peackers and non-dippers are the dominant forms of circadian rhythms in patients with RH in combination with RA. The knowledge on disturbances of a structural condition of the general carotid arteries and endothelial function at patients with RH in combination with RA was added. The idea of the pathogenesis of hypertensive heart in patients with RH in combination with RA was further developed. It was proved that the presence of RA in patients with RH is characterized by more pronounced disorders of cognitive function, psycho-emotional state, and reduced quality of life. For the first time, the relationships between the disturbance of the structural and functional state of the heart, main arteries, and ABPM indicators, the levels of pro- and anti-inflammatory cytokines in patients with H in combination with RA were determined. Scientific data on interleukin-6 as the most significant marker of laboratory activity and effectiveness of treatment of patients with RH in combination with RA have been supplemented.
