Наукові праці. Кафедра внутрішньої медицини № 1
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Item Comparison of structural and functional vascular disorders in patients with comorbidity of non-alcoholic fatty liver disease and two types of arterial hypertension(2023) Prosolenko, Kostyantyn; Molodan, Volodymyr; Panchenko, Galyna; Lapshyna, Kateryna; Shalimova, AnnaBackground: The aim was to conduct a comparative assessment of structural and functional vascular disorders in patiets with comorbidity of non-alcoholic fatty liver disease (NAFLD) and two types of arterial hypertension (HTN). Material and methods: The study included 329 patients 18–66 years old. All patients were divided into five groups: patients with comorbidity of NAFLD and primary HTN (121 subjects), patients with comorbidity of NAFLD and renal parenchymal HTN (88 subjects), patients with NAFLD (60 subjects), patients with primary HTN (30 subjects), patients with renal parenchymal HTN (30 people). The control group consisted of 20 healthy individuals of similar age and gender categories. Results: In the comparative analysis of the structural and functional ultrasonographic parameters of vessels, no significant differences between two comorbidity groups NAFLD + primary HTN and NAFLD + renal parenchymal HTN were found. The influence of AH and degree of liver steatosis on ultrasound indicators of arteries in examined patients with comorbidity was evaluated by MANOVA analysis. The influence of the HTN factor and the influence of the liver steatosis factor were evaluated separately, after which the influence of the comorbidity factor, i.e., the combined influence of these factors and one or another indicator, was evaluated. The additive effect of the factors of AH and liver steatosis was identified according to the parameters: intima media thickness, pulse wave velocity in the carotid artery, pulse wave velocity in the abdominal aorta and endothelial-related vasodilation, which indicates an important comorbid effect of NAFLD and primary/renal parenchymal HTN on the structural and functional state of arteries. Conclusions: There are no differences between the structural and functional indicators of arteries in patients with comorbidity of NAFLD + primary HTN and NAFLD + renal parenchymal HTN. The factor of the presence of HTN and the degree of liver steatosis significantly affect structural and functional indicators of the studied arteries.Item Comparison of structural and functional vascular disorders in patients with comorbidity of non-alcoholic fatty liver disease and two types of arterial hypertension(2023) Prosolenko, Kostyantyn; Molodan, Volodymyr; Panchenko, Galyna; Lapshyna, Kateryna; Shalimova, AnnaBackground: The aim was to conduct a comparative assessment of structural and functional vascular disorders in patiets with comorbidity of non-alcoholic fatty liver disease (NAFLD) and two types of arterial hypertension (HTN). Material and methods: The study included 329 patients 18–66 years old. All patients were divided into five groups:patients with comorbidity of NAFLD and primary HTN (121 subjects), patients with comorbidity of NAFLD and renal parenchymal HTN (88 subjects), patients with NAFLD (60 subjects), patients with primary HTN (30 subjects), patients with renal parenchymal HTN (30 people). The control group consisted of 20 healthy individuals of similar age and gender categories. Results: In the comparative analysis of the structural and functional ultrasonographic parameters of vessels, no significant differences between two comorbidity groups NAFLD + primary HTN and NAFLD + renal parenchymal HTN were found. The influence of AH and degree of liver steatosis on ultrasound indicators of arteries in examined patients with comorbidity was evaluated by MANOVA analysis. The influence of the HTN factor and the influence of the liver steatosis factor were evaluated separately, after which the influence of the comorbidity factor, i.e., the combined influence of these factors and one or another indicator, was evaluated. The additive effect of the factors of AH and liver steatosis was identified according to the parameters: intima media thickness, pulse wave velocity in the carotid artery, pulse wave velocity in the abdominal aorta and endothelial-related vasodilation, which indicates an important comorbid effect of NAFLD and primary/renal parenchymal HTN on the structural and functional state of arteries. Conclusions: There are no differences between the structural and functional indicators of arteries in patients with comorbidity of NAFLD + primary HTN and NAFLD + renal parenchymal HTN. The factor of the presence of HTN and the degree of liver steatosis significantly affect structural and functional indicators of the studied arteries. Key words: structural and functional vascular alterations; non-alcoholic fatty liver disease; hypertensionItem The impact of sleep disorders in the formation of hypertension(2022) Isayeva, Ganna; Buriakovska, Olena; Shalimova, AnnaHypertension is one of the most common chronic non-communicable diseases in the world. Risk factors, methods of prevention and treatment of hypertension have been sufficiently studied. However scientists are still looking for pathogenetic mechanisms of its development. At the same time, 36.9% of patients with hypertension had different sleep disorders. Patients with insomnia have a 21% higher risk of developing hypertension compared with those who have quality sleep. Hypnotics are given up to 15% of patients with hypertension. Hypnotics have been shown to increase the risk of cardiovascular events. As much as 44.1% of patients with established diseases of the cardiovascular system have problems with the quality or duration of sleep. At this time, hypertension and sleep disorders are considered mutually aggravating diseases.Item Different faces of resistant hypertension in obesity(2022) Shalimova, AnnaBackground: The aim was to conduct a comparative assessment between pseudo-resistant (due to different causes) and true resistant hypertension (RH) in obesity. Material and methods: The study included 302 patients with uncontrolled hypertension and obesity. Initial treatment efficacy was assessed 3 months after dual therapy was administered. Those patients who did not reach target blood pressure (BP) with dual therapy were switched to triple therapy. Among patients who received triple therapy, 69 people did not reach target BP (they received the fourth drug, spironolactone). All patients were additionally examined 6 months after the initiation of antihypertensive therapy. Results: Despite the achievement of target BP after 6 months of therapy, patients with resistant hypertension had significantly higher BP and more pronounced disturbances of the circadian rhythm compared with non-resistant patients. After 6 months of therapy, patients with true resistance had significantly higher SBP compared with pseudo-resistant patients. The normal circadian rhythm in patients with true resistance was significantly less common than in patients with pseudo-resistance. Compared with pseudo-resistance, the presence of true resistance in obesity was associated with higher SBP and aldosterone levels, as well as lower body mass index (BMI) and low-density lipoprotein cholesterol (LDL-C). Conclusions: Even when target BP levels in antihypertensive therapy are achieved, obese resistant patients are characterized by more pronounced disturbances of the circadian rhythm and higher levels of office and out-of-office BP, compared with non-resistant patients. New data were obtained in the difference in the systolic blood pressure (SBP) levels (significantly higher with true resistance) and LDL-C (significantly lower with true resistance).Item Effect of amlodipine on the manifestations of chronic insomnia in hypertensive patients with type 2 diabetes mellitus(2020) Isayeva, Ganna; Buriakovska, Olena; Shalimova, AnnaBackground: The aim of the study was to assess the association between antihypertensive therapy and the manifestations of insomnia in patients with arterial hypertension (AH) and type 2 diabetes mellitus (T2DM). Material and methods: The study included 120 hypertensive patients with and without T2DM (among them there were 60 patients with insomnia). The study consisted of three stages. The first stage was conducted as a cross-sectional study, during which an association was established between different antihypertensive products and the presence of insomnia in the study population. The second and third stages were a prospective study, during which a modification of the therapy to reduce the manifestations of insomnia was performed. Results: It was found that patients receiving amlodipine in the combination antihypertensive therapy had insomnia manifestations much less frequently as compared to indapamide. A statically significant decrease in blood pressure (BP) and a higher proportion of patients with target BP were observed in both groups. Replacement of indapamide with amlodipine was shown to improve sleep quality. Thus, the number of patients with insomnia significantly decreased in both groups. After correction of antihypertensive therapy after 12 months, all patients were assessed for sleep disorders. The incidence of insomnia was found to be significantly reduced in both groups after changing therapy from indapamide to amlodipine. Conclusions: Correction of antihypertensive therapy, namely the replacement of indapamide with amlodipine, contributes to an improvement in BP, quality of life, and a reduction in the proportion of patients with insomnia.Item Vascular endothelial growth factor as a marker of endothelial dysfunction in poly- and comorbidity: focus on hypertension, type 2 diabetes mellitus and subclinical hypothyroidism(2019) Nemtsova, Valeriya; Bilovol, Olexandr; Shalimova, AnnaBackground. The goal of our study was to investigate the content and particularities of change of vascular endothe- lial growth factor-A (VEGF-A) levels as a marker of endothelial dysfunction (ED) in patients with hypertension (HT) with or without type 2 diabetes mellitus (T2DM) and with or without subclinical hypothyroidism (SH). Material and methods. Two hundred and eleven patients with hypertension stage II were divided into 3 groups: Group 1 — with HT (n = 55); Group 2 — with AH and T2DM (n = 97); Group 3 — with HT, T2DM and SH (n = 59). The patients in Group 3 were divided into 3 subgroups depending on TSH levels: 3a (n = 26) — TSH 4.0–6.0 mIU/L; 3b (n = 20) — TSH 6.1–8.0 mIU/L; 3c (n = 13) — TSH 8.1–10.0 mIU/L. We evaluated lipids, carbohydrate metabolism, serum insulin concentration, insulin resistance index — HOMA, and the level of VEGF-A in plasma. Results. The levels of VEGF-A in Group 2 was significantly lower vs. Group1 (323.94 ± 22.17 pg/mL and 413.15 ± 29.02 pg/mL, respectively (p < 0.05)). The patients in Group 3d had lower VEGF-A levels than the patients in Group 1, but higher than those in Group 2. Among Group 3 patients, the levels of VEGF-A were the lowest in the 3a subgroup (375.91 ± 19.81 pg/mL), significantly different from 3b and 3c subgroups (p < 0.05), for which no differences were found (p > 0.05.). In the 3a subgroup VEGF-A levels were significantly higher than in Group 2 patients (p < 0.05). Conclusion. These data confirms the hypothesis of increasing ED in hypothyroidism even at the subclinical level.Item Risk factors аnd basic mechanisms of development of chronic heart failure at chronic kidney disease(2013) Kochuieva, Maryna; Shalimova, Anna; Prosolenko, KostyantynСardiovascular complications are the most frequent reasons of death of patients with chronic kidney disease. They can be both investigation of chronic diseases of kidneys and factor, that cause progress of chronic kidney disease at the diabetic and undiabetic defeats of kidneys. Support of having a special purpose level of AP at chronic kidney disease allows substantially to slow the rate of decline of speed of glomerular filtration that probability of development of cardiovascular complications. Complex research of cross-coupling of chronic kidney disease and chronic heart failure and going is differentiated near treatment of patients with the noted pathology is an important and aktual problem which requires a high-quality decision.