The dissertation is an independent scientific work. According to the results of the study, it was established that stable CHD against the background of concomitant hypertension is characterized by a complicated course. This is manifested by a worsening of the clinical condition, a decrease in tolerance to physical exertion, a deterioration in its individual perception, a higher functional class of heart failure, manifestations of left ventricular hypertrophy, a decrease in the bioelectric activity of the heart, and more frequent occurrence of rhythm and conduction disorders. It was recorded that the level of increase in tolerance to physical exertion, as well as indicators of remodeling of the left ventricle in patients with stable CHD depends not only on the presence of concomitant arterial hypertension, but also on the concentration of ST2 in blood serum. In the presence of arterial hypertension, there is an increase in blood serum of malondialdehyde and ST2 in patients with stable CHD (р˂0,05). In this contingent of patients, there is a weak direct correlation between the concentration of malondialdehyde (MA) and the level of low-density lipoprotein (LDL) in plasma (r=0,27; p<0,05). There is a weak direct correlation between the level of ST2 and LVMI (r=0,10; p˂0,05). It has been proven that the use of a combination of folic acid and meldonium against the background of standard treatment in patients with stable CHD and concomitant hypertension is accompanied by a positive clinical effect, anti-ischemic and cytoprotective effect. The use of these drugs stimulates reverse remodeling of the myocardium of the left ventricle, improves the clinical condition of patients, increases the functional class of heart failure, which is manifested in an increase in the patient's ability to cover the distance within 6 minutes by 29,9% and an improvement in individual perception of the load by 48,1%. The combined use of folic acid and meldonium against the background of standard therapy for 6 months reduced the risk of developing recurrent acute coronary syndrome (OR=0,27; [CI=0,02-2,65]). Scientific novelty of the obtained results. Added data on the peculiarities of the clinical and functional characteristics of the cardiovascular system in patients with stable CHD in the presence of concomitant hypertension. It was established that such patients are characterized by an increase in the frequency of anginal attacks, a decrease in tolerance to physical exertion, and an increase in the frequency of rhythm and conduction disturbances. In the presence of concomitant hypertension, a higher functional class of stable coronary artery disease occurs.
It has been proven that the increase in the levels of MA and ST2 are predictors of the adverse course of CHD against the background of hypertension and changes in the functional characteristics of the LV of the heart. A direct correlation was established between the levels of MA and total cholesterol, as well as between MA and LDL in patients with stable coronary artery disease and concomitant hypertension. A direct correlation between the level of ST2 and LVMI was established. The dependence between indicators of the quality of life of patients and the presence of concomitant hypertension was noted. In patients with stable CHD with concomitant hypertension, the most significant changes in the quality of life were a decrease in physical functioning, an increase in the number of angina attacks, and a decrease in the general state of health. The possibility of improving the clinical course, functional characteristics of the cardiovascular system, indicators of the blood lipid spectrum and the LV remodeling marker sST2 by using folic acid and meldonium in treatment has been proven. New pharmacodynamic effects of meldonium and folic acid in patients with stable coronary artery disease were established, depending on the presence of hypertension. Practical value of research. A comprehensive approach to the assessment of the course of stable CHD against the background of concomitant hypertension has been developed. A new approach to determining the contingent of patients with a high risk of an adverse course of the combined pathology is proposed by evaluating the clinical and functional changes of the cardiovascular system, the levels of ST2 and MA in the blood serum of such patients. Based on the establishment of new pharmacological effects of folic acid and meldonium, a scheme for their differentiated use in patients with stable coronary artery disease with concomitant hypertension was developed. Key words: stable coronary heart disease, arterial hypertension, recovery period, quality of life, percutaneous coronary intervention, oxidative stress, endothelial dysfunction, meldonium, folic acid, nitric oxide, quality of life, SF-36, correlational relationships, risks. Branch-Medicine.
