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Item Blood pressure dipping status affects the relationship between glucose fluctuation and heart rate variability in type 1 diabetic patients(2018) Shalimova, Anna; Graff, Beata; Szyndler, Anna; Wolf, Jacek; Blaszkowska, Magdalena; Orlowska-Kunikowska, Elzbieta; Wolnik, Bogumil; Narkiewicz, KrzysztofCardiac autonomic neuropathy is a frequent complication of type 1 diabetes (DM1). However, none of the previous study has assessed the inter-relationship between glucose fluctuation, circadian blood pressure rhythm and features of heart rate variability (HRV). The aim: to test the hypothesis that in patients with longstanding DM1 the relationship between HRV and glucose fluctuation is influenced by blood pressure diurnal profile. Methods: We examined 42 subjects with longstanding (>20 years) history of DM1 (without cardiovascular disease, including hypertension). In all patients, simultaneous 24-hour continuous glucose monitoring, ABPM and Holter electrocardiographic recording were performed. Subjects were divided into two groups according to dipping pattern (dippers n=20, non-dippers n=22). Results: Both groups of patients did not differ with respect to duration of hypo-, normo- and hyperglycaemia, while time- and frequency domain HRV parameters were significantly lower in non-dippers (p<0.05). Several HRV parameters including SDANN and LF spectrum power were positively related to duration of hypoglycaemic episodes both in dippers and non-dippers (p<0.05). However, other HRV parameters were associated with glucose fluctuation only in non-dippers. Time of hypoglycaemia was positively related to pNN50, rMSSD, diurnal and night HF spectrum power, in the presence of its negative correlations with 24-hour and day VLF% (p<0.05); time of hyperglycaemia was negatively related to pNN50, rMSSD, 24-hour, day and night ULF, VLF and HF spectrum power (p<0.05). Conclusions: In non-dippers with longstanding DM1, HRV is lower but more sensitive to glucose fluctuation than in dippers.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 Insufficient control of out-of-office blood pressure: the problem of masked uncontrolled hypertension(2021) Shalimova, AnnaDespite significant advances in the diagnosis and treatment of arterial hypertension (AH), the problem of insufficient blood pressure (BP) control in hypertensive patients is quite acute. According to current guidelines, the effectiveness of antihypertensive therapy is mainly assessed by reaching the target levels of office BP, while masked uncontrolled hypertension (MUCH), which is diagnosed on the basis of insufficient control of out-of-office BP, increases the risk of cardiovascular events. Patients with insufficient out-of-office BP control have an increased risk of cardiovascular events compared to patients with both office and out-of-office BP control, therefore MUCH requires timely diagnosis and correction. This minireview summarizes the understanding of the nature of MUCH. A particular attention is paid to risk factors and ways of influencing the out-of-office BP control. The article also assessed the important contribution of ABPM to the control of out-of-office BP and to determining the overall risk of MUCH.Item Diagnostic and Prognostic Potential of Kallistatin in Assessment of Liver Parenchyma Changes in Patients with Non-alcoholic Fatty Liver Disease and Hypertension(2021-09) Zhelezniakova, Natalia; Rozhdestvenska, AnastasiiaBackground and Aim. Non-alcoholic fatty liver disease (NAFLD) is closely linked to hypertension (HT). An important issue remains the search for non-invasive tests to NAFLD detection in the early stages of liver fibrosis. The objective of the study was to evaluate the diagnostic and prognostic value of kallistatin in assessing the liver fibrosis progression in NAFLD and HT patients. Patients and Methods. 115 patients with NAFLD with and without HT were examined. Plasma kallistatin level measurement, ultrasound steatometry and elastography were performed in all patients. Results. Kallistatin level was 65.03 ng/ml (95% CI 61.38; 68.68), 83.42 ng/ml (95% CI 81.89; 84.94) and 111.70 (95% CI 106.14; 113.22) in patients with NAFLD and HT, isolated NAFLD and control group, respectively. There were significant differences in the liver parenchyma condition between groups. Kallistatin levels strongly inversely correlated with the attenuation coefficient and the mean liver stiffness in NAFLD and HT (rs=-0.70) and in the isolated NAFLD patients (rs=-0.56; rs=-0.68, respectively). Kallistatin level was 71.82 ng/ml (95% CI 70.16; 79.51) and 58.62 ng/ml (95% CI 55.81; 64.45) in patients with HT stage I and HT stage II, respectively (p<0.001). Conclusions. Concomitant HT in NAFLD patients is associated with greater severity of fatty and fibrotic liver changes. The course of NAFLD is accompanied by decrease in kallistatin level. Increased degree of liver steatosis and fibrosis, inflammation activity, increased BMI and increased stage of HT lead to inhibition of kallistatin activity. Kallistatin can be a biomarker for progression assessment of NAFLD with or without HT.Item Features of hemodynamic and metabolic disorders in obese patients with resistant hypertension(2020) Shalimova, Anna; Psarova, Valentyna; Kochuieva, Maryna; Kolesnikova, Olena; Isayeva, Ganna; Zlatkina, Vira; Nemtsova, ValeriyaBackground. The aim was to establish the features of hemodynamic and metabolic parameters in obese patients with true and pseudo-resistant arterial hypertension (AH). Material and methods. The study included 200 patients with uncontrolled AH and obesity. Patients were initially prescribed dual antihypertensive therapy. Those patients who did not reach target blood pressure (BP) levels after 3 months on dual therapy were additionally prescribed a third antihypertensive drug. Of the 98 patients who were assigned to triple therapy, 48 patients did not reach target BP (27 patients had pseudo-resistant and 21 patients had true resistant AH). These patients were additionally prescribed a fourth antihypertensive drug (spironolactone). The effectiveness of the treatment was evaluated 6 months after the start of antihypertensive therapy. Results. After 6 months of therapy, unlike patients without resistance, individuals with resistant AH had more pro- nounced cardiovascular remodeling and metabolic disorders, disbalance of oxidative stress-antioxidant protection, proinflammatory activity and higher activity of the renin-angiotensin-aldosterone system. Patients with true resist- ance differed from pseudo-resistant patients by having significantly lower body mass index (BMI); in the absence of differences in BP levels, cardiovascular remodeling, lipid and carbohydrate profiles, patients with true resistance had significantly higher levels of aldosterone, higher activity of oxidative stress system, lower levels of general antioxidant protection, higher adiponectin levels, and lower leptin level. Conclusions. Obese patients with true resistance differed from pseudo-resistant patients by having significantly lower BMI, higher aldosterone levels, more pronounced imbalance of the system of oxidative stress-antioxidant protection and less pronounced adipokine imbalance.Item Condition of common carotid artery and levels of visfatin and interleukins hypertensive patient’s(2016-11-04) Андрєєва, Анастасія Олександрівна; Голенко, Тетяна МиколаївнаАll of the hypertensive patients regardless of the presence of AO have the damage of CCA, in which levels of visfatin and IL-6 are significantly increased. The results indicate the need for medicines reducing the levels of IL-6 and visfatin to decrease inflammation in the vascular wall. The detected imbalance between IL-4 and visfatin suggests a possible protective effect of this cytokine in the development of vascular remodelingItem Eating behavioral reactions of patients with chronic non-communicable diseases and its correction(2019) Shalimova, Anna; Isayeva, Ganna; Vovchenko, Maryna; Rieznik, L.; Buriakovska, Olena; Emelyanova, N.The peculiarities of the eating behavioral reactions of patients with chronic non-communicable diseases and the effect of group and individual therapy on them were evaluated. It was established, that with a tendency to positive changes in eating behavior, conducting both group and individual therapy for 1 year did not significantly change its indicators such as daily consumption of salt, vegetables and fruits, smoking and alcohol consumption, which confirms the complexity of the impact on the specified risk factor for the development and progression of chronic non-communicable diseases.Item The effect of antioxidant therapy on lipid peroxidations indicators in chronic pancreatitis(2013-05) Reznik, M.; Sypryn, S.The period of exacerbation CP is characterized by an disbalance in the system of the oxidative stress: by the activation of lipid peroxidation and the oppression of the AOC. The combined AT resulted in a significant improvement in antioxidant system and it was accompanied by a significant reduction of pain in these patients.Item Association of IRS-1 polymorphism with various components of the metabolic syndrome in hypertensive patients(2019) Kochuieva, Maryna; Psarova, Valentyna; Ruban, Valentyna; Kyrychenko, Nataliia; Alypova, Olga; Matlai, Olga; Shalimova, AnnaIntroduction: The metabolic syndrome is one of the most discussed cross-disciplinary problems of modern medicine. Now there are various definitions and criteria of diagnostics of metabolic syndrome. The abdominal obesity is considered the main component of the metabolic syndrome, as a reflection of visceral obesity which degree is offered to be estimated on an indirect indicator – a waist circumference. Alongside with abdominal obesity, a number of classifications distinguish insulin resistance (IR) as a diagnostic criterion of metabolic syndrome. It is proved that IR is one of the pathophysiological mechanisms influencing the development and the course of arterial hypertension (AH), type 2 DM and obesity. There are two components in the development of IR: genetic (hereditary) and acquired. In spite of the fact that IR has the accurate genetic predisposition, exact genetic disorders of its appearance have not been identified yet, thus demonstrating its polygenic nature. The aim: To establish possible associations of the insulin receptor substrate-1 (IRS-1) gene polymorphism with the severity of the metabolic syndrome components in patients with arterial hypertension (AH). Materials and methods: 187 patients with AH aged 45-55 years and 30 healthy individuals. Methods: anthropometry, reactive hyperemia, color Doppler mapping, biochemical blood analysis, HOMA-insulin resistance (IR), glucose tolerance test, enzyme immunoassay, molecular genetic method. Results: Among hypertensive patients, 103 had abdominal obesity, 43 - type 2 diabetes, 131 - increased blood triglycerides, 19 - decreased high density lipoproteins, 59 - prediabetes (33 - fasting hyperglycemia and 26 - impaired glucose tolerance), 126 had IR. At the same time, hypertensive patients had the following distribution of IRS-1 genotypes: Gly/Gly - 47.9%, Gly/Arg - 42.2% and Arg/Arg - 10.7%, whereas in healthy individuals the distribution of genotypes was significantly different: Gly/Gly - 86.8% (p<0.01), Gly/ Arg - 9.9% (p<0.01) and Arg/Arg - 3.3% (p<0.05). Hypertensive patients with Arg/Arg and Gly/Arg genotypes had significantly higher HOMA-IR (p<0.01), glucose, insulin and triglycerides levels (p<0.05), than in Gly/Gly genotype. At the same time, body mass index, waist circumference, blood pressure, adiponectin, HDL, interleukin-6, C-reactive protein, degree of endothelium-dependent vasodilation, as well as the frequency of occurrence of impaired glucose tolerance did not significantly differ in IRS-1 genotypes. Conclusions: in hypertensive patients, the genetic polymorphism of IRS-1 gene is associated with such components of the metabolic syndrome as hypertriglyceridemia and fasting hyperglycemia; it is not associated with proinflammatory state, endothelial dysfunction, dysglycemia, an increase in waist circumference and decrease in HDL.Item Pathomorphological features of gastroesophageal reflux disease realization in young people with autoimmune thyroiditis(2022-02) Pasiieshvili, Tamara; Bocharova, Tetiana; Zhelezniakova, Natalia; Pasiieshvili, LiudmylaThe aim: To evaluate the pathomorphological features of the esophageal mucous membrane in young people with GERD and autoimmune thyroiditis. Materials and methods: 120 patients with GERD and AIT and 45 people with isolated GERD matched for age, gender and social status were examined. Esophagogastroduodenoscopy, histological study and comparative morphometry of the esophageal mucosa were performed. Results: The frequency of erosive GERD in the examined groups of patients did not statistically differ. At the same time, integral analysis of the structure of erosive forms of GERD revealed statistically significant redistribution of grades of esophagitis towards its enhancement in patients with comorbid pathology. The histological study showed that in patients with GERD and AIT all the morphometric parameters studied had a significantly more severe course and exceeded similar indicators of the group with isolated GERD: epithelium total thickness, epithelium basal layer thickness, connective tissue papillae height, intercellular space. The analysis of morphological changes frequency showed that epithelium basal layer hyperplasia, dystrophic changes and epithelial edema, elongation of papillae and dilation of intercellular space were significantly more frequent in the group with comorbid pathology. Conclusions: GERD and euthyroid AIT comorbidity in the student population is accompanied by a statistically significant redistribution of esophagitis grades towards its aggravation. The presence of concomitant euthyroid AIT in patients with non-erosive GERD leads to statistically more pronounced disorganization of esophageal mucosal epithelium.