Особливості добового профілю артеріального тиску у хворих на артеріальну гіпертензію з метаболічним синдромом

Abstract

Проаналізовані особливості добового профілю артеріального тиску у хворих на артеріальну гіпертензію з метаболічним синдромом Так, у хворих на АГ з МС отримані вірогідно вищі середньодобові значення САТ і ДАТ, зменшується частота виявлення прогностично сприятливого ДП АТ (dipper) і збільшується частота реєстрації прогностично несприятливих типів ДП АТ (non¬-dipper), що свідчить про прогностично гірший перебіг АГ. Проведення аналогічних досліджень дозволить сімейним лікарям індивідуалізувати призначення адекватної терапії; Проанализированы особенности суточного профиля артериального давления у больных артериальной гипертензией с метаболическим синдромом . У больных АГ с МС полученны достоверно выше среднесуточные значения САД и ДАД, уменьшается частота выявления прогностически благоприятного СП АД (dipper) и увеличивается частота регистрации прогностически неблагоприятных типов СП АД (non¬dipper), что свидетельствует о прогностически неблагоприятном течение АГ. Проведение аналогичных исследований позволит семейным врачам индивидуализировать назначения адекватной терапии; Rationalizing the problem. The problem of metabolic syndrome (MS) and arterial hypertension (AH) is extremely urgent nowadays because of cardovascular pathology is among the leading causes of death and disability both in Ukraine and all over world. Mechanism of AH and developing the complications depends not only on absolute values of blood pressure (BP), but also on blood pressure fluctuations in different period of day, the extent of its night decreasing and a number of other indicators. The purpose of the research. To analyze the features of daily profile of arterial pressure (DP AP) at patients with hypertension and MS. Data and methods. The results of ambulatory daily monitoring of arterial blood pressure (DMABP) are processed at 38 patients (the first group – patients with AH and MS, the second group – patients with MS and without AH) who were gone under DMABP. The average age of patients is 62.3±5.6. Study of daily BP profile the DMABP was performed using the "Cardio-Sense" (Ukraine). Measurements were performed every 15 min during the period of daily activity and every 30 minutes during a night's sleep. The average values of systolic and diastolic BP (SBP and DBP), variability of the SBP, DBP and the circadian rhythm (DR) of BP were analyzed. For the diagnosis of metabolic syndrome it was used the criteria corresponding to the "global consensus on the criteria for MS". The confidence of differences at comparing the average values was determined using Student-t criteria. Statistical analysis of data was performed using the software package Statistica 6. Results. Indicator of the average daily systolic blood pressure (SBP) was significantly higher at the patients of the 1st group ((162.15±7.23 mm of mercury column) compared with patients of the 2nd group ((145.67±5.38) mm of mercury column). A similar trend for the average daily diastolic blood pressure (DBP): in patients of the 1st group (95.78±3.12) mm of mercury column, the 2nd group – (82.57±2.28) mm of mercury column). The standard deviation (SD) of SBP that under DMABP data shows the daily variability of blood pressure, significantly prevailed at patients of the 1st group ((18.35±0.88)%) compared with patients of the 2nd group ((12.79±0,57)%). A similar situation was observed for SB daily BP. The distribution of patients according to circadian rhythm (CR) of BP showed the following: the dominant type of DP at people of the 1st group was DP-type "non-dipper", which was recorded at 70.0% of the patients. The frequency of DP of BP of "non-dipper" type at the patients of the 2nd group was significantly less 27.78%. DP "dipper" type was recorded at 72.22% patients of the 2nd group compared with 25.0% of patients of the 1st group. Also one patient of the 1st group had DP BP of "over-dipper" type. DP BP of "night-peaker" type has not identified among the surveyed patients. Conclusions. At the patients with AH with MS have significantly higher average values of SBP and DBP, the frequency of identification of prognostic favorable DP BP (dipper) is decreasing, and the frequency of registration of prognostic unfavorable types of DP BP (non-dipper) is increasing, that shows prognostic worse mechanism of hypertension. Conducting the similar studies will allow the family physicians to individualize the prescription of adequate therapy. The prospects for further research. The obtained results determine the development of complex methods of treatment at patients with arterial hypertension with metabolic syndrome.