The dissertation provides a generalization and a new solution to the scientific task, which consists in determining the features of the essential arterial hypertension course in combination with cardiovascular comorbidity at the outpatient-polyclinic stage and optimizing the management of this cohort of patients by identifying socio-demographic, clinical, laboratory-instrumental and pharmacotherapeutic factors, which are associated with failure to reach the target blood pressure level (TBP). For the first time, in the conditions of real outpatient practice, a comprehensive comparative analysis of the course of AH was performed with an assessment of clinical, instrumental and laboratory parameters in patients with concomitant CHD and CHD in combination with CHF relative to patients without cardiovascular comorbidity, which will allow the family doctor to optimize the management of the specified cohort of patients, taking into account the following data: higher average age, higher frequency of damage of target organs, higher frequency of acute myocardial infarction in the anamnesis, higher frequency of concomitant CP and NAFLD, greater PWT of LV, higher relative number of blood monocytes, higher frequency of taking two or more antihypertensive tablets daily, higher frequency of taking β-blockers and statins both in patients with AH combined with CHD and in patients with AH combined with CHD and CHF, absence of individuals with stage I of arterial hypertension, higher values of MPV and PDW in patients with AH combined with coronary heart disease, longer disease duration, absence of individuals with 1st degree and 1st stage of AH, lower LVEF, lower relative number of blood lymphocytes, higher blood glucose level, lower level of TC, higher frequency of taking diuretics in patients with AH combined with CHD and CHF. Scientific data on the identification of socio-demographic and clinical predictors of non-achievement of TBP level in outpatients with AH in conditions of cardiovascular comorbidity were supplemented, in particular, it was established that the presence of concomitant CHD in patients with AH reduces the risk of failure to achieve TBP level by 3.1 times; female gender, salt abuse, and blood pressure level (each subsequent degree of AH) are associated with an increased risk of not reaching TBP level both in patients with AH combined with CHD and in patients with AH combined with CHD and CHF; an increase in BMI and the presence of concomitant CP are associated with an increased risk of not reaching TBP level in outpatients with arterial hypertension, regardless of the presence/absence of cardiovascular comorbidity. In outpatients with AH and cardiovascular comorbidity, significant associations were found between failure to achieve TBP level and routine laboratory parameters, in particular, a lower relative number of blood monocytes in patients with AH in combination with CHD; a lower level of HDL-C and higher values of the atherogenic coefficient in patients with AH in combination with CHD and CHF. ROC analysis was used to calculate the optimal cut-off points for blood serum lipid profile parameters, which determine the relative risk of not reaching TBP level in outpatients with essential AH, regardless of the presence/absence of cardiovascular comorbidity: TC levels ˃ 6.05 mmol/l, TG ˃ 2.01 mmol/l, HDL-C ˂ 1.22 mmol/l, LDL-C ˃ 4.02 mmol/l, VLDL-C ˃ 0.90 mmol/l, AC ˃ 3.60 Units. Scientific data on the level of adherence to antihypertensive treatment among outpatients with AH and cardiovascular comorbidity were added. A significant association of low adherence to antihypertensive treatment with female gender (p=0.030) was found in outpatients with AH in combination with CHD, and such predictors of low adherence to antihypertensive treatment in patients with arterial hypertension, regardless of the presence/absence of cardiovascular comorbidity were identified, such as older age and taking combined antihypertensive treatment. It was established, with the help of logistic regression analysis, that the presence of non-medication treatment reduces the probability of not reaching TBP level, and the use of combined antihypertensive therapy and low adherence to antihypertensive treatment are independent predictors of an increased risk of not reaching TBP level in outpatients with AH, regardless of the presence/absence of cardiovascular comorbidity.
